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

Code in the E.R.

Sorry this post is so long. Hopefully its worth reading, at least the first part.

The clinic today was pretty boring; a typical average day in the clinic with average cases. However, thanks to the ER, today was one of those days that I’ll never forget. It was about 10 am and I guess Dr. Lazo had forgotten about our previous conversation the day before because Dr. Gomero’s office was still empty and I wasn’t seeing any patients on my own. He was nice enough to ask me if I wanted to pull a urinary catheter out of this old dude though. Well, thank you so much Dr. Lazo, this will surely be a really important step in my quest to become a great physician. I did it if course; deflated the balloon and pulled, whoop-dee-doo! Well, around this time the ER called and doctor Lazo said, “Okay” and started rushing for the door. He usually doesn’t tell me where he’s going even though I’ve tried to show my interest a zillion times. He was heading to the ER as I knew though, so I followed him. In the ER was a 4-month-old infant who was pale, lethargic, floppy, and had a history of vomiting and diarrhea from the day before. I knew he looked really bad, but I wasn’t immediately aware of how perilous the situation was. I ran and got Dr. Sierra the pediatrician to come help. He showed up as the nurse was trying to put in an IV. We had a kid before us who was obviously dehydrated judging from his look and history, very dehydrated. His eyes were rolling around and his breathing was quite labored. In dehydration such as this the treatment is obvious and simple; give the patient fluids. It doesn’t even really matter what kind of fluids as long he/she gets something. The problem with dehydration is that if it is severe enough it can be life threatening. As the normal fluid of the body is dissipated through vomitus and loose stool, more and more fluid is taken by the body from the tissue outside of the vessels into the vessels to keep the blood pressure up and to keep precious oxygenated red blood cells flowing through vital organs like the brain, heart, kidneys, etc. If the dehydration gets severe enough no more fluid can flow into the vessels. As a result blood pressure drops, the blood becomes like sludge and the brain and heart start to lose oxygen. As the heart loses oxygen, the heart rate falls lower and lower until it stops, the brain has no blood flow, and the patient dies. This precipitous drop in blood pressure and heart rate is caused hypovolemic shock and our patient was suffering from it.

Up to this point, I’ve been impressed with the health care here at La Loma Luz. They don’t have much, but they make good use out of what they do have and things run pretty smooth; the physicians seem to really know what they are doing. I was overall unimpressed with how things ran in this life and death situation though. I’m not here dog on the staff here or anything, because I realize they aren’t used to such situations like this, but things were just chaotic. Like I said, the treatment is simple, but unfortunately we couldn’t gain access to this little guy’s vasculature system. Putting an IV in a baby is hard enough, but putting one in someone who is so dehydrated is darn near impossible. The nurses and doctor probably tried over 10 times in every area they could think of with no luck. The scene was chaotic with nurses running all over, two physicians working, and a screaming, crying mother by the baby’s side. I was just staying out of the way, observing, hoping that someone could get a vein. I had never put an IV in an infant and felt helpless to just watch. Dr. Sierra had them put a nasogastric tube in and start some oral rehydration fluid. I think everyone knew it was futile, but we didn’t have any other options at the time. Dr. Sierra grabbed a 16 gauge needle and stabbed it into the kid’s leg. I asked him if they didn’t have an intraosseus needle and he said they didn’t. All they could use was this huge needle, but it wasn’t working either. An intraosseus needle is a way to get fluids and medications into someone in an emergency situation by stabbing right through the bone and injecting into the bone marrow. It’s fast and easy, but wasn’t happing here. They tried to stick an IV into the neck, but couldn’t get the large vein there either. At this point, I was pretty worried, but didn’t know how close to death this baby was. What added to my frustration was that everything going on was in Spanish. Sure the official language is English, but among themselves everybody speaks in Spanish, so I couldn’t follow what was going on or what people were thinking.


At this point, I was sitting and thinking how unimpressed I was with how things were going. Granted they were addressing the issue of getting fluids into this kid, but there were no monitors on. Nobody was following the oxygen saturation, nobody was checking a blood pressure or pulse and the monitor was right there. Nobody was clearing the room. Nobody was trying to calm mom down and get her out of the room because she was not helping things. It was just was chaos. Maybe Dr. Sierra was too worried about just getting a line in this kid to think about anything else, but I couldn’t understand why they weren’t monitoring this kids vitals. Anyway, I think everyone felt helpless and frustrated.


I was wondering about a central line, but I wasn’t sure if they had the stuff to do that here. That was the last resort though, so Dr. Lazo, being the most experienced, attempted a last ditch try to surgically place a central line into the jugular vein. They created as sterile of a field as best they could and he made his initial incision. In order to create a sterile field they put a drape over the baby and there was one of the lab workers at the baby’s head holding his hand. The fan was blowing the drape around so I squeezed myself in a bit to try and hold the drape down. The procedure was slow and I’m sure very stressful to Dr. Lazo. It was hot, humid, crowded, and a life or death situation. As the procedure was continuing the lady at the baby’s face was stroking his hand and talking to him. Every once and a while somebody would ask her how the baby was doing and she would say he’s okay. Dr. Sierra even checked under the drape a few times. For one reason or another I was hesitant to do much at this point (I hadn’t had hardly any experience with such a situation either!), but tried to help where I thought I could. It was so crowded that I didn’t want to get in the way even though I wasn’t too impressed with how things were going. At one point though I didn’t see the baby moving at all and thought, “what if this baby dies and I just sat here holding this drape,” so I checked under the drape. The lady said the baby was doing okay, but that chest was not moving!!! I grabbed my stethoscope and placed it on the baby’s chest: no breath sounds and a very weak, nearly inaudible pulse were present. I told Dr. Sierra what my findings were and said we better intubate. He grabbed the ambu bag and put it over the baby’s mouth and I began chest compressions. I was going crazy at this point. This baby was as close to dead as he could be, we were doing CPR, and we couldn’t get any fluids in him. I could do CPR till the cows came home, but if we couldn’t get a line in there was no hope. All hope lay in the hands of Dr. Lazo at that point. I was also frustrated with the response to this baby’s cardiopulmonary arrest. Dr. Sierra had handed the bag to one of the staff members and I’m not sure where he had gone. I was compressing the chest and trying to explain to the person how to get air into the lungs. The mouth piece was upside down, there was no seal around the mouth so the air wasn’t even getting into the lungs, and we couldn’t get a good airway. Didn’t anyone there know how to properly bag somebody in a code!! Where were the nurses who were supposed to know these things to help?! They were all just watching! Why wasn’t anyone checking vitals and turning on the monitor like in a normal code! Why did I have to stop my chest compressions to check if the kid’s heart rate had improved! Didn’t anyone think the situation was as perilous as I did! No breathing + no heart beat = death!!!!!! Well, I kept trying to tell the person bagging how to do it so we could get some air into the lungs and we were finally doing okay. The whole time I’m doing chest compressions and Dr. Lazo is trying to put a tiny tube into a vein about the width of the head of a needle and mom is sobbing behind us. At this point, I was 100% sure this kid was dead. Such a simple treatment and we were helpless.


I was wondering where Dr. Sierra was and come to find out he was getting a bolus of epinephrine ready and injecting it, which was a smart thing to do. He came over and took over bagging as I continued chest compressions, but what was the point, this kid was dead. Well, I stopped and placed my stethoscope on his chest. Wait a second! I could actually hear a heart beat a little better. It was still below 60, but definitely better. I looked up at the IV bag. It was running!! I looked at Dr. Lazo’s incision. He had managed to place the line into that tiny vein and was working on securing it and stitching things up. We continued CPR and a few minutes later I checked the pulse again. Heart rate was in the 80’s! Yee ha!!! We continued and a few minutes later the heart rate was greater than 100. I stopped compressions as Dr. Sierra continued bagging the patient. After some time the baby began breathing on his own and Dr. Sierra stopped giving him breaths. I still think he should have been intubated and assisted because he was still struggling, but at least he was alive and stable. To add more stress to the situation though, Dr. Lazo couldn’t stop the bleeding from the wound he had made. They had nearly stitched everything up, but it continued to bleed quite a bit. Dr. Godoy, a surgeon from San Ignacio, had been called and showed up. Luckily, he was able to adjust a few things and stop the bleeding. The baby had lost quite a bit of blood, but was doing okay. The nurses prepared him for transfer and they sent him to Belize City to the pediatric intensive care unit.
When it was all over everyone was chatting in Spanish, but everyone kept saying “Gracias a Dios.” They are a really religious group obviously being an Adventist hospital. They all were grateful the baby was alive and gave all the praise to God which is pretty awesome. Dr. Sierra was sitting there praying at different moments during the whole situation which was very interesting to me. I talked to Dr. Lazo after and told him good job, as I was obviously impressed, but he just gave all the praise to God. I really like how they involve God with everything and I think it really helps considering the mostly good outcomes they have with limited resources.
I can’t be sure the baby will survive. I don’t know how long its brain was unoxygenated and what permanent damage might have occurred. He was stable when he left so hopefully everything will turn out okay. It was a crazy experience as I had never been in such an emergent situation like that (most of my ER experience has been pretty mild and I haven’t done an official ER rotation yet), but it was a great learning experience. I was disappointed with myself that I didn’t help more initially and I spent the evening second guessing my actions, wondering if I had done everything I could, regretting not being more vocal, and regretting some of the little details I didn’t think of during the high stress moment. That’s how I am though. I will analyze every little detail and replay the situation in my mind so I can think of every place where I need to improve. I know as a physician that may stress me out and will drive my wife crazy, but the way I look at it, at least I will always continue to improve and hopefully some day, be a great physician. Then I won’t have to think so much about my actions. While there are some regrets, at least the little guy is alive and he has Dr. Lazo to thank for that. In my mind, I have been a bit critical of Dr. Lazo for a few of the things he’s done while I’ve been working with him. He’s a pretty good physician, but I just don’t understand some of the things he does. Today he was a hero in my eyes. I asked him if he had ever done that before and he said only on adults. Being in such a high stress situation with such a difficult task I was more than impressed with how he kept his cool and was able to deliver. On the other hand, I was not impressed by the nurses and think they need a refresher course in emergency situations.

What’s great about the hospitals in America is that after a situation like that there would be a log of everything that happened, someone would review to check for mistakes, and then there would be quality improvement, retraining, etc. Here they didn’t record one thing and I imagine they aren’t going to see what areas they can improve on for next time. It’s odd because they don’t have any kind of continuing education or anything to ensure that the staff is continually learning and reviewing skills. Once you’re done with school you don’t have to do any continuing education to be sure you can do your job. Crazy!

This situation also made me think of how grateful I am for healthcare in America. Sure, it’s expensive, but it sure is good. The proper equipment for whatever situation is usually always available. Things run much smoother and usually everyone knows their place and what they’re doing. In addition, the training is much better and in general, hospital personnel are much more prepared. Be grateful to live in America and get the care you need when you need it. Sure it’s expensive, but I’m willing to pay the extra cost for the best healthcare in the world.

The rest of the day was slow and boring. The only other thing I can remember is that I had the x-ray dude do a chest x-ray of me. I’ve been feeling short of breath lately, coughing a lot, and not getting over my “cold”. I didn’t think it was anything serious, but I thought I would do a chest x-ray – It’s like $15 bucks here. It was normal so that is good. I’m worried I may have a mycoplasma pneumonia or bronchitis. It could also just be a really bad cold that is closing off my airway a bit and that is actually what it kind of feels like. If I don’t get over it soon I’ll start self medicating.

This evening I headed to San Ignacio to find a Tikal tour. Didn’t take long and I found a tour going on Saturday. It’s an all day trip, 7:30 am to 5 pm over the Guatemalan border about 70 miles away. It includes all the travel, border fees, entrance fees, lunch, and a knowledgeable guide of the area for a good price so I’m excited to go see the most popular Myan ruin in the world! Should be pretty fun. I practically ran the 45 minute walk home to get back to see The Office. They have NBC here! I was ticked when it wasn’t on. I thought it was on Wednesday night at 8 pm, but maybe it was Thursday. Hopefully it wasn’t Tuesday! I guess I’ll find out tomorrow. What a wild and great day. I can’t wait to see what tomorrow brings.

The little one I delivered a couple weeks ago.

Steak dinner from Eva's - $7.50!

Tuesday

Not much to write about today. I sat and watched Dr. Lazo work all day and asked him questions in between to show my interest. At one point I asked him if I could see some patients by myself and take call in the ER a couple nights a week and he said he’d think about it. Did he already forget about the last 2 weeks where I was already taking call, seeing patients, delivering a baby, and managing hospital patients? Does he have no idea what the last couple weeks were like? I guess so. I don’t understand what his problem is. I’m thinking he’ll come around, but he sure is resistant to the idea. I think he’s a bit of a control freak so he likes to do everything. Who knows? I would just go with Dr. Gamero, but guess what? He quit. Yea, over the weekend he just decided he didn’t want to work here anymore; not even a two weeks notice. He didn’t even make it 3 weeks working here. He said to Dr. Lazo over the phone that it was due to lack of time, but who knows? So, my plan of working with him just went out the window. I could just go with Dr. Sierra, but I don’t really want to be doing pediatrics. I already did a lot of that this year and while there’s always stuff to learn I would really like to get more experience in OB/Gyn and Lazo is the OB/Gyn. So, I decided I would stay with him this week and ask lots of questions and learn all I can regardless of what he lets me do and next week I’ll go with Sierra so I can have some independence. And after that I’m all done with my Belize experience!

Independence Day

September 21st – Belize’s 28th birthday was today. What a privilege to happen to be here for their independence day. Essentially, the commercial sector of the country shuts down to take off the holiday. Luckily, the buses were still running so I could get back to Santa Elena okay. I woke up to a huge storm this morning. It was raining like crazy! It didn’t look like there was any end in sight to all the rain so it kind of ruined my plans for today – no kayaking. I decided to just leave as soon as I could. I considered heading into Belize City downtown to see what was going on for the Independence Day. I decided not to though because I was worried about getting a bus back to the hospital. I’m glad I didn’t because I heard on the radio that they had canceled the parade. The rain was just too bad. It was flooding some of the streets as I was walking to the bus station and I had to slosh through 6 inch deep water at times.
The bus ride took forever like usual; 2 ½ hours to go about 60 miles. I was lucky to come back when I did though because I got to see the big parade in San Ignacio. I got home and headed right into to town to get a bite to eat. About half way there people started lining up and down the street. It was looking like a pretty big event. Once the floats started coming I decided to stop to watch the parade, which lasted for about an hour. Wow, Belizeans really know how to throw a party! The parade was really up beat with lots of island style music and dancing. About each float would be pulled by a truck that had a huge stack of speakers on it blasting music. Everyone was having a really good time and it was really cool to see this aspect of their culture. They really have a lot of pride in their country and their slogan for the parade was “Diverse Origins, Common Aspiration, Together We Celebrate as Belizeans.” I got a lot of pictures and video of the parade too, but unfortunately I can’t video on here.
After the parade I headed to Eva’s for dinner. I love that place. I ordered the most expensive thing on the menu – the steak dinner. It cost a whopping $7.50! Then I was able to lounge as long as I wanted and use their wireless internet. I love Eva’s. Tomorrow I start another week of work. Hopefully, this week will be as good as last week, but I don’t have my hopes up. Later.

Sabbath on the Caye

Today was the most boring day I’ve had yet in Belize and it was great. I woke up early and caught the boat to San Pedro. I was looking around for the church on that island and luckily I met a local named Jose. He knew every nook and cranny of the place. He said he thought he knew where the church was so I followed him. I thought he was wrong because it was totally not near the address that was on the church website. He was right though and led me to the 3rd floor of this random building. There were no signs on the outside of the building or anything, but to my surprise on the 3rd floor there was the chapel. There is no way I would have found the church without Jose. I tried to invite him in for church, but he didn’t want to, but at least I tried some missionary work.
Church was good and everyone was really friendly. They had me say the closing prayer of their sacrament meeting. I was surprised when the meeting was only two hours long. After church I had some time to kill before the water taxi was heading back to Caye Caulker, so I just walked around and got some lunch. San Pedro is pretty and everything, but I like Caye Cualker much more. San Pedro is much bigger and more fast paced so I was ready to get back to Caye Caulker soon.
Back on Caye Caulker I had planned on going sea kayaking, but the weather turned pretty bad. The wind was blowing pretty hard and the waves were white capping so I thought it wouldn’t be a good idea. Plus I was having a good time just lounging around on a Sunday afternoon. I sat around, MSN chatted with Jessica and Marcello for a while, watched some TV, and took a nap. It was a nice day. Dinner was at a takeout Italian place just down the road. The guy was a native Italian from Bologna, right close to Ferrara, a city I served on my mission. He was nice guy and made a pretty good batch of Pasta.
So, that’s it. My day was super boring and probably even more boring to read about, but I had fun. Tomorrow I head back to the hospital after a morning of sea kayaking, if the weather is good. I was talking to the Italian guy and he said he was pretty sure the buses weren’t running tomorrow because it is a holiday. Man, it would really stink if that is true. If it is I guess I’ll be stuck in Belize City for a day, but I’m okay with that. :)

At the church

Caye Caulker

I made it to Caye Caulker, an island paradise. I woke up early hoping to catch a bus travelling by the hospital. I wasn’t sure on the schedule, but wanted to make sure I was there by 7 am. The bus came right at 7 am and it was headed to Belize City. Belize City is only about 60-70 miles away, but it took 2 ½ hours to get there. The buses here stop wherever there are people that want to get on. We stopped over and over so our average speed was pretty slow. The bus was crammed and hot. People had to stand in the aisles it was so packed. I walked directly to the marine terminal after I arrived and took a taxi out to Caye caulker. It’s like 15 miles away from Belize City.
Stepping out of the boat onto the dock I knew I had arrived in paradise. Just like any tropical island there were palm trees, beaches, and crystal clear water. There was a sand street lining the entire beach up and down the shore and the only vehicles here are golf carts. In fact, all the streets on the island are sand and since this is such a small place the whole ambiance is just great. It is a place to chill and relax.
My place I had reserved was not too far down the shore road. This place looked great from the outside. It was right on the shore with its own dock. One good thing about Belize is that for the most part things are cheap. Also, because it’s slow season and there has been a recent swine flu outbreak keeping tourists at bay the clerk gave me any room of my choice for the price of their cheapest cabana. He mentioned the 3rd floor suite with a sea facing view so I went for that one. It wasn’t really much of a suite though even if the view was amazing. It didn’t have a TV or A/C, which I can live with, but when the toilet stopped working I had to put my foot down. They let me go to a different room in back without the view, but with a TV, A/C, and most important a toilet that would flush. Am I not such a pretty boy? I can deal with a lot, but I must at least have a place to go to the bathroom, so I thought I was justified in asking for a new room.
I felt like I was the only tourist on the island until the evening. I was trying to go on a snorkel tour, but not one tour guide had other people going. It’s impossible to get a tour guide to take a boat out for only one person so I was in a tough situation. I didn’t want to go tomorrow because I have plans for the Sabbath and I wasn’t sure if I would have time on Monday since I have to head back to Santa Elena. The guy finally offered to take me for the price of two people. It would have been nice if I could have just rented the equipment and gone by myself, but the coral reef is like a mile from the island. I finally caved in. It was only like 40 bucks to have my own personal guide, the boat ride, equipment, and all the water I could drink. I’m glad I went because it was sweet!!!
First, we headed to sting ray ally. I was a little hesitant to jump in the water as all I could think of was the crock hunter meeting his death by getting stabbed in the chest by a sting ray. It was a sting ray, right? The guide said they were safe as long as I didn’t step on one. What happens if I step on one, I thought? Do they eat me for lunch or spear me to death? Another reason I was stalling is because I have an irrational fear of open water. I think my fear mainly stems from being terrified of sharks, but being underwater and looking out into an unknown abyss is kind of unsettling. Even if I know things are safe I just have a problem with that, like I said, “irrational fear”. I think I watched too much Jaws as a kid too, because sharks scare the bajeebees out of me. If I saw a shark in the water while snorkeling I would probably just die right there from the shock. I couldn’t let Mario think I was a wimp though so I finally jumped in. Once I got comfortable it was great and lots of fun. There were quite a few sting rays and they would swim all around me. I could reach out and touch them. I also saw a barracuda and a few other fish. We then headed to two more places on the reef where the coral is. This was a blast. I saw so many diverse kinds of fish and luckily I had an underwater camera so I got some good pics. At one point I came across this huge school of fish that were hiding behind a rock. I scared them out and about 200 fish came zooming out. I also saw a humungous fish about the size of my upper body. Mario said it was a Parrot fish. Unfortunately I had used all my film by then so I couldn’t get a pic. Overall, it was way cool seeing all the fish and fun to have a personal guide although he didn’t really do much. He told me the names of like three fish and he didn’t even get in the water at the last place. Sheesh!
Dinner was great and I love how cheap food is here in Belize. This dude on the street guided me to a restaurant that had an outdoor barbeque. They had a fresh catch of fish, lobster, and shrimp that they were grilling up. The menu is according to what they were able to catch that day. Unfortunately, I don’t really like sea food, but I do enjoy shrimp so I got the shrimp kabob. I got a side of spaghetti, cole slaw, watermelon and this big kabob for $7.50. In the US, I’m sure it would have costed at least $20. It was soooo good and the restaurant was right on the street so I could watch all the locals pass. I had a great time, but I kept thinking I wish I had someone here with me. I mainly wish Jessica was here obviously, but any company would be nice. I meet a few of the locals when I go places, but it can get pretty lonely when there’s no one around I know. Oh well, I’m trying to have as much fun as I can even though I’m wishing Jess was here all the time.
So that was my pretty cool unexciting day. Tomorrow I’m going to Ambergis Caye to go to church and explore that island a bit. I don’t think they have any Sunday activities here, but I think I may rent a sea kayak and explore a bit. I did that once in Italy and had a great time. Until next time. . .

View from my hotel

On the dock Snorkeling. . .obviously

Caracol

My first day off was today and it was a great day. I left at 8 am and headed up to Mountain Pine Ridge. Kib picked me up at the hospital in a Susuki Samurai. It was a total piece of junk, open in the back, and had 0 shocks, but it made the trip fun. First off, I have to just say that the roads in Belize are horrible. I’ve never been on such a bad road for such a long stretch of road. The ride was about 2 ½ hours. All of those hours were on a way bumpy road up and back in a vehicle without much for shocks. I literally was about to puke when we finally reached the western highway. Thank goodness the trip wasn’t a few minutes longer. It didn’t help that Kib is a pretty crazy driver. I don’t know what he was thinking, but he would go barreling down the road not even trying to veer away from pot holes. A few times I would have flown out of the car if I hadn’t had my seatbelt on and I was shocked we didn’t pop a tire.
Well, after a bumpy, but beautiful drive over Mountain Pine Ridge and through the deep Belizean jungle we arrived at Caracol, the largest Mayan ruins in Belize. Archeologists are discovering that Caracol was likely a bigger kingdom than Tikal in the Mayan world, and they have proof that Caracol defeated Tikal during a war. We were the only tourists to go to Caracol all day so we had it all to ourselves. Since it is the middle of the rainy season, not tourist season, and it was raining throughout the day I guess no other people wanted to brave the road to Caracol. As I walked on the jungle road and then suddenly saw the first temple rising up high through the rain forest I literally gasped. All I can say is it was amazing! I absolutely cannot believe that the Mayans were able to build such astounding edifices in the middle of the thick jungle. Just seeing the thick forest around, it is astounding that anyone could even live around here so long ago let alone build such an amazing city. The temple is 43 meters high, so about 130 ft. I climbed to the top and had a great view of the landscape around the city. What is also amazing to me is when I looked off the back end of the temple there was just jungle. The front side is completely excavated from top to bottom, but the back literally has jungle all the way up to the top. I noticed that in the back there is a layer of dirt covering the temple maybe a few feet deep and the jungle has totally overgrown it, complete with very tall trees. It basically looks like a big hill from the backside. It’s no wonder this site is only partially excavated and that they are still finding other Mayan ruins with probably many others undiscovered. It would be easy for one to pass right by such ruins with all the overgrowth and never know they are there. This temple I was standing on is actually the main and largest temple in Caracol and it is called the Caana. It is a large pyramid with a flat top. On the top of this plaza there are three mini temples on three different sides of the temple. The central temple on top had a few rooms with staircases that went down into the darkness below. I didn’t have a light and wasn’t too keen on heading down there and meeting up with some critter so I didn’t bother exploring. On top of this temple I also saw some humongous spiders, much bigger than any spiders I’ve seen in the States. They weren’t as big as say a tarantula, but they were awfully close.
We took walk throughout all of the ruins of Caracol. They were all pretty cool, but none as massive or impressive as the first temple. There were about 3 different ball courts, where the Mayans played some sort of game. I’m not sure how the game was played, but I Kib was telling me he couldn’t remember if it was the winner or the loser, but one of them was sacrificed to the Mayan gods. I guess I need to watch “Apocalypto” and maybe that would tell me.
When I came down off of the Caana Temple Kib was sitting on the bench with some creature crawling on his shoulder. I couldn’t quite make it out till I got close and to my surprise there was a monkey crawling around on him! He said he was sitting there and it just appeared and jumped on him. It had its tale wrapped around his neck. As we were leaving the plaza a worker got our attention and explained that it was his monkey. I guess as a baby it fell high out of tree to the ground below and was stranded so he had nursed it to health and it had basically become tame. It ran around the grounds during the day, but always followed them back to the worker’s quarters and would sleep there at night. He explained she is a Black Howler Monkey. I need to read more about them, but I think I remember reading somewhere that they are native to Belize and a protected species here. It was fun to get an up close experience with her, but after a while she got a bit annoying. She wouldn’t get off of Kib all morning and just clinged to him. I tried to get her to crawl on me, but she refused. When it was time to go Kib couldn’t really get her off of him although he wasn’t being too aggressive. He got in the car and pulled out hoping she would jump off, but she never did. I told him he better get more aggressive or she was going to become his new pet. He grabbed her forcefully and tried to throw her down outside the car and she freaked out! She was squealing and trying to bite him, in fact, she actually did get a few bites in but didn’t break skin. After he eased off, she stopped freaking out and crawled back to his shoulder and sat there calmly. Then he tears her off his shoulder and tries to give her to me telling me I needed to throw her out my window. I’m thinking, “Get that filthy thing away from me!”, but I tried to get a hold of her and she tried biting my finger off! I was luckily too quick for her. We were in a bit of a dilemma with this ravenous monkey trying to bite us! Of course, if we didn’t try to get her out of the car she was as calm as could be. Finally, Kib grabbed her hard and held her out the window. I think this is where he got the bite, but he threw her on the ground and carefully drove off trying to not run over her. The whole time she’s trying to scratch her why up into the vehicle. When we finally got past her and on the road she was running fast trying to catch us. Luckily we were a little faster, and this was my last memory of Caracol: The beautiful grounds in the distance and a crazy howler monkey running with all her might trying to catch us. You couldn’t write this stuff!
We made our way back up the bumpy road and stopped at a few places along the way. The first was Rio Frio Cave, which is basically a massive tunnel that was carved through the mountain by the Frio River. This thing was humongous and a bit creepy. I went a ways in until I could see both ends of the cave. I didn’t have a light so I didn’t feel comfortable going any further, especially since Kib told me there was a deep ravine somewhere around and to be careful. There is actually one place in the cave where there is a sandy beach along the side of the river. I could tell from all the tracks that people go in there to swim and hang out. Swimming in a cave river doesn’t seem very enticing to me, but Kib told me it was a pretty popular thing for the locals. The whole area around the cave reminded me of the movies Rambo 2, Missing in Action, and Uncommon Valor. Actually, there are a number of 80s movies I used to watch as kid that were about the Vietnam War that the area reminds me of. Belize in general reminds me of those movies, but in this area we were out in the middle of nowhere and in the jungle so I kept thinking of scenes in those movies when they’re trekking through the jungle. The rain forest is crazy. It is soooo thick with foliage and wild life. There are so many insects around. I think I saw like 6 different species of ants scurrying around the jungle floor. The spiders are absolutely freaky and I’m sure they would scare the pants off of Jessica. She always got scared by the dinky spiders in Missouri and these ones you can’t just wipe up with some toilet paper and flush down the toilet. They may clog the toilet. I remember I had to get in the crawl space under our house in Missouri a few times for different things. If our house had been in the rain forest I don’t think there is any way I could have got myself under there. By the way, when I say rain forest it’s not technically considered a rain forest here, but it is pretty darn close!
After the cave we headed down the road some more to Rio on Pools. This is an area where the river crosses over an expanse of huge granite boulders and forms a number of waterfalls and pools. It is a very popular swimming spot for locals and tourists. I had brought my swimming suit, but didn’t really feel like swimming. The water is normally crystal clear, but was totally murky today. I guess this is due to all the rain they’ve been getting. It was also pouring at this point; not a really good day for a swim. It was fun to see though because it is an absolutely beautiful area and right around the area of pines on Mountain Pine Ridge.
We basically were done at this point and headed off the Mountain Pine Ridge. The area is pretty crazy, because there is a rapid change from jungle to pine forest then back to jungle. It’s not like an American pine forest, but there is a lot less foliage than the jungle and scattered tropical pine trees. The drive was actually one great part of the trip because of all the beautiful scenery although like I said, I bit bumpy.
When we got back to town I tried to give Kib money for gas, but he wouldn’t take it so I offered to buy him dinner. We went to an Italian place he knew of and I was totally fine with that obviously! The restaurant was run by Fabio and his wife who are from a small village close to Venice. The food was pretty good, but not the best Italian food I’ve had. It was right downtown though and actually cool to see San Ignacio in the light for once.
I better get to bed. I’m hitching a bus ride to Belize City early in the morning to head out to the cayes. Hopefully I’ll get there okay, since it’s quite a trek getting out there without my own transportation. I’m staying at Popeye’s in a cabana that is right close to the sea. Should be quite an adventure.

Caracol from the top of the temple Plaza A at Caracol Rio on Pools at Mountain Pine Ridge Me, Kib, and Jakie the Black Howler

Kib must have not known when it was going to take the picture!

Videos to come if I can get them on here.

Thursday

Today was a fairly slow day in the hospital, but I stayed busy. This morning as I was getting ready the nurse called because my patient with the burns wasn’t doing very well. He was spiking fevers all night, was tachycardic, and his blood pressure was 65/40! I’m wondering why they don’t call Dr. Gamero, since he’s the physician. Anyway, I was wondering what’s going on with him. He’s got to be septic, but his white count is normal and his urine is clean. I thought maybe I wasn’t giving him enough fluids, but I’ve been giving him a lot lately. Anyway, I did some labs, bolused him some more fluid, and increased his maintenance fluid. The labs were all normal except one. Only his protein was a bit low which is another reason his pressure could be low and him having swelling in his legs, but it wasn’t that low so I doubt it. I consulted with Dr. Manzanero, who is the internist who sees patients in the hospital when the doctors need him. He didn’t really change much except an antibiotic, and he’s getting a chest x-ray tomorrow. I hope we can get this figured out because I’m really worried about this kid.
I worked with Dr. Sierra, the pediatrician, all morning. The funny thing is he sees all ages of patients because the doctors here have to. He was pretty busy this morning so he just handed me a bunch of charts and I took Dr. Lazo’s office and saw them. He’s great because he gives me a lot of freedom. It got a little wild was when Dr. Sierra left. He was only working a half day this morning so he left at noon. Dr. Gamero had to leave yesterday, even though he was on call, and I covered the ER for him even though nobody really came in. He was supposed to return at noon, but never showed up. It’s kind of crazy that a doctor can just not show up who is supposed to see patients and be on call. He got held up for some reason. Well, I just started seeing all the afternoon patients out of necessity. They were all pretty simple cases. Things went well and I also had an ER patient that had smashed his hand and broke the end of his finger. Finally, Dr. Gamero shows up at 5:30 pm after all the work had been done. After I checked on the burn victim I decided to call it a day. Tomorrow I’m taking the day off and heading to the Caracol ruins and taking the whole weekend for that matter. I’ve been working a lot lately so I’m more than excited to finally be able to get out and see some things. Dr. Lazo got back tonight anyway, so my fun days doing a lot in the hospital are probably over, since he and his wife seem to be anti-student. I’m going to try and just stay with Sierra and Gamero for my last two weeks so it’s not totally lame as I finish up my experience here.
One crazy case was this Mennonite girl who came in during the morning and saw Dr. Sierra. She had aplastic anemia which had been initially diagnosed and treated in Guatemala. She was feeling fatigued and looked as pale as a ghost. Dr. Sierra did a CBC and her hemoglobin was like 4!! Normal is 12 and you should transfuse blood at 7 or 8. Even worse, her platelet count was 5! Normal is >200. Platelets clot your blood and sever bleeding usually will occur at <20!>5. Dr. Sierra admitted her of course. She needed platelets very badly so I asked Dr. Sierra about it. He said they didn’t have platelets. I wondered why don’t transfer her to a hospital in Belize that had platelets. He tells me there isn’t one! I said, “You got to be kidding me, there isn’t one hospital in Belize that has platelets?” Nope. I still can’t believe that, maybe there was a miscommunication, but they told me she would need to go to Guatemala for platelets. That should tell you how behind the times Belize is with their medical care. It is a small country, but come on. This girl is on steroids which will hopefully increase her platelet count.

Sick

My goal was to go through my whole trip to Belize not getting sick. I’ve been taking a lot of precautions; staying away from tap water, using hand sanitizer, permethrin soaking my clothes, using mosquito repellant, taking lots of fish oil pills, and I brought a bunch of medication just in case. Unfortunately I already got sick. Luckily, no diarrhea, dengue fever, or malaria, but this morning I woke up with congestion and gunk in my throat. I’ve been taking my fish oil regularly and I really think that stuff wards of sicknesses, at least upper respiratory things. Since I’ve been taking that I haven’t gotten sick until now, so maybe I got some super powerful Belizean bug that is not as strong because of the fish oil. Hopefully, this won’t last too long and won’t get worse. It’s just perfect timing before I head out to do some fun things this weekend!
Speaking of that, in addition to my Caracol trip on Friday, I’m officially heading out to Caye Caulker on Saturday. I got reservations at a beach side cabana for pretty cheap. It’s called Popeye’s and hopefully, it isn’t totally ghetto. It says there is wireless internet, so hopefully it’s fast and Jessica and I can webcam. I’m wondering how I’m going to get to Belize City though where the boat takes off from. I wanted to leave early in the morning and I thought there would be plenty of buses, but looking at the schedules online the buses don’t start running till 12:30 pm. Other people here have told me that the buses run all day though and they all go to Belize City. I guess I’ll just leave early and hopefully there will be a bus. The bus system is funny because you don’t need a ticket; you just pay the conductor and they’ll pick you up anywhere or drop you off anywhere on the main highway. If there are no buses maybe I can hitchhike. There are a ton of hitchhikers here in Belize all along the main highways.
Today was a fairly slow day in the hospital. There were only about 3 patients in the clinic in the morning seeing Dr. Gamero. Pretty routine stuff. My patient with the burns needed another debridement so I did that in the morning. It didn’t take nearly as long. He was doing so well, and the plan was to discharge him today and do the dressing changes and debridement at the local clinic in Spanish Lookout (which is where he is from). Well, right before he left the nurse comes and gets me and says he has a fever and is having chills. His heart rate was also racing. Dr. Gamero had left after lunch because he had stuff to do in Belize City and I wasn’t sure what he wanted to do with him. Anyway, I told them that I didn’t feel comfortable sending him home obviously, but the issue was money. The Mennonite community from Spanish Lookout got together and decided to sponsor his stay in the hospital so he didn’t have to go. Thank goodness! I felt sick having to send this kid home. It’s driving me nuts because he needs a lot more testing than what I have access too. Anyway, I bolused him 1 liter of fluid, increased his daily maintenance fluid, and he’s on two IV antibiotics, Amp. and Gent. His heart rate was much better when I checked on him tonight and his fever was improving. I want to keep him until his wounds are healing well, not oozing, and he’s totally stable, but I don’t know how long they can get the funds. Pretty sad deal overall, but I’m sure glad he’s still in the hospital. I’m on call tonight. I volunteered because Dr. Gamero had to go out of town. Dr. Sierra is the back-up attending. Lately the ER has been super slow so who

knows if anyone will come in.
I titled this photo: "Fatty fat fat at Mom's Place"

Another day. . .

Another day down, about 18 to go. It seems kind of crazy that I will be here only 18 more days. I guess that means time is starting to speed up as I get more comfortable here. Only a few more days and I’ll be half-way done with this experience, which seems kind of crazy! The first few days were really slow going, but now things are going pretty fast as I’m much more busy during the day actually seeing patients and doing procedures. I’m having fun, but missing my family of course, so I’ll be grateful to return home when that time comes.
Today I realized I haven’t seen a thing since I’ve been here in Belize. I only took one stroll into San Ignacio at night to eat. Other than that I’ve been stuck at the hospital. I’ll have this weekend and next to head out and see things, but my last weekend will be difficult because I’m heading out on Sunday. With this thought, and so much to see here, I decided I would take off this Friday and go out to see things. That will be about 11 days of work in a row, some of the days working into the night so I think I deserve an extra day off since I missed last weekend. I may never be here in Belize again, but I’ll have plenty more days of working at the hospital and being on call so I thought I better see what I can while I’m here. I called Kib, the guy I met at church this Sunday to see what he was doing Friday. He was happy to go out to see some of the sights. We decided we would head down to Caracol Friday morning at 8 am. He’s going to pick me up from the hospital. Caracol has been described as the most extensive and magnificent Mayan ruin in Belize. It is set in the deep jungles of southwestern Belize only a few miles from the Guatemalan border. It is a bit of a drive from Santa Elena, about 2 hours. I’ve heard that the whole drive is down a dirt road that can get pretty hairy in some places, but the drive is worth it. This is one place I definitely wanted to see while here so I’m grateful I’ll have the chance. Afterwards, on the way back to town, there are a few cool spots to see. There is a big cave with a river running through it where many tourists go and I guess there is a beautiful spot on top of the “mountain” with many pools where people love to go swim. We’ll probably stop off at those places or at some of the beautiful waterfalls in the area. Kib seems like a really nice guy and it’s really nice of him to take me out. I’ll have to pay for gas and give him a tip or something.
On Saturday through the weekend I think I’ll head east to the water and see what I can find to do. I’d also like to take a trip to Tikal in Guatemala and go to the Belize zoo before I leave. We’ll see if I can fit everything in.
I guess I’m rambling a bit because I don’t really have any good stories from the hospital today. It was a pretty slow day. The ER was literally dead. I don’t think we had one E.R. patient today! That was a bummer, but there was a good amount to see in the clinic. They were overall just routine visits with nothing too memorable. We had a guy with hypertension, a man with tendonitis, a woman with likely endometriosis, a few people with the flu, a kid with idiopathic hives, and others. One learning case was a boy who smashed his finger. He was a clinic patient and he had a significant comminuted fracture of the proximal phalynx of the 4th digit. There was basically no displacement and the alignment was mostly preserved, but it looked ugly so we called the ortho surgeon. I really like him because he is really friendly and likes teaching me things. He let me help him put a splint on it using their old school plaster cast material. We had to immobilize from the wrist to the far finger joint. I thought the kid would need a surgery and a pin, but the surgeon chose not to. It was a fairly interesting case.
My patient with the foot burns is doing well. His blood pressure was going a bit low today, but overall he is doing well. His wounds are looking a bit better and his white blood cells are coming down. Tomorrow I’m going to do a foot treatment and then Dr. Gamero wants to discharge him. I think it’s too early, but I guess were limited because of funds. We’ll just show them how to scrub the feet and hopefully they can keep the feet treated and clean.
Tonight I hitched a ride in to San Ignacio from the cook. He took me to a restaurant that he really liked that served American food. It was called Mom’s Place. Like I showed in my last post I was itching for some type of meat for once. I ordered a philly-cheese steak Belizean style! It was absolutely delicious! Probably the best philly-cheese steak sandwich I’ve ever had. To top it off I had fries with it and a sprite. That’s about as American as you can get I think? I’m sure it was loaded with calories, but it was great to have some food from home. Luckily, it was still light outside when I finished so I took a few pictures of the area as the sun went down. The sun goes down here at 6 - 6:30 pm which is really annoying! I walked down to Eva’s restaurant where I ate the time before and ordered a fanta as I used their free wireless internet. It was actually pretty fast compared to the hospital internet and I was able to chat/web cam with Jess and RJ, which is always fun! I could also actually upload more than one picture on the blog so I put all three of them from the foot burn experience. It still took a while, but the hospital takes FOREVER just to upload one picture. Next time I go back to Eva’s I’m going to try and upload one of the few videos I’ve done.
Anyway, this is getting super boring so I better finish up and go to bed. Adventist morning worship comes pretty early! Until next time. . .

Yummy Philly Cheese!

San Ignacio Street

Meat - It's what's not for dinner

Tonight I opened my dinner box to discover another night of gluten stir fry. Uhgg, I’m really starting to dread the stuff. When I was researching into La Loma Luz Hospital I didn’t think much about the hospital description when it mentioned that the cafeteria only served an Adventist vegetarian diet. I’m now realizing how grateful I am for a generous portion of meat with my meals. They are strict vegetarians here and don’t serve any meat whatsoever. What I don’t understand though is why they try and make things look like meat from plant products. If you’re going to be a vegetarian why go half way and try to pretend you’re having meat occasionally? If you choose to go without meat, be a man, and don’t try to pretend you’re eating meat by making gluten chicken strips or oat hamburger patties. The gluten chicken is starting to get on my nerves. They made a huge batch and have been serving it over and over the last 4-5 days. The first day I thought it was pretty good, though a paltry attempt to mimic the real thing. Now I may start skipping dinner if they keep serving it. Then the other night I had vegetarian hamburgers. They were actually pretty good, but loaded with spices to give it that meat taste. Like I said, I don’t understand the meat mimicking, but whatever. I’m not trying to mock them or anything because I can understand the idea of prescribing to a health code because of your religious beliefs and I respect them for that, but it’s just not for me. I’ve lately found out that vegetarianism is more of a choice among Adventists and not really a rule in their church. The funny thing is most of the Adventist staff here eat meat, but for some reason, the cafeteria won’t serve it. Otherwise, the food here is great and I really like the cooking staff. I’m buds with one of the cooks, Ignacio, and he always boxes me up my dinner and leaves it for me in case I don’t get to the cafeteria in time for dinner because of work. He’s a great guy and tells me he’s going to take me around the area some time to see the sites. That’s three people now who have told me they would do that. I guess I just need to find a day to do it.
I realized today what a high maintenance pretty boy I am. I never thought I was before this experience. In fact, I had always considered myself the tough, outdoor type, but I’m not so sure that is the case. I’ve been to yucky places before. The Dominican Republic mission had some gross conditions for sure in the bathroom and lots of bugs, but looking back that was only for a week. I knew that it was only a week so I didn’t worry about it. Now that I’m here in Belize and knowing this is going to be for a whole month, it is a different story. My previous apartment wasn’t really that bad. I mean, it wasn’t like a hut or something where some people live. And now I’m in a place with a TV and considered a fairly nice place by Belize standards, but I still think its ghetto. I still don’t take my sandals off to shower and I’m very grateful for the mosquito net. I kind of dread going number 2 because I never know what’s lurking under the seat. It’s usually nothing or an ant. And knowing that I’m going to be here for a whole month all these things have become apparent to me. Then again, maybe it’s just something I have to get used to. Missouri was pretty ghetto in our old country house, but I got to where I really liked it there, even if there were ants crawling around in our balsamic vinegar. My mission had some ghetto apartments, but was overall pretty clean. Here though, being in the jungle, things just always feel wet and dirty. So, I’ve come to the realization that I’m kind of high maintenance, but I think I’m okay with that. I can’t wait to get back to Utah where the air is dry and the bugs are minimal.
In the hospital today was a sweet day; quite a learning experience. Dr. Gamero was back from being home in Honduras and he let me work with him today. We were seeing patients in the clinic and managing the ER. We saw some routine stuff in the clinic, but the ER is where the real action was today. At about 10 am the nurses called Gamero in to see a patient. As he was interviewing that patient one of the nurses came up to me and said, “Dr. Crapo we have another patient if you’d like to see him.” I never have considered myself as being one who cares about the prestige factor of being a doctor, but I have to admit, I like the sound of Dr. Crapo. This patient had managed to shoot a nail into his is forearm. It was going all the way through, but toward the surface. I tested his strength and sensation and determined the nail had missed vital structures and I was sure it didn’t go through a bone. Dr. Gamero wanted to do an x-ray though, but I was trying to save the guy money. We got one though and it showed the bone was okay thank goodness. I numbed him up and went to pull out the nail. I was shocked at how much it was stuck in there. I pulled and pulled and it wouldn’t budge. I had to get a nurse to hold his arm and then I grabbed a pair of pliers and finally got it out. It was a pretty cool experience overall. The crazy thing was is how he got it in there. He said he tied fishing line around the nail and was trying to pull it out and when it finally came it shot out and went through his arm. That must have been some pretty hefty fishing line!
The next case was crazy. The nurses called about a foot burn and Dr. Gamero sent me down to check things out. I couldn’t believe the extent of this kid’s burns! It was only his feet thank goodness, but the burn was really gross and has an interesting story. This poor 17-year-old is a paraplegic. Two months ago he fell out of tree and landed on his back and ever since has been paralyzed from the chest down. His family is from a local village and fairly poor. They wanted to try anything to help their son so they took him to the local witch doctor. Interestingly, I guess there are a number of “witch doctors” around Belize that stay in business fairly well. I’m not sure of their exact translation, but that is what the locals call them in English. Anyway, they took him to the witch doctor and he had the idea that he would “shock” the boy’s feet and that would magically cause his nervous system to start working properly. Well, what better way to shock someone’s feet than by putting them into a vat of boiling hot water? And since this kid can’t feel anything, he can’t tell the guy that he is burning the soles of his feet off. This thing occurred last Wednesday. I guess the “doctor” wrapped the feet and sent them home. Since that time there has been no medical care whatsoever. So, when I get in there I remove the wrappings and I’m disgusted at what I find. The poor kid had severe 2nd degree burns throughout the soles of his feet that are all infected and they totally stink like bacteria having a fleshy feast. Luckily they were only second degree burns and not third or he would have needed surgery. Once again, we are limited by the cost of medical care and there is no burn unit in Belize. I had never seen such a bad burn let alone managed one so I went got Dr. Gamero. He said, well just debride them and get all the dead skin then admit him to the hospital. He didn’t really explain well how to do that very well, but I got the general idea. This obvious benefit to getting the debridement was that the patient couldn’t feel anything in his feet. If he had sensation we probably would have had to put him to sleep, but luckily we could just take care of it without anesthesia. The nurses and I set up a sterile field the best we could and I began scrubbing away with an iodine soaked scrubbing pad. Layer after layer of skin peeled away. I had to puncture through the many blister and cut away as much dead skin as I could. The whole process took me forever, but I wanted to make sure I did a good job. In the end, it turned our really well, and besides being a little gross I loved it! J You can see from the pictures the before and after product. Sorry if those pictures are gross to everyone, but I think they are really cool. I know Jessica will be able to appreciate them. Afterwards, we got him bandaged up and admitted him to the hospital. I put him on some pretty strong antibiotics and got some labs. He had a catheter in that they said had been there for 21 days! I tested the urine and he had the worst urinary tract infection I had ever seen. It’s just sad that this kid has had such poor medical care up to this point. He was in really bad shape and it’s lucky that they brought him in when they did. I worry about him being septic, but I’m limited on how much money I can spend. That’s the biggest frustration; not being able to run all the testing that is really necessary for the patients. Hopefully things will be okay, but he is going to have a long road ahead of him to get his feet healed up. The sad thing is they can only afford to stay a couple days in the hospital so we’ll have to train his family how to change bandages and clean the wounds, but I don’t know if they’ll be able to care for him properly.
Well, three people have voted and it looks like so far going to the bigger island is winning. I’m thinking that’s what I’m going to do. I should be able to take a fishing trip by going there and at least there will be some restaurants around. The bad thing is I was planning on going over the holiday weekend, which I discovered is this weekend. I was looking at the weather though and it’s supposed to rain all weekend. Grant told me rain here is really unpredictable and it may just rain for a little while, but I would be disappointed if rain ruined my trip to the coast. I’ll probably just risk it and go, but I’m hoping the rain will be minimal.

Foot before

Foot after

All in a good days work.

My first Sunday in Belize

Today is Sunday. The ER is currently empty and I’ve got nothing to do. I figured writing in my “journal” would be a good Sunday activity. I flipped on the tube first and thought I might watch a show, but Bill and Ted’s Excellent Adventure was just getting over and I was sooo disappointed that I missed it. Hopefully it will come on again later. J
I have tried to make today feel like the Sabbath as much as I could. I found out from one of the employees here that there was a branch not too far from the hospital. Grant and Ardis were nice enough to let me borrow there truck to drive down there. Believe it or not you can drive in Belize with a U.S. driver’s license, legally. I thought that was pretty cool. I found the church and entered the humble building. It was a small “chapel” as you can imagine. The minute I walked through the door I had members shaking my hands and welcoming me. They were all super nice. I was grateful that it was an English speaking branch, the only English speaking one in the area. As sacrament was about to be passed I thought of how grateful I was that you can be about anywhere in the world and find a church nearby with the same meeting, sacrament, songs, and lessons as home. What a huge blessing that is that the church is truly a world church. I was so grateful to be able to take the sacrament and participate in the lessons. Being so far away from home it made me feel at home.
Funny story: It was kind of funny because, they had planned on 3 talks with an intermediate hymn for the meeting. Two of those talks were youth talks, so you knew they would be short. The final speaker got up there and had about 35 minutes to kill. Well, he spoke about 5 minutes and sat down. I thought that was pretty funny. The 1st counselor said he would take a few minutes and I figured we would get out early. Well, to my surprise we actually got through with sacrament a little late! He spoke for a few minutes on about every topic there is in the church. You could say he was rambling quite a bit. I started dosing off a little, but I couldn’t help it as he just kept rambling from topic to topic. I think he covered all the gospel doctrine lessons in 30 minutes! I kept thinking he was about to stop, but he didn’t. When it was five till 10 after and he was still talking I thought, “You got to be kidding me.” I don’t know how one can have 25 minutes to kill off the cuff and then accidently go over. Luckily, he wrapped it up shortly thereafter.
The meeting was great and the classes were really good. I met some of the members. One missionary there was from Highland, UT of all places! Who would have thought the one branch I would be going to in Belize would have an Elder from where I live. It threw me off a bit because he looked Hispanic and had a bit of an accent, but when I was talking to him he said he was from Highland and went to Lone Peak high school. I’m not sure where the accent came from, but I guess he probably isn’t originally from Utah. I met another member named Kib. He’s the elders quorum president and originally from Salt Lake City. I asked why he moved here and he said, “Well, I just felt like moving here.” That’s pretty odd I thought to myself. He said he was a retired dentist and that shortly after he retired he just packed all his stuff up and drove down. He wasn’t wearing a wedding ring so I’m assuming he’s not married and I didn’t ask about family, but maybe he didn’t have much back in Utah to keep him there. He spends most of his time helping the missionaries. One thing lucky for me was that he gave me his phone number and said to call him any time if I wanted him to take me around the area to see the tourist sites. I think I’ll take him up on the offer.
Not much going on in the ER today. Just a guy came in who totally crushed his heel bone, calcanous. He broke it bad and had a severe looking displaced fracture. The ortho guy is coming tomorrow so I splinted it, gave him some anti-inflammatory and instructions and told him to come back tomorrow. I’ve never seen an ankle so swollen. It looked like it was on the verge of exploding. I hope he doesn’t lose circulation in the foot. Other than that the ER is DEAD!!!!

This is where Jessica will be delivering our

next child. Dr. Lazo said he would do it for free!!!

It's only a 2000 mile drive.