Random Observations on a Midsummer Day in Honduras

June 21st, 2019 by Bryce Loder

It’s easy for those of us from more affluent or high resource countries to feel that because we have more access to money and material things, we must also be smarter.  Of course we know better than that, but we need to be reminded.  When the very poor mother brings in her child or comes on her own behalf to an appointment and describes clearly what tests have been done, what dose of medication she has been taking, or her very clear understanding of how a certain disease process affects the platelet count of her child, I’m just blown away by my own ignorance and prejudices once again.  Or when I ask about previous lab tests, and a patient pulls up a PDF on his smart phone of the recent CT scan from a clinic in Tegucigalpa, I remind myself again that “poor” doesn’t mean “uninformed”.  I need to remind myself of that more than occasionally.

 

Having potable water in every faucet on the hospital compound, lots of natural light in the hospital hallways and plenty of electric outlets and ceiling fans makes almost everything else we do easier, or even possible. 

 

Charts here have handwritten names – each patient has four names which are often out of order and misspelled (I have to look up that word almost every time).  This morning, one teenage patient had his name spelled “Andrs, Andrés, and Andress” on different pages of his chart. Going to the waiting room to call in the next patient can be similar to a comedy routine, with the foreigner overheard by at least forty people.  But, the discovery of a copy of the birth certificate or national ID card in the back of every chart gave me a new way to get the names straight and practice before going out to the crowded waiting room.  Now I step out there and confidently let “Gareth Gonzalo Gutierrez Gonzales” roll off my tongue in a loud voice as easily as if I were calling out to an old high school classmate.

 

I didn’t realize how much I missed speaking Spanish every day.  Contact with the language in the form of text messages, a newspaper or music, several days a week on my phone is fine; but using it to talk with patients, joke with colleagues, while hearing the familiar sounds and seeing the familiar mannerisms and ways of Central America has brought back something that had been missing.  It’s been a lot like “going home again”.

 

Patients often tell me that they’ve used “natural meds” before they finally give in and come see us.  I’m not sure what “natural” means in these cases.  Those medications usually cost about twice as much as what is prescribed here and they are manufactured and packaged just like every other product we buy.  We’re the last resort, not the first choice.

 

It’s not uncommon for patients to arrive in the ER in the middle of the night with copies of their ultrasound and CT reports and lab tests and handwritten referral letters from other facilities.  It’s a rare night that someone doesn’t show up in the ER with an IV in the arm and connected to a bag of fluids, carrying reports and telling of having had a major surgery the day prior in a city hospital. They travel like this on a bus, a motorcycle, the back of a truck, or maybe in a car from places 2 or 5 hours away with their abdominal pain, broken bones, surgical wounds and untreated cancers.  Evidently the country’s hospitals are in poor condition right now with lack of supplies and personnel.  The ER doc (that would be me half of the nights) then becomes the consulting physician for these people, and they have to be admitted.   This was/is way beyond my comfort zone, but I’m not here to be comfortable.  We still have to provide quality care to the best of the ability of the medical staff and hospital facilities. Thankfully, there are two (plus one half time) incredible family medicine docs and two incredible surgeons here.  I get on the radio, wake someone up, and they always jump right in and talk me through these situations and then take over their care in the mornings if they require further surgical management.  They have no fear of tackling the toughest cases if they know that there is no one else who can better handle a particular case.  If I had to be isolated somewhere in the world and could have only two physicians with whom to work or to care for me or my family in the toughest of situations, I’d want to be in close proximity to any two of these people.  Late at night in the hot hallways or nurses’ station with poor lighting and patients’ family members sleeping on mats on the floors, we discuss cases and listen to each other’s opinion, and we come up with a plan.  If we’re really tired, we find chairs and make the discussions last even longer. This kind of collaboration allows the best use of scarce supplies and precious staff time to achieve the best outcome possible.  This really is a full service hospital, and I have such admiration for the people who work here and teach me so much every day.

 

Mangoes falling on a tin roof overhead can send out quite a ringing sound. All day. And night.

 

This afternoon, an elderly lady offered to go to the cafeteria and buy me a cup of fruit when she noticed that I wouldn’t be getting to the cafeteria during typical lunch time. I was able to thank her and decline by letting her know that I had a long break coming up after the next patient. What a truly generous offer.  And one of her main complaints was a painful ankle! 

 

Latin American culture and ways of doing business have been seeping back into my consciousness here at Loma de Luz Hospital.  Yesterday I needed instruments for toenail removal, and I searched several places around the clinic, ER, and hospital, and finally went to the instrument sterilization room where no one knew me.  “No.  None of those things available here.”  We talked awhile about work and life in general, made some jokes, laughed, and made no pretense of being in a hurry—after all, that digital block in the patient’s big toe would take about fifteen minutes to really take hold.  Suddenly a big Rubbermaid tub of sterile instruments appeared so I could search for what I needed.  This is a little ritual in Latin America that I recognized several times since I arrived here, but I hadn’t had the need to stop and chat in Central Supply yet.  Now I’m fairly certain that future instruments will be forthcoming.  It takes time.  There’s no real way to hurry these interactions.  A few minutes chatting in the pharmacy, nurses’ station, reception desk, and about any other department pays big dividends.  We see each other as humans, and then we work together.  Speed and efficiency aren’t the first goals.

 

Wow.  This has been random.  Were you not warned?