Heat & Hydration

Today was hot. Well, everyday is hot, but for some reason, today it really hit me. I think that I was verging on heat exhaustion. Acclimitizing to heat involves the expansion of blood plasma and extracellular fluid & increased rate of sweating, all in order to keep the body's core temperature cooler. An acclimatized person will require more fluids than someone who is non-acclimatized.

I have been drinking about 4 liters of water per day and still feelnig thirsty. I don't know what the tempurature outside is, but inside teh clinic, the galvanized corrugated steel roof radiates heat back down on us like a broiler oven. John says the roof is at least 130 degrees, and during this trip, insuluting reflective sheets were installed on most of the clinic building. The sheets were donated by a company that has a distributer here in Honduras in San Pedro Sula.

This morning, we ran out of water. We have been using the large 5 gallon "water cooler" jugs and have gone through at least a dozen of them. I began to conserve the water I had left, and by noon, had had less than a liter. I felt hot. The air was sticky and not moving at all. I started to get sleepy, I couldn't concentrate, I had to go somewhere else for a break.

I found myself sitting in a chair in front of the open door to the men's sleeping area. A hot breeze cooled my skin and made it tingle all over. In front of me was a small concrete porch, cinder block latrines to the right, the satellite dish to the left, and the red dirt just beyond the concrete porch. Beyond was a brand new chain link fence the men are building and just beyond that, the neighbors "yard" with a single coffee tree that had many ripe berries. Three chickens grazed among the grasses growing there. As I cooled off a little, another three chickens came walking by right in front of me from behind the latrines. I got up from my chair and chased them back and forth two or three times in a comical fashion until they had all squeaked underneath the new fence.

I had cooled off a bit, went back to clinic, finished my water. About an hour later, we were treated to a long thunder & lightening storm. Clinic finished early, and I got out a soccer ball for our first game with the kids. It poured down rain and we slipped and slid all over the muddy red field in front of the clinic. We got so muddy that we just showered with our clothes on.

-Suzanne Atkinson

Home Visit

Two days ago, my team was out on home visits and among many others, we met Paula M. Her house was a great place to stop because there was a wonderful breeze and so we stopped and gave our diarrhea survey. She seemed pretty sophisticated in her understanding of infectious disease and medicine. However, like everyone else, she believed that "mal de ojo" does cause diarrhea. I decided to visit her again for my home visit and learn about her and her family. My second visit with her was better than the first. She is such a generous and lovely woman. She has 9 children and 1 grandchild. Her family looks very happy and well taken care of. Although we needed a translator to communicate, I tried some of my bad Spanish on her and she was so patient with me. She was so generous with her time and her life stories. I had such a wonderful time talking to her. We talked about her family, her childhood, the history of the community, and her involvement in the community. The next day I saw her in clinic because she was accompanying her daughter and grandchild. We talked for a while and she found out that I loved coffee. The next day, she sent her daughter to bring me a bag of coffee. I was just so touched. I will definitely never forget her.

-Wiktoria

Exploring Yoro

Exploring Yoro
The B team, Nicole, Wiktoria, Shauna and I explored the municipality of Morazan today as a possible site for future work of Shoulder to Shoulder. The FAO (Food and Agriculture organization) kindly gave us a ride and we rode high into the mountains there to the small village of Candalaria. The terrain was different with many pine trees. They did not grow coffee there at least not as much, but grew more vegetables. It was dry and they used rain water in cisterns and surface wells. We visited one surrounding community (Los Angeles) and found it to be quite poor. There is no health post and the nearest one is about 4 km away in Palino. Clearly there is a need but there is still much ground work to be done before they will be ready for a brigade. It is exciting to think of some expansion of the work though, as there are many communities just like San Jose with little or no services.
Bill Markle

I can't decide what I enjoy the most about being here - the quiet; the lack of TV, radio, cell phones, electricity and the hurry-up pace of home or the people that live here and have already discovered how to enjoy the lack of TV, radio, cell phones and electricity.

I equally enjoy the people that have volunteered to be here to participate in the Brigade. What a great group of people full of positive engery. I wish I could work with these guys everyday.

I have seen and learned more in 1 1/2 weeks here than I have in 1 1/2 years in the ICU. I cant wait to come back. - Gotta run, Diane wants to shut down the generator, but I just wanted to give my two cents worth.
Josie, RN

Cerro Prieto Trip

Today was a very busy day. The A team plus a few others (Suzanne, Gabe, Natalie, Jamie, Amy, Emily, Sharon, Shannon), the translator Medardo and health comittee members Don Fidel & Naomi all drove up to a village about 6 miles up the mountain with a casefull of medicines, vitamins, scabicides and lots and lots of energy. we had 3 spanish speakers which was the limiting factor. On the way up, we revisited a man with pneumonia who had been given antibiotics and tylenol last week. He was using the tylenol, but not the antibiotics, and not surprisingly, not feeling much better. He looked sick. we gave him a shot of rocephin to get things started and stressed the importance of the antibiotics.

Next we set up a clinic in the high school. About 10 students held class outside under the tree while we unpacked everything. Gabe and Amy gave an impromptu "sex ed" talk, since that was one of their current subjects. They asked if you could get pregnant by sitting on a toilet seat, and how to avoid getting leukemia. (there were others, but those were the only two that I heard).

I took a fwe hours for word to get out that we were at teh school, and soon there were plenty of patients to see. Several of the teenagers took a liking to Gabe. Most of our patients were children with complaints of fever, cough, runny nose, asthma, and concern for dengue fever. Many of the children, 9 years old and younger, came to the clinic on their own, without parents or other supervision. A group of 4 siblings and cousins aged 3,5,6 and 7 was brought in by the oldest sister who was 9.

Our group finished & packed and had a giddy ride back to the clinic in teh back of the truck. When we arrived, clinic was still full, so we jumped right in and helped see the last of the patients, finishing clinic 2 hours past closing time.

it's been so busy that we havn't had time for teh usual games with the kids, coloring or playing soccer. :(

Time for dinner!

-Suzanne A, MD. -Team Leader of the A team! (the best team ever!)

bugs and babies

We have been in San Jose for over a week and during this time I have encountered what i fear the most (bugs) and what I love the most (children). The children here are so beautiful. Many of the children we encounter are malnourished, without shoes or adequate clothing and present with many different illnesses. The most extreme example of malnutrition was at a feeding center in El Negrito. El Negrito is one of the larger cities in Honduras. A feeding center is a place where severly malnourished or undernourished infants and children live for a few months to one year to obtain proper nourishment. We met a beautiful and playful 6 year old girl who physically and developmentally looked like a 3 year old. She was developmentally delayed and her growth was terribly stunted. Even after living at the feeding center for months she continues to be thin with a large protuberant belly. We learned that considering her deficits, she may never achieve her full growth or developmental potential. There were many other children like this little girl who physically looked 2 or 3 years younger than their actual age. However, many of these children would most likely have died if they were not brought to the center. Even in the clinic in San Jose we meet adolescents and teenagers who look like children. Luckily we have enough children's vitamins to supply every child that presents with vitamins for at least one month. Obviously this is not a solution but we hope this is the begining.

Now to what i fear and hate the most, THE BUGS! I honestly have never in my life seen such insects. The roaches, the spiders, the scorpians, the moths, beetles everything here is 2 to 3x the size of bugs in the states. And they seem to all come out at the same time. Any given night we see multiples of the above stated bugs in the bathroom, in our bedroom, in our BEDS, at dinner, in the clinic anywhere! Needless to say i am in a constant state of fear. Everyday i learn about new bugs that carry various diseases and even bugs that attack your eyes!
Well besides the bugs, Honduras is a beautiful place full of really wonderful people
-Nicole

Status post 1 week.

We've been here for a week now and it seems like time has stopped. For a good 2 days I had no idea what day it was and nicely enought, it didn't seem to matter. Our days in the clinic are long, but I never get that frustrated feeling that I get from working long hours as I do at home. It must be the great people that I'm here with and for that I'm very grateful. Sometimes I think I've already learned so much in school that I can't possibly fit anymore inside my head, but then I end up in Honduras and all of a sudden there is an explosion of information that I pick up. Very cool. So getting on to the story of the blog... yesterday was Festival Day el Negrito and it was quite festive. We got all kinds of great food: Tomale's, Corn on the cob w/ salt and lime (so good), fried bannana's w/ salsa, some abnormally large sweet potatoe that was also very good, and a steady supply of ice cream from the local town store. In the midst of all this food I found myself invited to a game of soccer w/ the local girls of the town. First let it be known that it was 11am and HOT, and we were playing w/ a plastic-y ball on a basketball court which made the game quite challenging to say the least. That being said, it was an absolute blast! and I was running all over the place chasing the ball. I wanted to keep playing but even in shorts and a t-shirt I was overheating very quickly so I sadly retired to the sidelines. I'm highly impressed at the girls who were able to keep playing in jeans! Well, I feel like my blog entries are always pretty long, so I'll end it here, but there is much more to write about... so I'll be back! ~em

The power of pills and good patience

We certainly do seem to believe in the power of good pharmaceuticals down here in San Jose. And I think we have good reason for that belief. We see, on a regular basis, albuterol nebulizers make asthmatics go from labored wheezing to easy breathing. Ciprofloxacin does wonders to cure those of us Gringos afflicted by "la diarrea"--just two doses later, several of us are back to normal. Which is a great thing, because diarrhea is not so fun when you have to put your toilet paper in a bag beside the toilet... My patient the other night with unstable angina was remarkably cured (her chest pain stopped and her EKG normalized) after just 2 tabs of nitroglycerin, an aspirin, and metoprolol. For the lady who came in with malaria today--diagnosed by Giemsa stain of a blood smear--we feel confident that chloroquine will cure her ailment. And you'd be amazed at the power of a little tylenol to cure almost any "dolor" (pain) that a patient has.

But, for all the good that dispensing meds to our patients does, I think a lot of them benefit the most from just having someone listen to them. For many of the tired, worn out mothers of 7 kids here, I doubt that there are many people who do sit down and listen to what is on their minds hearts. We have a chance to be that person, and this matters perhaps almost as much as the medicines we are able to dispense. And yet, sometimes we get frustrated because patients here are not "well-trained" to give us answers in the way that we have been trained to expect. They have a "laundry list" of complaints that seems overwhelming to the clinicians here. They have not been taught the "language" of the physician-patient relationship here in San Jose, you see. But perhaps we are the ones who need to learn something... how to listen better, how to sort through a laundry list of seemingly unrelated complaints, how to discern what it is that bothers them the most. How to have patience with our patients and the humility to be willing to adjust the way that we approach people to fit their particular culture and needs. Perhaps the verbal language barrier can even be a gift to us in this process; since some say that 90% of listening involves interpreting non-verbal cues, let's hope that all of us are able to use this time as an opportunity to really hone our skills of non-verbal communication. Despite the long-winded and confusing patient stories we hear, I think there is something beautiful about the interaction. It stretches us, and maybe we'll be more able to truly listen to our patients while learning how to effectively and efficiently communicate once we return to the states.

-Krista (Cristia)

Another Busy Day in San Jose

Thursday 10/12
Today we will see at least 95 patients, maybe more until the day is done. Late yesterday we had a cardiac patient with chest pain. She had EKG changes and we treated her and wanted to transport her to the hospital in El Progresso, but it was already dark and the roads are bad. Her EKG improved and we had her sleep in the clinic and her family took her to the hospital this morning.
No rain today--very hot.
The guys are working on electrical outlets, rewiring the breaker box, tapping into the existing water line (did not go well) and building shelves for the clinic. Several of the children from San Jose have been on the roof of the Clinica Medica scraping off the old rust-to prepare it for a new coat of paint.
Diane Balliet RN

Team Cool's Santa Lucia Trek

Greetings all,
Today Team Cool AKA Team C (Crista, Amy, Binney, Bernie) as well as Josie, Bill, Eric and myself (Emily) set foot outside the clinic to explore the countryside. Our destination: Santa Lucia, a small village about a half hour drive (3mi) from our clinic. Our guide graciously offered us a ride in the back of his truck which quickly aquired not only the brigaders but also 2 kids from the village that came along for the ride. If you do the math thats 9 people to the back of the truck which has the makings for a very fun albeit bumpy ride. As we wound our way around the mountainside we were blessed with a fatastic view of the valley sprawling out below us with clouds and sun bursting through above. When we arrived at Santa Lucia we took a 15min hike on a very muddy path to a family of 9 who had been recieving medications from the clinic. We took blood pressures, gave some medicine out, asked many questions for the various surveys we are taking. The family was very nice and we were able to save them a long trip to the clinic. After a quick stop back at the village to pick up a woman, we headed farther up the mountain to visit her parents, whom we heard were ill. This time we faced a much more treacherous path to the house we intended to visit... more on the path later. We climbed a very slipery slope, literally, and finally arrived at the house where we set to work examining her mother and father. Unfortunatey the woman's father was quite ill and we had very limited medicines with us. Luckily we were able to give him some of Amy's Cipro but we really need to come back with better medicines. At this point it was too late to visit any more families in the area, though we heard many people were too sick to come to the clinic. So we headed back to the truck with a resolution to be more prepared for ill patients (anitbiotics, pain meds, etc). Binney took a nice slide down the muddy hill but that was the only casualty of the day, and so we all packed back into the truck and headed back home. - Emily Dornblaser (the pharmacy student)

Nursing in Honduras

Using all my skills and more. This is every bit as challenging as critical care. The children that I have seen are so sick and look very forlorn. Many with asthma, poor nutrition, parasites and a variety of skin rashes. The moms seem very worn out and often depressed. Of course we can only help with the immediate problems but it is hard not to just want to fix everything. I am prone to wonder: do they have girlfriends? Do they have support form anywhere? Do they have any fun in their lives? Well I am hooked on Hombre a Hombre. I 'll be back!
Mainly doing nurse stuff, helping the docs and students and offering as much compassion as I can w/o speaking the language. Hope a smile or touch helps! Sharon Clark, RN, Reading, PA

Home visits

This morning Suzanne, Natalee, Jamie, Josie and I made home visits in San Jose. Senora Melinda led us to four different homes nearby; our plan was to see patients that were unable to make the trek.
At the first stop we visited Jose, a 33 year old man who was recovering from a motorcycle accident 2 weeks prior. He was resting in bed when Melinda introduced us. Jose described his accident and explained that he suffered several fractured ribs, a fractured left humerus, a head injury and various cuts and bruises. We counseled him on how to manage his injuries with various exercises and how to control his pain with ibuprofen. Jose was grateful that we could answer his questions and monitor his recovery.
The next house we found a woman who had fractured her foot months prior and could not leave her home. Her foot hurt and we could see that it was quite immobile and that her left leg muscles had atrophied. Again we provided pain medication and instructed on exercises to help strengthen the foot and increase mobility.
Melinda then led us down a steep trail to a small home nesteled along a hill. We met a woman who had a large lesion over her lower leg for several years. Suzanne had seen her on previous brigades and was dismayed to find that her condition had worsened since the last visit. She complained that the pain was quite severe and the she was not sleeping well. We cleaned the wound, applied a fresh dressing and gave more pain medicine. We planned to return the following day to change the bandage for her.
The last house we visited was for an elderly woman with arthritis in her knees, elbows and shoulders. The joint pain was causing difficulty with her daily activities such as dressing, cooking and cleaning. She reported that previous medicine she had received worked very well for her and so we gave her more aspirin. Her husband then arrived, sweating profusely from work in the morning. He sat exhausted, and reported an episode of chest pain, shortness of breath and collapse. Interpreting was particularly difficult as he had a tendency to mumble, speak softly and trail off. Fortunately his cardiac exam and blood pressure was normal so we gave him aspirin with the hope of preventing future cardiac events.
We eventually made our way back to the clinic with a busy day ahead of us, but happy to be able to explore the area and meet people in their own homes.

October 2006 Bridage Arrives

Hello from San Jose! The October 2006 brigade safely arrived yesterday, and we are running a full clinic today along with some construction projects. We've seen about 100 patients today and had about 12 inches of rain.

We hope to have up to 2 updates daily from the clinic crew and the community service crew, so keep checking.