Greetings from Balfate, Honduras, everyone!

I apologize for the delayed posting, it has been a CRAZY few days combined with some technical difficulties. So, to make up I will try to recap my first week at Hospital Loma de Luz to the best of my abilities.

My entire time here has been an adventure. Starting with getting off a regular Boeing 737 in Roatan and then having to board a tiny propeller plane to fly to La Ceiba on the Honduran mainland. I am terrified of flying so I prayed the entire 20minute duration of that flight. But survived, and unbeknownst to be, the taxi ride from La Ceiba to Balfate (1.5hrs) would be even more terrifying. I should be used to horrible Latin American driving standards (I learned to drive in Mexico for crying out loud!), but I guess you forget and get used to seat belts and air bags and side mirrors which aren't always necessarily available....anyways I survived and made it to Loma de Luz. The first day started being woken up at 5am by a howling monkey outside my window and running across a hanging bridge to get to the hospital. And so, it began...

My first day at Loma de Luz I shadowed Alisa, a nurse practitioner who showed me the ropes. She taught me how the EMR works. How patient flow is managed. Where to find things. Introduced me to the staff. I got a copy of the current med formulary and saw a few patients. I work in the clinic 5 days a week and am on 24hr call twice/wk, one of those days is usually a weekend. 

This week has been GI bleed week and motorcycle accident week. We had Mr. M who presented with a complaint of convulsions. After trying to piece together the story we realized he was recently started on warfarin for A fib. His INR was too high to read. His gums and conjunctiva were white. Surprisingly we had vitamin K and he received 2 doses overnight. Several of us donated blood as he required 4U PRBCs and there is no blood bank available. He recovered and got discharged yesterday!

Mrs M presented with hematemesis and melena. She is neutropenic (still unsure why). Has a history of recurrent GI bleed and we're currently treating her with PPI, H2 blockers and NPO. I just heard today we're running low on PPIs until Friday when the new shipment arrives. She is stable from a GI bleed stand point. It is definitely weird not being able to get an EGD on site and knowing this is all we can do for her, and replace blood if needed knowing if she lived somewhere else (developed nation) she could get a life saving EGD...

I was on call Saturday with Dr. Bryan Jennings (recent NCFM graduate) and we had the craziest/busiest shift they've had in a while. In 24hours I saw 19 legitimately sick patients. Admitted 4 patients. Managed an induction and delivered a baby. I had to repair a pretty gnarly head laceration after a motorcycle accident. I learned to do a infraorbital and mental nerve blocks to repair lip lacerations after yet another motorcycle accident. And a 16yr old walked in very calmly to the ED and said he had a cut on his hand, when I asked him to take the bandage off the entire tip of his 3rd finger was missing (how was he so calm?!). For some reason he stuck his finger and it got cut on the motorcycle chain...the tip was no where to be found. We have no hand surgeons available, but we have a general surgeon who does a lot of ortho surgeries who recommended closing as best we could and follow up in a couple of days with him. 

Most of the crazy cases are obviously seen in the ED. But, I like clinic (partially because there isn't a burden of heavy documentation and time constraints, unlike in the US). I get to sit and talk to the patients. Learn their stories. It is also nice because most of the time the patients do not know what medications they're on. What happened during a hospitalization. What the diagnoses were, etc so trying to piece the story together takes longer. The patient's at LDL are so grateful for the medical help. I've had patients that drove 8 or 12 hrs to be seen at the clinic. Some leave their villages 2 days in advance and make the pilgrimage to LDL in hopes of being seen. The worse clinic cases I've seen have been botched orthopedic cases. It truly is sad. I saw an 8yo F with Blount's disease. Usually bracing will do the trick and correct a bowing tibia, but if needed a relatively simple growth plate arrest surgery would've corrected her problem. However, she is 18months out from surgery she has infected hardware, non healing ulcers and the xray revealed an eroded fibula from the chronic infection. The likelihood of her needed an amputation is high. I cant help but think that this would never happen in the US.

I could go on and on about other cases over the last week, but I've written enough. To sum up my first week at LDL

1. I am in awe of how much the full-time missionaries can do with so little

2. My sense of compassion and love for medicine has been re-ignited by the gratitude and stories from the patients I've met at LDL

3. I cannot help but feel sad by some of these patients knowing that by no fault of their own they were meant to live in a developing country were some life saving resources are just not available- but that they exist somewhere else. 

P.S I've also become very good friends with the LDL dog: Paisley. I may or may not steal her in the afternoons to soothe my puppy withdrawals....

Till next time,

g