I've just finished my first full week at clinic here – 11 days on the island total. The clinic is what I expected, having heard descriptions from previous interns. The hospital itself is pretty run down, with the electricity going out often and the water running less so. The first days, I learned how to triage patients and enter the appropriate data into the computer. At first, I was nervous that my Spanish wouldn't be good enough—that the patients wouldn't be able to understand me and vice versa. That fear has abated somewhat, as I've picked up the general routine, but sometimes I still feel inept at what I do, due to the language.
With patients, I've noticed that there are a few diagnoses that are quite common. Otitis media, scabies, and internal parasites seem to be popular. I've also noticed that many of the mothers are extremely young. Only a few fathers have accompanied children. During triage, I ask all families where they live and have come to wonder if there is a trend in sickness due to what barrio people come from. Most children are below 50th percentile in weight and height.
After clinic, I have been volunteering at the local orphanage. There are 10 children there and they vary from 2 to 18 years of age. They seem to be well cared for, though the level of discipline is a bit low. I believe this may be due in part to the rapid turnover in administration. The children are friendly and energetic, and I wonder what kinds of effects the lack of a consistent adult figure in their life will have.
In addition to the RVPC, I've gotten to know the island pretty well. So far, I have visited both the western and eastern ends of the islands, hung out at a couple of resorts, snorkeled almost every day, watched a dolphin show, hiked up into La Colonia, and gone SNUBA diving. The other volunteers at Peggy's clinic have been welcome and inviting, which I have appreciated immensely.
This coming week, a new American doctor, Dr. Gross, will be coming to work in the clinic. I look forward to meeting him and possibly shadowing him to see what kinds of thought processes he goes through. More to come soon!
Sunday, June 29, 2008
Saturday, June 28, 2008
Ileana Journal 5
My second last week at the clinic was not very eventful because from Tuesday to Thursday the hospital was on strike. Although we relieved some of the patient load from emergency by tending to the non-urgent pediatric cases, we had very few patients to see. On Friday, people must have assumed that the strike was still on, because we only had one patient. The plus side of not having very many patients was that I was able to focus on other things. On Wednesday for example, Dr. Prado and I had time to go to a computer shop to get a quote on the price of a new computer. Lately the clinic computer has been running very slowly and it’s definitely time for a new one. We still have not received approval for the purchase, but I am hoping that we can get it before I leave. This might be tough since I only have one week left.
Having extra time at the clinic gave me the opportunity to discuss Roatan’s public health issues with Dr. Prado, as well as the differences amongst the different ethnic and socioeconomic groups here on the island. Not surprisingly, the biggest concern on the island is a lack of health education and awareness. So next week, we are hopefully going to be visiting some public schools to do some health presentations.
Dr. Prado also taught me a little bit about hypertension in children and showed me how to take blood pressure. I only practiced on her and not on real patients, which was definitely a great idea, because it was more difficult than I imagined. During my lesson I also learned a great deal about stethoscopes and was amazed to hear how sophisticated and expensive they can get.
Another thing Dr. Prado told me about was respiratory distress. As I was triaging a patient and trying to take his temperature with the thermometer, he started crying as babies typically do. Dr. Prado was with another patient, but as soon as she heard the boy crying, she got her stethoscope and listened to his lungs. I was a bit surprised at first, because the mother had not mentioned anything about difficulty breathing. However, as soon as Dr. Prado heard his lungs, she decided to see him right away, so I knew it must have been bad. She later put him on oxygen instead of just using the nebulizer, which I had never seen before. Since I was so confused about this, I had to ask her how she knew there was something wrong with the boy just from hearing him cry. She said that it was not a normal cry and then went on to briefly explain the signs of respiratory distress, its effects and its treatment. The next day a two-month-old was admitted to the E.R. with severe respiratory distress. I did not go see him until he was a bit more stabilized, but even when I saw him, I recognized the signs that Dr. Prado had pointed out and was pretty amazed at how fast he was breathing.
Week six also marked the end of my volunteering at the Sandy Bay Alternative School. My time at the school was interesting as I had not been exposed to such a group of children before. From what I have gathered about the school, it is a private school on the island that follows an American home-schooling curriculum. The advantage for the children is that they are able to socialize with their peers while also influencing the pace of their education. My experience with the children consisted of spending time in the classroom during their summer school program. In the summer, they are given the option to attend the school and so they do not follow a curriculum. The children that do decide to attend (or whose parents decide for them) are all put into the same classroom and do educational activities and exercises together during the day. When I was there, there were about 16 children aged six to 13. I volunteered for two weeks, Monday to Thursday 1-3pm, assisting two of Ms. Peggy’s volunteers whose lesson plans covered global awareness, environmental awareness and general health and nutrition.
Having extra time at the clinic gave me the opportunity to discuss Roatan’s public health issues with Dr. Prado, as well as the differences amongst the different ethnic and socioeconomic groups here on the island. Not surprisingly, the biggest concern on the island is a lack of health education and awareness. So next week, we are hopefully going to be visiting some public schools to do some health presentations.
Dr. Prado also taught me a little bit about hypertension in children and showed me how to take blood pressure. I only practiced on her and not on real patients, which was definitely a great idea, because it was more difficult than I imagined. During my lesson I also learned a great deal about stethoscopes and was amazed to hear how sophisticated and expensive they can get.
Another thing Dr. Prado told me about was respiratory distress. As I was triaging a patient and trying to take his temperature with the thermometer, he started crying as babies typically do. Dr. Prado was with another patient, but as soon as she heard the boy crying, she got her stethoscope and listened to his lungs. I was a bit surprised at first, because the mother had not mentioned anything about difficulty breathing. However, as soon as Dr. Prado heard his lungs, she decided to see him right away, so I knew it must have been bad. She later put him on oxygen instead of just using the nebulizer, which I had never seen before. Since I was so confused about this, I had to ask her how she knew there was something wrong with the boy just from hearing him cry. She said that it was not a normal cry and then went on to briefly explain the signs of respiratory distress, its effects and its treatment. The next day a two-month-old was admitted to the E.R. with severe respiratory distress. I did not go see him until he was a bit more stabilized, but even when I saw him, I recognized the signs that Dr. Prado had pointed out and was pretty amazed at how fast he was breathing.
Week six also marked the end of my volunteering at the Sandy Bay Alternative School. My time at the school was interesting as I had not been exposed to such a group of children before. From what I have gathered about the school, it is a private school on the island that follows an American home-schooling curriculum. The advantage for the children is that they are able to socialize with their peers while also influencing the pace of their education. My experience with the children consisted of spending time in the classroom during their summer school program. In the summer, they are given the option to attend the school and so they do not follow a curriculum. The children that do decide to attend (or whose parents decide for them) are all put into the same classroom and do educational activities and exercises together during the day. When I was there, there were about 16 children aged six to 13. I volunteered for two weeks, Monday to Thursday 1-3pm, assisting two of Ms. Peggy’s volunteers whose lesson plans covered global awareness, environmental awareness and general health and nutrition.
Monday, June 09, 2008
Ileana Journal 4
My fourth week at the clinic just seemed to have flown by. We didn’t have anything too unusual, but things were different because Dr. Rhee was gone and Dr. Prado was also away due to a family emergency. That left only Dr. Srinivasan and the new attending, Dr. Kuhl. Things went rather smoothly though, with none of the children needing to be admitted. On Monday, the highlight of the day was when I watched Dr. Kuhl lance a post-varicela abscess on an 18-month-old boy’s bottom. The boy had come in on the Friday and Dr. Rhee had prescribed him some antibiotics hoping the abscess would get smaller so that it wouldn’t have to be lanced, but they hadn’t helped. By Monday it had gotten so bad that the poor little boy couldn’t walk or sit down comfortably. The interesting thing about it was that with Dr. Prado gone we didn’t quite know where things were. I had to go to the E.R. to get a surgical blade and the doctors searched the clinic looking for gauze, iodine and bandages. We eventually managed to find the rest of the supplies at the clinic, but unfortunately, we didn’t have any anaesthetic. I had never seen an abscess be drained before so although I expected to see a lot of pus, I didn’t think it’d be so bloody. The boy took it really well though, he cried and screamed, but didn’t kick or squirm much. The rest of the week went by pretty steadily, and we managed to get out early a few times. On Friday, Dr. Srinivasan showed me an ear infection, so I was pretty happy about that.
Outside of the clinic, I didn’t do too much. On Tuesday I went to a yoga class at Land’s End with some of Peggy’s volunteers. It was very nice because we could see the sun setting on the ocean and hear the sound of the waves crashing, as we did yoga. I think we’ll return again this week. I am now living with two of Peggy’s volunteers in another apartment at the White Diamond. I am very happy with it.
On Wednesday the bad weather started on the island and I saw rain for the first time since I have been here. The rain didn’t stop until Sunday and the cloudiness and strong winds are expected to stay until Tuesday. Even though I had plans to go hiking at the Carambola Botanical Gardens on Friday and go on the glass-bottom boat in West Bay on Sunday, I wasn’t able to do so. I’m really hoping the weather clears up next week.
Outside of the clinic, I didn’t do too much. On Tuesday I went to a yoga class at Land’s End with some of Peggy’s volunteers. It was very nice because we could see the sun setting on the ocean and hear the sound of the waves crashing, as we did yoga. I think we’ll return again this week. I am now living with two of Peggy’s volunteers in another apartment at the White Diamond. I am very happy with it.
On Wednesday the bad weather started on the island and I saw rain for the first time since I have been here. The rain didn’t stop until Sunday and the cloudiness and strong winds are expected to stay until Tuesday. Even though I had plans to go hiking at the Carambola Botanical Gardens on Friday and go on the glass-bottom boat in West Bay on Sunday, I wasn’t able to do so. I’m really hoping the weather clears up next week.
Monday, June 02, 2008
Ileana Journal 3
It seems like every week in Roatan keeps getting better. Week 3 at the clinic was a bit busier, but by now I’ve really got myself into a routine. Overall the week was normal but like always there were a few interesting stories.
At the beginning of the week we had an 18 month old come in with a 103F fever. I told Dr. Srinivasan right away because it was the highest fever I had yet seen. He told me I could give the boy Motrin while he waited, so I was able to do that with a syringe. I had never given medicine to a child with a syringe before and at first I was a bit nervous. I didn’t know how quickly to push it and was worried that I’d give him too much medicine at once. It ended up being really easy though and the boy seemed to really enjoy it because it was bubblegum flavoured. After Dr. Srinivasan saw him, he decided to admit him because he looked a bit lethargic, which I learned is not very good in medical terms. The next day when I came in, I was told that his condition had worsened overnight and that he had passed away. It was a big shock because although he had looked sick, it didn’t look like he was dying. It upset me a bit because just the day before I had given the boy medicine and I remembered him so vividly because of that. I was able to accept his death though because I realized that sometimes things like that happen. I did the best I could by giving him medicine and Dr. Srinivasan did the best he could by admitting him.
On a lighter note, I got to use a stethoscope last week! I listened to my heartbeat, which is normal, listened to a murmur, which sounded very different and also listened to an asthmatic child’s breathing, which sounds normal without a stethoscope but actually has wheezing when you listen to the lungs through a stethoscope. Dr. Srinivasan also let me look inside his ear so that I could see a healthy ear and eventually I’ll be able to see what an ear infection looks like.
On Friday we had a child come in for his 10 day check-up who had hyperbilirubin. Dr. Rhee needed to take some blood out to have blood tests done, but since the baby was actually only 9 days old it was very difficult. The doctors had me put my finger in the baby’s mouth so that he could suck on it while they tried to draw the blood. It was amazing to see blood coming out of such a small child. They weren’t able to get all the blood they needed, but I think they got enough to do the tests.
Other than patient cases, the other exciting news in the clinic was that we got air conditioning! Ever since I got here the clinic had been too hot to be able to work comfortably in it. Even the patients would complain because the clinic was hotter than the hallway outside where they wait. Now that we have air conditioning, I’m sure things will be a lot more comfortable. Since Dr. Rhee worked on getting the air conditioner approved, he thought it should be named David, after him. Everyone had agreed to it, but then Dr. Prado thought it should be named Lidia after her, since she was the one that arranged for it to be delivered to the island and picked it up and arranged the installation. As of now it remains unnamed.
Friday was Dr. Rhee’s last day so Dr. Srinivasan and I went out for dinner with him to the Lighthouse. It’s Dr. Rhee’s favourite restaurant in Roatan and I can see why. The ambience was great, the breeze outside was very nice and the food was delicious! We were all so full afterwards that we had to sit there for a while before getting up to leave.
On Saturday, two of Peggy’s volunteers decided to rent a truck for the day, and they invited three of Peggy’s other volunteers and myself to join them on an excursion around the island. I got to see how beautiful the island really is. We went to Oakridge and then took a water taxi to the mangroves and to the Hole in the Wall restaurant. It was a very great experience. We then went to Paya Bay beach, it’s so far off the main road that hardly anybody goes there, but it’s absolutely gorgeous! On Sunday we went to West Bay again and we went snorkelling. The reef is so beautiful and so close to shore! I saw a lot of nice, colourful fish, and luckily no sting rays or other strange creatures!
At the beginning of the week we had an 18 month old come in with a 103F fever. I told Dr. Srinivasan right away because it was the highest fever I had yet seen. He told me I could give the boy Motrin while he waited, so I was able to do that with a syringe. I had never given medicine to a child with a syringe before and at first I was a bit nervous. I didn’t know how quickly to push it and was worried that I’d give him too much medicine at once. It ended up being really easy though and the boy seemed to really enjoy it because it was bubblegum flavoured. After Dr. Srinivasan saw him, he decided to admit him because he looked a bit lethargic, which I learned is not very good in medical terms. The next day when I came in, I was told that his condition had worsened overnight and that he had passed away. It was a big shock because although he had looked sick, it didn’t look like he was dying. It upset me a bit because just the day before I had given the boy medicine and I remembered him so vividly because of that. I was able to accept his death though because I realized that sometimes things like that happen. I did the best I could by giving him medicine and Dr. Srinivasan did the best he could by admitting him.
On a lighter note, I got to use a stethoscope last week! I listened to my heartbeat, which is normal, listened to a murmur, which sounded very different and also listened to an asthmatic child’s breathing, which sounds normal without a stethoscope but actually has wheezing when you listen to the lungs through a stethoscope. Dr. Srinivasan also let me look inside his ear so that I could see a healthy ear and eventually I’ll be able to see what an ear infection looks like.
On Friday we had a child come in for his 10 day check-up who had hyperbilirubin. Dr. Rhee needed to take some blood out to have blood tests done, but since the baby was actually only 9 days old it was very difficult. The doctors had me put my finger in the baby’s mouth so that he could suck on it while they tried to draw the blood. It was amazing to see blood coming out of such a small child. They weren’t able to get all the blood they needed, but I think they got enough to do the tests.
Other than patient cases, the other exciting news in the clinic was that we got air conditioning! Ever since I got here the clinic had been too hot to be able to work comfortably in it. Even the patients would complain because the clinic was hotter than the hallway outside where they wait. Now that we have air conditioning, I’m sure things will be a lot more comfortable. Since Dr. Rhee worked on getting the air conditioner approved, he thought it should be named David, after him. Everyone had agreed to it, but then Dr. Prado thought it should be named Lidia after her, since she was the one that arranged for it to be delivered to the island and picked it up and arranged the installation. As of now it remains unnamed.
Friday was Dr. Rhee’s last day so Dr. Srinivasan and I went out for dinner with him to the Lighthouse. It’s Dr. Rhee’s favourite restaurant in Roatan and I can see why. The ambience was great, the breeze outside was very nice and the food was delicious! We were all so full afterwards that we had to sit there for a while before getting up to leave.
On Saturday, two of Peggy’s volunteers decided to rent a truck for the day, and they invited three of Peggy’s other volunteers and myself to join them on an excursion around the island. I got to see how beautiful the island really is. We went to Oakridge and then took a water taxi to the mangroves and to the Hole in the Wall restaurant. It was a very great experience. We then went to Paya Bay beach, it’s so far off the main road that hardly anybody goes there, but it’s absolutely gorgeous! On Sunday we went to West Bay again and we went snorkelling. The reef is so beautiful and so close to shore! I saw a lot of nice, colourful fish, and luckily no sting rays or other strange creatures!
Friday, May 23, 2008
Ileana Journal 2
The second week at the clinic was busier than the first and a bit more eventful. Instead of having seven to 14 patients each day, we had 14 to 27. It was a lot more difficult to triage the patients quickly enough. The doctors would often find themselves waiting for me to triage before they could see a patient. With three doctors working at once, it’s hard to keep up with them. There were a few families that needed two or three children seen together, so even if I triaged three of them, one doctor would take them and the other two would have to wait for me to get to the other patients. There were also a lot of young babies which meant that the whole process of taking their weight took longer than that of older children, since babies first have to be undressed to be weighed and then dressed again. (It’s very important that babies be weighed without their clothes on in order to get the most accurate measure.)
We had a few interesting cases, one child with dextrocardia at the beginning of the week (that’s when their heart points towards the right instead of the left side) and at the end of the week another child had dextrocardia and situs inversus, which means that all of their organs are reversed. Although those cases were interesting to hear about, I wasn’t able to see the rare conditions myself since the children showed no external signs. However, there was one child that came in at the end of the week with hydrocephalus. He came to the clinic because he had fallen and had a sore tailbone, but I was still able to see that his head was very large in comparison to the rest of his body. At first I was a bit shocked, but the child was actually so cute and well-behaved that I couldn’t help but think he was adorable!
On Wednesday we had a lunch-and-learn led by Dr. Srinivasan. He gave a very informative presentation on PALS (Pediatric Advanced Life Support). A few nurses and most of the social service doctors attended it. In Honduras, after students complete medical school, they have to perform social service in high-need communities before they can become fully licensed. Since the social service doctors do not have much hands-on experience, it’s important for them to attend the talks in order to know what to do in certain situations. The PALS presentation was especially useful because when the doctors learn about life support in medical school, there is no special emphasis on pediatrics, and there are indeed some key differences between children and adults. Overall, I’ve already learned a lot during these past two weeks and can’t wait to keep learning more.
Outside of the clinic, I haven’t been doing too much. I’ve started going to the beach in West End in the afternoon for a couple of hours until sunset; I find it’s a really nice place to read a book. I also gave scuba diving another try, but I think it’s fair to say I failed. I was on the boat, all ready to go, but I was too scared to lean back to fall into the water. I was just way too scared to fall backwards! I had a lovely time snorkelling though and have decided that that will be my new hobby. On Saturday, Peggy’s new volunteers arrived, so we all went to the Rotisserie chicken place for dinner. Then on Sunday I went to West Bay with three of the new volunteers. It’s great to have more girls around and we all seem to get along very well.
We had a few interesting cases, one child with dextrocardia at the beginning of the week (that’s when their heart points towards the right instead of the left side) and at the end of the week another child had dextrocardia and situs inversus, which means that all of their organs are reversed. Although those cases were interesting to hear about, I wasn’t able to see the rare conditions myself since the children showed no external signs. However, there was one child that came in at the end of the week with hydrocephalus. He came to the clinic because he had fallen and had a sore tailbone, but I was still able to see that his head was very large in comparison to the rest of his body. At first I was a bit shocked, but the child was actually so cute and well-behaved that I couldn’t help but think he was adorable!
On Wednesday we had a lunch-and-learn led by Dr. Srinivasan. He gave a very informative presentation on PALS (Pediatric Advanced Life Support). A few nurses and most of the social service doctors attended it. In Honduras, after students complete medical school, they have to perform social service in high-need communities before they can become fully licensed. Since the social service doctors do not have much hands-on experience, it’s important for them to attend the talks in order to know what to do in certain situations. The PALS presentation was especially useful because when the doctors learn about life support in medical school, there is no special emphasis on pediatrics, and there are indeed some key differences between children and adults. Overall, I’ve already learned a lot during these past two weeks and can’t wait to keep learning more.
Outside of the clinic, I haven’t been doing too much. I’ve started going to the beach in West End in the afternoon for a couple of hours until sunset; I find it’s a really nice place to read a book. I also gave scuba diving another try, but I think it’s fair to say I failed. I was on the boat, all ready to go, but I was too scared to lean back to fall into the water. I was just way too scared to fall backwards! I had a lovely time snorkelling though and have decided that that will be my new hobby. On Saturday, Peggy’s new volunteers arrived, so we all went to the Rotisserie chicken place for dinner. Then on Sunday I went to West Bay with three of the new volunteers. It’s great to have more girls around and we all seem to get along very well.
Friday, May 16, 2008
Ileana Journal 1
Week one in Roatan has been filled with so many new experiences. It’s hard to even know where to begin but I will focus on the clinic since that’s the reason why I’m here. Not having much of a science background I was somewhat worried that it would take me a while to adjust to the clinic environment. Fortunately Rose trained me well, and I found the triage process to be straight-forward and easy to follow: greet the patient and their mother or guardian (I say mother because I have yet to see a father come in, and guardian because many times it’s not the mother bringing the patient in but a sister, grandmother or aunt), then I get them to have a seat, I ask about the child’s symptoms and write them down in the patient file in Spanish. I then take the patient’s temperature, height and weight, and tell them to wait outside. After this I have time to look words up in the Spanish-English Medical dictionary if necessary, plot the patient’s height and weight on a growth chart, and enter the information on the Global Healing spreadsheet and on a hospital sheet. During this time the doctors are usually on rounds where they do newborn check-ups, so it works out well because it allows me to get a head start before they get back. On Tuesday I got to go with them on their rounds, but unfortunately there were no newborns to be seen. Nonetheless it was a great experience, because I got to see some other parts of the hospital. It was definitely eye-opening since the only hospitals I had been to before were certainly not public hospitals in a developing country.
Right now I’m working with Dr. Lidia Prado, who is the Honduran doctor in the clinic, as well as Dr. David Rhee, who is from New York and is the attending pediatrician, and Dr. Sush Srinivasan who is finishing his residency in Michigan. I really couldn’t have asked for better doctors to work with. They’re all very friendly and I’ve already learned a lot from them. Lidia helps all of us translate from English to Spanish and corrects our spelling and grammatical errors. She even threatened to start grading our work, but Drs. Rhee and Srinivasan vetoed the idea. Despite their discomfort with the language, I think their Spanish is great and they’ve proven to be quite capable of communicating with patients. They often want to double-check that they’ve understood the patients, and that the patients have understood them, so they’ll get me to translate for them. It’s been a great opportunity for me because I get to learn more about the cases and the diagnoses. The mothers will often use that time as an opportunity to ask more questions that they hadn’t thought of or to clarify things that they didn’t completely understand. I find it very reassuring when they do this, because it shows that they’re concerned about their child’s health.
I’ve learned already that it’s very important to make the patients feel comfortable. I’m still working on trying to calm the kids down when I take their temperature or their height and weight. I was surprised at how many of them start screaming or crying. The doctors seem to have figured out their own techniques to calm kids down, so I might have to ask them for tips. It’s been so long since I’ve been around children, that I’ve forgotten the nuances involved in dealing with children. I think I’ve done a good job at communicating with the mothers though. I make sure to say good morning and to smile a lot. I also think it’s important to keep a straight face at times when listening to the information they’re providing. I’ve overcome my feelings of shock at mothers not quite remembering their child’s birth date or mixing up the birth year. In North America, birthdays are a big deal. I’m also getting used to hearing about children vomiting or excreting worms, and I’m also becoming accustomed to seeing some of their rashes and sores.
Besides spending time at the clinic I’ve also begun exploring the island a bit. I’ve really only gotten as far as West Bay though and have spent most of my time in West End. Despite my various efforts to keep occupied, homesickness seems to come and go and sometimes staying busy is hard to do. On Saturday I decided to give scuba diving a try, but it’s proving to be more difficult than I expected. I think the problem might be that I simply don’t like being underwater. Drs. Rhee and Srinivasan are encouraging me to keep going with it, especially since I have yet to do an open water dive. So far I have only done confined water safety skills which I did not enjoy. Other than diving I’ve also gone to West Bay beach and have enjoyed quite a few meals out in West End. So far the food here has been great and the abundance of kidney beans suits my vegetarianism rather well.
Right now I’m working with Dr. Lidia Prado, who is the Honduran doctor in the clinic, as well as Dr. David Rhee, who is from New York and is the attending pediatrician, and Dr. Sush Srinivasan who is finishing his residency in Michigan. I really couldn’t have asked for better doctors to work with. They’re all very friendly and I’ve already learned a lot from them. Lidia helps all of us translate from English to Spanish and corrects our spelling and grammatical errors. She even threatened to start grading our work, but Drs. Rhee and Srinivasan vetoed the idea. Despite their discomfort with the language, I think their Spanish is great and they’ve proven to be quite capable of communicating with patients. They often want to double-check that they’ve understood the patients, and that the patients have understood them, so they’ll get me to translate for them. It’s been a great opportunity for me because I get to learn more about the cases and the diagnoses. The mothers will often use that time as an opportunity to ask more questions that they hadn’t thought of or to clarify things that they didn’t completely understand. I find it very reassuring when they do this, because it shows that they’re concerned about their child’s health.
I’ve learned already that it’s very important to make the patients feel comfortable. I’m still working on trying to calm the kids down when I take their temperature or their height and weight. I was surprised at how many of them start screaming or crying. The doctors seem to have figured out their own techniques to calm kids down, so I might have to ask them for tips. It’s been so long since I’ve been around children, that I’ve forgotten the nuances involved in dealing with children. I think I’ve done a good job at communicating with the mothers though. I make sure to say good morning and to smile a lot. I also think it’s important to keep a straight face at times when listening to the information they’re providing. I’ve overcome my feelings of shock at mothers not quite remembering their child’s birth date or mixing up the birth year. In North America, birthdays are a big deal. I’m also getting used to hearing about children vomiting or excreting worms, and I’m also becoming accustomed to seeing some of their rashes and sores.
Besides spending time at the clinic I’ve also begun exploring the island a bit. I’ve really only gotten as far as West Bay though and have spent most of my time in West End. Despite my various efforts to keep occupied, homesickness seems to come and go and sometimes staying busy is hard to do. On Saturday I decided to give scuba diving a try, but it’s proving to be more difficult than I expected. I think the problem might be that I simply don’t like being underwater. Drs. Rhee and Srinivasan are encouraging me to keep going with it, especially since I have yet to do an open water dive. So far I have only done confined water safety skills which I did not enjoy. Other than diving I’ve also gone to West Bay beach and have enjoyed quite a few meals out in West End. So far the food here has been great and the abundance of kidney beans suits my vegetarianism rather well.
Monday, April 28, 2008
Rose Journal 6
It's been a pretty uneventful week at clinic. Monday Esteban was sick so Dr. Sabio was seeing patients on his own. The nurses tried to give us thirty charts but we had to tell them that there was no possible way we could see that many patients with just one doctor. I felt bad having to do so, but it would have been impossible for us to tend to that many patients and give them all a proper level of care. They ended up deferring those kids to other clinics, so at least they got seen by someone. Dr. Sabio saw around eighteen kids single-handedly and we ended up being at clinic until around two o'clock.
Tuesday was yet another feriago (holiday) and the clinic was closed. Apparently the holiday was to commemorate the British coming to Roatan centuries ago. It was kind of a nice surprise to have a day off as I didn't hear about it until right before I left on Monday. I was able to catch up on my sleep a bit and spend some time over in West Bay, marvelling at how gorgeous this island is.
Wednesday was pretty non-eventful. There were all the usual case of gripe, diarrhea, scabies, and intestinal parasites. There was also a kid with a fractured leg and another with trauma to a finger on their left hand. Elsa did a lot of triaging that day which gave me a change to observe a little bit. It's been really nice to have Elsa around because she is so eager to help out and I think her triaging is more effective than mine because, of course, she is a native Spanish speaker.
Lidia finally returned to work after her surgery on Thursday, which was so great! It was difficult to have new doctors in the clinic without here because they were always asking questions about the inner workings of the hospital that I had no idea how to answer. So Thursday Dr. Sabio, Esteban, and Lidia were all working and things went really fast. I could hardly triage fast enough to keep up with them. We only saw seventeen patients and were done with clinic by noon.
Friday was a bit more interesting. We admitted two little girls, one to the hospital and one to the emergency room. The girl we admitted to the hospital had a giant abscess and an awful ear infection. The little girl that went to the emergency room was suffering from a high fever and seizures. It was incredible to watch the family that brought her in. There was five of them in all: her brother, mother, two aunts, and father. They were all so concerned it was heartbreaking. Lidia had gone into another part of the hospital for a minute and when she started seizing they ran over to my desk with her, shouting frantically. I have so much sympathy for anyone that has to watch their loved one have seizures. No matter how many times I've seen a grand mal seizure it's always equally as terrifying.
So that pretty much sums up my seventh week here. I can't believe I've been here that long! Hopefully this weekend I'll be leaving the island for the first time since I got here and sailing on a catamaran with some friends. I'm really excited for that, I hear it's a lot of fun!
Tuesday was yet another feriago (holiday) and the clinic was closed. Apparently the holiday was to commemorate the British coming to Roatan centuries ago. It was kind of a nice surprise to have a day off as I didn't hear about it until right before I left on Monday. I was able to catch up on my sleep a bit and spend some time over in West Bay, marvelling at how gorgeous this island is.
Wednesday was pretty non-eventful. There were all the usual case of gripe, diarrhea, scabies, and intestinal parasites. There was also a kid with a fractured leg and another with trauma to a finger on their left hand. Elsa did a lot of triaging that day which gave me a change to observe a little bit. It's been really nice to have Elsa around because she is so eager to help out and I think her triaging is more effective than mine because, of course, she is a native Spanish speaker.
Lidia finally returned to work after her surgery on Thursday, which was so great! It was difficult to have new doctors in the clinic without here because they were always asking questions about the inner workings of the hospital that I had no idea how to answer. So Thursday Dr. Sabio, Esteban, and Lidia were all working and things went really fast. I could hardly triage fast enough to keep up with them. We only saw seventeen patients and were done with clinic by noon.
Friday was a bit more interesting. We admitted two little girls, one to the hospital and one to the emergency room. The girl we admitted to the hospital had a giant abscess and an awful ear infection. The little girl that went to the emergency room was suffering from a high fever and seizures. It was incredible to watch the family that brought her in. There was five of them in all: her brother, mother, two aunts, and father. They were all so concerned it was heartbreaking. Lidia had gone into another part of the hospital for a minute and when she started seizing they ran over to my desk with her, shouting frantically. I have so much sympathy for anyone that has to watch their loved one have seizures. No matter how many times I've seen a grand mal seizure it's always equally as terrifying.
So that pretty much sums up my seventh week here. I can't believe I've been here that long! Hopefully this weekend I'll be leaving the island for the first time since I got here and sailing on a catamaran with some friends. I'm really excited for that, I hear it's a lot of fun!
Saturday, April 19, 2008
Rose Journal 5
Another BUSY week at clinic #12!
Ever since Dr. Sabio and Esteban arrived we have been seeing more than our usual amount of patients, very steadily. No more early days where we have very few patients and get out before noon! I think that this is partly to do with the fact that our current doctors ask just about everyone that comes through here to come back to the clinic. They are very thorough. It's kind of nice to see the familiar faces of returning patients everyday.
Monday was a holiday, which I did not know about until the Sunday before so I was nicely surprised. It was apparently Day of the Americas, something I had never heard of before. When I tried asking several people about it they all told me they had no idea what was supposed to happen on this holiday. Perhaps it's just an excuse to take off school and work. Either way, I enjoyed it very much and spent the day catching up on sleep and school work.
Tuesday and Wednesday were long days, with lots of patients and many complicated, time consuming cases. This included a kid with a possible case of Tuberculosis that needed a chest x-ray and a child with very severe sickle cell anemia. There was also a sweet little boy that had such a bad case of lymphadenitis that he had to be admitted to the hospital. Apparently he had been on antibiotics for three days and the thing was growing, not shrinking. One really interesting thing about that boy was that eleven years old he was hardly 29 pounds and not quite up to my waist in height!
Elsa taught lectures on Tuesday and Thursday to a group of nurses and even a doctor. The lectures presented all sorts of general information on how to educate patients with diabetes. About eighteen people in total showed up and as far as I can tell, they were a success.
Thursday was a national strike day which, of course, included the hospital workers. Apparently farmers, teachers, and all sorts of other employees nationwide were striking for more funding and benefits from the government. During clinic I could hear people shouting into megaphones outside my window, although I could never really decipher exactly what they were saying. The strike of course meant that the clinic was really quiet and we saw only patients. The bad thing about the strike is that it makes it impossible to get patients charts and as a result, the examining sheets from that day will never make it into their records.
Everything returned to it's normal busyness on Friday. We saw around 20 patients, all with fairly common and treatable illnesses. We had quite a few ten day check-ups and almost all the babies seemed in good health. Unfortunately a one month old girl also came in with a heart murmur that we had to refer to Tegucigalpa. However I also saw probably the cutest baby I have ever seen at clinic today and that cheered me up quite a bit.
This weekend I plan to do a lot of nothing and hang out at the beach. I have reached the last month of my stay and it's strange to think that I only have four more weekends here!
Ever since Dr. Sabio and Esteban arrived we have been seeing more than our usual amount of patients, very steadily. No more early days where we have very few patients and get out before noon! I think that this is partly to do with the fact that our current doctors ask just about everyone that comes through here to come back to the clinic. They are very thorough. It's kind of nice to see the familiar faces of returning patients everyday.
Monday was a holiday, which I did not know about until the Sunday before so I was nicely surprised. It was apparently Day of the Americas, something I had never heard of before. When I tried asking several people about it they all told me they had no idea what was supposed to happen on this holiday. Perhaps it's just an excuse to take off school and work. Either way, I enjoyed it very much and spent the day catching up on sleep and school work.
Tuesday and Wednesday were long days, with lots of patients and many complicated, time consuming cases. This included a kid with a possible case of Tuberculosis that needed a chest x-ray and a child with very severe sickle cell anemia. There was also a sweet little boy that had such a bad case of lymphadenitis that he had to be admitted to the hospital. Apparently he had been on antibiotics for three days and the thing was growing, not shrinking. One really interesting thing about that boy was that eleven years old he was hardly 29 pounds and not quite up to my waist in height!
Elsa taught lectures on Tuesday and Thursday to a group of nurses and even a doctor. The lectures presented all sorts of general information on how to educate patients with diabetes. About eighteen people in total showed up and as far as I can tell, they were a success.
Thursday was a national strike day which, of course, included the hospital workers. Apparently farmers, teachers, and all sorts of other employees nationwide were striking for more funding and benefits from the government. During clinic I could hear people shouting into megaphones outside my window, although I could never really decipher exactly what they were saying. The strike of course meant that the clinic was really quiet and we saw only patients. The bad thing about the strike is that it makes it impossible to get patients charts and as a result, the examining sheets from that day will never make it into their records.
Everything returned to it's normal busyness on Friday. We saw around 20 patients, all with fairly common and treatable illnesses. We had quite a few ten day check-ups and almost all the babies seemed in good health. Unfortunately a one month old girl also came in with a heart murmur that we had to refer to Tegucigalpa. However I also saw probably the cutest baby I have ever seen at clinic today and that cheered me up quite a bit.
This weekend I plan to do a lot of nothing and hang out at the beach. I have reached the last month of my stay and it's strange to think that I only have four more weekends here!
Rose Journal 4
It is interesting to think of my weeks here broken down in numbers like this: journal entry #1,#2, etc. It makes my time here seem all that much shorter. Lately the days have become so busy that I hardly have any time to think! For some reason clinic hours have been really long, and I usually end up staying at the hospital until at least 1:30 every day. I think perhaps this team of doctors is slightly more methodical.
This week has been sweltering hot and the clinic remains to be one of the only offices in the hospital without air conditioning. It is a relief to step out into the relative cool of the hallway. I just looked up the weather on Yahoo and it told me that it was currently 86 degrees Fahrenheit in Roatan... yeah right! It's at least 95 degrees in the shade.
We've referred a lot of patients to the emergency room and surgery this week. One little girl had a foreign object so firmly lodged in her nose that one of the doctors caused some accidental trauma trying to remove it. A baby went to the ER for a serious case of croup and different respiratory problems. Three patients were referred to Dr. Sanchez for surgery: one for a herniated groin, one for frenum of the tongue, and another for a one centimeter ball growth on the penis. We also sent a little boy to La Ceiba to get an echo.
This week Esteban's father, Dr.Gershanik, and his Nurse Practitioner, Yakelis Anzola have been lecturing the nurses and Social Service doctors on neonatal resuscitation. I think it's quite interesting to them that babies who would still be in incubators back in the states are allowed to go home here. A few days ago we had an premature infant that weighed just 1.7 kg come into the clinic for a check-up. The baby was so tiny, but fully able to breastfeed! A less successful story is that of a preemie currently in the emergency room. It was 2 pounds at birth but had dropped down to 1 and was admitted, severely malnourished and dehydrated. Yakelis was able to get an IV going yesterday but it fell out during the night and because the baby was without IV for several hours, it dropped back into it's previous state. Hopefully they will be able to find a vein again but doing so is incredibly difficult because of the infant's small size.
Friday morning we were met with a giant stack of charts as both Dr. Jackie and the Cuban doctor were out today. We've never seen so many patients on a Friday! In fact, the whole week has been steadily busy. One patient of interest on Friday was a four year old boy that had been dropped on his head while he was an infant. He had petit mal seizures and was also microcephalic. His development was really delayed and he appeared to not speak more than a few words. It's so sad to see a kid like that who just doesn't get the care he needs. We were referring him to a neurologist in San Pedro, but who knows if he'll actually end up going.
On a brighter note we've seen so many happy and healthy children through the clinic this week, just getting routine check-ups. On Friday we had almost entirely little girls, including a set of 9 month year old twins that were absolutely gorgeous. There's nothing better to cheer you up than holding a plump, healthy, giggling, slobbery baby
This week has been sweltering hot and the clinic remains to be one of the only offices in the hospital without air conditioning. It is a relief to step out into the relative cool of the hallway. I just looked up the weather on Yahoo and it told me that it was currently 86 degrees Fahrenheit in Roatan... yeah right! It's at least 95 degrees in the shade.
We've referred a lot of patients to the emergency room and surgery this week. One little girl had a foreign object so firmly lodged in her nose that one of the doctors caused some accidental trauma trying to remove it. A baby went to the ER for a serious case of croup and different respiratory problems. Three patients were referred to Dr. Sanchez for surgery: one for a herniated groin, one for frenum of the tongue, and another for a one centimeter ball growth on the penis. We also sent a little boy to La Ceiba to get an echo.
This week Esteban's father, Dr.Gershanik, and his Nurse Practitioner, Yakelis Anzola have been lecturing the nurses and Social Service doctors on neonatal resuscitation. I think it's quite interesting to them that babies who would still be in incubators back in the states are allowed to go home here. A few days ago we had an premature infant that weighed just 1.7 kg come into the clinic for a check-up. The baby was so tiny, but fully able to breastfeed! A less successful story is that of a preemie currently in the emergency room. It was 2 pounds at birth but had dropped down to 1 and was admitted, severely malnourished and dehydrated. Yakelis was able to get an IV going yesterday but it fell out during the night and because the baby was without IV for several hours, it dropped back into it's previous state. Hopefully they will be able to find a vein again but doing so is incredibly difficult because of the infant's small size.
Friday morning we were met with a giant stack of charts as both Dr. Jackie and the Cuban doctor were out today. We've never seen so many patients on a Friday! In fact, the whole week has been steadily busy. One patient of interest on Friday was a four year old boy that had been dropped on his head while he was an infant. He had petit mal seizures and was also microcephalic. His development was really delayed and he appeared to not speak more than a few words. It's so sad to see a kid like that who just doesn't get the care he needs. We were referring him to a neurologist in San Pedro, but who knows if he'll actually end up going.
On a brighter note we've seen so many happy and healthy children through the clinic this week, just getting routine check-ups. On Friday we had almost entirely little girls, including a set of 9 month year old twins that were absolutely gorgeous. There's nothing better to cheer you up than holding a plump, healthy, giggling, slobbery baby
Monday, March 31, 2008
Rose Journal 3
It was fabulous having Semana Santa off from work, and I spent a lot of time on the beach. The enormous influx of vacationers that come for the week before easter is amazing. West End turned into an entirely different place and the prices at restaurants and for water taxis sky-rocketed. One of my friends from the States visited, and I showed him all over the island. I also spent lots of time snorkling and eating very, very well.
The clinic opened Monday for the first time since Semana Santa. We were fairly busy, but not to the level I had expected. I'm not sure what I was expecting (perhaps a flood of people or a swarm, like locusts?) but the week ended up being fairly normal and only a little bit busy. Monday we saw our usual array of scabies, gripe, and ear infections. Tuesday was not too much more exciting. Wednesday was an altogether different day, at least for me. I got violently ill for the first time ever while traveling and spent the entire day at home in absolute misery. I think the culprit was the hospital cafeteria lettuce that I had eaten the day before. Rebecca and Lidia did a wonderful job triaging without me, though, and apparently the day went on sin mi. Rebecca also did a presentation on fluids that day and Lidia drove all the way to French Harbor to buy nachos for the social service doctors.
Friday was Rebecca's last day in the clinic, a very sad day for Lidia and me. She was a fantastic attending and working with her every day was great. She made sure to show me points of interest, including her own ear when she contracted an ear infection. Lidia, Rebecca, and I all went out to pizza at Bella Napoli's to commemorate the occasion.
Friday also brought drama concerning my visa. It had been my understanding that visas in Honduras were good for 90 days, or at least that you were legally allowed that amount of time. however, when I had come through customs last month they only gave me 30 days. Looking at my passport I could see no indication of this time limit and decided that I might be okay without renewing it. Luckily, Lidia encouraged me to go into Immigration and talk to them, because, when we went, they informed me that if I had waited any longer I would have had to pay a 1,600 Lempira fine. Instead, I had to pay $40 to extend the visa for two more months. Lidia always keeps me out of trouble.
Saturday Alice and Howard flew in and took all the clinic folks out to dinner at the Argentinian Grill. The new attending, Dr. Sabio and his wife were also there. They seem really great and I look forward to working with them next week. Dr. Sabio is a native Spanish speaker which is absolutely essential when seeing patients in the clinic.
The clinic opened Monday for the first time since Semana Santa. We were fairly busy, but not to the level I had expected. I'm not sure what I was expecting (perhaps a flood of people or a swarm, like locusts?) but the week ended up being fairly normal and only a little bit busy. Monday we saw our usual array of scabies, gripe, and ear infections. Tuesday was not too much more exciting. Wednesday was an altogether different day, at least for me. I got violently ill for the first time ever while traveling and spent the entire day at home in absolute misery. I think the culprit was the hospital cafeteria lettuce that I had eaten the day before. Rebecca and Lidia did a wonderful job triaging without me, though, and apparently the day went on sin mi. Rebecca also did a presentation on fluids that day and Lidia drove all the way to French Harbor to buy nachos for the social service doctors.
Friday was Rebecca's last day in the clinic, a very sad day for Lidia and me. She was a fantastic attending and working with her every day was great. She made sure to show me points of interest, including her own ear when she contracted an ear infection. Lidia, Rebecca, and I all went out to pizza at Bella Napoli's to commemorate the occasion.
Friday also brought drama concerning my visa. It had been my understanding that visas in Honduras were good for 90 days, or at least that you were legally allowed that amount of time. however, when I had come through customs last month they only gave me 30 days. Looking at my passport I could see no indication of this time limit and decided that I might be okay without renewing it. Luckily, Lidia encouraged me to go into Immigration and talk to them, because, when we went, they informed me that if I had waited any longer I would have had to pay a 1,600 Lempira fine. Instead, I had to pay $40 to extend the visa for two more months. Lidia always keeps me out of trouble.
Saturday Alice and Howard flew in and took all the clinic folks out to dinner at the Argentinian Grill. The new attending, Dr. Sabio and his wife were also there. They seem really great and I look forward to working with them next week. Dr. Sabio is a native Spanish speaker which is absolutely essential when seeing patients in the clinic.
Saturday, March 15, 2008
Rose Journal #2
This week proved to be much busier than last week. On Monday we probably saw close to thirty patients between the two doctors. Tuesday was nearly that busy as well. I find the feeling of working in the clinic with two doctors much better than with just one as it was last week. There's much more for me to do and I don't find myself sitting around while the doctor is seeing patients. It was really great to have Rebbecca back and in the clinic. She is really an amazing new doctor and works so wonderfully with children. It's great to observe her and see how easily she gains the trust of her patients. I can tell that she truly loves being a pediatrician. She is also extremely helpful to someone like me who is interested in becoming a doctor. I ask her questions all day and she never seems to tire of answering them, despite how silly they might be.
We had a couple of noteworthy patients this week. The first was eight year old boy with a giant abscess on the top of his head, exactly the size and shape of an egg. The poor guy kind of resembled a cartoon character. I watched as Lidia and Rebbecca worked to drain it and was amazed and just a little grossed out about how much pus and liquid came out of it! The second patient of interest was a very premature baby (Rhoany Collins' baby) that was coming in for the second time to get checked-up. She weighed barely three pounds, but that was a huge improvement from the last time she was in. It was amazing to me to see a creature so small (was she really human?) and I instantly fell in love with her. Even though she was so tiny had strength in those miniature limbs, as I found out when she grabbed onto my finger. The mom seemed really receptive to all of our medical advice and I felt hopeful that the little girl would grow up to be healthy. The third patient was also a baby girl, coming in for a check-up. Everything about her was healthy, but there was another reason she came in that day. The mom had come in have stitches on the sides of both of the little girl's hands taken out. Apparently the girl had extra digits on both hands that were surgically removed after she was born. I helped Rebbecca take them out, which proved kind of difficult. The mom had waited much too long to take them out and they were buried under a thin layer of new skin. Eventually Rebbecca managed to get them out and we sent the little girl home, with only five fingers on each hand.
Next week the clinic is closed for Semana Santa and I look forward to having some time to relax on the beach. My friend Lindsay is coming down and I can't wait to show them around. I feel like I'm already getting really familiar with the island. I won't write a journal entry for next week because I won't be at the clinic at all. Hopefully it won't be too crazy what with Spring Break and the holiday. I expect taxis to be more expensive and tourists to be everywhere!
We had a couple of noteworthy patients this week. The first was eight year old boy with a giant abscess on the top of his head, exactly the size and shape of an egg. The poor guy kind of resembled a cartoon character. I watched as Lidia and Rebbecca worked to drain it and was amazed and just a little grossed out about how much pus and liquid came out of it! The second patient of interest was a very premature baby (Rhoany Collins' baby) that was coming in for the second time to get checked-up. She weighed barely three pounds, but that was a huge improvement from the last time she was in. It was amazing to me to see a creature so small (was she really human?) and I instantly fell in love with her. Even though she was so tiny had strength in those miniature limbs, as I found out when she grabbed onto my finger. The mom seemed really receptive to all of our medical advice and I felt hopeful that the little girl would grow up to be healthy. The third patient was also a baby girl, coming in for a check-up. Everything about her was healthy, but there was another reason she came in that day. The mom had come in have stitches on the sides of both of the little girl's hands taken out. Apparently the girl had extra digits on both hands that were surgically removed after she was born. I helped Rebbecca take them out, which proved kind of difficult. The mom had waited much too long to take them out and they were buried under a thin layer of new skin. Eventually Rebbecca managed to get them out and we sent the little girl home, with only five fingers on each hand.
Next week the clinic is closed for Semana Santa and I look forward to having some time to relax on the beach. My friend Lindsay is coming down and I can't wait to show them around. I feel like I'm already getting really familiar with the island. I won't write a journal entry for next week because I won't be at the clinic at all. Hopefully it won't be too crazy what with Spring Break and the holiday. I expect taxis to be more expensive and tourists to be everywhere!
Saturday, March 08, 2008
Rose Journal 1
So here concludes my first week. I was excited to quickly find out that my position here is not just observing but that I am able to interact with the patients and do my share. I don't think I knew quite what I was getting into when I signed up for this program so I am happily surprised to see how much I am actually able to do and learn here. All this week the only doctor has been Dr. Lydia which has given me a nice slow start to get used to doing triage. Maybe, too slow at times as right now I am taking a spare minute at the clinic to write this journal entry! I have settled into the job quite easily and feel fully ready for next week when Rebbecca gets back and the number of patients coming into our office is sure to double.
This week there was a strike Monday through Wednesday. Basically the only people still working were all the doctors and nurses as it was the secretaries, maids, etc. that were striking. I got the lovely experience of trying to triage people and keep track of their data without charts. The hardest part about it was probably making sure that the patients that needed to be seen got into the office as there was really no way of keeping track of it. You just had to stick your head out the door and say "next" (in Spanish of course). Our number of patients those three days was very low because no one wanted to come to the hospital when there was a strike going on. I think on Tuesday we only had two, total, one of whom was "no contesta". It was sad to see how little people were getting care because of the strike and it is my hope that the people who didn't come here went to Clinica Esperanza.
I've learned a few cool things this week. Lydia taught me how to hook up a kid to a nebulizer (easy but I'd never done it before) and showed me about the importance of having accurate growth charts. I see newborns almost every day, most of them healthy, which always makes me smile. I'm also getting the hang of deciphering patient's symptoms in Spanish. They usually all have similar symptoms and I've learned the words gripe and calentura. I'm also getting the hang of all the abbreviations in Spanish. For example, a urinary tract infection (UTI) is an IVU and an upper respiratory infection (URI) is an IRU.
I also had the opportunity to go to the local daycare with Lydia and assist with check-ups there. The kids were not too excited to interrupt their play time to get measured, weighed, and... well you know fully examined... but Lydia has a certain charisma with children and the check-ups went well. While Lydia was doing certain parts of the examinations she closed the door for privacy and I had a chance to interact with the kids and watch the women that work there do their best to keep the rowdy ones under control. It was actually amazing to watch them preside over the children, handling every dispute with a few quick words.
This weekend I plan to explore the island a bit more and hopefully visit my friend in Punta Gorda. I am finishing up this journal entry back at Peggy's house and over the course of the night a storm blew in. The waves splash right up to the stairs of her house and the wind is deafening. All the laundry was blown off the line and into the storm. I sit in awe, watching the waves and the amazing power that they possess.
This week there was a strike Monday through Wednesday. Basically the only people still working were all the doctors and nurses as it was the secretaries, maids, etc. that were striking. I got the lovely experience of trying to triage people and keep track of their data without charts. The hardest part about it was probably making sure that the patients that needed to be seen got into the office as there was really no way of keeping track of it. You just had to stick your head out the door and say "next" (in Spanish of course). Our number of patients those three days was very low because no one wanted to come to the hospital when there was a strike going on. I think on Tuesday we only had two, total, one of whom was "no contesta". It was sad to see how little people were getting care because of the strike and it is my hope that the people who didn't come here went to Clinica Esperanza.
I've learned a few cool things this week. Lydia taught me how to hook up a kid to a nebulizer (easy but I'd never done it before) and showed me about the importance of having accurate growth charts. I see newborns almost every day, most of them healthy, which always makes me smile. I'm also getting the hang of deciphering patient's symptoms in Spanish. They usually all have similar symptoms and I've learned the words gripe and calentura. I'm also getting the hang of all the abbreviations in Spanish. For example, a urinary tract infection (UTI) is an IVU and an upper respiratory infection (URI) is an IRU.
I also had the opportunity to go to the local daycare with Lydia and assist with check-ups there. The kids were not too excited to interrupt their play time to get measured, weighed, and... well you know fully examined... but Lydia has a certain charisma with children and the check-ups went well. While Lydia was doing certain parts of the examinations she closed the door for privacy and I had a chance to interact with the kids and watch the women that work there do their best to keep the rowdy ones under control. It was actually amazing to watch them preside over the children, handling every dispute with a few quick words.
This weekend I plan to explore the island a bit more and hopefully visit my friend in Punta Gorda. I am finishing up this journal entry back at Peggy's house and over the course of the night a storm blew in. The waves splash right up to the stairs of her house and the wind is deafening. All the laundry was blown off the line and into the storm. I sit in awe, watching the waves and the amazing power that they possess.
Becky Journal 7
We just finished another crazy week, and next week the clinic will only have half as many people working there, as TJ and the Grubers are going home this weekend. On Monday, we had a record 38 patients in the morning, which just added to thecraziness, as we were starting the ultrasound course. The course has been a huge success, and the ultrasound technician and radiologist have been able to provide many free and needed ultrasouds to the people here, in addition to teaching the doctors how to use the ultrasound machine. The baby with dehydration was sent home on Wednesday, at 1.6kg, so she finally gained some weight. She looked so much better too…I took a picture of her a few days before she left the hospital and compared it to the picture we had of the first day she came in, and you can’t even tell it’s the same baby…pretty incredible. The patient load the rest of the week has been pretty moderate, and since we have four doctors working, we always seem to get through all of the patients quickly.
On Wednesday we all went out to dinner and then went out on the dock and watched the entire lunar eclipse, which was absolutely spectacular in a place where there is little light pollution. Thursday after clinic, Dr. Patrick and I went to a meeting with a man named Clinton Everett, who used to be the governor of Cayos Cochinos and is still very important there. We discussed the prospect of setting up a clinic there that would be staffed by a physician once a month, just for about a weekend or so every month. There is a desperate need for medical care on the islands, and it seems like something we may realistically be able to provide. We are arranging for a trip out there next weekend, so we can go and talk to the Patronados of the island and truly assess what would be needed.
Friday was not too busy in clinic, but a very sick 2 year child came into the ER, and I am still unsure of what will happen with her. This child presented to the ER in respiratory distress, which had started about 2 days ago, and they could not figure out what was wrong with her. They thought it may have been an obstruction in the upper airway, but there was really no way to figure it out. They started her on all kinds of treatments and antibiotics, but after the whole morning she had still not improved at all. The scariest part is that if her body tires out, which is not unlikely, then she will have to be intubated, and there is no question that the public hospital is a bad place to be if you have to be intubated. They have the supplies for intubation, but as I have seen before, they have no vents, and so intubated patients have to be bagged by hand the entire time, and who knows how long that would be for. I really hope she starts to turn around and improve soon.
Next week the new Global Healing intern comes as well, and I will start orienting her. There is talk of karaoke tonight with Lydia, the other Global Healing docs, and some other doctors from the hospital, which could definitely be a good time. I have been here for over three and a half months now, which means I am more than halfway through my stay here. It is really hard to believe, and it’s scary to think that in three and a half more months im going to be in med school…crazy. Anyway, power is out again (it’s been a regular thing lately) so I need to go before the computer battery dies, and hopefully internet will be back soon so I can email this out.
On Wednesday we all went out to dinner and then went out on the dock and watched the entire lunar eclipse, which was absolutely spectacular in a place where there is little light pollution. Thursday after clinic, Dr. Patrick and I went to a meeting with a man named Clinton Everett, who used to be the governor of Cayos Cochinos and is still very important there. We discussed the prospect of setting up a clinic there that would be staffed by a physician once a month, just for about a weekend or so every month. There is a desperate need for medical care on the islands, and it seems like something we may realistically be able to provide. We are arranging for a trip out there next weekend, so we can go and talk to the Patronados of the island and truly assess what would be needed.
Friday was not too busy in clinic, but a very sick 2 year child came into the ER, and I am still unsure of what will happen with her. This child presented to the ER in respiratory distress, which had started about 2 days ago, and they could not figure out what was wrong with her. They thought it may have been an obstruction in the upper airway, but there was really no way to figure it out. They started her on all kinds of treatments and antibiotics, but after the whole morning she had still not improved at all. The scariest part is that if her body tires out, which is not unlikely, then she will have to be intubated, and there is no question that the public hospital is a bad place to be if you have to be intubated. They have the supplies for intubation, but as I have seen before, they have no vents, and so intubated patients have to be bagged by hand the entire time, and who knows how long that would be for. I really hope she starts to turn around and improve soon.
Next week the new Global Healing intern comes as well, and I will start orienting her. There is talk of karaoke tonight with Lydia, the other Global Healing docs, and some other doctors from the hospital, which could definitely be a good time. I have been here for over three and a half months now, which means I am more than halfway through my stay here. It is really hard to believe, and it’s scary to think that in three and a half more months im going to be in med school…crazy. Anyway, power is out again (it’s been a regular thing lately) so I need to go before the computer battery dies, and hopefully internet will be back soon so I can email this out.
Thursday, February 07, 2008
Becky Journal 6
I will be away this weekend (in Cayos Cochinos!) so it is Thursday night, and I am doing my journal entry a little early.
So this week the two new doctors started, and things have been going really well. Lydia left for the mainland on Wednesday, but she had the first two days to orient the two new doctors. On Wednesday night we all went over to West Bay, where one of Peggy’s volunteers is staying in a beachfront condo, and had a big party over there, which was really fun. It’s been so nice for me that Global Healing and Clinica Esperanza have such a close relationship since I have been working with both…almost every day the Global Healing doctors and Peggy’s volunteers all hang out together.
We started out on Monday with a really busy day, and I felt kind of bad for the new doctors, who must have been overwhelmed. We had 34 patients, which is the most that we have had since I started here. The rest of the week had an average patient load though, so things slowed down. This has been a busy week for me, because after clinic, I have been going over to Peggy’s every afternoon. I am organizing a trip to Cayos Cochinos this weekend, where me and 3 other volunteers from Peggy’s are taking a sailboat over for the weekend and doing a medical brigade. I’m really excited about this trip…the island is supposed to be really small, with no water or electricity. I had already organized a health screening up in the Colonia, but this brigade requires a lot more work, because we are bringing medications as well.
There was one really disappointing event this weekend…the mother of the baby that had come in at 1.2 kg with dehydration apparently signed out AMA yesterday and took the baby home, telling them she would come back today to get her weighed. She showed up at our clinic this morning and asked us to weigh her baby, which I did, and the baby still weighs only 1.3kg, and is in no shape to be at home. I persuaded her to talk with Dr. Cronin before she left for home again, and thankfully Dr. Cronin persuaded her to stay in the hospital today. Hopefully it will last, because the mom kept saying that she did not want to be in the hospital anymore, and this is exactly the sort of case that could end up really badly if we do not stay on top of it.
Anyway, I have to go (it’s Thursday night, so it’s time for the crab races), but hopefully I will have a lot to report next week about my weekend trip. Also, the Grubers and our other resident are coming this weekend, so there should be lots of excitement next week!
So this week the two new doctors started, and things have been going really well. Lydia left for the mainland on Wednesday, but she had the first two days to orient the two new doctors. On Wednesday night we all went over to West Bay, where one of Peggy’s volunteers is staying in a beachfront condo, and had a big party over there, which was really fun. It’s been so nice for me that Global Healing and Clinica Esperanza have such a close relationship since I have been working with both…almost every day the Global Healing doctors and Peggy’s volunteers all hang out together.
We started out on Monday with a really busy day, and I felt kind of bad for the new doctors, who must have been overwhelmed. We had 34 patients, which is the most that we have had since I started here. The rest of the week had an average patient load though, so things slowed down. This has been a busy week for me, because after clinic, I have been going over to Peggy’s every afternoon. I am organizing a trip to Cayos Cochinos this weekend, where me and 3 other volunteers from Peggy’s are taking a sailboat over for the weekend and doing a medical brigade. I’m really excited about this trip…the island is supposed to be really small, with no water or electricity. I had already organized a health screening up in the Colonia, but this brigade requires a lot more work, because we are bringing medications as well.
There was one really disappointing event this weekend…the mother of the baby that had come in at 1.2 kg with dehydration apparently signed out AMA yesterday and took the baby home, telling them she would come back today to get her weighed. She showed up at our clinic this morning and asked us to weigh her baby, which I did, and the baby still weighs only 1.3kg, and is in no shape to be at home. I persuaded her to talk with Dr. Cronin before she left for home again, and thankfully Dr. Cronin persuaded her to stay in the hospital today. Hopefully it will last, because the mom kept saying that she did not want to be in the hospital anymore, and this is exactly the sort of case that could end up really badly if we do not stay on top of it.
Anyway, I have to go (it’s Thursday night, so it’s time for the crab races), but hopefully I will have a lot to report next week about my weekend trip. Also, the Grubers and our other resident are coming this weekend, so there should be lots of excitement next week!
Sunday, February 03, 2008
Becky Journal 5
This week went by so quickly, and Andrea just left yesterday. I can’t believe that I have already been here for three months…it feels like I only got here a couple of weeks ago. It’s really weird having Andrea gone, but TJ came in yesterday, and he seems really nice, and I am on my way out to go meet the new attending, Becca. This week was pretty uneventful, and things were slower in the clinic since there is a new Cuban pediatrician that just opened up another pediatric outpatient clinic. It was good that things were a little bit slower, though, because Dr. Gross was gone, so it was just Andrea and Lydia. Our dehydrated, malnourished baby was doing better this week. We weighed her again and by Friday, she still only weighed 1.2kg, which is what she weighed when she first came in, but she still looks a lot better. She is now tolerating 10cc of fluid at a time, which is great. I am amazed that there is no scale in the pediatric area, at least no infant scale. They weigh the babies on a normal full size scale, which definitely doesn’t help when you are trying to see a difference of a few grams. We have been bringing in the scale from our clinic every day, and we are working on trying to get one donated.
On another note, I have been working with Peggy when I get out of the hospital, and I just got the amazing news last week that my fire department back home is donating 3 AEDs to Clinica Esperanza, along with a whole bunch of other medical supplies. There is only one AED on the island, so this will be really helpful. This coming week will be very busy, with the new doctors. I will also be doing a bunch of planning and organization in the afternoons, as I am going with a few doctors from Peggy’s to Cayos Cochinos next weekend, where we are going to set up a medical brigade for two days. I am really excited about that, as Cayos is supposed to be gorgeous, and apparently there is pretty much no medical care now. Anyway, the new Global Healing docs are waiting for me for dinner, so I need to go, but this should be a great week!
On another note, I have been working with Peggy when I get out of the hospital, and I just got the amazing news last week that my fire department back home is donating 3 AEDs to Clinica Esperanza, along with a whole bunch of other medical supplies. There is only one AED on the island, so this will be really helpful. This coming week will be very busy, with the new doctors. I will also be doing a bunch of planning and organization in the afternoons, as I am going with a few doctors from Peggy’s to Cayos Cochinos next weekend, where we are going to set up a medical brigade for two days. I am really excited about that, as Cayos is supposed to be gorgeous, and apparently there is pretty much no medical care now. Anyway, the new Global Healing docs are waiting for me for dinner, so I need to go, but this should be a great week!
Saturday, January 26, 2008
Becky Journal 4
So this week has been going kind of slow, since the weather has been really nasty and rainy. On Monday, I saw the most malnourished baby that I have ever seen…definitely the sickest baby I have ever seen that has not been in the NICU. A mom brought in her 12 day old for a well baby check. She said the baby was born premature, at somewhere between 32-34 weeks, and was kept in the hospital for 2 days. She went to unwrap the baby, and I hae seen a lot, and it takes a lot to shock me, but I was absolutely shocked at the sight of this baby. It was tiny, with arms and legs skinnier than a pencil. It’s skin was all shriveled up, and it’s face looked like an old person…it almost looked like a mummy. I couldn’t believe this baby was still alive. I asked the mom if there were any problems, and she replied that there weren’t and that the baby was breastfeeding just fine. We undressed the baby, and I was honestly afraid to pick up this baby and put it on the scale, because I was afraid I would hurt her if I moved her. We put her on the scale, and she weighed 1.2 kilograms. She had weighed 1.5kg at birth, meaning she had lost 18% of her birthweight, which was already really low. Andrea saw her right away, and told the mom that she needed to be admitted. At first the mother refused, but Andrea told her flat out that the baby would die if she went home and continued like this. Both Dr. Gross and Andrea agreed that the baby should be in a NICU, but since no such thing exists here, they put her in an incubator in the pediatric ward. They wanted to give her an NG tube to get nutrition, but were unable to. Apparently the baby was so tiny that when they put the tube in, the baby became apneic, due to the tiny size of her tubes. They also tried to put an IV in, but the baby was so tiny and so dehyrated that they could not put one in anywhere. Instead, they ended up trying to syringe feed her orally, which is still what they are doing, until she is hydrated enough that they can get a line in. The most shocking thing about this situation was that the mother had a two year old child as well, but still had no idea that something was drastically wrong with her baby.
On Tuesday, we had a four year old girl come in today with a cyst on her eyelid, which she had for 2 years and which scratched and irritated her eye when she blinked. They were going to try to send her to the mainland to an opthamologist, which of course would be costly, but I remembered Peggy mentioning that she had an opthamologist coming down to her clinic in March. I called Peggy, and ended up taking all of this girl’s information, along with pictures of the eye to send to the opthamologist in the states. Hopefully, it will be something he can fix, and it will save her family a very costly trip to the mainland.
As of Thursday, they still had not put an NG tube into our malnorished baby, who had now been in the hospital for 4 days. Dr. Gross brought our baby scale into the ward, since they don’t have an accurate scale on the ward. He weighed the baby on our scale, and the baby still weighed 1.2 kg, exactly the same she had been 4 days ago. We had Peggy bring over a couple of NG tubes, since they said they didn’t have any at the hospital. That afternoon, Lydia put a tube in the baby, and the baby is already looking better.
Friday was pretty slow, probably because of the rain, and so we finished clinic early and spent time with Dr. Gross. He is leaving this weekend, which is really sad, because he is an amazing doctor and I learned so much from him. We all went out to dinner at Romeos in French Harbor, which was nice for his last Friday night. Next week will just be me, Andrea, and Lydia, so hopefully things won’t be too crazy.
On Tuesday, we had a four year old girl come in today with a cyst on her eyelid, which she had for 2 years and which scratched and irritated her eye when she blinked. They were going to try to send her to the mainland to an opthamologist, which of course would be costly, but I remembered Peggy mentioning that she had an opthamologist coming down to her clinic in March. I called Peggy, and ended up taking all of this girl’s information, along with pictures of the eye to send to the opthamologist in the states. Hopefully, it will be something he can fix, and it will save her family a very costly trip to the mainland.
As of Thursday, they still had not put an NG tube into our malnorished baby, who had now been in the hospital for 4 days. Dr. Gross brought our baby scale into the ward, since they don’t have an accurate scale on the ward. He weighed the baby on our scale, and the baby still weighed 1.2 kg, exactly the same she had been 4 days ago. We had Peggy bring over a couple of NG tubes, since they said they didn’t have any at the hospital. That afternoon, Lydia put a tube in the baby, and the baby is already looking better.
Friday was pretty slow, probably because of the rain, and so we finished clinic early and spent time with Dr. Gross. He is leaving this weekend, which is really sad, because he is an amazing doctor and I learned so much from him. We all went out to dinner at Romeos in French Harbor, which was nice for his last Friday night. Next week will just be me, Andrea, and Lydia, so hopefully things won’t be too crazy.
Wednesday, January 23, 2008
Becky Journal 3
This week was amazingly productive, and the Global Healing team has been working amazingly well together. The week started out on a sad note as we found out on Monday that the baby we had flown to San Pedro last week had died sometime over the weekend. The news came as a shock to all of us, since as of Friday we had been told that the baby had been placed on a ventilator in the NICU and was stable. We did not get any other information from the hospital in San Pedro, only that the baby had died. It was really dishearteartening, not only because we had worked so hard to help the baby, but because we all believed that this baby was through the toughest part. However, we all knew that we did all that we could have possibly done to make a difference for this baby.
On Monday, the hospital was on strike again, so we played the part of pediatric ER, taking all of the kids who were coming into the ER to be seen. It was pretty much the same as a normal clinic day, except that overall the kids were a little bit sicker. We took advantage of ending early on Monday to go through all of our supplies, inventory, clean, and make lists of needed supplies for the next people coming down. On Tuesday, things were back to normal. Wednesday was a crazy busy day. We had clinic as usual in the morning, and afterward, we had a lecture given by Dr. Dominguez, the orthopoedist. It was very interesting, and he was a great speaker. I was a little bit worried that I wouldn’t be able to understand everything since it was done in Spanish, but the lecture supplemented by power point was very clear and easy to understand. After the lecture, I went right over to Peggy’s clinic, as I had organized a screening up in the Colonia for that afternoon.
We all met at Peggy’s clinic and laded the truck with supplies, and headed up to the church. We weighed and took temperatures on all of the children, and did pressures and sugars on the adults. Then they all got a brief check-in with the doctors, and were given reference cards to come to the clinic if they needed to. I was not at Clinica Esperanza today since I was at the hospital, but apparently lots of people for La Colonia came after going to the screening. This was really encouraging, because after talking to some people in the Colonia, I have realized that many people do not know that Clinica Esperanza is free for those who can not pay. There is one family in the Colonia that I have visited with a few times, and after their screening the mother told me that she knew she should take her kids to the clinic, but she had 5 kids and did not have the money to take them. I told her it was not a problem if she was unable to pay, and her whole face lit up, and gave me a hug. She also told me that her father was sick and she would like to take him to the clinic, but that he was unable to walk down to the screening. I went with her up to the top of the Colonia to do a screening on him, and his pressure ended up being dangerously high. He was advised to go to the clinic the next and promised that he would. It was definitely a satisfying day, which was ended by a night dive in West Bay with Dr. Gross and a few of Peggy’s volunteers.
On Thursday, we were finished clinic by 11, and we all went with Dr. Prado over to the daycare center, where she was going to give de-parasite medication to all of the kids, because apparently a few of them had been vomiting worms. We set up a mini-clinic at the daycare, where we first weighed all of the kids, then calculated medication for each one, and each child got medicated. It was soo different from the US, where I could not imagine what would happen if someone came in and gave all of the kids medicine without parental persmission. The kids were all so good with taking the medication, and we had fun playing with them as well. On Friday, we also went to the daycare after clinic to give the kids their second dose of medication, and got to play with them some more. Then we all went to lunch in Coxen Hole, and went shoppping for fish. Friday night, we helped Dr. Gross cook a big dinner as a send off for a big group of volunteers that had been at Peggy’s clinic. It was a great week, and very productive as well…we have already seen over 200 patients this month! Next week is my last week with Dr. Gross and Andrea, though, which is sad.
On Monday, the hospital was on strike again, so we played the part of pediatric ER, taking all of the kids who were coming into the ER to be seen. It was pretty much the same as a normal clinic day, except that overall the kids were a little bit sicker. We took advantage of ending early on Monday to go through all of our supplies, inventory, clean, and make lists of needed supplies for the next people coming down. On Tuesday, things were back to normal. Wednesday was a crazy busy day. We had clinic as usual in the morning, and afterward, we had a lecture given by Dr. Dominguez, the orthopoedist. It was very interesting, and he was a great speaker. I was a little bit worried that I wouldn’t be able to understand everything since it was done in Spanish, but the lecture supplemented by power point was very clear and easy to understand. After the lecture, I went right over to Peggy’s clinic, as I had organized a screening up in the Colonia for that afternoon.
We all met at Peggy’s clinic and laded the truck with supplies, and headed up to the church. We weighed and took temperatures on all of the children, and did pressures and sugars on the adults. Then they all got a brief check-in with the doctors, and were given reference cards to come to the clinic if they needed to. I was not at Clinica Esperanza today since I was at the hospital, but apparently lots of people for La Colonia came after going to the screening. This was really encouraging, because after talking to some people in the Colonia, I have realized that many people do not know that Clinica Esperanza is free for those who can not pay. There is one family in the Colonia that I have visited with a few times, and after their screening the mother told me that she knew she should take her kids to the clinic, but she had 5 kids and did not have the money to take them. I told her it was not a problem if she was unable to pay, and her whole face lit up, and gave me a hug. She also told me that her father was sick and she would like to take him to the clinic, but that he was unable to walk down to the screening. I went with her up to the top of the Colonia to do a screening on him, and his pressure ended up being dangerously high. He was advised to go to the clinic the next and promised that he would. It was definitely a satisfying day, which was ended by a night dive in West Bay with Dr. Gross and a few of Peggy’s volunteers.
On Thursday, we were finished clinic by 11, and we all went with Dr. Prado over to the daycare center, where she was going to give de-parasite medication to all of the kids, because apparently a few of them had been vomiting worms. We set up a mini-clinic at the daycare, where we first weighed all of the kids, then calculated medication for each one, and each child got medicated. It was soo different from the US, where I could not imagine what would happen if someone came in and gave all of the kids medicine without parental persmission. The kids were all so good with taking the medication, and we had fun playing with them as well. On Friday, we also went to the daycare after clinic to give the kids their second dose of medication, and got to play with them some more. Then we all went to lunch in Coxen Hole, and went shoppping for fish. Friday night, we helped Dr. Gross cook a big dinner as a send off for a big group of volunteers that had been at Peggy’s clinic. It was a great week, and very productive as well…we have already seen over 200 patients this month! Next week is my last week with Dr. Gross and Andrea, though, which is sad.
Monday, January 14, 2008
Becky Journal 2
As of this week, Dr. Gross, Dr. Lee, and the new Honduran doctor, Dr. Prado, are all working in the clinic, and things have finally come together. It was a great week this week, and it was a good thing we had so many doctors, because we were really busy. I saw a lot of interesting cases this week, and also got to help out with getting a patient to the mainland, which was amazing. Monday through Wednesday, we had about 25-30 patients each day, so I was kept busy with triage, shadowing, and doing paperwork. We had one case which was a 3 week old baby girl that had supernumery digits hanging off of each of her pinkies, which Dr. Gross removed. I also saw a few abcesses drained, as well as all of the usual cases.
On Tuesday, when Dr. Gross and Dr. Lee came back from rounds, they were talking about a baby with a lung problem whose left lung had not expanded. On Wednesday, they took an x-ray and discovered that the baby’s left lung was either collapsed, filled with fluid, or not opening for another reason. The baby was 5 days old, and although she was breathing spontaneously, her oxygen saturation was very low, so she was being bagged by the nurses. On Wednesday night they got a call that the hospital had a ventilator that they wanted to put the baby on, but they did not know how to use it. We went to the hospitial and the doctors looked at the vent, which was an ancient piece of equipment that they had never seen before, aside from the fact that it was for adults. They determined that there was no way the the vent was usable, so they continued bagging the baby overnight. The baby was only being given IV fluids and no nutrition, and was in very poor shape. Dr. Gross decided that it would be best for the baby to be sent for the mainland. After researcheing, he decided that Cieba did not have the right resources for the child, and so she would have to go farther.
On Thursday during rounds, Dr. Gross talked to Dr. Jackie and got permission to fly the baby out. Around 10, they sent me to the airport to try to arrange a flight. After 3 hectic hours at the airport, I learned that commercial planes did not allow oxygen, and so we arranged for a charter flight to fly the baby to San Pedro. By 12:30, everything was arranged, and I met Dr. Lee and the baby at the airport. Dr. Gross had driven them in her car, with the baby in a small plastic tub, and Dr. Lee ventilating the whole way. The whole experience was pretty surreal. We were rushed through screening at the airport, with Dr. Lee and I holding the tub with the baby, who was being bagged. We then were loaded into a tiny little four person plane, no bigger than the size of a small car. The mom sat up front with the pilot, and Dr. Lee and I sat in the back, with the baby in the tub on our knees. We bagged the baby for the entire hour and a half flight, with Dr. Lee constantly checking the baby’s color and feeling for chest rise. We had no pulse oximeter, and the plane was so loud that she could not hear breath sounds,s o she relied on feeling for chest rise. As soon as we landed at San Pedro airport, there was an ambulance waiting, and they met us at the door. It was very comforting to see an ambulance with 2 paramedics and a doctor, as wel as neonatal equipment, moniters, and pulse oximeters. It made me feel very confident that we were getting this baby to a higher level of care. After getting the baby loaded and giving report, the baby’s mother, who spoke no English, came up to us and said “Bless you”. It was truly amazing. We flew back to Roatan, and still made it home in time for the crab races that night. We called the hospital the next day, and the baby had been put on a vent, but had still not been diagnosed, but we were told that there was a pulmonary neonatologist as well as 3 pediatric surgeons there, so we knew that the baby was in good hands. Dr. Lee is going to call again today to see how things are going. I have helped out with manny individual patient cases since I have been here, but this was definitely the most satisfying case that I have been involved with, as the baby surely would have died if we had not gotten her transferred right away.
Then, for a climactic end to the week, when we all came in on Friday, feeling exhilirated from the day before, there were no patients around, and the workers were all on strike. The doctors did their rounds, and then we decided to do some reorganizing and inventorying in the clinic. However, then a nurse from the ER came over and asked if we could see all of their pediatric cases since they were so busy, so we became the pediatric ER for the rest of the morning. We finished up around noon, and I headed to Peggy’s clinic, as I usually do. Their waiting room was still completely full, because all of the people that would have gone to the hospital ended up there. I called Dr. Gross and Dr. Lee to tell them I would be late for snorkeling, and twenty minutes later they both showed up at Peggy’s, and helped see patients to speed things up. We got finished quickly, and spent the rest of the day relaxing on the beach. Yesterday I went with Dr. Gross, Dr. Lee, and some of Peggy’s volunteers down to the east end of the island to Paya Bay. I had been there before, but it is absolutely gorgeous. We followed that up with a dinner at the view, whicih was a perfect end to a perfectly relazxing day.
On Tuesday, when Dr. Gross and Dr. Lee came back from rounds, they were talking about a baby with a lung problem whose left lung had not expanded. On Wednesday, they took an x-ray and discovered that the baby’s left lung was either collapsed, filled with fluid, or not opening for another reason. The baby was 5 days old, and although she was breathing spontaneously, her oxygen saturation was very low, so she was being bagged by the nurses. On Wednesday night they got a call that the hospital had a ventilator that they wanted to put the baby on, but they did not know how to use it. We went to the hospitial and the doctors looked at the vent, which was an ancient piece of equipment that they had never seen before, aside from the fact that it was for adults. They determined that there was no way the the vent was usable, so they continued bagging the baby overnight. The baby was only being given IV fluids and no nutrition, and was in very poor shape. Dr. Gross decided that it would be best for the baby to be sent for the mainland. After researcheing, he decided that Cieba did not have the right resources for the child, and so she would have to go farther.
On Thursday during rounds, Dr. Gross talked to Dr. Jackie and got permission to fly the baby out. Around 10, they sent me to the airport to try to arrange a flight. After 3 hectic hours at the airport, I learned that commercial planes did not allow oxygen, and so we arranged for a charter flight to fly the baby to San Pedro. By 12:30, everything was arranged, and I met Dr. Lee and the baby at the airport. Dr. Gross had driven them in her car, with the baby in a small plastic tub, and Dr. Lee ventilating the whole way. The whole experience was pretty surreal. We were rushed through screening at the airport, with Dr. Lee and I holding the tub with the baby, who was being bagged. We then were loaded into a tiny little four person plane, no bigger than the size of a small car. The mom sat up front with the pilot, and Dr. Lee and I sat in the back, with the baby in the tub on our knees. We bagged the baby for the entire hour and a half flight, with Dr. Lee constantly checking the baby’s color and feeling for chest rise. We had no pulse oximeter, and the plane was so loud that she could not hear breath sounds,s o she relied on feeling for chest rise. As soon as we landed at San Pedro airport, there was an ambulance waiting, and they met us at the door. It was very comforting to see an ambulance with 2 paramedics and a doctor, as wel as neonatal equipment, moniters, and pulse oximeters. It made me feel very confident that we were getting this baby to a higher level of care. After getting the baby loaded and giving report, the baby’s mother, who spoke no English, came up to us and said “Bless you”. It was truly amazing. We flew back to Roatan, and still made it home in time for the crab races that night. We called the hospital the next day, and the baby had been put on a vent, but had still not been diagnosed, but we were told that there was a pulmonary neonatologist as well as 3 pediatric surgeons there, so we knew that the baby was in good hands. Dr. Lee is going to call again today to see how things are going. I have helped out with manny individual patient cases since I have been here, but this was definitely the most satisfying case that I have been involved with, as the baby surely would have died if we had not gotten her transferred right away.
Then, for a climactic end to the week, when we all came in on Friday, feeling exhilirated from the day before, there were no patients around, and the workers were all on strike. The doctors did their rounds, and then we decided to do some reorganizing and inventorying in the clinic. However, then a nurse from the ER came over and asked if we could see all of their pediatric cases since they were so busy, so we became the pediatric ER for the rest of the morning. We finished up around noon, and I headed to Peggy’s clinic, as I usually do. Their waiting room was still completely full, because all of the people that would have gone to the hospital ended up there. I called Dr. Gross and Dr. Lee to tell them I would be late for snorkeling, and twenty minutes later they both showed up at Peggy’s, and helped see patients to speed things up. We got finished quickly, and spent the rest of the day relaxing on the beach. Yesterday I went with Dr. Gross, Dr. Lee, and some of Peggy’s volunteers down to the east end of the island to Paya Bay. I had been there before, but it is absolutely gorgeous. We followed that up with a dinner at the view, whicih was a perfect end to a perfectly relazxing day.
Sunday, December 16, 2007
Christine Journal 13
Max and I are in disbelief that this will be our second to last update, but it's been a wonderful past few months and we still have a week left, so we can't get too sad yet.
I had an interesting week in the hospital with Jenn and a social service doctor who is taking over for Dr. Charles as he takes two weeks of vacation time. The new social service doctor is not very communicative, so hasn't been all that helpful with special cases and such, but he's nice enough. It has really emphasized for me how important the Honduran fellow is to provide some kind of continuity and local knowledge to the clinic. Pediatricians coming for a month at a time just really can't do it on their own.
I was happy to see the Global Healing ultrasound put to good use this week. The ultrasound is huge and was donated a couple of months ago. It's been sitting in the corner of the clinic for that time without much use, as no one in the hospital is trained in reading ultrasounds. Additionally, we don't want to move it out of the clinic in case parts (or all) of it get stolen, as happened with the last one, apparently. Howard has been organizing a visit for a couple of radiologists and an ultrasound tech to come down in February and teach local doctors how to use it, which I think will be great. Hopefully then it will be put to good work! Anyway, the surgeon did come by to use it once this week on a woman she believed had gall stones, but she couldn't actually find any in the ultrasound. Jenn also used it twice - once on a boy she wanted to check for an inflamed kidney and another time on a boy's brain.
The second case was pretty interesting. It was a premature baby (born at about 7 months and 1600 grams) who had been in the clinic for weight checks every week since he was born. He was growing very slowly (was 1900 grams this past week), but Jenn was the first doctor to feel his head and realize that his sutures were completely open and his posterior fontanelle was also very large. He presented with a fever of 101.6 degrees, so Jenn wanted to put him on antibiotics and admit him for the fever before we worried about the sutures. She sent him to the ER and went back after about an hour to check on him, only to realize that the ER had not even started the antibiotics because they were "waiting for a bed to free up." She was very angry and frustrated that there seemed to be no thinking outside the box, especially since it should be fairly obvious that the baby needed to be on antibitics asap and could really be put on any surface to do so. Additionally, when the did finally clear out a bed from him, they didn't change the sheets in between patients.
After the antibiotics were administered, we brought the baby back into the clinic and did an ultrasound on the brain. He seems to have pretty severe hydrocephalus, and Jenn was able to send pictures we took of the screen to a neurologist in the US for a consult, which was great. I cannot even imagine how much more difficult international work like this was before the internet...
The hardest part for me of the whole encounter was having to explain to the mom what it was we were doing and that her son would not develop normally, resulting in lower intelligence, decreased motor function, etc. It just all came out of nowhere, since she'd been coming to check-ups with the clinic for a few weeks and no one had caught the hydrocephalus before.
Also this week, I started tutoring a local high school graduate to prepare her for the SAT, as she's hoping to go to the US for college next year. I had taken her to the test in La Ceiba about a month ago, but her scores were not as high as she had hoped, so she'll take it again in January. She's fun to work with and I'm hoping someone else will be able to take over after next week, although I doubt that will be a problem with all the volunteers that come through Peggy's house.
I had an interesting week in the hospital with Jenn and a social service doctor who is taking over for Dr. Charles as he takes two weeks of vacation time. The new social service doctor is not very communicative, so hasn't been all that helpful with special cases and such, but he's nice enough. It has really emphasized for me how important the Honduran fellow is to provide some kind of continuity and local knowledge to the clinic. Pediatricians coming for a month at a time just really can't do it on their own.
I was happy to see the Global Healing ultrasound put to good use this week. The ultrasound is huge and was donated a couple of months ago. It's been sitting in the corner of the clinic for that time without much use, as no one in the hospital is trained in reading ultrasounds. Additionally, we don't want to move it out of the clinic in case parts (or all) of it get stolen, as happened with the last one, apparently. Howard has been organizing a visit for a couple of radiologists and an ultrasound tech to come down in February and teach local doctors how to use it, which I think will be great. Hopefully then it will be put to good work! Anyway, the surgeon did come by to use it once this week on a woman she believed had gall stones, but she couldn't actually find any in the ultrasound. Jenn also used it twice - once on a boy she wanted to check for an inflamed kidney and another time on a boy's brain.
The second case was pretty interesting. It was a premature baby (born at about 7 months and 1600 grams) who had been in the clinic for weight checks every week since he was born. He was growing very slowly (was 1900 grams this past week), but Jenn was the first doctor to feel his head and realize that his sutures were completely open and his posterior fontanelle was also very large. He presented with a fever of 101.6 degrees, so Jenn wanted to put him on antibiotics and admit him for the fever before we worried about the sutures. She sent him to the ER and went back after about an hour to check on him, only to realize that the ER had not even started the antibiotics because they were "waiting for a bed to free up." She was very angry and frustrated that there seemed to be no thinking outside the box, especially since it should be fairly obvious that the baby needed to be on antibitics asap and could really be put on any surface to do so. Additionally, when the did finally clear out a bed from him, they didn't change the sheets in between patients.
After the antibiotics were administered, we brought the baby back into the clinic and did an ultrasound on the brain. He seems to have pretty severe hydrocephalus, and Jenn was able to send pictures we took of the screen to a neurologist in the US for a consult, which was great. I cannot even imagine how much more difficult international work like this was before the internet...
The hardest part for me of the whole encounter was having to explain to the mom what it was we were doing and that her son would not develop normally, resulting in lower intelligence, decreased motor function, etc. It just all came out of nowhere, since she'd been coming to check-ups with the clinic for a few weeks and no one had caught the hydrocephalus before.
Also this week, I started tutoring a local high school graduate to prepare her for the SAT, as she's hoping to go to the US for college next year. I had taken her to the test in La Ceiba about a month ago, but her scores were not as high as she had hoped, so she'll take it again in January. She's fun to work with and I'm hoping someone else will be able to take over after next week, although I doubt that will be a problem with all the volunteers that come through Peggy's house.
Max Journal 13
Today is the three-month anniversary of our arrival in Roatan and the beginning of our last week here. I have a lot to reflect on, and hopefully I'll be able to put some more of that into words for my last update at the end of the week.
I spent this week working in Peggy's Clinic, alternating between shadowing Dr. Raymond and running the pharmacy. With Raymond I had the opportunity to look in ears, auscultate lungs, listen for heart murmurs, and palpate abdomens. Working with Dr. Raymond is a great learning experience, but unfortunately I did not feel like I could contribute much to his work. I look forward to learning more about medicine in future study, but right now I am more interested in feeling like I am making a difference using the skills that I already have.
Monday brought a surprising number of bad ear infections with at least one ruptured timpanic membrane – a shocking sight. Tuesday seemed to have a lot of eye injuries, with at least two resulting from construction accidents. Eyes are incredible organs, and contemplating the extraction of small splinters from them is a scary prospect. Raymond mentioned that he looked forward to talking to a meeting of construction contractors to address the lack of effective personal protective equipment (specifically glasses/goggles) used by their employees. Occupational safety has never really sparked my interest, but I am inspired by the wholesome approach that Raymond takes to improving healthcare on the island, and I look forward to being able to use my knowledge and experiences as a professional to influence health-related business practices.
Friday brought another large shipment of mattresses and chairs from the Carnival Legend cruise ship. Despite all of the economic complexity that accompanies cruise ship tourism, I am impressed by Carnival's willingness to donate in bulk to Peggy's clinic. The cruise ship is a glaring symbol of the accomplishments of sophisticated modern technology to provide comfort to the wealthy. It's hard to imagine that this several-hundred million dollar luxury ship can dock within a mile of a public hospital providing primary health care to around 50,000 people without a functioning ventilator, ultrasound machine, CT scan, adequately equipped laboratory, or single narcotic drug. Despite all that glaring inequality, I have to say that the 100 mattresses donated in the last two weeks have been well received.
On Thursday and Friday, I returned to Peggy's clinic to do more of the same pharmacy work. It is reassuring to be able to exercise a practiced skill within the clinic to help people get drugs to make their lives more comfortable. The pharmacy seems to be more organized and effective than it was three months ago, and I hope that it continues to move further in that direction as we develop a more consistent inventory system that will hopefully ensure better stocking of necessary drugs. I was happy to hear that Peggy finally placed an order from one of the drug donation companies that Christine and I applied to on the clinic's behalf. The order supposedly contains tens of thousands of dollars of medications for Peggy's clinic and other medical facilities on the island, at a whopping $465 cost to the clinic simply for shipping and handling. I hope the shipment arrives relatively soon and bears as many drugs as promised.
The tutoring program that we ran at Children's Palace Bilingual School came to a close this week. We administered another diagnostic test and saw modest improvement in all of the tutees' test scores. Overall, I was pretty disappointed by the school's disinterest for the tutoring program. It is not the children's fault that they did not want extra math classes outside of school, but I plan on taking better account of community needs in the future. If nothing else, I enjoyed connecting with the students when they did show up, I had a great time getting to know the other tutors, and I like to think that I imparted a bit of knowledge through my two afternoons each week of teaching basic math. I don't think the kids are worse-off after taking the program, and maybe future tutoring projects can use some of the lessons that we've learned to be much more effective.
Yesterday we had a little goodbye party with food and friends at our apartment, and now we have just five short workdays before our return to the United States. I'll give another reflective update before the end, and I hope all is well as usual back home.
I spent this week working in Peggy's Clinic, alternating between shadowing Dr. Raymond and running the pharmacy. With Raymond I had the opportunity to look in ears, auscultate lungs, listen for heart murmurs, and palpate abdomens. Working with Dr. Raymond is a great learning experience, but unfortunately I did not feel like I could contribute much to his work. I look forward to learning more about medicine in future study, but right now I am more interested in feeling like I am making a difference using the skills that I already have.
Monday brought a surprising number of bad ear infections with at least one ruptured timpanic membrane – a shocking sight. Tuesday seemed to have a lot of eye injuries, with at least two resulting from construction accidents. Eyes are incredible organs, and contemplating the extraction of small splinters from them is a scary prospect. Raymond mentioned that he looked forward to talking to a meeting of construction contractors to address the lack of effective personal protective equipment (specifically glasses/goggles) used by their employees. Occupational safety has never really sparked my interest, but I am inspired by the wholesome approach that Raymond takes to improving healthcare on the island, and I look forward to being able to use my knowledge and experiences as a professional to influence health-related business practices.
Friday brought another large shipment of mattresses and chairs from the Carnival Legend cruise ship. Despite all of the economic complexity that accompanies cruise ship tourism, I am impressed by Carnival's willingness to donate in bulk to Peggy's clinic. The cruise ship is a glaring symbol of the accomplishments of sophisticated modern technology to provide comfort to the wealthy. It's hard to imagine that this several-hundred million dollar luxury ship can dock within a mile of a public hospital providing primary health care to around 50,000 people without a functioning ventilator, ultrasound machine, CT scan, adequately equipped laboratory, or single narcotic drug. Despite all that glaring inequality, I have to say that the 100 mattresses donated in the last two weeks have been well received.
On Thursday and Friday, I returned to Peggy's clinic to do more of the same pharmacy work. It is reassuring to be able to exercise a practiced skill within the clinic to help people get drugs to make their lives more comfortable. The pharmacy seems to be more organized and effective than it was three months ago, and I hope that it continues to move further in that direction as we develop a more consistent inventory system that will hopefully ensure better stocking of necessary drugs. I was happy to hear that Peggy finally placed an order from one of the drug donation companies that Christine and I applied to on the clinic's behalf. The order supposedly contains tens of thousands of dollars of medications for Peggy's clinic and other medical facilities on the island, at a whopping $465 cost to the clinic simply for shipping and handling. I hope the shipment arrives relatively soon and bears as many drugs as promised.
The tutoring program that we ran at Children's Palace Bilingual School came to a close this week. We administered another diagnostic test and saw modest improvement in all of the tutees' test scores. Overall, I was pretty disappointed by the school's disinterest for the tutoring program. It is not the children's fault that they did not want extra math classes outside of school, but I plan on taking better account of community needs in the future. If nothing else, I enjoyed connecting with the students when they did show up, I had a great time getting to know the other tutors, and I like to think that I imparted a bit of knowledge through my two afternoons each week of teaching basic math. I don't think the kids are worse-off after taking the program, and maybe future tutoring projects can use some of the lessons that we've learned to be much more effective.
Yesterday we had a little goodbye party with food and friends at our apartment, and now we have just five short workdays before our return to the United States. I'll give another reflective update before the end, and I hope all is well as usual back home.
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