Last night was a terrific volunteer potluck. There were maybe 15 people there and the food was unbelievable! There were baleadas (staples of Honduran restaurants), rigatoni, potato hash, fried rice, and one of the docs made an unbelievable curry. Needless to say, I stuffed myself silly (and my Nillas were a hit… didn’t get to bring any home).
Peggy showed a slide show over the history of the clinic. It started in her house, moved to the entire first floor, then went to 5 rented rooms of a motel, and finally to the stand-alone clinic building around the corner from my hostel. It was a good background for my first clinic day.
Woke up around 6 am. It felt too unnatural to be up that early, so I dozed off again and got shaking around 7. Strapped on my Tevas and started on an exploration walk. I walked toward the beach (see photo of path to beachside) and took the dirt road west. It’s an interesting walk between the hodgepodge of local homes and fancy beach houses on the water front. It’s important to watch your step so not to slip on the mangos which are squashed all over the street. After twisting through a resort and then a village, I made my way onto the beach. I ran into Mel and Peggy on their way back from a morning walk. They warned me to avoid a certain turn on the beach because of the mean dogs. There are “private property” and “beware of dog” signs, and apparently they mean it.
There are some really lovely beach houses, resort lodgings, dive shops, a wind surfing school on the beach. The sun poked out for a bit which was a nice sight, though it’s plenty warm without the sunshine. I walked up to where the back street met the highway. The only thing required to get behind the wheel here is money for a license. It’s a bit crazy out there. And the taxis are some of the most bonkers drivers. U-turning whenever the spirit moves them and entering the street at their whim.
I made my way back to the hostel to grab some INMED papers to go over with Peggy. I went over my objectives and goals with her and we came up with a public health project that I’m excited about. I talked about my interest in women’s health and Peggy mentioned their less than efficient Pap smear system. The clinic lacks a cohesive, organized system for contacting patients with their results and many of the lab reports never make it to the patient’s chart. On top of that, there’s still a need to get more women into the clinic for pap smears. Cervical cancer remains the number one killer of women of childbearing age. We had a great conversation, I got excited about having some idea of a direction for my public health project, and I got a cup of coffee out of the meeting. I met Irma, Peggy’s longtime house keeper and her son who had a stomach flu. It was nice to speak Spanish again.
En route to the clinic, Peggy drove me up the hill to see the Colónia, a hut village of Hondurans from the mainland, most of whom lost everything in Hurricane Mitch (1998). It started as a couple hundred people. Now around 3000 people live in the various neighborhoods on the hill. Most of the clinic’s patients come from the Colónia.
Peggy and I went to the clinic. It’s a beautiful 2 story building (even has a/c!). The top floor is reserved for women’s health patients and the bottom floor houses the waiting room, pharmacy, triage/intake, and main clinic rooms. It was great to have a clinic introduction with Peggy. She introduced me to lots of the staff. I met Dr. Estrella who is the Ob/Gyn. I set up a meeting with her for tomorrow to go over the Pap Smear program, current practices, and what she would like to see improved. All the paid staff is Honduran. I met 3 of the doctors, a couple nurses, and several administrators. Peggy gave me a quick overview of the current Pap smear filing system. It consists of cut-up recycled envelopes dating back to April with names and phone numbers on the outside and lab reports inside. One has to assume that these patients have not been notified of their results. There is much to be improved upon.
Now it’s just about 11 am and I’m to be at the clinic at 12:30 for my afternoon shift. It’s a little bit slower in the afternoons which will be a good introduction to the flow. I’ll be working with Dr. Molina. More to come later.
And it’s later. I am exhausted, but it was a good first day. I showed up at the clinic at 12:30 to learn that this is island time. Dr. Molina, who I was to shadow today, didn’t arrive until almost 2:30. So I made myself busy in the storage room and meeting some of the staff. I got my own name tag and was introduced to the EMR system. I can function alright when talking to the staff in Spanish, but as soon as I started working with Dr. Molina, I became slightly discouraged by my inability to follow a conversation. Peggy said it’s because Dr. Molina is Nicaraguan and speaks a mile a minute, but I’m thinking my Spanish is rustier than previously thought. We saw an ear infection and wisdom tooth (the thing was huge and fully grown in), an OB visit, belly pain (I held the sleeping baby during the visit; he was a snorer), epileptic patient, an allergic skin rash, a stroke follow-up, several medication checks (usually a diabetic or hypertensive patient), and I that’s all I can recall right now. Mostly, I just did the med student hover behind the doctor and tried my best to follow along with the visit. Some of the nurses warned me that Dr. Molina is a bit gruff, but I found him quite pleasant, though he didn’t modify the encounters at all for a newbie. His English is very good and was willing to answer my questions, which I tried to keep to a minimum as we worked our way through the full schedule of patients. He says tomorrow he’s “putting me to work.” TBD what that entails.
It poured all afternoon at the clinic, so it was nice to be inside. Apparently, they had 2 hot months without rain, so this is a relief, though it’s odd weather I guess. It seems to me to be the rainy season, though I’m told it’s not. That’s November-January.
After wrapping everything up at the clinic around 6 pm, I went with Peggy and two nurses from Vancouver (one’s a nursing student and the other is an instructor) to a rotisserie chicken place. It was delicious and I mopped up my plate quickly.
Drove home in a deluge. Walked up to the hostel to find Mel, Anastasia and her boyfriend (I’m blanking on his name; he’s the Irishman, she’s from Germany), and a new boarder Brandon playing Bananagrams. I chitchatted a while and then retired upstairs, too tired from the day. Looking back now, this morning feels like 3 days ago. Crazy. Another “cool” night of sleep awaits.