The safe zone

Diving at the Waterfall

Big Star Fish

Tarantula

Hey guys J here again. Finally.

Since I last posted some pretty cool stuff has happened, along with some not so cool stuff. First the cool stuff. I did get to go snorkeling the other day and saw some pretty cool stuff. Big star fish and lots a colorful fish. Turns out its really hard to take pictures of fish under water while the waves are rocking you one way and the fish are swimming the other. I did manage to get a decent video though which I'm posting and hope to get some better shots later. The water was really clear considering all the rain we got the night before. I'm told there is another better reef further up the beach and hope to hit that one in the weeks to come.

Sunday we went to the Honduran church which is pretty much all kids it seemed like. NH of course got the kids talking and playing with us pretty quickly. I find using my spanish with little kids is alot easier than with adults. True they are alot closer to my level but I feel less judged somehow. When A kid laughs at your accent or grammer problems its so much less insulting for some reason. There were a couple girls there that were just too cute. Don't believe NH has downloaded those pics yet though.

Later that day we went to this sweet water fall where people could swim and jump off of this really high cliff into the water. I just hiked around it looking for critters though. Total bust in the wildlife department. But the impromptu Baptism was pretty cool.

Monday was a pretty slow day I guess. We had lunch at the little place just outside the compound where this Honduran lady has a kind of fast food restaurant. "Fast" being a relative term of course. Probly won't be eating there again seeing as how I have had to spend the last 24 hours in "The safe zone". For those of you unfamiliar with the safe zone allow me to explain. The safe zone is the radius around your toilet that you are confident you can overcome should nature call. The formula is based on your typical regularity (R= trips per hour) which typically lies between 0.1 and 0.2 for most people who are not sick. The next factor to take into account is stride length (S= # of inches per step from back toe to front heel). For those with a longer stride length who are able to cover more ground in a single step your safe zone will be slightly larger. After determining S you simply divide it by 2. Initially some obstacles may play a small roll in determining the safe zone but after you realize your zone is shrinking you can simply remove these (chairs, fans, etc.) to simplify your math. So to break it down for you. "The safe Zone" (in ft) = R(S/2) NOTE : only applicable for #2 trips #1's have a completely different formula, Which for me was 5to8(12in/2)+30-48ft. I'm pretty sure I have just created the most TMI blog post of all time. One cool thing about last night though was NH discovered a Tarantula right outside our door which luckily was inside the safe zone, so I was able to get a few pics of it.

It's Wednesday now and I think the worst is behind me. Not sure if thats a pun or not. Hoping to be able to get out and do some stuff again soon.

J

Eating at a Honduran food stand = diarrhea for all

NH here:
I know you are all probably getting quite tired of me writing. Josh, however, right now is confined to the bed and the toilet. It is not a pretty sight. I am having similar problems but not as bad. I attribute it to my rockin' immune system from eating off of the floor as a child. Anyways, he promises to update you soon.
Update on me: I feel as if my comfort zones are being stretched in every direction. I am fairly comfortable with the whole living-with-no-air-conditioning-lots-of-bugs stuff that comes with this territory. However, this is the first time since actually getting an MD behind my name that I have been treating people in another country. This is the first time I have actually been expected to know what I am doing and make important decisions. It feels like being an intern all over again with all of of the fear and self doubt. God brought me through my intern year stronger, and I know He will do the same for me here. I often think of the verse from II Corinthians 12:9 that says, "But my grace is sufficient for you, for my powers is perfected in weakness." I am comforted both in knowing His sufficiency for me and my patients but also that He is a God who uses the weak (like me).
I was dealing with a child last night with probable glomerulonephritis and high blood pressure. He went into status epilepticus. I don't care how common seizures are, they are scary... for everyone involved. Anyways, I gave phenobarbital IV, and he came out of it. Please pray for his continued healing, and my wisdom in treating him. He is 9 years old, in alot of pain, and scared to death. I too, honestly, am scared to death. As many of you know, you can give me adults in critical condition and women delivering babies, and I love it. Give me a sick kid, and I am scared to death.
I was also part of a twin C-section yesterday. awesome. Both babies came out crying. Mom is doing great.
Pictures to come... I PROMISE!

The great Exodus

NH here:
Well, friends,
An update on my last post: The baby is doing swimmingly. (I shall post a picture later). And after tossing and turning all night praying for my older patient with pneumonia, I walk in, and she looks SO much better. I think that she has finally turned the corner and will make it. Praise the Lord. (as Billy White would say).
I just got back from a day of clinic. There was nothing terribly exciting so I will take this time to fill you in on yesterday. We had originally planned on going to the missionary church, but we heard Saturday night of a Honduran service that was several miles up the road and decided to tag along with a missionary couple and a team from the U.S. Great decision! The church was, I don't know, 75-80% children. Many of these are children from the Sanctuary House Children's Center, just down the hill from the hospital. This place serves as a home for 30 something children who are either 1.) chronically disabled requiring close medical attention, 2.) from very rural areas and needing access to education, and 3.) abandoned, abused, at risk, or just needing a safe place to live for whatever reason. We were sitting at church surrounded by children who were all looking very unsure of these new gringo faces present in their congregation. All it took was a little broken Spanish and allowing them to "do my hair," and we made some fast friends. There were two girls, Josenda y Reina, who even Josh loved. I am pretty sure he would take home with us if we were able. Reina was delighted when I told her that her named sounded like the English word for rain and went around telling everyone. I have to be careful though, because then the rest of the children kept coming up to me wanting to know what THEIR name sounded like in English, looking very sad when I could not think of anything.
After church, we piled into two pick-up trucks with a couple of families from the church, a missionary couple and their grandchildren, and the team from Oregan. We set off for the waterfall. The water was cool and beautiful, and we all enjoyed watching the more daring of the group climb to the top and jump off. Benton is the grandson of one of the missionaries who has lived here for 10 months now. He is VERY precocious and says "I am more Honduran than American now." He decided that he wanted to be baptized. He was baptized on the spot by the pastor from Oregan. Such a beautiful, impromptu ceremony that would rival any of the formal baptism ceremonies that we have in the states. It reminds me of my own baptism by a Sudanese pastor named Abraham in a tributary of the Nile.
Prayer Request: Starting on Thursday, there will be a great exodus of health care providers, and I will be left to man the hospital with very few helpers. Thankfully at least one other physician will be staying. It is exciting but frightening at the same time as all of the providers throw as much information at me at once. "In case of emergency, call...." "The delivery kits and ultrasound machine can be found here....." "At night, the ambulances won't come so you may need to drive them yourself." It is scary, but I know that the Lord will be with me. Please be with me as well in your prayers.
Blessings to you all!
NH

Neonatal Advanced Lift Support Class comes in handy.

So there's nothing like getting my neonatal advanced life support training just prior to coming to Honduras and getting some first hand experience. I was woken up from my bed around 10:30ish pm by Rimas, the husband of the ER physician saying there was an emergency C-section. I rush over with 2 OB nurses who are here with a team from Oregan. The patient is a G1 lady at term with no rupture of membranes or previous problems during pregnancy. She came in with some contractions and when placed on the monitor had fetal heart tones less than 100. She was having deep variable decels that then turned into late decels, and the OB Dr. started making plans for C-section. Abby, the ER physician, did the anesthesia, which consisted of Ketamine and Fentanyl. I was with baby, accompanied by two veteran OB nurses. The baby came out deeply meconium stained, floppy, apneic, and bradycardic. We stimulated the baby and did deep tracheal suction that pulled up a decent amount of the aspirated meconium. Then we bagged the baby who was still apneic and bradycardic. When we are getting everything ready for intubation, the baby finally lets out a cry. YAY! The baby is still a set-up for infection after the aspiration, but when from APGAR of 3 to an APGAR of 7. Praise the Lord. David Davis would be very proud.
Sorry to all of you non-medical people who do not think my medical jargon is very interesting I thought that I would share. Josh will probably blog tomorrow about the rest of our Sunday which was very lovely. It included a Honduran church service and a hike to a waterfill with a spontaneous baptism. Stay tuned.
On a sadder note, my 70 year old patient with COPD and pneumonia is still in pretty serious condition. She has improved some, but I still worry every time I walk by her room, and she is struggling for her breaths. If we had a reliable ventilator, I would have already intubated her, but instead, we are giving her antibiotics, nebulizer treatments, steroids, and hoping for the best.

un senor y una doctora

Regular Scorpion

Whip-tailed scorpion

The view from atop the water tower. Pretty, huh?
Whiptail Lizard

It is Saturday morning at 6:00 am as I write this. I find myself going to bed early (8:30-9) and waking up around 5am. It is a nice schedule actually. I have always liked the lifestyle of awaking with the morning light and going to sleep when it gets dark.

I had my first day of clinic yesterday. It went pretty well, I think. It was like any day in clinic with a new system. The hardest part was not the medicine. The hardest part was learning what medications I have available and what labs they have available (yes, they actually have a pretty extensive lab AND radiology room). My interpreter's name is Ramon. He is what they call and "islander" which means he is actually black and speaks a language that is a strange combination of Spanish, French, and English. He, of course, also speaks English and Spanish flawlessly.... so jealous. My Spanish leaves alot to be desired, but I am working hard at it and find myself able to understand most conversations but often unable to find the words I need to participate.

Many of the things I saw in clinic were problems I was familiar with which was a relief. I saw one mystery case: a young (30's) man with 2 weeks of periodic fevers, joint aches, headaches, and malaise. He looked like he felt terrible. His malaria test was negative so I thought he could have the flu or Dengue fever neither of which I am able to test for. I gave him symptomatic management and will have him RTC on Tues. We had two patients who showed up simultaneously to our emergency care center. This put both myself and the other doctor working on hold in our clinic since we were the only docs around. He ended up sewing up a child's lip who fell from a tree and bit through her lip. I was left with an older lady with a COPD exacerbation, not from smoking her whole life but from cooking over an open flame and breathing in the smoke. We admit COPD most nights at Self back home so I felt very comfortable with this. The biggest challenge was finding medications that she needed AND they had in stock. For instance, I write for Solumedrol. They come back and say they have no Solumedrol. Ok, well, what about Prednisone? No prednisone. Prednisolone? Yes. Ok. Give her that. She was pretty sick and satting 88% on maximum dose oxygen and I hope that she does not get worse. They have one ventilator that sometimes works and no ABG machine.

Some of you who are not interested in all of my medical talk but perhaps wondering how it is that these patients are learning about Jesus. Well, when I am finished seeing a patient, they go to the "consejero" which is Spanish for counselor. There they meet with a Honduran pastor who listens to the patient, counsels them, and shares with them the truth of the gospel. His other job is to figure out how much and if a family is able to pay. You see, Loma de Luz is not a free hospital. They work on a sliding scale bases. There is one fee for locals (the lowest of them all), one fee for those who live outside a certain boundary since they have other hospitals available to them, and foreigners (the highest price). They rarely turn someone away, but they have had people claiming they cannot pay but probably can. This is Oscar, the consejero's job.

J and I may be headed to the reefs to go snorkeling today if the rain did not muddy the water too much.

J here:

Seeing as how I am not a Dr., I spent yesterday somewhat differently. I helped Rimas ( one of the Dr's husbands) clean up and organize part of a bodega (warehouse). It took about 4-5 hours total i guess, but felt like longer in this humidity and heat. I know some of you are wondering why I wasn't out trudging through the jungle finding animals and taking pictures. Well it was day one and I really had no clue where to go for one and we are going to be here for quite awhile so I have plenty of time. I did however find some pretty cool stuff while cleaning out the bodega. Hopefully I can get the pics to upload for you guys to see. After we finished working I came back for a cold shower (which felt great) and laid down during the heat of the day till NH got back. Being the culinary masters that we are we cooked up a pretty tasty dinner. We then broke out the Kindles for awhile before heading to bed. It did rain a good bit last night, but I'm hoping it didn't muddy the reef too much for us to go snorkeling this morning.

Bienvenidos a Honduras

NH here:
We have arrived. We landed around midday in Honduras. This was really strange to me since all of these kind of trips for me have been to China or African which require days of traveling and overnight flights. This was kind of like flying to California....no biggie. We are met by Don Sergia Avila, a man holding a sign ready to drive us. We tell him en espanol that we need to exchange money. He takes us to the money changer who is a guy standing on the sidewalk with a stack of US dollars and a stack of limpiras. Let me tell you. That really inspires confidence. But J did some quick math to make sure we didn't get totally cheated. We then head to the car with our luggage. If any of you have ever been in a developing country, you know. There are always multiple, very agressive people waiting to "help" you with your bags. I was ready for this and held tightly to mine. This did not stop a persistent Honduran man from trying to grab my suitcase as I put it in the car and then demanding un dolor.
We then began a 3 hour drive to La Ceiba to meet our missionary sponsors. We watched out the window at the intricacies of a new country and held on for dear life because Sergia apparently thinks he's a Nascar driver. We watch people traveling down the road in a variety of ways. There are a fair amount of cars and motorcycles with also many people riding on horse drawn buggies and bicycles. We were amazed at the things they can carry on a bike. At one point, we saw a child who could not have been more than 6 years old carrying what appeared to be an 80lb bag of rice on his handlebars. We passed fields of sugar cane, banana trees, and tons of lychees (a spikey red fruit with a white inside. delicious!) which are currently in season.
In La Ceiba we were picked up by our missionary sponsors: an emergency medicine doctor, her husband a pilot, and their 10month old Aliyah. We went grocery shopping there since where we are going there will not be the opportunity to go grocery shopping and headed down to the hospital. On our way (J wanted to make SURE I did not forget this), we saw a jaguarundi, a large cat that is comparative to a miniature jaguar.
We arrive and it is dark, and we explore some. The hospital is as pretty as it looks in the pictures, and we are really close to the beach. On our way here, the missionary told us how the hospital is currently working to be off the grid. They run off of regular electricity during the day and a generator at night. The hospital harvests palm oil that right now they sell to the government for processing. They are in discussions to try to buy a processor that will allow them to run fully off of palm oil and then be energy independent. I am tired but J is crazy full of energy. We explore a little around the compound, go watch Survivor with our hosts who we're delighted to discover are also fans, and settle into sleep.
I am starting work tomorrow. Apparently they are short doctors.
More to come.
NH

A Honduran Adventure

NH here:
I've never thought that I would be much of a blogger. I actually do not believe that my life would be that interesting to read about on a day-to-day basis. However, during our trip to China last year, J and I both enjoyed sharing with you our adventures and hearing your comments and prayers. So tomorrow morning at 4:30 am, we are embarking on yet another adventure: a 5 week stent in a Honduran hospital. (It is beautiful. Check it out at http://www.crstone.org/).
Mission for me:
1.) LEARN SPANISH
2.) Experience medicine in a different geographic location and situation.
3.) Give refresher courses in PALS, ACLS, and NALS to the providers at the hospital.
4.) Experience the excitement of another culture and the beauty of clear blue water, white sandy beaches, and diverse wildlife.
5.) Of course, most importantly, serve the Lord through the circumstances/people we encounter and perhaps figure out where and how we are to serve Him in the future.
Thanks to Rissa who is taking care of our babies (i.e. our kitties Artemis and Keira) while we are gone. Thanks to Oasis Church who is supporting us in prayer. Thanks to the Wickers and Deals for teaching us what it means to follow God.
More to come.
NH