Thursday

Today has been a busy day. I arrived at the clinic at 8am to get my scripts ready to distribute to my home visits. Our clinc pharmacy is located on the second floor of the clinic. It is small and narrow. Every inch of space is used! The long term MD volunteer has worked hard to bring order to the pharmacy. She has also created an inventory. Hopefully, this inventory will help us monitor par levels and give us adequate time to order meds.

I left the clinic with Patricia around 8:30am. Shortly down the road, is a family of 9, waiting in the rain for a bus. We stop, pile them in. Not a peep heard from the kids. Some of them were sick, others had mouth sores. We dropped them off at the hospital.

Our first stop was to a 41 year old female who has had more loss and suffering than I could even imagine. Last year, she was pregnant and her daughter, husband and mother in law died in a tragic car accident on the way to Belize City. She wanted to go with them on the trip, but due to complications with the pregnancy, she stayed home. Several weeks after losing her husband, daughter and mother in law, she miscarried. Shortly after that, she became completely blind in both eyes.

Today, when we arrived at her home and she greeted us with a warm smile and hug. She had a friend visiting her. Her spirits were good and so was her fasting blood glucose. Patricia was pleased. We added an afternoon dose of Metformin, prayed together and then left.

Stopped by my patient home with PVD (Peripheral Vascular Disease)to let her and her daughter know we would be picking her up at 1230pm for a trip to the hospital. I saw her two days ago and she just cried out in pain. No position was making her comfortable. She wasn't eating. Toes: black. Little to no trace of pulses. From the knee down, her leg was cold. Two weeks ago, her second toe toenail fell off. He foot was dying. She had her left leg amputated a bit over a year ago. Six years ago, a stroke left her paralyzed in the right arm. She knows that the only thing that will help alleviate the pain is to have to right leg amputated as well. She agreed to the hospital visit. I asked the daughter to give her two tylenol at 12pm.

Our 82 year old CHF patient was next. She had an CHF exacerbation last week. Edema down, breathing better. There were two young boys outside working in the yard. As we entered into the home, the two boys looked and then slowly walked behind us and waited in the doorway. They didn't say anything, just watched. Moments later, one of the construction workers from across the street, became curious and stood in the doorway for a few moments. Once he saw Patricia taking her patient's blood pressure, a dialog in spanish began between the patient and the worker. The worker wanted his pressure checked as well. It was a bit high and I provided some patient education regarding his diet.

Next, we went across town towards Indianville (that's the community I live in). My patient with COPD was waiting for us on his front porch. As I entered, I could hear his labored breathing. I did vitals and a quick assessment on him. When I asked him if he has been using his nebulizer, he sent me in to talk with his wife. She returned to me with the nebulizer still in the box. "We haven't used it since the last visit" "We were not quite sure how it worked". I walked -the patient thru the setup process and gave him a neb treatment. His O2 went from 85-86%RA up to 93% after the treatment. I encouraged the patient and wife to leave the nebulizer out of the box. I will return tomorrow and have them show me the set up process.

It's 12:10pm, we have 20 minutes for lunch. Marian's it is for some Conch soup. Tried coconut water and I don't like it. It's suppose to be really healthy for you. Exactly why I don't like it!!! The taste reminded me of colonoscopy prep. Nasty!

1:01 pm. "Patricia, we"re late", I exclaimed. We both took one last sip of our Folger's instant coffee, paid and left.

Our patient was ready to go to the hospital. We lifted her into the trooper. Her daughter came with us. Our little patient cried the whole way. "First the arm, then this leg (pointing to her left leg) and now this one. Three gone". The MD took one look and said "this is not good". He will meet with the specialist in the morning. Blood work was done and she was admitted. I think she is alone tonight and she is heavy on my mind. Will she get pain meds? Will the MOH pay for her transportation to Belize City to have the procedue? Tommorrow seems like such a long way off. I'm sure for my patient it seems like an eternity. I pray there is pain medication to keep her comfortable for the night.

My last two patients of the day were new patients to me. Patricia introduced me to each of them and she was able to see her patients while I was assessing. One diabetic and one 95 y.o. HTN, s/p CVA. Both were females and so precious.

4:15pm. I leave my last patient and remind myself to drop off vitamins I promised to a pt. yesterday. "I didn't forget about you" "I know", she replied, "I've seen you going back and forth and knew you would be by".

4:25pm Met Patricia at the internet. We both checked our email. Left at 5pm and outside, a patient's granddaughter was waiting for us. "Granny isn't doing too well today. She feels a bit shaky. She's being treated for parasites and is probably dehydrated. We pass by the clinic to see if we can get some oral rehydration solution. The pharmacist won't give it to use with out a order. WHAT?!?!?!!! This comes free to the MOH. We leave and stop at a local store. We get gatorade and a few other groceries and bring it back to our patient. Vitals are stable. Blood glucose high at 247. She's a diabetic and only eating 2x/day. Most patient's don't have money to buy foods to have a well balanced diet. More education and follow up.

535pm, Patricia and I head back toward my house "what about our friend who had the recent stroke", I asked". We both looked at each other and simultaneously said "first thing tomorrow morning".

PG has had heavy rain since yesterday afternoon. Thankfully, we had a vehicle to get around today. I love my new bike, but was thankful I didn't have to bike in the rain today.

As I reflect on today, I am thankful for my experience here in PG. After seeing some of the patient's today, and listen to their stories and see how they truly live day to day, relying on God's provision, I ask myself "Am I really trusting in Him with my whole heart?"

Week One

My first week went well. It was a bit slow, but I know things are going to pick up. I will have a caseload of about 30 patients. Most of the patients I will be seeing are elderly and can't get around town. Once every three months, they get invited to Hope. This is an afternoon at the Red Cross. They get there blood pressure checked, have a guest speaker, are served a healthy snack and then end the afternoon in a game with prizes for the winners. A handicap van (that was donated by a group that came down) picks them up for the event.

I worked at the Polyclinic on Thursday and saw a bunch of kids ranging in illness from a cut foot (children don't wear shoes here) to Malaria. Two children tested positive for Malaria and had fevers of 102+. Scary, because they are very young.

On Friday, I was asked to visit a lady who recently had a stroke. The family is very thankful to Hillside and the help that we are going to provide to her. She has total right sided paralysis and loss of speech. She is able to understand and can answer simple yes and no questions. When I met her, her husband was in the room. I asked her "Is this your husband"? She looked at me and shook her head no as if to say "I've never me this man". She then got a smile from ear to ear. This got a little joke started between her and her husband. Come to find out, they have been married for about 40 years and have four children. I could see the toll this was taking on the man. His eyes welled up and he said "she is my first girlfriend from high school".

I was invited to a women's meeting at the Baptist Church on Friday night. There is a group of short term missionaries and they put on a wonderful evening of dinner, music, fellowship and a guest speaker. The group had a children's program so the women wouldn't be distracted during the conference. There were still quite a few women with infants, so they stayed with their moms. There were probably 150 women in total. That is impressive since most of the women don't have the opportunity to get out. They are often in the home cooking, cleaning and taking care of the children. For some, it was very difficult to convince their husbands to go.

I got to hold a little 4 month old boy. He was born prematurely, at six months, but was a strong little guy. I held him for almost the entire time. His mom was so grateful, because this gave her an opportunity to participate in the event.

Today, I went to the Baptist church for worship. The church is just a small cement building with two lights. The missionaries built pews this week for the parishioners. No drums, guitar or keyboard. All songs were acapello, but the voices were beautiful. The children sat quietly (for the most part) in the front row. They kept looking back at me during worship and at times I would see then singing some of the hymns. The children are so precious.

Sorry to hear of all the snow you are all getting on the east coast. Remember, you are welcome to come down for a visit. It has been in the high 80's everyday so far.

Meet Ajohn and Steven

Ajohn and Steven are two boys who stop me everyday to chat "Miss", "Miss", they yell as I walk down the street. When I turn around and ask "are you talking to me", they giggle and start to act like typical boys, horseplaying with each other.

Introduction to Punta Gorda

Punta Gorda (aka:PG) is the southernmost town in Belize. PG is the capital of the Toledo district and home to about 6,000 people. Within PG, there are five different main ethnic groups; Mopan Maya, Kekchi Maya, Garifuna, Creoles and East Indian. The official language is English.

PG has one hospital in town. There are about 30 inpatient beds.

Market days are Monday, Wednesday, Friday and Saturday mornings. This is where you will find me and everyone else in PG, shopping for most of our grocery needs. The prices are right and the people are friendly. Wednesday, I bought 8 oranges for 1 Belizean dollar ($0.50)

The Texaco station is the only gas station in town. They have an air pump, so now I know where to go to fill my bike tires.

There are several churches in town; Catholic, Baptist, Assembly of God, Methodist and Pentocostal are the main ones I have seen so far. I have visited the Assembly of God church, which is primarily a spanish speaking congregation. It is located diagonal my house.

Marenco's, a local PG restaraunt is famous for their homemade icecream. Their is a group of menonites in PG that make the ice cream.

Safe Arrival

Today is Saturday, February 16, 2008. I flew out of Boston on Valentine’s Day (Thursday, Feb 14th). Since I didn’t book my Tropic Air flight well enough in advance, I was unable to make the connection from Belize City to Punta Gorda. I ended up staying at the Global Venture Hotel; a clean, safe hotel, owned by a man (Kevin) and his wife from Taiwan.

I arrived in Punta Gorda on Friday, February 15, 2008. I was welcomed at the airport by Patricia, a Nurse Practioner with Hillside. I will be working with Patricia on home visits as well as a variety of other community health projects.