Departure Day

July 28th, 2013 by Maggie Higgins
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maggie-higgins-friendsI was able to sleep through the night and woke up early feeling a better. I started packing up my things. Around 9, I caught a cab and went into West End on a souvenir mission. I found success at several shops (the ones that were open this early). Having not eaten much the day before, I was hungry hungry, so I went to Cafe Escondido above West End divers. Nothing was jumping out at me on the breakfast menu, but the fish tacos sounded delightful. So I relished a delicious plate of heaped up fish tacos while looking out over the water. The sun was out and West End was waking up, and I realized I was going to miss this island life a little bit.


After an ATM stop and one last souvenir stop (I didn’t have enough money before), I cabbed back to Sandy Bay. I dropped my things off at the hostel and headed over to the clinic for a final round of goodbyes. I stayed a little too long chatting with Kelly upstairs and had to scramble back to the hostel to finish packing. Dee arrived and waited while I finished packing and dropped off $40 for the wireless to Mel. Then it was off to the airport.


Miss Peggy had decided to stay another night on the mainland (she was visiting a hospital there), so I wasn’t going to be able to say goodbye to her. While I was at the bank paying my $40 visa exit fee, Miss Peggy snuck up on me! Her flight had just arrived. So I was able to give her a goodbye hug after all.


On the flight to Houston, I sat next to Mike who had been diving for the past 2 weeks. The view flying over the Caribbean was beautiful. I read the inflight magazine and did most of the crossword puzzle.


The Houston airport was a crowded nightmare. The customs line was ridiculously long, then you waited to get your bag, then you waited to recheck your bag, and then you waited in a terribly long line to go through security again. I had just enough time to grab a banana and juice at a Starbucks before my KC flight started boarding. Tiny airplane flying home. We flew around a terrific t-storm as the sun was setting. It was a beautiful sight to come home to.


But not quite as great as getting off the plane and having a jubilant reunion with my welcome home committee – Jack and Becca. As we were driving home, I started feeling worse. I am now writing this on Monday and for the past 3 days, I have been wallowing in feverish misery with all the symptoms of Dengue fever. A fantastic welcome home gift from the Honduran mosquitoes!


All in all, the trip was a wonderful experience. There were highs and lows, but it was an adventure to be able to explore a new country, new island, and get to know lots of new people. Though I already realize that I learned a lot while there, I know that the lessons from this adventure will unfold throughout the years.


This will be my last post on the blog (besides a photo dump which I will hopefully have the energy to put together later). Thank you to those that gave me shout-outs throughout my time in Honduras. I loved being away for a while, but it makes coming home all the sweeter.


July 26th, 2013 by Maggie Higgins
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A bit of a rough night’s sleep thanks to my hostel mates. It was the Irish siblings last night and they were ready to hit the town. They finally left the hostel around 11 pm and then woke me up at 12:45 with quite the street commotion (in my sleep fog, I wasn’t entirely clear on what was taking place outside my window). Heavy rains roused me again a few hours later, and then the rest of the group rolled in around 4:45. That’s the good thing about going to be early though, you still get enough sleep even if it’s interrupted multiple times.


Woke up with a little yoga – with the interesting twist of tight balcony space and trying to not wake the hostel mates. Then went for a walk. I walked as far as I could on the beach, heading east. The dogs here take their guard duty seriously. I had to smack one away once – he was all bark though. I walked and walked until finally the brush ahead looked too thick to pick through. Plus, there were some mean barks coming from up ahead. So I turned around and walked back.


The crabs here are all scaredy cats. The skitter away sideways at the slightest movement. One of them actually skedattled into the grass and wrapped himself in a plant. Didn’t fool me. I could still see his bubbles. And while I’m on the animal subject, there are lots of lizards around. My personal favorites are the ones that run on their hind legs. Their waddle cracks me up. There are lots of little geckos (one was my roommate last night – he took the ceiling, I took the bed) and I saw a really cool bright blue and green one on the balcony. There were two iguanas on the wall by the pool also.


I stopped by Miss Peggy’s on the way back and borrowed a medical Spanish book. I will improve, I will improve, I will improve. Then I returned to the hostel and read the book in a hammock, which soon turned into a semi-conscious snooze. I went for a swim in the pool and went in to take a shower before clinic to realize this was one of the random days (if there is a pattern, no one has informed me) that the community water is shut off between 11 am – 3 pm. Yet another swim to suffice as a shower. People might start being repelled.


Whipped up another gourmet lunch (corn tortillas with peanut butter have become a staple) and walked over to the clinic (wearing my Easter bunny scrub top, which is my favorite). I researched adolescent health interventions for tips and strategies while I waited for Dr. Molina. I helped Lena clean out an foot wound on a 13-ish year old kid. This kid had osteomyelitis and was in and out of the hospital for almost a year. The doctors would shave of some of the calcaneus and treat with antibiotics, but the infection always returned. He started coming to Clinica Esperanza about 3 months ago. Dr. Molina had to order supplies from the mainland – he put him on Rifampin and minocycline, and the boy responded wonderfully. His latest x-ray showed no infection in the bone. Now he comes in several times a week to get the wound cleaned out (he lost almost all of the soft tissue inferior to the calcaneus, now it just looks like a small crater a cm or 2 deep).


Today, I was allowed to see my own patients! One in English, one in Spanish. The one in English was a long patient encounter thanks to the man’s ability to convey his entire life story to me. His main issue was an open sore on his medial calf that was opened when he was rubbing his leg – the skin just peeled off from his touch. He had venous insufficiency that caused a blackening of the ankles and blood stasis. He also had high blood pressure that was most likely the cause of his past week of dizziness. Dr. Molina tweaked the meds for me (pharm is still foreign to me) and I sent him to Lena to get the ankle cleaned up. The Spanish speaking encounter was an old man who had just come in the other day for med refills, and today was in complaining of tingling, burning, swollen feet. He was a sweet old man (though a little kooky). It took me several clarification statements to understand the specifics of his problem, but the interaction went alright (though I didn’t even really present to Dr. Molina because he just talked to the patient for a second and then told me to prescribe a multivitamin – as nothing was going to improve this man’s neuropathy).


We saw a couple diabetic patients, a woman’s health exam, and drained an abscess on a little boy’s head (he was so brave). After wrapping up with the patients, I went to use the computer. Our family google hangout for my mom’s birthday was postponed for another day, but I caught up on some emails. Dr. Molina came in and asked me all about my background. We had a good chat for a while. Then we closed up and Lena and I walked back together toward our homes. I walked a little further to see where she lived. She invited me to go to the mall with her and her boys tomorrow. I said I’d show up at her house at 11 if I was going, but if I didn’t show up, it’s because I got into something else. I like Lena a lot.


Went back to the hostel and changed. I hemmed and hawed and finally decided I should go out and be social, so I went to the road to grab a cab. After waiting for a while with no avail, I started walking to the beach thinking this was a sign that I should just stay in Sandy Bay, but then I turned around and a bus came by, so I got in having no idea how the bus system worked.


Got off at West End and made a minor fool of myself because I couldn’t hear what the driver was saying so I just looked like a silly gringo (I try hard not to be that, but alas, I am). I then wandered up and down all of West End, not looking for anything in particular, but thinking maybe I’d find someone I knew. I stopped by Por qué no? (a German restaurant – Eddie would be proud) and was the only patron in there, so felt compelled to stay. I did a quick scan of my stomach and realized I was really hungry, and ordered the curry style waurst with the mixed salad. I sat out on the balcony, people watched and wrote in my journal. The food was really good and the water hit the spot. A little kitty tried to play cute with me, but no way cat, not getting my food. The bar next door was gearing up for the hopping night life, so I ate to some hot beats by Rihanna, Avicii, Lana Del Ray, and all the club faves. Perhaps the owner couple felt bad for me that I was by myself, or maybe they just wanted to show some love to their only customer, but they gave me a free cinnamon bun to go. I roamed about a bit more watching the pre-night life prep – this area is quite a party later in the evening. But this little party animal, got in a cab and headed back to Sandy Bay at a whopping 9 pm. I then watched a bootleg copy of The Help (there’s a stack in the hostel; there are guys that cell them all over the beach). This one was a low-quality one filmed in the theater – I could hear the audience laughing, commenting, and even saw someone walk across the screen. And lucky me, I got to do a choppy, silent (on my end) video hangout with Jack.

Tuesday In The ER

July 18th, 2013 by Maggie Higgins
Posted in Uncategorized|

maggie-higgins-pa-studentsAfter the crazy eye day on Monday, I presented Tuesday morning on pingueculum and pterygium. I then ran upstairs to show Dr. Estrella the PowerPoints. I told her to look them over throughout the day and give me her feedback when I returned. Then I went down to the road to get a cab to Coxen Hole – I was working with Dr. Molina in the emergency room this morning.


The public hospital does not look like a public hospital. It is a ramshackle collection of buildings on the main road leading into Coxen Hole (across from the Church of God school). I walked into the main entrance and asked for directions to the emergency room. There were patients waiting everywhere. I found Dr. Molina in the ER, a smallish room with sheet-separated bed space, a small office that also functions as two (or three patient areas) and a small room used for pediatric patients.


When I first arrived, Dr. Molina was with a critical patient. The woman had come to the ER around 5:30 that morning after a hypoglycemic diabetic spell. Her glucose was at 15, her heart rate at 10. They ended up intubating her an hour after arrival, but to no avail. By the time I got there, she was being hand ventilated, had minimal ocular reflexes, but was holding her stats. The entire time I was there, a resident was taking a shift pumping the hand ventilator. Dr. Molina told me the next day that the woman died at 2 pm, an hour after I left.


When I first arrived, the social service docs (like interns) were gathered the side room. They were eating chips, talking, laughing, listening to music on a phone and then I realized one of them was having a patient encounter with a young pregnant girl. This was the general theme of the day – I was constantly shocked at the social services’ seeming lack of concern and urgency. Often, patients would be waiting in the hall, eyes pleading to be seen, and they would go ignored. One woman came in holding her son and a bottle of something. She spoke to me and I was pretty sure she said her son drank the substance, but she was speaking very rapidly. I got Dr. Molina’s attention, he listened and gave her a little colored tab that patients take to central intake to get their file.


When she left, he looked at the bottle, saw that it involved NaOH, a caustic alkaline, and moved quickly out of the ER to go find the mom and boy. I then witnessed my first stomach pumping. The poor mom had to hold her son down while he screamed for help. At one point, one of the social service docs brought a little girl with a cut up face into the room to use another area. All I could think was “why the heck are you subjecting this little girl to borderline torture of a kid just like her?” After a few minutes, the social service doc moved location (the girl’s mother rushing her out).


After the nasal tube was pulled out (much to everyone’s relieve), Dr. Molina fed him antiacid cream. Probably the kid didn’t actually swallow any of the liquid. 9 months ago Dr. Molina had seen a girl around the same age who had swallowed the same stuff. She had gotten to the ER faster than this boy and already had severe burns on her lips, mouth and all down the esophagus. She spent 50 days in the ICU and now has no esophagus. There were no visible burns in the boys mouth or lips, but he was fully treated as if he had ingested the toxic stuff. Dr. Molina knew the boy (that’s a neat thing about health care on a small island because you know people’s medical histories over the years of working) and was additionally worried about his bleeding disorder. He has CMV and now has very low platelet counts.


There was a woman with a dislocated shoulder so I got to see Dr. Molina put that back in. Another woman showed up in an ambulance. She was a dialysis patient in kidney failure. There were lots of babies with coughs. In one of them, this second year med student could actually see the pneumonia in the right upper lobe. A boy came in with fever and shakes. His blood was sampled to look for malaria and dengue.


There was a to-do when a truck backed up to the ER and a stretcher was rolled out for a young man who had been in a moto accident. He wasn’t moving when he arrived, but after full body inspection and physical exam, Dr. Molina determined he was just scared, stunned, and putting on a bit of a show. All systems checked out.


At one point, Dr. Molina almost lost his cool because a little boy came in for a 15 day follow-up for his broken arm (his sister who brought him was actually the young girl with pterygium who I saw at the clinic the day before). He looked at the xray which clearly showed a green stick fracture, which needs to be broken the other way and reset. By casting it 15 days ago (and the ortho surgeon was on vacation), the boy is set up for deformed regrowth. There were several other points when Dr. Molina had to correct another doctor’s order, dx, or advice.


I was at the ER until 1 pm. I then walked around Coxen Hole for a little while. I bought a couple bananas and a couple baleadas and then found the bus “station” to get a bus back to Sandy Bay. They pack the buses to the brim and stop all the time. It would have been a lot faster to just take a cab, but when you can save 75 cents… by golly, you do it.


I snarfed down the balleadas while I went through class 4 with Dra. Estrella. She gave a big thumbs up to the whole course! And she’d love to teach it and wants to get going ASAP! All terrific news. I went home to change and get my computer. The rest of the afternoon was spent touching base with Leigh on the teen class and finishing up the girls’ classes.

Island Tour Sunday

July 15th, 2013 by Maggie Higgins
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Got some blogging done this morning, had a breakfast of champions, and then rallied the troops for our 9 am island tour departure. It being my last weekend, I worked hard to get people together for an island tour (the more people, the less expensive). We met at the end of the road and piled in the van. Leigh, Eric, and Nick came from West End, and Trevor, Oksana, Anastasia, Claudio and I came from the hostel. 8 in total and Billy, our driver/tour guide.


We drove through Coxen Hole and surrounding neighborhoods while Billy pointed out various homes, stores, and spouted island history. He was very difficult to hear from my seat, so we started working a telephone-like relay of information to the back seat. We stopped in French Harbour at two different look-outs – this is the area of the city formerly owned by the French (Spain owned the rest and then the British came and took it all) who built a French-only bridge to the French Cay.


We drove through a deer and pig farm to a hill overlooking Mahogany Bay (where Carnival Cruises dock) and Fantasy Island. Lots of the town on the south shore are big fishing towns, harbors loaded with shrimp boats. The last big “city” directly on the main road was Los Fuertos, a big barrio of mainland immigrants. Like the Colonia, it has grown tremendously in recent years. We drove to the top of the Pristine Bay hill overlooking the golf course and ocean on one side, and down on French Harbour on the other side.


Our next stop was the Iguana farm. This was a most bizarre place. The little dinosaurs were everywhere. Big ones, little ones, molting ones, spiky ones – because they’re fed banana leaves so often, the lazy bums just loaf around the driveway. There were also two monkeys (one very affectionate one, and one that bites), turtles, some beautiful parrots (including 2 spectacular macaws), and a caged off area of the bay with some gigantic fish (including a very ugly barracuda). The iguana factor was simultaneously slightly disturbing and weirdly interesting.


We drove a ways up the island – beautiful green rolling hills with improved pavement as we went east. We stopped at Parrot Tree, a spectacular resort with a beautiful lagoon. The sun was out and the lounge beds were calling our name, but Billy was antsy to move on. Our next stop was Punta Gorda, a Garifuna town. It is spread out over a single street right on the beach. There were some mud and stick structures and some open air houses. Sunday is a big festive day in Punta Gorda. Already there was a big beach soccer game picking up.


We then drove to the opposite side of the island to Oakridge, where we met Alex for a mangrove boat tour. There were 10 of us in the skinny, tippy fishing boat. We motored through Jonesville and a neighboring town – areas only accessible by boat. Lots of shrimp boats lined the coast. Fishermen were out line fishing and various boats were motoring around. Our tour continued through a tunnel in the mangroves. It was amazing to be in the midst of these bizarre root system of trees. We motored by Hole in the Wall café (a tiny stick house on the water that is “famous”) but didn’t eat because on Sundays they only have a $25 buffet BBQ. I loved these coastal towns – everything so oriented around water. On the way back, I had to urinate badly so Alex (the driver) stopped by what we presumed was his house. A lady called me over to the house (a stilted house over the water) and showed me to the bathroom. The toilet was a box with a hole in it. I removed the plank that covered the hole and peered straight into the water. As I was using the toilet, I watched the fish through the cracks in the floor. A reminder not to swim in this area. The woman (Alex’s wife) showed me the crocheted cell phone holders that she made and then I joined the group back at the boat. I must give props to Alex’s docking skills. The man is a master. He shuts of the engine 100 feet from the dock and floats in like a glove next to the pier. There was a bit of a flare up over the price, but we all ended up paying $15 (a little pricey since we were paying Billy the same for an entire day’s tour), but I wasn’t in the mood for a price tussle.


We tempers a little cranky and tummies rumbling, we returned to Punta Gorda for lunch. Darren, Anastasia’s boyfriend had called Trevor wanting to meet us on his moto, so we went to look for him in Punta Gorda to no avail. Needing to stretch my legs, Leigh, Eric, Nick and I walked down to peek in the grocery store. We walked along the beach back to where the van was parked. The rest of the group had ordered Machuka, which is a seafood soup in coconut/curry broth (local fare). While waiting for food, I lounged in a hammock and then a little band started up and an old man started doing the punta (local dance involving feet pattering and hip shaking to drums, singing, and other rhythm sounds). We had two drummers, a singer, a maraca player at work. After some time of enjoying the scene, the old man motioned to me and I joined the punta, having no idea what I was doing (he said I was doing good, but he was probably just being nice). It was a ball. I then ate beans and rice and tried the machuka (which was a broth with a whole fish, lobster tail, and conch served with a heap of papaya mush). There was another punta session and more people got involved. It was a festive and delicious afternoon.


After leaving our lunch hut, we drove out to Paya Bay. At this point the island is more agricultural, green, and less inhabited. It’s beautiful on the east end. Paya Bay is founded by one of the Jackson women (one of the richest, longest living, powerful families on the island – McNabb being another name we heard over and over). It is spectacular. The buildings sit on a rocky cliff. It is extremely blustery on the east side (at this point in the season, the west side is protected and the east gets the wind). There are fantastic nature trails winding all over the cliffs. It was the most peaceful, serene place. One of my little hikes led to a wooden yoga studio on a hill overlooking water on both sides. There were little nooks and crannies of the paths, each with a rustic charm. After exploring all the trails, we went kayaking in the ocean. At this point it was really choppy and overcast, so we all got tossed from the kayak as we arrived on shore. It was a ball. I just wish we were at Paya longer.


At 6 we started gathering ourselves up to head back west. It was a wonderful, exhausting day. I loved seeing the different flavor of the area, and if I ever come back to Roatan, I’m headed to Paya Bay. Ate more beans and rice (and a PB/honey sandwich and lots of cookies) back at the hostel, and I was soon overcome by sleepiness. A very good day.

Third Sunday

June 30th, 2013 by Maggie Higgins
Posted in Uncategorized|

Woke up with the write, yoga, bfast routine. Walked down to Dee’s at 9:30 for the West Bay ride. At Sundae by the Sea last week, the pastor and his wife asked me to come to lunch to go over my spiritual gifts test. They’re very nice people and I can’t turn down a free meal, so I happily obliged. So I headed to the R Church with Dee and Louie (of Lionfish Louie’s, a restaurant in West End that specializes in dishes made from the reef-killing, invasive species: lionfish). There was quite a crowd this morning – turned out there was a mission group in from NJ working with some ministry on the island. I liked singing the songs and today pastor Travis talked about some verses of John and the meaning of heaven.


I waited around after church, and rode with Travis, Trish, their 4 kids, and 2 other kids back to their home near Gumbalimba park. They have a beautiful home right on the beach. I ate my fill of pasta, veggies and cantaloupe while Travis dove into the gospel stuff. The first two questions were “do you feel secure in the fact that you will go to heaven?” and “what will you tell God when he asks you why you should be allowed into heaven?” Those were the toughest questions, to which I didn’t have proper answers because I honestly don’t think about that, but all in all we had a good conversation (I mostly listened) and I got a better understanding of what my spiritual gifts of discernment and missionary/multiculturalism meant.


They’re very kind and caring, but I was happy to move on with my day. I walked to West Bay and met a bunch of other volunteers. Dee led us on a wonderful snorkel adventure (I saw a huge grouper and lots of beautiful fish). Near the end, I looked up to find that I was all alone. Everyone else had gone in. Then Dee found me, and we swam in together. I read in the shade and enjoyed the gorgeous view. Then Danielle, Manu and I walked down to meet some other volunteers for a bite to eat. We ate fish sandwiches at Beacher’s. I tried Manu’s Monkey LaLa (the island drink) and it was way more delicious than the one I tried at Sundowners. It tasted like a milkshake. The sky was beautiful as we walked back (I’ll put up some pictures in a bit). Dee, Danielle and I watched the sunset for sometime. I felt very connected to the island this evening.


Then Dee drove us home, first stopping at an ice cream place and an ATM (much needed!). I opted to ride in the back and we picked up one of the massagers (I can’t remember her name but she’s a really sweet gal who gives massages on the beach) and then picked up 4 teenagers, two of whom were pregnant. They all had stalks of sugar cane which reminded me of Haiti and the DR. It was sad to me to hear their 15 and 16-y.o. banter on our drive home knowing that 2 of them were going to be moms soon. They asked me if I had any kids and told me that they want kids. I’ve thought this the whole time I was here, there’s just not much to do for kids. They only go to school half days (if they go at all) or they start working or they just lolly-gag around. When there’s not much to aim high for, what else are you going to do than start having kids. That’s for sure a generalization, and perhaps there are elements that are less toxic than the over-scheduled, manic childhood of the US, but a lot of kids enter adulthood way earlier than is probably healthy for their development.


I hopped out of the truck at the end of the Colonia and walked back to the hostel. Showered and wrote and soon to bed. Another week at Clinica Esperanza starts tomorrow.


June 28th, 2013 by Maggie Higgins
Posted in Uncategorized|

maggie-higgins-elder-patientDuring morning conference, David reviewed heart murmurs, but I got pulled away before he finished to head out for the vision screenings. We jumped in Manu’s truck, picked up 3 more volunteers along the way and headed to Instituto Jose Santos Guardiola in Coxen Hole. It’s a high school with 500 kids in the morning shift and 350 in the afternoon. We went upstairs to the library, which was air conditioned! The other volunteers set up the “clinic” in a heart beat. Two eye charts on the far end with two computers and a bit of tape on the ground at the other end.


Soon, the first batch of kids came in. At first I was sitting at a table fuming over the fact that I was missing out on a clinic morning to be completely superfluous at this vision screening. But then I took over for Manu at the door, so I became the bouncer, role caller, and flow maintainer. The kids were great. They were all excited to get called at the door. The kids crowding the door were eager to help me decide who was here and who wasn’t. They laughed at me when I miss pronounced a name. A few of them would stand on the balcony practicing covering their eyes. Some kids were very quick to speak English with us, and others had difficulty understanding what the testers wanted from them.


At one point there was some assembly going on in the courtyard, which combined with the general din of a whole bunch of kids hanging around on the balcony made for quite a chaotic environment to have two letter readings going on simultaneously. We finished 4 classes: the third class of 8th grade and 3 classes of 9th grade (though here their called second course and third course). It was fun to hang out with the kids and some of them really needed the vision screening, but I missed being at the clinic where I felt more engaged and helpful.


I gladly hopped in the back of the truck when we left the school. It was a nice tour through Coxen Hole and then Manu stopped at the big fancy grocery store! Huzzah, real food for Maggie! When Manu dropped me off near my hostel, I went back (sweating in my scrubs) and made myself a salad and sandwich for lunch!


Then I walked back to the clinic with my computer. I wasn’t sure whether I was going to be working on the adolescent program (which I had originally planned on) or head back out for vision testing. Soon after I got there Lena asked for my assistance on a wound clean out. I chatted with Dr. Raymond and then went upstairs to try to find Leigh. I popped in on Alanna, who was not doing so well. She said the pain was getting worse and nausea had set in. An insurance caretaker was arriving today to fly back with her tomorrow. She’ll be glad to have real pain meds back in Canada.


When I came back downstairs, Manu and the eye checkers had left, so my afternoon was free for public health thought. Leigh arrived and while she first met with the 2 new PAs to talk about a diabetes intervention, I went downstairs to see how things were going for Julia. She saw all the English speaking patients. I hung around to see an older woman who was recovering from a bad allergic reaction, was told she had some infection in her body, and needed a refill on her meds.


I went back upstairs to work on class 1 of the teen education course: anatomía, desarrollo y menstruación. I touched base with Leigh on some things, and then got to work. After some time, I went back downstairs. I asked Dr. Molina about a toe fungus that I haven’t done anything about for a while. He gave me an antifungal cream.


I saw a preeclamptic patient with Dr. Raymond, then went back upstairs to work on the PowerPoint. The internet in the clinic was bleeping in and out today, so I would jump back and forth between using the internet to find resources and working on the PowerPoint when the internet went down.


Headed back to the hostel. I was going to go for a walk, but the spirit moved me and I put my kicks on for a run. At first everything was grand. I was loving running on the beach. The colors were beautiful – yellow sun and blue water. But then a couple dogs came running at me. Their owners were outside and they started shouting at the dogs. I stopped to defend myself, but they didn’t attack. They must have roused the neighbor’s dogs who came barking toward me. I immediately started retreating, but one of them bit me on the butt. The owners of the second dogs were yelling and the first dogs owners were throwing coconuts at the dogs. I was trying to turn back the other way and the first dogs came at me again, I was shin deep in the water at this point. The coconut throwing cleared the dogs and I got the heck out of there, my heart racing. So that will be my last jog on the beach here.


I shot some hoops as I passed a group of neighborhood people. I missed 4 in a row and then made a backwards shot – so I left on that minor success. I showered and then returned to the beach house where Roger was cooking dinner for a few of us. I caught up on my blog while Roger cooked and Mikayla and Austin looked through movie selections and started watching Monsters University. Then we played a card game similar to gluck, but more like solitaire.


The food was delicious. He made sea bass and rice. We hung out for a while and then I was hostel-bound.


June 26th, 2013 by Maggie Higgins
Posted in Uncategorized|

Our 7:30 conference topic was all cephalosporins: the different generations and their MOAs and targets. After the learning, Julia and I got down to patient business. Our first patient was an American-turned-islander with a 15-year history of recurrent UTIs. She was also recovering from an allergic reaction to ciprofloxacin, which was after an allergic reaction to chloraquin, which a pharmacist had given her (3 tabs a day!) for her UTI. The poor lady was a little loopy because she had taken a codeine to kill the immense pain she was in, and she burst into tears twice. We couldn’t take a urine sample because she was on pyridium (which I learned turns your urine bright orange) and had only finished her round of antibiotics (I can’t remember which one it was now) 3 days ago. We put her on a 14-day cycle of the antibiotic that had worked for her and then told her to stop taking all meds for at least a week and get a urine sample.


After that first patient, the rest of my day was in Spanish. We had a lovely woman with GERD, osteoarthritis (the grinding of the knees on examination were serious), and pterygium (a new one for me – overgrowth of the conjunctiva of the eye). I fit her for reading glasses and she was so grateful to be able to read again.


Our next patient was a 17-y.o. gal with several issues. She had a fluid pouch near her outer malleolus, minor foot fungus, lower abdominal pain, and three palpable masses in her breasts with nipple discharge in one. This is the tough thing about working on an island with limited resources. The only place she could get a quality breast ultrasound was on the mainland, to which a trip and doctor’s visit is prohibitively expensive for most patients. She denied any family history of cancer, and perhaps the lumps are benign fibrocystic changes, but it’s alarming to feel such lumps in a young girl’s breasts.


The next young woman had a ganglion cyst on her wrist (which I diagnosed correctly when Dr. Raymond asked me what type of cyst that would be), chronic allergies, and neck stiffness. There’s a lot of neck pain and stiffness here. I should start teaching yoga to patients. Then there was a woman with a UTI. While Julia was taking care of the UA for the woman, I helped Eric with the debridement of an adorable little boy’s leg. Hot soup had spilled on his leg and he didn’t come into the clinic until 12 days after the incident (his mom had put butter on the wound – regardless of how that worked for the kid, his wound was free of infection when he came in). This was his second trip to the clinic to get the black eschar off the burn. He had walked by himself this time, and was so brave as Eric scrubbed the wound. He almost bit his shirt off from the pain, but man, was that kid a trooper.


Back in our exam room, we saw a woman with probable bacterial vaginosis and an old man with H. pylori, hypertension, and pterygium (2 in one day!). Since I’m writing this a bit delayed, there might have been a few other patients that I failed to scribble a note on.


After wrapping up with patients, Julia and I went up stairs to see Alana, she’s the volunteer who was badly burned on Monday night. I saw a picture of the burns – mostly partial thickness, but some areas of full thickness burns all over her chest, neck, and lesser burns on her arms where she tried to push down the flames – and an abrasion on her chin from when they threw her in a pool. It was a total freak incident. She was at a bar ordering food and the bartender was making a flaming drink. He wanted more flame, so a waitress poured more 151 rum on the drink. She’s a bit fuzzy on how the flames got to her, but I can only imagine the bar was liquor soaked. In any case, the flames flew down the bar and her freshly applied bug spray acted like a torch. She was still in a bit of shock at the surrealness of the experience, but was in pretty good spirits. What a crazy freak thing. Thank heavens for the clinic.


I walked with Angela (a peds ER doc from Wash U) to Golosinas Josue (the baleadas place at the end of my block) and then went to the store to get some ingredients for my gourmet lunch of eggs, beans, over-ripe avocado (the same one that was not at all ripe the first time I tried to eat it), corn tortillas, and some hot sauce that I found. After that feast, I went for a roam up my street (doesn’t go to far before the road ends) and then on the main road east. I then did some lounging and reading and peanut butter snacking – and then after the sun went down, I headed down to the dock. I was going lobster hunting!


I met Roger, Edison (brothers), and Anthony (all Island guys), and Austin at the dock with my snorkeling gear. We split up into two groups, to divide and conquer. I went with Anthony and Roger. I should mention that this is a secret because the reef off our beach area is a protected area and technically this is not a legal activity. I did not get a spear. This was a good thing. I was too busy dumping my mask, which is now leaking at an obnoxious pace, and trying to stay out of the way. These guys are unbelievable. They each make their own weapon. Roger uses a lance attached to elastic so that he can spear it and give it some moving space. Anthony works magic with a hook tool.


We swam out to the reef in darkness. I was enrapt with the luminescent algae. It is a wondrous sight and made me feel like I had magic coming out of my fingers as I swam along. Once we neared the reef, Roger beamed the flashlight and I hung by his flank to see where I was going. First of all, they could spot lobster way before I knew what was happening, and there was a while when I didn’t even see the capture, but Anthony would be ripping the tail off. That’s something I didn’t realize, we were only keeping the tails – so after the kill, they rip the tail off, put it in their pockets, and drop the rest. Lobsters make this weird squeaking and I felt a little bit bad for the fellas. It was always exciting to see a hunt go on. Roger would spot one and Anthony would dive down and hook it. If it got away (not too often), we’d pursue until it escaped the light beam. Most of the time, I was floundering in the back trying to stay out of the way and dumping my goggles, trying not to choke on the sea water. It was also the first time I’d felt cold since being in Roatan – I would periodically shimmy to stay warm.


It was all very exciting. Roger pointed out a slippery crab, a flounder (which is not at all like the Little Mermaid’s Flounder – it’s white and lies flat on the floor, looks more like a ray than a fish), and my personal fav, the octopus! There movements and their ability to change colors are so cool. We finally met up with Roger and Austin (who had caught an octopus which I was kind of sad about) and headed back to the dock. I played with the luminescence the whole way. All in all “we” caught 39 tails.


I chatted with Kempfer for a bit, then went home to shower, then returned to the Beach House where the cooking had started. Roger and Austin both love to cook, and they came up with a feast. We didn’t eat until after 10 pm, but yummo! It was so good. And while they cooked, I enjoyed Roger’s island jams that were bumping the house.


This is a good place to mention Island speak. The black islanders have a dialect of English that is absolutely fascinating. When they talk to each other, it is nearly indecipherable to me. Very Caribbean in the tone. So throughout the day, you hear Spanish, Island English, and English – it’s quite a hodgepodge of lingos.


I washed the dishes and walked home with a full belly and a cool night hunting experience.

Sunday By The Sea

June 23rd, 2013 by Maggie Higgins
Posted in Uncategorized|

maggie-higgins-esperanza-sunsetI started the day off doing research on adolescent health education programs. Found a couple good resources and a cartoon mascot, who I will name and she will be the “guide” the girls’ health education. I found a boy cartoon too. Once again, I could not find any piece of fire to light the burner, so I went with another dry breakfast (I must buy matches or a lighter, and thank God for peanut butter).


A little before 9:30, I headed down to Dee’s to catch a ride to West Bay. I decided to forego church for some snorkeling because the majority of my day would be spent helping out at Sundae By The Sea, an annual fundraiser for the clinic – more on that later. I snorkeled out to the reef and realized I had brought my underwater camera, so went back and got it, and returned to the reef. I’m really terrible with the underwater camera. I took maybe four pictures and it will be a surprise to me what I actually captured. I was able to dive down farther than the last time (my head cold has cleared up), but my mask is still leaky, so I was often snorting sea water or getting it in my eyes. I still have to work out the kinks in that activity.


I lounged on the beach for just a bit reading my medical Spanish book and then headed off to walk to Gumbalimba Park, where the event was being held. I was working the 12-2 pm check-in shift. I met two of the new volunteers (2 gals from Texas, one a med student and the other a psych PhD student) and we walked together along the beach (white sand, turquoise water), through Las Rocas resort and over a metal bridge into Gumbalimba, which is a nature sanctuary and gardens.


Sundae by the Sea was held in a pavilion area. It’s a silent auction, live auction, food and cash bar event to raise money. I was a bit confused why there were no sundaes, but I kept my disappointment to myself. My first task was to put rocks all over the silent auction sheets which kept blowing everywhere. Their were little bats up in the rafters. I looked for monkeys and didn’t see any, another disappointment, but I think we were sequestered at the back of the park near the beach.


The check-in table was quite stressful. It’s hard enough dealing with change in one currency, but mix lemps and dollars in there, and my math got all jumbled. I was happy to be relieved of that duty. I was glad Leigh and Eric were working with me. There was lots of mingling time. Finally the silent auction started around 3:30 and when I thought I was about to eat my forearm, they opened up the food line. I was towards the back of the line, so by the time I got there, a few things were all gone, but I loaded up my plate and inhaled the food. It was delicious. There were veggie puff pastries, lion fish meatballs, mixed seafood ceviche, two kinds of hummus with pita, white fish dip, pulled pork sandwiches, (several things I missed out on), and a table of desserts. Kempfir, a local kid, told me I had to try the island cake and it was not good – tasted like a marshmallow.


Feeling much better with a full belly, I hung around to clean up. Then a group of us walked along the beach back to West End. It was a beautiful walk, though the high tide meant a little more rock scrambling than was preferred with rubber flip flops on. I walked back with Eric and Leigh to their place – it’s so nice, spacious, and modern compared with my abode. I walked back to the beach to wade in the water and said bye to all the other volunteers. Luckily there was a little convenience store open so that I could break a $10 and have enough money for the taxi. I bought a sleeve of rainbow chip cookies to bring to Monday’s potluck, 2 eggs, and a can of beans. Just now occurring to me that I should have looked for matches as well. Dang.


Back at the hostel there was a man doing construction on the room next to me. I stepped in and around the saw dust, power tools, machete, and cords. Who does construction at 8 pm on a Sunday? Not the people across the street. The construction guard man is still out there. Last night he had a bonfire and music, tonight is less festive.


I’m working the morning shift all this week at the clinic, and I’m quite nervous. I’m working with Julie, who just finished her first year of nurse practitioner school and doesn’t speak any Spanish, so I’ll be acting as the interpreter, which is a daunting prospect. She is very kind and wonderful, and is probably more nervous than I am. It is bound to be a very different week than last.

Trucking through Thursday

June 20th, 2013 by Maggie Higgins
Posted in Uncategorized|

I hope you appreciated the alliteration in the title. We finished up clinic early, so I’m writing from the clinic as I wait for any stragglers to come in before we close at 6 pm. I’m settling into tropical sleepy mode I think. Perhaps the initial wave of newness (+ adrenaline) has worn off and now the humidity is making me lethargic. I’m not entirely accustomed to sweating all day, everyday. Anyway, slept in until almost 7:30 and popped over to the clinic to make sure Bertha got her citologia log book (the upstairs was locked up before I left yesterday so I couldn’t put it back where I found it). She and Carla laughed at me that I would come all the way over so early just to make sure she got the book. But it’s not funny. I was worried about it.


I popped in on Dra. Estrella to show her the new pap smear spreadsheet. She approved and we made a couple adjustments. I went over the spreadsheet and protocol with Bertha and she thought they could start using it today (Tues and Thurs are pap smear days). I’ll check in with them tomorrow morning. Having a little bit of time left (before I was going to meet Leigh at the clinic), I hiked up behind the clinic. I say hike because walking up this driveway was like walking up a ski slope. Steep and slippery (it rained in the night). Radio towers occupy the top of the hill. Not much of a view. The walk back down would have used the switchback technique, but with only two strips of concrete and plants everywhere else, that wasn’t a good option.


Scarfed down breakfast back at the hostel and then headed back over to the clinic with my computer. Leigh showed up an hour later unfazed by the time. It was only several hours later when she read my “where are you?” email that she realized she’d been late. She was quite befuddled by the mix up.


She and I worked all morning researching and brainstorming a plan of attack for an adolescent reproductive health curriculum. After lots of discussion, we came up with a four-session course outline and general themes for each course. I’d write down all our basic ideas and plan, but it might look silly after we continue looking into the research on successful adolescent education programs. Either way, we have our work cut out for us, but we’re both excited about the topic… so that counts for something.


At 12 pm, I quit to go home for lunch. I fixed a plate and headed back to eat it by the pool. Anastasia and Darren were canoodling and Lily the dog was hunting for geckos. Soon Mel and the boys came back home and immediately Orie came and jumped in the pool. I chitchatted with everyone for a while, took a dip (close enough to a shower), and then got ready to head back to the clinic.


Pretty slow afternoon. The man with the osteomyelitis returned for a dressing change and I helped Lena clean the foot up (it’s looking much better). I assisted another burn clean out and elbow scrape with Dr. Molina. We saw a man with diabetes, a woman with back pain, another with depression, a couple med checks, some high blood pressure, and I learned about sindrome flujo vaginal (indiscernible cause of yellow, odorous vaginal discharge). It would cost $250 to culture for candida, trichomonas, chlamydia, gonorrhea, and bacterial vaginosis (gardnerella), but it’s just $24 to treat the whole lot with 4 different pills – more cost effective and efficient. I also learned that if you have eye trauma or infection in one eye, the immune reaction will start attacking the other eye as well, so you have to take out the damaged eye, so that the body stops attacking the healthy eye. Fun facts!


After hanging around the clinic for a while to see what else I could help with, I left a little before six and stopped at the corner cafe for some baleadas (basically a soft shell taco). No way was I attempting to cook again tonight. I ordered two and the lady gave me a bonus corn taco filled with carnitas while I waited. She was a lovely lady and the whole thing was 40 lemps which is $2. Quite delicious to boot.


I changed at the hostel and then walked back over to the clinic to meet Manu who was going to drive to West End to watch game seven of the NBA finals. We went to Sundowners which is a tiki bar on the beach and a favorite for gringos. I ordered a couple Salva Vidas for Leigh and I (the local brew) and we mingled with the 7 new med students that arrived today. They’re from Oregon med school and also just finished their first year. I made it through the first half of the game and then caught a cab home. Roy drove me (it’s only $1.50) and sang to me his favorite American songs. He was a delight.


The three Irish siblings and Darren and Anastasia were out on the porch and I listened to them talk for quite some time before retiring upstairs. And now I sleep.


June 19th, 2013 by Maggie Higgins
Posted in Uncategorized|

Slept in until almost 7:30. Caught up on my blog (internet superstar here!) and finished reading the WHO guidelines on cervical cancer. Then went for a long walk. I walked quite a ways past beautiful beach homes and magnificent resorts. Especially the further east I walked. I would have kept going but a strong wind came up and the weather it looked to be blowing in was a bit ominous. Never ended up rolling in.


I took a swim off Peggy’s dock. It’s delightfully windy at the end of the dock, so I stayed out there and worked on my pap smear protocol, thinking of all the different questions I needed answered and different options for how to streamline the process. This was a good thing because when I got to the clinic, I caught Berta before she left and she showed me the log that she keeps of all citologias completed. It’s a handwritten notebook with lots of gaps in the info. And there’s no indication of whether the clinic received the report, contacted the patient, or gave the patient the original. And no way to tell (once the report leaves the building) whether the exam was positive or negative. All in all, it’s a mess and I’m going to fix it.


Seeing Berta’s book, however, it dawned on me to use a spreadsheet approach. Berta confirmed that she uses the computer during the visit anyway, to chart the procedure… so helloooo spreadsheet system! I borrowed her book and created a spreadsheet with all the necessary procedural and follow-up information. (I even made it pretty and colorful). I started to enter in the past entries from the book. It’s going to take a long while, but I think it will be good to have record of the women who received a pap smear, even if we don’t have the results anymore. Tomorrow, I will be going over the spreadsheet with Berta and figuring out what to do with the results stuffed in the drawer.


I worked with Dr. Molina again. I was quite tired today which was a detriment to my already minimal ability to follow along in a patient encounter. One interesting case was a women who had cervical cancer and was treated with chemo and radiation. The radiation damaged her nerves so bad she couldn’t walk and had to crawl. She’s been doing PT and is now walking with a single crutch. There were 2 OB patients, a man with hypertension, a woman with menopause concerns, a gringo with an eye infection, and a few others in there as well.


Oh before I forget, a quick note on mangos. If you recall, they’re the ones that smashed all over the back roads and are quite slippery. Well, I ate my first Honduran mango at the soccer watching party. They just handed me the whole thing and after watching a few others, I just bit in and started peeling the skin away with my teeth. It was so sweet and quite delicious.


I left the clinic with Lena, who is a wonderful help to us volunteers, and I walked back to the hostel to change. I then walked down by the beach to see what was going on and saw some people out on the dock. The guy volunteers were all preparing to go night snorkeling. It quickly grew dark and as they were preparing to head off, I was so jealous I didn’t have my gear. They were going on a clandestine fishing mission. I guess it was clandestine because you’re not supposed to fish at night in our area, but they all had cool little spears and were going to break up into groups so not to draw attention to themselves.


On the way back up the hill, I stopped at one of the little stores to purchase some eggs, tortillas and an avocado. As I walked back to my hostel, I thought what a yummy supper I was going to prepare. Darren and 3 other Irish folk (who arrived a couple days ago) were on the porch. One of them was cooking in the kitchen where I joined her. First, I cut a slice out of the avocado to realize it was horribly not ripe and it left a terrible taste in my mouth. I started to open a can only to realize it wasn’t beans I was trying to open, but a can of beets. So I went ahead and cracked the eggs, pulled out the shards of shell, whipped it up and poured it on the hot skillet that the Irish gal just finished soft boiling eggs in. I didn’t have any oil so I just poured the eggs on there. It’s a tiny little thing with no handle so you have to use a wet rag to touch it. I put the eggs on a tortilla and that was the meal. No seasoning or sauce or any accouterment. I then ate half the can of beets (which was a beast to open), a couple naked tortillas, and finished my bag of trail mix. I did my dishes and retired to my little room to touch base with the home front and hopefully hit the hay early.