June 1, 2010: Week 2
Prescriptions, Kids, and HIV
Happy june! I can’t believe week 2 in Roatan is already over! Even on island time, time seems to go by so quickly! My days at the clinic last week were really interesting, because only Dra. Sara was here. I would finish up triage and then be able to sit with her during each of her patient consults, which was an awesome shadowing experience. It was cool to see how much of the Spanish I could understand on my own, and Dra would always stop to explain a more confusing medical term, or a complex case. I’ve learned how you can tell when a diarrhea is serious, or if its just a mother with her first baby who is worried about everything- there are so many tricks of the pediatric trade!
We have a new doctor here this week, and she is really cool, but does not speak any Spanish, so I am going to get to do some translating along with my triage-ing. It is definitely a lot of responsibility, but very exciting!
I have come to realize in these two weeks how hard it must be for these mothers to keep up with their prescriptions. For example, yesterday we saw a baby with a terrible ear infection. The medicine for the baby was available in the pharmacy, but the woman brought it back to us because she did not understand the instructions. We found that 1) the bottle was incredibly hard to open 2) she was supposed to mix the powder with water herself (she lived in an area that had no access to clean water) and 3) it was meant to be kept refrigerated for all ten days she had to give it to her baby (she had no electricity, let alone a refrigerator). Thankfully, we were able to mix in some purified water for her at the clinic...but there is no way we can follow up with her every day to make sure the baby is improving. Its really frustrating because we are doing everything we can and the mothers are doing everything they can, but there is no guarantee that the children will get all of their medicine at the appropriate times. I know that for very complex drug regimens, like TB or HIV, lucky patients can sometimes get directly observed treatment, a personal assistant who comes and checks on them every day. While we are only giving out simple treatments/prescriptions, mothers often leave with 2 or 3 (or sometimes 6!), and I wish there was a way to directly observe/help them as well.
Unfortunately, the little boy with the injured foot never returned, and its really sad because the mother did not have a phone, so there is no way to contact him. All we know is the area of the island where they live, but that is not enough to find him. I was hoping/wishing every day that he would show up, but he never did. There are two possible explanations- the mother was frustrated and gave up, or the boy's foot improved with the antibiotics, but I know the latter is just wishful thinking :(
In happier news, I found the Familia Saludables office while wandering around Coxen Hole last week, and I walked in. The women who run it were extremely welcoming, and I will be spending as many hours as I can working over there when I am not at the clinic. Familia Saludable is an HIV/AIDS support organization that runs a variety of programs. They have an infant formula program for about 90 HIV+ mothers, providing free formula to prevent mother-to-child transmission of the virus. They also have a women's support group for HIV+ women that meets once a week. These women work together on various initiatives, such as selling soap and holding a raffle, in order to raise money. I was helping out in their office, which is basically a safe space for anyone who chooses to walk in. Women will come in to get tested, to pick up free condoms, to talk or ask questions, to let their babies play with toys, or just to hang out for a little bit in the air-conditioning.
Working in the office was an awesome and eye-opening experience. Neither of the women who work there speak spanish, and their normal translator is on maternity leave, so as soon as they discovered I could speak spanish, I became their unofficial translator/communicator. Women would come in to get tested, and then end up telling me their life stories. I loved the opportunity to have these longer conversations because it is something that is a bit inappropriate while triage-ing at the clinic, and something that I definitely miss. However, much of what the women were telling me was incredibly depressing and shocking. Sexual abuse, especially child sexual abuse, is a huge issue on this island, as is domestic violence. I am not comfortable giving out the details, but I have realized that the pediatric clinic was only giving me a narrow view of what goes on in Roatan. While I am not positive that my Spanish is good enough to be counseling women about using condoms, I hope I am making sense and being effective!
I am starting my work at the kindergarten this week, and I got a bunch of Miss Peggy's volunteers to help out, so we are reorganizing and repainting the kindergarten and 1st grade classrooms, which will be a lot of fun!
