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Fun fact: Did you know that Honduras is the second poorest nation in Central America?  The poorest is Nicaragua, Honduras's neighbor to the south. CAFTA brought textile jobs to the region, but there is dramatic disparity in the distribution of wealth.  Besides textiles other exports include sugar, coffee, various fruits, wood, and African palm. Any of your clothes say "Made in Honduras?"

Three days in the clinic under my belt.  It's always a bit daunting to jump in the middle of somebody else's game, especially in a place with such limited resources and a different array of common infectious diseases. The way you manage stuff in the states is not the way things are managed here - either because the tech or meds aren't available or because the pathology itself is different.  This may seem obvious, but it does bring you up short sometimes.  Take chest pain, for instance.  In the US there are massive protocols and interfacility strategies for managing chest pain.  You draw certain labs, do certain tests, give certain meds, and then the pt. either winds up with a noncardiac diagnosis or they likely wind up in the cath lab. Maybe that's a bit of an oversimplification, but you get the point.  Here somebody has chest pain, they get aspirin.  That's pretty much it.  There is no cath lab.  Very rarely is there a cardiologist.  You're lucky to have an EKG. It makes me grateful for the 3 am chest pain admission at home 'cause at least there's something I can do (if nothing else but call cardiology!).  

It's different working in medicine in the developing world at this stage in my training than any time before.  I'd traveled on medical missions before med school and during med school but this is the first time since becoming a doctor.  Now I have so much more experience to compare with and that makes the disparity much more distinct. In a rural setting you often see disease present at a more advanced stage than in other areas, but that's nothing compared to here.  Children with developmental disorders who have reached the age of 10 and are unable to communicate because they've been left alone in a hammock their whole lives. Kids with tumors that have grown so large that they can't walk. Young folks with wounds that have remained open for years with infection after infection leading to necrosis and likely amputation.  

Then there are the tropical illnesses - worms, dengue, malaria. People caome in weak and dizzy, which is common enough complaint in the US, but here it's because they've got a gut full of round worms draining them dry giving them anemia or they have amoebae that are draining them dry via diarrhea.  Parents calmly bring in their kid with a temp of 105, suspecting malaria since a few folks in their barrio have come down with it. Sure enough, there it is on the microscope slide.  Thankfully, in this region it is highly sensitive to the old-school drugs. 

Patient expectations are different too. Everybody feels better if they get some medicine when they go to the doctor. Here the back pain patient asks for ibuprofen, not Lortab. You don't realize how jaded you've become until you are so taken aback by someone telling you how well ibuprofen works and asking for some, and you become aware that you were mentally preparing to deny them narcotics (in this case 'cause there just aren't any).  Many surgeries, including c-sections, are done only under ketamine (no lasting pain relief once it wears off, unlike epidurals) and folks just get a few post-op doses of IV morphine for pain control.  People here have to put forth alot of effort to be seen in the clinic - maybe riding the bus or walking for miles, some even have to come by boat and then walk. They wait patiently, sometimes for hours.  Then they are grateful for the penicillin and tylenol they get for their efforts. It's truly humbling. 

So, the hospital itself is in a compound situated on a hillside. There is a gate which also houses the triage center.  Then there is housing for tempory staff and build teams and agriculture teams (the hospital has its own farm and runs a co-op with the nearby villages). At the front of the hill, the hospital building itself is built around a courtyard and houses the clinic, ER, OR, and wards as well as a lab and pharmacy.  Further up behind the hospital is housing for the permanent staff.  Everything is pretty much open air - screens for bugs and lots of fans (thank goodness for fans!).  

You can see the Carribean and Los Cayos, some islands just off the coast, from here.  On a clear day you can see Roatan. It's pretty much a tropical paradise - palms and other massive trees, tropical flowers, innumerable butterflies (among other less pleasant insects). There are so many birds (I love birds)! I even heard a toucan ( they say it sounds like running a pen along the metal of a spiral-bound notebook), but didn't see it.  I've also heard howler monkeys that live in the trees further up the hill.  It rains off and on, as it's the tail end of the rainy season, and the darkness once night falls is palpable. 

I'm on call tonight for any emergencies that may come in. Thankfully, one of the long-time docs is backing me up.  It makes you rely more heavily on your own knowledge and experience when you don't have every test or drug or treatment at your beck and call.  And it's all in a foreign language!  Estoy aprendiendo mucho, pero hay mucho a aprender. 


( 5 comments — Leave a comment )
Feb. 2nd, 2012 02:27 pm (UTC)
...Wow. I would say that "I can't even IMAGINE" but you paint an incredibly vivid picture. The people sound, quite frankly, pretty amazing. It makes me want to start appreciating what I have just a little bit more. Thank you for sharing.
Feb. 5th, 2012 03:40 am (UTC)
I'm so glad my experiences come across clearly, and that you are taking the time to share them! It means so much to me.
(Deleted comment)
Feb. 5th, 2012 03:39 am (UTC)
Thanks so much, dear. Got my DEET on hand! :-)
Feb. 3rd, 2012 12:53 pm (UTC)
I was thinking about this and your experience, and I think it must be wonderful...and despite the lack of medicine and equipment you are making a difference.

But then I got to thinking...you're in the middle of nowhere in a strange place, (without your dog for love and protection...and I know it's probably not dangerous but nevertheless it does carry risks) and it struck me just how BRAVE you are to actually do it! So v.well done and I hope you get all that you hope for from the mission!

And keep up with you wonderful travelogues...you make us see it through your happy eyes!

Feb. 5th, 2012 03:38 am (UTC)
Thank you so much for your kind and encouraging words. It means so much to me. And I'm glad you're taking this journey with me. :-)
( 5 comments — Leave a comment )