Honduras, Week 1

2/15/12

Posted by Hadia Siddiqui, MD (a third year pediatric resident from Kaiser Permanente, Oakland) currently serving a global health elective in Roatan, Honduras at Clinica Esperanza.

Naturally, I get a bit nervous when I am about to experience something new. So when I embarked on this journey, to a country I knew little about and my very limited Spanish, you could say I was a little apprehensive. However, as soon as Neelu, my co-resident and I arrived in Roatan, my mind was placed at ease when we were greeted by a smiling, energetic Ms. Peggy, who had an air of confidence that was contagious. As Ms. Peggy, the founder of Clinica Esperanza drove us to our residence, I tried to acquaint myself to this beautifully lush island, which has one main road running like a spine from one end to the other end of the island. The dirt roads that branched off the main road told a story of their own. Ms. Peggy’s home was off the main road in Sandy Bay, which was a humble place nestled in an impoverished neighborhood. We were greeted by small children running barefoot alongside our truck. Everyone seemed to know Ms. Peggy and their gratitude was apparent in their demeanor towards us, thanking us for being here even before we had set foot in the clinic.

 The next day, Neelu and I took a taxi from our residence on the West End, which was quite the rugged ride as it made its way through the bumpy dirt road, ridden with mud puddles from the sporadic downpours, to the clinic. After about 10 minutes, we were dropped off in front of a two story maize yellow building with a long line of patients waiting in front. It reminded me of the long queue of pregnant women patiently waiting from dawn to dusk at the maternity hospital in Kabul, Afghanistan, where I had done research 5 years ago. I recalled the dire conditions in the maternity hospital where there was no running water, latex gloves, or a working autoclave to sterilize instruments. Only, I was surprised to find that this clinic was clean, had running water, electricity with a backup generator, and a pharmacy with neatly labeled shelves stacked with a variety of drugs. The exam rooms were not that different than the ones I was used to in the United States. Each exam room had an exam table, instruments needed for a general exam, a sink for hand washing, and even a computer with a simplified EMR system that had its flaws but nonetheless impressive given some hospitals in the US still use paper records. I was told that this was by far one of the best and well reputed clinics on the island.

I was given my own exam room and the day began with patients pouring in, first come first serve, many arriving before sunrise. Most of the chief complaints were not that different from the ones I see back home: diarrhea, vomiting, fever, colds, and rashes to name a few. Impetigo seems to be fairly common on the island given the humid weather, crowding, and poverty; however, I was surprised by the severity of presentation. One child had large crusted lesions all over his body. In contrast to the US, many parents request vitamins and empiric antiparasite therapy. At first I was skeptical about liberally prescribing antiparasitics, but soon learned that the standard of practice here is largely experience based and seems to work well for the most part. Patients are treated with albendazole or piperazine anytime a parent asks for treatment or about three times a year to decrease the parasite load as most can be asymptomatic.

We had our first newborn on our fourth day at the new Birthing Center at the Clinica, a presumed 37 weeker with shoulder dystocia who was delivered by significant traction on the left arm. Neelu and I were asked to assess the infant. Fortunately, the infant was vigorous with reassuring APGAR scores and without any concerning findings. It was both exciting and a relief to all to have a successful delivery. I am looking forward to learning more about the Honduran people, seeing diverse pathology, and working with the staff here.