Alex Journal 3

I can’t believe my third week in Roatan is coming to a close! When I first arrived a month felt like such a long time, but I now realize that a month isn’t nearly long enough to really make any lasting improvements in the quality of life of the people on the island.
This past week was a little more hectic in the clinic with the arrival of the two new pediatric residents, Dr. Sydney Leibel and Dr. Sandra Lawrynowicz. Given that I spent much of Tuesday and Wednesday orienting the residents to the workings of the clinic, showing them around Coxen Hole, and doing quite a lot of interpreting, I really saw how important the intern’s job is in preserving the quality and continuity of care for patients that visit our clinic.


While there were numerous interesting patients in the clinic this week, one in particular stands out to me because it shows how difficult it can be for people on the island to get the healthcare they need. This patient was a spunky young boy of about 4 years old who more than anything wanted me to take a picture of him J. He had been diagnosed with a seizure disorder several years earlier and had been sent to La Ceiba to see a neurologist who after several tests prescribed the boy Phenobarbital. Unfortunately, in August of this year the mother ran out of the medication and had visited the Global Healing clinic to refill the prescription. Doctora Prado gave the mother a month’s supply of Phenobarbital as well as a referral to see the neurologist in Ceiba to properly manage the boy’s seizure condition throughout childhood and adolescence.

However, as is often the case with many of our patients, the mother was back in the clinic a month later asking again for another refill prescription. Now, if you are at all familiar with anti-epileptics you know that these medications are pretty nasty, and few physicians other than neurologists feel comfortable prescribing them, particularly third year pediatric residents. Therefore, I sat down with the mother and asked her why she had not gone to La Ceiba to see the neurologist as Doctora Prado had instructed? She told me that she had gone to see the neurologist and they had already done all the tests. At this, I was confused, which is when I realized that the mother was referring to the original appointment the boy had with the neurologist over a year ago. The poor woman had not understood that the referral was for a follow-up. I gently explained to the mother that her sons seizure disorder was complex in that just as he might outgrow his clothes, it is also possible that he can outgrow his medication dose, or the type of medication he would need to take. I explained that he would probably need yearly follow-ups with his neurologist until the problem was resolved. It might even be the case that he wouldn’t need to take the medication at all!

At this news, the mother became quiet and worried. This was probably the first time anyone had really explained to her the reality of her son’s problem, and the importance of properly managing his anti-epileptics. After all was said and done, we asked the women if she was going to be able to take her son to La Ceiba, to which she shrugged her shoulders. As is the case with many of our patients at the clinic, she could not afford a trip to La Ceiba but was too ashamed and proud to admit it. Thankfully, we were able to offer the women and her son free transport to and from La Ceiba. The mother and her son left the clinic completely grateful for all the education and help we had offered them. “Que Dios le bendiga” she said, which means “May God bless you”.

My interactions with this family showed me the importance of patient education. It is so important to make sure that your patient understands their problems, why they have them, how to avoid them, and how to treat them. All this mother knew was that the Phenobarbital helped her son, but she hadn’t the slightest idea that poorly managed seizure disorders could result in developmental delay, or how anti-epileptics affect cognition. While all this information may have surprised her, and even scared her a little, I am confident she left our clinic with an increased understanding of her son’s problem, and perhaps with increased confidence in her ability to help him.

Alex Journal 2

This past week was my first full week working at the global healing clinic and boy, was it busy! I think the reason we were so busy each day was because Monday was the Honduran Independence day and a national holiday for the whole country, so all the children had the entire week off of school. Therefore, all the mothers took advantage of the holiday to bring their school-aged children to the clinic. Whereas last week we had between 10-15 patients each day, this week we had about 20 to 25 patients a day. Since most of our pediatric patients at the clinic present with illnesses like bacterial skin infections, urinary tract infections, and parasites, all illnesses associated with poor hygiene or unsanitary food, water, and living conditions, imagine my surprise when we had a young girl come in complaining of migraines. Back at Stanford at the Pediatric Pain Management Clinic where I do clinical research, nearly every other kid we see has migraines or chronic daily headaches. Usually we take a long, detailed history of the child’s migraine history, the quality of the migraine (Ie. is the pain throbbing, stabbing, does it travel from one spot to another, etc.), their sleep hygiene, and finally all the different medications they’ve tried. We then go on to suggest a multi disciplinary approach to treat the migraines, including medication, biofeedback techniques, physical therapy and stretching routines, and finally acupuncture if the child is willing. Now, given how I was used to treating a migraine condition, imagine how utterly frustrated I felt when all we had to offer this poor girl was to take some Tylenol when she felt a migraine coming on and to avoid eating chocolate, sweets, and soda.
The harsh reality is that in a place like Roatan we don’t have the resources for properly treating many medical problems. In fact, we’re lucky if we can get patients to listen to us. Even if we had all the wonderful multi-disciplinary approach to treating chronic pain problems as we do at Stanford, we probably couldn’t get the families to invest all the time and effort needed to come to all the follow-up appointments or to take the medications as directed. This fact is one of the main reasons why I want to do an MPH in addition to my MD, because the only by learning the belief system of the community and finding effective ways to bring awareness and education can one begin to see long-term changes in the way people understand health care. I mean, educating one patient at a time is important, but is also quite futile if when they go home their grandmother, the matriarch and wisest most respected member of the family, convinces them that the gringo doctor doesn’t know what they are talking about, and that the baby needs to see the bush medicine doctor if they want to remove the curse of the evil eye that is making them sick.
Despite all my frustrations, I do still feel we are making a difference in the Global Healing Clinic. I see this in the mother’s who bring their children back for follow-up visits, who come to refill prescriptions before their child’s chronic problem becomes uncontrolled again, and who bring in a list of the medications their child is taking.
In the afternoons I continue to tutor the children in the orphanage. We’ve switched to learning spelling in Spanish, which is a lot more challenging for them since they speak primarily English. They’ve been doing well, however, and are bright kids. The challenge is mainly just to find ways to keep them focused and interested. One day I accomplished this by timing them on how fast they could say the Spanish alphabet without messing up a single letter. I used their natural competitiveness to get them focused on the task, and because they were so determined they were all able to recite it in less than a minute after only one lesson. There is nothing more rewarding than to see kids, who usually get easily frustrated and quit, learn to persevere and succeed with huge smiles on their faces.
Finally, I should probably talk about how completely beautiful Roatan is. Last weekend I completed my dive certification and one the four dives I’ve been on I’ve seen turtles, lobsters, sting rays, a green moray eel, a two-foot long barracuda, shrimp, and a huge crab that could have fed three people! There is so much to discover under the water, so anyone who comes down here should definitely take advantage of the aquatic beauty of the island. Today was also my first day going down to West Bay, a gorgeous white sand beach. I walked there from West End which took about 30 minutes, but if you aren’t in a rush it’s quite relaxing. Finally, I’ve taken up yoga again with a group that practices twice a week and on Sunday mornings. It’s a great way to start my morning and feel peaceful and centered after a long week at the clinic. Cheers!

Alex Journal 1

My first impression of Roatán was how similar the island was to my own island home, Guam. The weather, the vegetation, and the relaxed pace of life on the island all brought back memories of my childhood, particularly the images of children running around barefoot and jumping off the docks to cool off from the afternoon heat in the clear blue ocean. My first couple days in the clinic, however, brought me back to reality making it clear that although this was a gorgeous tropical paradise the people here have real problems and very few resources to remedy these problems due to in part to poverty but also because of Roatan’s geographic isolation.
The austerity of the Global Healing clinic and the doctors working with such limited resources was a real eye-opener for me, particularly coming from my clinical research job at Stanford where our Pediatric Pain Management team is so quick to spend money on superfluous supplies like heat lamps, or where we drink our five dollar chai tea lattes daily without thinking twice about the cost. I was completely humbled by the fact that part of our job at the clinic was to wash and disinfect the ear scopes once a week because it would cost too much to simply throw them away after one use, or how I was using alcohol to disinfect the temperature probe after each use for the same reason. The reality is that in places like Roatan, a large part of success is learning how be resourceful and efficient with the resources at hand, traits I’ve realized few American doctors have. Another example of how resourcefulness is key when practicing medicine in resource poor situations is how Doctora Prado, when she was unable to find the right size face mask, was able to MacGyver (so to speak) an oversized mask, some tubing, and some medical tape to fit onto the face of a 3 year old girl receiving a nebulized medication for her asthma. I should also add that we washed and disinfected these masks as well after their use.
Despite the limited resources, however, I am confident that the Global Healing clinic is making a positive difference in the lives of our patients. I feel the difference we make is primarily through the education we provide to patients during each visit. One example of this I saw was a young mother who had recently borne a premature baby. Doctora Prado had seen the baby two days earlier, and although nothing was wrong at the time, she had told the mother to return if she noticed that anything at all, even the smallest thing was wrong since her little baby was very fragile. When I triaged this mother and asked her why she had come, she confidently told me that her baby had watery stool and that “la doctora” had told her to return if she had noticed any sign of illness. Her saying this gave me hope that our patients were listening to our advice and following up with care, a task that is often difficult for a population that is poor and uneducated. In the coming weeks I hope I can witness more instances like this.

Stephanie Journal 4

It is my last week in Roatan! It feels like I just got here, but also like I've been here for a long time. It's strange. When you're on the island, you get into a routine. Mine was waking up at 6:40, getting to the clinic, leaving around 2 to go to the orphanage, and then working at the orphanage for a couple hours. This life compared to the life at school is so different. There's just an island feel to life here. You can study in the afternoons, be productive, or just waste it away snorkeling, kayaking, watching TV, cooking,... the list goes on. At the end of the day though, I feel good that I'm able to help people at the clinic, and also teach the kids in the afternoon. it feels like I'm actually accomplishing something!!

Last week at the clinic, a senora told me that her daughter had worms. I asked "have you seen them?" and she said "si" and started opening her bag to find something. Before I knew it, she was pulling out a jar with a long white worm squirming around in it and said that it was from her MOUTH. I almost puked. Almost. I got a good shot of that on my camera - I'll try to post it up.

The clinic actually closed a couple days last week because of the strike of the social services doctors. Apparently, there is one year when a doctor is considered 'social service" - they have to work to pay off the medical school that they have received. Currently, they are on strike because there is some unfair procedure occurring in the system. Some private school is breaking the law so all the SS doctors from all of Honduras are on strike. Because of that, part of the hospital shut down and the external clinics (including ours) shut down temporarily.

The kids at the orphanage are getting better at spelling! Their new favorite word - "animal". It has 6 letters! SIX! Compared to a couple weeks ago, when they couldn't even say "the" or spell "the" - it's an improvement. TRULY. The kids had a list of 60 words that they have to learn how to spell and I really thougt it was impossible - but the kids have proven me wrong. They have gotten good at spelling almost all the words. They do forget their vowels sometimes, which is a hard mistake to correct. I'm so glad they're actually learning!

This experience overall has been a good one. The island is beautiful and the people are relatively nice. They're a bit racist though, and haven't seen too many Asian individuals so I would say that's the only downside of coming to a place like Roatan. It is a good mix of cultures - there's the tourist groups in Westend, the local Black population, the "gringos" or expats from the US, and the Hondurans who come from the mainland. Considering that Roatan used to be a English speaking island, it's pretty surprising that everyone speaks Spanish now - mostly because of the mainlanders coming to the island in hopes of making good money. I think the mix of cultures was definitely the most distinctive part of Roatan and it was interested meeting a large range of people - from meeting a Belgian who grew up in Central America to volunteer doctors who work here 7 months out of the year. It's definitely an environment that I will miss.

Stephanie Journal 3

If the Roatans came to America and saw a hospital like Stanford Hospital or all the state-of-the-art recovery center, I think it would just blow their mind. It's the same thing with houses and shops, etc. It's just a different way of life here, and although I realized it the moment I got here and started learning about the culture, it still is extremely wondrous to me.


On that note, there have been some exciting cases. There was a kid with a huge absceso on his head, and it was humongous. When Dra Prado was puncturing the abscess with a syringe and squeezing out the bloody pus, he didn't even cry! I would be crying, to be honest. I really hate needles. I'm also learning new terms - balanitis for example is the infection of the gland near the penis. I definitely didn't know that before.


Something I have been noticing as patients come in is that they ask for medicine specifically, by name, even if they don't exactly know what the medicine do or are for. Granted, I don't know exactly what medicine does what and is for what, but mothers give acetaminophen for EVERYTHING. Everyone is overmedicated because they aren't educated. Many of the doctors in the hospital don't help with this either - they give the mothers what they want. Acetaminophen, loratadine (claritin), Broncomat/Albuterol - even if the kid doesn't need it. It's a placebo effect. Mothers see their kids getting better, but it's not because of the drugs or treatment. It's because things like flu, colds, and the cough just clear up after a while. What worries me most is giving out antibiotics when kids don't need it. This will just reinforce the resistance in the community, and no one - patients, doctors, mothers, kids - will benefit from that.

It's now the end of my 3rd week in clinic. I have about 1.5 weeks left. I am still volunteering at the orphanage and helping the kids with their reading/spelling. Unfortunately the four kids that I work with really cannot read yet - even though they are in first grade. They can barely say basic sounds: th, ch, sh, etc. I've been doing my best but the kids don't realize the importance of reading, and they are used to being rowdy, rude, and obnoxious so that is how they are. One of the kids chased me around with a tarantula spider in his hand in order to get out of studying!! Allen and I have been persevering, but it's getting very frustrating when the kids do more complaining and whining than studying during our time there. Surely but slowly, they're making progress. I just wish it was a more SURELY, than slowly.

From the experience I have had at the clinic and at the orphanage, I realize that I like working with older children or teenagers more so than babies and little kids. The little kids are adorable and cute, but I like making a connection with teenagers and young adults. During the school year, I tutor high school students on the side to make some money, and the experience is really rewarding. Realizing this is important for my future. Unlike most the interns, I am NOT pre-med! My goal is to become a nurse practitioner, and because of this experience I think I have decided on becoming a Family Nurse Practitioner. I was thinking of maybe becoming a Pediatric NP, but I think I would like to have general knowledge so that I can be someone's practitioner throughout his or her lifetime.

Stephanie Journal 2

The first week, I needed a bit of transition time, but I think I am pretty comfortable with my island life now. The clinic has been very interested, especially once I got a hang of the Spanish, medical terms, and pharmaceuticals with their Spanish names. It is a bit like a routine - we get a lot of Upper Respiratory Infections (or IRAs in Spanish), flus (gripe), scabies (escabiosis), impetigo (impetigo), and dermatitis (dermatitis). It's been very interesting watching Dra Sri and Dra Prado apply their knowledge to these cases. A lot of the time, it really depends on the family and therefore the drugs prescribed can be more or less, depending on how much the doctors think that they will comply to it.

There was one interesting child with dextrocardia. Her heart was on the right side of her body, although the rest of her organs were on the right side. There's another condition called Situs Invertus when everything that is normally right is on the left and vice versa, so everything is inverted. It's extremely uncommon, therefore I was lucky to even meet a little girl with this condition! She was really adorable and friendly.

Mondays are the busiest day, so we had a ton of patients then. Apparently, they have not been paid since 2004 and have only been given some "bonuses" but the hospital still owes them a lot of money so the nurses are unhappy. On Tuesday, the nurses went on strike at the hospital so the last week was pretty slow because the nurses were not sending patients to our clinic. Now some other workers.

The kids at the orphanage are having a spelling test in 2 weeks. They need to learn how to spell Roatan, flowers, dolphin, today, boy... and other words that they know how to say, but don't know how to spell. It's really frustrating because the kids themselves get frustrated. I don't blame them - I think that they are behind in school because they were homeschooled for a long time. The other thing is that the English/Spanish transition is confusing. The kids all speak English, but they also learn Spanish in school. Therefore the keep getting their "e"s and "i"s mixed up because "i" sounds like EEEEE in spanish. It's heartbreaking because the kids want to go play and don't want to study this difficult material, but I know that it's something we need to help them with.

I visited West Bay for the first time yesterday. It is SUCH A BEAUTIFUL BEACH. The water is turquoise and the sand is white. The water is warm with some cold currents running through it which feel so good when you're snorkleing. I've never been snorkeling before so doing it in Roatan has been a new experience. There were a lot of jellyfish at West Bay, so I was pretty afraid of getting stung. I didn't exactly want to find out the hard way whether these jellyfish were the stinging kind (I have a pretty limited knowledge of marine wildlife) so I definitely avoided those when I could, sometimes kicking them away with my flipper. I got to see a sea snake (which scared the life outta me), two huge barracudas (which also scared the life out of me), beautiful parrot fish, and lots of other interesting wildlife.

I'm slowly, but surely, getting over my fear of the open water and using my Spanish!

Stephanie Journal 1

I arrived last Sunday, sleepy and jetlagged, and was thrown into the Roatan environment. I'm staying at Miss Peggy's in Sandy Bay in her downstairs apartment, right at the edge of the ocean between two docks. Everyone has been great - the volunteers from Clinica Esperanza, Mia who left yesterday, Miss Peggy, and the staff at the clinic. At first, I was very anxious in the clinic, but after 3 days with Mia, I am ready to tackle the clinic on my own. It's smaller than I had imagined, but it's been a great experience shadowing the doctors, and as I get faster at paperwork and triaging, I get more and more time to shadow and talk to the doctors. Doctora Prado is the Honduran fellow in the clinic, and she's been very helpful, especially with translations from English to Spanish. There are a lot of medicines, treatments, and illnesses that have abbreviations or names that I do not know/understand because it's in Spanish. She's been really patient with me. Dra Tiyyagura is a pediatrician from New York and she's also been great to shadow and learn from.

I had heard so much about the clinic before I got here, and even seen a lot of pictures, but when I got here it seemed very foreign. It's great to be in this environment - where volunteers like Dra Tiyyagura and myself can help a large number of people - even if it's only seeing 20-25 patients a day. Most of my patients are under the age of 5, and they're almost always accompanied by their mothers (sometimes fathers). The people have been patient with my Spanish, which has an accent and is sometimes hard to understand compared to their Spanish. For me, it's easier to understand an American speak Spanish than a Hispanic person speak Spanish, and I think that's a bit ironic.

On my time off, I've been continuing the work at the orphanage. Mia told me about the improvement that Dawn started and that she has continued. I hope that Allen and I can keep going to the orphanage to help with their schoolwork. After the orphanage, I usually go fishing on the dock or kayaking in the ocean. Although I know my priority is in the clinic, it's been nice to have time off in the late afternoons to relax because I wake up early to go to clinic again. I've kinda caught a "fishing bug" and I go almost everyday :) Catching fish and then eating your catch is pretty satisfying, even if it's only a tiny fish!

Mia Journal 5

Sunday August 3 to Sunday August 10

Me and Hannah have had a very adventurous weekend as we were let loose on the Roatan roads by ourselves. We took Peggy's rickety truck and luckily survived the crazy taxi drivers-who love to pass cars on blind turns-the invisible potholes every couple feet, and the random people walking along the sides of the road. Yesterday we went to go solicit donations from businesses in Coxen Hole and West End for Sundae by the Sea, the silent auction that Peggy's clinic holds every year to raise funds for Clinica Esperanza. And today we picked up Stephanie and Allen - the new volunteers - at the airport. Today we were supposed to go la Colonia to distribute Kids Against Hunger food packets to the families, but Dr. Ivan - who was going to also give a presentation on dengue - was called to la Ceiba because one of his patients got dengue hemorrhagic fever. Hopefully next weekend before I leave.

I can't believe I only have three days left in the clinic! This past week we've been working at a really fast pace because we have Dra. Srit, Dra. Laura, and Dra. Prado here everyday. On Monday, Dra. Srit drained a scalp abscess and the scream of that young girl will forever be burned in my brain. On Tuesday she came in again and I watched Dra. Laura repack the hole. I thought the gauze would never end as she pulled it out of the gaping, bloody hole on the back of the poor girl's head. After clinic that day, we all went to the local daycare to administer antihelminth medication to the 15 or so children there. Boy was that chaotic. We had one tiny room to fit the four of us AND two or three crazy little children. We all felt like we had gone through war as we left the daycare; those kids were super energized because our team came right after they had had their nap. My little monkeys at the orphanage seemed like quiet little angels after the day care.

Wednesday started the introduction of the new patient sheet. For me, it only means asking four more questions about past medical ailments, current medication, vaccination history, and any known allergies to food or medicine. Lidia explained to me that getting this new sheet was such an accomplishment because apparently it had been vetoed multiple times. Lidia said the hospital bureaucracy does not particularly like changes in methodology. Thursday was super fun at the orphanage because the kids and I dyed Hannah's hair! We dyed her hair a burgundy, chocolate cherry color and of course as I reminded the kids to be careful about not getting dye on Hannah's face, Chenice slaps a big handprint of red on Hannah's forehead. It was a hilarious process, and the kids really enjoyed it.

I've still had several mothers come in with their chief complaint being, "no quiere comer nada nada." We had one mother come in with this complaint about her 2 year old child, and as Dra. Laura tried to convince her that she was the boss, not the child, I could see a look of doubt and confusion appear on the young mother's face. The two year old apparently walked around the town buying only junk food and candy. So Dra. Laura told the mother to stop giving her son money, to stop letting him walk out alone because of possible danger, and to just wait for the child to get hungry. "He'll eventually eat anything if he's starving," Dra. Laura said. I guess it sounded kind of harsh to the mother, because she left a bit disgruntled. Another mother came in with her daughter and as the mother started complaining that her child was not eating anythingwas answering my questions, her daughter sat there with cheese covered fingers, shoving cheetohs into her mouth. It's frustrating to keep seeing these mothers come in with the same complaint; I swear we see at least 5 a day!

Friday night I went with Peggy and the Clinica Esperanza team to rotisserie chicken (YUM) and we had to leave midway through for a medical emergency. The son of the future president of El Salvador had fish (and apparently he is allergic to fish) and did not have an epipen like was recommended to him, and so he was shipped to Peggy's clinic for treatment. Everything turned out fine but it was an exciting end to the night.
And now, me and Hannah are going to be adventurous and try and cook something delicious.

3 more days in the clinic!

Mia Journal 3+4

Week of Sunday, July 27 to Sunday, August 3rd

The beginning of this week has been a lot less hectic and crazy than last week. Last week started sin el doctor Gross and con una emergencia; a little girl with internal bleeding had all the doctors occupied for about 3 hours. I was grabbed and almost literally dragged to the laboratory to translate for Alice who was desperately trying to get blood for the girl. It was pretty scary trying to understand why we were being denied (ended up being a lot of bureaucratic filling out of forms) with noise and chaos surrounding the already scorching hospital. Not to mention, as I opened the door to the lab, I almost got nailed by a flying droplet of blood! After finally getting the order in for the blood, I went back to the clinic, where two children had puked all over the hallway, and I had to suck in my stomach as to keep myself from puking from the stench. I swear it was fever day because there were at least 5 children with fevers greater than 101. At least that insane day ended on a good note-the premie came in for a check up and seemed to be doing really well.

Tuesday didn't prove to be any less eventful; a baby girl in the waiting hall began to go into febrile seizures and had to be whisked away to the ER. I stood there with the mother, trying to comfort her as much as possible as she was sobbing and shaking uncontrollably. My heart absolutely broke for her.

The rest of the week was a lot milder; a lot of URIs and a lot of the popular chief complaint here on the island, "no quiere comer comida! solo dulces!" I've seen Dra. Laura get flustered multiple times this week trying to explain that antibiotics don't work for viruses, and it gets me thinking about the patient's perception of their quality of care. Here, as well as in the United States, parents feel more satisfied when they leave the doctor's with some sort of medication or injection. When I see empty handed parents leave with a quizzical unsatisfied look on their face, I wonder if they lose faith in the care their doctor's provide, or even in their doctor's education. I wonder what other implications arise, specifically and especialy in this Global Healing clinic where the patient-provider relationship is already tainted by a language barrier and a cultural distrust.

The orphanage has been wonderful times up until Wednesday. Shenice, who appears to be the sweetest girl (and super bright as well) did not take her nap and I feared for my life (exaggeration of course) as she threw the HUGEST temper tantrum I've ever seen in my ENTIRE life! We had to end the lesson early and calm her down because she stabbed the table pretty forcefully (and we weren't about to let her use that same force on somebody's eye).

A new resident came in this week- Dra. Srit Tiyyagura, a co-resident of Dra. Laura's from NYU. She came just in time for the Trauma Conference, which had a good turn-out. The conference was all in Spanish, and most of the Global Healing team could understand most of it if focusing at the utmost intensity possible. All in all, I'd say it was a success.

Sunday I spent my day at West Bay Beach again, and like always, it was superbly lovely. Tomorrow will mark my fourth week at the hospital!

Mia Journal 2

Week of Sunday, July 20th-Sunday, July 27, 2008.

Today marks the 15th day I've been on the island-almost the

halfway mark. This past week started off with the coming of

Howard and Alice Gruber. After a wonderful dinner at the

Argentine Grill with the entire Global Healing team, I went

home to rest up for my second week of work at the clinic.

That week at the hospital was distinctly different with

Howard, Alice, and Robin (nurse practitioner) there. Our

already tiny working space shrunk to the point where every 5

seconds someone was bumping into someone else. Alice spiffed

up the place, AND we got a new 19 inch flat screen computer!

Oh my goodness does that make a HUGE difference! The old

computer took FOREVER to perform ANY action and this new

computer is quick, fast, and never freezes up, saving all of

us lots of time. The air and electricity still go out quite

frequently which is a bummer; especially with a minimum of 6

people in the room rushing about creating heat. I triaged a

1.4 kg premature baby (I forgot how many weeks it was) which

was really very scary for me. I was scared she would break if

I made a mistake! We also saw a little boy with a nasty

infected lip, with swelling from his lip up to his right

eyebrow. The image of Dr. Gross cutting open and draining a

cranial abscess will forever be burned into my brain. On

Wednesday, Robin took me on a tour of the pediatric ward and

we watched the nurses clean and dress a child's fractured hand

(Robin is here to train the nurses and so she was taking

notes and telling me the differences in method as compared to

how it is done in the United States). The 7 children in there

were melancholy and a few were whimpering, but upon giving

them Global Healing teddy bears, we exited the ward leaving 7

smiles behind us.

Wednesday afternoon, we had a small conference with other

nurses and health workers from the Hospital in a separate

building across the way. Dra. Prado gave a presentation on

hypertension and Robin followed with a presentation on how to

properly administer sodium fluoride varnish to children.

Global Healing does quite a bit of community outreach in

addition to managing the pediatric clinic at the hospital;

this coming week we are planning to administer antihelminth

medication and next Saturday marks the 2nd Annual Trauma

Conference. I am really excited for the new pilot program

Howard is starting at the clinic to fight the prevalence of

dental caries. Not a day goes by that we don't see at least 5

children with horrible looking teeth. One child had a dental

abscess near the size of a ping pong ball due to lack of

dental hygiene and the consumption of chatarra! Although we

give out toothbrushes, I am skeptical as to whether the

parents really have the time or patience to force their

children to brush twice a day. I don't even want to think

about whether these kids floss. But, dental hygiene would

fall towards the bottom of my "important things to do" list if

I had to scrape around to obtain enough money to feed my

children. It was really discouraging to see mothers come into

the clinic worrying about their children's constipation and

stomach pains, say they understand they need to feed their

children fruits and vegetables instead of chips and Coke, and

then walk across the street and buy their children a soda and

some candy-a treat for putting up with a doctor's visit. I

have seen this in many underdeveloped countries and it is

frustrating and saddening because most parents can not afford

to buy fruits and vegetables for their children every day.

Something else must be done, possibly from the economic or

government sector, because doctor's can't do much else besides

tell the facts about nutrition and dental hygiene. In the

states, people have a choice to listen to what their doctors

and dentists recommend. Here, parents-especially single

mothers-don't have much choice other than to provide their

children with the food their income will allow them to buy.

Howard explained to us that this dental program is distinctly

different from other varnish administering programs that have

been recently proven successful in other Central American

countries because here in Roatan, the fluoride varnish will be

administered at the hospital by the nurses; once when the

children come in for the 12 month vaccinations, and again when

they come in at 18 months. We have posters to promote this

varnish all over the hospital and we are putting them up in

different barrios around the area. It is really neat to watch

this program develop because the kinks and other issues are

still being worked out. And, there is only supply enough for

300 children for 6 months-so there is half a year to come up

with an additional supply. Yikes. The nurses are stoked that

they are doing something unique to Central America and they

joked around about becoming famous. They are really excited

and hopeful for this program to be successfully implemented.

Friday I got to try out an audioscope for the first time!

Exciting! Dr. Laura shocked me when I was shadowing her

because she handed me the audioscope unexpectedly and said,

"Take a look at her ears. You'll see they are quite impacted

with wax." She taught me how to properly hold the audioscope

to be able to see best, and as I looked into this young girl's

ear, I saw a dark brown wall of wax. After Dr. Laura

prescribed drops of Cerum for the girl's impacted ears, she

let me look into her own ears for comparison. There was such

a stark difference between Dr. Laura's ears and the girl's

ears! Whereas the girl's ears were dark drown, Dr. Laura's

were completely clear and light and I could actually see her

tympanic membrane. I was able to check Alice's ears also, and

her tympanic membrane was in clear view as well. That was a

really cool hands on experience for me.

Another cool close-up experience I had this week was watching

an ultrasound being administered on a 6 month old baby with an

abnormal neck mass. Everyone was clustered around the

ultrasound monitor and with 4 doctors huddled around, there

was a lot of mumbling and hypothesizing and debating about

what the neck mass was or whether it was attached to anything

concerning. I watched the blood vessels in the neck open and

close like a fish does while swimming underwater, and the

consensus was open ended. All the mother could do was wait

until the child was old enough for surgery or until the neck

mass popped on its own-if it ever would.

Dr. Gross is leaving today; I am going to miss shadowing him

and translating for him. He has done so much in his life and

has been all over the world. I knew he was a crazy cool

doctor ever since he told us that he really liked chocolate

covered bees. "They have a nice little crunch," he said. I'm

definitely going to miss him in the clinic. Next week is

going to be a trip; just two doctors instead of three. But I'm

super excited as to what I will see and learn in the next

seven days!

Dawn Journal 4

15 July – 20 July

I can't believe this is my last entry! Time has flown by—especially because this past week has been rather eventful.

On Tuesday, I got really violently ill and spent the night throwing up everything –including water that I tried to drink. Peggy said that this same sickness had hit a bunch of volunteers a little while ago and that it usually took a few days to recover from. It was pretty awful but I managed to make it into clinic the next day to show Mia around. We spent the next few days getting Mia oriented and by Friday, she was completely in charge and running the show herself.

On Friday, because Mia had triaging under control, I got to shadow the three doctors on their rounds in the ward. It was great to be able to see the rest of the hospital, albeit a bit depressing. All of the equipment (even beds and curtains) seemed to have a thick layer of grime and rust on them. The pediatric ward had cribs that reminded me of rusted prison bars. The patients were upbeat though – I saw mothers with their newborns, a three year old with fractured fingers, a 9 month old with a severe burn on his face, and a 4 year old with a history of seizures.

Mia has also been volunteering at the orphanage with me, and the children seem to really like her. We continue to help them with their schoolwork and reading practice and I've noticed that the children have come to accept their study time as routine. When I first started working with them, there was no defined schedule and they were quick to resist any attempts towards work. Now, they come right down from their nap at 2 and are ready to start working with us. In my opinion, routines are definitely something children need.

Tomorrow I'll start work at La Clinica Esperanza – the clinic that Peggy runs. It'll be interesting to be able to compare the two environments and systems in which things are run. I'm looking forward to the experience.

Anyhow, I've really enjoyed my time here in Roatan and have learned loads. I'm confident that I want to enter the field of medicine (especially pediatrics) and have strengthened my desire to work in international health. Best of luck to Mia (you'll do great!) and the rest of the volunteers.

Dawn Journal 3

8 July – 14 July 2008

For the past 3 working days, Dr Gross, Dr. Laura, and I have been working at the hospital without Dr. Prado, who went away to a medical conference in Tegucigalpa. There were a few requests from patients that the three of us weren't quite sure how to handle, mostly because we didn't know how the hospital system worked. One poor woman who had arrived at 6am was made to visit three or four different departments, wait for hours, and finally told that there was no medication available for what her baby was sick with (rotavirus). I'd guess that she was probably there for about 6 hours total. Over my time here, I've discovered that it's a bit frustrating to work within a system that has such poor communication and organizational skills. I've also noticed this lack of organization within the patient files. For instance, there's no permanent record of past histories and medicines administered. Whatever happens to be in the patients file (a literal manila file folder) is it. I think a defined system would greatly improve efficiency and quality.

Along with triaging patients, I've been learning loads both from shadowing Dr. Gross and Dr. Laura and from other volunteers. Today for instance, I got to listen to a child's chest that was sick with pneumonia. I happened to know what to do because yesterday, another volunteer had taught me what to listen for, where to press the stethoscope, and how to interpret what I heard. It was really exciting to put that knowledge to work in clinical practice. In addition, Dr. Gross often has me translate for him, and is great at explaining different tests to me. Today he did a full examination of a child that was born at 27 weeks – very prematurely. He explained the various stages of child development and about the different tests that one might to do look for certain milestones. In the middle of the examination, both Dr. Laura and Dr. Prado popped in to take a look. It was great to hear them bouncing ideas off of each other and consulting. Each have varied specialties of knowledge and I appreciate their willingness to be flexible with their diagnoses.

The new Global Healing volunteer, Mia, arrived on Sunday. Peggy and I picked her up from the airport along with another volunteer named Sean. I'll start her orientation on Wednesday so she can get three good days in at the hospital before she's on her own. The new doctors are certainly looking forward to meeting her and I think it'll be a great transition. I can't believe it's my last week working for the hospital! I'll be on the island for a couple more weeks, volunteering with Peggy's clinic, but it definitely seems that time has flown by far faster than expected.

Dawn Journal 2

The new doctors, Dr. Gross & Dr. Papa. (abrv) have arrived to work in the clinic. Because there are now 3 doctors in the clinic, today was extremely busy – we took in around 32 patients. The waiting hall was absolutely crammed with people—whenever I opened the door to call in another patient to triage, a blast of warm, wet air would hit me in the face. About midway through the day, the power went out for around half an hour, leaving the 4 of us to operate in semi-darkness. In sum though, a very successful day. The new doctors are extremely nice and knowledgeable. They have also brought with them some extra medicines and vitamins, which are much appreciated.

As time has passed, I've gotten much better at refining my triage skills and also at administering fever medications. I'm also able to understand patients requests and explanations much better. Dr. Gross has even asked me to translate for him a few times, which makes me feel my communication skills have improved to some degree. Dra. Prado has also been great at explaining the various diseases and medications that I have questions about. I've been keeping a running tab of the various questions that have come up and am in the midst of creating a cheat-sheet for future interns' reference.

My work at the orphanage has also been coming along nicely. My job is to teach the house's four first graders how to read in Spanish, which has proved to be a daunting task. It's hard to explain why "me" sounds differently in English and Spanish and the children are easily frustrated. I've mostly been concentrating on getting them to sound out letters and figure out consonant combinations. In the end though, I feel like progress is being made. They're slowly improving and are great to play with afterwards.

Lastly, I've found great friendship in a few of the other volunteers here on the island. They are interning in Miss Peggy's clinic, which is across the street from where I live. It's definitely nice to spend time with people, especially those who have great medical stories to tell. We've had a few cooking and traveling adventures together, which has made my off-time very worthwhile.

Dawn Journal 1

I've just finished my first full week at clinic here – 11 days on the island total. The clinic is what I expected, having heard descriptions from previous interns. The hospital itself is pretty run down, with the electricity going out often and the water running less so. The first days, I learned how to triage patients and enter the appropriate data into the computer. At first, I was nervous that my Spanish wouldn't be good enough—that the patients wouldn't be able to understand me and vice versa. That fear has abated somewhat, as I've picked up the general routine, but sometimes I still feel inept at what I do, due to the language.

With patients, I've noticed that there are a few diagnoses that are quite common. Otitis media, scabies, and internal parasites seem to be popular. I've also noticed that many of the mothers are extremely young. Only a few fathers have accompanied children. During triage, I ask all families where they live and have come to wonder if there is a trend in sickness due to what barrio people come from. Most children are below 50th percentile in weight and height.

After clinic, I have been volunteering at the local orphanage. There are 10 children there and they vary from 2 to 18 years of age. They seem to be well cared for, though the level of discipline is a bit low. I believe this may be due in part to the rapid turnover in administration. The children are friendly and energetic, and I wonder what kinds of effects the lack of a consistent adult figure in their life will have.

In addition to the RVPC, I've gotten to know the island pretty well. So far, I have visited both the western and eastern ends of the islands, hung out at a couple of resorts, snorkeled almost every day, watched a dolphin show, hiked up into La Colonia, and gone SNUBA diving. The other volunteers at Peggy's clinic have been welcome and inviting, which I have appreciated immensely.

This coming week, a new American doctor, Dr. Gross, will be coming to work in the clinic. I look forward to meeting him and possibly shadowing him to see what kinds of thought processes he goes through. More to come soon!

Ileana Journal 5

My second last week at the clinic was not very eventful because from Tuesday to Thursday the hospital was on strike. Although we relieved some of the patient load from emergency by tending to the non-urgent pediatric cases, we had very few patients to see. On Friday, people must have assumed that the strike was still on, because we only had one patient. The plus side of not having very many patients was that I was able to focus on other things. On Wednesday for example, Dr. Prado and I had time to go to a computer shop to get a quote on the price of a new computer. Lately the clinic computer has been running very slowly and it’s definitely time for a new one. We still have not received approval for the purchase, but I am hoping that we can get it before I leave. This might be tough since I only have one week left.

Having extra time at the clinic gave me the opportunity to discuss Roatan’s public health issues with Dr. Prado, as well as the differences amongst the different ethnic and socioeconomic groups here on the island. Not surprisingly, the biggest concern on the island is a lack of health education and awareness. So next week, we are hopefully going to be visiting some public schools to do some health presentations.

Dr. Prado also taught me a little bit about hypertension in children and showed me how to take blood pressure. I only practiced on her and not on real patients, which was definitely a great idea, because it was more difficult than I imagined. During my lesson I also learned a great deal about stethoscopes and was amazed to hear how sophisticated and expensive they can get.
Another thing Dr. Prado told me about was respiratory distress. As I was triaging a patient and trying to take his temperature with the thermometer, he started crying as babies typically do. Dr. Prado was with another patient, but as soon as she heard the boy crying, she got her stethoscope and listened to his lungs. I was a bit surprised at first, because the mother had not mentioned anything about difficulty breathing. However, as soon as Dr. Prado heard his lungs, she decided to see him right away, so I knew it must have been bad. She later put him on oxygen instead of just using the nebulizer, which I had never seen before. Since I was so confused about this, I had to ask her how she knew there was something wrong with the boy just from hearing him cry. She said that it was not a normal cry and then went on to briefly explain the signs of respiratory distress, its effects and its treatment. The next day a two-month-old was admitted to the E.R. with severe respiratory distress. I did not go see him until he was a bit more stabilized, but even when I saw him, I recognized the signs that Dr. Prado had pointed out and was pretty amazed at how fast he was breathing.

Week six also marked the end of my volunteering at the Sandy Bay Alternative School. My time at the school was interesting as I had not been exposed to such a group of children before. From what I have gathered about the school, it is a private school on the island that follows an American home-schooling curriculum. The advantage for the children is that they are able to socialize with their peers while also influencing the pace of their education. My experience with the children consisted of spending time in the classroom during their summer school program. In the summer, they are given the option to attend the school and so they do not follow a curriculum. The children that do decide to attend (or whose parents decide for them) are all put into the same classroom and do educational activities and exercises together during the day. When I was there, there were about 16 children aged six to 13. I volunteered for two weeks, Monday to Thursday 1-3pm, assisting two of Ms. Peggy’s volunteers whose lesson plans covered global awareness, environmental awareness and general health and nutrition.

Ileana Journal 4

My fourth week at the clinic just seemed to have flown by. We didn’t have anything too unusual, but things were different because Dr. Rhee was gone and Dr. Prado was also away due to a family emergency. That left only Dr. Srinivasan and the new attending, Dr. Kuhl. Things went rather smoothly though, with none of the children needing to be admitted. On Monday, the highlight of the day was when I watched Dr. Kuhl lance a post-varicela abscess on an 18-month-old boy’s bottom. The boy had come in on the Friday and Dr. Rhee had prescribed him some antibiotics hoping the abscess would get smaller so that it wouldn’t have to be lanced, but they hadn’t helped. By Monday it had gotten so bad that the poor little boy couldn’t walk or sit down comfortably. The interesting thing about it was that with Dr. Prado gone we didn’t quite know where things were. I had to go to the E.R. to get a surgical blade and the doctors searched the clinic looking for gauze, iodine and bandages. We eventually managed to find the rest of the supplies at the clinic, but unfortunately, we didn’t have any anaesthetic. I had never seen an abscess be drained before so although I expected to see a lot of pus, I didn’t think it’d be so bloody. The boy took it really well though, he cried and screamed, but didn’t kick or squirm much. The rest of the week went by pretty steadily, and we managed to get out early a few times. On Friday, Dr. Srinivasan showed me an ear infection, so I was pretty happy about that.

Outside of the clinic, I didn’t do too much. On Tuesday I went to a yoga class at Land’s End with some of Peggy’s volunteers. It was very nice because we could see the sun setting on the ocean and hear the sound of the waves crashing, as we did yoga. I think we’ll return again this week. I am now living with two of Peggy’s volunteers in another apartment at the White Diamond. I am very happy with it.

On Wednesday the bad weather started on the island and I saw rain for the first time since I have been here. The rain didn’t stop until Sunday and the cloudiness and strong winds are expected to stay until Tuesday. Even though I had plans to go hiking at the Carambola Botanical Gardens on Friday and go on the glass-bottom boat in West Bay on Sunday, I wasn’t able to do so. I’m really hoping the weather clears up next week.

Ileana Journal 3

It seems like every week in Roatan keeps getting better. Week 3 at the clinic was a bit busier, but by now I’ve really got myself into a routine. Overall the week was normal but like always there were a few interesting stories.
At the beginning of the week we had an 18 month old come in with a 103F fever. I told Dr. Srinivasan right away because it was the highest fever I had yet seen. He told me I could give the boy Motrin while he waited, so I was able to do that with a syringe. I had never given medicine to a child with a syringe before and at first I was a bit nervous. I didn’t know how quickly to push it and was worried that I’d give him too much medicine at once. It ended up being really easy though and the boy seemed to really enjoy it because it was bubblegum flavoured. After Dr. Srinivasan saw him, he decided to admit him because he looked a bit lethargic, which I learned is not very good in medical terms. The next day when I came in, I was told that his condition had worsened overnight and that he had passed away. It was a big shock because although he had looked sick, it didn’t look like he was dying. It upset me a bit because just the day before I had given the boy medicine and I remembered him so vividly because of that. I was able to accept his death though because I realized that sometimes things like that happen. I did the best I could by giving him medicine and Dr. Srinivasan did the best he could by admitting him.
On a lighter note, I got to use a stethoscope last week! I listened to my heartbeat, which is normal, listened to a murmur, which sounded very different and also listened to an asthmatic child’s breathing, which sounds normal without a stethoscope but actually has wheezing when you listen to the lungs through a stethoscope. Dr. Srinivasan also let me look inside his ear so that I could see a healthy ear and eventually I’ll be able to see what an ear infection looks like.

On Friday we had a child come in for his 10 day check-up who had hyperbilirubin. Dr. Rhee needed to take some blood out to have blood tests done, but since the baby was actually only 9 days old it was very difficult. The doctors had me put my finger in the baby’s mouth so that he could suck on it while they tried to draw the blood. It was amazing to see blood coming out of such a small child. They weren’t able to get all the blood they needed, but I think they got enough to do the tests.

Other than patient cases, the other exciting news in the clinic was that we got air conditioning! Ever since I got here the clinic had been too hot to be able to work comfortably in it. Even the patients would complain because the clinic was hotter than the hallway outside where they wait. Now that we have air conditioning, I’m sure things will be a lot more comfortable. Since Dr. Rhee worked on getting the air conditioner approved, he thought it should be named David, after him. Everyone had agreed to it, but then Dr. Prado thought it should be named Lidia after her, since she was the one that arranged for it to be delivered to the island and picked it up and arranged the installation. As of now it remains unnamed.
Friday was Dr. Rhee’s last day so Dr. Srinivasan and I went out for dinner with him to the Lighthouse. It’s Dr. Rhee’s favourite restaurant in Roatan and I can see why. The ambience was great, the breeze outside was very nice and the food was delicious! We were all so full afterwards that we had to sit there for a while before getting up to leave.

On Saturday, two of Peggy’s volunteers decided to rent a truck for the day, and they invited three of Peggy’s other volunteers and myself to join them on an excursion around the island. I got to see how beautiful the island really is. We went to Oakridge and then took a water taxi to the mangroves and to the Hole in the Wall restaurant. It was a very great experience. We then went to Paya Bay beach, it’s so far off the main road that hardly anybody goes there, but it’s absolutely gorgeous! On Sunday we went to West Bay again and we went snorkelling. The reef is so beautiful and so close to shore! I saw a lot of nice, colourful fish, and luckily no sting rays or other strange creatures!

Ileana Journal 2

The second week at the clinic was busier than the first and a bit more eventful. Instead of having seven to 14 patients each day, we had 14 to 27. It was a lot more difficult to triage the patients quickly enough. The doctors would often find themselves waiting for me to triage before they could see a patient. With three doctors working at once, it’s hard to keep up with them. There were a few families that needed two or three children seen together, so even if I triaged three of them, one doctor would take them and the other two would have to wait for me to get to the other patients. There were also a lot of young babies which meant that the whole process of taking their weight took longer than that of older children, since babies first have to be undressed to be weighed and then dressed again. (It’s very important that babies be weighed without their clothes on in order to get the most accurate measure.)

We had a few interesting cases, one child with dextrocardia at the beginning of the week (that’s when their heart points towards the right instead of the left side) and at the end of the week another child had dextrocardia and situs inversus, which means that all of their organs are reversed. Although those cases were interesting to hear about, I wasn’t able to see the rare conditions myself since the children showed no external signs. However, there was one child that came in at the end of the week with hydrocephalus. He came to the clinic because he had fallen and had a sore tailbone, but I was still able to see that his head was very large in comparison to the rest of his body. At first I was a bit shocked, but the child was actually so cute and well-behaved that I couldn’t help but think he was adorable!

On Wednesday we had a lunch-and-learn led by Dr. Srinivasan. He gave a very informative presentation on PALS (Pediatric Advanced Life Support). A few nurses and most of the social service doctors attended it. In Honduras, after students complete medical school, they have to perform social service in high-need communities before they can become fully licensed. Since the social service doctors do not have much hands-on experience, it’s important for them to attend the talks in order to know what to do in certain situations. The PALS presentation was especially useful because when the doctors learn about life support in medical school, there is no special emphasis on pediatrics, and there are indeed some key differences between children and adults. Overall, I’ve already learned a lot during these past two weeks and can’t wait to keep learning more.

Outside of the clinic, I haven’t been doing too much. I’ve started going to the beach in West End in the afternoon for a couple of hours until sunset; I find it’s a really nice place to read a book. I also gave scuba diving another try, but I think it’s fair to say I failed. I was on the boat, all ready to go, but I was too scared to lean back to fall into the water. I was just way too scared to fall backwards! I had a lovely time snorkelling though and have decided that that will be my new hobby. On Saturday, Peggy’s new volunteers arrived, so we all went to the Rotisserie chicken place for dinner. Then on Sunday I went to West Bay with three of the new volunteers. It’s great to have more girls around and we all seem to get along very well.

Ileana Journal 1

Week one in Roatan has been filled with so many new experiences. It’s hard to even know where to begin but I will focus on the clinic since that’s the reason why I’m here. Not having much of a science background I was somewhat worried that it would take me a while to adjust to the clinic environment. Fortunately Rose trained me well, and I found the triage process to be straight-forward and easy to follow: greet the patient and their mother or guardian (I say mother because I have yet to see a father come in, and guardian because many times it’s not the mother bringing the patient in but a sister, grandmother or aunt), then I get them to have a seat, I ask about the child’s symptoms and write them down in the patient file in Spanish. I then take the patient’s temperature, height and weight, and tell them to wait outside. After this I have time to look words up in the Spanish-English Medical dictionary if necessary, plot the patient’s height and weight on a growth chart, and enter the information on the Global Healing spreadsheet and on a hospital sheet. During this time the doctors are usually on rounds where they do newborn check-ups, so it works out well because it allows me to get a head start before they get back. On Tuesday I got to go with them on their rounds, but unfortunately there were no newborns to be seen. Nonetheless it was a great experience, because I got to see some other parts of the hospital. It was definitely eye-opening since the only hospitals I had been to before were certainly not public hospitals in a developing country.
Right now I’m working with Dr. Lidia Prado, who is the Honduran doctor in the clinic, as well as Dr. David Rhee, who is from New York and is the attending pediatrician, and Dr. Sush Srinivasan who is finishing his residency in Michigan. I really couldn’t have asked for better doctors to work with. They’re all very friendly and I’ve already learned a lot from them. Lidia helps all of us translate from English to Spanish and corrects our spelling and grammatical errors. She even threatened to start grading our work, but Drs. Rhee and Srinivasan vetoed the idea. Despite their discomfort with the language, I think their Spanish is great and they’ve proven to be quite capable of communicating with patients. They often want to double-check that they’ve understood the patients, and that the patients have understood them, so they’ll get me to translate for them. It’s been a great opportunity for me because I get to learn more about the cases and the diagnoses. The mothers will often use that time as an opportunity to ask more questions that they hadn’t thought of or to clarify things that they didn’t completely understand. I find it very reassuring when they do this, because it shows that they’re concerned about their child’s health.

I’ve learned already that it’s very important to make the patients feel comfortable. I’m still working on trying to calm the kids down when I take their temperature or their height and weight. I was surprised at how many of them start screaming or crying. The doctors seem to have figured out their own techniques to calm kids down, so I might have to ask them for tips. It’s been so long since I’ve been around children, that I’ve forgotten the nuances involved in dealing with children. I think I’ve done a good job at communicating with the mothers though. I make sure to say good morning and to smile a lot. I also think it’s important to keep a straight face at times when listening to the information they’re providing. I’ve overcome my feelings of shock at mothers not quite remembering their child’s birth date or mixing up the birth year. In North America, birthdays are a big deal. I’m also getting used to hearing about children vomiting or excreting worms, and I’m also becoming accustomed to seeing some of their rashes and sores.
Besides spending time at the clinic I’ve also begun exploring the island a bit. I’ve really only gotten as far as West Bay though and have spent most of my time in West End. Despite my various efforts to keep occupied, homesickness seems to come and go and sometimes staying busy is hard to do. On Saturday I decided to give scuba diving a try, but it’s proving to be more difficult than I expected. I think the problem might be that I simply don’t like being underwater. Drs. Rhee and Srinivasan are encouraging me to keep going with it, especially since I have yet to do an open water dive. So far I have only done confined water safety skills which I did not enjoy. Other than diving I’ve also gone to West Bay beach and have enjoyed quite a few meals out in West End. So far the food here has been great and the abundance of kidney beans suits my vegetarianism rather well.

Rose Journal 6

It's been a pretty uneventful week at clinic. Monday Esteban was sick so Dr. Sabio was seeing patients on his own. The nurses tried to give us thirty charts but we had to tell them that there was no possible way we could see that many patients with just one doctor. I felt bad having to do so, but it would have been impossible for us to tend to that many patients and give them all a proper level of care. They ended up deferring those kids to other clinics, so at least they got seen by someone. Dr. Sabio saw around eighteen kids single-handedly and we ended up being at clinic until around two o'clock.

Tuesday was yet another feriago (holiday) and the clinic was closed. Apparently the holiday was to commemorate the British coming to Roatan centuries ago. It was kind of a nice surprise to have a day off as I didn't hear about it until right before I left on Monday. I was able to catch up on my sleep a bit and spend some time over in West Bay, marvelling at how gorgeous this island is.

Wednesday was pretty non-eventful. There were all the usual case of gripe, diarrhea, scabies, and intestinal parasites. There was also a kid with a fractured leg and another with trauma to a finger on their left hand. Elsa did a lot of triaging that day which gave me a change to observe a little bit. It's been really nice to have Elsa around because she is so eager to help out and I think her triaging is more effective than mine because, of course, she is a native Spanish speaker.

Lidia finally returned to work after her surgery on Thursday, which was so great! It was difficult to have new doctors in the clinic without here because they were always asking questions about the inner workings of the hospital that I had no idea how to answer. So Thursday Dr. Sabio, Esteban, and Lidia were all working and things went really fast. I could hardly triage fast enough to keep up with them. We only saw seventeen patients and were done with clinic by noon.

Friday was a bit more interesting. We admitted two little girls, one to the hospital and one to the emergency room. The girl we admitted to the hospital had a giant abscess and an awful ear infection. The little girl that went to the emergency room was suffering from a high fever and seizures. It was incredible to watch the family that brought her in. There was five of them in all: her brother, mother, two aunts, and father. They were all so concerned it was heartbreaking. Lidia had gone into another part of the hospital for a minute and when she started seizing they ran over to my desk with her, shouting frantically. I have so much sympathy for anyone that has to watch their loved one have seizures. No matter how many times I've seen a grand mal seizure it's always equally as terrifying.

So that pretty much sums up my seventh week here. I can't believe I've been here that long! Hopefully this weekend I'll be leaving the island for the first time since I got here and sailing on a catamaran with some friends. I'm really excited for that, I hear it's a lot of fun!