Reverse Culture Shock

October 21st, 2016 by Arthi Chawla
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Reverse Culture Shock: I’ve been home for 5 days. And I feel like I am getting back to normal, or whatever my new normal is. This is the 3rd time I have been Honduras, and I experienced reverse culture shock the first 2 times I went. This time, I expected to have more difficulty adjusting back to my life in the United States, since I was gone for a longer period of time. But, I haven’t. It actually has been much easier returning this time. I’ve been thinking about it all week, and I think there are a few reasons for this. One reason is because I know this won’t be the last time I go to Honduras. The last time I went, I was still in training, and the brigade I went on was through my training program. Once I left my program, I wasn’t sure how I would be able to continue to do this type of work.


This time, I went through INMED, and to a different location. I met a lot of people that taught me a lot, and people who will help me to return in the future. And I am very thankful for that. The other thing is I got through the honeymoon phase. For me, it was around the beginning of week 3 where I felt like the honeymoon phase was ending. At first, I was so excited to be there, and every bump in the road (both literal and figurative) was a fun new adventure. But at the beginning of week 3, I noticed the enthusiasm wearing off. The difficult things became difficult. But after a few days, it became normal. And by the end, I felt like I had finally adjusted to living there. Just in time to leave. The last 2 times, I was gone for only 2 weeks, not long enough for the honeymoon phase to end. With all of that being said, there have been a few things that have made me very confused:


  1. It is SO COLD. Today it was in the 50’s in Rochester, and I hid under a blanket all day and complained of how cold it was. This is certainly very different from Roatan. I remember my first night there. It must have been 80 degrees in my bedroom, and it was so hot I couldn’t sleep. And all I could think about was would I ever sleep for the next 4 weeks! Hint, it got cooler and I slept great.
  2. It is so quiet here, especially at night. I got used to the sounds of dogs barking, and the ocean crashing against the shore. Here, I live in a quiet, suburban neighborhood, and there certainly are not stray dogs wandering around, barking or jumping into the ocean.
  3. The nights are so bright. There were not a lot of lighting where I lived, and it got really dark. Here, there are so many streetlights, and houses have lights on all night.
  4. The water tastes so good. Although, I also think Rochester has the best tasting tap water in the USA.
  5. The days are longer, and I can get so much more done in the day. That is certainly a statement I never thought I would say about Rochester, NY. There, since it is close to the equator, the amount of daylight is consistent year round. The sun would rise around 5am, and set around 5:30pm. Since it would get so dark after sunset, I would not go far from home.
  6. The cars here are so nice, shiny, new and comfortable! Most of the cars there are fairly old, uncomfortable, but they used them until they would not run at all.
  7. There are lines on the road. I mean, traffic lines that divide the roads.
  8. The roads are so nice and smooth. I was driving down a road with my dad the other day, and he made a comment about how bad the road was and it was filled with potholes. I thought, man this is a great road! It was certainly similar to the roads I was on.
  9. The autumn leaves are beautiful! And everything is pumpkin flavored!
  10. I really miss baleadas.


I think experiences like this have more of an impact on the traveler, rather than the native people. I like to think that I made a huge impact, and that I saved someone’s life. In reality, I probably did not make a huge impact. And I am not being pessimistic or depressing. I am being realistic, about how much one person can do in 4 weeks. Ms. Peggy has been there for 17 years, and I am so impressed with how much she has achieved. But, just because I didn’t have a huge impact on the people there, doesn’t mean they didn’t have a large impact on me. I think it is important to understand that there is more to the world than besides what is outside your front step. And it is important to realize that difficulty and poverty in the United States, yes while terrible, is much better than poverty elsewhere.


But what is lacking in material wealth, is often made up for in the sense of community. People, for the most part, were very friendly, and neighborly. Since I didn’t have a working phone, I used to simply walk over and knock on my neighbors door if I needed something. One of my neighbors, who wasn’t affiliated with the clinic, brought over a delicious snack one day, just because. He is also the same neighbor that cut open a coconut for me with this machete. I had many people say hello to be while I was walking back and forth from the clinic. Obviously, not everyone is polite. But overall, it was more friendly than being here.


The point is, I won’t ever be the same person I was before I left. And I am thankful for that.

The People

October 13th, 2016 by Arthi Chawla
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Hondurans: Overall, the Honduran people I have met, and have taken care of, are very nice and welcoming. I have not had any patients complain to me about how long they waited, or how expensive things are, or other things I frequently hear in the United States. They rarely complain about the treatment plan, or what is available. If they can’t afford payment, we work something out and they seem grateful. Another thing I have noticed is they don’t seem frustrated or annoyed at my broken Spanish. I feel like if the roles were reversed, and I was talking to a doctor, as a patient, who didn’t understand what I was saying, I would get annoyed. Another thing that I have noticed is how many young women are pregnant. Well, young by my standards.


Many women who are as young as 16 are either pregnant, or have children. I have asked about whether sexual education is available, and I have gotten various responses. It ranges from “yes it is available but no one listens,” to “there is nothing, we are working on it.” I think the Honduran government has mandated that sexual / prenatal education be made available in schools, but there are no punishment if they don’t provide it, so no one does it. To me, that is too young, and it bothers me. However, most of these girls seem happy and it is the norm. I am not sure if their education is interrupted because of the pregnancy. There are a few women who are really upset when they discover they are pregnant. The clinic hosts prenatal classes throughout the year and frequently is full. There are contraceptive options at the clinic but I personally have not had any patients request them. I know others have prescribed them, and actually one placed an IUD on a patient recently.


People from the United States: I feel like there are two kinds of Americans here. There are a lot of people that have moved to Roatan to retire, and they typically live in resorts or in secluded areas. I am really surprised how many of these people don’t speak Spanish, and have no desire to learn Spanish. One of my patients told me, “I don’t speak Spanish because everyone here speaks American.” She then asked for a med refill on Ambien. I was a little too surprised to remind her that “American,” isn’t a language. I have a hard time understanding their motivation for not learning Spanish. Yes, learning a new language is hard, but after all, they are moving to a Spanish speaking country on their own free will. And not everyone speaks English. There have been plenty of situations where knowing some Spanish has been handy. I have seen a few of these people as patients, and they typically are a bit more demanding, but still nice enough.


The other kind of American I see here are people who have moved here to work. They are fascinating. Many people have sold everything, and moved their entire family to live and work here. They work either in the medical field, or in the tourism business like running restaurants or dive shops. They typically are earning a Honduran salary (which isn’t much), and are working on speaking Spanish and really trying to integrate themselves into the culture here. I met one physician today, who is a retired ENT from the USA. He knew he was going to move here, and has been working with a private tutor for 1 year. I think moving here to work permanently is a bold step, and I admire them for their courage.


September 28th, 2016 by Arthi Chawla
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I am working with Dr. R this week, who is the clinic pediatrician. He speaks minimal English, therefore I have been forced to use my Spanish as much as possible. We have seen a few interesting cases this week that has made me stop and really think. Most of the patients we see have colds or allergy like symptoms, but a few had developed complications from seriously illnesses. The first was a deaf girl. She was about 6 or 7 years old, and had meningitis a few months prior. She survived, but unfortunately she lost her hearing as a result. Unfortunately there are not a lot of services for the deaf. There are schools for deaf children, but not on the island. They are all on the main land in the capital. The second girl was 8 years old. She has congenital hypothyroidism. Dr. R saw her first when she was 6 months old, and was already showing symptoms of hypothyroidism, such as lethargy and poor muscle tone. He tested her, and started on treatment.


She has since regained her muscle tone, however the neurological damage was already done. Now she has intellectual impairment. In the United States, or at least at Magee, every baby at birth gets tested for a number of diseases, including hypothyroidism. Also for her, there are no schools available on the island for her to attend for special education. These two cases make me so sad, because not only could they have been prevented, but it will be very difficult for them to reach their full potential given the lack of schools and services. They do vaccinate children here, but it is fewer than in the US, and menactra is not one of them.


On a positive note, I heard that Mr. D is improving and was able to go for a walk!

Mr. D

September 24th, 2016 by Arthi Chawla
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I want to share a story from today. There once was a patient that I will refer to as “D.” D has schizophrenia that is poorly managed. In the past, he has wandered off by himself, and either has been violent with others, or others have been violent to him. His mother had tried other medications, but he wouldn’t take his medicines. His mother, out of desperation for his safety, chained him to their house. He is known to the clinic, and the psychiatrist (who comes once every 3 months), had prescribed him an IM 30 day anti-psychotic (I forgot the name of it), however it never actually got to him. The patient’s mother asked Ms. Peggy for help to get him to the mainland to see a psychiatrist there. Ms. Peggy found out that he never got his medicine, and decided to see D herself, and give him the medicine. So Ms. Peggy, one of the nurses, the patient’s mom, and myself drove to the house.


D was having a good day, and was very cooperative, and allowed Ms. Peggy to administer the shot. Ms. Peggy spent a lot of time talking to the D’s mother and brother about schizophrenia. Ms. Peggy told me that psychiatric disease is heavily stigmatized in Honduras, and it is very difficult to get help. What makes it even more difficult is that there are no psychiatrists on the island. The one that comes every 3 months comes from the main land. There is very little understanding and social support about psychiatric disease. There are a few things about this incident that had a large impact on me. The first was how bad things must have been for the mom to resort to chaining him to the house. He has his own little room, but still. I could not imagine how emotionally difficult it was to do that.


The other was Ms. Peggy’s response. She saw a problem, saw a cost efficient solution, and went out and did it herself. She actually gave the shot herself, and spent a lot of time educating the family. It was incredible to see how much she takes control of a situation and makes things happen. Ms. Peggy has had success with her schizophrenic patients using this medicine. Hopefully it works, and D can come to the clinic himself to get follow up.

First day!

September 20th, 2016 by Arthi Chawla
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First day! After a brief orientation, I started working by shadowing one of the staff doctors, Dr. Ashley. We saw about 15 pediatric patients in the morning, and around another 10 patients in the afternoon.


Overall, I’m really impressed with the clinic. There are a lot of people on staff at the clinic, and overall it seems organized and well run. There are two floors and each floor has its own registration and triage. The top floor is peds, OB and gyn. Downstairs is basically everything else, or anyone that comes in the afternoon.


img_3472-2They use a fairly simple but effective EHR. Ordering medicine in their EHR is really interesting. They have all of the medicines they carry in the drop down menu, but they list how many bottles or tubes they have of each medicine next to the choice. So you can easily see what the pharmacy has.


After work today, I went snorkeling with two of the other volunteers, and then ate BALEADAS at an amazing little restaurant across from where we all live. It. Was. Amazing. And it was so cheap! One simple baleada was 15 limpera’s, which is just under 1$. It is a thicker flour tortilla, filled with beans, and their hard cheese. It was so good! I think we will be regulars there! The woman who cooks doesn’t speak English, but her son does. He helps run the restaurant, and is a good sport and lets me practice my Spanish with him. The store next door has so many local amazing items, including the hard cheese I’ve been looking for, and CHILE LIMON Chips! I am so happy we found this restaurant and store. They are so cheap and so close by!


I Made It!

September 18th, 2016 by INMED
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img_3464I’m finally here! After so many months of planning, it’s strange to think that it has finally come. I’m in Coxen Hole, Roatan Honduras. So far, so good. It’s a little strange being here. I have been to Roatan before, but only for vacation. It is very different staying in an apartment without AC compared to a hotel with AC. I certainly don’t remember it being this hot. I’m staying in an apartment with one other girl, Kate, under Ms. Peggy’s house. Kate is a nurse from Minnesota who will be there for 3 months. She is super nice and I’m glad we are roommates. The apartment is really nice, complete with a little kitchen, bathroom and lots of storage place. We met some of the other volunteer’s as well. Mike is a family medicine physician, here with his wife Joanie, and they live next door.


Mr. Dee is part of the staff, and he also lives next door. He picked us up from the airport yesterday and took us to the grocery store. Ms. Peggy lives upstairs. She is very nice and welcoming. Fortunately for me, she has a dog very sweet dog, Lobo, that I can actually pet! There are so many stray dogs here, I just want to hug them all! She also has a bird feeder on her porch, and dozens of humming birds were feeding there yesterday. I have never seen so many humming birds so close! Her house and our apartment are right on the beach. So while I’m writing this on the porch, I can look up and see ocean and beach J Ms. Peggy takes the staff to Infinity bay on Sundays, which is a local resort for some rest and relaxation. I think we can attend Church if we like, and then play beach volleyball or we can snorkel right off the beach there. We are going later today. I cannot wait to get back into the ocean and snorkel!


Language. Most people speak Spanish, and many speak English. Of the people I have met so far, they seem eager to practice their English with me, and are willing to let me practice my Spanish with them. Hopefully my Spanish will improve over the next four weeks J The physicians I am working with tomorrow are bilingual, so a language barrier shouldn’t be a problem.


Most importantly, I have not yet had a baleada, and yes that makes me very sad. More to come!

Introducing Myself

September 12th, 2016 by INMED
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chawla-arthiHello! My name is Arthi Chawla. I am a family medicine resident physician at University of Pittsburgh Medical Center, and I’m starting my INMED service-learning experience at Clinica Esperanza in Honduras beginning in September 2016.