Posts filed under ‘Honduras)’
Hadia and I just completed our second week at Clinica Esperanza. Our attending pediatrician was gone for 4 days (as there was a ventilator course for the new pediatric hospital) so aside from a family medicine attending with a rather busy schedule, we were on our own. The most interesting case I saw this week was one I was relieved that I consulted him on, as it turned out to be a case of Strongyloides! We also saw a case of Chickenpox this week; unfortunately families are told their kids “have had all their vaccinations” so this girl’s mother was puzzled as to how her child developed chicken pox when she had been “fully” vaccinated. We later discovered after talking to our attending that the place she was immunized at doesn’t carry the varicella vaccine even though it does exist on the island.
It’s impressive to me how many children we see for colds and other viral syndromes when families are waiting so many hours to be seen. I’m told some families come in as early as 5:00 AM to get a spot and the earliest we start seeing patients is 8 AM. By the time we show up to work, the indoor and outdoor waiting areas are pretty full. After learning more about the prevalence of mortality from pneumonia and diarrhea in developing countries, I now have a better understanding of why patients must present for what seem to be rather benign illnesses. Interestingly, one of my families presented again this week after I saw them for a URI last week. She said she took her baby to the hospital for her 6-month vaccines the prior day and they said the baby had noisy breathing and was too sick to receive the vaccines. They sent her home with loratadine and PO albuterol! She did not feel comfortable giving them and returned to see what our thoughts were, at which time the baby sounded great and was afebrile; we advised against either medication and to proceed with the vaccines the next day. Fortunately, Honduras has been quite strict about making sure children have their vaccines so we don’t have to really convince families to get them done(especially since we mostly just carry the flu vaccine for high-risk individuals and have to send them off-site). It felt nice to know she trusted us and didn’t want to give her child any medications she was unfamiliar with without checking with us.
This week there is also an Emergency Room doctor from the US who visits the clinic about half of each year so it has been nice to see what his take is on some of the local practices. I also enjoy working with the pediatrician and having the chance to exchange stories about how we each manage certain conditions in our respective countries and teaching each other our respective languages. I continue to learn about alternatives for medications we would like to use but don’t have; fortunately many rather young kids swallow pills out here but sometimes we have them just crush the adult pills if they can’t. We also can send them to a pharmacy with a prescription if it’s something we don’t carry but they may not be able to afford it.
We just had our second and last weekend to enjoy the beautiful island; it has been rather hot and humid but fortunately it looks like the rainy season is finally over for the year!
Hadia and I have just finished our first week on the beautiful island of Roatan, Honduras. We are working at Clinica Esperanza, or “Ms. Peggy’s clinic” as it is often better known on the island, referring to the nurse whose vision it was to create a clinic for the underserved residents of Roatan and has worked very hard to make it a reality. While the outpatient clinic opened nearly 5 years ago, a new pediatric inpatient unit has recently opened and this week 2 patients were admitted for dehydration; prior to that, the closest inpatient unit was within a hospital that does not even have running water. There is also a newly opened birthing unit, where there was a successful delivery this week.
Managing a clinic with limited resources has been challenging yet educational, as I have to often seek alternatives to my usual care. Sometimes I cannot offer an immediate solution as it requires a service not offered at our clinic(or possibly the entire island!) or one that exceeds the patient’s ability to pay for it. Clinica Esperanza has definitely exceeded my expectations; I have found a much larger range and quantity of medications available than I had expected to and we have a visiting lab tech who performs simple lab tests as well. We also have the luxury of having a basic electronic charting system, though they are still working out some kinks. As the pictures had suggested on their website, the clinic is clean and has nicely painted walls (with otoscopes/ophthalmoscopes mounted on them in both of the pediatric rooms!).
There are many Honduran patients(of whom the great majority do not speak English) and some English-speaking islanders as well. Many of the Honduran patients come from a nearby village of about 4,000 people referred to as “La Colonia,” where immigrants from the mainland live with limited water and electricity. The clinic has a Honduran pediatrician, Dr. Solis, who is very friendly and available to answer questions about the local practice of medicine. He doesn’t speak much English so, while I am rather fluent in Spanish, interacting with him and my patients has helped me better learn how to think and communicate in medical Spanish. I have also been learning tropical medicine and becoming quite familiar with patients wanting to “desparasitar,” a frequent chief complaint that wins them a dose of albendazole and often a one-month supply of multi-vitamins. On Friday alone I had 2 patients with GI parasites(either seen by the parent or confirmed on labs)!
Living about 10 minutes away from our clinic has really taught me how much we take simple things like roads for granted, as we often end up taking taxis for only part of our route given how rough the roads are. There is one major paved road to clinic and the rest is dirt roads, which have been a bit challenging between the tropical rainy weather we intermittently experience and ongoing construction. I feel grateful to have running water and electricity at both my home and in clinic.
It has been an exciting trip so far and we have found the people here to be very friendly and welcoming; I am looking forward to seeing what the next week holds in store for us!
Upon arrival to Clinica Esperanza, I was impressed with how new and fully stocked the clinic was. I have worked at clinics in Guatemala, Mexico, and Ecuador, and this was by far the most modern and comfortable. There were ample gloves, hand gel, towels, gowns, medications and medical supplies, which led to a safe practicing environment for both the patients and practitioners.
The patient population was made up mostly of the local colonies of the poor immigrants who settled on the islands after the major Honduras hurricanes. These “towns” are called “La Colonias.” The average income is about $3,200 per family/year and they have very little access to healthcare. There is one public hospital, at which I had the opportunity to work, and it has virtually no financial support. There is no drinking water, toilet paper, or soap, and the wards are made up of 8-10 people in a room of beds without curtains. It only costs the patients fifty cents per visit, but they may end up waiting all day without ever seeing the doctor. Therefore, there is a huge local support for Clinica Esperanza.
My experience was mostly based in the clinic. They have a new Labor and Delivery (L&D) ward, which is still awaiting licensing, so it is not yet open. I worked from 8 am – 2 pm daily, seeing both routine gyn and obstetric patients, but also the more sub-specialized Ob/Gyn patients. I managed many teen pregnancies, gestational diabetes, pregnancies complicated by malaria, multiple missed abortions and outpatient management of pyelonephritis in pregnancy. I also saw several patients with secondary amenorrhea, in which I had to decide if a certain lab, which would I would normally reflexively order in the US, was worth the cost of one month’s salary. I had to rely on my history and physical to make the diagnoses and could only use labs as supplementary.
There is a strong need for women’s healthcare and advocacy in Honduras and I hope I was able to educate both the patients and the permanent clinic employees on how to better address these issues. I plan on working from the US to help involve a clinic based Ob/Gyn attending for more difficult cases and to help organize the infrastructure of the L&D. I plan on returning next March during my elective time to continue these goals. It was overall a great experience and one I would recommend to any second year or above Ob/Gyn resident.