clinics: mobile, stationary, and home bound

I started back to real life almost three weeks ago.  Well, I suppose it's more like the third layer of real life as it relates to the most recent holidays.  Layer 1: back in the US, layer 2: back home in Portland after my family left, layer 3: recommence school.  In any case, all that is to say that I am back trying to get into the swing of things in a new hospital with new faces, new room layouts, new nurses, new EMR, new bathrooms to find, new all of the things.  Prior to my first shift, I was talking with Julia on the phone on our shared far apart commute as is our customary first day tradition.  We pump each other up so that we feel less silly about what ridiculous things will come out of our mouths probably as soon as we arrive, and then afterwards we debrief about those exact things and laugh about them. But, we realized that we only have two more first days left! Yikes! and Yay? and also Oh Crap!? Hmmm.   

So, before I get sucked further into rotation 6, I knew I needed to unpack Belize a little more.  If these past two years have been any indication, I've gotten a little too good at letting time get away from me on here.  So, without further ado: clinics, mobile, stationary and home bound!

So, the Hillside clinic is located about 8 miles outside Punta Gorda in the Toledo District of Belize in a place called Eldridgeville.  The clinic itself is located on a fenced compound of sorts, and on that compound are various living places for the students and preceptors, as well as education buildings where physical therapy is performed and lectures are listened to.  The students all bunk in Abby's House, which is about fifteen steps from the clinic.

On days when your group works at Hillside, you go on a market run.  Our group did meal planning together and sent money and a shopping list along with those that were marketing.  First stop was the open air market, which was beautiful, chaotic, and fun.  We bargained like the best of them, well at least Natalie did, and we tried to follow her lead.  There was a small fish market there as well, and we braved that once.  I think our definitions of having a fish cleaned and ready were a little lost in translation.  But they sure were tasty!  Following that we would stop at a grocery store to pick up the staples.  Shopping for meals that involve 13 people is anxiety producing to say the least, but I think we all did pretty well!

Working at the Hillside clinic had the advantage of access to more.  More variety of drugs, more testing capabilities on site, more abilities to draw blood and store it properly, more clinical support staff.  It was basically a stand alone, as much as anything else would be in the world of belizean health care.  There were three very basic examination rooms, one had a door and the other two had curtains.  If the place was really hopping, you could see patients out back at the picnic table too. 

On mobile clinics, all bets were off.  We practiced at places ranging from a large cement slab covered with a thatched roof, to operational clinics with all separate examining rooms, to a one room school house that had one single rickety bed that we all rotated using if the patient required a more extensive abdominal exam, to a building so crammed with objects that I had patients sit in a wheelchair while I conducted the encounter.  It was really fun!  It made my brain stretch so far outside the confines of how I viewed traditional medical encounters.  The amount of labs I ordered in the entire time I was in Belize could be counted on my two hands.  We were pushed to hone our clinical skills to a fine point, to depend more on what we could illicit and feel and see rather than hiding behind scathes of unnecessary tests that so often buffer patient visit in the US, because often we couldn't even order them and if you did order them, it would take months to get results back.

  

 

It felt like MEDICINE and less like covering yourself for fear of impending litigation.  And it was frustrating, and hard and difficult for the same reasons that it was eye opening and exhilarating.  It's scary to prescribe medicines based on lab work that wasn't done the day before, or to know how much time will pass before the mobile clinic comes back to more rural villages.  It's hard to know what exactly the patient is telling you when you are working through a translator, and it's scary to think about how much better they could be managed in a different situation.  Which isn't always true, of course, but there were more than a few cases that kept me up at night with the frustrations of comparisons coming from a country so wealthy and so full of ways to squander that wealth.

We spent one night camped in a school room in the village of Aguacate after a failed attempt to make it to a village further away.  Thwarted by recent rainfall and a low road.

There were most definitely rats squeaking in our ears all night, scorpions hidden in the corners, and a giant spider lurking in what I shall loosely term a commode.  Luckily for me, I hadn't really slept the night before, so after Natalie and I strung up our bed feet to feet style on top of two narrow desks, and covered our entireties with mosquito nets.  I popped ear plugs in to ward away any interested passing insect parties, and actually slept fairly well all things considered!

The next morning while we were drinking coffee and eating our breakfast before opening the clinic, a woman walked upp to us and told us she was in labor and needed to go to a hospital.  She was extremely calm, and we talked to her for a good ten minutes trying to overcome the language barrier and ascertain that we were all talking about the same things.   Our preceptor took her down to the clinic and did an exam, which determined that she was in fact 6 cm dilated.  They made a makeshift bed in the back of the van and headed off to the nearest hospital, leaving just us poor students to hold down the clinic.  Here we are nervously putting our hands on deck as the van pulls away in the back ground!

Surprisingly, we didn't kill anyone!  We consulted with each other on medication adjustments, differentials, and treatment plans.  All things considered it went quite smoothly, but it was a pretty terrifying two hours of solo practice!

Home visits are something that has really fallen out of medicine in the US.  In Belize, we had a small number of patients who were home bound, and thus required us to come to them.  It was such an interesting and broadening experience to gain a glimpse of the day to day life that these people lead.  We examined patients who were laying in hammocks, navigated a yard guarded by a menacing turkey, hoofed up a muddy hillside post excessive rainfall, and crammed a group of seven into a room the size of a closet.  Home health care in Belize is fun!

We all pitched in together to make the best of every situation we encountered.  We worked as a group to push through the things that made us uncomfortable, to learn more about the conditions we lacked knowledge in, and collaborated to make the most out of this international medical experience.   I know I am so fortunate, and so blessed to have been a part of this experience, and to have shared a small part in the organization as a whole.  I will graduate in May, look out international medical organizations, I am coming for you!