Week 2 in Honduras

2/21/12

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

Hadia and I just completed our second week at Clinica Esperanza.  Our attending pediatrician was gone for 4 days (as there was a ventilator course for the new pediatric hospital) so aside from a family medicine attending with a rather busy schedule, we were on our own.  The most interesting case I saw this week was one I was relieved that I consulted him on, as it turned out to be a case of Strongyloides!  We also saw a case of Chickenpox this week; unfortunately families are told their kids “have had all their vaccinations” so this girl’s mother was puzzled as to how her child developed chicken pox when she had been “fully” vaccinated.  We later discovered after talking to our attending that the place she was immunized at doesn’t carry the varicella vaccine even though it does exist on the island.

It’s impressive to me how many children we see for colds and other viral syndromes when families are waiting so many hours to be seen.  I’m told some families come in as early as 5:00 AM to get a spot and the earliest we start seeing patients is 8 AM.  By the time we show up to work, the indoor and outdoor waiting areas are pretty full.  After learning more about the prevalence of mortality from pneumonia and diarrhea in developing countries, I now have a better understanding of why patients must present for what seem to be rather benign illnesses.  Interestingly, one of my families presented again this week after I saw them for a URI last week.  She said she took her baby to the hospital for her 6-month vaccines the prior day and they said the baby had noisy breathing and was too sick to receive the vaccines.  They sent her home with loratadine and PO albuterol!  She did not feel comfortable giving them and returned to see what our thoughts were, at which time the baby sounded great and was afebrile; we advised against either medication and to proceed with the vaccines the next day.  Fortunately, Honduras has been quite strict about making sure children have their vaccines so we don’t have to really convince families to get them done(especially since we mostly just carry the flu vaccine for high-risk individuals and have to send them off-site).  It felt nice to know she trusted us and didn’t want to give her child any medications she was unfamiliar with without checking with us.

This week there is also an Emergency Room doctor from the US  who visits the clinic about half of each year so it has been nice to see what his take is on some of the local practices.  I also enjoy working with the pediatrician and having the chance to exchange stories about how we each manage certain conditions in our respective countries and teaching each other our respective languages.  I continue to learn about alternatives for medications we would like to use but don’t have; fortunately many rather young kids swallow pills out here but sometimes we have them just crush the adult pills if they can’t.  We also can send them to a pharmacy with a prescription if it’s something we don’t carry but they may not be able to afford it.

We just had our second and last weekend to enjoy the beautiful island; it has been rather hot and humid but fortunately it looks like the rainy season is finally over for the year!