Wrapping Up

News from cental america:

We had our final day of medical clinic yesterday—nothing too crazy, thank goodness, but it felt better than the prior couple of days because people had more focused problems, rather than a huge long list of issues. Interestingly, very little heartburn in this village. I continue to be surprised at how I hear from all the kids and parents about headaches--not sure if this is just what American parents/kids call "stuffy" or what, but in America they'd all be getting scanned for brain tumors if they talked so much about headaches!

Later in the afternoon we got to tour the hospital. They have tons of equipment donated by various foreign governments (Spain, Mexico, Germany, and China all mentioned) and even have a 2-bed neonatal intensive care unit. And they deliver TWENTY FIVE BABIES A DAY! I would really love to come and do a rotation...

Today is a rest day. I ran with my exercise buddy this morning (she's an elementary phys ed teacher in VT), and now we are having a leisurely breakfast. In a few minutes we're going to pack up the pharmacy: meds that will expire soon will go to the local hospitals, and those that have awhile yet will be stowed away for the October Rotary team. This afternoon we are going to a local Equestrian Center for lunch and fun with the local Rotary, though apparently they don't have any horses yet.

Sunday we travel.

Clinic Day 4

Thursday's news from down south:

I can't believe we only have one day of clinic left! I am definitely ready to be heading for home.

Thursday, our medical clinic was set up at a school for orphans here in town. It was similar to the other days — mostly gripe and dolor de cabeza — though I did have a couple of alarming pediatric patients.

A grandmother brought her three grandsons, ages 5 and younger, and pointed to the five year old and said, "he has seizures."

"Is he on any medicines?" I asked through my interpreter? "No," came the answer.

"Has he only had seizures with fever? How many seizures has he had?"

"Yes, with fever. He's had two, the last one was six months ago. Well, actually, the first one he ever had, he didn't have a fever."

"Have you taken him to the doctor?"

"We took him to the hospital when it happened but the doctors were asleep so no one saw him." (!!!!)

"Does he learn and understand the way that other kids do?"

"Yes"

I'm just about to launch into a speech about how kids outgrow febrile seizures, but if he has another seizure without fever, he really needs to see a doctor, when grandma adds, "and he has diabetes."

"Diabetes????" I want to make sure I'm understanding this correctly, so I make my interpreter ask again.

"Si, diabetes."

"On medicines?? Shots???" (The only way to treat juvenile diabetes is insulin.)

"No."

It's at this point I start looking for the camera, because it has to be a joke. I make my interpreter ask again, and then grab one of the older Rotary ladies who is completely fluent, because there has to be some sort of misunderstanding.

"When did you find out he has diabetes?"

"Two days ago. They did some blood tests and said he has diabetes and to bring him back tomorrow, but I heard that you were here and brought him here instead."

The kiddo looks way too healthy to be in diabetic ketoacidosis, which is usually the way that kids are diagnosed, and there's no way that a kid in DKA would have been sent away from the hospital, they usually have to be admitted for several days. So I still don't understand the sequence of events at all. Nonetheless, I am NOT a pediatric endocrinologist and there is no way I can start insulin on this kid, and I still think there must be some sort of misunderstanding anyway. I explained several times through the interpreter that childhood diabetes is VERY dangerous, that they absolutely need to follow up at the hospital tomorrow and will probably need to see the doctor very often while they are starting treatment, and that we do not have the ability at our mini-clinic to do this!

Crazy.

Then there was the mom with the 8 month old who said he was vomiting all the time and losing weight. The child was INCREDIBLY chubby, 20 pounds on our scale! (B, for example, didn't reach 20 pounds til around her 2nd b-day). Mom insisted that he used to weigh 28 pounds. (???) I explained that babies spit up a lot, some much more than others, and that it would gradually improve over the next few months—it's only concerning if the baby is losing weight. She said he seemed skinnier to her, so I wrote her a referral to see the pediatrician at the hospital here. Who knows?

We're off for our last day of clinic now.

A Few More Photos From Honduras

Hi, Cynthia's family! Here are a few more photos from our week.

Don't tell Jasper that I'm makin friends with other dogs! This one lives at the nursing home.

Cynthia teaching geography. Concord was on the globe!

Cynthia at the airport in Tegucigalpa

Our medical set up at one of the schools. You're looking at 3 clusters of providers!

Dental team at work:

At the nursing home:

Some people at Las Robles, where the construction team is working (they asked me to take the photo...otherwise I have not been photographing people because it seems awfully intrusive!)

Suzanne laughing with Ann and a couple of our translators, who are hilarious.

Wednesday Wrap

So far this morning I am 0 for 2: no one from my little running group showed up, and the internet is not working. So I’m writing this as a Word document and hoping to be able to post it later (which, obviously, has now happened as you are reading it).

Yesterday (Wednesday), our clinic itself was way out from Danli, almost an hour, on the ranch of one of the Rotary club members. People came from miles around. We were set up in a school again, though this time all six providers were in a much tinier room—between that and the generator going outside, there was quite a din! I had another high schooler from the bilingual school translating for me, and he was fantastic—his English is excellent, and he didn’t flinch when asked to talk about various maladies from constipation to vaginal discharge to urinary tract infections. (He told me afterward that he had three sisters, so it was just like home.) By the middle of the day he had all of my regular patter down: “it’s a virus you don’t need antibiotics for that,” “don’t drink alcohol while taking Flagyl,” “coffee and soda and spicy food will make your heartburn worse,” “a spoonful of honey at bedtime is the best medicine for cough,” and he would launch immediately into all my questions for differentiating migraine from tension headache without me even having to ask. He’s planning to apply to medical school, and I think he’ll do great!

Aside from the fun of working with David, the clinic itself was so-so. This place actually gets a fair amount of medical attention since it’s on the land of this Danli Rotarian, and many of the people felt like professional patients—reciting a litany of complaints to get a certain set of medicines. This is a bit frustrating because each new thing that they say spools out a long differential diagnosis in my head (is that stomach pain reflux? Gastritis? Bad enough to be an ulcer? Viral? Constipation? Parasites? Diabetic gastroparesis? Lactose intolerance?) and then we do it all over again for headache and cough. I don’t think there’s much of a concept of well child care—the parents seem to think that they have to have some complaint about the kids (usually “gripe,” which is a cold), whereas I’d be happy to just hand over some vitamins and pronounce them healthy! This has happened to some extent at the other places we have gone, and is certainly a result of both sporadic access to medical care and our medical mission groups “training” them that there’s a pill for everything, but yesterday was the first day that EVERY patient seemed to have three, four, five, six issues they wanted to discuss and it was a bit draining. Some of the other providers (and the experienced interpreters) are better at cutting through those things.

I did take MANY animal pictures for Brynna. They are all from the ranch.

The real fun of yesterday was after the clinic. The ranch, as I wrote, belongs to one of the Rotary families, and the husband is retired from being very highly placed in the government (that’s why there will be soldiers in some of the photos: look Mom, a military escort!). His wife took a small group of us back to their ranch house afterward to look at their horses. They have some breeding stallions: a couple of Peruvians, who have a smooth “Cadillac” gait and thus make great all-day riding horses, a Peruvian-Spanish cross, a very hyper Quarter Horse who had recently been injured (yikes! The idea of barbed wire on a horse farm gives me chills) and a beautiful Spanish horse (by which I’m almost positive they meant Andalusian). The groom longed them each for us so we could see them in action. Beautiful!

After about an hour of oogling the gorgeous horses, and wishing that we’d had time to ride, we headed back to Danli. Cynthia and I rode with the ex-government minister, one of his friends, and this also meant that we were driven by one of the soldiers. After winding our way through a succession of dirt roads, we approached a lovely river. And then kept approaching. And then realized that the road continued on the other side, which probably meant that we were going to drive through it! My photos do not adequately capture how nerve wracking this was, especially after the guys in the front of the two pickup trucks got out and had a brief conversation, I think about which gear to use while driving across the river. The truck managed to swim across and then lurch up the opposite cliff onto the road without actually causing either of us to have a heart attack, but it was a close thing, and involved a lot of hysterical giggling. I was able to lean out and get a photo of the truck behind us coming up the bank.

The rest of the ride back was pretty uneventful, and then we went to a Honduran restaurant for dinner. It was quite late by the time we got back, and once I resuscitated my computer (which had somehow lost all its battery power despite sleeping all day), I was too tired to go back out to the lobby (where the wireless is) to send emails. I guess I should have, since now the network is not working this morning.

We have two more days of clinic—today and tomorrow—and I think we are going to tour the main hospital tomorrow too. Friday night one of the Rotarians is hosting a “do” and Saturday I think we’re going to someone else’s ranch to relax before heading back to Teguc on Sunday for our flight. So far, this is definitely something that I’d like to do again (though with better Spanish, I hope). 

Clinic Day 3

The latest from down south:

Third day of clinic today was at a village just outside town, near the city dump. We were set up, as usual, in a school complex. Today was a bit different in that we were relying mainly on teenagers from a local bilingual high school for interpretation. They were enthusiastic, and goodness knows their English was much better than my Spanish (tenses! they had tenses!), but they didn't have much in the way of medical terminology. However, we muddled through quite well. I had a run of fairly complicated patients, including a VERY prolonged discussion with a young woman who came asking for a pill so that she could get pregnant, because she had had seizures in her last pregnancy. It took about 20 minutes of questioning to try to figure out whether she had an underlying seizure disorder that worsened in pregnancy, versus eclampsia (which is seizures along with high blood pressure during pregnancy)--both very serious but approached completely differently. I think it was the former, but gave her a referral to see the OB-GYN here in town to discuss the matter prior to attempting pregnancy.

Tonight a group of us walked into town and had dinner at a Mexican restaurant. Very tasty, though somewhat tempered by our reluctance to eat fresh veggies (like salsa) or drink things with ice in them due to concerns about water purity. Then it was off to the local Rotary meeting. This trip is sponsored by the Bow Rotary and they've been coming here for many years, so it's a big reunion. I was dreading a long meeting in Spanish, but instead it was short, bilingual, and ended with, "so we will close our short meeting so we can drink and talk to each other." Now that's my kind of meeting.

We have three more days of medical clinics left. Saturday we are spending the day at someone's ranch/estate for relaxation, and Sunday will be mostly traveling. The construction team is working incredibly hard on the school, and our water/sanitation team had a wildly successful day today, installing two latrines in a village that did not have any previously. They will build two more tomorrow, and then install about 40 water filters on Thursday and Friday.

Las Roblas

Update from Honduras:

Today was clinic day 2, held in Las Roblas, where our construction team is building another school building. Our clinic was held in the two-room school that the Rotary built several years ago. All six medical providers were set up in one big room, with clusters of table and chairs around each of us, and our pharmacy (suitcases full of drugs) was set up on desks in the other room. I saw forty patients today in about five hours, mostly clusters of moms and kids. I did have one gentleman who told me he'd had two heart attacks. I'd been wondering who I was going to give our cholesterol medicine to, since we have no way to do blood tests, but he definitely qualified! Lots of "gripe," which they translate as flu but to me seems more like a cold or other viral upper respiratory infection. Lots of ringworm. No more icky lice and no huge wounds, though I did treat one skin infection AND got to drain a ganglion cyst, which was awesome.

We had some rotating interpreters, and I did a lot more on my own today and then would grab one of them if people started talking a lot, or talking fast—I found that I was usually able to get the basic questions across, and understand simple answers. I now know the words for rash ("erupcion") and for lungs ("pulmonas"). As long as I can stay in the present tense, everything is fine. I'm vaguely aware when I should be using the subjunctive, but usually don't quite manage it. People seem to understand anyway.

Our team finished early, just after 2:00, and we came back to the hotel. Some of the providers went to a nearby detox place to do some primary care, but I needed a little down time so did not join them. I did go for a walk with Cynthia (my attending) and one of the veteran Rotarians to the beautiful new huge grocery store, where we stocked up on plaintain chips (yum!!!), water, and I also discovered that the Skittles here have no gelatin, so now I have some Skittles too.

This evening a big chunk of our group—about 20 people—went to a steakhouse. It was quite fancy, and ironically, I was able to get some decent veggie-friendly food. It was lovely to eat a real salad (we'd been told by the Rotarians that it was safe to eat salad at this place because they wash things in purified water), and once I told them that I was vegetarian, they modified one of their platters for me. I ended up having beans, a fried egg, and avocado, but passed on the funny salty cheese that is everywhere here.

My little running club has taken off, they went without me this morning because our medical team was supposed to have a meeting at 6:30, which never really materialized. We're planning to run again tomorrow. It's a nice way to get to chat with people who are on the other teams (construction and water/sanitation) because we don't see them during the day.

Things are generally going well. After talking with some of the other people who had done this trip, I was concerned that I'd spend a lot of time bemoaning the lack of big-picture public health focus, but I've mostly tried to focus on the people we are really making a difference for (like heart attack guy--I convinced the pharmacy to give him 6 months of meds, til our next team comes down), or who we can reassure (several people have thought they've had cancer for various reasons and they almost certainly don't). Plus, it's just flat-out interesting to get to be in a part of the world where I've never been. Tomorrow is going to be even crazier—we are going to a village right by the town dump which is apparently much much poorer than any of the places we've been so far. Possibly also going to visit a nursing home.

This is really making me want to get my Spanish back into shape. Not sure how to work this into the rest of my life, though!

First Clinic Day

No valentine's day in the Moose household. From our foreign correspondent:

We had quite the introduction to Honduran medical treatment yesterday. We went to a newly built hospital about half an hour away. The six people on our provider team (three physicians, two NPs, and a nurse partway through her NP training) saw upwards of 200 people and were there for about eight hours. The dental team (a dentist plus a few helpers) saw 20 patients and pulled 35 teeth.

The majority of what I saw was cough (toz) both acute and chronic, headache (dolor de cabeza)--of which I was able to identify several migraines and give Excedrin--and gastritis/reflux (dolor de estomago)--we were handing out Tums like candy. People drink lots of coffee and soda, which is NOT good for the stomach. Also many skin and nail fungal infections.

Our first patient of the day was a woman with a chronic leg ulcer that had been there for fourteen years! She was keeping it meticulously clean, but it was huge. All we could do was give her a referral to see a specialist at the hospital here in Danli, but it's hard for me to imagine what they are going to be able to do. I think we'd have her in a hyperbaric chamber in the States.

We also saw a girl with the most horrendous case of head lice—all of us were having psychosomatic itching for hours afterwards.

And I saw a woman with pelvic pain and discharge, but without the space and supplies to do a pelvic exam I wanted to treat all the possibilities, so she ended up with meds for bacterial vaginitis, yeast infection, and chlamydia (we didn't have the right antibiotic to treat gonorrhea, but we looked through our pharmacy stores this morning and now we do have something that should serve). It was a bit frustrating, because with a pelvic exam and maybe I microscope I could have narrowed my differential diagnosis a bit!

Usually, talking to patients is my very favorite thing, but it took so much effort and mental intensity to try to understand the Spanish, and then formulate a response (though I did have an interpreter to help), that it was SO lovely to just put a stethoscope on a chest and listen to heart and lungs, which is a language I feel pretty comfortable with!

We had a few patients who I knew EXACTLY what to do with, and we even had the meds to help, and it was such a relief: a teenage girl with bad menstrual cramps (high-dose ibuprofen, and then go find a clinic for birth control if that doesn't work), and the migraine folks (yay for whoever donated that Excedrin!). We're also giving out a few month's worth of blood pressure and diabetes medications when indicated.

It was overall quite exhausting. My Spanish got a bit better through the day and peaked around 2 or 3 PM, then collapsed for the last few hours as I got tired. I still can't use the subjunctive at all, and was too tired last night to do much grammar review! Thank goodness for the translators.

Today we're off to hold a clinic in Las Robles, where part of our larger Rotary team is building a school.

Honduras

Hilary is our foreign correspondent this week. She is traveling with some colleagues from the hospital and a contingent from the local Rotary to a rural town in Honduras. After staying up all night Friday to clean up loose ends with her Concord patients, she left around 3 am Saturday for an early flight out of Logan to Miami. From there, on to Tegucigalpa, the largest city and capital. Google Earth has been a wonderful tool explaining all this to Brynna, although she doesn't quite understand that the airplane on the tarmac in the picture isn't actually Hilary's.

The whole contingent loaded onto a bus for a several-hour drive through the countryside before arriving at the hotel that will be their base of operations this week. Her take:

We have arrived safely in Honduras. Our travels went very smoothly, we seem to have gotten all the giant medication-containing suitcases hauled down here just fine. The drive from Tegucigalpa gave us a beautiful view of various sorts of countryside, including many mountains, and we're now at our hotel. Where there is wireless in the lobby! Hurray!

I'm pretty exhausted due to no sleep last night, though I did manage some naps while traveling. We're going to do some organizing of our "pharmacy" and then, I hope, head to bed pretty soon. We start our medical clinics tomorrow.

Warm January

For anyone in the Northeast, it has been a very disappointing winter. Since our freak snowstorm before Halloween, we've had much more precipitation as rain (several inches) than snow (less than a foot). This past weekend'spond hockey tournament, after being postponed several weeks ago, still had logistical problems of all kinds trying to keep the rinks from getting too chewed up. Ski areas have struggled even to keep their man-made base, as daytime highs have been routinely above freezing. We've also been effected by the lack of snow elsewhere: if it doesn't snow in NYC or Boston, no one down there thinks to come up here - just not in the mood. Anecdotally, some have seen their crocuses and daffodils poking up through the (not at all frozen) ground. In some places they are already sugaring. My relations in Rochester inform me that they've received barely two feet of snow all winter, for an area that routinely receives 100"+ each year!

To illustrate just how outta whack things have been, consider this graphic:

I worry that B isn't going to grow up to be a cold-hardened Yankee!