Roatan Volunteer Pediatric Clinic HEAL Interns

Nilasha Journal #3

2011-01-11T13:01:00.000-08:00

August 1, 2010: Week 3

This week was a short week in the clinic – we only worked Monday, Tuesday and Wednesday. There was a pediatric conference on Thursday and Friday, so all the pediatric clinics were closed. I suspect we had more patients in these 3 days than we normally do because of this closure. We saw over 20 patients everyday, instead of 10-12 patients. I liked being able to see more patients. It kept me in the clinic longer, and we were able to see more sick children. This was also the last week that Dr. Quinn (Kevin) was going to be with us. There is a new doctor coming in on Monday though.

Because we were able to see more patients, there was a larger variety of illnesses aside from the usual diagnoses of parasites, chickenpox, cough/cold and fever. Some of the more notable patients had cancer and hydrocephaly. I felt really bad for these kids because it seems as though they need more medical care than they were receiving here on the island. Both cases were shipped to the mainland for additional care. I really liked these children because even though they had disadvantages, they were still the happiest and least tempermental in the clinic.

Outside of the clinic, I continued teaching in the afternoons with ESL and E-learning. This was going to be the last week for ESL because there was a break in the school session. We did a thorough review of everything we had learned in the last 3-4 weeks and played a couple of games to help the material sink in. We had an awards presentation for those kids who regularly came to the classes. In E-learning, we continued with reading comprehension, vocabulary and spelling. The kids are warming up to me and the other volunteer. They look forward to our lessons and reading sessions.

I’m starting to get into the swing of things here. The weeks are passing by a lot quicker than it did my first week in Roatan. The weather is still a little erratic, but it has gotten a lot cooler. I did a couple tourist-like things like white water rafting and ziplining so far. I plan to go snorkeling more and visit more shops to buy souvenirs soon.

Nilasha Journal #2

2011-01-11T13:00:00.002-08:00

July 25, 2010: Week 2

My second week at the hospital went a lot smoother than the first week. This was my first week being the only intern, as the previous intern left last weekend. My Spanish has been improving, and I am able to pick up on new words and phrases quicker now. I have even started making conversation with the patients and the patients’ mothers also (even though my Spanish is still a little broken – but understandable nonetheless). Since I am becoming more efficient in triaging, I am able to shadow the doctors a little more during their exams of the patients. It is interesting to see/hear the thought process of the doctors as they try to come up with a diagnosis. I was also able to follow the doctors on their rounds as they checked-up on the newborns. I learned how to fill out the charts for the newborns and how to do a physical exam on the newborns. The doctors are really helpful and nice about showing me interesting findings and deformities. There was one baby that was in the uterus too long. As a result, his skin was dry and “leathery” because the placenta dried out. After being in the clinic, seeing patients that are least a month old, it was nice to see newborns and their diagnoses. After being in this clinic, I have started considering of specializing in an area of pediatrics. I really like kids, especially the well-behaved kids. There is the occasional child that is afraid of everything and screams all the time. However, all of them are really cute and I can definitely see myself working with kids in the future.

Outside of the clinic, I am still teaching ESL classes and helping English-speaking students with their computer studies. We have moved onto reading comprehension with the English-speaking students. For the ESL classes, we have started on complete sentences and various aspects of introductions, such as names, birthdays, age, likes/dislikes and where they live. Along with working with kids in the clinic, I have discovered that I like teaching a lot. It feels good imparting knowledge to those who are hungry for it. Lastly, I am doing a little bit of research into breastfeeding. Coming to this island and seeing a lot of malnourished children, I am interested in the breastfeeding patterns of the mothers here. Along with my triaging, the Dr. Quinn and I are asking questions about breastfeeding, especially if the child doesn’t eat and/or is underweight. Hopefully with enough data and surveys, I can put together a presentation at Clinica Esperanza or give the information to the social workers at the hospital by the end of my internship.

Nilasha Journal #1

2011-01-11T13:00:00.001-08:00

July 18, 2010: Week 1

My first week at the RVPC was a good experience, although it was not was I was expecting. While the Global Healing pediatric clinic is fairly decent, the poverty of the island is obvious looking at the rest of the hospital. Combined with the crowds and the heat, it seems as though coming to the hospital is a terrible experience for the patients and their families. There is also a shortage of doctors, so patients are coming in to wait as early as 6 a.m. to be seen 4-5 hours later. With such little funding from the government the hospital must do the best with what they have. Now I can see why donations are so important.

I really enjoy my clinic duties in the pediatric clinic. The previous intern, Natalia, was very helpful in showing me what to do and where to go. My Spanish was a little rusty coming into Roatan; however, she helped me get my foundation back. I’m becoming more and more confident everyday conversing with the patient’s mothers in Spanish. I was hoping for the clinic to be open longer everyday, rather than just ending around eleven or noon. This is one of my questions for the Global Healing directors – wouldn’t be it more effective to prolong clinic hours (possibly to 2 or 3 pm) so that we could see more patients? But, besides that, I am really enjoying my time in the clinic.

In the afternoons, I do ESL classes with kids aged 6-14 from La Colonia in Sandy Bay. A nice American couple who is living in Sandy Bay for the next 3 years organized the whole thing. I really enjoy working with children because I feel like I can see things from their eyes and explain things that would make sense to them. I also do an E-learning class with some kids near Ms. Peggy’s house a couple afternoons a week. As far as community health is concerned, I am trying to coordinate a survey/intervention with one of the doctors here at the clinic, Dr. Kevin. We have found that most mothers stop breastfeeding very early, or don’t breastfeed at all, thus depriving the infant of important nutrients. We would like to know when, why and what they are using instead. While this will not reduce all of the medical problems children face, it can help with malnutrition and their immune system.

Neha Journal #2

2011-01-11T12:53:00.001-08:00

June 1, 2010: Week 2

Prescriptions, Kids, and HIV

Happy june! I can’t believe week 2 in Roatan is already over! Even on island time, time seems to go by so quickly! My days at the clinic last week were really interesting, because only Dra. Sara was here. I would finish up triage and then be able to sit with her during each of her patient consults, which was an awesome shadowing experience. It was cool to see how much of the Spanish I could understand on my own, and Dra would always stop to explain a more confusing medical term, or a complex case. I’ve learned how you can tell when a diarrhea is serious, or if its just a mother with her first baby who is worried about everything- there are so many tricks of the pediatric trade!

We have a new doctor here this week, and she is really cool, but does not speak any Spanish, so I am going to get to do some translating along with my triage-ing. It is definitely a lot of responsibility, but very exciting!

I have come to realize in these two weeks how hard it must be for these mothers to keep up with their prescriptions. For example, yesterday we saw a baby with a terrible ear infection. The medicine for the baby was available in the pharmacy, but the woman brought it back to us because she did not understand the instructions. We found that 1) the bottle was incredibly hard to open 2) she was supposed to mix the powder with water herself (she lived in an area that had no access to clean water) and 3) it was meant to be kept refrigerated for all ten days she had to give it to her baby (she had no electricity, let alone a refrigerator). Thankfully, we were able to mix in some purified water for her at the clinic...but there is no way we can follow up with her every day to make sure the baby is improving. Its really frustrating because we are doing everything we can and the mothers are doing everything they can, but there is no guarantee that the children will get all of their medicine at the appropriate times. I know that for very complex drug regimens, like TB or HIV, lucky patients can sometimes get directly observed treatment, a personal assistant who comes and checks on them every day. While we are only giving out simple treatments/prescriptions, mothers often leave with 2 or 3 (or sometimes 6!), and I wish there was a way to directly observe/help them as well.

Unfortunately, the little boy with the injured foot never returned, and its really sad because the mother did not have a phone, so there is no way to contact him. All we know is the area of the island where they live, but that is not enough to find him. I was hoping/wishing every day that he would show up, but he never did. There are two possible explanations- the mother was frustrated and gave up, or the boy's foot improved with the antibiotics, but I know the latter is just wishful thinking :(

In happier news, I found the Familia Saludables office while wandering around Coxen Hole last week, and I walked in. The women who run it were extremely welcoming, and I will be spending as many hours as I can working over there when I am not at the clinic. Familia Saludable is an HIV/AIDS support organization that runs a variety of programs. They have an infant formula program for about 90 HIV+ mothers, providing free formula to prevent mother-to-child transmission of the virus. They also have a women's support group for HIV+ women that meets once a week. These women work together on various initiatives, such as selling soap and holding a raffle, in order to raise money. I was helping out in their office, which is basically a safe space for anyone who chooses to walk in. Women will come in to get tested, to pick up free condoms, to talk or ask questions, to let their babies play with toys, or just to hang out for a little bit in the air-conditioning.

Working in the office was an awesome and eye-opening experience. Neither of the women who work there speak spanish, and their normal translator is on maternity leave, so as soon as they discovered I could speak spanish, I became their unofficial translator/communicator. Women would come in to get tested, and then end up telling me their life stories. I loved the opportunity to have these longer conversations because it is something that is a bit inappropriate while triage-ing at the clinic, and something that I definitely miss. However, much of what the women were telling me was incredibly depressing and shocking. Sexual abuse, especially child sexual abuse, is a huge issue on this island, as is domestic violence. I am not comfortable giving out the details, but I have realized that the pediatric clinic was only giving me a narrow view of what goes on in Roatan. While I am not positive that my Spanish is good enough to be counseling women about using condoms, I hope I am making sense and being effective!

I am starting my work at the kindergarten this week, and I got a bunch of Miss Peggy's volunteers to help out, so we are reorganizing and repainting the kindergarten and 1st grade classrooms, which will be a lot of fun!

Neha Journal #1

2011-01-11T12:52:00.000-08:00

May 23, 2010: Week 1

Journal #1: Welcome to Island Life!

I arrived in Roatan last Saturday, amazed by the airport landing strip only feet away from the beach. At first, I was a bit worried, because I learned that Miss Peggy is out of the country for the month, and I thought I would not be able to make any connections without her. However, I immediately felt welcomed by the volunteer/NGO community. I met several pre-med and nursing students from Miss Peggy's Clinica Esperanza, and the previous HEAL intern, Kate, invited me over for dinner my first night, so I met many of her friends as well. Everyone was super friendly and told me all about the various projects they are involved in.

After a relaxing Sunday on the gorgeous West Bay Beach, I came to the Roatan Hospital to start work on Monday. The hospital was just as I had pictured it- I spent my fall semester in Costa Rica and visited several public hospitals there. It was very crowded, with at least fifty people waiting in line to get their assigned to a clinic. I found out that most patients line up around 6-7 AM, and that the hospital, or at least the pediatrics ward, stops taking new patients by around 9 AM. The mentality seems to be come early, or its not worth coming at all. Kate took me on a quick tour of the hospital, we picked up the day's expedientes (or patient files), and entered Clinica #10, the Global Healing clinic. Its interesting because I had not realized that Global Healing was completely incorporated into the hospital, and is one of the three pediatric clinics to send patients to.

We immediately jumped into work, and began triage. It was to pick up the basics, like filling out the form and asking the standard questions. After two patients where I shadowed, Kate let me try one on my own. At first, I was a bit too cautious with my Spanish, limiting myself to only very robotic questions. I was also baffled by the stethoscope for a while, and found out I had been putting it on in the wrong direction for most of my life. I learned that a baby's heart beats incredibly fast, and that most babies are not a fan of having a cold hard piece of metal on their chests, and that crying children do not usually want their weight measured.

But overall, its been great- the description of the internship was totally accurate. Once Kate left after two days, I really was "directing' the clinic. I come in every morning and set up, begin triage, and wait for the doctora(s) to come. Last week, we had three doctoras here, so they were taking in patients as fast as I finished triage. This week, it is just me and Dr. Sara Sadrzadeh, so I get to sit in for a lot of the patient consults. I've learned a ton about what diseases are common here in children, such as scabies and impetigo, and how to tell a dangerous diarrhea from just a typical rotavirus. I also had the chance to follow the doctoras as they did rounds, doing chequeos for all of the newborn babies, which was a new and interesting experience, both talking to the new moms and learning about all of the possible things that can go wrong in baby development (there are so many, its incredible how many of us turn out okay!) It was really fun to have the three doctoras around and see their different styles of care, and also just to talk to them about their experiences with medical school. Shadowing Dr. Sara has been very interesting as well, and she always takes time to explain to me what she is thinking, and will discuss the case with me in as much depth as I want after the patient has left.

For the first few days, I was not sure how the payment system worked. All of these mothers and children were leaving our clinic with two to three prescriptions- but how were they paying for the drugs? Then, I learned about the many facets of the honduran insurance system. From my understanding, for employed persons there is a seguro social in which they pay a percentage of their income in order to have access to all seguro hospitals. Unfortunately, there is no exclusive seguro hospital on the island, but the Roatan Hospital is sort of the replacement. As a public hospital, all patients have to pay a small fee to be seen (25 lempiras, I believe), and then everything else is free. The emergency room is completely free as well, and since all of the clinicas close by 1 PM, it is where a lot of patients end up going. The system is far from perfect though, because the budget for the hospital can't cover everything. While the pharmacy has seemed well-stocked so far, I can see it easily running out of things.

The one case that has struck me so far was a little boy who came in on Friday. His foot had been run over by a car several months ago, and he spent six months in a hospital in La Cieba (on the mainland) getting plastic surgery. Unfortunately, the surgery had not been a complete success, and the boy came in to our clinic with an incredibly infected foot. We gave him antibiotics for the infection, but he also needed to get back to La Cieba to get a consult. His mom did not have the money for the ferry, so Dr. Sara filled out a form that would give the mother and son permission to take the ferry for free. This form had to be authorized, but the centro refused, saying the boy should just see the orthopedic surgeon in the Roatan Hospital. This didn't make any sense, since the boy needed to see a plastic surgeon, not an orthopedic one. The woman came back to relay the news, but the doctoras had already left, and I was closing up the clinic. I called Dr. Sara, but in order to get the woman onto the ferry, she had to fill out another form, which had to wait until Monday (the hospital in La Cieba would be closed all weekend). I asked the woman to come back on Monday, but I could see her frustration. While I promised we could help her, she has yet to come back. I know the antibiotics eliminated the emergency situation, and the boy should be somewhat okay, but I really hope she comes back, and I will do my best to follow up with this case. Bureaucracy is so frustrating!

The only thing that has been bothering me so far is how much free time I have! Its a silly complaint, but I guess I've always been a bit of a work-aholic, so the idea of finishing up at the clinic before lunch time feels wrong to me. Finding work to do in the afternoons has proved more difficult than I intended, since Miss Peggy is not here for guidance, and the clinica esperanza already has too many volunteers. Schools are about to start their summer breaks, so they do not really need any help with tutoring or anything. But I am excited to start a project this afternoon where I will be helping a local school redecorate/paint/organize its kindergarten classroom! I am also searching for other opportunities, and found a very cool organization called Familia Saludable that I am trying to contact.

Kate Journal #4

2010-07-29T22:17:00.002-07:00

May 2, 2010: Week 4

This weekend has been an absolute whirlwind. Contrary to popular belief, the “island time,” slow moving way of life has not made its way into my daily schedule quite yet…yes schedule. My days are not always as planned but go a little something like this…I wake up most mornings around 5:00am to birds chirping outside then at 5:30am to blasting music from my native Roatan neighbor. Sometimes she plays Christian music and belts it out, sometimes drumming, or even Akon “sexy bitch”..very classy. Its become so convenient for waking up that I no longer use an alarm. I start my workout around 5:35am, hospital/clinic work 7:30am-2pm, meeting with Jose who lives next door to practice my Spanish or 10 year-old Aimee, anyone really/or study Spanish, 5-7pm coach soccer and teach English at bilingual school, then eat dinner and head to bed around 9pm. I thought I was a grandma before when I went to bed at 11pm but am starting to realize I am definitely a grandma now.

Friday was a very busy day at the hospital. We had 30 or so patients come in with various ailments although the most common have been upper repertory infections, diarrhea, flu, cough, parasites with occasional malaria, scabies and cuts that have become very infected. I am learning about all the treatments and testing for the most common diseases in Roatan. In the United States we tend to do multiple tests when a doctor has an inkling about a disease, then follow with treatment. In Roatan testing like MRI, Xrays, are not available, or cost too much here so the most cost effective way is to do treatment right away. This system obviously would not work in the United States but saves many families a lot of money on the island, especially since the interventions are very low maintenance and cost effective. Most recently we have seen a lot of young mothers who are on baby 3 by age 19. Global healing is starting to counsel these women to “close the shop down” as we call it especially if it’s a low resource family and educate them on reproductive health resources and correct usage of those resources.

Work at the clinic ended around 1pm, then I immediately started to pack for a weekend retreat in la ceiba with Raul, Maddie and Sain for their last weekend here before they return to the states to finish med school and nursing school. I basically packed sunscreen, bathing suit and a camera plus the clothes on my back for the one-day venture on the main land. We headed to the Ferry for our hour-long ride to La Ceiba to go rafting and cliff jumping in the mountains. I awoke from the Ferry ride red as a tomato as we approached the main land. Before the trip to Roatan I was trying to stay out of the sun as much as possible so my white skin was pretty surprised by the blazing sun burning it to death.

The main land smelled like diesel and like any developing major city it had busy dirt streets, open markets and people everywhere you look. We took a taxi up the mountain for our 40-minute drive to Jungle River. The ride to the cabin was full of bumps and dirt holes, and im pretty sure by the time I got there my butt had about 10 bruises. From the street we walked down a few concrete steps to our cabin literally on the river. There was a beautiful red parrot that greeted us upon our entrance as well as the 2 main locals that ran the rafting business. We immediately stripped off our clothes and ran onto the huge boulders/cliffs that were around 60 feet high to jump into the river. When jumping off large objects I have realized there is a short window of time where I will actually do it (about 5 seconds) so I try not to think and just do. We then ventured down the river climbing up rocks, the sky scraping mountains filled with luscious green trees (anything we could). Raul is my monkey climbing friend so we usually explore most places we go by climbing and jumping, even if its not necessary, and most times its definitely not.

When it started to get dark we headed to our cabin to unwind, read a bit, then eat some delicious dinner. The local owners made us the most amazing chicken in a tomato chile based sauce, rice and red beans, salad, and fried plantains (that according to Raul who is a Mexican born plantain connoisseur were perfect and not too sweet). We played a card came called casino (an awesome game I was taught in college) with some candle light and headed to bed around 9pm. I awoke in the morning to beautiful chirping birds and other unfamiliar animal type noises. For breakfast the owners made us a fried egg omelet (actually fried), with rice, plantains and a crema sauce (kind of like sour cream and yogurt mixed together, sweet and sour). I stopped drinking coffee quite along time ago and have transitioned to matte in the morning but decided to venture out and try the coffee which was the most delicious chocolately creamy coffee I have EVER had. I drank 2 more cups then decided after stuttering on my words that I should stop.

At around 9am we started our rafting venture. A few Canadians joined us that Raul and Sain had met on the mainland while they were diving. I was very intrigued by their Canadian accent, especially the “oooohhhh yuhhhh) for oh yeah after I would say something mildly entertaining, and “yuh we have “bean thur” for been there. I have not traveled enough to know how other countries view our American accents but it CANT be as wonderful as Australian, Canadian or Egyptian. To train us for the trip we followed our guides for an hour up boulders, through hiking paths, jumped off cliffs down river, floated to other rocks to climb up then jump off again, into crevices in the rock boulders to see snakes, and huge spiders that resemble water spiders is the states, native plants that act as medicine for bites, soap, and a remedy for colds….naturalist medicine is just so gosh dang awesome. We then had to swim upstream to get to the other side of the river with our paddle to prove we could survive the trip. I have been rafting before and have never had such an extreme prep for the rapids. Anyone who knows me can vouch for the fact that I look like a cat drowning when I try to swim. I have tried to learn how to swim many times before but keep resorting back to my dog paddling. The life jacket didn’t help much as I waddled across the river gasping for breathe and praying I made it to the other side. I was happy I survived the 20 yard swim haha and 15 people laughing at me the whole 2 minutes it took to get to the other side. Since it was Maddies first time rafting we did tops level 3 rapids. After doing rapids 4-5 with the soccer team this was nothing but nonetheless I managed to fall out of the raft after every drop. My favorite part about rafting is floating down the river with my feet up and life jacket in the water. I jumped off the boat every opportunity I had to float down the rapids.

At the end of our trip we ate a bunch of perfectly ripe and sweet bananas, watermelon and pineapple that jungle river supplied and decided to stay one more night in La Ceiba to get a feel for the real city life that Roatan does not have. We stayed with the Canadians in a hostel in the heart of La Ceiba. I walked around the markets with Raul and Maddie looking at all the wild fruits, vegetables and shops. We headed to the coast to listen to the waves that Roatan also does not have and to watch the 40-50 locals fish off the main dock. While posted up on our log watching the sunrise a little dog sat behind us watching our every move. I turned around and stared this doggy in the eyes, looking at its very infected bulge on its face, and missing 2 toes. We had quite a moment then the dog decided to follow us around for the next 2 hours to EVERY place we went. When we stopped to get a drink or go to the bathroom there it would be waiting outside. I named it Bud and decided for all its hard effort I would feed it some bread. The dog continued to follow us to a random indoor soccer field in the middle of the city. I was so uncontrollable excited to find this treasure and immediately decided to ask them to play. Raul and I jumped in to play for about an hour while Maddie and Bud (doggy) watched us play. I realized at the end of the game that I was wearing the only clothes I had packed and was fully drenched in sweat. I quickly absorbed the fact that I would be showerless and covered in river water, bug spray, sweat and sun tan lotion as I slept in the Hostel that night. The boys we were playing with bought us some bolsa de agua (bag of water) after the game which is a liter of distilled water the locals drink because its very cheap. We chatted with the locals for a bit and exchanged emails. When we told them we worked in Roatan at the hospital and with Miss Peggy everyone knew who she was. After the game we bought a baleadas (home made tortilla with beans, cheese and any topping). I had egg and avocado. The total meal cost $1 and was very tasty, and filling.

After a long day of rafting and exploring we all headed to bed. I woke up at 3am overwhelmed with the heat, and unpeeled my sticky legs to talk with one of the Canadians Shauna who was still up. Shauna who is from Vancouver gave me her life story of working temporary jobs and traveling around the world. Not a bad way to live at all. She was a very friendly VERY talkative gal, maybe a bit too hippie for me, which says a lot, but full of awesome energy and a great heart. I finally went back to sleep around 5am to awake at 6 for breakfast and our Ferry back to La Ceiba.

I am very eager to start my next week, and also excited to get some sleeeeeeeeeeeep.

Kate Journal #3

2010-07-29T22:16:00.000-07:00

April 25, 2010: Week 3

I knew watching episode after episode of the dog whisperer with mi madre would pay off some day. I finally stood up to the dog that always starts the barking and nipping at me during my morning run. This is who Cesar Millan calls the pack header haha. In order to counter the dogs dominance in my deepest and manliest voice I yelled stop over and over again until the dog looked confused and just walked away haha…but it worked! I no longer run down the beach with a huge stick looking like a crazy gringo.

Raul's internship at Global healing ended yesterday so hes working for Miss Peggy this week before he leaves which means yesterday was my first day at work alone. It was pretty awesome. We were really busy and saw 25 patients. The air conditioning was broken so I was no joke dripping sweat the whole time. The most startling and sad case we saw today was a young boy with a brain tumor. Global healing puts aside money for special cases like this to send them to the main land, so we worked out a time to send the boy to La Ceiba. His cancer had metastasized (in the later phases, and spread throughout his body), really sad to see. He was only 5 years old with the biggest smile and brightest eyes.

After work I decided to explore Coxen Hole where the hospital is located. I found some wonderful cheap fruit and vegetable stands with pineapple, mango, cucumber, avocado and lettuce. My body has completely adapted to the flora on the island so I tend to eat whatever I want. Because the island is so small I ran into more than 5 patients and their children as well as the girl that lives across the street from me who I make lunch for when her mother is at work.

I went to bed verrryy late last night around 10:30pm haah so I could not wake up for my usual 5am work out. I ran mid day today around 2pm and will never do it again. It was so hott I felt like the sun was burning my soul hahah. I then ran into Jose who lives next door and speaks broken English to me and I speak broke Spanish to him. He always brings something crazy with him or shows me something crazy. Yesterday he climbed up a 40-foot tall cocoanut tree to show me how to pick cocoanuts. He then tried to show me how to straighten my arms and use my toes to propel myself up the tree. I tried for about 10 minutes and climbed about 10 feet up the tree before I realized what I was doing and quickly feel off. The cocoanut milk and skin were not as sweet as the ones I drank in Costa Rica or the states, they had a very unique sour and tart flavor….very good. Today Jose brought over some bamboo looking stuff and kept repeating caña, caña, caña. This went on for probably way too long before he finally yelled azúcar and I realized he was trying to say sugar cane. He shaved the hard shell off and showed me how to bite off the top, chew up the sugar water and spit out the rest. It was delicious and tasted exactly as expected but in its purest form of sugar water.

In the evening Sain, Raul and I started cooking food to celebrate Maddies's 22nd birthday. I not so stealthily quizzed her on all of her favorite things in life last night like what would your favorite day be like and favorite food, drink, what do you miss most from the states etc? I found out her favorite things are breakfast for dinner pancakes, bacon and eggs and loves sauvignon blanc wine, misses kiwi, and grapes, and bonfires with smores so we did all of that for her. I almost bought a Hannah Montana pinata for her but unfortunately because I am a gringo they tried to sell it for $40 which is more than the states. I was very tempted. Very tempted.

Fortunately breakfast for dinner is one of my favorite things as well so I ate until I could not move then started on the smores and wine. We shared our favorite music, movies and books. I started to make a list and am very excited to venture into the world of nerdy sci fi books. I started with Ender’s game and loved it…..neeed moreeeee!

Today the Roatan Hospital had a 4 hour non stop conference on Malaria (all in Spanish) in a 20 by 20 room packed with doctors. I can’t sit still for more than 20 minutes at a time so expectedly after a half hour I panicked and left the room to take a breather. I tried to contain myself after that and focused on Spanish words I could not understand. This lasted for about 2 hours until I started to fall asleep. I have learned a very valuable lesson and will not be attending any more of these conferences. Dang ADHD. Today is my very first day off in the afternoon. I have no idea what to do with myself but am pretty sure it involves a long nap and Jane Austen (you would be proud Tony).

Kate Journal #2

2010-07-29T22:13:00.001-07:00

April 18, 2010: Week 2

Today was an awesome day. Everyone bailed on me this morning for running so I ran alone. I started running with a stick which probably makes me look like a weirdo but its worth it since I have been attacked by the same freakin dog about 4 times now. The clinic had some interesting cases today. I saw a boy who had Pica. His neighbor brought him in and explained that she saw him eating dirt and mixing it with sugar to make dirt shakes because his mom works all day and does not feed him till night and expects her to take care of him all day. This was all in spanish so thats what I got from it at least. He was 8 and had not started kindergarden yet. Socially the boy was developmentally delayed and Dr. Sarah explained to me that Pica causes anemia because of iron deficiency (and vitamin deficiency) as well as gripe (flu). She prescribed the boy with vitamins and parasite antibiotics for the worms he most likely had. The boy looked very sick and pale when he came in and didn't answer any of my questions. I tried to do a follow-up to check up on the boy after a few days to make sure the parents use the resources I gave them but they do not have a phone, or internet. A lot of mothers on the main land are single moms employed by temporary jobs such as cruise ships. The are no alternative jobs so the mothers end up leaving the children with neighbors or family members that don't take very good care of the children. There are only 2 day cares on the island that only the rich people can afford. I am learning so much about the culture and how the honduran health system works. There is a substantial gap between the rich and the poor on the island, like many other developing countries, which leaves very few resources for the poor. I am looking into the day cares on the island and hoping they can set up a program for low-income families, or hopefully there is one already available that can be improved on to refer the families to. Its hard to see these kind of things and do nothing.

In the clinic I am working with Raul, Dr. Sarah (born in Iran, lived in Honduras for 11 years, moved to USA for middle school, high school, college and Med school, then moved back to Honduras to work. She speaks 3 languages excluding English and is very cute and Witty). I also work with Dr. Gross who is a 72 year old american attending who lives in San Diego and travels around the world to help as a doctor in third world countries such as Thailand, Malaysia, Haiti, India, etc. He said he has seen the worst things in Northern India, and if I wanted to come see them with him at some point that I was welcome. I am beginning to absorb and process everything I am seeing and hearing to make some sense of it all.

Now its around 3pm and I am headed to the beach to do some thai chi, then look into coaching soccer at this place down the street. My life has no order, changing every 3 months, but I am starting to get used to it. Not sure if thats good or not but i'm adapting.

Kate Journal #1

2010-07-29T22:12:00.001-07:00

April 11, 2010: Week 1

My first day in Roatan, Raul (global healing volunteer) showed me around the pediatric hospital and west bay of Roatan. We went grocery shopping and headed to a beach resort where Peggy (founder of Clinica Esperenza) knows the owners so we all played around for the day. We played soccer 3 vs 3, volleyball and laid on the beach....rough life volunteering haha. It was a great opportunity to get to know all the volunteers in a relaxed setting. Everyone I met was wonderful and full of energy. We are all from such different backgrounds and places around the world. I am learning so much from all of them already. After watching a beautiful sunset we went to dinner at the only Thai restaurant in Roatan that I thought was better than the majority of Thai restaurants in the states. This kind of defeats the purpose of being in Honduras but I am sure I will get a lot of authentic food in the next couple months…and well….I LOVE thai food. After dinner Sain (just graduated med school), Maddie (ICU RN), Crista (just graduated med school), Raul (current HEAL intern applying to med school who I will be working with for another 2 weeks) went to karaoke. I sang my first karaoke song ever with Sain (duet) which was aladdin..a whole new world...it was terrible but we got really into to it so maybe that made it better...although probably not. The ride back to the apartments was beautiful. Nurse Peggy owns 1 truck, but constantly drives around 5-10 people so all of us packed into the back of the truck. I sat silently on the way back home watching all the stars that were magnified by the lack of light on the island. I have never seen the stars so bright and clear. I looked for every constellation I know...which encompasses about 5 haha but I fully intend on learning many more...it was breathtaking.

On Sunday when everyone returned from the health fair (listened to the president of honduras and did HIV/AIDS screening) we went to dinner. I ordered literally half of a rotisserie chicken and ate it all! We had fried plantains and a yellow rice mix as well. My roommate Cottie and I watched religiosity and journaled together.

This morning I woke up to run around 5am (sockless) with my NEW NIKE FREEEE's (most amazing shoe in the world and my first new shoe since high school)!!! I ran on the beach till it ended which was about 15 minutes there and 15 minutes back. This does not mean it was a long distance run, it means I was awfully slow haha but I am working on it. I was feeling maybe a bit too adventurous and decided to run it twice so now I cant feel my legs..ooops. Also note to self, do not run next to dogs that are sleeping soundly because they will attack you. I got a little too close to one and it jumped at me and started chomping so I backed off and just starting running into the water like an idiot hoping that the dog couldn’t swim? Eventually the dog backed off after I was chest deep in water. There are stray dogs all along the beach so I am prepared to jump into the water every morning to avoid being attacked.

Today was my first day of triage at Clinica Esperenza and the Pediatric Public Hospital of Coxen Hole. Raul (other global healing volunteer) and I waited for our bus (big van) outside of the volunteer apartments promptly at 7:30am. I had no idea you could fit 20 people inside a van...but hey...its possible. Ten minutes later we arrived at the public hospital fully drenched in sweat. This hospital is far from anything you will see in the states. It was 90 degrees and muggy today and the hospital has no air conditioning. I walked around the hospital with Dr. Gross the American attending volunteer to watch him do rotations with mothers who had just delivered. I learned so much about the normal signs of a newborn through the first trimester. I was terribly nervous and extremely excited as I walked through a sea of mothers and some children crawling on the floor who were waiting to be seen at the global healing clinical office.

Today I saw 15 patients. The children came in with a variety of diseases I had never seen before ranging from chickenpox to scabies and parasites (mostly worms). It is very clear I do not speak fluent Spanish so the mothers that speak English reply in English. I am already becoming more confident with my Spanish and especially my medical Spanish but I still need a lot of work.

I ended the day working in Miss Peggy's Clinica Esperenza counting pills in the pharmacy and cleaning up. Tomorrow I will start working with a few soccer teams around west end (the more touristy side of the island). I am so excited to become enthralled in soccer again, especially with a group of kids who live and breathe the game. My first three days here have been amazing to say the least.

Raul Journal #3

2010-07-26T17:19:00.002-07:00

April 4, 2010: Week 3

So I arrive at the clinic early on Monday morning, ready to get to work, and I am surprised not to see any patients waiting in the hallway. There are only patients waiting by the emergency room. I was a little earlier than usual, but it still seemed strange that there was not anyone. Still, I opened up the clinic and got ready for the day as usual. Ten minutes went by and still no patients. I go down to where the patient check-in area and I see it is locked up. I had no idea why. I had still had some work to do in the clinic as the painting had been done on Friday, and I still had to make sure everything was dusted off and wiped down. Soon Dr. Sara arrived, and let me know what happened. Apparently there was a tiny sign on half of a manila folder, near the entrance of the hospital that I had missed. It said ‘No habra consulta externa del 29 de Marzo a el 4 de Abril’ meaning no consults all this week. We had not been given any prior notice of this, so Dr. Sara went to investigate. She found the director of the hospital, who was in the Statistics Department, angry because the Statistics Department decided, on their own; to put up the sign and send all of the patients home early in the morning before anyone else arrived. They took it upon themselves to let everyone have the week off for Semana Santa, even though the Director had previously decided that patients would be seen until Wednesday. Needless to say, we were not thrilled about this development either, as not only had we planned to be there, but our patients were sent home unseen. Dr. Sara then explained to me that this is not the first time something like this has happened at the hospital, which is really horrible, because just because it is a holiday does not mean people do not get sick. And what options do people have, either get sick enough that the emergency will take them, or come back next week! Dr. Sara also explained to me that for chronically ill patients it is especially bad, because if they had an appointment to come in this week, it just gets lost and they do not get rescheduled. They have to come back next week at which point they are wither turned away because they do not have an appointment or forced to wait to see IF they can be seen that day or they have to come back and try again, which throws off their entire treatment schedule as well as their personal schedule. It is really sad that the hospital workers feel that they can just do something like this.

So I had to make the best of a bad situation, since Dr. Sara and I were already there, we went through the clinic and did some housekeeping. I had organized almost everything my first week there but there are always little things that can be done, and it was helpful to go through everything together so that we would both know where everything is and exactly what we have. We also tried to see if we could drag the guy who is supposed to install the automatic door closure device to finally do it, but it seems he decided to take the week off too. For the rest of the week I went to Clinica Esperanza and worked with the doctors there. I got to see some really interesting cases. One young man came in with a large growth on his cheek, probably a little smaller than a ping pong ball. It was small fluid filled sack, and I got to help one of the doctors as he opened it up and removed all the fluid. Well help is probably too strong a word, I got to get him his supplies and hand him tools as he needed. But it was amazing! It is not too often that I get to see something like that live and up close.

The rest of the week, the days we were actually supposed to have off, one of the new doctors at Clinica Esperanza and I went to West End to get our diving certification, which is also one of the most incredible things I have done. Diving is amazing! Getting to float around almost weightless in a completely different world, is relaxing and so exhilarating all at the same time. And I cannot express how unbelievably amazing it is to be able to do something like swim alongside a sea turtle, so close that you could just reach out and touch him, or floating alongside a giant coral reef wall when you are forty feet underwater and see that it still extends at least another fifty or sixty feet below you. That last one gave me a little nervous giggle at first, because it is like standing at the edge of a cliff, but this is like a dream because you can actually go over the cliff and “fly” alongside it. If you ever have the chance do go diving, I definitely recommend it. And the dive shop we went to gave us a good deal because we were volunteers.

So, although the hospital tried to stop me, I was still able to accomplish some good thanks to Miss Peggy and Clinica Esperanza, and I finally got to find out why there are so many divers on this little island, all in all not a bad week. Alright, well I think that is enough from me, Happy Easter to everyone, until next week!

Raul Journal #2

2010-07-26T17:17:00.001-07:00

March 28, 2010: Week 2

So I am coming to the end of my second week here in Roatan, and each day I feel really glad that I came. Working at the clinic has been a great experience. The majority of patients that we see come in with some type of parasite infection, mostly ascariasis. However there are also several other parasites and bacterial infections that we see. We have also seen a couple of patients with malaria, as well as other topical bacterial and fungal infections. One poor child had a fungal infection that had gotten so bad it was forming a very large lump near the top of her head. Many of the children also come in with a combination of parasites, upper respiratory infection, and/or fungal infection. Many mothers come in stating the same chief complaints for their children, gripe, cough, diarrhea, and sometimes also fever (although very few if any actually have a thermometer to take their child’s temperature). It is very interesting to observe the doctors as they tactfully extract the necessary information from the mother have to arrive at the correct diagnosis. Even though the mother are sometimes unhappy at first because they come in requesting a specific medication because it worked for someone else, or it worked last time. The doctors have to patiently explain that antibiotics will not do anything for a viral infection or that their child does not actually have the same infection and that another medication will be much more effective. But it has been a great learning experience to see how to deal with these types of issues effectively as almost all the mothers walk away happy when they leave our clinic. Sometimes we see patients again outside of the clinic and they are always very happy to see us and thank the doctor’s letting them know that their child is doing much better.
Working with the children who come into the clinic has been really fun as well. Most of the children are very friendly and happy despite being sick and very few are afraid to be coming in to the doctor. Those that are nervous or afraid usually easily assuaged by some comforting words or a little bribe. I usually tell them that if the help me with a few things they will win a prize, and once I get them to step on the scale, stand by the wall to measure them, and let me take their temperature, I reward them by giving them a sticker, or a sheet of paper to color on, and a pen. Before I came here my parents bought me a bag full of assorted colored pens and pencils, so I usually give them away to the kids that are old enough to use them. And also we have some little chairs and some story books in the clinic that the children are usually happy to play with, and having their own personally sized chairs usually makes them feel very happy and comfortable. It is really great to see their smiling little faces, happy to be there, and saying “gracias” to me, even though I am the one that is thankful to be here, and thankful that the clinic exists to be able to help them.

Well to continue with my overly emotional tone, I would like to say that one sad thing happened this week. The two doctors from the U.S. returned home. Dr. Catherine and her husband went back home Friday afternoon, and Dr. Preetha went home today. It is too bad that I only got to work with them for two weeks, but the two weeks were really great. Now it will be just me and Dr. Sara for a little while, which also has its advantages, because I will be able to spend more time with her, which will allow us to get to know each other better and work together even more effectively.

Another update is that the clinic has been repainted! Well part of the clinic. One of the walls in the front room of the clinic had apparently suffered some water damage some time before I arrived, and the doctor’s had been trying to get someone to fix it but the people who were supposed to fix it were just not coming, and we really needed to get it done, so I volunteered to do it this past Friday that way it could be ready by Monday. It was just a matter of scraping away the damaged portion of the wall, sealing it to help prevent damage in the future, and then repainting it. Dr. Sara and I went to the hardware store to buy the supplies on Thursday, after we were done at the clinic, and Friday I got to work. And since we were going to buy the paint, I took advantage to paint most of the front room as many of the walls had begun chipping or had some minor scrapes, or poorly painted areas where the color that was underneath still showed through the top coat. So the nice yellow room where our computer area is, and where I take the patients info and weigh the children, as well as our informal third exam area is contained, is all bright and new again.
Well I think those are all the major happening of the week, I cannot wait to see what next week brings. Until next Sunday, adios.

Raul Journal #1

2010-07-26T17:09:00.002-07:00

March 21, 2010: Week 1

My first week in Roatan was nothing short of amazing. Busy and a little stressing at times, but nonetheless amazing. I arrived in Roatan on Monday afternoon, one of the doctors working at Miss Peggy’s clinic picked me up from the airport and drove me to the condo were I would be staying in Sandy Bay, right next door to Miss Peggy’s home. After settling in and unpacking my things, I got a ride into Coxen-Hole, from my neighbor, so I could do some grocery shopping. After getting a cab back home and eating some dinner I promptly crashed into bed and fell asleep, so I could start my morning bright and early on Tuesday.

Tuesday morning I arrived at the clinic fairly early and waited for the doctors to arrive. I sat out in the hall with the patients of the hospital, the waiting area consisting of no more than a hallway with old wooden benches on either side, between the entrances to the clinics in the Hospital. It was a sweltering hot day and the mother’s fanned their children as they sat waiting to be seen by a doctor. Many had come from far away and arrived as early as 6:30am so they could be assured that they would see a doctor as soon as possible.

The doctors arrived promptly and greeted me and we stepped into the clinic, where they showed me around the different areas of the clinic. After which I proceeded to give them the supplies Mrs. Gruber had sent with me, alcohol swabs, ointments, antifungal creams, aspirators, etc., of which they were very happy to receive. There are currently there doctors working at the clinic, Dr. Sara Sadrzadeh a doctor from Honduras, Dr. Preetha Krishnan a fellow Bay Area resident, and Dr. Catherine Boston from Louisiana. The three of them gave me a brief tour of the hospital and introduced me to several people in different departments, before taking me with them to examine the newborns. Then we went back to the clinic and they showed me exactly what I should do with each patient, were and how to notate all the vitals, and I quickly began calling names. I will not lie, the first day was a little nerve racking, I have taken vital signs before but the being in a different country, with doctors I had just met only moments ago, and doing something that felt so simple and yet so important at the same time, the pressure to not make a mistake felt intense. I didn’t want even so much as a smudge on the patient’s sheet. But after the first few patients I began to relax a little and not feel like someone was waiting for me to make a mistake.

We saw about fourteen patients that first day, which was one of the lighter days we had this first week, a fact which made my first day at the clinic a bit easier. After seeing all the patients for the day the doctors taught me how to input all the information into the global healing spreadsheet and the hospital spreadsheet, and where to turn in hospitals form for the department of statistics. My day at the clinic being done, I took some time to explore Coxen-Hole and familiarize myself where everything was around the hospital before I took a cab home to Sandy Bay. Upon returning to Sandy Bay, I took some time to walk around my neighborhood, and meet some of my neighbors. All in all my first day was pretty great, even taking into account my minor attack of nerves.

The rest of the week at the clinic grew progressively better, as I grew more comfortable and more familiar with the clinic. I continued to arrive early to the clinic, so that I could do some cleaning and organizing of all the cupboards and shelves in the clinic, now what I need to do is make some labels for the shelves and some of the boxes to help keep things organized and make them easier to find. The doctors at the clinic have been really appreciative of my being there and have really welcomed me with open arms. Dr. Krishnan, Dr. Boston and Dr. Boston’s husband showed me around West End, where they are staying, and we had dinner there at a delicious place called Rotisserie Chicken, which so far I have found to be the most affordable place in West End and the food is great. Thursday night, Dr. Krishnan also invited all of us at the clinic out to dinner, including Dr. Boston’s Husband, and Dr. Sadrzadeh’s husband, so all of us are getting to know each other pretty well. Friday afternoon I was also able to visit Miss Peggy’s clinic and see how things run there, as well as get oriented with the pharmacy so that I can help out there in the future.

This first week in Roatan has been, as I said, amazing. I have met so many great people and gotten to do so many great things that I would probably never have the chance to do in the U.S., both medical, and recreational, such as snorkeling! However I seem to have brought some of the Bay area weather with me, as we had two days of stormy weather, which delayed my snorkeling until Saturday. But it was just as well as the first few days I had so much to do I probably wouldn’t have had much time to really enjoy it.

The only problem I have run into, if I can even call it a problem, is with some of the cab drivers who realized I was new to the island and tried to charge me more than the normal fare, I had to haggle with them most of the time so they would not give me the tourist price. However one thing to note is that the prices have gone up from what the orientation packets stated, I have consulted with the locals and they have agreed that these are the correct fares. A cab from Sandy Bay to Coxen-Hole is twenty-five Lempiras, and the bus from Sandy Bay to Coxen-Hole is eighteen Lempiras. I finally decided to try and take the bus on Friday at Miss Peggy’s insistence, and I am very glad I did. It actually did not take that much longer than a cab ride and the people on the bus were much friendlier and more open to conversation, and as soon as they heard that I was here to volunteer at the Global Health clinic and Miss Peggy’s Clinic they were very happy and really welcomed me and even commended me for doing so. It was really nice to feel that sort of acceptance from the locals, especially since I had only met them a few minutes ago.

Molly Journal #11

2010-07-26T17:07:00.002-07:00

January 10th: Week 11

We have had terrible weather all week. Many fewer mothers bring their children in when it is raining outside. With the low numbers of patients, we have actually had high numbers of 10-day check ups. These mothers are braving the rains to bring their 10-day-old babies in for check ups. I think that Dr. Bob must be stressing the importance of returning during new born exams because only in the past few weeks have I seen so many diligent moms bringing in their babies right on the 10 day mark. Even if kids with colds are saving up their problems for better weather, these hopeful moms are taking good preventive care of their newborns by bringing them in for check ups. It is good to see some follow through.

This week was our first week with Dr. Sarah, the 2010 Global Healing Fellow. She is very smart and kind, I have enjoyed working with her so far. Dr. Mario is now finished at the hospital sadly. He is hoping to get into a program in Mexico to specialize in surgery.

Because we were slower this week, I got to shadow the doctors on rounds in the pediatric inpatient ward and in maternity for newborn exams. We saw newborn that had aspirated the fetal meconium. A baby may have it’s first bowel movement of meconium in utero. Then because of the stress of birth, the baby may aspirate some meconium mixed with the amniotic fluid causing pneumonia. This particular baby had not aspirated very much and was doing well. She was hooked up to an antibiotic IV and an oxygen tube. The necessity of the antibiotics was questionable, and apparently an overuse of antibiotics is characteristic of Dr. Jacquie. Sarah talked about how the L&D nurses are very unprepared to resuscitate a newborn. She had an experience where a newborn stopped breathing after meconium aspiration and the nurses just shook him to reanimate and wouldn’t use the proper equipment. This is pretty terrifying.

Molly Journal #10

2010-07-26T17:07:00.001-07:00

January 3rd: Week 10

We closed this week for New Year’s. Dr. Bob went to California for Christmas, and Dr. Mario went to Tegucigalpa. My sister arrived on Christmas Eve to visit for 2 weeks, so we took advantage of my week off and went traveling on the mainland. We went white water rafting on Rio Canrejal in Parque Nacional Pico Bonito, sunrise canoeing and bird watching in Refugio Cuerdo y Salvo, and explored the ruins of Copan. It was a lot of fun and a great opportunity to see the mainland.

Molly Journal #9

2010-07-26T17:06:00.000-07:00

December 27th: Week 9

This week was incredibly slow. We were only open Monday-Wednesday as Christmas Eve and Day were Thursday and Friday. We had very few patients as people were traveling or preparing for the holidays.

Nearly every baby up until about 6 months wears on this island wears a red beaded bracelet. I have asked a few mothers what the bracelet means and they say something like “to keep them safe.” This made no sense to me so finally I asked Mario. She said he had been curios too as it is not a tradition on the mainland. He explained basically wearing the red bracelet protects infants from “mal ojo,” or “the bad eye.” In this superstition, if a baby is looked at the wrong way in the first few months of life they may get sick or die. I suppose the “mal ojo” concept gives people a something to blame for infant mortality.

Infants do not receive names normally until a month or two, or sometimes five. I wonder if this practice stems from a hope to not get too attached to a baby who statistically may not survive. If the baby does not yet have a name, maybe it is not considered a thriving person yet, and therefore not as sad if it dies. Or maybe they are just lazy namers.

Molly Journal #8

2010-07-26T17:04:00.001-07:00

December 20th: Week 8

Compared to normal standards, the hospital lobby was nearly empty today. Mario said this was typical for Fridays pretty much up until the time I arrived. Fridays are cruise ship days. Also the wind had picked up and the skies seemed threatening to unleash a tropical storm. This “rainy season” has been surprisingly full of sun and blue skies, so the stormy days keep people at home.

All patients were seen by10:15am after which Dr. Robert and I dug into the nebulizer/respiratory treatments/miscellaneous junk shelf. We found tons of expired inhalers and other meds. It was a shame to throw bags full of medications, but they say the clinic could really get in trouble if caught by the ministry of health. So away they went, only a few months expired. The rest of the shelves contained 8 different organizational systems left by the rapidly changing succession volunteers and employees. There were probably 200 pulse-ox electrodes stashed in various boxes and corners. We also found 4 more nebulizers although we’re yet to find out if they work. We got some organization in the jumble of supplies. Yesterday Dr. Robert threw out shelves full of expired meds in the cupboard of one consolation room. I think it needs to be decided what the plan of action is for the donated meds. If the doctors only write pharmacy prescriptions and never give them away, then we end up with shelves full of expired meds. It’s such a shame these meds aren’t helping kids who could really benefit from them, not to mention the wasted packaging and product.

This week I switched from growth charts by the CDC to ones by WHO. Dr. Bob brought print outs of these and explained how the CDC’s measurements are based on fat American kids, where as the WHO takes into account the less nourished 3rd world countries. The measurements don’t appear to be too different but this hopefully will be more relevant for the population. While I have seen a good deal of quite plump children and parents, there are also the occasional chronically mal nourished kids from the households of 10 children and bad hygiene.

This week I had a great proportion of terrified or angry children. 3 years of age seems to be the time when kids become skeptical, temperamental, and mistrusting. I had quite a few temper tantrums, which normally start before they even walk through the door. But some kids take one look at the scale I am asking them to get on and start screaming. I don’t know why they find it better to scream and fight than just to sand in a particular place. I have learned a few tactics for dealing with the screamers:
1. If the kid won’t stand on the scale, put a chair on it (it weighs 1 pound), sometimes they will sit
2. Give stickers to make a friend or bribe them with stickers if making friends is not a possibility
3. Weigh the mom with and with out the child then subtract the difference
4. Explaining everything before it happens

On Wednesday we had the first supposedly weekly conference since I’ve been here. Louis, a social service doctor presented on nephrotic syndrome. Most of it was straight over my head because it was not only technical medical terminology and in Spanish. Still, it was interesting to learn about this kidney disorder. We are going to try now to have a presentation luncheon each Wednesday.

Molly Journal #7

2010-03-14T22:13:00.001-07:00

December 13th: Week 7

On Thursday a hospital nurse came in and gave us free H1N1 vaccines. I gladly accepted because the vaccine was not ready in Oregon when I left. I suppose it is a good precaution, although it’s a little late in the season. Mario said there were only a few H1N1 cases this fall at the hospital anyway. However, I thought it was nice the hospital gave free vaccines to their workers.

It is interesting how the load of patients flows with cruise ship days. Fewer mothers bring their children in when the cruise ships are here because they need to work and try to profit off the tourism. Cruise ship days are pretty entertaining around West End as it is very obvious which confused Americans found themselves here for the day.

On our busier days I do not have time to do much other than paperwork for the charts, weighing and measuring. It is getting a little redundant and I prefer when I have a little time to shadow the doctors. Also the range of Spanish I get to use is pretty limited to repeating phrases like “put the baby here for the weight.” There is not much time or opportunity for more conversation. I am also a little disappointed by the lack of Spanish speaking in my life outside of clinic. Everyone in West End speaks English. I thought I would be speaking Spanish all the time here, but it is not the case. Even about a third of our patients speak English primarily.

My parents are visiting and over the weekend we took a catamaran to Utila. It was a 4-hour sail each way. We had great weather and I enjoyed sitting on the boat in the sun and watching Roatán disappear then the little island of Utila appear to the West. We could clearly see the silhouette of the mainland from the boat, especially the peak of Pico Bonito. Utila is a really neat island. It is small, about the size of West End to West Bay, and much less developed. It has a nice neighborhood feel and is kept very clean. Because there is only one town, the ex-pats and the locals seem more intermixed than here on Roatán. The cost of living is much lower, which attracts many young backpackers. It seemed like a nice place to live, although Roatán has better beaches.

Molly Journal #6

2010-03-14T22:12:00.000-07:00

December 6th - Week 6

This week went by quickly as we had Monday off for the post-election
holiday. We have been busier in the clinic now with two doctors. We
are seeing 25-30 patients per day now in contrast to about 15 when it
was only Dr. Mario. Dr. Robert has settled in well here but is still
surprised by the short work day. It is always a big rush for 3 or 4
hours, and then clinic is done before noon. With two doctors, I do not
have as much time to sit in on the appointments because I am preparing
the patients as fast as they get through them. However, both doctors
are very kind to call me in to see, for example, an interesting case
of impetigo or shingles.

My dentist at home in Oregon, Dr. Bodyfelt, has agreed to donate 300
toothbrushes to the clinic! My sister will bring them in a few weeks
when she comes to visit. I am so happy we will have toothbrushes to
hand out to some of the children. Even if the supply only lasts a
month or two, it will be helpful to those 300 children.

I may have written about this before, but I keep thinking how grateful
I am to have a job on the island that keeps me connected to the real
lives of the citizens here. It is so easy for ex-pats living in West
End to never leave that “bubble,” never speak Spanish, and never
understand the poverty that the great majority of the population live

Molly Journal #5

2010-03-14T22:11:00.001-07:00

November 29th - Week 5

Yesterday, November 29th was the Honduran presidential Election Day. Today the hospital and all government businesses were closed for the day-after-election national holiday. Today it was announced that Pepe Lobo is the next president of Honduras, which the US has agreed to recognize. The weekend went smoother than I expected. There were no disruptive demonstrations. The government mandated bars to close for the weekend and liquor sales cut off. Also, Saturday night about 7pm the power was shut off. So without alcohol or lights, the chance of the public getting riled up was low. Islanders admit there was no particularly great candidate but they are happy with Pepe as he is pro-tourism. Also good for tourism- the US has lifted it’s travel advisor to Honduras. Hopefully tourists will come because the local economy was terribly hurt by the political situation.

The new attending, Dr. Robert, arrived yesterday. He is a pediatrician from Wisconsin who has spent half of the past two years doing medical work in Peru. I am looking forward to learning from him in the clinic.

This last week I worked on some organization in the clinic. It is obvious that many people have worked there for short periods of time and created their own partial organization systems, which do not translate to the next person. Having resources is one thing, and being able to find them is another.

I have really enjoyed working closely with Dr. Mario this week. He has been wonderful at explaining to me any disease, medication, or illness I have questions about. He lets me listen in on his consultations and shows me, for example, how to look into a child’s ear and tell if it is infected. I am very much enjoying working with children and leaning about the particular issues here, as well as common health problems with children everywhere such as tonsillitis. I feel lucky to volunteer in a position where I work hands on with the patients and closely with the doctors. Most opportunities, especially back home, do not allow for this great of exposure.

Molly Journal #4

2010-03-14T22:09:00.000-07:00

November 22nd - Week 4

I have officially been here 1 month. I am glad I have chosen to stay for 3 months, because I am just beginning to understand the island and the culture. More so, I am learning more every day about the common diagnoses in the clinic and understanding the patterns of the medicines used. There are the most frequently prescribed medicines such as Diphenhydramine, Acetaminophen, Piperazine, Mebendazol, Amoxicillin, Salbutamol etc. These all are prescribed for a wide variety of illnesses because there are really so few medications available. Nearly every kid gets the parasite medications as a general precaution. Many come in just to get multivitamins. I have had several people this week ask for a toothbrush. We don’t have any, so I am going to make it a goal to get a supply soon. Giving each child a toothbrush would help also one of the causes of malnutrition here: dental carries. Many children have rotting brown molars, making it painful for them to eat. This leads to malnutrition, which leads to greater susceptibility to illnesses. Clearly I cannot stop this downward spiral but at least giving out toothbrushes is a place to start.

Once a week or so the hospital nurses present information to the mothers waiting in the hallway outside the pediatric clinics. Last week the nurse had a large colorful chart demonstrating the benefits of vaccinations. This week she spoke about H1N1 and passed out pamphlets. The nurses are really just yelling this information to anyone willing to listen in the busy hallway, but it does seem that most mothers do pay attention. I am really impressed by this. However random the presentations are, the information does reach some people. These mothers have already taken the effort to bring their children to the doctor and are made to wait so really it is the best timing possible to convey relevant health information.

Now that I am comfortable in the intern job and the necessary Spanish vocabulary, I can spend more time learning about the diagnoses. Dr. Mario explains to me a lot of the medical vocabulary and tells me about the illnesses, symptoms, and causes. I am surprised actually that we do not see many Malaria cases. I had expected it to be more common. Also, I do not think we have had any H1N1 cases, or else they just don’t test to verify.

In news outside of clinic, we have had beautiful weather this week. I got to eat some fresh caught Tuna, Bonito and Baracuda fish with friends here. I spent Saturday at beautiful West Bay beach. I also finished my advanced diver certification this week. I feel incredibly lucky that this internship opportunity has brought me to such a gorgeous place.

Molly Journal #3

2010-03-14T22:08:00.000-07:00

November 15th –Week 3

It has been 3 weeks now and I feel quite settled in. I have met lots of great people through scuba diving here. There have been difficult days of extended rain but then it clears up again and I am extra grateful for the sun and calm water.

I am sad that the residents left on Wednesday; I really enjoyed them and feel a bit lonely now. In clinic now Mario is the sole doctor for a few weeks. This actually works out well because now we go through patients slower, so I can get all the triaging done and have time to listen in on the consultations. Before with 3 doctors I could only just keep up getting kids ready as they went through them. This will be good to listen to Dr. Mario work with the patients and learn more from him.

I am happy that the woman with the premature infant has been returning for weight checks. She is so proud that every time he is gaining weight (yay!). It is wonderful that she listened to the doctor’s advice and is really following through. So, there is hope for this baby.

I’m feeling competent with my duties in the clinic, My Spanish is warming up and even when a mother goes off on all the problems of the child, I can follow pretty well. Unfortunately though, everyone in West End speaks English, so my Spanish practice is more limited to clinic.

Molly Journal #2

2010-03-14T22:07:00.000-07:00

November 8th- Week 2

This week the residents and I went to Anthony’s Keys resort to swim with the dolphins. First, we were lucky enough to have Dr. Howard arrange a tour with his friend Dr. Paul of the hyperbaric chamber at the AKR clinic. They decompress hundreds of patients a year, mostly lobster and conch divers. We even got to see a rescue course do a nitrogen narcosis simulation in the tank, which was entertaining as they all started laughing and loosing motor function at 165 feet of pressure. Then the dolphin swim was a pretty incredible and fun experience; I would highly recommend it.

Dr. Howard arrived last Saturday and this week we all went to the gala fundraiser for Hospitál Roátan. We were concerned that our sundresses and flip-flops wouldn’t cut it for the formal dress code, but we didn’t come prepared for a gala. It was in a nice ballroom at the Henry Morgan resort. In true island fashion, it began about an hour and a half late. The director of the hospital, a few doctors, and the minister of health made speeches about the lack of funding from the Honduran government, the poor or lacking equipment, and the lack of medicines and supplies. Yet, they do have impressive numbers successful treatments, surgeries, and healthy babies delivered, and lives saved. The speeches though did drag on and finally we had a nice dinner. The crowd seemed to be various ex-patriots, business owners, and medical workers. I hope they raised a significant amount of money.

One day this week I got to follow Dr. Nicole and Dr. Rachel on rounds in the maternity ward. There were no deliveries in progress, but I was shocked by the delivery room with its black mold ceiling, lack of sheets on beds, and total lack of privacy. I watched as Dr. Rachel performed a newborn exam and kindly explained to me everything she was looking for on this healthy baby. Sadly, earlier this week we saw a much less healthy baby. A young mother brought in her one month old 1500-gram baby. Dr. Nicole did not believe I weighed correctly because a baby that small would surely be living in the hospital on all sorts of monitors in the US. The baby’s chart did not say how premature the infant was, but the mother said she was able to take him home the same day. Dr. Nicole encouraged her to feed they baby as much as possible and return for weight checks twice a week. This is just one example of a problem that gets let go because of lack of money, space, or resources to conduct proper treatment. A was also surprised to find out, as Dr. Howard told us, the average age of a 1st time mother on Roátan is 14 years old!

One afternoon the doctors did check ups on a few sick kids at the day care in Coxen Hole. They had a difficult time, as there were no records or parents to give health history. We questioned how helpful this was, but realistically some of these kids may otherwise never see a doctor.

Another sad story this week was a woman who brought in a 3 month old with swollen rock hard cervical lymph nodes. She told us that she was in fact not the mother because the mother had died during the birth and this woman was simply given the baby, I’m not sure that she was even related. She was totally unprepared financially for a child but was doing the best she could. The doctors decided to admit the baby to the hospital for care and testing to determine the problem to rule out TB or cancer. The next day we went and bought a can of formula for the woman. She clearly didn’t have much, so we thought at least this would help feed the boy for a few weeks. She was grateful.

This weekend hurricane Ida was projected to hit Roátan, but thankfully it changed course and we had a beautiful sunny weekend. We celebrated Nicole’s birthday and rented a pick up truck and drove to the East end of the island. The one road across the island goes high into the hills and along the ridge the ocean is visible off the North and the South sides. Beautiful views. We went to Camp Bay (a 30 mile drive that took 1.5 hours!). We spent they day there, the only ones on a beautiful expansive beach.

Molly Journal #1

2010-03-14T22:06:00.001-07:00

November 1st- Week 1

I’ve been here for 1 week! It already went by quickly. I arrived last Sunday and Dr. Mario picked me up from the airport. I had been so excited looking out the window of the airplane to the blue waters and the mountainous green island below. Excited and nervous. I was finally beginning this experience I’d been looking forward to and planning for months. Up until about a week before I left I wasn’t even sure if or would be able to go because of the current Honduran political mess. But good thing Global Healing decided it was okay, because after a week here I can see that what goes on in Tegucigalpa effects Roátan no more than causing a decline in tourism. Life here is peaceful. Locals I’ve asked say “that is over there in Honduras, but this is Roátan.”

There are currently 2 3rd year pediatric residents from Stanford hospital here, Rachel and Nicole as well as Rachel’s boyfriend Robby. I am living in West End at Julie’s apartments with them as was decided would be best for extra safety precautions in this unusual time. I am very glad to be staying near them as they brought me along out to meals and showed me around West End. Monday was a holiday, although no one could identify what holiday, so the hospital was closed. It was nice to have a few days to settle in to my (bright pink) apartment and get oriented. The weather has been fantastic so far; apparently I just missed a big storm. I have been enjoying the beautiful beach of Half Moon Bay right outside my building. We also made a trip to West Bay, the nicest beach on the island with sparkling turquoise waters and a clean white sand beach. I am impressed by the lack of high-rise mega resorts that have taken over so many beautiful beach destinations.

My first day in clinic was a little overwhelming. I was surprised at how small and run down the public hospital was. We—the obvious American medical crew—walked into the extremely crowded lobby and waded through the waiting people toward clinica 10. There are no appointments, they simply arrive around 6:30 am, get a number, and wait. Robby had been helping out doing the intern job since there wasn’t one for a few weeks. I learned how retrieve the charts from the nurses and dig through the scattered medical records to find the child’s name or birth date. Once the forms are ready, we called in the kids and mothers, yelling their names the best I could pronounce into the crowded hallway. I learned to weigh the child or baby, measure height, take temperature, and plot growth charts. My Spanish was quite wary the first day because I was nervous. Then at the end of the day we record each patient, diagnosis and treatment in a file for the month.

Over the rest of the week I got a hang of the duties and improved my own system of accomplishing them. I am amazed at the number of children who have parasites here. Supposedly 90%! The doctors prescribe medicines for parasites to nearly every child as a routine, because it can be assumed that they have one. We also see a lot of asthma, upper respiratory infections, bronchiolitis, skin infections, and even a boy with Dengue Fever. Many mothers bring their children in for a common cold and are very unsatisfied when the doctor says that prescribing an antibiotic will not help them. They want to walk away with some treatment for their child or they feel the trip was not worth it.

Overall my first week has gone great. I went on 2 beautiful dives, found a great yoga studio, and even celebrated Halloween last night!

Quynh Journal #2

2009-08-30T11:54:00.001-07:00

It has only been two weeks on the island, but I already feel my medical Spanish improving, as it’s taking me less and less time to formulate questions and record answers while triaging patients. Although triaging exposes me to the variety of illnesses from which Honduran children suffer, I have learned the most through shadowing the physicians and asking them questions. It has surprised me to find out that the patients here only have to pay around 15 lempiras (equivalent to a little less than a dollar) in order to see a doctor. Furthermore, medications only cost about 3 lempiras each, which is affordable to most patients. One particular mother came in with a child who had a high fever and chills; because the doctors suspected she had malaria, they ordered a malaria smear. The first thing the mother asked of course, was how much did it cost. I was very relieved to tell her that it cost only 30 lempiras, which was luckily inexpensive enough for her to have the lab test. Incidentally, the results were positive, which immediately influenced the doctors to prescribe Chloroquine to treat her. I am glad that the public health care system in Honduras makes it possible for many patients to be treated for their illnesses; however, I also realized that this came with a 12% sales tax, and the help of many social service and volunteer doctors.

One of the most interesting medical cases I encountered this past week was an umbilical hernia, which presents itself as a two-inch protrusion of the belly button. Although this was the first time I had witnessed anything like this, I quickly learned that they were very common in Honduras, which again reinforced the notion that the children here suffer from so many things that we do not really worry about when in the United States. And although the public hospital does offer their services at an affordable price, the problem is that they do not offer many services—thus, those who needed complicated surgeries or chemotherapy treatment needed to be referred to the Mainland for care. This of course, would involve at least a two-hour ferry ride, following a by nearly a seven hour wait to arrive to one of the main hospitals.

This past week also included my first time volunteering at the eLearning Center. There, half of the children were doing computer activities that helped them learn English, while the other half were listening to cassettes that read aloud children’s books. However, I noticed that the children were requesting the tapes to be in Spanish! It was then that I began to read to the children the stories in English, teaching them to point at the pictures that represented certain words. I think I will start with these baby steps in teaching English before moving on to more ambitious lessons, such as how to maintain a healthy diet on a daily basis.

Meanwhile, I’ve had the chance to hang out with the locals more. In addition to eating out in West End with friends, I snorkeled in the mangroves, swam in the ocean, and even had a dolphin encounter!

Quynh Journal #1

2009-08-30T11:51:00.001-07:00

My first thought when I stepped foot on Roatan was that this island was like a tropical paradise! Everywhere, I saw palm trees and colorful flowers; in the distance was a beautiful ocean with glistening water, and although the climate was quite hot and humid, the occasional soft breeze made the heat more than tolerable. Walking down the dirt road to Miss Peggy’s apartment where I now live, however, I was struck by the harsh conditions under which Hondurans reside—run-down houses built close together in clumps, with trash lining the dusty pathways, and the strong smell of garbage prevalent in the air. I had a feeling that although the trees and the earth seemed to be in perfect harmony, the people of Honduras endured many challenges each day.

Arriving at the hospital on my first day at the clinic, I understood that one of these challenges must be long wait-times necessary to see a doctor. Up to 50 people were waiting on the three or so benches that lined the hallway leading up to the Roatan Volunteer Pediatric Clinic. Mothers and their children clustered closely together as they waited to be called in this hospital—and unlike the hospitals in the states, this one was a rather short dusty brown building that blended in with the rest of the convenient stores and small family-run businesses in Coxen Hole.

The clinic that Global Healing itself was more appealing with its soft baby blue color and the “Healthy Eating” posters lining the walls. It didn’t take me too long to learn that many children here love to drink fanta and frescos, and weren’t eating correctly. Interestingly, the kids coming who came to clinic did not suffer from obesity—instead, many were diagnosed with Failure to Thrive and poor growth. One particular child, at one year of age, was at only 6.2 kilograms! He had bulging eyes that were too large for his rather small head, and a spinal cord that seemed to protrude from his backside in several small spikes. The baby suffered from many seizures, but he came due to other illnesses as well. It was overwhelming to see how just one child presented with so many different problems.

In the four days I have spent thus far at clinic, I have learned so much about the common health problems that the kids here must deal with. The most frequent case I’ve seen is diarrhea and a loss of a appetite, caused by worms. I’ve realized that the kids here suffer from many things that we never really even think about when we’re in the states—about 90% of the kids have parasites, perhaps due to fecal matter and other contaminants often present in the water. In fact, the government mandates the administration of Mebendazol to all children every six months just because it is that prevalent. Other common illnesses include asthma, a variety of skin rashes, and of course, the fevers and coughs often found in young children.

Through conversations with the residents and the attending, I’ve also learned that in underdeveloped countries such as Honduras, the lack of medical resources is a huge problem. It’s so common in the states to order lab tests and brain scans so as to better evaluate a medical situation, but here, such options are not available—and even if they were, parents would most likely forego them due to the high cost. Therefore, I think a skill more valuable than a vast knowledge of the full treatment of various diseases, is the ability to almost improvise-- use what you have to treat illnesses you suspect present.

I’ve spent most of this first week adjusting to the island, exploring West End with its variety of restaurants and tourist shops, and enjoying the gelato and clear turquoise beaches of West Bay. Just today, I spent an entire afternoon at Gumbalimba Park to volunteer at an event Miss Peggy ran to fundraise for Clinica Esperanza. What I like about Roatan is that it’s a beautiful place with so many friendly people! However, the problems of poor health and education remain at the forefront of my mind, and in addition to working at the hospital, I plan to volunteer at the Learning Center starting next week. I’m not quite sure what to expect yet, but I hope I’ll be able to teach English to the kids and impact their lives in some small way by also providing a bit of health education.

Erin Journal #4

2009-08-30T11:49:00.001-07:00

I can’t believe that I’m writing this journal update from the US! I returned home late last night (Saturday) and now I’m reflecting on my last week on the island.

Clinic this week was different than previous weeks because I started training the new intern, Quynh, on Tuesday. That meant that Monday was my last day to be by myself in clinica diez. It was a crazy day with nearly 15 patients. We had a very sick kid who also had difficulty breathing and needed nebulizer treatment. With the neb machine running and three doctors seeing patients, the clinic felt very crowded and noisy. The chaos made the time go by very quickly, and before I knew it, clinic was over for the day. I helped Dr. Kristen prepare for her first class for the nurses by showing her the fotocopias shop. Then we hopped on a bus that took us through La Colonia. I’m not sure what I was expecting of this poor neighborhood, but what struck me as most interesting was the location of all the houses on the hills. The houses did not look particularly stable, so I can imagine that when it rains and mudslides occur, the houses may be damaged. It was interesting to see the barrio that so many of our patients come from. After living for weeks in Sandy Bay and hanging out in West End, it is easy to forget that there are neighborhoods on the island that are as poor as La Colonia. Driving through the main street gave me a bit of perspective of why giving of time, energy, and effort to help people is so important. I hope I can return in the near future to personally impact this community.

It was nice to slowly hand over the triage and clinic duties to Quynh so that I could shadow the residents and Dr. Mario. Although being a clinic coordinator is a fun and interesting job, my true love of medicine stems from being able to witness the doctors interact with patients and turn the information given to them into a diagnosis and course of treatment. I’ve learned so much about common pediatric ailments and medications. It’s been very helpful to have constant internet access and a library of medical text books in the clinic for us to look up terminology that we are unfamiliar with. Working in the clinic has also shown me how collaborative medicine can be. Whenever there was a question or doubt of what a child had or how to treat the child, the doctors would confer together and give each other their professional opinions. I appreciate that although doctors operate alone in some situations, practicing medicine is a team effort.

On Friday, I accompanied Dr. Emily, Dr. Ahila, Dr. Kristen, and Dr. Mario to the Coxen Hole Day Care next to Yaba Ding Ding and HB Warren’s. Every couple of weeks, the Global Healing fellow and the current American physicians visit the day care to give the children physicals. The kids were super enthusiastic for our visit and couldn’t wait to be seen so they could claim stickers. I have never worked in a day care before, and I was surprised at the energy of all the children together. An hour with them truly exhausted me! The kids really took to the stethoscope; they borrowed Dr. Kristen’s stethoscope and walked around the room listening to each other’s hearts. They looked like future doctors!

In other news, I celebrated the Honduran futbol victory over Costa Rica with some of the doctors from the hospital at a local spot in Dixon Cove. After every goal, the team songs were played and everyone stood up to dance and high-five each other. It was really fun! On Friday, a bunch of Peggy’s volunteers and I went to Angelo’s in West Bay to make gelato with Juan Pablo. We made cookies and crème, ferrero rocher aka bon bon, and mango. Without a doubt, my favorite part was the taste testing!

I had such a great time in Roatan! It’s so strange to be back to reality after weeks in paradise. I’m grateful for the opportunity to experience the island and give of my time to the clinic. I plan on returning to Roatan at some point in the future. Until then, adios!

Nos vemos,
Erin

Erin Journal #3

2009-08-12T12:21:00.000-07:00

In 5 days, I return to the states. In some ways, my time on the island has flown by, as I’ve acclimated to the hot, humid weather, the frequent power outages, and laid-back island attitude. In other ways, the time has passed slowly as I have tried to take advantage of all Roatan has to offer. I really cannot believe how much I have learned and grown since I have been here. Before I came, I was terribly afraid of all sorts of bugs; now, a gecko on the wall is no big deal and creepy, crawly insects have become part of the experience. My rusty Spanish has improved substantially, and I have learned many medical words. I have learned to be more adventurous with food and have ever dared to eat the hospital cafeteria food. (Just imagine what the cafeteria food must be like here if people in the US even avoid eating hospital food!)

I think the most important lesson I will take away from this place is the realization that one person really can make a difference, whether it be in healthcare, education, or policy. The idea of philanthropy is widespread on this island, and although I’m sure I’ve talked about this before, it still amazes me that people like Miss Peggy and the owners of Bay Islands Beach Resort can touch so many lives on the island. A bunch of us went to the Tequila Downs Crab Races again this past Thursday, which is a fundraising event for the e-Learning Center. We raised $472, which is enough to put one child through one year of the educational program. It was so great to see so many people giving back to a community that isn’t their own. I guess crab races are pretty popular as a fundraising event, as there was another one that we went to in West Bay that raised money for families affected by HIV on the island.

This past week in clinic really flew by. We were lucky to have Dr. Howard with us the whole week as he prepared for the third annual Trauma Conference. On Friday, he took me to visit with a newborn in the pediatric ward. She was born full-term but low weight for gestational age; she looked very tiny and fragile. We examined her fully, finding that she had cleft lip and palate, a heart murmur, and an enlarged liver. As I have never really listened to hearts before, I wasn’t sure what to listen for when I held a stethoscope up to her chest. Dr. Howard said I would hear a shuffling sound after the first heart sound; thank goodness he told me, otherwise I wouldn’t have been able to tell what I was listening to! This baby was interesting because during the entire exam, she didn’t cry or flinch at all. She was unresponsive and lethargic. After returning to the clinic, we looked up chromosomal trisomies that could cause severe cleft lip and palate and found that many of the children don’t survive their childhood. I really hope this child does.
Dr. Howard taught me a good lesson on pediatrics this week. Patient care relies on trust between the patient and doctor and in the case of peds, also between the doctor and parent. With adults, trust can be established with some form of body language or kind words. With kids, it’s a bit harder. Dr. Howard told me to think about people as if they have an imaginary box around them; this is their space and others must be invited to invade their space. He discovered that peds patients respond much better to him (as in they don’t cry or squirm around) when the kids cross the imaginary line (between your space and theirs) themselves. The way to do this is to offer them a sticker or tongue depressor, but hold it on your side; this way, the child reaches over into your space and unconsciously invites you to enter theirs. I never thought to think about patient-physician trust and communication in this way, but it makes a lot of sense. I’m really going to try to do this with kids next week and see if they trust me more when I let them cross that imaginary line first.

Saturday I attended the Trauma Conference, which I thought was a success! Accomplished speakers were lined up the whole day to give lectures on pediatric trauma, advanced life support, abdominal injuries, and burns. Although the lectures were all in highly technical Spanish, I was able to understand a bit of it. I made a list of all the words I heard and saw on slides that I didn’t know; it’s a very long list! I especially enjoyed Dr. Janice’s talk on H1N1, not only because it was given in English, but also because it added to my knowledge of the pandemic. I had no idea that swine flu may present with diarrhea, which is a symptom not commonly seen in regular flu. It’s scary that swine flu only responds to a few medications, and those medications are in short supply around the world. The physicians at the conference joked that Roatan would be one of the last places to get the drugs; the sad fact is that it’s probably the truth.

In other news, I finished my last training dive today! We went to Overheat Reef out past Anthony’s Key towards West End. We followed the reef around to a wall of coral and swam along with the current. There was a ton of bright blue fish that swam in schools all around us. I really wish I knew the names of some of these fish because really all I can tell people about my dive is that I saw a blue fish, some black fishes, and fish with stripes. Our divemaster Shane pointed out fire coral, which looked like a large brownish red coral bush with white tips. It was interesting to try to interpret his shaking finger and subsequent touching of his arm to mean stay away from the coral. I guess this is where sign language would come in handy to communicate!

This afternoon, we’re heading to West Bay for beach time and Angelo’s gelato. We’ll probably do dinner at Banarama and then stay for the fire dance show. I’ve heard it’s really amazing with little kids flinging fire around.

Until next week,
Erin

Erin Journal #2

2009-08-04T07:25:00.000-07:00

It’s my second Sunday on the island and time is really flying by. Last week was my first time in clinic and I was really surprised by what I found. Firstly, the hospital is bare with wooden benches for waiting rooms, limited air conditioning, and floors that never seem to be clean. The wards are small- up to 5 or 6 beds in each of the men’s and women’s health and pediatric wards. Labor and delivery (labor y parto) is a bit more impressive with a nice, air-conditioned birthing suite. Thankfully, the recovery room for newborns and their mothers is also air-conditioned. Secondly, the machines are somewhat ancient. The two engineering students from University of Michigan tell us about machines that are from the 80s and early 90s that the hospital depends on. What’s amazing is that the hospital runs quite effectively for having such limited resources.

Mondays are the busiest days and I was greeted by a group of people in the hospital lobby and in the hallway leading to the two pediatric clinics (one being the Global Healing clinic) and the immunization clinic. We saw about 10 patients that day, which was an unusually small number. The mass hysteria about swine flu discouraged people from going to the hospital; the day was a bit slow because of it. It was interesting to try to work through my elementary medical Spanish to explain to patients that I was going to measure their height and weight and take their temperature. I’m sure by the time I leave I’ll be a pro, but for now I have to really study my Spanish medical vocabulary!

It’s amazing to shadow the American and Honduran physician during the purely Spanish visits. Although I have shadowed doctors during bilingual Spanish visits before, I find it very enlightening to deliver healthcare in a country that speaks a language that is not my native tongue. There are nuances to the language and culture that only someone who is from the country or region might know. An example is the tendency to show affection or concern by touching the patient on the arm or the shoulder. In the US, the extent of showing concern would be a pat on the hand or sitting close by the patient. The invisible box that Americans put around themselves is not a concept that really exists in this country. It makes me think that the people on this island have created a more united community, although I am beginning to see some signs of a cultural divide among the native islanders and Honduran mainlanders.

In my effort to be more cognizant of the different cultural groups on the island, I’ve noticed that the native islanders generally like to be spoken to in English and are offended if you speak to them purely in Spanish. Roatan was once a British colony with English as its primary language. Once the Honduran mainlanders started to move to the island, the children began to be taught both languages. The transition to Spanish was fairly recent and some islanders don’t speak Spanish at all. I’ve heard many a side comment from mainlanders about the need for natives to learn Spanish because Honduras is a Spanish-speaking country. Now that I know this prejudice exists, I’m beginning to see it everywhere. I’ve also noticed that there are a lot of foreign ex-patriots on the island that are here for philanthropic reasons. The owners of Bay Islands Resort not only run a tourist and dive company but also dedicate time and money to improving education on the island with their E-learning centers. Miss Peggy has devoted her time on the island to open Clinica Esperanza, a clinic in Sandy Bay that has helped so many people. This island is full of people who are trying to do good in this world and it’s inspiring to be here.

So far, I’m thoroughly enjoying island life. The weather is hot, but lately it’s been raining and has cooled the earth substantially. I went for my first dive today! Three of Miss Peggy’s volunteers and I dove off of Bay Islands Resort to Spooky Channel for a 30 foot and 40 foot dive. It was amazing to see lots of brightly colored fish, conch, and sea urchins! Diving is a zen-like activity where you are very aware of your breathing and surroundings. Shane, our diver instructor, tested us on our skills. I really dislike taking my mask off underwater and clearing the water out of it. There’s something about being blind down there that really freaks me out. Otherwise, the island is beautiful and I’m already getting sad about leaving this place in two weeks. For now, I’m just trying to enjoy the beautiful weather and delicious mangoes.

Erin Journal #1

2009-07-26T16:59:00.001-07:00

Hola! My name is Erin and I am the newest HEAL intern to arrive on Roatan island. After delaying my departure by nearly two weeks, I finally made it to the island after two flights and a five hour lay-over in Houston. Flying over the island for the first time gave me a glimpse of a place I had heard about from so many of my friends, but have never visited. The landscape is lush with palm trees, gumbalimbo trees (aka gumbalimba), and various other flowering plants and trees. From the plane, the beaches looked sandy white and the water a crystal blue. I couldn't wait to set foot on the island! The consequences of the political instability on the mainland were manifested in the sniper policemen on top of the airport building (either to protect the island from tourists or the tourists from the island. I can't be sure) and the limited number of tourists flying to the island. The tourism industry is obviously being affected by the negative media even though the situation has not touched Roatan.

Since my arrival on Thursday (it is now Sunday), I have taken some vacation days and plan on starting in the clinic on Monday. With my two friends from college who met me on the island, we did a bunch of touristy things. We visited West End, ate at a delicious rotisserie chicken place (Creole's Rotisserie Chicken) and devoured thai peanut noodles from the Noodle Shack. I loved going to West Bay, where many of the high-end resorts are. The beaches are beautiful and the water is absolutely clear. Yesterday we went to Gumbalimba Canopy Tour and park and had an amazing time zip lining through the trees with iguanas and other wildlife around us. We saw beautiful spider monkeys and parrots and talked to the game keeper who gave us insight on what it's like to care for these exotic animals.

It was my goal to learn how to dive, so this morning I took my first diving certification class with three volunteers with Miss Peggy at Clinica Esperanza. It was the strangest thing to breath with a regulator underwater, but once I realized ample oxygen was being supplied to my lungs I became more comfortable with learning the skills. Even in the shallow bay where we learned to clear our masks of water, take off our tanks and weight belts, and recover our regulators, the sea life was beautiful. Lots of sea anemones and sea grass littered the ocean floor and little fish peeked out beneath rocks. I'm looking forward to our next dive on Tuesday!

Sandy Bay, where I am staying at the White Diamond Apartments, is a beautiful area. Many local families live here and walking along the roads offers a rare glimpse into everyday life on the island. Most tourists only see West End or West Bay and interact with Hondurans who work in tourism. I am blessed to have the opportunity to really experience both the tourist hot spots and local Honduran life. I've already discovered some local fare; my favorite so far are baleadas - thick tortillas topped with refried beans and delicious cheese that doesn't melt when heated. Any kind of meat can be added to the baleada, but I prefer the plain bean and cheese.

The weather (hot, humid, and a bit unbearable) really bothered me when I arrived, but my body is starting to acclimate to the constant sweating and overheating. I'm also getting used to the bugs and lizards that are found in the apartment. But, I don't think I can get used to the continual itch from mosquito bites. I've counted nearly 6 on my right leg alone and I fear it's only the beginning!

Amanda Journal 1

2009-07-02T20:44:00.002-07:00

My name is Amanda Schwartz and I just finished my first year of
medical school at Stanford. I’m originally from a suburb of New York
City and I also attended Stanford as an undergrad. I’ve studied
Chinese for most of my life but decided to begin studying Spanish in
medical school. I’m thrilled to be spending this summer as a HEAL
intern!

After two flights, one two-hour delay, and a nearly-missed connection,
I arrived on Roatan yesterday afternoon! The island is absolutely,
breathtakingly beautiful. Peggy Stranges (who runs Clinica Esperanza)
and a friend met me at the airport and drove me back to Peggy’s
apartment, where I’ll be staying for the next four weeks. On the way
home we stopped by Clinica Esperanza, where Peggy gave me a brief
overview and tour of her clinic. I must say I’m really impressed with
everything she has set up here—there is a dentist and pharmacy
on-site, and they are in the process of opening a pediatric in-patient
unit. It definitely seems like a wonderful place and one that is much
appreciated by the islanders.

Last night mostly consisted of unpacking, figuring out how to check my
e-mail, finding something to eat for dinner, and meeting the other
interns who are also here volunteering at Peggy’s clinic. Right now
there are a total of 6 of us here, but people will be rotating on and
off throughout my time here. The current interns have been great in
terms of showing me the ropes, including helping me do my first
grocery shopping (items purchased: Corn Flakes, white bread, and an
avocado!) and explaining how to negotiate for a reasonable price with
taxi cab drivers. I tried my first baleada, which is sort of like a
quesadilla but with a thicker tortilla shell. I’m looking forward to
shopping at the larger grocery store in Coxen Hole this week as
well…I’m not sure my current food supply will sustain me for too long!

After some much-needed sleep, I met up with three other interns this
morning and took a cab to West End, which is a hub of dive shops and
small cafes/restaurants about a ten-minute drive from Sandy Bay. Two
interns had scheduled a scuba diving lesson, and myself and one other
intern decided to snorkel, so the four of us spent about three hours
out on the water. I have done some snorkeling in the past, but
nothing compares to this—we saw probably 25 different kinds of fish,
plus lots of beautiful coral. The water is very clear and calm—I can
understand completely why Roatan is such a maven for divers. Our two
scuba divers had a great time and successfully completed their first
dives—in addition to fish and coral, they saw eels as well (although
sadly no turtles, which had been their goal)! After our trip we
headed back up to Sandy Bay for lunch and managed to watch the
U.S.-Brazil soccer game on TV—things were looking up for the U.S. at
half-time but sadly Brazil won in the end.

It is really hot, although there seems to be a breeze moving in
tonight, which will be nice. I’ve been told I’ll acclimate quickly to
the heat-- I'm hopeful that is true!

Tomorrow morning I’m meeting the current HEAL intern at hospital
publico to begin my training. I’m nervous and excited to see what
tomorrow will hold. The hospital is about a ten-minute taxi drive
from my apartment—this will be my first time going somewhere on my
own—I think I will spend some time tonight brushing up on my Spanish
vocabulary! I will update soon with information on how my first week
goes. In the meantime, here is a picture taken a few minutes ago from
my balcony.

Michelle Journal 5

2009-07-02T20:42:00.005-07:00

It is unbelievable to me how fast this internship has gone by, the new
intern, Amanda arrived safely on Saturday and is getting used to the
island. It seems strange to be leaving after finally getting used to
the hospital and figuring out how to avoid some of the frustrations it
poses. My parents are down here visiting and explaining to them how
the clinic works and what I have seen and learnedis amazing to hear
outloud. Although frustrating that mothers give thier kids antibiotic
even if not needed and babies and children are malnutritioned and
encouraged to eat soda and chips I have really learned the importance
of health education. I know that the doctors in the clinic do a
wonderful job treating these patients but is is frustrating that so
many of these sicknesses could be prevented with education and when we
tell the mothers about proper nutrition and hydration they seem
genuinely thankful to have been told. I think that maybe the schools
and community centers around the island could start doing education
programs that would be very beneficial. Working in this clinic has
been an amazing experience and really opened my eyes to the healthcare
much of the world receives which is in stark contrast to the great
albeit expensive healthcare I am lucky enough to receive. These last
few days I am soaking up as much of the sun, diving and mango I can
handle and taking lots of pictures as well as training Amanda to take
over my place.

Michelle Journal 4

2009-07-02T20:42:00.004-07:00

This week has been surprisingly slow in the clinic but pretty exciting out of the clinic. On Tuesday I came back to my apartment to find several hundred bees in my bathroom! They lived in the wall and had snuck it through a hole in the wall! Murphy the owner in the building patched up the holes and we thought it was fixed, only to find the next day that several hundred more were in my kitchen! we found there spot and stopped it up only to have the next say several hundred come out in the bedroom! I am not sure if there are still bees but I moved downstairs into an apartment that has far less critters! Also I got my diving certification so I have been enjoying all of Roatans amazing dive sites.

In the clinic we have had far less patients than usual I am not sure if it is because of the two cruise ships this week or maybe the rain? but the hospital has been empty by eleven am everyday! It still boggles my mind how an entire hospital can be empty by noon everyday and all the doctors leave. What happens if someone gets sick in the afternoon? The patients wait for several hours early in the morning only to be told if four hours later that many of the doctors of the left. It seems like such an inefficient system and sometimes it is very frustrating. Especially because I am down here to help out and I have the time to spend more than just a few hours everyday in the clinic. However, this week I have found something to do in the afternoons. Dr Diane, had a group of friends come down for these two weeks who are close friends of Miss Valerie (who owns the HIV clinic in Coxen Hole). Scott Fried is a professional speaker about HIV and safe sex and he and a group of people came down last year and this year to build a house for a family. This year the house is for this man named Alec and his family of four children (he just recently lost a child to a heart complication from Down Syndrome). He is the nicest man and has been the biggest help in building his own house. Every time he speaks he says he is so grateful for the gift we are giving him and he makes all of us cry. The neighborhood he lives in is called La Colonia which is one of the poorest areas on the island where the houses are all perched precariously on hills. The big project for his house is to build a retaining wall to make sure that when bad weather comes the whole thing doesn't topple over. The whole thing has come together extremely fast however we were at a standstill this weekend because la colonia only gets water once every 8 days for two hours and we need water to make cement for the floor. Hopefully we will get it so we can continue the rest of the work this week. Seeing how grateful he is for this house is amazing, especially because his entire family is living in a house much much smaller than the apartment I am staying in by myself. And regardless of everything everyone in the neighborhood is happy. All of the neighbor children come out to help lug buckets of sand and gravel even though they have no shoes and some don't even have complete outfits! This experience of building this house has been amazing especially to see some of the conditions that patients in the clinic come from. I can't believe that this is my last full week in the clinic already, I hope its a little busier than last week.

Michelle Journal 3

2009-07-02T20:41:00.000-07:00

This past week has been so busy. Alice and Howard have been a huge help organizing and sprucing up the clinic, however they have been extremely busy setting up the physicians conference which took place thursday, friday and saturday. This conference unfortunately took Dr. Mario out of the clinic, but Dr. Diane and Dr. Vicky and I managed to do just fine. This week in the clinic we had two particulary interesting cases. The first one was this extremely intelligent six year old girl came in with her grandmother who said that she has never spoken a word in her life. How could this girl be seeing a doctor for the first time at six years old and she has never spoken? With the limited resources on the island we had a hard time deciding what the best course of action was for her, so we finally decided to refer her to a recently opened rehabilitation and therapy clinic in French Harbor. That same day a mother came in with her baby who she said was having a difficult time breast feeding. It didn't even dawn on me that something else could be wrong so I finished triaging and sent her to see Dr. Vicky who immediately diagnosed this little girl as having down syndrome. This baby was almost one and a half and no one had ever told this woman that her baby had down syndrome or given her any information about it.Im not sure she left the clinic understanding exactly what she has been told.

Outside of the clinic this last week I have been working to finish my diving certifications, however since I seem to be perpetually sick with the gripe I see every day at the clinic, I am too congested to be able to dive. Hopefully I will recover enough to finish it in the next three weeks! Also on Wednesday, Andrea, another Ms. Peggy volunteer and I went up to la colonia to talk with some women about nutrition while pregnant, nutrition for their babies and the importance of breast feeding. The women seemed intrested in what we had to say but no one asked any questions or had any comments so I hope that everything was understood and that our terrible spanish accents didn't get too much in the way. I understand why they might be confused though, we are telling them the importance of eating dark leafy greens, eating protein, calicum, folic acid and iron. However, I can't even find spinach and broccoli on this island and if I do it is certaintly not cheap. For these women who live in poverty many of the rules and suggestions we were providing don't apply at all. In retrospect, I think we would have been far more helpful if we had changed our discussion to apply to the particular situations that many of these women are in.

Today, was the first time I have seen rain and it hasn't stopped for almost two hours! I am learning to enjoy Roatan more as a local than a tourist and I am loving every minute of it!

Michelle Journal 2

2009-07-02T20:40:00.000-07:00

Two days before coming to Roatan, I was sitting at dinner with my parents discussing plans for when I graduate next year. Do I want to go to Public Health School, Physicians Assistant, or maybe a nutritionist? I had thought I never wanted to be a doctor. However, after only 3 days working in the clinic I had decided without a doubt that being a doctor was definitely something I wanted to do. It has been amazing talking to people in all steps of the doctor process about their experiences. Dr Mario, Diane and Vicky have been a great help and could not have been more enthusiastic about med school. However, it wasn't until one night when Andrea, who is going to med school in August and Dr Mario, and Dr Dennis (another Dr from the clinic) who are in their last year of residency and I were sitting on the dock watching the sunset and answering the question "why do you want to be a doctor". It was a unanimous answer, "to help people". I am down here working in a clinic, helping people and doing exactly what I want to do in ten years. What could be more convincing?

This week at the clinic has been great. Monday and Tuesday were the busiest while wed (cruise ship day) was the quietest. Also, Dr. Howard and Alice arrived this week and have big plans for the clinic. We have been reorganizing as best as possible and loading up with all the supplies they brought down. They have also been a great help teaching me about the different sicknesses as well as how to exactly take the height and weight measurements of the children. One child came in who had swallowed an entire bottle of acetaminophen (Tylenol) and then had a fever overnight so when the parents came into the ER with a fever the first thing the doctors did was give him more acetaminophen! I feel that miscommunication between patients and the doctors is unfortunately pretty common in the hospital as well as not enough communication between different areas of the hospital. If not for the mother we would have had no idea that this boy was given more acetaminophen that morning. After Dr. Diane made a call to a surprised poison control branch in Minnesota we figured out that the boy was not in danger of poisoning and in fact he tested positive for Dengue Fever. It is very difficult with many of the patients to figure out what is wrong with their children, for how long have they had it, and what medicine was given. I have had to practice a lot of Spanish in order to finally figure out how to get parents to tell me that yes they actually have been giving their child the antibiotic for the last 5 days. Although it is so rewarding, it can also be very frustrating. The next couple days will be busy with Howard and Alice preparing a physicians conference for all of the doctors on the island and Dr. Mario will also be away from the clinic a little bit more.

The island itself is amazing and I am loving the sun almost every day and have yet to get a sunburn thankfully! my task for tonight is to read my diving certification book and figure out how to get the bumble bees out of my shower!

Michelle Journal 1

2009-07-02T20:39:00.000-07:00

Well, my first day in Honduras started out exciting because everyone was talking about the 7.1 earthquake that happened the night before I arrived. First I heard of it was on the runway in Houston when the pilot informed us that just in case we had enough gas to make it back to Texas if we can't land! I arrived safely and Andrea the previous intern was there to pick me up. The island appears OK with very minimal damage done to the infastructure although everyone was pretty shook up. The first thing that surprised me was how hot it is down here, I knew it would be hot but I wasn't at all prepared! The first day here, Andrea showed me around Sandy Bay and we went to West End and walked around a little bit. I love the island so far and everyone I have met has been extremely friendly. The first day at the hospital was amazing. I am glad that I kind of new what to expect, otherwise I would have been a little shocked by the seemingly chaotic and hot hospital. Andrea, and Dr. Mario are great at helping me get organized and get the hang of things. For the first couple of days I shadowed Dr. Mario while he did his newborn checkups. Dr. Mario is great about showing me everything he is doing and explaining to me what it means. Since I have yet to go to medschool, everything I get to see is facinating. Most of the kids coming in have respiratory infections, parasites, colds and a couple of them have chicken pox. I am practicing my medical spanish and learning new words everyday! I have one more day in the clinic with Andrea and then I take over with the new doctors who got here this morning. So far, minus the earthquake my time here has far surpassed what I was expecting!

Andrea Journal 3

2009-07-02T20:32:00.001-07:00

Last week in the clinic we were lucky to be joined by Annie’s mom, Rosie, who came to the hospital as a “volunteer volunteer” while on vacation. Rosie was absolutely fantastic! She made the babies stop crying, gave out stickers, took heights and weights, drew pictures with the kids, rearranged the furniture in the intake room and even spoke some Spanish! I was spoiled to have so much help, and I got to spend extra time shadowing the doctors on rounds and in clinic.

Monday and Tuesday were quiet days in the hospital because of the worker’s strike. The people usually doing intake were on strike as well, so I stood at the hospital entrance and tried to point all the babies and children who came through the door towards Clinica 10. We even saw a few young adults because the other clinics were closed.

One young mother brought herself and her child in for a check up. The mom had been experiencing shortness of breath, dizziness, heart racing and palpitations in periodic episodes ever since her daughter was born 3 years ago. One of the doctors ordered a urine test for the child and a blood test for the mom. Mom and daughter returned, but the mom had not gotten her blood test done; when I asked why she had no results, mom told me she was scared of needles. The doctor told her she could get an EKG in the emergency room instead. I decided to walk her down to the emergency room to make sure the EKG got done. I had a feeling that things might not go smoothly, and did not want the scenario of the premature failure to thrive baby from last week to be repeated in another lost patient. I’m glad I escorted her, because the doctor that she spoke to in the ED curtly turned her request down saying that the EKG tech was not in the hospital that day. I sat mom down and reassured her that an EKG was completely painless and quick. I asked her to please come back tomorrow to have the test done and tried to emphasize the importance of her compliance. She promised she would return, but given her noncompliance with the blood draw orders, I could only hope to see her again. I asked her to stick her head in Clinica 10 to say hello to us tomorrow so that we would know she had come back. As she walked out the door, I was doubtful that I would see her again.

The following day, in the height of clinic, mom and daughter peaked through the door with a printed EKG! I was incredibly surprised and thrilled. The patient may have followed through with the doctor’s orders regardless of my efforts, but I had been so disappointed about the sad little baby from last week, that I considered this an uplifting success, however small. The possibility that the 10 minutes I spent walking her to the ED and convincing her to return may actually have made a difference makes me want to be able to spend just as much personal time with every patient that I see as a Global Healing intern, future medical student and doctor. Hah! Naive and blissful, but I’ll wish it anyways.

By Thursday, the hospital was back to hot, crowded and smelly normalcy. As usual, we saw a lot of cough, cold and fever. We admitted a few very sick babies to the hospital, administered nebulizer treatment to asthmatics, prescribed tons of medicines for parasites and creams for rashes. My immune system is finally failing and I have come down with the beginnings of a cold. I have been bracing myself for this to happen since I am playing with, picking up and talking to sick kids and their parents all day long. Lucky for me that Vitamin C grows wild on trees in front of my apartment!

Andrea Journal 2

2009-05-15T20:40:00.002-07:00

I planned to write an email last night, but was stymied by a small catastrophe- the pipe leading into the toilet in our apartment snapped off as I tried to turn the water off for the evening, sending liters upon liters of clean fresh water gushing into our apartment! We ran for help and finally found Hector who is somehow related to the owners of the apartment. Hector cut the circuit to stop the water. How ironic that in a country where clean water is so hard to find, within 10 minutes, the entire apartment had flooded- the bathroom, kitchen and bedrooms were covered in an inch of water. I had raced throughout the apartment throwing everything onto chairs and beds as the water spilled out of the bathroom, so luckily nothing was ruined. In fact, to our surprise, only half an hour later, we had successfully scooped buckets of water from the floor into the shower, soaked up most of the water with bath towels, and swept it out the door. Gracias a Dios that things dry so quickly here! Hector then declared that he was going to reconnect the pipe with glue. I was doubtful and begged him to wait until morning for the pipes to be replaced. I was sure that the water would come gushing into our apartment again. "No queremos agua anoche!" (We don't want water tonight!) I insisted. Again, the irony! Haha. Per the usual, the locals always know more than the gringos- 5 minutes later, Hector turned the water on and, sure enough, the pipes held! I was amazed. "American glue," Hector said pointing at the EZ Cement label. Ha ha! Anyways, it was an exciting welcome to plumbing in Roatan, where flimsy water pipes are left exposed so that silly tourists can snap them off and flood a building in minutes. Again, the idea of me wading through pools of clear water drowning our kitchen, while surrounded by entire neighborhoods without access to a reliable source of running water is ludicrous! How did resources come to be divided SO ridiculously disproportionately?

Flooding problems aside, I have been learning so much about the public hospital here in Coxen Hole, health care on the island and medicine in general! Between the Global Healing pediatric clinic in the public hospital in Coxen Hole and Miss Peggy's private clinic in Sandy Bay, all of the residents and doctors (both volunteers and Hondurian staff) have been so wonderful and eager to teach me. I shadowed the doctors during newborn infant exams in the hospital maternity ward- the infants are so tiny and cute! I have seen dengue, malaria, parasites, rashes of all sorts, scabies, chicken pox, conjunctivitis, TB...tons of cough, cold, congestion, fever. I've listened to breath sounds and looked at chest xrays for kids with pneumonia. I held the light while a doctor scraped heaping spoonfuls of dark brown ear wax out of a patient's ear; afterwards, I got to peer inside the patient's ear to examine the tympanic membrane. Yum! I listened to hearts beating, examined pupils, looked at strep throat, oral herpes. I translated for a teenage girl during her first vaginal exam. I looked at the malaria parasite under a microscope in the hospital lab.

Coxen Hole Public Hospital-
The hospital here has an "x ray machine." The xray tech joked that the machine was a gift from Christopher Columbus because it is an ancient, massive, wrought iron structure that looks like it could be 100 years old! Nonetheless, it does take xrays (albeit without any sort of radiation protection for the techs or in the walls of the room) The hospital also has a lab and a pharmacy, so we can order blood and urine tests, write prescriptions. If the hospital runs out of a particular medicine, the patient is given a prescription to purchase the drug elsewhere on the island. "Prescriptions," by the way, are notes scribbled by the docs on the back of a scrap piece of paper torn into quarters. In any case, I tell you what capabilities the hospital HAS because the list is short.

The hospital is usually very crowded and hot. The clinics have air conditioning, so we stay cool, but the patients wait for hours and hours in the hot, smelly hallways full of sick children with myriads of contagious disease. The patients begin arriving at 7 AM and receive a number from the front desk to mark their place in line. The clinics do not open until at least 8:30 or 9AM. The hospital only sees a certain number of patients each day, so if patients arrive too late and intake has run out of numbers, they are turned away. The clinic that I work in is an additional pediatric clinic within the hospital, funded privately by Global Healing, set up to supplement the public hospital's pediatric facilities. It was founded to address the overcrowding that still persists today! We usually finish clinic by about noon, but that means that the last patients have been waiting for at least 4 hours.

One big advantage of the hospital- The cost for a doctor's visit here including all medicines is 7 - 11 Lempiras or less than 50 cents- very cheap, even for the poor!
A Sad Case-
I held an emaciated, bony infant with floppy skin- in medicine, they call this "failure to thrive." He weighed something like 3kg at 40 days old :( He turned out to actually be a sad and frustrating patient. The docs decided to admit him to the hospital to observe feeding and try formula milk. However, the mother was clearly reluctant to admit the baby, frustrated that she had been kept in the hospital with him 2 weeks ago and was so recently discharged. I heard the next day that the mother and baby had fled the ward just hours after admission. Later, I mulled over our mistakes- it was clear that the mother cared about her baby. And with large families as the norm here in Roatan as in most of the developing world, I wouldn't be surprised if the mother had other children at home to care for. We clearly should have listened more to her concerns and perhaps come up with a compromise- Could we have treated the baby as an outpatient? Could we have given mom formula to take home, observed one feeding in the outpatient clinic and asked her to return? Would she have returned? Sadly, we are now afraid that she will be scared to come back if things get worse. The docs said that if the baby's growth does not turn around within a week, there could be dire consequences for the child. If this were Children's Hospital Boston, I know we would send a brigade from Farley 135 to the patient's house with the best bottles, formula and babysitters in the world. Sadly, though, we are a world away from Boston. For now, we have to hope that she will return when the baby needs our help.

Fun things I have done outside the clinic (because no one likes to end on a sad note)-
I have been volunteering at a nighttime sports program for kids called S.O.L., which was started by two American guys a few years ago. It is SUCH a success! The kids have a shack full of old, donated equipment- baseball mitts, soccer balls, basketballs- and they go nuts! They love soccer and baseball, so you can imagine the fun that I get to have. They are a rag-tag group of kids- half of them have shoes, they fight like you wouldn't believe, and I have yet to see a single parent show up to the court. I made up an ESL lesson and taught English on the side to some of the Spanish-speaking S.O.L. kids one night. I have also been teaching English to a guy who works at the apartment I lived in. Like most Spanish speakers here, he really wants to learn English. He brings a beginners English workbook that he borrowed from a friend, and we spend an hour or two talking in Spanglish during the afternoons. I have also been snorkeling again and can't get enough! It is AMAZING. I saw a HUGE spotted eagle ray, a SEA TURTLE, a porcupine fish, barracuda (scary ones that followed us!), tons of Doris swimming around in huge groups, beautiful coral, conches, and billions of other gorgeous fish and weird sea creatures I cant describe! My local friend took me out on his boat to fish. We didn't catch anything, but we rode right through a whole school of wild dolphins swimming right next to our boat! Incredible. And the view of the island from the water was amazing. I am tan and COVERED in bug bites. The sand flies love foreigners. I'm going to keep telling myself that the bites are from sand flies, but the resident and I joke that we have bed bugs and scabies :-)

Andrea Journal 1

2009-05-15T20:40:00.001-07:00

ROATAN, HONDURAS- An absolutely wild place that I am still struggling to understand. A 30-mile long, skinny island off the Caribbean coast of Honduras, about 1.5 hour ferry ride from the closest mainland port, La Ceiba. It is almost nothing like I had imagined except that the beaches are gorgeous, tropical fruits and flowers grow wild everywhere, and the weather is hot! My biggest surprise has been that the few parts of the island I have seen so far are much more developed than I had expected. I have spent the last 5 days comparing everything to the Dominican villages I worked in last year, which were homogenously rural, primitive and quite impoverished. Here, there are multiple classes of people ranging from the very wealthy to the extremely poor. I think the socioeconomic stratification of the island has been exacerbated in recent years by a massive spike in tourism. Less than a decade ago, the island's economy was primarily fishing-based; what a change from now! Resort developments are springing up left and right; cruise ships, which used to be a novelty (evidenced by the fact that the Spanish speakers call them "cruise ships" because they had never seen any before and didn’t have a Spanish word for them!), stop on the island multiple times each week. I’m sure this story sounds as familiar to you as it does to me…the touristification J of a tropical island…the rapid change in economic priorities…the resulting rich-poor gap…local culture and goods replaced by plastic lawn chairs and cheap souvenirs. It feels like Roatan is in the beginning stages of this unfortunate transition, and the only people who enjoy the change are (obviously) those who are making dinero!

THE PEOPLE (who I have heard of or met so far)-
1. The “islanders” or the “locals” are the black or dark-skinned people who speak English with a crazy Creole drawl- dey sound lik dis mon! End dey very hahd da undastand at fuhst (They sound like this man! And they very hard to understand at first J). The island was originally owned by the British and I think at least some of them are the descendents of slaves who came from the Cayman islands during the first half of the 19th century. Others may be Black afro-Carib. The internet is down, so I can’t look it up! Edits to come I’m sure… Anyways, so far I have spent most of my time hanging out with islanders in the West End, one of the two most touristy areas of the island and more of a backpacker’s budget spot. It seems that work comes and goes for many of my new friends, and that their jobs largely depend on tourism- construction, waitressing; if they own a boat, they can take tourists on the water to fish or taxi. I have seen some islanders with nicer houses for island standards, and others who come from poorer neighborhoods that I gather are not quite as bad as the shanty towns.
2. The “Spaniards” are the people who immigrated from mainland Honduras after Britain gave the island to Honduras in….the mid 1900s?? These are the lighter-skinned Hispanic people who speak only Spanish. Apparently Honduras left Roatan to its own resources for many years before realizing the economic potential of the island’s coral reefs and beautiful beaches. More resources from Honduras created tourism, which created jobs, which spurred the movement of people from mainland Honduras to Roatan. Most of the Spaniards I have come in contact with drive taxis or work in the resorts. They seem to be poorer than the islanders, but it's hard to generalize. I have heard they tend to live inland in the poorer barrios and shanty towns- i.e.: La Colonia or El Swampo (yes, El Swampo = the swamp, named as such because it is apparently one huge valley of mud during the rainy season)
3. White islanders. I think there is a small group of white local island dwellers who have been here for generations. Haven’t met any yet, but I think they're here somewhere...
4. Random people who have settled here, mostly the white hippie type from the U.S. or Europe. (i.e.: Carl, a white guy with an American accent who plays volleyball with the islanders most nights despite their endless and ruthless taunting about his lack of coordination, who built his own submarine and runs submarine tours for a living. Hah!)
5. Tourists!!

OF NOTE ON THE PEOPLE- There is a lot of tension between the islanders and the Spaniards. I have been told that the islanders feel invaded and want the Spaniards to go back to the mainland. Roatan’s government, controlled by the islanders, has apparently made this sentiment clear by neglecting the Spaniard neighborhoods. La Colonia is a Spaniard shanty town that has grown from population 300 to 3,000 in less than 5 years and sits across from my apartment in Sandy Bay. The entire community did not have running water until a Texan couple (the guy happened to be the “pastor” at a crazy church service I attended on Sunday!), started an NGO 2 years ago called Living Water for Roatan. The people of La Colonia now get water for 3 hrs each week. The doctor at Miss Peggy’s Clinic in Sandy Bay says that even with such a limited water supply, the public health situation of La Colonia has been exponentially improved. Anyways, I guess the point is that it was an American couple, not the Roatanian government, who brought water up to La Colonia. Then again, the only public hospital in Roatan (which is where I work and write from today) does not have running water either. Yes! The public HOSPITAL does NOT have running WATER. It is incredible. Anyways, I'll leave the health care and hospital stories for later after I have spent more time here…

STORIES-

Snorkeling was just about the most amazing experience ever. Seriously, Nemo, Dori and all of their friends live about a 5 minute swim from my apartment. What an incredible and fascinating little world that I have never seen before!! NOW i know what people mean when they say "the reef."

I went for a swim yesterday just to get some exercise (You can't run on the beach because the wild dogs will chase and bite you. You can't run on the roads because the cars will hit you. So...I swam!). I stayed close to the beaches in the grass where there are a few fish but not nearly as many as the reef... I wasn't even swimming to see the fish, but off to my left about halfway through the swim, I saw a familiar looking black shape flop right past me- a sting ray! hah!! Exercise here is so much more entertaining than an ipod and treadmill :-)

On Saturday, I stumbled upon the birthday party of a 3 year old Sandy Bay local islander named Wendel (the second cousin of my friend). It was a giant affair for which Wendel's mom cooked mounds of food for nearly 100 kids...plus random guests like myself who happened to be passing by. There were about 8 yellow "bombas" (balloons) and 10 plastic chairs lined up along the fence of the property as I passed by on my way home. 20 mintues later, hoards of children were being dropped off the back of pick up trucks, some carrying wrapped gifts. they piled inside a tiny patio area and screened porch to sit and eat- Conch soup (spicy and amazing!), arroz con pollo (also fantastically delicious), spiral pasta with a mayo sauce and huge juicy shrimps ("shrimp salad"), the island version of enchiladas- open-faced deliciousness piled on homemade fried tortillas, soda and strawberry cupcakes from a box topped with green frosting! HAH! Local food at its finest. Of course, the seafood is plucked from the ocean just steps away straight onto the plate! And despite eating local food like this and more, I have YET to experience any sort of indigestion...

FUTURE PLANS- This evening, I plan to work with the kids of Sandy Bay in an after-school program called S.O.L., which is currently being organized by two young guys from Ireland who are here for 8 months. Outside of the clinic, it sounds like I can make myself most useful in the poor barrio of La Colonia. They need everything, including health care education and a system for trash pick-up. Perhaps I will focus on these 2 items during my month on the island.

TO CONCLUDE- Yikes! This is taking forever. There is no running water at the hospital so the bathroom is a pour-a-bucket-of-water-in-the-toilet-and-hope-it-goes-down ticket, so I can't stay here much longer if I want to avoid that! I know this update is mostly island history, background and people, but with the hospital closed for the holiday and weekend, I really have spent most of my time learning what I've written above through word of mouth. My next update will hopefully focus more on my work in the clinic and community.

Chrissy Journal 15

2009-05-15T20:37:00.000-07:00

This week was just Dr. Mario and I in the clinic. Sabreen left last Friday, she is a really nice person to get to know and a great sounding board for me as I am wrapping up this internship and figuring out what steps I need to take to get into a medical career. Dr. Hott left Thursday, I found him to be an inspirational doctor, and hope I can be half the doctor he is. He has an amazing attitude and is overflowing with energy and great ideas. I’m so glad I had the opportunity to work with both of them.
Again, Friday was a holiday. Labor Day, April is quite the celebratory month out here.
Mario admitted a baby to phototherapy this week, not quite as high as the last baby, but jaundice, she also went home the next day, after her bilirubin levels dropped down to 11.

Swine flu has become quite the scare down here. They had a meeting on Tuesday afternoon for the doctors, which I did not attend, but they are worried about it. I think Mario is going to try to contact Dr. Howard about getting some Tamiflu for the hospital. The hospital wanted us to start filling out special paperwork for everyone that comes through with a cold. Can you imagine what that would look like from our clinic, that’s every other patient?! I think they talked them down to reporting only the cases that look like they could be the flu or pneumonia, because I never saw any special paperwork to fill out.
Yelsi gained 200 grams! She’ll come in next week for a weight check and the following week she’ll go back to San Pedro for a check up.

Dr. Hott did a presentation on pallitive care on Wednesday and even had the surgeon and the internal medicine doctor in attendance, impressive. It was a good presentation on prescribing medications and helping families of patients that are dying. I thought it was very interesting, and I think it was something new for the social service doctors. They seemed to really appreciate a list he made of how to talk to the family of a deceased patient and what to do to help them by just taking a few extra minutes.
Andrea arrived Wednesday and started in the clinic Thursday. We showed her around and got her oriented. I think she’ll do a great job and have a wonderful experience.

Chrissy Journal 14

2009-05-15T20:36:00.000-07:00

Another relaxing week, as we had Monday and Wednesday off. Two more holidays, so the clinic was closed, although noone could tell us what the occasion was.
Yelsi came in this week!!! After being admitted in San Pedro Sula for 24 days, little three month old Yelsi came in with a diagnosis of a Patent Ductus Arteriosis. She has surgery scheduled in November, and a check up again in May. She looked much better. She is still really skinny, but she is on high calorie formula and she is going to come in for weekly weight checks and we are going to try to help them with transportation, if we can.

I single handedly successfully identified a case of chicken pox, Dr. Tami taught me how to identify them. I put them up front to try to get them in and out of the hospital, and back home. Only to see them walking around the market after we left clinic. We had a little girl come in with croup. I think it was the first time I had heard a cough like that, it was very ‘barky’. Lots of parasites this week, too.
Dr. Sabreen did a presentation over different skin diseases and problems in pediatrics. It was a lot of fun as it was set up as Jeopardy. I think everyone really enjoyed it, although Dr. Hott dominated the game. Then Dr. Hott and Dr. Sabreen did a presentation for the nurses. It was basic Emergency medicine, simple procedures, reviewing ABC’s and some advice, or tips on things to think about when patients present and how to procede. I think they really appreciated the doctors taking the time to give them an educational presentation.

Chrissy Journal 13

2009-05-15T20:35:00.003-07:00

The clinic was really busy the other days, probably because of not being able to get into the doctors the last week.
We had one six day old baby come into the clinic Tuesday with high bilirubin levels and we had to admit her and put her in phototherapy. Her parents were very bright and her father went home and did all sorts of research on jaundice on the internet. After two days she went home. Her bilirubins spiked again over the weekend, but they kept putting her out into the sun and they came back down and she is doing good, now she’d getting a suntan.
Dr. Hott did a presentation on CPR, he had videos in Spanish. I didn’t get as much out of it, but I think the social service doctors did, so that’s what matters.
We did see two kids with malaria this week, and the let us see their blood smears in the lab. Other than that, lots of the ‘usual’, colds, scabies, ear infections, and parasites.

Chrissy Journal 12

2009-05-15T20:35:00.001-07:00

This week was a holiday week in Central America, Semana Santa, or Holy Week. The hospital had already said that Thursday and Friday would be holidays and the clinic wouldn’t be open, but when we showed up on Monday, the government had declared the whole week a holiday. We were already here and there were a few patients wanting to be seen so we saw them. Mario had arrived really early and had the newborn exams done by the time Sabreen and I arrived. We just saw a few colds, pink eye, and tonsillitis.

Chrissy Journal 11

2009-05-15T20:34:00.003-07:00

Ostin gained a pound!
It was Dr. Tami’s last week, and I will miss her, she was a really excellent teacher. She taught me how to do the newborn exams and supervised while I did them on my own on Thursday and Friday. Dr. Sabreen also arrived Wednesday afternoon and started in the clinic on Thursday. We won’t have any residents this month.
Dr. Dennys did a presentation on drowning, in preparation of the holy week, and anticipation of possible problems with the tourist influx on the beaches.
It was a usual week, other than that. Colds, faringitis, tonsillitis, eczema, just a little bit of everything. The best part was definitely learning how to do the newborn exams!

Chrissy Journal 10

2009-05-15T20:29:00.002-07:00

I talked with Baby Yelsi’s mom multiple times through the weekend to make sure she got admitted and would get the echo. She got the echo on Wednesday and still hadn’t seen the cardiologist, and they wanted to keep her longer, but Yelsi is doing well. I asked her to make sure that she bring copies of all the test results and everything when she returns to the island and come by our clinic to let us know how all is going.

First thing Monday morning I passed a baby boy, and I asked if he was a ten day check, so that I would get him through first and the mother said that he was a three month old. Ostin, ended up coming to our clinic from Miss Peggy’s clinic. He was 8 pounds at three months, and had brochiolitis and a failure to thrive. His mother died when he was two weeks old, so his aunt is caring for him. We decided we didn’t want to admit Ostin to the hospital, so Tami taught Dilsia, the aunt, to increase his caloric intake with more formula, and just treat the cold with supportive care. She then asked her to follow up in three days. He came back and Tami gave him an inhaler but he seemed to be doing okay, and we asked her to come in at least once a week to check his weight and make sure he was growing.

It was Dr. Preetha’s last week in the clinic. Dr. Tami did a presentation on back pain. She presented a case and went through the differential and it was a case of Tuberculosis. It was really interesting.

In addition, we could have used some permethrin this week. Lots of scabies, I was starting to itch just seeing all the kids with scabies. And all we can give them is Scabicide, which one of the doctors told me just treats the itching and doesn’t really kill the scabies. Other than that we had lots of faringitis and a possible Tuberculosis case that we had to send to La Ceiba to get tested.

Chrissy Journal 9

2009-05-15T20:25:00.001-07:00

Again, the clinic was full this week. Although it was nice as Dr. Tami sat right next to me, so I got to see a lot of cases and eavesdrop on the consults, it was very interesting. Of course, we saw lots of colds. We had quite a few scabies cases and Tami taught me how to identify some of the signs of varicella, we had two cases this week.
We had one four month old baby who has come in four times in the last month with diarrhea, this week he had blood in his stool, so Tami treated him for parasites and he finally got better!

We had a girl that came in with a spot on her neck that was growing and Dr. Howard showed us the excellent resource we have of sending pictures to a dermatologist in the states for a consult. He came back with the the same results as Andrew, Mario and Howard, but then narrowed it down to a fungus. It is a nice resource, as we see many skin problems here.
Dr. Preetha she did a presentation on Ascaris and empiric treatment on Wednesday, that was really interesting.
On Friday, Tami and Preetha were pulled into 3 cesarean deliveries and when Preetha went to check on one of the kids, she was stopped in the emergency room for advice on how to treat a 3 month old baby girl in congestive heart failure. Andrew and Tami went to see her and treated her with Lasix and decided she needed to go to the mainland to see a pediatric cardiologist. They decided that she was stable enough that she could take the ferry and busses, and Global Healing would have to fund the trip as the mother could not afford it. Dr. Dennys made a lot of phone calls to make sure that we could get the baby admitted into the hospital and seen by the cardiologist once she arrived in San Pedro Sula. It seemed that everything would work out. The mother couldn’t get clothes and everything she needed on Friday afternoon, so she went Saturday morning and Tami and I went with her on the ferry, she seemed to be stable enough to make it to San Pedro when we parted in La Ceiba.
It was Dr. Andrew’s last week, too, but he left his cell phone number at home on the wall, to call for consults. Dr. Howard departed this week as well. It was great getting to know him a little better and I am really looking forward to all of his advice for getting into the medical field.

In addition, I also set up a way to copy the typed charting and tape it onto the hospitals required charting, which eliminates the task of typing it all up and then handwriting exactly the same information onto the hospital chart. Now I just copy it into a Word document, adjust some of the columns, print it, and tape it onto the hospital form. The Statistics department, said they think it’s fine, so I have saved myself a lot of time and hand cramping, I’m very happy with it. Only wish I had done it sooner.

Chrissy Journal 8

2009-03-18T22:27:00.001-08:00

The nurses were promised a raise, so Monday we were in the clinic again, I thought we would be busier, but we saw about 25 kids. Dr. Howard came down for a week and a half. He is busy arranging and meeting with people. Dr. Hott is still in the ER, and still enjoying it, he sees much different things than we do. He has made some nice improvements to the ER, by improvising a handwashing station. He also did a meeting with them about HAZMAT. He’s pretty cool.

Wednesday, another resident arrived, Dr. Tamy, the clinic was pretty crowded with five doctors and an intern, but we made the space work and were able to see lots of patients. Not to many interesting cases, lots of upper respiratory infections and scabies. It seemed like every chart said ‘cough and cold’ as the chief complaint, and if it didn’t, they would say they did as soon as you asked. Friday looke like the nebulizer special, as we had three kids in one corner all on nebulizers at the same time.

Dr. Mario and Dr. Howard were pretty busy arranging meeting and had a great meeting about setting up a tooth varnish program through the vaccination clinic, getting it set up across Roatan, and using it as a model to have it set up across Honduras. It sounds like Mario should be spearheading the project, and I think he’s excited about it. It was a good week, with a good team.

Chrissy Journal 7

2009-03-04T19:41:00.000-08:00

Dr. Andrew, Dr. Preetha and Dr. Hott arrived over the weekend. Dr. Andrew is the attending, Dr. Preetha is the resident and Dr. Hott is an ER doctor who is going to be working with the ER here in the hospital. Dr. Stephanie is going to go over to Ms. Peggy’s clinic, but she came in this Monday morning to make sure all was going well. There was a little boy who had been mauled by three dogs, and Dr. Dennys was going to operate, so Stephanie went to that. It was quite an experience when his heart rate fell to 33 and the doctor looked up, then reached over and turned the monitor off. He turned it back on and his heart rate was ok.

We arrived Monday morning to find the gate to the hospital closed and no patients inside. Apparently, the nurses were on strike. I’m not sure exactly why, because they didn’t get a promised raise or because they want a raise. So, they wouldn’t let us see patients, it was especially disappointing to patients that were coming from far away places like Oak Ridge, that had to get up early and pay a lot to get here and then they couldn’t see a doctor, unless they went to the ER.

I showed the new doctors the hospital and they saw the newborns, then I took Dr. Andrew and Dr. Preetha over to Ms. Peggy’s to help. Dr. Hott stayed in the ER. Tuesday the clinic was open and we had quite a few patients. Then Wednesday the nurses were on strike again, they were all outside the hospital protesting. One of the Social Service Doctors, gave a presentation over lunch on Hyperglycemic Shock, so we all sat in on that. It was a nice conversation between the doctors and a nice opportunity to get all of them together, many of the doctors, and all the social service doctors came.

Chrissy Journal 6

2009-03-04T19:40:00.002-08:00

This week was busy. The other two doctors/clinics that see patients were gone and so we were getting a lot of patients. It wasn’t too much, though, just busy. The cases were about the same as what we usually see.

There was one boy who came in that had been on the ward the week before for a broken arm. Dr. Jackie was giving him a little ibuprofen for the pain and thought that the reason his blood pressure was so high was because he was anxious, and so they put him on blood pressure medication. He came into the clinic and Dr. Stephanie took him off of it, and his blood pressure is doing fine now. Dr. Aditi heard a few heart murmurs, so she filled out the referral to mainland hospitals, then we found out that Ms. Peggy will have someone doing Echos in a couple weeks. We need to figure out a way to have better communication on the resources she has. She is an amazing asset to healthcare on the island.

Dr. Stephanie and Dr. Aditi stopped going on rounds in the morning, because they felt that Dr. Jackie and Dr. Lemos were patronizing them, and they couldn’t see eye to eye with the medicine they were practicing here.

Chrissy Journal 5

2009-03-04T19:39:00.001-08:00

Dr. Stephanie and Dr. Aditi arrived last weekend, and will be in the clinic for two weeks. Dr. Dennys, one of the social service doctors came in to help as Dr. Mario had to go to Tegucigalpa.

Dr. Stephanie had been here before, so she got adjusted fairly quickly, and they were on rounds and seeing newborns right away. There were a lot of kids in the ward, so clinic got started a little late. Dr. Dennys saw a kid with an abscess on his head and tried to drain it with a syringe, but it didn’t work out very well and he tried to squeeze out the pus and that didn’t get enough out so the poor child had to be admitted to the hospital, so the surgeon could use some anesthetic and lacerate it. He did fine. We had a boy come in with malaria p. falciparum, he actually didn’t even look or act as sick as one would expect. There was another boy that came in with a head lesion that was a parasitic infection. It looked like an abscess on his scalp, but there was a worm living in it. The surgeon came in for a consult and they set up an appointment for the surgeon to remove the worm the next day. Other than that, there were lots of scabies cases this week, in addition to the intestinal parasites and respiratory problems.

Dr. Stephanie did an ultrasound course at Ms. Peggy’s clinic with Dr. Laleh. I somehow was coerced into being the model for all the ultrasounds, but it was very interesting. A couple of doctors from Anthony’s Key were there and all the doctors Clinica Esperanza and a few nurses too. I think they are using the ultrasound machine more already.

There was one baby on the ward that Stephanie and Aditi were worried about and the hospital discharged with a distended abdomen, and abnormal hematocrit and platelet counts. Aditi talked to Sarah, another social service doctor that was in peds, and they arranged to have the mother come by our clinic after she was discharged so we could take her to Ms. Peggy’s. She ended up getting discharged an hour earlier than we expected and she left. We tracked her name down from the chart and that she lived in Sandy Bay, so we had people asking around for her. Somebody foung her and she came into Ms. Peggy’s the next day. Dr. Laleh did an ultrasound and found free fluid around the liver. The clinic bought her a ferry ticket and gave her money to take the baby to the mainland. She ended up going to the hospital in La Ceiba because she had family there, I don’t know what the diagnosis is.

Chrissy Journal 4

2009-03-04T19:36:00.000-08:00

Week 5

This week started out pretty busy on Monday we saw 19 patients, whereas we usually only see 15 with one doctor and then got really slow to no patients on Friday. We can only assume the island was healthy. The most interesting case to me was a baby girl that Dr. Gross had seen a few weeks earlier in the newborn exam and thought she had Down’s Syndrome. She came in this week for her ten day check up and had lost weight, she only weighed 5.5 pounds, littlest baby I’ve ever held. Dr. Mario suggested that she take some high calorie protein formula too.

Since the clinic slowed down, I spent some time cleaning and dusting and organizing before Dr. Stephanie and Dr. Aditi arrive next week. Dr. Mario made arrangements for one of the social service doctors, Dr. Dennis, to come into the clinic next week as well, since he will be in Tegucigalpa taking tests next week.

One of the doctors gave a presentation over lunch on Monday, I think, but I didn’t realize it until after it happened, so I wasn’t there.

I did ask Dr. Mario about Miss Valerie, but he hasn’t heard of her, so I will have to ask around some more.

Chrissy 3

2009-03-04T19:35:00.001-08:00

This was Dr. Jessie’s last week in the clinic. The baby is still not breathing normally, and the mother has lost any trust she had in Dr. Jessie. They painted the hospital really nice, most likely in an effort to placate the problems of this hospital and delay building the ‘new’ hospital that has been promised for so many years.

The clinic was steady all week. The most interesting case was a 20 month old with Icthyosis. Dr. Jessie nor I had seen it before, but Dr. Mario knew what it was instantly and said he had seen other cases of it in Tegucigalpa. Keith, a friend of Dr. Gary’s, came into the clinic a few days and took pictures of the kids and moms and he brought a little printer and gave everyone pictures, everyone really enjoyed that.

I had family visiting all week, so I didn’t make it to Peggy’s clinic at all. I did hear that there is an American woman here in Coxen Hole working with people living with HIV and AIDS. Miss Valerie, is what I heard her name is, so I might try to touch base with her and see what she has going on.

Chrissy Journal 2

2009-02-25T03:02:00.001-08:00

The clinic has been busy with three doctors, the Global Healing clinic saw just fewer than 350 patients in January. In the clinic we see a lot of common problems; ear infections, respiratory infections, parasites, infected bug bites and gastroenteritis. Lots of cavities, and we went through all the toothbrushes Dr. Gary brought down. Some more unusual cases for the clinic was a young girl with alopecia areata, and a rash that Dr. Gross thought might be typhoid, because nobody in the clinic had ever seen one like it, but after looking at typhoid rash pictures he decided it was probably pitynasis Rosita.

Last week was very intense in the hospital. Wednesday night, the hospital caught fire, the hospital sent everyone home in taxis. The women’s ward burned, nobody was hurt and everyone got out fine. Dr. Mario was in Tegucigalpa, and Dr. Gross, Dr. Lindsay and I didn’t find out about it until we arrived Thursday morning. They told us some of the patients had been transferred to the private hospital, Wood Medical Center. On our way out to go to the other hospital, there was a two month old baby girl on the bench in the lobby, breathing very heavy and the doctors both agreed that the baby should be admitted.

When we arrived at the private hospital none of the kids from the hospital were there, they had all gone home in taxis at two in the morning. We talked to the director of the hospital, Dr. Wood and told her about the baby that needed to be admitted. She told us she didn’t know if she would have any beds. We took a tour of the hospital, it is cleaner than the public hospital, but seems to have about the same technology and same staff as the public hospital. When we saw the Pediatric ward, we didn’t see a single child in the beds.

We came back to the hospital and Dr. Wood said they would clean up the hospital and the baby could stay here, so they got oxygen and a nebulizer and baby laid on the wooden bench in the lobby all morning. They took and X-Ray once the electricity came back on, and noticed she has a collapsed lung. Dr. Lindsay and Dr. Gross thought that she needed to be transferred to another hospital that has a CPAP machine. Global Healing offered to cover the cost of transportation for the baby to be transferred. The mother of the baby didn’t want to go. The baby is only two months old and has already been to Tegucigalpa where she was supposed to see a pediatric cardiologist, they were there for days, and never saw him and all they did was an EKG and sent her home with no more information. Meanwhile, the baby got into a bed at the public hospital. We were waiting for the husband to come to decide whether or not they would transfer the baby. Dr. Mario was calling to try to make arrangements in Tegucigalpa.

Friday, the mother did not want transport the baby. The baby was still in the same condition, the mother thought she was doing a little better though. We were getting a little upset because it seemed like nobody cared, there was no sense of urgency, everybody just wanted to wait until tomorrow to see. The previous week a baby died, she didn’t transfer and then she was too sick to transfer out. Another doctor, Guido, came in and explained to us that if the baby transferred to Tegucigalpa that she would have to go through the emergency room in order to be admitted to ICU. The baby really could be waiting in the Emergency Room for days trying to get in, and they don’t triage, it basically comes down to you need to know someone in order to get a bed in the hospital.

At least the explanation made us understand the mother telling us that ‘if her baby is going to die she wants her do die in Roatan.’ We were all pretty downhearted when we left the hospital on Friday, and it was Dr. Gross’ last day as well. He is a great asset to the clinic, I very much enjoyed working with him.

Chrissy Journal 1

2009-02-25T03:00:00.001-08:00

My first week in the clinic was very interesting. Elena came in on Monday to show me the ropes and Dr. Mario was the only doctor in the clinic for the week, it was a nice slow week to get started with. I think we saw fifteen patients everyday. I didn’t do much shadowing as I was getting used to everything and not too far ahead of him with patients. Most of the cases were normal things that kids get, like strep throat, colds, and respiratory infections.

Mario showed me around the hospital as well, and took me on rounds with him one morning as well. The facility is not what you would see back home but about exactly what I expected. There were 8 new mothers with their newborns all sharing one room. No running water or actual restrooms, even though patients wait for hours to see a doctor. Since it is my first clinic experience at all, I have nothing to compare it to, but I can tell they get by on much more limited resources. Of course, it’s also pretty amazing that they only pay $.50 for a doctor consult and all of their prescriptions.

I spent my afternoons at Clinica Esperanza. My original plan was to help out at the Sandy Bay orphanage, but they are going through a transitional phase and don’t need help now. They have really built an amazing facility in Sandy Bay. Miss Peggy has been an amazing resource, everything from picking me up from the ferry and showing me around to donating any extra supplies to the hospital and openly sharing her resources with the Global Healing clinic. I had the opportunity to work a few days in the pharmacy at her clinic, filling prescriptions the doctors wrote up. It’s an opportunity I’m sure I would never get to experience back home. I’m hoping to get to shadow some of the doctors at her clinic as well. It was a really great first week and I’m looking forward to learning more next week.

This week started off with Dr. Gary and Jessie joining us in the clinic. Things got a little more crowded but more interesting as well. We had a rainy week, which I think kept a lot of people from coming into the clinic, because it was a slow week. Thursday we only saw 10 patients. We saw a lot of parasite cases, ear infections, and pneumonia. I was able to shadow Dr. Gary a few times and combine our limited Spanish, he’s very nice about explaining things. I also accompanied them all on rounds to check the newborns, all healthy! I also saw the bathroom at the hospital, out of necessity. The cleaning lady escorted me to a small room with a toilet, no seat or back cover. There was water all over the floor and a big barrel of water next to it. There was a door, no way to close it properly, and no toilet paper. The only redeeming thing about it was that it did smell of bleach. It’s amazing to think of a hospital without proper running water.

I had the opportunity to take the doctors to meet Miss Peggy and see her clinic on Tuesday as well, Jessie and Mario had the opportunity to meet her and get a tour of the facility, and Dr. Gary got to see the progress. I heard they had some cases of Rota Virus come through the clinic as well. I didn’t miss any clinic days, but I got sick Wednesday, so I didn’t make it up to Miss Peggy’s Thursday or Friday.

Elena Journal

2009-02-25T02:56:00.000-08:00

My three and a half weeks in Roatan were amazing, and I feel incredibly fortunate to have had this opportunity. While I really enjoyed working at the clinic, volunteering around the island, and having fun in my free time, I think that the most valuable aspect of my experience was having the chance to meet and speak with many different people. Between volunteers, locals, nurses and doctors, I was able to meet people with different and valuable perspectives all united under the cause of helping the island.
The first person I met on the island was Peggy Stranges, the nurse I would stay with. Stepping off the plane, I completely missed the man holding my name sign and walked straight towards Peggy, recognizing her friendly face from pictures on her clinic’s website. I’m incredibly thankful to have been connected with such a gracious host. In my weeks on the island, Peggy opened her house to me and served as a useful source of information and advice. Some of my fondest memories with Peggy are the two of us sitting at her dining table talking about how she started her private clinic from the very table at which I was sitting. Peggy left to see her family in Ohio for two of the less than four weeks that I was there, so I tried to soak up as much of her wisdom and advice as I could in the time that I was with her.
With Peggy at the airport I met Becky and Jacob, the two volunteers that I would end up spending my first two weeks with. Both volunteers are currently in med school, and one of them (Becky) had spent seven months of the previous year volunteering on the island. Becky proved to be an invaluable resource, as she knew the island well and had spent two of those months volunteering in the global healing clinic. From the airport, we hopped in the truck and headed into Coxen Hole so that I could catch my first glimpse of the public hospital where I’d be spending my mornings.
Coxen Hole itself is similar to how I pictured it, only with more stray dogs. I don’t think that I could have even imagined the hospital without seeing it for myself (even with the helpful maps that Stephanie drew for me:) ). I was instantly struck by how different it was from what we would allow to be called a hospital in the United States. The door is a wide, open frame, and in many places the ground is concrete. Between the two receptionist type desks stood a long line of people waiting around to be seen. The majority of the people in the hospital seemed to be from the mainland, but there were also islanders intermixed. When we turned the corner to look at the actual clinics, we could see that the line of patients went all the way down to the end of the hall. We peaked into a few of the clinics, and it was pretty clear that the hospital is operating on next to no resources. We walked down to the Global Healing clinic in the hospital, and Becky was able to orient me a little bit to what I would be doing.
After taking my first day easy, I was ready to start experiencing all that the island had to offer. I woke up bright and early with Jacob to start our first day of scuba school. Peggy had already made the arrangements with Bay Island Beach Resort, so it was incredibly easy to get started. Over the month I went to scuba school on weekends and days that Peggy’s clinic got out early. Roatan has beautiful coral, and it was an amazing experience to swim around with the fish 60 feet below the surface. In my short time I was able to see a turtle, an eagle ray, a moray eel, a grouper and a bunch of crabs. With each dive I felt that I was entering a new world, and was amazed at how its inhabitants barely noticed my intrusion.
My time at the Global Healing clinic was great, but the first few days were sort of challenging. Because there was no intern before me, and all of the doctors were relatively new, we were all sort of feeling our way out together. Mario, the Honduran doctor, had been at Global Healing for about a month, while the two American doctors, Erin and Sarah, had been there for a week. My biggest challenge in the beginning was figuring out exactly what I was supposed to be doing. Before I got there, the three doctors took on all of the tasks of the intern, so it was a hard to separate out what my responsibilities were. Becky was very helpful with this, and even two weeks in I would come to her with questions about how things were when she was an intern.
Erin and Sarah are both from Illinois, and my favorite memories from the clinic were working with them. This is partly because they used me as a translator, but mainly because they were caring doctors and thorough teachers. Translating allowed me to become comfortable with the patients pretty quickly, and was incredibly rewarding, especially when easing the minds of first time mothers. But it was the lessons that I picked up from the doctors that gave me deeper insight into medicine in impoverished areas. When they arrived in the mornings they would take me to see the new born babies, making sure to explain the different tests they would do in their newborn health checks. My first glimpse at the struggles involved with providing health care on the island came after one of our morning health checks. The American doctors found a heart palpitation in a newborn boy. They wanted to proceed as they would in the states with follow up tests and possibly even surgery. When they consulted the other doctors in the hospital, the doctors said that it wouldn’t be possible to take these measures. The baby was asymptomatic, so the hospital could not justify using the scarce resources on him even though they had the medical knowledge, skill and technology. We understood the reasoning, but it didn’t make it any easier to send a baby home that might become symptomatic when it was too late. After that, I began to realize that one of the ways medical care is possible with such limited resources is through rationing, and that preventative medicine was one of the first things to be sacrificed.
The hardship of this sacrifice became abundantly clear when a week later we admitted a patient – the only patient we admitted during my stay. A mom brought in her son of about 8 years with a bad foot infection. Doctor Mario broke the news to the mother that her child would be admitted, and I watched her face turn from hopeful to worried to almost frantic. Later that day I would retell the story to a doctor from Peggy’s clinic and ask him why her reaction was so strong. “On the island, you don’t get admitted to the hospital to get better…” he told me. The next day I talked to the American doctors about it and they said that the infection had probably spread to the bone, and that if it had the foot would need to be amputated before it spread further. Coming from a country where those receiving care are often over-doctored, it was strange to see the other extreme, where doctoring often comes too little, too late. In the case of the boy, it was through no fault of the hospital that he was brought in so late. Yet I cannot help but wonder if the mother would have been more likely to bring him earlier in a system with better preventative care.
Working at the clinic wasn’t all teary-eyed moms and tough lessons; it was usually fun and always valuable. My favorite patients were the ones who came with brothers and sisters. Often one child would be ill, and the whole pack would come in for a check up. I had so much fun watching them peek through our keyhole, spin around on our chairs and hang on their mothers. I would say that the most common issues were malnutrition and parasites. Being able to dispense advice and multivitamins to mothers might seem pretty small, but I know that it is a big step towards keeping the kids healthy.
Clinic often got out early – sometimes as early at 11:00 a.m. Usually to keep myself busy in the afternoons, I volunteered where I could around the island. A couple of times after clinic I followed Erin and Sarah back to their West End apartment. We talked a lot about their experiences on the island and in their residency programs, as well as Sarah’s experiences volunteering in Haiti. Mainly we just enjoyed the nice weather and beaches of West End. Most afternoons I would take a taxi back into Sandy Bay, walk up the hill towards La Clinica Esperanza and lend a hand to Peggy’s volunteers. Volunteering in Peggy’s clinic gave me a more holistic view of providing health, as every aspect was contained in the five or so rooms of the clinic. By the time I would arrive in the afternoon all of the triage would be done, and the volunteers would either fill prescriptions in the pharmacy or shadow doctors in the exam rooms.

Alex journal 4

2008-10-07T10:04:00.001-07:00

This past month in Roatan has come and gone so quickly I can hardly believe I will be leaving in three days! I feel like I’ve only started to settle in to my surroundings here, and now I have to start packing again. The truth is that a month is really not long enough to make a difference, particularly since it takes you long to establish relationships and find your niche. Nevertheless, the connections I have made here in Roatan are good for networking, especially since I hope to work in Global Health during my career. I hope I get the opportunity to come down and volunteer again in the future, perhaps while in medical school or residency so I can have a more active role in seeing patients rather than just triaging. Not that triaging patients and interpreting has not been a huge help, because it has, I just want to be able to experience everything from the perspective of a physician.

I also wanted to talk about the opportunities to do research here at the RVPC. Before coming down to Roatan, I learned that the population of the island is very diverse. In addition to the Hondurans immigrants from the mainland, Roatan has a mix of ethnic groups quite unique to the island, such as the Garifuna, whom are descendants of escaped African slaves, and the Miskito population. One thread that connects all these groups, I found, is their belief in complementary alternative medicines, also known as “remedios caseros” (home remedies) or “bush medicine”. My research project while here was to see how many of our clinic patients also prescribed to these other treatment modalities.

What I found was that nearly everyone on the island believes in non-western treatments to a certain extent. For example, teas made of manzanilla (chamomile), eucalypto (eucalyptus), romero (rosemary), or anise were said to aid with digestion and help relieve stomach problems. Many of the locals with abscesses would come in with a leaf from a specific plant covering their abscess with the belief that the plant’s enzymes would help it mature and draw out the puss. While I found that many of these alternative treatments might have some scientific validity, given that many of our modern day medicines were discovered via their uses in ethno medicine, there were others that I thought were overwhelmingly based on superstition. For example, nearly every newborn we saw in the clinic wore a red beaded bracelet that was to protect them from the evil eye. When I asked the mother’s whether they believed in curses, the evil eye, and whether the bracelet really worked, some said yes confidently, but many said they weren’t sure and that they just prescribed to the practice out of tradition or because some relative had told them to.

While I may not have had the time to do a full-blown research study, I learned a lot about the alternative medicine beliefs held by people in Roatan. For example, despite being quite popular amongst the people visiting the clinic, most said they still had confidence in the abilities of the doctors and that they used alternative medicines mostly as a complement to western medicine.

Overall, my experience here in Roatan has been great! I’ve learned a lot about tropical medicine, infectious diseases, and the challenges of practicing medicine in a resource poor environment. I only have one more day left in the Global Healing clinic (there is a nurse’s strike on Monday, a common occurrence here in Roatan) so I’m looking forward to my last day shadowing the doctors and interacting with the patients. Cheers!

Alex Journal 3

2008-09-28T21:55:00.002-07:00

I can’t believe my third week in Roatan is coming to a close! When I first arrived a month felt like such a long time, but I now realize that a month isn’t nearly long enough to really make any lasting improvements in the quality of life of the people on the island.
This past week was a little more hectic in the clinic with the arrival of the two new pediatric residents, Dr. Sydney Leibel and Dr. Sandra Lawrynowicz. Given that I spent much of Tuesday and Wednesday orienting the residents to the workings of the clinic, showing them around Coxen Hole, and doing quite a lot of interpreting, I really saw how important the intern’s job is in preserving the quality and continuity of care for patients that visit our clinic.

While there were numerous interesting patients in the clinic this week, one in particular stands out to me because it shows how difficult it can be for people on the island to get the healthcare they need. This patient was a spunky young boy of about 4 years old who more than anything wanted me to take a picture of him J. He had been diagnosed with a seizure disorder several years earlier and had been sent to La Ceiba to see a neurologist who after several tests prescribed the boy Phenobarbital. Unfortunately, in August of this year the mother ran out of the medication and had visited the Global Healing clinic to refill the prescription. Doctora Prado gave the mother a month’s supply of Phenobarbital as well as a referral to see the neurologist in Ceiba to properly manage the boy’s seizure condition throughout childhood and adolescence.

However, as is often the case with many of our patients, the mother was back in the clinic a month later asking again for another refill prescription. Now, if you are at all familiar with anti-epileptics you know that these medications are pretty nasty, and few physicians other than neurologists feel comfortable prescribing them, particularly third year pediatric residents. Therefore, I sat down with the mother and asked her why she had not gone to La Ceiba to see the neurologist as Doctora Prado had instructed? She told me that she had gone to see the neurologist and they had already done all the tests. At this, I was confused, which is when I realized that the mother was referring to the original appointment the boy had with the neurologist over a year ago. The poor woman had not understood that the referral was for a follow-up. I gently explained to the mother that her sons seizure disorder was complex in that just as he might outgrow his clothes, it is also possible that he can outgrow his medication dose, or the type of medication he would need to take. I explained that he would probably need yearly follow-ups with his neurologist until the problem was resolved. It might even be the case that he wouldn’t need to take the medication at all!

At this news, the mother became quiet and worried. This was probably the first time anyone had really explained to her the reality of her son’s problem, and the importance of properly managing his anti-epileptics. After all was said and done, we asked the women if she was going to be able to take her son to La Ceiba, to which she shrugged her shoulders. As is the case with many of our patients at the clinic, she could not afford a trip to La Ceiba but was too ashamed and proud to admit it. Thankfully, we were able to offer the women and her son free transport to and from La Ceiba. The mother and her son left the clinic completely grateful for all the education and help we had offered them. “Que Dios le bendiga” she said, which means “May God bless you”.

My interactions with this family showed me the importance of patient education. It is so important to make sure that your patient understands their problems, why they have them, how to avoid them, and how to treat them. All this mother knew was that the Phenobarbital helped her son, but she hadn’t the slightest idea that poorly managed seizure disorders could result in developmental delay, or how anti-epileptics affect cognition. While all this information may have surprised her, and even scared her a little, I am confident she left our clinic with an increased understanding of her son’s problem, and perhaps with increased confidence in her ability to help him.

Alex Journal 2

2008-09-22T10:08:00.000-07:00

This past week was my first full week working at the global healing clinic and boy, was it busy! I think the reason we were so busy each day was because Monday was the Honduran Independence day and a national holiday for the whole country, so all the children had the entire week off of school. Therefore, all the mothers took advantage of the holiday to bring their school-aged children to the clinic. Whereas last week we had between 10-15 patients each day, this week we had about 20 to 25 patients a day. Since most of our pediatric patients at the clinic present with illnesses like bacterial skin infections, urinary tract infections, and parasites, all illnesses associated with poor hygiene or unsanitary food, water, and living conditions, imagine my surprise when we had a young girl come in complaining of migraines. Back at Stanford at the Pediatric Pain Management Clinic where I do clinical research, nearly every other kid we see has migraines or chronic daily headaches. Usually we take a long, detailed history of the child’s migraine history, the quality of the migraine (Ie. is the pain throbbing, stabbing, does it travel from one spot to another, etc.), their sleep hygiene, and finally all the different medications they’ve tried. We then go on to suggest a multi disciplinary approach to treat the migraines, including medication, biofeedback techniques, physical therapy and stretching routines, and finally acupuncture if the child is willing. Now, given how I was used to treating a migraine condition, imagine how utterly frustrated I felt when all we had to offer this poor girl was to take some Tylenol when she felt a migraine coming on and to avoid eating chocolate, sweets, and soda.
The harsh reality is that in a place like Roatan we don’t have the resources for properly treating many medical problems. In fact, we’re lucky if we can get patients to listen to us. Even if we had all the wonderful multi-disciplinary approach to treating chronic pain problems as we do at Stanford, we probably couldn’t get the families to invest all the time and effort needed to come to all the follow-up appointments or to take the medications as directed. This fact is one of the main reasons why I want to do an MPH in addition to my MD, because the only by learning the belief system of the community and finding effective ways to bring awareness and education can one begin to see long-term changes in the way people understand health care. I mean, educating one patient at a time is important, but is also quite futile if when they go home their grandmother, the matriarch and wisest most respected member of the family, convinces them that the gringo doctor doesn’t know what they are talking about, and that the baby needs to see the bush medicine doctor if they want to remove the curse of the evil eye that is making them sick.
Despite all my frustrations, I do still feel we are making a difference in the Global Healing Clinic. I see this in the mother’s who bring their children back for follow-up visits, who come to refill prescriptions before their child’s chronic problem becomes uncontrolled again, and who bring in a list of the medications their child is taking.
In the afternoons I continue to tutor the children in the orphanage. We’ve switched to learning spelling in Spanish, which is a lot more challenging for them since they speak primarily English. They’ve been doing well, however, and are bright kids. The challenge is mainly just to find ways to keep them focused and interested. One day I accomplished this by timing them on how fast they could say the Spanish alphabet without messing up a single letter. I used their natural competitiveness to get them focused on the task, and because they were so determined they were all able to recite it in less than a minute after only one lesson. There is nothing more rewarding than to see kids, who usually get easily frustrated and quit, learn to persevere and succeed with huge smiles on their faces.
Finally, I should probably talk about how completely beautiful Roatan is. Last weekend I completed my dive certification and one the four dives I’ve been on I’ve seen turtles, lobsters, sting rays, a green moray eel, a two-foot long barracuda, shrimp, and a huge crab that could have fed three people! There is so much to discover under the water, so anyone who comes down here should definitely take advantage of the aquatic beauty of the island. Today was also my first day going down to West Bay, a gorgeous white sand beach. I walked there from West End which took about 30 minutes, but if you aren’t in a rush it’s quite relaxing. Finally, I’ve taken up yoga again with a group that practices twice a week and on Sunday mornings. It’s a great way to start my morning and feel peaceful and centered after a long week at the clinic. Cheers!

Alex Journal 1

2008-09-13T21:15:00.001-07:00

My first impression of Roatán was how similar the island was to my own island home, Guam. The weather, the vegetation, and the relaxed pace of life on the island all brought back memories of my childhood, particularly the images of children running around barefoot and jumping off the docks to cool off from the afternoon heat in the clear blue ocean. My first couple days in the clinic, however, brought me back to reality making it clear that although this was a gorgeous tropical paradise the people here have real problems and very few resources to remedy these problems due to in part to poverty but also because of Roatan’s geographic isolation.
The austerity of the Global Healing clinic and the doctors working with such limited resources was a real eye-opener for me, particularly coming from my clinical research job at Stanford where our Pediatric Pain Management team is so quick to spend money on superfluous supplies like heat lamps, or where we drink our five dollar chai tea lattes daily without thinking twice about the cost. I was completely humbled by the fact that part of our job at the clinic was to wash and disinfect the ear scopes once a week because it would cost too much to simply throw them away after one use, or how I was using alcohol to disinfect the temperature probe after each use for the same reason. The reality is that in places like Roatan, a large part of success is learning how be resourceful and efficient with the resources at hand, traits I’ve realized few American doctors have. Another example of how resourcefulness is key when practicing medicine in resource poor situations is how Doctora Prado, when she was unable to find the right size face mask, was able to MacGyver (so to speak) an oversized mask, some tubing, and some medical tape to fit onto the face of a 3 year old girl receiving a nebulized medication for her asthma. I should also add that we washed and disinfected these masks as well after their use.
Despite the limited resources, however, I am confident that the Global Healing clinic is making a positive difference in the lives of our patients. I feel the difference we make is primarily through the education we provide to patients during each visit. One example of this I saw was a young mother who had recently borne a premature baby. Doctora Prado had seen the baby two days earlier, and although nothing was wrong at the time, she had told the mother to return if she noticed that anything at all, even the smallest thing was wrong since her little baby was very fragile. When I triaged this mother and asked her why she had come, she confidently told me that her baby had watery stool and that “la doctora” had told her to return if she had noticed any sign of illness. Her saying this gave me hope that our patients were listening to our advice and following up with care, a task that is often difficult for a population that is poor and uneducated. In the coming weeks I hope I can witness more instances like this.

Stephanie Journal 4

2008-09-11T03:58:00.003-07:00

It is my last week in Roatan! It feels like I just got here, but also like I've been here for a long time. It's strange. When you're on the island, you get into a routine. Mine was waking up at 6:40, getting to the clinic, leaving around 2 to go to the orphanage, and then working at the orphanage for a couple hours. This life compared to the life at school is so different. There's just an island feel to life here. You can study in the afternoons, be productive, or just waste it away snorkeling, kayaking, watching TV, cooking,... the list goes on. At the end of the day though, I feel good that I'm able to help people at the clinic, and also teach the kids in the afternoon. it feels like I'm actually accomplishing something!!

Last week at the clinic, a senora told me that her daughter had worms. I asked "have you seen them?" and she said "si" and started opening her bag to find something. Before I knew it, she was pulling out a jar with a long white worm squirming around in it and said that it was from her MOUTH. I almost puked. Almost. I got a good shot of that on my camera - I'll try to post it up.

The clinic actually closed a couple days last week because of the strike of the social services doctors. Apparently, there is one year when a doctor is considered 'social service" - they have to work to pay off the medical school that they have received. Currently, they are on strike because there is some unfair procedure occurring in the system. Some private school is breaking the law so all the SS doctors from all of Honduras are on strike. Because of that, part of the hospital shut down and the external clinics (including ours) shut down temporarily.

The kids at the orphanage are getting better at spelling! Their new favorite word - "animal". It has 6 letters! SIX! Compared to a couple weeks ago, when they couldn't even say "the" or spell "the" - it's an improvement. TRULY. The kids had a list of 60 words that they have to learn how to spell and I really thougt it was impossible - but the kids have proven me wrong. They have gotten good at spelling almost all the words. They do forget their vowels sometimes, which is a hard mistake to correct. I'm so glad they're actually learning!

This experience overall has been a good one. The island is beautiful and the people are relatively nice. They're a bit racist though, and haven't seen too many Asian individuals so I would say that's the only downside of coming to a place like Roatan. It is a good mix of cultures - there's the tourist groups in Westend, the local Black population, the "gringos" or expats from the US, and the Hondurans who come from the mainland. Considering that Roatan used to be a English speaking island, it's pretty surprising that everyone speaks Spanish now - mostly because of the mainlanders coming to the island in hopes of making good money. I think the mix of cultures was definitely the most distinctive part of Roatan and it was interested meeting a large range of people - from meeting a Belgian who grew up in Central America to volunteer doctors who work here 7 months out of the year. It's definitely an environment that I will miss.

Stephanie Journal 3

2008-09-01T12:08:00.004-07:00

If the Roatans came to America and saw a hospital like Stanford Hospital or all the state-of-the-art recovery center, I think it would just blow their mind. It's the same thing with houses and shops, etc. It's just a different way of life here, and although I realized it the moment I got here and started learning about the culture, it still is extremely wondrous to me.

On that note, there have been some exciting cases. There was a kid with a huge absceso on his head, and it was humongous. When Dra Prado was puncturing the abscess with a syringe and squeezing out the bloody pus, he didn't even cry! I would be crying, to be honest. I really hate needles. I'm also learning new terms - balanitis for example is the infection of the gland near the penis. I definitely didn't know that before.

Something I have been noticing as patients come in is that they ask for medicine specifically, by name, even if they don't exactly know what the medicine do or are for. Granted, I don't know exactly what medicine does what and is for what, but mothers give acetaminophen for EVERYTHING. Everyone is overmedicated because they aren't educated. Many of the doctors in the hospital don't help with this either - they give the mothers what they want. Acetaminophen, loratadine (claritin), Broncomat/Albuterol - even if the kid doesn't need it. It's a placebo effect. Mothers see their kids getting better, but it's not because of the drugs or treatment. It's because things like flu, colds, and the cough just clear up after a while. What worries me most is giving out antibiotics when kids don't need it. This will just reinforce the resistance in the community, and no one - patients, doctors, mothers, kids - will benefit from that.

It's now the end of my 3rd week in clinic. I have about 1.5 weeks left. I am still volunteering at the orphanage and helping the kids with their reading/spelling. Unfortunately the four kids that I work with really cannot read yet - even though they are in first grade. They can barely say basic sounds: th, ch, sh, etc. I've been doing my best but the kids don't realize the importance of reading, and they are used to being rowdy, rude, and obnoxious so that is how they are. One of the kids chased me around with a tarantula spider in his hand in order to get out of studying!! Allen and I have been persevering, but it's getting very frustrating when the kids do more complaining and whining than studying during our time there. Surely but slowly, they're making progress. I just wish it was a more SURELY, than slowly.

From the experience I have had at the clinic and at the orphanage, I realize that I like working with older children or teenagers more so than babies and little kids. The little kids are adorable and cute, but I like making a connection with teenagers and young adults. During the school year, I tutor high school students on the side to make some money, and the experience is really rewarding. Realizing this is important for my future. Unlike most the interns, I am NOT pre-med! My goal is to become a nurse practitioner, and because of this experience I think I have decided on becoming a Family Nurse Practitioner. I was thinking of maybe becoming a Pediatric NP, but I think I would like to have general knowledge so that I can be someone's practitioner throughout his or her lifetime.

Stephanie Journal 2

2008-08-25T12:11:00.002-07:00

The first week, I needed a bit of transition time, but I think I am pretty comfortable with my island life now. The clinic has been very interested, especially once I got a hang of the Spanish, medical terms, and pharmaceuticals with their Spanish names. It is a bit like a routine - we get a lot of Upper Respiratory Infections (or IRAs in Spanish), flus (gripe), scabies (escabiosis), impetigo (impetigo), and dermatitis (dermatitis). It's been very interesting watching Dra Sri and Dra Prado apply their knowledge to these cases. A lot of the time, it really depends on the family and therefore the drugs prescribed can be more or less, depending on how much the doctors think that they will comply to it.

There was one interesting child with dextrocardia. Her heart was on the right side of her body, although the rest of her organs were on the right side. There's another condition called Situs Invertus when everything that is normally right is on the left and vice versa, so everything is inverted. It's extremely uncommon, therefore I was lucky to even meet a little girl with this condition! She was really adorable and friendly.

Mondays are the busiest day, so we had a ton of patients then. Apparently, they have not been paid since 2004 and have only been given some "bonuses" but the hospital still owes them a lot of money so the nurses are unhappy. On Tuesday, the nurses went on strike at the hospital so the last week was pretty slow because the nurses were not sending patients to our clinic. Now some other workers.

The kids at the orphanage are having a spelling test in 2 weeks. They need to learn how to spell Roatan, flowers, dolphin, today, boy... and other words that they know how to say, but don't know how to spell. It's really frustrating because the kids themselves get frustrated. I don't blame them - I think that they are behind in school because they were homeschooled for a long time. The other thing is that the English/Spanish transition is confusing. The kids all speak English, but they also learn Spanish in school. Therefore the keep getting their "e"s and "i"s mixed up because "i" sounds like EEEEE in spanish. It's heartbreaking because the kids want to go play and don't want to study this difficult material, but I know that it's something we need to help them with.

I visited West Bay for the first time yesterday. It is SUCH A BEAUTIFUL BEACH. The water is turquoise and the sand is white. The water is warm with some cold currents running through it which feel so good when you're snorkleing. I've never been snorkeling before so doing it in Roatan has been a new experience. There were a lot of jellyfish at West Bay, so I was pretty afraid of getting stung. I didn't exactly want to find out the hard way whether these jellyfish were the stinging kind (I have a pretty limited knowledge of marine wildlife) so I definitely avoided those when I could, sometimes kicking them away with my flipper. I got to see a sea snake (which scared the life outta me), two huge barracudas (which also scared the life out of me), beautiful parrot fish, and lots of other interesting wildlife.

I'm slowly, but surely, getting over my fear of the open water and using my Spanish!

Stephanie Journal 1

2008-08-18T11:46:00.004-07:00

I arrived last Sunday, sleepy and jetlagged, and was thrown into the Roatan environment. I'm staying at Miss Peggy's in Sandy Bay in her downstairs apartment, right at the edge of the ocean between two docks. Everyone has been great - the volunteers from Clinica Esperanza, Mia who left yesterday, Miss Peggy, and the staff at the clinic. At first, I was very anxious in the clinic, but after 3 days with Mia, I am ready to tackle the clinic on my own. It's smaller than I had imagined, but it's been a great experience shadowing the doctors, and as I get faster at paperwork and triaging, I get more and more time to shadow and talk to the doctors. Doctora Prado is the Honduran fellow in the clinic, and she's been very helpful, especially with translations from English to Spanish. There are a lot of medicines, treatments, and illnesses that have abbreviations or names that I do not know/understand because it's in Spanish. She's been really patient with me. Dra Tiyyagura is a pediatrician from New York and she's also been great to shadow and learn from.

I had heard so much about the clinic before I got here, and even seen a lot of pictures, but when I got here it seemed very foreign. It's great to be in this environment - where volunteers like Dra Tiyyagura and myself can help a large number of people - even if it's only seeing 20-25 patients a day. Most of my patients are under the age of 5, and they're almost always accompanied by their mothers (sometimes fathers). The people have been patient with my Spanish, which has an accent and is sometimes hard to understand compared to their Spanish. For me, it's easier to understand an American speak Spanish than a Hispanic person speak Spanish, and I think that's a bit ironic.

On my time off, I've been continuing the work at the orphanage. Mia told me about the improvement that Dawn started and that she has continued. I hope that Allen and I can keep going to the orphanage to help with their schoolwork. After the orphanage, I usually go fishing on the dock or kayaking in the ocean. Although I know my priority is in the clinic, it's been nice to have time off in the late afternoons to relax because I wake up early to go to clinic again. I've kinda caught a "fishing bug" and I go almost everyday :) Catching fish and then eating your catch is pretty satisfying, even if it's only a tiny fish!

Mia Journal 5

2008-08-10T20:01:00.002-07:00

Sunday August 3 to Sunday August 10

Me and Hannah have had a very adventurous weekend as we were let loose on the Roatan roads by ourselves. We took Peggy's rickety truck and luckily survived the crazy taxi drivers-who love to pass cars on blind turns-the invisible potholes every couple feet, and the random people walking along the sides of the road. Yesterday we went to go solicit donations from businesses in Coxen Hole and West End for Sundae by the Sea, the silent auction that Peggy's clinic holds every year to raise funds for Clinica Esperanza. And today we picked up Stephanie and Allen - the new volunteers - at the airport. Today we were supposed to go la Colonia to distribute Kids Against Hunger food packets to the families, but Dr. Ivan - who was going to also give a presentation on dengue - was called to la Ceiba because one of his patients got dengue hemorrhagic fever. Hopefully next weekend before I leave.

I can't believe I only have three days left in the clinic! This past week we've been working at a really fast pace because we have Dra. Srit, Dra. Laura, and Dra. Prado here everyday. On Monday, Dra. Srit drained a scalp abscess and the scream of that young girl will forever be burned in my brain. On Tuesday she came in again and I watched Dra. Laura repack the hole. I thought the gauze would never end as she pulled it out of the gaping, bloody hole on the back of the poor girl's head. After clinic that day, we all went to the local daycare to administer antihelminth medication to the 15 or so children there. Boy was that chaotic. We had one tiny room to fit the four of us AND two or three crazy little children. We all felt like we had gone through war as we left the daycare; those kids were super energized because our team came right after they had had their nap. My little monkeys at the orphanage seemed like quiet little angels after the day care.

Wednesday started the introduction of the new patient sheet. For me, it only means asking four more questions about past medical ailments, current medication, vaccination history, and any known allergies to food or medicine. Lidia explained to me that getting this new sheet was such an accomplishment because apparently it had been vetoed multiple times. Lidia said the hospital bureaucracy does not particularly like changes in methodology. Thursday was super fun at the orphanage because the kids and I dyed Hannah's hair! We dyed her hair a burgundy, chocolate cherry color and of course as I reminded the kids to be careful about not getting dye on Hannah's face, Chenice slaps a big handprint of red on Hannah's forehead. It was a hilarious process, and the kids really enjoyed it.

I've still had several mothers come in with their chief complaint being, "no quiere comer nada nada." We had one mother come in with this complaint about her 2 year old child, and as Dra. Laura tried to convince her that she was the boss, not the child, I could see a look of doubt and confusion appear on the young mother's face. The two year old apparently walked around the town buying only junk food and candy. So Dra. Laura told the mother to stop giving her son money, to stop letting him walk out alone because of possible danger, and to just wait for the child to get hungry. "He'll eventually eat anything if he's starving," Dra. Laura said. I guess it sounded kind of harsh to the mother, because she left a bit disgruntled. Another mother came in with her daughter and as the mother started complaining that her child was not eating anythingwas answering my questions, her daughter sat there with cheese covered fingers, shoving cheetohs into her mouth. It's frustrating to keep seeing these mothers come in with the same complaint; I swear we see at least 5 a day!

Friday night I went with Peggy and the Clinica Esperanza team to rotisserie chicken (YUM) and we had to leave midway through for a medical emergency. The son of the future president of El Salvador had fish (and apparently he is allergic to fish) and did not have an epipen like was recommended to him, and so he was shipped to Peggy's clinic for treatment. Everything turned out fine but it was an exciting end to the night.
And now, me and Hannah are going to be adventurous and try and cook something delicious.

3 more days in the clinic!

Mia Journal 3+4

2008-08-06T23:19:00.002-07:00

Week of Sunday, July 27 to Sunday, August 3rd

The beginning of this week has been a lot less hectic and crazy than last week. Last week started sin el doctor Gross and con una emergencia; a little girl with internal bleeding had all the doctors occupied for about 3 hours. I was grabbed and almost literally dragged to the laboratory to translate for Alice who was desperately trying to get blood for the girl. It was pretty scary trying to understand why we were being denied (ended up being a lot of bureaucratic filling out of forms) with noise and chaos surrounding the already scorching hospital. Not to mention, as I opened the door to the lab, I almost got nailed by a flying droplet of blood! After finally getting the order in for the blood, I went back to the clinic, where two children had puked all over the hallway, and I had to suck in my stomach as to keep myself from puking from the stench. I swear it was fever day because there were at least 5 children with fevers greater than 101. At least that insane day ended on a good note-the premie came in for a check up and seemed to be doing really well.

Tuesday didn't prove to be any less eventful; a baby girl in the waiting hall began to go into febrile seizures and had to be whisked away to the ER. I stood there with the mother, trying to comfort her as much as possible as she was sobbing and shaking uncontrollably. My heart absolutely broke for her.

The rest of the week was a lot milder; a lot of URIs and a lot of the popular chief complaint here on the island, "no quiere comer comida! solo dulces!" I've seen Dra. Laura get flustered multiple times this week trying to explain that antibiotics don't work for viruses, and it gets me thinking about the patient's perception of their quality of care. Here, as well as in the United States, parents feel more satisfied when they leave the doctor's with some sort of medication or injection. When I see empty handed parents leave with a quizzical unsatisfied look on their face, I wonder if they lose faith in the care their doctor's provide, or even in their doctor's education. I wonder what other implications arise, specifically and especialy in this Global Healing clinic where the patient-provider relationship is already tainted by a language barrier and a cultural distrust.

The orphanage has been wonderful times up until Wednesday. Shenice, who appears to be the sweetest girl (and super bright as well) did not take her nap and I feared for my life (exaggeration of course) as she threw the HUGEST temper tantrum I've ever seen in my ENTIRE life! We had to end the lesson early and calm her down because she stabbed the table pretty forcefully (and we weren't about to let her use that same force on somebody's eye).

A new resident came in this week- Dra. Srit Tiyyagura, a co-resident of Dra. Laura's from NYU. She came just in time for the Trauma Conference, which had a good turn-out. The conference was all in Spanish, and most of the Global Healing team could understand most of it if focusing at the utmost intensity possible. All in all, I'd say it was a success.

Sunday I spent my day at West Bay Beach again, and like always, it was superbly lovely. Tomorrow will mark my fourth week at the hospital!

Mia Journal 2

2008-07-29T09:44:00.002-07:00

Week of Sunday, July 20th-Sunday, July 27, 2008.

Today marks the 15th day I've been on the island-almost the

halfway mark. This past week started off with the coming of

Howard and Alice Gruber. After a wonderful dinner at the

Argentine Grill with the entire Global Healing team, I went

home to rest up for my second week of work at the clinic.

That week at the hospital was distinctly different with

Howard, Alice, and Robin (nurse practitioner) there. Our

already tiny working space shrunk to the point where every 5

seconds someone was bumping into someone else. Alice spiffed

up the place, AND we got a new 19 inch flat screen computer!

Oh my goodness does that make a HUGE difference! The old

computer took FOREVER to perform ANY action and this new

computer is quick, fast, and never freezes up, saving all of

us lots of time. The air and electricity still go out quite

frequently which is a bummer; especially with a minimum of 6

people in the room rushing about creating heat. I triaged a

1.4 kg premature baby (I forgot how many weeks it was) which

was really very scary for me. I was scared she would break if

I made a mistake! We also saw a little boy with a nasty

infected lip, with swelling from his lip up to his right

eyebrow. The image of Dr. Gross cutting open and draining a

cranial abscess will forever be burned into my brain. On

Wednesday, Robin took me on a tour of the pediatric ward and

we watched the nurses clean and dress a child's fractured hand

(Robin is here to train the nurses and so she was taking

notes and telling me the differences in method as compared to

how it is done in the United States). The 7 children in there

were melancholy and a few were whimpering, but upon giving

them Global Healing teddy bears, we exited the ward leaving 7

smiles behind us.

Wednesday afternoon, we had a small conference with other

nurses and health workers from the Hospital in a separate

building across the way. Dra. Prado gave a presentation on

hypertension and Robin followed with a presentation on how to

properly administer sodium fluoride varnish to children.

Global Healing does quite a bit of community outreach in

addition to managing the pediatric clinic at the hospital;

this coming week we are planning to administer antihelminth

medication and next Saturday marks the 2nd Annual Trauma

Conference. I am really excited for the new pilot program

Howard is starting at the clinic to fight the prevalence of

dental caries. Not a day goes by that we don't see at least 5

children with horrible looking teeth. One child had a dental

abscess near the size of a ping pong ball due to lack of

dental hygiene and the consumption of chatarra! Although we

give out toothbrushes, I am skeptical as to whether the

parents really have the time or patience to force their

children to brush twice a day. I don't even want to think

about whether these kids floss. But, dental hygiene would

fall towards the bottom of my "important things to do" list if

I had to scrape around to obtain enough money to feed my

children. It was really discouraging to see mothers come into

the clinic worrying about their children's constipation and

stomach pains, say they understand they need to feed their

children fruits and vegetables instead of chips and Coke, and

then walk across the street and buy their children a soda and

some candy-a treat for putting up with a doctor's visit. I

have seen this in many underdeveloped countries and it is

frustrating and saddening because most parents can not afford

to buy fruits and vegetables for their children every day.

Something else must be done, possibly from the economic or

government sector, because doctor's can't do much else besides

tell the facts about nutrition and dental hygiene. In the

states, people have a choice to listen to what their doctors

and dentists recommend. Here, parents-especially single

mothers-don't have much choice other than to provide their

children with the food their income will allow them to buy.

Howard explained to us that this dental program is distinctly

different from other varnish administering programs that have

been recently proven successful in other Central American

countries because here in Roatan, the fluoride varnish will be

administered at the hospital by the nurses; once when the

children come in for the 12 month vaccinations, and again when

they come in at 18 months. We have posters to promote this

varnish all over the hospital and we are putting them up in

different barrios around the area. It is really neat to watch

this program develop because the kinks and other issues are

still being worked out. And, there is only supply enough for

300 children for 6 months-so there is half a year to come up

with an additional supply. Yikes. The nurses are stoked that

they are doing something unique to Central America and they

joked around about becoming famous. They are really excited

and hopeful for this program to be successfully implemented.

Friday I got to try out an audioscope for the first time!

Exciting! Dr. Laura shocked me when I was shadowing her

because she handed me the audioscope unexpectedly and said,

"Take a look at her ears. You'll see they are quite impacted

with wax." She taught me how to properly hold the audioscope

to be able to see best, and as I looked into this young girl's

ear, I saw a dark brown wall of wax. After Dr. Laura

prescribed drops of Cerum for the girl's impacted ears, she

let me look into her own ears for comparison. There was such

a stark difference between Dr. Laura's ears and the girl's

ears! Whereas the girl's ears were dark drown, Dr. Laura's

were completely clear and light and I could actually see her

tympanic membrane. I was able to check Alice's ears also, and

her tympanic membrane was in clear view as well. That was a

really cool hands on experience for me.

Another cool close-up experience I had this week was watching

an ultrasound being administered on a 6 month old baby with an

abnormal neck mass. Everyone was clustered around the

ultrasound monitor and with 4 doctors huddled around, there

was a lot of mumbling and hypothesizing and debating about

what the neck mass was or whether it was attached to anything

concerning. I watched the blood vessels in the neck open and

close like a fish does while swimming underwater, and the

consensus was open ended. All the mother could do was wait

until the child was old enough for surgery or until the neck

mass popped on its own-if it ever would.

Dr. Gross is leaving today; I am going to miss shadowing him

and translating for him. He has done so much in his life and

has been all over the world. I knew he was a crazy cool

doctor ever since he told us that he really liked chocolate

covered bees. "They have a nice little crunch," he said. I'm

definitely going to miss him in the clinic. Next week is

going to be a trip; just two doctors instead of three. But I'm

super excited as to what I will see and learn in the next

seven days!

Dawn Journal 4

2008-07-20T14:41:00.001-07:00

15 July – 20 July

I can't believe this is my last entry! Time has flown by—especially because this past week has been rather eventful.

On Tuesday, I got really violently ill and spent the night throwing up everything –including water that I tried to drink. Peggy said that this same sickness had hit a bunch of volunteers a little while ago and that it usually took a few days to recover from. It was pretty awful but I managed to make it into clinic the next day to show Mia around. We spent the next few days getting Mia oriented and by Friday, she was completely in charge and running the show herself.

On Friday, because Mia had triaging under control, I got to shadow the three doctors on their rounds in the ward. It was great to be able to see the rest of the hospital, albeit a bit depressing. All of the equipment (even beds and curtains) seemed to have a thick layer of grime and rust on them. The pediatric ward had cribs that reminded me of rusted prison bars. The patients were upbeat though – I saw mothers with their newborns, a three year old with fractured fingers, a 9 month old with a severe burn on his face, and a 4 year old with a history of seizures.

Mia has also been volunteering at the orphanage with me, and the children seem to really like her. We continue to help them with their schoolwork and reading practice and I've noticed that the children have come to accept their study time as routine. When I first started working with them, there was no defined schedule and they were quick to resist any attempts towards work. Now, they come right down from their nap at 2 and are ready to start working with us. In my opinion, routines are definitely something children need.

Tomorrow I'll start work at La Clinica Esperanza – the clinic that Peggy runs. It'll be interesting to be able to compare the two environments and systems in which things are run. I'm looking forward to the experience.

Anyhow, I've really enjoyed my time here in Roatan and have learned loads. I'm confident that I want to enter the field of medicine (especially pediatrics) and have strengthened my desire to work in international health. Best of luck to Mia (you'll do great!) and the rest of the volunteers.

Dawn Journal 3

2008-07-15T13:32:00.001-07:00

8 July – 14 July 2008

For the past 3 working days, Dr Gross, Dr. Laura, and I have been working at the hospital without Dr. Prado, who went away to a medical conference in Tegucigalpa. There were a few requests from patients that the three of us weren't quite sure how to handle, mostly because we didn't know how the hospital system worked. One poor woman who had arrived at 6am was made to visit three or four different departments, wait for hours, and finally told that there was no medication available for what her baby was sick with (rotavirus). I'd guess that she was probably there for about 6 hours total. Over my time here, I've discovered that it's a bit frustrating to work within a system that has such poor communication and organizational skills. I've also noticed this lack of organization within the patient files. For instance, there's no permanent record of past histories and medicines administered. Whatever happens to be in the patients file (a literal manila file folder) is it. I think a defined system would greatly improve efficiency and quality.

Along with triaging patients, I've been learning loads both from shadowing Dr. Gross and Dr. Laura and from other volunteers. Today for instance, I got to listen to a child's chest that was sick with pneumonia. I happened to know what to do because yesterday, another volunteer had taught me what to listen for, where to press the stethoscope, and how to interpret what I heard. It was really exciting to put that knowledge to work in clinical practice. In addition, Dr. Gross often has me translate for him, and is great at explaining different tests to me. Today he did a full examination of a child that was born at 27 weeks – very prematurely. He explained the various stages of child development and about the different tests that one might to do look for certain milestones. In the middle of the examination, both Dr. Laura and Dr. Prado popped in to take a look. It was great to hear them bouncing ideas off of each other and consulting. Each have varied specialties of knowledge and I appreciate their willingness to be flexible with their diagnoses.

The new Global Healing volunteer, Mia, arrived on Sunday. Peggy and I picked her up from the airport along with another volunteer named Sean. I'll start her orientation on Wednesday so she can get three good days in at the hospital before she's on her own. The new doctors are certainly looking forward to meeting her and I think it'll be a great transition. I can't believe it's my last week working for the hospital! I'll be on the island for a couple more weeks, volunteering with Peggy's clinic, but it definitely seems that time has flown by far faster than expected.

Dawn Journal 2

2008-07-07T18:52:00.002-07:00

The new doctors, Dr. Gross & Dr. Papa. (abrv) have arrived to work in the clinic. Because there are now 3 doctors in the clinic, today was extremely busy – we took in around 32 patients. The waiting hall was absolutely crammed with people—whenever I opened the door to call in another patient to triage, a blast of warm, wet air would hit me in the face. About midway through the day, the power went out for around half an hour, leaving the 4 of us to operate in semi-darkness. In sum though, a very successful day. The new doctors are extremely nice and knowledgeable. They have also brought with them some extra medicines and vitamins, which are much appreciated.

As time has passed, I've gotten much better at refining my triage skills and also at administering fever medications. I'm also able to understand patients requests and explanations much better. Dr. Gross has even asked me to translate for him a few times, which makes me feel my communication skills have improved to some degree. Dra. Prado has also been great at explaining the various diseases and medications that I have questions about. I've been keeping a running tab of the various questions that have come up and am in the midst of creating a cheat-sheet for future interns' reference.

My work at the orphanage has also been coming along nicely. My job is to teach the house's four first graders how to read in Spanish, which has proved to be a daunting task. It's hard to explain why "me" sounds differently in English and Spanish and the children are easily frustrated. I've mostly been concentrating on getting them to sound out letters and figure out consonant combinations. In the end though, I feel like progress is being made. They're slowly improving and are great to play with afterwards.

Lastly, I've found great friendship in a few of the other volunteers here on the island. They are interning in Miss Peggy's clinic, which is across the street from where I live. It's definitely nice to spend time with people, especially those who have great medical stories to tell. We've had a few cooking and traveling adventures together, which has made my off-time very worthwhile.

Dawn Journal 1

2008-06-29T17:57:00.001-07:00

I've just finished my first full week at clinic here – 11 days on the island total. The clinic is what I expected, having heard descriptions from previous interns. The hospital itself is pretty run down, with the electricity going out often and the water running less so. The first days, I learned how to triage patients and enter the appropriate data into the computer. At first, I was nervous that my Spanish wouldn't be good enough—that the patients wouldn't be able to understand me and vice versa. That fear has abated somewhat, as I've picked up the general routine, but sometimes I still feel inept at what I do, due to the language.

With patients, I've noticed that there are a few diagnoses that are quite common. Otitis media, scabies, and internal parasites seem to be popular. I've also noticed that many of the mothers are extremely young. Only a few fathers have accompanied children. During triage, I ask all families where they live and have come to wonder if there is a trend in sickness due to what barrio people come from. Most children are below 50th percentile in weight and height.

After clinic, I have been volunteering at the local orphanage. There are 10 children there and they vary from 2 to 18 years of age. They seem to be well cared for, though the level of discipline is a bit low. I believe this may be due in part to the rapid turnover in administration. The children are friendly and energetic, and I wonder what kinds of effects the lack of a consistent adult figure in their life will have.

In addition to the RVPC, I've gotten to know the island pretty well. So far, I have visited both the western and eastern ends of the islands, hung out at a couple of resorts, snorkeled almost every day, watched a dolphin show, hiked up into La Colonia, and gone SNUBA diving. The other volunteers at Peggy's clinic have been welcome and inviting, which I have appreciated immensely.

This coming week, a new American doctor, Dr. Gross, will be coming to work in the clinic. I look forward to meeting him and possibly shadowing him to see what kinds of thought processes he goes through. More to come soon!

Ileana Journal 5

2008-06-28T10:44:00.000-07:00

My second last week at the clinic was not very eventful because from Tuesday to Thursday the hospital was on strike. Although we relieved some of the patient load from emergency by tending to the non-urgent pediatric cases, we had very few patients to see. On Friday, people must have assumed that the strike was still on, because we only had one patient. The plus side of not having very many patients was that I was able to focus on other things. On Wednesday for example, Dr. Prado and I had time to go to a computer shop to get a quote on the price of a new computer. Lately the clinic computer has been running very slowly and it’s definitely time for a new one. We still have not received approval for the purchase, but I am hoping that we can get it before I leave. This might be tough since I only have one week left.

Having extra time at the clinic gave me the opportunity to discuss Roatan’s public health issues with Dr. Prado, as well as the differences amongst the different ethnic and socioeconomic groups here on the island. Not surprisingly, the biggest concern on the island is a lack of health education and awareness. So next week, we are hopefully going to be visiting some public schools to do some health presentations.

Dr. Prado also taught me a little bit about hypertension in children and showed me how to take blood pressure. I only practiced on her and not on real patients, which was definitely a great idea, because it was more difficult than I imagined. During my lesson I also learned a great deal about stethoscopes and was amazed to hear how sophisticated and expensive they can get.
Another thing Dr. Prado told me about was respiratory distress. As I was triaging a patient and trying to take his temperature with the thermometer, he started crying as babies typically do. Dr. Prado was with another patient, but as soon as she heard the boy crying, she got her stethoscope and listened to his lungs. I was a bit surprised at first, because the mother had not mentioned anything about difficulty breathing. However, as soon as Dr. Prado heard his lungs, she decided to see him right away, so I knew it must have been bad. She later put him on oxygen instead of just using the nebulizer, which I had never seen before. Since I was so confused about this, I had to ask her how she knew there was something wrong with the boy just from hearing him cry. She said that it was not a normal cry and then went on to briefly explain the signs of respiratory distress, its effects and its treatment. The next day a two-month-old was admitted to the E.R. with severe respiratory distress. I did not go see him until he was a bit more stabilized, but even when I saw him, I recognized the signs that Dr. Prado had pointed out and was pretty amazed at how fast he was breathing.

Week six also marked the end of my volunteering at the Sandy Bay Alternative School. My time at the school was interesting as I had not been exposed to such a group of children before. From what I have gathered about the school, it is a private school on the island that follows an American home-schooling curriculum. The advantage for the children is that they are able to socialize with their peers while also influencing the pace of their education. My experience with the children consisted of spending time in the classroom during their summer school program. In the summer, they are given the option to attend the school and so they do not follow a curriculum. The children that do decide to attend (or whose parents decide for them) are all put into the same classroom and do educational activities and exercises together during the day. When I was there, there were about 16 children aged six to 13. I volunteered for two weeks, Monday to Thursday 1-3pm, assisting two of Ms. Peggy’s volunteers whose lesson plans covered global awareness, environmental awareness and general health and nutrition.

Ileana Journal 4

2008-06-09T05:43:00.001-07:00

My fourth week at the clinic just seemed to have flown by. We didn’t have anything too unusual, but things were different because Dr. Rhee was gone and Dr. Prado was also away due to a family emergency. That left only Dr. Srinivasan and the new attending, Dr. Kuhl. Things went rather smoothly though, with none of the children needing to be admitted. On Monday, the highlight of the day was when I watched Dr. Kuhl lance a post-varicela abscess on an 18-month-old boy’s bottom. The boy had come in on the Friday and Dr. Rhee had prescribed him some antibiotics hoping the abscess would get smaller so that it wouldn’t have to be lanced, but they hadn’t helped. By Monday it had gotten so bad that the poor little boy couldn’t walk or sit down comfortably. The interesting thing about it was that with Dr. Prado gone we didn’t quite know where things were. I had to go to the E.R. to get a surgical blade and the doctors searched the clinic looking for gauze, iodine and bandages. We eventually managed to find the rest of the supplies at the clinic, but unfortunately, we didn’t have any anaesthetic. I had never seen an abscess be drained before so although I expected to see a lot of pus, I didn’t think it’d be so bloody. The boy took it really well though, he cried and screamed, but didn’t kick or squirm much. The rest of the week went by pretty steadily, and we managed to get out early a few times. On Friday, Dr. Srinivasan showed me an ear infection, so I was pretty happy about that.

Outside of the clinic, I didn’t do too much. On Tuesday I went to a yoga class at Land’s End with some of Peggy’s volunteers. It was very nice because we could see the sun setting on the ocean and hear the sound of the waves crashing, as we did yoga. I think we’ll return again this week. I am now living with two of Peggy’s volunteers in another apartment at the White Diamond. I am very happy with it.

On Wednesday the bad weather started on the island and I saw rain for the first time since I have been here. The rain didn’t stop until Sunday and the cloudiness and strong winds are expected to stay until Tuesday. Even though I had plans to go hiking at the Carambola Botanical Gardens on Friday and go on the glass-bottom boat in West Bay on Sunday, I wasn’t able to do so. I’m really hoping the weather clears up next week.

Ileana Journal 3

2008-06-02T10:12:00.000-07:00

It seems like every week in Roatan keeps getting better. Week 3 at the clinic was a bit busier, but by now I’ve really got myself into a routine. Overall the week was normal but like always there were a few interesting stories.
At the beginning of the week we had an 18 month old come in with a 103F fever. I told Dr. Srinivasan right away because it was the highest fever I had yet seen. He told me I could give the boy Motrin while he waited, so I was able to do that with a syringe. I had never given medicine to a child with a syringe before and at first I was a bit nervous. I didn’t know how quickly to push it and was worried that I’d give him too much medicine at once. It ended up being really easy though and the boy seemed to really enjoy it because it was bubblegum flavoured. After Dr. Srinivasan saw him, he decided to admit him because he looked a bit lethargic, which I learned is not very good in medical terms. The next day when I came in, I was told that his condition had worsened overnight and that he had passed away. It was a big shock because although he had looked sick, it didn’t look like he was dying. It upset me a bit because just the day before I had given the boy medicine and I remembered him so vividly because of that. I was able to accept his death though because I realized that sometimes things like that happen. I did the best I could by giving him medicine and Dr. Srinivasan did the best he could by admitting him.
On a lighter note, I got to use a stethoscope last week! I listened to my heartbeat, which is normal, listened to a murmur, which sounded very different and also listened to an asthmatic child’s breathing, which sounds normal without a stethoscope but actually has wheezing when you listen to the lungs through a stethoscope. Dr. Srinivasan also let me look inside his ear so that I could see a healthy ear and eventually I’ll be able to see what an ear infection looks like.

On Friday we had a child come in for his 10 day check-up who had hyperbilirubin. Dr. Rhee needed to take some blood out to have blood tests done, but since the baby was actually only 9 days old it was very difficult. The doctors had me put my finger in the baby’s mouth so that he could suck on it while they tried to draw the blood. It was amazing to see blood coming out of such a small child. They weren’t able to get all the blood they needed, but I think they got enough to do the tests.

Other than patient cases, the other exciting news in the clinic was that we got air conditioning! Ever since I got here the clinic had been too hot to be able to work comfortably in it. Even the patients would complain because the clinic was hotter than the hallway outside where they wait. Now that we have air conditioning, I’m sure things will be a lot more comfortable. Since Dr. Rhee worked on getting the air conditioner approved, he thought it should be named David, after him. Everyone had agreed to it, but then Dr. Prado thought it should be named Lidia after her, since she was the one that arranged for it to be delivered to the island and picked it up and arranged the installation. As of now it remains unnamed.
Friday was Dr. Rhee’s last day so Dr. Srinivasan and I went out for dinner with him to the Lighthouse. It’s Dr. Rhee’s favourite restaurant in Roatan and I can see why. The ambience was great, the breeze outside was very nice and the food was delicious! We were all so full afterwards that we had to sit there for a while before getting up to leave.

On Saturday, two of Peggy’s volunteers decided to rent a truck for the day, and they invited three of Peggy’s other volunteers and myself to join them on an excursion around the island. I got to see how beautiful the island really is. We went to Oakridge and then took a water taxi to the mangroves and to the Hole in the Wall restaurant. It was a very great experience. We then went to Paya Bay beach, it’s so far off the main road that hardly anybody goes there, but it’s absolutely gorgeous! On Sunday we went to West Bay again and we went snorkelling. The reef is so beautiful and so close to shore! I saw a lot of nice, colourful fish, and luckily no sting rays or other strange creatures!

Ileana Journal 2

2008-05-23T11:13:00.001-07:00

The second week at the clinic was busier than the first and a bit more eventful. Instead of having seven to 14 patients each day, we had 14 to 27. It was a lot more difficult to triage the patients quickly enough. The doctors would often find themselves waiting for me to triage before they could see a patient. With three doctors working at once, it’s hard to keep up with them. There were a few families that needed two or three children seen together, so even if I triaged three of them, one doctor would take them and the other two would have to wait for me to get to the other patients. There were also a lot of young babies which meant that the whole process of taking their weight took longer than that of older children, since babies first have to be undressed to be weighed and then dressed again. (It’s very important that babies be weighed without their clothes on in order to get the most accurate measure.)

We had a few interesting cases, one child with dextrocardia at the beginning of the week (that’s when their heart points towards the right instead of the left side) and at the end of the week another child had dextrocardia and situs inversus, which means that all of their organs are reversed. Although those cases were interesting to hear about, I wasn’t able to see the rare conditions myself since the children showed no external signs. However, there was one child that came in at the end of the week with hydrocephalus. He came to the clinic because he had fallen and had a sore tailbone, but I was still able to see that his head was very large in comparison to the rest of his body. At first I was a bit shocked, but the child was actually so cute and well-behaved that I couldn’t help but think he was adorable!

On Wednesday we had a lunch-and-learn led by Dr. Srinivasan. He gave a very informative presentation on PALS (Pediatric Advanced Life Support). A few nurses and most of the social service doctors attended it. In Honduras, after students complete medical school, they have to perform social service in high-need communities before they can become fully licensed. Since the social service doctors do not have much hands-on experience, it’s important for them to attend the talks in order to know what to do in certain situations. The PALS presentation was especially useful because when the doctors learn about life support in medical school, there is no special emphasis on pediatrics, and there are indeed some key differences between children and adults. Overall, I’ve already learned a lot during these past two weeks and can’t wait to keep learning more.

Outside of the clinic, I haven’t been doing too much. I’ve started going to the beach in West End in the afternoon for a couple of hours until sunset; I find it’s a really nice place to read a book. I also gave scuba diving another try, but I think it’s fair to say I failed. I was on the boat, all ready to go, but I was too scared to lean back to fall into the water. I was just way too scared to fall backwards! I had a lovely time snorkelling though and have decided that that will be my new hobby. On Saturday, Peggy’s new volunteers arrived, so we all went to the Rotisserie chicken place for dinner. Then on Sunday I went to West Bay with three of the new volunteers. It’s great to have more girls around and we all seem to get along very well.

Ileana Journal 1

2008-05-16T16:25:00.001-07:00

Week one in Roatan has been filled with so many new experiences. It’s hard to even know where to begin but I will focus on the clinic since that’s the reason why I’m here. Not having much of a science background I was somewhat worried that it would take me a while to adjust to the clinic environment. Fortunately Rose trained me well, and I found the triage process to be straight-forward and easy to follow: greet the patient and their mother or guardian (I say mother because I have yet to see a father come in, and guardian because many times it’s not the mother bringing the patient in but a sister, grandmother or aunt), then I get them to have a seat, I ask about the child’s symptoms and write them down in the patient file in Spanish. I then take the patient’s temperature, height and weight, and tell them to wait outside. After this I have time to look words up in the Spanish-English Medical dictionary if necessary, plot the patient’s height and weight on a growth chart, and enter the information on the Global Healing spreadsheet and on a hospital sheet. During this time the doctors are usually on rounds where they do newborn check-ups, so it works out well because it allows me to get a head start before they get back. On Tuesday I got to go with them on their rounds, but unfortunately there were no newborns to be seen. Nonetheless it was a great experience, because I got to see some other parts of the hospital. It was definitely eye-opening since the only hospitals I had been to before were certainly not public hospitals in a developing country.
Right now I’m working with Dr. Lidia Prado, who is the Honduran doctor in the clinic, as well as Dr. David Rhee, who is from New York and is the attending pediatrician, and Dr. Sush Srinivasan who is finishing his residency in Michigan. I really couldn’t have asked for better doctors to work with. They’re all very friendly and I’ve already learned a lot from them. Lidia helps all of us translate from English to Spanish and corrects our spelling and grammatical errors. She even threatened to start grading our work, but Drs. Rhee and Srinivasan vetoed the idea. Despite their discomfort with the language, I think their Spanish is great and they’ve proven to be quite capable of communicating with patients. They often want to double-check that they’ve understood the patients, and that the patients have understood them, so they’ll get me to translate for them. It’s been a great opportunity for me because I get to learn more about the cases and the diagnoses. The mothers will often use that time as an opportunity to ask more questions that they hadn’t thought of or to clarify things that they didn’t completely understand. I find it very reassuring when they do this, because it shows that they’re concerned about their child’s health.

I’ve learned already that it’s very important to make the patients feel comfortable. I’m still working on trying to calm the kids down when I take their temperature or their height and weight. I was surprised at how many of them start screaming or crying. The doctors seem to have figured out their own techniques to calm kids down, so I might have to ask them for tips. It’s been so long since I’ve been around children, that I’ve forgotten the nuances involved in dealing with children. I think I’ve done a good job at communicating with the mothers though. I make sure to say good morning and to smile a lot. I also think it’s important to keep a straight face at times when listening to the information they’re providing. I’ve overcome my feelings of shock at mothers not quite remembering their child’s birth date or mixing up the birth year. In North America, birthdays are a big deal. I’m also getting used to hearing about children vomiting or excreting worms, and I’m also becoming accustomed to seeing some of their rashes and sores.
Besides spending time at the clinic I’ve also begun exploring the island a bit. I’ve really only gotten as far as West Bay though and have spent most of my time in West End. Despite my various efforts to keep occupied, homesickness seems to come and go and sometimes staying busy is hard to do. On Saturday I decided to give scuba diving a try, but it’s proving to be more difficult than I expected. I think the problem might be that I simply don’t like being underwater. Drs. Rhee and Srinivasan are encouraging me to keep going with it, especially since I have yet to do an open water dive. So far I have only done confined water safety skills which I did not enjoy. Other than diving I’ve also gone to West Bay beach and have enjoyed quite a few meals out in West End. So far the food here has been great and the abundance of kidney beans suits my vegetarianism rather well.

Rose Journal 6

2008-04-28T03:42:00.000-07:00

It's been a pretty uneventful week at clinic. Monday Esteban was sick so Dr. Sabio was seeing patients on his own. The nurses tried to give us thirty charts but we had to tell them that there was no possible way we could see that many patients with just one doctor. I felt bad having to do so, but it would have been impossible for us to tend to that many patients and give them all a proper level of care. They ended up deferring those kids to other clinics, so at least they got seen by someone. Dr. Sabio saw around eighteen kids single-handedly and we ended up being at clinic until around two o'clock.

Tuesday was yet another feriago (holiday) and the clinic was closed. Apparently the holiday was to commemorate the British coming to Roatan centuries ago. It was kind of a nice surprise to have a day off as I didn't hear about it until right before I left on Monday. I was able to catch up on my sleep a bit and spend some time over in West Bay, marvelling at how gorgeous this island is.

Wednesday was pretty non-eventful. There were all the usual case of gripe, diarrhea, scabies, and intestinal parasites. There was also a kid with a fractured leg and another with trauma to a finger on their left hand. Elsa did a lot of triaging that day which gave me a change to observe a little bit. It's been really nice to have Elsa around because she is so eager to help out and I think her triaging is more effective than mine because, of course, she is a native Spanish speaker.

Lidia finally returned to work after her surgery on Thursday, which was so great! It was difficult to have new doctors in the clinic without here because they were always asking questions about the inner workings of the hospital that I had no idea how to answer. So Thursday Dr. Sabio, Esteban, and Lidia were all working and things went really fast. I could hardly triage fast enough to keep up with them. We only saw seventeen patients and were done with clinic by noon.

Friday was a bit more interesting. We admitted two little girls, one to the hospital and one to the emergency room. The girl we admitted to the hospital had a giant abscess and an awful ear infection. The little girl that went to the emergency room was suffering from a high fever and seizures. It was incredible to watch the family that brought her in. There was five of them in all: her brother, mother, two aunts, and father. They were all so concerned it was heartbreaking. Lidia had gone into another part of the hospital for a minute and when she started seizing they ran over to my desk with her, shouting frantically. I have so much sympathy for anyone that has to watch their loved one have seizures. No matter how many times I've seen a grand mal seizure it's always equally as terrifying.

So that pretty much sums up my seventh week here. I can't believe I've been here that long! Hopefully this weekend I'll be leaving the island for the first time since I got here and sailing on a catamaran with some friends. I'm really excited for that, I hear it's a lot of fun!

Rose Journal 5

2008-04-19T01:12:00.001-07:00

Another BUSY week at clinic #12!

Ever since Dr. Sabio and Esteban arrived we have been seeing more than our usual amount of patients, very steadily. No more early days where we have very few patients and get out before noon! I think that this is partly to do with the fact that our current doctors ask just about everyone that comes through here to come back to the clinic. They are very thorough. It's kind of nice to see the familiar faces of returning patients everyday.

Monday was a holiday, which I did not know about until the Sunday before so I was nicely surprised. It was apparently Day of the Americas, something I had never heard of before. When I tried asking several people about it they all told me they had no idea what was supposed to happen on this holiday. Perhaps it's just an excuse to take off school and work. Either way, I enjoyed it very much and spent the day catching up on sleep and school work.

Tuesday and Wednesday were long days, with lots of patients and many complicated, time consuming cases. This included a kid with a possible case of Tuberculosis that needed a chest x-ray and a child with very severe sickle cell anemia. There was also a sweet little boy that had such a bad case of lymphadenitis that he had to be admitted to the hospital. Apparently he had been on antibiotics for three days and the thing was growing, not shrinking. One really interesting thing about that boy was that eleven years old he was hardly 29 pounds and not quite up to my waist in height!

Elsa taught lectures on Tuesday and Thursday to a group of nurses and even a doctor. The lectures presented all sorts of general information on how to educate patients with diabetes. About eighteen people in total showed up and as far as I can tell, they were a success.

Thursday was a national strike day which, of course, included the hospital workers. Apparently farmers, teachers, and all sorts of other employees nationwide were striking for more funding and benefits from the government. During clinic I could hear people shouting into megaphones outside my window, although I could never really decipher exactly what they were saying. The strike of course meant that the clinic was really quiet and we saw only patients. The bad thing about the strike is that it makes it impossible to get patients charts and as a result, the examining sheets from that day will never make it into their records.

Everything returned to it's normal busyness on Friday. We saw around 20 patients, all with fairly common and treatable illnesses. We had quite a few ten day check-ups and almost all the babies seemed in good health. Unfortunately a one month old girl also came in with a heart murmur that we had to refer to Tegucigalpa. However I also saw probably the cutest baby I have ever seen at clinic today and that cheered me up quite a bit.

This weekend I plan to do a lot of nothing and hang out at the beach. I have reached the last month of my stay and it's strange to think that I only have four more weekends here!

Rose Journal 4

2008-04-19T01:11:00.000-07:00

It is interesting to think of my weeks here broken down in numbers like this: journal entry #1,#2, etc. It makes my time here seem all that much shorter. Lately the days have become so busy that I hardly have any time to think! For some reason clinic hours have been really long, and I usually end up staying at the hospital until at least 1:30 every day. I think perhaps this team of doctors is slightly more methodical.

This week has been sweltering hot and the clinic remains to be one of the only offices in the hospital without air conditioning. It is a relief to step out into the relative cool of the hallway. I just looked up the weather on Yahoo and it told me that it was currently 86 degrees Fahrenheit in Roatan... yeah right! It's at least 95 degrees in the shade.

We've referred a lot of patients to the emergency room and surgery this week. One little girl had a foreign object so firmly lodged in her nose that one of the doctors caused some accidental trauma trying to remove it. A baby went to the ER for a serious case of croup and different respiratory problems. Three patients were referred to Dr. Sanchez for surgery: one for a herniated groin, one for frenum of the tongue, and another for a one centimeter ball growth on the penis. We also sent a little boy to La Ceiba to get an echo.

This week Esteban's father, Dr.Gershanik, and his Nurse Practitioner, Yakelis Anzola have been lecturing the nurses and Social Service doctors on neonatal resuscitation. I think it's quite interesting to them that babies who would still be in incubators back in the states are allowed to go home here. A few days ago we had an premature infant that weighed just 1.7 kg come into the clinic for a check-up. The baby was so tiny, but fully able to breastfeed! A less successful story is that of a preemie currently in the emergency room. It was 2 pounds at birth but had dropped down to 1 and was admitted, severely malnourished and dehydrated. Yakelis was able to get an IV going yesterday but it fell out during the night and because the baby was without IV for several hours, it dropped back into it's previous state. Hopefully they will be able to find a vein again but doing so is incredibly difficult because of the infant's small size.

Friday morning we were met with a giant stack of charts as both Dr. Jackie and the Cuban doctor were out today. We've never seen so many patients on a Friday! In fact, the whole week has been steadily busy. One patient of interest on Friday was a four year old boy that had been dropped on his head while he was an infant. He had petit mal seizures and was also microcephalic. His development was really delayed and he appeared to not speak more than a few words. It's so sad to see a kid like that who just doesn't get the care he needs. We were referring him to a neurologist in San Pedro, but who knows if he'll actually end up going.

On a brighter note we've seen so many happy and healthy children through the clinic this week, just getting routine check-ups. On Friday we had almost entirely little girls, including a set of 9 month year old twins that were absolutely gorgeous. There's nothing better to cheer you up than holding a plump, healthy, giggling, slobbery baby

Rose Journal 3

2008-03-31T10:55:00.002-08:00

It was fabulous having Semana Santa off from work, and I spent a lot of time on the beach. The enormous influx of vacationers that come for the week before easter is amazing. West End turned into an entirely different place and the prices at restaurants and for water taxis sky-rocketed. One of my friends from the States visited, and I showed him all over the island. I also spent lots of time snorkling and eating very, very well.

The clinic opened Monday for the first time since Semana Santa. We were fairly busy, but not to the level I had expected. I'm not sure what I was expecting (perhaps a flood of people or a swarm, like locusts?) but the week ended up being fairly normal and only a little bit busy. Monday we saw our usual array of scabies, gripe, and ear infections. Tuesday was not too much more exciting. Wednesday was an altogether different day, at least for me. I got violently ill for the first time ever while traveling and spent the entire day at home in absolute misery. I think the culprit was the hospital cafeteria lettuce that I had eaten the day before. Rebecca and Lidia did a wonderful job triaging without me, though, and apparently the day went on sin mi. Rebecca also did a presentation on fluids that day and Lidia drove all the way to French Harbor to buy nachos for the social service doctors.

Friday was Rebecca's last day in the clinic, a very sad day for Lidia and me. She was a fantastic attending and working with her every day was great. She made sure to show me points of interest, including her own ear when she contracted an ear infection. Lidia, Rebecca, and I all went out to pizza at Bella Napoli's to commemorate the occasion.

Friday also brought drama concerning my visa. It had been my understanding that visas in Honduras were good for 90 days, or at least that you were legally allowed that amount of time. however, when I had come through customs last month they only gave me 30 days. Looking at my passport I could see no indication of this time limit and decided that I might be okay without renewing it. Luckily, Lidia encouraged me to go into Immigration and talk to them, because, when we went, they informed me that if I had waited any longer I would have had to pay a 1,600 Lempira fine. Instead, I had to pay $40 to extend the visa for two more months. Lidia always keeps me out of trouble.

Saturday Alice and Howard flew in and took all the clinic folks out to dinner at the Argentinian Grill. The new attending, Dr. Sabio and his wife were also there. They seem really great and I look forward to working with them next week. Dr. Sabio is a native Spanish speaker which is absolutely essential when seeing patients in the clinic.

Rose Journal #2

2008-03-15T09:26:00.001-08:00

This week proved to be much busier than last week. On Monday we probably saw close to thirty patients between the two doctors. Tuesday was nearly that busy as well. I find the feeling of working in the clinic with two doctors much better than with just one as it was last week. There's much more for me to do and I don't find myself sitting around while the doctor is seeing patients. It was really great to have Rebbecca back and in the clinic. She is really an amazing new doctor and works so wonderfully with children. It's great to observe her and see how easily she gains the trust of her patients. I can tell that she truly loves being a pediatrician. She is also extremely helpful to someone like me who is interested in becoming a doctor. I ask her questions all day and she never seems to tire of answering them, despite how silly they might be.

We had a couple of noteworthy patients this week. The first was eight year old boy with a giant abscess on the top of his head, exactly the size and shape of an egg. The poor guy kind of resembled a cartoon character. I watched as Lidia and Rebbecca worked to drain it and was amazed and just a little grossed out about how much pus and liquid came out of it! The second patient of interest was a very premature baby (Rhoany Collins' baby) that was coming in for the second time to get checked-up. She weighed barely three pounds, but that was a huge improvement from the last time she was in. It was amazing to me to see a creature so small (was she really human?) and I instantly fell in love with her. Even though she was so tiny had strength in those miniature limbs, as I found out when she grabbed onto my finger. The mom seemed really receptive to all of our medical advice and I felt hopeful that the little girl would grow up to be healthy. The third patient was also a baby girl, coming in for a check-up. Everything about her was healthy, but there was another reason she came in that day. The mom had come in have stitches on the sides of both of the little girl's hands taken out. Apparently the girl had extra digits on both hands that were surgically removed after she was born. I helped Rebbecca take them out, which proved kind of difficult. The mom had waited much too long to take them out and they were buried under a thin layer of new skin. Eventually Rebbecca managed to get them out and we sent the little girl home, with only five fingers on each hand.

Next week the clinic is closed for Semana Santa and I look forward to having some time to relax on the beach. My friend Lindsay is coming down and I can't wait to show them around. I feel like I'm already getting really familiar with the island. I won't write a journal entry for next week because I won't be at the clinic at all. Hopefully it won't be too crazy what with Spring Break and the holiday. I expect taxis to be more expensive and tourists to be everywhere!

Rose Journal 1

2008-03-08T16:53:00.001-08:00

So here concludes my first week. I was excited to quickly find out that my position here is not just observing but that I am able to interact with the patients and do my share. I don't think I knew quite what I was getting into when I signed up for this program so I am happily surprised to see how much I am actually able to do and learn here. All this week the only doctor has been Dr. Lydia which has given me a nice slow start to get used to doing triage. Maybe, too slow at times as right now I am taking a spare minute at the clinic to write this journal entry! I have settled into the job quite easily and feel fully ready for next week when Rebbecca gets back and the number of patients coming into our office is sure to double.

This week there was a strike Monday through Wednesday. Basically the only people still working were all the doctors and nurses as it was the secretaries, maids, etc. that were striking. I got the lovely experience of trying to triage people and keep track of their data without charts. The hardest part about it was probably making sure that the patients that needed to be seen got into the office as there was really no way of keeping track of it. You just had to stick your head out the door and say "next" (in Spanish of course). Our number of patients those three days was very low because no one wanted to come to the hospital when there was a strike going on. I think on Tuesday we only had two, total, one of whom was "no contesta". It was sad to see how little people were getting care because of the strike and it is my hope that the people who didn't come here went to Clinica Esperanza.

I've learned a few cool things this week. Lydia taught me how to hook up a kid to a nebulizer (easy but I'd never done it before) and showed me about the importance of having accurate growth charts. I see newborns almost every day, most of them healthy, which always makes me smile. I'm also getting the hang of deciphering patient's symptoms in Spanish. They usually all have similar symptoms and I've learned the words gripe and calentura. I'm also getting the hang of all the abbreviations in Spanish. For example, a urinary tract infection (UTI) is an IVU and an upper respiratory infection (URI) is an IRU.

I also had the opportunity to go to the local daycare with Lydia and assist with check-ups there. The kids were not too excited to interrupt their play time to get measured, weighed, and... well you know fully examined... but Lydia has a certain charisma with children and the check-ups went well. While Lydia was doing certain parts of the examinations she closed the door for privacy and I had a chance to interact with the kids and watch the women that work there do their best to keep the rowdy ones under control. It was actually amazing to watch them preside over the children, handling every dispute with a few quick words.

This weekend I plan to explore the island a bit more and hopefully visit my friend in Punta Gorda. I am finishing up this journal entry back at Peggy's house and over the course of the night a storm blew in. The waves splash right up to the stairs of her house and the wind is deafening. All the laundry was blown off the line and into the storm. I sit in awe, watching the waves and the amazing power that they possess.

Becky Journal 7

2008-03-08T16:48:00.001-08:00

We just finished another crazy week, and next week the clinic will only have half as many people working there, as TJ and the Grubers are going home this weekend. On Monday, we had a record 38 patients in the morning, which just added to thecraziness, as we were starting the ultrasound course. The course has been a huge success, and the ultrasound technician and radiologist have been able to provide many free and needed ultrasouds to the people here, in addition to teaching the doctors how to use the ultrasound machine. The baby with dehydration was sent home on Wednesday, at 1.6kg, so she finally gained some weight. She looked so much better too…I took a picture of her a few days before she left the hospital and compared it to the picture we had of the first day she came in, and you can’t even tell it’s the same baby…pretty incredible. The patient load the rest of the week has been pretty moderate, and since we have four doctors working, we always seem to get through all of the patients quickly.

On Wednesday we all went out to dinner and then went out on the dock and watched the entire lunar eclipse, which was absolutely spectacular in a place where there is little light pollution. Thursday after clinic, Dr. Patrick and I went to a meeting with a man named Clinton Everett, who used to be the governor of Cayos Cochinos and is still very important there. We discussed the prospect of setting up a clinic there that would be staffed by a physician once a month, just for about a weekend or so every month. There is a desperate need for medical care on the islands, and it seems like something we may realistically be able to provide. We are arranging for a trip out there next weekend, so we can go and talk to the Patronados of the island and truly assess what would be needed.

Friday was not too busy in clinic, but a very sick 2 year child came into the ER, and I am still unsure of what will happen with her. This child presented to the ER in respiratory distress, which had started about 2 days ago, and they could not figure out what was wrong with her. They thought it may have been an obstruction in the upper airway, but there was really no way to figure it out. They started her on all kinds of treatments and antibiotics, but after the whole morning she had still not improved at all. The scariest part is that if her body tires out, which is not unlikely, then she will have to be intubated, and there is no question that the public hospital is a bad place to be if you have to be intubated. They have the supplies for intubation, but as I have seen before, they have no vents, and so intubated patients have to be bagged by hand the entire time, and who knows how long that would be for. I really hope she starts to turn around and improve soon.

Next week the new Global Healing intern comes as well, and I will start orienting her. There is talk of karaoke tonight with Lydia, the other Global Healing docs, and some other doctors from the hospital, which could definitely be a good time. I have been here for over three and a half months now, which means I am more than halfway through my stay here. It is really hard to believe, and it’s scary to think that in three and a half more months im going to be in med school…crazy. Anyway, power is out again (it’s been a regular thing lately) so I need to go before the computer battery dies, and hopefully internet will be back soon so I can email this out.

Becky Journal 6

2008-02-07T20:33:00.000-08:00

I will be away this weekend (in Cayos Cochinos!) so it is Thursday night, and I am doing my journal entry a little early.
So this week the two new doctors started, and things have been going really well. Lydia left for the mainland on Wednesday, but she had the first two days to orient the two new doctors. On Wednesday night we all went over to West Bay, where one of Peggy’s volunteers is staying in a beachfront condo, and had a big party over there, which was really fun. It’s been so nice for me that Global Healing and Clinica Esperanza have such a close relationship since I have been working with both…almost every day the Global Healing doctors and Peggy’s volunteers all hang out together.

We started out on Monday with a really busy day, and I felt kind of bad for the new doctors, who must have been overwhelmed. We had 34 patients, which is the most that we have had since I started here. The rest of the week had an average patient load though, so things slowed down. This has been a busy week for me, because after clinic, I have been going over to Peggy’s every afternoon. I am organizing a trip to Cayos Cochinos this weekend, where me and 3 other volunteers from Peggy’s are taking a sailboat over for the weekend and doing a medical brigade. I’m really excited about this trip…the island is supposed to be really small, with no water or electricity. I had already organized a health screening up in the Colonia, but this brigade requires a lot more work, because we are bringing medications as well.

There was one really disappointing event this weekend…the mother of the baby that had come in at 1.2 kg with dehydration apparently signed out AMA yesterday and took the baby home, telling them she would come back today to get her weighed. She showed up at our clinic this morning and asked us to weigh her baby, which I did, and the baby still weighs only 1.3kg, and is in no shape to be at home. I persuaded her to talk with Dr. Cronin before she left for home again, and thankfully Dr. Cronin persuaded her to stay in the hospital today. Hopefully it will last, because the mom kept saying that she did not want to be in the hospital anymore, and this is exactly the sort of case that could end up really badly if we do not stay on top of it.
Anyway, I have to go (it’s Thursday night, so it’s time for the crab races), but hopefully I will have a lot to report next week about my weekend trip. Also, the Grubers and our other resident are coming this weekend, so there should be lots of excitement next week!

Becky Journal 5

2008-02-03T20:32:00.000-08:00

This week went by so quickly, and Andrea just left yesterday. I can’t believe that I have already been here for three months…it feels like I only got here a couple of weeks ago. It’s really weird having Andrea gone, but TJ came in yesterday, and he seems really nice, and I am on my way out to go meet the new attending, Becca. This week was pretty uneventful, and things were slower in the clinic since there is a new Cuban pediatrician that just opened up another pediatric outpatient clinic. It was good that things were a little bit slower, though, because Dr. Gross was gone, so it was just Andrea and Lydia. Our dehydrated, malnourished baby was doing better this week. We weighed her again and by Friday, she still only weighed 1.2kg, which is what she weighed when she first came in, but she still looks a lot better. She is now tolerating 10cc of fluid at a time, which is great. I am amazed that there is no scale in the pediatric area, at least no infant scale. They weigh the babies on a normal full size scale, which definitely doesn’t help when you are trying to see a difference of a few grams. We have been bringing in the scale from our clinic every day, and we are working on trying to get one donated.

On another note, I have been working with Peggy when I get out of the hospital, and I just got the amazing news last week that my fire department back home is donating 3 AEDs to Clinica Esperanza, along with a whole bunch of other medical supplies. There is only one AED on the island, so this will be really helpful. This coming week will be very busy, with the new doctors. I will also be doing a bunch of planning and organization in the afternoons, as I am going with a few doctors from Peggy’s to Cayos Cochinos next weekend, where we are going to set up a medical brigade for two days. I am really excited about that, as Cayos is supposed to be gorgeous, and apparently there is pretty much no medical care now. Anyway, the new Global Healing docs are waiting for me for dinner, so I need to go, but this should be a great week!

Becky Journal 4

2008-01-26T20:36:00.000-08:00

So this week has been going kind of slow, since the weather has been really nasty and rainy. On Monday, I saw the most malnourished baby that I have ever seen…definitely the sickest baby I have ever seen that has not been in the NICU. A mom brought in her 12 day old for a well baby check. She said the baby was born premature, at somewhere between 32-34 weeks, and was kept in the hospital for 2 days. She went to unwrap the baby, and I hae seen a lot, and it takes a lot to shock me, but I was absolutely shocked at the sight of this baby. It was tiny, with arms and legs skinnier than a pencil. It’s skin was all shriveled up, and it’s face looked like an old person…it almost looked like a mummy. I couldn’t believe this baby was still alive. I asked the mom if there were any problems, and she replied that there weren’t and that the baby was breastfeeding just fine. We undressed the baby, and I was honestly afraid to pick up this baby and put it on the scale, because I was afraid I would hurt her if I moved her. We put her on the scale, and she weighed 1.2 kilograms. She had weighed 1.5kg at birth, meaning she had lost 18% of her birthweight, which was already really low. Andrea saw her right away, and told the mom that she needed to be admitted. At first the mother refused, but Andrea told her flat out that the baby would die if she went home and continued like this. Both Dr. Gross and Andrea agreed that the baby should be in a NICU, but since no such thing exists here, they put her in an incubator in the pediatric ward. They wanted to give her an NG tube to get nutrition, but were unable to. Apparently the baby was so tiny that when they put the tube in, the baby became apneic, due to the tiny size of her tubes. They also tried to put an IV in, but the baby was so tiny and so dehyrated that they could not put one in anywhere. Instead, they ended up trying to syringe feed her orally, which is still what they are doing, until she is hydrated enough that they can get a line in. The most shocking thing about this situation was that the mother had a two year old child as well, but still had no idea that something was drastically wrong with her baby.

On Tuesday, we had a four year old girl come in today with a cyst on her eyelid, which she had for 2 years and which scratched and irritated her eye when she blinked. They were going to try to send her to the mainland to an opthamologist, which of course would be costly, but I remembered Peggy mentioning that she had an opthamologist coming down to her clinic in March. I called Peggy, and ended up taking all of this girl’s information, along with pictures of the eye to send to the opthamologist in the states. Hopefully, it will be something he can fix, and it will save her family a very costly trip to the mainland.

As of Thursday, they still had not put an NG tube into our malnorished baby, who had now been in the hospital for 4 days. Dr. Gross brought our baby scale into the ward, since they don’t have an accurate scale on the ward. He weighed the baby on our scale, and the baby still weighed 1.2 kg, exactly the same she had been 4 days ago. We had Peggy bring over a couple of NG tubes, since they said they didn’t have any at the hospital. That afternoon, Lydia put a tube in the baby, and the baby is already looking better.

Friday was pretty slow, probably because of the rain, and so we finished clinic early and spent time with Dr. Gross. He is leaving this weekend, which is really sad, because he is an amazing doctor and I learned so much from him. We all went out to dinner at Romeos in French Harbor, which was nice for his last Friday night. Next week will just be me, Andrea, and Lydia, so hopefully things won’t be too crazy.

Becky Journal 3

2008-01-23T11:25:00.000-08:00

This week was amazingly productive, and the Global Healing team has been working amazingly well together. The week started out on a sad note as we found out on Monday that the baby we had flown to San Pedro last week had died sometime over the weekend. The news came as a shock to all of us, since as of Friday we had been told that the baby had been placed on a ventilator in the NICU and was stable. We did not get any other information from the hospital in San Pedro, only that the baby had died. It was really dishearteartening, not only because we had worked so hard to help the baby, but because we all believed that this baby was through the toughest part. However, we all knew that we did all that we could have possibly done to make a difference for this baby.

On Monday, the hospital was on strike again, so we played the part of pediatric ER, taking all of the kids who were coming into the ER to be seen. It was pretty much the same as a normal clinic day, except that overall the kids were a little bit sicker. We took advantage of ending early on Monday to go through all of our supplies, inventory, clean, and make lists of needed supplies for the next people coming down. On Tuesday, things were back to normal. Wednesday was a crazy busy day. We had clinic as usual in the morning, and afterward, we had a lecture given by Dr. Dominguez, the orthopoedist. It was very interesting, and he was a great speaker. I was a little bit worried that I wouldn’t be able to understand everything since it was done in Spanish, but the lecture supplemented by power point was very clear and easy to understand. After the lecture, I went right over to Peggy’s clinic, as I had organized a screening up in the Colonia for that afternoon.

We all met at Peggy’s clinic and laded the truck with supplies, and headed up to the church. We weighed and took temperatures on all of the children, and did pressures and sugars on the adults. Then they all got a brief check-in with the doctors, and were given reference cards to come to the clinic if they needed to. I was not at Clinica Esperanza today since I was at the hospital, but apparently lots of people for La Colonia came after going to the screening. This was really encouraging, because after talking to some people in the Colonia, I have realized that many people do not know that Clinica Esperanza is free for those who can not pay. There is one family in the Colonia that I have visited with a few times, and after their screening the mother told me that she knew she should take her kids to the clinic, but she had 5 kids and did not have the money to take them. I told her it was not a problem if she was unable to pay, and her whole face lit up, and gave me a hug. She also told me that her father was sick and she would like to take him to the clinic, but that he was unable to walk down to the screening. I went with her up to the top of the Colonia to do a screening on him, and his pressure ended up being dangerously high. He was advised to go to the clinic the next and promised that he would. It was definitely a satisfying day, which was ended by a night dive in West Bay with Dr. Gross and a few of Peggy’s volunteers.

On Thursday, we were finished clinic by 11, and we all went with Dr. Prado over to the daycare center, where she was going to give de-parasite medication to all of the kids, because apparently a few of them had been vomiting worms. We set up a mini-clinic at the daycare, where we first weighed all of the kids, then calculated medication for each one, and each child got medicated. It was soo different from the US, where I could not imagine what would happen if someone came in and gave all of the kids medicine without parental persmission. The kids were all so good with taking the medication, and we had fun playing with them as well. On Friday, we also went to the daycare after clinic to give the kids their second dose of medication, and got to play with them some more. Then we all went to lunch in Coxen Hole, and went shoppping for fish. Friday night, we helped Dr. Gross cook a big dinner as a send off for a big group of volunteers that had been at Peggy’s clinic. It was a great week, and very productive as well…we have already seen over 200 patients this month! Next week is my last week with Dr. Gross and Andrea, though, which is sad.

Becky Journal 2

2008-01-14T09:10:00.000-08:00

As of this week, Dr. Gross, Dr. Lee, and the new Honduran doctor, Dr. Prado, are all working in the clinic, and things have finally come together. It was a great week this week, and it was a good thing we had so many doctors, because we were really busy. I saw a lot of interesting cases this week, and also got to help out with getting a patient to the mainland, which was amazing. Monday through Wednesday, we had about 25-30 patients each day, so I was kept busy with triage, shadowing, and doing paperwork. We had one case which was a 3 week old baby girl that had supernumery digits hanging off of each of her pinkies, which Dr. Gross removed. I also saw a few abcesses drained, as well as all of the usual cases.

On Tuesday, when Dr. Gross and Dr. Lee came back from rounds, they were talking about a baby with a lung problem whose left lung had not expanded. On Wednesday, they took an x-ray and discovered that the baby’s left lung was either collapsed, filled with fluid, or not opening for another reason. The baby was 5 days old, and although she was breathing spontaneously, her oxygen saturation was very low, so she was being bagged by the nurses. On Wednesday night they got a call that the hospital had a ventilator that they wanted to put the baby on, but they did not know how to use it. We went to the hospitial and the doctors looked at the vent, which was an ancient piece of equipment that they had never seen before, aside from the fact that it was for adults. They determined that there was no way the the vent was usable, so they continued bagging the baby overnight. The baby was only being given IV fluids and no nutrition, and was in very poor shape. Dr. Gross decided that it would be best for the baby to be sent for the mainland. After researcheing, he decided that Cieba did not have the right resources for the child, and so she would have to go farther.

On Thursday during rounds, Dr. Gross talked to Dr. Jackie and got permission to fly the baby out. Around 10, they sent me to the airport to try to arrange a flight. After 3 hectic hours at the airport, I learned that commercial planes did not allow oxygen, and so we arranged for a charter flight to fly the baby to San Pedro. By 12:30, everything was arranged, and I met Dr. Lee and the baby at the airport. Dr. Gross had driven them in her car, with the baby in a small plastic tub, and Dr. Lee ventilating the whole way. The whole experience was pretty surreal. We were rushed through screening at the airport, with Dr. Lee and I holding the tub with the baby, who was being bagged. We then were loaded into a tiny little four person plane, no bigger than the size of a small car. The mom sat up front with the pilot, and Dr. Lee and I sat in the back, with the baby in the tub on our knees. We bagged the baby for the entire hour and a half flight, with Dr. Lee constantly checking the baby’s color and feeling for chest rise. We had no pulse oximeter, and the plane was so loud that she could not hear breath sounds,s o she relied on feeling for chest rise. As soon as we landed at San Pedro airport, there was an ambulance waiting, and they met us at the door. It was very comforting to see an ambulance with 2 paramedics and a doctor, as wel as neonatal equipment, moniters, and pulse oximeters. It made me feel very confident that we were getting this baby to a higher level of care. After getting the baby loaded and giving report, the baby’s mother, who spoke no English, came up to us and said “Bless you”. It was truly amazing. We flew back to Roatan, and still made it home in time for the crab races that night. We called the hospital the next day, and the baby had been put on a vent, but had still not been diagnosed, but we were told that there was a pulmonary neonatologist as well as 3 pediatric surgeons there, so we knew that the baby was in good hands. Dr. Lee is going to call again today to see how things are going. I have helped out with manny individual patient cases since I have been here, but this was definitely the most satisfying case that I have been involved with, as the baby surely would have died if we had not gotten her transferred right away.

Then, for a climactic end to the week, when we all came in on Friday, feeling exhilirated from the day before, there were no patients around, and the workers were all on strike. The doctors did their rounds, and then we decided to do some reorganizing and inventorying in the clinic. However, then a nurse from the ER came over and asked if we could see all of their pediatric cases since they were so busy, so we became the pediatric ER for the rest of the morning. We finished up around noon, and I headed to Peggy’s clinic, as I usually do. Their waiting room was still completely full, because all of the people that would have gone to the hospital ended up there. I called Dr. Gross and Dr. Lee to tell them I would be late for snorkeling, and twenty minutes later they both showed up at Peggy’s, and helped see patients to speed things up. We got finished quickly, and spent the rest of the day relaxing on the beach. Yesterday I went with Dr. Gross, Dr. Lee, and some of Peggy’s volunteers down to the east end of the island to Paya Bay. I had been there before, but it is absolutely gorgeous. We followed that up with a dinner at the view, whicih was a perfect end to a perfectly relazxing day.

Christine Journal 13

2007-12-16T20:01:00.000-08:00

Max and I are in disbelief that this will be our second to last update, but it's been a wonderful past few months and we still have a week left, so we can't get too sad yet.

I had an interesting week in the hospital with Jenn and a social service doctor who is taking over for Dr. Charles as he takes two weeks of vacation time. The new social service doctor is not very communicative, so hasn't been all that helpful with special cases and such, but he's nice enough. It has really emphasized for me how important the Honduran fellow is to provide some kind of continuity and local knowledge to the clinic. Pediatricians coming for a month at a time just really can't do it on their own.

I was happy to see the Global Healing ultrasound put to good use this week. The ultrasound is huge and was donated a couple of months ago. It's been sitting in the corner of the clinic for that time without much use, as no one in the hospital is trained in reading ultrasounds. Additionally, we don't want to move it out of the clinic in case parts (or all) of it get stolen, as happened with the last one, apparently. Howard has been organizing a visit for a couple of radiologists and an ultrasound tech to come down in February and teach local doctors how to use it, which I think will be great. Hopefully then it will be put to good work! Anyway, the surgeon did come by to use it once this week on a woman she believed had gall stones, but she couldn't actually find any in the ultrasound. Jenn also used it twice - once on a boy she wanted to check for an inflamed kidney and another time on a boy's brain.

The second case was pretty interesting. It was a premature baby (born at about 7 months and 1600 grams) who had been in the clinic for weight checks every week since he was born. He was growing very slowly (was 1900 grams this past week), but Jenn was the first doctor to feel his head and realize that his sutures were completely open and his posterior fontanelle was also very large. He presented with a fever of 101.6 degrees, so Jenn wanted to put him on antibiotics and admit him for the fever before we worried about the sutures. She sent him to the ER and went back after about an hour to check on him, only to realize that the ER had not even started the antibiotics because they were "waiting for a bed to free up." She was very angry and frustrated that there seemed to be no thinking outside the box, especially since it should be fairly obvious that the baby needed to be on antibitics asap and could really be put on any surface to do so. Additionally, when the did finally clear out a bed from him, they didn't change the sheets in between patients.

After the antibiotics were administered, we brought the baby back into the clinic and did an ultrasound on the brain. He seems to have pretty severe hydrocephalus, and Jenn was able to send pictures we took of the screen to a neurologist in the US for a consult, which was great. I cannot even imagine how much more difficult international work like this was before the internet...

The hardest part for me of the whole encounter was having to explain to the mom what it was we were doing and that her son would not develop normally, resulting in lower intelligence, decreased motor function, etc. It just all came out of nowhere, since she'd been coming to check-ups with the clinic for a few weeks and no one had caught the hydrocephalus before.

Also this week, I started tutoring a local high school graduate to prepare her for the SAT, as she's hoping to go to the US for college next year. I had taken her to the test in La Ceiba about a month ago, but her scores were not as high as she had hoped, so she'll take it again in January. She's fun to work with and I'm hoping someone else will be able to take over after next week, although I doubt that will be a problem with all the volunteers that come through Peggy's house.

Max Journal 13

2007-12-16T19:55:00.000-08:00

Today is the three-month anniversary of our arrival in Roatan and the beginning of our last week here. I have a lot to reflect on, and hopefully I'll be able to put some more of that into words for my last update at the end of the week.

I spent this week working in Peggy's Clinic, alternating between shadowing Dr. Raymond and running the pharmacy. With Raymond I had the opportunity to look in ears, auscultate lungs, listen for heart murmurs, and palpate abdomens. Working with Dr. Raymond is a great learning experience, but unfortunately I did not feel like I could contribute much to his work. I look forward to learning more about medicine in future study, but right now I am more interested in feeling like I am making a difference using the skills that I already have.

Monday brought a surprising number of bad ear infections with at least one ruptured timpanic membrane – a shocking sight. Tuesday seemed to have a lot of eye injuries, with at least two resulting from construction accidents. Eyes are incredible organs, and contemplating the extraction of small splinters from them is a scary prospect. Raymond mentioned that he looked forward to talking to a meeting of construction contractors to address the lack of effective personal protective equipment (specifically glasses/goggles) used by their employees. Occupational safety has never really sparked my interest, but I am inspired by the wholesome approach that Raymond takes to improving healthcare on the island, and I look forward to being able to use my knowledge and experiences as a professional to influence health-related business practices.

Friday brought another large shipment of mattresses and chairs from the Carnival Legend cruise ship. Despite all of the economic complexity that accompanies cruise ship tourism, I am impressed by Carnival's willingness to donate in bulk to Peggy's clinic. The cruise ship is a glaring symbol of the accomplishments of sophisticated modern technology to provide comfort to the wealthy. It's hard to imagine that this several-hundred million dollar luxury ship can dock within a mile of a public hospital providing primary health care to around 50,000 people without a functioning ventilator, ultrasound machine, CT scan, adequately equipped laboratory, or single narcotic drug. Despite all that glaring inequality, I have to say that the 100 mattresses donated in the last two weeks have been well received.

On Thursday and Friday, I returned to Peggy's clinic to do more of the same pharmacy work. It is reassuring to be able to exercise a practiced skill within the clinic to help people get drugs to make their lives more comfortable. The pharmacy seems to be more organized and effective than it was three months ago, and I hope that it continues to move further in that direction as we develop a more consistent inventory system that will hopefully ensure better stocking of necessary drugs. I was happy to hear that Peggy finally placed an order from one of the drug donation companies that Christine and I applied to on the clinic's behalf. The order supposedly contains tens of thousands of dollars of medications for Peggy's clinic and other medical facilities on the island, at a whopping $465 cost to the clinic simply for shipping and handling. I hope the shipment arrives relatively soon and bears as many drugs as promised.

The tutoring program that we ran at Children's Palace Bilingual School came to a close this week. We administered another diagnostic test and saw modest improvement in all of the tutees' test scores. Overall, I was pretty disappointed by the school's disinterest for the tutoring program. It is not the children's fault that they did not want extra math classes outside of school, but I plan on taking better account of community needs in the future. If nothing else, I enjoyed connecting with the students when they did show up, I had a great time getting to know the other tutors, and I like to think that I imparted a bit of knowledge through my two afternoons each week of teaching basic math. I don't think the kids are worse-off after taking the program, and maybe future tutoring projects can use some of the lessons that we've learned to be much more effective.

Yesterday we had a little goodbye party with food and friends at our apartment, and now we have just five short workdays before our return to the United States. I'll give another reflective update before the end, and I hope all is well as usual back home.

Christine Journal 12

2007-12-09T20:08:00.000-08:00

I was happy to be back in clinic for the end of next week after my trip to the mainland. We were pretty busy, as Dr. Jackie was not in her clinic, but Drs. Jennifer and Sarah were both comfortable with most things, so it went relatively quickly. We did have a little trouble again with Dr. Charles coming in late, and had to figure out on our own how to deal with a child with a 104 degree fever and possible dengue, malaria, bad viral infection, or early stages of appendicitis. After talking with the staff at the lab, I learned that there is no lab for dengue at the public hospital. I have no idea how expensive or complicated it is to test for, but it seems like something they would probably test for often and I was surprised they did not have the equipment to test for it. We were able to get a malaria smear and CBC, though, but the patient never came back with the results. Hopefully the child will be okay.

Sarah left on Friday and Dr. Charles is taking the next couple of weeks as vacation, so it will be me, Jenn, and a social service doctor in the clinic for a while. I hope it all goes smoothly with the new social service doctor.

As Max mentioned, we helped out at the Concert for the Angels on Thursday afternoon. Peggy had brought a number of patients and their families to the event, so we got to hang out with them, which was fun. It was definitely a different side of the island than I'm used to working with and a little bit ridiculous, but it raised a lot of much needed money!

I helped Peggy and some other volunteers clean out the pharmacy shelves on Saturday, and we were able to send a bunch of meds to a doctor working on the mainland. It still amazes me how much Peggy shares with different people, knowing who will need what and getting it to them.

Max Journal 12

2007-12-09T20:07:00.000-08:00

I had a good week full of visitors and business in the clinics. I started the week in Global Healing working with Jen and Charles as Sara wrapped her trip to the mainland. The father of our previous week's ranula patient returned to tell us that his son had been in the Woods Medical Center all weekend being treated with antibiotics. If this is true and the swelling truly went down, then the Global Healing doctor's diagnosis seems unlikely, but we just emphasized the importance of traveling to the mainland for a specialist's attention. I always have to remind myself that some physicians' opinions, put forth with great confidence, are nonetheless wrong.

On Tuesday we had very few patients and I was able to leave the Global Healing clinic early to run some errands. On Tuesday evening Christine returned from a somewhat disappointing trip to the mainland with a patient.

On Wednesday I faced the cruise ship security forces once again to pick up a large donation of used mattresses.

Thursday and Friday I spent in the clinic, doing mostly pharmacy work.

I did my best to coordinate the transportation of three of Peggy's patients to visit an American cardiac brigade in San Pedro Sula. They departed on Saturday morning and I haven't heard from them since they were supposed to have arrived, so I hope that all went well.

On Tuesday afternoon I returned to tutor at the bilingual school and was disappointed that no students came. I was quickly reminded of the uselessness of providing a community service that isn't desired by a community. On Thursday afternoon Christine and I helped set up for a fundraiser in the Roatan airport. The event was a success, and it was humorous to see so many wealthy people putting on fancy shoes in the name of poor islanders' health.

I also dropped an injured bird off at a nature reserve on Peggy's request.

I am getting ready for my departure from this island, and I look forward to a few more quiet days enjoying the scenery before I leave.

Christine Journal 11

2007-12-02T09:48:00.000-08:00

Once again, my update schedule was thrown off this week, as I was traveling until Tuesday night.
I had a wonderful trip with my family and was very happy that I got the opportunity to see the mainland with them. We spent a few days in a lodge at Pico Bonito by La Ceiba. The staff there was all Honduran and we had them pretty much to ourselves, as there weren't any other tourists there, and it was really interesting to spend time with them. Our guide was a native of the Mosquito coast and his knowledge of the rainforest was incredible. It was great to learn from him about all different uses of plants and animals. It just really brings to life the importance of conserving lands that are being cut down so rapidly now.
The trip to El Progreso, take two, was once again a let down. I went with Jessica and Neri, the patient and mother I took about a month ago because of her scratched corneas. The clinic had a visiting plastic surgeon who was going to operate on her eyelids so that her eyelashes no longer scratched against the cornea, but the surgery was canceled when she had a cold and thus couldn't undergo general anesthesia. I really wished someone had warned us about that ahead of time, as it was a long trip for the mother and daughter to make. The clinic said we'd have to wait until the next plastic surgeon came, which could be another six months. They normally get two a year, but don't yet have next year's schedule. Since it's such a time-sensitive procedure, though, I'm hoping to find somewhere else she can go to sooner. It's just really important in the future that we get the patients cleared for surgery by the pediatricians here before we send to the mainland, even if we're not sure that they will get operated on. The clinic was going to have us visit a pediatrician there before the surgery for approval before they realized that Jessica had a cold, which could have been complicated, as we didn't know any doctors there.

It was also interesting to see the clinic's way of charging for surgeries. They take the patient into a private room and go through a number of questions to see the economic state of the patient. For example, they asked whether she owned land or a house, whether she had electricity or running water, and how much she spent a week on food. I was with her at the time, and did say that the clinic would be helping with the price of surgery, but other than that all her answers clearly showed that she didn't have much extra money to spend on the care. The price of the surgery still came out at $150 dollars, clearly way out of her price range. I know that the surgeries are incredibly expensive, but I'm wondering about how patients are able to pay for them. The clinic is a non-profit started by Americans to help poor Hondurans with medical care, and I just found it very surprising that they'd still charge someone like the patient I was with 150 dollars. Maybe it was because I was there, but I really hope that other people who can't afford to pay that much don't get turned away.

Max Journal 11

2007-12-02T09:47:00.000-08:00

I've had a good week here in Roatan, so I hope you've had a good week back in the States. I began the week showing my girlfriend, Maya, the ropes in Peggy's pharmacy, which was fun as it added a slightly "new dimension" to our relationship. Work in the pharmacy is going well, although I am definitely a lot less inspired when I cannot interact with patients every day. Tuesday was another day of working in the pharmacy, and it brought a rude surprise when I realized that I had been entering data wrongly into the computerized inventory system for the last two months. The inventory system is still very new and lacks a few key features (like a way to view the actual inventory of any given drug), but we have been making an effort to accurately input data from every prescription filled for the last few months. When I realized that use of the inventory was very inconsistent, I became a little frustrated at the effort that we had put into the system. Although we will not be able to calculate the inventory of drugs in the pharmacy at any given time, the data for which drugs have been given out over the course of the last few months should still be fairly accurate, so all is not lost, but this error was a bit of a blow. I am realizing now that Peggy's Clinic is in the middle of a very important phase of its development as it formalizes a lot of the systems that it has depended on in the last seven years. Everything from the pharmacy inventory to the clinic's financial bookkeeping is now more important than ever, and where a lot of "under the table" jobs worked fine up until now, those jobs will have to come into the light of day in very transparent ways for the Clinic to continue to grow. I hope that I can help in some of this transition.

From Wednesday until Friday I greatly enjoyed going back to work in the Global Healing Clinic while Christine took a short vacation with her family. The clinic is a lot busier now than it was when I worked there before. For the last two months the clinic has been staffed by just one or two doctors, so the current staffing of three doctors seems very busy. Coincidentally our patient load seems to have increased, so I'm happy that we have so many doctors attending all of these patients. I have also really enjoyed being able to interpret for Sara because that brings me in a lot closer contact with the medical care that our clinic is actually delivering. While it can be a little stressful sometimes to triage all of the patients and translate for Sara, I am constantly reminded of why I came here to Honduras.

One interesting case of the week was a ~1 year old boy that came into the clinic with a ranula. During triage I weighed the boy and was surprised to see that he weighed only 17 lbs because he looked like a big chubby baby, but then I realized that he was not really fat at all, he just had a drastically swollen head and neck. Dr. Jennifer diagnosed the boy as having a blocked sublingual salivary duct that was causing the saliva to build up in the salivary gland and in the tissue around the boy's neck and jaw. I was surprised that the boy had no difficulty breathing, but he was already unable to eat and needed urgent corrective surgery before the condition worsened to block his airway. We sent him to seek care in San Pedro Sula because the hospital surgeon was not comfortable with such an unusual surgery, but I was confident that the patient would get the care he needed because I knew that his father works for the municipality and therefore has "social security," a form of government health insurance. Although I was disappointed that the public health system that cares for the Honduran poor could not solve this patient's problem, I was quickly reminded of how familiar this situation is to the American medical system. I have to acknowledge that although Honduras has a national health system that aims to protect each person's right to medical care, the Honduran government is not really able to guarantee that right. Alongside that I acknowledge that the United States government officially recognizes very few "rights" concerning medical care, despite the fact that the US has many more resources at its disposal than the Honduran Ministry of Health. Of course I recognize a far bit more complexity in the situation than I mention here, but the situation is nonetheless worth verbally acknowledging.

Max Journal 10

2007-11-25T09:45:00.000-08:00

This week has been a bit of a vacation for me as I've had two visitors from the US to entertain. I worked at Peggy's both Monday and Tuesday mostly in the pharmacy filling prescriptions. I'm feeling much more confident in that job as I get to know the organization of the pharmacy and the uses of most of the drugs. I have had a Canadian nurse's aide helping me in the pharmacy, and it has reminded me of how hard it is to utilize short-term unskilled volunteers. She helps me count pills and enter some information in the inventory, but really she mostly just reminds me of how amazing Peggy is to be able to
utilize so many people so graciously when a lot of them really just create more work for her.

On Monday, the psoriasis patient from several weeks ago returned to the clinic looking much better, and I took him down to Peggy's to clean off (this time he was able to shower himself). I was happy to see that he returned when told to and his skin was much better than when I first saw him, but I could tell that he hadn't bathed in days and was probably not going to be able to bathe in the sea as instructed to keep his skin clean, moist, and exfoliated.

I took Wednesday and Thursday off, which worked nicely because Peggy's clinic is always closed on Wednesdays and was closed this Thursday for Thanksgiving. Friday was a pretty normal day filling prescriptions in the pharmacy. I don't think I will ever be a professional pharmacist, but for the time being I do enjoy learning about the drugs.

Outside of clinic hours I have done a few work-related things. On Wednesday I stopped by Los Fuertes with my dad and girlfriend to look for a deaf girl that should receive a hearing aid next week. We had a vague address (above the Adventist Church) and two different names (neither of which was correct) to look for in Los Fuertes, but it ended up being a fun little search. I think especially having my father there helped lend a fresh perspective on the situation; recognizing that tracking someone down in the United States would proceed much differently than here. We found the girl without much trouble and gave her the necessary information, and I felt good about being able to navigate Honduran society to complete at least very
basic messenger tasks.

I have also been chauffeuring a lot of people back and forth around town, which I am happy to do, but I do worry a little bit about the liability involved. I feel comfortable driving on the streets, but I fear that it is just a matter of time before some driver makes a poor decision resulting in an accident. I know that in terms of safety, my driving is probably just as safe as if not more safe than other peoples', but I do feel a slight burden of responsibility being the regular designated driver.

I spent most of my Sunday at Peggy's clinic inventorying new medications that just arrived in a big shipment from the US, which was fun. My girlfriend, Maya , will be taking over for me in Peggy's pharmacy next week as I go back to the Global Healing clinic while Christine visits the mainland, so this afternoon was a good opportunity for Maya to get to know the clinic outside of regular business hours.

Our tutoring project is not going well because the students have not been showing up. Tomorrow we hope to meet with the students and maybe the principal to ask how else we could structure the tutoring to be less of a burden on the students, but I am disappointed that we will not be able to conclude the curricula that we began.

In addition to clinic work this week, I've had a wonderful time hanging out with my visitors and getting to know some of Christine's visitors. We've eaten tasty Indian food, toured Oak Ridge by water taxi, scuba-dived with turtles, had a proper Thanksgiving feast, and fished real "island style." This all makes me realize very clearly how "social tourism" or "voluntourism" can really work to many organizations' advantages, and how non-profits in less picturesque locations have a lot of unique challenges.

Christine Journal 10

2007-11-25T09:44:00.000-08:00

Things are going well down here, and we've been having a lot of visitors, which is always fun. Max's dad and girlfriend were here last week, and my mom and sister just came this past weekend. My family will just be here a few days and then is going to the La Ceiba area and Copan ruinas, and I wanted to check with you guys whether it would be okay if I accompanied them a couple of days in Ceiba. I would be out of the clinic on Thursday and Friday of this week, and Peggy has said it's fine if Max leaves her clinic to work in the Global Healing one so there's still an intern there. I'd also be gone the early part of the next week with Jessica and Neri, the patient and mother I took to El Progreso a few weeks ago, to see if we can get Jessica plastic surgery at the clinic in El Progreso. Let me know if it would be okay for me to take those two days to travel a bit with my family, as I completely understand that I have committed to the internship and that it might not be okay to take the time off.

This week was a little crazy in the hospital on Monday and Tuesday, as we saw 23 patients (!) on Monday and quite a few on Tuesday. It then slowed down quite dramatically, as we saw four on Wednesday and about three on Thursday. Friday we were back to about twelve, so it was quite different day-to-day. At the beginning of the week, the social service doctor was still here and kind of in-and-out, so Dr. Normandin was seeing most of the patients and it was fairly overwhelming for her. I've been interpreting too, as she's still learning Spanish, so I'm always busy between interpreting and triaging. I'm loving all the time I get to spend with her and the patients, though! And she's heard me give the same schpeal about viral URIs in Spanish that's she's about ready to give one herself.

Dr. Normandin, Peggy, and I went up to visit a patient in La Colonia on Wednesday that really helped put these hospital visits for URIs in perspective, though. The lengths that some of the patients have to go to in order to get to the hospital (especially when it's rained and the roads have turned to mud) are incredible, so even if the kid really does just have a cold, it's really important to still spend time with the family and give them something (like vitamins) to walk away with. The patient that we were visiting lived at the very top of La Colonia, and we were practically rock climbing up the slope to his house. It was a 9-year-old with an end-stage abdominal tumor with inguinal metastasis who had been through a number of courses of chemo on the mainland. He probably weighed 10-15 kilos and often didn't eat because of the pain. We're going to try to get something to ease his pain, and the family seemed really appreciative that we had come to their house to visit them. It was a pretty emotional visit and was hard to see a family living on nearly nothing who had to care for a dying son.

Dr. Charles came back from his trip to Tegucigalpa applying for a new job, and things are back to normal (or as normal as they get) in the hospital. We had the internal medicine doctor give the lunch time talk this week, and Dr. Normandin will have one prepared for this coming week. A new doctor (Dr. Jennifer Cohen) came in on Saturday, so I cleared up the third examining room (or more like section) for her to use, which was a bit tough with the ultrasound machine we still have waiting for someone to be able to use and move to a place where it will be safe.

The math tutoring project seems to be needing a new direction. We went on Tuesday to, again, find all the students had gone home because they had too much work. After speaking with the school's director about how holiday season was especially hard for students with exams and other projects, we decided that we needed to reassess the tutoring sessions and how to best help the students. I think that it's hard for the students to really see how this directly benefits what they're learning in math, as a lot of what we're teaching really does give them the foundation for what they're doing, but it's not so obvious how it helps them with algebra or geometry homework. So, it was disappointing to see no one there again, but we're hoping to meet with them tomorrow to talk about a direction to go with the tutoring and see how we can best be of help.

Thanksgiving was really nice - we had a fun, eclectic group of people for dinner at Dr. Patrick's house. We did potluck style, too, and had all of the Thanksgiving essentials! Everything was delicious and the company was great - volunteers with Peggy and Global Healing, Dr. Raymond and Dr. Charles, Joe Soloman (the chief of police), etc.

Christine Journal 9

2007-11-18T09:43:00.000-08:00

As Max wrote, we have now switched work places, and I'll be in the RVPC for the next few weeks. It's crazy how fast our time is passing, and it's been fun to see so many volunteers come and go. I'm so impressed by Peggy's ability to be so welcoming to each person who comes through when there are so, so many.

I've been enjoying working in the RVPC, although it can be very frustrating and depressing to work in the public hospital due to the politics and lack of resources. Dr. Charles was in Tegucigalpa this week doing job interviews for the jobs he's applying to for next year, so a social service doctor took over for him. The new doctor came in on Sunday, too, so she had a little less orientation than normal, but it is all going well. Even though there were a number of cruise ships this week, the clinic has been pretty busy. The new doctor isn't very comfortable with Spanish, so I've been able to interpret for her this week, which I'm really enjoying. It does make the morning much more hectic, though, since I'm triaging and seeing all the patients with her, but I've been getting there early and trying to triage in any spare time and it's working out.
I've come across a number of interesting medical beliefs while interpreting this week in the clinic, and it's been pretty interesting to hear some of the same beliefs from a number of patients. For example, many people believe that if you sleep with your eyes open you have "bichos," or you get skin infections because of "bad blood." People have been very receptive to the doctor's explanations of disease that go against these beliefs, but it still is an interesting clash of cultures.

We had a few cases this week that highlighted the island's gaps in medical care. One boy's mom claimed that he had to sit very close to the TV and turn it to its highest volume to see and hear well, so we wanted to get him sight and hearing exams, which shouldn't be too difficult. However, according to the social service doctor, there was nowhere to get them in the public hospital.

Another child had a fused sagittal suture, meaning his head was growing front to back, but not expanding on the sides. What was interesting was that the mother never mentioned that in the list of reasons she had come in, so I don't know if she had been told in the past that there was nothing she could do about it or what the history was. Dr. Normandin, the current doctor in the clinic, said that in the US you would just send the baby to the neurologist and probably break up his skull bones to let them set back together correctly, but there aren't any specialists on the island that could do such a procedure. We ended up referring him to the mainland, so hopefully they'll be able to take care of it. It's probably just going to be a cosmetic problem for the baby, but there is a possibility of increased intracranial pressure, and so it's really important to get it checked out by a specialist.

Tutoring went well on Tuesday - we had four students and four tutors, so we were still one-on-one. The girl I'm working with seems really interested and I'm really looking forward to being with her for the next few weeks and seeing her progress. Thursday, though, was quite a let-down. We got the tutors together and were driving over to the school when one tuttee called us (about 10 minutes before we were to start) to tell us she couldn't attend. And then we got a text message from another. However, when we showed up, it turned out that they had all gone home to study for a test they had the next day, so we had made a trip out to French Harbor for nothing. We'll talk with the students on Tuesday and re-assess their interest in the program, but it was pretty frustrating. I think the hard part about it is that it does seem like extra work to them, since we are really working on math concepts that precede what they're learning but that they may not see as really helpful at the moment. We'll see what they say on Tuesday, though, in terms of their commitments and interest, since we're really there to help them.

We have now moved into the apartment under Peggy's house, which is really nice and it's fun to be living downstairs from her.

Max Journal 9

2007-11-18T09:42:00.000-08:00

I've had a good first week at Peggy's Clinic now that Christine is working every day at the Global Healing Clinic. I started the week out with Betty in the pharmacy filling drug orders and running some random jobs around town. Betty the pharmacist left for the United States on Wednesday, so since then I have been the official pharmacist for Peggy's clinic. It is a little amazing that I am practicing a profession that requires a graduate degree to practice in the United States. On Wednesday I went into the Global Healing clinic in the morning and bought food for the Wednesday lunch conference before I went to pick up some donations from the Carnival Valor cruise ship. The security precautions at the cruise ship dock are pretty amazing and the cruise ship culture seems very alien to Roatan, but after a few hours of struggling I was able to drive out onto the dock to pick up a few boxes of donated clothing. The cruise ships play such a large role in Roatan's economy that it is almost offensive to suggest that
they should be outlawed, but it is a thought that crosses many visitor's minds. Peggy's clinic has been slower because we have only one volunteer doctor, and Betty is gone so the pharmacy is quiet and a little lonely. This weekend my girlfriend and father arrived from the States for a visit, so I am understandably distracted and will keep this update short. I look forward to getting better at the pharmacy job and learning more about the drugs that we use here.

Max Journal 8

2007-11-11T20:55:00.000-08:00

I started out the week by holding down the fort at the Global Healing clinic while Christine was still on the mainland. There was no volunteer physician so I worked alone with Charles until Wednesday when I switched to working at Peggy's. We moved efficiently through a pretty high patient volume, and I was honestly impressed at how many patients Charles could see on his own in such a short amount of time. Charles is applying for jobs for after finishing his second Global Healing Fellowship in December, so he has been frantically preparing a heap of paperwork. I wonder if there is a functional reason why "diplomas" certifying participation in conferences and continuing medical education courses are so important here. It seems like a never-ending occupation of a lot of doctors to get many pieces of paper with the appropriate stamps and signatures to certify and acclaim them for their accomplishments. To a certain extent I think the obsession with "diploms" and "reconicimientos" is cultural (some people just like physical representations of their accomplishments), but I also wonder if there are big problems with forgery of certificates.

Christine got home thoroughly exhausted from her journey on Tuesday, and I was happy to have her company again. I think she made good friends with the mom and baby, met some interesting medical professionals on the mainland, and learned a lot about international medicine in Honduras. On Thursday I worked in the pharmacy at Peggy's and went to the ferry dock to pick up a patient that didn't end up coming. This patient was supposed to come to get an excisional biopsy from an ENT doctor working at Peggy's, which would have been an unusual reversal of the standard shipment of Roatan's patients to the
mainland to receive specialized care.

On Thursday evening Peggy, Christine, Becky (a future Global Healing intern) and I responded to a car accident near Sandy Bay. We were with Peggy when she received a call that one of the carpenters working at her clinic had totaled his car and his wife who was in the passenger seat was unresponsive. By the time we arrived on the scene, the passenger was awake and ready to leave, but we skipped over about every protocol that I ever learned in EMT class and walked her to the passenger seat of our parked pick-up truck. I was amazed that we didn't even have a spine board to provide some degree of immobilization, and I can only imagine how people who are not personal friends with Peggy deal with traumatic emergencies on the island.
Because there were no emergency services (police, fire, nor ambulance) on the scene, traffic continued passing by us on the narrow two-lane road. As we were slowly pulling out into traffic, I committed the cardinal sin of emergency response: I put myself and the other responders in danger by colliding with a passing taxi. Honestly, the cab swerved at me and in an American traffic court I'm sure that I could have reasonably argued my innocence, but in the moment none of that mattered because now there were two accidents and still no formal system for sorting anything out. I didn't even know if there was a tow truck on the island. I sent Peggy, Christine, Becky, and the patient to the clinic in the truck and I stayed behind to sort things out with the cab driver. As it turned out we had hardly collided at all and I had rather miraculously managed to snap his bumper off without denting or scratching it at all, so we talked it out and settled with a small amount of cash and a handshake and without further legal complications. I was very relieved when I got home and learned that the passenger was without serious injury and our hectic night was coming to a close with no more than a few scrapes, bruises, and some property damage.

Friday at the clinic was fun as I showed Becky around the pharmacy and celebrated Betty the pharmacist's birthday. Around 9:15 a.m. I received a phone call from a friend of mine in Coxen Hole who is a middle-aged woman that recently moved to Roatan from the United States to start a spa/beauty salon. She was very upset as she hurriedly told me about a man in her home who had some serious skin problem and needed urgent medical assistance. I managed to ascertain over the phone that it was not really a real emergent problem (no respiratory distress, no impairment of circulation or sensation), and I instructed
her to put him in a cab and send him to the clinic. About an hour later I received another call from my friend stating that there had been no available cabs (cruise ship day!) and asking if I could come pick him up. I drove to her home (cautiously after the previous night's debacle) and arrived to find a 41-year old man in a lot of pain as the skin all over his body appeared to be peeling off. I drove (still cautiously) back to the clinic and learned that he was from Diamond Rock (a Black Islander community on the far east end of Roatan), he had had skin problems for just over a year, and he had come to Coxen Hole the previous day to go to the hospital and had been sent away then and again on Friday morning for unclear reasons. Apparently he knew my friend through a mutual acquaintance and, lacking other recourse, had hobbled all the way across town on badly swollen feet from the hospital to her house and had collapsed on her floor. I arrived at the clinic and asked the patient to remain in the
car as I prepared a treatment room and announced to the doctors his arrival (the clinic has no functioning landline telephone and I was unable to reach anyone via cell phone on the way over, which is a problem in and of itself). By the time I had a room prepared and retrieved the wheelchair to help him in, the security guard had helped him out of the car and onto the clinic porch, so I wheeled him through the clinic in front of a crowd of raised eyes. Some other volunteers rather-inappropriately left their workplaces in the clinic and rushed to take pictures of him while ostensibly "triaging him" and I felt like I had brought him into a very uncomfortable position, but of course at the time this was the price of much-needed urgent medical attention. This feeling touches on a characteristic of American medical care that many people have commented on: the objectification of patients and their diseases. While I cannot imagine taking pictures of a patient without a specific medical excuse (for instance to consult with other doctors regarding the case), I have often appreciated being called in by a doctor to teach me something from a patient's condition. The truth is that as a student of medicine and of public health, I walk a delicate line between learning from and treating patients, and different people have different ideas of what is "appropriate" treatment of a patient.

Anyway, back to the case...the doctor decided that the most immediate treatment necessary would be a warm bath to moisturize and exfoliate the dry peeling skin. The clinic does have a working shower and a water heater, but because the inpatient wards haven't opened yet there is no demand for hot water so the boiler was turned off and no hot water was available. The nearest available shower was at a motel owned by a friend of Peggy's, so I drove the patient over there. I then entered the shower fully clothed with the now naked patient and proceeded to abrade the dead skin off of his entire body for 45 minutes. It can only be described as an unusually intimate encounter between strangers that I have since reflected a lot on. The severe psoriasis that affected him was an extreme auto-immune disease that had only one probable explanation. As I washed every inch of his body and learned more about him than I may have ever wished to, I felt like I was finally doing what I came here to do: helping someone. He felt tremendous relief as his skin regained moisture and after the shower when we applied Vaseline and hydrocortisone to his entire body. As the water dripped down my face and I looked at my soaking wet leather shoes flecked with bits of dead skin, I started to reconsider what it means for me to help another person. There is a little more to this story than I can include here (ask me about some interesting tattoos when we meet someday), but I can say that that 45 minute shower taught me a lot about myself and the meaning of altruism. After that industrial-strength exfoliation, he dressed in some new clothing and left feeling like a whole new person. I gave him cab fare, various creams and soaps, a few medications and vitamins, and strict instructions to bathe twice weekly in the sea and return to the clinic in two weeks. I hope he does come back.

After that overly stimulating Thursday and Friday, I enjoyed a Saturday swimming at West Bay Beach and baking pretzels at home followed by eating Sunday brunch with the new Global Healing resident and scuba diving.

On Tuesday and Thursday afternoons we finally were able to get our much-awaited tutoring program started, which has been a lot of fun. The students we are working with lack some amazingly fundamental math skills, but are really very bright students that I feel we can help a lot. I look forward to continuing this tutoring for the rest of the time that we're here and I hope that the other tutors and students are enjoying it as much as I am. Alright, this seems like plenty of text for now. I hope you had an exciting week too.

Oh, and I'd like to say a big "thank you" for your personal response to my and Christine's journal entries. I can only imagine how busy you both are, but after spending a while going through many of the same trials and tribulations that you both have experienced here, I greatly appreciated reading some of your perspectives on things. I also really enjoyed meeting the new resident from Dartmouth this morning, so I hope that she – as a young female doctor – has an overall good experience with Global Healing. Thanks again and I'll talk at you again next week.

Christine Journal 8

2007-11-08T21:25:00.000-08:00

Max and I have reached our halfway point of working by ourselves in each clinic, so we switched places on Thursday. Peggy’s clinic is closed on Wednesdays, so I got to go to the hospital to hear Dr. Dominguez’s talk (part of the weekly lectures Global Healing tries to put on) on developmental displasia of the hip. He was a great speaker and the talk was interesting to hear, so that was fun.

Dr. Welcome had to go to Tegucigalpa to interview for jobs for the coming year, so there is now a social service doctor (Dr. Andres Ordóñez) in his place until he comes back either late next week or the following week. He’s a nice guy and knows the hospital very well, obviously, so I think it will be fine, although the new pediatrician came in today and hopefully he’ll give her a good orientation tomorrow. He does seem to take his time in the morning, though, and especially now that I know how it feels to arrive early in the morning at a clinic and not be seen until the afternoon, I do wish that patients could be seen starting a little earlier. We’ll see what the schedule this week is like.

There weren’t really any unusual cases this week in clinic, but I’m enjoying being in the Global Healing clinic so far, although it can be frustrating working in the public health system. For example, for some reason the lab decided to stop doing stool exams and urine tests this week, and a patient referred there from our clinic came back without anything to help us diagnose his illness, which was frustrating.

Although the tutoring program started on Tuesday, I was in La Ceiba so didn’t start until Thursday. I think it will go really well – we had five students on Thursday with five tutors, so it worked out perfectly. We’re still expecting a few more to join the program, but we might also be able to get a few more tutors, including the new Global Healing resident. The girl I worked with is an honor student, and was very bright and fun to work with. She seemed genuinely interested in learning the material, which makes the tutoring so much more worthwhile.

We had an eventful night on Thursday (see Max’s journal for even more eventfull-ness), as someone who works with Peggy got in a car accident with his wife. There was a large truck stopped in the middle of the road without any lights on it, and by the time he saw it, it was too late to swerve. So he hit it front on, and, luckily, both he and his wife are fine. They called Peggy, though, to come help the wife, who had slammed her head into the dashboard and needed some medical attention. We went to the crash site, where there were no police, ambulances, or anything, something you’d never see in the states. Peggy said that it’s practically useless to call an ambulance, as they can take hours to get there and were even shopping at Eldon’s once when she tried to call them. So, we took the wife up to the clinic and Dr. Patrick examined her. She had no bleeding, but had had a concussion. Dr. Patrick highly doubts that she has any kind of internal bleeding, but it’s impossible to tell on the island without any kind of brain imaging. So, the whole night was a powerful reminder of how limited medicine is on the island and how people can really suffer from it.

Outside of clinic, I’ve gotten to go back and visit Neri, Jessica (the patient I took to the mainland), and the family, and really love being able to spend time with them. I just really hope they don’t get too overwhelmed with all the different medications Jessica has to use, since it is a lot to keep track of (some every six hours, some every 4, etc.). Max and I also finally went on our first SCUBA dive today, which was lots of fun!

Christine Journal 7

2007-11-07T21:21:00.000-08:00

I just got back last night from a really interesting trip to La Ceiba and El Progreso, during which I accompanied a Roatan high school student to the SAT test in Ceiba and a mother and one-year-old daughter to an ophthalmologist in Progreso and a dermatologist in Ceiba. The trip as a whole really opened my eyes to how other organizations in Honduras work and provide health care to the country.

I left with Nurian, a recent high school graduate from Roatan, on the ferry on Friday, leaving behind rain on Roatan and heading into it in La Ceiba. She had been to take the test in La Ceiba the May before, so knew the drill pretty well. She'd also been studying for the test in the time leading up to it, receiving private tutoring from Shelli, a volunteer with Peggy who is here for the year. I think she was feeling pretty prepared, which was great. As I dropped her off, I was remembering how nervous I was about the test, as it was something that I had known was important since I was in middle school. It was great to see how calm Nurian was, and how much it was really just her own motivation that had gotten her there, not an expectation that her school, family, friends, etc. had for her since she was younger. She felt really good about how it had gone, so I'm really happy about that. The test was administered at a bilingual school that was opened for the children of the Standard Fruit Company's workers who came from the USA, and apparently is still the best (and most expensive, as they apparently charge in US dollars) school in the city.

I spent Saturday night alone in La Ceiba after Nurian left to go back on the afternoon ferry and before Neri and Jessica came in on Sunday morning, which was relaxing. I went to meet the ferry on Sunday morning and was happy to see that Neri and Jessica arrived safe and sound. I had spent Saturday talking with a few people who work in La Ceiba, and we were able to get a ride with a group from an orphanage who were bringing two boys to get operations at the eye clinic. We were able to wait at Dr. Black's house in the morning before we left for El Progreso after lunch, and it was great to be able to talk with Dr. Black about his experiences and work in Honduras. His observations were really interesting in the context of my experiences throughout the trip, so I?ll reflect on those after I talk about how the doctors? appointments go.

We drove to El Progreso with the ?tio? from the orphanage (the father figure for the kids) and two eleven-year-olds, who were all really fun to travel with. The kids were really curious about everything, asking lots of questions about things we passed and making good conversation, and we took a little detour through Tela, so it was an enjoyable trip. We arrived safe and sound at a house that rents rooms and sells food in front of the eye clinic, and although they had not received our reservations (the clinic was supposed to make them for us), they had a couple of rooms. The woman told us if it was our first time at the clinic, we had to be there at 5 am, so we woke up bright and early and left before breakfast, only to wait until 1 pm to be seen by the doctor. It made me really appreciate the patients that wait so long at the clinic to be seen, and it was also a bit frustrating that they weren?t able to tell us about when we would be seen so we could leave and get something to eat.

The clinic was started by an American ophthalmologist missionary, was in a pretty nice building, and seemed to be staffed mainly by Hondurans. There was a visiting American pediatric ophthalmologist for the week, which is why we were all there, but she seemed to be pretty overwhelmed with all of the patients. When we were finally seen, she didn't ask many questions about the history of Jessica's eye problems, but did tell us pretty quickly that she did not have cataracts. It turns out that her cornea is being scratched by her eyelashes, as her eyelids are pressing too hard against her eyes. She did let us know that they would have a plastic surgeon at the clinic in early December, and also gave some antibiotic drop prescriptions for Jessica since she apparently also had an infection, but it was a little disappointing to go all that way to find out she did not need cataract surgery. It's good to finally know what's wrong, though. All in all, I was not very impressed by the care at the clinic. The American doctor didn't speak very good Spanish, and, as I said before, didn't ask many questions. She left the Honduran doctor to explain to the mother what Jessica had, but he used very complicated medical terms that neither she nor I understood, so I had to tell her what I had picked up as the American doctor was working so that she could know what was going on.

We left there on Monday afternoon by bus, as the two boys from the orphanage were sticking around for surgery on Wednesday. We arrived in La Ceiba at night to pouring rain and flooding streets, but safely made it to Dr. Black?s house, where he sent someone with us to check into a hotel he recommended. It was such a help to have him as a contact in La Ceiba, as well as to have the group from the orphanage with us in El Progreso, and it really showed how helpful and important it is for different NGOs to work together and let each other know about opportunities, etc.

On Monday morning we got a few blood tests done for Jessica that the opthamologist had sent for, and it really made me wish there was a way for us to know what tests she had already gotten. Neri said they had done many tests on her, but couldn?t remember what they were, and we wanted to get them done before coming back to Roatan, as Roatan couldn't doing some of them, so we just went ahead and got them. I think in the future it would be good to make a copy of the patient's file to bring on trips like this one so that there isn't any overlap and the doctors can better see the patient's medical history. I don't know if this is possible, but I'll look into it.

We saw a dermatologist in La Ceiba that Dr. Raymond from Peggy?s had recommended, and he seemed to be really good. He was not able to diagnose a specific skin disease, but did explain very clearly to Neri everything that he was thinking. He said that since it is congenital, he doesn?t really think it will ever go away, but that it may get better as she gets older. He also looked at her eyes and agreed that the cornea was being scratched, but also with just a few questions was able to discover that Jessica slept with her eyes open (her mom usually closed them), so her cornea is probably also getting dried out. He prescribed her lubricating eye drops for that, which he was very surprised the American ophthalmologist had not done. He also explained very clearly how important it was for Neri to use the eye drops, as her eyes need light to enter to develop nerves that will be critical in her sight later on. He prescribed some soap and creams for Jessica's skin, as well.

I think that it was hard for Neri to hear that there wasn't really anything we could do for the skin condition, but she is up to go back in December for the plastic surgeon's visit to hopefully fix the eye problem.

The trip and my previous experiences here have really showed me the importance of talking with patients and trying to spend as much time as possible with them. As I traveled with Neri she told me a lot about the history of Jessica?s skin and eye conditions that I noticed she did not share with doctors unless asked specific questions or given enough time to really give a complete answer. I?ve also noticed while interpreting at Peggy?s clinic that the patients won?t mention something to the doctor when he or she?s asking questions, but when he or she leaves for a minute and I just stay and chat, they?ll bring up other important information. Dr. Black complained that he no longer works with missionary groups because they will try to brag about how many people they saw in one day, when really they?re not giving very quality care to their patients, and I can really see how just spending that extra few minutes with a patient to chat or ask them more questions can make a big difference in the quality of care they receive.

Something else that Dr. Black mentioned that has gotten me thinking is that the Honduran government can use the groups of medical missionaries who come down to perform specialty surgeries or other medical procedures and consults as an excuse to not develop their own medical infrastructure. Since the groups are filling in the gaps that the public system has, the government sees no need to develop in those areas on their own. So, I started thinking about somewhere like Peggy's clinic and how it can fit into this kind of situation. On the one hand, Peggy's clinic is doing great things by trying to provide a quality of care that is not available on the island. On the other hand, the public hospital can use the clinic to get specific medications they may not stock and, as Peggy's grows, may even start sending people over there for operations or in-patient care. However, if Peggy's clinic (or any specialty group who comes down to Honduras) is providing a level of care that the public health didn't seem to be getting close to (or trying to get close to) before she began, does it hurt the public health system? But doesn't it also hurt the people if such brigades or clinics are not started, as they really are filling in a gap that the public health system is not fixing on its own?

I'll be starting my time in the pediatric clinic, and look forward to getting to understand the public health system better!

Max Journal 7

2007-11-07T20:54:00.000-08:00

This week I have been working as usual at RVPC and we seem to finally be getting back in the swing of things after the strike. Anita finished her last week here and we saw patients every day. The patient load has been pretty moderate, which keeps things relatively calm in the clinic. The rainy weather and the arrival of lucrative cruise ships keep patients away on any given day.

Probably the most interesting case of the week was a mother that brought in her son with a speech delay. The boy was almost four years old and didn't say anything while I was in the room with him, but apparently mumbled something when he was with Anita. His sister is around two years old and speaks well, so his mother is starting to worry. A few things about this situation were interesting to me. First of all, as far as we know, the mother didn't bring her child to see anyone until now, which seems like a long time to wait. Secondly, the diagnostic tools that Anita used to try to get a hold on the child's condition intrigued me. The mother didn't think the child had any trouble hearing, but she also said that when he did talk it sounded like a "deaf person." We can't do a real hearing test in the clinic, but by saying things when the boy is looking away you can test his reaction to sound, and by asking him to complete simple tasks you can test his hearing and some of his comprehension. The mother also said that he plays normally with the other kids in the neighborhood, which suggests that he is not severely mentally delayed, but rather that he might really just have a speech impediment. Also, during most of the time that the patient was in the clinic, which was most of the morning, Dr. Charles was unavailable to help Anita. Diagnosing a speech impediment is understandably difficult for a non-native speaker. The last thing worth mentioning is what the next step is. The boy needs a hearing test and possibly some sort of more detailed mental exam to evaluate the full extent of his developmental delay. Then he will need some sort of speech therapy, which as far as I know is unavailable on the island. I hope we are able to follow-up with this boy and see that he gets the attention he needs to fulfill his potential for speech.

From a more philosophical perspective, I've been thinking a lot about the relationship between the Roatan Volunteer Pediatric Clinic, the Roatan Hospital administration, and the other sources of medical care on the island. Anita tried for several weeks to participate in rounds at the hospital, but she always received some excuse why she couldn't (they'd already happened, they weren't happening, or they were happening later). This made me think more about whether the hospital really welcomes Global Healing there at all. From one perspective, I can fully understand why anybody would get tired of outsiders continually coming into their workplace and telling them that they are doing everything wrong, and in that sense I think that Global Healing should be careful about delivering criticism to the hospital. And from a completely other perspective, the resistance to change within the hospital is amazing. A certain amount of the problem can be blamed on a large bureaucratic public health system that the hospital must function within, but that cannot be the complete story. The number of small fixable problems in the hospital and the presence of people trying to fix them combined with the lack of fixing going on suggests that there are people *actively resisting* change. It should come as no surprise to me to see corruption in public administration here in Central America, but people fighting real improvement in the hospital nonetheless affects me.

Anyway, on a more upbeat note, I a dropped a patient with congenital cataracts off at the ferry terminal this morning to go to La Ceiba to meet Christine and travel with her to get corrective surgery in El Progreso, a city between here and San Pedro Sula. Christine is doing most of the actual work to make this happen for baby Jessica, but I hope all goes well and I see them soon back here in Roatan. You probably won't hear from Christine for a while because she's on the road, but I'll let you know if anything comes up.