The clinic where I work is in the Public Hospital of Roatan. It is the Pediatric Clinic, and bare bones doesn't even begin to describe its resources.
The patients show up at 6 a.m. everyday, get assigned a number and then wait to be seen by the doctor in order. Sometimes waiting up to 5 or 6 hours to be seen. We can do some triage by walking through the masses of people and pulling out the sicker looking children, but we have to carefully explain to everyone else why we are doing so, lest someone who has been waiting for longer gets upset.
I see a lot of common stuff, upper respiratory infections, asthma, diarrhea, ear infections, scabies - and then some not so common stuff - malaria, parasitic infections (worms and giardia being the most common), chicken pox (which back home we don't see very often thanks to the availability of vaccines), undiagnosed congenital heart disease, multiple abscesses (there often isn't enough money for shoes). The patients are friendly and grateful, never getting upset when I tell them they have a virus and don't need an antibiotic.
I was a bit worried about the Spanish here - how different would it be than the Mexican Spanish that I primarily speak? Would I be able to understand them? Would they be able to understand me? Turns out it isn't very different at all, and communication has not been a problem. If anything I have much more difficulty understanding the beautiful Carribean-style English that the Garifuna speak, then the Spanish that anyone speaks.
The most challenging part about working in the clinic is figuring out the resources. They have very limited antibiotics (amoxicillin - thank God! - and dicloxicillin), no albuterol inhalers, no permethrin cream (for scabies) and consults are next to impossible to get - often requiring the very poor patient's to pay out of pocket for transportation to a different town or the main land of Honduras just to sit and wait forever at a different clinic if they are seen at all. I often have to run to the pharmacy to see what is in stock, and have become much more accustomed to giving prescriptions for things that I wouldn't at home.
The lab tests available are also very limited. I can order a blood smear to look for malaria, check someone's hemoglobin level for anemia, and I can dip urine myself to check for infection or other problems. Cultures are just plain not done - for the clinic or the hospital (but you may be lucky enough to see a worm in someone's vomit or diarrhea, which makes the diagnosis a breeze (thanks little wormy!), or you may just be stuck treating empirically).
So, if someone is sick enough to get admitted, they get a standard set of antibiotics thrown at them without rhyme or reason or ability to check and see if those antibiotics are going to work with whatever is making the patient sick (ampicillin, gentamicin and amikacin, plus or minus flagyl).
The doctors in training are left overnight to monitor the entire hospital, including performing urgent surgeries (yikes!), without the supervision of someone more experienced. It must be such a scary experience for them.
The hospital is not able to intubate someone. They don't have the equipment or a ventilator. I have been to a few deliveries (preemies & C-sections) and just pray that the baby is going to have no trouble breathing. They don't even have suction to get the gunk out of the baby's mouth and nose (yes, gunk is the medical terminology for it). And I often have to remind the nurses to keep bringing fresh towels (or pillow cases as the case may be) so we can adequately dry the baby and keep them warm (not leave them lying on a wet surface.)
All of the mother's get tested for HIV, and if the results aren't back by the time the baby is delivered they are not allowed to breastfeed the child (nobody can give a clear reason where or why this rule is in place). If those mothers don't have money for formula the baby is given sugar water via a syringe. Sugar water. Via a syringe. Heaven forbid the kid get adequate nutrition or learn to suck on a nipple.
The patients show up at 6 a.m. everyday, get assigned a number and then wait to be seen by the doctor in order. Sometimes waiting up to 5 or 6 hours to be seen. We can do some triage by walking through the masses of people and pulling out the sicker looking children, but we have to carefully explain to everyone else why we are doing so, lest someone who has been waiting for longer gets upset.
I see a lot of common stuff, upper respiratory infections, asthma, diarrhea, ear infections, scabies - and then some not so common stuff - malaria, parasitic infections (worms and giardia being the most common), chicken pox (which back home we don't see very often thanks to the availability of vaccines), undiagnosed congenital heart disease, multiple abscesses (there often isn't enough money for shoes). The patients are friendly and grateful, never getting upset when I tell them they have a virus and don't need an antibiotic.
I was a bit worried about the Spanish here - how different would it be than the Mexican Spanish that I primarily speak? Would I be able to understand them? Would they be able to understand me? Turns out it isn't very different at all, and communication has not been a problem. If anything I have much more difficulty understanding the beautiful Carribean-style English that the Garifuna speak, then the Spanish that anyone speaks.
The most challenging part about working in the clinic is figuring out the resources. They have very limited antibiotics (amoxicillin - thank God! - and dicloxicillin), no albuterol inhalers, no permethrin cream (for scabies) and consults are next to impossible to get - often requiring the very poor patient's to pay out of pocket for transportation to a different town or the main land of Honduras just to sit and wait forever at a different clinic if they are seen at all. I often have to run to the pharmacy to see what is in stock, and have become much more accustomed to giving prescriptions for things that I wouldn't at home.
The lab tests available are also very limited. I can order a blood smear to look for malaria, check someone's hemoglobin level for anemia, and I can dip urine myself to check for infection or other problems. Cultures are just plain not done - for the clinic or the hospital (but you may be lucky enough to see a worm in someone's vomit or diarrhea, which makes the diagnosis a breeze (thanks little wormy!), or you may just be stuck treating empirically).
So, if someone is sick enough to get admitted, they get a standard set of antibiotics thrown at them without rhyme or reason or ability to check and see if those antibiotics are going to work with whatever is making the patient sick (ampicillin, gentamicin and amikacin, plus or minus flagyl).
The doctors in training are left overnight to monitor the entire hospital, including performing urgent surgeries (yikes!), without the supervision of someone more experienced. It must be such a scary experience for them.
The hospital is not able to intubate someone. They don't have the equipment or a ventilator. I have been to a few deliveries (preemies & C-sections) and just pray that the baby is going to have no trouble breathing. They don't even have suction to get the gunk out of the baby's mouth and nose (yes, gunk is the medical terminology for it). And I often have to remind the nurses to keep bringing fresh towels (or pillow cases as the case may be) so we can adequately dry the baby and keep them warm (not leave them lying on a wet surface.)
All of the mother's get tested for HIV, and if the results aren't back by the time the baby is delivered they are not allowed to breastfeed the child (nobody can give a clear reason where or why this rule is in place). If those mothers don't have money for formula the baby is given sugar water via a syringe. Sugar water. Via a syringe. Heaven forbid the kid get adequate nutrition or learn to suck on a nipple.
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