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Physician, heal thyself.

Fun fact: Did you know that the population of Honduras is 90% mestizo?  The other 10% breaks down to 7% “Amerindian”, 2% black, 1% white.  This is in contrast to the population of Guatemala (the only other Central American country with which I have any direct personal experience) whose population is only about 59% mestizo, with the remainder largely comprised of various Mayan peoples.  Interestingly, Honduras has a fairly good sized population of Garifuna people, an ethnic group of African extraction with a unique culture residing mainly on the Caribbean coast and the island of Roatan.

It’s been a long week!  I worked in the clinic Monday, nothing too terribly exciting.  Then Monday night I woke with shaking chills.  When it’s at least 85 F and close to 100% humidity and no airconditioning, your teeth have no business chattering.  I just felt achy and sore and feverish.  Had a little bit of GI upset, but it definitely wasn’t the primary feature.  Called in sick Tuesday and pretty much spent the day in bed reading and dozing.  I felt somewhat better Wednesday, so I got ready and hiked up to the hospital.  By the time I got there I was pretty well wiped out.  They did a malaria smear just to make sure I hadn’t got that (it was negative), and I saw a couple of patients since I’d been following them over the last few weeks.  Then I headed back to my bed.  Thursday I had been planning to take the day off to go into the city, so I just stayed in bed all day instead.  By Friday I felt better - had that drained feeling you get when you’ve been sick, but no more fever - so I went back to work.  I feel like I wasted 3 whole days.  It’s so frustrating.

On Friday an older lady came in from a distant town complaining of inability to swallow and a mass in her abdomen.  She’d been seen in a private hospital in the city several months ago and diagnosed with and treated for gastritis.  She continued to have difficulties and has lost about 30 lbs since then.  She was referred to us by her local Centro de Salud for either ENT or GI to see her.  Unfortunately we don’t have either of those specialties at our little facility.  Teams of specialists come through periodically, but it’s hit or miss.  I think there is this assumption that since we’re from the States we must have everything.  At this point, the patient has been unable to swallow anything, even water, for 4 days.  She also has a firm, approximately 6 cm mass in her left upper quadrant.  She needs somebody to look down her throat and figure out why she can’t swallow and she needs some imaging to figure out what that mass is.  We gave her IV fluids, built a sturdy differential diagnosis, but unfortunately are without the tools to arrive at a definitive diagnosis much less treat her.  We transferred her to the nearest public hospital which is, in fact, closer to her home for further IV fluids and eval. by either ENT or GI.  I hate that we don’t have the resources to help her and she came all the way out here for us just to send her somewhere else where she may or may not get the treatment she needs.

Sunday I went in to help with a delivery - first time mom, post-dates (42 weeks rather than the 40 weeks that is term for a baby), and preeclamptic with pretty significantly elevated blood pressure.  I was with one of the med students, kind of coaching her to do the delivery.  It was a pretty long labor and took alot of pushing.  Eventually we got to the point where it was clear she needed some help to get this baby out, so I took over and did a vacuum assisted delivery - you put a suction device on the baby’s head to provide traction while the mother pushes.  Baby came out pretty floppy and pale - had aspirated meconium (baby poop).  She perked up pretty well, but still wasn’t 100% a little over an hour after the delivery.  Mom was pretty wiped out, too.  Due to recent bad outcomes with sick babies experienced by the physician on call last night, he didn’t feel comfortable keeping the baby so he took it to the nearest city where there is a public hospital and a NICU.  Now, chances are the baby will do fine.  She was stable and definitely holding her own.  But by the same token, we don’t have nursery or peds nurses or the equipment to deal with a really sick baby if she decides to crash with meconium aspiration syndrome or something of the sort.  It’s always a tough call to make - to decide whether you can really manage a patient or not.  But even more so when there are no ambulances, no paved roads, no guarantee that the place you’re sending the patient can or will take care of them, and no telling what it will cost.

Though I did spend much of the week holed up in my room, I did manage to get out of the compound a few times.  Last Sunday I went with some of the nurses to a little Honduran church out in the country.  It’s on the other side of the village I’d visited the day before, across the ford in the river.  There are mud huts with thatched roofs lining the roadside at intervals and fields on either side of the where Brahma cows graze or corn or cane grow.  Some of the sets of houses are squatter settlements.  The people are welcoming and kind and take a sabbath respite from trying to carve out a living from the strip of land between the coast and the mountains.  

Mid-morning it started to rain - a steady, heavy, soaking rain.  After the service, I went into town with one of the missionary nurses for lunch and a quick grocery run.  We went to a hotel on the shore to sample some comida tipica - typical Honduran food.   Beans, rice, plantains, tortillas - pretty typical and pretty good.  By the time we finished lunch the streets in this seaside city were starting to flood, but as it’s nothing unusual for them this time of year we just went on about our business.

This weekend I went back out to the country side with my nurse friend and a few new Honduran friends - taking the road through various colonias all the way to where it ends at Rio Coco.  From there, you either have to take a boat or walk to get to the villages further up the coast.  The bizarre juxtaposition of modern technology and squalor in the developing world always brings me up short.  This area has only had electricity for about 6 months.  They don’t have reliable potable water.  Thanks to a recent sanitation project most homes do have an outdoor latrine - even though they are usually in the front yard.  But there are satellite dishes everywhere and most people have cell phones.  There’s a mud house with empty windows and chickens running in and out of the front door, pigs on the doorstep with diapered children and the Simpsons can be seen playing on the TV on the wall.  It’s just such a strange sight.  People sometimes bring their cell phones to charge at the clinic because they don’t have electricity at home.  

The countryside itself is gorgeous.  The mountains and the sea meet and retreat from one another along this stretch of coast.  Sometimes is seems the hills come right down to the water, but in places a plain stretches broad and flat between the jungle covered hillsides and the shore.  It’s here the herds graze and crops grow.  It’s also here towns with their cinder-block and open-air schools and churches and shops, their conglomerate of mud huts and brightly-colored brick and mortar dwellings, and of course the requisite fútbol field lie.  

It’s Monday and I’m back in the clinic.  It’s slow but steady.  Mostly checking up on kids with anemia, adults with diabetes and hypertension.  I’m already sad about leaving.  I haven’t done enough, seen enough, taken enough photos.  I’m not entirely sure there’s any such thing



Feb. 23rd, 2012 01:59 am (UTC)
Oh you are IN Honduras! That explains mini-Justin. Bleh I've missed so much with my flist this year.

What an amazing experience, I'm so pleased for you getting to do this at all, even if you feel you haven't been able to see enough. :)
Feb. 28th, 2012 03:19 am (UTC)
Yeah, I bet that seemed pretty random. :-D I still can't get over how much he looked like him.