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.
Sunday, November 11, 2007
Thursday, November 08, 2007
Christine Journal 8
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!
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!
Wednesday, November 07, 2007
Christine Journal 7
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!
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
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.
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.
Sunday, October 28, 2007
Christine Journal 6
We've survived our first big Roatan storm, which has been a nice, cool change from the hot weather we had been having. On Wednesday morning I woke up to heavy rain out my window and no power (not all that uncommon, but it was out for 14 hours total this time!). Max and I both went into the Global Healing clinic, since Peggy's is closed on Wednesdays, but there was hardly anyone in the hospital. As the rain continued to come down, the entryway to the hospital filled with about 6 inches of water, and many other places were leaking. There were no patients for us to see (I think no one really wanted to travel in such a big rainstorm, especially if they live on dirt roads), so Max and I tried to figure out the Access database that he had found from last year (which seems to do pretty much what our current Excel file does in terms of keeping track of patients). We were hoping that we could get it so that the patients' past medical history could come up when we typed in their ID number, but are still pretty new to the system. Dr. Charles was nice enough to give us a lift home (although the roads were so flooded in Coxen Hole we almost didn't make it!), but it was still pretty early so we went up to Peggy's to see what we could do there. She has a couple of visitors who are working on construction projects, so they put us to work putting in floor tiles. However, there was no electricity still (the whole island seemed to be out) and so it was hard to see and we couldn't cut any more tiles, so we soon ran out of jobs and went home.
Work in Peggy's clinic is still going really well - the staff is all so great and I still learn so much every day. I got to do a lot of interpreting this past week, which I love, as well as work in the pharmacy (also lots of fun). I helped out with triaging some as well, but it gets pretty crowded with two people triaging at once, so I mainly tried to do it when Sherry Kay was busy with something else. Monday and Tuesday were pretty busy, but there were very few patients on Thursday and Friday, since the weather continued to be bad. It was nice to be able to spend more time with patients those days, though. Power was off for another 11 hours on Wednesday night/Thursday morning, which makes it hard to work in the clinic. Hopefully they'll get a generator soon, though!
In the afternoons, I've continued to work on drug donations, as well as help Shelli get ready for the tutoring, which is set to start next week. We'll have a 5-week session, going to the school twice a week and each working with 1-2 students on math. There are a few other community members (American ex-pats living here) who will do it with us, which should be fun. I'm really looking forward to that starting up!
I'm also planning on accompanying a girl to La Ceiba to take the SAT on Saturday morning, as well as going with a patient to El Progreso to visit a cataract surgeon and hopefully a dermatologist in La Ceiba. The patient is about 1-year-old and has an unidentified skin condition as well as congenital cataracts, so hopefully we'll be able to get the cataract surgery done and make some headway on helping her skin condition. That will be from Sunday-Wednesday or Thursday.
Work in Peggy's clinic is still going really well - the staff is all so great and I still learn so much every day. I got to do a lot of interpreting this past week, which I love, as well as work in the pharmacy (also lots of fun). I helped out with triaging some as well, but it gets pretty crowded with two people triaging at once, so I mainly tried to do it when Sherry Kay was busy with something else. Monday and Tuesday were pretty busy, but there were very few patients on Thursday and Friday, since the weather continued to be bad. It was nice to be able to spend more time with patients those days, though. Power was off for another 11 hours on Wednesday night/Thursday morning, which makes it hard to work in the clinic. Hopefully they'll get a generator soon, though!
In the afternoons, I've continued to work on drug donations, as well as help Shelli get ready for the tutoring, which is set to start next week. We'll have a 5-week session, going to the school twice a week and each working with 1-2 students on math. There are a few other community members (American ex-pats living here) who will do it with us, which should be fun. I'm really looking forward to that starting up!
I'm also planning on accompanying a girl to La Ceiba to take the SAT on Saturday morning, as well as going with a patient to El Progreso to visit a cataract surgeon and hopefully a dermatologist in La Ceiba. The patient is about 1-year-old and has an unidentified skin condition as well as congenital cataracts, so hopefully we'll be able to get the cataract surgery done and make some headway on helping her skin condition. That will be from Sunday-Wednesday or Thursday.
Max Journal 6
At the beginning of this week I was pleased to see the ever-present "flag of the syndicate" removed from the entryway of the hospital, signifying the end of a three-and-a-half week strike. It's not clear to me what kind of resolution the workers and administrators came to, but from what I've heard the workers' demands were not completely fulfilled. The hospital seems to be up and running, though, and everyone seems to be in a lot better mood, so my life is a bit simpler now that the strike is over. Patients are being attended to and hopefully the hospital will see a return to some modicum of normalcy in the coming weeks.
Monday and Tuesday were surprisingly slow (only 12-15 patients per day), and I think that's probably because word was still getting around the island that the hospital had reopened. We had one interesting case of a mother coming in for a regular well-child check for her four-year old son (which is pretty much unheard of in our clinic), and she said that she comes in for monthly check-ups because he had had had leukemia. I duly recorded her comment on the chart, and looked back through his medical record for some more detailed history. The child had in fact visited the hospital with some regularity, but never mentioning any history of cancer. We checked the kid out and he seemed fine, and it was certainly possible that he had received effective treatment years ago for cancer, but something in the story seemed a little odd. The mother proceeded to tell us that she also had "cancer of the blood," as did her other baby, at which point we guessed that she was probably talking about sickle-cell anemia. Later in the day I spoke with someone who knew the mother and suggested that she was known for getting baby formula from free clinics to sell on the street, so my "index of suspicion" of the mother's spurious history increased significantly. Fortunately the situation we were in didn't put the child in any danger (except maybe an unnecessary blood draw) and we were able to confidently do what the mother asked (confirm his good health) without wasting many resources, but it certainly exposed our vulnerability to exploitation by our patients. We have to balance our trust and willingness to help the community with a reasonable level of skepticism. The role of this organization is to provide medical care, not to encourage entrepreneurship through black-market drug and baby-formula markets, so from now on I will actively try to keep my eyes open to the exploitation not only of community members, but also of community organizations.
When it started pouring down rain on Wednesday, I had to chuckle as the patients disappeared and the hospital quickly started filling with water. Luckily our clinic seemed safe from serious water damage, but I do not lie when I say that water was coming into the hospital from above, from below, and from all sides. As we drove away through several inches of standing water I saw one hospital worker futilely bailing out the hospital lobby with a small bucket. I think that providing first-rate evidence-based medical care is a fine goal for any public health system, but maybe a solid roof should be one of the hospital's first steps in achieving that goal. It's amazing that we are trying to build so much up on such a weak infrastructural base. Modern medical technology costs a lot more than a leak-free roof, but without an effective roof in place (and clean sanitation, and running water, and proper ventilation), the medical technology will be useless.
Thursday and Friday I was happy to see that the hospital dried out significantly, and we continued seeing patients, although fewer than normal probably because of the persistent rains and the quickly eroding roads.
In the afternoons Christine and I have continued working on drug donations and prepared for the upcoming tutoring session. Hopefully the last few pieces of paperwork will come together and we can see short-dated pharmaceuticals knocking down Peggy's door in no time.
In the meantime Christine and I have been baking a lot, running on the beach when the rain abates, playing Skip-Bo in our dark apartment during the downpours, and enjoying the company of other volunteers. Despite the rain, we've enjoyed a respite from the heat, and we look forward to sunnier skies someday soon (I think right now the wind is finally dying down after five blustery days). We also enjoyed meeting a young Canadian who works with HIV/AIDS testing, counseling, treatment, and prevention in Roatan. The three of us shared our different perspectives on the public health network here, and learned a lot from each others' experiences.
Monday and Tuesday were surprisingly slow (only 12-15 patients per day), and I think that's probably because word was still getting around the island that the hospital had reopened. We had one interesting case of a mother coming in for a regular well-child check for her four-year old son (which is pretty much unheard of in our clinic), and she said that she comes in for monthly check-ups because he had had had leukemia. I duly recorded her comment on the chart, and looked back through his medical record for some more detailed history. The child had in fact visited the hospital with some regularity, but never mentioning any history of cancer. We checked the kid out and he seemed fine, and it was certainly possible that he had received effective treatment years ago for cancer, but something in the story seemed a little odd. The mother proceeded to tell us that she also had "cancer of the blood," as did her other baby, at which point we guessed that she was probably talking about sickle-cell anemia. Later in the day I spoke with someone who knew the mother and suggested that she was known for getting baby formula from free clinics to sell on the street, so my "index of suspicion" of the mother's spurious history increased significantly. Fortunately the situation we were in didn't put the child in any danger (except maybe an unnecessary blood draw) and we were able to confidently do what the mother asked (confirm his good health) without wasting many resources, but it certainly exposed our vulnerability to exploitation by our patients. We have to balance our trust and willingness to help the community with a reasonable level of skepticism. The role of this organization is to provide medical care, not to encourage entrepreneurship through black-market drug and baby-formula markets, so from now on I will actively try to keep my eyes open to the exploitation not only of community members, but also of community organizations.
When it started pouring down rain on Wednesday, I had to chuckle as the patients disappeared and the hospital quickly started filling with water. Luckily our clinic seemed safe from serious water damage, but I do not lie when I say that water was coming into the hospital from above, from below, and from all sides. As we drove away through several inches of standing water I saw one hospital worker futilely bailing out the hospital lobby with a small bucket. I think that providing first-rate evidence-based medical care is a fine goal for any public health system, but maybe a solid roof should be one of the hospital's first steps in achieving that goal. It's amazing that we are trying to build so much up on such a weak infrastructural base. Modern medical technology costs a lot more than a leak-free roof, but without an effective roof in place (and clean sanitation, and running water, and proper ventilation), the medical technology will be useless.
Thursday and Friday I was happy to see that the hospital dried out significantly, and we continued seeing patients, although fewer than normal probably because of the persistent rains and the quickly eroding roads.
In the afternoons Christine and I have continued working on drug donations and prepared for the upcoming tutoring session. Hopefully the last few pieces of paperwork will come together and we can see short-dated pharmaceuticals knocking down Peggy's door in no time.
In the meantime Christine and I have been baking a lot, running on the beach when the rain abates, playing Skip-Bo in our dark apartment during the downpours, and enjoying the company of other volunteers. Despite the rain, we've enjoyed a respite from the heat, and we look forward to sunnier skies someday soon (I think right now the wind is finally dying down after five blustery days). We also enjoyed meeting a young Canadian who works with HIV/AIDS testing, counseling, treatment, and prevention in Roatan. The three of us shared our different perspectives on the public health network here, and learned a lot from each others' experiences.
Monday, October 22, 2007
Max Journal 5
Last week was better than the previous, even though the strike persisted. On Monday we unpacked, inventoried, and repacked meds that arrived at Peggy's Clinic from the International Dispensary Association, which was exciting and fun. The drugs have been expected for the last half year, so they were a welcome addition to the pharmacy. Tuesday was back to the strike, but Charles showed up (briefly) and we were able to see patients for most of the week. On Friday the records department stopped handing out patient charts completely (even to the ED), which gave us a little scare, but we decided that if we didn't help out, the patients would just get seen by other doctors without their chart, so we kept functioning as an "urgent care clinic" extension of the ED delivering a lower standard of care than would be expected in the US. Peggy told us to start looking into soliciting drug donations from a number of international relief organizations, so that has kept us somewhat busy in the afternoons. We also spent an afternoon delivering drugs to a small clinic in Diamond Rock that Patrick Connell and the Clinica Esperanza folks helped start, which was an interesting excursion. Yesterday there was a fundraiser for Peggy's clinic in Coxen Hole, and we helped out (a little) and ate snacks (a lot) for much of the afternoon. I am optimistic about soliciting these drug donations and hope that something positive comes out of our work. Also, we spent Saturday morning crunching some demographic data collected by Krista Bruckner about La Colonia, which was interesting and different. Alright, this is a concise journal, but hopefully it's sufficient. And in a special sneak preview of next week: I'll let you know that the hospital strike ended over the weekend.
Christine Journal 5
Things were good in Peggy's clinic last week. I continued interpreting for a doctor who doesn't speak Spanish, and also got to start triaging, which was fun. I also helped Betty out in the pharmacy. On last Monday, the clinic finally received its huge shipment of medications, which was very exciting. We spent the day putting them away and preparing boxes to bring some out to Diamond Rock and to Dr. Black on the mainland. It's great to see how much people collaborate here. We're already running low again on some meds we got in just last week, since the need here is so great for some things.
Max and I have started looking into more long-term donations, soliciting different organizations and drug companies for donations to Peggy's clinic. Hopefully some of those will come through, since as the clinic grows they're really going to need some constant donations.
The clinic was really busy last week since the hospital's been on strike (although it finally ended!).
Max and I have also been doing some work with Shelli on both her tutoring program and a survey that Krista and Dr. Patrick conducted this summer in La Colonia. The tutoring is scheduled to start next week, which is exciting! We have worksheets made up for each tutor to do with their student, based on how they did on the diagnostic test. There has been a lot of interest in tutoring from people living on the island, so hopefully there will be a good group of people.
The survey conducted this summer includes basic personal information, like education level, birthplace, length on the island, etc. as well as medical information. They surveyed about 100 families, and we are in the middle of compiling their data to see the trends. I'm really looking forward to getting a better sense of the community when we get all the numbers together.
Max and I have started looking into more long-term donations, soliciting different organizations and drug companies for donations to Peggy's clinic. Hopefully some of those will come through, since as the clinic grows they're really going to need some constant donations.
The clinic was really busy last week since the hospital's been on strike (although it finally ended!).
Max and I have also been doing some work with Shelli on both her tutoring program and a survey that Krista and Dr. Patrick conducted this summer in La Colonia. The tutoring is scheduled to start next week, which is exciting! We have worksheets made up for each tutor to do with their student, based on how they did on the diagnostic test. There has been a lot of interest in tutoring from people living on the island, so hopefully there will be a good group of people.
The survey conducted this summer includes basic personal information, like education level, birthplace, length on the island, etc. as well as medical information. They surveyed about 100 families, and we are in the middle of compiling their data to see the trends. I'm really looking forward to getting a better sense of the community when we get all the numbers together.
Monday, October 15, 2007
Christine Journal 4
I’ve had another enjoyable week in Peggy’s Clinic and doing odd jobs in the afternoons. In clinic, I’ve still been mostly helping out in the pharmacy and doing some interpreting for a doctor who doesn’t speak Spanish. I’m still learning more and more every day, and the work has been really rewarding so far.
One young woman I interpreted for was about 5 months pregnant and wanted to get a pregnancy check-up. When the doctor asked her where she was planning on having the baby and if she was going to breast-feed, she explained that she was on the island without any family and was working full-time, so would go to La Ceiba to have the child, breast-feed for a couple weeks, and then leave the baby with family indefinitely and come back to the island to work. It made me really realize how hard it can be for women here to raise children, especially when they are not near family members.
Another woman came in presenting symptoms that seemed like she probably had kidney stones, but the only way to really tell was to send her to get an ultrasound in La Ceiba, an expensive ferry ride from the island. I’ve come to realize how limiting it is to try to provide high-quality health care on an island that has very limited resources when it comes to testing, etc. Often we can get the people over to the mainland for free or a discounted rate, but they still need to sometimes spend the night there, get transportation to and from medical centers there, etc.
I went in to the Global Healing clinic on Wednesday because Peggy’s is closed, and they are still on strike. Dr. Charles also hadn’t come in, which was stressful for the new attending, as she really wanted to have someone there who knew the system and population better, which is completely understandable. Hopefully the next couple of months will go smoothly.
Max and I have also been taking care of odd jobs for Miss Peggy, including making a poster for a conference they went to in Copan Ruinas, grading diagnostic tests to get ready for the tutoring program, and dealing with special cases. I went to La Colonia on Friday to find a girl with a club foot, as Dr. Raymond wanted her to come into Miss Peggy’s clinic so he could refer her to the surgeon in the public hospital. I found the mom with the help of Irma’s daughter, and she seemed rather disillusioned, since apparently the last time they tried to get the girl to a medical brigade on the mainland, it all fell through and she didn’t really know why. I was happy when she still came in to the clinic on Monday, though, as she’d promised. Hopefully it all works out this time.
Other than that, I’ve been enjoying island life, although we had a big rainstorm all weekend. We did make it out to the east end of the island, which is beautiful and so much different from the more touristy west side.
One young woman I interpreted for was about 5 months pregnant and wanted to get a pregnancy check-up. When the doctor asked her where she was planning on having the baby and if she was going to breast-feed, she explained that she was on the island without any family and was working full-time, so would go to La Ceiba to have the child, breast-feed for a couple weeks, and then leave the baby with family indefinitely and come back to the island to work. It made me really realize how hard it can be for women here to raise children, especially when they are not near family members.
Another woman came in presenting symptoms that seemed like she probably had kidney stones, but the only way to really tell was to send her to get an ultrasound in La Ceiba, an expensive ferry ride from the island. I’ve come to realize how limiting it is to try to provide high-quality health care on an island that has very limited resources when it comes to testing, etc. Often we can get the people over to the mainland for free or a discounted rate, but they still need to sometimes spend the night there, get transportation to and from medical centers there, etc.
I went in to the Global Healing clinic on Wednesday because Peggy’s is closed, and they are still on strike. Dr. Charles also hadn’t come in, which was stressful for the new attending, as she really wanted to have someone there who knew the system and population better, which is completely understandable. Hopefully the next couple of months will go smoothly.
Max and I have also been taking care of odd jobs for Miss Peggy, including making a poster for a conference they went to in Copan Ruinas, grading diagnostic tests to get ready for the tutoring program, and dealing with special cases. I went to La Colonia on Friday to find a girl with a club foot, as Dr. Raymond wanted her to come into Miss Peggy’s clinic so he could refer her to the surgeon in the public hospital. I found the mom with the help of Irma’s daughter, and she seemed rather disillusioned, since apparently the last time they tried to get the girl to a medical brigade on the mainland, it all fell through and she didn’t really know why. I was happy when she still came in to the clinic on Monday, though, as she’d promised. Hopefully it all works out this time.
Other than that, I’ve been enjoying island life, although we had a big rainstorm all weekend. We did make it out to the east end of the island, which is beautiful and so much different from the more touristy west side.
Max Journal 4
Monday was some sort of holiday from the hospital, although the hospital was closed anyway for the strike, so the Grubers told me to spend the day at Peggy's. I worked in the pharmacy and got to triage a couple of patients. I also took a trip up to La Colonia with Peggy and Irma to track down a child with a congenital skin/eye condition that will (hopefully) visit a pediatric ophthalmologist in El Progresso in the beginning of next month. I am trying to help out with the coordination of that visit as much as possible, and it has been rewarding so far.
Tuesday was the Gruber's last chance to reorganize the clinic a few times, so we did that and saw patients referred from the ED. Anita Kandiar, the new attending, arrived and Howard showed her around the hospital.
I also had the opportunity to try to coordinate transportation of a hydrocephalic baby and her mother and grandmother to Tegucigalpa. The grandmother came to me asking for assistance, and before I really had all of the pertinent information she had dragged me to the mayor's office and the police chief's trying to resolve some personal conflict of hers. I am still trying to assist them in getting to Teguc, but I am a bit more skeptical about taking people's requests at face value.
The strike has also been a point of recent disappointment. At the end of this week more workers decided to at least come sit (or sleep) on benches in front of the hospital to increase their visibility, as opposed to staying at home as they had for the previous week and a half. Every time I ask a striking worker what the demands are, I get a different answer, and every time I ask if any progress is being made, they shake their heads and say that this is a "long-term" strike. I am feeling constrained by a cultural divide, because in the United States I wouldn't hesitate at reprimanding both the union and the hospital management for making so little progress in so much time, but I resign myself to the fact that everyone here comes from a different cultural background and has different standards of what to expect from a public hospital. A couple of children died in the hospital this week for not-completely-clear reasons, and I can't help but think that the disorganization with the strike and some degree of negligence were involved.
I don't mean to sound too negative, but I think many people view this strike as a big setback for public health on Roatan. Anita is great and I am still learning a lot, but I can't quite imagine what the next two months hold for the Global Healing clinic in Roatan.
On a slightly different note, we are now in the midst of rainy season and I happily spent my Saturday watching a movie and baking cinnamon-raisin bread with Christine and another volunteer. The community of volunteers here is great and we are constantly bouncing our impressions of Roatan's health off of each other to learn more
Tuesday was the Gruber's last chance to reorganize the clinic a few times, so we did that and saw patients referred from the ED. Anita Kandiar, the new attending, arrived and Howard showed her around the hospital.
I also had the opportunity to try to coordinate transportation of a hydrocephalic baby and her mother and grandmother to Tegucigalpa. The grandmother came to me asking for assistance, and before I really had all of the pertinent information she had dragged me to the mayor's office and the police chief's trying to resolve some personal conflict of hers. I am still trying to assist them in getting to Teguc, but I am a bit more skeptical about taking people's requests at face value.
The strike has also been a point of recent disappointment. At the end of this week more workers decided to at least come sit (or sleep) on benches in front of the hospital to increase their visibility, as opposed to staying at home as they had for the previous week and a half. Every time I ask a striking worker what the demands are, I get a different answer, and every time I ask if any progress is being made, they shake their heads and say that this is a "long-term" strike. I am feeling constrained by a cultural divide, because in the United States I wouldn't hesitate at reprimanding both the union and the hospital management for making so little progress in so much time, but I resign myself to the fact that everyone here comes from a different cultural background and has different standards of what to expect from a public hospital. A couple of children died in the hospital this week for not-completely-clear reasons, and I can't help but think that the disorganization with the strike and some degree of negligence were involved.
I don't mean to sound too negative, but I think many people view this strike as a big setback for public health on Roatan. Anita is great and I am still learning a lot, but I can't quite imagine what the next two months hold for the Global Healing clinic in Roatan.
On a slightly different note, we are now in the midst of rainy season and I happily spent my Saturday watching a movie and baking cinnamon-raisin bread with Christine and another volunteer. The community of volunteers here is great and we are constantly bouncing our impressions of Roatan's health off of each other to learn more
Sunday, October 07, 2007
Christine Journal 3
We’ve been here a week now and I am feeling very settled in – we’re already seeing volunteers come and go, and I am so amazed by Miss Peggy’s hospitality for the amazing number of volunteers she takes care of throughout the years.
The highlight of this week was being busy in the afternoons, as we finally got a project for the week. One of Shelli’s friends was visiting for the week to teach an SAT preparation class at a bilingual school in French Harbour. The class had 9-12 graders in it, some of whom wanted to take the SAT and some of whom didn’t want to have double homework the next week (the other option). They were a great class though – always paying attention and very respectful. The class was after school for two hours a day, and I helped out for the five days they had class. I didn’t really know what to expect, but soon discovered how hard it was to teach an SAT prep class to a class of people with such different levels (9th graders who hadn’t seen algebra before to 12th graders who had seen it a few years before) and who didn’t know a lot of the obscure vocabulary the SAT tends to put in the verbal section of the test, as well as all the cultural references that the word problems have. I quickly noticed that the kids were overwhelmed by the test, as they had never taken it before and were not used to the types of questions they asked.
We spent the week giving them practice problems to do alone or in groups, and then went over the answers as a class or in small groups. I soon changed my expectations for how much I could do in the week, and began focusing less on the individual problems we went over and more on just emphasizing the idea of going to college, whether in the US or elsewhere, and in the need to study for the SAT if they were going to take it. They’re going to start individualized tutoring with kids soon, which I think will be much more effective than the larger group.
Clinic has been going really well. I’d been helping out in the pharmacy, but we had two doctors last week who don’t speak Spanish, so I got to do a lot of interpreting, which was really interesting. I loved getting to see the visits with the doctors and see all the steps they take to diagnose different diseases. And I enjoyed getting to chat with the patients as we waited for the doctor to check tests or consult with other doctors. One thing that I found frustrating was the lack of advanced medical care and equipment available on the island, as a lot of patients who need more specialized care have to be referred to the mainland, which is an expensive trip to make. For example, one woman I interpreted for probably had kidney stones, but without an ultrasound, there wasn’t any way to really tell.
We got to meet the Grubers this week, and it was great to spend time with them and hear about the beginnings of the pediatric clinic and how it runs, etc.
This coming week I’ll be in Miss Peggy’s clinic in the morning and have yet to fill my afternoons, so we’ll see what kinds of projects are needed – hopefully I’ll be busy!
The highlight of this week was being busy in the afternoons, as we finally got a project for the week. One of Shelli’s friends was visiting for the week to teach an SAT preparation class at a bilingual school in French Harbour. The class had 9-12 graders in it, some of whom wanted to take the SAT and some of whom didn’t want to have double homework the next week (the other option). They were a great class though – always paying attention and very respectful. The class was after school for two hours a day, and I helped out for the five days they had class. I didn’t really know what to expect, but soon discovered how hard it was to teach an SAT prep class to a class of people with such different levels (9th graders who hadn’t seen algebra before to 12th graders who had seen it a few years before) and who didn’t know a lot of the obscure vocabulary the SAT tends to put in the verbal section of the test, as well as all the cultural references that the word problems have. I quickly noticed that the kids were overwhelmed by the test, as they had never taken it before and were not used to the types of questions they asked.
We spent the week giving them practice problems to do alone or in groups, and then went over the answers as a class or in small groups. I soon changed my expectations for how much I could do in the week, and began focusing less on the individual problems we went over and more on just emphasizing the idea of going to college, whether in the US or elsewhere, and in the need to study for the SAT if they were going to take it. They’re going to start individualized tutoring with kids soon, which I think will be much more effective than the larger group.
Clinic has been going really well. I’d been helping out in the pharmacy, but we had two doctors last week who don’t speak Spanish, so I got to do a lot of interpreting, which was really interesting. I loved getting to see the visits with the doctors and see all the steps they take to diagnose different diseases. And I enjoyed getting to chat with the patients as we waited for the doctor to check tests or consult with other doctors. One thing that I found frustrating was the lack of advanced medical care and equipment available on the island, as a lot of patients who need more specialized care have to be referred to the mainland, which is an expensive trip to make. For example, one woman I interpreted for probably had kidney stones, but without an ultrasound, there wasn’t any way to really tell.
We got to meet the Grubers this week, and it was great to spend time with them and hear about the beginnings of the pediatric clinic and how it runs, etc.
This coming week I’ll be in Miss Peggy’s clinic in the morning and have yet to fill my afternoons, so we’ll see what kinds of projects are needed – hopefully I’ll be busy!
Max Journal 3
This was a busier week than the previous few despite the fact that the hospital strike continues and we've seen very few patients in the clinic this week. Having the Grubers around has been a treat, although we have reorganized the same shelves in the clinic several times since they arrived. Alice has kept me busy reorganizing the filing cabinets, the computer, and all of the medications and medical supplies. I also worked on updating her physician orientation guide with current information about the hospital and the island. I have been meeting with technicians from Paradise Computers to try to install some new internet connections in the hospital and repair the old ones that aren't working, and that has given me the opportunity to meet more hospital employees and explore a bit.
The most interesting cases we saw this week were a child with hydrocephaly and a cleft lip and palette and another child with a congenital skin/eye/hair condition that thusfar defies diagnosis. The child with hydrocephaly came to the hospital (referred from Ms. Peggy's) to receive pre-surgery testing because Peggy wanted to send him to the mainland to meet an American surgical brigade to repair his cleft palette. The child came to the clinic to receive an ultrasound (by one of Peggy's volunteers, an ER resident) and then to get all the necessary labs. I spent a full morning walking with the mother and child between offices to get the necessary paperwork and labs, and in the end they did not go to the mainland to get the surgery because of a paperwork hang-up. Dr. Breslin and all the other folks in the clinic have been working hard to resurrect our patient follow-up system (the patient list you sent me was from 2005), and we already have several patients entered into the new database.
The other interesting case was an 11-month old girl with a mysterious icthyosiform erythroderma and congenital cataracts. The doctors sent some photos to a pediatric dermatologist at Boston Children's Hospital and came up with a differential diagnosis, but the patient had already been sent home. A social service doc referred the patient to a dermatologist who was visiting Woods Medical Center on Saturday, so I spent several hours waiting for the dermatologist to try and intercept the patient yesterday. I was doubtful that the patient was going to show, so I spoke with the dermatologist and exchanged contact information with her in case she did see the patient later in the day. I am still hoping to track down the patient to give her mother more information and resources to visit an ophthalmologist on the mainland and possibly get cataract surgery by a medical brigade in November.
In the afternoons Peggy has kept me busy with odd jobs and errands and I spent three days tutoring high schoolers at a bilingual school in French Harbour with one of Peggy's volunteers and Christine. Hopefully this week I'll make it over to the day care and hopefully develop some more regular projects. Also, in a few weeks the tutoring should turn into at least a two-afternoon per week job.
The most interesting cases we saw this week were a child with hydrocephaly and a cleft lip and palette and another child with a congenital skin/eye/hair condition that thusfar defies diagnosis. The child with hydrocephaly came to the hospital (referred from Ms. Peggy's) to receive pre-surgery testing because Peggy wanted to send him to the mainland to meet an American surgical brigade to repair his cleft palette. The child came to the clinic to receive an ultrasound (by one of Peggy's volunteers, an ER resident) and then to get all the necessary labs. I spent a full morning walking with the mother and child between offices to get the necessary paperwork and labs, and in the end they did not go to the mainland to get the surgery because of a paperwork hang-up. Dr. Breslin and all the other folks in the clinic have been working hard to resurrect our patient follow-up system (the patient list you sent me was from 2005), and we already have several patients entered into the new database.
The other interesting case was an 11-month old girl with a mysterious icthyosiform erythroderma and congenital cataracts. The doctors sent some photos to a pediatric dermatologist at Boston Children's Hospital and came up with a differential diagnosis, but the patient had already been sent home. A social service doc referred the patient to a dermatologist who was visiting Woods Medical Center on Saturday, so I spent several hours waiting for the dermatologist to try and intercept the patient yesterday. I was doubtful that the patient was going to show, so I spoke with the dermatologist and exchanged contact information with her in case she did see the patient later in the day. I am still hoping to track down the patient to give her mother more information and resources to visit an ophthalmologist on the mainland and possibly get cataract surgery by a medical brigade in November.
In the afternoons Peggy has kept me busy with odd jobs and errands and I spent three days tutoring high schoolers at a bilingual school in French Harbour with one of Peggy's volunteers and Christine. Hopefully this week I'll make it over to the day care and hopefully develop some more regular projects. Also, in a few weeks the tutoring should turn into at least a two-afternoon per week job.
Sunday, September 30, 2007
Christine Journal 2
I've been working in Clinica Esperanza this past week, while Max has been in the pediatric clinic (well, most of the time - see his email for the strike update). On Monday and Tuesday, Betty, the normal pharmacist, was out of town, so a nurse and I were in there all day trying to figure out where meds were kept, etc., but we ended up finding everything eventually and got all the meds out. I've also been helping to enter patients into the new database they're making, which includes looking through old charts and just filling out online records. They go back to 2005, so there's a lot of work to do!
On Wednesday, I went in to the public hospital with Max because the clinic is closed, but I woke up with a cold, headache, and nausea, so didn't last long. I did get to go on the morning rounds with Kristen, the current pediatrician, and see her visit two newborn babies and see the rest of the hospital for the first time, which was great. I'd never seen a newborn before, so that was interesting! However, after the rounds I was feeling really sick, and the hospital staff was on strike so there were very few patients, so I got a cab and went home, sleeping for pretty much the rest of the day.
On Thursday and Friday, I was back at the clinic, and helped again in the pharmacy, this time with Betty back. The doctors have been really great about calling me in to see interesting cases, or to help them out a little bit, which has been so rewarding. I listened to a lung crackle with Dr. Charles, and then saw the patient when he came back to get the fluid in his abdomen drained - it filled a bucket that probably held a gallon or more of liquid! I also helped a doctor clean and re-wrap a patient's fingers that he had sliced pretty badly, and saw a boy who had a thyroglosal cyst.
We've still been pretty bored in the afternoons, waiting for either the tutoring to start up, or someone to give us an idea for a project, since we're ready to get going. As I said earlier, Miss Peggy is back now and has given us lots of ideas, but we still need to really sit down with her and decide what would fit our interests, time constraints, and the island's needs the best. I definitely want to make sure whatever we do is sustainable and practical for our skills and time here. It sounds like the tutoring is starting up this week (or at least SAT tutoring is), there are schools at which we could teach English or basic health, among other things. We'll definitely let you know when we decide on something.
That's about it for the week. Everything has been going really well and I think that we're in for a wonderful few months. I'm really looking forward to everything we'll be doing!
On Wednesday, I went in to the public hospital with Max because the clinic is closed, but I woke up with a cold, headache, and nausea, so didn't last long. I did get to go on the morning rounds with Kristen, the current pediatrician, and see her visit two newborn babies and see the rest of the hospital for the first time, which was great. I'd never seen a newborn before, so that was interesting! However, after the rounds I was feeling really sick, and the hospital staff was on strike so there were very few patients, so I got a cab and went home, sleeping for pretty much the rest of the day.
On Thursday and Friday, I was back at the clinic, and helped again in the pharmacy, this time with Betty back. The doctors have been really great about calling me in to see interesting cases, or to help them out a little bit, which has been so rewarding. I listened to a lung crackle with Dr. Charles, and then saw the patient when he came back to get the fluid in his abdomen drained - it filled a bucket that probably held a gallon or more of liquid! I also helped a doctor clean and re-wrap a patient's fingers that he had sliced pretty badly, and saw a boy who had a thyroglosal cyst.
We've still been pretty bored in the afternoons, waiting for either the tutoring to start up, or someone to give us an idea for a project, since we're ready to get going. As I said earlier, Miss Peggy is back now and has given us lots of ideas, but we still need to really sit down with her and decide what would fit our interests, time constraints, and the island's needs the best. I definitely want to make sure whatever we do is sustainable and practical for our skills and time here. It sounds like the tutoring is starting up this week (or at least SAT tutoring is), there are schools at which we could teach English or basic health, among other things. We'll definitely let you know when we decide on something.
That's about it for the week. Everything has been going really well and I think that we're in for a wonderful few months. I'm really looking forward to everything we'll be doing!
Max Journal 2
This week has involved more great learning opportunities for both me and Christine. Monday was a heavy patient load at Global Healing, so I stayed busy all morning triaging and inputting information. On Tuesday I showed up a bit earlier to the clinic, hoping to prevent getting overwhelmed by patients, and we ended up seeing only about six kids. Wednesday I arrived at the hospital to find the Preclinica closed and surprisingly few patients in the clinic. After Kristen and Charles arrived, we ascertained that the hospital workers (or some subset of them) were on strike, so we would be unable to get patient files and see patients. The strike continued until the end of the week and I am still not sure if it will be over tomorrow.
On Wednesday, Kristen gathered the social service doctors together to give a lunchtime lecture on meningitis, which went really well. While she was working on organizing that, I assisted with an American medical brigade called Hearts in Motion that was using the hospital for OB/GYN, dentist, and general internist consults. We let them use our clinic because we weren't using it, and I stayed there helping to translate and deal with patients. Probably the most interesting case that I saw this week was a woman who came to the brigade for a medical report to present to the police after being attacked. We couldn't give her a full medical report without X-rays (there was a possible fracture and radiology was closed due to the strike) and we didn't know what the form should look like, so I just wrote out a semi-official looking letting stating our findings and referred her to Woods Medical Center (on the public attorney's recommendation). I was sorry we couldn't help her more and it definitely made me realize the kind of proaction that is necessary in that sort of situation. We spoke with the woman for a while and gave her antibiotics for a possible infection of the wound site, but I couldn't leave the clinic to accompany her to find an X-ray, which I would have liked to do. Maybe that was the first opportunity I had for case management and I passed it up, but I'll try not to let that happen again.
On Thursday I returned to the clinic to find that the strike was still going on, so Kristen and Charles went to check up on kids in the day care while I did an inventory of soon-to-expire meds.
Each day after I got out of the clinic, I went to Peggy's clinic to help in the pharmacy there, and on Friday I didn't go to the hospital at all, staying at Peggy's clinic instead. Christine and I have also been working on a poster for Clinica Esperanza. It was a good week despite the strike and next week will surely be an adventure too.
This weekend Peggy and the Grubers arrived, so hopefully we will hit the ground running with a public health project before long. We have been trying to figure out where to work in the afternoons, but nothing has realized yet. This evening we will meet Howard and Alice for the first time, so I look forward to them putting us to work.I also spent a number of hours this week trying to track down a dog that bit me on the beach, but I'm not worried about it and I am getting PLENTY of medical advice!
On Wednesday, Kristen gathered the social service doctors together to give a lunchtime lecture on meningitis, which went really well. While she was working on organizing that, I assisted with an American medical brigade called Hearts in Motion that was using the hospital for OB/GYN, dentist, and general internist consults. We let them use our clinic because we weren't using it, and I stayed there helping to translate and deal with patients. Probably the most interesting case that I saw this week was a woman who came to the brigade for a medical report to present to the police after being attacked. We couldn't give her a full medical report without X-rays (there was a possible fracture and radiology was closed due to the strike) and we didn't know what the form should look like, so I just wrote out a semi-official looking letting stating our findings and referred her to Woods Medical Center (on the public attorney's recommendation). I was sorry we couldn't help her more and it definitely made me realize the kind of proaction that is necessary in that sort of situation. We spoke with the woman for a while and gave her antibiotics for a possible infection of the wound site, but I couldn't leave the clinic to accompany her to find an X-ray, which I would have liked to do. Maybe that was the first opportunity I had for case management and I passed it up, but I'll try not to let that happen again.
On Thursday I returned to the clinic to find that the strike was still going on, so Kristen and Charles went to check up on kids in the day care while I did an inventory of soon-to-expire meds.
Each day after I got out of the clinic, I went to Peggy's clinic to help in the pharmacy there, and on Friday I didn't go to the hospital at all, staying at Peggy's clinic instead. Christine and I have also been working on a poster for Clinica Esperanza. It was a good week despite the strike and next week will surely be an adventure too.
This weekend Peggy and the Grubers arrived, so hopefully we will hit the ground running with a public health project before long. We have been trying to figure out where to work in the afternoons, but nothing has realized yet. This evening we will meet Howard and Alice for the first time, so I look forward to them putting us to work.I also spent a number of hours this week trying to track down a dog that bit me on the beach, but I'm not worried about it and I am getting PLENTY of medical advice!
Sunday, September 23, 2007
Christine Journal 1
It’s been a week now since we arrived on Roatan, and I’m loving meeting everyone and getting a sense for how things happen here. We were met at the airport by Edwin, the intern before us, and Shelli, who’s working in Miss Peggy’s clinic, and were quickly introduced to all the other people working down here. There’s a really great community feeling among all the volunteers, and I’m excited to learn from everyone who’s working with both clinics (Global Healing and Clinica Esperanza) in different ways.
After moving in to our apartment on Sunday, we were ready to start in the clinic the next morning. We arrived early to find many, many people already waiting outside to see the doctor, and have been told that they arrive around 6 am. I was immediately struck by how different the hospital is from anywhere I’ve been in the United States – no running water was the biggest surprise. I think it will be really interesting to really get to know how things work there over the next three months. Edwin taught us how to triage the patients, where we could find everything, and how to fill out forms at the end of each day. There is an American doctor and a Honduran doctor there right now, and they’ve both been really open to explaining different things to us. It should be a really great learning experience to work so close with them.
I’ve loved all the patient interaction we get as the triagers. It’s been interesting to see the different ways that the kids react to the triaging. Some think it’s fun to stand up on the scale, while some kick and scream and cry when we try to weigh them. I’m looking forward to getting to know people better as time goes on.
Max and I have realized that having two of us at the Global Healing clinic does not really achieve much more than have one of us there, so we both worked at Clinica Esperanza one day last week as well. I went in on Friday, and Alex, a volunteer, helped me learn the ropes of the pharmacy there. That’s probably where Max and I will primarily work when we’re in that clinic. It’s amazing how many donations they receive and how smoothly everything seems to run!
In terms of our public health projects, Max and I are still trying to get a feel for what’s available and needed, especially since Nurse Peggy has been out of town. I’m really looking forward to finding a few projects for the afternoons, though. It seems like there are a lot of tutoring opportunities, and I’m sure there are many other things that Nurse Peggy can tell us about when she’s back.
In our free time, we’ve been enjoying exploring Sandy Bay and other parts of the island, as well as snorkeling, cooking, and getting to know other volunteers and workers at the two clinics.
It should be a really great three months!
After moving in to our apartment on Sunday, we were ready to start in the clinic the next morning. We arrived early to find many, many people already waiting outside to see the doctor, and have been told that they arrive around 6 am. I was immediately struck by how different the hospital is from anywhere I’ve been in the United States – no running water was the biggest surprise. I think it will be really interesting to really get to know how things work there over the next three months. Edwin taught us how to triage the patients, where we could find everything, and how to fill out forms at the end of each day. There is an American doctor and a Honduran doctor there right now, and they’ve both been really open to explaining different things to us. It should be a really great learning experience to work so close with them.
I’ve loved all the patient interaction we get as the triagers. It’s been interesting to see the different ways that the kids react to the triaging. Some think it’s fun to stand up on the scale, while some kick and scream and cry when we try to weigh them. I’m looking forward to getting to know people better as time goes on.
Max and I have realized that having two of us at the Global Healing clinic does not really achieve much more than have one of us there, so we both worked at Clinica Esperanza one day last week as well. I went in on Friday, and Alex, a volunteer, helped me learn the ropes of the pharmacy there. That’s probably where Max and I will primarily work when we’re in that clinic. It’s amazing how many donations they receive and how smoothly everything seems to run!
In terms of our public health projects, Max and I are still trying to get a feel for what’s available and needed, especially since Nurse Peggy has been out of town. I’m really looking forward to finding a few projects for the afternoons, though. It seems like there are a lot of tutoring opportunities, and I’m sure there are many other things that Nurse Peggy can tell us about when she’s back.
In our free time, we’ve been enjoying exploring Sandy Bay and other parts of the island, as well as snorkeling, cooking, and getting to know other volunteers and workers at the two clinics.
It should be a really great three months!
Max Journal 1
We started work on Monday with both of us in the clinic with Edwin. He showed us basically what he does each day, and we took turns interviewing patients. On Tuesday all three of us went to the clinic again and did essentially the same thing.
On Wednesday Edwin left for El Salvador so Christine and I both went to Global Healing to make sure we remembered how to do everything before we left each other alone in the clinic. Dr. Breslin gave me a very short tour of the hospital and I was very grateful to get a little more of the "big picture" of how the different departments there interact. I would still love a more complete tour by Dr. Charles or anyone else, but that will probably come when I need to get something done and I'll just figure it out for myself.
On Thursday I went to work in Clinica Esperanza because the pre-med volunteer there was taking a day off and I wanted to see the place. I spent the day in the pharmacy with Betty mostly doing data entry and learning how the clinic works. I assume that once I work there a few days I will be able to help measure out prescriptions and possibly translate for the nurses and doctors, which will be interesting. It was also enlightening to see how the clinic takes in large quantities of donated medications and incorporates them into their pharmacy. I noticed that the clinic there will take peoples' personally prescribed medication, which is different from Global Healing but seems to make sense. For both the Global Healing clinic and Clinica Esperanza I am slightly amazed by how they keep consistently providing quality services with what seem like inconsistent supplies of medications, equipment, and volunteers. For most of the non-profits that I've worked with in the states, "turn-over" a very sore point and constant reason for concern, but here these clinics seem to be built around an acceptance of extremely high turnover with volunteers coming and going every month, and they seem to function alright. Also, with the medical supplies that seem to come in randomly (except for the few things that the clinic buys outright), somehow prescriptions manage to get filled one way or another. It's like stability out of chaos. Very cool, and not at all easy to pull off, but I look forward to learning more how it all works.
On Friday I went to the Global Healing Clinic and Christine went to work in Clinica Esperanza. We had almost 20 patients so we stayed quite busy. I am enjoying practicing and improving my Spanish and haven't run into any insurmountable barriers, although my Spanish is definitely a long way from being as fluent as Christine's. I look forward to practicing and improving more over the next few months, and I hope that I can be effective if I am put into the position of translator. I was expecting one patient whose chart had a number of notes from previous Global Healing clinic interns, but the patient never came to the clinic. The boy had some sort of seizure/muscle spasm disorder for which a previous intern considered coordinating an expensive surgery in San Pedro Sula, but the charts say he is responding well to seizure medication. Although I never saw this patient, it reminded me of the "case manager" portion of the orientation packet.
Christine and I decided that we will work most effectively if we each have a large chunk of time at each clinic, so for the next month and a half I will work in the Global Healing clinic each morning and Christine will work in Clinica Esperanza each morning except Wednesday (when they're closed), and then we will trade places. I think this will provide the most continuity for each clinic and will allow us to get to know each place well.
In the afternoons we have mostly been getting to know the area and swimming a lot. Because Peggy has been out of town, I feel like our "public health project" questions haven't been getting very straight answers. I know it is up to us to arrange something, so we will keep asking around and exploring possibilities, but it may take a little while for us to find a project even though I think we both would like something to keep us busy in the afternoons. It seems that Edwin was playing/coaching basketball with Dr. Raymond's team in the afternoons, but we got rained out while he was here and now I don't know where the courts are and I'm honestly not much of a basketball player. Shelli (the long-term volunteer living in Peggy's downstairs apartment) has mentioned several times a tutoring project she is starting up, but I don't know when that will come to fruition. Also Peggy mentioned via email the possibility of us teaching a health class, but she's not here now and I haven't heard anything about it from anyone else. We will keep asking around and I hope that by the end of the week we'll have a better idea of how we can contribute to the health of the island with our afternoons. For the time being we are learning a lot about how things work here and enjoying some fabulous snorkeling (swam amongst a pod of ~30 dolphins this morning, including at least 4 babies!).
The White Diamond Luxury Apartment is very luxurious and probably the nicest place I'll live in the next decade. It's a little more than Christine and I were expecting to pay, but the landlord is nice and we'll just have to have a lot of guests. The clinic seems to be in generally good shape and I am looking forward to meeting the Gruber's and Nurse Peggy soon.
Tonight we are having several volunteers over for dinner, so we've got some cooking to do, but if I left out any pertinent information or used a completely inappropriate format for this email journal entry, please let me know and I'll change it. I imagine that in the future I will present more case studies and reports on my projects outside of the clinic, but for the time being I'm still just getting my bearings.
On Wednesday Edwin left for El Salvador so Christine and I both went to Global Healing to make sure we remembered how to do everything before we left each other alone in the clinic. Dr. Breslin gave me a very short tour of the hospital and I was very grateful to get a little more of the "big picture" of how the different departments there interact. I would still love a more complete tour by Dr. Charles or anyone else, but that will probably come when I need to get something done and I'll just figure it out for myself.
On Thursday I went to work in Clinica Esperanza because the pre-med volunteer there was taking a day off and I wanted to see the place. I spent the day in the pharmacy with Betty mostly doing data entry and learning how the clinic works. I assume that once I work there a few days I will be able to help measure out prescriptions and possibly translate for the nurses and doctors, which will be interesting. It was also enlightening to see how the clinic takes in large quantities of donated medications and incorporates them into their pharmacy. I noticed that the clinic there will take peoples' personally prescribed medication, which is different from Global Healing but seems to make sense. For both the Global Healing clinic and Clinica Esperanza I am slightly amazed by how they keep consistently providing quality services with what seem like inconsistent supplies of medications, equipment, and volunteers. For most of the non-profits that I've worked with in the states, "turn-over" a very sore point and constant reason for concern, but here these clinics seem to be built around an acceptance of extremely high turnover with volunteers coming and going every month, and they seem to function alright. Also, with the medical supplies that seem to come in randomly (except for the few things that the clinic buys outright), somehow prescriptions manage to get filled one way or another. It's like stability out of chaos. Very cool, and not at all easy to pull off, but I look forward to learning more how it all works.
On Friday I went to the Global Healing Clinic and Christine went to work in Clinica Esperanza. We had almost 20 patients so we stayed quite busy. I am enjoying practicing and improving my Spanish and haven't run into any insurmountable barriers, although my Spanish is definitely a long way from being as fluent as Christine's. I look forward to practicing and improving more over the next few months, and I hope that I can be effective if I am put into the position of translator. I was expecting one patient whose chart had a number of notes from previous Global Healing clinic interns, but the patient never came to the clinic. The boy had some sort of seizure/muscle spasm disorder for which a previous intern considered coordinating an expensive surgery in San Pedro Sula, but the charts say he is responding well to seizure medication. Although I never saw this patient, it reminded me of the "case manager" portion of the orientation packet.
Christine and I decided that we will work most effectively if we each have a large chunk of time at each clinic, so for the next month and a half I will work in the Global Healing clinic each morning and Christine will work in Clinica Esperanza each morning except Wednesday (when they're closed), and then we will trade places. I think this will provide the most continuity for each clinic and will allow us to get to know each place well.
In the afternoons we have mostly been getting to know the area and swimming a lot. Because Peggy has been out of town, I feel like our "public health project" questions haven't been getting very straight answers. I know it is up to us to arrange something, so we will keep asking around and exploring possibilities, but it may take a little while for us to find a project even though I think we both would like something to keep us busy in the afternoons. It seems that Edwin was playing/coaching basketball with Dr. Raymond's team in the afternoons, but we got rained out while he was here and now I don't know where the courts are and I'm honestly not much of a basketball player. Shelli (the long-term volunteer living in Peggy's downstairs apartment) has mentioned several times a tutoring project she is starting up, but I don't know when that will come to fruition. Also Peggy mentioned via email the possibility of us teaching a health class, but she's not here now and I haven't heard anything about it from anyone else. We will keep asking around and I hope that by the end of the week we'll have a better idea of how we can contribute to the health of the island with our afternoons. For the time being we are learning a lot about how things work here and enjoying some fabulous snorkeling (swam amongst a pod of ~30 dolphins this morning, including at least 4 babies!).
The White Diamond Luxury Apartment is very luxurious and probably the nicest place I'll live in the next decade. It's a little more than Christine and I were expecting to pay, but the landlord is nice and we'll just have to have a lot of guests. The clinic seems to be in generally good shape and I am looking forward to meeting the Gruber's and Nurse Peggy soon.
Tonight we are having several volunteers over for dinner, so we've got some cooking to do, but if I left out any pertinent information or used a completely inappropriate format for this email journal entry, please let me know and I'll change it. I imagine that in the future I will present more case studies and reports on my projects outside of the clinic, but for the time being I'm still just getting my bearings.
Sunday, September 09, 2007
Edwin Journal 2
The week started out with a little scare, as Hurricane Felix was making its way to Honduras. On Monday morning I woke up to the sound of hammering as locals were boarding up their windows as they headed for higher ground. Businesses were closed, and as I'll mention later, the clinic was shut down for the first half of the week. By this time, there still wasn't any certainty whether the hurricane would actually make landfall on Roatan, but folks here were not taking any chances. In fact, thousands of locals and tourists decided to evacuate the island and head to the mainland. Perhaps some saw this as a free trip to visit family and friends, although they'd eventually have to foot the bill coming back on the ferry. As things turned out, the mainland of Honduras actually got the worst of the hurricane while Roatan only saw a minimal amount of rain with hardly any wind. Despite the rain, conditions were good enough for us to play board games out on Peggy's deck overlooking the Caribbean as the storm passed. Compared to some of the horror stories I've heard about past hurricanes tearing off roofs and demolishing docks, it looks as though we dodged a pretty significant bullet.
Although the sky was clear with no sight of the forthcoming storm, Dr. Kristen and I came to clinic on Monday only to be given the news that our clinic would be closed until Wednesday. It came as a surprise and a disappointment to us both, especially since Dr. Kristen was eager to start her first day in the hospital. Nevertheless, we managed to quickly triage and give OTC treatments to folks who were patient enough to wait for the news of our closure, though we weren't able to see them as thoroughly as we would've liked. The only good that came out of the clinic's closure was that Dr. Kristen and I were able to spend a little more time seeing and examining newborn babies in the neonatal ward. I got to help Dr. Kristen out by filling out each baby's height, weight, head circumference, method of delivery, APGAR scores, and vaccinations taken up to that point on the exam forms. I really enjoyed interacting with newborns and their mothers, and so hopefully I'll get the chance to do more of that next week.
The remaining three days of clinic went smoothly, with many of the same cases I have come to recognize right away—impetigo, skin rashes, and viral infections to name a few. Dr. Welcome is temporarily on assignment elsewhere on the island, so filling in for him is Dr. Delia, a Cuba-trained doctor completing a social service rotation here on the island. Herself a Honduran, Dr. Delia described to us the tension between Honduras-trained and Cuba-trained doctors. For instance, Cuba-trained doctors on rotation are given two separate stipends, one from their medical school and the other from the Honduran government, while Honduras-trained doctors are given just one. She also told us that there are often problems with hospitals that choose not to recognize medical practicing licenses from Cuba. Dr. Kristen, on the other hand, is a Harvard-trained doctor originally from Boston and now practicing in Washington DC. She took time to explain to me the different tracks in third- and fourth-year medical school and some of her personal experiences in her chosen track. In my time here I have found it so fascinating not only observing the doctor-patient interaction, but seeing how such broad and different experiences can bring doctors together in an organization such as this. I hope to learn more from Dr. Kristen and Dr. Delia in my last couple of days here.
Although the sky was clear with no sight of the forthcoming storm, Dr. Kristen and I came to clinic on Monday only to be given the news that our clinic would be closed until Wednesday. It came as a surprise and a disappointment to us both, especially since Dr. Kristen was eager to start her first day in the hospital. Nevertheless, we managed to quickly triage and give OTC treatments to folks who were patient enough to wait for the news of our closure, though we weren't able to see them as thoroughly as we would've liked. The only good that came out of the clinic's closure was that Dr. Kristen and I were able to spend a little more time seeing and examining newborn babies in the neonatal ward. I got to help Dr. Kristen out by filling out each baby's height, weight, head circumference, method of delivery, APGAR scores, and vaccinations taken up to that point on the exam forms. I really enjoyed interacting with newborns and their mothers, and so hopefully I'll get the chance to do more of that next week.
The remaining three days of clinic went smoothly, with many of the same cases I have come to recognize right away—impetigo, skin rashes, and viral infections to name a few. Dr. Welcome is temporarily on assignment elsewhere on the island, so filling in for him is Dr. Delia, a Cuba-trained doctor completing a social service rotation here on the island. Herself a Honduran, Dr. Delia described to us the tension between Honduras-trained and Cuba-trained doctors. For instance, Cuba-trained doctors on rotation are given two separate stipends, one from their medical school and the other from the Honduran government, while Honduras-trained doctors are given just one. She also told us that there are often problems with hospitals that choose not to recognize medical practicing licenses from Cuba. Dr. Kristen, on the other hand, is a Harvard-trained doctor originally from Boston and now practicing in Washington DC. She took time to explain to me the different tracks in third- and fourth-year medical school and some of her personal experiences in her chosen track. In my time here I have found it so fascinating not only observing the doctor-patient interaction, but seeing how such broad and different experiences can bring doctors together in an organization such as this. I hope to learn more from Dr. Kristen and Dr. Delia in my last couple of days here.
Sunday, September 02, 2007
Edwin Journal 1
The past two weeks have gone by incredibly fast--so fast that it's taken me until today to finish writing my first journal entry (sorry for the delay!). I've got a lot to recap so I'll try my best to stay organized and on point.. first, after a day-plus of connections and layovers, I arrived on August 20th at the Aeropuerto Roatan, where I was greeted by Vanessa, Dr. Welcome and Dr. Rhee. They showed me around Coxen Hole and took me to where I'll be staying for the next 4 weeks, in the White Diamond apartments in Sandy Bay. My arrival also marked the arrival of Hurricane Dean, which wasn't nearly as bad as it could have been. Fortunately, we only caught a piece of it.
There was question as to whether conditions would be good enough to have clinic the following day, but the sky cleared up nicely so Vanessa and I ended up going. Training went fast and smoothly, and I even got to triage a few patients on my own and ether their data on the first day. Over the course of the week, I began to see trends of the more common illnesses brought to the clinic. Viral infections, parasites, and impetigo are seen on practically a daily basis, with cases of lice, scabies and dengue fever also seen from time to time. Because we aren't supplied with the more advanced, technological resources found in the states, Drs Rhee and Welcome often have to rely on blood, stool and urine tests to pinpoint the illness and prescribe medication accordingly. However, seeing as how parents are often either unable or unwilling to bring in their children for follow-ups (whether for personal or financial reasons, ie., living far away, inability to afford another roundtrip cab fare to Coxen Hole, etc), we do our best to treat patients in their first visit, while also stressing the importance of returning to the clinic if their condition persists or worsens.
Although I have worked with children as well as interpreted in clinics in the past, I have never had the exposure to pediatrics that I am now fortunate to have. A number of cases come to mind that I know I wouldn't normally see in an adult clinic. One day, a nine-year-old girl came in with complaint of itchiness on her scalp. Her mother would scratch the top of her head, and the girl's scalp would turn white and flaky. When Dr. Rhee was examining her, the girl quickly reached up and picked some lice off the top of her head. Dr. Rhee joked how sometimes kids can be so cooperative that they do all the work for you. Other times, as I quickly learned, this is far from being the case. Taking ear temperatures can sometimes be an experience in itself, but I've gotten better at it by distracting kids with toys and stickers. I also had to help a mother hold down her screaming six-year-old daughter while Dr. Rhee looked in her ears for a possible infection.
I have also picked up on a couple of things that I didn't expect to see in clinic. One patient needed an x-ray read, so Dr. Rhee showed me the A-I method of examining chest x-rays. Another girl (we get boys in clinic too, but strangely the more memorable cases have been with girls) had an abscess on the sole of her foot, and with the help of Dr. Lidia Prado we were able to open up the abscess, drain out the liquid and fill the cavity with gauze to prevent infection. Of course, with cases such as this we ask that they return in a couple of days for a follow up, but as I mentioned above, we are sure to provide them with enough dressing and antibiotic to get them by.
Since my arrival there has been a lot of movement to and from the island, by volunteers from both Peggy's Clinic and Global Healing. David and Igor finished their time in Hospital Miss Peggy and have since returned to Edmonton and Nashville, respectively. On the Global Healing end, Dr. Rhee returned to New York yesterday, where he will continue his residency and begin apply for fellowships after his board exams in October. We've also had two recent arrivals--Shelly Heil, who will be helping Peggy with computer networking and data back-up, and Global Healing's newest attending, Dr. Kristen Breslin from Washington DC. She will be starting tomorrow with Dr. Welcome, and we may even be graced by the presence of Dr. Prado. Looks like a busy weeks ahead.. unless, of course, Felix says otherwise.
Other highlights:
crab races, constant (aka daily) power outages, getting devoured by mosquitoes on my very first day, helping out at the afterschool sports facility, nightly dinners in West End, playing basketball against the local high school team, and diving certification!!!
There was question as to whether conditions would be good enough to have clinic the following day, but the sky cleared up nicely so Vanessa and I ended up going. Training went fast and smoothly, and I even got to triage a few patients on my own and ether their data on the first day. Over the course of the week, I began to see trends of the more common illnesses brought to the clinic. Viral infections, parasites, and impetigo are seen on practically a daily basis, with cases of lice, scabies and dengue fever also seen from time to time. Because we aren't supplied with the more advanced, technological resources found in the states, Drs Rhee and Welcome often have to rely on blood, stool and urine tests to pinpoint the illness and prescribe medication accordingly. However, seeing as how parents are often either unable or unwilling to bring in their children for follow-ups (whether for personal or financial reasons, ie., living far away, inability to afford another roundtrip cab fare to Coxen Hole, etc), we do our best to treat patients in their first visit, while also stressing the importance of returning to the clinic if their condition persists or worsens.
Although I have worked with children as well as interpreted in clinics in the past, I have never had the exposure to pediatrics that I am now fortunate to have. A number of cases come to mind that I know I wouldn't normally see in an adult clinic. One day, a nine-year-old girl came in with complaint of itchiness on her scalp. Her mother would scratch the top of her head, and the girl's scalp would turn white and flaky. When Dr. Rhee was examining her, the girl quickly reached up and picked some lice off the top of her head. Dr. Rhee joked how sometimes kids can be so cooperative that they do all the work for you. Other times, as I quickly learned, this is far from being the case. Taking ear temperatures can sometimes be an experience in itself, but I've gotten better at it by distracting kids with toys and stickers. I also had to help a mother hold down her screaming six-year-old daughter while Dr. Rhee looked in her ears for a possible infection.
I have also picked up on a couple of things that I didn't expect to see in clinic. One patient needed an x-ray read, so Dr. Rhee showed me the A-I method of examining chest x-rays. Another girl (we get boys in clinic too, but strangely the more memorable cases have been with girls) had an abscess on the sole of her foot, and with the help of Dr. Lidia Prado we were able to open up the abscess, drain out the liquid and fill the cavity with gauze to prevent infection. Of course, with cases such as this we ask that they return in a couple of days for a follow up, but as I mentioned above, we are sure to provide them with enough dressing and antibiotic to get them by.
Since my arrival there has been a lot of movement to and from the island, by volunteers from both Peggy's Clinic and Global Healing. David and Igor finished their time in Hospital Miss Peggy and have since returned to Edmonton and Nashville, respectively. On the Global Healing end, Dr. Rhee returned to New York yesterday, where he will continue his residency and begin apply for fellowships after his board exams in October. We've also had two recent arrivals--Shelly Heil, who will be helping Peggy with computer networking and data back-up, and Global Healing's newest attending, Dr. Kristen Breslin from Washington DC. She will be starting tomorrow with Dr. Welcome, and we may even be graced by the presence of Dr. Prado. Looks like a busy weeks ahead.. unless, of course, Felix says otherwise.
Other highlights:
crab races, constant (aka daily) power outages, getting devoured by mosquitoes on my very first day, helping out at the afterschool sports facility, nightly dinners in West End, playing basketball against the local high school team, and diving certification!!!
Sunday, August 19, 2007
Vanessa Journal 4
My time in Roatan is coming to an end, and I can honestly say that I’m going to miss it! My fourth week here was pretty busy. Most of the diagnoses at clinic were skin conditions, specifically scabies and impetigo. Viral syndrome, diarrhea and fever were also common. There were also some familiar faces at clinic. The mother who had been feeding her baby rice mixed with water returned to the RVPC, claiming that her baby was still having diarrhea. Dr. Rhee explained that the baby may have a milk protein allergy, and gave the mother a different, simpler formula to feed him. Dr. Dunlop gave a referral to admit a little boy overnight at the hospital because of his difficulty breathing and asthma.
Peggy and Dr. Patrick arranged to have a medical brigade in La Colonia this week. Everything was set up at the church and there was a great turnout! Along with Peggy and Dr. Patrick came Dr. Rhee, Dr. Dunlop, Bea and Joe (two physicians assistants), Kathy (a nurse) and her daughter Megan, Igor and David (two of Peggy’s volunteers) and myself. I spent most of the time with Dr. Rhee and Dr. Dunlop, helping them and translating for them. Most of the patients we saw had skin conditions, including scabies and impetigo. This was expected because of the lack of running water in La Colonia. Medication for parasites was given to many of the patients as well. At one point, I found myself surrounded by about ten cute kids asking for meds against “lombrices.” Even after the doctors saw them, the children stayed close by and were very excited to have their picture taken!
Also this week, I got certified in scuba diving with Igor and Molly! We did four dives and we are planning to do another one soon with Dr. Rhee. We’ve spent time at West Bay Beach. We are also planning to do the canopy tours and the dolphin encounter at Anthony’s Key. We said our goodbyes to Dr. Dunlop, who left today back to the States. I’m sad to see him go – he was very informative and a pleasure to be around at clinic. Tomorrow I’ll be picking up Edwin, the next intern, from the airport. I’ll be training him the next few days and showing him around the island.
I can’t believe my time is almost up in Roatan! This has been one of the best experiences I’ve ever had and I’ve met so many great people to stay in touch with! I’m also going to miss the island lifestyle once I’m back to school in L.A. One thing is for sure – I definitely plan on coming back as soon as I can!
Peggy and Dr. Patrick arranged to have a medical brigade in La Colonia this week. Everything was set up at the church and there was a great turnout! Along with Peggy and Dr. Patrick came Dr. Rhee, Dr. Dunlop, Bea and Joe (two physicians assistants), Kathy (a nurse) and her daughter Megan, Igor and David (two of Peggy’s volunteers) and myself. I spent most of the time with Dr. Rhee and Dr. Dunlop, helping them and translating for them. Most of the patients we saw had skin conditions, including scabies and impetigo. This was expected because of the lack of running water in La Colonia. Medication for parasites was given to many of the patients as well. At one point, I found myself surrounded by about ten cute kids asking for meds against “lombrices.” Even after the doctors saw them, the children stayed close by and were very excited to have their picture taken!
Also this week, I got certified in scuba diving with Igor and Molly! We did four dives and we are planning to do another one soon with Dr. Rhee. We’ve spent time at West Bay Beach. We are also planning to do the canopy tours and the dolphin encounter at Anthony’s Key. We said our goodbyes to Dr. Dunlop, who left today back to the States. I’m sad to see him go – he was very informative and a pleasure to be around at clinic. Tomorrow I’ll be picking up Edwin, the next intern, from the airport. I’ll be training him the next few days and showing him around the island.
I can’t believe my time is almost up in Roatan! This has been one of the best experiences I’ve ever had and I’ve met so many great people to stay in touch with! I’m also going to miss the island lifestyle once I’m back to school in L.A. One thing is for sure – I definitely plan on coming back as soon as I can!
Sunday, August 12, 2007
Vanessa Journal 3
My third week has gone by incredibly fast. This week, the Minister of Health from Tegucigalpa, Dr. Jenny Meza, visited the RVPC. Along with her came Dr. Cibeles (Epidemiologist), Dr. Cruz (the director of the Hospital), and Lic. Galindo (Chief manager of the Hospital). Although they stopped by for only a few minutes, there was enough time to capture a picture of them with Dr. Welcome, Dr. Rhee and Dr. Dunlop.
There were also several memorable cases this week at clinic. A little boy came in with what seemed like an abscess of pus inside his mouth. He was referred to the dentist here at the Public Hospital, but the dentist claimed that he tried to drain it and there was no liquid inside. Dr. Dunlop gave the little boy’s mother a prescription for antibiotics, and instructed her to return with her son to the clinic in a few days if there was no improvement. They returned a few days later, and it turns out the antibiotics had not helped. Dr. Welcome made a referral for them to travel to Tegucigalpa, where a different doctor could examine the hard palate mass. Dr. Rhee referred a different patient, a 10-month-old baby, to La Ceiba due to the baby’s delayed development. Dr. Rhee explained that among other things, the baby girl could not sit up on her own, something that a 10-month-old should be able to do. The most common diagnoses this week were fever, viral syndrome, diarrhea, impetigo and possible parasites. A mother brought her month-old baby, saying that she had been not been able to feed the baby milk the past three days because of the diarrhea that it caused. Instead, she had been feeding the baby ground rice mixed with water. Dr. Rhee stressed that the baby needs to be fed milk, not rice and water. After examining the baby, Dr. Rhee provided the mother with a different type of formula, Similac, to feed the baby. One day this week, Dr. Dunlop allowed me to do a urinalysis with his help. I accompanied Dr. Welcome, Dr. Rhee and Dr. Dunlop to hear a conference about brain lesions and hemorrhages. Dr. Welcome and I have also been planning on giving a talk to parents on the psychosocial development of teenagers.
Aside from clinic, I’ve continued to teach English. New volunteers at Peggy’s clinic also arrived this week: David, a pre-med student from Canada, and Igor, a fourth-year medical student at Vanderbilt. We all went to the crab races this week, dinner in West End, and I went to West Bay Beach yesterday. We are finally starting our scuba diving certification tomorrow!
There were also several memorable cases this week at clinic. A little boy came in with what seemed like an abscess of pus inside his mouth. He was referred to the dentist here at the Public Hospital, but the dentist claimed that he tried to drain it and there was no liquid inside. Dr. Dunlop gave the little boy’s mother a prescription for antibiotics, and instructed her to return with her son to the clinic in a few days if there was no improvement. They returned a few days later, and it turns out the antibiotics had not helped. Dr. Welcome made a referral for them to travel to Tegucigalpa, where a different doctor could examine the hard palate mass. Dr. Rhee referred a different patient, a 10-month-old baby, to La Ceiba due to the baby’s delayed development. Dr. Rhee explained that among other things, the baby girl could not sit up on her own, something that a 10-month-old should be able to do. The most common diagnoses this week were fever, viral syndrome, diarrhea, impetigo and possible parasites. A mother brought her month-old baby, saying that she had been not been able to feed the baby milk the past three days because of the diarrhea that it caused. Instead, she had been feeding the baby ground rice mixed with water. Dr. Rhee stressed that the baby needs to be fed milk, not rice and water. After examining the baby, Dr. Rhee provided the mother with a different type of formula, Similac, to feed the baby. One day this week, Dr. Dunlop allowed me to do a urinalysis with his help. I accompanied Dr. Welcome, Dr. Rhee and Dr. Dunlop to hear a conference about brain lesions and hemorrhages. Dr. Welcome and I have also been planning on giving a talk to parents on the psychosocial development of teenagers.
Aside from clinic, I’ve continued to teach English. New volunteers at Peggy’s clinic also arrived this week: David, a pre-med student from Canada, and Igor, a fourth-year medical student at Vanderbilt. We all went to the crab races this week, dinner in West End, and I went to West Bay Beach yesterday. We are finally starting our scuba diving certification tomorrow!
Sunday, August 05, 2007
Vanessa Journal 2
My second week in Roatan began with the arrival of New York’s Dr. John Dunlop to clinic. This week I’ve been getting to clinic slightly earlier. This gives me an early start on triage, which I’ve found to be especially helpful now that there are three doctors seeing patients and the pace has picked up. It also gives me more time to survey patients after they’ve seen Dr. Welcome, Dr. Rhee or Dr. Dunlop.
One day this week, a little girl with a heart murmur came to the clinic with her mother. Dr. Dunlop explained exactly to me what a heart murmur is and then allowed me to hear for myself. First, he gave me the stethoscope and told me to listen to my own heartbeat, followed by his. After having listened to two “regular” heartbeats, he brought me into the room with the little girl and asked her mother if it was alright for me to listen to her daughter’s heartbeat. I was given the chance to listen to her heartbeat, a distinct sound that was very different from the heartbeats I had just heard. Another day this week, a mother came in complaining that her daughter was eating dirt. After Dr. Dunlop examined the little girl, he explained to me that eating dirt if often a symptom of iron deficiency. Also at clinic this week, a mother brought in her 9-day-old baby for fever. After taking the baby’s temperature, which was 101.2 degrees, Dr. Rhee ordered that the baby be rushed to the ER. He let me accompany him as he walked the mother with her baby to the ER and later explained the dangers of fever in newborns.
After clinic on Wednesday, the three doctors and myself made our way to the daycare I’ve been volunteering at in Coxen Hole. The doctors came to look at the children, specifically those that were sick or had any conditions at the time. There ended up being three children with skin conditions. The doctors examined the children and then delivered the extra medicine they had brought for the daycare. They wrote down the names of each on a piece of paper with their use, so that the teachers would know in the future. These ranged from hydrocortisone creams to cough suppressants to fever reducers.
I’ve really been enjoying my time at clinic. It’s been especially rewarding to be able to speak to patients directly. A mother came in to clinic this week, and right away I recognized her from a few days earlier, when she had brought in her first child. She asked me how long I was going to be in Roatan and at the clinic. After I explained to her that I would be here until the end of August, she seemed genuinely disappointed and asked when I was coming back. I told her that I had to go back to school in August, but that I would try to come back when there was time. This conversation made me feel welcome and it made me feel like I was making a difference to someone.
Aside from clinic and daycare, I started teaching Maria Cristina English. We met twice this week, and she is putting great effort into learning the language. We started off with useful phrases, simply vocabulary, etc. After just two days, she can introduce herself and tell me a little about herself, including where she is from and how old she is.
On my free time, I’ve been spending time with the other volunteers. We went to the crab races on Thursday, which raise money for the schools here in Roatan. The winner gets to choose what to do with his or her half of the prize, but everyone usually gives their part to the schools. My crab (#28) came in first place! I was given a sash and certificate, and I of course gave the part I won to the schools. We’ve gone to dinner and spent time in West End. This coming week I’ll be looking into the canopy tours and diving.
Many of the other volunteers left this week. They included Krista, Raquel, Diana and Asha. I thought I would feel lonely without them all here, but more people have arrived. When we went to drop Asha off at the airport today, we picked up Dr. Patrick and two physician assistants that have come to volunteer. Peggy also mentioned that two more volunteers will be arriving tomorrow.
One day this week, a little girl with a heart murmur came to the clinic with her mother. Dr. Dunlop explained exactly to me what a heart murmur is and then allowed me to hear for myself. First, he gave me the stethoscope and told me to listen to my own heartbeat, followed by his. After having listened to two “regular” heartbeats, he brought me into the room with the little girl and asked her mother if it was alright for me to listen to her daughter’s heartbeat. I was given the chance to listen to her heartbeat, a distinct sound that was very different from the heartbeats I had just heard. Another day this week, a mother came in complaining that her daughter was eating dirt. After Dr. Dunlop examined the little girl, he explained to me that eating dirt if often a symptom of iron deficiency. Also at clinic this week, a mother brought in her 9-day-old baby for fever. After taking the baby’s temperature, which was 101.2 degrees, Dr. Rhee ordered that the baby be rushed to the ER. He let me accompany him as he walked the mother with her baby to the ER and later explained the dangers of fever in newborns.
After clinic on Wednesday, the three doctors and myself made our way to the daycare I’ve been volunteering at in Coxen Hole. The doctors came to look at the children, specifically those that were sick or had any conditions at the time. There ended up being three children with skin conditions. The doctors examined the children and then delivered the extra medicine they had brought for the daycare. They wrote down the names of each on a piece of paper with their use, so that the teachers would know in the future. These ranged from hydrocortisone creams to cough suppressants to fever reducers.
I’ve really been enjoying my time at clinic. It’s been especially rewarding to be able to speak to patients directly. A mother came in to clinic this week, and right away I recognized her from a few days earlier, when she had brought in her first child. She asked me how long I was going to be in Roatan and at the clinic. After I explained to her that I would be here until the end of August, she seemed genuinely disappointed and asked when I was coming back. I told her that I had to go back to school in August, but that I would try to come back when there was time. This conversation made me feel welcome and it made me feel like I was making a difference to someone.
Aside from clinic and daycare, I started teaching Maria Cristina English. We met twice this week, and she is putting great effort into learning the language. We started off with useful phrases, simply vocabulary, etc. After just two days, she can introduce herself and tell me a little about herself, including where she is from and how old she is.
On my free time, I’ve been spending time with the other volunteers. We went to the crab races on Thursday, which raise money for the schools here in Roatan. The winner gets to choose what to do with his or her half of the prize, but everyone usually gives their part to the schools. My crab (#28) came in first place! I was given a sash and certificate, and I of course gave the part I won to the schools. We’ve gone to dinner and spent time in West End. This coming week I’ll be looking into the canopy tours and diving.
Many of the other volunteers left this week. They included Krista, Raquel, Diana and Asha. I thought I would feel lonely without them all here, but more people have arrived. When we went to drop Asha off at the airport today, we picked up Dr. Patrick and two physician assistants that have come to volunteer. Peggy also mentioned that two more volunteers will be arriving tomorrow.
Sunday, July 29, 2007
Vanessa Journal 1
It’s the end of my first week here in Roatan, and I’ve already made lasting memories. I’ve grown accustomed to many things that are part of daily life on the island: random power outages, putting on mosquito repellent before stepping outside, the sound of barking dogs early in the mornings, bargaining with the taxi drivers for the best fare. Sarah has been showing me around the island, giving me her best advice and recommendations, as well as training me at the clinic. We’ve been seeing about 20 patients a day at the clinic, and the most common conditions so far have been diarrhea, scabies, viral syndrome, and fever. I’ve noticed that most of the mothers request for the doctors to check their child for parasites, as well as for vitamins because they believe their child is underweight. In several instances this week, the child has actually been in a healthy weight range for his/her age. Therefore, Sarah and I have filled out the growth chart in front of the mothers and explained what it means. At times, the mothers seem to be in disbelief, so we’ve explained that their child does not have to appear chubby in order to be healthy.
Dr. Welcome and Dr. Rhee have been very helpful and welcoming. They take the time to answer any questions and explain the medical conditions that are presented. Dr. Welcome has been courteous enough to help me translate certain medical terms into Spanish. Dr. Rhee has particularly explained about fever in babies and infants. He explained the differences between treating a baby that has a fever in the United States and here on the island. In the States, he explained, parents have easy access to a thermometer and know right away if their child has a fever. Here on the island, however, parents may not have access to a thermometer and usually rely on the fact that their child feels very hot, as most of the parents have told us here at the clinic this week. Dr. Rhee also explained that with the limited resources here, doctors must ask for a blood test and stool test here, which is different from the more advanced treatment in the States.
We’ve also started on Sarah’s research project this week at clinic. Sarah thought of an idea to see how well parents understand the doctor, as well as their child’s condition and meds. We’ve been questioning a few patients a day. We’ve found that getting to the clinic a little earlier gives us more time to triage and survey after the patients see the doctors. From the surveys so far, we’ve noticed that some mothers do not know what condition or prescription they were given. Instead, they’ve simply shown us or pointed at the paper with the name of the medicine on it. However, there have also been mothers who show to have a clear understanding. These mothers have used terms such as “virus” and have been able to tell us exactly when and how to give the meds. I’m going to continue doing surveys in the next couple of weeks to gather more research.
Aside from time at the clinic, Sarah introduced me to everyone at the daycare she has been volunteering at. I’ll be helping out here as long as they need me – they are expecting a family of volunteers to arrive sometime in August. Sarah has also introduced me to Moises, who I will begin tutoring this week. I’m also going to start teaching English to Maria Cristina. She is heading to the States because her daughter is having surgery, and Peggy explained to me that she wants to know at least some basic English to help her get around.
We’ve also had time to relax and enjoy the island this week. We rented a car and drove to the East End of the island to an isolated beach. From there we had dinner at a resort nearby – there were no other guests there – and our table was on a deck overlooking the water and the sunset. We have been going to dinner in West End frequently (so far, our favorite has been the Creole Chicken Rotisserie). We’ve gone to West Bay Beach and swam off the dock by Peggy’s. We’ve also spent quality time with the locals, who have all been so nice and welcoming. Sarah and I bought baleadas and spent time with Nereyda and Tania just talking. We’ve also spent time with the local boys. One day, we spent a few hours with them on the dock. They told us they would help us with our Spanish if we started teaching them English. They began to quiz us on our Spanish: they pointed at things (the moon, sky, water, dock) and asked us to say the word in Spanish. They also asked us to pronounce words with double R’s (apparently we have difficulty rolling the R’s in Spanish). We then began to teach them simple words in English. They’ve been asking me when our first official English class is going to be, so I’ll probably start with them this week. I just need to coordinate a time – half of the children say they end school at noon and the other half say 5.
We dropped Sarah off at the airport yesterday and now she has officially passed the torch to me. I’ll keep you updated on everything that happens within the next couple of weeks. Now I’m off to relax and read some more of the book Peggy recommended – Mountains Beyond Mountains.
Dr. Welcome and Dr. Rhee have been very helpful and welcoming. They take the time to answer any questions and explain the medical conditions that are presented. Dr. Welcome has been courteous enough to help me translate certain medical terms into Spanish. Dr. Rhee has particularly explained about fever in babies and infants. He explained the differences between treating a baby that has a fever in the United States and here on the island. In the States, he explained, parents have easy access to a thermometer and know right away if their child has a fever. Here on the island, however, parents may not have access to a thermometer and usually rely on the fact that their child feels very hot, as most of the parents have told us here at the clinic this week. Dr. Rhee also explained that with the limited resources here, doctors must ask for a blood test and stool test here, which is different from the more advanced treatment in the States.
We’ve also started on Sarah’s research project this week at clinic. Sarah thought of an idea to see how well parents understand the doctor, as well as their child’s condition and meds. We’ve been questioning a few patients a day. We’ve found that getting to the clinic a little earlier gives us more time to triage and survey after the patients see the doctors. From the surveys so far, we’ve noticed that some mothers do not know what condition or prescription they were given. Instead, they’ve simply shown us or pointed at the paper with the name of the medicine on it. However, there have also been mothers who show to have a clear understanding. These mothers have used terms such as “virus” and have been able to tell us exactly when and how to give the meds. I’m going to continue doing surveys in the next couple of weeks to gather more research.
Aside from time at the clinic, Sarah introduced me to everyone at the daycare she has been volunteering at. I’ll be helping out here as long as they need me – they are expecting a family of volunteers to arrive sometime in August. Sarah has also introduced me to Moises, who I will begin tutoring this week. I’m also going to start teaching English to Maria Cristina. She is heading to the States because her daughter is having surgery, and Peggy explained to me that she wants to know at least some basic English to help her get around.
We’ve also had time to relax and enjoy the island this week. We rented a car and drove to the East End of the island to an isolated beach. From there we had dinner at a resort nearby – there were no other guests there – and our table was on a deck overlooking the water and the sunset. We have been going to dinner in West End frequently (so far, our favorite has been the Creole Chicken Rotisserie). We’ve gone to West Bay Beach and swam off the dock by Peggy’s. We’ve also spent quality time with the locals, who have all been so nice and welcoming. Sarah and I bought baleadas and spent time with Nereyda and Tania just talking. We’ve also spent time with the local boys. One day, we spent a few hours with them on the dock. They told us they would help us with our Spanish if we started teaching them English. They began to quiz us on our Spanish: they pointed at things (the moon, sky, water, dock) and asked us to say the word in Spanish. They also asked us to pronounce words with double R’s (apparently we have difficulty rolling the R’s in Spanish). We then began to teach them simple words in English. They’ve been asking me when our first official English class is going to be, so I’ll probably start with them this week. I just need to coordinate a time – half of the children say they end school at noon and the other half say 5.
We dropped Sarah off at the airport yesterday and now she has officially passed the torch to me. I’ll keep you updated on everything that happens within the next couple of weeks. Now I’m off to relax and read some more of the book Peggy recommended – Mountains Beyond Mountains.
Thursday, July 26, 2007
Sarah Journal 3
Last weekend, we sadly said our goodbyes to Dr. Gruber, Mrs. Gruber, Dr. Toledo, and Natalie, all of whom have been with us for many weeks. But with this farewell came the arrival of our new attending from New York, Dr. David Rhee. He has been a wonderful addition to the clinic, and things have been running smoothly since his arrival. After working in the clinic for three weeks, I’ve begun to notice certain trends in the different illnesses we treat – scabies, respiratory viral infections, impetigo, and intestinal parasites are among the most common – and I’ve learned to recognize different skin conditions after seeing so many cases. One of the most exciting aspects of my work in the clinic here has been working with Dr. Rhee as he explains the children’s’ conditions to their mothers. I often get a chance to help explain Dr. Rhee’s diagnosis to the child’s mother and how exactly mom should give the prescribed medicine to her child. It’s been extremely fulfilling getting to be the one who reassures mom that her child is healthy, or that he will feel much better in a week after taking the medicine we prescribe. Just yesterday, for instance, a mother brought her children in for a follow-up visit to make sure they no longer had intestinal parasites. When I told her that her two baby boys were perfectly healthy and that their residual stomach pain would pass within a matter of days, her face relaxed into a smile. Then we laughed, talking about how silly her two boys were, and Dr. Rhee and I sent her on her way with a month’s supply of Flintstone chewable vitamins and some stuffed animal toys. Even simple cases like these can be rewarding, making every day in clinic a fulfilling experience.
Through my experience I’ve found that sometimes when I explain a child’s diagnosis to his mother, mom simply nods her head to signal that she’s understood, when in fact she doesn’t quite understand how to properly give her child his medicines. So I’ve learned that the most effective way to make sure mom understands everything is to ask her to explain back to me the doctor’s advice and how she is going to use the medicines when she goes home – only then can I rest assured that she understands everything I’ve told her. Working with moms who sometimes don’t understand everything when it’s first explained has made me realize that it would be a good idea to find out just how well the patients in general are understanding the doctors and their directions. So I began brainstorming with Dr. Rhee about a good way to assess this level of understanding, and we agreed that a great way to do so would be to conduct a quick interview with patients after they finish seeing the doctor, to learn how well they understand their child’s condition and to ask them to explain to us how they will be taking their medicines. From there, we can use the surveys to provide the doctors with feedback about the things they are doing well and those they can work on. Hopefully, this little project will be a good way to help our clinic continue to improve and to ensure that we are providing our patients with exceptional care.
Through my experience I’ve found that sometimes when I explain a child’s diagnosis to his mother, mom simply nods her head to signal that she’s understood, when in fact she doesn’t quite understand how to properly give her child his medicines. So I’ve learned that the most effective way to make sure mom understands everything is to ask her to explain back to me the doctor’s advice and how she is going to use the medicines when she goes home – only then can I rest assured that she understands everything I’ve told her. Working with moms who sometimes don’t understand everything when it’s first explained has made me realize that it would be a good idea to find out just how well the patients in general are understanding the doctors and their directions. So I began brainstorming with Dr. Rhee about a good way to assess this level of understanding, and we agreed that a great way to do so would be to conduct a quick interview with patients after they finish seeing the doctor, to learn how well they understand their child’s condition and to ask them to explain to us how they will be taking their medicines. From there, we can use the surveys to provide the doctors with feedback about the things they are doing well and those they can work on. Hopefully, this little project will be a good way to help our clinic continue to improve and to ensure that we are providing our patients with exceptional care.
Wednesday, July 18, 2007
Sarah Journal 2
I’ve been here two weeks now, and I finally feel like I’ve fallen into a good routine in clinic: triaging patients, shadowing the doctors, entering patient information into the computer. Earlier this week, I was able to accompany the doctors to see the newborns, and I got a chance to hold a day-old baby girl: she was wearing a little red dress and was so adorable! Seeing these mothers and children, I realized that I had never seen a live birth. After meeting and speaking with one of the ER docs, Dr. Avila, he let me know that I could accompany him to see a birth if I wanted to. So, on Thursday afternoon when he was on call, I shadowed him while he delivered a baby! It was quite an exhilarating experience – watching a birth for the first time. I have to admit, it was very different from what I had envisioned. I watched as the mother pushed and pushed; she was exhausted and in a tremendous amount of pain. In fact, here in Honduras they don’t give these mothers anesthesia; the birth is completely natural. I was pretty shocked when I learned this; later I asked Dr. Avila and learned that the mothers cannot receive painkillers because there are not enough anesthesiologists available. As I watched the birth, I was amazed at how quickly the baby delivered – it was the mom’s second child, so the baby came out pretty easily. After the baby came the long umbilical cord, white and tough. The nurse clamped the cord and quickly cleared the baby’s small mouth and nostrils so that he could take his first breath. I went over to the baby, letting him wrap his teeny fingers around my pinky: he was so small and adorable. Next, the doctor delivered the placenta, a large, bloody mass. Finally, the doctor sutured up the small vaginal tear that the mother had suffered during the birth. The doctor hummed happily as he sewed up the tear. It was amazing to me how routine the birth seemed to the doctor, and how new and almost foreign it had been to me. Here I was, still in a little shock after the entire process, and the doctor singing to himself as if the whole procedure was as simple as tying one’s shoe. At the end of it all, I felt extremely lucky that I was able to sit in and watch something so amazing. I think this experience is a perfect demonstration of how generous and accommodating some of the doctors in this hospital are; if you are curious about something, just simply ask and you might be able to sit in on an exciting procedure or learn something interesting you never knew before.
In my free time, I’ve continued to volunteer at the Daycare Center in Coxen Hole; this week we set up little easels outside, and had the kids paint with tempera paint. It was a joy to see the little kids in their oversized smocks so intently concentrating on the painting in front of them. When they were finished, they were each so proud of their own paintings and eagerly asked me to help them write their names on each of their pieces of work. After the daycare, I return to my apartment to teach Moises English. This week I began teaching him how to conjugate simple verbs like “to run,” “to see,” and “to swim.” It constantly amazes me how quickly he learns and how excited he gets when he is able to form a sentence in English on his own. He is a very bright kid, and I am lucky to be able to work with him.
In my free time, I’ve continued to volunteer at the Daycare Center in Coxen Hole; this week we set up little easels outside, and had the kids paint with tempera paint. It was a joy to see the little kids in their oversized smocks so intently concentrating on the painting in front of them. When they were finished, they were each so proud of their own paintings and eagerly asked me to help them write their names on each of their pieces of work. After the daycare, I return to my apartment to teach Moises English. This week I began teaching him how to conjugate simple verbs like “to run,” “to see,” and “to swim.” It constantly amazes me how quickly he learns and how excited he gets when he is able to form a sentence in English on his own. He is a very bright kid, and I am lucky to be able to work with him.
Sunday, July 15, 2007
Natalie Journal 2
I’m sitting on my porch enjoying my last morning in Roatan. We had a big storm last night, so today is humid but painfully beautiful as the skies are once again their inviting light blue. I can’t believe how fast these two weeks flew by and, although I’m excited for what’s next, I am sad to be leaving this peaceful, natural paradise.
I’ve become a little complacent about the DEET recently and have been rewarded with my fair share of bug bites, conveniently located on my joints for increased discomfort. So I suppose I’m taking a little piece of Roatan home with me (though hopefully not a lot of Roatan home with me in the form of dengue or malaria). I’m happy to report that my GI problems finally resolved, just in time for me to leave. I think my body has adjusted to life in Roatan just in time for my mind to re-adjust to a bustling life in the States.
My two weeks here have been simply amazing. Being surrounded by passionate health care workers, both locals and foreign volunteers, has reinforced my desire to become a physician and given me incredible insight into future career paths in international health. The physicians I’ve worked with give so much of themselves to the community, not just doing everything possible for the children coming into the clinic, but dedicating their extra time to community projects - teaching at the public schools, doing health screenings at the daycare, teaching English in the community. Even during off hours, it seems that all we talk about is improvements to the hospital, teaching efforts, community projects, acquiring meds for a specific patients.
In working with the leaders of Global Healing for the past two weeks, I have learned invaluable lessons about nonprofit work in the developing world. It is not simply enough to have the desire and the financial means to effect change; an organization must understand the existing system in precise detail and embrace the personalities and politics that it contains in order to make sustainable changes. Global Healing does just that by collaborating with hospital directors and leading teaching efforts in various hospital departments. Last weekend’s Surgical and Trauma Conference at Anthony’s Key Resort was a huge success, and the weekly Grand Rounds continue to be well-attended by hospital staff.
I feel very fortunate to be part of the Global Healing team, and I am so thankful for the opportunity to keep working in such a passionate and professional group. Returning to the RVPC as a medical student, I feel the same enthusiasm and hope I felt as an undergraduate. It has truly been a refreshing and inspiring two weeks. I wish I could stay longer, but I know I will be back again in the not-too-distant future and can take these lessons back with me in the meantime.
I’ve become a little complacent about the DEET recently and have been rewarded with my fair share of bug bites, conveniently located on my joints for increased discomfort. So I suppose I’m taking a little piece of Roatan home with me (though hopefully not a lot of Roatan home with me in the form of dengue or malaria). I’m happy to report that my GI problems finally resolved, just in time for me to leave. I think my body has adjusted to life in Roatan just in time for my mind to re-adjust to a bustling life in the States.
My two weeks here have been simply amazing. Being surrounded by passionate health care workers, both locals and foreign volunteers, has reinforced my desire to become a physician and given me incredible insight into future career paths in international health. The physicians I’ve worked with give so much of themselves to the community, not just doing everything possible for the children coming into the clinic, but dedicating their extra time to community projects - teaching at the public schools, doing health screenings at the daycare, teaching English in the community. Even during off hours, it seems that all we talk about is improvements to the hospital, teaching efforts, community projects, acquiring meds for a specific patients.
In working with the leaders of Global Healing for the past two weeks, I have learned invaluable lessons about nonprofit work in the developing world. It is not simply enough to have the desire and the financial means to effect change; an organization must understand the existing system in precise detail and embrace the personalities and politics that it contains in order to make sustainable changes. Global Healing does just that by collaborating with hospital directors and leading teaching efforts in various hospital departments. Last weekend’s Surgical and Trauma Conference at Anthony’s Key Resort was a huge success, and the weekly Grand Rounds continue to be well-attended by hospital staff.
I feel very fortunate to be part of the Global Healing team, and I am so thankful for the opportunity to keep working in such a passionate and professional group. Returning to the RVPC as a medical student, I feel the same enthusiasm and hope I felt as an undergraduate. It has truly been a refreshing and inspiring two weeks. I wish I could stay longer, but I know I will be back again in the not-too-distant future and can take these lessons back with me in the meantime.
Wednesday, July 11, 2007
Sarah Journal 1
It is almost the end of my second week here, and I am happy to say that I finally feel settled in. Work at the clinic has been an eye-opening experience, and it has been a joy to speak with the mothers and children who visit our clinic. Usually our clinic is pretty busy, with about 30 patients coming in to see us each morning, but this week that number has dropped to about 15. With fewer patients to see today, I had the opportunity to make a difference in one mother’s experience when she walked through our door this morning. She wasn’t our patient, but she was confused and needed help. Her daughter had been seen at another clinic in the hospital for dehydration and vomiting and mom was carrying an array of medicines prescribed to her by her doctor. But after speaking with her for a few minutes, I could see that she didn’t understand her doctor’s instructions. She didn’t know what each of the medicines were used for or how much or how often to give them to her child. The pharmacist had written the dosages on each of the bottles, but the mother was illiterate and couldn’t read the instructions. Like many other patients who visit the hospital, the mother was too quiet to speak up and let her doctor know that she didn’t understand and that she couldn’t read. So in order to help her as best I could, I pulled the mother aside into one of our exam rooms and attempted to explain to her how to use the medicines she was given. I showed her how to prepare the electrolyte solution that her doctor prescribed for the child’s dehydration. To help her remember which medicines corresponded to specific dosages, I color-coded the bottles with markers and different shapes. The technique sounds silly, but when a mother is illiterate and color-coding the bottles is the only alternative you have to helping her recall the instructions you explain, it’s practical.
I think the most difficult part about helping this woman (and patients like her) was making sure my advice was well received. I needed to make sure that she trusted me as a person before she would listen to what I was saying. And I needed to be conscious that I wasn’t disrespecting her by seeming superior or condescending in my effort to help. In the end, I felt great about being able to personally help someone like her receive better healthcare. I felt like I had actually made a difference. And that is what I love about working with the Global Healing clinic. Patients are constantly popping their heads in with questions, and I am the one who gets to help them. Sometimes that means walking down the hall with a patient to track down her medical file when the hospital says it’s lost, or speaking up for a mother at the pharmacy when she is too timid to do so herself, or (as in this case) helping a mother understand the medicines and dosages she has been given.
After clinic closes, I make my way down the street to the daycare in Coxen Hole that cares for children whose mothers are busy working and earning a living. At the daycare, I lead arts and crafts projects for the kids to help them explore their creative sides. When I first began working at the daycare, I was impressed with the collection of donated crayons, markers, paint, construction paper, easels, stickers, and glue – all the supplies the kids need in order to develop their creativity and have fun. The kids are all so cute and very fun to play with and have warmed up to me very quickly. In fact, yesterday was only my second time going to the center, and as soon as I walked in the door, the kids were so excited to see me again and screamed “yay” all in unison.
In between these two volunteer jobs, I tutor Moises in English and spend quality time with the volunteers that work at Peggy’s clinic. I’m constantly trying to find new opportunities to make a difference – right now I’m looking to get involved in the local HIV clinic that counsels HIV-positive patients on the island. On the weekends there is also time for relaxation. I go snorkeling in the reef right off of Peggy’s dock and spend time at the beautiful beach in West Bay.
After my experience today helping the illiterate mother in clinic, I began to think that lots of mothers – not just her – must end up in similar situations, unclear about their medications and confused about their doctor’s instructions. In fact, I’ve heard from several other volunteers that this situation is all too common for patients on the island. Not that this is the doctors’ fault – often doctors must work quickly to see all of their patients, and patients often are too shy to tell their doctor they do not understand. It seems the hospital needs a better way to serve its illiterate patients, making sure they understand how to take their medicines. Perhaps the pharmacist could use a straight-forward color-coding system to indicate different dosages to illiterate patients or provide a slip of paper with pictures of breakfast, lunch, and dinner that are circled in order to indicate the time of day and frequency with which the medicines should be taken – anything at all to help lessen the number of confused patients who go home with medications they don’t know how to use. In my remaining few weeks, I hope to create a practical solution for the hospital and help implement it so that more patients receive effective healthcare.
I think the most difficult part about helping this woman (and patients like her) was making sure my advice was well received. I needed to make sure that she trusted me as a person before she would listen to what I was saying. And I needed to be conscious that I wasn’t disrespecting her by seeming superior or condescending in my effort to help. In the end, I felt great about being able to personally help someone like her receive better healthcare. I felt like I had actually made a difference. And that is what I love about working with the Global Healing clinic. Patients are constantly popping their heads in with questions, and I am the one who gets to help them. Sometimes that means walking down the hall with a patient to track down her medical file when the hospital says it’s lost, or speaking up for a mother at the pharmacy when she is too timid to do so herself, or (as in this case) helping a mother understand the medicines and dosages she has been given.
After clinic closes, I make my way down the street to the daycare in Coxen Hole that cares for children whose mothers are busy working and earning a living. At the daycare, I lead arts and crafts projects for the kids to help them explore their creative sides. When I first began working at the daycare, I was impressed with the collection of donated crayons, markers, paint, construction paper, easels, stickers, and glue – all the supplies the kids need in order to develop their creativity and have fun. The kids are all so cute and very fun to play with and have warmed up to me very quickly. In fact, yesterday was only my second time going to the center, and as soon as I walked in the door, the kids were so excited to see me again and screamed “yay” all in unison.
In between these two volunteer jobs, I tutor Moises in English and spend quality time with the volunteers that work at Peggy’s clinic. I’m constantly trying to find new opportunities to make a difference – right now I’m looking to get involved in the local HIV clinic that counsels HIV-positive patients on the island. On the weekends there is also time for relaxation. I go snorkeling in the reef right off of Peggy’s dock and spend time at the beautiful beach in West Bay.
After my experience today helping the illiterate mother in clinic, I began to think that lots of mothers – not just her – must end up in similar situations, unclear about their medications and confused about their doctor’s instructions. In fact, I’ve heard from several other volunteers that this situation is all too common for patients on the island. Not that this is the doctors’ fault – often doctors must work quickly to see all of their patients, and patients often are too shy to tell their doctor they do not understand. It seems the hospital needs a better way to serve its illiterate patients, making sure they understand how to take their medicines. Perhaps the pharmacist could use a straight-forward color-coding system to indicate different dosages to illiterate patients or provide a slip of paper with pictures of breakfast, lunch, and dinner that are circled in order to indicate the time of day and frequency with which the medicines should be taken – anything at all to help lessen the number of confused patients who go home with medications they don’t know how to use. In my remaining few weeks, I hope to create a practical solution for the hospital and help implement it so that more patients receive effective healthcare.
Friday, July 06, 2007
Natalie Journal 1
Watching the sunlight skip off the gentle ripples of the Caribbean from my hammock, it’s hard to believe I am already a week into my two-week journey to Roatan. This is my third trip to Roatan and my first as a medical student. I spent one week here last year, but it was more of a Spring Break adventure in the jungle in La Ceiba and less of a clinical experience at the Roatan Volunteer Pediatric Clinic (RVPC) in the Hospital Público de Roatán. In the spring of 2005, I lived here for three months, working as the first student intern at Global Healing’s RVPC. Inevitably, being back here gazing at the same waves calls for some reflection.
First off, I am struck by how different it is to be a first year medical student than an undergraduate in a clinical environment. Sure, as a Stanford undergrad you think you know everything. Sure, as a first year medical student, I still know absolutely nothing about medicine. But is that entirely true? I feel like I held my own this week when asked to list common abscess culprits (staph aureus+Group A strep), perform a neuro exam (thank you, long painful neuro exam workshop), compare red reflexes to check for retinoblastoma in a newborn, and define the boundaries of cranial sutures. Meanwhile, it was an optimal learning environment for someone like me who loves to learn in a clinical setting. I learned how to hear pneumonia in an infant’s lower lobe, use an otoscope in the tiniest of ears, and make a baby poop huge amounts while taking a rectal temp. All without making anyone cry (Dr. Gruber says we fail if we make anyone cry!). It turns out that I have learned a little something in the last year. More importantly, it turns out that I truly love this profession and love to learn. And since we’re talking about scary, how frightening is it that I really love kids?
This week was certainly not all fun or pleasure or mindless excitement. We saw several tragic cases in clinic, and I can’t help but feel conflicted when I see a child with a condition that is so easily prevented or treated in the States. It’s certainly not the parents’ fault, and to think so is blatantly naïve. Attributing blame to anyone specific is inaccurate, but every case like this provides, in my opinion, empiric evidence for increased global aid by countries that have so much and contribute so little. There are an infinite number of cases that could be discussed, but it seems to be the ones with shock value that stick in your mind. On Wednesday, we saw a one-year-old boy with severe hydrocephalus and an array of other congenital deformities, including cleft lip and cleft palate. The child had limited feeding function due to his worsening condition and had become dangerously dehydrated. Suffice to say, this was a difficult case to observe as a medical student, for the child looked much like a slide from Neurosciences Pathology, and there was limited medical care to be provided at this point in time. Apparently, a brain shunt had been proposed in the past but not carried out for a variety of reasons. He was re-hydrated by our incredibly patient, compassionate physicians and treated for probable infections.
We also had a great number of successes this week due to the tireless efforts of Dr. Welcome, the Honduran/RVPC Fellow, Dr. Toledo from CHOP, and the Grubers, Global Healing extraordinaires. We saw over 120 kids in clinic this week, a huge increase from the time I worked in the clinic two years ago. Drs. Welcome, Toledo, and Gruber each taught me a great amount – after misdiagnosing my first scabies case as chicken pox, Dr. Welcome taught me the various presentations of scabies in kids of different ages and varying degrees of infection. Dr. Toledo taught me the art of a gentle pediatric otoscope exam and showed me classic ringworm presentation, among many other things. He was also very patient with me as I learned to take a blood pressure on a toddler (don’t laugh – it’s pretty challenging on a tiny arm). Dr. Gruber spent hours and hours explaining pediatric physical exams and diagnoses, while I taught him Spanish vocabulary and interpreted instructions for killing “bichos” (“bugs”) and “lombrices” (“GI worms”). I still can’t believe how fast a newborn heart beats, but I’m getting better at hearing the murmurs.
Outside of clinic, I have spent most of my free-time reading This Side of Paradise and reflecting introspectively as the afternoon sun rays reflect off the Caribbean back at me. A fellow med student from SC and I spent last weekend touring the island on a scooter (of which the scooter part I do not recommend to any future intern). We also met some powerful investors that invited us to dinner on the eastern side of the island, and this experience gave us a glimpse into the “other side” of Roatan, the one I do not see in the public clinic. The tourist culture of West End, where I am living, is the same as I remembered it – tanned bodies with foreign accents, mostly Canadian and Western European and Southern, drinking too much cheap, tasty Honduran beer and cheap, disgusting tequila. If I lived here for a longer period of time, I would surely live in Sandy Bay with the other interns, but West End will do for two weeks since USC is generously paying for my accommodations through a Travel Grant. As always, I am drawn to the Creole Rotisserie Chicken restaurant, and we’ve decided that it makes sense that the chicken here is the best in the world since there are robust chickens meandering on every road just waiting to be roasted for our culinary delight. I guess my days of Berkeley-Hollywood pseudo-vegetarianism have ended, for now.
I’m off to catch the last hour of sunshine with the kids at the pool, a “Coca-Cola light”, and my faithful Fitzgerald protagonist Amory Blaine. Thanks for reading - More to come next week.
First off, I am struck by how different it is to be a first year medical student than an undergraduate in a clinical environment. Sure, as a Stanford undergrad you think you know everything. Sure, as a first year medical student, I still know absolutely nothing about medicine. But is that entirely true? I feel like I held my own this week when asked to list common abscess culprits (staph aureus+Group A strep), perform a neuro exam (thank you, long painful neuro exam workshop), compare red reflexes to check for retinoblastoma in a newborn, and define the boundaries of cranial sutures. Meanwhile, it was an optimal learning environment for someone like me who loves to learn in a clinical setting. I learned how to hear pneumonia in an infant’s lower lobe, use an otoscope in the tiniest of ears, and make a baby poop huge amounts while taking a rectal temp. All without making anyone cry (Dr. Gruber says we fail if we make anyone cry!). It turns out that I have learned a little something in the last year. More importantly, it turns out that I truly love this profession and love to learn. And since we’re talking about scary, how frightening is it that I really love kids?
This week was certainly not all fun or pleasure or mindless excitement. We saw several tragic cases in clinic, and I can’t help but feel conflicted when I see a child with a condition that is so easily prevented or treated in the States. It’s certainly not the parents’ fault, and to think so is blatantly naïve. Attributing blame to anyone specific is inaccurate, but every case like this provides, in my opinion, empiric evidence for increased global aid by countries that have so much and contribute so little. There are an infinite number of cases that could be discussed, but it seems to be the ones with shock value that stick in your mind. On Wednesday, we saw a one-year-old boy with severe hydrocephalus and an array of other congenital deformities, including cleft lip and cleft palate. The child had limited feeding function due to his worsening condition and had become dangerously dehydrated. Suffice to say, this was a difficult case to observe as a medical student, for the child looked much like a slide from Neurosciences Pathology, and there was limited medical care to be provided at this point in time. Apparently, a brain shunt had been proposed in the past but not carried out for a variety of reasons. He was re-hydrated by our incredibly patient, compassionate physicians and treated for probable infections.
We also had a great number of successes this week due to the tireless efforts of Dr. Welcome, the Honduran/RVPC Fellow, Dr. Toledo from CHOP, and the Grubers, Global Healing extraordinaires. We saw over 120 kids in clinic this week, a huge increase from the time I worked in the clinic two years ago. Drs. Welcome, Toledo, and Gruber each taught me a great amount – after misdiagnosing my first scabies case as chicken pox, Dr. Welcome taught me the various presentations of scabies in kids of different ages and varying degrees of infection. Dr. Toledo taught me the art of a gentle pediatric otoscope exam and showed me classic ringworm presentation, among many other things. He was also very patient with me as I learned to take a blood pressure on a toddler (don’t laugh – it’s pretty challenging on a tiny arm). Dr. Gruber spent hours and hours explaining pediatric physical exams and diagnoses, while I taught him Spanish vocabulary and interpreted instructions for killing “bichos” (“bugs”) and “lombrices” (“GI worms”). I still can’t believe how fast a newborn heart beats, but I’m getting better at hearing the murmurs.
Outside of clinic, I have spent most of my free-time reading This Side of Paradise and reflecting introspectively as the afternoon sun rays reflect off the Caribbean back at me. A fellow med student from SC and I spent last weekend touring the island on a scooter (of which the scooter part I do not recommend to any future intern). We also met some powerful investors that invited us to dinner on the eastern side of the island, and this experience gave us a glimpse into the “other side” of Roatan, the one I do not see in the public clinic. The tourist culture of West End, where I am living, is the same as I remembered it – tanned bodies with foreign accents, mostly Canadian and Western European and Southern, drinking too much cheap, tasty Honduran beer and cheap, disgusting tequila. If I lived here for a longer period of time, I would surely live in Sandy Bay with the other interns, but West End will do for two weeks since USC is generously paying for my accommodations through a Travel Grant. As always, I am drawn to the Creole Rotisserie Chicken restaurant, and we’ve decided that it makes sense that the chicken here is the best in the world since there are robust chickens meandering on every road just waiting to be roasted for our culinary delight. I guess my days of Berkeley-Hollywood pseudo-vegetarianism have ended, for now.
I’m off to catch the last hour of sunshine with the kids at the pool, a “Coca-Cola light”, and my faithful Fitzgerald protagonist Amory Blaine. Thanks for reading - More to come next week.
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