Communicating with my peeps

June 17th, 2019 by Bryce Loder

The suspension bridges are a lot of fun at 2:00 a.m. coming home from ER. It’s really dark.  And I’m fairly sure that I’ll be jumping off into the dry shallow canyon below if one of those howler monkeys suddenly appears in a branch overhead and starts to roar at the wrong time. 

 

All those years ago when I was working and studying in various places in Latin America, I didn’t dream of the miracle of the communications and connections we now enjoy.  I pretty much left Kansas and mailed a postcard at some point, and then returned.  What happened in between was not well recorded.  But this week, while seeing such advanced cases of “everything”, I needed (and received) some encouragement from fellow medical/nursing people from my immediate family/friend circle.

 

I’ve received “text message encouragement” and advice from Federico, an ophthalmologist friend in Córdoba, Argentina, who understands work in low resource areas of the world and travels to Fiji regularly with an eye surgery team. I can text him as I work in this remote Honduran hospital, and he works in his practice in Jesus Maria, Argentina.

 

I’ve also been texting to describe the serious cases and lack of resources to a young mother and physician who grew up in our house.  At age 16 Kayt acted as a medical interpreter for Nancy and Elliott, my former med school classmates, when we worked in Honduras after Hurricane Mitch more than twenty years ago in lieu of attending our 20 year med school reunion. Who would have dreamed that we could be texting medical information back and forth in a matter of seconds with her in the position of a family practice doctor who understands what I am doing here?  And Rachel, the baby in our family, now understands medical/nursing jargon in her role as a last year nursing student. She successfully worked two years under conditions much more challenging than these, and she is my other “go to” stress reliever.   We all need someone who truly empathizes with any given situation, and I’m lucky enough to have three great ones available by text .  This ability to bounce ideas off of someone who understands both medicine and the limitations of low resource areas is a real gift to me. Thank you Federico, Kayt and Rachel.

 

Even in these areas of poor economic circumstances, the patients we see are deserving of high quality medical care.  Lack of supplies, preferred medications or a variety of lab tests doesn’t excuse us from practicing the highest quality of care possible.  It just requires that we search a little more deeply in our hearts and brains to come up with solutions.  People don’t come to Loma de Luz because of two new temporary doctors being here.  They have been coming here for years because of high quality compassionate care.  And we can just relieve the current doctors so they can get away a bit or sleep at night, but the quality of care has to be maintained.

 

Some Thursday patients (this is written more for medical people and could be boring to anyone else):

 

1. Advanced hyperthyroidism and thyrotoxicosis – weight of 35 kg in a tall woman.  Medication to control the hyperthyroidism is not available now in our pharmacy.  Too  expensive for her to buy at a regular pharmacy. 
2. 10 year old whose mom is a teacher.  Mom speaks such beautiful Spanish. Girl plays violin.  “Worried well”.  Mom and I discussed politics and the teachers’ strike.  Government is trying to privatize school system.  Then only the wealthy will have access to schools.  Teachers are on strike, but four administrators in her school have “gone over to the other side” or “been bought” by the government, as she describes it.  Roadblocks, strikes of teachers and health care workers. 
3. 45 y.o. woman — Follow up wrist fracture.  Order x-rays, lab, etc. in Spanish.  Progress notes in English.
4. 70 year old.  Blind in one eye from glaucoma and came today with an eye infection that has basically eaten away his right eye cornea.   It hadn’t cleared up after more than a year of trying home remedies.  Also new diagnosis of atrial fibrillation and significant hypertension.  Options for treatment are limited.
5. 55 y.o. who had a GI bleed while in Philadelphia recently.  Came back without hospital discharge summary, but did have copy of lab sheet.  New cirrhosis of liver and probable esophageal varices. Needs endoscopy.  Wrote referral (in Spanish) to a clinic in La Ceiba.  Looking at his clothes and his eyeglasses, I’d guess that he can afford to go there and pay the $75 fee for the procedure.  Sister was present for exam.  She took photos and video while I examined him and she recorded our conversation.  Probably going to post the “foreign doctor interview” on “Funniest Foreign Accents in Honduras” radio show or something like that.  Thankful for useful proficiency in Spanish.  One can’t work here without it.  Trying to explain lab tests, x-rays, disease process and expectations would be a struggle, but I have confidence that our conversations are accurate, and we’re able to make little jokes and find humor where appropriate.  Comfortable feeling.
6. 41 y.o. with the thyrotoxicosis (another one).  She’s just skin and bone.  Missed the weekly thyroid test blood draw by 1 hour.  Is from La Ceiba, and shouldn’t have come two hours out here anyway.  Referred her back to La Ceiba rather than waiting a week for a thyroid test while her heart races and she loses more weight.
7. 33 year old woman with gout.  Asked about pregnancy.  Was pregnant, but “se me cayó” last month, literally it “fell out of me” – she had a spontaneous abortion.

 

 

Coming up: My quick bus trip to La Ceiba Saturday a.m.