First Days!

Hi from Honduras!
I was just re-reading Georgina's posts about her time in Honduras- lots to look forward to and be prepared for. I am only on my 3rd day here, but it has already been a whirlwind of an experience. Arriving here as Georgina laid out was quit a feat- 3 plane rides and a bumpy car ride through the jungle. Luckily, the nurses and nurse mid-wife as well as Anne Hotz, one of the family physicians here, were in La Ceiba (a small coastal town of 200,000) to accompany me to Loma de Luz. I got to sit next to Carolina, a nurse midwife from the Netherlands, on the car ride to the hospital- she was a wealth of knowledge and so excited to share about her experiences so far in Honduras. She loved telling me about a patient with TRAP sequence...look it up if you want to be entertained.

On my first day, I had about a 5 minute orientation on how to function in the system. I got a 5 minute tour. Then I was off seeing patients (with many questions along the way, of course). My first patient was a 30 yo pt coming in for a routine prenatal visit--except not routine at all. She thought she was about 6 months along- this was her first prenatal visit. She explained that this was her second baby- and the first delivery was normal, no complications. As we discussed further, I realized that she had a blood transfusion in the middle of her last pregnancy for severe anemia- no complications?!?!? I quickly ordered prenatal labs (here they do a CBC, RPR, HIV, and blood type for prenatal labs- I think they choose to do labs only on the infections or disease they can do something about). She also needed a dating ultrasound and lived far away- so had to get that done during her appt. She then shared she had never had a Pap Smear done and since we were doing a pelvic exam, we decided to do a Pap too. Again, thought it would be no big deal, but turns out as Georgina outlined, we have to prepare our own slides for Pap, fix the cells with hair spray (yes, really) and send them to the US hoping we prepared a good sample. This patient exposed me to what a routine prenatal visit is at Loma de Luz-now I was ready for anything (or so I thought).

On my second day, I was on call. I saw several kiddos with fevers- thought about my usual diagnoses but also had to think about malaria, dengue, and helminthic infections in these kids given they are endemic in this region. Thank goodness I don't think any of these kiddos had anything serious. I went to the OR for a closed reduction of a boy who came from Roatan (a 1.5 hr ferry ride and 1.5 hr car ride to the hospital) with a double forearm fracture (radius and ulna) and had a patient with a mid-shaft humerus fracture all within an hour. Speaking with the docs down here, there are a lot more patients with trauma and fractures down here, mostly due to moto accidents and kiddos climbing in trees and falling without supervision. A lot of injuries from animals as well. Anyway, had another pt with a TIA and syncope, RLQ pain (likely appendicitis), and an asthma exacerbation with likely HHS (all conditions we frequently see in the US).

I have so much respect for the doctors and nurses who work here. Even with these common conditions that are fairly straightforward to work up in the US, here you have to decide what to do based not only on what is medically indicated but also what resources you have and what resources the patients have. I also have so much respect for the patients. Patients have to pay for everything out of pocket and sometimes admitting them to the hospital is going to put a serious financial strain on their family. It's a delicate balancing act for both providers and patients and seeing patients having to make decisions between their finances and their health in such extreme circumstances is heartbreaking. I wish I could pay for everyone's admission myself...

I want to say tons more, but I don't want to tell you everything before I get back, and I have several weeks more of time here to write about. The howler Monkeys are awesome (here's what they sound like in the middle of the night- https://www.youtube.com/watch?v=-vxlnZ8BihI). It's so beautiful but hot as heck here (worse than Colorado in July I think). Miss you all and can't wait to tell you more about my time at Loma de Luz!

<3 Abigail