September 28th, 2014 by jamesnorman
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I returned safely home one week ago today. For my last post, I though I would share the email that I sent to my co-residents and faculty upon my leaving Honduras.

Friends and colleagues: Today, I’ll finish my last clinic at Loma de Luz and begin a long series of bus-bus-plane-plane-bus rides that will eventually get me back to South Bend before the end of the weekend. In most of my correspondences with you all, I have perhaps been a bit chistoso in place that is very often the opposite of silly.

The healthcare system here is nothing short of fractured and dysfunctional, exacerbated by varying degrees of poverty and a public health system that is unable to approach meeting the needs of its citizens. During my time here, the physicians and nurses at the “tertiary care” hospital in San Pedro Sula marched in protest of insufficient supplies and medications. In many ways, Loma de Luz an exception, but it is, of course, far from any concept of standard-of-care that we know. I have had to make decisions here, difficult and painful, that would be unthinkable back home. I do not envy, but do revere, those here who have dedicated a portion of their lives to relentless pursuit of high quality care in spite of limited resources. And I am thankful that I got to spend a few days joining in their fight and lightening their workload.

Though pushed to the limits of my comfort zone, I was never asked to perform outside of my scope of practice. That scope of practice we have the privilege of defining very broadly. Three years ago, Memorial promised me broad-based training, and this month proved that they made good on that promise.

Lastly, this trip came at a time in my life when I needed it most. The past few months for me have been difficult for myriad reasons, and, given the day-to-day expectations of the work, I had not had time to appropriately process it all. While there were very busy days here, there was more time for study and reflection than I have had in very long while. I feel more centered now, than I have perhaps in years. The fact that my absence meant more work almost all of you is not lost on me. For each of you that rounded on my groupers, managed my box, and were flexible with the schedule, I cannot begin to thank you.

I look forward to seeing some of you Sunday night and many more on Monday.

Hasta entonces, Norman

September 18th, 2014 by jamesnorman
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When I traveled abroad, working with clinics as a medical student, I remember feeling that perhaps the level of that we were delivering was less than what might be done back home.  But for every situation we were always able to provide care that was adequate.  When the acuity of illness is more pronounced the disparities become glaringly and painfully obvious.  The absence of NICU. The inability to perform dialysis.  The boundaries of poverty and distance that prevent access to timely care and appropriate diagnostic tests.  A fractured healthcare system where past records from half a dozen physician encounters and procedures all across the country are simply not available.

As a physician here, one can feel hamstrung.  There is a limit to what can be done.  The rest is left to God and prayer.  It is difficult to practice medicine in the developing world.  How even more difficult it must if one did not have hope in a world after this one.

September 2nd, 2014 by jamesnorman
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I am well into my second week at Loma de Luz and have gradually settled in reasonably well.  I am reminded a lot of intern year at a new hospital, trying to learn where things are, what medicines are available, who to talk to make things happen.  Except now, all of these frustrations are compounded by the fact that my Spanish is a lot rustier than I anticipated it being.   Even that is improving, albeit much more slowly than I would like.

It seems that I was somewhat disillusioned, and inappropriately intimidated, by the thought that almost every case that I saw would be tropical medicine related.  Much to the contrary, I have almost completely been performing routine primary care of non-exotic viral illness, arthritis, hypertension, and asthma.  With each passing day, I become a little less anxious when I hear my name called to the ER to evaluate a patient.

One thing that has become abundantly clear to me is the fact that I chose well when I decided to become a family medicine physician.  I have been able to comfortably offer a wide range of services and techniques to an equally wide range of patients.  Whether it’s simple reassurance that a child’s viral rash will resolve or performing a digital block and removing an  infected and necrotic toenail, I feel very comfortable and confident in what have been able to provide for those seeking care at LDL.

My mission sponsors continue to show love in abundance, welcoming me into their homes and providing me with the occasional home cooked meal and card game.  Those kind gestures help to keep homesickness at bay.  The view of the Caribbean Sea does hurt either.

August 26th, 2014 by jamesnorman
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I safely arrived in Balfate, Honduras, after a long, but reasonably smooth, day of travel.  After a very good night’s sleep I was able to enjoy a refreshing day of worship and fellowship with the long-term missionaries of Loma de Luz.  Immediately I was struck by the vision and focus of those that had spent so much of their lives in the great work this is the hospital and all the other projects of Cornerstone.  While I’m excited to be able to have a very unique medical experience that this month, I am even more excited to be immersed in such a strong group of believers.  I pray that God will use me in the service of this ministry and guide me in the works that He would have me to do.

August 14th, 2014 by INMED
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Hello! My name is James Norman, and I’m starting my INMED service-learning experience at Hospital Loma de Luz in Honduras.