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The long and the short of it...

Fun fact: Did you know that Honduras has the highest maternal mortality rate in Central America at 110/100,000 live births?  Well, that's not entirely accurate. According to the 2008 data they're practically tied with Guatemala and El Salvador. The infant mortality rate at a little over 20/1,000 live births is in fact marginally better than many of their neighbors. For comparison the US infant mortality rate is around 6/1,000 and our maternal mortality rate is 24/100,000.    

Has it been a week? Gosh, the time has flown. Been pretty busy and it's starting to run together. I was on call again Monday, Thursday, and Friday.  Got the weekend off this week, but I'm getting ahead of myself.  Saturday night had a young man come in with belly pain.  His vitals were stable, and come to find out he'd had this pain for over a month. Why it suddenly became emergent at 0300 on the weekend, I don't know.  He really wanted an x-ray, which isn't available at that hour.  Anyway, his exam was benign and I figured it was likely gastritis which is a pretty common issue in these parts. I discussed this with him and told him to come see me Monday when we could get some labs done.  Then I found out that it was his sister who had that giant ovarian mass that we removed last week. It clicked then, and there was no more suppressed annoyance for getting awakened at such an ungodly hour for a nonemergency. Poor guy was stewing over this belly pain in light of his older sister's recent traumatic diagnosis. At least I could reassure him that he doesn't have an ovary!  He came in Monday and he does have H. pylori, which is a bacterial infection that causes gastritis. So he's on treatment and much less stressed.  His sister is doing much better, too.  She is up and about, eating some, anemia stabilized. Still waiting on path. 

Monday night around midnight a girl from the pueblo nearby came in in early labor with her first baby. It was really early labor, and we don't have dedicated L&D staff or quality monitoring equipment or anything to give her for pain. So, we sent her home and told her to come back when her contractions were stronger or if her water broke. She came back between 6 and 7 at 6 cm and a good contraction pattern. Started IV fluids, got things ready and within 2 hours she had given birth to an 8# 5oz. baby girl. The delivery itself when really quickly - the amniotic sac ruptured right before delivery with thick meconium-stained fluid (baby poop, presents risk of aspiration and respiratory distress) so I called for backup. That baby slid on out so fast nobody could get there in time, but she opened her eyes and started screaming as soon as I held her up, so it didn't bother her!  Both mom and baby did well and went home the next day.

Tuesday and Wednesday presented with some interesting wounds. A young guy from up in the mountains was cutting fruit out of the top of a tree with his machete when he caught his leg on the downward stroke. He climbed down the tree, took a boat and a bus to get to the clinic.  Turns out he sliced a piece of his fibula off.  We cleaned it out, stitched it up, and gave him a crutch to stay off of it.  And lots of antibiotics.  An older lady came in who had won a fight with an anteater. She heard her dog making a ruckus and went out to find it in a standoff with a big anteater.  She pulled the dog back and the anteater started swiping at her. They have some massive claws and they ripped into her leg.  But she had a machete, so it didn't end well for the animal in that case.  We had to stitch up several deep gashes on both of her legs. I never thought of an "ant bear" ( the literal translation of the Spanish name) as a dangerous predator, but there ya go. 

Thursday morning another young mom-to-be came in in early labor with her first baby.  It was around 8 or 9 o'clock when she came at about 3cm dilation (gotta get to 10 to deliver). She labored all day, finally getting to 10cm around 1600.  Then she pushed for a good hour and a half before delivering. It was slow but steady and she did so well with no pain meds, nothing.  I was able to talk her through it, and the delivery was controlled and careful with no tears (there was lacrimation but no laceration!), and she had a very healthy 7.5# baby boy!  That night she did pass some large clots and dropped her blood pressure and passed out.  Turned out to be very anemic, but we tanked her up with IV fluids and plenty of iron and she did very well.  

Thursday I also sent my little kiddo with the seizure home.  Once we got the initial seizure stopped, he didn't have a recurrence.  He got a couple days of antibiotics, then we finally could get some labs.  He had a dramatically elevated eosinophil count which is indicative of parasitic infection.  Around here you have to worry about neurocysticercosis - brain infection with the larval form of Taenia solium, a kind of tapeworm. Given the setting of fever, seizure, and eosinophilia we had to treat him for it.    There's no good way to confirm the diagnosis at this point with what we've got, but he's getting the treatment for either bacterial or parasitic neurological infection. But the seizure may very well have been the result of the fever itself.  Who knows?  But the main thing is that he is worlds better!  Like any happy, healthy, chunky little 14 month old babbling and toddling around. It's such a relief.  Turns out his 12 year old sister had a similar illness - fever, vomiting, seizures - and she has lingering developmental and physical deficits and continues to have occasional seizures for which she has had no treatment.  I'm going to see them both again next week to see what we can do for the sister.  

Friday we had a lady come in with a 20 wk fetal demise.  It had been dead at least 4-5 days.  She delivered the 5oz. fetus fairly easily with some pitocin to induce the labor.  It appeared to be normally formed with the exception of the left hand and foot.  The hand seemed to be caught up in the cord.  It's likely an amniotic band formed with wrapped around in the hand and the umbilical cord, cutting off blood supply.  It's so hard, but she had come in earlier in the week for no reason - she just knew something wasn't right. She seems pretty resigned. 

Last night was pretty quiet - just one of the nurses with some chest pain that turned out to be likely esophageal spasm from too much cake and coke from a going-away party for one of the other nurses.  The nurse who's leaving has been working here for several years and is currently living in the nurses' quarters with her infant son while her husband works about 7-8 hours away in the capital city. She's going to join him, but she is sad to leave her job and friends here and face the uncertainty of life in the city. 

Today I went into one of the nearby villages with one of the missionary nurses and her grandson to get some eggs at the local pulperia and meet some of her friends. Penny has been living and working in this community for 8 years. The people are friendly and kind and have great respect for the older nurse. The family we went to visit is one of the more well-to-do families with a daughter in nursing school. They live in a compound of sorts with a main house and a few smaller ones scattered around a central water supply.  There are chickens and parrots everywhere and lots of banana trees.  The matriarch and her teen son were in the yard surrounded by children playing.  They hire some girls who live in a squatter community on the other side of the river to help with laundry and looking after the slew of grandkids swarming all over the place. There are three sisters, ages 16, maybe 17 or 18, and 8. The older two where doing laundry at the big cistern on the property while the youngest watched the middle sister's 1 year old son. None of them have ever been to school or can read or write.  The matriarch of the family asked Penny for help sending the youngest of these girls to school.  It'll probably cost about $40 to get her outfitted for the year. I can only imagine what a difference a simple thing like literacy could make for her.  We'll see what we can do about getting her a uniform this afternoon.

Last Sunday I went down to the beach with some of the girls. There is a lovely isolated strip of sand on the other side of the massive, primordial looking trees that line a large section of the coast. I realized that I've never been in the Caribbean Sea before, just the oceans on either side of US and the Gulf of Mexico.  It's the perfect temperature and very blue, when the light is right. There is something so soothing and yet wonderfully unsettling about the sea.  I like nothing better than to stand in the foaming and fizzing surf and feel the water pull the sand out from under me. 

This week the howler monkeys were very active, hanging out in the trees just behind staff housing. I kept hearing them, this loud cross between a dog and a hog. Finally I spotted one - this dark hairy thing about the size of a 3-year-old using its opposable thumbs to pick tender leaves and it prehensile tail to hold on the branches for balance as it leans way out to grab on to the neighboring tree. I've seen monkeys before, but for some reason it's so much more fascinating when they're living wild right out your window. The med students and I watched him for a while, then followed him up the hill where he met up with a few of his brethren hanging out under the massive palm fronds as it started to drizzle again.   



( 10 comments — Leave a comment )
Feb. 11th, 2012 09:03 pm (UTC)
May I repeat my expression of jealousy? Sounds alternately distressing/sad and completely and utterly fucking amazing.
Feb. 22nd, 2012 09:04 pm (UTC)
It is all of those things. Don't want it to be over.
(Deleted comment)
Feb. 22nd, 2012 09:05 pm (UTC)
Thanks, bb! *snuggles back*
Feb. 12th, 2012 06:35 am (UTC)
That infant mortality rate is saddening, even if it's better than its neighbors...I suppose it has a lot to do with accessibility of medical care and prenatal care?

You sound like you're having an intensely rewarding time. <3

I heard recently that there've been clashes in Honduras re: corrupt police. Are you seeing any of that where you are?
Feb. 22nd, 2012 09:11 pm (UTC)
The main sentiment about the police around here (rural Honduras) is not so much corruption but impotence. People inact violence against each other for vendettas because they believe - often rightly so - that there's nothing the police can or will do about any injustice that befalls them. Besides, there just aren't enough. I've been told that there are 2 policemen for an area with a population of 40,000. We've seen (and heard the gunshots) related to some of the crime and vigilantism that goes on. It's sad, but people don't feel they have any legal recourse.

There are police roadblocks on the main thoroughfares. We haven't had any trouble, and the purpose is to stop drug trafficking, but I'm feel there is a lot of potential for corruption there.
Feb. 12th, 2012 06:54 am (UTC)
Sounds wonderful, even when it is angsty.

The anteater thing? There was a movie called 'Fierce Creatures' with John Cleese and Jamie Lee Curtis. They decide to get rid of all the animals at a zoo that aren't 'fierce' and exciting. So the zookeepers run around trying to convince the bean-counters that their animals are 'fierce'. Point? They stick a little orange cone on top of the anteaters cage with the a flag sticking out that says 'danger' Every time I see this, it makes me laugh like an insane person, bc I know anteaters got some impressive claws and could do some damage if motivated. Now I've got your story to back me up!
So, thanks =)
Feb. 22nd, 2012 09:15 pm (UTC)
One of my favorite Monty Python's Flying Circus sketches was when Michael Palin, an accountant, wanted to become a lion tamer. John Cleese was the employment officer assigned to him. The gist of the sketch was that accountancy made him far too dull for such an exciting job. Of course, it turns out he thought anteaters were lions, so when confronted by an actual lion he decided something like insurance was more his speed. Even anteaters would have been too fierce for him, I think.
Feb. 22nd, 2012 11:59 pm (UTC)
"When I find somebody looking for a lion tamer, their first question isn't going to be 'does he have a hat'."

I do love that sketch too, and sometimes wish I had that light up hat, lol!

And the one where they do the job interview? John Cleese with the little bell? I try to picture that whenever job interviews get stressful. =)
Feb. 14th, 2012 06:11 pm (UTC)
It doesn't matter where you are that tempis fugit thingy applies!

Infant mortality is one of those things that makes my blood boil...and probably not for the reason you may think. Each year for many years we have a telethon over here to raise money for Africa and all these celebs go out there and cry at the appalling conditions... it is horrific and unbelievable in the 21st Century. And yet...as I said these telethons have been doing the rounds probably for twenty-five years...a QUARTER of a century and when you see the films each year...hardly ANYTHING has changed and the poor children die horribly in their thousands. Who the fuck is culpable? Africa of so corrupt that money lines the pockets of men and war mongers...you rarely if ever see any fathers...or men for that matter...in the filmed reports. And yet their women have child after child...born into such poverty it defies description. (And in the UK they say there are families in poverty because they're on benefits...there is NO comparison.)

I know that the basic problem is education but even those educated *men* defy belief...the previous S.African president didn't even believe that AIDS and HIV were related...

Mbeki has received worldwide criticism for his AIDS stance. He questions the link between viruses and AIDS and believes that the correlation between poverty and the AIDS rate in Africa was a challenge to the viral theory of AIDS. His fate was not helped by Health Minister Manto Tshabalala-Msimang and the overhaul of the pharmaceutical industry in South Africa. The delay in distributing antiretroviral drugs is attributed to the ban he placed on their use in public state hospitals, and is also linked to the estimated deaths of some hundreds of thousands. Thabo Mbeki has also been criticized for responding on negative comments made about governance by accusing them of racism.

And this comes from an educated man.

It is still a common custom among tribal men that raping a BABY will protect them from the virus...

So where do you start? Is this problem of abject poverty ever going to be solved? I do donate every year but I have given up watching these telethons...

Sorry to jump on my soapbox. Only people, like yourself, keep things afloat but do you ever feel that you could drown in the difficulties these people endure, not day after day, but decade after decade?

Feb. 22nd, 2012 09:23 pm (UTC)
It's true that looking at the big picture can make you feel like you are sinking. I have resigned myself to the fact that I can't change the world, but just maybe I can change one person's life for the better. And maybe, eventually, that will have a cumulative effect.

I agree that it is maddening that folks keep pouring money into problems with few results. I think corruption and willful ignorance is definitely a big part of the problem, as well as failure to focus on the root causes. We treat symptoms - poverty, hunger, disease - instead of causes - lack of education, lack of resources, lack of hope and the corresponding initiative. It's a complex problem that can't be solved by writing a check once a year or sending foreigners in to put bandaids on things. We have to help people help themselves and give them the tools to do so.

I've got plenty of soapboxes, too, and I get fired up pretty easily. But between us, I'm sure the small parts we play will help some if not all.
( 10 comments — Leave a comment )