Joie de vivre

Looking at the date today, and realizing I will leave Honduras in a little more than a month, makes me oh so aware of the beauty and joy here around me.

I love walking out my door to be greeted with the full bloom of tulip trees and hibiscus.

I walk into morning report and am greeted with a smile and a welcoming “Buenos dias, Lic.!  All of the nurses here call me by my title “Licenciada,” but the students have taken to affectionately shortening it to “Lic.”  It sounds like a cross between the word leek and lick.  A funny sounding word in English to be sure, but there is something wonderfully “belonging” about having a nickname.  I love it.  When I first was given the responsibility of supervising the student nurses I viewed it as a chore.  They were constantly making mistakes that I was ultimately responsible for, one of the doctors was unhappy about having students (and let me know about it in full detail), and whenever there were students on shift I had to be physically present checking into every detail.  Yet, as I got to know each of them personally, it became a joy instead.  They come here, every day of the week, working for a bare minimum government stipend (they are in their year of government social service before they can work as full graduate nurses) and happily put up with all the menial tasks that students are given.  Several weeks ago we heard that the government may not pay them anything this year – that they will have been working A YEAR without any pay, and yet they still show up with smiles in place and work diligently.  They all have their strengths and weaknesses.  I have had to work on my dislike of confronting people when there is discipline needed, and they have had to put up with a nurse manager who does not speak either of their languages very well, but I feel very privileged to have gotten to know all of them.  When I see the smile and hear “Lic.!” called out in greeting I am grateful for all we have taught each other.

I have made so many dear friends here.  This week was Lesvia’s birthday.

I was invited to her house for dinner and cake.  This was my first Miskito birthday party.  We sat on the porch of her stilt house and watched the sunset over the Moravian church. Her daughter (also named Lesvia, who was celebrating her birthday as well) had a friend come and set up a sound system.

What an interesting contrast sitting in a house with no plumbing, and watching the young man run a power line from the generator to his lovely sound setup.  I was treated to a night of Miskito pop music, some Latin dance music, wonderful times of conversation and laughter, and delicious cake.  Since coca cola is a huge part of the birthday tradition here (enough that a verse about it was added onto the birthday song) I found myself suddenly extremely talkative and ebullient at 9pm.  One would think a daily habit of coffee drinking would diminish caffeine sensitivity over time, but in my case this just is not true.

I have made friends with all the boys on the youth soccer team.  They are very amused that I enjoy playing soccer, and apparently the novelty of a gringa playing sports makes up for the fact that I am so very less talented then all of them.  They frequently ask me to play when there is a pickup soccer game and laugh good naturedly with me when I fall over in the mud (yes, I am just that ungraceful, but my cleats were stolen back in November and the ground is very slippery!).

I was very happy to see one of these boys, Nehmias, at Lesvia’s party, since he was good enough to sit by me and chat in Spanish while many of the older generation were speaking only in Miskito.  He was also sweet enough to walk me home, since it was well after dark.  When we passed by several young men that reeked of alcohol and made suggestive comments I was quite glad that that I was not walking solo.

During the Saturday soccer match whichever boys are not playing are happy to keep up a running commentary in Spanish and Miskito.  I am afraid my Spanish learning has plateaued at a not-quite-fluent-yet level, but the my Miskito vocabulary increases everyday!

 

 

One of the best things that happened this week was fairly mundane for everyone else, but was a great victory for me!  The floor is fixed!

Selen, one of the hospital’s handimen, took pity on me (or perhaps he too sensed the malingering evil of these floor tiles) and gathered the necessary materials.  No longer shall the fear of ballistic feces-infused scum water threaten my day.

There is so much joy to be had in every day if you just go looking for it!

Life is good.

Feet, cleats, and futbol – a plea

This blog is the first I will write directly asking for your help with something.  I am writing a plea on the behalf of the youth soccer league of Ahuas.  Every Saturday these young men play their hearts out on the futbol field - many of them barefoot amidst the mud and cow pies.  I know there were always old cleats hanging around my house when I was growing up with three brothers.  I am writing to ask for beg for old cleats.  Please just take a moment to look in your closet.  Haven’t played soccer for a couple years?  Know anyone with fast growing teenagers who might have outgrown some cleats recently?  Any and all soccer equipment would be hugely appreciated – cleats, long socks, shin guards, jerseys – but most especially the cleats.

The boys here love playing soccer.  They are also incredibly talented.  All the kids in my neighborhood grew up playing soccer, but we never had the innate talent, grace and crazy footwork these boys have developed day by day by playing diligently.  Every Saturday they gather – up to half of them with no shoes, or just one cleat.  At first I was confused about the one cleat fashion, but then I realized that two boys had split the pair – thereby giving them each a little bit of traction.  They have jerseys they have gathered and, in some cases, sewed themselves.  Even when the rain comes pounding down they keep playing – playing for the joy of the game.

The league gives the youth of Ahuas (and the surrounding villages) a chance to get together and play an organized game of soccer every Saturday leading up to the championship later this year.  Some of these boys walk from villages 3 hours away just to come play.  With ever encroaching narcotic trafficking, and the options for easily ruining (or loosing) your life making a quick dollar, having a healthy alternative way to spend time is very important for these boys and young men.  Our players range from age 10 to 18, but don’t feel bad for the little guys – they are some of our best players.

Last Saturday all the boys came out and meticulously went over the field picking up cow dung and sharp rocks.  The painstakingly laid down boundary lines using sawdust, and spent hours tying cardboard over the surrounding barbed wire fence (so they wouldn’t immediately puncture the ball).  You can see the results below.

So please, if you or anyone you know has some cleats they could donate please drop me a line.  If you are the Santa Cruz county area I have some people who will help me gather all the donations and I will pay for them all to be shipped here.  If you are in another city please still comment and I will facilitate the cleats getting out here.  Even if we could get 20 pairs together it would make a difference!

 

Wabul

There are a variety of delicious foods that I have been introduced to here in La Mosquitia.  I am certainly looking forward to having frequent “Honduran cooking days”when I return home, although I cannot promise that my tortillas will resemble anything other than amorphous amoebas.  More than anything I have been impressed with the great variety of dishes that can be made with bananas (and their relatives: plátano, pilipitas, etc.).  Along with the delicious banana bread that I was already familiar with bananas can be fried like french fries, boiled in their skin and then lightly fried in brown sugar and cinnamon, dried and ground up for flour to make dumplings, bread, and cake… and the list goes on.  Madura (ripe banana or pilipita) jam has to be one of the most delicious substances in the world.

When I was little my Mom used to always talk about loving “wabul” when she was a child in Honduras.  For months after I arrived here I still had not encountered this mysterious substance.  Finally, last month, we were introduced.  And, oh what a joyous meeting it was.  Since then I have had several variations on the recipe and it only gets better.

It seemed only right to share this deliciousness with all of you.

Wabul recipe

10 bananas (or any relative of the banana family.  I prefer the sweeter options, but I have a serious sweet tooth).

1 coconut (you are only going to use the “meat” so you can drink the coconut water as a pre-cooking snack)

Peel the bananas and cut them in half.  Place them in a pot with enough water to cover them and simmer for approx 20 minutes.  Pour off the water and then mash the bananas.  (Lesvia our cook actually strains them to get a smoother texture, but I think a food processor would work even better.  I don’t mind the lumps myself, but some people are picky)

Cut the coconut in half.  If you are really legit you will accomplish this task with a machete.  Grate the white coconut “meat.”  Pour 1 cup hot water over the gratings and let sit for several minutes.  Squeeze the gratings (and save the water to the side).

Again pour hot water (this time up to 4 cups) over the gratings and let sit for several minutes.  Squeeze out the milky water and add to the mashed banana.  Lastly add the first cup you squeezed out (the first cup has higher oil content and must be added last).

Stir together over heat (on the stove) and serve warm.

I prefer my wabul flavored with a good dose of cinnamon, but I am sure it would be good with allspice, cloves, ginger, and many more!  You can also cut up mango or other fresh fruits and add into the mix.  ENJOY!

http://www.turkulka.net/diccionario/palabra/7920

Nurses

I feel I have seriously neglected a subject which is a wonderful part of our daily life here.  Namely, that of our nurses.

My official job here is “enfermera jefe.”  I am the manager in charge of the nurses (and random other extraneous things such as linen, legal paperwork, and stocking the pharmacy).  This has given me a wonderful chance to work directly with, and get to know all of our nurses.

We have 11 LVNs – two of whom have been here since my Grandparents time!  Our nurses are amazing.  They switch between the challenges of assisting in labor and delivery, surgery, trauma and daily to day hospital tasks without complaining (well, mostly without complaint).

It is a high achievement to finish 6^th grade  and be able to read here.  In order to enter nursing school one must have finished 9th grade.  Then there are two years of nursing school, and then one year of social service to the government.  Truly an accomplishment.  Right now we have 6 students serving their year of social service with us in Ahuas, along with our 11 experienced nurses.

Some of our nurses have gravitated towards certain specialties.  Flor (who was called Florcita in my Grandparents’ days) learned how to use the autoclave from my Grandmother, and spent some time in the States training to be a surgical nurse.  She is a wonderful scrub nurse.  She scrubs into every routine surgery (she is scheduled Monday through Friday from 8am to 5pm) and then is always on call for emergency caesarians or traumas that come our way.  She has become a particular friend of mine, telling me stories of the old days, giving me life advice, and teaching me about working in the OR.  She knows where everything is in our sterile supply room (a somewhat daunting collection of new and resterilized materials, and ancient archaic machines that Dr. Rudy cannot bear to throw away) and is always good for a long talk while folding campos azules (surgical towels).  Completing a generational circle, she taught me how to use the giant autoclave and sterilize materials for surgery.

Flor is the only nurse “on-call” for surgery, but several of our other nurses have trained to take and develop xrays and they too can be called in at any hour of the night or weekend.  Last night a young boy was carried in after falling in front of a moving car.  He had deep lacerations on his forehead with the skin peeled back to expose his scalp.  His pelvic bone was broken and he had multiple abrasions down one side of his body.  The shift nurse and nursing student helped as the doctor stitched up his head wound and then Jeny, one of the xray nurses, came in and we took multiple films to discern what all he had broken.  Fortunately his skull was intact, but I was still very worried about internal bleeding and intracranial pressure.  The family has no money for a flight to La Ceiba (where they have a CT scan, MRI, and more advanced surgical facilities) so we will have to watch and see how he does.  The night nurse did neuro checks every two hours,  as well as caring for her other nine patients and he looked better this morning.  Vamos a ver.

Our nurses Brenda, Digna, Jeni, and Soila all take turns running the pharmacy and doing shift work.  The farmacia nurse doles out medications and fills prescriptions, as well as running a thriving chatamusca (frozen coolaid) business whose proceeds go to a local Moravian church.  Carmen runs the Preclinica and assists the doctors in the clinic.  Monday through Saturday there is a nurse in Preclinica, a nurse in pharmacy, and then of course whoever is on shift in the hospital.  We have one nurse on shift in the hospital (along with a nursing student right now) at all times.  The A shift nurse is here from 7am to 2pm, the B shift nurse is here from 2pm to 9pm, and the C shift nurse spends the night from 9pm until 7 the next morning.

The patient load can range from 5 patients up to 20.  We try and keep the acuity level to a manageable level, but at times there are gravely ill patients who simply cannot afford to fly out, so then the nurses care for them as well.  It is all in a day’s work here  to start an IV on an infant, do a vaginal check on a pregnant woman in labor, stitch up a wound, scrub into an emergency c-section, and get the local psychiatric patient to stop harassing people.  Delroy – who does our monthly government paperwork, as well as being the best shift nurse on staff – was telling me how nervous he was when he first was hired.  He had done his social service in Central Salud (the government clinic) giving vaccines and doing clinic work, so he was worried about not knowing how to check the cervix or help a laboring mother.  Apparently he learned just fine, because I have seen him deliver two babies all by himself when the doctor could not get there in time.  He is very patient with the students, can get an IV on the most difficult invisible vein, and is meticulous about charting.  Plus he actually likes working C shifts, a task some of the other nurses do not prefer.

While I have been impressed for some time at the variety of skills possessed by our nurses here, and their ability to overcome challenges never conceived of in the States, I still am occasionally caught by surprise.  Rafael, another wonderful shift nurse who also takes xrays, approached me asking for some extra time off one weekend.  He explained that it was planting season and he needed to go tend to his “finca” (farm).  I had no idea, but when I asked Dr. Rudy he said that most families need a small area of crops to survive.  Whether it is just to grow food for themselves, or to sell the plantains, beans, coconuts, etc to others; having a farm or plantation is part of the daily existence.  So Rafael has been tending to his bean plantation down river every day, while also working shifts in the hospital.  Nurses get one month off a year, and Rafael asked for a month in spring so he could harvest his crop.  Not what I think of when considering vacation.

Even for those nurses without farms daily life is hard.  All cooking is done from scratch, including killing the cow to get the meat for dinner, separating the rocks from the harvested rice, soaking the beans for hours before cooking them, and hacking open coconuts with a machete.  Laundry is done by hand, with water hauled up from the river, and then hung out to dry.  Jenaine, a great shift nurse who also runs our prenatal care program, sorrowfully informed me one day that her favorite scrub top had been eaten off the clothes line by a passing cow.  She found it mangled and masticated beyond repair in some nearby bushes.

One day in a particularly hectic surgery Dr. Norvelle asked me to do the first prep for the patient.  I responded that I was happy to do it, but not quite sure of the process (having never done it before).  Norvelle sniffed and made a comment about “what do they teach in nursing schools these days?”  I don’t know what all they do teach in Honduran nursing school, but if these nurses are a good sample, I can tell you they are doing something right!

A day in the life of an enfermera jefe in Ahuas, Gracias A Dios, Honduras

Day in the life of a licenciada – 27 de Febrero, 2012

6:00am Awaken to alarm and roosters crowing outside the window, fight through the gauzy clingy mosquito netting to emerge into a new day

6:30am Wander over to the doctors’ house for breakfast.  Make a face when I see instant coffee out on the table, and Lesvia the cook laughs and conspiratorially starts making real coffee for me.

7:00am Slather some toast with mango jam for the night shift nurse and head over for morning devotions and daily report at the nurses’ station.

7:15am Realize that one of the student nurses is going to need to call out of work – her Mom was admitted to the hospital last night – so call around and eventually convince another student to come in to cover the morning shift.  While waiting for him to arrive check over all the charts to make sure orders have been transcribed correctly, and all patients written into the admit/discharge diagnosis book.

8am Start patient rounds with Dr. Rudy.  Check on the little boy in traction to make sure there are no pressure ulcers, check the blood sugar of the diabetic amputee, discuss the need for getting up and walking with the post-op caesarian patient.

8:30am Then it’s on over to the clinic for the madness of Monday morning.  This Monday is particularly hectic because Dr. Phil Mackenly, the eye doctor from the States, is here on his annual trip.  We have triple the amount of patient charts to pull out of the archives and set in order.  There are vitals to be taken and charts to be organized for several hours.

9:30am Since most of our staff goes to get their annual eye check I figure it wouldn’t be a bad idea to have a check-up myself.  Being the lone member of my family who does not wear corrective lenses I’ve held out almost as a point of pride, but the headaches from computer work and direct sunlight might just mean I need a change…

Dr. Phil checks my eyes and pronounces them “quite healthy.”  He says the headaches are most likely due to the stronger sunlight here closer to the equator, and says his only diagnosis would be “overworked and under rested” for the computer issues.  I go back to Preclinica and am relieved to continue sans lenses.

12:30pm Run over to the house for a quick lunch and read my book for a half hour.  Currently engrossed in  In The time of the Butterflies by Julia Alvarez and am loath to put it down.

2:00pm Preclinica is ongoing and suddenly there is a large sweaty man yelling in the waiting area.  I go to figure out what the problem is and find Dr. Rudy calmly trying to explain that the man cannot expect to leave the hospital (after being admitted last night) without telling anyone and then jump the head of the line when he shows up again at the clinic.  The sweaty man eventually calms down and sits to wait to be re-admitted.

2:30pm The two students working day shift have run into a problem.  One of the babies with bronchiolitis lost his O2 tube and the students are stressed.  We have a teaching session about how to insert the tube, proper placement, taping techniques, and the things they should know about the oxygen concentrator.  I supervise the placement of the tube and congratulate the student on her fine work.  I ask that she please check oxygen saturation again in 10 minutes and then wean the oxygen slowly if possible.

3:00pm Dr. Rudy calls me to the emergency room and I arrive to see a young man whose boxers are soaked in blood.  Very soaked.  He is pale and crying.  We peel back the underwear to see a deep jagged wound into his pelvic area – at the base of the genitals.  He was riding his horse and fell onto an out-jutting tree branch.  Somewhat miraculously his genitals seem completely unharmed although the hole is deep enough that several fingers fit inside.  Dr. Rudy cleans and flushes the area and I assist him as he stitches up the wound.  We give an IM dose of antibiotics and he is able to limp out of the ER.  I go to check on the bronchiolitis baby and see the O2 saturation and slow weaning of oxygen documented nicely in the chart.  Commend the student for her diligence.

4:00pm Our young patient arrives for her scheduled surgery.  She has a small sebaceous cyst on the side of her eyebrow that Dr. Rudy is going to remove with cautery.  He and Flor scrub in and I am administering ketamine for anesthesia.  The surgery is going along fine.  A tiny arteriol is cut and a pinpoint stream of blood spurts up toward the ceiling – just as the power goes out.  The seconds of darkness seems a very long time, but then the generator kicks in and the lights and cautery come back online and surgery proceeds as planned.  Ah, life in the sticks…

5:30pm Finish all the cleaning up and transcribing of orders after surgery.  Watch the local boys playing soccer in the field next to the hospital  - as the sun sets over the interspersed palm and pine trees.

6:30pm Dinner time!  Coconut shrimp and fried yucca (cassava) are delicious.  Peter’s soccer friends are crowded into the entry way with needles and thread.  Wait, what?  Yes indeed.  These teenage boys are sewing – mending tears in jeans, shirts and shorts.  Rather skillfully too.  Much more skillfully than I could ever manage.  Once again the lesson on avoiding waste is reinforced.  I would have just thrown out the ripped clothes, or given them to a thrift store, and then spent needless money buying new ones –  when all that was needed was a needle and thread.  I wish I had had my camera to capture these teenagers gleefully sewing and laughing together.

8:00pm Finish the dishes and walk back to my room.  Read for a while then shut off the light and listen the rain as it comes rolling in.  I know the weather and her moods here now.  She tends towards the light wind, picking up in intensity, then a light pattering of little skittering drops before the full brunt of the skies opening to pour forth.  Oh how I love that sound.  But she can be capricious as well.  You might get lulled into thinking the day is sunny (and leave your wash out on the line) only to be surprised by a sneak attack of downpour.  Tonight I have no laundry to worry about and I am happy just to listen.  Sadly all too soon it fades away and I am left to fall asleep to someone yelling into their cell phone outside my window.  I guess some things are the same no matter which country you live in…

Smiles

It can be discouraging here.  When you have too many patients with complicated problems (advanced diabetes, stroke, seizure disorder in children, cancer, HIV) and you are deeply limited by the available resources every case seems depressing.  Patients with sky high blood sugars who can’t buy insulin (the hospital has a VERY limited supply since insulin is expensive) and who cannot heal from diabetic ulcers.  Patients who need a complex surgery, but do not have the money to travel to La Ceiba, much less pay for the operation itself.  You could start to wonder why you are even here….

and you need a little reminder of why.

A little boy came into the clinic – more than 45% of his skin badly burned from pulling a pot of boiling beans over on top of himself.

We took him to surgery and Dr. Ovelio spent hours cleaning and treating the wounds.  Burn victims are complicated.  This is why – in large hospitals – there are special burn units dedicated to their care.  Burn victims can lose massive amounts of fluid through the burns.  There is a high risk for infection, and many other complications.  When they are children it is particularly difficult – to get them to keep the dressing in place, because they do not understand why they have so much pain, and because you feel awful when you have to do the daily dressing change.  Despite all that, this little boy did well.  He did wonderfully in fact.  He was discharged home this weekend, all smiles and intact skin.  It is good to realize we do make a difference here.  For a family that could barely afford a trip upriver, much less all the way to a major city, it was wonderful we could care for him in rural Ahuas. It was wonderful to see the smiles.

It’s on, floor tiles!

I am in a personal war with the main hospital hallway. There is a loose tile along the middle of the hallway leading up to the nurses’ station. This tile happens to be directly across from the bathroom with plumbing problems. Every day this tile lies in wait for me…

I probably should explain a little more about plumbing and sanitation here. The hospital has had plumbing for many decades, but it is a rarity here in Ahuas. The majority of the people in the village have no running water, no indoor toilet, and clean water only after boiling it.  In some more rural villages there is also a prevailing lack of education on germs and the dangers of unboiled river water. If it looks clear why wouldn’t you drink it? The more advanced houses in the village have a wooden outhouse building built over a large hole. The people go to the river every day to carry water back up to the house. Washing of dishes, clothes, and bathing is all done in the river. In fact, the main water hole under the bridge is known as a general “meeting place” where women go to wash and catch up on the daily happenings in Ahuas. All of this added together means that the general population here is not very familiar with indoor plumbing.

This lack of familiarity leads to many problems at the hospital. Many times we find water taps left wide open, draining precious water out onto the floor. When the toilets overflow, they too feed dirty water out into the hallway. Although we are not in a drought right now, it does take electricity to run the pumps that feed the water tanks, and on a cloudy day (when the solar panels aren’t taking in much power) we tend to run low. Another problem is that people don’t understand just what is appropriate to flush down the toilet. One time our handyman took an overflowing toilet apart only to discover an entire bar of soap had been flushed down. Many times the people are without toilet paper (there are thieves who constantly take the newly furnished rolls from the bathroom) and after using leaves or some cardboard to wipe, they flush that down as well. So the toilet off the main hallway is almost constantly overflowing. I have also seen a patient’s mother take the bedpan her daughter had just used, walk out into the hallway, and dump it right there. Appalled, I asked why on earth she would think that was an appropriate place. She explained that the toilet had overflowed out into the hallway and so she was only adding to what was already there. When I asked if she would please empty it outside were this to be the case she rolled her eyes and explained (what should have been immediately obvious to me) that it was dark and she did not want to meet any spirits. She was not necessarily a good picture of our patient population, but you begin to get the picture.

So, the hallway stinks. Every morning our cleaning ladies wash, scrub, and mop the area and return it to a semblance of cleanliness, and then almost every night it descends to filth again. The sala de labor y parto is also along this hallway so many times there is also a trail of blood from where a woman whose water just broke was carried or walked along to the labor room. The chickens and dogs that run through the halls occasionally add their own little gifts to the murk. Our nurses do have some awareness of cleaning, but many times there are 15 – 20 patients for one nurse and she (or he) is simply too busy to clean.

I loathe walking up this hallway to get to report in the morning. I lift my scrub pants and tiptoe through the fetid puddles attempting the least amount of contact possible with the disease ridden liquid. The hallway sensed my loathing. It went on the attack. Last week as I tiptoed through the swamp one of the tiles shifted under my foot and shot putrid liquid up the length of my pant leg. I gagged and attempted to hold the cloth away from my flesh. I resolved to walk on the opposite side of the hallway, but it managed to get me twice more when I was rushing to do some important task and forgot. Today, I automatically navigated off to the side, only to get splashed once, twice, more with scum water. There were a total of 6 tiles now loose from the constant water drainage. It was war. I approached Dr. Rudy with the issue and he said we can consider buying new tiles and grout only after we buy the monthly inventory of medications. I approached our maintenance men and they promised to fix them as soon as we have supplies. I gave the nurses a long talk on keeping the hallway clean whenever possible and they referred again to lack of education in the patient population, and the fact that they, too, would love a clean bathroom that was not constantly overflowing with filth. I glared in hatred at the floor tiles, and they said nothing at all.  But I could feel them waiting to spray me once again. This is not over floor tiles. I will conquer you.

A challenge to myself

Looking forward

It is now less than two months until I shall be homeward bound.  I begin to think in anticipation of seeing family and dear friends again, of meeting sweet little babies that had not been born when I left, and oh so many things!

I have been asked what I am most looking forward to when I return.  Kristian asked me, what is the first thing you’re going to do when you get home? Mental lists of delights began scrolling through my imagination.

1. Getting to choose what I will eat!  Along with this comes, getting to eat large quantities of vegetables!  The food I have been given here daily is quite delicious and filling.  I have never been hungry.  Lesvia the cook does amazing things with a very small list of ingredients, but I cannot wait to get home and make a huge Thai or Indian stir fry.  One morning I was listening in on Dr. Rudy, Peter, and Hazel having Bible Study and discussing free will and choice.  Dr. Rudy asked the kids what “choice” entailed and Hazel answered “choice is having more than one type of cereal for breakfast.”  It’s true – after eating cornflakes almost every breakfast for 5 months I will be excited to have some choice!
2. Getting to toss my dirty clothes in a wash machine, add some soap, turn the dial, and walk away.  Washing clothes by hand is hard work – as any of the women here could tell you.  Your back hurts, your hands get dry and cracked, and you begin to resent your socks.  Socks are so annoying, they are tiny and must each be individually washed.  They get dirtier than most other articles of clothing (especially in this muddy weather), and there are so many of them every week!  They seem to multiply as they are pulled one by one from the water and scrubbed on the washboard.  Oh, the joys of a wash machine!
3. Walking to the beach.  I love the savannah here.  There is a majestic beauty in the rolling fields that stretch endlessly to the horizon.  But I have always lived near the water.  I miss the crashing surf and the glory that is walking West Cliff Drive in Santa Cruz.  I cannot wait to see the Pacific.
4. How lovely it will be to have a glass of wine with dinner and not have to worry about offending anyone!  Drinking alcohol is more than frowned upon in Miskito culture; good people do not even consider imbibing wine.  So I am looking forward to ending a 5 month period of almost total teetotalism.  Not to any excess of course, but the thought of a glass of wine after a hard day brings a smile.
5. I am greatly looking forward to having time all to myself.  To walk away from my job (when I get one) and not have to think about it for the rest of the day.  Living on the hospital grounds provides many benefits, and I learn so much from every experience, but I cannot wait to have free time with no chance of it being taken away!
6. But most of all I want to hold onto how blessed I will be to have these things.  I don’t want to immediately get sucked back into “normal” life and forget to be thankful for these simple things.  When I have a hot shower, I want to remember that many people do not have running water.  When I have a hard day and want to complain about my boss, or my difficult work schedule, I want to remember the millions of people are laboring desperately every day to make less than a dollar an hour (in some cases less than a dollar a day) – struggling just to feed their families.  When I feel the “need” to go shopping or splurge on a new expensive phone, I want to remember how easy it is to live simply.  I do plan on enjoying the luxuries of home when I get there, guilt free, but I want to remember.  I want Honduras not just to be an anecdotal amazing interlude in my life, but something that leads me to live differently.

Dr. Ovelio

When Dr. Rudy left on his two week trip to the States I was quite nervous.  I did not know how my Spanish would hold up with no other English speakers around to help out with the occasional translation.  I did not know if I trusted the medical decisions of the new doctor.  I was uncertain how well we would work together.

The week did not start out auspiciously.  We were overwhelmed with staff sick calls – including our administrator (who had to fly out to La Ceiba because he got so sick)-  the surgical cases kept piling up, there were staffing conflicts, Dr. Ovelio and I disagreed on several decisions on patient care, and I was desperately counting down the days until Dr. Rudy returned.

I admit to feeling some mistrust of Dr. Ovelio’s ability.  I knew that he was a relatively new doctor.  He went to medical school and was trained in Cuba, and then did some of his practicum in Venezuela, but had to leave before finishing the full course of study.  I know he is lacking the surgical experience that Dr. Rudy has, after 17 years operating on the wide variety of issues that come through our door.  Just before Dr. Rudy left he took me aside and reminded me I needed to have patience.  Reminded me that everyone is new at one time or another, we can’t start something with an automatic upload of experience and skill (oh Matrix…), it has to be learned over time.  Yet I quickly forgot his words.

I was irritated when Dr. Ovelio did not write his orders as legibly as Dr. Rudy (you think doctors’ handwriting is bad?  Try reading it in another language…), I was irritated when he changed the wound care orders that I was supposed to be tending to, I was irritated when he asked me to redo the staffing schedule I had spent two days creating.  Nothing was the same, nothing was under my control, and I’m sure I snapped a couple times and responded tersely when he asked a favor.  Yet Dr. Ovelio was always kind, calm, and smiling – even after spending all night delivering a baby or tending to an emergency.

I dreaded going to surgery, so of course there was one surgical case after another.  Two tendon repairs in the first few days, a gangrenous foot to be debrided and toes amputated, then a child with burns over 45% of his body, and finally a femur fracture needing traction.  I know that every surgeon has to perform each surgery for the first time at some point in his career, but I was so nervous.  Would there be complications?  If the patient started crumping, would I have the resources to run the code?  This was not my perfectly controlled ICU environment.  Before each surgery I nervously set out the medications I might need: succinylcholine for emergency intubations, ephedrine, epinephrine, and atropine for code situations, labetalol for high blood pressure.  When we began the surgery I checked each dosage of anesthesia that he ordered and monitored everything closely.  I waited for the mistakes that I was certain would occur, and then was surprised!  Surprised at the grace with which each surgery was completed.  Each movement was meticulous and well planned.   With each complex surgery everything went well!  Even days afterwards, the patients continued to recover.  There were no post-op infections or fevers, no inexplicable bleeding, no complaints of overwhelming pain.  The placement of the traction pin actually made the procedure look easy.  I was humbled.  My lack of trust, and lack of understanding were failures indeed, and I had certainly made them known.  Yet Dr. Ovelio continued to thank me for assisting in each surgery, and to work diligently every day with a good attitude and a smile for everyone.

I am excited that Dr. Rudy returns tomorrow, but I am also glad that I have two months to continue learning from both Dr. Ovelio and Dr. Rudy before I go home.  Perhaps the next time I encounter a new doctor, or someone beginning at anything, I will not be so quick to judge.

Images

December and January were such busy months (with all of our visitors and teams) I never got around to posting many pictures.  The internet connectivity issues may have had something to do with that as well.  So here are some recent pictures for your viewing pleasure

Sunset walk on the savannah with Taly

Taly was certain that she had a secret talent as a “horse whisperer.” This was not true

Glorious sunset on the savannah

Little bits of beauty littering the path

Taly again attempting, unsuccessfully, to sneak up on a horse

Stephen and Uri spent many hours helping build this schoolhouse at the JUCUM base

Stephen, Uri and the Hofstad boys

Taly and I went to visit the boys at the base, and to take random pictures

Kristian and Jarle working hard

Ben and Tobias Hofstad

There was also a team of North Carolinians volunteering to build the new airplane hanger

While Taly and I worked in the clinic we got to visit the attic – and all the local bats – to find supplies

Pensively analyzing some chest xrays

The loyal workhorse of the Ahuas airfield – the Cessna

The traditional Moravian church in Ahuas

Lesvia preparing dinner

Sosimo and Karixa – our lab techs

Helping in preclinica

Uri pretty much ran preclinica during our busy specialist week

Carmen, the preclinica nurse, finding patient charts

My youngest brother Micah and George

Mom drinking coconut water on Sunday after church in Paptalaya

Fresh coconut water is delicious

Miskito wedding in Paptalaya

Peter was one of the groomsmen in the wedding

The pastor entering the church

Kristian, Uri, Micah, and me

Mom and Adela – the woman who cooked for Mom’s family and carried my Mom and Aunt around while they were babies

Adela and her family