Watching the sunlight skip off the gentle ripples of the Caribbean from my hammock, it’s hard to believe I am already a week into my two-week journey to Roatan. This is my third trip to Roatan and my first as a medical student. I spent one week here last year, but it was more of a Spring Break adventure in the jungle in La Ceiba and less of a clinical experience at the Roatan Volunteer Pediatric Clinic (RVPC) in the Hospital Público de Roatán. In the spring of 2005, I lived here for three months, working as the first student intern at Global Healing’s RVPC. Inevitably, being back here gazing at the same waves calls for some reflection.
First off, I am struck by how different it is to be a first year medical student than an undergraduate in a clinical environment. Sure, as a Stanford undergrad you think you know everything. Sure, as a first year medical student, I still know absolutely nothing about medicine. But is that entirely true? I feel like I held my own this week when asked to list common abscess culprits (staph aureus+Group A strep), perform a neuro exam (thank you, long painful neuro exam workshop), compare red reflexes to check for retinoblastoma in a newborn, and define the boundaries of cranial sutures. Meanwhile, it was an optimal learning environment for someone like me who loves to learn in a clinical setting. I learned how to hear pneumonia in an infant’s lower lobe, use an otoscope in the tiniest of ears, and make a baby poop huge amounts while taking a rectal temp. All without making anyone cry (Dr. Gruber says we fail if we make anyone cry!). It turns out that I have learned a little something in the last year. More importantly, it turns out that I truly love this profession and love to learn. And since we’re talking about scary, how frightening is it that I really love kids?
This week was certainly not all fun or pleasure or mindless excitement. We saw several tragic cases in clinic, and I can’t help but feel conflicted when I see a child with a condition that is so easily prevented or treated in the States. It’s certainly not the parents’ fault, and to think so is blatantly naïve. Attributing blame to anyone specific is inaccurate, but every case like this provides, in my opinion, empiric evidence for increased global aid by countries that have so much and contribute so little. There are an infinite number of cases that could be discussed, but it seems to be the ones with shock value that stick in your mind. On Wednesday, we saw a one-year-old boy with severe hydrocephalus and an array of other congenital deformities, including cleft lip and cleft palate. The child had limited feeding function due to his worsening condition and had become dangerously dehydrated. Suffice to say, this was a difficult case to observe as a medical student, for the child looked much like a slide from Neurosciences Pathology, and there was limited medical care to be provided at this point in time. Apparently, a brain shunt had been proposed in the past but not carried out for a variety of reasons. He was re-hydrated by our incredibly patient, compassionate physicians and treated for probable infections.
We also had a great number of successes this week due to the tireless efforts of Dr. Welcome, the Honduran/RVPC Fellow, Dr. Toledo from CHOP, and the Grubers, Global Healing extraordinaires. We saw over 120 kids in clinic this week, a huge increase from the time I worked in the clinic two years ago. Drs. Welcome, Toledo, and Gruber each taught me a great amount – after misdiagnosing my first scabies case as chicken pox, Dr. Welcome taught me the various presentations of scabies in kids of different ages and varying degrees of infection. Dr. Toledo taught me the art of a gentle pediatric otoscope exam and showed me classic ringworm presentation, among many other things. He was also very patient with me as I learned to take a blood pressure on a toddler (don’t laugh – it’s pretty challenging on a tiny arm). Dr. Gruber spent hours and hours explaining pediatric physical exams and diagnoses, while I taught him Spanish vocabulary and interpreted instructions for killing “bichos” (“bugs”) and “lombrices” (“GI worms”). I still can’t believe how fast a newborn heart beats, but I’m getting better at hearing the murmurs.
Outside of clinic, I have spent most of my free-time reading This Side of Paradise and reflecting introspectively as the afternoon sun rays reflect off the Caribbean back at me. A fellow med student from SC and I spent last weekend touring the island on a scooter (of which the scooter part I do not recommend to any future intern). We also met some powerful investors that invited us to dinner on the eastern side of the island, and this experience gave us a glimpse into the “other side” of Roatan, the one I do not see in the public clinic. The tourist culture of West End, where I am living, is the same as I remembered it – tanned bodies with foreign accents, mostly Canadian and Western European and Southern, drinking too much cheap, tasty Honduran beer and cheap, disgusting tequila. If I lived here for a longer period of time, I would surely live in Sandy Bay with the other interns, but West End will do for two weeks since USC is generously paying for my accommodations through a Travel Grant. As always, I am drawn to the Creole Rotisserie Chicken restaurant, and we’ve decided that it makes sense that the chicken here is the best in the world since there are robust chickens meandering on every road just waiting to be roasted for our culinary delight. I guess my days of Berkeley-Hollywood pseudo-vegetarianism have ended, for now.
I’m off to catch the last hour of sunshine with the kids at the pool, a “Coca-Cola light”, and my faithful Fitzgerald protagonist Amory Blaine. Thanks for reading - More to come next week.
