I planned to write an email last night, but was stymied by a small catastrophe- the pipe leading into the toilet in our apartment snapped off as I tried to turn the water off for the evening, sending liters upon liters of clean fresh water gushing into our apartment! We ran for help and finally found Hector who is somehow related to the owners of the apartment. Hector cut the circuit to stop the water. How ironic that in a country where clean water is so hard to find, within 10 minutes, the entire apartment had flooded- the bathroom, kitchen and bedrooms were covered in an inch of water. I had raced throughout the apartment throwing everything onto chairs and beds as the water spilled out of the bathroom, so luckily nothing was ruined. In fact, to our surprise, only half an hour later, we had successfully scooped buckets of water from the floor into the shower, soaked up most of the water with bath towels, and swept it out the door. Gracias a Dios that things dry so quickly here! Hector then declared that he was going to reconnect the pipe with glue. I was doubtful and begged him to wait until morning for the pipes to be replaced. I was sure that the water would come gushing into our apartment again. "No queremos agua anoche!" (We don't want water tonight!) I insisted. Again, the irony! Haha. Per the usual, the locals always know more than the gringos- 5 minutes later, Hector turned the water on and, sure enough, the pipes held! I was amazed. "American glue," Hector said pointing at the EZ Cement label. Ha ha! Anyways, it was an exciting welcome to plumbing in Roatan, where flimsy water pipes are left exposed so that silly tourists can snap them off and flood a building in minutes. Again, the idea of me wading through pools of clear water drowning our kitchen, while surrounded by entire neighborhoods without access to a reliable source of running water is ludicrous! How did resources come to be divided SO ridiculously disproportionately?
Flooding problems aside, I have been learning so much about the public hospital here in Coxen Hole, health care on the island and medicine in general! Between the Global Healing pediatric clinic in the public hospital in Coxen Hole and Miss Peggy's private clinic in Sandy Bay, all of the residents and doctors (both volunteers and Hondurian staff) have been so wonderful and eager to teach me. I shadowed the doctors during newborn infant exams in the hospital maternity ward- the infants are so tiny and cute! I have seen dengue, malaria, parasites, rashes of all sorts, scabies, chicken pox, conjunctivitis, TB...tons of cough, cold, congestion, fever. I've listened to breath sounds and looked at chest xrays for kids with pneumonia. I held the light while a doctor scraped heaping spoonfuls of dark brown ear wax out of a patient's ear; afterwards, I got to peer inside the patient's ear to examine the tympanic membrane. Yum! I listened to hearts beating, examined pupils, looked at strep throat, oral herpes. I translated for a teenage girl during her first vaginal exam. I looked at the malaria parasite under a microscope in the hospital lab.
Coxen Hole Public Hospital-
The hospital here has an "x ray machine." The xray tech joked that the machine was a gift from Christopher Columbus because it is an ancient, massive, wrought iron structure that looks like it could be 100 years old! Nonetheless, it does take xrays (albeit without any sort of radiation protection for the techs or in the walls of the room) The hospital also has a lab and a pharmacy, so we can order blood and urine tests, write prescriptions. If the hospital runs out of a particular medicine, the patient is given a prescription to purchase the drug elsewhere on the island. "Prescriptions," by the way, are notes scribbled by the docs on the back of a scrap piece of paper torn into quarters. In any case, I tell you what capabilities the hospital HAS because the list is short.
The hospital is usually very crowded and hot. The clinics have air conditioning, so we stay cool, but the patients wait for hours and hours in the hot, smelly hallways full of sick children with myriads of contagious disease. The patients begin arriving at 7 AM and receive a number from the front desk to mark their place in line. The clinics do not open until at least 8:30 or 9AM. The hospital only sees a certain number of patients each day, so if patients arrive too late and intake has run out of numbers, they are turned away. The clinic that I work in is an additional pediatric clinic within the hospital, funded privately by Global Healing, set up to supplement the public hospital's pediatric facilities. It was founded to address the overcrowding that still persists today! We usually finish clinic by about noon, but that means that the last patients have been waiting for at least 4 hours.
One big advantage of the hospital- The cost for a doctor's visit here including all medicines is 7 - 11 Lempiras or less than 50 cents- very cheap, even for the poor!
A Sad Case-
I held an emaciated, bony infant with floppy skin- in medicine, they call this "failure to thrive." He weighed something like 3kg at 40 days old :( He turned out to actually be a sad and frustrating patient. The docs decided to admit him to the hospital to observe feeding and try formula milk. However, the mother was clearly reluctant to admit the baby, frustrated that she had been kept in the hospital with him 2 weeks ago and was so recently discharged. I heard the next day that the mother and baby had fled the ward just hours after admission. Later, I mulled over our mistakes- it was clear that the mother cared about her baby. And with large families as the norm here in Roatan as in most of the developing world, I wouldn't be surprised if the mother had other children at home to care for. We clearly should have listened more to her concerns and perhaps come up with a compromise- Could we have treated the baby as an outpatient? Could we have given mom formula to take home, observed one feeding in the outpatient clinic and asked her to return? Would she have returned? Sadly, we are now afraid that she will be scared to come back if things get worse. The docs said that if the baby's growth does not turn around within a week, there could be dire consequences for the child. If this were Children's Hospital Boston, I know we would send a brigade from Farley 135 to the patient's house with the best bottles, formula and babysitters in the world. Sadly, though, we are a world away from Boston. For now, we have to hope that she will return when the baby needs our help.
Fun things I have done outside the clinic (because no one likes to end on a sad note)-
I have been volunteering at a nighttime sports program for kids called S.O.L., which was started by two American guys a few years ago. It is SUCH a success! The kids have a shack full of old, donated equipment- baseball mitts, soccer balls, basketballs- and they go nuts! They love soccer and baseball, so you can imagine the fun that I get to have. They are a rag-tag group of kids- half of them have shoes, they fight like you wouldn't believe, and I have yet to see a single parent show up to the court. I made up an ESL lesson and taught English on the side to some of the Spanish-speaking S.O.L. kids one night. I have also been teaching English to a guy who works at the apartment I lived in. Like most Spanish speakers here, he really wants to learn English. He brings a beginners English workbook that he borrowed from a friend, and we spend an hour or two talking in Spanglish during the afternoons. I have also been snorkeling again and can't get enough! It is AMAZING. I saw a HUGE spotted eagle ray, a SEA TURTLE, a porcupine fish, barracuda (scary ones that followed us!), tons of Doris swimming around in huge groups, beautiful coral, conches, and billions of other gorgeous fish and weird sea creatures I cant describe! My local friend took me out on his boat to fish. We didn't catch anything, but we rode right through a whole school of wild dolphins swimming right next to our boat! Incredible. And the view of the island from the water was amazing. I am tan and COVERED in bug bites. The sand flies love foreigners. I'm going to keep telling myself that the bites are from sand flies, but the resident and I joke that we have bed bugs and scabies :-)
