Day 11 - last clinic day!!!

So this is our last day of doing clinics and giving patient care. I can't believe we are done! I have become so accustomed to waking up each morning and going to each house in a village and making new friends. 

This day was so hot. Normally there is a cool breeze that keeps the humidity bearable. My patients told me that when a hurricane or a storm is brewing that it takes all the wind away. So no breeze coupled with being in the furthest corner of the building made for a very hot and stuffy day. I hate assessing patients with sweat dripping off my face. 

We were all in a small concrete building that is the community center for the village. The patients waited out on the porch while outside some kids put their foal through paces. 

I met a woman with a three month old today. She is a gorgeous young woman and she has a goiter and hypothyroidism. She also spoke candidly to me about her symptoms of post partum depression. I asked if she had thought of hurting herself or her baby and she told me yes. She moved in with her mother for support during her depression. 

Shannah and I told her that post partum depression is very normal and nothing to be ashamed of. I also reinforced what a smart and responsible move it was to come love with her mom and recognize she needed help. 

The doctor ended up referring her to follow up at the hospital at some point. 

I found it very frustrating that she has such fixable problems that we can't fix! Of she was in the US it would be so easy to prescribe some low dose anti depressant and get some blood work done for her TSH levels. Here though we sent he away with nothing. 

One of my patients was an adorable 11 year old. She was very mature and felt very sick with fever. When I could make her laugh she had the best smile. We drew with crayons while waiting for the doctor. 

As we were packing up for the day, a rain shower started suddenly. We all ended up running out and cooling off in the rain. We also took pictures cause you know we are girls. 

When we arrived at the hotel Leah had an awesome idea for a picture. We ended up lined up along the side of the pool, still wearing out scrubs, and jumping in on the count of three. 

It was crazy and the video was awesome. I want to get am the file from Tracey and post it for everyone to see! 

Day ten - last day of house visits

What a busy day! We are so fast at doing house visits now that we finished making appointments all before lunch. 

I went with Tracey and Larry today. She is a nurse so she knows what to assess for and what more to ask. She is very good at making people feel good about themselves. She always points out something I do that she thinks is clever. I admit I do adore her! 

So we came across a young toddler and her mother at one point. The little one was resting, sprawled on her back on the bed. She wore only a diaper and had a fan blowing on her. I did a full assessment and her respiration an heart rate were normal, she was a bit warm but I only hand my hands no thermometer. I asked how many wet diapers she has had, listened to her lungs and heart and abdomen, and checked her pupils. She was limp, lethargic, and only stirred when I felt for swollen lymph nodes under her arms. The clinic doesn't know if it is chicken pox or not. It didn't look like chicken pox to Tracey or me. Tracey thinks it might be measles. Hopefully it will resolve in a few more days. 

I also noticed a basin out back filled with water and leaves. The mother says it is Chaka leaves. I thought it smelled slightly like eucalyptus but we don't know. She puts the water on her daughters chest every hour to help with the fever. 

Later we met Alma. Alma has a large area of land and is an animal lover. She has four parrots, a cat and kitten, two bulls and cows, and many hens. Oh and a tame fawn she has been raising from two weeks old! 

She baked honey rolls that we bought hot from the oven for 50 cents. Of course her stove isn't hooked up to gas or electricity. It has fire wood on top and coals within, with the baking pan. 

I got to speak to a Mennonite woman as well. She was very approachable and easy to talk to. She even answered my blundering questions asking how long she has been Mennonite. She said she prefers to be called Christian or a believer since Mennonite is a broad term. She said she doesn't believe a lot of Mennonites live the way they should. 

It was odd that she lived in a village with everyone else. Most of them live in their own villages and are somewhat secluded. She is a school teacher who teaches the little children of Mennonite families, originally from Canada. 

One of the families we talked with had a little kitten who came over and joined us. One look told me she was not in the best of health. The kitten needs worm medications and a vet. A big dish of cat food wouldn't hurt either. I nearly cried when I had to leave her. I really love cats. I miss my own at home so much! I miss my husband as well. 

 

Before dinner Delia and a lot of the girls went shopping. I told Delia I'm kind of bad at shopping but I really wanted something lovely from Belize. I ended up buying three dresses for $30 US. I will be very excited to wear them later! 

We all went for ice cream before heading back to the hotel. They had the strangest flavors! Crabo is a a strange berry that grows here. Some of the villagers have given us some before. They taste kind of bleh. Sara got sugar corn with real corn in it. I got a scoop of coconut and a scoop if avocado. It was perfect for a humid afternoon in Belize. 

Also before dinner Tracey gave a brief lecture on diabetes and the history if the disease and the three crises associated with it. Even though I finished nursing school I am still learning new things about relatively common diseases! 

Later we had escabeche at the hotel. It is an onion soup they served with crispy chicken and corn tortillas. The women who work in the kitchen also baked some amazing banana bread. It smelled so rich and decadent and tasted even better. 

After dinner we had the other half of our group do their presentations on tropical diseases. Only a group of nurses can get so excited about scabies and dengue fever!

Day nine- Lamanai

Today we took a boat down the river to the Mayan ruins called Lamanai. It was an hour long boat ride in this man's little speed boat. The weather was perfect, the sun bright, and the wind kept the Mosquitos and heat off us. 

We saw these air plants growing like snakes on the tree branches everywhere. 

On the way the girls saw bats (I didn't), a snake (I didn't), and a Jesus bird that walks on lily pads (I did see that one!). 

While on the river as we pulled in to Lamanai we could see a man standing just barely above the jungle tree canopy. He had climbed to the top of the largest Mayan temple in the area. 

Leah convinced our guide to let us drive... Oh god. 

Once we docked we all listened to a talk from our guide as we ate bananas and sweet rolls. He also had five different jugs of fresh fruit juice! Papaya, pine apple, lime, mango, and watermelon. I should have grabbed a picture but I was slacking on the photography in favor of drinking watermelon juice. 

We did a hike through the jungle, stopping periodically for our guide to talk to us about various plants and trees. He handed around the leaves of one plant that smelled exactly like cinnamon when crushed. Another time we smelled some bark that smells like Christmas, like cloves and a slight citrus undertone. One of the ISL ladies says she uses it to burn in her house for the smell and also to cleanse the air. She uses it like I use sage to smudge my home. 

I'm deathly afraid of heights, but I managed zip lining just fine. Hiking to the top of the temples was a bit different though. I did fine on the smaller one, the jaguar temple. The very tall one however was pretty intense. At one point there's a rope we hang on to as we climb up. The stairs are very steep and slanted almost so it is too easy to fall. 

I made it to the top, took some pictures, then scooted my way down the stairs again. I even started feeling a little nauseous from the nerves! I wish I could have enjoyed the view more. It seems like it isn't that steep until you're standing at the top of the stairs looking down at the ground and tiny people below you. 

After an amazing lunch of homemade cole slaw, plantains, chicken, arroz, and more watermelon juice, we got some souvenir shopping done! I bought some post cards to send to my amazing donors and a statue of a Mayan goddess. 

Her name is Ixchel (ish-chel) and she is the only female Mayan god. She is the goddess of the moon, medicine, and the child-bringer. I absolutely had to have her. She is depicted everywhere as kneeling and holding an open flower in her hands with a snake crowning her head. 

The boat ride back was so relaxing. I read awhile and just enjoyed the wind and water. We passed by some guys in a little row boat fishing. They were showing off their catch and we have them some bananas. 

Tomorrow we get back to work with our last day of house visits! 

Day 8- zip lining & cave tubing

I missed writing a post yesterday. I'm sorry! 

Yesterday was a free day. We drove kn the bus for an hour an a half before arriving at the place for zip lining and cave tubing. 

First we lined up and got fitted with a harness (that hugged our butt cheeks quite nicely) a helmet and some awful smelling gloves that about a million people before us used. 

I went in the first group of eight. We climbed some shady looking wooden stairs to a platform to our first zip line. 

I'm terrified of heights but honestly I wasn't nervous. I just didn't focus on the scary and followed everyone else's lead. 

I wish I had pictures of myself! Unfortunately I have an awful expression in the pictures we did take. Oh well! 

Zip lining is amazing. I want to do it again but I'd prefer something higher and longer. We went on 7 zip lines and the tallest was 60 ft in the air. We were on a small platform built around a single tree. It kept swaying and made some people nervous. It was only 500 ft long but I still got to pick up some speed. 

Afterwards we had lunch, buffet-style. All the food here is phenomenal by the way. But they served some spaghetti that reminded me so much of my mother in law's that I got homesick. 

Cave tubing took up the rest of the afternoon. I also don't have any pictures because I don't want to get my phone wet. Once we get home all the girls are going to upload the pics on shutterfly. 

I discovered I have an extra bone in my feet. We were kind of forced into renting water shoes. Except they were these hideous pink crocs. I nearly died, first from the embarrassment then from the blisters. 

We hadn't even walked two minutes and I actually got a huge blister on the inside tarsal bone of my ankle. It was a three minute walk to the river then a 45 minute walk to where we begin floating through the cave system. I nearly turned back at the river. I've had blisters in my feet there before and when I pushed myself I could barely walk for the rest of Christmas. 

Luckily one of the guides ran back and brought some gauze and tape. He isn't a nurse so his first aid skills were kind if questionable. I spent the rest of the 45 min hike mincing along in those god awful pink crocs. 

Once we reached the start of the cave system it was so worth it. I can't wait to post pictures when I get home. The caves were dark and gorgeous. The river water was cool and a lovely blue-green. We floated along slowly, paddling at times to avoid rocks inside the caves. 

There was a point where the cave wall fell away and showed the most perfect panorama of a jungle. The light was perfect. There was also a waterfall spilling from the panorama part. We got to go right up to it and get soaked by the cold water. 

Later, after dinner, was our culture night. Three dancers came by and showed us different dances of mestizo culture, Belizean, and Hindu. After each dance they asked for two volunteers to learn it. I volunteered for the second one!!! Leah was shocked because normally I am a little shy and nervous. 

So Delia and I danced a cute little number that involved much hip shaking and twisting. I made sure to get the name of some if the songs so I can get them when I go home. 

Day 7 -hospital day

I learned that I should drink more than 900 mL of water during the day. I ended up spending the whole day in the hospital and I was so excited I didn't drink anything. Now I am very dehydrated with an awful head ache. I am in bed very early while everyone else is going swimming. 

We split into two groups and picked AM or PM. I picked AM and spent the morning in the maternal-child unit. I think the name is misleading though because it is really more of the community women's health clinic. Each day of the week is something different. Today was all Pap smears all the time. 

I forgot how much I really love women's health. My clinical rotation in OB really put a damper on my excitement. I think I really enjoy gynecology. 

The nurses here have so much autonomy it's crazy to me. The nurses in my area are all nurse midwives. They even have two male midwives! 

The nurse I shadowed did a vaginal exam, diagnosed the patient with trichomaniasis, and handed her some medicine right then. They only consult with doctors for anything out of the norm. 

After lunch I was supposed to go back to the hotel but I asked Tracey if I could go back to the hospital. I was hoping to tag along with her and pick up some more Spanish. I ended up being put in out patient with Taylor. They finish with their patients early though and we ran out of things to do really fast. 

They shooed us into the orthopedic surgeon's office where we spent the rest of the day. 

The doctor there was so talkative. He trained in the US in Baltimore I believe. He is originally from India and he was awarded a complete scholarship from the government there to be a doctor. It is only awarded to the top 500 out of everyone in the schools there. He and his sister won. Every year he spends a couple weeks in India giving health care for free as a thank you. He says now that he is older he is going for six weeks a year so he can help more before his hands start to shake and his eye sight goes and he gets too old. When he said that it kind of made me tear up a little bit. 

He loves to teach and immediately encouraged us to glove up and get our hands dirty. Quite literally because I was able to cut off someone's bandages for a dressing change. 

Apparently it is common for young men to get drunk here and get in fights. Except they don't fist fight, they use machetes. 

Our patient had someone led fingers and stitches in place. The other guy got it worse; his little finger got chopped off. 

The doctor also showed us how to wrap casts. I actually wrapped a cast almost completely on my own. It is kind of different than the way we did it in the ER. 

Everything in the hospital was like stepping back in time. The nurses wear white uniforms, the meds are in glass ampules, and they have glass thermometers and no alcohol wipes. 

Their sterile supplies are autoclaved and wrapped in cloth, not like our disposable supplies. They don't have IV pumps or syringe flushes. I realize how spoiled I am as a nurse. 

Day six- second clinic day

For Our second clinic day we were in the school in San Felipe. The little artist boy from yesterday, Freddy, came by and we all bought some of his drawings. I got a cute drawing of a fairy. They're all simple tracings but we want to encourage him; he seemed so proud! 

Later I met a boy named Joel who was so loving. He hugged all of us and just loved us talking to him and making him feel special. He was sitting at a table with the other kids coloring. When school is in session the kids eat lunch at that table. Huge rusty nails are sticking out all over the table and one of the boys said sometimes the kids scratch themselves on them. Sara and one of the other girls had rocks as hammers and were trying to flatten the nails out. I covered them with medical tape after to keep them covered. 

I spent the whole day assessing patients and taking their history. I got to work with Sara and she is SO good at catching things and observing things that I just don't think of. She's very quick and will be a great nurse. 

One of our patients was a hilarious old lady with awful arthritis. She has been taking prednisone for twelve years!!! The doctor forbade her from taking any more prednisone causes osteoporosis and she has already had one hip replacement an is waiting in the other. She has dislocated her shoulder three times. These are all from the prednisone. Unfortunately it is the only thing that she takes that relieve the stiffness enough that she can get out of bed in the morning. I felt so bad for her. The doctor prescribed her calcium supplements and naproxen. 

She also had hands straight from a textbook. She has boutannieres deformity, which is from arthritis. I identified it ;)

So I also discovered I'm not as good of a team player as I thought. I'm kind of competitive and I keep being in this mind set of wanting to impress and be the one who is always right. That's something I need to work on now. I think I like to show off a little as well. 

I did get taken down a notch when we had our suture class tonight. I thought I would be great at suturing because I like to sew. There was basically no crossover between sewing and suturing though. I struggled a lot and Dr Riverol is even left handed so it should have been easier for me. Leah took to it so easily, she definitely should have been a surgeon. She showed me how and then I used a horizontal mattress stitch to close up my "patient." 

Tomorrow we get to work in the hospital here. Apparently this is the first time for this so we aren't sure what will go on. I signed up for the AM shift in the mother-child unit. I'm wondering if I should have taken the Trauma and Emergency shift though. Too late to change now! I still always worry I'm terrible in pediatrics but its the place I've done best in as a nurse. 

Day five- more house visits

We had our second day of house visits and it went much faster we split into four groups and covered a lot of ground. Martin, our driver, accompanied us to translate. He had us focus on the houses that were poorer so the people who needed free medical care most get treated. 

We had more experience today so we made appointments quickly. Gloria and I both speak Spanish so we were able to help. 

This community was better off than the first one. There is a Mennonite community near by and they hire people from the village to work in the fields. If any of the villagers speak German they make more money because the Mennonites speak German. This village had more mestizo people while the last one had more Mayan or Indian. 

This little girl is named Daphne. She came right up to us on her bike and asked "como se llama?" She is so outgoing and sweet. We had a great conversation about her bike, dolls, and her school. Her sister has a doll that they put in the seat of her bike. She doesn't have a doll though. I wish I could have given her one. When I grew up I had at least 15 Barbies at one point. 

There is a woman in the village who makes amazing Mayan sweet buns. It was three for a Belizean dollar which is fifty US cents. She sent her children over with a tray of them and we bought them all! They are so good and hot from the oven. 

Later I went and spoke with her and she told us about how she sells buns to the village. On Saturday she makes tamales to sell but by then we will be elsewhere. 

Her husband is in the hospital today for an inguinal hernia. He hasn't been able to work for a couple months so she has been trying to make enough money to send the kids to school. She said it is about $400 Belizean dollars for the two kids. She has the kids sell her food in the village on their bikes on weekends and when they are out of school. 

One of the council members if the town runs a little shop in her house. She was so friendly. She is the one who is working with ISL. apparently she is the first woman elected to the town council ever! 

We had our lunch at the school. We also set up our clinic in several of the class rooms there. I also took the opportunity to draw on the chalkboard. 

Day four - Clinic day

First things first: it was so humid today. I have never sweat so much in my life. Imagine sitting in a steam room for eight hours surrounded by mosquitos while wearing scrubs. 

Secondly, I am having an unbelievable amount of fun! 

We took the bus to the village from yesterday. The doctors rode with us. Once we got there people were already waiting for us. We set up as fast as possible. 

I took the first patient. Working in the pediatric ER for my preceptorship prepared me so well for working with patients. We worked in groups of three and we stayed with our patient from beginning to end. We took turns presenting patients to the doctor and sat in on the assessments. 

These doctors spend a lot of time with each patient and talk a lot with them. In the US the doctors focus on the physical assessment and ask a couple questions before prescribing meds. 

The second half of the day Leah and I worked the pharmacy with Tracey's husband, Larry. I got to transcribe the doctors prescriptions (written on index cards) onto labels and count out pills into little bags. They prescribed a lot of ibuprofen and vitamins. Unfortunately we ran out of children's vitamins pretty quickly.

The people had to wait for so long. You would think they would be unhappy or impatient. But they were all so chill and helpful. When it started pouring rain in the afternoon the roof began leaking. The water went right down my neck. A bunch if guys immediately helped me move the "pharmacy". 

The council members were saying that try would have fixed the roof for us. They are all so friendly and sweet. 

I learned to explain medications to mis pacientes en español. I'm so excited to use my Spanish with my patients in the States.