Back Home

Well, I made it back to Utah. I had some change of plans with coming home. There were a number of reasons I wanted to come home earlier than Sunday, and when I looked into it, with the money I would save in lodging and getting a shuttle to the airport (I found a ride on Friday), I broke about even with the cost to change my flight. Plus, Ardis gave me a big discount on my final bill because of the work I did so things ended up working out for me to come home Friday. I was getting frustrated with the work there anyway. I wasn't getting the experiences I wanted so I figured there was no point in me staying extra. Thursday was better though, becase there were a few surgeries that I was able to scrub in on. We did a hysterectomy, C-section, and a vesicocyle repair.
On Friday I woke up early and took the bus to the zoo. I wanted to see that at least before I left for home. I'm glad I went there. It was a lot of fun and I was able to see much of the Belizean wildlife up close. I was the only tourist there for the whole morning so I had the whole place to myself. I saw jaguars, agouti, pumas, crocodiles, and many other things. It was a pretty cool experience. Grant was my ride and picked me up that afternoon as he was having to drive to Belize City. He dropped me off at the airport and I caught my flight.
As I flew away from Belize I had mixed feelings. I'm glad I came and I had many good experiences, but I was sure glad to be leaving. I had experienced some disappointments with the work at the hospital, so I made sure to talk to Ardis about that and some of the things they need to try and improve for students. I don't think she really felt like it was something that she needed to worry about though. I was able to say bye to all the friends I made here and will miss them, but I was so excited to be getting back to the U.S. It is a different world entirely in Belize and while it does have some advantages I like the lifestyle in the U.S. alot more. It is what I am used to and comfortable with. Plus, I missed my family alot and was looking forward to finally seeing them after being away a month. Jessica and I had never been apart so long since our marraige so that wasn't easy. I called her right before my plane took off from Belize and asked her if she wanted to hang out that evening? She of course didn't know what I was talking about, so I said I would see her soon because I was coming home. She was very excited.
My flight went well, but as flights always are, seemed way too long. They gave me a hard time in customs in Houston, going through my bags and asking me all sorts of questions. I'm not sure if it was just a routine check or if I looked supspicious or something. I had let me hair grow out quite a bit, but didn't think I looked to dangerous. The lady asked me a couple times what school I went to and wrote down and seemed to look it up on the internet or something which I thought was odd. Well, I made it through anyway without having anything confescated so thank goodness for that.
Now I am home and grateful to see the beautiful mountains out my window. I was surprised at how cold it was when I got home because when I left it was still reaching the 90s and now suddenly it is almost winter time. I had a great time seeing R.J. again after so long. He didn't seem too excited to see me, but he was being onery and crying. He's been really clingy to me since I got home though so that has been fun. I tried to leave to the priesthood session last night and he came screaming, running after me. Maybe he thought I was going to leave him again for a long time.
Belize is an amazing country. The people there are great and some of the nicest people I've been around. They always tried to make me feel so welcome. They are all mostly poor by my standards, but all seem so content with their lives. That's something I was reminded of there; that I should be more grateful and content for all things I do have. Things could be much worse. I also had some amazing experiences the first couple weeks when I was left on my own. That was a great experience and showed me areas I need to improve and more importantly gave me confidence that I will be ready for my intern year. It wasn't an easy experience, but such a great learning experience and I am happy that I was able to go. When I was leaving, Ardis mentioned I should maybe consider coming back as a resident and I could bring my family. She mentioned that the physicians let residents act completely as co-workers and share call. I doubt my family would want to go, but it is definitely something I'll consider in the future.
So, this is my last post and I hope those who read this blog enjoyed it. :)

Velda - Nurse, Keisha - CNA

Black Howler Monkey

Me and an American Crocodile

Green Parakeet

Jaguar

Wednesday

I did a presentation to the nurses today. I guess you could say it was the most exciting thing that happened. I had the vision of wowing the staff with a colorful powerpoint presentation full of pictures, but my computer was broken. I even had access to a projector so that was a shame. Instead I found a white board and fit it in the corner of the nurses lounge. We were going to do it in the cafeteria, but the head nurse said that hardly anybody could make it so we switched to the small nurses lounge. I figured nobody at all would show so just a few was better than I expected. It was only the nurses that were actually working so they would come and go as they pleased because they had work to do. I'd say it went okay, but took a lot longer than I expected because I had to write everything out. I thought it was funny that they made me wait to start until they all had a pencil and a paper. They wrote down every little word I wrote on the white board; what great students! I talked about post-partum hemorrhage and childhood vaccinations. I think it was the most beneficial for me just preparing everything because I really learned a lot.
Besides that the day was good. We just saw kids in the clinic, mainly upper respiratory infections and a few other interesting things. I saw some weaknesses in Dr. Sierra's abilities today when a young lady came in with "dizziness". He's a good doctor, but it's difficult for a pediatrician to work with all types of patients which is what he has to do here. He can't be proficient in everything. After taking her history, she would get dizzy only when she stood up and sometimes she would black out a little. There was definitely no vertigo involved, which is when the world is spinning around you. Pre-syncope as it is called or orthostatic hyptension causes the symptoms she was describing. He kept talking about vertigo to her though and naming off diseases that cause vertigo. I mentioned (when the patient left the room) that I don't think it's vertigo and that she seems to have orthostasis with pre-syncope. He kind of just brushed me off. Well fine, I thought, but I know what I'm talking about. He drew her blood and she did have a slight anemia which could contribute to her symptoms so he gave her a treatment for that. Still though, anemia does not cause vertigo, but whatever, he's the doctor, maybe I'm wrong. Anyway, not like we were arguing, but that's the first time I think he's been way off on a diagnosis, but at least the treatment ended up being the same.
Only 4 more days left in Belize! I think I'll miss some of the people I've met here though. Some of the staff are great. My favorite department is imaging as they are all pretty cool. Steve is the rad tech and I probably get along with him the best. It's weird that me and rad techs just seem to go together. Maybe I should have been a radiologist? There are a few nurses that are really cool too and all the cooking staff. The preacher is a great guy too. It's been fun to get to know the people here and learn about their culture. They are amazing people and some of the nicest people I have been around. I like seeing them in the hall and they yell out to me, "Hey Dac!" (meaning Doc as in doctor) or they say "Hey Rrrrayt!" It's hard to write out how they pronounce my name, but it is something like that. It's really hard for them to say for some reason. The first week I had to just show everyone my name tag in order for them to be able to say it. Tomorrow I'm going to get some pictures of everybody to remember them.
As I'm typing there are two Belizean kids on the computer next to me that keep looking at the screen then may hands and then the screen. I asked them what the deal is and they couldn't believe how fast I can type! Probably the fastest they've ever seen! I thought that was pretty funny. Anyway, better go.

The Cooks

Letice the Pharmacy Tech

Lab workers

Ignacio - cook and handyman

Ardis - Student Rotation Coordinator

Keisha - CNA, Merriam - Rad tech

Tuesday

I woke up today a little later than usual and didn't make it to the morning worship service they do. I've actually missed it quite a few times. It's a pretty fun with the singing, but lately not worth getting up 15 minutes early. I've been staying up later trying to get my presentations ready for tomorrow and so I haven't been sleeping as long. It's shown as I've felt so tired in the office during the morning. Hopefully, my presentation will go well and I can get to bet earlier.
Today was a better day than most, because things stayed busy. The morning looked like it would be slow, but we had a steady amount of patients coming in. One guy that got my interest was a middle aged Hispanic, who had a rash all over his body. It started on his head and had covered wherever his hear was on his scalp. Then it had spread around to different places; his back, chest, and groin. The rash was large scaly raised plaques that didn't quite look like anything I had seen before in real life. I think a previous physician had tried treating him with anti-fungal things, but that wasn't helping at all. It actually looked like psoriasis, but was present in areas where it's not typical although doesn't mean it's not psoriasis. It reminded me the most of mycosis fungiodes, which is a rare T-cell lymphoma that occurs in the skin. I had learned about it over and over from undergrad. on, but have never seen it. I doubt that's what this is, but wouldn't it be cool for me if it was to see it. Of course, it would not be cool at all for this guy. I guess I'll never know though, because Dr. Sierra tested it for fungus, which was negative, and sent him to a dermatologist. I would have biopsied it myself if it had been me because I love that kind of stuff so I was a little disappointed he sent him away.
After this guy left there was a delivery that Dr. Sierra and I went to attend to receive the baby. Again, I had no word from Dr. Lazo that this was going on. While I was in there though Dr. Lazo came and got me to help him with a C-section. All the other doctors were busy so I was the only option. I only helped him as 1st assist for a little while when his wife came in and took over, so it was back to holding a retractor. This was the 3rd c-sectio for this lady and the previous ones had been done very low, so that is where we had to do it. It was such a pain because she had so much scar tissue in there I coudln't tell what was what. Plus the bladder is right there when you do a section that low, which is a real pain to get around so I'm not sure why you would want to that as a surgeon; probably for cosmetic reasons. Well, the section went well and there was actually another c-section right after it! I assisted with that one and tended to the baby after delivery because Dr. Sierra hadn't made it in. I got some good pictures of the surgery thanks to the nurse taking them. At one point she disrupted the surgery and made everyone look at the camera, which I thought was funny. Wouldn't you know it, after this c-section there was another woman who came in labor, so that's 4 deliveries in one day when there has only been like 5 since I've been here. I've been trying to get my presentation ready and the delivery all the suddened happened really fast so I missed that one, but that is okay.
Tomorrow I'm going to be doing a presentation to the staff on post-partum hemorrhage and childhood vaccinations. I was planning on using power point with a projector, but my stinkin' computer crashed and had all my files on it so I'm going to just have to use a white board. It's at 3:30 pm, right in the middle of the work day, so I'm not sure how that is going to work, but I imagine there won't be many people there. It's in the cafeteria so I imagine if nobody shows I can just give the presentation to the cooks.
Another day in Belize down and I think I can officially start counting them down since I'm getting close. Only 5 more to go!

Odd Rash - Any want to diagnose?

Doing a c-section with the Drs Lazo

New Week

My final and last week in Belize began today. It is nice to know I'll be going home in a week and seeing my family. This experience has been pretty fun though and I'm glad I came.
I can't say the day was too exciting today. I've been trying to figure out how I can make my last week here more productive than the last week was. It's hard when they don't really seem to want my help here. I talked to Dr. Lazo and told him I would like to be doing every procedure possible this week under a doctor's supervision of course. I thought that might be a better approach than asking for total freedom which he seems to be really against. Then he may at least let me know if there's something going on. Up to this point, it seems like I've had bad luck with procedures. Many times stuff would happen when I was out on one of my weekend trips. And I swear whenever I'm hanging around the ER it is slow and nobody shows up, but as soon as I turn my head something comes in that I miss. I've been showing my interest to Dr. Lazo, but he doesn't seem to want to include me. I gave him my cell phone number (a phone I'm borrowing from Ardis) and told him if he could come get me or call me when procedures are going on I would appreciate it, because this week I'll be working with Dr. Sierra and in his office. When I'm in his office I don't usually know what's going on in other areas of the hospital. Well, I was feeling good about this upcoming week. I'll be able to work with Dr. Sierra who is great to work with and actually let's me be involved and I'll be able to be involved in any procedures happening whether its stitches or putting a cast on. So I was talking to Steve after lunch about his day and he asks me if I had gone in to participate in the D&C they had this morning. I responded, "What D&C!" He tells me a lady came in and for one reason or another she needed a D&C. Dr. Lazo's wife did it, but I am sure that Dr. Lazo knew about it, because he is the medical director and always knows what's going on. I was so ticked! Here we have this conversation this morning and I thought I might actually get somewhere with him, but it was to no avail. I'm not sure why he didn't get me. He knew where I was and he knew what I wanted. I doubt that he didn't know about it, so what can I do? I don't think I've missed many things overall since not many things seem to be happening in the slowest month of the year, but it just makes me that more ticked when I do miss something!
I was venting my frustrations to Steve and he just chuckles and says that I'm one of the many students that come here and end up having a bad experience. They all say the same thing about how Dr. Lazo hates students and won't try to include the students in anything. I'm just wishing I would have known this before I spent the money to come down here. I'm greatful for the week and a half that I had more responsiblity; I was having a blast even if it was pretty slow during that time. The problem is that the rest has been bad with an occasional good experience squeezed in there. I would probably do it again for some of the good experiences I've had and the tourist things I've seen and who knows, maybe this week will be a good one, but it sure is frustrating. Maybe my expectations were too high. I figured I would come down here to a place where they would appreciate my help and let me act independently and since that hasn't been happening for the most part I'm disappointed. Some of my rotations in the U.S. have been like this, but I didn't have much for expectations. I just wish I could start my intern year tommorrow. I know I'm probably not ready for that, but I just don't think I can learn much more unless I'm the primary physician doing things. I learn by doing and not so well by watching. If I don't know how to do something, well, I can always just look it up or ask somebody, but it's impossible for something to stick in my brain if I just read about it and never do it. Even if I watch somebody do it, it doesn't stick unless I'm directly involved. I need to be able to think independently and gain confidence in my skills. I wish I could just do the rest of my 4th year in Delta. It was fun there because Dr. Shamo would let me do alot and actually help him get things done. I felt like I was contributing. I could do all kinds of procedures and be first assist in all the surgeries. It was great. Anyway, I'm just rambling and venting here. Sorry about that.
Today I did get to put a splint on a little kid. He broke his arm, radius and ulna, near the distal end when he fell down. They have old school supplies here for that. I had never used the old plaster casting material which is all they have so it's a much more dirty, labor intensive process, but fun all the same. Besides that we just had a number of upper respiratory infections in the clinic and a few lower respiratory bronchiolitis infections. Nothing too special or exciting. We'll see what tomorrow brings.

Sign in front of the hospital

Dr. Sierra and I

Weekend

Well, I have some bad news. My laptop crashed today and I can't get it working. It won't even boot up at all. Hopefully I can get all my files off of it when I get home so I don't lose those, but that makes blogging kind of hard. I guess I can't put pictures on here anymore unless I find a good internet cafe that has an SD card slot on their computers. Anyway, I'm so ticked about this it is ruining my whole day. The way it's acting I bet the motherboard is toast or something, probably not something that can be fixed. I sure hope it's not a hard drive problem or it might be difficult for me to get the files off of it. If it's working though I have tool that should get them right off so I don't lose all my pictures of Belize.
The trip to Tikal yesterday was a lot of fun. I left early at 7:30 am. Drive was about 2 to 21/2 hours. There were only two other people on my tour, a couple from Alaska. They were really cool and lived out in bush of Alaska. They don't even really live in a town. They said they are out in the sticks and there are like 6 other families in the general area. They have to provide all their own water, electricity, plumbing, etc. No TV and slow satellite internet. They didn't look like someone who would be living out in the sticks either. They looked pretty normal and were about my age. They were on their honeymoon, so it was fun to talk to them and hear about their interesting life.
Anyway, regarding Tikal it was amazing; an absolutely beautiful place. Some of the temples have been excavated so well and preserved. They are massive and even taller than the temple at Caracol. Unfortunately you can't climb the ones at Tikal. Like Caracol, only a small fraction of the city has been unearthed. There are mounds of dirt and jungle all over with ruins poking out so you can see there are many more temples and edifices around that still need to be discovered. I can't imagine what this place was like back in it's prime. Amazing that such a place could be made by such primitive people. I guess they weren't too primitive if they can build such elaborate cities.
Other than Tikal I haven't done much this weekend. Church was today and was good. The mission president of this mission and the District president were there. The mission president is hispanic and doesn't really speak english. I think that's pretty cool that the church is growing so much that they can have native people be the mission presidents and leaders. Interestingly, in this mission, most of the elders are native to Central America, but in my mission almost all were from the US. Everyone here is really nice and introduces themselves and welcomes me. I really like the branch and will be sad to leave it, although I have to say I'm excited to get home.
I only have one more week officially. This has gone by fast, but I'm getting kind of sick of being here. It's not too bad, but I'm definitely tired of the cafeteria vegetarian food and all the humidity. Plus, my hospital experience hasn't been that great either this last week so hopefully this week will bring something more exciting. Working with Dr. Sierra should make things better.
Well, I'm paying for my internet now at a local cafe so I better go.

I was able to get my computer working, get the pictures off of it, and add these after my trip.

Temple of the Jaguar and Me

Tikal in the distance

Sacrificial blocks where they would chop heads off

Friday

The hospital was pretty slow again today. I’m not sure why things are so slow, but it might be the weather. It’s been raining a lot lately and most people have to walk to get anywhere. I received some bad news today. That little 4-month-old that coded in the ER and was transferred to Belize City died. All the staff was talking about it. He was stable when he left here so I was surprised he didn’t make it. There must have been some other underlying problem besides the dehydration, or maybe he had some brain damage for lack of oxygen. At first there were no answers; nobody knew what happened, just that he didn’t make it. I found Dr. Sierra to see if he had any other information. He had just talked to the grandma-in-law of the baby. Coming from her, he said the patient was doing okay until the evening of the day he left our hospital. Apparently, they had to put him on a ventilator at one point. Then Dr. Sierra tells me that during the night the ventilator malfunctioned and stopped working so the patient died. I was like, “What!?” I was surprised by the way he said it too, like, it was just one of those things and nobody could do anything about it. So, again, I said, “What?!” in disbelief, “Didn’t they have a back up ventilator?” I guess they didn’t. Mind you, this is the only pediatric intensive care unit in Belize and at a government hospital. How could somebody possibly die because the ventilator malfunctioned? Wasn’t there somebody watching him? Didn’t they have monitors going? Didn’t they have more than one ventilator? This is another great example showing the poor access to healthcare here in Belize. Maybe the grandma-in-law wasn’t giving us the correct version of the story. Whatever was the cause wasn’t important at this point. I was so disappointed to hear that after all we did to save this little life he still died. It’s one of those things that I know I’ll have to face regularly as a physician, but I have never experienced it this close yet. I haven’t even seen any situations where the patient died before my eyes. There was a patient in the NICU in which life support was withdrawn, which was pretty sad. Other than that I haven’t seen death first hand and having been involved in this patient’s care directly I was really disappointed to hear the final outcome. I don’t think it will ever get easy for me to see patients I care for die. While I may get more used to it with time, I’m sure every case is hard on you emotionally. That’s part of the job though and a difficulty I knew about going into this. Along with the high of saving lives you have to deal with the lows of losing lives sometimes.
I’m looking forward to next week when I’m going to start working with Dr. Sierra. He is much better at having students with him and while I would like the OB/Gyn experience I’m not getting much out of working with Dr. Lazo. He still hasn’t gotten back to me regarding seeing my own patients. I wonder why he is so against having me help him, especially since I was doing all this while he was gone. This has been a big frustration with this rotation. I also didn’t realize how slow things would be at this hospital and that is frustrating. Normally, they see a fairly good amount of patients and have about 20 deliveries per month. While I’ve been here they’ve had 4 deliveries, one I did, and the other ones happened over the weekend while I was gone. Little did I know that September is their slowest month of the year. I guess I’m still grateful that I came for some of the good experiences I have had, but this experience has not been exactly what I had hoped. I imagined being involved in many surgeries, deliveries, and procedures in the ER and having stuff to do all day long. I guess I should have researched things a little more, but in the site description they sure made it sound a lot better than it really is. Oh well.

Macal River - right by San Ignacio

Thursday

It’s not even worth writing a post for today. The hospital was really slow this morning, then picked up a little bit this afternoon, but was still pretty slow. No interesting cases came in: a few fevers, upper respiratory infections, abdominal pains, and routine physicals. I don’t think I learned much of anything, but I did get more reading done than usual. My sickness is getting worse, during the morning clinic I was having more difficult breathing and coughing more than usual. I’ve been thinking viral bronchitis or mycoplasma pneumonia, so I thought that I better get some treatment. I talked to Dr. Lazo about it and he got me an antibiotic, albuterol inhaler, and a mucolytic/decongestant. I’m hoping this will take care of it because I am sick and tired of being sick. Hopefully tomorrow will be a better day.

LDS Church in San Ignacio

Sunset from hospital grounds