I am certainly having a lovely time on Roatan so far. Began my diving class yesterday and have done all confined dives and two of the four open waters so far, so I should finish that up this week - I have my own instructor, and it has been a fabulous experience so far.
Things at the clinic continue to be busy but under control. We have been seeing 20-25 patients (usually plus some follow-ups) each day, which means that Charles usually has to hurry towards the end of the day so he can finish in time to get to his other job. Things are running smoothly though.
Eileen left me with some educational posters that she made earlier, and so I had them laminated on colored construction paper this week and they are ready to be used in the clinic. They are about breastfeeding, dental hygiene, and general kids nutrition, and scabies treatement. Basically they are a series of 5-6 notebook page size illustrations with a little bit of writing/information. I think the idea was that the doctors could use them while doing patient consults if they think it would be useful to go over the information - such as, if the kids has scabies, go over the posters for scabies treatment and prevention. All of the posters are in Spanish too. Hopefully they will be a useful educational aid in the clinic.
I also noticed that at least one day a week, the nurses do a little mini class in the hallway, teaching the moms that are waiting about breastfeeding usually. It is a highly amusing demonstration involving many poster-sized pictures of breasts, but the moms really seem to pay attention and like it. The only problem is that they send the kids to another part of the hospital during this time, so we can't see any patients for a while because they are all off playing elsewhere.
There are two people here volunteering at Peggy's for a couple of weeks (a nurse and a pre-med student, both in their mid-20s) who would like to come and see our clinic and possibly help out a bit. I tentatively told them that would be okay with me, but I wanted to run it by you guys too. I don't know that there's really a lot for them to help with at this point, other than that they could possibly do some of the admin stuff for a bit which would free me up to do more surveys. Anyway, I was thinking maybe they could just come by towards the end of the morning and see how things run, I could show them
around a bit, but then they wouldnt' be in the way at all. Let me know what you think.
Progress on my water survey has been a bit slow this week. Monday I dropped off a bunch of copies of the survey to Peggy, because she wanted to have her students administer it in clinic this week. I went through it with her housekeeper, Irma, who also lives in La Colonia, and it seemed like she understood all the questions and everything. However, I stopped by again Tuesday to see how it was going and Rob and Ginger, the two students that were going to do it, had decided that the way it was currently designed they didn't think I would really get truthful and/or meaningful answers from people. They thought people would be too embarassed to say that they don't have soap, etc, don't always have money to buy purified water, etc. So, while they didn't have any other suggestions, the end result is that the survey is not going to be done at Peggy's at all anymore. While I agree with their criticisms completely, I don't really know how to fix the situation and get people to be more comfortable answering things honestly. Rob and Ginger seemed to think that the survey was also generally much too sophisticated for the people in La Colonia - that they wouldn't really understand the questions, and would just look to me for the answers and tell me what they thought I wanted to hear.
All of this said, I have still managed to find out a lot about the water infrastructure on the island, and specifically the water systems in La Colonia. I went to see the new purification system in Polycarpo (one of the three colonias) with Chuck, the water engineer/missionary who owns the hotel where Peggy's clinic is, which was very cool. I feel like I have a much better understanding of the water situation in general, and I have begun to keep notes and write up what I find out when I talk to people. I am hoping that when I have more time in clinic (ha ha, if that ever happens), I will ask some of the basic infrastructure questions from my survey to our patients from other parts of the island, so I at least know the basics of the water systems elsewhere - like Los Fuertes, the different barrios of Coxen Hole, Flowers Bay, Gravel Bay, etc. I think I will try the survey in our clinic and just see how it goes, whether I think people are understanding and answering honestly or not, and then reevaluate whether it is worthwhile to try to do it on a larger scale. Any thoughts you guys have on this would be appreciated as well.
Dr. Leonel arrives one week from today, next Sunday, so he will start in clinic that Monday. Dr. Charles, however, is going to be gone that entire week for his graduation, so it will just be Dr. Leonel and I in the clinic until the following week when Charles returns (and Alissa arrives as well).
We had a very sad case this past week, a follow-up from last week that Dr. Eileen was able to see while she was in clinic on Monday - an 8 month old baby with advanced AIDS and several opportunistic infections. Due to a miscommunication, the mom was told that Eileen wasn't there and so she left, but Eileen later found her at Valerie's clinic. She decided that the only way the baby was going to get the care she needed was to take her to the hospital in Ceiba, so they took the afternoon ferry, got the baby admitted, and Eileen was barely able to make it back to the island on a flight that evening so she could make her early morning flight back to the US the next day. It sounded like the doctors in Ceiba were very helpful and accomodating, and that the baby's mother was willing to take her there monthly for treatment if necessary, as ARV therapy typically isn't available for kids here on the island.
Sunday, July 24, 2005
Monday, July 18, 2005
Katie Journal 1
My first week has been pretty busy, but things are going relatively well in the clinic. Agnieszka was in clinic Monday and Tuesday with me, and then it was just Dr. Charles and I the rest of the week. Since neither of us really knows exactly how things are supposed to work or where anything is, we are sort of learning together. We've had 20-25 patients each day, and with only one doctor, we usually aren't done until 1-2pm. I am doing all the record keeping on the computer, updating and
organizing the charts, calling patients, doing weight/temp measurements, etc, and then helping Charles as necessary.
This is keeping me pretty busy, so I haven't gotten to do many surveys yet - maybe 15-20 total for the week. Perhaps once I am a bit more organized I'll have time to do more, and certainly the last week when Alissa comes that will be more possible with two of us. My Spanish is okay, but definitely still leaves something to be desired - I can do the surveys okay, and direct
the patients to where they need to go and answer basic questions, but I'm sure I'm missing a lot of the nuances of what they're saying sometimes and when they start talking to me really fast I get lost really quickly.
Otherwise, the only problem I've had is trying to keep the patient flow smooth and keep the clinic calm inside, when a lot of the patients want to wait inside or come in every five minutes and ask me how long it will be. Another problem is that follow-up patients (with test results, either from earlier the same day or previous clinic days) come back in and want to be seen right away. Charles usually sees them next (they're usually pretty fast consults, writing a prescription or giving meds and instructions usually), but this tends to make the other patients who have been waiting rather irritated. And then sometimes one of the nurses or another hospital worker will come by and demand that we see a certain patient first (for reasons that are
entirely unclear to me - as far as I understand, it's usually a patient they know personally or a relative or something like that), even when their file is at the end - again, other patients get irritated. But all of this said, I think things are running relatively smoothly given that Charles and I are both new, and I'm sure things will get better as we get used to the system more.
Dr. Eileen is returning tonight and will be here for a day or two before she returns home. We are hoping that she can see a follow-up patient, an 8 month old baby with AIDS, that she treated a while ago in clinic. The baby has a severe oral thrush infection, but the meds that other doctors have given her apparently don't agree with her. Her mother said that Eileen gave her something else that worked previously, so she is coming back to clinic tomorrow to see her.
I have been to Peggy's three times so far. She now has Dr. Raymond working with her, as well as a group of Irish dental students, and several other student helpers. Plus several family members are staying with her, so she has a very full house right now. She has been very helpful with the water survey, and I think I am going to drop the final version off to her tomorrow afternoon. She thought it would be better to at least start by having her student assistants administer the survey at her clinic instead of going up into the Colonia. I feel bad that I can't help with it then since her clinic is also only open in the morning, but I think we'll see how it goes the first few times and then probably have to revise anyway. Also, it looks
like my sister may be able to come out here for a few days so she can help me with the survey as well. I also talked a lot to the owners of the hotel where Peggy's clinic is - they are from CA and just came here four months ago, and the guy is a water treatment engineer. He put in a mixed oxidant chlorination system for the well there at the hotel, and got one donated for the Colonia, so as of two months ago, one third of the Colonia has completely purified water (for drinking, cooking, bathing, everything - at least every three days). So it will be interesting to see if there is a difference in the surveys between the people who now have purified water and those that don't. Peggy thinks that the owner of Anthony's Key, who is
running for Mayor, could also be convince to pay for a purification system for the rest of the Colonia in the near future. Interestingly though, people who are part of the purified system apparently don't like it - they think it smells funny (chlorine) and makes them itch, so they are constantly complaining to the system operator to turn down the chlorine levels - the
hotel owner keeps going up there to turn the chlorine back up to safe levels. In any case, I think it will be really interesting to see what we find with the surveys.
In the clinic surveys, every single person I have asked has said that they drink only purified store-bought water, all the time, and yet a really high percentage of the kids have bacterial or parasitic intestinal infections, so I'm not really sure how to reconcile those two facts. When I have more clinic surveys done and have more time, I will go back and cross-reference
the surveys to the kid's diagnosis in the computer spreadsheet, and then we can see if there's any correlation with survey answers and the types of medical problems they are coming in with. Someone mentioned that in addition to drinking water contamination, the other way that a lot of kids get parasites is by sleeping on the dirt floor - I don't know how true that
is, and I would imagine that applies more to skin parasite, not intestinal ones, but it would be interesting to look at that more too.
Otherwise, things are going really well - the apartment is great and I've got it all stocked for cooking. Agnieszka and Ben introduced me to a lot of good restaurants and fun places in West End, but while I'm here by myself for the next two weeks, I think it makes more sense to just cook for myself as much as possible. After Eileen leaves, I am going to try to clean out
the other apartment a little bit - it is quite a mess, especially the kitchen - filled with gross food, and the fridge desperately needs to be defrosted as the door currently doesn't shut because there's so much ice. Hopefully Eileen and I can also go through all the extra supplies that are over in that apartment and take what is useful to the clinic and get rid of the rest - I get the idea a lot of it is supplies for equipment we don't even have. In the clinic itself, what do you think we should do with the old computer and the printer, both of which are completely non-functional? Arup said he has another computer ready to go, but it's unclear when that is coming, and I don't think we have another printer yet. Any thoughts on whether we should try to get rid of this stuff or just keep it around for a while?
Also, Agnieszka left me with the cell phone that she bought, which works quite well here - the number is 504-368-6590 if anyone needs to get ahold of us at some point. I will just leave it with the next doctor or with Alissa when I leave. It works on a prepaid card systems that you can refill almost anywhere, and incoming calls are free - apparently its about 30 cents/min to call from the US, so Agnieszka was having her parents call on that, it seems to be a little bit better connection than at the clinic, plus it works in West End as well. Also, it is the best way to find Raymond, Charles, Peggy, and others with local phone numbers, who are otherwise difficult to track down. Arup called when we were in clinic on Thurs, and Charles and I talked with him for about an hour - he just wanted to be filled in on everything that was going on, how Charles and I were settling in, etc. It was good to talk to him and get his perspective on how the clinic should be run, what our roles should be, etc.
The computers are both a bit tempermental but generally working fine. I have just been taking the Global Healing laptop back and forth to clinic each day, but using Jenn's laptop for my personal use. I keep saving the patient files on a jump stick because I don't quite trust the computer. Jenn's laptop works fine for email (although internet at Casa Calico has been in and out), but doesn't do much else because the hard drive is completely full and "low disk space" errors come up all the time. So I have been keeping my survey files on the other computer and on my jumpstick just to be safe. But basically, for my purposes, everything is working just fine. Agnieszka and I took a bunch of pictures in clinic last week too, so now that she is back she'll probably send some of those to you guys for the website. I'll take the GH digital camera and take more photos at some point too.
organizing the charts, calling patients, doing weight/temp measurements, etc, and then helping Charles as necessary.
This is keeping me pretty busy, so I haven't gotten to do many surveys yet - maybe 15-20 total for the week. Perhaps once I am a bit more organized I'll have time to do more, and certainly the last week when Alissa comes that will be more possible with two of us. My Spanish is okay, but definitely still leaves something to be desired - I can do the surveys okay, and direct
the patients to where they need to go and answer basic questions, but I'm sure I'm missing a lot of the nuances of what they're saying sometimes and when they start talking to me really fast I get lost really quickly.
Otherwise, the only problem I've had is trying to keep the patient flow smooth and keep the clinic calm inside, when a lot of the patients want to wait inside or come in every five minutes and ask me how long it will be. Another problem is that follow-up patients (with test results, either from earlier the same day or previous clinic days) come back in and want to be seen right away. Charles usually sees them next (they're usually pretty fast consults, writing a prescription or giving meds and instructions usually), but this tends to make the other patients who have been waiting rather irritated. And then sometimes one of the nurses or another hospital worker will come by and demand that we see a certain patient first (for reasons that are
entirely unclear to me - as far as I understand, it's usually a patient they know personally or a relative or something like that), even when their file is at the end - again, other patients get irritated. But all of this said, I think things are running relatively smoothly given that Charles and I are both new, and I'm sure things will get better as we get used to the system more.
Dr. Eileen is returning tonight and will be here for a day or two before she returns home. We are hoping that she can see a follow-up patient, an 8 month old baby with AIDS, that she treated a while ago in clinic. The baby has a severe oral thrush infection, but the meds that other doctors have given her apparently don't agree with her. Her mother said that Eileen gave her something else that worked previously, so she is coming back to clinic tomorrow to see her.
I have been to Peggy's three times so far. She now has Dr. Raymond working with her, as well as a group of Irish dental students, and several other student helpers. Plus several family members are staying with her, so she has a very full house right now. She has been very helpful with the water survey, and I think I am going to drop the final version off to her tomorrow afternoon. She thought it would be better to at least start by having her student assistants administer the survey at her clinic instead of going up into the Colonia. I feel bad that I can't help with it then since her clinic is also only open in the morning, but I think we'll see how it goes the first few times and then probably have to revise anyway. Also, it looks
like my sister may be able to come out here for a few days so she can help me with the survey as well. I also talked a lot to the owners of the hotel where Peggy's clinic is - they are from CA and just came here four months ago, and the guy is a water treatment engineer. He put in a mixed oxidant chlorination system for the well there at the hotel, and got one donated for the Colonia, so as of two months ago, one third of the Colonia has completely purified water (for drinking, cooking, bathing, everything - at least every three days). So it will be interesting to see if there is a difference in the surveys between the people who now have purified water and those that don't. Peggy thinks that the owner of Anthony's Key, who is
running for Mayor, could also be convince to pay for a purification system for the rest of the Colonia in the near future. Interestingly though, people who are part of the purified system apparently don't like it - they think it smells funny (chlorine) and makes them itch, so they are constantly complaining to the system operator to turn down the chlorine levels - the
hotel owner keeps going up there to turn the chlorine back up to safe levels. In any case, I think it will be really interesting to see what we find with the surveys.
In the clinic surveys, every single person I have asked has said that they drink only purified store-bought water, all the time, and yet a really high percentage of the kids have bacterial or parasitic intestinal infections, so I'm not really sure how to reconcile those two facts. When I have more clinic surveys done and have more time, I will go back and cross-reference
the surveys to the kid's diagnosis in the computer spreadsheet, and then we can see if there's any correlation with survey answers and the types of medical problems they are coming in with. Someone mentioned that in addition to drinking water contamination, the other way that a lot of kids get parasites is by sleeping on the dirt floor - I don't know how true that
is, and I would imagine that applies more to skin parasite, not intestinal ones, but it would be interesting to look at that more too.
Otherwise, things are going really well - the apartment is great and I've got it all stocked for cooking. Agnieszka and Ben introduced me to a lot of good restaurants and fun places in West End, but while I'm here by myself for the next two weeks, I think it makes more sense to just cook for myself as much as possible. After Eileen leaves, I am going to try to clean out
the other apartment a little bit - it is quite a mess, especially the kitchen - filled with gross food, and the fridge desperately needs to be defrosted as the door currently doesn't shut because there's so much ice. Hopefully Eileen and I can also go through all the extra supplies that are over in that apartment and take what is useful to the clinic and get rid of the rest - I get the idea a lot of it is supplies for equipment we don't even have. In the clinic itself, what do you think we should do with the old computer and the printer, both of which are completely non-functional? Arup said he has another computer ready to go, but it's unclear when that is coming, and I don't think we have another printer yet. Any thoughts on whether we should try to get rid of this stuff or just keep it around for a while?
Also, Agnieszka left me with the cell phone that she bought, which works quite well here - the number is 504-368-6590 if anyone needs to get ahold of us at some point. I will just leave it with the next doctor or with Alissa when I leave. It works on a prepaid card systems that you can refill almost anywhere, and incoming calls are free - apparently its about 30 cents/min to call from the US, so Agnieszka was having her parents call on that, it seems to be a little bit better connection than at the clinic, plus it works in West End as well. Also, it is the best way to find Raymond, Charles, Peggy, and others with local phone numbers, who are otherwise difficult to track down. Arup called when we were in clinic on Thurs, and Charles and I talked with him for about an hour - he just wanted to be filled in on everything that was going on, how Charles and I were settling in, etc. It was good to talk to him and get his perspective on how the clinic should be run, what our roles should be, etc.
The computers are both a bit tempermental but generally working fine. I have just been taking the Global Healing laptop back and forth to clinic each day, but using Jenn's laptop for my personal use. I keep saving the patient files on a jump stick because I don't quite trust the computer. Jenn's laptop works fine for email (although internet at Casa Calico has been in and out), but doesn't do much else because the hard drive is completely full and "low disk space" errors come up all the time. So I have been keeping my survey files on the other computer and on my jumpstick just to be safe. But basically, for my purposes, everything is working just fine. Agnieszka and I took a bunch of pictures in clinic last week too, so now that she is back she'll probably send some of those to you guys for the website. I'll take the GH digital camera and take more photos at some point too.
Sunday, July 03, 2005
Agnieszka
Where do I begin? My experience in Roatan has been amazing, although much different from what I imagined. The people are incredibly kind and giving and I only wish I could do more for them. Unfortunately, due to my lack of knowing Spanish and because I am frantically trying to finish my medical school application, I cannot contribute as much to the clinic as I would have liked.
The clinic is in a slight state of turmoil. When I got here there were two residents (Mollie and Isabelle), one attending (Eileen) and the Honduran fellow (Raymond), but things have dramatically changed. The residents left last week and Eileen left today. Raymond’s last day is Thursday, but only because they convinced him to stay a few days longer (his official last day was June 30th). He will be working at Miss Peggy’s clinic in the future, but is going to San Francisco July 18th-24th. Global Healing hired Charles as the new Honduran fellow, and he is supposed to start Monday- but Eileen was skeptical of this. I met Charles when he was interviewing and he seems like a nice enough guy. He is from the island but has never worked in the hospital. I think our main role in the clinic will be to help Charles and to keep things under control. With only one physician and one that has never worked there, things will be a little chaotic (they have no one coming from the states during July and August). To help I have been basically triaging patients. I call them in, take their temperature (and if they have a fever give them ibuprofen), weigh them, measure them, mark their growth chart, and enter all of their information into the database. Then when the physician is ready, I bring them in. I also have been getting supplies for the doctors. I tried administering the surveys, but without knowing Spanish this was impossible. I tried doing a few in English, but found that it was slowing things down and it was better that I focus on triaging patients and improving the patient flow.
As far as patient follow up, I have not done any. I am not sure which patients to focus on and have not heard of any specialists coming to the island. Raymond and Eileen said they went through our follow-up list and said no one was critical and most of the patients have not expressed interest in following through on their own care (they didn’t show up to the ferry, didn’t come back when they were supposed to etc.). I added a few new cases to the follow up list: two are children that need to have an audiologist review them and one is a girl that has epilepsy like symptoms. Unfortunately, they all speak Spanish and I don’t think I can help them much.
There have been a few very interesting cases on the island that have worried the doctors. A baby was born to some missionaries with a severe cleft palette and conjoined extremities (EEC or ECC syndrome). Eileen went to La Ceiba with the family and we are trying to help them find specialists in the states that can help them (but without insurance this may be tough). Also, we had a scare because one of the other missionaries that was pregnant was past due and refused to come to the hospital to deliver the baby- actually she wanted to have an underwater birth in a tub in her shack. The doctors thought that her water had been broken for over 36 hrs and were freaking out- They spent all night at her house waiting for the baby. In the end everything worked out well, the water broke for real (the first time was a false alarm) and the baby was delivered in an hour.
I’ve also learned a little about how the pediatric ward functions and I am a little appalled. Although I haven’t gone on rounds, I have peaked my head in there a few times. I can’t believe who they keep in there and who they send home. They have kids that are basically ok- with a little cellulites that they’ll keep for days, but then they’ll have really sick kids that they’ll try to send home right away. We had a little 7 month old baby presumably with AIDS in the ward, that had terrible thrush and PCP among other things and the doctors sent her home really quickly. Eileen was really upset about this and sent the mom to Valerie’s clinic and has been checking on the baby. She is now doing really well, but I have learned a lot about the politics at the hospital and am disappointed. This baby should have never had AIDS, but the mom was not detected in time. She had tried to get an HIV test done when she was pregnant but could never find the person that was suppose to give her the consultation. She didn’t find out she had HIV until 2 weeks before the baby was born, when it was too late to take AZT effectively.
Eileen has been looking into improving the screening and treatment process for people with AIDS on the island and I think it would be great if we could help with this. Apparently, no one is really responsible for the moms with AIDS and because the way they are stereotyped and treated moms don’t want to get tested. Apparently they are opening a new clinic up in October specifically for this purpose, but we’ll see if it actually happens.
I went to La Ceiba last weekend with Eileen and met this really interesting man named Pepe. He is supposedly the first Honduran conservationist. I think he works for the US consulate now on watershed stuff. He knows a lot about water law and situations and is willing to work with us on this in Roatan. He is a really kind and generous person, he took us kayaking at his river house and gave us a tour of La Ceiba. I recommend we keep in touch with this guy- especially if people have environmentally focused projects.
Other than that we have been painting, sorting supplies, and cleaning the clinic. It looks really nice now. Unfortunately the printer is very broken- we need to get a new one. It won’t even print a single page. As for the computer situation the computer and internet in clinic are working great, and Ben was able to get Jenn’s computer to work. Unfortunately the internet at Casa Calico is broken, so we can’t guarantee that it can connect to the internet (although who knows when they’ll fix the internet). Let me know if you have questions about anything.
The clinic is in a slight state of turmoil. When I got here there were two residents (Mollie and Isabelle), one attending (Eileen) and the Honduran fellow (Raymond), but things have dramatically changed. The residents left last week and Eileen left today. Raymond’s last day is Thursday, but only because they convinced him to stay a few days longer (his official last day was June 30th). He will be working at Miss Peggy’s clinic in the future, but is going to San Francisco July 18th-24th. Global Healing hired Charles as the new Honduran fellow, and he is supposed to start Monday- but Eileen was skeptical of this. I met Charles when he was interviewing and he seems like a nice enough guy. He is from the island but has never worked in the hospital. I think our main role in the clinic will be to help Charles and to keep things under control. With only one physician and one that has never worked there, things will be a little chaotic (they have no one coming from the states during July and August). To help I have been basically triaging patients. I call them in, take their temperature (and if they have a fever give them ibuprofen), weigh them, measure them, mark their growth chart, and enter all of their information into the database. Then when the physician is ready, I bring them in. I also have been getting supplies for the doctors. I tried administering the surveys, but without knowing Spanish this was impossible. I tried doing a few in English, but found that it was slowing things down and it was better that I focus on triaging patients and improving the patient flow.
As far as patient follow up, I have not done any. I am not sure which patients to focus on and have not heard of any specialists coming to the island. Raymond and Eileen said they went through our follow-up list and said no one was critical and most of the patients have not expressed interest in following through on their own care (they didn’t show up to the ferry, didn’t come back when they were supposed to etc.). I added a few new cases to the follow up list: two are children that need to have an audiologist review them and one is a girl that has epilepsy like symptoms. Unfortunately, they all speak Spanish and I don’t think I can help them much.
There have been a few very interesting cases on the island that have worried the doctors. A baby was born to some missionaries with a severe cleft palette and conjoined extremities (EEC or ECC syndrome). Eileen went to La Ceiba with the family and we are trying to help them find specialists in the states that can help them (but without insurance this may be tough). Also, we had a scare because one of the other missionaries that was pregnant was past due and refused to come to the hospital to deliver the baby- actually she wanted to have an underwater birth in a tub in her shack. The doctors thought that her water had been broken for over 36 hrs and were freaking out- They spent all night at her house waiting for the baby. In the end everything worked out well, the water broke for real (the first time was a false alarm) and the baby was delivered in an hour.
I’ve also learned a little about how the pediatric ward functions and I am a little appalled. Although I haven’t gone on rounds, I have peaked my head in there a few times. I can’t believe who they keep in there and who they send home. They have kids that are basically ok- with a little cellulites that they’ll keep for days, but then they’ll have really sick kids that they’ll try to send home right away. We had a little 7 month old baby presumably with AIDS in the ward, that had terrible thrush and PCP among other things and the doctors sent her home really quickly. Eileen was really upset about this and sent the mom to Valerie’s clinic and has been checking on the baby. She is now doing really well, but I have learned a lot about the politics at the hospital and am disappointed. This baby should have never had AIDS, but the mom was not detected in time. She had tried to get an HIV test done when she was pregnant but could never find the person that was suppose to give her the consultation. She didn’t find out she had HIV until 2 weeks before the baby was born, when it was too late to take AZT effectively.
Eileen has been looking into improving the screening and treatment process for people with AIDS on the island and I think it would be great if we could help with this. Apparently, no one is really responsible for the moms with AIDS and because the way they are stereotyped and treated moms don’t want to get tested. Apparently they are opening a new clinic up in October specifically for this purpose, but we’ll see if it actually happens.
I went to La Ceiba last weekend with Eileen and met this really interesting man named Pepe. He is supposedly the first Honduran conservationist. I think he works for the US consulate now on watershed stuff. He knows a lot about water law and situations and is willing to work with us on this in Roatan. He is a really kind and generous person, he took us kayaking at his river house and gave us a tour of La Ceiba. I recommend we keep in touch with this guy- especially if people have environmentally focused projects.
Other than that we have been painting, sorting supplies, and cleaning the clinic. It looks really nice now. Unfortunately the printer is very broken- we need to get a new one. It won’t even print a single page. As for the computer situation the computer and internet in clinic are working great, and Ben was able to get Jenn’s computer to work. Unfortunately the internet at Casa Calico is broken, so we can’t guarantee that it can connect to the internet (although who knows when they’ll fix the internet). Let me know if you have questions about anything.
Tuesday, June 14, 2005
Natalie Chavez Journal 3
Having Dr. Eileen, Dr. Molly, and Dr. Isabelle in the clinic this week made things much easier for everyone. There was barely enough room for each of them, including Dr. Raymond, to create there own private space to see clinics. I figured that since I was mostly taking medical histories, chief complaint, and administering survey I could just set up my own little space outside the clinic where I could have one-on-one conversations with the patients waiting to be seen. Before I used to just stand the whole time I was asking the survey questions and writing down chief complaints. After using the chairs to actually sit down with each patient, I realized that the conversations were more personal and in-depth than before we used them. This helped the patient sit down, relax, and confide in you. It was nice. I just had to keep a close eye on the chairs to make sure they did not disappear to another part of the building, since we already had a shortage of chairs. Dr. Eileen loved the idea of using the surveys to determine the nutrition of the children, their families, and figure out ways of educating them on better health in case the patient was dropping below normal growth levels. The doctors would always like to see a patient who had already taken the survey, so that they could look up their eating habits when checking their weight and growth levels. I felt like I had a really important role because the surveys were a great help for the doctors in order for them to offer good health advice to the patients and their parents. I felt like a true member of a team.
This week I saw my first bronchiolitis case, which was a 9 month old boy. He was breathing so heavily and rapidly, that I could see the skin under his ribcage cave in way under it. The baby’s brochioles were inflamed, so it was really hard for him to breathe and it was also very difficult for the doctors to do anything because the airways were too small for any muscle relaxing medication. The doctors would just have to continue giving the baby oxygen through a nebulizer and wait for the mucous build-up and all the gunk in his lungs to break apart and get out of his system. I was afraid for the boy, since I could not even breathe that fast for days at a time. I was afraid that his heart would give out pumping so much blood into his system, since his heart rate was way above normal. He was such a trooper, looking into his mothers eyes with such control and calmness as his body moved uncontrollably. That baby was of strong blood. Dr. Molly explained to the patient’s mom how she should sit the baby up and gently pat the baby’s back every half-hour to help with the mucous break-up. The baby is doing much better now that he has a runny nose and is getting rid off all the mucous he had in his system. The nasal pumps were a great help then. However before the baby started getting better the doctors had to deal with a splitting dilemma. The baby had to be under hourly supervision after clinic hours since the nurses were not very attentive to each individual patient, but instead the overall order of things and there was only physician in the hospital during the evening/night shifts. So it was either that the doctors take turns in coming in to watch over the patient during the height of his sickness or they set their boundaries and go on home. In the end the doctors did end up staying longer to watch over the boy and make sure he was getting the proper oxygen levels, but after most of the evening they decided that this was the limit of the care they could give to that particular patient. They decided to check back with him in the morning after they agreed that he was in a more stable condition and was well enough to be on his own until the next day.
I am proud to say that I have surveyed at least 120 patients throughout my stay here in Roatan. All of the information on the excel spreadsheet will go towards finding the target foods needed for patients to have a well-balanced diet, pinpoint problems, and overall helping the patients take better care of themselves. Many patients have been very curious and have asked what the survey was used for and I would say that they were a great way for us (pediatrics clinic officials) to know more about our patients, their nutritional lifestyle, their language, and location in case we decided to develop a class that would benefit them. This was all going to be used in a way to ultimately benefit the patients. They would look with me with approving eyes, in a way like they could not believe that we were going through all of this paperwork in order to help them. After taking the survey some of the patient’s mothers would say ‘thank you’ to me instead of the other way around. I feel that I should do as many as I can because I while I am here I should use my Spanish skills to reach out to as many people as I can before I have to take my skills back to California. I am glad to see that the patients are glad that I am here. When I start speaking Spanish most of the only-Spanish speaking mothers blow a sigh of relief like I have just saved them the struggle of using signals or straining their sketchy English. But most of them also look at me slightly confused because they say I look like I am half Asian, white, or even Spanish. After conversing with them in Spanish they try to persuade themselves that yes, I am Mexican. It’s surprising to me how among Americans I they can easily point me out as Hispanic/Mexican, but among my own Hispanic community I look like another ethnicity. That was interesting for me, especially since the taxi drivers got a kick out of it.
Last Friday we painted the medicine cabinets in the clinic and did some spring cleaning. I created a gorgeous plaque to hang up on the wall of the clinic that read ‘Nuestra Clinica Es Su Clinica’, which kind of spun off from the whole ‘Mi casa es su casa” saying. It was a beautiful plaque, which had a light blue background, with dark pink writing and colorful hummingbirds on each side. It seemed to match with the baby blue cabinets that were freshly painted. I am not sure where we are putting it, but I am sure the patients will love it.
I had a date with the dolphins this week and it was the best snorkeling experience I ever had in my life. I would sometimes feel like I was trespassing onto their territory because they about 7 dolphins would huddle all around me making me feel like a speck in the sand, but then they would play with me and let me touch them. They are magical creatures and it’s mesmerizing to hear the sounds they make underwater. I would feel them torpedo past me as they chased on another around the ocean. They’d scare me every time they snuck next to me trying to take a peak at me, but after my sudden startle I would reach out my hand and pet their soft, humongous bodies. It was truly the experience of a lifetime.
I volunteered at Peggy’s clinic on Friday morning as well and it was unexpectedly busy. Many moms were waiting in line since 6 AM waiting to be seen. I helped translate, dispense meds, pull charts, glucose screening, and talk with most of the women about their health, their social lives, and politics of the island. They are strong-minded women. We spoke about the powerful families that control all of Roatan, Indios being the bottom of the social ladder in Roatan, the differences between the school systems in Roatan in comparison to the ones in La Ceiba, and marital problems, like this woman who ran away from her husband after years of abuse. I met a medical student named Richard who was there from Arkansas for a day to help out. He was a business major as an undergraduate and he assured me that although medical school is very hectic and overwhelming, it was constructed to help you learn and succeed, so eventually all that information will sink in. I can’t get over all of the nice people I have met here. I am unsure as to what makes the culture here so rich and the natives so kind to visitors. It’s not only the natives here that are welcoming, but other visitors coming to the island seem to have a friendly factor that ties them all together. It is very different from the often impersonal ways of people back home. Of course, there are amazing people back in California that I would not trade for the world, but here in Roatan the strengths of human nature seem to magnify.
Unfortunately I have not been able to work on all of the follow up patients as attentively as I had wanted to when I arrived. The group of opthomologists were supposed to come to Roatan today, but Dr. Raymond was unsure of the exact location of where they were going to be because the group had said that they would stop by the Sandy Bay area if they had extra time. ‘Extra time’ were the key words. Also, it was difficult to focus on follow ups when I was focused on survey data entry and analysis, nutritional research, preparing my nutritional class, and trying to settle into my environment all at once. I think this was my weakest point of my role here in Roatan. But my ultimate goal was to understand, appreciate, and help the natives of Roatan and so far I think I have progressed significantly. I loved the experience.
This week I saw my first bronchiolitis case, which was a 9 month old boy. He was breathing so heavily and rapidly, that I could see the skin under his ribcage cave in way under it. The baby’s brochioles were inflamed, so it was really hard for him to breathe and it was also very difficult for the doctors to do anything because the airways were too small for any muscle relaxing medication. The doctors would just have to continue giving the baby oxygen through a nebulizer and wait for the mucous build-up and all the gunk in his lungs to break apart and get out of his system. I was afraid for the boy, since I could not even breathe that fast for days at a time. I was afraid that his heart would give out pumping so much blood into his system, since his heart rate was way above normal. He was such a trooper, looking into his mothers eyes with such control and calmness as his body moved uncontrollably. That baby was of strong blood. Dr. Molly explained to the patient’s mom how she should sit the baby up and gently pat the baby’s back every half-hour to help with the mucous break-up. The baby is doing much better now that he has a runny nose and is getting rid off all the mucous he had in his system. The nasal pumps were a great help then. However before the baby started getting better the doctors had to deal with a splitting dilemma. The baby had to be under hourly supervision after clinic hours since the nurses were not very attentive to each individual patient, but instead the overall order of things and there was only physician in the hospital during the evening/night shifts. So it was either that the doctors take turns in coming in to watch over the patient during the height of his sickness or they set their boundaries and go on home. In the end the doctors did end up staying longer to watch over the boy and make sure he was getting the proper oxygen levels, but after most of the evening they decided that this was the limit of the care they could give to that particular patient. They decided to check back with him in the morning after they agreed that he was in a more stable condition and was well enough to be on his own until the next day.
I am proud to say that I have surveyed at least 120 patients throughout my stay here in Roatan. All of the information on the excel spreadsheet will go towards finding the target foods needed for patients to have a well-balanced diet, pinpoint problems, and overall helping the patients take better care of themselves. Many patients have been very curious and have asked what the survey was used for and I would say that they were a great way for us (pediatrics clinic officials) to know more about our patients, their nutritional lifestyle, their language, and location in case we decided to develop a class that would benefit them. This was all going to be used in a way to ultimately benefit the patients. They would look with me with approving eyes, in a way like they could not believe that we were going through all of this paperwork in order to help them. After taking the survey some of the patient’s mothers would say ‘thank you’ to me instead of the other way around. I feel that I should do as many as I can because I while I am here I should use my Spanish skills to reach out to as many people as I can before I have to take my skills back to California. I am glad to see that the patients are glad that I am here. When I start speaking Spanish most of the only-Spanish speaking mothers blow a sigh of relief like I have just saved them the struggle of using signals or straining their sketchy English. But most of them also look at me slightly confused because they say I look like I am half Asian, white, or even Spanish. After conversing with them in Spanish they try to persuade themselves that yes, I am Mexican. It’s surprising to me how among Americans I they can easily point me out as Hispanic/Mexican, but among my own Hispanic community I look like another ethnicity. That was interesting for me, especially since the taxi drivers got a kick out of it.
Last Friday we painted the medicine cabinets in the clinic and did some spring cleaning. I created a gorgeous plaque to hang up on the wall of the clinic that read ‘Nuestra Clinica Es Su Clinica’, which kind of spun off from the whole ‘Mi casa es su casa” saying. It was a beautiful plaque, which had a light blue background, with dark pink writing and colorful hummingbirds on each side. It seemed to match with the baby blue cabinets that were freshly painted. I am not sure where we are putting it, but I am sure the patients will love it.
I had a date with the dolphins this week and it was the best snorkeling experience I ever had in my life. I would sometimes feel like I was trespassing onto their territory because they about 7 dolphins would huddle all around me making me feel like a speck in the sand, but then they would play with me and let me touch them. They are magical creatures and it’s mesmerizing to hear the sounds they make underwater. I would feel them torpedo past me as they chased on another around the ocean. They’d scare me every time they snuck next to me trying to take a peak at me, but after my sudden startle I would reach out my hand and pet their soft, humongous bodies. It was truly the experience of a lifetime.
I volunteered at Peggy’s clinic on Friday morning as well and it was unexpectedly busy. Many moms were waiting in line since 6 AM waiting to be seen. I helped translate, dispense meds, pull charts, glucose screening, and talk with most of the women about their health, their social lives, and politics of the island. They are strong-minded women. We spoke about the powerful families that control all of Roatan, Indios being the bottom of the social ladder in Roatan, the differences between the school systems in Roatan in comparison to the ones in La Ceiba, and marital problems, like this woman who ran away from her husband after years of abuse. I met a medical student named Richard who was there from Arkansas for a day to help out. He was a business major as an undergraduate and he assured me that although medical school is very hectic and overwhelming, it was constructed to help you learn and succeed, so eventually all that information will sink in. I can’t get over all of the nice people I have met here. I am unsure as to what makes the culture here so rich and the natives so kind to visitors. It’s not only the natives here that are welcoming, but other visitors coming to the island seem to have a friendly factor that ties them all together. It is very different from the often impersonal ways of people back home. Of course, there are amazing people back in California that I would not trade for the world, but here in Roatan the strengths of human nature seem to magnify.
Unfortunately I have not been able to work on all of the follow up patients as attentively as I had wanted to when I arrived. The group of opthomologists were supposed to come to Roatan today, but Dr. Raymond was unsure of the exact location of where they were going to be because the group had said that they would stop by the Sandy Bay area if they had extra time. ‘Extra time’ were the key words. Also, it was difficult to focus on follow ups when I was focused on survey data entry and analysis, nutritional research, preparing my nutritional class, and trying to settle into my environment all at once. I think this was my weakest point of my role here in Roatan. But my ultimate goal was to understand, appreciate, and help the natives of Roatan and so far I think I have progressed significantly. I loved the experience.
Sunday, June 05, 2005
Natalie Chavez Journal 2
I am finally getting used to all of the heat, although I am still getting those really small painless boils all over my tan. Dr. Raymond says that it is a post-reaction to something in the seawater, which makes sense because the skin reaction only started after coming back from a day in West Bay. The skin reaction is only temporary, so I am not too worried. I am fascinated by the different changes and reactions my body has undergone since arriving in Roatan. Other than the skin reaction I think my body is finally started to acclimate itself to its new surroundings.
Monday was a very intense day at clinic, since it was the busiest day of the week and Dr. Raymond and I were the only ones working in clinic. I think we saw about thirty to thirty-five patients that day. We finished like at 1:40pm and Dr. Raymond had to be in clinic at 2:00pm, so we quickly closed up and had a couple of balleadas for lunch. They are so delicious. I have bean and cheese burritos at home sometimes, but they taste nothing like the ones here. The cheese has more flavor here and I think they use red beans instead of pinto. The rest of the week was a steady 20 patients/day. After that Monday in clinic, I felt like I was ready for any other day of the week.
I met a 6 year old patient named Stanley who was born with a disease that causes the tendons in his wrist joints, elbow joints, and ankle joints to cringe up. Stanley has had about 3 surgeries performed already, but needs about 6 more in order to extend all of his limbs. He is constantly traveling to San Pedro Sula for physical therapy as well. Mom says that he has been improving dramatically over the past few months. She showed me pictures of how he looked before the surgery and post-surgery. She says that she is running out of money to pay for all of the surgeries and therapies, so I decided to add her into our Sign-Out sheet to see if we could offer her some financial assistance. She explained to me how difficult it is for her to have a child who is 6 years old and unable to walk yet. Her child can speak and is very intelligent, but she is afraid of the social repercussions he may face as he gets older. I had a nice day with Stanley in the clinic and after a half hour he felt so comfortable with me that he gave me a hug before he left. I was touched by his warmth and strength for his young age. Would it be fine for me to look for financial assistance for this patient for the long run? First priority of course would be for patient’s needing surgical procedures of the heart and eyes. What do you think?
We admitted two patients this week. One patient was about 9 years old who would vomit every hour. Dr. Raymond said that she had was severely dehydrated, had diarrhea and could not keep anything down (I forgot the medical term for that). They took her in to the pediatrics ward and were going to try to give her an I.V. in order to hydrate her body. The other patient that was admitted was a 7 month old little girl who had bumps on her head. When I first spoke to the mother to find out the chief complaint, she had said that it had started off as a rash and just bubbled up after a couple days. I assumed that it was just a superficial infection, but it actually ended up being more serious than that. Dr. Raymond said that the patient most likely had a couple infected cuts on the head that swelled up with pus. One of the pus-filled abscesses was right behind her ear and Dr. Raymond feared that the pus might travel into her ear and in her brain, causing meningitis. I never thought that infected wounds on the head could lead to meningitis. It would be so sad to see such a small baby end up with meningitis. Dr. Raymond wanted to show me the draining procedure he was going to perform on the patient, so I went into the pediatrics ward in an undercover mode, so that Dr. Jackie would not find out. It was a funny feeling to be doing that at my age, but Dr. Raymond really wanted me to see. He was going to drain one abscess at a time, so he decided to do the less complicated one today and the one near the ear tomorrow. He wanted to hold off because the abscess near the ear was still hard, meaning that the puss was not formed yet, so he wouldn’t really be able to drain anything. He made a cross incision on the baby’s occipital abscess and drained three large tissues full of blood and fluid. The baby was screeching and crying, while the mother tried hard to hold her baby down so that Dr. Raymond could collect the fluid and disinfect the cut. Dr. Raymond says that the reason why he did a cross and not just a single slit was that a cross would allow the wound to keep draining over the next few hours because it takes longer for a cross incision to close than a single slit incision. A few days later I saw the patient’s mom outside of the ER she came up to me to say hello and that her daughter had just had the second abscess drained out. I was glad to hear the good news and the mom seemed very grateful for the medical attention we gave her daughter. It was nice of her to share with me the progress of her daughter’s health and show gratitude towards me, although I had nothing to do with the procedure that helped her daughter get better, but maybe she did this because I spent the time talking to her on the first day when I asked for the chief complaint. It really makes a difference to the patient’s parents when I sit down and converse with them about their child’s health in general. That same day I saw a patient’s mom cleaning up her baby’s throw up while the baby was on his back and I told the mother to lay the baby on his side, so that if he throws up again he won’t choke on his vomit. The mom looked at me with open eyes, like she couldn’t believe that her baby could choke by being in that position. It was a good feeling to notice a potential health hazard and intervene by educating the parent. Education saves lives and it’s hard to see that many people lack a basic health education. It’s a challenge to try to talk to everyone about their health, but it’s a great feeling to know that I have at least taught someone an important lesson or technique in how to take better care of themselves.
I did about 60 surveys this week in clinic. I learned a lot about the population here in Roatan. Most of the patient’s diet consists of flour tortillas, beans, fried chicken, and rice. They eat a lot starchy food, but little or no vegetables or fruit. Grapes and apples are the most expensive produce in the patient’s communities. Most patients that are Indio/Caribbean don’t speak another language besides Spanish. Some patients feed their babies after the age of 15 months. I spoke to Dr. Eileen about this when she arrived on Saturday and she said that as long as the mother has strictly been feeding her baby with breast milk for the first 6 months of life, it’s okay to be feeding them breast-milk until about two years old, but that after the baby turns 6 months mom should start feeding baby formula, along with other nutritious food in order to increase their iron intake. I was really surprised to see 14 month old babies, with a full set of teeth, still drinking breast milk. In California, babies are usually weaned off breast milk before the age of 1 year, so I was really surprised to see these larger kids still lying on mommy’s lap. Being here in Roatan has definitely opened my eyes to different traditions and ways of thinking.
I know it is sad, but I just realized that I have heard of 5 deaths during my time here. The first death was of the premature baby that died in the Roatan Hospital. Last Friday two adults drowned in a septic tank down the street from the Roatan Hospital in Coxen Hole, after attempting to save a life a child that fell in. A firefighter of the area almost drowned himself while trying to save the lives of the drowning adults. Then last night there was a shoot out in Sandy Bay between a local Honduran and tourist police officers. I happened at around 10pm in an area where the police officers had put up a blockade for random checks, like they do occasionally. I heard that the Honduran (who owned a hotel in Sandy Bay) was driving by the blockade unwilling to stop and so the police officers shot at his car when they saw that he was not stopping. The man was pissed off that they shot at his car and later returned to the scene of the police shooting and shot the police officer dead, so then another neighboring police officer shot the Honduran several times and killed him. The dead police officer had part of his skull blown off with his brain on the streets and the Honduran was left at the scene of the crime until the next morning, when a pickup truck came to take him to the ER in Coxen Hole to do an autopsy for governmental records. I was going to take a taxi to French Harbor that morning when I heard about the incident, so I decided to walk up to the scene of the crime before catching a taxi, and just as I was walking up the path down came the pick up truck with two police officers on both sides of the dead body. The Honduran body had his hands lifted up and cringed inward. I had never seen a dead body so close in my life. It was frightening and upsetting. It could all have been avoided if the police officer would just have let the car go and not have shot at it. By letting the Honduran ride off would not have cost him a thing. It was all very unnecessary. From talking to the local I got the sense that the police officers have not interpersonal skills because they don’t talk to the Roatan citizens with respect and that everything is in military mode. They act more like they are at war with the citizens because of their defensive nature instead of protecting the public like most cops in the U.S. do. My fear here has always been of something tragic happening outside of West End and me not having anyone to turn to for help because most of the police here are corrupt. Of course it is not true of all cops, but it does not help to constantly hear bad stories about the police from the locals themselves. It reminds me of my first week here when I saw an injured man making a documentary of himself to release to the government and general public to show how the police abuse of their own people. This man was mistaken for a robber and was stabbed multiple times by the police, causing him to go to the emergency room to repair his internal organs and get stitched up. When I looked at the man I noticed that his stitches were only a couple days old, so I wasn’t exactly feeling the most secure. I know that I must always think smart and not put myself in stupid situations where I set myself up for a potential disaster, so I feel fine about my current situation.
Overall this week was full of eye-openers.
Raymond showed me his adult clinic this week and it was one of the nicest clinics I have seen here in Roatan. The walls are a brightly colored baby-blue color, with nice tile floors, and a glass case filled with medications and other tools. I have also had the opportunity to know Francisco Reyes, the Honduran resident, very well. I realize that although these doctors are very committed to their practice, they always make time to just go out, relax, and just be human. They create such a nice balance for themselves. I learn a lot from their practice and their lifestyles. It’s really nice to get to know different physicians, their different practices, and techniques, and just pick and choose what things I would like to incorporate into my own life and practice. ☺
Monday was a very intense day at clinic, since it was the busiest day of the week and Dr. Raymond and I were the only ones working in clinic. I think we saw about thirty to thirty-five patients that day. We finished like at 1:40pm and Dr. Raymond had to be in clinic at 2:00pm, so we quickly closed up and had a couple of balleadas for lunch. They are so delicious. I have bean and cheese burritos at home sometimes, but they taste nothing like the ones here. The cheese has more flavor here and I think they use red beans instead of pinto. The rest of the week was a steady 20 patients/day. After that Monday in clinic, I felt like I was ready for any other day of the week.
I met a 6 year old patient named Stanley who was born with a disease that causes the tendons in his wrist joints, elbow joints, and ankle joints to cringe up. Stanley has had about 3 surgeries performed already, but needs about 6 more in order to extend all of his limbs. He is constantly traveling to San Pedro Sula for physical therapy as well. Mom says that he has been improving dramatically over the past few months. She showed me pictures of how he looked before the surgery and post-surgery. She says that she is running out of money to pay for all of the surgeries and therapies, so I decided to add her into our Sign-Out sheet to see if we could offer her some financial assistance. She explained to me how difficult it is for her to have a child who is 6 years old and unable to walk yet. Her child can speak and is very intelligent, but she is afraid of the social repercussions he may face as he gets older. I had a nice day with Stanley in the clinic and after a half hour he felt so comfortable with me that he gave me a hug before he left. I was touched by his warmth and strength for his young age. Would it be fine for me to look for financial assistance for this patient for the long run? First priority of course would be for patient’s needing surgical procedures of the heart and eyes. What do you think?
We admitted two patients this week. One patient was about 9 years old who would vomit every hour. Dr. Raymond said that she had was severely dehydrated, had diarrhea and could not keep anything down (I forgot the medical term for that). They took her in to the pediatrics ward and were going to try to give her an I.V. in order to hydrate her body. The other patient that was admitted was a 7 month old little girl who had bumps on her head. When I first spoke to the mother to find out the chief complaint, she had said that it had started off as a rash and just bubbled up after a couple days. I assumed that it was just a superficial infection, but it actually ended up being more serious than that. Dr. Raymond said that the patient most likely had a couple infected cuts on the head that swelled up with pus. One of the pus-filled abscesses was right behind her ear and Dr. Raymond feared that the pus might travel into her ear and in her brain, causing meningitis. I never thought that infected wounds on the head could lead to meningitis. It would be so sad to see such a small baby end up with meningitis. Dr. Raymond wanted to show me the draining procedure he was going to perform on the patient, so I went into the pediatrics ward in an undercover mode, so that Dr. Jackie would not find out. It was a funny feeling to be doing that at my age, but Dr. Raymond really wanted me to see. He was going to drain one abscess at a time, so he decided to do the less complicated one today and the one near the ear tomorrow. He wanted to hold off because the abscess near the ear was still hard, meaning that the puss was not formed yet, so he wouldn’t really be able to drain anything. He made a cross incision on the baby’s occipital abscess and drained three large tissues full of blood and fluid. The baby was screeching and crying, while the mother tried hard to hold her baby down so that Dr. Raymond could collect the fluid and disinfect the cut. Dr. Raymond says that the reason why he did a cross and not just a single slit was that a cross would allow the wound to keep draining over the next few hours because it takes longer for a cross incision to close than a single slit incision. A few days later I saw the patient’s mom outside of the ER she came up to me to say hello and that her daughter had just had the second abscess drained out. I was glad to hear the good news and the mom seemed very grateful for the medical attention we gave her daughter. It was nice of her to share with me the progress of her daughter’s health and show gratitude towards me, although I had nothing to do with the procedure that helped her daughter get better, but maybe she did this because I spent the time talking to her on the first day when I asked for the chief complaint. It really makes a difference to the patient’s parents when I sit down and converse with them about their child’s health in general. That same day I saw a patient’s mom cleaning up her baby’s throw up while the baby was on his back and I told the mother to lay the baby on his side, so that if he throws up again he won’t choke on his vomit. The mom looked at me with open eyes, like she couldn’t believe that her baby could choke by being in that position. It was a good feeling to notice a potential health hazard and intervene by educating the parent. Education saves lives and it’s hard to see that many people lack a basic health education. It’s a challenge to try to talk to everyone about their health, but it’s a great feeling to know that I have at least taught someone an important lesson or technique in how to take better care of themselves.
I did about 60 surveys this week in clinic. I learned a lot about the population here in Roatan. Most of the patient’s diet consists of flour tortillas, beans, fried chicken, and rice. They eat a lot starchy food, but little or no vegetables or fruit. Grapes and apples are the most expensive produce in the patient’s communities. Most patients that are Indio/Caribbean don’t speak another language besides Spanish. Some patients feed their babies after the age of 15 months. I spoke to Dr. Eileen about this when she arrived on Saturday and she said that as long as the mother has strictly been feeding her baby with breast milk for the first 6 months of life, it’s okay to be feeding them breast-milk until about two years old, but that after the baby turns 6 months mom should start feeding baby formula, along with other nutritious food in order to increase their iron intake. I was really surprised to see 14 month old babies, with a full set of teeth, still drinking breast milk. In California, babies are usually weaned off breast milk before the age of 1 year, so I was really surprised to see these larger kids still lying on mommy’s lap. Being here in Roatan has definitely opened my eyes to different traditions and ways of thinking.
I know it is sad, but I just realized that I have heard of 5 deaths during my time here. The first death was of the premature baby that died in the Roatan Hospital. Last Friday two adults drowned in a septic tank down the street from the Roatan Hospital in Coxen Hole, after attempting to save a life a child that fell in. A firefighter of the area almost drowned himself while trying to save the lives of the drowning adults. Then last night there was a shoot out in Sandy Bay between a local Honduran and tourist police officers. I happened at around 10pm in an area where the police officers had put up a blockade for random checks, like they do occasionally. I heard that the Honduran (who owned a hotel in Sandy Bay) was driving by the blockade unwilling to stop and so the police officers shot at his car when they saw that he was not stopping. The man was pissed off that they shot at his car and later returned to the scene of the police shooting and shot the police officer dead, so then another neighboring police officer shot the Honduran several times and killed him. The dead police officer had part of his skull blown off with his brain on the streets and the Honduran was left at the scene of the crime until the next morning, when a pickup truck came to take him to the ER in Coxen Hole to do an autopsy for governmental records. I was going to take a taxi to French Harbor that morning when I heard about the incident, so I decided to walk up to the scene of the crime before catching a taxi, and just as I was walking up the path down came the pick up truck with two police officers on both sides of the dead body. The Honduran body had his hands lifted up and cringed inward. I had never seen a dead body so close in my life. It was frightening and upsetting. It could all have been avoided if the police officer would just have let the car go and not have shot at it. By letting the Honduran ride off would not have cost him a thing. It was all very unnecessary. From talking to the local I got the sense that the police officers have not interpersonal skills because they don’t talk to the Roatan citizens with respect and that everything is in military mode. They act more like they are at war with the citizens because of their defensive nature instead of protecting the public like most cops in the U.S. do. My fear here has always been of something tragic happening outside of West End and me not having anyone to turn to for help because most of the police here are corrupt. Of course it is not true of all cops, but it does not help to constantly hear bad stories about the police from the locals themselves. It reminds me of my first week here when I saw an injured man making a documentary of himself to release to the government and general public to show how the police abuse of their own people. This man was mistaken for a robber and was stabbed multiple times by the police, causing him to go to the emergency room to repair his internal organs and get stitched up. When I looked at the man I noticed that his stitches were only a couple days old, so I wasn’t exactly feeling the most secure. I know that I must always think smart and not put myself in stupid situations where I set myself up for a potential disaster, so I feel fine about my current situation.
Overall this week was full of eye-openers.
Raymond showed me his adult clinic this week and it was one of the nicest clinics I have seen here in Roatan. The walls are a brightly colored baby-blue color, with nice tile floors, and a glass case filled with medications and other tools. I have also had the opportunity to know Francisco Reyes, the Honduran resident, very well. I realize that although these doctors are very committed to their practice, they always make time to just go out, relax, and just be human. They create such a nice balance for themselves. I learn a lot from their practice and their lifestyles. It’s really nice to get to know different physicians, their different practices, and techniques, and just pick and choose what things I would like to incorporate into my own life and practice. ☺
Sunday, May 29, 2005
Natalie Chavez Journal 1
This week was very interesting, trying, and eventful. I feel that this journal may be a few pages long, since I have so many memories in my head I want to organize on paper. The plane ride was the most difficult part of this whole experience. I had to take off from four different airports in order to finally get to Roatan. I managed to pull it off well, taking in mind that this was my very first time traveling alone. I really had to grow up almost instantly and take care of myself in the real world. When I arrived to the airport Dr. Black found me. He says he knew it was me because I was the only American looking lost. I was trying to look for Krista the whole time, so I was a bit surprised when a larger man approached me. Dr. David Black is a real sweet guy, who speaks freely about how his kind (aka Gringos) are taking over the business in Roatan and exploiting the native population there. He also never hates to criticize the corruption in the U.S. field of medicine and the pay system ruled by insurance companies. He gave me a crude wake-up call to the reality of the medical system in the U.S. and how insurance companies determine how physicians attend their patients and how they get paid per patient, not taking into deep consideration the quality of health care.
Dr. Eli Sills was the attending I was going to be sharing a room with during my stay. He is a third generation Californian who was born in south California and raised in Oakland. We shared a lot of things in common because we were brought up with a lot of the same things that were unique to California, like local radio stations, for example. He was 29 years old and was to graduate from residency this July. He completed his undergraduate studies in UC Davis and went to medical school in both Tel Aviv, which is in Israel and in NYU in the USA. I didn’t know a medical student could go to two different medical schools. He said he was in a special program, but I forgot to ask what. I had never heard of that before. He also told me about all of the different things that have occurred to him throughout his life, like witnessing the suicide bombings in Iraq and also being in New York during 9/11. During 9/11 he was anticipating a swarm of injured people from the tragedy, so he discharged all patients who were not critically ill, which was about 90-95% of the patients in the ER. To his surprise, barely any people showed up for help and this was because they either escaped with minor scrapes, cuts, or bruises, or they were dead. He travels a lot. I believe he has also been to Vietnam, Thailand, and a few other countries. Traveling sounds like a wonderful thing I’d want to continue doing. He is very knowledgeable of different cultures, which is good to know especially in California where the population is so diverse. We shared many conversations about different universities and the importance or unimportance of prestige. He says that as long as a person is passionate and committed to what they are trying to achieve it does not matter where that person came from. He said that when patients come and see him they don’t ask what school he is from because they don’t care. They are there to see him because they like the care they receive. I got rid of a lot of assumptions that night. He reminded me a lot of Dr. McCullough when he said that there is no right way into medical school. I have heard that so many times it has become 100% internalized.
I also met a group of nurses from Alabama who were traveling and volunteering at Peggy’s clinic, as well as the Roatan hospital in Coxen Hole. They were much more different than Dr. Eli in that they liked to party hard after a long day of work. I went out with them a couple times and they made me wonder how they maintained fully functional the next morning. Those nights I spent with them were the most fun I have had ever. I have always been shy to dance around people I did not know, but their energy just rubbed off. They were spending the night in the two rooms next to ours, so we all became good friends.
I bonded more with a couple from Canada named Bobbie and Darron. They were both my age and had independently contacted Ms. Peggy to see if they could travel down here to volunteer. They have taught me so much about the Canadian government, medical system, school system, and overall culture. Bobbie kept telling me that I was deprived because I had never tasted Canadian ketchup chips. They are very motivated, passionate, and influential individuals that have inspired me to travel, take up different languages, and experience a different world outside my own. They will be leaving next Saturday, so hopefully we can hang out before then because I am seriously considering visiting them in Canada before I graduate. Their school system is so much different from that of California. It isn’t unusual for a student to graduate at the age of 21 and become a doctor in their mid-twenties. When I told them that usually students in California took a year off to do research or do internships abroad, they almost jumped out of their pants because the trend for them is to apply for medical school during their late third-year/early fourth-year. Darron says that medical schools in Canada focus on the marks (aka grades) more than anything else, while most medical schools in the U.S. focus on the well-roundedness of the applicant. That made sense to Bobbie and Darron, but they didn’t know why the medical schools in Canada did not think that way. Overall, they are friends I’ll never forget.
I have been reviewing the follow-up sign out sheet from the hospital and emailed the latest version to myself, so I could work on it from home. Dr. Raymond says that he wants me to focus on the children that need eye medical care because a group of optometrists and opthamologists will be coming in sometime in June or July and he wants to get a large group together so they can get the medical attention they need. Dr. Raymond was also going to go to La Ceiba this weekend to get in contact with a cardiologist he wanted to network with for the kids.
We had a small birthday party for Dr. Raymond after the clinic closed. He was turning thirty-three years old, so the clinic’s administrative staff members baked him a cake and appetizers for the guests. The food was delicious and Dr. Raymond looked really happy. I have a picture of him cutting his cake with a huge smile on his face. He showed me a picture of his young daughter, who has the most lively eyes.
I learned a lot from being in the clinic like how important it is to show a patient that you care about their health and getting them to care about their own. Emphasis on important information is key in order for the patient and his/her mother to leave the clinic with a clear understanding of what needs to be done for optimal health. The most extreme case I have seen in the clinic was a four month old baby who had trouble sucking on his mother’s nipple. The baby’s frenulum was too short making it difficult for the baby to suck properly. This would cause greater difficulty in speech and eating as the child grew older. Dr. Raymond decided to take a sterile razor blade and snip the baby’s frenulum in order to free it. Dr. Eli had to hold the baby’s head real steady or else there was a chance that Dr. Raymond could puncture something else in the baby’s mouth. Dr. Raymond snipped the baby’s frenulum and their was minimal bleeding, but a loud screech coming from the baby. I baby cried for a whole three minutes before he fell silently asleep. I had never seen that procedure done before, so this was a new experience for me. Later on, Dr. Eduardo joked by saying “would you like to go next, it’ll be fun”. The baby’s mother was very grateful towards the clinic staff and left home with a happy baby.
I really like it here in Roatan because of the potential this island has to become a clean and healthy environment for the children, as well as the adults. There have been many good and bad experiences here so far that has really opened my eyes to the innate goodness, as well as selfishness of the human population. Some tourists have no shame in taking advantage of the situation of the poor, while some natives come up with different ways to exploit their own. Overall, I have been greeted with smiling faces and have been treated with the utmost respect. The people of Roatan are willing to help out anyone in need of assistance, even if they have nothing. They are always smiling and full of energy, especially the children.
Next week I will administer the clinic survey, most likely on binder paper, to the patients waiting to be seen. Since it will be pretty busy this week because Dr. Raymond will be the only attending in the clinic for most of this week, I will administer the research survey questions to the remaining patients (women and children) after clinic hours. I plan to also walk around Coxen Hole asking random women the list of questions on my research handout, but I am not quite sure what the response will be. I am hoping most of them will be okay with answering a few questions about their nutrition, as long as I explain to them where I am from and what I am trying to accomplish. I will also try using the clinic phone to contact the follow up patients to see how they are doing and find out the progress of their situation in comparison to what was last recorded in the sign-out sheet. If the phone becomes a problem I will try to set up an appointment where I can meet with them in person to discuss their current situation. Hopefully I make some progress with each follow-up patient. This has been my experience so far and hopefully there is more to come.
Dr. Eli Sills was the attending I was going to be sharing a room with during my stay. He is a third generation Californian who was born in south California and raised in Oakland. We shared a lot of things in common because we were brought up with a lot of the same things that were unique to California, like local radio stations, for example. He was 29 years old and was to graduate from residency this July. He completed his undergraduate studies in UC Davis and went to medical school in both Tel Aviv, which is in Israel and in NYU in the USA. I didn’t know a medical student could go to two different medical schools. He said he was in a special program, but I forgot to ask what. I had never heard of that before. He also told me about all of the different things that have occurred to him throughout his life, like witnessing the suicide bombings in Iraq and also being in New York during 9/11. During 9/11 he was anticipating a swarm of injured people from the tragedy, so he discharged all patients who were not critically ill, which was about 90-95% of the patients in the ER. To his surprise, barely any people showed up for help and this was because they either escaped with minor scrapes, cuts, or bruises, or they were dead. He travels a lot. I believe he has also been to Vietnam, Thailand, and a few other countries. Traveling sounds like a wonderful thing I’d want to continue doing. He is very knowledgeable of different cultures, which is good to know especially in California where the population is so diverse. We shared many conversations about different universities and the importance or unimportance of prestige. He says that as long as a person is passionate and committed to what they are trying to achieve it does not matter where that person came from. He said that when patients come and see him they don’t ask what school he is from because they don’t care. They are there to see him because they like the care they receive. I got rid of a lot of assumptions that night. He reminded me a lot of Dr. McCullough when he said that there is no right way into medical school. I have heard that so many times it has become 100% internalized.
I also met a group of nurses from Alabama who were traveling and volunteering at Peggy’s clinic, as well as the Roatan hospital in Coxen Hole. They were much more different than Dr. Eli in that they liked to party hard after a long day of work. I went out with them a couple times and they made me wonder how they maintained fully functional the next morning. Those nights I spent with them were the most fun I have had ever. I have always been shy to dance around people I did not know, but their energy just rubbed off. They were spending the night in the two rooms next to ours, so we all became good friends.
I bonded more with a couple from Canada named Bobbie and Darron. They were both my age and had independently contacted Ms. Peggy to see if they could travel down here to volunteer. They have taught me so much about the Canadian government, medical system, school system, and overall culture. Bobbie kept telling me that I was deprived because I had never tasted Canadian ketchup chips. They are very motivated, passionate, and influential individuals that have inspired me to travel, take up different languages, and experience a different world outside my own. They will be leaving next Saturday, so hopefully we can hang out before then because I am seriously considering visiting them in Canada before I graduate. Their school system is so much different from that of California. It isn’t unusual for a student to graduate at the age of 21 and become a doctor in their mid-twenties. When I told them that usually students in California took a year off to do research or do internships abroad, they almost jumped out of their pants because the trend for them is to apply for medical school during their late third-year/early fourth-year. Darron says that medical schools in Canada focus on the marks (aka grades) more than anything else, while most medical schools in the U.S. focus on the well-roundedness of the applicant. That made sense to Bobbie and Darron, but they didn’t know why the medical schools in Canada did not think that way. Overall, they are friends I’ll never forget.
I have been reviewing the follow-up sign out sheet from the hospital and emailed the latest version to myself, so I could work on it from home. Dr. Raymond says that he wants me to focus on the children that need eye medical care because a group of optometrists and opthamologists will be coming in sometime in June or July and he wants to get a large group together so they can get the medical attention they need. Dr. Raymond was also going to go to La Ceiba this weekend to get in contact with a cardiologist he wanted to network with for the kids.
We had a small birthday party for Dr. Raymond after the clinic closed. He was turning thirty-three years old, so the clinic’s administrative staff members baked him a cake and appetizers for the guests. The food was delicious and Dr. Raymond looked really happy. I have a picture of him cutting his cake with a huge smile on his face. He showed me a picture of his young daughter, who has the most lively eyes.
I learned a lot from being in the clinic like how important it is to show a patient that you care about their health and getting them to care about their own. Emphasis on important information is key in order for the patient and his/her mother to leave the clinic with a clear understanding of what needs to be done for optimal health. The most extreme case I have seen in the clinic was a four month old baby who had trouble sucking on his mother’s nipple. The baby’s frenulum was too short making it difficult for the baby to suck properly. This would cause greater difficulty in speech and eating as the child grew older. Dr. Raymond decided to take a sterile razor blade and snip the baby’s frenulum in order to free it. Dr. Eli had to hold the baby’s head real steady or else there was a chance that Dr. Raymond could puncture something else in the baby’s mouth. Dr. Raymond snipped the baby’s frenulum and their was minimal bleeding, but a loud screech coming from the baby. I baby cried for a whole three minutes before he fell silently asleep. I had never seen that procedure done before, so this was a new experience for me. Later on, Dr. Eduardo joked by saying “would you like to go next, it’ll be fun”. The baby’s mother was very grateful towards the clinic staff and left home with a happy baby.
I really like it here in Roatan because of the potential this island has to become a clean and healthy environment for the children, as well as the adults. There have been many good and bad experiences here so far that has really opened my eyes to the innate goodness, as well as selfishness of the human population. Some tourists have no shame in taking advantage of the situation of the poor, while some natives come up with different ways to exploit their own. Overall, I have been greeted with smiling faces and have been treated with the utmost respect. The people of Roatan are willing to help out anyone in need of assistance, even if they have nothing. They are always smiling and full of energy, especially the children.
Next week I will administer the clinic survey, most likely on binder paper, to the patients waiting to be seen. Since it will be pretty busy this week because Dr. Raymond will be the only attending in the clinic for most of this week, I will administer the research survey questions to the remaining patients (women and children) after clinic hours. I plan to also walk around Coxen Hole asking random women the list of questions on my research handout, but I am not quite sure what the response will be. I am hoping most of them will be okay with answering a few questions about their nutrition, as long as I explain to them where I am from and what I am trying to accomplish. I will also try using the clinic phone to contact the follow up patients to see how they are doing and find out the progress of their situation in comparison to what was last recorded in the sign-out sheet. If the phone becomes a problem I will try to set up an appointment where I can meet with them in person to discuss their current situation. Hopefully I make some progress with each follow-up patient. This has been my experience so far and hopefully there is more to come.
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