Honduras Part 7

Well our Honduras trip is almost over… time sure has flown by…

Monday we had a day of clinic… nothing too exciting to write about there. Brittney has gotten pretty good with her Spanish.. me I am still working on it. It’s a long process, and I am slow at picking up languages. It’s a good thing smiling is universal.

Tuesday we all (Brittney, Dupree, Dra. Xiomara, Dr. Ayes and myself) got in the lovely VCOM truck and traveled 3 hours up and down and around the mountains to Catacamas. It’s a little town north and east of Tegucigalpa that has a clinic. The original reason for visiting this clinic was that their people came to see our clinic and we started talking about a program that they run for their chronic patients (diabetes, dyslipidemia, and hypertension). They invited us to see their clinic and take the information they have gathered at their program so we can start a program of our own. Well anyone who knows me well knows that I do not fare well in cars, or boats, or plans, or basically anything that moves. So I had to be medicated and sleep through most of the trip. Brittney was glad she had Dupree to talk to while I slept. I am pretty much the most un-fun traveler in the world. I love to travel and see new places I just don’t enjoy the process to get there.

We met with the doctors that run the clinic and they told us all about their program; how it focuses on family education, especially in the diabetic patients. They have come to the realization that you can’t stop diabetes, you can only prevent the complications, so the best way to help the patients is to help the families learn about proper diet, exercise, you know all the really fun things in life. Apparently eating fried plantains all day is not a good meal plan… and yes, I would eat them at every meal if I could. The program sounds really amazing, and the doctors working on it are so smart. Someone really needs to do their PhD work on this, because it’s a really great opportunity. I hope Baxter is able to set up a similar program here because we see so many patients with chronic diseases.

After we learned about the program they gave us a tour of their facility…. I would go there as a patient or a doctor. Brittney and I were trying to figure out if we could start residency programs there or not. This place was beautiful. It’s in the valley of a bunch of mountains, and the clinic is clean and new and well taken care. They have everything from surgery, ultrasounds, EKG’s, x-rays, physical therapy. .. basically anything you need they have. We took a bunch of pictures there, so you can essentially recreate the entire clinic by photo. The clinic is Christian based and basically runs off donations. They have one main clinic and then several smaller medical clinics in the mountains…If you are interested in more information about the clinic visit their website .. http://www.predisan.org/ Hopefully the students after us will get the chance to work there for a few days, because it would be awesome, minus the 3-hour car ride.

After our lovely visit at the Predisan clinic we did a little site seeing. Catacamas has caves of glowing bones. There are caves in the mountains that were used as a second burial sites way back in the day. The locals would bury their dead, and then several years later take the bones and prepare them again and place them in the caves. The caves have many different minerals including pure calcium. Between the river running through the caves and all the minerals the bones are now covered in calcium which causes them to “glow” or sparkle. We didn’t get to see the actual bones, because they now have them blocked off, especially for those gringo touristas.. we are such trouble. But, we did get to hike through a cave and see some very beautiful stalactites and stalagmites. Brittney and I also saw a bat… and yes it was a bat and not a bird, even if the rest of the group doesn’t believe us. There are some lovely pictures of the caves (from Brittney – my camera battery hates me), and pictures of the national forest.

Wednesday Dupree got to spend some time over at Hospital San Felipe catching babies. Brittney and I ran the clinic. Dra. Xiomara took Dupree over to the hospital and left us with Dra. Julieta came to supervise Brittney and me. We saw and treated patients all on our own with minimal translations. We were like real doctors… it was pretty cool.

In the afternoon, we helped organize some of the many boxes of supplies that the clinic has. Why anyone would need 300 French Tip suction catheters is beyond me… but in case you need some the clinic has plenty to spare. We made boxes of supplies that the clinic can’t really utilize (surgery supplies, etc) and made boxes to donate to the hospitals we work at, basically bribing them to let us keep coming to visit.

Brittney and I cooked up a storm last night, it was very tasty, and we had fried plantains. I told you I really would make them for every meal. Dupree came over, recapped his OB day, and told us stories from the farm. We were all laughing so hard we cried a little bit, so all in all it was a good night. We took our extra food and made up plates for the guards, thanking them for keeping the scary gang people out of the Baxter institute.

Today we had our last Brigade out in the community. Of course, Brittney and I took a million pictures. The Brigades are very fun because we get to go into the community, see where they live and help them a little bit. Most of the time it’s just antibiotics and ibuprofen, but it’s the thought that counts right?

Tonight we are taking Dr. Xiomara, Dr. Ayes, and Marco (who’s driven us around the entire month).. out to La Cumbere which is a nice restaurant on top of the mountains that over look Tegucigalpa. The weather is pretty horrible right now.. it’s windy slightly rainy and only 70 degrees. We hope to get to the restaurant before it gets too dark so we can get a couple good pictures of the city.

I’ll be heading back to the states on Saturday morning. Brittney and Dupree are leaving tomorrow.. I am not sure what I am going to do with all my free time tomorrow without new best friend.

Well that’s all for now…hope all is well at home.

Allison

Link to pictures -- http://www.flickr.com/gp/14059370@N07/4tGU5u

Hoduras Part 6

Well it's been a few days since I sent an email… I wasn't feeling very inspired. I've been fighting the gripe the last couple days. Snotty noses do not make me a happy person. I've come to the conclusion though if you are going to get sick in a developing country a cold is by far the best thing to get. At least I don't have dengue yet…

Wednesday (2-20) We again tried to see cardiothoracic surgery at Hospital Escuela. We actually got in the OR, and the we sat outside of it for an hour or so. Brittney and I were pretty sure that Dr. Ayes' brother forgot about us. Well it turns out they had the patient in the room ready to be prepped and then decided that the patient was too sick to have the operation. I guess it's a good thing to figure that out before you actually start the surgery. I was bummed. I really, really, really, want to see some cardiothoracic surgery one of these days. I got to touch a lung once, and it was awesome, so I can only imagine seeing surgery on the heart is cooler, especially in developing countries where they make do with whatever they have. Anyway.. enough about me being sad. We finally did get to see some surgery. YAY!!! Turns out there were surgeons from America doing a brigade last week and were operating in the OR next to where the cardiothoracic surgery was suppose to be. We got permission to watch their surgery. The surgeons are oral maxillary facial surgeons and they were working with one of the plastic surgeons from Honduras. They arrived on Friday night and spent all weekend screening patients and figuring out which patients they would operate on, etc. The surgery we got to see.. (not sure on the exact name of it, because I haven't seen much oral maxillary surgeries)… but the young man fell off his bycicle and landed on his face. He had a LaForte fracture II and they were pretty sure it involved the orbits of the eyes. He had a traumatic cleft palate. So they ended up wiring his mouth, fixing the cleft, and places a plate over his cheekbone. Then to see if they fracture involved the eyes, they first sewed the eyelids shut. Then they cut right under the orbit and dissected away the skin and fat to examine the bone. I was totally in awe of their surgical skills… it was amazing. I want to be that good when I grow up. I am working on getting pictures from the surgery... we were told not to bring our cameras, but there was a Honduran medical student there and she took pictures... so I might get them later. I'll keep you updated on the pictures. The doctors were very nice, and it was refreshing to be around a language we understood (and in the OR for me). They even had southern accents, so that made Brittney happy. It's pretty cool to fix someone's face from inside their mouth, so all in all it was a great day in the OR.

Hospital Escuela wasn't nearly as scary the second time as the first. We decided it was mainly the ER is scary in general. ER's in America are scary sometimes, so at the national hospital in a developing country, would you expect anything less than frightening. It was a Monday, and for some reason Monday mornings are always busy at hospitals…. I don't think people do work on Sundays anywhere. And lastly the OR's had just reopened from all the infections, so there were more people than usual. I still don't want to be a patient or a doctor there, but at least we weren't afraid for our lives.

Thursday (Feb-21) We went on a Brigade with the Health department. I would tell you what part of the city we were in if I knew it… so I can't. This brigade was held at a daycare/school. So, I have a million pictures of cute little kids that I kept trying to take home with me. I really just want one. We did pap smears again, but this time was not nearly as scary as the last time. We actually had a separate room, with an exam table. Shocker I know. The only light we had was a flashlight, but it's better than nothing. The ladies weren't really sure about having a male (Dupree) in the room, nor was he really excited about doing pap smears but there were not deaths during the day so I am pretty sure everyone was ok.

After the Brigade we ate Baleadas. Which are basically grilled tortillas with beans, cheese, and cream. There's a lady that makes them that works right across from the Baxter institute. Dupree wasn't so keen on the eating of street food idea… but Brittney and I are so convincing that we all enjoyed a lovely lunch of Baleads. We haven't died yet, so I am pretty sure we'll be ok. Steve vouches for the place, so I think we are safe.

Friday (Feb-22) We had clinic in the morning, but very few patients. I saw patients all on my own. It's a good thing when they bring me lab results for their problems, and it doesn't require me to know much Spanish. One of my patients had H. pylori. I gave her all the medication she needs, but it's hard to treat in America so who knows if she'll get rid of the infection or not. I was trying to explain how important it was that she take ALL the medication and not just some of it and save it for later. Which is what they do. Oh.. one antibiotic now… then save the rest for another time I don't feel well. It defeats the purpose of treating anything.

After our morning at the clinic Dr. Xiomara took us to Hospital Escuela for a tour. Brittney and I took a bunch of pictures. Dupree said we could reconstruct the entire hospital from our photos, and I think he might be right. We saw all the pediatric areas – post surgical, neurosurgery, oncology, ortho, you name it they have it. As we were walking through the Pediatric ER someone stopped us and said.. Virginia as in Tech or UVA? As we explained it was Tech the guy that stopped us asked oh do you know a Brooke Bennis… yeah she's in our class. Turns out he's a medical student from Indiana doing a brigade at Hospital Escuela. We keep running into people that we know or know people that we know. The world is a very small place sometimes. We then went over to the adult side of the hospital and saw everything over there. The rooms have 5-6 beds, some times more, to each room. Blue rooms are for boys, and pink rooms are for girls. They generally have rooms segregated by sex but that's it. You can definitely see why infection would be a problem in the hospital. We saw the area where they treat the TB and HIV patients but we didn't go in. I am not sure it really matters, I think TB lives in the air. So at least if my PPD test comes back positive next year I have a good reason. The nicest area of the hospital was by far the pediatric oncology area. It was actually clean (it's one of the newer sections of the hospital). I still want to see the anatomy lab for the medical students, because from the stories we've heard it sounds rather scary...maybe sometime this week.

Friday afternoon Brittney and I had to give presentations on Folic Acid Deficiency and worm infections to Dr. Xiomara. I won't bore you with the details. But now everyone is smarter because they know the recommended daily folic acid requirements and how to treat intestinal parasites.

Friday night we all headed to the mall, ate some American food for dinner (TGI Friday's), and did a little shopping. Poor Dupre had to wait for us to shop, I kinda felt bad for him. We won't mention the fact that he brought medical journals to read at the mall, because only really nerdy people do that. The mall might have one of the most delicious deserts on the planet… it's a close second the best cannoli on planet earth that I had in NYC. The stand sells fondue chocolate and fresh fruit, strawberries, pineapple, pears, apples, bananas. It's amazing. Brittney and I were trying to figure out if we could franchise it in America, but decided internship probably wasn't conducive to such adventures.

Saturday (Feb 23) Brittney had her 24 hour OB shift. Dupree, David, Carmen (David's daughter) and I all went to see the big statue of Jesus. I should look up the actual name of the statute, but for now it's Jesus Grande. It's at the top of one of the mountains overlooking the city. There is a large catholic population in central America, so Jesus protects them by looking out over the city. It's similar to the statue in Brazil, but the hands are portrayed different than that one. Where the statue is there are also a few Mayan ruins. We saw on the areas where they use to sacrifice people and collect all the blood in a giant pool. Of course I took pictures of that.. seriously how cool is that stuff. That was about all the excitement of the day. I wasn't quite sure what to do with myself without my constant buddy Brittney. It was weird to go to the library or places without her. I am glad she's back now.

When she got home this morning, she gave me a recap of her night. Apparently, they were less busy yesterday than they were when I was there. She did get a couple of deliveries in but not as many as she would have liked. She did get a better explanation of the hierarchy system. Apparently, the female doctoras were all general practitioners so they can only do the vaginal deliveries, and the male doctors are the actual Ob-gyns, so they only show up for the complicated births and the c-sections. So that makes a little more sense. The doctoras asked Brittney if she knew me and then said that I was very quiet.. hahahahaha. Only because I don't speak Spanish very well. That and being sick are the only times I am not talking.

Brittney worked with one of the interns, which is equivalent to our third year of medical school. They change rotations every 15 days… and I thought every 27 was hard enough. Apparently, at Hospital Escuela where they do most of their OB training there is no Doppler, you have a stethoscope and your hand. They monitor the patients every 30 minutes, so if more than three people are laboring, you cannot physically do the work without bending time. I have tried to bend the space-time continuum a couple times and it just doesn't work. She said they are yelled at a lot. It interesting seeing how similar but different the medical training is here compared to home.

So a funny story from this week. Brittney has been on a mission to find low fat or fat free milk since we got here. Well we eventually found some and it comes in a bag. Yes you read that right, a bag. And let's just say the refrigeration of foods like milk and eggs is really just a suggestion in the grocery store. So Brittney had been using the milk out of a bag for several days, saying it tasted funny, but thought it was just the plastic that made it taste that way. The next morning, the milk was definitely chunky. Now we felt bad for poor Brittney drinking rotten milk all week. The funny part is she keeps telling people this story and she usually tries to tell it in Spanish…. Which is hysterical. We bought new milk, and that one also went bad, but before anybody drank it. We sure will be glad to be back in the states where we don't have to buy milk daily out of fear of it being curdled.

Tonight we are going to have dinner with the Whites. They are good people and Mrs. White makes really yummy food so I am looking forward to that.

Well it's been a good trip so far, and I only have one more week left. Hope everyone is well at home. I'll be seeing some people in just a few short days.

Allison

Link to pictures -- http://www.flickr.com/gp/14059370@N07/4tGU5u

Honduras Part 5

Well… the past couple of days sure have been tiring.

Saturday (Feb 16^th) the whole crew (Abraham, Sofia, Brittney, Dr. David Ayes (who's in charge of the clinic), his daughter and myself) headed up to the top of La Tigra Mountain (a national forest) to do some hiking. We still aren't sure exactly how high we were, but when you are above the clouds it's high. Let's just say the road to get there was windy, and sometimes a little scary. Seeing as I really don't travel well I was looking a little green when we got there, but I wasn't going to let a little car sickness ruin our day. Being Gringos we had to pay $10 compared to the 10 limpiras that locals get to pay... I am pretty sure it's a scam they have going, and completely not fair. We took the moderate course, which had us huffing and puffy not too far into the trail. We like to blame the attitude with our inability to breathe, or the fact that it was steep incline. The forest was beautiful, very lush vegetation, but it was really hard to take pictures of it. Cameras don't really like fog, and have a hard time focuses. I think once we turned off the flash, the pictures started coming out better. Apparently Jaguars live in La Tigra, but we didn't see any. The live higher up on the mountain, all we saw was a groundhog or some other small animal that looks like a groundhog. We have a standing joke that Brittney would give away all our passports to save her life if need be, and for some reason she is always trying to give mine away first… anyway I doubt the Jaguars will stop attacking with just a passport, unless they were really looking for a way to come to America.

After our hiking adventure we went shopping at Valley of the Angels. We didn't have much time in the shops, but we were able to buy a few souvinors before it was time to go. Then it was time to head home so I could sleep before the 24 hour OB shift.

Sunday (Feb 17) -- My OB shift started at 8 am. I basically was dropped off at the triage area of the maternity ward and was told I'd be picked up the next morning. The doctor I was suppose to work with didn't get there until 9, so I just sat around being confused not knowing exactly where or what I was to do. Then he gave me a tour of the maternity area, the laboring room, the birthing room, the OR, and the post partum wings. Then he left me in the laboring rooms with the nurses and doctoras (female doctors) who didn't really speak English. First there was a c-section. I believe the cause was failure to progress, but asking that in Spanish didn't really give me an answer I understood. The male doctors pretty much only show up for the c-sections. The female doctor was first assist and there was also a scrub nurse. Everything was pretty much the same in terms of the procedure as it would have been in the USA. They use washable gowns and draping cloths and they close everything with chromic. I can count the number of times I've seen chromic used on one hand.

After the c-section I was shown how they monitor the laboring patients. One of the doctoras speaks almost as much English as I do Spanish, but between the two I got the gist of what was going on. As you would expect, things are pretty primitive, as there are no monitors or anything high tech. The toco "monitor" is your hand, you place it on the fundus of the uterus and keep it there for 10 minutes, counting the number and duration of each contraction. At least if the machines ever break back home, I am totally ok to still know what's going on. They did have a Doppler for the fetal heart rate, and those were checked every 30 minutes. Other than that, we sat there and watched the patients. They get NO pain meds what so ever. So if I ever hear a pregnant lady complain about the pain, I am just going to ignore it. The laboring room had 10 beds in it. And for some reason all the babies always want to be born at the same time, I still haven't figured that one out yet. But essentially when the baby is crowning they move them from the laboring room to the birthing room, which is the bed with stirrups. A couple pushes later and we have a baby. They do an abnormally large number of episiotomies.. almost everyone got one, and these women have small babies. I think it has something to do with the training, because again I can count the number of episiotomies I've seen on one hand too.

After the delivery mom and baby lay on a stretcher in the hall for 30 minutes or so then they are wheeled to the post partum hall, which is another big room with lots of beds. There really is no privacy or anything along those lines. The moms stay for 6-8 hours, they get 2 Tylenol and a shot of oxytocin and then the boot to the door. I watched several deliveries and how things were done. Later on in the day, I delivered 5 babies all on my own, and when I say on my own, that's exactly what happened. Sometimes there was a nurse there, but mainly she yelled things in Spanish, which I took as push the baby out now. Now 5 might seem like not a lot, or a whole bunch. But on my OB rotation during 3^rd year, we had 6 babies all month. They kept apologizing for it being a "slow" day, they usually have 35+ a day. I think we ended up with 25 or so.

I enjoyed delivering the babies, it was cool, but I still don't think it converted me back to OB-gyn. I do believe I am a surgeon at heart, even if it did take me a long time to realize that. After one of the babies didn't want to come out, and we had to rotate the head and push on the fundus to get the baby out, I am pretty sure I don't want anything more complicated like that in terms of newborn lives. I took pictures of the hospital and one of the babies that I delivered, so check them out.

The overall experience was great. I know that I can deliver a baby on my own, without any high tech machines and things will be ok. Bring on internship.

Monday (Feb 18) I finished work at 7 am, and came back to Baxter to sleep. Brittney, Sofia, and Abraham were all in the clinic. Sofia's PhD project involves nutrition education to moms of malnourished kids. All the kids were coming in for evaluation and medical attention. Brittney ended up seeing all the regular clinic patients on her own in the morning. She did have Amber to help her translate all that, but she did say it was weird for me not to be there, we've been pretty inseparable since we got here. After lunch I met up the rest of the group at the clinic. We finished seeing the rest of the nutrition program kids. There were several special needs kids, which is usually something rare in developing countries. It was a long day for me.. I was very tired at the end of the day.

Also last night it POURED all night. I swear they made up this "dry" season thing, because it rains almost every other day. I'd hate to be here during rainy season, if this is dry.

Today (Feb 19) we were supposed to get to see cardiothoracic surgery at Hospital Escuela but that did not happen. I am not sure if I've mentioned Hospital Escuela before, but I'll go over it again. It's the main teaching hospital in Honduras. The Honduran Medical students all do their training there, and it's where most of the specialists work. They pretty much let their upper level students (our 3 or 4^th years) do whatever they want, they are the doctors. I know that I don't know enough to be completely responsible yet, and I still need to be taught lots of things. Patients mainly go there to die, or that's what they say on the streets. We've been told that there's dried blood on gurneys, and patients stacked everywhere (which after our brief trip there this morning, is true). Many patients will ask to go to one of the other hospitals like San Felipe if given the option. They've had a recent outbreak of infections, which caused them to shut down the OB floor and the OR's due to high mortality. The OR's are still not completely open, so we didn't get to see anything today. We are going to try again tomorrow. I'll give you a full account of the hospital once we actually get to spend more than 5 minutes there.

This week we have another medical student (Dupree) here from University of Florida. He and Brittney were talking pediatrics today (Crazy peds loving people), and I was trying to get all the gossip on MICU (medical intensive care unit) for my March rotation.

We are hopefully still doing a Brigade this week with the health department, so that should be interesting. Hope all is well in the USA. Don't forget to check out the new pictures.

http://www.flickr.com/gp/14059370@N07/4tGU5u

Allison

Honduras Part 4

Greetings,

This week has just flown by it seems. It seems way too early to be almost Friday.

2/13

We went to the main health department office. We were given a tour of the facility by one of the epidemiologists. The main laboratory is at this clinic. It was by far busier than the Health Department we visited last week. We found out that there are 59 health department buildings in Tegucigalpa alone. There is essentially one for every neighborhood. The main health department clinic has a clinical area solely dedicated to AIDS or SIDA (in espanol) patients. They are able to receive all their medication and medical attention in a separate clinical area. They also have more diagnostic testing in this center, there was even ultrasound. Most pregnant patients are not able to afford ultrasounds, but they try to get all teen pregnancies scanned before delivering.

After our tour we talked to the epidemiologist about how they collect data on various diseases (dengue, AIDS/HIV, pneumonia, Tuberculosis, malaria, diarrhea, malnutrition). Each health department center keeps records on the number of patients they see with these diseases, their age and location. This data is written on a spread sheet which is then brought to the main health department and it’s analyzed. It is often hard to keep track of patients because they do not really have addresses. Most people live in an area, but there is no designation of street or actual houses, they all kina run together. Also some people will visit multiple clinics, hospitals, or health departments for the same problem and each of these will report the problem. So sometimes the information is not always correct.

We spoke to the group that organizes the treatment of AIDS, we learned more about this today… So I’ll only cover our AIDS education once.

We toured Hospital San Felipe, which is where we will be doing our 24 hour OB shifts. The hospital is very nice. We found out that the average stay post delivery is 6-8 hours. That just seems crazy. If you have a c-section you get to stay a whole 24 hours. Then it’s back home, and probably back to work. The design of the hospital is very open and it has a lot of trees and foliage along the corridors. The patient rooms are buildings off these corridors. We were discussing as to whether the design style would catch on in America, but then we figured that birds flying around probably would not go over too well. The OR is essentially the only part that’s not open in some shape or form, so we didn’t get to see any of that.

Last night we went out to dinner to celebrate the Match. Apparently it is “dry” season right now, someone should have informed the weather that, because I think we got about 3 inches of rain, the roads were flooded as we drove to the restaurant. You’d never know it rained today, other than we had to rewash our clothes that were drying outside last night. The dinner was very nice and the 5 of us went with Dr. White and his wife, who are in charge of the Baxter institute. They are originally from the USA, but spend most of their time down here running the school and clinic.

2/14/08

This morning we had clinic. Brittney is able to see patients with little help on the translating. Every once in a while they lose her, but her Spanish is really improving. I can see some patients with no help, but sometimes they still talk to fast, or I don’t know the words on how to explain things.

After clinic today the counselor who works with the AIDS/HIV patients came to talk to us about her job, and the treatment of AIDS. Most detection of AIDS occurs because people ask for the test. All pregnant patients are required to be tested at the health department upon confirmation of pregnancy. The counselor is there to offer support, social work, and guide them through the process of treatment. The government has a protocol on treatment, although sometimes it is changed based on the cost of available medicines, or medications that may have been donated. They have protocols as to when to start different prophylactic treatments, and essentially the only difference from the US version is their treatment of TB in AIDS patients. Since TB is so prevalent they are at much higher risk of catching it than in America. Patients are able to receive CD-4 counts, antiviral medication and the appropriate treatment if there are found to be compliant with their counseling sessions. Pregnant patients have their babies at a National Hospital which has a separate area for AIDS patients. There they are able to receive proper treatments, and also care for their babies. The babies are tested for the virus every 3 months for the first year, then annually after that. The counselor told us some stories of different patients being in denial, refusing to change their lifestyles (prostitutes, etc.), so it seems they face the same problems with patient compliance as we do.

We are hoping to do some hiking in a cloud forest this weekend on Saturday before my 24 hour OB shift. I am sure I’ll have lots to write about that.

If anyone has any questions about the trip, please let me know… and I’ll try to answer them J

Take care,

Allison

Honduras Part 3

Greetings…

Brittney and I had our free weekend this past weekend. We decided what better use of our time than to spend it at the beach in February. We traveled two hours by car to a little town called Coyolito. From Coyolito we took a boat to the city of Ampala which is the only town on Isla del Tigre. There really isn't much on the island other than a couple hotels, a few beaches, and a few locals that live there. For $55 we got a hotel for the night and all of our meals, which were pretty tasty, and we didn't even get food poisoning and die. It might be the most remote location I've ever been. The beach is beautiful and serene, it's very secluded. From the shore you can see both El Salvador and Nicaragua. I am pretty sure you could swim to them if you needed to, except I don't know if I want to brave the Pacific Ocean and the sharks that live there. Brittney and I spent most of the day basking or baking in the sun. It seems that the temperature in Ampala can reach over 40 degrees Celsius, which is 104 degrees Fahrenheit. It was the hottest day I've personally ever experienced and that's saying a lot from surviving many a summers in the humidity of Florida. We did lather in sunscreen, but the near equator sun was no match for our very pale skin. Brittney and I managed to go through an entire can of sunscreen in 1.5 days... I think that should be a record of some sort.

The random story of going to the beach was that we ran into another group of gringos (non-Hispanic people) that spoke English, which excited us greatly. One of the girls looked very familiar to me.. I thought…. hey I know that girl. It turns out I DO know that girl. She's the younger sister of a kid I went to high school/middle school/ elementary school with. We were both members of the Indian River Youth Orchestra when I was in High School. She's living in Tegucigalpa teaching English at a bilingual school. We are going to try to do a few things together before we head back to the states. Maybe visit the market, see a futbol game, or help her on the weekends when she gives food to needy kids. At the most remote location in the world, I run into fellow Vero Beachers.

Dr. Parish (Evelyn) got in Sunday morning (2-10). We all had dinner together last night and spent a while catching up and chatting. This morning Brittney and I made breakfast plantains, toast, eggs (which we won't talk about), and turkey bacon, it was a pretty tasty meal. Next time we won't add so much salt to the eggs. Brittney and I gave Evelyn a tour of the clinic yesterday and then Brittney was on her own seeing patients. I had a translator this morning, but for the most part I could get the gist of the problem. We saw at least cases of amebas yesterday. Evelyn said she was pretty sure she hasn't seen three cases of amebas in three years, let alone one day.

Yesterday (2-11) was match day….and I matched at UCONN. So I am headed to Connecticut next year, which is super exciting. They were my top program, so I am glad that they liked me. I think it will be a challenging but very rewarding year. Sofia and Abraham both matched at Geisinger and so far everyone I've heard from is happy with their match results. I am still trying to track down a few of my friends, and of course we are still waiting on everyone doing the allopathic match next month.

After lunch yesterday Dr. Xiomara (our doctor from the clinic) took me to the Montes Hospital, which is a private clinic. It is more middle class. They have an OR, a delivery room, and a few overnight patient rooms. They also have an emergency room, which functions like a doctor's office and a walk in clinic. We didn't have very many patients yesterday. But it was interesting to see the vast contrast in the difference between this setting, our clinic, and the health department. Office visits at the Montes Hospital are about 200 Limpiras, which does not include any medication or laboratory services, those are all extra. So that's a very large difference compared to the 30 lempiras or 1 lempira that the other clinics charge with medications being included. We met the doctor who we work with during the 24 OB shift. Apparently he will be out of town this weekend, so I am working with someone else, one who speaks English, and like teaching. I am very excited about this. Brittney is still working with the scary man, but he at least talks slow enough that you can understand most of what he's saying, we just don't always know how to respond in Spanish. Brittney is going to the hospital tomorrow to work with Dr. Xiomara, and then we each have one more day next week.

Today (2-12) we went to work at the health department. They sent a Brigade out into the community. It's like a mobile medical/vaccine/vector group that goes to a particular neighborhood for people that cannot make it to the actual health department building. On today's brigade we had the opportunity to do a couple pap smears and help with medical treatments. First let me explain that the clinic is basically someone's house. A house is volunteered to hold the brigade and one room became the medical clinic and pharmacy and the other room became the gynecology room. Brittney, Evelyn and I all did a few pap smears. Let's just say it was not the most ideal situation in the world. A bed, a sheet and a robe which were both reused, a speculum, and a flashlight were all we had to work with. It was definitely not up to American standards for hygiene or privacy. I can't imagine anyone volunteering their bedroom for strangers to get their paps done. They are able to get their results in about 15 days, which is pretty good. Then in the main living room, were the medical clinic and the pharmacy. We mainly watched the doctors and interacted when possible. We saw a little girl that had 2^nd degree burns on her arm and all over her body that she got from spilling boiling water. We also saw many skin infections, scabies, and the oh so famous gripe (cold/flu).

Abraham and Sofia walked through the neighborhood with the vector group helping to distribute disinfectant for the water basins. Dengue fever is a major problem in this area… just ask Abraham, he managed to get it last time he was here. But the water they use for cooking and cleaning sits in open containers and the mosquitoes lay eggs in the water and this spreads Dengue. The packets of disinfectant last for 3 months. It's just hard to get people to understand why they need to use them. The neighborhood we visited is mostly slum level living. Abraham and Sofia said it was very interesting to see the living arrangements and how they made the best of what little materials they have. Next week Brittney and I will be going on another community Brigade with the health department and we are supposed to help with the vector group.

I'll stop there for now… this has been a long update… Thanks for making it to the end. Hope all is well in the States.

Attached are a picture from the health department, the brigade sign, and one from the beach. I am working on getting the pictures on Flickr, so I'll let you know when those are up.

Adios.

Allison

Honduras Part 2

Brittney and I starting see our own patients, well we see them together and mostly without a translator. She is able to get most of the history and I can give directions for the physical exam.. it's a good system we have. Mostly we've seen Gripe, which is cold/flu symptoms, presion alta - high blood pressure, and diabetes - which is still diabetes. Brittney and I were both shocked on the number of patients we've seen who have high blood pressure. They don't even have the bad lifestyles and diet like we do in America... it's just proof that sometimes genetics out wins lifestyle. We did have a patient with chest pain today… which was very exciting to us, because one we understood dolor en el pecho, and it wasn’t Gripe. No worries.. he’s fine, and will do well with his anti-inflammatory medications for costochondritis.

Yesterday we visited the Health Department. Let’s just say that was an interesting experience. Each state or region has multiple Health Departments, similar to the county system we have. The medical care is essentially free, they pay 1 limpira which is about 5 cents. The clinic that we work, the people pay 30 limpira, which is about $1.50. So the poor of the poor go to the Health Department. We meet with the director and she gave us a tour, speaking very fast Spanish that neither Britney nor I understood. One of the doctors from our clinic translated little bits for us. We saw the dental area, the pharmacy, the counseling area. They have programs for vaccinations, family planning and nutrition. The vectors program was out and about in town vaccination all the wild dogs… sounds like a fun job to me. Some of the medical students from the Medical University were having class while we were there. All of their students are required to do a social service year, which is similar to residency but they work at clinics like ours or the health department. We are apparently going to go once a week now to work at the Health Department, again… I don’t think our Spanish is up to that, but we’ll try our best. The most notable difference from the Health Department in America to the one in Honduras was the two stray dogs running around. I am pretty sure that stray dogs are not allowed in the health department in America.

Dr. Parish is coming this week. She is one of the professors from our school. I am not sure exactly what the schedule will be like once she gets here, but it will be nice to have another English speaking person around.

Brittney and I went to the mall today to exchange money. I am pretty sure the mall in downtown Tegucigalpa might be one of the nicest malls I’ve even been too. It’s way better than the mall in Christiansburg, VA, but really that’s not really saying much. We’ve decided we need to go back and go shopping later. I still can’t get over the armed guards with BIG guns at every store, entrance, etc. They really like to have guns.

We have many small ninos that live near us that enjoy running around till all hours of the night, so we haven’t been getting much sleep. But things are going well and I will leave you with pictures of our lovely accommodations and some pictures of the clinic and Baxter institute.

Allison

Our house -- Kitchen, our room, and our clinic room.

Honduras Part 1

Greetings Family and Friends...

Some of you probably know, but for those who don't know... I am in Tegucigalpa Honduras on a one month medical mission trip. I am here with 3 other classmates of mine... We are at the Baxter Institute which is a Theology school. Abraham and Sofia (who are recent newlyweds) are working on their international PhD program thesis. Brittney and I are working in the clinic for the month.

I left for Miami early Sunday morning and actually ended up on the same flight with Brittney, she was connecting from D.C., so it was nice to see a familiar face on the plane and have someone to go through customs with. Customs is always an interesting experience, and it doesn't help that we didn't understand most of what the security guards were telling us. They checked our luggage to my horror all my powder laundry soap had exploded all over my clothes in transit, so lots of white powder fell out as I opened by bag. I am glad that it had that spring time freshness fragrance or I might still be in customs. At least my clothes are definitely clean and smell nice.

Brittney and I oriented to the Clinic on Monday. Today and Yesterday we each spent a day working with the doctor and one day in the pharmacy. I at least know most of my numbers in Spanish, so that wasn't too bad. We did have a minor surgery today!!! and you know how much I love that. We removed a lipoma from an elbow. I've decided that I don't really like suturing elbows.. they are tricky little things. Tomorrow we are going to see patients on our own for the first time... it should be very interesting seeing as we don't know much Spanish yet. I've mastered a few phrases. Abra la boca por favor -- please open your moth, and respire profundo por su boca -- breathe deeply through your mouth. I am working on the phrase that tells the patient that I speak little Spanish and to please speak slowly and answer yes or no when possible. We are going to visit the Department of Health, and spend a few days at the hospital, so that should be fun and exciting. We will be taking 24 hour call at the teaching hospital in the OB department. Which is a little intimidating because the doctor we will be working with will not speak English... but we'll see how that goes.

The only real excitement we've had so far was getting locked out of our apartment. Abraham somehow locked the door so you could only open it from the inside. After several hours of trying to get the door open, someone had to climb up a ladder and climb in our second story window (the only window without bars on it), remove the glass shingles and screen and open the door from the inside. It was quite the drama yesterday.

I am not sure how many times I will be able to send emails... but I will to update at least once a week.

I attached pictures that I took from the plane. I haven't taken many other pictures yet, but I will try.

I hope everyone is doing well.

Take care,

Allison