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