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
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