Leaving Hospital Loma de Luz

July 7th, 2019 by Bryce Loder

On the road again.

While I was finishing Monday morning patients in the clinic and seeing my inpatients off and on as time permitted, I got a text from Isaac.  The driver had been able to get past the roadblocks on the highway to la Ceiba and would arrive in about 45 minutes to pick me up and take me directly to the ferry terminal.  Waiting in the town of La Ceiba seemed like a poor idea as the demonstrations against the impending privatization of health care and public education often closed major streets and highways around La Ceiba.  They also involved some small fires. Not having time for one last delicious lunch at the “comedor” in the hospital was a downer.  The possibility of getting past the roadblocks in early afternoon was the plus side.

 

So what is good about leaving Hospital Loma de Luz?  First of all, it’s an established healthcare facility with ongoing care that will continue just fine when I leave.  My role was essentially to learn and to be a relief worker so their regular docs could take short breaks.  Patients will continue to receive excellent care, but I’d like to think that Isaac and Jason will miss me just a little when the radio blasts them from sleep during a night on call for the ER.

 

Leaving patients with ongoing unstable medical situations is always hard for me, even though coordinated care with the two “local” live-in American doctors was arranged.  What will happen to:

  • Emil – the 9 month old child with hydrocephalus who had the infected valve in his brain shunt removed just hours before I left.  Emil’s head is probably larger than mine. He can only gaze to his left side, but he was waking up and smiling at me a little before I left.  His smiles were a major part of each morning and afternoon in hospital rounds, but he wasn’t getting better with the infected shunt.  He has big battles ahead with just trying to stay alive.  Will I ever see him again on return trips to Loma de Luz?
  • My friendly elderly patient with the sore ankle who wanted to walk to the hospital dining area to buy me fruit on that terribly busy day a couple of weeks ago. Will she still be limping along trying to help someone else?
  • The elderly man who showed up in the ER with the multiply fractured leg just about 18 hours before I left.  Did anyone ever bring him the “refresco” (sugary fruit drink) that he requested at 1:00 a.m. when the nurses were so busy?  Oh…and will his leg be fixable, or will it be amputated?
  • Will the three separate young women with thyrotoxicosis be able to purchase medication so they can actually feel well again and gain weight and continue working to support their families?
  • And the pregnant young mother with triplets, one with anencephaly (without a head).  Will she be able to carry the two viable babies to near-term so they can survive?   And when the reality of the loss of the third triplet becomes apparent at birth, will she still have the same joy she had on that hot Saturday afternoon when Carolina showed her the ultrasound confirming that she had two normal babies and one without a head, rather than twins with one healthy and one without head as she had been informed previously? She was overjoyed to find that she had triplets instead of twins, in spite of the fact that the third one would be born dead.  It’s a matter of perspective.  She found happiness in that situation.
  • And will Elsabel, an older woman on crutches from polio in the mid-1960s when it should have been eradicated, continue to take her medications for heart failure after a big improvement with three days in the hospital?  Her niece works in a pharmacy and understood the names of medications (and advised me which ones wouldn’t be available in their hometown pharmacy), so she has a chance of continuing to do well for a few years.  And what will she do with the selfie she insisted on taking with both of us smiling broadly as she went home?    She then agreed that we would both share our photos, and we joked that she’d use our faces (hers and mine) in some type of advertising in a new business she’d create, and I’d possibly receive royalties from the use of the photo.  This was another reminder of the normal life and humor that can exist everywhere in the world, even in conditions that could otherwise be depressing.
  • When will I again see members of this nursing and medical staff who taught me every day and night when they thought I was there to work and help teach them?
The patient insisted on us taking this selfie and agreed that I could use it on this blog or on Facebook. Her niece also took several photos of us.

Saying goodbye to hospital staff had to be done quickly, and some of the goodbyes were by text messages a few miles down the road as we sat at the newly replaced roadblock of tree trunks and tires between Balfate and Jutiapa an hour later.  Conversations with the young protesters were friendly and never threatening.  They moved some logs and tires to allow me to pass through with Sergio, a great driver who got me to the ferry terminal about three hours early.  On the way Sergio and I talked about the similarities in our childhoods on farms and about our pride in our children. Waiting near the ferry terminal was pleasant, and there were plenty of food stalls in the neighborhood where I could snack and watch life go by, including the wealthy coming to buy ice for their boats, the linemen working for TIGO telephone company stopping to buy baleadas (really great meat or vegetable filled pastries like you might find in most countries around the world) and the 6 and 8 year old brother-sister pair who counted the crayons in the 64 Crayola box and colored in their new coloring books.  They tried to convince me that they had 75 different colors, but those boxes haven’t changed much in 60 years; they still have multiples of 8 in the copycat yellow and green Crayola boxes. This was a 64 crayon box just like one of my fortunate classmates (with a wealthy relative) brought to Marquette Grade School 4th Grade class in the fall of 1960 when the rest of us made do with 16 colors.   Arguing with me about the number of crayons in that box would have been equivalent to arguing with me about which set of beautiful fins defined a 1959 Chevy as opposed to the slightly softer fins on the 1960 Chevy.  You’ll lose that argument.  Argue with me about religion or politics and it will be much more satisfying and less likely to lead to bloodshed.

 

So, what did I learn at Hospital Loma de Luz?    I learned that in that small jungle hospital, the amount of good care provided to that community (or the bang for the buck) would probably supersede what we are able to do in our beautiful and well-loved hospitals in our small towns of Kansas.  That’s saying a lot.

 

I learned again how much I still need to learn about providing good health care with few resources.  The INMED course was designed to open our eyes to that dilemma.  Working at Hospital Loma de Luz certainly gave me a chance to put into practice some of the concepts from the INMED International Medicine and Public health courses.  I also saw an impressive determination and compassion in the hearts and souls of the small physician and nurse volunteer population who are the backbone of the hospital and who constantly teach the people around them as they work at Loma de Luz.  In hot hallways with seemingly no movement of air late at night as we waited for a test result or for another patient to arrive, I listened to stories of how these few brave people made the decision to spend years at this isolated hospital in the jungle of the Colón province of Honduras and how they find purpose and happiness in what they do as they struggle to find ways to keep a spouse or teenage children feeling safe and thriving in this slightly hostile environment.  The person who is working there daily doesn’t have a lot of time to think about the realities and dangers of daily life in the jungle with political strife and violence just down the road; work beckons and demands immediate response.  The spouse of the doctor or nurse, who live up the hill in a pretty decent house with electricity, safe running water, a washing machine and a big refrigerator still aren’t living in a typical “neighborhood”.  There aren’t many peers or neighbors.  It’s tough.  Their idea of how to serve “the forgotten” might not match up with that of the medical parent.

 

And what else did I learn?  Those books by Drs. Tom Dooley and Albert Schweitzer from over fifty years ago described situations that weren’t much different from what I saw at Hospital Loma de Luz.  Political conflicts still were just down the road or over the hill, but seemingly less threatening than in Dr. Dooley’s books. 

 

Best of all, I was correct in my very basic assumptions all those years ago as I read those books on a farm in rural Kansas:  

  • There was green jungle all around here, even in the dry season.  
  • Not once did I have to break ice on the pond with a hedge post to let the cattle drink water while I was in Honduras.
  • The work was real. It wasn’t just a bandage. It was rewarding and soul-filling.
  • And one of the few skills I have truly mastered over the years:  I DID have to learn to like vegetables and other equally strange foods.
Fried plantain slices, covered with a sauce and some cheese. Hospital comedor food was incredible.

Some photos of my last 24 hours in Honduras, as I traveled by ferry to the island where I’d meet my flight home.

 

Back in Alaska.

Musk oxen walking on the newly green tundra just outside my window up here just below the Arctic Circle as I finish writing my last blog for this INMED site.

“Whatever you do will be insignificant, but it is very important that you do it.”
– Mahatma Gandhi, Indian nationalist and civil rights leader

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