Last Week

Cam has been here for nine days. Our reunion was so wonderful, in the most beautiful tropical setting imaginable. We have cooked together, explored the reef out front of our condo, relaxed, read aloud from Cam’s adventure / scifi novel, worked in the clinic together, and relaxed some more. My last day at the clinic was Tuesday. The first two days of this past week were quite harried at the clinic. Gavin and Paul, two PA students from Robert’s class at Pacific University, arrived last weekend. Getting situated at the clinic always takes a little while. Their first days as Clínica Esperanza providers were especially tricky because Dr. Janice was the only CE provider present. Gavin and Paul worked in the main consult room, which holds two sets of exam table, desk, otoscope setup, etc, separated by a curtain. Dr. Janice sat in a chair in the middle of the two consult areas, answering questions and listening in on patient visits. I worked with both PAs as their translator. I felt a bit over-committed: besides translating for two providers at a time, Kate, our clinic manager, would flit in to the room every few minutes asking for help with a patient who needed wound care or diabetes education. Cam was amazed at the incredible bustle and multitasking going on in the clinic throughout its open hours!

Cam shadowed me during Monday and Tuesday afternoons. He got to see some interesting, challenging cases. One really struck us both. A 27-year-old patient I will call Marcy came in with her mother for a prenatal visit. Because of my interest and experience with “control prenatal” visits, Kate let me take the wheel on this one while she looked on. After a few attempts at engaging Marcy in conversation, it became clear that she has some serious developmental or psychological issues. Her mother started answering me, clearly frustrated at her daughter’s refusal to speak. Marcy had a sweet, vacant smile on her round face, which looked more like it belonged to an innocent teenager, rather than a nearly 30-year-old woman. She babbled a few phrases of nonsense when I asked her, “how are you feeling, Marcy?” Her mother would bark at her, “Stop talking crazy!” I took a look through the rest of her chart and found the following phrases in the provider notes: “patient reports hearing voices,” “patient affect unresponsive and distant,” and “mother reports patient will not take psych meds.” I started directing a few key questions at the mother, inquiring about how far along Marcy is in her pregnancy (28 weeks), if she is taking prenatal vitamins (no), has she felt the baby moving (yes), and if she had experienced any vaginal bleeding (no). Once I got a clearer picture of Marcy’s pregnancy, I decided to take her away from her mother for a while to see if she would open up. I led Marcy to the bathroom to take a urine sample. On the way there, I asked her, “Marcy, are you hearing voices that aren’t real?” She answered me in a long, lilting sentence of nonsense, her eyes out of focus. After that, I asked Dr. Janice to help with this case, because I didn’t feel comfortable leading the exam anymore. Dr. Janice, Cam, and I did her physical exam, measuring fundal height and listening for the fetal heart rate using the Doppler. Every aspect of the exam was normal, and we sent the mother and daughter pair home with prenatal vitamins and a follow-up appointment with Dr. Raymond in two weeks.

That visit left me with a sinking, hollow feeling in my stomach. Marcy looked like the victim of a sadly common phenomenon on the island: men take advantage of women with developmental disabilities. Often, they leave their victims pregnant without any support from the abuser and in an unfortunate situation that would only become more complicated and difficult with the birth of a child. A week before this visit, I saw the result of the island’s public health efforts to help these women: a patient came in who had been sterilized against her will to prevent her from ending up with children she couldn’t care for. This strategy makes me sick to me stomach. Instead of working to prevent the abuse of these innocent women, it abuses them in another way, furthering their disenfranchisement from their rights over their own bodies. I hope some of the compassion and care we gave to these two patients sunk in, helping them to heal a little bit from the wounds they have suffered.

On a much more lighthearted note, Cam and I have seen some awesome aquatic life in the past few days. On our dive, we descended right towards the one fish I had been hoping to see in my last few days on Roatán: a honeycomb cowfish! Check it out on google images, if you get the chance.

We also saw a bunch of nudibranks and a juvenile spotted drone, one of the cutest, coolest fishies around. It has two long, ribbon-like fins on its dorsal and ventral sides that swirl around mesmerizingly. It is striped black and white. This one was tiny, it’s body only about an inch long and its ribbons extending another two inches.

On our snorkeling adventures over the past few days, we’ve seen lots more cool stuff. On Tuesday, we saw a turtle that had wedged itself in a little cave in the reef to wait out the rather powerful waves. It looked so sleepy and content! On Thursday, we say two more turtles cruising through the depths. One was little, with a shell about a foot in diameter from head to tail! We also saw two spotted cowfish, with their long, skinny horns protruding from their foreheads. We saw many large parrotfish, whose mouths actually looked like parrot beaks, pecking at the corral. It’s been amazing!

Today, we are heading off to French Key for a day of fun and a delicious meal. It’s Cam’s and my 5-month anniversary!

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Malaria Free!

I have been feeling under the weather for the past six days. When I first arrived, I was told that every clinic volunteer gets sick—no arguing your way out of it. I have been so lucky up till this past week. No stomach ailments, just a few bug bites and a touch of fatigue.

Last Tuesday, I woke up with a pressure headache all the way around my head and a pretty hefty feeling of fatigue. During preconference (our little meetings between the volunteers before we start out seeing patients), Michelle taught us how to start IVs. I was her model (I have great veins and was willing to be poked). Right after the stick, I felt lightheaded like I’ve never felt before. I’m not squeamish or needle-shy; if anything, I was really interested in what she was doing. My dizziness continued, even after I’d gulped my second liter of water. I ended up sitting in the sun for a few minutes to warm up my clammy limbs and then decided to head home. I have never felt that overwhelmingly wiped out. I’ve had that feeling on and off since then: Wednesday I felt better, Thursday I felt good, Friday I felt terrible, Saturday was okay, and then yesterday was the worst yet. This weekend, I began having bad joint and muscle aches, so the point where a lazy swim out to snorkel was an ordeal.

This morning, I woke up with the fatigue, head pounding, and dizziness. I went in to the clinic just long enough to have my blood drawn, then headed home to rest. All the tests were negative: no anemia, no malaria. I’m now nursing a pitcher of Oral Rehydration Solution mixed with some peach iced tea powder to attempt to mask the awful saltiness. Maybe my electrolytes are low? We shall see.

Besides this little sick spell, we have had some exciting updates on the island. Hurricane Ernesto is approaching! This morning, for the first time, I ate breakfast to the sound of the waves on the beach and a view of whitecaps out by the reef. Usually the ocean is glassy, only occasionally lined with gentle swells. The next signs of the storm are just appearing now: the sky has turned a medium grey, rain is pelting down, and the wind is picking up. One advantage of being sick today: I have a front-row seat in this natural drama!

I will try to snap some photos of the waves soon. For now, here are some shots of the spectacular view of Sandy Bay from the house that Evan, our computer guru, and his family rent. We trekked up and up to get to this place on Saturday.

Reef Romps

I realized while I was snorkeling today that I haven’t posted much about all of the fab underwater sightings I have had recently.

Dee, the wonderful retired engineer who moved to the island almost three years ago and helps make volunteers’ experiences comfortable and fun, took me out snorkeling on Sunday. We meandered west down the coast from Infinity Bay, around one jagged point after another, until we came to the Western tip of the island. This part of the coast is known for wicked currents, but the water was calm and clear that day. (Don’t worry, Mom and Dad, Dee is a very experienced snorkeler and would not have taken me that far had the conditions been dangerous.) We saw so many great things! Dozens of pairs of Queen Angelfish who skirted the coral on the ocean floor, one following the other. I find I can’t look away from their vivid colors—canary yellow and neon turquoise—until they dip into a tunnel, out of sight. We saw tons of needle fish, ranging from one foot to four feet long, darting around in schools of three or four. We passed above a plateau on which what must have been fifty triggerfish were feeding. From the surface, these funny creatures appeared all silky black; however, diving down for a closer look revealed an intricate pattern of colors over the black, starting out orange at the nose, turning blue on the forehead, and fading gradually across the back. It was like someone doodled all over the slate of their bodies with colored pencils! So cool.

Barracuda punctuated this snorkeling trip with little bursts of apprehension. Dee is so nonchalant around them! At the beginning of the adventure, a five-foot-long one passed me about ten feet away. In the middle, a four-foot-long one dove down below me. At the end of the trip, a three-foot one hovered over a shallow ledge of coral. Even though I gave them plenty of room and startled each time I saw one, I think I’m getting a bit more habituated to them…At least I want to think so.

This afternoon, Alexis and I set out in the choppiest, cloudiest waters I’ve seen here yet. It was quite the struggle! We headed out past the mini island in front of our dock into the deeper water, where the visibility was better. We decided to swim against the current towards the little island east of us. It took us an hour to get there and only twenty minutes to get back! I was dragging by the end. On the way there, I saw a spotted cowfish. From overhead, it was so thin–probably only an inch thick! From the side, it was at least three feet long and two feet tall. It had a single, long horn sticking out of its forehead like an antennae. On the way back, I saw a little hawksbill turtle about the size of my chemistry textbook. The pattern on its shell was a magnified snapshot of black, brown, and white granite. Stunning! It nibbled at the coral, batting its flippers against the current.

I love exploring these waters. Each time, some element of the snorkeling is completely different. I can’t wait to show Cam in eight days!!!

Promoting Health

Apologies for the long wait between posts! Here’s a bit a wrote on Monday, but couldn’t publish because of failed internet:

I had a fabulous day at the clinic. The morning was normally great—spoke with a bunch of patients, went on a few wild goose chances in search of lost meds, got to learn about some interesting patient cases, had a couple cups of coffee.  This afternoon was the real highlight. I gave a little talk on cervical cancer to the Promotoras, a group of eight women from the various communities near the clinic whom the clinic employs for outreach education in their own neighborhoods. What a lovely, inspiring group! Melee, Miss Peggy’s assistant and women’s health extraordinaire, leads the program with a local, Miss Emily. Today was the final meeting of their training. After our discussion about the causes, signs, risk factors, and prevention measures of cervical cancer, we celebrated the ladies’ accomplishments. A reporter from a local television station attended, video taping the remarks Miss Peggy, Melee, and Doctor Raymond made. I translated for Miss Peggy, which was a bit nerve wracking, but really cool! Who knows, maybe I’ll make it on the Bay Islands TV channel. After the presentation of certificates, we all enjoyed chocolate cake and fresh orange juice. Delish!

This meeting totally reaffirmed my desire to not only be a health provider, but also an educator. The Promotoras are all so special—I know they will have a huge impact in their communities and empower their neighbors to take ownership of their health. Contributing a bit to their training was so fulfilling. I’m so glad I got to witness this incredible program!

Lazy Saturday

I loved getting to show my parents around the island for the past week—it was like each place reinvented itself for me, like I was experiencing them as wide-eyed newcomer. It was so fun! We also sampled some of the island’s offerings that I otherwise would not have tried…aka the fancier side of things. But the best part, by far, was getting to spend quality time with my wonderful padres. Everyone who met them adored them. I hope they get a chance to return to the island as clinic volunteers! Here’s a photo of Dad and me in West End:

Dad and I at the West End turnaround.

Last night, all of the volunteers and a few members of the clinic staff went out to dinner to celebrate the work of Tami, Cathy, Ben, and James, who have to leave this weekend. We went to Bites on the Beach, a restaurant in West Bay that is an expansive deck connected to various platforms and docks over the water. What a lovely spot! Even the power outage that lasted for the entire evening couldn’t spoil the fun. Here are some photos of the occasion, including the first group photo I’ve managed to snap yet:

Jiz, Michelle, and I in our island-fancy outfits.

The entire group–volunteers, staff, and related family members.

While I was sad to see my parents leave yesterday, I have really enjoyed the change of pace today. This morning, I slept in, made banana and walnut pancakes for Michelle’s and my breakfast, then finally got to skype with Cam. It was so great to finally see my wonderful boyfriend’s face! I’m nearly trembling with excitement for his visit in 12 days.

Two hours ago, I headed over to the clinic to help Carla, the incredible woman who first brought patients to Miss Peggy and has worked to make the clinic a reality for a decade. She teaches a prenatal class every Saturday. Today, we reviewed female pelvic anatomy and the basics of pregnancy before talking about the behavioral changes women need to make while pregnant. I learned a bunch of useful phrases for use in the clinic, like “la panza” (belly) and “el cuello del útero” (another phrase for cervix). Carla asked me to help teach the next class!

Tami stopped by a few hours ago after a rather shocking swim. She saw what she thinks was an 8 foot long barracuda!!! The water visibility (the “viz,” as the hardcore divers say) was pretty poor in the shallows, so she only caught glimpses of the gnarly, protruding jaw, a beady eye, and the long, thin silhouette. She immediately headed back in to shore and won’t even think about going back out off our dock. Somehow, Jiz and Alexis managed to talk me into going out an hour ago…we saw lots of cool things and no barracudas, gracias al cielo!

Parental Attention

My parents arrived on Friday and have been living it up ever since! I met up with them late Friday afternoon—after they had some lunch in West End and snorkeled off the dock by their place and I had taken a much-needed post-clinic nap—and chatted the night away. Showing them this wonderful place is such a joy!

Yesterday was a whirlwind of fun. Early Saturday morning, the electric crack of lightening and booms of thunder woke us all up. The rain was torrential! My dear mother had a bad migraine, which kept her out of commission for the morning and early afternoon. We still managed to grab their first baleadas—avocado, egg, beans, and a sprinkle of Honduran cheese in a homemade, naan-like flour tortilla—before Dad and I went on our two dives.

The clarity was fantastic! Over the course of the hour and a half that we spent submerged, we saw countless amazing things. My dad described it well: he said that in the middle of each dive he felt he needed to close his eyes for a moment to give his brain a chance to catch up. We saw two midnight parrot fish, with navy blue scales with blotches of baby blue on its head. We saw four dark beauties, the yellow and black fish wearing the black lipstick. A hawksbill turtle swam between Dad and me on the second dive, coming so close that we could have felt its teal and white shell if we had stretched out our hands. At the beginning of this dive, we swam over a spiny puffer fish that was mustard-yellow with white spots rimmed in black. Its eyes looked like large, gold sequins stuck to the sides of their heads, covered in transparent bubbles that bulged off its head. In the middle of the second dive, we found ourselves surrounded by a school of cuddle fish. Their backs shimmered in pastel pinks, purples, and blues, while their bellies where transparent. The skirt around their bodies rippled to move them forward and back around us. I was mesmerized!

Dad and I had a wonderful time. He is working on convincing me to dive in the kelp forest of Point Lobos in California. Back home, you have to suit up in a complete dry suit and can only go on one dive per day because you need many hours to warm up your bones afterwards. Sounds ghastly compared to the wondrous ease and simplicity of diving here…

Last night we went to The Lighthouse, a quaint restaurant on a mini-peninsula in the middle of West End. Mom and I split the grilled garlic lobster and similarly prepared shrimp, which were fantastic! Yesterday, we headed over to French Key for a day of snorkeling, lounging, and eating. It was the perfect day! Here are some photos:

Michelle and Robert jumping from the palapa.

View of the mainland from French Key.

My lovely mother under a Sea Grape tree.

Sorry about the infrequent posting…the internet at my place has been down for the past five days! I will try to post some more family photos soon. ¡Cheque!

One Month

Exactly one month and an five hours ago, I stepped off the puddle jumper into the all-encompassing humidity of the Caribbean. Since then, I have gotten to know so much about this place and yet continually discover incredible gems of island life. On Sunday, the volunteers hopped in two pick-ups and an SUV and drove the approximately 20 miles to Camp Bay. This trek took an hour due to the windiness of the road that snakes along the northern coast towards the east end of the island. The ride made for some gorgeous views! The island gets so thin on the east side that we would see the ocean on one side, make a turn, and see it on the other side too.

We visited a wonderful clinic supporter who lives in a lovely, open beach house in Camp Bay. All of the walls of the house are painted canary colors–sunflower yellow, aqua, magenta, and avocado green. We enjoyed a tasty spread of potluck food, lounged in the many hammocks strung around the patio, and swam. Here are some views of the spectacular scenery there:

This week, I have been working with Robert, our wonderful PA, and Dr. James, an incredible resident. Truly, the providers here are so inspiring and knowledgeable. I hope I pick up some of their wisdom by osmosis! Already I feel like I’ve learned so much. I have gotten to translate and assist James on many prenatal visits in the last three days. Yesterday I got to do an ultrasound! James and I were having trouble finding the fetal heart sounds using a Doppler, a little detector that amplifies sound. We decided to do a quick ultrasound to check the baby. Turns out the little tike’s head is positioned on the right side of the mother’s abdomen, and it’s back is against her pelvis. It was tricky to detect the heart rate via Doppler because the best parts of the body for detection, the head and back, were hidden by the kiddo’s limbs. I got to visualize the four heart chambers and the rest of the little belly! I also got to measure the cranial diameter to estimate the gestational age. It was breathtaking.

Last night, we had to say goodbye to lovely Jenna, who flew back to Michigan today after spending a month on the island. We miss you already! Here’s a shot of us enjoying a celebratory round of Monkey La Las:

Michelle, Jenna, and I with our last Monkey La Las together 😦

I can’t wait for my parents to arrive in a day and a half! To sign off like an islander, “¡cheque!”

Live and Let Dive

To borrow a phrase a woman greeted me with on my walk home today, ¡Buenas tardes, preciositos! I just arrived home from a full day in the ocean. I completed my Confined Water Skills and my first two Open Water Dives! It was fabulous.

On the first dive, Kiwi (my dive instructor from New Zealand), two other student divers, two Dive Masters in Training, and I explored a spot called Overheat. We saw tons of parrot fish, angel fish, and spiny lobster. The highlight for me was a two foot long flounder I spied resting on a sand patch. Flounder are so awkward looking, with their bulgy eyes that point off in different directions and their  funny, frantic movement. This one had dark blue and pale pink camouflage on its edges.

The second dive was at a section of the reef called Hole in the Wall, named after a vertical tunnel in the corral right next to the drop off (at least I think so…). On this dive, I felt really comfortable using my breathing to make minor adjustments in my buoyancy. We saw two turtles: a large green that flew by us using long fin strokes and a smaller hawksbill that pecked at the coral like its namesake. We also saw a spotted cowfish (so funny looking, like a pufferfish that has been stretch so that it’s eyes pop out even more and it’s tail gets long) and another humungous parrot fish.

I am so excited to get back in the water, next with Mom and Dad, who arrive on Friday, and then with Cam! I will break out the underwater camera once I feel a bit more comfortable with all the rest of my gear. For now, here’s one of the best sunset views so far…

Sunset from our porch.

This week has been a busy, at times bumpy ride. I would like to take a moment to remember the Burch family’s dear puppy Pippa who had to be put to sleep two days ago. I would also like to celebrate the life of my dear grandmother, Pat, who passed away a year ago.

Sunday was another fun day. At Infinity Bay, we played rounds and rounds of beach volleyball and tried to soak up the sun that barely filtered through the thick grey clouds overhead. Though we did not have the best beach weather, we still had a wonderful time snorkeling, romping in the sand, and reading.

On our snorkel, I saw the largest parrotfish ever. Seriously, from the side view, it was as large as a standard boogie board. It was also at least a foot thick. Its body was chocolate brown, while its lips and tail were splashed with sage green. I hovered in place for at least 5 minutes, watching this magnificent specimen nibble on the top of a mound of coral.

We also got to see another eagle ray, this time on the edge of the drop off. I got a great view of its back, which looked like a piece of diamond-shaped slate that had been doodled all over with little circles and squiggles. It flapped far below me before sinking into the deep.

So far, my clinic shifts have been long, but rewarding, this week. I have been translating and observing Robert, a PA doing a rotation at the clinic. He is a fabulous teacher—very patient and genuinely interest in making my service here informative and fun. I have been learning so much! I really admire the way Robert talks to patients. He builds trust through compassion and patience and meets them where they are. He uses the words patients use to describe their symptoms, which helps to ensure that they feel comfortable in the often overwhelming, unfathomable medical environment. For example, Robert used a patient’s own term, “nerves,” when asking her to repeat her description of a psychological symptom she was experiencing. He also uses the term “suga” when he asks patients about their diabetes and asks them if they “drink their meds,” phrases that are common in Island English. Translating for Robert and James, a volunteer resident, has been a wonderful, rewarding experience; my Spanish is flowing freely and easily!

More to come soon. I’m planning on posting a few patient case studies next! For now, here’s a photo of the volunteer team at Infinity Bay:

Jumping for joy at Infinity Bay.

A Full Saturday

What a week! My day in clinic yesterday was a bit rough. I returned to the pharmacy as the only official volunteer dispersing meds because another volunteer was sick. In the next few weeks, the clinic is expecting a massive shipment of meds from the mainland (four entire cargo carriers have been stuck in the bureaucratic quagmire of Tegucigalpa for the last few months). The clinic administration thinks that the pharmacy does not currently operate well enough to be able to handle the huge arrival. As the only volunteer pharmacist present, I was given firm feedback yesterday that differed significantly from the instructions I had been given when I arrived and in the last few weeks. It was a frustrating situation, and I felt like a lot of blame was thrown around. I took a moment to compose myself outside and then finished the rest of my shift, trying not to internalize the situation too much.

The rest of the afternoon refreshed me after my tough morning. Michelle and I made a delicious lunch, chatted for a while, and then headed out into the big blue. It was the best snorkeling yet! On the swim out, I noticed a flash of white in the corner of my eye. It was a gorgeous eagle ray undulating through the water above the reeds. Its back was slate grey with quarter-sized white spots that blended in with the designs of sunlight playing on the ocean floor. The rippling of its wings revealed the bright white of its underbelly. Michelle and I chased after this magnificent creature until it outpaced us and faded into the depths.

We also got to see two octopi, one of which actively snacked on the innards of a conch shell right in front of us. Both would be about the size of a soccer ball if their tentacles were wrapped around their bodies. They both remained partially in their burrows while we watched them, surrounded by old conch shells.

I got to see another mid-afternoon meal: a little moray eel jabbed its head into a sandy crevice, gobbling down some little creature. The eel was beige with little white spots and a pure white crest down its back. I hovered over it, watching sand poor from its gills as it attacked and swallowed. In the coral mound next door, we spied a shy puffer fish about the size of a watermelon with big, dark eyes and little fins that whirred about like propellers. It was so innocent and cute!

Michelle, Tammy, and I each separately saw the same thing: a fish that was long and shiny and swam right under the surface like a barracuda, but had a thin, pointy snout. We wondered how this large needlefish (the identity we hypothesized for it) different in size and shape from its look-alike. We decided to head back towards shore and, just as we rounded another mound of coral, we saw both—a needlefish and a barracuda—within five feet of each other! They were similarly long, but the needlefish was slightly paler, thinner, and, obviously, much sharper in the snout. The barracuda had a darker sheen to its scales and that typically gnarly looking mouth. What a perfectly timed demonstration of their differences!

After a low-key dinner, Megan, Maia, Tammy, Robert, and Jenna joined Michelle and me for Movie Night. We enjoyed piña coladas, freshly baked cookies, and kettle corn while we watched Casino Royale. The lovely conclusion to the day helped me recover from the morning’s stress.

Today, I knocked out a major chunk of my SCUBA certification—finished the academics, took the final exam, and almost all of the closed water dives. The skills I learned in the last part were definitely unfamiliar—just breathing underwater through the mouthpiece was weird! It felt so good to approach these challenges boldly, trust myself that I didn’t need to freak out, and succeed on the first try for almost all of them. And I cleared my ears without even really thinking about it!

When I got home, rain was poring down and the power was out. There’s nothing like sitting on the couch with a cup of iced coffee in hand, watching the rain fall into the ocean and listening to its patter.

Best,

Hanna