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!


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!