The Stings

Yesterday morning Eric and I got up early to snorkel in a beautifully quiet, crystal clear ocean that hadn't yet been touched by the day's boats and swimmers. Unfortunately, it was a colder day than usual, with the wind blowing pretty hard making the usual still water bumpy with little waves.

We headed out anyway, in hopes of seeing the brilliant green moray eel we had seen a couple days before, along with my friends Mr. Bojangles and Sr. Barracuda. We were in the water for less than 2 minutes before I felt the first few little burns on my arms and legs. They were short-lived stinging sensations, just enough to make me kick my legs or wave my arms. We continued forth only to find that not only was the visibility not very good, but our little bay was full of tiny dime-sized jellyfish. The further we swam the more stings we felt. Eric even got stung on the mouth, not once, not twice, but three times! It was enough to make the most adventurous and tough snorkelers swim as fast as possible back to the beach.

After discussing our experience with some locals we learned that the "West Wind" ALWAYS blows in the jellyfish. Thanks a lot for the warning!

We decided to spend the rest of our day hiking in the gorgeous botanical gardens instead of being stung by mini jellyfish. The hike was hot and humid, but absolutely beautiful. Along with the fabulous flora, we also saw a number of cool lizards and a large rodent thing with round ears and brown fur. We got a few bug bites, but they were nothing compared to the thousand little stings of those jellyfish!

The Egggarbageeater

A few days ago I was with some of the people from the hospital and we decided to have lunch at our favorite baleada place in the town near the hospital. Granted, the baleadas (made of thick tortillas, refried red beans, cheese and whatever else you like) are delicious, but the place itself is certainly not up to any countries health standards. It is just downright filthy. But the price (cheaper than cheap) and quality of the food somehow allow the patrons to turn a blind eye.

On that particular day it was difficult to turn a blind eye to the large furry animal that walked through the restaurant with a ring-striped tail. I got very excited, thinking that I was seeing one of the island's rare anteaters. Not knowing the word for anteater in Spanish, I asked the waiter if that animal "eats ants". "No, he eats eggs and garbage", was the reply. Oh. An Egggarbageeater, huh?

The word he used for the animal was Pizote, which after much google searching I discovered to mean Coatie. The same animals that Eric and I had seen at Iguazu Falls in Argentina. Not quite as exciting as an anteater, but perhaps a close second.

The Best Meal. Ever.

Last night, Eric's first night in Roatan, we got invited by one of the locals that I have become friends with, Kevin, to join him and his family for dinner. Kevin had gotten up early that morning to catch some fresh lobster (for the authorities that may be reading, Kevin was unable to locate any lobster on the Marine Reserve).

So, at his house, we are treated to a spectacular meal of lobster soup (made with the heads of the lobster, sweet plantains, potatoes and a fabulous mix of spices and coconut milk) and grilled lobster tail that puts the boiled lobster we had in Maine to shame. Soaking in an incredible roasted garlic butter sauce that was so tasty we all wanted to lick the plate afterwards.

What a perfect introduction to this paradise for Eric!

The Surprise

Thursday was just like any other day. I went to work in the morning at the hospital, came home, laid in the sun for a few minutes before snorkeling (thank you, Mr. BoJangles, Sr. Barracuda and new friend, Harry, the octopus, for allowing me to see you), laying on the beach for a bit longer and then showering at my apartment before heading out for the night. But, on this particular Thursday, an odd thing happened. I received a text message from Eric, who was supposed to get in on Sunday, asking me where I was. "Roatan, duh!", I thought, before another few seconds passed and I thought "does he mean where on Roatan? Could he somehow be here now?! No way."

Way. He was here. From about 1 p.m. until 5 p.m. (the whole time I was on the beach and snorkeling just a few feet from him) he had been sitting in the Palapa Bar (Sundowners) across the street from my apartment. How had we not seen each other?

What a wonderful surprise. It is spectacular to have him here. He is now a guest writer on this blog, so you will hear from both us (and see if I really am doing this place justice with my posts). And in his less than 24 hours here, he has already adjusted quickly to the island lifestyle and knows everyone on our end of the island!

Yeah, I guess it's alright.

You know, if you're into things like spending your first couple hours hanging out in a Palapa Bar 10 feet from a crystal clear tropical bay before being invited to a local's house for homemade lobster soup and grilled lobster tails with garlic butter (Lobsters that were, of course, pulled off the reef just that morning by the chef). If you like that kind of thing, this place is passable. Then of course you could always supplement that with things like snorkling for hours on end with the barracuda (Senor Barracuda apparently), sea turtles (Mr. Bojangles and friend) and a huge electric green moray eel (Murray). Or crashing a wedding reception and immeditaley being welcomed into the festivities. After, of course, saying hi to all the people you met at said Palapa Bar because, yes, they're there too. And yes, they all act like you've known them for years. In the unlikely case that you're into these things then, sure, I'd recommend Roatan. Let us know if you're planning a trip here because we'll probably be living here. Lobster soup anyone?

Snorkeling Karma

I must have stored up a lot of good snorkeling karma in my lifetime, and I think I spent it all today.

Today was the best snorkeling experience I have ever had.

It was actually a terrible day for snorkeling. The water was murky and rough, so that the crystal clear visibility that I am used was reduced drastically. It must be a cruise ship day (cruise ships come into Roatan about 2 days a week completely populating the island with tourists who just drop money in their path) because there were many more boats cruising in and out of my little peaceful bay than usual. I have realized that although I may be scared of big fish, that fear is nothing compared to the fear of being hit by a boat while snorkeling. And finally, my magical trick of smearing Palmolive dish soap on my mask to prevent fogging only seemed to work on one side so I had to stop frequently to clear my mask. The foggy right side with the murky water seemed like a sure guarantee of a terrible snorkeling day.

The other resident (who is also a third year resident at a Childrens Hospital in California (Fresno) doing a rotation in Roatan, but who aside from all of that has very, very precious little in common with me) asked me to go out to West Bay to snorkel with her today. West Bay is gorgeous. It is about a 45 minute walk from our place (or a cheap 15 minute water taxi ride). The difference between Half Moon Bay (where I am in West End) and West Bay is like the difference of getting Italian food from the Olive Garden and from a high end Italian restaruant in Italy. Seriously. West Bay is that great. So why don't I go there every chance I get?!

For a number of reasons, but mainly that I didn't feel like spending a lot of time with this person who finds a way to complain about the increible free accomodation we have on a tropical island. Also, the beauty in West Bay is so in your face and obvious. Half Moon Bay feels like it needs to be explored - has ground yet to be uncovered. And finally Half Moon Bay is literally 10 steps away from our apartment.

So, with all of this background now in place, let me tell you about the snorkeling experience. I will warn you that the only thing that seems to do the experience justice is a string of profanities. It was amazing (insert your own profanities at will as adjectives). Within 3 minutes of my murky, foggy, boat dodging swim I saw a huge Permit Fish (see picture above). So huge that it had a little carrier fish sucking on its side. I have never seen a fish like that before (I actually thought it was a Sun Fish at first, but after a quick consultation with my friend Mr. Google, I realized I was wrong). I did my usual snorkel out to the dock to say hello to the barracuda that hangs out there (Senor Barracuda, to which I always politely request he not swim too quickly in my direction), then headed out to the sunken submarine (a failed project of some crazy American who had an obsession of submarines and decided to move out here and build them), then out to the buoy where the boats leave to the open water. (You can actually see the dock and if you squint & look far out in the middle of the photo you can see the buoy, too, in the photo under the post "The Relaxation".)

I will admit that I go to the dock and the buoy everytime in search of sea turtles. I have heard of people seeing them in these locations, but in my 2.5 weeks had not seen them. Seeing a sea turtle became a new obsession for me. I saw one on the surface of the water while I was fishing, but that's not the same. My sea turtle obsession is very similar to my moose obsession while exploring the North East of the U.S. I was so desperate to see a moose that I think I made Eric and I drive at least 100 miles out of our way. We never saw one. I thought the same would go for the sea turtles of Roatan.

I swam from the sunken submarine (which always has fun surprise fish playing Jack-In-the-Box inside and out) out to the buoy, around the back side and all the way over to the west side of the beach. I saw 2 other Permit Fish and a ton of other HUGE fish. I figured that murky, rough water must attract the large fish. I saw enormous versions of the fish that I see everyday (Parrot fish, some ugly brown ones that hang out at the bottom, angel fish, etc) as well as new huge schools of big fish, that I can only describe as looking like large tuna with a beautiful blue stripe down their sides.

On my way back I stopped by the buoy again to check for turtles and headed back to the submarine. I saw a burst of sand in the distance, and swam towards it. There, on the bottom, was a glorious bat ray. It showed me its peaceful way of gliding through the water and I paddled after it in complete awe.

After a while I headed back to the dock and there, stairing up at me as if he had been waiting for me to get there all day was a large, docile sea turtle (I assume his name to be Mr. Bojangles). Mr. Bojangles looked at me gasping at him from the surface, opened his mouth a couple of times and then gently swam off. I followed him, too for a while, straight to the site of another bat ray.

Incredible!! (Remeber to insert the profanities for emphasis of how amazing this all was). I could compose my own version of a Partridge in a Pear Tree, with the ending being 3 Permit Fish, 2 Batty Rays and a Bojangle Sea Turtle. The whole experience made me wish that I had made finding World Peace or a Million Dollars in Half Moon Bay, Roatan, my latest obsession. Who knows? Now maybe it will be.

The Town of West End

I am living in West End, the SCUBA diving and snorkeling capital of Roatan. It is gorgeous. The town is small and quaint. Above is a picture of some of the brightly colored shacks that pose as restaurants, shops, internet cafes, bars, etc. It is the cutest thing a town could do - be made of tiny little wooden shacks all brightly colored and filled with friendly townsfolk. They are like little beads strung together to made a stunning necklace for the beautiful face of the ocean.

The nightlife is also very vibrant. With dollar beer nights 2 nights a week, an 80s night on Thursdays, and an amazing live band (seriously, I would pay a lot to see these guys in the States - where they are from - but instead I get to enjoy them for free) on Tuesdays and Fridays . . . well, it leaves for very few nights with nothing to do.

Life Without An Attending

The attending physician who was here from the States went home on Friday. Even the local doctor didn't show up for clinic today - I have no idea why. So, it is myself and another 3rd year resident running the clinic (until Friday when she leaves and then it will just be me). It is a little bit nerve racking, but to be completely honest, it has been wonderfully reassuring. It has been a true test of all that I have learned in residency. I am comfortable identifying who is dying from who is really sick, from who isn't very sick at all. And, with the exception of the limited resources here, I am comfortable dealing with all of those scenarios.

What concerns me is the potential patient who walks in with something I have never seen, or with something that I have never taken care of before. I guess the internet will be my guide (yikes!) and maybe a few phone calls to some people back at CHLA for help.

This photo is the entrance into the hospital. Usually the area just beyond those doors is hot, stuffy and packed with people waiting to get a number for the clinic or admission into the emergency department or hospital. It is a good predictor of how busy the morning is going to be. And the best part is, no matter how busy the morning is, I always have that gorgeous beach and lounge chair to return to in the afternoons.

The Relaxation

This picture was taken on the beach directly in front of the apartment where I am living. This is my life. I snorkel in that beautiful ocean everyday and then dry off in the sun while resting in that very lounge chair.

I cannot remember a time when I have felt so relaxed. I am so well rested that there are times when I have time for a nap, and I don't even take it, I don't need to take it, I can go for a swim or a walk instead. It is amazing. All that residency has sapped from me, this place has returned.

It should be a requirement that all residents do a month rotation in Roatan.

The Book

Every now and then I come across a book that within the first few pages I fall in love with. It is the type of book that you want to give to everyone you meet because you know it will enrich their lives. I savor each beautifully written page as though it were a piece of decadent dark choclate that I want to make last.

It makes me feel warm and inspired. It's a great book.

Not surprisingly one of my best friends, Chris Cho, gave it to me.

It's called Eat, Pray, Love by Elizabeth Gilbert: http://www.elizabethgilbert.com/eatpraylove.htm

You should read it. It's kind of girlie.

The Baby with Congenital Heart Disease

On Friday as we were getting ready to leave the clinic we got called into the Emergency Department (I am always grateful when they do that, because it shows their willingness to take our advice and be open to some of the teaching we can give them). There was a 2 month old baby named Yelsi, in there who had already been hospitalized in the past with pneumonia. The baby had respiratory distress and they weren't too sure what to do about it.

This baby was tiny. Had actually lost weight from her birthweight. She was sweaty and breathing rapidly and shallowly. She had an incredible heart murmur that could be heard everywhere - her chest, her back, practically her feet. You could feel it vibrate beneath her chest. Her liver was enlarged, she had large veins in her neck (JVD), and her lungs sounded very wet.

Essentially this baby has congenital heart disease, causing fluid to back up into her lungs, liver and veins. Her murmur was undeniable. Mom confirmed that she would sweat profusely anytime she cried or ate, which is a clear sign of someone whose heart has to work overtime to do everyday activities.

She hadn't been gaining weight because she had been working so hard and needed extra calories to help her grow.

In the States she would have likely been prenatally diagnosed, or at very least diagnosed at birth. She would have been started on medicine to help support her heart and remove excess water from her lungs and body. She would have been placed on a high calorie formula so that she could gain weight until her surgery. And yes, she would have likely had corrective surgery.

Here, she just slipped through the cracks. The pneumonia she was diagnosed with was likely just signs of heart failure that yet again went misdiagnosed. The fact that she is 2 months old is a good sign - maybe the heart lesion isn't so severe...but the fact that she is showing signs of heart failure is not such a good sign.

There is no ability to perform an echocardiogram on the island. There are no pediatric cardiologists (I'm not sure if there are any cardiologists). We tried to do an ultrasound of her heart, but it was difficult to pick out all of the chambers and the doppler wasn't working. We recommended giving her a dose of a diuretic and transferring her as soon as possible to a place that could do an echo and had a pediatric cardiologist.

The hospital doesn't pay for such transfers, and mom doesn't have any money, so luckily the organization that I am working with was able to set aside enough money for: taxi to the ferry station, ferry to the mainland, taxi to the bus station, bus to the larger city with the pediatric cardiologist, and then pay for the echocardiogram at the private hospital. Crazy.

The baby did much better after the diuretic, but she had a very persistent cough. She and mom were actually on the ferry with me over to the mainland. I sat next to them and watched the baby bob her head with each breath as she slept and flare her little nostrils - signs that even while asleep she was working pretty hard to breath.

I watched her and prayed that she would be able to make it to the hospital and then get the help that she needed.

I last spoke to the mom on Sunday - she had been admitted to the Public Hospital, but hadn't seen a doctor yet and didn't know when she would get the echocardiogram. I asked her to please get the phone number of her doctor so that I could call them and find out what was being done for little Yelsi. I feel fortunate that we were there to look at Yelsi and give our opinions, but at the same time I am frightened for all of those patients who don't get that chance.

The Mainland

My time on the mainland was incredibly brief, so I am by no means an expert on Honduras. This weekend I went with a friend to the city of La Ceiba on the coast of Honduras. We took a 2 hour long ferry ride from Roatan over.

(As an aside: My friend is amazing. She has completed her undergraduate degree, did 2 years in the Peace Corps, joined Americorps and is now living in Roatan for almost 6 months volunteering with the same organization I am working with, Global Healing. She is confident, sarcastic, hilarious and knows everyone on the island. Her name is Chrissy, and she has greatly added to my experience here.

A lot of people have asked if I am travelling with anyone else, and the answer is no. I came down on my own. There is another volunteer doctor here, also in her third year of residency, and there is Chrissy, who plans to go to medical school in a few years, but for the most part it is just me - and Eric who comes in next Sunday.)

Now back to the mainland.

The city itself is large, dirty, busy and you can feel your lungs filling with the pollution of the poorly maintained cars as you walk around. Where the island is a stress reliever, the city is a stress giver - with its hustle and bustle and overcrowdedness. I was eager to get back to my little paradise.

It was wonderful to see the beautiful green mountain ranges. And we travelled into the jungle one day, which was exciting in and of itself. We went to an area that had waterfalls cascading into beautiful deep pools where you could swim. The water was ice cold (not the perfect 70 degree water I had become accustomed to). There were a lot of bugs.

I am usually not as big of a complainer as I am now. Looking on the bright side is my usual state of mind. . . I guess I have grown used to living in paradise. It'll be hard to go back to L.A.!

The Sickness

I do plan on going back through and adding in pictures for most of my blogs, but I hereby promise to not include any pictures with this post.

I will also avoid going into great detail.

Just a word of advice. Never, ever utter the words "I have a strong stomach" or "I have never had traveller's diarrhea before" in a country ripe with ameoba, parasites and bacteria. They will hear you and they will find you. That's all I am going to say about that. I can't even comment about how grateful I was that it was short-lived...lest they seek their revenge again.

The Snorkeling

Oh. My. The snorkeling is fantastic. Amazing. Brilliant. Stunning. Beautiful. Awesome.

I have snorkeled everyday except for 2 during my time here so far, and I really missed it those 2 days. The water alone is spectacular (see my blog on The Water). But the fish and the coral and the lobster and the crab and the turtles. . . Well, that almost blows the water out of the water in terms of spectacularity (yes, words need to be made up to describe it).

I have snorkeled over SCUBA divers and thought, "man, they don't know what they are missing up here!" From the top of the water you can see all of the coral and amazing tropical fish up above, as well as the larger fish and sea life (and divers) down below. On a side note, I now know why the sea lions in Monterrey always loved to play with our bubbles when we went diving. Their bubbles are FUN. Big ones, small ones, you can break them apart, you can let them tickle you all over.

The Clinic & Hospital

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 Water

I wish I were a poet, because only poetry has the ability to capture the essence and beauty of the water here. Imagine every beautiful shade of blue possible, and then imagine them all intensified and more glorious. That doesn't even come close to how beautiful the water is to look at.

And to get in it! To submerge yourself in that beauty, with the perfect temperature. Just cool enough to be refreshing; warm enough to stay in all day. And so crystal clear that you can snorkel in incredibly deep areas (60 ft) and still see what is swimming around on the bottom.

Without exaggeration, from the time I got to my apartment to the time I was swimming in the water on my first day was less than 45 minutes. It's that appealing.

The People

The people in Roatan are incredibly friendly and laid back. I love the island culture that seems to afflict all occupants of hot, beautiful, water-surrounded locations. Peaceful, no need to rush anywhere. Ever. The sun will always shine. The water will always be the perfect temperature and glorious shades of blue. And there will always be delicious sweet fruit to eat.

Roatan is a small island off the coast of Honduras. There a few different types of people here. I am going to over-simplify and generalize, and for that I apologize ahead of time. I categorize the people into 3 main groups.

1. Ex-pats - people from all over the world come to visit Roatan and fall in love with it. The extend their vacations and extend their vacations until all of a sudden they have quit their jobs back home and are living permanently in this paradise. There is a huge mixture of ex-pats living here. Many Americans, many Europeans, and many people from other countries in Latin America. These people have adapted to the island lifestyle quickly and easily. As though a part of them always knew that this was how life should be lived.

2. Hondurans - the look of the people you would expect from Central America. A rich indigenous heritage and classic skin tone and facial features. They almost exclusively speak Spanish. They are warm and friendly and will help out all of those who need it. There are a number of unique Amerindian tribes here, but a lot of inter-tribal mixing as well.

3. Garifunas - an incredibly attractive group of people with African heritage, dark black skin, with gorgeous, yet difficult to understand, thick Caribbean accents. They speak 3 languages: Spanish, English and their own (I think it may be called Garifuna). They are actually a group of mixed race people descending from the indigenous people of another Caribbean island, St. Vincent, and a group of slaves who escaped from slave ships from Nigeria that had been wrecked at sea during the voyage over to the Americas. They settled on St. Vincent, and battled both French and English Colonists, only to lose to the English and be exiled to the Bay Islands of Honduras (of which Roatan is one). Also an incredibly friendly and laid back group.

I guess I could also add a fourth group of people. The tourists. People like me, whose skin isn't quite the rich brown of everyone who lives here and is exposed to glorious sunshine everyday. Who walk around with their mouths agape, constantly in awe of how beautiful everything is. Whose pace is a little quicker and who still contain a hint of past stress on their faces. They rush to get out of everyone's way, including their own.

May I look and live more like a native each day!!

Travelogue in Form of Blog

I love writing travelogues of the places I visit - especially if the visits are prolonged (more than a couple of weeks). They are a great way for me to solidify my memories, capture and highlight certain moments and share my experiences with my friends and loved ones.

Until this point I have emailed all of my travelogues to people that I think may be interested in knowing about my happenings. I usually add people at random while going through my contact list - sometimes including people and other times not, forgetting who has received which blog. When I do this, I am in constant fear that the people receiving the emails are not too happy to see my emails pop up in their inboxes. Perhaps they feel a bit of contempt for the author, like I am showing off and rubbing people's faces in it.

That is certainly not my intention.

So I have decided to blog. Any interested parties can check in on the blog from time to time. Anyone who feels like an update of my travels may incite some negative emotion, can choose not to log on.

Plus it might be nice to have all of my stories in one place.

I will try to update periodically with pictures as well.

Welcome. Thanks for sharing in my experience!!