all the small things

I’ve been here for three months. It’s been a big three months. But today I want to think about all the small things. These are the simple, important, amazing things that together have made this experience so big for me.

Organizing patient files and learning the importance of decent, legible handwriting. It really is important to the time to write a person's name and their history so that the next person who touches the file can understand what happened... I know it's kind of a long-standing joke that people who work in healthcare have really bad handwriting, but seriously folks, decent handwriting really goes a long way.

Handwashing. I spent a day teaching all the kids (and their parents) who came through the clinic how to properly wash their hands and the importance of handwashing. These big bottles of hand sanitizer were purchased through a very generous donation and distributed throughout the hospital. The hospital staff was so grateful – There are few places in the hospital to wash your hands and the running water doesn’t always work. This donation was so important to the hospital!

in the pediatric ward

in the maternity ward

in the dengue clinic

Weighing and measuring with accuracy. This is one of those things that I do over and over and over again all day at the hospital. Weigh and measure kiddos. But these numbers are what help the docs determine if kids are healthy, if something is not right, how much medication to prescribe… height, weight, temperature, head circumference, these are important numbers that have to be accurate.

Cleaning supplies. These were another donation that has made a big deal. When I got here we were running out a of this. Thanks to this donation, we have not had to spend money (that is not so easy to obtain) to purchase more cleaning supplies, and there will still be some here to use for a few months after I leave.

 

All the little touches. A cover for the baby scale. A bookshelf to hold books and informational pamphlets for families to read while they wait to see the doctor (and, as I’ve said before, they wait hours and hours). These are the things that seem small, but a lot of work and love and kindness of friends and strangers went into making them available for this clinic.

I am so thankful for the small things.

go with the flow

A piece of advice that is often given to travelers is to learn to be very flexible. Often things don't happen on time. Or they don't happen at all. Or they happen in a round-about way that doesn't seem to make any sense and takes a lot more time and maybe doesn't produce the results or arrive at the destination you were looking for but you just have to go with the flow.

While living in Brazil, I learned that when people want things to be done at a specific time (for example, a business meeting), they request that it be done on "American time" (as in, like a person from the United States would do it). It was not uncommon for both students and professors to show up half an hour late (or more... or not at all) to classes. When someone says they'll be there soon, usually that means within the next hour or two, not the next five minutes. Sometimes the bus doesn't show up. Sometimes the metro is broken down. Sometimes there is a strike or a holiday so everything is closed for three days (or more).

It's good to learn to go with the flow, to be able to adapt and figure things out when things don't go exactly as planned.  The idea that "time is money" is pretty deeply ingrained in our culture, and don't get me wrong, I like to have my schedule just as much as any other gringo (you should see my day planner from college... yikes!), but traveling has definitely helped me learn that a schedule can't rule my day or my life.

But how does that translate to healthcare?

In both clinics that I am working in here on the island, appointments are not scheduled at a specific time. You can set up an appointment for a specific day, but you still have to make sure you arrive early enough that your "spot" isn't taken. Dra. Cerritos hands out little tiny signed slips of paper with a date written on it. Patients/parents come back on that day and turn in that little slip of paper to the receptionist, who then gives them an even smaller piece of a paper with a number written on it. That represents their place in line to see the doctor. The doctors only see a certain number of patients every day (Dra. Cerritos sees 15) so if you are not here early enough, you don't get to see the doctor. I have talked to parents who have come as early as 6 in the morning to ensure that they are seen by the doctor. I don't start triage until 8:30. Dra. Cerritos doesn't usually arrive in the clinic until around 10:30 (She works in maternity in the morning with the new mommas), and sometimes it is even later than that. So families are waiting in the heat for literally hours to see the doctor.

I can't tell you how many times a morning parents peek their head in the clinic to ask, will the doctor be seeing patients today? What time does the doctor show up? And I cringe because I have to answer, "Well... usually she's here around 10:30, but sometimes she gets here as early as 8:30 or 9..." More than once, emergencies have come up in the maternity ward and she has had to rush off. In these cases, I have to work up the courage to step out into the little waiting area and tell the parents who have been waiting for hours in the heat with their hot, sick, crying kiddos that the doctor will not be able to see you today. I am so sorry.

The inconsistencies are really tough, and this goes beyond the scheduling. One day, the electricity went out. I was reading babies' weights with a flashlight. And with the electricity, we lost our air conditioning (Global Healing has provided an air conditioner that we get to use inside the clinic). So instead of stepping into a refreshing clinic, families stepped into a hot, dark room with a sweaty volunteer (me) to measure their kiddos. Another day, a different lock had been used to lock the clinic, so I spent all morning looking for the key and started triage late. The first week I was here, we ran out of paper towels so I had to use gauze to wipe down the clinic at the end of the day (PS thank you ALL for those donations.....I have never been so excited for disinfecting wipes). One morning I spent half an hour chasing a tarantula out of the clinic. Yesterday, I showed up at the hospital to find out that the specialized doctors had gone on strike after not receiving their pay. All of Dra. Cerritos' patients were turned away by the receptionist, which shouldn't have happened -- She is part of the hospital staff, but her salary from the pediatric clinic is paid for by Global Healing.

I've said it before, but to my foreign eyes all of this can feel a bit chaotic. It is good to see some of these inconsistencies alleviated by Global Healing. Today, thanks to the consistent paycheck from them, we will be able to see 15 patients while the other pediatric doctors do not.  As far as all the other surprises, I guess I'll just keep going with the flow.

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.

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