May 23, 2010: Week 1
Journal #1: Welcome to Island Life!
I arrived in Roatan last Saturday, amazed by the airport landing strip only feet away from the beach. At first, I was a bit worried, because I learned that Miss Peggy is out of the country for the month, and I thought I would not be able to make any connections without her. However, I immediately felt welcomed by the volunteer/NGO community. I met several pre-med and nursing students from Miss Peggy's Clinica Esperanza, and the previous HEAL intern, Kate, invited me over for dinner my first night, so I met many of her friends as well. Everyone was super friendly and told me all about the various projects they are involved in.
After a relaxing Sunday on the gorgeous West Bay Beach, I came to the Roatan Hospital to start work on Monday. The hospital was just as I had pictured it- I spent my fall semester in Costa Rica and visited several public hospitals there. It was very crowded, with at least fifty people waiting in line to get their assigned to a clinic. I found out that most patients line up around 6-7 AM, and that the hospital, or at least the pediatrics ward, stops taking new patients by around 9 AM. The mentality seems to be come early, or its not worth coming at all. Kate took me on a quick tour of the hospital, we picked up the day's expedientes (or patient files), and entered Clinica #10, the Global Healing clinic. Its interesting because I had not realized that Global Healing was completely incorporated into the hospital, and is one of the three pediatric clinics to send patients to.
We immediately jumped into work, and began triage. It was to pick up the basics, like filling out the form and asking the standard questions. After two patients where I shadowed, Kate let me try one on my own. At first, I was a bit too cautious with my Spanish, limiting myself to only very robotic questions. I was also baffled by the stethoscope for a while, and found out I had been putting it on in the wrong direction for most of my life. I learned that a baby's heart beats incredibly fast, and that most babies are not a fan of having a cold hard piece of metal on their chests, and that crying children do not usually want their weight measured.
But overall, its been great- the description of the internship was totally accurate. Once Kate left after two days, I really was "directing' the clinic. I come in every morning and set up, begin triage, and wait for the doctora(s) to come. Last week, we had three doctoras here, so they were taking in patients as fast as I finished triage. This week, it is just me and Dr. Sara Sadrzadeh, so I get to sit in for a lot of the patient consults. I've learned a ton about what diseases are common here in children, such as scabies and impetigo, and how to tell a dangerous diarrhea from just a typical rotavirus. I also had the chance to follow the doctoras as they did rounds, doing chequeos for all of the newborn babies, which was a new and interesting experience, both talking to the new moms and learning about all of the possible things that can go wrong in baby development (there are so many, its incredible how many of us turn out okay!) It was really fun to have the three doctoras around and see their different styles of care, and also just to talk to them about their experiences with medical school. Shadowing Dr. Sara has been very interesting as well, and she always takes time to explain to me what she is thinking, and will discuss the case with me in as much depth as I want after the patient has left.
For the first few days, I was not sure how the payment system worked. All of these mothers and children were leaving our clinic with two to three prescriptions- but how were they paying for the drugs? Then, I learned about the many facets of the honduran insurance system. From my understanding, for employed persons there is a seguro social in which they pay a percentage of their income in order to have access to all seguro hospitals. Unfortunately, there is no exclusive seguro hospital on the island, but the Roatan Hospital is sort of the replacement. As a public hospital, all patients have to pay a small fee to be seen (25 lempiras, I believe), and then everything else is free. The emergency room is completely free as well, and since all of the clinicas close by 1 PM, it is where a lot of patients end up going. The system is far from perfect though, because the budget for the hospital can't cover everything. While the pharmacy has seemed well-stocked so far, I can see it easily running out of things.
The one case that has struck me so far was a little boy who came in on Friday. His foot had been run over by a car several months ago, and he spent six months in a hospital in La Cieba (on the mainland) getting plastic surgery. Unfortunately, the surgery had not been a complete success, and the boy came in to our clinic with an incredibly infected foot. We gave him antibiotics for the infection, but he also needed to get back to La Cieba to get a consult. His mom did not have the money for the ferry, so Dr. Sara filled out a form that would give the mother and son permission to take the ferry for free. This form had to be authorized, but the centro refused, saying the boy should just see the orthopedic surgeon in the Roatan Hospital. This didn't make any sense, since the boy needed to see a plastic surgeon, not an orthopedic one. The woman came back to relay the news, but the doctoras had already left, and I was closing up the clinic. I called Dr. Sara, but in order to get the woman onto the ferry, she had to fill out another form, which had to wait until Monday (the hospital in La Cieba would be closed all weekend). I asked the woman to come back on Monday, but I could see her frustration. While I promised we could help her, she has yet to come back. I know the antibiotics eliminated the emergency situation, and the boy should be somewhat okay, but I really hope she comes back, and I will do my best to follow up with this case. Bureaucracy is so frustrating!
The only thing that has been bothering me so far is how much free time I have! Its a silly complaint, but I guess I've always been a bit of a work-aholic, so the idea of finishing up at the clinic before lunch time feels wrong to me. Finding work to do in the afternoons has proved more difficult than I intended, since Miss Peggy is not here for guidance, and the clinica esperanza already has too many volunteers. Schools are about to start their summer breaks, so they do not really need any help with tutoring or anything. But I am excited to start a project this afternoon where I will be helping a local school redecorate/paint/organize its kindergarten classroom! I am also searching for other opportunities, and found a very cool organization called Familia Saludable that I am trying to contact.
