Half way through!

Hi all, well I can't believe I am half-way through my time here in Honduras. The people here have been so wonderful, patients and employees alike, in embracing me during my time here. I have been invited over for dinner many nights which has saved me because I have not been able to go to the grocery store due to my schedule and have mostly been subsisting on cheese and crackers with a side of oranges for dinner!

The last week of clinic and being on call has been different from my first week. I began to feel frustration this week with some of the patients I was seeing- vague complaints of stomach pain, body aches, and foot pain (everyone here works in sandals doing manual labor, no wonder they have foot pain!). Because of my short orientation, I was not well-versed in what these complaints meant and felt frustrated as I could not pin a diagnosis on anyone given constantly changing history and vagueness of the complaints. It turns out there are several very common ailments here to explain these aches and pains that I was not aware of. Stomach pain is often a gastritis or parasitic infection, so everyone gets treatment for GERD and parasites. With these treatments (and maybe a multivitamin for good measure), most people amazingly get better! The same goes for body aches and pains- a little Tylenol or Ibuprofen goes a long way as most people have not tried or had access to either one of these medications at home. I started to become more familiar with what people wanted when they complained of "stomach pains" and the like, and with this my frustration with these complaints subsided.

The country of Honduras is on alert for Dengue at this time. However, we do not have the serology test to confirm or refute a diagnosis. There is unfortunately no cure for Dengue anyway, so we treat a lot of people supportively with close return precautions with the assumption that they have Dengue (or a similarly presenting disease such as Chikungunya or Zika). I have seen tons of kids with fevers but otherwise no focal symptoms, which is likely one of the above diseases. This is something we rarely see in the US, so it has been interesting to talk with parents about return precautions of "bleeding from the gums" instead of our usual respiratory return precautions in the US.

I continue to be impressed with the diagnostic acuity and "art of medicine" practiced by the docs down here. I realize how spoiled we are to have a CT scanner at our fingertips to differentiate between diverticulutis vs pyelo vs ovarian pathology when a woman comes in with LLQ pain (had this exact scenario and still have no idea what the patient's final diagnosis was!). CT scans are available here but the family has to travel 1.5 hours away on bumpy roads to a town called La Ceiba and pay 5000 lempiras (equivalent to $200) up front to have this done which is no small feat here.We really reserve CT scans for dire cases or chronic cases we cannot find the answer to. For example, a couple days before I came there was a 22 year old student who had acutely become anuric with lower back pain. His creatinine was rising quickly and no urine was accumulating in his bladder by ultrasound. He was going to need dialysis unless he miraculously had bilateral obstructing kidney stones on CT (impossible right?). Dialysis is basically a death sentence here as it is quite expensive and once you can't pay, you are basically done for. One of the docs here felt he couldn't let this young man die without a CT scan- he sent him to La Ceiba and turns out...he had bilateral obstructing renal stones (it CAN happen). They immediately did surgery and the patient went home several days later with an improving Cr. Again, the providers here do so much within the means they have and are so astute to think outside the box when they are called upon to do so.

This week has been filled with some interesting diagnoses- new HIV diagnosis, a stinky diabetic foot ulcer with gallons of underlying pus (treated with several days of IV antibiotics and Dakin's washes only), likely inflammatory bowel disease (and get this, they came to ME for a second opinion from a gastroenterologist). Mostly just lots of "Honduran" primary care work. I am very grateful for the chance to be here and fill in where I can (there are only 3 FP doctors down here now when 2 months ago there were 6).

On a fun note, I went to my first restaurant (Arena's) in the small town of Balfate nearby (the food was not good in case you are ever in Balfate and wondering where you should eat). I hung out at the gas station and ate ice cream (the gas station is the hip part of town), tried a guanabana (soursop- best fruit EVER), and went swimming in the local watering hole (Rio Coco). Life is slower here which has been a nice change of pace from residency.

That's all for now, miss you all!