A Travellerspoint blog

Money

sunny 80 °F

Yesterday I was on call again, naturally, when a little girl came into the ER. I was already in the room taking care of a different patient, but when I heard the girl sobbing I went over to her bed to see what was going on. Pulling back the curtain, it was clear what was wrong with her: the girl's right leg, from thigh to foot, was covered in burns and blisters. Big, floppy blisters hung from the back of her calf and heel, leaking purulent fluid onto the sheet beneath her. The nurse handed me her chart. Temperature: 104.

I came closer to the crying girl and saw her mother standing by.

"Que paso?" I asked, "What happened?"

The mother explained that the girl had been burned when she bumped into and spilled a pot full of tajadas frying in lard.

"Cuando?"

"Viernes," replied Mom. Wait, really? This happened on Friday and she's just now bringing her daughter in on Tuesday? After confirming that yes, it was viernes and yes, viernes definitely does mean Friday, I was still a little shocked.

I asked the obvious question: Why did she wait so long to bring her daughter in?

The mother lowered her eyes and said quietly, "Falta de dinero." Not enough money. At this point, I chattered on for quite some time about this hospital being different, not turning away people who didn't have money. Unlike other hospitals, this one isn't here to make profits so we can help patients who don't have enough money and we'd never turn a patient away who couldn't pay. She nodded and mostly just kept looking at the floor.

I went on evaluating her daughter, glad that she had at least come in today and not tomorrow. Later, I was talking with some of the other American docs about this patient. We were all pretty horrified that it had taken 5 days for them to get to the hospital, but once other people started telling stories of what goes on in the public and private hospitals on a regular basis I could see that her story was not only not unique but was based on logic.

The largest regional center is Hospital Atlantida, the public hospital in La Ceiba. Despite being public, it is not by any means free. In fact, patients have to prove that they can pay before they are treated. I've heard stories of children showing up with visibly broken arms who are turned away because their parents have no money. Many families use all of their money just getting to the hospital, and when they arrive will sit outside the doors for days waiting for family members to bring money.

Some kids with broken bones end up with worse fates than a whole lot of pain and possible infection, though. As it turns out, amputation is a lot cheaper than complicated orthopedic surgeries involving plates and screws. Because of this a lot of young people end up with amputations after fractures simply because their families cannot afford the more complex surgery. This happened to a 19-year-old man here who was a local soccer star. Ironically, he broke his leg playing soccer and unfortunately the surgeon here at LdL was gone at the time. The other doctors sent him to Hospital Atlantida, thinking that he would get decent medical care (what an assumption). He came back with a below knee amputation and the entire hospital was shocked.

Because of stories like this, Loma de Luz often keeps critically ill patients and performs surgeries usually thought to be outside the scope of general surgery because the alternative is potentially lethal. We thought long and hard last week before finally sending a newborn in respiratory distress to the NICU there despite the fact that we barely have enough nurses, let alone an incubator, ventilator, or surfactant.

So after some thought, I can see where the mother was coming from. It's their first time at the hospital, so it would be fair for them to assume that this hospital would be like every other one and would ask for money up front before treating her very sick daughter. Of course, we did not. If money is an option here, we send patients to speak with someone about discounts and payment plans, or just covertly write "no charge" on their chart before they leave. Followup in clinic after hospital stays is often something that patients have trouble affording, given that they spend a good chunk of money on their hospitalization. This was the case for the family of a 5-week-old girl who I took care of in the hospital last week. When her mom told me that she couldn't come to the appointment I wanted to schedule for a few days out, I had to promise her we wouldn't charge in order to get her to agree. Luckily, she did come in (and the baby is doing fine). I'm so thankful that we have this option.

As for the little girl, her fever has come down significantly, though she is still pretty unhappy that she has to be in the hospital. We're doing daily betadine baths and using every non-adherent dressing we can find to wrap up her leg. Only time will tell if she'll need skin grafting or surgery to help her fully straighten her leg out, since the burn wraps nearly the whole way around it at the knee. Updates to come...

Posted by vagabundos 12:46 Archived in Honduras Comments (0)

Endings & Beginnings

sunny 88 °F

As I write this entry, we're starting to realize that our time here at Loma de Luz is coming to an end pretty soon. In just 2 weeks, Mariel will be in the air headed toward Chicago (and eventually Iowa City) and Ben and his brother will be starting their bro-cation together to the Copan ruins. We're looking back and reflecting on what we've learned, seen, and done here.

At the same time, we're looking forward. On Wednesday, we submitted our residency program rank list, which is now officially set in stone and unchangeable. The weight of the decision was sitting pretty heavily on our shoulders for the last few weeks (and months...) so it feels great to have it out of our hands! Now we, along with every other fourth year med student in the country, will find out where we'll be for the next 3-4 years on Friday, March 16. We're really excited, and luckily would love to end up at any of our top 5 choices so we don't anticipate being too disappointed come March 16.

But back to the now. I wanted to take this time and do a run-down, both for our sake to see it all in front of us, and to let you all know what we're up to. Here goes!

Stuff we've cut open/sewed up
Abscesses - III (one pyomyositis - deep, intramuscular abscess that you see in the tropics semi-frequently)
Skin tags - III
Anteater attack wounds (seriously)
Dog bites
Machete whacks - III (one of which cut into bone, another of which left quadriceps muscle bulging out)
Toenail removal
Laceration repair after toddler fell off a horse
Foreign body removal (from hand)
Skin biopsy
Sebaceous cyst removal
Little toe amputation (ok, this wasn't us who repaired it but it's still pretty interesting! The guy whacked the toe just about the whole way off with - you guessed it - a machete, then the doc just took it the rest of the way!)

Lumps and bumps
Thyroid nodules - IIIII+ (one confirmed cancer)
Pyogenic granuloma (large noncancerous gum mass)
Basketball-sized ovarian cancer

Interesting ER/hospital cases
Strongyloidosis
Neurocysticercosis
Meningitis
Ipecac flower ingestion - http://en.wikipedia.org/wiki/Carapichea_ipecacuanha
Enormous lung mass which suddenly the patient bled into and died
Distracted fracture of radius and ulna after falling off of hammock
Seizures in a 2 year old
Seizures disorder in a patient with appendicitis
Barb of barbed wire implanted in tibialis anterior muscle
Cholecystitis
Known leukemia patient casually coming in with a hematocrit (red blood cell level in the blood) of 12%, normal being near 40%

Patients we've done CPR on: 3, 2 unsuccessful

OB stuff
Deliveries - II (hoping for more!)
Self-induced abortion at 28 wks - (Apparently the patient took some kind of 'abortion pills' - possibly Cytotec sold out of the back door of a pharmacy, since it was in a box of omeprazole - at 7 months pregnant because she decided she didn't want her baby anymore. She was sent to La Ceiba where they have a NICU since these pills basically induce birth.)
Retained placenta after birth, which stayed in as the woman hiked 6 hours through the mountains to get to the hospital
Pre-eclampsia, and full-blown eclampsia with seizures

Clinic patients
Hypertension - a whole lot
Diabetes - another whole lot
Reactive airway disease in small kids - a surprising amount, often leading to hospitalization
Possible hypertrophic cardiomyopathy with outflow obstruction - rare cause of sudden death in young people
Congestive hepatopathy in a CHF patient
Bilateral hydroceles
Malaria (P. vivax) - III
Dengue fever - I
Cleft lip/palate - IIII
And a lot of colds, coughs, pneumonias, UTIs, muscle strains/sprains, renal stones

Whew! No wonder it feels like we've been so busy. We'll have to do another round-up like this in 2 weeks, but for now it's fun to see it all in one place. Cheers!

Posted by vagabundos 06:22 Archived in Honduras Comments (0)

A Day in the Life

sunny 85 °F

This past weekend, we took off Friday and went out to the beautiful island of Roatan to snorkel and relax. We also met up with Mariel's dad there and had a really great time. We will post some photos on Facebook once we get it together a little. But this blog entry isn't really about the weekend (though it was wonderful). I thought that instead I'd give you a synopsis of a day in the life of a med student down here.

It can be a little deceiving and seem like we're really taking it easy when we say that we have clinic only from about 8am to 2 or 3 in the afternoon most days (because all the patients try to catch the last bus back home, which runs at 3:00). We also take call every 4th or 5th day with one of the physicians here overseeing us, and jump in wherever else help is needed or something interesting is going on. So here it is, a day in the life...

Wednesday, 6:30 am - wake up, decide I'm too tired to go for a run and snooze for another 20 minutes. Eventually drag myself out of bed and get ready.

8:00 am - I get to the hospital and survey the waiting room. Lots of people today. Uh oh. Before heading to my clinic office, I go to the ward to check on the patients I'm responsible for. Today I just have one, a woman one day post-op after a hysterectomy, and she's doing well so I chat with her and then write a quick note with orders to advance her diet and encourage her to walk.

8:20 - Head back over to clinic, by way of the ER to make sure there's nobody there I need to see, since I'm on call. I start seeing patients and am delighted to see that my first one is a return patient who is here to get his sutures removed. I had put them in a week or so before after he cut his hand with a machete. It healed up well, so I sent him on his way. Afterward I swing by Ben's office, where he is rechecking the woman whose leg he sutured up last week after she was clawed by an anteater that was fighting with her dog (she won the fight in the end and killed it with a machete). Looks like she's a bit infected, so he keeps her on antibiotics.

9:00 - Head back to my office to find more charts have appeared. I quickly see another return patient, a young woman I admitted a week or so prior with respiratory distress who is finally doing better. Next I see a few older patients with diabetes/hypertension/pain complaints, with a few sick kids slipped in between.

About mid morning we hear about a case going on in the OR: a one year old boy is here to have a giant Wilms tumor on his kidney removed. It's happening now because an anesthesiologist is here for the week. He clearly has some other problems, though, including developmental delay and a general floppiness. Everyone keeps this baby in mind as they continue with clinic patients.

12:00 - There's a lul in clinic as I'm waiting for labs on several patients, so I sneak off to lunch quickly and feel relieved that it's not a 3:00 lunch day, which we've been having too many of lately.

1:00 - Return from lunch ready to go again, and find plenty of patients also ready. I spend a lot of time with an older man with lots of complaints, including prostate problems, out of control hypertension, prior strokes, athletes foot, and an unsightly growth on his face (a seborrheic keratosis, for my med student friends). I deal with him and a few other people and manage to sort out all of his problems and even lop off the seb K in time to get him on the 3:00 bus.

3:00 - Now that I've finished with clinic, I stop by to say hello to my hospitalized patient again and swing by the OR to see what's going on with the baby. He is out of surgery but hasn't come out of anesthesia well and isn't breathing on his own. I settle in and start rotating in to help him breathe with a manual bag venitilator, since there is no automatic ventilator here. We start to notice that his temperature is quite high and seems to be rising. At 104 degrees we start getting ice packs to put on his little body and we feel helpless as his temp rises to a max of 106 degrees despite all of the ice packs on him. I find more and more ice to put in the wet towels we have on him and the anesthesiologist administers dantrolene, presuming malignant hyperthermia, a very rare but potentially lethal complication of anesthesia. After a few hours of this, his temp finally starts to drop.

6:00 - The baby is looking more stable and his temp is still down, but his blood pressure is acting funny. He still isn't breathing on his own and we're having a hard time keeping his CO2 level down. I continue rotating in to help him breathe. His parents come in to say goodbye for the night, kissing him and talking to him in baby Spanish.

7:00 - The nurse on call comes into the recovery room to tell me that there is a patient in the ER ready to be seen and another who just arrived. I abandon all hopes of dinner anytime soon. A young woman about 7 weeks pregnant is here complaining of abdominal pain and passing blood clots. Her vital signs are stable, so after talking with her for a while I go see what the other patient has going on. He is laying on the other side of the curtain with blood covering his lower leg. He tells me the story: he was outside working with some kind of machinery cutting something, and he accidentally cut a piece of old wire which the machine threw into his leg. Sure enough, there is an old rusty-looking wire poking out from his shin. After his tetanus shot, we clean up the area as best we can and get ready to try and pull the wire out. The labs and X-ray techs don't work at night, so we can't get an X-ray to see how long this wire is and where it is, but we figure it's best to try to get it out and hopefully send him on his way. Despite the lidocaine to numb him, the man yells out and writhes in pain as we pull with all our might on the wire, which doesn't budge. We decide he should be admitted so that we can give him pain Meds and antibiotics through the night and check an X-ray in the morning. Later that night, I add a few words to my vocabulary and discover that he'd told me he was using a weed wacker and accidentally whacked some old fencing wire, which may or may not have been barbed wire. Spoiler alert: it was definitely barbed wire, and he was lucky enough to get the barb itself embedded in his muscle.

8:00 - We ultrasound the pregnant woman and send her on her way, and I get the weed wacker man admitted to the ward. I head back to the recovery room where the baby is still being cared for. The nurses are making a schedule for the night for bagging the baby and i notice my name under the 3am to 6 am shift. My body suddenly feels more tired, and more hungry. It looks like the baby is doing about the same though his temperature has come down significantly. He fails an attempt to breathe on his own and we adjust our bagging to make up for the deficit just created by this trial. As he becomes more stable again, we go over the schedule, the 9:00 bagger arrives, and I decide to go get some dinner and sleep before my shift is up, or until someone else comes in to the ER.

9:00 - As I round the corner of the hallway out of the hospital, my radio cries out, "Code blue, code blue, recovery! We need help!" I spin on my heels and run back to the recovery room where the tube has fallen out of the baby's mouth. The anesthesiologist is quickly trying to re-intubate the baby and I help hold his tiny mouth open. The tube goes in and we relax, only to watch the tube slip out yet again. After a few more moments battling, the tube is back in place and we give him more breaths through it after sticking it down with a whole lot of tape. Once he is stable, I grab my bag and walk the half mile home in the dark to find Ben has made me a great dinner. We go to bed early, anticipating our shifts later that night. I put my radio close to my head and pray it won't wake me until 3:00.

12:30am - Knock, knock, knock! We both start awake and look around thoroughly confused. Ben opens our door and we hear the anesthesiologist's voice, "Hey, you guys don't need to come in for your shifts anymore." Oh good, I think, he's breathing now. "The little boy died." he finishes. "Oh, no," mutters Ben. The anesthesiologist turns and walks away to his room, obviously upset. Ben closes the door and comes back to bed. We sit quietly in the dark. "What the hell happened?" I ask eventually. Ben shakes his head. We lay back down but I can't turn my brain off.

1:00 - My radio goes off: "HR3HOT, Dra. Mariel me escucha?" the nurse calls. I jump and answer, "Si, adelante" expecting a patient in the ER. The nurse starts to tell me about the baby and also says we don't need to come in, and when I ask "que pasó?" Renee takes the radio and tells the story. The baby just had more and more trouble breathing and his blood pressure wouldn't stay up. The anesthesiologist thought it was probably a metabolic disturbance, a profound acidosis resulting from the malignant hyperthermia, that was to blame, but we can't do the required tests to say for sure here. They said the mother wailed for hours. I get up and read for awhile after this news before I can fall asleep.

4:55 am - "HR3HOT, Dra. Mariel me escucha?" the radio calls out. I shuffle to the next room and answer. There's a patient in the ER, a man with excruciating flank pain radiating to his testicles. Kidney stones, I think, as I get my scrubs on and walk over in the pre-dawn dark. Sure enough, his story fits well with this disease so I admit him and start pain Meds and fluids. We'll have to wait for morning to get an abdominal X-ray to confirm the diagnosis.

6:00 - I shuffle back over to our apartment, now disoriented in the light of the day. I fit in another hour or so of sleep before I can no longer ignore the alarm clock.

At 8:30, I'm back in the hospital ward talking with my three patients before a full day of clinic.

Posted by vagabundos 19:03 Archived in Honduras Comments (0)

Hospital Loma de Luz and Blackfeet Community Hospital

A comparative study

rain 75 °F

This afternoon coming home from clinic I was thinking about our past three weeks here. We've definitely seen a lot of strange things, plenty of bread and butter family med things, a few sad things, and a lot of happy things. We have had the opportunity to do lots of things, like repair a machete wound (which Ben did today), suture up kids after dog bites and falls from horses, remove nodules, first assist on major surgery, sprint from bed to help do CPR in the middle of the night, manage our own clinic patients, and learn some ultrasound.

But today what I was thinking was about the many similarities between life in and out of the hospital here and in Browning, Montana, where many of you (whoever you are) may know that we did a 4-week elective last fall. Since Indian reservations in the US have a lot of the problems that most Americans associate with so-called third world countries, like poverty, joblessness, lack of decent food, violence, and stray dogs, comparing the two reveals a lot of similarities. We encountered a lot of these problems firsthand in Montana, and definitely see a lot of the problems we've seen in places like Mali and Mexico there, do I began to compare many aspects of Loma de Luz to the Blackfeet Community Hospital and noticed some interesting stuff. So without further ado, here is the ULTIMATE BATTLE: LdL vs. BCH!

Category 1: Medical Facilities
Loma de Luz is definitely much smaller than BCH with a lot less clinic space. The inpatient wards here consist of 4 smallish rooms with curtains between the 5 or 6 patient beds. BCH on the other hand had large, private rooms. I think there were also more than 2 working IV pumps at BCH... As far as clinic facilities, LdL and BCH both have most of the things we need to run our clinics. Clinic rooms here are private and have nice exam tables, oto and ophthalmoscopes, and halfway computerized charting. Prescriptions are computerized and there is a formal pharmacy, which is really nice. Our clinic rooms even have air conditioning, so life is good. Clinic is a bit disorganized since few of the patients have appointments, but the same fan be said for BCH. One downside here is the lack of sufficient clinic rooms which generally means that one of us has to work out of the ER, which is a big room with 3 beds and emergency equipment inside. (BCH definitely wins the ER contest since that was the busiest part of the hospital and one of the busier ERs in the state of Montana!) On the plus side for LdL: the middle of the hospital is an open-air, covered pavilion that is very pleasant to walk through. The ORs also have windows, which is really amusing to me. Still, since the OR also has functional anesthesia equipment and disposable sterile gowns, the win for facilities has to go to Blackfeet Community Hospital.

Category 2: medical problems
When you're a med student, you always want to see the stuff you learned about the first two years of med school. Diabetes is interesting in a cerebral sort of way, but really can't hold a candle to Fournier's gangrene (caution while googling that one) or a machete wound with open fibular fracture. We saw exciting and interesting things at BCH and learned well the impact of diabetes and alcohol on native peoples. Esophageal variceal bleeds and fulminant hepatitis are a lot scarier in real life. We also got to deliver some babies, comfort and collect evidence from victims of rape, assist in the OR and open a bunch of abscesses. Here at LdL we've seen some of the same brand of stuff, but also had a much broader clinic experience, with some adult chronic medicine, some routine peds visits, and a lot of followup visits on our own patients, which is incredibly valuable and usually hard to get at our stage of training. We've gotten to be a part of a lot of hospital care and been the primary decison makers there at times, and also have gotten a lot of experience in emergencies and code blue (CPR) situations. Because of that, Loma de Luz wins this category.

Category 3: living arrangements
Let's see, our government apartment in Browning had an extremely bad odor, one twin bed, and two chairs for seating in the entire place. It was dirty when we moved in and we had to sleep on an air mattress for four weeks. Here we have our own small apartment in a bigger staff housing building with a nice common space besides our non-smelly apartment. We have a hot shower, a clean and cool bed, good fans, and a full kitchen. Clearly Loma de Luz is winning here. Food availability is also an issue in both places, though, to varying degrees. In Browning, there is a grocery store, but it's small and overpriced, and anything fresh is a little sketchy. We generally made a weekly pilgrimage to Cut Bank, a town about 45 minutes from Browning, where we had a much bigger selection of groceries. The town doesn't have much besides that and a Dollar General, though, so it's pretty limited. Here, we're actually located between two small villages so there's nothing nearby except a little restaurant at the hospital's front gate that serves fried chicken for lunch (or hot dogs if you come too late). Everyone makes a weekly trek to La Ceiba, about 45 mins-1 hour away over very bumpy dirt roads. The grocery stores are pretty decent, but fresh vegetables are often a little limp looking and better bought at a farmers market. Still, the nice thing about Ceiba is that you can find most anything you might need: replacement flip flops, floaty toys for the sea, bootleg American movies, etc. The clear winner of this category is.... Loma de Luz!

Category 4: surroundings
This one will be tough. Glacier National Park, just 12 miles west of our aforementioned apartment in Browning, is full of breathtaking mountain vistas, beautiful clear, blue lakes, and amazing wildlife. We camped and hiked and biked in stunning places that always looked like calendar photos to me. We saw moose, mountain goats, pikas, and a lot of wild dogs (oh wait, that was in town). Despite all this, Glacier is up against a tough rival: the Caribbean. We walk through the jungle to get from our apartment to the hospital every morning and have a great ocean view as we do so. Lush green mountains jam-packed with trees and beautiful, fragrant flowers are everywhere. Just today we saw 2 toucans and 3 howler monkeys - from our house! The dirt road we do our morning runs on is like a movie set to me, and getting to swim in the warm sea on our own basically private beach after a five minute walk is pretty hard to beat. Loma de Luz for the win!

Definitely more than a few similarities! The truth is we love both places, despite the unique challenges of both. But still, pretty fun game. :) Next week we should have some killer photos to share since we're going to Roatan this weekend to hang out with Mariel's dad for a few days and snorkle. Hasta luego!

Posted by vagabundos 19:21 Archived in Honduras Comments (0)

Week 2 and Cayos Cochinos

rain 70 °F

We're back at LdL after a long weekend doing clinic and hanging out in the beautiful Cayos Cochinos, a group of small islands just off the coast here (a bit closer to mainland than Roatan and Utila). We went with Dr. Renee and a few other girls who acted as nurses/pharmacists.

We set out early Friday morning in a small boat from the beach just across from the hospital and made it to the Cayos about an hour later. We were greeted by sunny, cloudless skies, turquoise water, and white sand beaches. After settling into our digs for the weekend, a beautiful house overlooking the sea (!) owned by friends of the hospital, we set off in another, smaller boat to the other side of the island where there's a makeshift clinic. It was built by a nurse from Texas decades ago, and she still comes a few times a year, but now Renee also works with her to see patients in between times. The clinic is nothing more than a tiny, open air, one-room cement building, but the location is amazing. It's right on the beach with beautiful coral reef a few feet away. Boatloads of tourists hoping to snorkle showed up more than once while we were inside working. And luckily, island time is a little slower than usual so we had plenty of time to snorkle and relax in the water in between patients! We did clinics on Friday and Saturday and saw probably 50 patients between the three of us.

On Sunday we went into the Garifuna village of Chachawate and the other three girls (who happen to be teachers) put on a Sunday school class for the kids in the tiny church there. It was fun to play with the kids some. The village is really interesting too. The island is only about a half mile long and a quarter mile wide but houses 300 people, and even has a couple of hotels and restaurants though there's no fresh water, plumbing, or electricity! It's surrounded by a bunch of private islands of about the same size that house 1 family each or so, so it's kind of a strange juxtaposition. After grabbing lunch there, we went back to our island for more snorkeling and relaxing. We saw lots of beautiful fish including parrotfish, angelfish, squirrelfish, cowfish, etc. and some lobsters and rays too. Unfortunately we also saw (and felt) more than a couple jellyfish so we didn't snorkle quite as much as we'd have liked to.

After the great weekend, we came back to the mainland yesterday morning and are back in action in the clinic and hospital. This weekend an anesthesiologist and plastic surgeon are here so there are lots of cases in the OR. Today Mariel got to scrub in and first assist on an abdominal hysterectomy, which was a lot of fun. We're looking forward to more surgeries and other interesting stuff this week with them.

All of this vacation and fun cases has been a nice break after some tough days last week. On Wednesday, clinic was interrupted in the morning by a code blue (cardiac arrest). We ran over to find the patient was the 7-year-old girl who had been admitted a few days before for fever and abdominal pain. She had been in another hospital in La Ceiba for a week or more before coming to us because she just didn't get better. It was Tuesday that the team figured out she was infected with the worm Strongyloides, an uncommon but not unheard of parasite down here. They had begun treatment with mebendazole and were awaiting the arrival of the drug of choice, ivermectin. Late Tuesday night, though, she had begun to have some breathing problems. By morning she was doing even worse and, we soon found out, going into shock. After several rounds of CPR throughout the morning, her body finally couldn't take any more and she passed away. Ben and I were among those taking turns doing CPR and it was really difficult to lose her, especially after the other sad cases we were part of last week. Therefore, the Cayos trip was much appreciated and helped us to get back in a good place to work with other patients.

Es todo para ahora, esperamos que todo pase bien con todos de ustedes!

Posted by vagabundos 18:43 Archived in Honduras Comments (0)

1 week in

sunny 85 °F

Hi everybody,

Well, we're at the one week mark of our 8-week rotation here at Hospital Loma de Luz. Things are going really well and we're enjoying our time here, both in the hospital and out. We've already seen some interesting and some sad cases.

Mariel saw a little 7 year old girl with a huge, hard mass in her abdomen that is most likely an advanced cancer. Her grandmother cares for this little girl, who is also severely developmentally delayed, and did not seem to grasp the severity of the little girl's disease. When I tried to gently explain to her that the diagnosis was serious and she might not even be a surgical candidate, though, the tears flowing from her eyes revealed that she probably knew more than she would let herself believe. Sadly, the girl was seen back in June and had an ultrasound that was suspicious for this sort of thing, but they didn't get the recommended CT scan until a week ago - most likely because of the huge expense of the scan. Who knows now if whatever she has would have been treatable back then. All I could do today was to offer her a surgical consult and the assurance that we will help her in whatever way we can, body and soul.

Also in our four days of work last week we collectively saw 3 cleft lip/palates, in kids aged 18 months to newborn. Discovering the cleft in the newborn was sad, but not as sad as the 18-month-old little boy who has never been able to be understood and will likely have permanent speech and possibly hearing problems. The hospital has limited support for these kids, but luckily there are a few ENT specialist teams who come down every year to do several cleft surgeries over a short amount of time.

For every sad story here, though, I think there are many more happy ones. We've been a part of a few births already, and they went very well. We've also been able to help make diagnoses for hospitalized patients that they have waited weeks in other hospitals to be cured of before coming here. The hospital is surprisingly well-stocked once you learn what they have, and everyone working here really cares about the patients. The care here is so good that the missionaries and their families come here, too, even for surgery (this just happened yesterday!). We've also seen people with grave diagnoses who finally get the care they need and deserve here.

Besides seeing a lot of varied pathology, we're getting better with our Spanish and getting used to working more autonomously. Writing prescriptions yourself is a lot different from just knowing what drug to use, it turns out! We're also learning a lot about how to practice medicine in a resource-poor setting and with very underserved patients (and affirming that we love it). We're also getting plenty of chances for suturing, abscess I&D, learning ultrasound technique, and lots more.

When we're outside of the hospital, we're learning too. We took a bike ride through several of the nearby villages and got a good sense of the way folks live around here. It looks a lot like rural Mali, somewhat surprisingly. Lots of outhouses without plumbing and outdoor kitchens with dogs and chickens running everywhere. It's been interesting to see what a missionary community looks like, too. They are somewhat isolated, since most of the houses are behind the guarded gate of the hospital drive, but also get out into the larger community a lot, too. There isn't a church here so most attend community churches in the different nearby villages and make a lot of connections with locals there. Besides that, there is a weekly Thursday night get-together for all the missionaries. We've been invited to lots of houses for dinner, coffee, ice cream, and gone on lots of outings with different people, too. They are a really fun group - we're loving how risk-embracing they are! (within reason, of course) :)

That's all for now. We'll keep you updated!

Mariel & Ben

Posted by vagabundos 12:29 Archived in Honduras Comments (0)

Hospital Loma de Luz

sunny

Hello faithful readers!

We've made it to Hospital Loma de Luz. Actually, we made it yesterday - 1 day behind schedule due to some very inconvenient gastroenteritis that kept us stuck in Guatemala City for two nights after a very unpleasant ride from Xela. We're recovered 100% now, but sadly missed out on seeing the Copan ruins. Some other time...

Yesterday we spent the day checking out the nearby city of La Ceiba and getting groceries there to take out here, as we aren't really in any town (and all the surrounding towns are pretty small). After that, we made the 45 minute trip, from highway to paved road and finally to dirt road, and arrived at the hospital. It's on a dirt road that runs parallel to the ocean, about 1/4 mile away. There are small villages dotting the road every 5-10 minutes of driving, and lots of people going between them on foot, horseback, bikes, motorcycles, and sometimes cars. There are also a few buses everyday that help to bring patients in from the many surrounding small towns. All in all, it's very rural. Patients come from these small farming and fishing communities from the coast to way up in the mountains.

The hospital sits on a hill overlooking the road and the beach, along with staff housing and a few other buildings here and there. The hospital itself is fairly small, though it still boasts a high volume general clinic, OB and gynecology clinics (with ultrasound capability), 2 delivery rooms, 2 operating rooms, 15 or so inpatient beds divided into communal rooms for men, women, and children, and an ER which is much more a room than a department. All of these areas are arranged in a big square with a courtyard in the middle, which is covered and acts as a sort of open-air chapel.

Up another hill near the hospital is the staff housing. We live in an apartment that is part of a larger building with common spaces and more apartments for other visitors. Our little two-room apartment has everything we need and is private, which is nice after living with a family for a few weeks. We cook all of our meals ourselves, which is great after not cooking for ourselves for several months! A few other visitors are living here now too, and the permanent staff live in a nearby communal building, up the hill further in their own houses, or in villages.

As for our daily life, we come to the hospital at 8am or so to begin seeing patients in clinic. Some people have appointments ahead of time, but many just show up and hope to be seen, so it's very hard to know what a day will be like. After a full day of clinic, caring for hospitalized patients, and maybe some babies and emergencies, the day winds down around 3pm, since the buses stop running at that time and many people have very long trips back to their homes. After that time, the on-call physician takes over. We'll be starting to take call a few times a week along with one of the docs, too. While on call, you handle after-hours clinic visits, emergencies, and deliveries, so it should be fun! We have some weekend call, but other weekends we are completely free so we should be able to do a little traveling and relaxing.

Today after clinic we threw on our swimsuits and walked 5 minutes down the dirt road to find the path between cow pastures that leads to the beach. It's a wild, natural beach - very different from the manicured ones on Roatan, etc - but really beautiful. The waves were surprisingly good for the Caribbean, and we still have to figure out if there's any snorkeling here. Apparently there is a reef nearby, but it is out a little ways and we need some flippers before we try to go out. The weather is great, 70s at night and 80s during the day, with lots of humidity - so much so that most fabrics feel moist all the time! I still think it's a good tradeoff, given the low tonight in Iowa City is 4 degrees (!).

We'll be sure to keep you posted with any interesting stories and photos, and we'll definitely snap some of the hospital and grounds at some point.

Love,
Mariel y Ben

Posted by vagabundos 18:39 Archived in Honduras Comments (0)

Last days in Xela

We're in Xela again after spending the weekend at the beautiful Lake Atitlan a few hours southeast of the city. We took a 'chicken bus' there on Saturday morning, arriving at the tourist Mecca of Panajachel around lunchtime. After a meal of grilled chicken and decidedly non-Guatemalan mac n cheese, we took the 45-minute boat ride to Santiago Atitlan. It's a far less touristy city on the lake with much more Mayan influence. We had a great time biking around the lake and visiting little Mayan towns where it was tough to find a Spanish speaker! We also had a chance to paddle on the lake in a canoe and take some nice photos, which I promise to post sometime soon. :)

This week has been filled with studying Spanish and checking out the sites in and around Xela, like the very interesting cemetery and bustling markets. Mariel also had the chance to spend some time doing exams on children and babies at the orphanage in town, which was a very good experience. We had our graduation dinner and received our mini diplomas from the school on Wednesday, and tomorrow we say goodbye to our great teachers and awesome fellow students. We've learned a lot that will make working in Honduras and the US easier. We also have our last dinner with our wonderful host family tonight, as we will be heading out of town tomorrow afternoon to Guatemala City. On Saturday, we bus from there to Copan, where we hope to get a little time to check out the amazing Mayan Copan ruins. On Sunday, we head from Copan to San Pedro Sula where we will meet up with someone from the hospital and ride with them to Balfate. We plan to start working on Monday.

Again, we will post photos as soon as we get time in between all these bus rides. Until then, hasta luego!

Love,
M&B

Posted by vagabundos 17:36 Archived in Guatemala Comments (0)

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