Thursday, June 23, 2005

The Last Days

The joy of hope and cooperation is tempered by my sadness. It is nearing my last hours here and once again I have mixed emotions. One never feels as though they have accomplished enough in the bottomless pit of poverty. I was buying a skirt and shoes yesterday at a local store and the guilt was tremendous. I know that buying things helps the store owners whose clothes hang from the ceiling rafters month in and month out. But it reminds me of the have and have not situation we live. It forces me to reconcile my own desire for success and convenience against my desire to help a group of people I love achieve a better life. I know that every penny I spend not just here but when I get back home, could buy more food and medicine. How can I accept that?

For now I must look back at this month one success at a time, some great and some small but with each taking us a step further than we were before. They officially have electronic medical records……there is a mirror in the girls dorm which we hope will improve hygiene….the local physicians have hope for a better way…..there is a village deep in the mountains whose children are protected for a few more months from consumption by parasites…..families have been reunited after months of separation…..a little girl will live to see her first birthday against incredible odds…..another will walk…..and as for Anothony he will continue to smile………

Water and Rain

The rainy season has begun. We have had 7 straight days constant down pours with violent lightning storms. I am starting to understand how Noah must have felt, but the only animals I could gather right now are a mouse, 3 goekos and a giant spider. I have gotten used to the mouse living under the sink. I am sure it’s a girl because she likes my clothes. I call her poo for obvious reasons.

With the storms we have been with out electricity for several days. It will flicker for a little while but ultimately kick out. This has put a damper on the internet connections. We have been fortunate though to still have water in most places because we operate on collecting system that uses pumps in the dry season and can catch rain in the rainy season. It is amazing how crafty the design of the plantation is. Dr. Youngberg did a lot with a very little.

Speaking of water we received wonderful news yesterday. It began over “burgers” at a fairly local restraunt/bed and breakfast which caters to the American way of life. I heard a group of gringos talking and being the shy girl I am forced my self to go and chat. It turns out they have invested a bunch of money into building a new clinic nearby to serve the poor. They actually knew about us but hadn’t made any contact to find out our story. Their funding was clearly superior to ours because they have corporate sponsors and we survive on personal donations. I was pretty direct in the conversation discussing the goal we have of unifying the medical system in Pina Blanca to better serve over 50 villages that feed into the town. At one point I flat out asked why they didn’t try to work with us instead of building their own infrastructure from scratch. I didn’t get an answer but the seeds of thought had been planted. Two days ago a bus full of doctors and contractors showed up at our door. They came to get a tour and understand what we were about. They brought clothes and books for our smallest children. They were really wonderful and so excited to see how much we had to offer. In the end they said they wanted to help us finish the new dorms for the children. You see, the hospital as we call it, that we currently have, is built of wood. The children live in it along with 50,000 termites, a dozen bats and couple hundred rodents. In this building is also the small clinic we operate throughout the day and our “kitchen”. When it rains the water pours in along with the wind. It’s constantly damp and the stench will knock your nose off. God help us if we ever had a fire, with the severe lightning storms it is a constant worry. We need new buildings to get the children out of the hospital as soon as possible, at which time we will tear it down and start building a new more modern hospital that can protect the children from the elements. Last evening we had a meeting with them. They made clear their intentions to help. They can’t fund it all but will help to the degree that they have excess. They also said they were going to help us get a water collection/purification system at a low cost that would help us guarantee our water supply to the whole plantation. If this really happens we could utilize more of the ground for growing crops. A major barrier to increasing our agriculture has been the inability to keep the ground watered in the dry season.

We are holding our breath but we are hopeful……..

Summary of the project goals

The trip to the mountains went extremely well despite torrential rain. We saw 80 people in one day. Most for simple parasite medication but 30 consults were other issues ranging from on the spot abscess draining to more tragic diseases that I could not help. There were tears and smiles to fill the void of emotion I initially subconsciously tried to create as I saw the massive crowd accumulate before my eyes. Each time I travel into the mountains my mind races my heart in an inner battle to overcome the feeling of helplessness generated by the knowledge that my resources are too scarce to care for all the people I will see, the knowledge that there will be several I will turn away with out conclusion with out treatment, the knowledge that I too will leave some to die and some will die in spite of my attempts, my frailties will be revealed to me and only me for those who come expect I know it all. I climb the dirt roads full of trenches and remnants of landslides which manifest, physically, the mental journey I am on.

It is through this experience that I remain able to focus on the goal….the goal to develop a medical system that finally allows for more than just medication delivery but attempts to address education as well as prevention. A system that empowers the local physicians with tools to obtain tele-consults from US physicians who want to help, x-rays, lab values and tools that help them deliver the kind of care that they dream of in their hearts. I have set the wheels in motion with my job this year at the University of Rochester Medical Center to arrange for multidisciplinary teams to rotate through the clinic creating a win- win atmosphere of collaboration between Honduras and Home. There are times when I wonder if there is anyone out there as crazy as me who really wants to do this, who can tolerate the physical and emotional flux. I remain encouraged by reports of other universities who have heard of the site and wish to participate as well. We have developed a website to manage the visits and we made a video documentary to help orient volunteers to the inner workings of the site. If anyone is out there who is not in the health field but wishes to give a little time to a great cause there is no lack of need for multiple other types of work and expertise that are needed.

And now I must sleep, my arms are scorched and my soul is restless with anticipation of what the future holds…..

Acquisition of Compassion

Anthony suffered a major set back. He had been doing so well. We were careful with his diet and gentle with the anti-worm medication. He was working up on his diet, his swelling greatly subsided and he had begun playing with the other children. Then his world came crashing down. He awoke yesterday morning with face more swollen than when he first came to us. He wouldn’t eat and he had little energy. We suspected his kidney’s and did a very simple urine test which demonstrated he had developed nephrotic syndrome. Jenny and I were surprised. We have seen lots of complications but this we hadn’t seen. Nephrotic syndrome is an immunologic disease launched against the kidney’s which can be triggered by multiple different entities. It was necessary to get him to the main hospital in San Pedro in case he needed dialysis. It was so sudden we were afraid that steroids might not be enough. He knew something bad was happening as we scrambled about poking and prodding him. He knew he would be leaving to go somewhere but where he couldn’t understand. His eyes were large and helpless. He held my finger and tears began to well up in his eyes as sweat beads poured from his forehead. I felt like a traitor as we took him to the bus stop. In his arms I placed a small teddy bear and I kissed him on the forehead as I explained he’d be back soon. He wasn’t buying it. Sarah a worker on the plantation was in charge of getting him to the hospital and caring for him while he was there. The hospital doesn’t have enough funding to provide a nursing staff that can give medications and baths and do treatments so when a child goes there they must be accompanied by an adult to stay with them 24 hours a day. Sarah is great with the children an experienced mom and a good one at that. She swept him up in her arms more gruff than I would have but this is her life and her world where children get sick everyday, their parents leave and don’t come back, they have needs that go unmet and sometimes they die. Sarah had that wall of emotional experience that she used as a guard to ward off unwanted sadness. It worked and in some ways her cold strength, like a bluff in poker, protected the children from the level of worry we each held inside. I couldn’t sleep last night wondering what would happen, what would they do to him, how frightened he must be, wondering about parents in the States that lay at night and worry when their child is in the hospital even when to us it seems like a straight forward admission to them it may be terrifying for all the same reasons. Compassion I did not know I did not have till now that I have it…….

Monday, June 06, 2005

Sea Sick

As many of you noticed we have good days and bad days like any other place in the world, but sometimes we have so many highs and lows in a day I get sea sick.

We have been with out money for 7 days.

Someone stole the remaining beans so now we only have rice, plantains and cornflakes with soy milk.

There was a sizable donation over the weekend so many of the workers got part of their salary, (always good for moral).

Our only truck to get into the mountains and pick up new children broke down. I am pretty sure it’s the starter, but the men keep saying it’s just the battery. I”ll be curious to see who is right.

Two volunteers from the states came down today and they are awsome. They just pitched right in and started helping. A willing set of hands can do a world of good in a short period of time here.
Electricity is scarce because we can't pay the bill.

The telemedicine had a small boost today we have received news that we may be able to get satellite internet here at the hospital with an adequate amount of upload at a significantly more affordable price, but we have to get beans first, oh and electricity would be nice too!

As for the children we suffered the same kind of high's and low's. We have two children from one family which have been here twice for approximately 3 mos each time. They are doing terrific. We have been waiting for their parents to return for them. Today their mother returned but with her she brought their little sister. She is 2, her face solemn, her body lethargic, with 4 little limp limbs that are slightly bigger in diameter than a quarter. To give you some perspective, a normal child at two years old should have an upper arm diameter greater than 13.5 cm. That is about 5 inches. She can’t say any words, there is not enough muscle mass to allow her to sit up by herself and she can barely hold her head up. Forget standing. It was good to reunite the family, sad to see the two boys go not knowing for sure they would get their next meal. We were glad the mother brought the little girl not ashamed to admit she just didn’t have the means. We could have kept the two boys but she wanted to take them home. It’s hard to argue that and with our funds in short supply we can’t keep everyone either. In the end we do what we can one mouth at a time and pray for the best.

I have very sad news about Anthony and tonight I just don’t feel like writing about it, maybe tomorrow in the light of day it won’t hurt so much......

Thursday, June 02, 2005

The Week and the River

This week will go down in history here as “the week they drained the river”. The emerald green river, a hallmark of Pina Blanca , which allowed this little town a small amount of uniqueness and beauty, was drained. Nearly the entire town came out in disbelief. They watched the water dry up and along with it a certain amount of dignity and pride. There were rumors of why and for how long. Some said months some said forever. I overheard in the café that the mafia had taken over the Tilapia market of Lake Yahoa and the growing amount of pollution in the lake was being attributed to the river. Who knows the truth but the muddy basin left behind was horribly ugly and filled with a tremendous amount of rubbish that had accumulated over years. Many farmers depended on the river to help with cattle raising and a large portion of the town used it as a washer and dryer for clothes because there are gigantic cliff rocks that the clothes can be laid on to dry. For many it was a bath tub, others a recreation site for swimming and boating (sorry no sailing) for others still it was food supply by means of fishing. It would be only weeks before it became garbage dump and a mosquito breeding heaven. A great many towns people complained and with in a few short days the river was ordered to be filled again. Jenny and I were so happy. There is a significant amount of public health education required around the use of the river but until other structures are put in place it does have a purpose. It was good to see the authorities have a vested interest in what is important to the town.

We brought in 2 new children this week to keep a bit, both severely malnourished and quite ill. Both of them had Kwashiorkor a form of protein malnourishment which causes the child to swell up like the Michelin man. The children eat a lot of starch which fills the belly but has no other nutritious components. Their faces were so puffy the skin was taught and their hair was falling out. Both had severe pneumonia and bad dermatitis. Neither one had the energy to smile. The boy was 3 yrs old, brought by his grandfather and older brother. It was painful for the man to admit he couldn’t take care of the little one. He was afraid to leave him as he did not know us. The oldest child was also quite thin but not nearly so malnourished. His demeanor was one of humble pride much like the grandfather, with an element of quiet strength and a sense of protector. He was clearly the primary care taker of the 3 yr old. When we offered them food he turned it down and said “No, save it for Anthony”. When it was time for the grandfather to leave with the older child Anthony’s eyes welled up as he held out his tiny little hand, fingers spread. Anthony tried to walk after them but his little legs could not keep up. His older brother turned and saw Anthony following, he went running back and hugged Anthony one last time. As I picked Anthony up he began to sob, quietly at first then he couldn’t hold back. I held him and sung to him for a long time but his tears still flowed.

The other child was 10 mos old and had been at the government hospital for a week. She came in with measles and received an IV in the scalp because she was so swollen they couldn’t find a vessel in her arm. Unfortunately the IV infiltrated which resulted in a giant burn covering ¾ of her scalp. She wasn’t getting better and the family had no money so the hospital sent her home with vitamins to die. By the time her mother got her to us her head was badly infected her lungs were filled with fluid and she had a horrible case of Scarlet fever. After a few days of intense IM antibiotic therapy, appropriate wound care and being gentle with refeeding she is doing quite well. Neither are out of the woods but both have definite improvement, in fact, Anthony smiled at me today….

Trouble and Irony

In my hand a small piece of an earthworm squirmed as I tried to drop it in the mouth of baby bird that had fallen out of the nest in front of my room. I felt nauseated but the plight of the bird seemed stronger than that of the worm and so I persisted. Jen chuckled and taunted in the background as she is not sure what to make of me sometimes. The chance of survival for this ugly little thing was slim but in both of our eyes allowing it to suffer hours of starvation was harder than feeding it worms. Suddenly our chuckles were interrupted by terrible screaming. There were two voices outside, one young and fearful the other deep and enraged. We ran to the door in time to hear loud cracks. A bit fearful we pushed open the door and became for a moment frozen as a man stood with piece of hose snipped at both ends arm raised biceps bulging and sweat pouring from his back as he brought down with all the force his shoulder and arm could muster a blow to the child’s back. The child was begging for mercy with tears on her cheeks. What do you do in a moment like that? With only an instant of hesitation to note the fear I had inside, I lept out into the walk way with a voice I did not know I had. The man turned on me and I was no longer afraid I was furious. His eyes wavered between rage and shock. The only thing between me and the whip were my words and the knowledge he had that I was a doctor. Even in Honduras it is against the law to abuse children. I’d be lying if I told you I said something profound, I did not. I spoke the truth about beating children words I once spoke because I was taught them words I now spoke because I understood them. The shock took away his power. His necessity to justify his actions deflated his rage. Jen came behind me pulling me back with enough force to bruise my arm…….. it was done. He walked away yelling back at me to mind my own business this is Honduras not America, blah blah blah. Jen called me foolish, and maybe that’s true, but I could not let a man hide behind the concept of cultural moray to protect himself from his own in ability to deal with self generated anger while he committed an atrocity. My sadness comes from my sense of powerlessness to protect this child from future beatings.

Children look to their parents for protection, food, shelter and guidance. The psychological damage that is generated by having the only people in the world you trust turn on you and hurt you is enormous. Violence of any kind teaches a child they can not trust anyone, it teaches them that the way to control people is through fear, it takes away self esteem because children are concrete thinkers, life is black or white, I’m bad or good, I’m lovable or I am not lovable, if I’m being beaten I must be all bad, I must not be lovable…….if I was lovable I wouldn’t be beaten. In America many people hide behind the saying “well I was beaten and I turned out okay”,..…I beg the right to ask the question…when they look in the mirror at night are they really okay, or have they strived for an entire lifetime to overcome the injuries of childhood. I can not argue against the fact that physical and mental violence can be effective control mechanisms, but I do say there are other ways Educating parents on effective parenting techniques is the one thing that can be done not just here but in America in our inner cities in our suburbs. Remember, the woman I spoke of last year whose children were shot and one of them was locked under a hut for 4 years while the father tried to starve him. She too beat her children, it was a problem. We spent a lot of time talking with her and teaching her other ways. They paid for her to attend adult education classes. She learned to read, she gained hope for a better life, she obtained tools to deal with her feelings, she doesn’t beat her children any more…...

That night the bird died.

After a week of inner silence I have come to a realization. When I was a child the first thing that caused me to want to be a physician was my frustration with my inability to save the baby peeps my parents purchased for our farm. Several died without an obvious cause. I buried each one with a little cross of sticks and prayed for God to take care of them and if he could maybe someday would he help me to know how to fix them. Here I am finishing my training, I have finally reached what I thought was the top of mountain and I can’t save the damn birds. I cried…..

I recognize that I have not reached the top of the mountain only a small perch along the way. I accept that I may still not save the bird or the child but if I continue to try there will be some that will benefit like the woman from the plantel if all of us try there will be many who will benefit……….
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