Week 3-community health

July 18th, 2019 by Rachel Loder
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I’m a little too adjusted to island time with these very belated weekly blog posts. Sorry! My friend and former coworker Stacey has been here this week, so it has been fun to enjoy even more of the island after clinic. Everything continues to go very well here, and I’m sad thinking about ever having to leave this island! If anybody would be willing to ship me Marty, I might stay forever. Anyway, I recently began scuba certification! I didn’t intend to get certified with so much stand up paddle boarding and snorkeling available, but I gave in and I’m very happy with my decision! Taking my first breaths underwater felt surreal, and the dive sites around Roatan are unbelievable. There are many turtles, eagle rays, millions of colorful fish, intricate coral, etc. How lucky we are to share this planet with such extraordinary species!


My huge highlight from week 3 was doing house visits in a local community. While I have thoroughly enjoyed living a pretty touristy life outside of clinic hours with a group of volunteers, I have been missing the local community aspect during this (incredibly fun) rotation. I recognize that the lifestyle I’ve had here isn’t what most locals truly live most days, so getting out into the community was really meaningful. Clínica Esperanza’s community health nurse is Carla, and she is a true rockstar. Before we even got out of the taxi she was waving and calling out to people she knew from the window. It’s clear that she has a great rapport and “confianza” (trust)  with this community, which results in much more successful work! That doesn’t happen overnight, much like I experienced in Peace Corps. But how rewarding once it’s established! Ironically, we met up with a health promoter named Consuelo to do house visits. I also worked with a health promoter named Consuelo in Peru J I felt strangely “at home” tagging along to do such familiar work, though in a very unfamiliar setting. Between Consuelo and Carla, it felt like a party greeting everyone and talking about everything from local gossip to hypertension and everything in between. They are both incredibly talented at delivering clear, comprehensible messages about nutrition in young children and controlling hypertension in adults. Knowing how to small talk and cleverly guide the conversation towards health maintenance/prevention is a great skill both Carla and Consuelo have mastered. One woman insisted garlic was enough to control her high blood pressure (it was 170/100 when we measured) and instead of shutting down her beliefs, Carla explained that maybe it had helped in the past but her “hypertension was advancing and now requires a little extra help with one easy little pill a day to avoid dizziness, headaches and future complications like strokes.” I have a feeling that the way she delivered this message, the words she used, and the fact that we were in her home rather than a sterile clinic setting, made understanding and action on her part a lot more likely. That’s what I love about community health!



As we hiked up the steep hill we stopped where Consuelo knew there were children to measure height/weight or adults with hypertension. Carla always insisted on looking around one more corner or venturing up just one more set of precarious stairs to not miss a single child, joking and singing about finding all the children no matter where they were. The culture here is very warm and friendly, which made the house visits even more fun and enjoyable. No matter where they are in the world, I believe health promoters are a vital piece to the puzzle of public health and building relationships between communities and health centers. Cheers to Carla and Consuelo for the invaluable work they do to bridge local communities with access to healthcare!



Today’s agenda includes a “lunch and learn” presentation in which volunteers are assigned topics to present to the entire clinic staff. I was paired with another nursing student from UVA to present on vital signs, so we decided to make an interactive Jeopardy game to review parameters and discuss clinical scenarios!

(Belated) Week 2

July 9th, 2019 by Rachel Loder
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Week 2 flew by at Clínica Esperanza! I was assigned to the adult triage/treatment area of the clinic, and really enjoyed my experiences learning from the nurses, Kendy and Aydelette. There are more doctors in the adult area, thus a higher volume of patients to triage/treat, which made each day fly by. Between the motorcycle accident wound treatments, bilateral ear irrigations, IM antibiotic injections, HHS, preeclampsia, a toenail removal, and dengue treatment there was a lot to observe and assist with! I am very thankful to Kendy and Aydelette for taking time to explain procedures/diagnosis to me and for allowing me to participate alongside them in caring for the wide array of patients last week.



Though my first year of nursing school was full of pathophysiology, pharmacology, etc, I truly believe the single best thing I learned was Professor Gay’s line, “arrange your face.” This simple and direct phrase has helped me breeze through situations where my gut reaction is a grimace/gag/gasp (or at to least maintain my composure until I am far enough away to let my facial muscles react). While watching Doctora Andino seamlessly remove a very ingrown toenail, I used that clutch line as my steadfast mantra while also feeling absolutely impressed with 1) the efficacy of lidocaine—what a gem and 2) the patient’s stoic manner as he watched the entire procedure without a single comment or flinch. I recognize that I’m clearly still a rookie to direct patient care, but boy have I come a long way since the first time I shadowed a nurse and passed out approximately 10 minutes into the experience!


Next on my rambling blog agenda: touring the public hospital. While the topic of access to healthcare in the U.S./privilege in general could be discussed, analyzed and debated for literal centuries on end, I would like to “go there” for a minute. Last Wednesday I had the opportunity to tour the local public hospital (government funded) with 2 other volunteers. The C.E. staff that took us reminded us to “arrange our faces” and not take photos of what they thought might be a shock to our (very privileged) U.S. lenses while observing the stark differences in resources, amenities, realities etc of the public hospital compared to what we’re used to at home. Since I had visited my host brother in a public hospital in Peru I was less shocked than what I would’ve been otherwise, but it was still extremely eye opening.  I realize some of you reading this may have also spent time in or toured a government-funded hospital abroad and some might not. So, without getting lost in the aesthetic/technological/surface-level details, my general initial observations were obviously centered around the overall lack of resources. Patients and their families are responsible for buying most gauze, cotton balls, alcohol wipes, meals, saline, tubing, needles, etc—it’s essentially BYOS (bring your own supplies), equipped with technology that is probably considered about 30 years outdated by most U.S. standards. Yes, this poses a whole slew of difficulties when it comes to accessing care and treatment, and many evidence based practice scholars could crank out infinite dissertations on these problems associated with risk of infection, standards and quality of care, etc, but that’s not what struck me as the “shocking” part of the public hospital tour. (That’s not to say that EBP isn’t worth considering or maintaining even in low-resource settings)


What stood out to me is the simple truth that whether you’re in the beautiful new Cambridge towers at UKHS in Kansas City or at this hot, crowded hospital—medicine is medicine! And that’s exactly what the doctors, nurses, lab techs, aides, etc show up to do every day here in Honduras, even when they haven’t gotten paid in 2 months due to any number of governmental challenges. To serve their patients and do the absolute best they can with what they’ve got. To waste as little as possible. To be resourceful and creative in their approach to diagnosis and treatment with the limited resources available to them. No, they don’t have access to many supplies we would (thankfully) consider basic and essential in an emergency room at home in the U.S., but when someone wrecks their motorcycle on the windy, two-lane road on the island and ends up in Roatan’s public ER, those doctors, nurses, etc will provide thorough and effective care no matter what. They’re excellent at what they do despite the unimaginable challenges they face, and to assume anything less or spend too much time gawking at the lack of resources is a huge misjudgment. On the ride to the public hospital, I had mentally prepared myself for the aesthetic/surface-level “shocks” of what we might see. I didn’t even consider the potential to walk away thoroughly impressed by all that can be and IS done there on a daily basis around the clock, and that was my humbling error. I’m still reeling with respect for those healthcare professionals and the tough work they pull off every minute of every day!



Anyway, I’m continuing to be blown away by those from whom I get to learn every day (staff and patients) and genuinely loving this experience. How did I get so lucky?


My 8-year-old laptop is on its last leg and radiating so much fiery heat that I better take a hint and end my novel here. More to come later this week!


Currently reading: Body of Work (Meditations of Mortality From the Human Anatomy Lab) by Christine Montross.

Week 1

June 29th, 2019 by Rachel Loder
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Greetings from Sandy Bay, Roatan! My first week here has been incredible. I arrived Monday afternoon, and started the 8am-4pm rotation at the clinic on Tuesday with the Pediatric nurse, Everlin. In the morning, the appointments are first come first serve, so people come from all around the island sometimes as early as 5am to ensure they’re on the list of patients to be seen. The afternoon is mostly filled with scheduled appointments and a few “urgent care”-esque visits peppered in. Pun intended, because I watched with admiration at the resourcefulness of the pediatrician and nurse Everlin as they attempted to remove a seed from a three-year-old’s nose by wafting pepper under her nose, hoping to force a sneeze & thus expel the seed. The pepper didn’t do the job (a combination of a patient mother, proper positioning and a small instrument did), but it was yet another shining example of the creativity I’ve observed the clinic staff use to get the job done. While the clinic receives gracious donations of supplies and funds to purchase supplies, the resources aren’t as abundant as they are in most U.S. hospitals & clinics, and I truly admire the ways in which the staff adapts to these challenges while still providing excellent care for all patients. I have so much to learn from them in the coming weeks!


Smiling ear-to-ear for the sweet, sweet air conditioning inside parts of the clinic!

There are currently around 7 other volunteers/students at the clinic right now, and the administrative staff assigns us to an area of the clinic for a week at a time. As a nursing student, my primary role is to observe and learn alongside the nurses at Clínica Esperanza, and assist with random tasks within my scope of practice. An example of this included holding down a child while the nurse and pediatrician drained a large abscess! Dreamy 🙂 I’ve assisted the nurse with triaging patients, sterilizing equipment, cleaning toys, finishing nebulizer treatments, etc. and am eager to see where I am assigned next week! The community health nurse is out of the office for a few weeks, but I can’t wait to pick her brain and learn more about the prevention and education efforts in which her team is involved.


Disclaimer: Though I’m considered a “volunteer” by the clinic, my main focus is to observe and learn (while making myself useful whenever possible/appropriate). The clinic is fully staffed with excellent Honduran healthcare professionals including family med docs, a pediatrician, an OBGYN, a dentist, a dental hygienist, a doctor focused on diabetes, 4 nurses, etc, who alllll know how to do what they do better than any unlicensed “volunteer” so I’m not here to move mountains but rather learn from their work within a new context. I appreciate the enthusiasm & encouragement from those who have reached out with praise but really I’m just here to learn from these experts who are much more worthy of the kudos!


All in all, this has been quite the change of pace from the Transplant ICU, but has stretched my mind in different ways, proving to be a wonderful learning experience thus far. While most people here speak both English and Spanish (Roatan has an interesting history-check it out!) Spanish is predominately used at the clinic, and I feel so “at home” hearing this beautiful mixture of Spanish and English being used simultaneously. I have to really fine tune my ears to a different frequency to understand the Caribbean English spoken amongst staff, and it’s been a fascinating challenge. The inevitably blaring music (because this is still Central America, baby!) in any taxi is quite the Russian roulette of either reggaeton or simply reaage, which is precisely my favorite combination! Will 6 weeks be enough?


The island itself is stunning, and the extracurricular activities are hard to beat! I was fortunate to cross paths with my dad as he returned to Roatan from his INMED rotation at Hospital Loma de Luz (head over to https://inmedblogs.us/bryceloder/ for the good writing, humor & fascinating stories), and we enjoyed snorkeling and walking around West End/Half Moon Bay. On Thursday, I found a stand up paddleboard shop and had a great time paddling around the surrounding bays with the owner, Anita. (I could barely move on Friday, but that’s a minor detail…..) Also worth mentioning is her husband’s pet monkey, Solomon, who rides their dog around like a jockey. (pics to come)


This weekend’s activities include: sloths, snorkeling, attending a hermit crab race where betting proceeds benefit an AIDS clinic, a nighttime snorkel, lots of reading, and time on the beach. “Not in Kansas anymore!” *cue eye rolls, I know.


Currently reading: Cutting for Stone by Abraham Verghese (so far, so so good!)

Post snorkel, pre frisbee in Half Moon Bay
Half Moon Bay

Introducing Myself

May 15th, 2019 by INMED
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Hello! My name is Rachel Loder. I am a nursing student at University of Kansas School of Nursing, and I’m starting my INMED service-learning experience at Clinica Esperanza in Honduras beginning in June, 2019.