A Few Pictures

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Back Home Again

We did in fact arrive home safely after 2 days of travel. The family met me at the airport about 10:30 at night, and we had a great reunion. There are many stories to tell, and many experiences still to be processed. Walking through the hospitals the next afternoon while I checked for any crisis at work, I was silenced by the amazing resources that surrounded me; so many people, so much infrastructure. I am catching up with the family and on sleep, but more pictures are coming. Thanks for all of your prayers and support!

Dinner in Houston!

Hey All!

Mark just called me on his cell from Houston! They are doing well, had an uneventful trip so far, and were sitting down to dinner together during their layover! Just a few more hours!

Bess

IN FLIGHT!!

The Continental website says:


Status: In Flight - Estimated to Arrive 7 Minutes Early

YAHOO!

On Schedule

So the Continental website says the flight out of San Pedro Sula should leave on Schedule, in about an hour.

Will, Noah and I are fairly sure that time has never moved as slowly as it is today.

Off to pace the living room-
Bess

Packing up

From Mark this morning:

"Good morning! It is 10 after 5am here, and I am up, somewhat cleaned up, and packed. I took call last night, but the last patient was at about 10pm. So I got some sleep before the roosters woke me up at 4:40. Not the mention the gecko that I thought was someone knocking at the door multiple times last night. So, we're done with our medical work here- which feels very surreal; seems like we've been here about 5 days. Anyway we driving to El Progresso now, and flying out of San Pedro tomorrow. Supposedly we're stopping to see a big waterfall on our way today."

Hey all:

Bess here. They are scheduled to arrive at Cincinnati Airport tomorrow at 10:15 pm. I don't suspect we'll get any more emails from Mark before he returns home, but I'll keep you posted on his airplane progress tomorrow as I watch it on the computer! We can't wait to have him home!

Roosters in the Mist

From Mark today:

"HUGE rain last night. We were at the church service when it started. One room with about 25 people. The pastor was using a speaker system, but the rain on the metal roof drowned him out completely. As it fell in sheets, the courtyard on the uphill side of the church filled, and then began to come in below the side door of the church. Everyone got up and began moving chairs and speakers out of the water pouring onto the tile floor. Someone from the church decided to open those side doors to look at what was going on- that proved to be a mistake as the doors had been holding back even more water. The ladies of the church grabbed brooms and moved the water across the church and out the downhill door with amazing efficiency. After the rain slowed, church resumed. With all the doors open, I could see the children picking up al lthe green mango that had been blown from the mango tree in the courtyard. The service was not too unlike our familiar setting- a guitar and drumset for music, a songleader, a pastor preaching from Luke- I didn't get much more than that- except for understanding different numbers that
came up.

This morning I went walking with my camera as the sun came up. Mist in all the valleys around us. Apparently frogs come out in great numbers after the rain, as evidenced by the unlucky ones on the road. I took several pictures of the most striking or peculiar roosters along my route. It you give them 30 seconds,you can catch them crowing. Roosters in the mist. Today, I am scheduled to visit the homes of several local children who are believed to have significant cardiac disease- congenital vs. acquired rheumatic heart disease. A reminder of why we try to be vigilant with the treatment of strep throat. I will be taking a stethoscope, a light, an adult and pediatric BP cuff, and a pulse oximeter that was just donated and sent with our group. There is a city several hours away where they can get an echocardiogram, but even with this, cardiac surgery is not done in this country, so images must be sent to the US and elsewhere to find a hospital and group willing to sponsor such a treatment.

Breakfast is served, and I see a plate full of avacado halves!"

Day off

From Mark today:

"We have been having a great day off. I got up before a late, 730, breakfast and had a quiet time. After breakfast we went into a small once weekly market int he next town and I bought 3 mangos for 8 Limpera. One of which I ate. It was amazing!! They won´t last long.

After the market we headed for the border, where we swam across a small slow moving river into a neighboring country that shall not be named. Very fun. I put on sunblock, but midday sun still got the best of me. Pink face, neck, and arms. So much for waterproof spf 30.

After a quick nap in the hammock overlooking the town, trying to escape the sun and heat, I´m walking into town with some of the staff docs to attend a church service. It promises to be hot as well. I hope there are more tortillas for dinner when we get back. So no, we´re not having too rough of a time of it down here! "

PHONE CALL!!!

Hey all!

I was totally surprised this afternoon when my cell phone rang and Mark was on the other end of the line!! He had purchased a calling card and was borrowing a phone from one of the doctors stationed there. He sounds great- relaxed and happy! (In fact, he said when the urge to check work email came over him, he climbed into the hammock and ate a banana!) They had a rather quiet day, and he was headed out for a walk (with lots of water this time) as soon as it cooled off. Tomorrow is a day off for them and sounded like they had some fun activities planned. He also spent some time in the clinica kitchen today learning how to make tortillas from the ladies who run it. By report, it is much harder than it looks, but he was able to pat out and bake a few on his own! I'm hoping for a lesson when he returns.

I'll keep you posted on more emails as they come...
Bess

Clinica

From Mark:

"Today was steady all day, but really never over busy. I was based here in the clinica and saw patients on my own instead of precepting which was fun. I am on call now tonight, so we´ll see what happens. I was not scheduled for tonight, but as no attending was scheduled somehow, I took it. That was so the local docs get a bit of a break while we´re here. They´re pretty much on q3 call when no brigade is hanging out."

Crazy

From Mark this morning

"I've been working on rolling my R's the whole trip but to little avail. One of the interpreters told me to use the word Perro for practice because it positions the tongue forward in the mouth. I wondered what the locals thought of me on my walk. I think it was something like "look at the crazy gringo walking around with no water muttering 'dog, dog, dog, dog'."

The long walk

From Mark last night:

Call was uneventful throughout the night. We had one patient come in early in the morning with stomach pain which was concerning given that she had been shipped out 4 days ago for an emergent appendectomy. Concerns for infection, perforated bowel, gallbladder issue that could have previously been misdiagnosed as an appy. After the docs taking the xray themselves, developing the xray in the darkroom, and giving some mild pain meds, the patient recovered over several hours as was able to go home close by.

I did not stay for the xray, but instead, loaded into the back of a pickup, rolled through the cobblestone and paver streets of Santa Lucia out onto rutted dirtroad leading to a school about 40 minutes away but likely only a few miles up into the hills really. We continued our childhood screening and intervention initiative. Thankfully, very few significantly anemic children. Vitamin A, multivitamins with iron, and albendazole deworming was given for all. I went with one child, a resident doctor, and an interpretor to visit the home of one of the children who lived close by and was diagnosed with asthma. We explained the medications and possible contributing factors to the mother, and she agreed to come to the clinic in about 2 weeks. Many homes have a slow burning cooking fire inside the small 1 or 2 room houses, and we have seen a lot of children and adults with respiratory symptoms.

I took along one of the soccer balls and a pump to the school. The boys and a few girls went crazy over it, careening around a school yard that had large rocks, cement blocks, exposed random metal pieces and trash thoughout it. I asked someone to check to see if we had brought along suture material, but amazingly, the boys just dusted off their various falls and kept playing. Whenever I got the ball, they would call¨Marco!Marco!¨ A great time. I left the ball and pump with the school caretaker for judicious use.

This evening, I took my camera and went out to ¨walkaround town¨ I got a Pepsi Light from the tiny cornerstore for 12 limpera, which is about 75 cents, and went walking. My walk took me through the town square about 5 blocks away and then out of the square on aroad Liz Schlaudecker had recommended as heading up to give a good view of the city. My pepsi long gone, I found myself unable to turn around, and an hour later I was about 1000 vertical feet up in the mountains overlooking the city and the valleys beyond, with the volcanoes once again prominent in the background. I passed a wide range of homes, those with a fence and gate, evidence of a pickup in any state of repair, I now find quite elaborate. As I topped the saddle of the ridge, I sat down for a few minutes to soak up the view, the brightly colored birds, and to slow my rate of perspired fluid loss. My return was delayed as a herd of 20 to 30 cattle were driven by me by a man and a young boy who laughed when I took a picture of his cow. Don´t worry, I´ve had an orange soda and 2 liters of water since returning to the clinica.

Morning News

From Mark this morning:
"Good morning! I worked last night on emergency patients, which were really just urgent care acute issue patients. We finished that about 9pm, missing dinner, but thankfully someone had set aside a few plates of rice, vegetables, and chicken in addition to pretty much an entire pineapple that just melted when you bit into it. No overnight issues, but got called to the clinic just before breakfast that a woman needed to be seen now with severe abdominal pain, before clinic opens at 8am. The resident is across the hall seeing her. We do have a chart system, and were able to find record that she was seen here only a week ago, diagnosed with pancreatitis and sent to the tertiary hospital for appendectomy. Off to field clinic again today."

On Call

From Mark last night:

"I'm still on call tonight. We worked all day in the clinic- a lot of chronic belly pain interspersed with diagnosis of new pregnancy, strange skin rash still not clear diagnosis, ear infection, and checking on the baby that was born overnight- all is well. Strange how we are all working to understand what resources we really have and how to use them or conserve them. Do we really need a pregnancy test? do they really need a full month of antacids? how about 2 weeks. I may be up tonight depending, so I'm off to bed. Looks like I may have a lighter work schedule tomorrow, so may be more email. My Spanish isn't getting any better, but I'm trying it more often. A little boy showed me how to use his homemade wooden top today- slick little toy. I can't make it work, which makes him very happy."

A big day

Good Morning! Two emails from Mark last night:

"Hi! I'm exhausted, but still kicking. Up at 5:30,bkfast at 6:30. We made it to the school that we converted into a med clinic about 8:30. Picture me standing up in the back of a pickup holding on to the ever-present metal bar system/light bar system that every pickup has here. It was still hazy in the valleys, and we were winding through 1 1/2 lane dirt/rock road at 10-25mph for about one hour. Came around one turn and in the background behind 3-4 levels of green/brown loosely forested hillsides, rose from the mist several huge flat topped volcanoes. Yep, erupted last in the 70's they said. Confused on which direction from here...but beautiful. Orange,yellow, green birds- one crazy woodpecker. Amazing. Massive toad, as big as South Whitley bullfrogs was just hanging out on our porch. At the school, we were welcomed with about 200 children all in the schoolyard. They sang the national anthem, and said what appeared to be a prayer all together. The kids, some with family there, abandoned all their open construction classroom, about 10 of them, to us for the day, while they moved from station to station or watched through the window frames. Checkin, weighin and measure, eye chart,fluoride application, hemocrit/anemia check, and physical exam with pharmacy clinic station. I precepted 3 residents in the clinic station for the morning, and then did finger pricks with hematocrit checks all afternoon. The children were separated by language, but boys and girls are still the same. Giggling groups of girls, pushing boys for the front of the line. We gave vitamin A, multivitamins with iron, and de-worming medicine- seeing them in most all of the stations to over 250 children and few adults today. Most of our trip will focus on such"preventative medicine" school based interventions. However, I will be staffing the base clinic here in Santa Lucia tomorrow, and "on-call" tomorrow night for any emergencies or deliveries- don't worry, I have a local doc as my backup."

And then later that night:

" I just attended the birth of the 7th child for a small honduran woman. Seems that she was past her due date by about 2 weeks. After a hard labor, the baby came out with meconium, so I was asked to help resuscitate the infant. They had oxygen an a neonatal mask, along with basic suction. A little slow to come around, but the infant looks good. Meconium has the risk of fluid beginning to accumulate on the lungs even now, so we'll see what the evening holds. wow."

Supplies Stocked

Morning! I got another email from Mark this morning that he sent late last night. (It looks like email is going to be the best way to communicate from there.) He said that all of the supplies you send with him have been stocked in the pharmacy, the childrens books have gone to the library, the baby items have been stocked in the mother/baby program area, and toothbrushes are set out to head out into the field today. Things were winding down about 9 last night for them. I can't wait to hear how today goes!

News from the home front... If you ask Will where Daddy is, he says "Hondur-sis" If you ask him what Daddy is doing there, he says "Helping people out". Out of the mouths of babes.

Email!!

Hey all! I just got this email from Mark:

"We are all here and safe! After 2 days of small bus travel, often over winding mountain roads through the mountains, we got to Santa L. at about 3pm today- we are 2 hours behind Cincinnati. The US docs here have greeted us warmly, given us a tour of the clinic, and fed us well (this is a recurring theme) So now we will begin to unload our boxes of supplies (which are supposedly with our luggage on a truck we loaded at the airport 2 days ago-hasn't been seen since) Our job tonight, unload, organize and restock the pharmacy and supplies here. Tomorrow I will be 1 of 2 attending on an all pediatric field clinic some miles of bumpy pickup truck ride away. I will also serve as attending at the clinic here. We already had a woman deliver her 6th baby as we were sitting down to dinner. She arrived here about an hour before the baby. We are well supplied, well staffed, well fed, and temperatures are about 80 with a little blessed rain. Not so much roughing it. I've almost filled a 1 GB card...good thing I've got 6."

Bess

On his way!

Hey all! It's Bess, and I'll be your guest blogger until Mark can get to a computer! The whole family loaded in the minivan at 3:45 this morning and took Mark and his huge suitcase and huge rubbermaid bin of supplies to the airport. He got checked in with no trouble, and if all goes smoothly, will be eating lunch in Honduras! We'll keep you posted!

Bess

An Accounting

For those who have supported the trip financially and with supplies, thank you. The group is meeting on a nearly daily basis to study tropical diseases, health disparity, and culture.

Although not finished, the current inventory that we will together contribute to the trip includes:
85 toothbrushes
several dozen infant outfits
several dozen infant receiving blankets
Soaps, shampoo, lotions
10 wrist braces (for carpal tunnel and overuse injuries)
2 full knee immobilizers (ACL and other knee injuries)
3 walking canes
56 bottles of infant and children Tylenol
Spanish children's books
School supplies including crayons, erasers, pencils, pens, etc.
5 Ace bandages
Alcohol swabs


It is amazing to watch the supplies stack up as they arrive or are purchased incrementally. It has been an outpooring of love for these people, who none of us have met. I will try to represent us well. I am working on an order for iron supplements for children in Honduras. This is a need in light of intestinal parasites, however, must be approached cautiously, as iron is a medicine that can be overdosed leading to significant harm. Instead of trying to make these decisions as a mental exercise from here, I await an email from the doctors stationed for a year in the Honduran clinic with their thoughts. T minus 5 days!

Orientation

"Part of Spain's vast empire in the New World, Honduras became an independent nation in 1821. After two and one-half decades of mostly military rule, a freely elected civilian government came to power in 1982. During the 1980s, Honduras proved a haven for anti-Sandinista contras fighting the Marxist Nicaraguan Government and an ally to Salvadoran Government forces fighting against leftist guerrillas. The country was devastated by Hurricane Mitch in 1998, which killed about 5,600 people and caused approximately $2 billion in damage

Population:
6,823,568 (July 2004 est.)
Age structure:
0-14 years: 41.2% (male 1,434,555; female 1,376,216)

15-64 years: 55.1% (male 1,866,219; female 1,896,027)
65 years and over: 3.7% (male 118,404; female 132,147) (2004 est.)

Median age:
total: 19 years male: 18.6 years female: 19.4 years (2004 est.)

Economy: Honduras is the third poorest country in the Western Hemisphere. The 2001 GNP per capita is only $740 per year placing it in the World Bank classification system in the poorest quartile. It has an extraordinarily unequal distribution of income and massive unemployment, is banking on expanded trade privileges under the Enhanced Caribbean Basin Initiative and on debt relief under the Heavily Indebted Poor Countries (HIPC) initiative."

Santa Lucia, Honduras - Background

International medicine has been a desire of mine since college, however things never seemed to come together for me to go. Now, a plane ticket to Honduras has my name on it for April 12th, less than a month away. I will be joining a group of medical students, resident physicians, and faculty physicians from family medicine, internal medicine, and pediatrics. It is with a renewed excitement that I try to picture practicing medicine in a radically different setting, Santa Lucia, Honduras.


The organization that I will be working with is called Shoulder to Shoulder. More information is on their website at shouldertoshoulder.org. An excerpt from the website includes:


“Shoulder to Shoulder is a private, non-profit, non-governmental organization formed in Cincinnati, Ohio in 1996. It began providing health care services in western Intibuca in 1990, six years prior to its official incorporation. In the spirit of local empowerment, Shoulder to Shoulder worked with local community leaders in Santa Lucia to form Hombro a Hombro, a grassroots community-based, non-profit NGO (non-governmental organization) registered in Honduras since 1996. Shoulder to Shoulder and Hombro a Hombro work in tandem to achieve a single mission: to develop educational and health programs to help poor rural communities in Honduras achieve sustainable development and improve the overall health and well being of its residents. We seek to address the health, education, economic, and social needs of isolated communities in the Western Intibuca region.


The three missions of Shoulder to Shoulder are:
1. To provide medical and dental care, nutrition services and community development for poor communities in rural Honduras.
2. To provide faculty supervised experiences for health care providers in an international setting that enhances skills in community health, tropical medicine, cross cultural medicine and working in resource poor environments.
3. To provide a setting for reflection and personal growth through service.”

List of Needs

In preparation for the trip, the group members are collecting needed items, as identified by the current staff in Honduras. We will each be taking one suitcase of personal items, and one with the needed supplies. If you would like to contribute items or funds toward specific supplies of your choosing, please let me know.

For example:
Target has toothbrushes for $0.97 and a box of alcohol swabs in $1.59.

----
Alcohol wipes*** (*** = really needed)
Toothbrushes***
Arm Slings***

Soaps
Shampoos
Toothbrushes
Diaper cream
Baby layette gifts (infant soaps, nail clippers, etc.) (Bess told me girls would know what this means)
Newborn baby hats
School Supplies
Art supplies: paint brushes, colored pencils (box of 8), pencils, erasers, crayons
Newborn diapers, formula, receiving blankets, onesies, diaper bags/canvas bags, small baby toys
Children’s Books in Spanish (Listed on Amazon.com under Wish List for “Shouldertoshoulder “, please change address to our home)
Children’s toddler shoes (new or gently used)

Ace Wraps
Canes
Thumb spica splints
Cock up wrist splints, all sizes