My time in Roatan is coming to an end, and I can honestly say that I’m going to miss it! My fourth week here was pretty busy. Most of the diagnoses at clinic were skin conditions, specifically scabies and impetigo. Viral syndrome, diarrhea and fever were also common. There were also some familiar faces at clinic. The mother who had been feeding her baby rice mixed with water returned to the RVPC, claiming that her baby was still having diarrhea. Dr. Rhee explained that the baby may have a milk protein allergy, and gave the mother a different, simpler formula to feed him. Dr. Dunlop gave a referral to admit a little boy overnight at the hospital because of his difficulty breathing and asthma.
Peggy and Dr. Patrick arranged to have a medical brigade in La Colonia this week. Everything was set up at the church and there was a great turnout! Along with Peggy and Dr. Patrick came Dr. Rhee, Dr. Dunlop, Bea and Joe (two physicians assistants), Kathy (a nurse) and her daughter Megan, Igor and David (two of Peggy’s volunteers) and myself. I spent most of the time with Dr. Rhee and Dr. Dunlop, helping them and translating for them. Most of the patients we saw had skin conditions, including scabies and impetigo. This was expected because of the lack of running water in La Colonia. Medication for parasites was given to many of the patients as well. At one point, I found myself surrounded by about ten cute kids asking for meds against “lombrices.” Even after the doctors saw them, the children stayed close by and were very excited to have their picture taken!
Also this week, I got certified in scuba diving with Igor and Molly! We did four dives and we are planning to do another one soon with Dr. Rhee. We’ve spent time at West Bay Beach. We are also planning to do the canopy tours and the dolphin encounter at Anthony’s Key. We said our goodbyes to Dr. Dunlop, who left today back to the States. I’m sad to see him go – he was very informative and a pleasure to be around at clinic. Tomorrow I’ll be picking up Edwin, the next intern, from the airport. I’ll be training him the next few days and showing him around the island.
I can’t believe my time is almost up in Roatan! This has been one of the best experiences I’ve ever had and I’ve met so many great people to stay in touch with! I’m also going to miss the island lifestyle once I’m back to school in L.A. One thing is for sure – I definitely plan on coming back as soon as I can!
Sunday, August 19, 2007
Sunday, August 12, 2007
Vanessa Journal 3
My third week has gone by incredibly fast. This week, the Minister of Health from Tegucigalpa, Dr. Jenny Meza, visited the RVPC. Along with her came Dr. Cibeles (Epidemiologist), Dr. Cruz (the director of the Hospital), and Lic. Galindo (Chief manager of the Hospital). Although they stopped by for only a few minutes, there was enough time to capture a picture of them with Dr. Welcome, Dr. Rhee and Dr. Dunlop.
There were also several memorable cases this week at clinic. A little boy came in with what seemed like an abscess of pus inside his mouth. He was referred to the dentist here at the Public Hospital, but the dentist claimed that he tried to drain it and there was no liquid inside. Dr. Dunlop gave the little boy’s mother a prescription for antibiotics, and instructed her to return with her son to the clinic in a few days if there was no improvement. They returned a few days later, and it turns out the antibiotics had not helped. Dr. Welcome made a referral for them to travel to Tegucigalpa, where a different doctor could examine the hard palate mass. Dr. Rhee referred a different patient, a 10-month-old baby, to La Ceiba due to the baby’s delayed development. Dr. Rhee explained that among other things, the baby girl could not sit up on her own, something that a 10-month-old should be able to do. The most common diagnoses this week were fever, viral syndrome, diarrhea, impetigo and possible parasites. A mother brought her month-old baby, saying that she had been not been able to feed the baby milk the past three days because of the diarrhea that it caused. Instead, she had been feeding the baby ground rice mixed with water. Dr. Rhee stressed that the baby needs to be fed milk, not rice and water. After examining the baby, Dr. Rhee provided the mother with a different type of formula, Similac, to feed the baby. One day this week, Dr. Dunlop allowed me to do a urinalysis with his help. I accompanied Dr. Welcome, Dr. Rhee and Dr. Dunlop to hear a conference about brain lesions and hemorrhages. Dr. Welcome and I have also been planning on giving a talk to parents on the psychosocial development of teenagers.
Aside from clinic, I’ve continued to teach English. New volunteers at Peggy’s clinic also arrived this week: David, a pre-med student from Canada, and Igor, a fourth-year medical student at Vanderbilt. We all went to the crab races this week, dinner in West End, and I went to West Bay Beach yesterday. We are finally starting our scuba diving certification tomorrow!
There were also several memorable cases this week at clinic. A little boy came in with what seemed like an abscess of pus inside his mouth. He was referred to the dentist here at the Public Hospital, but the dentist claimed that he tried to drain it and there was no liquid inside. Dr. Dunlop gave the little boy’s mother a prescription for antibiotics, and instructed her to return with her son to the clinic in a few days if there was no improvement. They returned a few days later, and it turns out the antibiotics had not helped. Dr. Welcome made a referral for them to travel to Tegucigalpa, where a different doctor could examine the hard palate mass. Dr. Rhee referred a different patient, a 10-month-old baby, to La Ceiba due to the baby’s delayed development. Dr. Rhee explained that among other things, the baby girl could not sit up on her own, something that a 10-month-old should be able to do. The most common diagnoses this week were fever, viral syndrome, diarrhea, impetigo and possible parasites. A mother brought her month-old baby, saying that she had been not been able to feed the baby milk the past three days because of the diarrhea that it caused. Instead, she had been feeding the baby ground rice mixed with water. Dr. Rhee stressed that the baby needs to be fed milk, not rice and water. After examining the baby, Dr. Rhee provided the mother with a different type of formula, Similac, to feed the baby. One day this week, Dr. Dunlop allowed me to do a urinalysis with his help. I accompanied Dr. Welcome, Dr. Rhee and Dr. Dunlop to hear a conference about brain lesions and hemorrhages. Dr. Welcome and I have also been planning on giving a talk to parents on the psychosocial development of teenagers.
Aside from clinic, I’ve continued to teach English. New volunteers at Peggy’s clinic also arrived this week: David, a pre-med student from Canada, and Igor, a fourth-year medical student at Vanderbilt. We all went to the crab races this week, dinner in West End, and I went to West Bay Beach yesterday. We are finally starting our scuba diving certification tomorrow!
Sunday, August 05, 2007
Vanessa Journal 2
My second week in Roatan began with the arrival of New York’s Dr. John Dunlop to clinic. This week I’ve been getting to clinic slightly earlier. This gives me an early start on triage, which I’ve found to be especially helpful now that there are three doctors seeing patients and the pace has picked up. It also gives me more time to survey patients after they’ve seen Dr. Welcome, Dr. Rhee or Dr. Dunlop.
One day this week, a little girl with a heart murmur came to the clinic with her mother. Dr. Dunlop explained exactly to me what a heart murmur is and then allowed me to hear for myself. First, he gave me the stethoscope and told me to listen to my own heartbeat, followed by his. After having listened to two “regular” heartbeats, he brought me into the room with the little girl and asked her mother if it was alright for me to listen to her daughter’s heartbeat. I was given the chance to listen to her heartbeat, a distinct sound that was very different from the heartbeats I had just heard. Another day this week, a mother came in complaining that her daughter was eating dirt. After Dr. Dunlop examined the little girl, he explained to me that eating dirt if often a symptom of iron deficiency. Also at clinic this week, a mother brought in her 9-day-old baby for fever. After taking the baby’s temperature, which was 101.2 degrees, Dr. Rhee ordered that the baby be rushed to the ER. He let me accompany him as he walked the mother with her baby to the ER and later explained the dangers of fever in newborns.
After clinic on Wednesday, the three doctors and myself made our way to the daycare I’ve been volunteering at in Coxen Hole. The doctors came to look at the children, specifically those that were sick or had any conditions at the time. There ended up being three children with skin conditions. The doctors examined the children and then delivered the extra medicine they had brought for the daycare. They wrote down the names of each on a piece of paper with their use, so that the teachers would know in the future. These ranged from hydrocortisone creams to cough suppressants to fever reducers.
I’ve really been enjoying my time at clinic. It’s been especially rewarding to be able to speak to patients directly. A mother came in to clinic this week, and right away I recognized her from a few days earlier, when she had brought in her first child. She asked me how long I was going to be in Roatan and at the clinic. After I explained to her that I would be here until the end of August, she seemed genuinely disappointed and asked when I was coming back. I told her that I had to go back to school in August, but that I would try to come back when there was time. This conversation made me feel welcome and it made me feel like I was making a difference to someone.
Aside from clinic and daycare, I started teaching Maria Cristina English. We met twice this week, and she is putting great effort into learning the language. We started off with useful phrases, simply vocabulary, etc. After just two days, she can introduce herself and tell me a little about herself, including where she is from and how old she is.
On my free time, I’ve been spending time with the other volunteers. We went to the crab races on Thursday, which raise money for the schools here in Roatan. The winner gets to choose what to do with his or her half of the prize, but everyone usually gives their part to the schools. My crab (#28) came in first place! I was given a sash and certificate, and I of course gave the part I won to the schools. We’ve gone to dinner and spent time in West End. This coming week I’ll be looking into the canopy tours and diving.
Many of the other volunteers left this week. They included Krista, Raquel, Diana and Asha. I thought I would feel lonely without them all here, but more people have arrived. When we went to drop Asha off at the airport today, we picked up Dr. Patrick and two physician assistants that have come to volunteer. Peggy also mentioned that two more volunteers will be arriving tomorrow.
One day this week, a little girl with a heart murmur came to the clinic with her mother. Dr. Dunlop explained exactly to me what a heart murmur is and then allowed me to hear for myself. First, he gave me the stethoscope and told me to listen to my own heartbeat, followed by his. After having listened to two “regular” heartbeats, he brought me into the room with the little girl and asked her mother if it was alright for me to listen to her daughter’s heartbeat. I was given the chance to listen to her heartbeat, a distinct sound that was very different from the heartbeats I had just heard. Another day this week, a mother came in complaining that her daughter was eating dirt. After Dr. Dunlop examined the little girl, he explained to me that eating dirt if often a symptom of iron deficiency. Also at clinic this week, a mother brought in her 9-day-old baby for fever. After taking the baby’s temperature, which was 101.2 degrees, Dr. Rhee ordered that the baby be rushed to the ER. He let me accompany him as he walked the mother with her baby to the ER and later explained the dangers of fever in newborns.
After clinic on Wednesday, the three doctors and myself made our way to the daycare I’ve been volunteering at in Coxen Hole. The doctors came to look at the children, specifically those that were sick or had any conditions at the time. There ended up being three children with skin conditions. The doctors examined the children and then delivered the extra medicine they had brought for the daycare. They wrote down the names of each on a piece of paper with their use, so that the teachers would know in the future. These ranged from hydrocortisone creams to cough suppressants to fever reducers.
I’ve really been enjoying my time at clinic. It’s been especially rewarding to be able to speak to patients directly. A mother came in to clinic this week, and right away I recognized her from a few days earlier, when she had brought in her first child. She asked me how long I was going to be in Roatan and at the clinic. After I explained to her that I would be here until the end of August, she seemed genuinely disappointed and asked when I was coming back. I told her that I had to go back to school in August, but that I would try to come back when there was time. This conversation made me feel welcome and it made me feel like I was making a difference to someone.
Aside from clinic and daycare, I started teaching Maria Cristina English. We met twice this week, and she is putting great effort into learning the language. We started off with useful phrases, simply vocabulary, etc. After just two days, she can introduce herself and tell me a little about herself, including where she is from and how old she is.
On my free time, I’ve been spending time with the other volunteers. We went to the crab races on Thursday, which raise money for the schools here in Roatan. The winner gets to choose what to do with his or her half of the prize, but everyone usually gives their part to the schools. My crab (#28) came in first place! I was given a sash and certificate, and I of course gave the part I won to the schools. We’ve gone to dinner and spent time in West End. This coming week I’ll be looking into the canopy tours and diving.
Many of the other volunteers left this week. They included Krista, Raquel, Diana and Asha. I thought I would feel lonely without them all here, but more people have arrived. When we went to drop Asha off at the airport today, we picked up Dr. Patrick and two physician assistants that have come to volunteer. Peggy also mentioned that two more volunteers will be arriving tomorrow.
Sunday, July 29, 2007
Vanessa Journal 1
It’s the end of my first week here in Roatan, and I’ve already made lasting memories. I’ve grown accustomed to many things that are part of daily life on the island: random power outages, putting on mosquito repellent before stepping outside, the sound of barking dogs early in the mornings, bargaining with the taxi drivers for the best fare. Sarah has been showing me around the island, giving me her best advice and recommendations, as well as training me at the clinic. We’ve been seeing about 20 patients a day at the clinic, and the most common conditions so far have been diarrhea, scabies, viral syndrome, and fever. I’ve noticed that most of the mothers request for the doctors to check their child for parasites, as well as for vitamins because they believe their child is underweight. In several instances this week, the child has actually been in a healthy weight range for his/her age. Therefore, Sarah and I have filled out the growth chart in front of the mothers and explained what it means. At times, the mothers seem to be in disbelief, so we’ve explained that their child does not have to appear chubby in order to be healthy.
Dr. Welcome and Dr. Rhee have been very helpful and welcoming. They take the time to answer any questions and explain the medical conditions that are presented. Dr. Welcome has been courteous enough to help me translate certain medical terms into Spanish. Dr. Rhee has particularly explained about fever in babies and infants. He explained the differences between treating a baby that has a fever in the United States and here on the island. In the States, he explained, parents have easy access to a thermometer and know right away if their child has a fever. Here on the island, however, parents may not have access to a thermometer and usually rely on the fact that their child feels very hot, as most of the parents have told us here at the clinic this week. Dr. Rhee also explained that with the limited resources here, doctors must ask for a blood test and stool test here, which is different from the more advanced treatment in the States.
We’ve also started on Sarah’s research project this week at clinic. Sarah thought of an idea to see how well parents understand the doctor, as well as their child’s condition and meds. We’ve been questioning a few patients a day. We’ve found that getting to the clinic a little earlier gives us more time to triage and survey after the patients see the doctors. From the surveys so far, we’ve noticed that some mothers do not know what condition or prescription they were given. Instead, they’ve simply shown us or pointed at the paper with the name of the medicine on it. However, there have also been mothers who show to have a clear understanding. These mothers have used terms such as “virus” and have been able to tell us exactly when and how to give the meds. I’m going to continue doing surveys in the next couple of weeks to gather more research.
Aside from time at the clinic, Sarah introduced me to everyone at the daycare she has been volunteering at. I’ll be helping out here as long as they need me – they are expecting a family of volunteers to arrive sometime in August. Sarah has also introduced me to Moises, who I will begin tutoring this week. I’m also going to start teaching English to Maria Cristina. She is heading to the States because her daughter is having surgery, and Peggy explained to me that she wants to know at least some basic English to help her get around.
We’ve also had time to relax and enjoy the island this week. We rented a car and drove to the East End of the island to an isolated beach. From there we had dinner at a resort nearby – there were no other guests there – and our table was on a deck overlooking the water and the sunset. We have been going to dinner in West End frequently (so far, our favorite has been the Creole Chicken Rotisserie). We’ve gone to West Bay Beach and swam off the dock by Peggy’s. We’ve also spent quality time with the locals, who have all been so nice and welcoming. Sarah and I bought baleadas and spent time with Nereyda and Tania just talking. We’ve also spent time with the local boys. One day, we spent a few hours with them on the dock. They told us they would help us with our Spanish if we started teaching them English. They began to quiz us on our Spanish: they pointed at things (the moon, sky, water, dock) and asked us to say the word in Spanish. They also asked us to pronounce words with double R’s (apparently we have difficulty rolling the R’s in Spanish). We then began to teach them simple words in English. They’ve been asking me when our first official English class is going to be, so I’ll probably start with them this week. I just need to coordinate a time – half of the children say they end school at noon and the other half say 5.
We dropped Sarah off at the airport yesterday and now she has officially passed the torch to me. I’ll keep you updated on everything that happens within the next couple of weeks. Now I’m off to relax and read some more of the book Peggy recommended – Mountains Beyond Mountains.
Dr. Welcome and Dr. Rhee have been very helpful and welcoming. They take the time to answer any questions and explain the medical conditions that are presented. Dr. Welcome has been courteous enough to help me translate certain medical terms into Spanish. Dr. Rhee has particularly explained about fever in babies and infants. He explained the differences between treating a baby that has a fever in the United States and here on the island. In the States, he explained, parents have easy access to a thermometer and know right away if their child has a fever. Here on the island, however, parents may not have access to a thermometer and usually rely on the fact that their child feels very hot, as most of the parents have told us here at the clinic this week. Dr. Rhee also explained that with the limited resources here, doctors must ask for a blood test and stool test here, which is different from the more advanced treatment in the States.
We’ve also started on Sarah’s research project this week at clinic. Sarah thought of an idea to see how well parents understand the doctor, as well as their child’s condition and meds. We’ve been questioning a few patients a day. We’ve found that getting to the clinic a little earlier gives us more time to triage and survey after the patients see the doctors. From the surveys so far, we’ve noticed that some mothers do not know what condition or prescription they were given. Instead, they’ve simply shown us or pointed at the paper with the name of the medicine on it. However, there have also been mothers who show to have a clear understanding. These mothers have used terms such as “virus” and have been able to tell us exactly when and how to give the meds. I’m going to continue doing surveys in the next couple of weeks to gather more research.
Aside from time at the clinic, Sarah introduced me to everyone at the daycare she has been volunteering at. I’ll be helping out here as long as they need me – they are expecting a family of volunteers to arrive sometime in August. Sarah has also introduced me to Moises, who I will begin tutoring this week. I’m also going to start teaching English to Maria Cristina. She is heading to the States because her daughter is having surgery, and Peggy explained to me that she wants to know at least some basic English to help her get around.
We’ve also had time to relax and enjoy the island this week. We rented a car and drove to the East End of the island to an isolated beach. From there we had dinner at a resort nearby – there were no other guests there – and our table was on a deck overlooking the water and the sunset. We have been going to dinner in West End frequently (so far, our favorite has been the Creole Chicken Rotisserie). We’ve gone to West Bay Beach and swam off the dock by Peggy’s. We’ve also spent quality time with the locals, who have all been so nice and welcoming. Sarah and I bought baleadas and spent time with Nereyda and Tania just talking. We’ve also spent time with the local boys. One day, we spent a few hours with them on the dock. They told us they would help us with our Spanish if we started teaching them English. They began to quiz us on our Spanish: they pointed at things (the moon, sky, water, dock) and asked us to say the word in Spanish. They also asked us to pronounce words with double R’s (apparently we have difficulty rolling the R’s in Spanish). We then began to teach them simple words in English. They’ve been asking me when our first official English class is going to be, so I’ll probably start with them this week. I just need to coordinate a time – half of the children say they end school at noon and the other half say 5.
We dropped Sarah off at the airport yesterday and now she has officially passed the torch to me. I’ll keep you updated on everything that happens within the next couple of weeks. Now I’m off to relax and read some more of the book Peggy recommended – Mountains Beyond Mountains.
Thursday, July 26, 2007
Sarah Journal 3
Last weekend, we sadly said our goodbyes to Dr. Gruber, Mrs. Gruber, Dr. Toledo, and Natalie, all of whom have been with us for many weeks. But with this farewell came the arrival of our new attending from New York, Dr. David Rhee. He has been a wonderful addition to the clinic, and things have been running smoothly since his arrival. After working in the clinic for three weeks, I’ve begun to notice certain trends in the different illnesses we treat – scabies, respiratory viral infections, impetigo, and intestinal parasites are among the most common – and I’ve learned to recognize different skin conditions after seeing so many cases. One of the most exciting aspects of my work in the clinic here has been working with Dr. Rhee as he explains the children’s’ conditions to their mothers. I often get a chance to help explain Dr. Rhee’s diagnosis to the child’s mother and how exactly mom should give the prescribed medicine to her child. It’s been extremely fulfilling getting to be the one who reassures mom that her child is healthy, or that he will feel much better in a week after taking the medicine we prescribe. Just yesterday, for instance, a mother brought her children in for a follow-up visit to make sure they no longer had intestinal parasites. When I told her that her two baby boys were perfectly healthy and that their residual stomach pain would pass within a matter of days, her face relaxed into a smile. Then we laughed, talking about how silly her two boys were, and Dr. Rhee and I sent her on her way with a month’s supply of Flintstone chewable vitamins and some stuffed animal toys. Even simple cases like these can be rewarding, making every day in clinic a fulfilling experience.
Through my experience I’ve found that sometimes when I explain a child’s diagnosis to his mother, mom simply nods her head to signal that she’s understood, when in fact she doesn’t quite understand how to properly give her child his medicines. So I’ve learned that the most effective way to make sure mom understands everything is to ask her to explain back to me the doctor’s advice and how she is going to use the medicines when she goes home – only then can I rest assured that she understands everything I’ve told her. Working with moms who sometimes don’t understand everything when it’s first explained has made me realize that it would be a good idea to find out just how well the patients in general are understanding the doctors and their directions. So I began brainstorming with Dr. Rhee about a good way to assess this level of understanding, and we agreed that a great way to do so would be to conduct a quick interview with patients after they finish seeing the doctor, to learn how well they understand their child’s condition and to ask them to explain to us how they will be taking their medicines. From there, we can use the surveys to provide the doctors with feedback about the things they are doing well and those they can work on. Hopefully, this little project will be a good way to help our clinic continue to improve and to ensure that we are providing our patients with exceptional care.
Through my experience I’ve found that sometimes when I explain a child’s diagnosis to his mother, mom simply nods her head to signal that she’s understood, when in fact she doesn’t quite understand how to properly give her child his medicines. So I’ve learned that the most effective way to make sure mom understands everything is to ask her to explain back to me the doctor’s advice and how she is going to use the medicines when she goes home – only then can I rest assured that she understands everything I’ve told her. Working with moms who sometimes don’t understand everything when it’s first explained has made me realize that it would be a good idea to find out just how well the patients in general are understanding the doctors and their directions. So I began brainstorming with Dr. Rhee about a good way to assess this level of understanding, and we agreed that a great way to do so would be to conduct a quick interview with patients after they finish seeing the doctor, to learn how well they understand their child’s condition and to ask them to explain to us how they will be taking their medicines. From there, we can use the surveys to provide the doctors with feedback about the things they are doing well and those they can work on. Hopefully, this little project will be a good way to help our clinic continue to improve and to ensure that we are providing our patients with exceptional care.
Wednesday, July 18, 2007
Sarah Journal 2
I’ve been here two weeks now, and I finally feel like I’ve fallen into a good routine in clinic: triaging patients, shadowing the doctors, entering patient information into the computer. Earlier this week, I was able to accompany the doctors to see the newborns, and I got a chance to hold a day-old baby girl: she was wearing a little red dress and was so adorable! Seeing these mothers and children, I realized that I had never seen a live birth. After meeting and speaking with one of the ER docs, Dr. Avila, he let me know that I could accompany him to see a birth if I wanted to. So, on Thursday afternoon when he was on call, I shadowed him while he delivered a baby! It was quite an exhilarating experience – watching a birth for the first time. I have to admit, it was very different from what I had envisioned. I watched as the mother pushed and pushed; she was exhausted and in a tremendous amount of pain. In fact, here in Honduras they don’t give these mothers anesthesia; the birth is completely natural. I was pretty shocked when I learned this; later I asked Dr. Avila and learned that the mothers cannot receive painkillers because there are not enough anesthesiologists available. As I watched the birth, I was amazed at how quickly the baby delivered – it was the mom’s second child, so the baby came out pretty easily. After the baby came the long umbilical cord, white and tough. The nurse clamped the cord and quickly cleared the baby’s small mouth and nostrils so that he could take his first breath. I went over to the baby, letting him wrap his teeny fingers around my pinky: he was so small and adorable. Next, the doctor delivered the placenta, a large, bloody mass. Finally, the doctor sutured up the small vaginal tear that the mother had suffered during the birth. The doctor hummed happily as he sewed up the tear. It was amazing to me how routine the birth seemed to the doctor, and how new and almost foreign it had been to me. Here I was, still in a little shock after the entire process, and the doctor singing to himself as if the whole procedure was as simple as tying one’s shoe. At the end of it all, I felt extremely lucky that I was able to sit in and watch something so amazing. I think this experience is a perfect demonstration of how generous and accommodating some of the doctors in this hospital are; if you are curious about something, just simply ask and you might be able to sit in on an exciting procedure or learn something interesting you never knew before.
In my free time, I’ve continued to volunteer at the Daycare Center in Coxen Hole; this week we set up little easels outside, and had the kids paint with tempera paint. It was a joy to see the little kids in their oversized smocks so intently concentrating on the painting in front of them. When they were finished, they were each so proud of their own paintings and eagerly asked me to help them write their names on each of their pieces of work. After the daycare, I return to my apartment to teach Moises English. This week I began teaching him how to conjugate simple verbs like “to run,” “to see,” and “to swim.” It constantly amazes me how quickly he learns and how excited he gets when he is able to form a sentence in English on his own. He is a very bright kid, and I am lucky to be able to work with him.
In my free time, I’ve continued to volunteer at the Daycare Center in Coxen Hole; this week we set up little easels outside, and had the kids paint with tempera paint. It was a joy to see the little kids in their oversized smocks so intently concentrating on the painting in front of them. When they were finished, they were each so proud of their own paintings and eagerly asked me to help them write their names on each of their pieces of work. After the daycare, I return to my apartment to teach Moises English. This week I began teaching him how to conjugate simple verbs like “to run,” “to see,” and “to swim.” It constantly amazes me how quickly he learns and how excited he gets when he is able to form a sentence in English on his own. He is a very bright kid, and I am lucky to be able to work with him.
Sunday, July 15, 2007
Natalie Journal 2
I’m sitting on my porch enjoying my last morning in Roatan. We had a big storm last night, so today is humid but painfully beautiful as the skies are once again their inviting light blue. I can’t believe how fast these two weeks flew by and, although I’m excited for what’s next, I am sad to be leaving this peaceful, natural paradise.
I’ve become a little complacent about the DEET recently and have been rewarded with my fair share of bug bites, conveniently located on my joints for increased discomfort. So I suppose I’m taking a little piece of Roatan home with me (though hopefully not a lot of Roatan home with me in the form of dengue or malaria). I’m happy to report that my GI problems finally resolved, just in time for me to leave. I think my body has adjusted to life in Roatan just in time for my mind to re-adjust to a bustling life in the States.
My two weeks here have been simply amazing. Being surrounded by passionate health care workers, both locals and foreign volunteers, has reinforced my desire to become a physician and given me incredible insight into future career paths in international health. The physicians I’ve worked with give so much of themselves to the community, not just doing everything possible for the children coming into the clinic, but dedicating their extra time to community projects - teaching at the public schools, doing health screenings at the daycare, teaching English in the community. Even during off hours, it seems that all we talk about is improvements to the hospital, teaching efforts, community projects, acquiring meds for a specific patients.
In working with the leaders of Global Healing for the past two weeks, I have learned invaluable lessons about nonprofit work in the developing world. It is not simply enough to have the desire and the financial means to effect change; an organization must understand the existing system in precise detail and embrace the personalities and politics that it contains in order to make sustainable changes. Global Healing does just that by collaborating with hospital directors and leading teaching efforts in various hospital departments. Last weekend’s Surgical and Trauma Conference at Anthony’s Key Resort was a huge success, and the weekly Grand Rounds continue to be well-attended by hospital staff.
I feel very fortunate to be part of the Global Healing team, and I am so thankful for the opportunity to keep working in such a passionate and professional group. Returning to the RVPC as a medical student, I feel the same enthusiasm and hope I felt as an undergraduate. It has truly been a refreshing and inspiring two weeks. I wish I could stay longer, but I know I will be back again in the not-too-distant future and can take these lessons back with me in the meantime.
I’ve become a little complacent about the DEET recently and have been rewarded with my fair share of bug bites, conveniently located on my joints for increased discomfort. So I suppose I’m taking a little piece of Roatan home with me (though hopefully not a lot of Roatan home with me in the form of dengue or malaria). I’m happy to report that my GI problems finally resolved, just in time for me to leave. I think my body has adjusted to life in Roatan just in time for my mind to re-adjust to a bustling life in the States.
My two weeks here have been simply amazing. Being surrounded by passionate health care workers, both locals and foreign volunteers, has reinforced my desire to become a physician and given me incredible insight into future career paths in international health. The physicians I’ve worked with give so much of themselves to the community, not just doing everything possible for the children coming into the clinic, but dedicating their extra time to community projects - teaching at the public schools, doing health screenings at the daycare, teaching English in the community. Even during off hours, it seems that all we talk about is improvements to the hospital, teaching efforts, community projects, acquiring meds for a specific patients.
In working with the leaders of Global Healing for the past two weeks, I have learned invaluable lessons about nonprofit work in the developing world. It is not simply enough to have the desire and the financial means to effect change; an organization must understand the existing system in precise detail and embrace the personalities and politics that it contains in order to make sustainable changes. Global Healing does just that by collaborating with hospital directors and leading teaching efforts in various hospital departments. Last weekend’s Surgical and Trauma Conference at Anthony’s Key Resort was a huge success, and the weekly Grand Rounds continue to be well-attended by hospital staff.
I feel very fortunate to be part of the Global Healing team, and I am so thankful for the opportunity to keep working in such a passionate and professional group. Returning to the RVPC as a medical student, I feel the same enthusiasm and hope I felt as an undergraduate. It has truly been a refreshing and inspiring two weeks. I wish I could stay longer, but I know I will be back again in the not-too-distant future and can take these lessons back with me in the meantime.
Wednesday, July 11, 2007
Sarah Journal 1
It is almost the end of my second week here, and I am happy to say that I finally feel settled in. Work at the clinic has been an eye-opening experience, and it has been a joy to speak with the mothers and children who visit our clinic. Usually our clinic is pretty busy, with about 30 patients coming in to see us each morning, but this week that number has dropped to about 15. With fewer patients to see today, I had the opportunity to make a difference in one mother’s experience when she walked through our door this morning. She wasn’t our patient, but she was confused and needed help. Her daughter had been seen at another clinic in the hospital for dehydration and vomiting and mom was carrying an array of medicines prescribed to her by her doctor. But after speaking with her for a few minutes, I could see that she didn’t understand her doctor’s instructions. She didn’t know what each of the medicines were used for or how much or how often to give them to her child. The pharmacist had written the dosages on each of the bottles, but the mother was illiterate and couldn’t read the instructions. Like many other patients who visit the hospital, the mother was too quiet to speak up and let her doctor know that she didn’t understand and that she couldn’t read. So in order to help her as best I could, I pulled the mother aside into one of our exam rooms and attempted to explain to her how to use the medicines she was given. I showed her how to prepare the electrolyte solution that her doctor prescribed for the child’s dehydration. To help her remember which medicines corresponded to specific dosages, I color-coded the bottles with markers and different shapes. The technique sounds silly, but when a mother is illiterate and color-coding the bottles is the only alternative you have to helping her recall the instructions you explain, it’s practical.
I think the most difficult part about helping this woman (and patients like her) was making sure my advice was well received. I needed to make sure that she trusted me as a person before she would listen to what I was saying. And I needed to be conscious that I wasn’t disrespecting her by seeming superior or condescending in my effort to help. In the end, I felt great about being able to personally help someone like her receive better healthcare. I felt like I had actually made a difference. And that is what I love about working with the Global Healing clinic. Patients are constantly popping their heads in with questions, and I am the one who gets to help them. Sometimes that means walking down the hall with a patient to track down her medical file when the hospital says it’s lost, or speaking up for a mother at the pharmacy when she is too timid to do so herself, or (as in this case) helping a mother understand the medicines and dosages she has been given.
After clinic closes, I make my way down the street to the daycare in Coxen Hole that cares for children whose mothers are busy working and earning a living. At the daycare, I lead arts and crafts projects for the kids to help them explore their creative sides. When I first began working at the daycare, I was impressed with the collection of donated crayons, markers, paint, construction paper, easels, stickers, and glue – all the supplies the kids need in order to develop their creativity and have fun. The kids are all so cute and very fun to play with and have warmed up to me very quickly. In fact, yesterday was only my second time going to the center, and as soon as I walked in the door, the kids were so excited to see me again and screamed “yay” all in unison.
In between these two volunteer jobs, I tutor Moises in English and spend quality time with the volunteers that work at Peggy’s clinic. I’m constantly trying to find new opportunities to make a difference – right now I’m looking to get involved in the local HIV clinic that counsels HIV-positive patients on the island. On the weekends there is also time for relaxation. I go snorkeling in the reef right off of Peggy’s dock and spend time at the beautiful beach in West Bay.
After my experience today helping the illiterate mother in clinic, I began to think that lots of mothers – not just her – must end up in similar situations, unclear about their medications and confused about their doctor’s instructions. In fact, I’ve heard from several other volunteers that this situation is all too common for patients on the island. Not that this is the doctors’ fault – often doctors must work quickly to see all of their patients, and patients often are too shy to tell their doctor they do not understand. It seems the hospital needs a better way to serve its illiterate patients, making sure they understand how to take their medicines. Perhaps the pharmacist could use a straight-forward color-coding system to indicate different dosages to illiterate patients or provide a slip of paper with pictures of breakfast, lunch, and dinner that are circled in order to indicate the time of day and frequency with which the medicines should be taken – anything at all to help lessen the number of confused patients who go home with medications they don’t know how to use. In my remaining few weeks, I hope to create a practical solution for the hospital and help implement it so that more patients receive effective healthcare.
I think the most difficult part about helping this woman (and patients like her) was making sure my advice was well received. I needed to make sure that she trusted me as a person before she would listen to what I was saying. And I needed to be conscious that I wasn’t disrespecting her by seeming superior or condescending in my effort to help. In the end, I felt great about being able to personally help someone like her receive better healthcare. I felt like I had actually made a difference. And that is what I love about working with the Global Healing clinic. Patients are constantly popping their heads in with questions, and I am the one who gets to help them. Sometimes that means walking down the hall with a patient to track down her medical file when the hospital says it’s lost, or speaking up for a mother at the pharmacy when she is too timid to do so herself, or (as in this case) helping a mother understand the medicines and dosages she has been given.
After clinic closes, I make my way down the street to the daycare in Coxen Hole that cares for children whose mothers are busy working and earning a living. At the daycare, I lead arts and crafts projects for the kids to help them explore their creative sides. When I first began working at the daycare, I was impressed with the collection of donated crayons, markers, paint, construction paper, easels, stickers, and glue – all the supplies the kids need in order to develop their creativity and have fun. The kids are all so cute and very fun to play with and have warmed up to me very quickly. In fact, yesterday was only my second time going to the center, and as soon as I walked in the door, the kids were so excited to see me again and screamed “yay” all in unison.
In between these two volunteer jobs, I tutor Moises in English and spend quality time with the volunteers that work at Peggy’s clinic. I’m constantly trying to find new opportunities to make a difference – right now I’m looking to get involved in the local HIV clinic that counsels HIV-positive patients on the island. On the weekends there is also time for relaxation. I go snorkeling in the reef right off of Peggy’s dock and spend time at the beautiful beach in West Bay.
After my experience today helping the illiterate mother in clinic, I began to think that lots of mothers – not just her – must end up in similar situations, unclear about their medications and confused about their doctor’s instructions. In fact, I’ve heard from several other volunteers that this situation is all too common for patients on the island. Not that this is the doctors’ fault – often doctors must work quickly to see all of their patients, and patients often are too shy to tell their doctor they do not understand. It seems the hospital needs a better way to serve its illiterate patients, making sure they understand how to take their medicines. Perhaps the pharmacist could use a straight-forward color-coding system to indicate different dosages to illiterate patients or provide a slip of paper with pictures of breakfast, lunch, and dinner that are circled in order to indicate the time of day and frequency with which the medicines should be taken – anything at all to help lessen the number of confused patients who go home with medications they don’t know how to use. In my remaining few weeks, I hope to create a practical solution for the hospital and help implement it so that more patients receive effective healthcare.
Friday, July 06, 2007
Natalie Journal 1
Watching the sunlight skip off the gentle ripples of the Caribbean from my hammock, it’s hard to believe I am already a week into my two-week journey to Roatan. This is my third trip to Roatan and my first as a medical student. I spent one week here last year, but it was more of a Spring Break adventure in the jungle in La Ceiba and less of a clinical experience at the Roatan Volunteer Pediatric Clinic (RVPC) in the Hospital Público de Roatán. In the spring of 2005, I lived here for three months, working as the first student intern at Global Healing’s RVPC. Inevitably, being back here gazing at the same waves calls for some reflection.
First off, I am struck by how different it is to be a first year medical student than an undergraduate in a clinical environment. Sure, as a Stanford undergrad you think you know everything. Sure, as a first year medical student, I still know absolutely nothing about medicine. But is that entirely true? I feel like I held my own this week when asked to list common abscess culprits (staph aureus+Group A strep), perform a neuro exam (thank you, long painful neuro exam workshop), compare red reflexes to check for retinoblastoma in a newborn, and define the boundaries of cranial sutures. Meanwhile, it was an optimal learning environment for someone like me who loves to learn in a clinical setting. I learned how to hear pneumonia in an infant’s lower lobe, use an otoscope in the tiniest of ears, and make a baby poop huge amounts while taking a rectal temp. All without making anyone cry (Dr. Gruber says we fail if we make anyone cry!). It turns out that I have learned a little something in the last year. More importantly, it turns out that I truly love this profession and love to learn. And since we’re talking about scary, how frightening is it that I really love kids?
This week was certainly not all fun or pleasure or mindless excitement. We saw several tragic cases in clinic, and I can’t help but feel conflicted when I see a child with a condition that is so easily prevented or treated in the States. It’s certainly not the parents’ fault, and to think so is blatantly naïve. Attributing blame to anyone specific is inaccurate, but every case like this provides, in my opinion, empiric evidence for increased global aid by countries that have so much and contribute so little. There are an infinite number of cases that could be discussed, but it seems to be the ones with shock value that stick in your mind. On Wednesday, we saw a one-year-old boy with severe hydrocephalus and an array of other congenital deformities, including cleft lip and cleft palate. The child had limited feeding function due to his worsening condition and had become dangerously dehydrated. Suffice to say, this was a difficult case to observe as a medical student, for the child looked much like a slide from Neurosciences Pathology, and there was limited medical care to be provided at this point in time. Apparently, a brain shunt had been proposed in the past but not carried out for a variety of reasons. He was re-hydrated by our incredibly patient, compassionate physicians and treated for probable infections.
We also had a great number of successes this week due to the tireless efforts of Dr. Welcome, the Honduran/RVPC Fellow, Dr. Toledo from CHOP, and the Grubers, Global Healing extraordinaires. We saw over 120 kids in clinic this week, a huge increase from the time I worked in the clinic two years ago. Drs. Welcome, Toledo, and Gruber each taught me a great amount – after misdiagnosing my first scabies case as chicken pox, Dr. Welcome taught me the various presentations of scabies in kids of different ages and varying degrees of infection. Dr. Toledo taught me the art of a gentle pediatric otoscope exam and showed me classic ringworm presentation, among many other things. He was also very patient with me as I learned to take a blood pressure on a toddler (don’t laugh – it’s pretty challenging on a tiny arm). Dr. Gruber spent hours and hours explaining pediatric physical exams and diagnoses, while I taught him Spanish vocabulary and interpreted instructions for killing “bichos” (“bugs”) and “lombrices” (“GI worms”). I still can’t believe how fast a newborn heart beats, but I’m getting better at hearing the murmurs.
Outside of clinic, I have spent most of my free-time reading This Side of Paradise and reflecting introspectively as the afternoon sun rays reflect off the Caribbean back at me. A fellow med student from SC and I spent last weekend touring the island on a scooter (of which the scooter part I do not recommend to any future intern). We also met some powerful investors that invited us to dinner on the eastern side of the island, and this experience gave us a glimpse into the “other side” of Roatan, the one I do not see in the public clinic. The tourist culture of West End, where I am living, is the same as I remembered it – tanned bodies with foreign accents, mostly Canadian and Western European and Southern, drinking too much cheap, tasty Honduran beer and cheap, disgusting tequila. If I lived here for a longer period of time, I would surely live in Sandy Bay with the other interns, but West End will do for two weeks since USC is generously paying for my accommodations through a Travel Grant. As always, I am drawn to the Creole Rotisserie Chicken restaurant, and we’ve decided that it makes sense that the chicken here is the best in the world since there are robust chickens meandering on every road just waiting to be roasted for our culinary delight. I guess my days of Berkeley-Hollywood pseudo-vegetarianism have ended, for now.
I’m off to catch the last hour of sunshine with the kids at the pool, a “Coca-Cola light”, and my faithful Fitzgerald protagonist Amory Blaine. Thanks for reading - More to come next week.
First off, I am struck by how different it is to be a first year medical student than an undergraduate in a clinical environment. Sure, as a Stanford undergrad you think you know everything. Sure, as a first year medical student, I still know absolutely nothing about medicine. But is that entirely true? I feel like I held my own this week when asked to list common abscess culprits (staph aureus+Group A strep), perform a neuro exam (thank you, long painful neuro exam workshop), compare red reflexes to check for retinoblastoma in a newborn, and define the boundaries of cranial sutures. Meanwhile, it was an optimal learning environment for someone like me who loves to learn in a clinical setting. I learned how to hear pneumonia in an infant’s lower lobe, use an otoscope in the tiniest of ears, and make a baby poop huge amounts while taking a rectal temp. All without making anyone cry (Dr. Gruber says we fail if we make anyone cry!). It turns out that I have learned a little something in the last year. More importantly, it turns out that I truly love this profession and love to learn. And since we’re talking about scary, how frightening is it that I really love kids?
This week was certainly not all fun or pleasure or mindless excitement. We saw several tragic cases in clinic, and I can’t help but feel conflicted when I see a child with a condition that is so easily prevented or treated in the States. It’s certainly not the parents’ fault, and to think so is blatantly naïve. Attributing blame to anyone specific is inaccurate, but every case like this provides, in my opinion, empiric evidence for increased global aid by countries that have so much and contribute so little. There are an infinite number of cases that could be discussed, but it seems to be the ones with shock value that stick in your mind. On Wednesday, we saw a one-year-old boy with severe hydrocephalus and an array of other congenital deformities, including cleft lip and cleft palate. The child had limited feeding function due to his worsening condition and had become dangerously dehydrated. Suffice to say, this was a difficult case to observe as a medical student, for the child looked much like a slide from Neurosciences Pathology, and there was limited medical care to be provided at this point in time. Apparently, a brain shunt had been proposed in the past but not carried out for a variety of reasons. He was re-hydrated by our incredibly patient, compassionate physicians and treated for probable infections.
We also had a great number of successes this week due to the tireless efforts of Dr. Welcome, the Honduran/RVPC Fellow, Dr. Toledo from CHOP, and the Grubers, Global Healing extraordinaires. We saw over 120 kids in clinic this week, a huge increase from the time I worked in the clinic two years ago. Drs. Welcome, Toledo, and Gruber each taught me a great amount – after misdiagnosing my first scabies case as chicken pox, Dr. Welcome taught me the various presentations of scabies in kids of different ages and varying degrees of infection. Dr. Toledo taught me the art of a gentle pediatric otoscope exam and showed me classic ringworm presentation, among many other things. He was also very patient with me as I learned to take a blood pressure on a toddler (don’t laugh – it’s pretty challenging on a tiny arm). Dr. Gruber spent hours and hours explaining pediatric physical exams and diagnoses, while I taught him Spanish vocabulary and interpreted instructions for killing “bichos” (“bugs”) and “lombrices” (“GI worms”). I still can’t believe how fast a newborn heart beats, but I’m getting better at hearing the murmurs.
Outside of clinic, I have spent most of my free-time reading This Side of Paradise and reflecting introspectively as the afternoon sun rays reflect off the Caribbean back at me. A fellow med student from SC and I spent last weekend touring the island on a scooter (of which the scooter part I do not recommend to any future intern). We also met some powerful investors that invited us to dinner on the eastern side of the island, and this experience gave us a glimpse into the “other side” of Roatan, the one I do not see in the public clinic. The tourist culture of West End, where I am living, is the same as I remembered it – tanned bodies with foreign accents, mostly Canadian and Western European and Southern, drinking too much cheap, tasty Honduran beer and cheap, disgusting tequila. If I lived here for a longer period of time, I would surely live in Sandy Bay with the other interns, but West End will do for two weeks since USC is generously paying for my accommodations through a Travel Grant. As always, I am drawn to the Creole Rotisserie Chicken restaurant, and we’ve decided that it makes sense that the chicken here is the best in the world since there are robust chickens meandering on every road just waiting to be roasted for our culinary delight. I guess my days of Berkeley-Hollywood pseudo-vegetarianism have ended, for now.
I’m off to catch the last hour of sunshine with the kids at the pool, a “Coca-Cola light”, and my faithful Fitzgerald protagonist Amory Blaine. Thanks for reading - More to come next week.
Monday, June 25, 2007
Natasha Journal 4
As I write this, I realize that this is my last weekend on the island – my final picture-perfect weekend in one of the most beautiful places in the world. It seems as though I just got here, yet in a week's time, my internship will come to a close. But a week is still plenty of time to learn and explore – and that is exactly what I intend to do.
Clinic was an enriching experience this week – in addition to my morning triage and screening duties, I was able to spend more time with the physicians as they rotated through the pediatric wards in the afternoons. Simply walking through the wards and seeing familiar faces – some that we had in fact referred here from our own outpatient clinic – provided me some sense of comfort, as though the children were now safe and would be constantly cared for until their departure from the hospital. Of course, it was even more rewarding when we saw a child's health improving dramatically over the course of just three days – and an empty bed the day after. Stories of success make the challenges of medicine worthwhile, I believe; without the challenges, there would be no rewarding recoveries. I also believe that it is this hope that makes the losses – like the tragic death of a convulsive febrile baby last week – just a little bit easier to bear. Medicine is not, after all, a field of magic or perfect certainties. It is, however, a reminder of the power of people helping people, and that is exactly where I want to be.
One simple but powerful observation I made this week was the effectiveness of positive reinforcement in the medical setting. I noticed that, when doctors praised mothers for their vigilance and determination in caring for their children, the same mothers were more likely to bring in lab tests the next day and obtain all necessary prescriptions from the pharmacy. When mothers were looked in the eye and thanked for their tireless efforts – waiting in long lines, taking time off from work or other pursuits, paying for medications despite an already tight budget – they would feel genuinely appreciated. The appreciation manifested itself through sincere attentiveness when our physician explained the causes and treatments for asthma. It manifested itself as a mother passing on her new knowledge to her sister and her niece, encouraging them both to come to our clinic the next day. And I find that absolutely incredible. It is about time that we appreciated the patient; because as difficult as a physician's job is, it is ultimately the patient who must be willing to take necessary steps to ensure success. If one simple “thank you” can convince a mother to provide her children a healthier home, then we have succeeded in our mission of providing sustainable patient care.
Outside of clinic, I have busy with my other pursuits – tutoring at the bilingual school, teaching English to Moises, and spending quality time with the other volunteers I've met here, especially those here in Sandy Bay. This weekend I was initially a bit disheartened when the last of the original friends I had made here left for the states – I felt very alone, all of a sudden; it struck me how easy it was to make friends here, but how difficult it was to let go of them. On the bright side, I met a whole new set of incoming medical students volunteering here in the community – thirteen of them! Indeed, the volunteer efforts on this island are best characterized by a state of constant flux, with people coming in and out as their schedule permits, but with the guarantee of finding incredible and diverse friends regardless of when one decides to come down. I hope I can keep in touch with those who have already left, as well as with those who are just arriving – a forum to reflect upon our experiences here and perhaps shape future journeys.
This next week will be my last on the island, but it is a crucial week nonetheless; the Grubers will be coming down, as well as Sarah (my replacement for the month of July), and lab technicians from the Bay Area. Hopefully with all of their help the clinic will see a host of improvements and efficiency in the coming days and months. As for me, I am simply ready to relish my final days here and do my best to pass on what I have learned to Sarah. I know that while the 'end' may be near for my internship, it is yet the beginning of better days to come.
Clinic was an enriching experience this week – in addition to my morning triage and screening duties, I was able to spend more time with the physicians as they rotated through the pediatric wards in the afternoons. Simply walking through the wards and seeing familiar faces – some that we had in fact referred here from our own outpatient clinic – provided me some sense of comfort, as though the children were now safe and would be constantly cared for until their departure from the hospital. Of course, it was even more rewarding when we saw a child's health improving dramatically over the course of just three days – and an empty bed the day after. Stories of success make the challenges of medicine worthwhile, I believe; without the challenges, there would be no rewarding recoveries. I also believe that it is this hope that makes the losses – like the tragic death of a convulsive febrile baby last week – just a little bit easier to bear. Medicine is not, after all, a field of magic or perfect certainties. It is, however, a reminder of the power of people helping people, and that is exactly where I want to be.
One simple but powerful observation I made this week was the effectiveness of positive reinforcement in the medical setting. I noticed that, when doctors praised mothers for their vigilance and determination in caring for their children, the same mothers were more likely to bring in lab tests the next day and obtain all necessary prescriptions from the pharmacy. When mothers were looked in the eye and thanked for their tireless efforts – waiting in long lines, taking time off from work or other pursuits, paying for medications despite an already tight budget – they would feel genuinely appreciated. The appreciation manifested itself through sincere attentiveness when our physician explained the causes and treatments for asthma. It manifested itself as a mother passing on her new knowledge to her sister and her niece, encouraging them both to come to our clinic the next day. And I find that absolutely incredible. It is about time that we appreciated the patient; because as difficult as a physician's job is, it is ultimately the patient who must be willing to take necessary steps to ensure success. If one simple “thank you” can convince a mother to provide her children a healthier home, then we have succeeded in our mission of providing sustainable patient care.
Outside of clinic, I have busy with my other pursuits – tutoring at the bilingual school, teaching English to Moises, and spending quality time with the other volunteers I've met here, especially those here in Sandy Bay. This weekend I was initially a bit disheartened when the last of the original friends I had made here left for the states – I felt very alone, all of a sudden; it struck me how easy it was to make friends here, but how difficult it was to let go of them. On the bright side, I met a whole new set of incoming medical students volunteering here in the community – thirteen of them! Indeed, the volunteer efforts on this island are best characterized by a state of constant flux, with people coming in and out as their schedule permits, but with the guarantee of finding incredible and diverse friends regardless of when one decides to come down. I hope I can keep in touch with those who have already left, as well as with those who are just arriving – a forum to reflect upon our experiences here and perhaps shape future journeys.
This next week will be my last on the island, but it is a crucial week nonetheless; the Grubers will be coming down, as well as Sarah (my replacement for the month of July), and lab technicians from the Bay Area. Hopefully with all of their help the clinic will see a host of improvements and efficiency in the coming days and months. As for me, I am simply ready to relish my final days here and do my best to pass on what I have learned to Sarah. I know that while the 'end' may be near for my internship, it is yet the beginning of better days to come.
Tuesday, June 19, 2007
Natasha Journal 3
The past week at the Global Healing clinic has finally taken on a semblance of routine, and of continuity – for these next couple of weeks, anyways. Dr. Lea Cunningham left the clinic the previous weekend and moved to West Bay, where she plans to relax and enjoy a short vacation before returning to the states. Meanwhile, Dr. Anne Tran, Dr. Leonel Toledo, Dr. Charles and I are to be a team until the end of June. This past week gave us a taste of the teamwork dynamic, and I must say, we all get along wonderfully. Both of the American doctors are highly trained yet approachable, often taking the time to explain, clarify, and illustrate to me some of the medical information behind their diagnoses and treatments of their patients. While administrative work and triage have inherent value for an intern like me, it really is the one-on-one time I get to spend with the doctors that has made all the difference. The learning experience is incredible. These doctors provide an amazing wealth of knowledge, and it is my privilege to be working so closely with them on a day-to-day basis.
I have pretty thoroughly settled into my duties as clinic intern by now, and as such, I am able to finish my tasks more quickly and effectively, leaving me more time to observe and shadow the physicians as they work. I also had the opportunity to accompany them at the weekly Wednesday-afternoon medical talk held in the upstairs room – Dr. Toledo gave an interesting presentation (in Spanish) on the causes, symptoms, and treatment options for common childhood disabilities on this island, complete with pictures and a PowerPoint presentation, and free Bojangles for all doctors attending (which was another important lesson for me: provide free food, and the audience will come!). I think this is an excellent way for all the doctors at the hospital – American, Cuban, and Honduran alike – to better collaborate, share their experiences and expertise, and thus optimize the quality of care they provide their patients. Plus, it's a great way for them to get to know one another and build a sense of community within the hospital – something I feel would greatly benefit all involved.
My past week has marked another important milestone of my trip – I have officially crossed the halfway point of my internship and am now heading into the final two weeks of this adventure. I know that I still have much to do and see and learn, but I cannot deny just how pleased and proud I am to have at least gotten this far, learned this much, and enjoyed myself during the three weeks I have been here. For me this trip has been different from anything I had ever experienced before, my first solo journey to a new country. It has already done wonders on my Spanish, and I look forward to whatever the final two weeks will bring. Now that Peggy and several of her volunteers have left for the States, it just serves to add more to that “solo adventurer” feeling. (Although new volunteers have also been coming in regularly; I just haven't gotten to know them very well yet). My optimism might also have to do with the fact that I have almost fully recovered from my viral illness that made last weekend miserable. The plan is to stay happy, healthy, and strong for two more weeks.
Three weeks into my internship here, I feel as though I am on the threshold between two distinct states of mind – in a transitional state somewhere between an islander and an American. Three weeks is not an incredibly long amount of time; in fact, it is hardly much time at all. But be as that may, three weeks is plenty to gain an appreciation for the way of life here– the people, their culture, their needs, and their interactions with the world beyond these waters. I feel somewhat more immersed in this culture, but the ties to home are still strong. I now feel equipped to deal with perpetual power failures, sand crabs infesting by bathroom sink, and dog urine stinking up my front porch...take it in stride, I say. During a beautiful afternoon on Anthony's Key yesterday, I discovered that, maybe if I were to stay here another two months instead of the two weeks that remain of my trip...I may never want to come back home.
I have pretty thoroughly settled into my duties as clinic intern by now, and as such, I am able to finish my tasks more quickly and effectively, leaving me more time to observe and shadow the physicians as they work. I also had the opportunity to accompany them at the weekly Wednesday-afternoon medical talk held in the upstairs room – Dr. Toledo gave an interesting presentation (in Spanish) on the causes, symptoms, and treatment options for common childhood disabilities on this island, complete with pictures and a PowerPoint presentation, and free Bojangles for all doctors attending (which was another important lesson for me: provide free food, and the audience will come!). I think this is an excellent way for all the doctors at the hospital – American, Cuban, and Honduran alike – to better collaborate, share their experiences and expertise, and thus optimize the quality of care they provide their patients. Plus, it's a great way for them to get to know one another and build a sense of community within the hospital – something I feel would greatly benefit all involved.
My past week has marked another important milestone of my trip – I have officially crossed the halfway point of my internship and am now heading into the final two weeks of this adventure. I know that I still have much to do and see and learn, but I cannot deny just how pleased and proud I am to have at least gotten this far, learned this much, and enjoyed myself during the three weeks I have been here. For me this trip has been different from anything I had ever experienced before, my first solo journey to a new country. It has already done wonders on my Spanish, and I look forward to whatever the final two weeks will bring. Now that Peggy and several of her volunteers have left for the States, it just serves to add more to that “solo adventurer” feeling. (Although new volunteers have also been coming in regularly; I just haven't gotten to know them very well yet). My optimism might also have to do with the fact that I have almost fully recovered from my viral illness that made last weekend miserable. The plan is to stay happy, healthy, and strong for two more weeks.
Three weeks into my internship here, I feel as though I am on the threshold between two distinct states of mind – in a transitional state somewhere between an islander and an American. Three weeks is not an incredibly long amount of time; in fact, it is hardly much time at all. But be as that may, three weeks is plenty to gain an appreciation for the way of life here– the people, their culture, their needs, and their interactions with the world beyond these waters. I feel somewhat more immersed in this culture, but the ties to home are still strong. I now feel equipped to deal with perpetual power failures, sand crabs infesting by bathroom sink, and dog urine stinking up my front porch...take it in stride, I say. During a beautiful afternoon on Anthony's Key yesterday, I discovered that, maybe if I were to stay here another two months instead of the two weeks that remain of my trip...I may never want to come back home.
Monday, June 11, 2007
Natasha Journal 2
Week two here on Roatan has been a challenging one for me, but not one without its rewards. This was my first week working as the sole intern at the Global Healing intern at the hospital, an experience marked by an increase in both responsibility and time commitment. As the number of attending physicians increased – we had four altogether, including Dr. Charles Welcome, Dr. Leonel Toledo, Dr. Lea Cunningham, and Dr. Ann Tran—so did the number of patients waiting to be seen. Whereas I had had more time to myself last week (due to sharing work with Ryanne), this week I have been regularly working in clinic until 2pm or later, triaging patients, updating the computer database, filling out the inventory forms, buying a few supplies for the office, and preparing materials for our daycare health screening project.
While working in clinic, I came to realize just how many common diagnoses, treatments, and medical terminology I have picked up in just my short while here – I no longer have any trouble deciphering the ever-famous handwritings of seasoned physicians, nor the abbreviations for upper respiratory infections (URI in English, IRA in Spanish) or acute otitis media (AOM). I have become accustomed to frequently coming across salbuterol and prednisone treatments for asthma, and a host of other treatments including albendazole, metronidazole, and acetominaphen; prior to my trip these terms would have seemed like the remote language of a medical culture far beyond my reach or comprehension, while now they continually reinforce how much I have learned. I may not yet be able to differentiate between scabies and impetigo simply by looking at the patients' symptoms and skin abrasions, but I certainly am working on it.
For three of the five work days this past week, the doctors and I committed about 2-3 hours to the daycare health screening project we are working on. This project, while vastly different from my routine clinical duties, provided insight into completely new aspects of cultural competence, childcare and development here on Roatan. For example, because we understood that many of the kids' parents at the daycare would be unable or perhaps unwilling to provide a comprehensive US-style medical history, we adapted this format to one-page questionnaires, consisting of important health issues presented in a friendly question-and-answer format. We hope that this format will encourage parents to become more involved in their children's education and health. As for the screenings themselves, we found it quite difficult to get the children to perform the tasks that were crucial to assessing their developmental progress: our requests for them to copy a circle, turn the page of a book, or stand on one foot seemed strange and somewhat intimidating to them, as they had probably never had such screenings performed on them in the past. But with the help of Linsday and Lilliana (daycare managers who we need to thank immensely for their bilingual expertise), the overall project was a success. Based on the questionnaires and the developmental screenings, we referred some of the kids to come visit us at the clinic.
And now, life after clinic. Well, due to my busy schedule at work, I did not have much time for other pursuits, although I did meet with Moises for tutoring on Monday. Unfortunately, he has a week of school off now and I do not think he intends to come to tutoring during his vacation time – which is kind of sad, considering that I had prepared fun activities for us to do this week. But not everything can always turn out as planned, and that is probably another important lesson I have learned so far during my time here. Sometimes the spontaneous moments are the most memorable ones – like sleeping out under the stars with Mike and Sierra when the electricity went out on Thursday night, chatting about anything and everything, 'saving' my pistachio ice cream from an unfortunate end. Or singing “Lavense las manos” with the kids at daycare (a song we wrote to the tune of 'La Cucaracha' to help the kids remember to wash their hands) and the Spanish version of the 'Hokey Pokey' and being amazed at Dr. Toledo's vocal and guitar skills. It is these moments that will bring a smile to my face years from now.
And on that positive note, I'm trying my best to deal with one of the not-so-pleasant aspects of medical work with children: children and hygiene seem to be natural enemies, everywhere in the world! Whether in the States or here on Roatan, the cutest kids are those who absolutely cannot be convinced to cover their mouths and wash their hands, perpetually spreading germs as a result. For as hard as I have tried, I have not been able to escape the inevitable falling sick at the hands of children who cough on my face, put their hands in their mouths before giving me a hug, and then display the most adorable smiles I have ever seen. It is impossible to get mad at them, for children will be children; therefore it is parents and medical professionals who need to do their very best to teach them early and often the importance of cleanliness – we are the sole guardians of their (and our own) health. As for me, I am determined to deal with my fever, fatigue, and sore throat as an ongoing reminder of this very important lesson and fervently practice the techniques I preach to children and their parents in clinic.
As this second week draws to a close, I continue to reflect on what I have already learned about medicine and life in general here, and look forward to the weeks to come.
While working in clinic, I came to realize just how many common diagnoses, treatments, and medical terminology I have picked up in just my short while here – I no longer have any trouble deciphering the ever-famous handwritings of seasoned physicians, nor the abbreviations for upper respiratory infections (URI in English, IRA in Spanish) or acute otitis media (AOM). I have become accustomed to frequently coming across salbuterol and prednisone treatments for asthma, and a host of other treatments including albendazole, metronidazole, and acetominaphen; prior to my trip these terms would have seemed like the remote language of a medical culture far beyond my reach or comprehension, while now they continually reinforce how much I have learned. I may not yet be able to differentiate between scabies and impetigo simply by looking at the patients' symptoms and skin abrasions, but I certainly am working on it.
For three of the five work days this past week, the doctors and I committed about 2-3 hours to the daycare health screening project we are working on. This project, while vastly different from my routine clinical duties, provided insight into completely new aspects of cultural competence, childcare and development here on Roatan. For example, because we understood that many of the kids' parents at the daycare would be unable or perhaps unwilling to provide a comprehensive US-style medical history, we adapted this format to one-page questionnaires, consisting of important health issues presented in a friendly question-and-answer format. We hope that this format will encourage parents to become more involved in their children's education and health. As for the screenings themselves, we found it quite difficult to get the children to perform the tasks that were crucial to assessing their developmental progress: our requests for them to copy a circle, turn the page of a book, or stand on one foot seemed strange and somewhat intimidating to them, as they had probably never had such screenings performed on them in the past. But with the help of Linsday and Lilliana (daycare managers who we need to thank immensely for their bilingual expertise), the overall project was a success. Based on the questionnaires and the developmental screenings, we referred some of the kids to come visit us at the clinic.
And now, life after clinic. Well, due to my busy schedule at work, I did not have much time for other pursuits, although I did meet with Moises for tutoring on Monday. Unfortunately, he has a week of school off now and I do not think he intends to come to tutoring during his vacation time – which is kind of sad, considering that I had prepared fun activities for us to do this week. But not everything can always turn out as planned, and that is probably another important lesson I have learned so far during my time here. Sometimes the spontaneous moments are the most memorable ones – like sleeping out under the stars with Mike and Sierra when the electricity went out on Thursday night, chatting about anything and everything, 'saving' my pistachio ice cream from an unfortunate end. Or singing “Lavense las manos” with the kids at daycare (a song we wrote to the tune of 'La Cucaracha' to help the kids remember to wash their hands) and the Spanish version of the 'Hokey Pokey' and being amazed at Dr. Toledo's vocal and guitar skills. It is these moments that will bring a smile to my face years from now.
And on that positive note, I'm trying my best to deal with one of the not-so-pleasant aspects of medical work with children: children and hygiene seem to be natural enemies, everywhere in the world! Whether in the States or here on Roatan, the cutest kids are those who absolutely cannot be convinced to cover their mouths and wash their hands, perpetually spreading germs as a result. For as hard as I have tried, I have not been able to escape the inevitable falling sick at the hands of children who cough on my face, put their hands in their mouths before giving me a hug, and then display the most adorable smiles I have ever seen. It is impossible to get mad at them, for children will be children; therefore it is parents and medical professionals who need to do their very best to teach them early and often the importance of cleanliness – we are the sole guardians of their (and our own) health. As for me, I am determined to deal with my fever, fatigue, and sore throat as an ongoing reminder of this very important lesson and fervently practice the techniques I preach to children and their parents in clinic.
As this second week draws to a close, I continue to reflect on what I have already learned about medicine and life in general here, and look forward to the weeks to come.
Monday, June 04, 2007
Natasha Journal 1
Last Saturday afternoon, when I landed at the Roatan airport and made my way down the rusty staircase leading from the front of the plane to the crude concrete runway below, I quickly understood that I had entered a new world. The humid air, the tropical trees and smells, the ocean and sky that extend as far as the eye can see...indeed, I had come quite a long way from California.
On the drive to Peggy's house that day, I caught my first glimpse of the social and economic stratification that I had only vaguely heard about before then: along the road to Sandy Bay, I saw several multi-million-dollar gated properties; but along the same road, the countryside was dotted with tin-roofed shacks and stray dogs. And as I got settled into my own apartment furnished with cable TV, a full kitchen, and a private bedroom w/ bath, I was told that many of the neighbors did not even have running water or an indoor toilet. While I am not a stranger to poverty in all its manifestations—my frequent trips to India have already shown me plenty—it is nevertheless disturbing to see it so closely, on such a grand scale.
Of course, there were other differences as well – but many of these would not become apparent until I had spent a bit more time here, until I had seen more of the island. There was surprisingly a “Bojangle's” in Coxen Hole, but other than that, there was no other evidence of the beloved staples of modern American life—no fast-food joints, and certainly no Starbucks. The closest equivalent to fast food I have seen is the 'balleada' – an island snack consisting of bean and sharp white cheese wrapped in a soft tortilla. While I had heard that this island was greatly shaped by tourism, a walk through Coxen Hole or La Colonia would certainly not give that impression to a newcomer, given the poor conditions of the roads, buildings, and homes. Rather, it is West End of the island that distinguishes itself as a tourist haven – expensive gourmet restaurants, resorts, and dive shops...even a Paradise Computers Internet Cafe and store...most islanders don't even have computers.
During my first week as a clinical intern at the Global Healing clinic at the Roatan Public Hospital in Coxen Hole, the term “hospital” took on a new meaning – far from the immaculate, air-conditioned facilities one gets accustomed to in the States, this hospital was simply one of the only places where islanders could come for medical help; most patients came out of desperation, not choice. The air conditioning often failed, as did the lights, and there was no running water inside the clinic. The patients lined up along the long corridor that also served as a waiting room, often for several hours, just for a chance to speak with one of the few available doctors on duty. And our clinic was one of the more popular ones in the hospital, as many islanders seemed to take comfort in the bright white “médicos americanos” sign on our door, as if an indication of superior training and knowledge, a small gift to Roatan from the 'land of plenty.'
But my clinical experiences have been greatly positive in many other ways. For one, here I have had greater exposure and access to patients and medical care than I ever would have dreamed of in the States – and all in a week! My primary duties included taking height, weight, and temperature measurements for each scheduled patient, and keeping a record of their symptoms and treatment procedures. I also updated growth charts and the clinic patient database, and verified crucial identification information from each patient as the basis for follow-up care if needed. In addition, I spoke more Spanish in the clinic than perhaps in all my years of Spanish in school...I hope that this month will improve my fluency and pronunciation. And I had the unparalleled opportunity to work side-by-side with highly trained doctors – usually pediatric residents in their last year of training – who gave me e me a glimpse into the world of possibilities that is open to an aspiring physician, including international medicine. Dr. Leila Sabet and Dr. Darren Fiore were in clinic until Wednesday, which also happened to be Ryanne's last day. Since Thursday, it has been just me and Dr. Charles Welcome in the clinic, and he has done his best to further answer my questions about my work.
Finally, let us get to life outside the clinic—because it most certainly exists! There are so many educational, volunteer, and recreational activities that I want to participate in before I leave the island. So far, I have been tutoring math and English at the Learning Center at a nearby bilingual school, and starting next week, I will be privately tutoring English after school for a boy named Moises. Another item on my agenda: arrange and jump-start a daycare health screening program between the Global Healing clinic and a local daycare in Coxen Hole...once the new doctors come to work on Monday, I will talk to them about this plan. Other than that, I have been snorkeling, swimming, enjoying breath-taking sunset views, and reading some of my favorite books. My first week has been a wonderful educational experience, and I hope that the remaining weeks will afford me the same kind of unique learning opportunities.
On the drive to Peggy's house that day, I caught my first glimpse of the social and economic stratification that I had only vaguely heard about before then: along the road to Sandy Bay, I saw several multi-million-dollar gated properties; but along the same road, the countryside was dotted with tin-roofed shacks and stray dogs. And as I got settled into my own apartment furnished with cable TV, a full kitchen, and a private bedroom w/ bath, I was told that many of the neighbors did not even have running water or an indoor toilet. While I am not a stranger to poverty in all its manifestations—my frequent trips to India have already shown me plenty—it is nevertheless disturbing to see it so closely, on such a grand scale.
Of course, there were other differences as well – but many of these would not become apparent until I had spent a bit more time here, until I had seen more of the island. There was surprisingly a “Bojangle's” in Coxen Hole, but other than that, there was no other evidence of the beloved staples of modern American life—no fast-food joints, and certainly no Starbucks. The closest equivalent to fast food I have seen is the 'balleada' – an island snack consisting of bean and sharp white cheese wrapped in a soft tortilla. While I had heard that this island was greatly shaped by tourism, a walk through Coxen Hole or La Colonia would certainly not give that impression to a newcomer, given the poor conditions of the roads, buildings, and homes. Rather, it is West End of the island that distinguishes itself as a tourist haven – expensive gourmet restaurants, resorts, and dive shops...even a Paradise Computers Internet Cafe and store...most islanders don't even have computers.
During my first week as a clinical intern at the Global Healing clinic at the Roatan Public Hospital in Coxen Hole, the term “hospital” took on a new meaning – far from the immaculate, air-conditioned facilities one gets accustomed to in the States, this hospital was simply one of the only places where islanders could come for medical help; most patients came out of desperation, not choice. The air conditioning often failed, as did the lights, and there was no running water inside the clinic. The patients lined up along the long corridor that also served as a waiting room, often for several hours, just for a chance to speak with one of the few available doctors on duty. And our clinic was one of the more popular ones in the hospital, as many islanders seemed to take comfort in the bright white “médicos americanos” sign on our door, as if an indication of superior training and knowledge, a small gift to Roatan from the 'land of plenty.'
But my clinical experiences have been greatly positive in many other ways. For one, here I have had greater exposure and access to patients and medical care than I ever would have dreamed of in the States – and all in a week! My primary duties included taking height, weight, and temperature measurements for each scheduled patient, and keeping a record of their symptoms and treatment procedures. I also updated growth charts and the clinic patient database, and verified crucial identification information from each patient as the basis for follow-up care if needed. In addition, I spoke more Spanish in the clinic than perhaps in all my years of Spanish in school...I hope that this month will improve my fluency and pronunciation. And I had the unparalleled opportunity to work side-by-side with highly trained doctors – usually pediatric residents in their last year of training – who gave me e me a glimpse into the world of possibilities that is open to an aspiring physician, including international medicine. Dr. Leila Sabet and Dr. Darren Fiore were in clinic until Wednesday, which also happened to be Ryanne's last day. Since Thursday, it has been just me and Dr. Charles Welcome in the clinic, and he has done his best to further answer my questions about my work.
Finally, let us get to life outside the clinic—because it most certainly exists! There are so many educational, volunteer, and recreational activities that I want to participate in before I leave the island. So far, I have been tutoring math and English at the Learning Center at a nearby bilingual school, and starting next week, I will be privately tutoring English after school for a boy named Moises. Another item on my agenda: arrange and jump-start a daycare health screening program between the Global Healing clinic and a local daycare in Coxen Hole...once the new doctors come to work on Monday, I will talk to them about this plan. Other than that, I have been snorkeling, swimming, enjoying breath-taking sunset views, and reading some of my favorite books. My first week has been a wonderful educational experience, and I hope that the remaining weeks will afford me the same kind of unique learning opportunities.
Ryanne Journal 4
Today was my last day in clinic. I had to fight the urge to cry when saying goodbye to all the Global Healing doctors. Though my focus has been to facilitate patient flow, I couldn’t help but learn a ton from my experience here, and I am more excited than ever to begin medical school in July.
This last week has been the perfect ending to my time on Roatan. Saturday, a few volunteers from Clínica Esperanza and I went snuba diving (similar to scuba diving, but the air tank remains on the surface on a raft). Our guide took pictures of us, and there’s an embarrassing video of me dog paddling 10 feet underwater. Then, we went on the zip line canopy tour through Gumba Limba Gardens. Sunday, I went with a Global Healing physician and her husband, along with a couple of Peggy’s volunteers, to Barbaretta Island. We passed a group of about 12 dolphins on our way there – an absolutely amazing sight. Jade Beach was our first stop. Thousands of jade rock fragments covered the shore, and I have never seen water so clear or sand so clean. We had the entire beach to ourselves. Next was Pigeon’s Key, a bank of white sand with a few palm trees, surrounded by reef. I saw so many different types of fish and sea life while snorkeling. How am I supposed to return to the States, to a life of watching movies and going to the mall, after all this? I’m going to try my best to not think about it too much.
Well, the new Global Healing intern, Natasha, came in on Saturday, and I have been training her for the last three days. The clinic is being left in good hands, and now it’s time for me to say my final goodbyes. Goodbye cat-calling parrots, road-crossing crabs, dogs that bark but don’t bite, children without shoes, Rotisserie Chicken, Buccaneers, Eagle Ray’s, Deep Ted’s, snuba diving, zip lining, mosquitoes, sun-dried laundry, waking up at 5am, toilets that don’t flush, sniffling babies, sun burns, sandy shoes, baleadas, gripe, tos, calentura and another hundred things that I will miss about this island. I hope to see you all again some day.
This last week has been the perfect ending to my time on Roatan. Saturday, a few volunteers from Clínica Esperanza and I went snuba diving (similar to scuba diving, but the air tank remains on the surface on a raft). Our guide took pictures of us, and there’s an embarrassing video of me dog paddling 10 feet underwater. Then, we went on the zip line canopy tour through Gumba Limba Gardens. Sunday, I went with a Global Healing physician and her husband, along with a couple of Peggy’s volunteers, to Barbaretta Island. We passed a group of about 12 dolphins on our way there – an absolutely amazing sight. Jade Beach was our first stop. Thousands of jade rock fragments covered the shore, and I have never seen water so clear or sand so clean. We had the entire beach to ourselves. Next was Pigeon’s Key, a bank of white sand with a few palm trees, surrounded by reef. I saw so many different types of fish and sea life while snorkeling. How am I supposed to return to the States, to a life of watching movies and going to the mall, after all this? I’m going to try my best to not think about it too much.
Well, the new Global Healing intern, Natasha, came in on Saturday, and I have been training her for the last three days. The clinic is being left in good hands, and now it’s time for me to say my final goodbyes. Goodbye cat-calling parrots, road-crossing crabs, dogs that bark but don’t bite, children without shoes, Rotisserie Chicken, Buccaneers, Eagle Ray’s, Deep Ted’s, snuba diving, zip lining, mosquitoes, sun-dried laundry, waking up at 5am, toilets that don’t flush, sniffling babies, sun burns, sandy shoes, baleadas, gripe, tos, calentura and another hundred things that I will miss about this island. I hope to see you all again some day.
Ryanne Journal 3
It’s beautification week in the clinic! New cabinets have been installed, lights have been fixed, and shelves have been tidied up. A couple of the physicians and I have been staying after nearly every day to organize medications and tidy up. The volunteers really care about the appearance of the clinic. A resident bought a tapestry to adorn an empty wall, and then she and another doctor took extra fabric from behind an examination table and are making curtains with it. I think that this extra effort really makes the difference. I am so proud to be working with people who want to go the extra mile to make the clinic better.
Ryanne Journal 2
The Global Healing clinic may not look too impressive to someone coming from North America or from Europe, but it’s important to take into account that the greatest resources are not the donated medications and equipment but the doctors who volunteer their time. I have been constantly amazed at the care shown by the GH physicians. I often question people’s motivations, but that effort is wasted when I observe the GH volunteers pour over medical texts, consulting with each other frequently, before deciding upon the optimal treatment for a given patient. Concern over certain patients even keeps one of the physicians up well past midnight. I assumed that extensively-trained physicians would be so reflexive with their diagnoses that the patient-doctor interaction would be reduced to a question and answer session, a checklist of yeses and nos, adding up to a prescription. But, I couldn’t have been more wrong. These doctors understand that medicine is about treating the person as well as the patient.
Tuesday, May 15, 2007
Ryanne Journal 1
There’s no better way to shatter one’s complacency than by coming to Roatán, Honduras. It would be negligent of me to discuss my experience in the clinic without providing a background for why Global Healing’s services are needed on the island. Here, the lack—and misappropriation—of resources manifests itself in the form of a decrepit infrastructure, where problems in healthcare, education, and transportation abound. From a public hospital with no running water to shanties made of corrugated metal, the island is certainly underdeveloped.
Underdeveloped, but more importantly, developing. The potential for growth on Roatán is astounding. Savvy entrepreneurs have already wised up to this fact, and cruise lines and realtors are expanding their networks to include this tiny Caribbean island. Whether the motivation is expansion or exploitation, the end result is growth. The central problem, however, is that Roatan’s development is designed to serve tourists, and not necessarily islanders.
It is easy for a tourist to go straight from the airport to one of the many resorts on the island, thereby missing the communities that go without running water, the children that play in the dirt without shoes, and the thirteen year old girls with babies. I did not intend to talk about the sociopolitical issues on Roatán more than the medical ones, but I find it difficult for me to splice these elements into separate categories, as they are all so intertwined and all so crucial to the betterment of Roatán.
A self-sustaining method for improvement—one that equips Roatán’s people to serve the island’s needs—is necessary. People like Peggy help Roatán’s poor by working independent of the system, but the island needs an inherent system that does the job on its own. Right now, the Ministry of Health in Tegucigalpa reimburses 95% of Roatán’s medical expenses. Under ZOLITUR (Free Tourist Zone for the Bay Islands—a law that goes into effect within ten years), funds for healthcare will depend on how the budget for all social services is allotted. An Education Commission for the island was recently created. Likewise, a Healthcare Commission is needed to insure that a fair allotment of funds for medical services on the island.
But, I digress. My experience in clinic has been amazing, and I am already planning to return to the island for more intensive training during and after medical school. In the first week, I have regularly seen cases that would only occasionally appear in the United States. Malaria, scabies, and intestinal parasites no longer seem exotic. Just in the last four days, three children tested positive for falciparum – the most dangerous strain of malaria. I have been told that this many cases would have been rare five years ago. Next week I’ll talk more about the clinic and what I have been doing outside of clinic time.
Underdeveloped, but more importantly, developing. The potential for growth on Roatán is astounding. Savvy entrepreneurs have already wised up to this fact, and cruise lines and realtors are expanding their networks to include this tiny Caribbean island. Whether the motivation is expansion or exploitation, the end result is growth. The central problem, however, is that Roatan’s development is designed to serve tourists, and not necessarily islanders.
It is easy for a tourist to go straight from the airport to one of the many resorts on the island, thereby missing the communities that go without running water, the children that play in the dirt without shoes, and the thirteen year old girls with babies. I did not intend to talk about the sociopolitical issues on Roatán more than the medical ones, but I find it difficult for me to splice these elements into separate categories, as they are all so intertwined and all so crucial to the betterment of Roatán.
A self-sustaining method for improvement—one that equips Roatán’s people to serve the island’s needs—is necessary. People like Peggy help Roatán’s poor by working independent of the system, but the island needs an inherent system that does the job on its own. Right now, the Ministry of Health in Tegucigalpa reimburses 95% of Roatán’s medical expenses. Under ZOLITUR (Free Tourist Zone for the Bay Islands—a law that goes into effect within ten years), funds for healthcare will depend on how the budget for all social services is allotted. An Education Commission for the island was recently created. Likewise, a Healthcare Commission is needed to insure that a fair allotment of funds for medical services on the island.
But, I digress. My experience in clinic has been amazing, and I am already planning to return to the island for more intensive training during and after medical school. In the first week, I have regularly seen cases that would only occasionally appear in the United States. Malaria, scabies, and intestinal parasites no longer seem exotic. Just in the last four days, three children tested positive for falciparum – the most dangerous strain of malaria. I have been told that this many cases would have been rare five years ago. Next week I’ll talk more about the clinic and what I have been doing outside of clinic time.
Friday, October 20, 2006
Michael Journal 4
After my four and a half weeks in Roatan, I definitely feel like the experience has changed me in several ways. It was very refreshing to get away from the hustle and bustle of college pre-med life, where one must worry about classes, MCATs, extracurriculars, research, and applications – so many balls in the air in the simultaneous premed juggle. But down in Honduras, living with Peggy and the other medical volunteers, one is reminded of what medicine is really about – putting the wellbeing of patients above all else. The greatest happiness for all is not achieved by selfish pleasures, like sleeping in or spending an afternoon on the beach – but rather by the small sacrifices doctors make on whatever level (whether it’s Dr. Karina waking up two hours early to meet a patient at the ferry to hand off medical documents to bring to the mainland, or Dr. Patrick taking time off from his job in Phoenix and paying his way down here to see patients – a true medical volunteer), and if you have to get up early on a Saturday, call in a favor, or make a special house call in order to get a patient the best care, then so be it. In this sense, life in Roatan was simple indeed.
One question I’ve gotten many times, especially in the past few days, is whether I’d return to Roatan. What exactly do people mean by this? Was it just a general inquiry on my experience for the past month, or do they want to know whether I’ll bring my tourism dollars back to Roatan? Or are they asking about medical missionaries in general? I decided that I would definitely love to come back to Roatan – either as a medical volunteer or just as a tourist looking for some cheap diving. I could see myself living down there for a few months, maybe doing some volunteer work – I just don’t know when or how that’d fit into my life.
On the other hand, it seems to me that Roatan is in pretty good hands. Of course, the quality of life there will never be as great as it is in the United States, but the island is vitalized by the tourism money the resorts bring, and on some level this money trickles down. As I was there, it did not seem like what I imagined a “third-world country” to be in my head. It reminded me a lot of Taiwan, maybe a little bit poorer, but I’d classify it as a “second-world country,” if there is such a thing. Sometimes I’d ask whether or not Roatan would be as well off as it was if it wasn’t a tourist attraction, and sadly, I think it wouldn’t be. A lot of the volunteers and donors to the island first visited as tourists, and then decided that the island needed help and began to contribute. This is great and all, but it leaves one wondering about the undiscovered poverty in the world, in countries such as the Dominican Republic or Haiti, or in central Africa. Why does it take firsthand experience – a rich tourist driving by El Swampo – before they’re willing to help? What about all those countries that don’t have tourist attractions? Who is going to help them? This makes me want to look for other opportunities to volunteer in less fortunate countries.
Being in Roatan and seeing the disparity in wealth distribution also got me thinking about social injustice in the world. Right now, the government and various organizations are waging all sorts of wars for the supposed betterment of mankind – wars for democracy, wars against terrorism, battles against abortion, against stem cell research, for gay rights, against cancer, for battered women, for orphans, against HIV/AIDS, for immigration reform, for social security reform, just to name a few. Paul Farmer’s view as presented in Mountains Beyond Mountains seems to be that every single human being on the planet deserves a healthy mind and body, regardless of his or her socioeconomic and legal status. I think few people would dispute this, and if you subscribe to this belief, then we as the world have a lot of work to do. But in the list of problems with the world today, where does this directive land? As Americans, should our responsibility to feed, clothe, and care for every kid in Somalia take precedence over our own social issues? Organizations can spend thousands of manhours marching and fundraising to raise money for cancer, a disease that takes thousands of lives each year, many of them elderly, but millions of kids die every year of malnutrition or preventable diseases. The money used for cancer research would save many more lives per dollar if it was used to build bread ovens or buy cheap vaccines. But the difference is, in the United States we all have a friend, a relative, or an acquaintance who has died from or fought cancer. That makes the suffering that much more real. And likewise – how does one put a price on life? It’s not as if people in developing countries don’t get cancer either – it’s just that you can save more lives by treating the “easier” problems first. But how many lives in Honduras are worth one life in the United States? Thinking about this just makes me all the more appreciative of living in a developed nation and being born with such opportunities.
Finally, this whole experience made me appreciate donors more. Peggy began with seeing a few patients in her downstairs apartment – a humble service to the community – but through the generosity of various donors, will open a brand new clinic built from the ground up, complete with a lab and inpatient care (all it needs is a small operating room and she could call it El Hospital Esperanza). Of course I have the most respect for Peggy and her persistence, and the doctors and nurses who supported her from beginning to end, but after seeing her come home smiling every day when another donor moved her that much closer to making her clinic a reality, it made me realize that becoming a doctor isn’t the only way to directly help people – all it takes is the right intentions and means.
One question I’ve gotten many times, especially in the past few days, is whether I’d return to Roatan. What exactly do people mean by this? Was it just a general inquiry on my experience for the past month, or do they want to know whether I’ll bring my tourism dollars back to Roatan? Or are they asking about medical missionaries in general? I decided that I would definitely love to come back to Roatan – either as a medical volunteer or just as a tourist looking for some cheap diving. I could see myself living down there for a few months, maybe doing some volunteer work – I just don’t know when or how that’d fit into my life.
On the other hand, it seems to me that Roatan is in pretty good hands. Of course, the quality of life there will never be as great as it is in the United States, but the island is vitalized by the tourism money the resorts bring, and on some level this money trickles down. As I was there, it did not seem like what I imagined a “third-world country” to be in my head. It reminded me a lot of Taiwan, maybe a little bit poorer, but I’d classify it as a “second-world country,” if there is such a thing. Sometimes I’d ask whether or not Roatan would be as well off as it was if it wasn’t a tourist attraction, and sadly, I think it wouldn’t be. A lot of the volunteers and donors to the island first visited as tourists, and then decided that the island needed help and began to contribute. This is great and all, but it leaves one wondering about the undiscovered poverty in the world, in countries such as the Dominican Republic or Haiti, or in central Africa. Why does it take firsthand experience – a rich tourist driving by El Swampo – before they’re willing to help? What about all those countries that don’t have tourist attractions? Who is going to help them? This makes me want to look for other opportunities to volunteer in less fortunate countries.
Being in Roatan and seeing the disparity in wealth distribution also got me thinking about social injustice in the world. Right now, the government and various organizations are waging all sorts of wars for the supposed betterment of mankind – wars for democracy, wars against terrorism, battles against abortion, against stem cell research, for gay rights, against cancer, for battered women, for orphans, against HIV/AIDS, for immigration reform, for social security reform, just to name a few. Paul Farmer’s view as presented in Mountains Beyond Mountains seems to be that every single human being on the planet deserves a healthy mind and body, regardless of his or her socioeconomic and legal status. I think few people would dispute this, and if you subscribe to this belief, then we as the world have a lot of work to do. But in the list of problems with the world today, where does this directive land? As Americans, should our responsibility to feed, clothe, and care for every kid in Somalia take precedence over our own social issues? Organizations can spend thousands of manhours marching and fundraising to raise money for cancer, a disease that takes thousands of lives each year, many of them elderly, but millions of kids die every year of malnutrition or preventable diseases. The money used for cancer research would save many more lives per dollar if it was used to build bread ovens or buy cheap vaccines. But the difference is, in the United States we all have a friend, a relative, or an acquaintance who has died from or fought cancer. That makes the suffering that much more real. And likewise – how does one put a price on life? It’s not as if people in developing countries don’t get cancer either – it’s just that you can save more lives by treating the “easier” problems first. But how many lives in Honduras are worth one life in the United States? Thinking about this just makes me all the more appreciative of living in a developed nation and being born with such opportunities.
Finally, this whole experience made me appreciate donors more. Peggy began with seeing a few patients in her downstairs apartment – a humble service to the community – but through the generosity of various donors, will open a brand new clinic built from the ground up, complete with a lab and inpatient care (all it needs is a small operating room and she could call it El Hospital Esperanza). Of course I have the most respect for Peggy and her persistence, and the doctors and nurses who supported her from beginning to end, but after seeing her come home smiling every day when another donor moved her that much closer to making her clinic a reality, it made me realize that becoming a doctor isn’t the only way to directly help people – all it takes is the right intentions and means.
Thursday, September 14, 2006
Michael Journal 3
I’m very sad that the three-week milestone is already here. It’s hard for me to believe that I’ve been here for that long, just as it’s hard for me to believe that in a week and a half I’ll be back to the drudgery of university life.
My time here has been everything I expected and more. I’m getting to see so much more of Honduran culture than I’ve ever seen of any other culture when I’m traveling. I used to wonder what the appeal of traveling was to people – to me, it meant long hours on tour buses, smiling photos in front of obscure landmarks, and unfamiliar hotels. My month in Honduras has showed me what traveling is really about: taking the time to live and learn in a foreign location with different cultures, perspectives, and expectations. I’m glad that I’ve had the chance to interact with patients both in and out of the clinic and to see how they live. The population in Honduras, I’ve learned, is very courteous – a personality trait often lacking in California, where time and patience are in short supply. I’ve also had the chance to meet a lot of locals through church here, and I’ve learned that islanders are very religious people.
I’ve really enjoyed my work in the clinic. It’s really great to be able to help patients get the care they need. This week, one particularly complicated case involved rapidly spreading pneumonia – subsequent x-rays show a drastic diffusion of liquid through the lungs within a span of 3 days. I remember screening and admitting the patient, and I saw them again in the wards as I accompanied the doctors on rounds. I had to travel to Dixon Cove, about a 15 minute drive, to the Galaxy Ferry office to get them tickets, and hitchhiked back because I wasn’t able to get a taxi. I was just glad to be able to help them in their situation.
In my last two weekends here, I am determined to make the most of my time. Tomorrow, a group of 10 volunteers and American workers are going on a shark dive – that is, a dive where they feed the sharks right in front of you. The weekend after that – my last weekend – we plan on going to La Ceiba, the port city closest to Roatan. I’m excited to see other parts of Honduran culture; Roatan has a very distinctive island culture that is not completely representative of the mainland culture. I’ve also heard of a nearby island called Helena, which is a small undeveloped island of 900 people with no roads and no cars. Last week, at the Parrot Tree church, I met a group of medical workers who had built a clinic there and was serving the population there, which was essentially all the descendents of 5 slave families that had been left there a few generations ago. It sounded like a very different place, and I’m sad that I won’t have the time to visit the island before I leave.
My time here has been everything I expected and more. I’m getting to see so much more of Honduran culture than I’ve ever seen of any other culture when I’m traveling. I used to wonder what the appeal of traveling was to people – to me, it meant long hours on tour buses, smiling photos in front of obscure landmarks, and unfamiliar hotels. My month in Honduras has showed me what traveling is really about: taking the time to live and learn in a foreign location with different cultures, perspectives, and expectations. I’m glad that I’ve had the chance to interact with patients both in and out of the clinic and to see how they live. The population in Honduras, I’ve learned, is very courteous – a personality trait often lacking in California, where time and patience are in short supply. I’ve also had the chance to meet a lot of locals through church here, and I’ve learned that islanders are very religious people.
I’ve really enjoyed my work in the clinic. It’s really great to be able to help patients get the care they need. This week, one particularly complicated case involved rapidly spreading pneumonia – subsequent x-rays show a drastic diffusion of liquid through the lungs within a span of 3 days. I remember screening and admitting the patient, and I saw them again in the wards as I accompanied the doctors on rounds. I had to travel to Dixon Cove, about a 15 minute drive, to the Galaxy Ferry office to get them tickets, and hitchhiked back because I wasn’t able to get a taxi. I was just glad to be able to help them in their situation.
In my last two weekends here, I am determined to make the most of my time. Tomorrow, a group of 10 volunteers and American workers are going on a shark dive – that is, a dive where they feed the sharks right in front of you. The weekend after that – my last weekend – we plan on going to La Ceiba, the port city closest to Roatan. I’m excited to see other parts of Honduran culture; Roatan has a very distinctive island culture that is not completely representative of the mainland culture. I’ve also heard of a nearby island called Helena, which is a small undeveloped island of 900 people with no roads and no cars. Last week, at the Parrot Tree church, I met a group of medical workers who had built a clinic there and was serving the population there, which was essentially all the descendents of 5 slave families that had been left there a few generations ago. It sounded like a very different place, and I’m sad that I won’t have the time to visit the island before I leave.
Saturday, September 09, 2006
Michael Journal 2
Last week we went hiking through a barrio in Roatan called "La Colonia", which basically means "the settlement". La Colonia was created in 1998 during Hurricane Mitch when basically all the poorest islanders living on the shores of the island had their houses destroyed by the hurricane and fled up the hills to escape the water. Once the hurricane left, the people stayed and built their houses directly on the hillside. The problem was, they didn't own any of the land they'd built their houses on; it was owned privately by a Canadian. But they're still there today.
Since it's built into the hills, and since it was built so quickly, La Colonia has basically no infrastructure. As we hiked through the villages, we were taken up narrow and really steep dirt paths completely surrounded by tall grass, completely inaccessible by car, so anything the people needed had to be carried up by hand. The water is pumped up through PVC pipes that we saw above ground, and even then, the people only get running water 3-4 times per month. And there is no sewage system - which means that the sewage from the people at the top of the hill runs through the yards of the people at the bottom of the hill, creating a huge health hazard with GI diseases. This is especially a problem when there's no clean running water to begin with. I guess that's why a lot of the kids we see at the clinic are from La Colonia.
Anyway, here's La Colonia in pictures:
Built on the hillside
The locals we talked to insist that it's safe, even in the heaviest of rains
At the very top of the hill, where there was once a cellular tower, now destroyed. Doesn't look like it's going to be rebuilt any time soon.
Some cute kids we saw, doing chores I guess.
It doesn't take much to build a church.
I finally finished Mountains Beyond Mountains by Tracy Kidder. Everybody swears by this book, and gushes about Paul Farmer and how great a visionary and model he is and how he inspires you to want to change the world, and I can see his influence as they try to open new clinics in other parts of the island too. It's really inspiring to see such inspiration in other volunteers, but I wonder if I could ever lead the lifestyle that they or Paul Farmer lead - spend a few months in the States, and then fly out to wherever poor place to raise money, build your clinic, and see patients. A lot of the doctors/nurses here spend about a quarter to a half of their time here, and there's really no good reason not to when you could be helping so many people directly. One of the other volunteers asked me whether I’d ever come back. I’d definitely like to return again, preferably as a doctor (in 8 years when I’m done with my residency, if all goes to plan) so I can be more useful. It’s kind of frustrating working with all these other volunteers who are nurses and doctors and pharmacists who are helping out so much with Global Healing or Peggy’s Esperanza Clinic, and although I know I’m helping out too, I want to be able to help out more. Also, it seems like with all the tourism and diving, Roatan has attracted enough donors and volunteers that in 8 years, there will be enough clinics to serve the population – perhaps I should consider other destinations to help out, like other Latin American countries or some African countries.
Since it's built into the hills, and since it was built so quickly, La Colonia has basically no infrastructure. As we hiked through the villages, we were taken up narrow and really steep dirt paths completely surrounded by tall grass, completely inaccessible by car, so anything the people needed had to be carried up by hand. The water is pumped up through PVC pipes that we saw above ground, and even then, the people only get running water 3-4 times per month. And there is no sewage system - which means that the sewage from the people at the top of the hill runs through the yards of the people at the bottom of the hill, creating a huge health hazard with GI diseases. This is especially a problem when there's no clean running water to begin with. I guess that's why a lot of the kids we see at the clinic are from La Colonia.
Anyway, here's La Colonia in pictures:
Built on the hillside
The locals we talked to insist that it's safe, even in the heaviest of rains
At the very top of the hill, where there was once a cellular tower, now destroyed. Doesn't look like it's going to be rebuilt any time soon.
Some cute kids we saw, doing chores I guess.
It doesn't take much to build a church.
I finally finished Mountains Beyond Mountains by Tracy Kidder. Everybody swears by this book, and gushes about Paul Farmer and how great a visionary and model he is and how he inspires you to want to change the world, and I can see his influence as they try to open new clinics in other parts of the island too. It's really inspiring to see such inspiration in other volunteers, but I wonder if I could ever lead the lifestyle that they or Paul Farmer lead - spend a few months in the States, and then fly out to wherever poor place to raise money, build your clinic, and see patients. A lot of the doctors/nurses here spend about a quarter to a half of their time here, and there's really no good reason not to when you could be helping so many people directly. One of the other volunteers asked me whether I’d ever come back. I’d definitely like to return again, preferably as a doctor (in 8 years when I’m done with my residency, if all goes to plan) so I can be more useful. It’s kind of frustrating working with all these other volunteers who are nurses and doctors and pharmacists who are helping out so much with Global Healing or Peggy’s Esperanza Clinic, and although I know I’m helping out too, I want to be able to help out more. Also, it seems like with all the tourism and diving, Roatan has attracted enough donors and volunteers that in 8 years, there will be enough clinics to serve the population – perhaps I should consider other destinations to help out, like other Latin American countries or some African countries.
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