parents of sick kids

At least once a day, if not two or three times a day, a parent asks specifically to see Dr. Cerritos. We currently have a doctor here, Dr. Mark, who is doing a rotation and has been here for three weeks. He also sees patients, allowing us to see twice as many a day, but some parents simple say no. They want to be seen by Dr. Cerritos.

I was curious, so I started asking parents why they wait, even if it means waiting an hour or two longer. One woman told me, "Dr. Cerritos know the entire history of my son. She has known him since he was born. When he was born, he and I were both very sick. I nearly died. She has been with us from the very beginning and she will always be my child's doctor".  Another mother told me she really believes Dr. Cerritos is a great doctor. She told me she has also been coming to this clinic since her daughter was born. She trusts Dr. Cerritos because she checks everything: "She doesn't just look at my daughter then write a prescription on a piece of paper. She looks all over her body. She makes sure her whole body is healthy."

These parents are just like all parents all over the world. They want the best for their kids and they know that a consistent pediatrician is important. Parents always ask me questions about their kids' weight, height, is it normal? We use CDC growth charts to keep track of height and weight for kids as they grow up, and they are a great tool to show parents how their child's growth compares to an average child and at what point they should be concerned, and I always tell them they should bring any concerns up with the doctor. 

Usually, we see moms or grandmothers bringing in their kids, but every once and while, I see dads, brothers, sisters, aunts and uncles.

We've had a couple very sick kids over the last week, and with them come some very scared, nervous parents and family. One little teeny tiny preemie baby was here, just a couple of weeks old and only 5 pounds. He had a cough and had a lot of difficulty breathing. Dr. Cerritos listened closely and carefully and spent a lot of time with this little baby. It broke my heart to see that little baby and his mother, who looked so sad and scared. She sat there with her baby in her hands and cried. Dr. Cerritos had the baby admitted to the pediatric in-patient unit in the hospital. Another kiddo came in with x-ray results showing a fractured skull. Upon hearing this from the doctor, the sister (who was the one who had brought the little boy) gasped and covered her mouth with shock. She held back her tears as Dr. Cerritos signed a pass for her to take the ferry to the mainland; she needed to go to the hospital in San Pedro Sula, today, as soon as possible, to see a neurosurgeon there, and it was important that they admit the child today. The fear (and sometimes guilt) that comes up for these family members is heartbreaking. They just want their child to be healthy.

Last week a sick baby was in here for a long time with Dr. Cerritos with a very high fever. She was admitted to the hospital. This week, her mom came into the clinic, carrying her baby girl with her. She was beaming. Her baby was doing much better and they had been able to go home. She wanted to come thank Dr. Cerritos for her care and to show off her happy, healthy baby girl.

It is so good to see parents who care about their kids. I'm hoping to find some materials for parents to read while they are waiting those 2-3 hours and make a reading shelf to put in the waiting area. It will (hopefully) include coloring and reading books for kids along with educational materials for parents. If anyone knows how to get a hold of books, magazines, pamphlets, or flyers in Spanish about family health, I'd be interested to hear! I know these parents want the best for their kids; they seek out good pediatricians and stick with them and ask good questions, and better informed parents will have healthier kiddos!

Information Overload & Independence Day

I’ve been in Roatán for a little over a week. It’s been exhausting (mostly due to information overload) but it has been really good.

one room

Last week, I got a good taste of what the next three months will be like: in the mornings I’ll be in the public hospital in Coxen Hole at a pediatric clinic with Dra. Cerritos, a Honduran pediatrician. There, the core part of my day is spent doing triage before Dr. Cerritos sees patients. I weigh babies and kiddos, measure heights and head circumferences, take temperatures, hand out stickers and tickle tummies. After the doctor (or doctors – right now we have a doctor here doing a rotation with the clinic, which is super helpful; we can see twice as many patients every day!) sees patients, I enter the data from the visits into a database that keeps track of who we see, where they’re from, and the doctor’s diagnosis and recommendations.

this is where I weight & measure kiddos

the other room

waiting area

The hospital is so different than what I’m used to. It is unbelievably hot. People are everywhere. While doctors are seeing patients, other patients and nurses and doctors walk in and out of the room. It feels… chaotic. All of this, of course, is through the eyes of foreigner. Of course it feels different. But it does not feel unsafe. Doctors and nurses are caring for their patients, and caring for them very well, with the few resources they have. The hard part is that they have few resources.

Nursing Education

On Thursday and Friday, I sat in on a couple of classes that were given by three nurse educators who came down for Global Healing to look at how they might expand their outreach in the hospital. The classes were for nurses and covered care for diabetes patients, and care for low birth weight babies. One of the educators mentioned that she has seen nurses sit with a baby for an hour without leaving their side to monitor the baby’s health. A Honduran nurse spoke up, saying there is no way they would have to sit with one patient for an hour. Later, the question of hand washing came up – The hospital has few sinks with functioning water and I have yet to see a dispenser for antibacterial gel. The nurses recognize that they don’t always use the best hand washing techniques between every patient, sometimes they don’t make it to the sink, or there is no soap, or whatever. They fully understand the importance of washing their hands (they spend just as much time in nursing learning to wash their hands as we would in the USA—and any nursing student would tell you it’s the first thing you learn), but how can they wash their hands properly when they don’t have soap? Or antibacterial gel?

These are my initial observations. It is hard to see some of these things, and it’s important to see them. But equally (if not more) important is seeing that these professionals want to care for their patients in the best way possible, and they are trying to do so. As far as my role as a volunteer in all of this, I’m not sure what to think exactly, except that I am going to learn a lot. If anyone has any insight, I would love to hear it. All these things have been tumbling around my head all week. Luckily I’ve been able to chat about it with other volunteers, but I’d love to hear what friends and family back home think about this, or experiences they’ve had. 

So yes, it’s been exhausting. But I have been incredibly blessed to be living with an amazing, welcoming family who I have no doubt will take really good care of me while I’m here. They’ve showed me around the island, introduced me to their family, and have made me some amazing food (Doris’ baleadas are AMAZING!!). Sunday was Independence Day here, and this weekend was full of festivities, including several parades.

One week has already been eye opening… it’s going to be an interesting three months.

On my way to Roatán!!!

Hello from Houston, Texas! I’m finally on my way to Roatán. I left Denver at 6 this morning -- yikes! Thanks, Mom and Dad for waking up to take me!! And I really did need their help… I am bringing with me over $2000 worth of donated medical and school supplies!!!!!!!!!! About half of these donations are from friends and family in the Denver area, and the other half is a donated Project C.U.R.E. kit.

This is what 100 pounds of donations looks like!

making sure it was under the weight limit—is there a better way to do this?

and here it all is changing flights at Houston (The two giant green-grey duffle bags. Photos taken from my seat in the airplane.)

So now I’m in Houston and (thank you, coffee) I am able to think about the last couple months and the months ahead. I have already learned so much just by preparing for this experience, and first and foremost, I have learned about the incredible generosity of people, so allow me a moment to give a shout-out to the Castle Rock High Noon Rotary Club, First Presbyterian Church in Boulder, the Castle Pines Rotary Club, Project C.U.R.E. and countless friends and family. I could not be in this airport today without the support (financial and otherwise) of my community.

A lot of people have asked me what I am most excited about. Aside from, um.. EVERYTHING, I am really excited to start to learn about some of the nitty-gritty of healthcare. In the reading and research I’ve done this summer, especially focused on international health outreach (which included some books and lots of reading news articles and blogs about international development, e-mailing or sending twitter messages (seriously) to people who write those articles and blogs) I really feel like I have only barely begun to attempt to scratch the surface of learning what healthcare outreach looks like. This is a little overwhelming (and very humbling). But now, the opportunity is in front of me to see what a couple of these organizations actually look like in action – and I get to be a part of that action! THAT is the thing I am most looking forward to. This opportunity to work in Roatán is a chance to get my foot in the door in the kind of work I see myself doing for a long time.

But, you know, I’m only in Houston now J I’ll be updating from Roatán soon!

Clínica Esperanza

In the last post, I wrote about Global Healing and the Roatán Volunteer Pediatric Clinic, where I’ll be interning most of the day during my time in Roatán. After RVPC closes in the afternoon, however, I’ll be volunteering at Clínica Esperanza.

When I was in Roatán in May, I went by Clínica Esperanza (“Hope Clinic”) on a whim to see if I could just check it out. My mom, my friend Elyssa, and I walked shyly into the reception area (me first, mom and Elyssa no hablan mucho español…), but once we were inside we found there was no reason to be shy. The receptionist greeted us warmly and found Karla, the sweetest, kindest, friendliest nurse I’ve ever met. She spoke mostly in Spanish, but tried to speak some English to help my mom and Elyssa understand (mom was very thankful). Nurse Karla gave us a tour of the facility and told us a little bit about how it started. Peggy Stranges, an American nurse who had previously volunteered in Roatán, permanently relocated to the island in 2001. Nurse Karla told us that when Nurse Peggy arrived on the island, locals learned she was a nurse and came to her for medical advice, and thus the idea for the clinic was born. It began in the basement of her home, and then was moved to a church, then eventually moved into it’s own freestanding facility. And folks, this facility is really quite lovely.

Clínica Esperanza’s services include a walk-in medical clinic, women's health center, pediatrics inpatient hospital, birthing center (brand new!), and adult and pediatrics dental clinics with support from a laboratory and pharmacy. They also have outreach clinics and community health education programs. All of these services are low-cost/no-cost to their patients. It's about $5 for a visit, but Nurse Karla told us that no one is ever turned away because they cannot pay. Sometimes they just pay a portion if they can. Sometimes they pay nothing and say they will pay later when they have the money, which sometimes happens and sometimes does not. The clinic runs on donations and has a permanent staff (like Nurse Karla, who is from Roatán) and volunteer doctors, nurses, and students who come and go. This is a great, brief video about Clínica Esperanza and Nurse Peggy:

I feel very fortunate to be able to see two different kinds of healthcare outreach during my time in Roatán. The clinics seem so different (the public hospital where RVPC is located is a concrete slab of a building the bustling “downtown” area, Clínica Esperanza is air conditioned…). I am less certain about what I will be doing with Clínica Esperanza, but I’m really interested in learning more about the outreach programs they offer; public health and health education sounds right up my alley. I also hope that I can lend my language skills to any volunteers who don’t speak Spanish.

Like RVPC, Clínica Esperanza is always looking for medical and financial donations, so if you’re interested in learning more about how you can support the clinic, contact me or check out ClinicaEsperanza.org.

Oh yeah… two weeks from tomorrow I’ll be on a plane!!

Global Healing, RVPC, & HEAL

This whole business with Roatán, Honduras came to be because earlier this summer, I was accepted as the HEAL intern for the Roatán Volunteer Pediatric Clinic. The clinic is run by Global Healing, which is an organization that goes into developing parts of the world to establish programs to promote health care reform where modern medical care is often not available. What is key about Global Healing is that they aim to create sustainable programs. It’s not just about short-term interventions, but it’s about creating long-lasting relationships with the communities they work in to become self-sufficient programs. Global Healing has programs in Georgia, Armenia, Dominica, Moldova, Nepal, Haiti, Ukraine, and (ta-da!) Honduras.

Global Healing came to Honduras in 2003, opening the Roatán Volunteer Pediatric Clinic. The clinic is based out of the Public Hospital, of which there is one on the island of a population of around 65,000. With the government only able to support one permanent pediatrician, the hospital could not meet the demands of the pediatric outpatients, and often patients were turned away. So Global Healing stepped in to relieve this demand. The clinic is staffed by volunteer physicians from the US, and there are year-round rotations for pediatric resident physicians as well as a Health Education and Advocacy Liaison interns (HEAL - that’s me!). The RVPC provides perinatal care, newborn care, and inpatient pediatrics.

The HEAL intern serves as the Clinic Coordinator, locating resources (i.e. meds, specialty referrals, etc.) for patients, helping them through the logistics of utilizing these resources (i.e. locating funding for trips to the mainland for follow-up care). Interns assist in setting up the clinic before patients arrive, triage as patients and their families come into the clinic, collecting patient data, and interpreting for Global Healing physicians.

I will also have the opportunity to work with long-term patients individually, coordinating care among many health care providers and locating resources where there may not seem to be many – this is the aspect of the internship that most excites me. I am excited to get to know patients and families better to be part of creating a care plan that is best for them, and I’m hoping to get to know the community and the culture well so that I can learn how to personalize care for every person.

In an effort to help the clinic, I am now trying to gather donations of all sorts to take with me. Below is the list of things that the clinic always needs. I’ll be collecting in the Denver/Boulder/Colorado Springs area until I leave – please contact me or leave a message below if you’re interested in donating

25 days and counting…!

Non-prescription Medications & Supplies Infant and children's acetaminophen Infant and children's liquid cold medication (e.g., pseudoephedrine) Ibuprofen (liquid or infant drops) Benadryl (liquid preferred) Hydrocortisone ointment or cream Topical antibiotic ointment Selsun Blue shampoo Anti histamine ointment or cream (anti-itch cream) Eucerin or other moisturizing creams A&D, Desitin, or other diaper creams Vaseline petroleum jelly Cetaphil lotion Oral calcium supplements Children’s vitamins Debrox ear drops Clotrimazole (Lotrimin) ointment Saline bullets Individual alcohol rubs 3cc & 5cc syringes Nizoral shampoo Nix (lice treatment) Silver Nitrate applicators Urinalysis dip-sticks Glucometer / glucometer strips Thermometers (no mercury) Ear thermometer w/covers Infant nasal suction bulbs Pulmo-Aide or other nebulizers General Donations Infant formula Preemie, infant, and baby pampers Combs Shampoo, Conditioner, & soaps Toothbrushes & toothpaste Sandals, shoes, flip flops Clothes Socks

Children’s stickers Small Toys and Stuffed Animals Writing Utensils Spanish & English kids’ books Notebooks Child backpacks Crayons and coloring books Hand Towels Kleenex, Paper Towels Nail Clippers Sports Equipment: Soccer Balls Pumps for balls Flashlights (ones that do not need batteries) Clinic Supplies Antibacterial hand gels Paper towels 409 disinfectant sprays Plastic Ziploc bags     (little ones most needed) Print cartridges (HP cartridges 21 and 22 for HP Deskjet D1460 printer) Printer paper Prescription Medications Ceftriaxone for injection Any oral antibiotics (liquid preferred) Amoxicillin Augmentin Azithromycin Clarithromycin Erythromycin Cefazolin Other cephalosporins Penicillin Dicloxacillin Ciprofloxacin Metronidazole Topical Bacitracin Topical Neosporin Nystatin ointment Cortisporin otic suspension Erythromycin ophthalmic ointment Albuterol/salbutamol liquid for nebulization Albuterol etered dose inhalers (MDIs) Permethrinor Lindane (for scabies) Topical Sterids Oral steroids Prednisolone Prednisone Dexamethasone Dexamethasone for injection Inhaled steroid MDIs MDI spacers