October 29th, 2021 by Rachel Somers
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When George came in to the clinic, he was looking for a second opinion. The day before, a battery had exploded in front of him, damaging his eyes and causing vision loss in one eye. He had gone to the public emergency room and been told he was unlikely to regain his vision. That wasn’t a diagnosis George was willing to accept, so he came to Clinica Esperanza. We couldn’t do much for him at the clinic other than give him a referral to an ophthalmologist, but we did give him a shot for the pain and a pair of sunglasses to help protect his eyes from the bright, tropical sun. The brief interaction I had with him, though, showed him to be an uncommonly positive person. He wasn’t worried or frustrated. In fact, the only thing he told me was that he knew that God was going to heal his eye. I did the only thing I could do for him in the middle of a busy day: I said “Amen” and wished him the best.  He left with the same positive attitude he came in with, expressing his thanks for the little we were able to do.  

One of the down sides of taking care of people on an emergency basis is that you seldom learn the outcome of the story. While that’s just an accepted part of the job, every once in a while I wonder how someone did. Imagine my surprise when I went to a local church the following Sunday, and saw George sitting in the congregation! Not only that, but he got up and shared his story with the church. He shared how he asked his friends to pray for a miracle, and went to see the ophthalmologist with only a few hundred lempira in his pocket, and hope for a different report about his vision. The ophthalmologist treated his eye, which included the removal of some debris, and told George that he could expect recovery of his vision. Along with that, he accepted as payment the lempira that George had on him, rather than requiring the full payment, which would have been well over one thousand lempira. And indeed, by that Sunday, George was able to report that his eye was healing and his vision was improving!

I didn’t see George again, but his story and his outlook will stick in my memory for a good long time…

October 14th, 2021 by Rachel Somers
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In my first post I mentioned that the clinic provides care regardless of someone’s ability to pay. That sounds lovely, doesn’t it? But it has a much greater impact than you might think.

Healthcare in Honduras isn’t like it is in the States. No surprise there, I’m sure. But in Honduras there aren’t EMTALA laws protecting patients. EMTALA is what ensures that everyone gets emergency treatment regardless of insurance or lack thereof. Where I work (and I imagine it’s the same elsewhere), the staff at registration aren’t even allowed to ask for insurance or payment information until the patient has been seen by a provider.

In Honduras, you pay up front. I’ve heard it’s the same in other countries, so this won’t be a surprise to some of you. But it still takes a bit of work to wrap my mind around the concept, so I figured it would be worth explaining a bit. Because not only do you have to pay up front, you often have to go and buy your own supplies. Imagine going to the emergency room or urgent care because you’d cut yourself and needed stitches. You go in, the doctor takes a look at it, and then says, “I’ll need gauze, sutures, sterile saline, gloves and needles. Here’s the list.” Now you or a family member has to go to the nearest pharmacy and buy the supplies, bring them back, and then you’ll get treated. Or imagine that you’re going there because you’re vomiting and dehydrated, but they don’t have the medication or the syringe to draw it up in. So a trip to the pharmacy again to get what they need to treat you, and back you go. I don’t want to think about what happens if you are having a heart attack or stroke or were in a bad accident…

One of the nurses at the clinic used to work at the public hospital and told me a bit about it. She said the hospital would have supplies delivered once every 2 weeks, but it was never enough, so they’d always run out of things. She took to buying certain supplies and keeping them in her bag so she could at least treat her patients. It made me think of a friend of mine who’s a music teacher. She’s put a lot of her own money towards her classroom and supplies, more than she’ll ever really get reimbursed for. Imagine if nurses had to do the same? In places like Honduras, that could be true.

So imagine that instead, you go to Clinica Esperanza (“esperanza” is Spanish for “hope,” by the way). You are seen by the doctor, and if you need treatment there, you get it. Thanks to the generosity of donors, the clinic has supplies, so you don’t have to go out and buy anything first. And when it’s all over, you can leave with a month’s supply of your prescriptions. If you can pay, you pay, and if you can’t, you’ll still be taken care of.

October 11th, 2021 by Rachel Somers
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Before I go too much farther in this blog, I want to take a moment to discuss something about travel. Traveling to new countries and climates can ask a lot of you, as you adjust and adapt to new situations. Sometimes you find that you need to accept the inevitable, some aspect of life in this new setting that you’re just not going to change. And in this instance, I’m talking about bugs.

Sure, I’ve dealt with bugs before. They’re everywhere, even in New England. We’ve got some nasty ones too. Black-flies and mosquitoes will eat you alive, deer flies will leave you with welts, and ticks will burrow in, suck you dry and give you Lyme’s disease or anaplasmosis. But as a rule, you can keep bugs at bay. Not so here.

I decided on this trip that I just needed to accept that bugs are everywhere. Ants are the most common, but of course there are the mosquitoes and the “no-see-ums.” And the “no-see-ums” in Roatán aren’t like the ones I’ve encountered before! Countless times I’d feel a little painful prick on my arm or leg only to look down and find that the apparent speck of dirt on my skin was in fact a biting insect that has now left its mark and flown off. Dagnabbit! Even DEET only did so much to deter them. I had a recommendation from Susie to get picaridin lotion, which doesn’t have the noxious odor of DEET and can last up to 12 hours. Next time, that’s exactly what I’m bringing.

Less awful are the beetles that come in. Heidy and I took to leaving the door to our balcony open to get a better cross breeze. Since we’re on the second floor, it’s less of a concern, but there isn’t a screen in that door, so you need to decide if you’d rather keep some bugs out or enjoy the breeze. Regardless of doors or screens, some bugs inevitably find a way in, therefore the breeze is usually what wins out. Because of this, there are always a couple small beetles hanging out in the apartment. They’re apparently short lived, or else they make their way in just to die, because I can sweep their carcasses out by the next morning.

Being resigned to the presence of bugs doesn’t mean I let them stay, though. When Heidy spotted the 2 inch long cockroach on the kitchen window curtain, I was delighted that the rod lifts off easily so I could take the whole thing outside and shake the roach off. And when the kitchen floor was covered with maggots one morning because we hadn’t taken out the trash for a couple days, I grabbed the broom and got to work. I would like to point out that the trash was neither full nor that disgusting, and it did have a lid. The flies are just more adept at getting in places that one might expect. And apparently the maggots were bored with staying in one location. Sweeping maggots is about as fun as herding cats. Those guys are fast.

You know, it’s surprising what ER nursing can prepare you for. Having encountered maggots on foot wounds on more than one occasion made dealing with them in the kitchen much easier that it otherwise would’ve been. Even so, you better believe that I changed the trash far more frequently after that incident.

October 9th, 2021 by Rachel Somers
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Clinic days had a nice routine to them.  My roommate Heidy and I would get picked up by Martha in one of the clinic’s bright orange vans.  If I was the first to notice Martha’s arrival, sometimes I would just announce it with the word “Naranja!” (“Orange” in Spanish).  Martha would always greet us with a her bright smile and some morning chat on our way to the clinic.  Martha spent years living in the USA, but is now back living on Roatán, and working as an administrative assistant at Clinica Esperanza.

We would arrive at the clinic at 8 AM, and always a full waiting area, inside and out.  The clinic is set up where the pediatric, diabetic and OB/Gyn offices are upstairs, and the general medicine, pharmacy and laboratory are on the lower level.  Each floor has its own indoor waiting room with covered porches outside for overflow.  Mornings are always the busiest, especially Mondays.  Mid-week might be a bit slower if any cruise ships had arrived, and cruise ships mean work!  During my three weeks I spent time in every area except the lab and the OB/Gyn office.  Oh!  How could I forget?!  The lower level also houses their dental room and the treatment room.  That’s right, the clinic also provides dental care!  All they need now is an eye doctor, and they’ll really have things covered.   (Any optometrists/ophthalmologists looking to relocate to a tropical island, I’m sure they’ll be glad to have you!)

According to Miss Peggy, the most common health concerns for adults are hypertension, diabetes and gastritis.  For children, they are diarrhea/dehydration, skin issues (rashes, etc) and respiratory issues.  From the time I spent there I can appreciate the truth of that.  I took more high blood pressure readings in those three weeks than I’ve ever done in a similar time frame, with multiple patients having readings in the 200s for their systolic pressures.  Even women in their 30s often had systolic pressures well over 160.  Severely hypertensive patients would be brought to the doctors’ attention, and would get IV medications in the treatment room to help get their pressure down to a slightly less shocking number.  And as for diabetes…  I think I’ll go into that more at a later date, but the majority of diabetic patients had blood sugar levels ranging from 200-500.  Diabetes isn’t poorly controlled; it runs rampant.

I didn’t spend as much time in pediatrics, but when I was there I found that for the children, cough and cold like symptoms were very frequent.  We also had several with GI complaints, including concern for parasites.   If they had fevers, we would treat them with some acetaminophen and make sure there was space for them to wait in the air conditioned waiting room, rather than outside where the heat index could be over 100 degrees Fahrenheit.

This octopus mural portrays the clinic well! A very busy octopus, cleaning teeth, treating patients, and giving medications.

The afternoons tended to be quieter, at least from a nurse’s perspective, although the doctors and the pharmacy were usually busy right up until the end.  But there was always something to do, whether it was taking care of patients in the treatment room, helping out in pharmacy, or sorting through donations.  The end of the day fell between 4 and 5 pm, when Martha and the orange van were ready to take us home.

On a completely different note, I think one of the greatest works of fiction is that roosters crow when the sun rises.  Perhaps it’s my sheltered, semi-rural upbringing that led me to believe such a thing, but spending anytime where chickens roam freely will quickly disprove that.  Roosters will crow whenever they want to, day or night.  Let’s just say that I was grateful to have an air conditioner in my room for the noise cancelling aspect as well as the cooling one.

October 2nd, 2021 by Rachel Somers
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Hello everyone, and welcome to my Roatán blog! I wanted to take a moment to introduce myself and let you know how things are going to go on this blog. Full disclosure, most of this will be written after my trip is over, and because of that I’m going to format it a bit differently. So rather than a daily/weekly update, I want to discuss things more by topic than by time. But I reserve the right to change my mind at any moment, so we’ll see how it goes!

About the Author
Friends and family reading this will already know who I am and what I do, but just in case anyone else is reading, here’s a little bit about me…

I am a nurse, living and working in New Hampshire. Originally from Vermont, I’m a true northerner – I even love snow and cold weather! Despite growing up in small-town New England, I’ve always loved other cultures and languages, and had a staple diet of reading missionary biographies in my teenage years. So when it came time to go to college, I chose to major in Biology and Intercultural Studies, with the vague goal of being able to work overseas, somehow, somewhere, someday. There was a seven year journey after graduation that led me to returning to school for nursing. I have been a nurse now for nearly seven years, starting in an inpatient cardiology unit before moving on to the emergency department. It was always on my mind to prepare myself to take my nursing skills overseas, so when I heard about INMED, I jumped at the chance to get some practical training. And now I’m here in Roatán, Honduras, for a three week service learning experience at Clinica Esperanza.

Location
Roatán is one of the Bay Islands, or Islas de la Bahia, off the eastern coast of Honduras. It was originally a British Protectorate, and has some famous pirates associated with its history, including John Coxon (after whom the main city of Coxen Hole is named), and Captain Morgan.  Now the islands, including Útila and Guanaja, belong to Honduras. But because of the British influence (and the current influence of massive tourism), many of the native islanders speak English and Creole. I have certainly encountered more English speakers here than I have in any other Spanish speaking country! Many people from the mainland of Honduras have moved over here due to the tourism industry. Roatán is famous for its beaches and reefs, so many tourists come for snorkeling and scuba diving, and it is also a cruise ship destination. As you can imagine with any tourism based economy, the Bay Islands have been hard hit by COVID-19. While things are slowly opening back up, a significant amount of people have been without a stable income since the beginning of 2020.

Clinica Esperanza is a private clinic run by Peggy Stranges, an American nurse who moved to Roatán about 20 years ago, and subsequently founded this clinic due to the need for medical care she encountered here. Clinica Esperanza now provides care to anyone and everyone, regardless of ability to pay, and easily sees over 100 patients daily. They provide dental, pediatric, OB/GYN, diabetic and general health care. You can learn more about the clinic at their website: http://clinicaesperanza.org. I encourage you to check it out – the clinic does an amazing work here, and is staffed by many amazing people.

Cast of Characters
Peggy Stranges: founder of Clinica Esperanza, and basically a legend
Martha: administrative assistant and chauffeur estraordinaire
Beiry: Peggy’s right-hand woman and manages a lot of the clinic’s operations
Aidylet, Everlie, Lic, Greicy, Lena and Karla: fantastic nurses at the clinic
Dr. Nathan and Dra. Heidy: “servicio social” doctors who are here at the clinic for 6
months as part of their “give back” after having completed their medical training.
Dra. Susanna: diabetic specialist
Dra. Laura and Dr. Alfredo: general medicine/primary care providers
Dr. Rafael: pediatrician
Dra. Francia: OB/gyn provider
Dra. Shironi: dentist
Dra. Marjori: pharmacist
Jessie and Christopher: receptionists
Gladis: housekeeper
Julio: main security guard
Allison: administrative assistant
Susie: in her own words, “I do whatever job they need.”
Nic and Adrian: hosts at the “Roatán Refuge”
John and Bev: networkers, guides, and all around wonderful people

Hopefully you’ll get to know some of these people a little better throughout the rest of this blog

September 14th, 2021 by INMED
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Hello! My name is Rachel Somers. I am a graduate nursing student, and I’m starting my INMED service-learning experience at Clinica Esperanza in Honduras in September 2021.