Week two here on Roatan has been a challenging one for me, but not one without its rewards. This was my first week working as the sole intern at the Global Healing intern at the hospital, an experience marked by an increase in both responsibility and time commitment. As the number of attending physicians increased – we had four altogether, including Dr. Charles Welcome, Dr. Leonel Toledo, Dr. Lea Cunningham, and Dr. Ann Tran—so did the number of patients waiting to be seen. Whereas I had had more time to myself last week (due to sharing work with Ryanne), this week I have been regularly working in clinic until 2pm or later, triaging patients, updating the computer database, filling out the inventory forms, buying a few supplies for the office, and preparing materials for our daycare health screening project.
While working in clinic, I came to realize just how many common diagnoses, treatments, and medical terminology I have picked up in just my short while here – I no longer have any trouble deciphering the ever-famous handwritings of seasoned physicians, nor the abbreviations for upper respiratory infections (URI in English, IRA in Spanish) or acute otitis media (AOM). I have become accustomed to frequently coming across salbuterol and prednisone treatments for asthma, and a host of other treatments including albendazole, metronidazole, and acetominaphen; prior to my trip these terms would have seemed like the remote language of a medical culture far beyond my reach or comprehension, while now they continually reinforce how much I have learned. I may not yet be able to differentiate between scabies and impetigo simply by looking at the patients' symptoms and skin abrasions, but I certainly am working on it.
For three of the five work days this past week, the doctors and I committed about 2-3 hours to the daycare health screening project we are working on. This project, while vastly different from my routine clinical duties, provided insight into completely new aspects of cultural competence, childcare and development here on Roatan. For example, because we understood that many of the kids' parents at the daycare would be unable or perhaps unwilling to provide a comprehensive US-style medical history, we adapted this format to one-page questionnaires, consisting of important health issues presented in a friendly question-and-answer format. We hope that this format will encourage parents to become more involved in their children's education and health. As for the screenings themselves, we found it quite difficult to get the children to perform the tasks that were crucial to assessing their developmental progress: our requests for them to copy a circle, turn the page of a book, or stand on one foot seemed strange and somewhat intimidating to them, as they had probably never had such screenings performed on them in the past. But with the help of Linsday and Lilliana (daycare managers who we need to thank immensely for their bilingual expertise), the overall project was a success. Based on the questionnaires and the developmental screenings, we referred some of the kids to come visit us at the clinic.
And now, life after clinic. Well, due to my busy schedule at work, I did not have much time for other pursuits, although I did meet with Moises for tutoring on Monday. Unfortunately, he has a week of school off now and I do not think he intends to come to tutoring during his vacation time – which is kind of sad, considering that I had prepared fun activities for us to do this week. But not everything can always turn out as planned, and that is probably another important lesson I have learned so far during my time here. Sometimes the spontaneous moments are the most memorable ones – like sleeping out under the stars with Mike and Sierra when the electricity went out on Thursday night, chatting about anything and everything, 'saving' my pistachio ice cream from an unfortunate end. Or singing “Lavense las manos” with the kids at daycare (a song we wrote to the tune of 'La Cucaracha' to help the kids remember to wash their hands) and the Spanish version of the 'Hokey Pokey' and being amazed at Dr. Toledo's vocal and guitar skills. It is these moments that will bring a smile to my face years from now.
And on that positive note, I'm trying my best to deal with one of the not-so-pleasant aspects of medical work with children: children and hygiene seem to be natural enemies, everywhere in the world! Whether in the States or here on Roatan, the cutest kids are those who absolutely cannot be convinced to cover their mouths and wash their hands, perpetually spreading germs as a result. For as hard as I have tried, I have not been able to escape the inevitable falling sick at the hands of children who cough on my face, put their hands in their mouths before giving me a hug, and then display the most adorable smiles I have ever seen. It is impossible to get mad at them, for children will be children; therefore it is parents and medical professionals who need to do their very best to teach them early and often the importance of cleanliness – we are the sole guardians of their (and our own) health. As for me, I am determined to deal with my fever, fatigue, and sore throat as an ongoing reminder of this very important lesson and fervently practice the techniques I preach to children and their parents in clinic.
As this second week draws to a close, I continue to reflect on what I have already learned about medicine and life in general here, and look forward to the weeks to come.
