Sunday, September 07, 2014

Zoe Malot Summer 2014

After living in Roatan, Honduras for a month I found it to be beautiful, humid and hot, and full of wonderful people, many of who are suffering from extreme poverty. After settling in, we went to the hospital the following day to receive our tour of the hospital. Genevieve, the nurse practitioner volunteering in the pediatric clinic, showed us around the hospital including the incredibly small emergency room, the crowded maternity ward, the pediatric ICU, the sole room for dengue and malaria patients, and the rest of the small hospital. The malaria/dengue room was a dark room only lined with empty lawn chairs. She also introduced us to the doctors, nurses, and other hospital staff members as we started to familiarize ourselves with the hospital and the system.

The first two things that stuck out to me the most was how many people were there just waiting. The hallways were lined with benches on either side, filled with people just waiting to be seen. They wait there for hours, sometimes from 6 in the morning. I learned that thanking them for waiting for so long went a long ways, and the moms seemed to appreciate the acknowledgment.    

Since I was one of the two Global Healing interns for the clinic, on some of the days after we finished triage I would help the social worker, Ingrid, give health “charlas” to the people waiting in the hallways. I helped give informational talks on HIV/AIDS, Tuberculosis, and Malaria, all of which are prevalent on the island.

The talks were informative about symptoms, how infections and diseases are transferred, treatments, and preventative guidance. Public health and health education is underprovided on the island, so preventative health education goes a long way. 

The other most shocking sight was what was called ‘The Medical Equipment Graveyard’. This was a dumping ground in the hospital courtyard for medical equipment that was broken such as wheelchairs, gurneys, filing cabinets, infant incubators, and even cars or tires. This broken equipment just lies there deteriorating and rusting next to patients waiting in line outside.

In the next few days I assisted Dr. Chantry teach the course Helping Babies Breathe® to Genevieve and Dra. Cerrritos, which is a course for infant resuscitation designed for low-resource settings. Teaching a ‘Train the Trainers’ course is especially helpful because it has the potential to help more babies as the Trainers teach more providers, giving it the ability to spread and thus be more effective. The course is a 2-day, 12 hour course where learners practice on NeoNatalie®, a water-filled baby dummy. In the next couple of weeks we also spent a couple days teaching the course to a couple of nurses including Sarah, Jesse, Bertha and Gabriel.  It was not only a wonderful experience to learn the Helping Babies Breath course, but also to help teach it because we learned so much about the hospital, the doctors, the nurses and the culture.

During the course Jesse, one of the nurses, explained to us how hard it is to work in the hospital, and how hard it is to change procedures as a nurse. She explained, frustrated and near tears how she knows the umbilical cord shouldn’t be cut within the first minute and a half (WHO recommends 1-3 minutes after birth - 2 being optimal), but doctors continually cut it immediately after birth. Hearing her describe her struggles was heart-breaking, because she is there trying to provide the best care for the babies but disheartened because she feels she is unable to change anything. We then discussed the long list of procedures and practices that need to change in the hospital. Listening to the discussion, it was hard not to feel disheartened since it seemed that it was so hard to make changes with so many obstacles, with resources being a major one.

Concluding the discussion Dra. Cerritos told them she knows how hard it its, that it is a constant struggle, but encouraged them not to give up the fight, and hopefully Helping Babies Breathe would lead to at least one thing that could change within the hospital and on the island.

When we returned the following Monday, I was delighted to find the nurses and doctors on strike. It was great to see them stand up for what they were constantly fighting for. Jesse and Sarah were sitting outside with other hospital staff members who were hanging up signs in protest. The signs did not read “more benefits” or more pay” like many protests in the United States are for, but rather “No hay suturas para pacientes cesarean; guantes descartables” (We don’t have sutures for caesarean patients or disposable gloves) and “Tenemos mes y medio de no hacer cirugias programadas, por tener la maquina de anestecia mala” (Its been a month and a half without scheduled surgeries because the anesthesia machine is broken). They weren’t striking for themselves (even though some of the nurses hadn’t been paid in months) they were striking for the patients, so that they would have the resources and materials they needed to just even provide basic care.

On a couple days I would go to the maternity ward with Dr. Chantry to check-up on the newborns. There would be anywhere from one mom and baby to ten moms and babies in the same room. It was great to listen to. Dr. Chantry and Dra. Cerritos give anticipatory guidance to the new moms on breastfeeding and other healthy practices. The doctors would check the heartbeat and breathing of the babies; listening to the fast, strong heartbeat of such a small, fragile baby is incredible. I was amazed how fast it really was even though I already knew on book how much faster it should be than an adult heart rate.

The best part of the internship and my experience on the island was the interaction with the kids in the clinic. Although some cried and screamed because they did not want to be there, and were afraid of the thermometer in their ear or the scale, but the few that were happy to be there and would smile when I took their weight and height were wonderful. Those smiles from the month-old babies were very special.

We would see quite a wide variety of diagnosis in the clinic. To name just a few of the more common ones; we saw mild to severe cases of malnourishment, contact with resistant Tuberculosis, allergies, pre and post surgery consultations, bacterial infections, and common colds.

Overall, I had a wonderful experience that really opened my eyes to the low public health capabilities of Roatan, Honduras. So thank you to all that made the Global Healing internship possible for students like me.