It’s More Than Just a Home Visit

I was asked to write a short article for Hillside's newsletter. Thought I would share since I've been slacking on the updates! Enjoy!

For the last sixteen months, I’ve been serving the homebound patients of Punta Gorda town. I’ve realized home visits are much more to me now than just assessing a patient, giving medication, and providing useful information. The relationships I’ve built with my patients and their family members are extremely rewarding.

My patients have become a part of my life and are my Belizean family. It takes a few months for families to trust a new nurse. After some time, they feel comfortable enough to call my phone and communicate with me. For me, this is an effective way of providing quality care. Patients feel at ease incorporating me into their lives and explaining how the Belizean culture affects their home care.

 By letting me into their personal lives, my patients consider me as more than just a nurse, but also as a family member.  I’ve realized that building a strong rapport takes many home visits and multiple interactions. For example, if I say I’ll return to do a dressing change, the patient and family will expect me. It’s important to follow through with what you say, which is how I started to gain their trust. I also respond to calls at various hours of the day. For example, it’s not unusual to see me at a patient’s house at 8 pm if they need some medication for their chest pain or other ailments. I also visit my patients at the hospital and regularly communicate with the doctors and family. I like to make sure everyone is on the same page. I get so focused on the medical aspects of the patient and forget that a simple visit at the hospital can mean a lot. I was once told, “Thanks for coming to see me here. I’ve been lonely and scared.” My relationship with the patient was no longer just about medications; they needed me by their side.

With these strong relationships, providing care becomes much easier, because patients tell me their actual concerns and exactly how they’re feeling. Families feel comfortable coming to me for advice and let me know when they’re concerned, confused, or overwhelmed. For example, I recently went on a home visit with six medical students and a doctor. I was the last one to walk into my patient’s house and all I could hear was, “Where is Celia?!” My patient’s daughter ran past everyone in the room and grabbed my arm. She led me into the back room where her mom was and showed me a rash she was concerned about. That situation in particular has resonated with me…the daughter ran past everyone and grabbed my arm. I had butterflies in my stomach; she had complete faith in me.

            I feel blessed to have had this opportunity at Hillside and enjoy these bonds I have worked so hard to build. I get chills when I see how much these people look up to me. They have absolute trust in me, and it’s an amazing feeling that I’ll always remember.

Advanced Life Support in Obstetrics

A few weeks ago Dr. Thomas and I were invited to an obstetrics course in a town called Dangriga. The U.S. Air Force in conjunction with the Ministry of Health funded this conference for MDs and midwives from all over Belize. About 40 people attended. It was a great opportunity for Dr. Thomas and I to meet other MDs and nurses from the various districts of Belize. We were also able to have productive conversations with Belizean doctors and nurses that we work with from Punta Gorda town.  I was excited/nervous to learn more about obstetrics because it’s an area I’m not very comfortable in.

Day 1 of the conference:

U.S. Air Force introduced themselves and jumped right into the course called ALSO (Advanced Life Support in Obstetrics). Dr. Thomas taught this exact course in the states so this was nothing new to her! She has delivered MANY babies herself! Our binder of information given to us was overwhelming. It was huge! All this in 2 days? They flew through the information by powerpoint and I followed along. The teachers would emphasize certain slides that were very important so I made sure to highlight them and study! We also broke into groups to practice our skills on manikins and to go over case studies.

Day 2 of the conference:

More lecture in the morning. Then we had a review session of all the info learned. They stressed certain topics we should focus on. We had to be prepared for a 50 question test in the afternoon followed by a practical. I was nervous. So much new information and mnemonics to remember! I wanted to pass so bad….and I did! Whoohoo! Practical was a bit rough for me but I made it through.

I thought this conference was very beneficial for me.

#1 I gained more medical knowledge and this course surprisingly sparked my interest in obstetrics.

#2: Just being present at a conference was interesting to me. It was a new experience being around and interacting with some of the doctors and nurses who practice here in Belize.

#3: Making connections with others.

#4: Dr. Thomas and I were able to represent Hillside clinic! Whoot Whoot!

We enjoyed our stay at the hotel. I loved hearing the waves at night. We had a TV in our room, my bed had a mattress that didn’t “sink” down in the middle, and the shower was hot with great water pressure! Luxury! We had a deck attached on to our room with a beautiful view. I was in heaven. So much good food too! 

Success! Proof right here.

Hotel on the water. Beautiful view. 

Walking around the town Dangriga with Dr. Thomas after taking the exam and practical. 

Clinic and Pharmacy

I wanted to get more in depth about where I work in the morning, what I do, and what happens Monday- Friday.  So here I go! :)

Hillside clinic is open from 8am- noon. Patients take a number at the front of the building and wait to be called into triage. In triage their chart is found, vital signs are taken, and patients state their main complaints. Medical and/or PA students call patients to be seen. (The medical students are split into two teams. For example, Team 1 stays to work in the clinic and Team 2 goes out to villages to provide healthcare. Everyday or every other day Team 1 and Team 2 swap places.)

We have three exam rooms. First room is private. We try and use this room for patients who need pap smears and minor procedures done. Curtains separate the next two rooms. All the rooms have exam tables with necessary supplies near by. When really busy we even see patients outside to the back of the clinic at a picnic table. After the medical students assess the patient they present their findings to the working MD that day. Usually it’s the medical directors Dr. Thomas and/or Dr. Brown working, but quite frequently we have volunteer doctors helping out as well.

The doctors know I enjoy wound care and minor procedures so they call me to gather the supplies and assist them. Those are my favorite days in the clinic. I’m also available to help the med students find supplies, write prescriptions, assess patients for a second opinion etc. I also enjoy drawing blood when labs are ordered. I do the urinalysis and pregnancy tests when needed.

Our staff is Belizean (expect the volunteers like me!). Ages range from 17-29. Most are interested in the medical field and are planning on going into pharmacy, nursing, or medical school. Our older staff member Jenny is in her first year of nursing school. Victor just applied to a medical school outside of Belize. (Belize has no medical schools). Alva and Alfia have been doing an online pharmacy course. 

How the jobs are organized:

Intake- 1 staff member

Pharmacy- 1 staff member + a pharmacy student + our volunteer pharmacist Natalie Ryan

Laboratory- 1 staff member

Clinic – 1 staff member + 4-5 medical students + MD

Mobile (going out to the villages) - 2 staff members + 4-5 medical students + MD

We try and help each other out when things get hectic and busy. Almost all staff is cross-trained so help should be readily available to the doctors and students. The staff are extremely fun to work with and they have taught me a lot about teamwork and communication. I enjoy spending my mornings around them. The clinic gives me a chance to practice more skills and see more acute issues vs chronic than I do during home visits.

Setting up for a afternoon colposcopy appointment. Dr. Thomas brought this colposcope from the states!

Examination rooms #2 & #3. Separated by a curtain in the middle.

 Inside exam room #1

One of my coworkers Virginio getting ready to transport blood in a coffee container. 

 Cleaning medication bottles so we can reuse them.

 Inside our laboratory. Very basic.

Can you see how our medications are organized?

We get many of our medications through various organizations for free. We also buy medications as well. We rely heavily on donations and on our medical students who pay to come volunteer.

No more scabies and lice!!

Victor!!! He's applying to medical school. Very intelligent. Getting ready to leave for a village in the mobile.

Lice & Scabies

Meagan Young, who is finishing up her masters in public health, was a huge help in organizing our lice and scabies project.  She has worked closely with one of our medical directors and physicians, Dr. Thomas. They have been planning the steps on how to eradicate lice and scabies from an entire village after treating every village member. Meagan looked through hundreds of medical charts from different villages, tracking to see how many people have been diagnosed with lice and scabies in the past. This gave us an idea of which villages needed the most help in the Toledo district of Belize.  Meagan and Dr. Thomas communicated with village council members and the ministry of health to get things started and completed an IRB (Institutional review board).

WHO (World Health Organization) has had success with this approach to eliminate lice and scabies in the Solomon Islands and Australia, treating Aborigines. We are hoping to do the same by following their approach.

The village we treated had a census of 500 people. We were ready for a long day. But the actual number of people we treated that day was 628!!!

We started early in the morning and split up into teams. There were medical students, physicians, pharmacists, and our Hillside student lesion all helping out.

Our plan of attack: Permethrin 0.5% spray used on hammocks, bedding, clothing, etc. Permethrin 5% lotion was used on kids under 15kg. We rubbed the lotion all over their body. Head to toe. This treats scabies and lice. First dose of ivermectin is given to everyone over 15kg plus an additional dose (that will be taken in one week). To remind people of taking their second dose of ivermectin, the village church made an announcement the next week.

My job: Permethrin bather and educator. All families are given plastic bags to put any items that are difficult to wash.  It’s best to leave the bag of items out in the sun for about 2-3 days to kill the bugs. Families were also given laundry detergent and encouraged to wash any clothing lying around that may be infected. I also explained what lice and scabies are and how to treat for them. Every family received a small flyer about this.

Some families would say, “We don’t have lice or scabies.” We would then explain that you may not have it, but your next-door neighbor might. That’s the importance of treating every person in the village. Prevention is key.

Everyone was welcoming and okay with us coming into their home. I had fun bathing the small children in permethrin. Most of them would giggle and laugh. It was interesting to see how people lived in the village. One thatched roofed house only had one hammock, but there were 6 family members. The kids told me they slept on the floor. That seemed to be the norm. The kids had smiles on their faces and genuinely seemed content with what they had. 

It was a long hot day walking from house to house. We worked for a total of 9 hours. We hope to treat other villages in the near future. Follow up work will be done in 2-3 months to see how successful we were in treating lice and scabies.  It was a great experience!

Hanging out with the kids :)

 Saying bye!

 Traditional housing

 Traditional living space

 Found some new friends

 Meagan bathing a little boy in permethrin (kills lice and scabies)

 Inside a home

 Taking a little break

 A baby I bathed in permethrin trying to air dry!

Honduras Medical Trip 2013

From the end of January to the beginning of February, I was in Honduras providing medical care to the unserved people of their country. This was my fourth year traveling with the medical mission group called Amigos de San Carlos, which means "Friends of St. Charles." St. Charles is a church located in Tacoma, Washington. Our mission group has grown to about 55-60 people in total. The group is mixed with people of many different professions such as physicians,registered nurses, pharmacists, dentists, spanish translators, etc. We visited five villages northeast of the capital Tegucigalpa. We saw a total of 2,400 patients. Over the years we have developed a fluid system that keeps the patients organized and proper care can be administered. When arriving to a village, we are greeted by hundreds of people waiting in line.
Here is how the system works:

1. The patient is checked in (gives their name, birthday, age, weight is taken)

2. Seen by nurses in triage (if needed, RNs send patient to the
laboratory to get tests done such as urinary analysis,Hemoglobin/hematocrit, or a pregnancy test. Patients also get referred

to our dental team if needed). 

3. Seen by physician

4. Sent to pharmacy to pick up medications

5. Next is our sunglasses/reading glasses station

6. For kids there is a crafts station

7. Then to clothing  (we bring down shirts, pants, shoes, undergarments, etc.) Any woman who is pregnant or has a new born receives pre-packed maternity bags with the necessities. All families receive a
bag of toiletries.


There is an article in the Journal of the American Medical Association called "Duffle Bag Medicine." I encourage you to read to this. I feel our group does NOT fall under this category. We try and see the same villages every year and keep paperwork organized and filed so we can refer to previous notes. Even though a year goes by, I can tell people enjoy seeing our familiar faces and we give them hope. We prepare all year to see them, making
sure we have all the medications and supplies needed. Over the years,we have built a relationship with these people and they have grown to trust us.

The children are growing so fast! I LOVE when they come running towards me calling my name. I try to bring them small gifts each year such as stickers, costume jewelry, and coloring books. Some of our
group members give out pictures to people from the previous year. I'm planning on bringing some next year for the kids. Always fun to have a hard copy of yourself and your family that can last years and years.

This year I tried to start an "education station". I brought some posters I made in Spanish, so the people could learn about the common diseases/diagnoses we see such as scabies, lice, high blood pressure, diabetes, anemia, dehydration, and dental care. Here in Belize, I've learned first hand that prevention is number one. We need the Honduran people to understand what they are being treated for, why, and how to avoid this in the future. My Spanish is very limited and having a booth with posters next to the sunglasses station made me less popular. No one seemed interested. I tried teaching people while they were waiting in line, but I needed a translator to really help me get my point across. We are very limited on translators so I gave up
after an hour or two. I then hung some posters up by the doctors and nurses so patients could read them while waiting (if they are able to read). I kept  the lice, scabies, and high blood pressure posters with me while
working with my dad, who is a gastroenterologist. People seemed surprised when reading some of the information. They were learning and hopefully can spread the word to friends and family.

I'm hoping to join our mission group next year and I'm looking forward to seeing some familiar faces. It was a great experience working beside my dad. I saw a lot of the same diseases/ diagnoses in Honduras that I
see here in Belize. I was surprised at how much I have learned medically over this year! Maybe one year I'll be able to work independently as a nurse practitioner there!

 Shaking hands with my good friend Lorraine in front of our banner: Amigos de San Carlos!

 Organizing our clothes and supplies at our compound.

 Patiently waiting to been seen.

 Sunglasses and reading glasses station!

 Nurses at work in triage :)

 Found a new friend at the sunglasses station while taking a break.

 Our dental team at work.

 Pharmacy.

 Dr. Roes working hard.

Displaying my posters I made. This poster was about "piojos" which translates to "lice."

 Coloring with this little one while her mom gets assessed by my Dad.

Teaching our patients about high blood pressure with my poster!

After taking Spanish classes for 5 years my dad is able to communicate with the patients by himself. He is still continuing Spanish class.

 How we organize our medications.

Lorraine and I hanging out with friends from the village Flor Azul.

Lorraine is one of our spanish translators! This was our 4th year together in Honduras!

My favorite kids at the village Lomas Limpias.

 Line of patients waiting in the village Tatumbla.

 Working with Dad.

Made a new friend this year! 

I'm Back!

Yes yes it's been too long since since my last blog. So here I go!

Here is my first update:  I am now the official "Nursing Medical Director" of Hillside! I was very excited to receive my new title, it feels amazing! I also extended my time here in Belize until December 15th so far. I'm not ready to leave yet! So much to see and learn still!

Home visits are going well. I find it difficult to discharge my patients who no longer meet the criteria of being "home bound." I become very close with my patients and especially their family members. It breaks my heart when I hear things like "Nurse, you're giving up on me!" I have to say "No! You're doing so well that I now have to see you at Hillside clinic. Consider this a huge accomplishment on your part. I'll still be your nurse!" That's an example of a conversation I had a few days ago. We pick patients up in town twice a week and bring them to the clinic and back home. I always make sure they know that this option is available, so we can follow up with them. I have a waiting list of very sick patients that I would like to start seeing once I discharge someone who is no longer home bound. There's only one of me, so I have to be careful about how many patients I take on! I want to provide the best care possible and not spread myself too thin.

I am still enjoying working with/helping out the doctors and medical students in our clinic. Clinic is from 8am - noon. I'm finally starting to discover my strengths in nursing. Wound care is my number one! I also like the adrenaline rush when helping the patients who come into the clinic with acute issues that need to be addressed right away. Working in the clinic challenges my brain in a different way compared to working with my chronically ill patients, which is why I schedule myself in the clinic in the mornings and see my home bound patients in the afternoons. This way, I get the best of both worlds!

Charting in the early AM

Inside our pharmacy. Alfia has been working with Hillside for about 5 years! She's crossed trained to do many things in the clinic. Currently working on becoming a certified pharmacy tech.

Pharmacists + Nurse

My usual morning coffee while charting

Home visit :)

Overnight

Hillside takes the Toyota land cruiser twice a month and spends the night in remote villages so we can provide health care to underserved people. My first overnight experience was last week and I’m proud to say, I survived!

We drove 2 ½ hours to a village close to the border of Guatemala called San Vicente. Once we arrived, we quickly unpacked our medical supplies and waited for any people needing medical attention. We ended up seeing 40 patients that were split between 2 physician assistant (PA) students, a doctor in residency, and myself. The most interesting patient I had was a young boy who had a large abscess. We ended up doing an I&D (incision and drainage) and started him on some antibiotics. I’ve been practicing diagnosing and prescribing meds with the doctor’s supervision. Sometimes, I’m falling out of the nursing role and feel more like a PA student, which I really enjoy. 

At 4 pm, we started to pack things up and ate dinner at a local’s house in the village. We ate inside a small thatched hut while watching Mayan women make tortillas on the open stove. Our dinner was “caldo,” which is Spanish for soup. You eat the chicken and broth with tortillas and drink the leftovers from the bowl. I think it’s a tasty meal, especially when I don’t find a chicken foot in my soup.

After dinner, the PA students gave a short presentation about scabies and lice to men, women, and children who gathered in the community center. Many people attend because they know we raffle out prizes at the end. We always hope people go home learning a few new facts so they can start to prevent these issues.

As soon as the presentation ended, we drove to a near by village called Jalacte. This is where we spent the night…in the town’s community center building. I called first dibs on one of the exam room tables for my bed. I quickly covered the table with piece of foam, hung my bug net up and laid out my sheets. I was all settled. Then a few of us walked to the river running through town to bathe. It was completely dark and all we had were our headlamps and flashlights. That was my first time bathing in a river at night with just a headlamp on. The cold water felt refreshing after a long day of working. After we were all done getting clean, we headed back to get some sleep. Most of us fell asleep around 9 pm. At around 3 am the roosters starting crowing and did not stop all morning. We were also next door to the mill, where the villagers get their corn grounded for them to make tortillas and such.

We were exhausted when we woke up at 6 am. We had to clear out all of our beds and backpacks because the patients would be coming soon. Slowly, but surely, patients started trickling in.  That day we ended up seeing 54 patients, who were mostly all women and children. Unfortunately, most of the men were gone out in the fields working. I referred two of my patients to our physical therapist Annette who came with us this trip. I enjoyed watching her assess my patient’s muscular skeletal issues. I’ve realized that “back pain” can be much more than just tight or strained muscles. When seeing our last patient, we packed up all of our supplies and started our journey back to the clinic.  Our long drive consisted of many potholes and windy dirt roads. We made it home safely. I was drained and ready for bed.

Unpacking the medical supplies from the land cruiser.

San Vicente's community center.

 Teaching about lice and scabies to the community.

Jalacte health center/ our overnight sleeping quarters.

Taking a short break.

Jalacte village.