In Case of Emergency

Well this past week has been another week of excitement and learning.  It was another 4 day week as there was a holiday on Thursday (Armed Forces Day), which we deferred to Friday for a 3 day weekend!  While 3 day weekends are nice, they don't quite have the same appeal as in the US, unless you have plans for the weekend.  This morning I woke up feeling like it should be Sunday because we spent yesterday doing things that we would normally do on a Saturday.  Maybe in the future 3 day weekends will have a greater appeal, but for now, we just take 'em as we get 'em.

Let's see....what things did I learn this week?  I  learned many of things, the most important thing being, we were not adequately prepared for emergencies at the clinic.  AHHH!!!  Thursday, when we were a bit busier than normal because of our holiday scheduled for Friday, a little boy about 4 years old started to have convulsions and was seizing due to a fever.  How did this all play out?  Let me tell you:

I was in the gynecology room putting something away.  Dr. Rafael, the pediatrician, comes to me as I am exiting the room and say something in spanish to me as he is pointing to the oxygen tank in the room and putting his hand up to his face to symbolize a O2 mask.  I peak my head down the hall to see a kid convulsing on his exam table, the mother trying to calm him along with doing somewhat of a sternal rub.  My initial thought?  This kid is non-responsive; after all what else could a sternal rub mean?  My initial reaction?  Rafael must want the ambu bag so that's what I return to the gyne room to grab.  But then I see Dr. Rafael turn the child on his side; something you do when a person is seizing.  This kid is 'ok' but it is still an emergent situation we are dealing with; Dr. Rafael wants the oxygen tank.  However, keep in mind the 2 tanks we have are both about 5 feet tall....not something you would transport out of the gyne room.  Therefore I ask Dr. Rafael to bring the kid next door.  What was lost in spanish/english translation was, "I can bring the kid to the gyne room, but I need the other patient cleared out of there and the exam table prepared with an oxygen mask."  One time that having a language barrier is a problem.  We get the table prepared and are going to put oxygen on the child only to find out that both, I repeat both, of our O2 tanks are EMPTY!  Now what?!  Well we have a small little hand held tank with our emergency kit.  Do you suppose that one had oxygen in it? Nope!  Great, we have this kid that could use oxygen but no oxygen to give him.  But wait....luckily we had 2 small tanks upstairs that had some oxygen in them, they saved us!  Needless to say though, getting oxygen to this kid, which should have taken 2 min, took close to 15 minutes I'm sure.  Luckily it was a highly emergent situation!  After we had the child very stable, Dr. Rafael told me that it is important, in cases of emergency, that we have oxygen and other supplies that we can use.  I could not agree more!

This is the culture!  Everyone moves at their own pace, doing their own thing.  When something needs fixed or done, others are not always informed, they just wait until someone else finds the problem too and decides to do something about it.  The case of the oxygen tanks?  Well the nurse that had been in charge of making sure they stayed filled had probably been swamped with 3 jobs at the time and just forgot to make arrangements for them to be filled.  Then, when she quit the job at the clinic however many months back, nobody was informed of this issue probably because she had simply forgotten.  To add on top of this, I have never been in an emergency situation before so I still needed to be walked through it.  However, being walked through an emergency situation in another language?  Not the ideal situation! So plan for the next week or two?  Have the doctors walk me through an 'emergent' situation from start to finish so next time I know what needs to happen.  Emergencies aside, I did get to perform my own pap smears this week so that was exciting! 

In other news: I met this lady, Debi, at the clinic on Thursday. Her and her husband Bob, who are from Canada, have been on the island for 2 years as missionaries.  She told me about how she loves to do things for volunteers and she was having a game night last night.  So I decided to check it out.  We had soo much fun at game night and learned of a great resource, Debi herself.  She loves to interact with island people and she has connections with people all over the island.  Her and her husband work down by the cruise ship dock with locals and she loves to give true island tours where you get out and interact with the people of the island.  Looks like I will be seeing more of her!  I am very excited and looking forward to doing that sometime in the near future! 

Another hurricane is also on the horizon.  Last time when Matthew was due to be coming in the next day, we had a 'hurricane party' the night before (aka a potluck).  Since Peggy has 10 lbs of fish we were going to have a potluck with, why not make it another hurrican party!  Who knows, maybe this hurricane will turn out just like that last: windy/light showers over night and a gorgeous sunshiny day the next day.  We can only hope.  However, I still want to experience a hurricane sometime cause when else will I get the chance?!

I got my first glimpse inside the hospital as well yesterday.  That is a very interesting scenario, but I will save that for another day's reading. 

Love to all those at home!
Laura

1 Month and Counting

Yes, believe it or not, I have been here for a month; and what a fast month it has been.  It feels like I just got here, but at the same time, it feels like I have been here forever.  So you may ask, "What have you accomplished in the past month?"  Well, to that I answer, "I don't really know!"  Actually, it has been a month full of many things, but mainly it has been a time of adjustment.  Getting used to the speed of life here, the routine of working at the clinic and having free time...yeah I know, what's that?! and getting to know the people that I will be spending time with over the next weeks, months, and some, year.  Let me give you a brief recap of what life has been like over the past month.

At the clinic, I have been learning many things.  Aside from Ms. Peggy, I am the only nurse at the clinic...what big shoes I have to fill!  What would take at least a couple weeks in the states, my orientation to the clinic lasted 4 days.  After that?  I was on my own for the next two weeks; Peggy was on her way to the US for that time.  Wow!  What a busy, busy woman she is.  I can see why she needed help.  Clinic runs from about 8 to 12:30, with patients showing up starting at about 7 to get registered and then triage starts at 7:30.  On any given morning at the clinic, my job ranges from triaging patients, doing EKG's, distributing medications, answering questions for the docs and/or pharmacist, cleaning up after docs (go figure!), watching/assisting with small procedures, and learning more and more about medicine everyday.  By about 1:00 we are worn out and ready to go home for lunch.  Somedays our work is finished at this time, while other days, it continues in the afternoon.   This past Thursday, we had to make a house call to administer a shot of Haldol to a schizophrenic patient.  This patient literally is locked in a "house" which in the states, we would refer to more of as a large shed.  It's got four walls, a toilet, a bookcase (with nothing on it), a table and chair, and a bed (with no mattress or sheets).  The lady, Miss Sarah, is locked in this "house" because she is suffering from severe schizophrenia and there is literally nothing else they can do for her.  To add to this, she is also blind.  Typically, she is supposed to get a shot every month; however, this time around it had been nearly two months since the last time she got a shot.  Needless to say, it showed!  While I have dealt with a schizophrenic patient during my mental health rotation while in school, it was much more controlled than what I saw here.  This lady, because she hadn't had her medicine in a while, was suffering from the illness.  She didn't have any cloths on because they were all full of the evil spirits...she needed new ones, with clean souls.  She kept screaming at us that she didn't want her injection because it was from the devil; it wasn't going to help her.  Now, you may think, just stick her real quick, get it over with, and then once the medicine kicks in she will be better.  Not that easy...Miss Sarah is quite strong and there was a whole mL of Haldol that needed to be injected; not something that happens quickly, especially when you are fighting against the person.  After Ms Peggy talked to Miss Sarah for a good 10 minutes or so, we decided we needed to take another approach.  We went back to the clinic to get some oral medicine that we were going to mix with some food and then come back once that had kicked in to give the injection.  Well when we got back to the house, the daughter was home and she decided that we would just hold Sarah down and give the injection.  That's what we did, but man, was it work.  Hopefully that won't happen again!  Anyways, I digress.  Aside from clinic in the morning, the select house calls in the afternoon, and the meet and greats with donors and friends of the clinic, there are always emails to be answered and things to be lined up--lucky for me, Ms. Peggy does those; unfortunately, that usually leaves her quite swamped.  Hopefully now that I have had some time to get adjusted to life here and kind of get a feel for how things run around the clinic I will slowly be able to help her with more of those things.

Now you ask, "If clinic only goes until 1, and you aren't answering all the emails, what do you do with all your free time?"  I would like to know the same thing.  What do I do with all my free time.  There seems to be only so many things I can do online before I get bored of the computer.  I can usually only read for so long before I get bored with reading.  In order to get to any other towns on this island, it costs a taxi fare.  We are right in the midst of rainy season so the weather has cooled off a bit, you never know when it will rain, and sunny days have become few and far between.  We'll have to start playing more games and come up with something to fill our time I guess.  Tuesdays and Thursday afternoons, I go to the Sandy Bay Alternative School where I work with a girl named Vanessa on reading comprehension.  She is in 3rd grade, but I would say she probably has the comprehension skills of about a 1st grader; simply because her english isn't that good yet.  I have also learned of another program called the Sol Foundation that meets just down the road everyday from 5-9.   This program is a program where kids can come for tutoring help as well as just come to hang out.  I think this week I am going to go check that out, because hey, I can't pass up the opportunity to spend time with kids!  Then there are the evenings.  Typically, Jessie and I cook dinner together and the 2 PA students come over as well.  Some nights it's kind of funny because we will make dinner but then just sit in the room in silence each doing our own thing.  When the guys leave to head back to their apartment they will make a comment..."well, it was nice talking with you guys"....when actually not much conversation took place.  Sometimes though it is just nice to be in each others' presence.  Makes you feel not alone.  Last night, we went down to West End for dinner and a drink and then we decided we would walk part of the way home because the volunteer teachers that are here live within walking distance.  Well on our way, the bartender drove by and offered us a ride.  So we ended up hitching our first ride in Honduras in the back of a truck for part of the way home.  Then when she turned off the main road we hopped out and continued walking the rest of the way home....in the rain!  But let me tell you, it didn't actually end up being at terrible as I would usual assume walking in the rain to be.  It was actually quite enjoyable!

Another thing that I have learned here, is that weekdays go by really fast and the weekends go by really slow...who would have thought!  It's the complete opposite of in the US, but I think it's because we are not used to being able to rest and relax.  If only it could be that way sometimes in the US.  I must admit it is kind of nice, but at other times, I feel like I am just wasting my time not doing anything.  I will have to come up with a hobby or something I think.. Any suggestions?!

Some of you may be wondering about my first trip off the island.  Well, unfortunately it did not actually end up happening.  A long serious of events leading into it and just some lack of coordination and organization meant it didn't happen.  But I'm alright with it; I will get a chance to leave the island in due time.  Hey, instead of my first trip off the island, this weekend I got to have my first 3-day weekend due to the holiday this past week!

But, that's probably about enough for this time.  I've taken enough of your time for now, next time I will think of some things that you can ponder.  Hope all is well.  Enjoy the fall colors for me!

Laura

There's a First Time for Everything!

As I near the 1st month mark at the end of this week and I reflect on some of the things that I have done for the first time, I can't help but think back to the days of being a baby and then a child and the calendar got marked for Baby's first ____.  Therefore, get out your calendars, cause some more important dates are goign on it!

• Sept 20th- my first job as an RN
• Sept 23rd- first time assisting with a surgical procedure
• Sept 24th- my first "hurricane" experience (which mind you ended up being sunshine!)
• Sept 26th- first day snorkeling the reefs of Honduras
• Sept 27th- after a week of orientation, I am in charge of my first clinic!
• Sept 28th- ran my first EKG on a patient (which now happens several times a week)
• Sept 30th- assisted with my first (of what i'm sure will be many) pap smears
• Oct 11th- first time celebrating Canadian Thanksgiving
• Oct 11th- first time preparing for a medical facility inspection
• Oct 12th- first time removing sutures
• Soon to come: my first trip off the island (this weekend to Cayos Cuchenos) and my first month here

Wow!  Have I done a lot.  And there will only be more; why did we ever stop marking the calendar after we turned 1 or 2 or whatever age it was?!  Like for instance, today Angely our secretary came back and asked where Ms Peggy was because there was someone there to get some stitches removed.  Then she asked if I could just do it.  I of course answered saying yes I can!  To myself though, I was thinking hey, I've never done this before but how hard can it really be?!  After getting the right supplies, aka a suture removal kit- not too difficult, I had those stitches out in no time and am now able to chalk up one more accomplishment.

I've also decided that trying to run a clinic is soo much work, it is unbelievable!  Trying to run a clinic in the US is probably one thing, but then try running a clinic  in another country where you rely purely on donations.  That becomes tricky...especially when the Honduran Board of Pharmacy calls at 6:30 the night before they are coming.  I guess it was nice of them to give us warning, but that also meant that we had to go in and go through every single pill bottle and bag, check expiration dates, and pull all the expired ones out of the pharmacy.   Five people and two and half hours later, we finally had the task accomplished.  Now we awaited the arrival of the board to see if we would pass.  The verdict?  We passed, and they only picked up one bottle!  Really?!  All that work for nothing?  and the bottle they picked up wasn't to look at the expiration date, it was because it was a bottle of medicine provided by the government to the public hospital not us.  So then we had to explain that we trade meds between our supplies and the hospital's supplies; we don't buy or sell them (which they don't allow either).

This upcoming weekend I will hopefully be headed to Cayos Cuchinos, another island of Honduras, with an organization called the Floating Doctors.  They live on a boat and do traveling clinics all over.  For the next 2 months or so they are in Honduras.  Therefore, we will go and see as many of the 160 people of the island as possible.  Most of the interventions will be based on teaching and lifestyle adjustments and some antibiotics, because they have little to no access to medications on the island.  So we shall see how that goes-- mind you it will all be in spanish as well!

That's all I got for right now...I think there's probably more, but that will have to wait for another time.  Hope all is well back in the states!  Keep it real! lol

Laura

A Day in the Life...

...of an islander Gerafuno, Veronica.

Oh sweetie, I wake at 5:30 or 6 in the morning and do my work, you know?  And then once I am done with that I sit and embroider.  Oh I embroider for hours at a time.  Sometimes from 9 to 12 or 1 or something like that, you know sweetie?!  Oh and these glasses, I have to use them to embroider; it's fine needlework.  It takes good eye sight to see it, so I wear these glasses honey.  I don't wear them at other times, just when I am embroidering.  It takes a good eye.   Oh I have people all from all over that want things embroidered.  In fact I have 3 customers in the states that sends me things to embroider with designs that they want embroidered.  I sell these things then.  Not to those people, those tourists, those vacationers, that come of that cruise ship. Oh they are too cheap honey.  And then they just go and buy those things that have Roatan written on them.  Well they aren't genuine.  They aren't genuine at all; they are made elsewhere and then get shipped here.  No sweetie, I sell mine by the aiport.  I'm trying to get a little shop there.  My sister and I, we sell them.  Oh, and I always like to sit there and work on them while I'm selling them so people know that I make them.  With the rest of my time during the day, I rest.  I embroider and rest, sweetie, that's all I do.  I need something to keep me going, you know?  In the afternoon I like to take some time to take a nap or just sit.  Then sometimes in the evening I will embroider a little more.  But not late at night; I never embroider at night.  My day is usually done about 9 or 10; no later.  That's it sweetie; I embroider and rest.  It's very nice.

There you have it folks.  The gerafuno.  Gerafunos are those people that originally came to the island to live and are therefore, true islanders.  They were here before any other people lived on and starting taking over this island.  Their lives are very simple.  They don't do much but the basics.  They have a hobby that keeps them going, but otherwise they are content just being.  Imagine what life would be like it all of us we able to do this.  Simply be.  Not have things here and there that we feel need to get done; always running around and filling our time with this or that.  I must admit; I think I would get very bored if that were my life day after day.  But these people have come to enjoy the simplicity that can be a part of life.  Wow!  (Might I mention that I love talking to these women, as they seem to say, "yes sweetie"  "all right sweetie" "ok honey" "thank you sweetie" in their gerafuno accents after everything you say!)

I have decided that over the next few weeks, I am going to explore the lives of people on the island.  We have the islanders, the volunteers, the tourists, the ex-pats, the hispanics that live in the colonia.  What is it like to be one of them on this island sometimes thought of as paradise?  By first impressions, I can tell you that is doesn't really look like paradise, that's for sure.  What do they think?  Why are they here?  It just happened to work out well that Veronica came in today and was just itching to tell me all about her and her life.  The things you can learn from people.

On Monday we received a new volunteer at the clinic who will be with us for a month.  He is a med student in his 1st year of residency.  While in clinic this week, he started off by doing some triaging to get used to the computers and to practice his spanish.  I must say, you can tell that he is a doctor and not a nurse; aka, doesn't have to take vitals in the US. haha  When watching him take people's blood pressures, he doesn't pump up the cuff once; oh no, he pumps it up about 4 or 5 times before he has gotten a reading.  I had to laugh to myself when he was talking a blood pressure of this lady and on about the 3rd time, she gave a little wince.  Then comes blood sugar testing.  He is very considerate when he decides which finger to prick by asking them what hand is there dominant hand and so far; granted I would do this when giving shots, I would not consider doing this for a simple finger prick.  Continuing on, he then goes about pricking the guys finger.  You know how it goes, some people wince at a finger prick.  His response?  "Oh I'm so sorry, I know that hurts, doesn't it; yeah it does, I'm sorry, are you going to be ok?  That's what we have to do in order to test your sugar though, I'm so sorry"  How genuine is he?!  Carrying on, I would then listen to him ask the patients why they came in to see the doctor and then later I would see what he wrote in the triage note.  He would list the symptoms and then list possible diagnosis.  While I often times think of diagnosis and ask a fair amount of questions, I don't go into an entire H and P with my triaging and arrive at a diagnosis.  Oh to be a future doctor, stuck in the triage room for a day.  Provided me with some humor non the less!

Forcast for the week (next 5 days)? Rain, rain, and oh yeah, more rain.  Yippee!  My main path to work has a giant lake in front of it that I could wade through if I wanted to, but it is all muddy and who knows what kind of parasites are groing in there.  I think I will just stick to my alternate route.  Hey, I think it may even be faster!

Well in the words of my favorite cartoon, "Tut-tut, it looks like rain!"

Everything Looks Better in the Dark...

... except the inside of my house that is.  That's right...all weekend long I had to live without power, and let me tell you it really isn't all that fun.  Here in Roatan, we have frequent power outages but they typically only last a few hours; during this time we have to rely on candles and flashlights.  Therefore, when I woke up Saturday morning and went to turn the bathroom light on only to find out that it didn't work, I thought nothing of it.  I went the next 3 hours living in the dark before the 2 PA students came over from there apartment in hopes of using the internet at Ms. Peggy's.  I informed them that the power was out so there would be no internet that morning.  They looked confused, so I asked them if they had had power that morning, to which they answered yes.  About at that time I heard our water pump running indicating that some of the power in Ms. Peggy's house was working.   I then ventured downstairs to see if Jess was without power as well and to my surprise she was just sitting there watching TV thinking nothing of it.  After checking out the breakers and flipping all of them with no success to getting power upstairs we decided we had a problem.  We called over Dee from next door and he too didn't know what was wrong.  Later that day he came back to look at it to see if he could figure out what was wrong--what did he find?  A bad circuit.  What did that mean?  We had to empty the upstairs fridge (which has just a lot of random stuff in it that gets left behind by volunteers but Peggy doesn't necessarily eat) and move everything downstairs to Jess's fridge.  It also meant, that since it was a weekend, we would have to wait until Monday before our power would be restored because the whole circuit needed to be replaced.  A whole weekend of living in a dark house with no electricity.  It wasn't all that terrible it was more of just an inconvenience.  What little things we take for granted back in the states.  While my power was out, I got to thinking-- the people living in the colonia here on the island live without power day after day.  How challenging it must be for them.  This means that their days with light go from about 6 am to 5:30/6 pm.  Then the rest of the night they are without any light other than candles or flashlights which they may or may not have.  Refrigerators?  They probably don't have them and therefore anything they have is either fresh or sits out for days at a time until they use it all.  What great lesson you can get from being without conveniences we have on a daily basis.  

Life at the clinic has been going pretty well, aside from a few stressful days.  Wow, who knew running a clinic could be soo much work!  Last week was pretty slow because most of the days it was rainy and therefore, people don't necessarily come in unless they absolutely have to.  We ended Friday on a good note by getting done a little early and by having a lot of english speakers come to the clinic.  Who ever knew encountering someone that speaks your own language could be so gratifying?!  Another thing that we take for granted everyday as we go about our lives.  Think if english weren't your first language or not a language for you at all, and the only people around you were people that spoke english.  Do you know how hard it is to get what you want and or need?  It can be so challenging to communicate if you don't speak the right language!  Then today, we had some new volunteers start (which seems to be pretty typical of Monday's....therefore I have decided I'm not a huge fan of Mondays!) so it took a little time to get them situated.  There was some miscommunication with one of our volunteers so that was even a little more frustrating on all of our parts just because we felt bad things couldn't have gone smoother with getting her to her hotel and then getting her set up in the clinic; but after a hectic morning, we got her all set up and she is ready to go for the rest of the week.  Then about an hour and a half into clinic time this morning, we realized the pediatrician still hadn't shown up yet.  Little to our knowing, he took vacation this week.  Maybe an important detail, just a thought!  So therefore, neither of our primary doctors were in this morning (because the other had a scheduled day off today) so we were running off all volunteer medical staff today!  Kind of a scary thought....and let me tell you it was very hectic!  But, we made it through, all the patients got seen and treated without too much of a wait and they were all sent on their way.  Tomorrow is a new day, all the volunteers have had a day to adjust to the clinic, and some of our primary (spanish speaking) staff will be back.  YAY!

I don't know if I made mention of this last time, but rainy season has officially started as it has been raining for about the last week now.  It usually doesn't rain all day everyday so that is nice, but still, we are ready for rainy season to be over with and we still have a few months to go.  Typically, I will wake up and it will be raining but I've been fortunate enough for it to stop by the time I need to head to the clinic.  Then throughout the morning it will rain for an hour here or an hour there.  If I'm lucky it isn't raining when it is time to go home from the clinic, but over the course of the evening it will rain another 3-4 hours.  Therefore, we plan our trips from one destination to another strategically so that we can make it there in between rain showers.  Doesn't always work, but a lot of the time it does.

We had a really nice day on Saturday, which we took advantage of by venturing over to east side of the island to check that out.  It is amazing how much we hadn't realized that we were cooped up in Sandy Bay.  It felt so good to get out and see the sky when looking up instead of the trees.  We also went to the grocery store to get a food supply for awhile.  It was much easier to shop this time since we have had some time to get adjusted and realize what we want.  Jess and I combined our groceries (because we do most meals together) and together our bill was 1460.66 (Limps that is.....not dollars, but it still seems like a lot) or something like that!  In addition to a grocery stop, we also just got a chance to see what the rest of the island has to offer.  Mom, I will have you know, there is a zoo on the island and we were going to go to it, but it looked like it was probably closed on Saturday; so when Peggy gets back we are going to inquire about that.  Across the rest of the island, it varied as far as population went.  There were several villages/towns of very, very poor people that build their houses out of whatever supplies they can find.  However, sadly enough, there are also a couple of plantations and a few high class condos and resorts.  It's sad to see that there are soo many poor people living amongst the few wealthier people on the island. How can people live in such a huge mansion and overlook a poor village and not think twice about it?  

That's about all for now.  I hope all is well in the lives of my readers and hopefully I will have a chance to chat with some of you soon!  I encourage each of you to take some time to count your blessings and consider those things that you may take for granted.  What would it be like to live without them?  

Have a blessed week!

Laura