February 26th, 2022 by seldondavis
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          My last two weeks at the clinic flew by quicker than the first two. Having gotten comfortable in my role only accelerated this process. The experience I had at Clinica Esperanza was an unforgettable and moving one, and one that I leave knowing fully well that I will return. From a clinical standpoint I don’t have too much to add that differs from my prior posts, as these weeks were more of the same. More GERD, more infections and sniffles, and more Hypertension and Diabetes. During my time here two separate groups of nursing students came to volunteer, both groups from Ameritech University. It was great to be able to share such a valuable hands-on experience with such eager hard working individuals. While I was in the Clinic each and every day, many of these students were able to venture out into the Community of La Colonia with the Community Health Worker. From what I’ve heard these were eye-opening and enlightening moments for many of them, and something I hope to share in when I return. Their hard work is part of why the Clinic plays the role it does within the community, and helps to reaffirm to the local population why and who for the clinic was built in the first place.

          One key event in the last two weeks however was the “Bush Medicine” presentation lead by the mother of one of the volunteer coordinators. At this presentation we learned various medicinal applications to a wide variety of the plants and herbs found on the island, and were privy to long passed traditions present here on the island long before the first cruise ship arrived. For instance using eucalyptus as an expectorant, to aid in alleviating symptoms of a cough. Using flax to alleviate gastrointestinal upset and inflammation, in gastritis. Using aloe vera for a wide variety of means, such as with gastritis, colitis, and skin irritation following a burn or allergic reaction. Using prickly pear cactus to assist in diabetes control. Using Papaya to elevate “las defenses”, or romaine lettuce to ease a stomach ache and even a headache. For fever and cough one might use coconut oil, oregano leaves, and garlic. They even have a plant called the “stone breaker” that can help in flushing kidney stones. Potatoes or gastritis, garlic for asthma and circulation issues, onion for cough, lime or lemongrass tea for cold or fever, sapote seeds for acne, and even an elaborate “COVID Tea” recipe our professor admitted to using daily during the heat of the pandemic. To speak with her so candidly and learn of a foreign world slowly being forgotten due to the convenience of our newer world was an amazing experience, plus she was hands down one of the best cooks I have ever met. The homemade baleada she made us was simply delectable, and at her home in her kitchen I had one of the most authentic Roatan culinary experiences. A beautiful person indeed, and an extremely important member of her community. I’ll leave you here with a quote of hers from that evening, “I don’t change my kitchen, my island, my people, for nothing.”

     Hasta Pronto Roatan.

February 15th, 2022 by seldondavis
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It’s a bit scary to think about how fast time is flying, two weeks down and two more to go. This week I felt much more in my element, and was able to increase my efficiency in the Clinic. Having been able to see patients independently and present them to Dr. Canales has helped me monumentally with my Spanish, and each day feels a little easier. Of course there are still some conversations where I know my language barrier presents a barrier to care, and in these moments he is always available to help me and translate. For the patients I can handle independently, he gives me room to work and trusts my intuition. Management of things like chronic medication refills, musculoskeletal aches and pains, GERD, or upper respiratory/urinary tract infections allows me to fill in heavily. I’ve really come to see this the last week, and its helped me feel more integral to the work he and the clinic are doing. To think I’m able to help alleviate the patient load for him and the other Fam Med doc down here gives me more appreciation to the hard work of the last four years. The patient care conversations have also become easier and easier, and without a doubt the experience in Ashley Regional Hospital during my third year prepared me for this. The verbal exercise of engaging a patient gets easier with practice, but it was humbling after having the safety rug of my native tongue being pulled out. While awkward at first, just like anything, its easier with practice. Feelings of apprehension and anxiety when entering a new and unfamiliar environment are normal, but it’s for this reason that getting out of your own bubble is so important. It’s easy to get caught up in your own day to day, with your own stresses and battles, and to in turn reflect these onto others while turning a blind eye to what their experience may entail. Getting out of your comfort zone, getting a little uncomfortable, exposing yourself to the difficulties others face, remains an important part of these trips.

It’s natural to compare, experience, environment, and opportunity. It helps me gain perspective, and one perspective I’ve gleaned so far is that we’re not that different back home from here. A large portion of our patients present for management of chronic conditions, like hypertension and diabetes. During my family medicine rotation we saw exactly this. The differences arise from the clinics place in the bedrock of this community. These people here rely on the clinic to get their medications at a reasonable price, and with many struggling financially they would be out of luck if the clinic found themselves without the pharmaceutical donations they so desperately need. Irbesartan, hydrochlorothiazide, aspirin, amlodipine, metoprolol, and metformin. These drugs are as essential here as they are back home, but the key difference is availability. Availability skewed by a variety of socioeconomic factors. In this vein many struggle, and their health is what may fall by the wayside. There have been a few firsts here. The first time I saw a blood pressure of 230/120, with a patient casually sitting there smiling at me, saying they feel great. Other BP’s of 190/110, 190/120, 210/120, and 170/100 make me see the prevalence yet undertreatment of this issue. Its as easy as taking their medication every day, but getting that medication every month presents their barrier. Roatan is also a cruise ship island, so the days that cruise ships dock in the port bring with them passengers ready to spend money. The Islanders know this, and each day a cruise ship is here we have much less patients. The financial opportunity takes precedence when the focus is to feed your family for the next month, rather than take medication to prevent a problem years down the road. Unfortunately one thing leads to another, and a missed appointment may turn into several. I had one patient this last week, and English speaking Islander with Garifuna roots, who knew he had high blood pressure and needed medication, but has gone without it for the last four years. He expressed understanding about his condition, and relayed the ways in which he has tried to change his lifestyle in the last few years to no avail. His symptoms of palpitations, tachycardia, easily becoming winded with little activity, and having to rest several times just climbing the hill to the clinic give way to anxiety over his, and his children’s, future. I tell these patients not to sweat over spilled milk, and to not focus on a less than perfect past. I tell them to focus on what they can control, and to build a better tomorrow. We will see him again next week, with 5 days worth of BP values collected to confirm his diagnosis, or at least I hope we will see him next week. Its tough to know sometimes.

Amigdalitis, or the Spanish word for Tonsillitis, and how much I’ve seen it here came as a shock. The amount of adult patients I have treated here for this rivals my experience in pediatrics back in the Dinosaur Land Pediatrics Clinic from Vernal, UT. Many young adults, but also many middle aged individuals as well. One patient was 62 years old, and she actually had the largest tonsils I had ever seen. I took the time to pull a fellow volunteer, a nursing student, aside to show her. These tonsils were massive. Easy to diagnose and easy to treat, these patients are usually a quick in and out, but its funny to me to think how drastically people back home hold themselves in contrast to the Hondurans here. In many ways we are different, but in many ways we are the same. The patient back home got Augmentin, as does the patient here. I tell the American to take it with food, as I do the Honduran. I tell them “Si no se siente bien despues una semana, regresa aqui” (if you don’t feel better after a week, come back), just the same. Other issues mirror themselves from home and abroad. Upper respiratory and urinary tract infections are just as common here. Aches and pains are also a common shared complaint after a lifetime of work, and GERD is as present here as it is back home. One other thing I have learned from Dr. Canales is that we offer almost each patient vitamins, and he came to explain that often times its not for the patient only but the patients family at large. Or even the neighbors who may have fallen on hard times. This helped me further appreciate the role of the clinic, and how essential its place is to the “La Colonia” community whom we serve. While this week doesn’t feature any dramatic stories like suturing and the lights cutting out, or being surrounded by a school of surgeonfish, each day has a beauty to it that will leave me sad once I depart. Attached are some pictures from exploring Punta Gorda and Camp Bay, a bit of a trek out there but definitely worth the time.

February 6th, 2022 by seldondavis
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The week started as any first clinic day does, with a tour. I arrive at Clinica Esperanza early to get a lay of the land. I am greeted by the lovely volunteer coordinator, Beiry, who proceeds to show me around. On the second floor we have the Pediatrics clinic, the OB/GYN area, the Diabetes doctor (one doctor managing a program with 500+ patients, wow), and the administrative offices. On the ground floor we have the family medicine clinic, triage, the pharmacy, a treatment room, and the stock room. Pretty straight forward. I am to be working with Dr. Fernando Canales this week, an awesome young Honduran doctor from San Pedro Sula trained in a variety of Honduran and Guatemalan cities, notably San Pedro Sula and Tegucigalpa. He provides all levels of family medicine care, but has interests similar to mine. He aims to study Orthopedic Surgery in a few years in Madrid, so this was a bonding point for us for sure.

I was welcomed with open arms by the clinics staff, and even more so by the patients, who were more than happy to put up with my rudimentary Spanish. Others may shy away from the laughter that one’s attempts elicit, but honestly I kinda loved it. Bringing humor and most importantly comfort into the hospital/clinic is sometimes a difficult task, but if its as easy as the patient laughing at the Gringo trying to speak Spanish then I’m all for it. Plus I’ve gotten some very necessary Medical Spanish practice, and the only way to build a skill like that is to get out of my comfort zone and stretch my abilities through these conversations. Only then can I learn what I don’t know and build on it. I’d like to throw a quick shout out to Dr. Mark Wardle, my medical school mentor who I first began a Medical Spanish course with as a 1st year prior to a Medical Mission Spring Break trip to Ecuador. The same Dr. Wardle who wrote me a letter of recommendation for my INMED application. I think he’ll be happy to read that this week for the first time ever I did a full patient encounter purely in Spanish. I’m not fluent, or even close, but I think I can finally call myself Intermediate.

This week was an enlightening and eye-opening experience, for many of the same reasons that I came to love International Service or Medical Mission trips in the first place. Coming to a developing country, volunteering to assist in their healthcare, providing care to a community that really needs you, and using your skills and knowledge for a purpose and cause much greater than yourself. Each time I embark on a journey like this it only reminds me why I do this and cements my love for these trips. Here I can think of no better example than a story. As my patient leans over on his left arm, elbow and forearm flat, planted on the bed, hand draped in a sterile gown with his gashed (and likely fractured) pinky exposed, he begins to weep. I look up from the sutures I’m throwing and ask if he is okay. Choking back tears and covering his face, I only hear one word, “gracias”.

Allow me to rewind. I am seeing a patient for a routine checkup, a medication refill for their chronic hypertension. Un paciente en buena salud y sin otra sintomas, or a patient in good health without other symptoms. I finish adding their prescriptions to the system, have Dr. Canales check my work, and then send the note and the meds through to the Pharmacy. Que pase un buen dia, I say to the patient, as another doc at the clinic, Dr. Natan Webster, tells me of a pinky laceration that requires closure and asks if I’d like to assist. My eyes beam a little when I think of the opportunity to get my hands dirty in any procedure, especially a finger lac, as a hopeful future orthopedic surgeon I hop on quickly. With a nod from my preceptor I’m on my way. I find the man in treatment room, middle aged with dirty clothes, clearly having came directly from work, gripping his left wrist tightly. At the end of his left pinky is a circular gash, maybe 5 mm from the fingertip, extending from the middle of his nail around into his fingerprint, almost half the circumference of the digit. There’s always a whoa moment for me when I see a dramatic wound, and this was no exception. I ask what happened and he tells Dr. Webster and I of the rock that dropped on it at work as he was shifting a heavy load, and asks if I think he can return to work.

The next few thoughts I had brought with them excitement for the future, as I realized how much I actually learned these last few months on my Orthopedic Surgery Audition Rotations. Dr. Webster asks what I want to do, so I tell him. Antibiotics, tetanus shot, digital nerve block, irrigation and cleaning of the wound, debridement of dead tissue and the half-attached nail chunks, wound sterilization, primary closure, X-ray of the digit, and follow up 7-10 days later in clinic for suture removal. With a few nods he agrees with my overall plan. I arrange my supplies and we begin. First with our digital nerve block, something I had learned first hand from a 2nd year resident at Montefiore in the Bronx a few weeks prior. Lidocaine drawn up and injected between the web of the 4th and 5th digits, and the only part of the procedure where the patient drew back from pain. After a few more minutes we irrigate profusely, I pick out the small rocks and dead chunks, and then get my sterile gloves on. After poking around a bit and confirming the anesthetic works, I begin to suture. With quite a bit of practice up until now, I find myself humming along casually as I work. A few horizontal mattress sutures circling his finger and the wound begins to come together nicely. I get to the nail where the damage is a bit worse. As I circle back to the nailbed, with the worst part of the laceration already closed, my patient begins to cry. Worried about pain or him passing out I pull back, protecting my needle, and ask if he’s alright. Then I hear the one word, “gracias”, to which I respond “de nada mi amigo, es porque estoy aqui”. My Spanish, albeit broken Spanish, tries to convey “Its nothing my friend, its why I’m here”. With a mask-covered smile, I begin to throw a suture when all of the sudden I hear a click, as all the lights and power cut out and the room goes dark. I chuckle as I look up to Dr. Webster, who then pulls out his phone and turns on his flashlight. With his flashlight I finish one simple interrupted until a minute later the power kicks back on. Luckily the clinic has its own backup generator. One more suture, some cleaning, a nice bandage later, and we’re done and onto the next patient.

Fast forward a bit, and later that day I go on a scuba dive with two other volunteers. A nice little dive to a not-so-far offshore reef. A reef I had played around twice in already. Any scuba experience I’ve realized is unique and incomparable to priors, but this one, after the events of that day, features a moment I’ll never forget. At this point I’m pretty comfortable in the water, so I let my thoughts breathe into the surroundings around me, losing track of time. Never so quickly can an hour pass you by. As I turn a corner in the reef I spot a school of fish quite a few yards off, numbering around a hundred I estimated, coming straight towards me. My thoughts turn to my breath, as I try to inhale and exhale as slowly as possible, maintaining my depth without a kick or flutter of my fins. Without any motion save for my heartbeat and the stretch of my lungs, this school of fish, black and blue surgeonfish, swims right next to me. I find myself encompassed by this moving mass, and I can only picture the size of the smile I had on my face. A minute later and they proceed on their way. I’ll include a picture above for reference. You can determine a surgeonfish by a very unique spine, special to surgeonfish, seen in the pic above (its the yellow spot just in front of the tailfin). They have become a favorite of mine to spot around here while diving. I’m not one for signs, but as I hope to match into Orthopedic Surgery with Match day around the corner in a few weeks, I sure hope this was one. Another fish I’ve come to love is the Queen Angelfish (the yellow and blue one), one with quite a bit a beauty.

We end the night with a bon fire and smores at the Roatan Refuge, where another pic below was taken with the kids of the family hosting us. I couldn’t imagine a better day, and honestly I’m not sure my imagination could even come close.

Que una vida.

January 30th, 2022 by seldondavis
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Bienvenidos!

So I arrived in Roatan, Honduras 11 days ago and its been a phenomenal experience since. Prior to this trip I wasn’t a diver, but now I’m happy to say I’m both PADI Open and Advanced Open Water Diver certified. With Roatan featuring the second largest reef in the world, only second to the Australia’s Great Barrier reef, this place is a mecca for divers. After these few days its obvious to see why. This was worth every penny, and I will definitely be recommending to all those who will listen that everybody who is physically capable should try their hand at scuba diving. Those first few breaths underwater are unreal, but the breath is easily outmatched by the beauty of the underwater world. Words simply don’t do it justice.

I come fresh off of my last dive, a night dive, to the same reef (Lighthouse Reef) that I actually had my first Open Water dive at, where I apparently first became “Scuba Seldon”. Experiencing the underwater world at night was a different ball game all together, and while surreal it was also a bit scary at first. I definitely found myself less lackadaisical about exploring and floating off a bit from my instructor. Lots of beautiful fish, active sea urchins, a few crabs, a gigantic slumbering turtle, two crazy looking eels, and one very grumpy looking lionfish. I will admit I felt bad about how many fish I startled from their sleep with my flashlight. Hands down the best part of the night dive however was the last 10 minutes. We entered a sandy patch close to the boat, got settled, shut off all of our lights, and let our eyes adjust. Once adjusted we were engulfed by the bioluminescence of the world around us, and we saw what the locals call the “string of pearls”. Neon lit turquoise dots separated by an inch, cascading vertically from top to bottom, point blank in front of your eyes and for yards past as far as the eye could see. Again words or even pictures would not do this sight justice, it looked like something straight out of the movie Avatar. Breathtaking and memorable, I’ll cherish that unique experience for many years to come.

I’ve also done quite a bit of exploring on the Island so far, and I have many pictures to highlight some of these days. The pictures will go further than my description but unfortunately on this Honduras WiFi I’m having difficulties with uploads. I’ll leave you with a few things that actually transferred. I’m happy to say I’ve seen much, from the beautiful yet touristy areas of West End and West Bay to the honest Honduran living conditions of Coxen Hole, to Consolation Bight and Flowers Bay. I’ve spoken bluntly with locals in some of these regions, from the young adult working hard crafting bracelets, trinkets, and necklaces from Honduran gems at the same stall outside the same restaurant all day every day (I literally never saw him not there, all 11 days) who will be bringing his wages back to his family on the mainland in a few days, to the security guard at my hostel who told me of his wife and three children, one with down syndrome, and his inability to provide stable food for them on a weekly basis due to the inadequacies of his security guard wages when met with higher food costs. These sights and conversations have provided enlightening context on a part of Roatan few tourists are exposed to.

Last but not least I’ll leave you with the sunsets, and what a sight they have been. These sunsets are specifically from the West End strip, so I’m excited to add some Sandy Bay sunsets in the weeks to come (for reference Sandy Bay is closer to Clinica Esperanza, where I’ll be helping out for the month). I’ve easily spent at least an hour each day or so watching as the sun rolled back into the clouds and disappeared into the horizon, and I wouldn’t have had it any other way.

Qué vida.

January 13th, 2022 by INMED
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Hello! My name is Seldon Davis. I am a Rocky Vista University College of Osteopathic Medicine student, and I’m starting my INMED service-learning experience at Clinica Esperanza in Honduras beginning in February 2022.