So this week has been going kind of slow, since the weather has been really nasty and rainy. On Monday, I saw the most malnourished baby that I have ever seen…definitely the sickest baby I have ever seen that has not been in the NICU. A mom brought in her 12 day old for a well baby check. She said the baby was born premature, at somewhere between 32-34 weeks, and was kept in the hospital for 2 days. She went to unwrap the baby, and I hae seen a lot, and it takes a lot to shock me, but I was absolutely shocked at the sight of this baby. It was tiny, with arms and legs skinnier than a pencil. It’s skin was all shriveled up, and it’s face looked like an old person…it almost looked like a mummy. I couldn’t believe this baby was still alive. I asked the mom if there were any problems, and she replied that there weren’t and that the baby was breastfeeding just fine. We undressed the baby, and I was honestly afraid to pick up this baby and put it on the scale, because I was afraid I would hurt her if I moved her. We put her on the scale, and she weighed 1.2 kilograms. She had weighed 1.5kg at birth, meaning she had lost 18% of her birthweight, which was already really low. Andrea saw her right away, and told the mom that she needed to be admitted. At first the mother refused, but Andrea told her flat out that the baby would die if she went home and continued like this. Both Dr. Gross and Andrea agreed that the baby should be in a NICU, but since no such thing exists here, they put her in an incubator in the pediatric ward. They wanted to give her an NG tube to get nutrition, but were unable to. Apparently the baby was so tiny that when they put the tube in, the baby became apneic, due to the tiny size of her tubes. They also tried to put an IV in, but the baby was so tiny and so dehyrated that they could not put one in anywhere. Instead, they ended up trying to syringe feed her orally, which is still what they are doing, until she is hydrated enough that they can get a line in. The most shocking thing about this situation was that the mother had a two year old child as well, but still had no idea that something was drastically wrong with her baby.
On Tuesday, we had a four year old girl come in today with a cyst on her eyelid, which she had for 2 years and which scratched and irritated her eye when she blinked. They were going to try to send her to the mainland to an opthamologist, which of course would be costly, but I remembered Peggy mentioning that she had an opthamologist coming down to her clinic in March. I called Peggy, and ended up taking all of this girl’s information, along with pictures of the eye to send to the opthamologist in the states. Hopefully, it will be something he can fix, and it will save her family a very costly trip to the mainland.
As of Thursday, they still had not put an NG tube into our malnorished baby, who had now been in the hospital for 4 days. Dr. Gross brought our baby scale into the ward, since they don’t have an accurate scale on the ward. He weighed the baby on our scale, and the baby still weighed 1.2 kg, exactly the same she had been 4 days ago. We had Peggy bring over a couple of NG tubes, since they said they didn’t have any at the hospital. That afternoon, Lydia put a tube in the baby, and the baby is already looking better.
Friday was pretty slow, probably because of the rain, and so we finished clinic early and spent time with Dr. Gross. He is leaving this weekend, which is really sad, because he is an amazing doctor and I learned so much from him. We all went out to dinner at Romeos in French Harbor, which was nice for his last Friday night. Next week will just be me, Andrea, and Lydia, so hopefully things won’t be too crazy.
Saturday, January 26, 2008
Wednesday, January 23, 2008
Becky Journal 3
This week was amazingly productive, and the Global Healing team has been working amazingly well together. The week started out on a sad note as we found out on Monday that the baby we had flown to San Pedro last week had died sometime over the weekend. The news came as a shock to all of us, since as of Friday we had been told that the baby had been placed on a ventilator in the NICU and was stable. We did not get any other information from the hospital in San Pedro, only that the baby had died. It was really dishearteartening, not only because we had worked so hard to help the baby, but because we all believed that this baby was through the toughest part. However, we all knew that we did all that we could have possibly done to make a difference for this baby.
On Monday, the hospital was on strike again, so we played the part of pediatric ER, taking all of the kids who were coming into the ER to be seen. It was pretty much the same as a normal clinic day, except that overall the kids were a little bit sicker. We took advantage of ending early on Monday to go through all of our supplies, inventory, clean, and make lists of needed supplies for the next people coming down. On Tuesday, things were back to normal. Wednesday was a crazy busy day. We had clinic as usual in the morning, and afterward, we had a lecture given by Dr. Dominguez, the orthopoedist. It was very interesting, and he was a great speaker. I was a little bit worried that I wouldn’t be able to understand everything since it was done in Spanish, but the lecture supplemented by power point was very clear and easy to understand. After the lecture, I went right over to Peggy’s clinic, as I had organized a screening up in the Colonia for that afternoon.
We all met at Peggy’s clinic and laded the truck with supplies, and headed up to the church. We weighed and took temperatures on all of the children, and did pressures and sugars on the adults. Then they all got a brief check-in with the doctors, and were given reference cards to come to the clinic if they needed to. I was not at Clinica Esperanza today since I was at the hospital, but apparently lots of people for La Colonia came after going to the screening. This was really encouraging, because after talking to some people in the Colonia, I have realized that many people do not know that Clinica Esperanza is free for those who can not pay. There is one family in the Colonia that I have visited with a few times, and after their screening the mother told me that she knew she should take her kids to the clinic, but she had 5 kids and did not have the money to take them. I told her it was not a problem if she was unable to pay, and her whole face lit up, and gave me a hug. She also told me that her father was sick and she would like to take him to the clinic, but that he was unable to walk down to the screening. I went with her up to the top of the Colonia to do a screening on him, and his pressure ended up being dangerously high. He was advised to go to the clinic the next and promised that he would. It was definitely a satisfying day, which was ended by a night dive in West Bay with Dr. Gross and a few of Peggy’s volunteers.
On Thursday, we were finished clinic by 11, and we all went with Dr. Prado over to the daycare center, where she was going to give de-parasite medication to all of the kids, because apparently a few of them had been vomiting worms. We set up a mini-clinic at the daycare, where we first weighed all of the kids, then calculated medication for each one, and each child got medicated. It was soo different from the US, where I could not imagine what would happen if someone came in and gave all of the kids medicine without parental persmission. The kids were all so good with taking the medication, and we had fun playing with them as well. On Friday, we also went to the daycare after clinic to give the kids their second dose of medication, and got to play with them some more. Then we all went to lunch in Coxen Hole, and went shoppping for fish. Friday night, we helped Dr. Gross cook a big dinner as a send off for a big group of volunteers that had been at Peggy’s clinic. It was a great week, and very productive as well…we have already seen over 200 patients this month! Next week is my last week with Dr. Gross and Andrea, though, which is sad.
On Monday, the hospital was on strike again, so we played the part of pediatric ER, taking all of the kids who were coming into the ER to be seen. It was pretty much the same as a normal clinic day, except that overall the kids were a little bit sicker. We took advantage of ending early on Monday to go through all of our supplies, inventory, clean, and make lists of needed supplies for the next people coming down. On Tuesday, things were back to normal. Wednesday was a crazy busy day. We had clinic as usual in the morning, and afterward, we had a lecture given by Dr. Dominguez, the orthopoedist. It was very interesting, and he was a great speaker. I was a little bit worried that I wouldn’t be able to understand everything since it was done in Spanish, but the lecture supplemented by power point was very clear and easy to understand. After the lecture, I went right over to Peggy’s clinic, as I had organized a screening up in the Colonia for that afternoon.
We all met at Peggy’s clinic and laded the truck with supplies, and headed up to the church. We weighed and took temperatures on all of the children, and did pressures and sugars on the adults. Then they all got a brief check-in with the doctors, and were given reference cards to come to the clinic if they needed to. I was not at Clinica Esperanza today since I was at the hospital, but apparently lots of people for La Colonia came after going to the screening. This was really encouraging, because after talking to some people in the Colonia, I have realized that many people do not know that Clinica Esperanza is free for those who can not pay. There is one family in the Colonia that I have visited with a few times, and after their screening the mother told me that she knew she should take her kids to the clinic, but she had 5 kids and did not have the money to take them. I told her it was not a problem if she was unable to pay, and her whole face lit up, and gave me a hug. She also told me that her father was sick and she would like to take him to the clinic, but that he was unable to walk down to the screening. I went with her up to the top of the Colonia to do a screening on him, and his pressure ended up being dangerously high. He was advised to go to the clinic the next and promised that he would. It was definitely a satisfying day, which was ended by a night dive in West Bay with Dr. Gross and a few of Peggy’s volunteers.
On Thursday, we were finished clinic by 11, and we all went with Dr. Prado over to the daycare center, where she was going to give de-parasite medication to all of the kids, because apparently a few of them had been vomiting worms. We set up a mini-clinic at the daycare, where we first weighed all of the kids, then calculated medication for each one, and each child got medicated. It was soo different from the US, where I could not imagine what would happen if someone came in and gave all of the kids medicine without parental persmission. The kids were all so good with taking the medication, and we had fun playing with them as well. On Friday, we also went to the daycare after clinic to give the kids their second dose of medication, and got to play with them some more. Then we all went to lunch in Coxen Hole, and went shoppping for fish. Friday night, we helped Dr. Gross cook a big dinner as a send off for a big group of volunteers that had been at Peggy’s clinic. It was a great week, and very productive as well…we have already seen over 200 patients this month! Next week is my last week with Dr. Gross and Andrea, though, which is sad.
Monday, January 14, 2008
Becky Journal 2
As of this week, Dr. Gross, Dr. Lee, and the new Honduran doctor, Dr. Prado, are all working in the clinic, and things have finally come together. It was a great week this week, and it was a good thing we had so many doctors, because we were really busy. I saw a lot of interesting cases this week, and also got to help out with getting a patient to the mainland, which was amazing. Monday through Wednesday, we had about 25-30 patients each day, so I was kept busy with triage, shadowing, and doing paperwork. We had one case which was a 3 week old baby girl that had supernumery digits hanging off of each of her pinkies, which Dr. Gross removed. I also saw a few abcesses drained, as well as all of the usual cases.
On Tuesday, when Dr. Gross and Dr. Lee came back from rounds, they were talking about a baby with a lung problem whose left lung had not expanded. On Wednesday, they took an x-ray and discovered that the baby’s left lung was either collapsed, filled with fluid, or not opening for another reason. The baby was 5 days old, and although she was breathing spontaneously, her oxygen saturation was very low, so she was being bagged by the nurses. On Wednesday night they got a call that the hospital had a ventilator that they wanted to put the baby on, but they did not know how to use it. We went to the hospitial and the doctors looked at the vent, which was an ancient piece of equipment that they had never seen before, aside from the fact that it was for adults. They determined that there was no way the the vent was usable, so they continued bagging the baby overnight. The baby was only being given IV fluids and no nutrition, and was in very poor shape. Dr. Gross decided that it would be best for the baby to be sent for the mainland. After researcheing, he decided that Cieba did not have the right resources for the child, and so she would have to go farther.
On Thursday during rounds, Dr. Gross talked to Dr. Jackie and got permission to fly the baby out. Around 10, they sent me to the airport to try to arrange a flight. After 3 hectic hours at the airport, I learned that commercial planes did not allow oxygen, and so we arranged for a charter flight to fly the baby to San Pedro. By 12:30, everything was arranged, and I met Dr. Lee and the baby at the airport. Dr. Gross had driven them in her car, with the baby in a small plastic tub, and Dr. Lee ventilating the whole way. The whole experience was pretty surreal. We were rushed through screening at the airport, with Dr. Lee and I holding the tub with the baby, who was being bagged. We then were loaded into a tiny little four person plane, no bigger than the size of a small car. The mom sat up front with the pilot, and Dr. Lee and I sat in the back, with the baby in the tub on our knees. We bagged the baby for the entire hour and a half flight, with Dr. Lee constantly checking the baby’s color and feeling for chest rise. We had no pulse oximeter, and the plane was so loud that she could not hear breath sounds,s o she relied on feeling for chest rise. As soon as we landed at San Pedro airport, there was an ambulance waiting, and they met us at the door. It was very comforting to see an ambulance with 2 paramedics and a doctor, as wel as neonatal equipment, moniters, and pulse oximeters. It made me feel very confident that we were getting this baby to a higher level of care. After getting the baby loaded and giving report, the baby’s mother, who spoke no English, came up to us and said “Bless you”. It was truly amazing. We flew back to Roatan, and still made it home in time for the crab races that night. We called the hospital the next day, and the baby had been put on a vent, but had still not been diagnosed, but we were told that there was a pulmonary neonatologist as well as 3 pediatric surgeons there, so we knew that the baby was in good hands. Dr. Lee is going to call again today to see how things are going. I have helped out with manny individual patient cases since I have been here, but this was definitely the most satisfying case that I have been involved with, as the baby surely would have died if we had not gotten her transferred right away.
Then, for a climactic end to the week, when we all came in on Friday, feeling exhilirated from the day before, there were no patients around, and the workers were all on strike. The doctors did their rounds, and then we decided to do some reorganizing and inventorying in the clinic. However, then a nurse from the ER came over and asked if we could see all of their pediatric cases since they were so busy, so we became the pediatric ER for the rest of the morning. We finished up around noon, and I headed to Peggy’s clinic, as I usually do. Their waiting room was still completely full, because all of the people that would have gone to the hospital ended up there. I called Dr. Gross and Dr. Lee to tell them I would be late for snorkeling, and twenty minutes later they both showed up at Peggy’s, and helped see patients to speed things up. We got finished quickly, and spent the rest of the day relaxing on the beach. Yesterday I went with Dr. Gross, Dr. Lee, and some of Peggy’s volunteers down to the east end of the island to Paya Bay. I had been there before, but it is absolutely gorgeous. We followed that up with a dinner at the view, whicih was a perfect end to a perfectly relazxing day.
On Tuesday, when Dr. Gross and Dr. Lee came back from rounds, they were talking about a baby with a lung problem whose left lung had not expanded. On Wednesday, they took an x-ray and discovered that the baby’s left lung was either collapsed, filled with fluid, or not opening for another reason. The baby was 5 days old, and although she was breathing spontaneously, her oxygen saturation was very low, so she was being bagged by the nurses. On Wednesday night they got a call that the hospital had a ventilator that they wanted to put the baby on, but they did not know how to use it. We went to the hospitial and the doctors looked at the vent, which was an ancient piece of equipment that they had never seen before, aside from the fact that it was for adults. They determined that there was no way the the vent was usable, so they continued bagging the baby overnight. The baby was only being given IV fluids and no nutrition, and was in very poor shape. Dr. Gross decided that it would be best for the baby to be sent for the mainland. After researcheing, he decided that Cieba did not have the right resources for the child, and so she would have to go farther.
On Thursday during rounds, Dr. Gross talked to Dr. Jackie and got permission to fly the baby out. Around 10, they sent me to the airport to try to arrange a flight. After 3 hectic hours at the airport, I learned that commercial planes did not allow oxygen, and so we arranged for a charter flight to fly the baby to San Pedro. By 12:30, everything was arranged, and I met Dr. Lee and the baby at the airport. Dr. Gross had driven them in her car, with the baby in a small plastic tub, and Dr. Lee ventilating the whole way. The whole experience was pretty surreal. We were rushed through screening at the airport, with Dr. Lee and I holding the tub with the baby, who was being bagged. We then were loaded into a tiny little four person plane, no bigger than the size of a small car. The mom sat up front with the pilot, and Dr. Lee and I sat in the back, with the baby in the tub on our knees. We bagged the baby for the entire hour and a half flight, with Dr. Lee constantly checking the baby’s color and feeling for chest rise. We had no pulse oximeter, and the plane was so loud that she could not hear breath sounds,s o she relied on feeling for chest rise. As soon as we landed at San Pedro airport, there was an ambulance waiting, and they met us at the door. It was very comforting to see an ambulance with 2 paramedics and a doctor, as wel as neonatal equipment, moniters, and pulse oximeters. It made me feel very confident that we were getting this baby to a higher level of care. After getting the baby loaded and giving report, the baby’s mother, who spoke no English, came up to us and said “Bless you”. It was truly amazing. We flew back to Roatan, and still made it home in time for the crab races that night. We called the hospital the next day, and the baby had been put on a vent, but had still not been diagnosed, but we were told that there was a pulmonary neonatologist as well as 3 pediatric surgeons there, so we knew that the baby was in good hands. Dr. Lee is going to call again today to see how things are going. I have helped out with manny individual patient cases since I have been here, but this was definitely the most satisfying case that I have been involved with, as the baby surely would have died if we had not gotten her transferred right away.
Then, for a climactic end to the week, when we all came in on Friday, feeling exhilirated from the day before, there were no patients around, and the workers were all on strike. The doctors did their rounds, and then we decided to do some reorganizing and inventorying in the clinic. However, then a nurse from the ER came over and asked if we could see all of their pediatric cases since they were so busy, so we became the pediatric ER for the rest of the morning. We finished up around noon, and I headed to Peggy’s clinic, as I usually do. Their waiting room was still completely full, because all of the people that would have gone to the hospital ended up there. I called Dr. Gross and Dr. Lee to tell them I would be late for snorkeling, and twenty minutes later they both showed up at Peggy’s, and helped see patients to speed things up. We got finished quickly, and spent the rest of the day relaxing on the beach. Yesterday I went with Dr. Gross, Dr. Lee, and some of Peggy’s volunteers down to the east end of the island to Paya Bay. I had been there before, but it is absolutely gorgeous. We followed that up with a dinner at the view, whicih was a perfect end to a perfectly relazxing day.
Sunday, December 16, 2007
Christine Journal 13
Max and I are in disbelief that this will be our second to last update, but it's been a wonderful past few months and we still have a week left, so we can't get too sad yet.
I had an interesting week in the hospital with Jenn and a social service doctor who is taking over for Dr. Charles as he takes two weeks of vacation time. The new social service doctor is not very communicative, so hasn't been all that helpful with special cases and such, but he's nice enough. It has really emphasized for me how important the Honduran fellow is to provide some kind of continuity and local knowledge to the clinic. Pediatricians coming for a month at a time just really can't do it on their own.
I was happy to see the Global Healing ultrasound put to good use this week. The ultrasound is huge and was donated a couple of months ago. It's been sitting in the corner of the clinic for that time without much use, as no one in the hospital is trained in reading ultrasounds. Additionally, we don't want to move it out of the clinic in case parts (or all) of it get stolen, as happened with the last one, apparently. Howard has been organizing a visit for a couple of radiologists and an ultrasound tech to come down in February and teach local doctors how to use it, which I think will be great. Hopefully then it will be put to good work! Anyway, the surgeon did come by to use it once this week on a woman she believed had gall stones, but she couldn't actually find any in the ultrasound. Jenn also used it twice - once on a boy she wanted to check for an inflamed kidney and another time on a boy's brain.
The second case was pretty interesting. It was a premature baby (born at about 7 months and 1600 grams) who had been in the clinic for weight checks every week since he was born. He was growing very slowly (was 1900 grams this past week), but Jenn was the first doctor to feel his head and realize that his sutures were completely open and his posterior fontanelle was also very large. He presented with a fever of 101.6 degrees, so Jenn wanted to put him on antibiotics and admit him for the fever before we worried about the sutures. She sent him to the ER and went back after about an hour to check on him, only to realize that the ER had not even started the antibiotics because they were "waiting for a bed to free up." She was very angry and frustrated that there seemed to be no thinking outside the box, especially since it should be fairly obvious that the baby needed to be on antibitics asap and could really be put on any surface to do so. Additionally, when the did finally clear out a bed from him, they didn't change the sheets in between patients.
After the antibiotics were administered, we brought the baby back into the clinic and did an ultrasound on the brain. He seems to have pretty severe hydrocephalus, and Jenn was able to send pictures we took of the screen to a neurologist in the US for a consult, which was great. I cannot even imagine how much more difficult international work like this was before the internet...
The hardest part for me of the whole encounter was having to explain to the mom what it was we were doing and that her son would not develop normally, resulting in lower intelligence, decreased motor function, etc. It just all came out of nowhere, since she'd been coming to check-ups with the clinic for a few weeks and no one had caught the hydrocephalus before.
Also this week, I started tutoring a local high school graduate to prepare her for the SAT, as she's hoping to go to the US for college next year. I had taken her to the test in La Ceiba about a month ago, but her scores were not as high as she had hoped, so she'll take it again in January. She's fun to work with and I'm hoping someone else will be able to take over after next week, although I doubt that will be a problem with all the volunteers that come through Peggy's house.
I had an interesting week in the hospital with Jenn and a social service doctor who is taking over for Dr. Charles as he takes two weeks of vacation time. The new social service doctor is not very communicative, so hasn't been all that helpful with special cases and such, but he's nice enough. It has really emphasized for me how important the Honduran fellow is to provide some kind of continuity and local knowledge to the clinic. Pediatricians coming for a month at a time just really can't do it on their own.
I was happy to see the Global Healing ultrasound put to good use this week. The ultrasound is huge and was donated a couple of months ago. It's been sitting in the corner of the clinic for that time without much use, as no one in the hospital is trained in reading ultrasounds. Additionally, we don't want to move it out of the clinic in case parts (or all) of it get stolen, as happened with the last one, apparently. Howard has been organizing a visit for a couple of radiologists and an ultrasound tech to come down in February and teach local doctors how to use it, which I think will be great. Hopefully then it will be put to good work! Anyway, the surgeon did come by to use it once this week on a woman she believed had gall stones, but she couldn't actually find any in the ultrasound. Jenn also used it twice - once on a boy she wanted to check for an inflamed kidney and another time on a boy's brain.
The second case was pretty interesting. It was a premature baby (born at about 7 months and 1600 grams) who had been in the clinic for weight checks every week since he was born. He was growing very slowly (was 1900 grams this past week), but Jenn was the first doctor to feel his head and realize that his sutures were completely open and his posterior fontanelle was also very large. He presented with a fever of 101.6 degrees, so Jenn wanted to put him on antibiotics and admit him for the fever before we worried about the sutures. She sent him to the ER and went back after about an hour to check on him, only to realize that the ER had not even started the antibiotics because they were "waiting for a bed to free up." She was very angry and frustrated that there seemed to be no thinking outside the box, especially since it should be fairly obvious that the baby needed to be on antibitics asap and could really be put on any surface to do so. Additionally, when the did finally clear out a bed from him, they didn't change the sheets in between patients.
After the antibiotics were administered, we brought the baby back into the clinic and did an ultrasound on the brain. He seems to have pretty severe hydrocephalus, and Jenn was able to send pictures we took of the screen to a neurologist in the US for a consult, which was great. I cannot even imagine how much more difficult international work like this was before the internet...
The hardest part for me of the whole encounter was having to explain to the mom what it was we were doing and that her son would not develop normally, resulting in lower intelligence, decreased motor function, etc. It just all came out of nowhere, since she'd been coming to check-ups with the clinic for a few weeks and no one had caught the hydrocephalus before.
Also this week, I started tutoring a local high school graduate to prepare her for the SAT, as she's hoping to go to the US for college next year. I had taken her to the test in La Ceiba about a month ago, but her scores were not as high as she had hoped, so she'll take it again in January. She's fun to work with and I'm hoping someone else will be able to take over after next week, although I doubt that will be a problem with all the volunteers that come through Peggy's house.
Max Journal 13
Today is the three-month anniversary of our arrival in Roatan and the beginning of our last week here. I have a lot to reflect on, and hopefully I'll be able to put some more of that into words for my last update at the end of the week.
I spent this week working in Peggy's Clinic, alternating between shadowing Dr. Raymond and running the pharmacy. With Raymond I had the opportunity to look in ears, auscultate lungs, listen for heart murmurs, and palpate abdomens. Working with Dr. Raymond is a great learning experience, but unfortunately I did not feel like I could contribute much to his work. I look forward to learning more about medicine in future study, but right now I am more interested in feeling like I am making a difference using the skills that I already have.
Monday brought a surprising number of bad ear infections with at least one ruptured timpanic membrane – a shocking sight. Tuesday seemed to have a lot of eye injuries, with at least two resulting from construction accidents. Eyes are incredible organs, and contemplating the extraction of small splinters from them is a scary prospect. Raymond mentioned that he looked forward to talking to a meeting of construction contractors to address the lack of effective personal protective equipment (specifically glasses/goggles) used by their employees. Occupational safety has never really sparked my interest, but I am inspired by the wholesome approach that Raymond takes to improving healthcare on the island, and I look forward to being able to use my knowledge and experiences as a professional to influence health-related business practices.
Friday brought another large shipment of mattresses and chairs from the Carnival Legend cruise ship. Despite all of the economic complexity that accompanies cruise ship tourism, I am impressed by Carnival's willingness to donate in bulk to Peggy's clinic. The cruise ship is a glaring symbol of the accomplishments of sophisticated modern technology to provide comfort to the wealthy. It's hard to imagine that this several-hundred million dollar luxury ship can dock within a mile of a public hospital providing primary health care to around 50,000 people without a functioning ventilator, ultrasound machine, CT scan, adequately equipped laboratory, or single narcotic drug. Despite all that glaring inequality, I have to say that the 100 mattresses donated in the last two weeks have been well received.
On Thursday and Friday, I returned to Peggy's clinic to do more of the same pharmacy work. It is reassuring to be able to exercise a practiced skill within the clinic to help people get drugs to make their lives more comfortable. The pharmacy seems to be more organized and effective than it was three months ago, and I hope that it continues to move further in that direction as we develop a more consistent inventory system that will hopefully ensure better stocking of necessary drugs. I was happy to hear that Peggy finally placed an order from one of the drug donation companies that Christine and I applied to on the clinic's behalf. The order supposedly contains tens of thousands of dollars of medications for Peggy's clinic and other medical facilities on the island, at a whopping $465 cost to the clinic simply for shipping and handling. I hope the shipment arrives relatively soon and bears as many drugs as promised.
The tutoring program that we ran at Children's Palace Bilingual School came to a close this week. We administered another diagnostic test and saw modest improvement in all of the tutees' test scores. Overall, I was pretty disappointed by the school's disinterest for the tutoring program. It is not the children's fault that they did not want extra math classes outside of school, but I plan on taking better account of community needs in the future. If nothing else, I enjoyed connecting with the students when they did show up, I had a great time getting to know the other tutors, and I like to think that I imparted a bit of knowledge through my two afternoons each week of teaching basic math. I don't think the kids are worse-off after taking the program, and maybe future tutoring projects can use some of the lessons that we've learned to be much more effective.
Yesterday we had a little goodbye party with food and friends at our apartment, and now we have just five short workdays before our return to the United States. I'll give another reflective update before the end, and I hope all is well as usual back home.
I spent this week working in Peggy's Clinic, alternating between shadowing Dr. Raymond and running the pharmacy. With Raymond I had the opportunity to look in ears, auscultate lungs, listen for heart murmurs, and palpate abdomens. Working with Dr. Raymond is a great learning experience, but unfortunately I did not feel like I could contribute much to his work. I look forward to learning more about medicine in future study, but right now I am more interested in feeling like I am making a difference using the skills that I already have.
Monday brought a surprising number of bad ear infections with at least one ruptured timpanic membrane – a shocking sight. Tuesday seemed to have a lot of eye injuries, with at least two resulting from construction accidents. Eyes are incredible organs, and contemplating the extraction of small splinters from them is a scary prospect. Raymond mentioned that he looked forward to talking to a meeting of construction contractors to address the lack of effective personal protective equipment (specifically glasses/goggles) used by their employees. Occupational safety has never really sparked my interest, but I am inspired by the wholesome approach that Raymond takes to improving healthcare on the island, and I look forward to being able to use my knowledge and experiences as a professional to influence health-related business practices.
Friday brought another large shipment of mattresses and chairs from the Carnival Legend cruise ship. Despite all of the economic complexity that accompanies cruise ship tourism, I am impressed by Carnival's willingness to donate in bulk to Peggy's clinic. The cruise ship is a glaring symbol of the accomplishments of sophisticated modern technology to provide comfort to the wealthy. It's hard to imagine that this several-hundred million dollar luxury ship can dock within a mile of a public hospital providing primary health care to around 50,000 people without a functioning ventilator, ultrasound machine, CT scan, adequately equipped laboratory, or single narcotic drug. Despite all that glaring inequality, I have to say that the 100 mattresses donated in the last two weeks have been well received.
On Thursday and Friday, I returned to Peggy's clinic to do more of the same pharmacy work. It is reassuring to be able to exercise a practiced skill within the clinic to help people get drugs to make their lives more comfortable. The pharmacy seems to be more organized and effective than it was three months ago, and I hope that it continues to move further in that direction as we develop a more consistent inventory system that will hopefully ensure better stocking of necessary drugs. I was happy to hear that Peggy finally placed an order from one of the drug donation companies that Christine and I applied to on the clinic's behalf. The order supposedly contains tens of thousands of dollars of medications for Peggy's clinic and other medical facilities on the island, at a whopping $465 cost to the clinic simply for shipping and handling. I hope the shipment arrives relatively soon and bears as many drugs as promised.
The tutoring program that we ran at Children's Palace Bilingual School came to a close this week. We administered another diagnostic test and saw modest improvement in all of the tutees' test scores. Overall, I was pretty disappointed by the school's disinterest for the tutoring program. It is not the children's fault that they did not want extra math classes outside of school, but I plan on taking better account of community needs in the future. If nothing else, I enjoyed connecting with the students when they did show up, I had a great time getting to know the other tutors, and I like to think that I imparted a bit of knowledge through my two afternoons each week of teaching basic math. I don't think the kids are worse-off after taking the program, and maybe future tutoring projects can use some of the lessons that we've learned to be much more effective.
Yesterday we had a little goodbye party with food and friends at our apartment, and now we have just five short workdays before our return to the United States. I'll give another reflective update before the end, and I hope all is well as usual back home.
Sunday, December 09, 2007
Christine Journal 12
I was happy to be back in clinic for the end of next week after my trip to the mainland. We were pretty busy, as Dr. Jackie was not in her clinic, but Drs. Jennifer and Sarah were both comfortable with most things, so it went relatively quickly. We did have a little trouble again with Dr. Charles coming in late, and had to figure out on our own how to deal with a child with a 104 degree fever and possible dengue, malaria, bad viral infection, or early stages of appendicitis. After talking with the staff at the lab, I learned that there is no lab for dengue at the public hospital. I have no idea how expensive or complicated it is to test for, but it seems like something they would probably test for often and I was surprised they did not have the equipment to test for it. We were able to get a malaria smear and CBC, though, but the patient never came back with the results. Hopefully the child will be okay.
Sarah left on Friday and Dr. Charles is taking the next couple of weeks as vacation, so it will be me, Jenn, and a social service doctor in the clinic for a while. I hope it all goes smoothly with the new social service doctor.
As Max mentioned, we helped out at the Concert for the Angels on Thursday afternoon. Peggy had brought a number of patients and their families to the event, so we got to hang out with them, which was fun. It was definitely a different side of the island than I'm used to working with and a little bit ridiculous, but it raised a lot of much needed money!
I helped Peggy and some other volunteers clean out the pharmacy shelves on Saturday, and we were able to send a bunch of meds to a doctor working on the mainland. It still amazes me how much Peggy shares with different people, knowing who will need what and getting it to them.
Sarah left on Friday and Dr. Charles is taking the next couple of weeks as vacation, so it will be me, Jenn, and a social service doctor in the clinic for a while. I hope it all goes smoothly with the new social service doctor.
As Max mentioned, we helped out at the Concert for the Angels on Thursday afternoon. Peggy had brought a number of patients and their families to the event, so we got to hang out with them, which was fun. It was definitely a different side of the island than I'm used to working with and a little bit ridiculous, but it raised a lot of much needed money!
I helped Peggy and some other volunteers clean out the pharmacy shelves on Saturday, and we were able to send a bunch of meds to a doctor working on the mainland. It still amazes me how much Peggy shares with different people, knowing who will need what and getting it to them.
Max Journal 12
I had a good week full of visitors and business in the clinics. I started the week in Global Healing working with Jen and Charles as Sara wrapped her trip to the mainland. The father of our previous week's ranula patient returned to tell us that his son had been in the Woods Medical Center all weekend being treated with antibiotics. If this is true and the swelling truly went down, then the Global Healing doctor's diagnosis seems unlikely, but we just emphasized the importance of traveling to the mainland for a specialist's attention. I always have to remind myself that some physicians' opinions, put forth with great confidence, are nonetheless wrong.
On Tuesday we had very few patients and I was able to leave the Global Healing clinic early to run some errands. On Tuesday evening Christine returned from a somewhat disappointing trip to the mainland with a patient.
On Wednesday I faced the cruise ship security forces once again to pick up a large donation of used mattresses.
Thursday and Friday I spent in the clinic, doing mostly pharmacy work.
I did my best to coordinate the transportation of three of Peggy's patients to visit an American cardiac brigade in San Pedro Sula. They departed on Saturday morning and I haven't heard from them since they were supposed to have arrived, so I hope that all went well.
On Tuesday afternoon I returned to tutor at the bilingual school and was disappointed that no students came. I was quickly reminded of the uselessness of providing a community service that isn't desired by a community. On Thursday afternoon Christine and I helped set up for a fundraiser in the Roatan airport. The event was a success, and it was humorous to see so many wealthy people putting on fancy shoes in the name of poor islanders' health.
I also dropped an injured bird off at a nature reserve on Peggy's request.
I am getting ready for my departure from this island, and I look forward to a few more quiet days enjoying the scenery before I leave.
On Tuesday we had very few patients and I was able to leave the Global Healing clinic early to run some errands. On Tuesday evening Christine returned from a somewhat disappointing trip to the mainland with a patient.
On Wednesday I faced the cruise ship security forces once again to pick up a large donation of used mattresses.
Thursday and Friday I spent in the clinic, doing mostly pharmacy work.
I did my best to coordinate the transportation of three of Peggy's patients to visit an American cardiac brigade in San Pedro Sula. They departed on Saturday morning and I haven't heard from them since they were supposed to have arrived, so I hope that all went well.
On Tuesday afternoon I returned to tutor at the bilingual school and was disappointed that no students came. I was quickly reminded of the uselessness of providing a community service that isn't desired by a community. On Thursday afternoon Christine and I helped set up for a fundraiser in the Roatan airport. The event was a success, and it was humorous to see so many wealthy people putting on fancy shoes in the name of poor islanders' health.
I also dropped an injured bird off at a nature reserve on Peggy's request.
I am getting ready for my departure from this island, and I look forward to a few more quiet days enjoying the scenery before I leave.
Sunday, December 02, 2007
Christine Journal 11
Once again, my update schedule was thrown off this week, as I was traveling until Tuesday night.
I had a wonderful trip with my family and was very happy that I got the opportunity to see the mainland with them. We spent a few days in a lodge at Pico Bonito by La Ceiba. The staff there was all Honduran and we had them pretty much to ourselves, as there weren't any other tourists there, and it was really interesting to spend time with them. Our guide was a native of the Mosquito coast and his knowledge of the rainforest was incredible. It was great to learn from him about all different uses of plants and animals. It just really brings to life the importance of conserving lands that are being cut down so rapidly now.
The trip to El Progreso, take two, was once again a let down. I went with Jessica and Neri, the patient and mother I took about a month ago because of her scratched corneas. The clinic had a visiting plastic surgeon who was going to operate on her eyelids so that her eyelashes no longer scratched against the cornea, but the surgery was canceled when she had a cold and thus couldn't undergo general anesthesia. I really wished someone had warned us about that ahead of time, as it was a long trip for the mother and daughter to make. The clinic said we'd have to wait until the next plastic surgeon came, which could be another six months. They normally get two a year, but don't yet have next year's schedule. Since it's such a time-sensitive procedure, though, I'm hoping to find somewhere else she can go to sooner. It's just really important in the future that we get the patients cleared for surgery by the pediatricians here before we send to the mainland, even if we're not sure that they will get operated on. The clinic was going to have us visit a pediatrician there before the surgery for approval before they realized that Jessica had a cold, which could have been complicated, as we didn't know any doctors there.
It was also interesting to see the clinic's way of charging for surgeries. They take the patient into a private room and go through a number of questions to see the economic state of the patient. For example, they asked whether she owned land or a house, whether she had electricity or running water, and how much she spent a week on food. I was with her at the time, and did say that the clinic would be helping with the price of surgery, but other than that all her answers clearly showed that she didn't have much extra money to spend on the care. The price of the surgery still came out at $150 dollars, clearly way out of her price range. I know that the surgeries are incredibly expensive, but I'm wondering about how patients are able to pay for them. The clinic is a non-profit started by Americans to help poor Hondurans with medical care, and I just found it very surprising that they'd still charge someone like the patient I was with 150 dollars. Maybe it was because I was there, but I really hope that other people who can't afford to pay that much don't get turned away.
I had a wonderful trip with my family and was very happy that I got the opportunity to see the mainland with them. We spent a few days in a lodge at Pico Bonito by La Ceiba. The staff there was all Honduran and we had them pretty much to ourselves, as there weren't any other tourists there, and it was really interesting to spend time with them. Our guide was a native of the Mosquito coast and his knowledge of the rainforest was incredible. It was great to learn from him about all different uses of plants and animals. It just really brings to life the importance of conserving lands that are being cut down so rapidly now.
The trip to El Progreso, take two, was once again a let down. I went with Jessica and Neri, the patient and mother I took about a month ago because of her scratched corneas. The clinic had a visiting plastic surgeon who was going to operate on her eyelids so that her eyelashes no longer scratched against the cornea, but the surgery was canceled when she had a cold and thus couldn't undergo general anesthesia. I really wished someone had warned us about that ahead of time, as it was a long trip for the mother and daughter to make. The clinic said we'd have to wait until the next plastic surgeon came, which could be another six months. They normally get two a year, but don't yet have next year's schedule. Since it's such a time-sensitive procedure, though, I'm hoping to find somewhere else she can go to sooner. It's just really important in the future that we get the patients cleared for surgery by the pediatricians here before we send to the mainland, even if we're not sure that they will get operated on. The clinic was going to have us visit a pediatrician there before the surgery for approval before they realized that Jessica had a cold, which could have been complicated, as we didn't know any doctors there.
It was also interesting to see the clinic's way of charging for surgeries. They take the patient into a private room and go through a number of questions to see the economic state of the patient. For example, they asked whether she owned land or a house, whether she had electricity or running water, and how much she spent a week on food. I was with her at the time, and did say that the clinic would be helping with the price of surgery, but other than that all her answers clearly showed that she didn't have much extra money to spend on the care. The price of the surgery still came out at $150 dollars, clearly way out of her price range. I know that the surgeries are incredibly expensive, but I'm wondering about how patients are able to pay for them. The clinic is a non-profit started by Americans to help poor Hondurans with medical care, and I just found it very surprising that they'd still charge someone like the patient I was with 150 dollars. Maybe it was because I was there, but I really hope that other people who can't afford to pay that much don't get turned away.
Max Journal 11
I've had a good week here in Roatan, so I hope you've had a good week back in the States. I began the week showing my girlfriend, Maya, the ropes in Peggy's pharmacy, which was fun as it added a slightly "new dimension" to our relationship. Work in the pharmacy is going well, although I am definitely a lot less inspired when I cannot interact with patients every day. Tuesday was another day of working in the pharmacy, and it brought a rude surprise when I realized that I had been entering data wrongly into the computerized inventory system for the last two months. The inventory system is still very new and lacks a few key features (like a way to view the actual inventory of any given drug), but we have been making an effort to accurately input data from every prescription filled for the last few months. When I realized that use of the inventory was very inconsistent, I became a little frustrated at the effort that we had put into the system. Although we will not be able to calculate the inventory of drugs in the pharmacy at any given time, the data for which drugs have been given out over the course of the last few months should still be fairly accurate, so all is not lost, but this error was a bit of a blow. I am realizing now that Peggy's Clinic is in the middle of a very important phase of its development as it formalizes a lot of the systems that it has depended on in the last seven years. Everything from the pharmacy inventory to the clinic's financial bookkeeping is now more important than ever, and where a lot of "under the table" jobs worked fine up until now, those jobs will have to come into the light of day in very transparent ways for the Clinic to continue to grow. I hope that I can help in some of this transition.
From Wednesday until Friday I greatly enjoyed going back to work in the Global Healing Clinic while Christine took a short vacation with her family. The clinic is a lot busier now than it was when I worked there before. For the last two months the clinic has been staffed by just one or two doctors, so the current staffing of three doctors seems very busy. Coincidentally our patient load seems to have increased, so I'm happy that we have so many doctors attending all of these patients. I have also really enjoyed being able to interpret for Sara because that brings me in a lot closer contact with the medical care that our clinic is actually delivering. While it can be a little stressful sometimes to triage all of the patients and translate for Sara, I am constantly reminded of why I came here to Honduras.
One interesting case of the week was a ~1 year old boy that came into the clinic with a ranula. During triage I weighed the boy and was surprised to see that he weighed only 17 lbs because he looked like a big chubby baby, but then I realized that he was not really fat at all, he just had a drastically swollen head and neck. Dr. Jennifer diagnosed the boy as having a blocked sublingual salivary duct that was causing the saliva to build up in the salivary gland and in the tissue around the boy's neck and jaw. I was surprised that the boy had no difficulty breathing, but he was already unable to eat and needed urgent corrective surgery before the condition worsened to block his airway. We sent him to seek care in San Pedro Sula because the hospital surgeon was not comfortable with such an unusual surgery, but I was confident that the patient would get the care he needed because I knew that his father works for the municipality and therefore has "social security," a form of government health insurance. Although I was disappointed that the public health system that cares for the Honduran poor could not solve this patient's problem, I was quickly reminded of how familiar this situation is to the American medical system. I have to acknowledge that although Honduras has a national health system that aims to protect each person's right to medical care, the Honduran government is not really able to guarantee that right. Alongside that I acknowledge that the United States government officially recognizes very few "rights" concerning medical care, despite the fact that the US has many more resources at its disposal than the Honduran Ministry of Health. Of course I recognize a far bit more complexity in the situation than I mention here, but the situation is nonetheless worth verbally acknowledging.
From Wednesday until Friday I greatly enjoyed going back to work in the Global Healing Clinic while Christine took a short vacation with her family. The clinic is a lot busier now than it was when I worked there before. For the last two months the clinic has been staffed by just one or two doctors, so the current staffing of three doctors seems very busy. Coincidentally our patient load seems to have increased, so I'm happy that we have so many doctors attending all of these patients. I have also really enjoyed being able to interpret for Sara because that brings me in a lot closer contact with the medical care that our clinic is actually delivering. While it can be a little stressful sometimes to triage all of the patients and translate for Sara, I am constantly reminded of why I came here to Honduras.
One interesting case of the week was a ~1 year old boy that came into the clinic with a ranula. During triage I weighed the boy and was surprised to see that he weighed only 17 lbs because he looked like a big chubby baby, but then I realized that he was not really fat at all, he just had a drastically swollen head and neck. Dr. Jennifer diagnosed the boy as having a blocked sublingual salivary duct that was causing the saliva to build up in the salivary gland and in the tissue around the boy's neck and jaw. I was surprised that the boy had no difficulty breathing, but he was already unable to eat and needed urgent corrective surgery before the condition worsened to block his airway. We sent him to seek care in San Pedro Sula because the hospital surgeon was not comfortable with such an unusual surgery, but I was confident that the patient would get the care he needed because I knew that his father works for the municipality and therefore has "social security," a form of government health insurance. Although I was disappointed that the public health system that cares for the Honduran poor could not solve this patient's problem, I was quickly reminded of how familiar this situation is to the American medical system. I have to acknowledge that although Honduras has a national health system that aims to protect each person's right to medical care, the Honduran government is not really able to guarantee that right. Alongside that I acknowledge that the United States government officially recognizes very few "rights" concerning medical care, despite the fact that the US has many more resources at its disposal than the Honduran Ministry of Health. Of course I recognize a far bit more complexity in the situation than I mention here, but the situation is nonetheless worth verbally acknowledging.
Sunday, November 25, 2007
Max Journal 10
This week has been a bit of a vacation for me as I've had two visitors from the US to entertain. I worked at Peggy's both Monday and Tuesday mostly in the pharmacy filling prescriptions. I'm feeling much more confident in that job as I get to know the organization of the pharmacy and the uses of most of the drugs. I have had a Canadian nurse's aide helping me in the pharmacy, and it has reminded me of how hard it is to utilize short-term unskilled volunteers. She helps me count pills and enter some information in the inventory, but really she mostly just reminds me of how amazing Peggy is to be able to
utilize so many people so graciously when a lot of them really just create more work for her.
On Monday, the psoriasis patient from several weeks ago returned to the clinic looking much better, and I took him down to Peggy's to clean off (this time he was able to shower himself). I was happy to see that he returned when told to and his skin was much better than when I first saw him, but I could tell that he hadn't bathed in days and was probably not going to be able to bathe in the sea as instructed to keep his skin clean, moist, and exfoliated.
I took Wednesday and Thursday off, which worked nicely because Peggy's clinic is always closed on Wednesdays and was closed this Thursday for Thanksgiving. Friday was a pretty normal day filling prescriptions in the pharmacy. I don't think I will ever be a professional pharmacist, but for the time being I do enjoy learning about the drugs.
Outside of clinic hours I have done a few work-related things. On Wednesday I stopped by Los Fuertes with my dad and girlfriend to look for a deaf girl that should receive a hearing aid next week. We had a vague address (above the Adventist Church) and two different names (neither of which was correct) to look for in Los Fuertes, but it ended up being a fun little search. I think especially having my father there helped lend a fresh perspective on the situation; recognizing that tracking someone down in the United States would proceed much differently than here. We found the girl without much trouble and gave her the necessary information, and I felt good about being able to navigate Honduran society to complete at least very
basic messenger tasks.
I have also been chauffeuring a lot of people back and forth around town, which I am happy to do, but I do worry a little bit about the liability involved. I feel comfortable driving on the streets, but I fear that it is just a matter of time before some driver makes a poor decision resulting in an accident. I know that in terms of safety, my driving is probably just as safe as if not more safe than other peoples', but I do feel a slight burden of responsibility being the regular designated driver.
I spent most of my Sunday at Peggy's clinic inventorying new medications that just arrived in a big shipment from the US, which was fun. My girlfriend, Maya , will be taking over for me in Peggy's pharmacy next week as I go back to the Global Healing clinic while Christine visits the mainland, so this afternoon was a good opportunity for Maya to get to know the clinic outside of regular business hours.
Our tutoring project is not going well because the students have not been showing up. Tomorrow we hope to meet with the students and maybe the principal to ask how else we could structure the tutoring to be less of a burden on the students, but I am disappointed that we will not be able to conclude the curricula that we began.
In addition to clinic work this week, I've had a wonderful time hanging out with my visitors and getting to know some of Christine's visitors. We've eaten tasty Indian food, toured Oak Ridge by water taxi, scuba-dived with turtles, had a proper Thanksgiving feast, and fished real "island style." This all makes me realize very clearly how "social tourism" or "voluntourism" can really work to many organizations' advantages, and how non-profits in less picturesque locations have a lot of unique challenges.
utilize so many people so graciously when a lot of them really just create more work for her.
On Monday, the psoriasis patient from several weeks ago returned to the clinic looking much better, and I took him down to Peggy's to clean off (this time he was able to shower himself). I was happy to see that he returned when told to and his skin was much better than when I first saw him, but I could tell that he hadn't bathed in days and was probably not going to be able to bathe in the sea as instructed to keep his skin clean, moist, and exfoliated.
I took Wednesday and Thursday off, which worked nicely because Peggy's clinic is always closed on Wednesdays and was closed this Thursday for Thanksgiving. Friday was a pretty normal day filling prescriptions in the pharmacy. I don't think I will ever be a professional pharmacist, but for the time being I do enjoy learning about the drugs.
Outside of clinic hours I have done a few work-related things. On Wednesday I stopped by Los Fuertes with my dad and girlfriend to look for a deaf girl that should receive a hearing aid next week. We had a vague address (above the Adventist Church) and two different names (neither of which was correct) to look for in Los Fuertes, but it ended up being a fun little search. I think especially having my father there helped lend a fresh perspective on the situation; recognizing that tracking someone down in the United States would proceed much differently than here. We found the girl without much trouble and gave her the necessary information, and I felt good about being able to navigate Honduran society to complete at least very
basic messenger tasks.
I have also been chauffeuring a lot of people back and forth around town, which I am happy to do, but I do worry a little bit about the liability involved. I feel comfortable driving on the streets, but I fear that it is just a matter of time before some driver makes a poor decision resulting in an accident. I know that in terms of safety, my driving is probably just as safe as if not more safe than other peoples', but I do feel a slight burden of responsibility being the regular designated driver.
I spent most of my Sunday at Peggy's clinic inventorying new medications that just arrived in a big shipment from the US, which was fun. My girlfriend, Maya , will be taking over for me in Peggy's pharmacy next week as I go back to the Global Healing clinic while Christine visits the mainland, so this afternoon was a good opportunity for Maya to get to know the clinic outside of regular business hours.
Our tutoring project is not going well because the students have not been showing up. Tomorrow we hope to meet with the students and maybe the principal to ask how else we could structure the tutoring to be less of a burden on the students, but I am disappointed that we will not be able to conclude the curricula that we began.
In addition to clinic work this week, I've had a wonderful time hanging out with my visitors and getting to know some of Christine's visitors. We've eaten tasty Indian food, toured Oak Ridge by water taxi, scuba-dived with turtles, had a proper Thanksgiving feast, and fished real "island style." This all makes me realize very clearly how "social tourism" or "voluntourism" can really work to many organizations' advantages, and how non-profits in less picturesque locations have a lot of unique challenges.
Christine Journal 10
Things are going well down here, and we've been having a lot of visitors, which is always fun. Max's dad and girlfriend were here last week, and my mom and sister just came this past weekend. My family will just be here a few days and then is going to the La Ceiba area and Copan ruinas, and I wanted to check with you guys whether it would be okay if I accompanied them a couple of days in Ceiba. I would be out of the clinic on Thursday and Friday of this week, and Peggy has said it's fine if Max leaves her clinic to work in the Global Healing one so there's still an intern there. I'd also be gone the early part of the next week with Jessica and Neri, the patient and mother I took to El Progreso a few weeks ago, to see if we can get Jessica plastic surgery at the clinic in El Progreso. Let me know if it would be okay for me to take those two days to travel a bit with my family, as I completely understand that I have committed to the internship and that it might not be okay to take the time off.
This week was a little crazy in the hospital on Monday and Tuesday, as we saw 23 patients (!) on Monday and quite a few on Tuesday. It then slowed down quite dramatically, as we saw four on Wednesday and about three on Thursday. Friday we were back to about twelve, so it was quite different day-to-day. At the beginning of the week, the social service doctor was still here and kind of in-and-out, so Dr. Normandin was seeing most of the patients and it was fairly overwhelming for her. I've been interpreting too, as she's still learning Spanish, so I'm always busy between interpreting and triaging. I'm loving all the time I get to spend with her and the patients, though! And she's heard me give the same schpeal about viral URIs in Spanish that's she's about ready to give one herself.
Dr. Normandin, Peggy, and I went up to visit a patient in La Colonia on Wednesday that really helped put these hospital visits for URIs in perspective, though. The lengths that some of the patients have to go to in order to get to the hospital (especially when it's rained and the roads have turned to mud) are incredible, so even if the kid really does just have a cold, it's really important to still spend time with the family and give them something (like vitamins) to walk away with. The patient that we were visiting lived at the very top of La Colonia, and we were practically rock climbing up the slope to his house. It was a 9-year-old with an end-stage abdominal tumor with inguinal metastasis who had been through a number of courses of chemo on the mainland. He probably weighed 10-15 kilos and often didn't eat because of the pain. We're going to try to get something to ease his pain, and the family seemed really appreciative that we had come to their house to visit them. It was a pretty emotional visit and was hard to see a family living on nearly nothing who had to care for a dying son.
Dr. Charles came back from his trip to Tegucigalpa applying for a new job, and things are back to normal (or as normal as they get) in the hospital. We had the internal medicine doctor give the lunch time talk this week, and Dr. Normandin will have one prepared for this coming week. A new doctor (Dr. Jennifer Cohen) came in on Saturday, so I cleared up the third examining room (or more like section) for her to use, which was a bit tough with the ultrasound machine we still have waiting for someone to be able to use and move to a place where it will be safe.
The math tutoring project seems to be needing a new direction. We went on Tuesday to, again, find all the students had gone home because they had too much work. After speaking with the school's director about how holiday season was especially hard for students with exams and other projects, we decided that we needed to reassess the tutoring sessions and how to best help the students. I think that it's hard for the students to really see how this directly benefits what they're learning in math, as a lot of what we're teaching really does give them the foundation for what they're doing, but it's not so obvious how it helps them with algebra or geometry homework. So, it was disappointing to see no one there again, but we're hoping to meet with them tomorrow to talk about a direction to go with the tutoring and see how we can best be of help.
Thanksgiving was really nice - we had a fun, eclectic group of people for dinner at Dr. Patrick's house. We did potluck style, too, and had all of the Thanksgiving essentials! Everything was delicious and the company was great - volunteers with Peggy and Global Healing, Dr. Raymond and Dr. Charles, Joe Soloman (the chief of police), etc.
This week was a little crazy in the hospital on Monday and Tuesday, as we saw 23 patients (!) on Monday and quite a few on Tuesday. It then slowed down quite dramatically, as we saw four on Wednesday and about three on Thursday. Friday we were back to about twelve, so it was quite different day-to-day. At the beginning of the week, the social service doctor was still here and kind of in-and-out, so Dr. Normandin was seeing most of the patients and it was fairly overwhelming for her. I've been interpreting too, as she's still learning Spanish, so I'm always busy between interpreting and triaging. I'm loving all the time I get to spend with her and the patients, though! And she's heard me give the same schpeal about viral URIs in Spanish that's she's about ready to give one herself.
Dr. Normandin, Peggy, and I went up to visit a patient in La Colonia on Wednesday that really helped put these hospital visits for URIs in perspective, though. The lengths that some of the patients have to go to in order to get to the hospital (especially when it's rained and the roads have turned to mud) are incredible, so even if the kid really does just have a cold, it's really important to still spend time with the family and give them something (like vitamins) to walk away with. The patient that we were visiting lived at the very top of La Colonia, and we were practically rock climbing up the slope to his house. It was a 9-year-old with an end-stage abdominal tumor with inguinal metastasis who had been through a number of courses of chemo on the mainland. He probably weighed 10-15 kilos and often didn't eat because of the pain. We're going to try to get something to ease his pain, and the family seemed really appreciative that we had come to their house to visit them. It was a pretty emotional visit and was hard to see a family living on nearly nothing who had to care for a dying son.
Dr. Charles came back from his trip to Tegucigalpa applying for a new job, and things are back to normal (or as normal as they get) in the hospital. We had the internal medicine doctor give the lunch time talk this week, and Dr. Normandin will have one prepared for this coming week. A new doctor (Dr. Jennifer Cohen) came in on Saturday, so I cleared up the third examining room (or more like section) for her to use, which was a bit tough with the ultrasound machine we still have waiting for someone to be able to use and move to a place where it will be safe.
The math tutoring project seems to be needing a new direction. We went on Tuesday to, again, find all the students had gone home because they had too much work. After speaking with the school's director about how holiday season was especially hard for students with exams and other projects, we decided that we needed to reassess the tutoring sessions and how to best help the students. I think that it's hard for the students to really see how this directly benefits what they're learning in math, as a lot of what we're teaching really does give them the foundation for what they're doing, but it's not so obvious how it helps them with algebra or geometry homework. So, it was disappointing to see no one there again, but we're hoping to meet with them tomorrow to talk about a direction to go with the tutoring and see how we can best be of help.
Thanksgiving was really nice - we had a fun, eclectic group of people for dinner at Dr. Patrick's house. We did potluck style, too, and had all of the Thanksgiving essentials! Everything was delicious and the company was great - volunteers with Peggy and Global Healing, Dr. Raymond and Dr. Charles, Joe Soloman (the chief of police), etc.
Sunday, November 18, 2007
Christine Journal 9
As Max wrote, we have now switched work places, and I'll be in the RVPC for the next few weeks. It's crazy how fast our time is passing, and it's been fun to see so many volunteers come and go. I'm so impressed by Peggy's ability to be so welcoming to each person who comes through when there are so, so many.
I've been enjoying working in the RVPC, although it can be very frustrating and depressing to work in the public hospital due to the politics and lack of resources. Dr. Charles was in Tegucigalpa this week doing job interviews for the jobs he's applying to for next year, so a social service doctor took over for him. The new doctor came in on Sunday, too, so she had a little less orientation than normal, but it is all going well. Even though there were a number of cruise ships this week, the clinic has been pretty busy. The new doctor isn't very comfortable with Spanish, so I've been able to interpret for her this week, which I'm really enjoying. It does make the morning much more hectic, though, since I'm triaging and seeing all the patients with her, but I've been getting there early and trying to triage in any spare time and it's working out.
I've come across a number of interesting medical beliefs while interpreting this week in the clinic, and it's been pretty interesting to hear some of the same beliefs from a number of patients. For example, many people believe that if you sleep with your eyes open you have "bichos," or you get skin infections because of "bad blood." People have been very receptive to the doctor's explanations of disease that go against these beliefs, but it still is an interesting clash of cultures.
We had a few cases this week that highlighted the island's gaps in medical care. One boy's mom claimed that he had to sit very close to the TV and turn it to its highest volume to see and hear well, so we wanted to get him sight and hearing exams, which shouldn't be too difficult. However, according to the social service doctor, there was nowhere to get them in the public hospital.
Another child had a fused sagittal suture, meaning his head was growing front to back, but not expanding on the sides. What was interesting was that the mother never mentioned that in the list of reasons she had come in, so I don't know if she had been told in the past that there was nothing she could do about it or what the history was. Dr. Normandin, the current doctor in the clinic, said that in the US you would just send the baby to the neurologist and probably break up his skull bones to let them set back together correctly, but there aren't any specialists on the island that could do such a procedure. We ended up referring him to the mainland, so hopefully they'll be able to take care of it. It's probably just going to be a cosmetic problem for the baby, but there is a possibility of increased intracranial pressure, and so it's really important to get it checked out by a specialist.
Tutoring went well on Tuesday - we had four students and four tutors, so we were still one-on-one. The girl I'm working with seems really interested and I'm really looking forward to being with her for the next few weeks and seeing her progress. Thursday, though, was quite a let-down. We got the tutors together and were driving over to the school when one tuttee called us (about 10 minutes before we were to start) to tell us she couldn't attend. And then we got a text message from another. However, when we showed up, it turned out that they had all gone home to study for a test they had the next day, so we had made a trip out to French Harbor for nothing. We'll talk with the students on Tuesday and re-assess their interest in the program, but it was pretty frustrating. I think the hard part about it is that it does seem like extra work to them, since we are really working on math concepts that precede what they're learning but that they may not see as really helpful at the moment. We'll see what they say on Tuesday, though, in terms of their commitments and interest, since we're really there to help them.
We have now moved into the apartment under Peggy's house, which is really nice and it's fun to be living downstairs from her.
I've been enjoying working in the RVPC, although it can be very frustrating and depressing to work in the public hospital due to the politics and lack of resources. Dr. Charles was in Tegucigalpa this week doing job interviews for the jobs he's applying to for next year, so a social service doctor took over for him. The new doctor came in on Sunday, too, so she had a little less orientation than normal, but it is all going well. Even though there were a number of cruise ships this week, the clinic has been pretty busy. The new doctor isn't very comfortable with Spanish, so I've been able to interpret for her this week, which I'm really enjoying. It does make the morning much more hectic, though, since I'm triaging and seeing all the patients with her, but I've been getting there early and trying to triage in any spare time and it's working out.
I've come across a number of interesting medical beliefs while interpreting this week in the clinic, and it's been pretty interesting to hear some of the same beliefs from a number of patients. For example, many people believe that if you sleep with your eyes open you have "bichos," or you get skin infections because of "bad blood." People have been very receptive to the doctor's explanations of disease that go against these beliefs, but it still is an interesting clash of cultures.
We had a few cases this week that highlighted the island's gaps in medical care. One boy's mom claimed that he had to sit very close to the TV and turn it to its highest volume to see and hear well, so we wanted to get him sight and hearing exams, which shouldn't be too difficult. However, according to the social service doctor, there was nowhere to get them in the public hospital.
Another child had a fused sagittal suture, meaning his head was growing front to back, but not expanding on the sides. What was interesting was that the mother never mentioned that in the list of reasons she had come in, so I don't know if she had been told in the past that there was nothing she could do about it or what the history was. Dr. Normandin, the current doctor in the clinic, said that in the US you would just send the baby to the neurologist and probably break up his skull bones to let them set back together correctly, but there aren't any specialists on the island that could do such a procedure. We ended up referring him to the mainland, so hopefully they'll be able to take care of it. It's probably just going to be a cosmetic problem for the baby, but there is a possibility of increased intracranial pressure, and so it's really important to get it checked out by a specialist.
Tutoring went well on Tuesday - we had four students and four tutors, so we were still one-on-one. The girl I'm working with seems really interested and I'm really looking forward to being with her for the next few weeks and seeing her progress. Thursday, though, was quite a let-down. We got the tutors together and were driving over to the school when one tuttee called us (about 10 minutes before we were to start) to tell us she couldn't attend. And then we got a text message from another. However, when we showed up, it turned out that they had all gone home to study for a test they had the next day, so we had made a trip out to French Harbor for nothing. We'll talk with the students on Tuesday and re-assess their interest in the program, but it was pretty frustrating. I think the hard part about it is that it does seem like extra work to them, since we are really working on math concepts that precede what they're learning but that they may not see as really helpful at the moment. We'll see what they say on Tuesday, though, in terms of their commitments and interest, since we're really there to help them.
We have now moved into the apartment under Peggy's house, which is really nice and it's fun to be living downstairs from her.
Max Journal 9
I've had a good first week at Peggy's Clinic now that Christine is working every day at the Global Healing Clinic. I started the week out with Betty in the pharmacy filling drug orders and running some random jobs around town. Betty the pharmacist left for the United States on Wednesday, so since then I have been the official pharmacist for Peggy's clinic. It is a little amazing that I am practicing a profession that requires a graduate degree to practice in the United States. On Wednesday I went into the Global Healing clinic in the morning and bought food for the Wednesday lunch conference before I went to pick up some donations from the Carnival Valor cruise ship. The security precautions at the cruise ship dock are pretty amazing and the cruise ship culture seems very alien to Roatan, but after a few hours of struggling I was able to drive out onto the dock to pick up a few boxes of donated clothing. The cruise ships play such a large role in Roatan's economy that it is almost offensive to suggest that
they should be outlawed, but it is a thought that crosses many visitor's minds. Peggy's clinic has been slower because we have only one volunteer doctor, and Betty is gone so the pharmacy is quiet and a little lonely. This weekend my girlfriend and father arrived from the States for a visit, so I am understandably distracted and will keep this update short. I look forward to getting better at the pharmacy job and learning more about the drugs that we use here.
they should be outlawed, but it is a thought that crosses many visitor's minds. Peggy's clinic has been slower because we have only one volunteer doctor, and Betty is gone so the pharmacy is quiet and a little lonely. This weekend my girlfriend and father arrived from the States for a visit, so I am understandably distracted and will keep this update short. I look forward to getting better at the pharmacy job and learning more about the drugs that we use here.
Sunday, November 11, 2007
Max Journal 8
I started out the week by holding down the fort at the Global Healing clinic while Christine was still on the mainland. There was no volunteer physician so I worked alone with Charles until Wednesday when I switched to working at Peggy's. We moved efficiently through a pretty high patient volume, and I was honestly impressed at how many patients Charles could see on his own in such a short amount of time. Charles is applying for jobs for after finishing his second Global Healing Fellowship in December, so he has been frantically preparing a heap of paperwork. I wonder if there is a functional reason why "diplomas" certifying participation in conferences and continuing medical education courses are so important here. It seems like a never-ending occupation of a lot of doctors to get many pieces of paper with the appropriate stamps and signatures to certify and acclaim them for their accomplishments. To a certain extent I think the obsession with "diploms" and "reconicimientos" is cultural (some people just like physical representations of their accomplishments), but I also wonder if there are big problems with forgery of certificates.
Christine got home thoroughly exhausted from her journey on Tuesday, and I was happy to have her company again. I think she made good friends with the mom and baby, met some interesting medical professionals on the mainland, and learned a lot about international medicine in Honduras. On Thursday I worked in the pharmacy at Peggy's and went to the ferry dock to pick up a patient that didn't end up coming. This patient was supposed to come to get an excisional biopsy from an ENT doctor working at Peggy's, which would have been an unusual reversal of the standard shipment of Roatan's patients to the
mainland to receive specialized care.
On Thursday evening Peggy, Christine, Becky (a future Global Healing intern) and I responded to a car accident near Sandy Bay. We were with Peggy when she received a call that one of the carpenters working at her clinic had totaled his car and his wife who was in the passenger seat was unresponsive. By the time we arrived on the scene, the passenger was awake and ready to leave, but we skipped over about every protocol that I ever learned in EMT class and walked her to the passenger seat of our parked pick-up truck. I was amazed that we didn't even have a spine board to provide some degree of immobilization, and I can only imagine how people who are not personal friends with Peggy deal with traumatic emergencies on the island.
Because there were no emergency services (police, fire, nor ambulance) on the scene, traffic continued passing by us on the narrow two-lane road. As we were slowly pulling out into traffic, I committed the cardinal sin of emergency response: I put myself and the other responders in danger by colliding with a passing taxi. Honestly, the cab swerved at me and in an American traffic court I'm sure that I could have reasonably argued my innocence, but in the moment none of that mattered because now there were two accidents and still no formal system for sorting anything out. I didn't even know if there was a tow truck on the island. I sent Peggy, Christine, Becky, and the patient to the clinic in the truck and I stayed behind to sort things out with the cab driver. As it turned out we had hardly collided at all and I had rather miraculously managed to snap his bumper off without denting or scratching it at all, so we talked it out and settled with a small amount of cash and a handshake and without further legal complications. I was very relieved when I got home and learned that the passenger was without serious injury and our hectic night was coming to a close with no more than a few scrapes, bruises, and some property damage.
Friday at the clinic was fun as I showed Becky around the pharmacy and celebrated Betty the pharmacist's birthday. Around 9:15 a.m. I received a phone call from a friend of mine in Coxen Hole who is a middle-aged woman that recently moved to Roatan from the United States to start a spa/beauty salon. She was very upset as she hurriedly told me about a man in her home who had some serious skin problem and needed urgent medical assistance. I managed to ascertain over the phone that it was not really a real emergent problem (no respiratory distress, no impairment of circulation or sensation), and I instructed
her to put him in a cab and send him to the clinic. About an hour later I received another call from my friend stating that there had been no available cabs (cruise ship day!) and asking if I could come pick him up. I drove to her home (cautiously after the previous night's debacle) and arrived to find a 41-year old man in a lot of pain as the skin all over his body appeared to be peeling off. I drove (still cautiously) back to the clinic and learned that he was from Diamond Rock (a Black Islander community on the far east end of Roatan), he had had skin problems for just over a year, and he had come to Coxen Hole the previous day to go to the hospital and had been sent away then and again on Friday morning for unclear reasons. Apparently he knew my friend through a mutual acquaintance and, lacking other recourse, had hobbled all the way across town on badly swollen feet from the hospital to her house and had collapsed on her floor. I arrived at the clinic and asked the patient to remain in the
car as I prepared a treatment room and announced to the doctors his arrival (the clinic has no functioning landline telephone and I was unable to reach anyone via cell phone on the way over, which is a problem in and of itself). By the time I had a room prepared and retrieved the wheelchair to help him in, the security guard had helped him out of the car and onto the clinic porch, so I wheeled him through the clinic in front of a crowd of raised eyes. Some other volunteers rather-inappropriately left their workplaces in the clinic and rushed to take pictures of him while ostensibly "triaging him" and I felt like I had brought him into a very uncomfortable position, but of course at the time this was the price of much-needed urgent medical attention. This feeling touches on a characteristic of American medical care that many people have commented on: the objectification of patients and their diseases. While I cannot imagine taking pictures of a patient without a specific medical excuse (for instance to consult with other doctors regarding the case), I have often appreciated being called in by a doctor to teach me something from a patient's condition. The truth is that as a student of medicine and of public health, I walk a delicate line between learning from and treating patients, and different people have different ideas of what is "appropriate" treatment of a patient.
Anyway, back to the case...the doctor decided that the most immediate treatment necessary would be a warm bath to moisturize and exfoliate the dry peeling skin. The clinic does have a working shower and a water heater, but because the inpatient wards haven't opened yet there is no demand for hot water so the boiler was turned off and no hot water was available. The nearest available shower was at a motel owned by a friend of Peggy's, so I drove the patient over there. I then entered the shower fully clothed with the now naked patient and proceeded to abrade the dead skin off of his entire body for 45 minutes. It can only be described as an unusually intimate encounter between strangers that I have since reflected a lot on. The severe psoriasis that affected him was an extreme auto-immune disease that had only one probable explanation. As I washed every inch of his body and learned more about him than I may have ever wished to, I felt like I was finally doing what I came here to do: helping someone. He felt tremendous relief as his skin regained moisture and after the shower when we applied Vaseline and hydrocortisone to his entire body. As the water dripped down my face and I looked at my soaking wet leather shoes flecked with bits of dead skin, I started to reconsider what it means for me to help another person. There is a little more to this story than I can include here (ask me about some interesting tattoos when we meet someday), but I can say that that 45 minute shower taught me a lot about myself and the meaning of altruism. After that industrial-strength exfoliation, he dressed in some new clothing and left feeling like a whole new person. I gave him cab fare, various creams and soaps, a few medications and vitamins, and strict instructions to bathe twice weekly in the sea and return to the clinic in two weeks. I hope he does come back.
After that overly stimulating Thursday and Friday, I enjoyed a Saturday swimming at West Bay Beach and baking pretzels at home followed by eating Sunday brunch with the new Global Healing resident and scuba diving.
On Tuesday and Thursday afternoons we finally were able to get our much-awaited tutoring program started, which has been a lot of fun. The students we are working with lack some amazingly fundamental math skills, but are really very bright students that I feel we can help a lot. I look forward to continuing this tutoring for the rest of the time that we're here and I hope that the other tutors and students are enjoying it as much as I am. Alright, this seems like plenty of text for now. I hope you had an exciting week too.
Oh, and I'd like to say a big "thank you" for your personal response to my and Christine's journal entries. I can only imagine how busy you both are, but after spending a while going through many of the same trials and tribulations that you both have experienced here, I greatly appreciated reading some of your perspectives on things. I also really enjoyed meeting the new resident from Dartmouth this morning, so I hope that she – as a young female doctor – has an overall good experience with Global Healing. Thanks again and I'll talk at you again next week.
Christine got home thoroughly exhausted from her journey on Tuesday, and I was happy to have her company again. I think she made good friends with the mom and baby, met some interesting medical professionals on the mainland, and learned a lot about international medicine in Honduras. On Thursday I worked in the pharmacy at Peggy's and went to the ferry dock to pick up a patient that didn't end up coming. This patient was supposed to come to get an excisional biopsy from an ENT doctor working at Peggy's, which would have been an unusual reversal of the standard shipment of Roatan's patients to the
mainland to receive specialized care.
On Thursday evening Peggy, Christine, Becky (a future Global Healing intern) and I responded to a car accident near Sandy Bay. We were with Peggy when she received a call that one of the carpenters working at her clinic had totaled his car and his wife who was in the passenger seat was unresponsive. By the time we arrived on the scene, the passenger was awake and ready to leave, but we skipped over about every protocol that I ever learned in EMT class and walked her to the passenger seat of our parked pick-up truck. I was amazed that we didn't even have a spine board to provide some degree of immobilization, and I can only imagine how people who are not personal friends with Peggy deal with traumatic emergencies on the island.
Because there were no emergency services (police, fire, nor ambulance) on the scene, traffic continued passing by us on the narrow two-lane road. As we were slowly pulling out into traffic, I committed the cardinal sin of emergency response: I put myself and the other responders in danger by colliding with a passing taxi. Honestly, the cab swerved at me and in an American traffic court I'm sure that I could have reasonably argued my innocence, but in the moment none of that mattered because now there were two accidents and still no formal system for sorting anything out. I didn't even know if there was a tow truck on the island. I sent Peggy, Christine, Becky, and the patient to the clinic in the truck and I stayed behind to sort things out with the cab driver. As it turned out we had hardly collided at all and I had rather miraculously managed to snap his bumper off without denting or scratching it at all, so we talked it out and settled with a small amount of cash and a handshake and without further legal complications. I was very relieved when I got home and learned that the passenger was without serious injury and our hectic night was coming to a close with no more than a few scrapes, bruises, and some property damage.
Friday at the clinic was fun as I showed Becky around the pharmacy and celebrated Betty the pharmacist's birthday. Around 9:15 a.m. I received a phone call from a friend of mine in Coxen Hole who is a middle-aged woman that recently moved to Roatan from the United States to start a spa/beauty salon. She was very upset as she hurriedly told me about a man in her home who had some serious skin problem and needed urgent medical assistance. I managed to ascertain over the phone that it was not really a real emergent problem (no respiratory distress, no impairment of circulation or sensation), and I instructed
her to put him in a cab and send him to the clinic. About an hour later I received another call from my friend stating that there had been no available cabs (cruise ship day!) and asking if I could come pick him up. I drove to her home (cautiously after the previous night's debacle) and arrived to find a 41-year old man in a lot of pain as the skin all over his body appeared to be peeling off. I drove (still cautiously) back to the clinic and learned that he was from Diamond Rock (a Black Islander community on the far east end of Roatan), he had had skin problems for just over a year, and he had come to Coxen Hole the previous day to go to the hospital and had been sent away then and again on Friday morning for unclear reasons. Apparently he knew my friend through a mutual acquaintance and, lacking other recourse, had hobbled all the way across town on badly swollen feet from the hospital to her house and had collapsed on her floor. I arrived at the clinic and asked the patient to remain in the
car as I prepared a treatment room and announced to the doctors his arrival (the clinic has no functioning landline telephone and I was unable to reach anyone via cell phone on the way over, which is a problem in and of itself). By the time I had a room prepared and retrieved the wheelchair to help him in, the security guard had helped him out of the car and onto the clinic porch, so I wheeled him through the clinic in front of a crowd of raised eyes. Some other volunteers rather-inappropriately left their workplaces in the clinic and rushed to take pictures of him while ostensibly "triaging him" and I felt like I had brought him into a very uncomfortable position, but of course at the time this was the price of much-needed urgent medical attention. This feeling touches on a characteristic of American medical care that many people have commented on: the objectification of patients and their diseases. While I cannot imagine taking pictures of a patient without a specific medical excuse (for instance to consult with other doctors regarding the case), I have often appreciated being called in by a doctor to teach me something from a patient's condition. The truth is that as a student of medicine and of public health, I walk a delicate line between learning from and treating patients, and different people have different ideas of what is "appropriate" treatment of a patient.
Anyway, back to the case...the doctor decided that the most immediate treatment necessary would be a warm bath to moisturize and exfoliate the dry peeling skin. The clinic does have a working shower and a water heater, but because the inpatient wards haven't opened yet there is no demand for hot water so the boiler was turned off and no hot water was available. The nearest available shower was at a motel owned by a friend of Peggy's, so I drove the patient over there. I then entered the shower fully clothed with the now naked patient and proceeded to abrade the dead skin off of his entire body for 45 minutes. It can only be described as an unusually intimate encounter between strangers that I have since reflected a lot on. The severe psoriasis that affected him was an extreme auto-immune disease that had only one probable explanation. As I washed every inch of his body and learned more about him than I may have ever wished to, I felt like I was finally doing what I came here to do: helping someone. He felt tremendous relief as his skin regained moisture and after the shower when we applied Vaseline and hydrocortisone to his entire body. As the water dripped down my face and I looked at my soaking wet leather shoes flecked with bits of dead skin, I started to reconsider what it means for me to help another person. There is a little more to this story than I can include here (ask me about some interesting tattoos when we meet someday), but I can say that that 45 minute shower taught me a lot about myself and the meaning of altruism. After that industrial-strength exfoliation, he dressed in some new clothing and left feeling like a whole new person. I gave him cab fare, various creams and soaps, a few medications and vitamins, and strict instructions to bathe twice weekly in the sea and return to the clinic in two weeks. I hope he does come back.
After that overly stimulating Thursday and Friday, I enjoyed a Saturday swimming at West Bay Beach and baking pretzels at home followed by eating Sunday brunch with the new Global Healing resident and scuba diving.
On Tuesday and Thursday afternoons we finally were able to get our much-awaited tutoring program started, which has been a lot of fun. The students we are working with lack some amazingly fundamental math skills, but are really very bright students that I feel we can help a lot. I look forward to continuing this tutoring for the rest of the time that we're here and I hope that the other tutors and students are enjoying it as much as I am. Alright, this seems like plenty of text for now. I hope you had an exciting week too.
Oh, and I'd like to say a big "thank you" for your personal response to my and Christine's journal entries. I can only imagine how busy you both are, but after spending a while going through many of the same trials and tribulations that you both have experienced here, I greatly appreciated reading some of your perspectives on things. I also really enjoyed meeting the new resident from Dartmouth this morning, so I hope that she – as a young female doctor – has an overall good experience with Global Healing. Thanks again and I'll talk at you again next week.
Thursday, November 08, 2007
Christine Journal 8
Max and I have reached our halfway point of working by ourselves in each clinic, so we switched places on Thursday. Peggy’s clinic is closed on Wednesdays, so I got to go to the hospital to hear Dr. Dominguez’s talk (part of the weekly lectures Global Healing tries to put on) on developmental displasia of the hip. He was a great speaker and the talk was interesting to hear, so that was fun.
Dr. Welcome had to go to Tegucigalpa to interview for jobs for the coming year, so there is now a social service doctor (Dr. Andres Ordóñez) in his place until he comes back either late next week or the following week. He’s a nice guy and knows the hospital very well, obviously, so I think it will be fine, although the new pediatrician came in today and hopefully he’ll give her a good orientation tomorrow. He does seem to take his time in the morning, though, and especially now that I know how it feels to arrive early in the morning at a clinic and not be seen until the afternoon, I do wish that patients could be seen starting a little earlier. We’ll see what the schedule this week is like.
There weren’t really any unusual cases this week in clinic, but I’m enjoying being in the Global Healing clinic so far, although it can be frustrating working in the public health system. For example, for some reason the lab decided to stop doing stool exams and urine tests this week, and a patient referred there from our clinic came back without anything to help us diagnose his illness, which was frustrating.
Although the tutoring program started on Tuesday, I was in La Ceiba so didn’t start until Thursday. I think it will go really well – we had five students on Thursday with five tutors, so it worked out perfectly. We’re still expecting a few more to join the program, but we might also be able to get a few more tutors, including the new Global Healing resident. The girl I worked with is an honor student, and was very bright and fun to work with. She seemed genuinely interested in learning the material, which makes the tutoring so much more worthwhile.
We had an eventful night on Thursday (see Max’s journal for even more eventfull-ness), as someone who works with Peggy got in a car accident with his wife. There was a large truck stopped in the middle of the road without any lights on it, and by the time he saw it, it was too late to swerve. So he hit it front on, and, luckily, both he and his wife are fine. They called Peggy, though, to come help the wife, who had slammed her head into the dashboard and needed some medical attention. We went to the crash site, where there were no police, ambulances, or anything, something you’d never see in the states. Peggy said that it’s practically useless to call an ambulance, as they can take hours to get there and were even shopping at Eldon’s once when she tried to call them. So, we took the wife up to the clinic and Dr. Patrick examined her. She had no bleeding, but had had a concussion. Dr. Patrick highly doubts that she has any kind of internal bleeding, but it’s impossible to tell on the island without any kind of brain imaging. So, the whole night was a powerful reminder of how limited medicine is on the island and how people can really suffer from it.
Outside of clinic, I’ve gotten to go back and visit Neri, Jessica (the patient I took to the mainland), and the family, and really love being able to spend time with them. I just really hope they don’t get too overwhelmed with all the different medications Jessica has to use, since it is a lot to keep track of (some every six hours, some every 4, etc.). Max and I also finally went on our first SCUBA dive today, which was lots of fun!
Dr. Welcome had to go to Tegucigalpa to interview for jobs for the coming year, so there is now a social service doctor (Dr. Andres Ordóñez) in his place until he comes back either late next week or the following week. He’s a nice guy and knows the hospital very well, obviously, so I think it will be fine, although the new pediatrician came in today and hopefully he’ll give her a good orientation tomorrow. He does seem to take his time in the morning, though, and especially now that I know how it feels to arrive early in the morning at a clinic and not be seen until the afternoon, I do wish that patients could be seen starting a little earlier. We’ll see what the schedule this week is like.
There weren’t really any unusual cases this week in clinic, but I’m enjoying being in the Global Healing clinic so far, although it can be frustrating working in the public health system. For example, for some reason the lab decided to stop doing stool exams and urine tests this week, and a patient referred there from our clinic came back without anything to help us diagnose his illness, which was frustrating.
Although the tutoring program started on Tuesday, I was in La Ceiba so didn’t start until Thursday. I think it will go really well – we had five students on Thursday with five tutors, so it worked out perfectly. We’re still expecting a few more to join the program, but we might also be able to get a few more tutors, including the new Global Healing resident. The girl I worked with is an honor student, and was very bright and fun to work with. She seemed genuinely interested in learning the material, which makes the tutoring so much more worthwhile.
We had an eventful night on Thursday (see Max’s journal for even more eventfull-ness), as someone who works with Peggy got in a car accident with his wife. There was a large truck stopped in the middle of the road without any lights on it, and by the time he saw it, it was too late to swerve. So he hit it front on, and, luckily, both he and his wife are fine. They called Peggy, though, to come help the wife, who had slammed her head into the dashboard and needed some medical attention. We went to the crash site, where there were no police, ambulances, or anything, something you’d never see in the states. Peggy said that it’s practically useless to call an ambulance, as they can take hours to get there and were even shopping at Eldon’s once when she tried to call them. So, we took the wife up to the clinic and Dr. Patrick examined her. She had no bleeding, but had had a concussion. Dr. Patrick highly doubts that she has any kind of internal bleeding, but it’s impossible to tell on the island without any kind of brain imaging. So, the whole night was a powerful reminder of how limited medicine is on the island and how people can really suffer from it.
Outside of clinic, I’ve gotten to go back and visit Neri, Jessica (the patient I took to the mainland), and the family, and really love being able to spend time with them. I just really hope they don’t get too overwhelmed with all the different medications Jessica has to use, since it is a lot to keep track of (some every six hours, some every 4, etc.). Max and I also finally went on our first SCUBA dive today, which was lots of fun!
Wednesday, November 07, 2007
Christine Journal 7
I just got back last night from a really interesting trip to La Ceiba and El Progreso, during which I accompanied a Roatan high school student to the SAT test in Ceiba and a mother and one-year-old daughter to an ophthalmologist in Progreso and a dermatologist in Ceiba. The trip as a whole really opened my eyes to how other organizations in Honduras work and provide health care to the country.
I left with Nurian, a recent high school graduate from Roatan, on the ferry on Friday, leaving behind rain on Roatan and heading into it in La Ceiba. She had been to take the test in La Ceiba the May before, so knew the drill pretty well. She'd also been studying for the test in the time leading up to it, receiving private tutoring from Shelli, a volunteer with Peggy who is here for the year. I think she was feeling pretty prepared, which was great. As I dropped her off, I was remembering how nervous I was about the test, as it was something that I had known was important since I was in middle school. It was great to see how calm Nurian was, and how much it was really just her own motivation that had gotten her there, not an expectation that her school, family, friends, etc. had for her since she was younger. She felt really good about how it had gone, so I'm really happy about that. The test was administered at a bilingual school that was opened for the children of the Standard Fruit Company's workers who came from the USA, and apparently is still the best (and most expensive, as they apparently charge in US dollars) school in the city.
I spent Saturday night alone in La Ceiba after Nurian left to go back on the afternoon ferry and before Neri and Jessica came in on Sunday morning, which was relaxing. I went to meet the ferry on Sunday morning and was happy to see that Neri and Jessica arrived safe and sound. I had spent Saturday talking with a few people who work in La Ceiba, and we were able to get a ride with a group from an orphanage who were bringing two boys to get operations at the eye clinic. We were able to wait at Dr. Black's house in the morning before we left for El Progreso after lunch, and it was great to be able to talk with Dr. Black about his experiences and work in Honduras. His observations were really interesting in the context of my experiences throughout the trip, so I?ll reflect on those after I talk about how the doctors? appointments go.
We drove to El Progreso with the ?tio? from the orphanage (the father figure for the kids) and two eleven-year-olds, who were all really fun to travel with. The kids were really curious about everything, asking lots of questions about things we passed and making good conversation, and we took a little detour through Tela, so it was an enjoyable trip. We arrived safe and sound at a house that rents rooms and sells food in front of the eye clinic, and although they had not received our reservations (the clinic was supposed to make them for us), they had a couple of rooms. The woman told us if it was our first time at the clinic, we had to be there at 5 am, so we woke up bright and early and left before breakfast, only to wait until 1 pm to be seen by the doctor. It made me really appreciate the patients that wait so long at the clinic to be seen, and it was also a bit frustrating that they weren?t able to tell us about when we would be seen so we could leave and get something to eat.
The clinic was started by an American ophthalmologist missionary, was in a pretty nice building, and seemed to be staffed mainly by Hondurans. There was a visiting American pediatric ophthalmologist for the week, which is why we were all there, but she seemed to be pretty overwhelmed with all of the patients. When we were finally seen, she didn't ask many questions about the history of Jessica's eye problems, but did tell us pretty quickly that she did not have cataracts. It turns out that her cornea is being scratched by her eyelashes, as her eyelids are pressing too hard against her eyes. She did let us know that they would have a plastic surgeon at the clinic in early December, and also gave some antibiotic drop prescriptions for Jessica since she apparently also had an infection, but it was a little disappointing to go all that way to find out she did not need cataract surgery. It's good to finally know what's wrong, though. All in all, I was not very impressed by the care at the clinic. The American doctor didn't speak very good Spanish, and, as I said before, didn't ask many questions. She left the Honduran doctor to explain to the mother what Jessica had, but he used very complicated medical terms that neither she nor I understood, so I had to tell her what I had picked up as the American doctor was working so that she could know what was going on.
We left there on Monday afternoon by bus, as the two boys from the orphanage were sticking around for surgery on Wednesday. We arrived in La Ceiba at night to pouring rain and flooding streets, but safely made it to Dr. Black?s house, where he sent someone with us to check into a hotel he recommended. It was such a help to have him as a contact in La Ceiba, as well as to have the group from the orphanage with us in El Progreso, and it really showed how helpful and important it is for different NGOs to work together and let each other know about opportunities, etc.
On Monday morning we got a few blood tests done for Jessica that the opthamologist had sent for, and it really made me wish there was a way for us to know what tests she had already gotten. Neri said they had done many tests on her, but couldn?t remember what they were, and we wanted to get them done before coming back to Roatan, as Roatan couldn't doing some of them, so we just went ahead and got them. I think in the future it would be good to make a copy of the patient's file to bring on trips like this one so that there isn't any overlap and the doctors can better see the patient's medical history. I don't know if this is possible, but I'll look into it.
We saw a dermatologist in La Ceiba that Dr. Raymond from Peggy?s had recommended, and he seemed to be really good. He was not able to diagnose a specific skin disease, but did explain very clearly to Neri everything that he was thinking. He said that since it is congenital, he doesn?t really think it will ever go away, but that it may get better as she gets older. He also looked at her eyes and agreed that the cornea was being scratched, but also with just a few questions was able to discover that Jessica slept with her eyes open (her mom usually closed them), so her cornea is probably also getting dried out. He prescribed her lubricating eye drops for that, which he was very surprised the American ophthalmologist had not done. He also explained very clearly how important it was for Neri to use the eye drops, as her eyes need light to enter to develop nerves that will be critical in her sight later on. He prescribed some soap and creams for Jessica's skin, as well.
I think that it was hard for Neri to hear that there wasn't really anything we could do for the skin condition, but she is up to go back in December for the plastic surgeon's visit to hopefully fix the eye problem.
The trip and my previous experiences here have really showed me the importance of talking with patients and trying to spend as much time as possible with them. As I traveled with Neri she told me a lot about the history of Jessica?s skin and eye conditions that I noticed she did not share with doctors unless asked specific questions or given enough time to really give a complete answer. I?ve also noticed while interpreting at Peggy?s clinic that the patients won?t mention something to the doctor when he or she?s asking questions, but when he or she leaves for a minute and I just stay and chat, they?ll bring up other important information. Dr. Black complained that he no longer works with missionary groups because they will try to brag about how many people they saw in one day, when really they?re not giving very quality care to their patients, and I can really see how just spending that extra few minutes with a patient to chat or ask them more questions can make a big difference in the quality of care they receive.
Something else that Dr. Black mentioned that has gotten me thinking is that the Honduran government can use the groups of medical missionaries who come down to perform specialty surgeries or other medical procedures and consults as an excuse to not develop their own medical infrastructure. Since the groups are filling in the gaps that the public system has, the government sees no need to develop in those areas on their own. So, I started thinking about somewhere like Peggy's clinic and how it can fit into this kind of situation. On the one hand, Peggy's clinic is doing great things by trying to provide a quality of care that is not available on the island. On the other hand, the public hospital can use the clinic to get specific medications they may not stock and, as Peggy's grows, may even start sending people over there for operations or in-patient care. However, if Peggy's clinic (or any specialty group who comes down to Honduras) is providing a level of care that the public health didn't seem to be getting close to (or trying to get close to) before she began, does it hurt the public health system? But doesn't it also hurt the people if such brigades or clinics are not started, as they really are filling in a gap that the public health system is not fixing on its own?
I'll be starting my time in the pediatric clinic, and look forward to getting to understand the public health system better!
I left with Nurian, a recent high school graduate from Roatan, on the ferry on Friday, leaving behind rain on Roatan and heading into it in La Ceiba. She had been to take the test in La Ceiba the May before, so knew the drill pretty well. She'd also been studying for the test in the time leading up to it, receiving private tutoring from Shelli, a volunteer with Peggy who is here for the year. I think she was feeling pretty prepared, which was great. As I dropped her off, I was remembering how nervous I was about the test, as it was something that I had known was important since I was in middle school. It was great to see how calm Nurian was, and how much it was really just her own motivation that had gotten her there, not an expectation that her school, family, friends, etc. had for her since she was younger. She felt really good about how it had gone, so I'm really happy about that. The test was administered at a bilingual school that was opened for the children of the Standard Fruit Company's workers who came from the USA, and apparently is still the best (and most expensive, as they apparently charge in US dollars) school in the city.
I spent Saturday night alone in La Ceiba after Nurian left to go back on the afternoon ferry and before Neri and Jessica came in on Sunday morning, which was relaxing. I went to meet the ferry on Sunday morning and was happy to see that Neri and Jessica arrived safe and sound. I had spent Saturday talking with a few people who work in La Ceiba, and we were able to get a ride with a group from an orphanage who were bringing two boys to get operations at the eye clinic. We were able to wait at Dr. Black's house in the morning before we left for El Progreso after lunch, and it was great to be able to talk with Dr. Black about his experiences and work in Honduras. His observations were really interesting in the context of my experiences throughout the trip, so I?ll reflect on those after I talk about how the doctors? appointments go.
We drove to El Progreso with the ?tio? from the orphanage (the father figure for the kids) and two eleven-year-olds, who were all really fun to travel with. The kids were really curious about everything, asking lots of questions about things we passed and making good conversation, and we took a little detour through Tela, so it was an enjoyable trip. We arrived safe and sound at a house that rents rooms and sells food in front of the eye clinic, and although they had not received our reservations (the clinic was supposed to make them for us), they had a couple of rooms. The woman told us if it was our first time at the clinic, we had to be there at 5 am, so we woke up bright and early and left before breakfast, only to wait until 1 pm to be seen by the doctor. It made me really appreciate the patients that wait so long at the clinic to be seen, and it was also a bit frustrating that they weren?t able to tell us about when we would be seen so we could leave and get something to eat.
The clinic was started by an American ophthalmologist missionary, was in a pretty nice building, and seemed to be staffed mainly by Hondurans. There was a visiting American pediatric ophthalmologist for the week, which is why we were all there, but she seemed to be pretty overwhelmed with all of the patients. When we were finally seen, she didn't ask many questions about the history of Jessica's eye problems, but did tell us pretty quickly that she did not have cataracts. It turns out that her cornea is being scratched by her eyelashes, as her eyelids are pressing too hard against her eyes. She did let us know that they would have a plastic surgeon at the clinic in early December, and also gave some antibiotic drop prescriptions for Jessica since she apparently also had an infection, but it was a little disappointing to go all that way to find out she did not need cataract surgery. It's good to finally know what's wrong, though. All in all, I was not very impressed by the care at the clinic. The American doctor didn't speak very good Spanish, and, as I said before, didn't ask many questions. She left the Honduran doctor to explain to the mother what Jessica had, but he used very complicated medical terms that neither she nor I understood, so I had to tell her what I had picked up as the American doctor was working so that she could know what was going on.
We left there on Monday afternoon by bus, as the two boys from the orphanage were sticking around for surgery on Wednesday. We arrived in La Ceiba at night to pouring rain and flooding streets, but safely made it to Dr. Black?s house, where he sent someone with us to check into a hotel he recommended. It was such a help to have him as a contact in La Ceiba, as well as to have the group from the orphanage with us in El Progreso, and it really showed how helpful and important it is for different NGOs to work together and let each other know about opportunities, etc.
On Monday morning we got a few blood tests done for Jessica that the opthamologist had sent for, and it really made me wish there was a way for us to know what tests she had already gotten. Neri said they had done many tests on her, but couldn?t remember what they were, and we wanted to get them done before coming back to Roatan, as Roatan couldn't doing some of them, so we just went ahead and got them. I think in the future it would be good to make a copy of the patient's file to bring on trips like this one so that there isn't any overlap and the doctors can better see the patient's medical history. I don't know if this is possible, but I'll look into it.
We saw a dermatologist in La Ceiba that Dr. Raymond from Peggy?s had recommended, and he seemed to be really good. He was not able to diagnose a specific skin disease, but did explain very clearly to Neri everything that he was thinking. He said that since it is congenital, he doesn?t really think it will ever go away, but that it may get better as she gets older. He also looked at her eyes and agreed that the cornea was being scratched, but also with just a few questions was able to discover that Jessica slept with her eyes open (her mom usually closed them), so her cornea is probably also getting dried out. He prescribed her lubricating eye drops for that, which he was very surprised the American ophthalmologist had not done. He also explained very clearly how important it was for Neri to use the eye drops, as her eyes need light to enter to develop nerves that will be critical in her sight later on. He prescribed some soap and creams for Jessica's skin, as well.
I think that it was hard for Neri to hear that there wasn't really anything we could do for the skin condition, but she is up to go back in December for the plastic surgeon's visit to hopefully fix the eye problem.
The trip and my previous experiences here have really showed me the importance of talking with patients and trying to spend as much time as possible with them. As I traveled with Neri she told me a lot about the history of Jessica?s skin and eye conditions that I noticed she did not share with doctors unless asked specific questions or given enough time to really give a complete answer. I?ve also noticed while interpreting at Peggy?s clinic that the patients won?t mention something to the doctor when he or she?s asking questions, but when he or she leaves for a minute and I just stay and chat, they?ll bring up other important information. Dr. Black complained that he no longer works with missionary groups because they will try to brag about how many people they saw in one day, when really they?re not giving very quality care to their patients, and I can really see how just spending that extra few minutes with a patient to chat or ask them more questions can make a big difference in the quality of care they receive.
Something else that Dr. Black mentioned that has gotten me thinking is that the Honduran government can use the groups of medical missionaries who come down to perform specialty surgeries or other medical procedures and consults as an excuse to not develop their own medical infrastructure. Since the groups are filling in the gaps that the public system has, the government sees no need to develop in those areas on their own. So, I started thinking about somewhere like Peggy's clinic and how it can fit into this kind of situation. On the one hand, Peggy's clinic is doing great things by trying to provide a quality of care that is not available on the island. On the other hand, the public hospital can use the clinic to get specific medications they may not stock and, as Peggy's grows, may even start sending people over there for operations or in-patient care. However, if Peggy's clinic (or any specialty group who comes down to Honduras) is providing a level of care that the public health didn't seem to be getting close to (or trying to get close to) before she began, does it hurt the public health system? But doesn't it also hurt the people if such brigades or clinics are not started, as they really are filling in a gap that the public health system is not fixing on its own?
I'll be starting my time in the pediatric clinic, and look forward to getting to understand the public health system better!
Max Journal 7
This week I have been working as usual at RVPC and we seem to finally be getting back in the swing of things after the strike. Anita finished her last week here and we saw patients every day. The patient load has been pretty moderate, which keeps things relatively calm in the clinic. The rainy weather and the arrival of lucrative cruise ships keep patients away on any given day.
Probably the most interesting case of the week was a mother that brought in her son with a speech delay. The boy was almost four years old and didn't say anything while I was in the room with him, but apparently mumbled something when he was with Anita. His sister is around two years old and speaks well, so his mother is starting to worry. A few things about this situation were interesting to me. First of all, as far as we know, the mother didn't bring her child to see anyone until now, which seems like a long time to wait. Secondly, the diagnostic tools that Anita used to try to get a hold on the child's condition intrigued me. The mother didn't think the child had any trouble hearing, but she also said that when he did talk it sounded like a "deaf person." We can't do a real hearing test in the clinic, but by saying things when the boy is looking away you can test his reaction to sound, and by asking him to complete simple tasks you can test his hearing and some of his comprehension. The mother also said that he plays normally with the other kids in the neighborhood, which suggests that he is not severely mentally delayed, but rather that he might really just have a speech impediment. Also, during most of the time that the patient was in the clinic, which was most of the morning, Dr. Charles was unavailable to help Anita. Diagnosing a speech impediment is understandably difficult for a non-native speaker. The last thing worth mentioning is what the next step is. The boy needs a hearing test and possibly some sort of more detailed mental exam to evaluate the full extent of his developmental delay. Then he will need some sort of speech therapy, which as far as I know is unavailable on the island. I hope we are able to follow-up with this boy and see that he gets the attention he needs to fulfill his potential for speech.
From a more philosophical perspective, I've been thinking a lot about the relationship between the Roatan Volunteer Pediatric Clinic, the Roatan Hospital administration, and the other sources of medical care on the island. Anita tried for several weeks to participate in rounds at the hospital, but she always received some excuse why she couldn't (they'd already happened, they weren't happening, or they were happening later). This made me think more about whether the hospital really welcomes Global Healing there at all. From one perspective, I can fully understand why anybody would get tired of outsiders continually coming into their workplace and telling them that they are doing everything wrong, and in that sense I think that Global Healing should be careful about delivering criticism to the hospital. And from a completely other perspective, the resistance to change within the hospital is amazing. A certain amount of the problem can be blamed on a large bureaucratic public health system that the hospital must function within, but that cannot be the complete story. The number of small fixable problems in the hospital and the presence of people trying to fix them combined with the lack of fixing going on suggests that there are people *actively resisting* change. It should come as no surprise to me to see corruption in public administration here in Central America, but people fighting real improvement in the hospital nonetheless affects me.
Anyway, on a more upbeat note, I a dropped a patient with congenital cataracts off at the ferry terminal this morning to go to La Ceiba to meet Christine and travel with her to get corrective surgery in El Progreso, a city between here and San Pedro Sula. Christine is doing most of the actual work to make this happen for baby Jessica, but I hope all goes well and I see them soon back here in Roatan. You probably won't hear from Christine for a while because she's on the road, but I'll let you know if anything comes up.
Probably the most interesting case of the week was a mother that brought in her son with a speech delay. The boy was almost four years old and didn't say anything while I was in the room with him, but apparently mumbled something when he was with Anita. His sister is around two years old and speaks well, so his mother is starting to worry. A few things about this situation were interesting to me. First of all, as far as we know, the mother didn't bring her child to see anyone until now, which seems like a long time to wait. Secondly, the diagnostic tools that Anita used to try to get a hold on the child's condition intrigued me. The mother didn't think the child had any trouble hearing, but she also said that when he did talk it sounded like a "deaf person." We can't do a real hearing test in the clinic, but by saying things when the boy is looking away you can test his reaction to sound, and by asking him to complete simple tasks you can test his hearing and some of his comprehension. The mother also said that he plays normally with the other kids in the neighborhood, which suggests that he is not severely mentally delayed, but rather that he might really just have a speech impediment. Also, during most of the time that the patient was in the clinic, which was most of the morning, Dr. Charles was unavailable to help Anita. Diagnosing a speech impediment is understandably difficult for a non-native speaker. The last thing worth mentioning is what the next step is. The boy needs a hearing test and possibly some sort of more detailed mental exam to evaluate the full extent of his developmental delay. Then he will need some sort of speech therapy, which as far as I know is unavailable on the island. I hope we are able to follow-up with this boy and see that he gets the attention he needs to fulfill his potential for speech.
From a more philosophical perspective, I've been thinking a lot about the relationship between the Roatan Volunteer Pediatric Clinic, the Roatan Hospital administration, and the other sources of medical care on the island. Anita tried for several weeks to participate in rounds at the hospital, but she always received some excuse why she couldn't (they'd already happened, they weren't happening, or they were happening later). This made me think more about whether the hospital really welcomes Global Healing there at all. From one perspective, I can fully understand why anybody would get tired of outsiders continually coming into their workplace and telling them that they are doing everything wrong, and in that sense I think that Global Healing should be careful about delivering criticism to the hospital. And from a completely other perspective, the resistance to change within the hospital is amazing. A certain amount of the problem can be blamed on a large bureaucratic public health system that the hospital must function within, but that cannot be the complete story. The number of small fixable problems in the hospital and the presence of people trying to fix them combined with the lack of fixing going on suggests that there are people *actively resisting* change. It should come as no surprise to me to see corruption in public administration here in Central America, but people fighting real improvement in the hospital nonetheless affects me.
Anyway, on a more upbeat note, I a dropped a patient with congenital cataracts off at the ferry terminal this morning to go to La Ceiba to meet Christine and travel with her to get corrective surgery in El Progreso, a city between here and San Pedro Sula. Christine is doing most of the actual work to make this happen for baby Jessica, but I hope all goes well and I see them soon back here in Roatan. You probably won't hear from Christine for a while because she's on the road, but I'll let you know if anything comes up.
Sunday, October 28, 2007
Christine Journal 6
We've survived our first big Roatan storm, which has been a nice, cool change from the hot weather we had been having. On Wednesday morning I woke up to heavy rain out my window and no power (not all that uncommon, but it was out for 14 hours total this time!). Max and I both went into the Global Healing clinic, since Peggy's is closed on Wednesdays, but there was hardly anyone in the hospital. As the rain continued to come down, the entryway to the hospital filled with about 6 inches of water, and many other places were leaking. There were no patients for us to see (I think no one really wanted to travel in such a big rainstorm, especially if they live on dirt roads), so Max and I tried to figure out the Access database that he had found from last year (which seems to do pretty much what our current Excel file does in terms of keeping track of patients). We were hoping that we could get it so that the patients' past medical history could come up when we typed in their ID number, but are still pretty new to the system. Dr. Charles was nice enough to give us a lift home (although the roads were so flooded in Coxen Hole we almost didn't make it!), but it was still pretty early so we went up to Peggy's to see what we could do there. She has a couple of visitors who are working on construction projects, so they put us to work putting in floor tiles. However, there was no electricity still (the whole island seemed to be out) and so it was hard to see and we couldn't cut any more tiles, so we soon ran out of jobs and went home.
Work in Peggy's clinic is still going really well - the staff is all so great and I still learn so much every day. I got to do a lot of interpreting this past week, which I love, as well as work in the pharmacy (also lots of fun). I helped out with triaging some as well, but it gets pretty crowded with two people triaging at once, so I mainly tried to do it when Sherry Kay was busy with something else. Monday and Tuesday were pretty busy, but there were very few patients on Thursday and Friday, since the weather continued to be bad. It was nice to be able to spend more time with patients those days, though. Power was off for another 11 hours on Wednesday night/Thursday morning, which makes it hard to work in the clinic. Hopefully they'll get a generator soon, though!
In the afternoons, I've continued to work on drug donations, as well as help Shelli get ready for the tutoring, which is set to start next week. We'll have a 5-week session, going to the school twice a week and each working with 1-2 students on math. There are a few other community members (American ex-pats living here) who will do it with us, which should be fun. I'm really looking forward to that starting up!
I'm also planning on accompanying a girl to La Ceiba to take the SAT on Saturday morning, as well as going with a patient to El Progreso to visit a cataract surgeon and hopefully a dermatologist in La Ceiba. The patient is about 1-year-old and has an unidentified skin condition as well as congenital cataracts, so hopefully we'll be able to get the cataract surgery done and make some headway on helping her skin condition. That will be from Sunday-Wednesday or Thursday.
Work in Peggy's clinic is still going really well - the staff is all so great and I still learn so much every day. I got to do a lot of interpreting this past week, which I love, as well as work in the pharmacy (also lots of fun). I helped out with triaging some as well, but it gets pretty crowded with two people triaging at once, so I mainly tried to do it when Sherry Kay was busy with something else. Monday and Tuesday were pretty busy, but there were very few patients on Thursday and Friday, since the weather continued to be bad. It was nice to be able to spend more time with patients those days, though. Power was off for another 11 hours on Wednesday night/Thursday morning, which makes it hard to work in the clinic. Hopefully they'll get a generator soon, though!
In the afternoons, I've continued to work on drug donations, as well as help Shelli get ready for the tutoring, which is set to start next week. We'll have a 5-week session, going to the school twice a week and each working with 1-2 students on math. There are a few other community members (American ex-pats living here) who will do it with us, which should be fun. I'm really looking forward to that starting up!
I'm also planning on accompanying a girl to La Ceiba to take the SAT on Saturday morning, as well as going with a patient to El Progreso to visit a cataract surgeon and hopefully a dermatologist in La Ceiba. The patient is about 1-year-old and has an unidentified skin condition as well as congenital cataracts, so hopefully we'll be able to get the cataract surgery done and make some headway on helping her skin condition. That will be from Sunday-Wednesday or Thursday.
Max Journal 6
At the beginning of this week I was pleased to see the ever-present "flag of the syndicate" removed from the entryway of the hospital, signifying the end of a three-and-a-half week strike. It's not clear to me what kind of resolution the workers and administrators came to, but from what I've heard the workers' demands were not completely fulfilled. The hospital seems to be up and running, though, and everyone seems to be in a lot better mood, so my life is a bit simpler now that the strike is over. Patients are being attended to and hopefully the hospital will see a return to some modicum of normalcy in the coming weeks.
Monday and Tuesday were surprisingly slow (only 12-15 patients per day), and I think that's probably because word was still getting around the island that the hospital had reopened. We had one interesting case of a mother coming in for a regular well-child check for her four-year old son (which is pretty much unheard of in our clinic), and she said that she comes in for monthly check-ups because he had had had leukemia. I duly recorded her comment on the chart, and looked back through his medical record for some more detailed history. The child had in fact visited the hospital with some regularity, but never mentioning any history of cancer. We checked the kid out and he seemed fine, and it was certainly possible that he had received effective treatment years ago for cancer, but something in the story seemed a little odd. The mother proceeded to tell us that she also had "cancer of the blood," as did her other baby, at which point we guessed that she was probably talking about sickle-cell anemia. Later in the day I spoke with someone who knew the mother and suggested that she was known for getting baby formula from free clinics to sell on the street, so my "index of suspicion" of the mother's spurious history increased significantly. Fortunately the situation we were in didn't put the child in any danger (except maybe an unnecessary blood draw) and we were able to confidently do what the mother asked (confirm his good health) without wasting many resources, but it certainly exposed our vulnerability to exploitation by our patients. We have to balance our trust and willingness to help the community with a reasonable level of skepticism. The role of this organization is to provide medical care, not to encourage entrepreneurship through black-market drug and baby-formula markets, so from now on I will actively try to keep my eyes open to the exploitation not only of community members, but also of community organizations.
When it started pouring down rain on Wednesday, I had to chuckle as the patients disappeared and the hospital quickly started filling with water. Luckily our clinic seemed safe from serious water damage, but I do not lie when I say that water was coming into the hospital from above, from below, and from all sides. As we drove away through several inches of standing water I saw one hospital worker futilely bailing out the hospital lobby with a small bucket. I think that providing first-rate evidence-based medical care is a fine goal for any public health system, but maybe a solid roof should be one of the hospital's first steps in achieving that goal. It's amazing that we are trying to build so much up on such a weak infrastructural base. Modern medical technology costs a lot more than a leak-free roof, but without an effective roof in place (and clean sanitation, and running water, and proper ventilation), the medical technology will be useless.
Thursday and Friday I was happy to see that the hospital dried out significantly, and we continued seeing patients, although fewer than normal probably because of the persistent rains and the quickly eroding roads.
In the afternoons Christine and I have continued working on drug donations and prepared for the upcoming tutoring session. Hopefully the last few pieces of paperwork will come together and we can see short-dated pharmaceuticals knocking down Peggy's door in no time.
In the meantime Christine and I have been baking a lot, running on the beach when the rain abates, playing Skip-Bo in our dark apartment during the downpours, and enjoying the company of other volunteers. Despite the rain, we've enjoyed a respite from the heat, and we look forward to sunnier skies someday soon (I think right now the wind is finally dying down after five blustery days). We also enjoyed meeting a young Canadian who works with HIV/AIDS testing, counseling, treatment, and prevention in Roatan. The three of us shared our different perspectives on the public health network here, and learned a lot from each others' experiences.
Monday and Tuesday were surprisingly slow (only 12-15 patients per day), and I think that's probably because word was still getting around the island that the hospital had reopened. We had one interesting case of a mother coming in for a regular well-child check for her four-year old son (which is pretty much unheard of in our clinic), and she said that she comes in for monthly check-ups because he had had had leukemia. I duly recorded her comment on the chart, and looked back through his medical record for some more detailed history. The child had in fact visited the hospital with some regularity, but never mentioning any history of cancer. We checked the kid out and he seemed fine, and it was certainly possible that he had received effective treatment years ago for cancer, but something in the story seemed a little odd. The mother proceeded to tell us that she also had "cancer of the blood," as did her other baby, at which point we guessed that she was probably talking about sickle-cell anemia. Later in the day I spoke with someone who knew the mother and suggested that she was known for getting baby formula from free clinics to sell on the street, so my "index of suspicion" of the mother's spurious history increased significantly. Fortunately the situation we were in didn't put the child in any danger (except maybe an unnecessary blood draw) and we were able to confidently do what the mother asked (confirm his good health) without wasting many resources, but it certainly exposed our vulnerability to exploitation by our patients. We have to balance our trust and willingness to help the community with a reasonable level of skepticism. The role of this organization is to provide medical care, not to encourage entrepreneurship through black-market drug and baby-formula markets, so from now on I will actively try to keep my eyes open to the exploitation not only of community members, but also of community organizations.
When it started pouring down rain on Wednesday, I had to chuckle as the patients disappeared and the hospital quickly started filling with water. Luckily our clinic seemed safe from serious water damage, but I do not lie when I say that water was coming into the hospital from above, from below, and from all sides. As we drove away through several inches of standing water I saw one hospital worker futilely bailing out the hospital lobby with a small bucket. I think that providing first-rate evidence-based medical care is a fine goal for any public health system, but maybe a solid roof should be one of the hospital's first steps in achieving that goal. It's amazing that we are trying to build so much up on such a weak infrastructural base. Modern medical technology costs a lot more than a leak-free roof, but without an effective roof in place (and clean sanitation, and running water, and proper ventilation), the medical technology will be useless.
Thursday and Friday I was happy to see that the hospital dried out significantly, and we continued seeing patients, although fewer than normal probably because of the persistent rains and the quickly eroding roads.
In the afternoons Christine and I have continued working on drug donations and prepared for the upcoming tutoring session. Hopefully the last few pieces of paperwork will come together and we can see short-dated pharmaceuticals knocking down Peggy's door in no time.
In the meantime Christine and I have been baking a lot, running on the beach when the rain abates, playing Skip-Bo in our dark apartment during the downpours, and enjoying the company of other volunteers. Despite the rain, we've enjoyed a respite from the heat, and we look forward to sunnier skies someday soon (I think right now the wind is finally dying down after five blustery days). We also enjoyed meeting a young Canadian who works with HIV/AIDS testing, counseling, treatment, and prevention in Roatan. The three of us shared our different perspectives on the public health network here, and learned a lot from each others' experiences.
Monday, October 22, 2007
Max Journal 5
Last week was better than the previous, even though the strike persisted. On Monday we unpacked, inventoried, and repacked meds that arrived at Peggy's Clinic from the International Dispensary Association, which was exciting and fun. The drugs have been expected for the last half year, so they were a welcome addition to the pharmacy. Tuesday was back to the strike, but Charles showed up (briefly) and we were able to see patients for most of the week. On Friday the records department stopped handing out patient charts completely (even to the ED), which gave us a little scare, but we decided that if we didn't help out, the patients would just get seen by other doctors without their chart, so we kept functioning as an "urgent care clinic" extension of the ED delivering a lower standard of care than would be expected in the US. Peggy told us to start looking into soliciting drug donations from a number of international relief organizations, so that has kept us somewhat busy in the afternoons. We also spent an afternoon delivering drugs to a small clinic in Diamond Rock that Patrick Connell and the Clinica Esperanza folks helped start, which was an interesting excursion. Yesterday there was a fundraiser for Peggy's clinic in Coxen Hole, and we helped out (a little) and ate snacks (a lot) for much of the afternoon. I am optimistic about soliciting these drug donations and hope that something positive comes out of our work. Also, we spent Saturday morning crunching some demographic data collected by Krista Bruckner about La Colonia, which was interesting and different. Alright, this is a concise journal, but hopefully it's sufficient. And in a special sneak preview of next week: I'll let you know that the hospital strike ended over the weekend.
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