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. 

Belizean Diet

High blood pressure, high cholesterol, diabetes, and strokes are some of the most common diagnoses I see here in Belize. I’ve noticed that the majority of Belizeans here are overweight. I understand why weight is an issue in this area. I have first hand experience. Unfortunately. I personally have experienced gaining weight during my time here. Here are my thoughts as to why:

1. Portion sizes: Belizeans enjoy BIG meals which usually include large portions of rice, beans, and chicken. When I order a meal like this I tell myself, “I’ll only eat half and save the rest for later.” It never works. I feel like I need to eat a lot of rice and beans to feel satisfied. It’s not filling! So with this said, I’ve come to the conclusion that large portions + overeating = guaranteed weight gain. This is an obvious issue in America as well.

Side note: I realized I had gained some weight when a local told me while I was buying milk, “Gyal, you looking fat!”…. And that’s the day I started to make exercise my priority.

2. Heat vs. hunger: after talking with other American volunteers here, we’ve all come to agree that the temperature outside influences our cravings for carbohydrates, chocolate, and junk food. We strongly believe that there is some scientific data somewhere that has been done to back up our theory. I also firmly believe that this extreme heat and humidity causes us to feel lethargic, which we tend to confuse with feeling hungry. So, when we really need to take a nap, instead we just snack and snack.

3. Availability: It’s very difficult to eat healthy here. I like options and we don’t have very many. My current staple is peanut butter and bread. I wish I could buy things like non fat yogurt,100 calorie snack packs, bag of mixed veggies, etc. I miss prepacked mixed greens from Trader Joes and low calorie frozen meals. You have to search hard just to find a head of lettuce. There’s no “one-stop shopping” here. I usually make rounds and visit multiple stores to gather all the items I need. Sometimes certain veggies and fruits aren’t available for various reasons. Buying something as simple as milk can be tricky… You never know how long it’s been sitting out in the sun before it was stocked in the store refrigerators. Milk here will only last a day or two before it goes sour. I have now learned to buy “Lala,” which is powdered milk.

4. Coca cola: It’s available everywhere!! Only 1 dollar Belize (50 cents American) for a glass bottle. It’s refreshing to drink in this hot weather. Drinking water all day long gets boring after a while. I need change, and coca cola is readily available for a cheap cost! The coca cola here is made with sugar, not high-fructose corn syrup. You can tell the difference! It’s VERY addicting. I’ve realized quickly that I need to start cutting back on the soda. It contributes to weight gain and also I want to keep my teeth for much longer.

5. Lack of exercise: I’ve noticed that, culturally, it’s not common to go on runs or take a walk like in the U.S. Women are the cooks of the household and take care of the children. Exercise is not a part of what has been passed down from generation to generation. Cooking, cleaning, sewing, selling food, etc. is normal. Not jogging down the street or going on a power walk. I also think people may just need to be educated more on the benefits of exercise and be encouraged to start. However, I have a different excuse for my lack of exercise. It’s TOO HOT! I would pass out if I ran in this weather. I try and wait until 4 or 5pm when the sun goes down. I then only have until 6 pm, when it gets dark, to get back to campus from a walk or run. I tend to take naps after working, so then I run into the problem of napping too long. I have been struggling with this. It’s been a challenge!

 Yummy cultural meal called jippi jappa which is a type of palm. It tastes so much better than it looks!

 Medical students love to make cake for everyone.

 Belizean coca cola. Yum.

Fried fish and chips. Eyeballs and all!

My favorite: fried panades- fried corn shells with beans or fish inside

Charlotte cooks across the street from Hillside clinic. She makes an amazing panade sauce- chopped up cabbage in vinegar and other spices. 

Typical Belizean meal. LOTS of rice and beans with pork or chicken. 

“The oldest trees often bear the sweetest fruit”

The majority of my patients are elderly, so inevitably I have experienced some of them passing away. As their caretaker, I always find it personally challenging when a patient dies. Thoughts run through my head and I wonder: could I have done anything more?

I consider myself a hospice home visit nurse at times. When a patient is dying, I work closely with family members on ways to keep their loved one comfortable during the end of life process. Morphine is not available at the clinic at the moment. The strongest pain medicine we have in our pharmacy right now is Ultram ER (narcotic like pain reliever). Therefore, I encourage alternative measures of comfort as well such as massages, playing comforting/calming music, sponge baths, keeping patients clean and dry, repositioning frequently, and engaging the patient in conversations if possible.

Recently, I was able to attend one of my patient's funeral in town. I learned about the typical process and traditions a family goes through. When someone passes away here in town, their body is taken to a morgue to be identified, cleaned, prepared, etc. Then the family starts to plan for the wake. A wake is a ceremony which takes place at the house of the deceased with the body present. Friends and family gather to mourn, celebrate, drink, eat, sing, and reminisce. This lasts all through the night until the next day in which the funeral takes place. The funeral I attended was an open casket, which I was told is standard. After the funeral, the body was put in the back of a truck and slowly driven to the cemetery across town. Others walked and followed behind in a procession. Once at the cemetery, it was surreal to see the casket placed into a hollow cement grave. Some songs were sung and last words were said, then cement was poured on top of the casket and spread all around. The sun was blazing hot and the family members were sobbing uncontrollably. I was lost for comforting words at that time. I stood and watched as the family mourned and the cement continued to pile on, layer by layer.

I find it amazing how well the elderly are taken care of by family members and the community here in town.  Many times when I visit a patient, they have family members all around--even great great grandchildren are running around the house. In my opinion, no nursing homes are needed here. It’s encouraging to see how involved the family can be with the care of their loved one. For example, I rarely see things like bed sores on my patients who are bed bound. They are turned every couple of hours by their supportive family. I’ve built some strong relationships with family members, communicating with them has helped me provide better care for the patient. The family helps me get to know what’s normal or abnormal during my assessments. It’s been an enjoyable experience learning how to work with a family and the patient as a whole unit.

Celebrating turning 100 years old!

Scorpion encounter

Monday morning started off like any normal morning. I woke up at 7 am, threw on my scrubs, and started to pull my hair up in a ponytail. If you talk to my family or close friends, they might say I can be messy at times. On either sides of me was a heaping pile of clean and/or questionable dirty clothes. As I finished with my hair I turned around and suddenly felt an excruciating pain on my pinky toe. I quickly looked down and saw the culprit--- a scorpion about 4-5 inches long with lobster like black pinchers and the infamous arched tail. It quickly jolted under my bed. I could almost sense that it knew its life would soon be ended. The pain increasingly got worse –like an injection that never ends. I started to scream due to the sharp pain. Two physical therapists came running into my room with looks of panic on their face, followed by a visiting doctor and two medical students. I was in good hands, to say the least. I was carried to the closest chair and ice was applied to my toe. Then, I was brought warm milk by one of the Belizean staff members. I was told this helps decrease the pain, so I drank it without question. Then another Belizean staff member said to take the guts of the scorpion and rub it on my toe. The toxins are supposedly drawn out of the body that way. I politely declined. Another staff member ran into the room and asked where the scorpion was. I forced the words “under my bed” through my tears. I usually hate killing insects or any type of critters. If I find them inside the house, I pick them up and let them free outside. The scorpions on the other hand… they don’t count. I moved down stairs to the clinic and continued to ice my toe. I started to feel like I was coming down with the flu. I decided to take the morning easy. No home visits this AM. Then something strange happened. Around 1 hour after the sting, my lips, tongue, and hands started to get a tingling sensation. The numbness and tingly feeling lasted for over 18 hours! I googled the symptoms while icing my foot in the clinic and found that the scorpion injects a neuro-toxin which produces the numb sensation. The scorpion can actually regulate how much venom is injected as well. Another fun fact about Scorpions is that they glow when exposed to certain wavelengths of ultraviolet light (i.e. a black light) due to the presence of fluorescent chemicals in the cuticle. I might invest in some black lights very soon. On the bright side, I had a great cultural experience, right? Hopefully I won’t have another quite like this one. I moved out of the treehouse, which is now being sprayed, bug bombed, and repaired. There are holes in the roof where insects and other critters can easily crawl inside. I have a family of bats, rats and mice that I can hear at all times of the day running around in the ceiling. And also, of course, my geckos. I usually have around 5-10 in my room at all times on the wall. With all the spraying and repairs, I’m hoping to move back in and live a scorpion free life. I now have learned the hard way that keeping my room clean is important. You were right, mom.

Occasional headaches

I like most of my patients. Especially when they simply tell me thank you. I feel like I run around all day, sweating profusely, and a simple thanks every once in a while makes everything I do worth while. Then there are the days when I wonder, “what am I doing here?” Those are the days my patients give me massive headaches. This may be more of a venting session than a blog but here I go:

#1. When my patients go to the local hospital for various reasons and forget to take their list of medications. Sounds harmless right? Well here’s what happens: my patient gets discharged with a completely new medication regimen because the doctors have no idea what they are taking. Then my patient gets confused about how to take their new medications. I don’t find out about the hospital visit and medication changes until weeks later because they didn’t call. When I arrive to their house for a routine home visit follow up, I find out they have no idea what exactly they were in the hospital for.  I’ve been told vague things like, “It had something to do with my heart.” Best part is, they have no discharge paperwork. I then have to act like a detective and go to the local hospital and figure out what exactly happened. Sometimes I'm lucky enough to get the discharge diagnoses.

Hillside has been trying to build a solid relationship with the local hospital for many years. Getting information from the doctors or nurses is tough. You get the vibe that they think you’re prying or questioning whether or not they are doing their job well. It’s an awkward and very difficult situation to be in.  The new doctors here at Hillside are thinking of volunteering in the emergency room on Sundays so we can get to know the hospital staff a bit better. They hope to strengthen our relationship with the hospital staff and hopefully they’ll feel more comfortable working with us. 

#2. Patients who lie about taking their medications daily. I know when you’re lying!  I give patients only a certain amount of pills every visit so I can keep track of their compliance. Many patients still love to tell me that they take their pills everyday exactly as prescribed. False. I can count the pills in their bottles and see that they have only taken a few days worth. If a patient is completely non-compliant, I’ve learned to sit down and have a serious conversation about it. There are many other people who would benefit from having the wasted pills (I’ve found pills don’t last long in the humidity and heat down here). I also let them have a choice whether or not they want medications brought to them. I encourage my patients to communicate with me, especially if they feel uncomfortable about a certain medication- I just need to be told. I do like to take the time and explain what each medication is for and why it would be helpful for their body. This seems to help many people feel more comfortable taking their pills as prescribed and many times they see great results such as decreasing extremely high blood pressures and blood sugars.

#3. Receiving labs after a blood draw can be challenging. Many labs cannot be processed at the local hospital. Patients' blood has to be sent up north to Belize City (by bus) to be tested. This can take weeks. Many of the times we don’t get the results for unknown reasons.

Examples of tests sent to Belize City:

-HgbA1C (test which reflects an average blood sugar level for the past 2 to three months)

-LDL (bad cholesterol)

-HDL (good cholesterol)

-Acid PHOS (enzyme)

-Potassium

-Magnesium

-Chloride

-Calcium

-Ferritin (iron)

-Chagas (disease)

-PSA (prostate specific antigen)

Patients are required to pay for:

-TSH, T3, T4 (thyroid panel) $50 U.S.

-CEA $60 U.S.

-PSA $30 U.S.

-HDL/LDL $5 U.S

-HgbA1c  $50 U.S.

*****If the patient has a social security number and we get the tests approved by the physicians at the local hospital- PSA, HDL/LDL, and HgbA1c can be paid for by the government.

Receiving the exact labs we ordered is difficult. Sometimes blood gets lost or tests weren’t done or data wasn’t entered into the computer ect.  There are times certain labs would be extremely helpful to have when figuring out what is going on with the patient.  We have to rely heavily on our clinical skills and work with the limited resources we have to do the best we can. 

Continuous Revolving Door

Hillside prides themselves on being a teaching facility. Each month we have medical, pharmacy, and physician assistant students here for their elective abroad. Hillside relies on these students for their assistance in caring for patients in the clinic and in many villages. The students pay a fee which provides them housing and occasional meals during their stay.  Hillside heavily relies on these fees to pay for bills and medical supplies, which keeps the clinic running.

Most of the students are my age so naturally I relate with many of them. I enjoy spending the weekends traveling as a group with the students. We all have so much in common. But after four weeks they leave Belize and continue their schooling. I’m finding myself bouncing in and out of relationships. It’s hard having people constantly coming and going. It’s a continuous revolving door here. I’ve realized that many of the home-visit patients must feel this way as well. Constant new faces in and out of their homes, but they get to see my face for another 7 months! ;-)

Mixed in with the students we have doctors who come and volunteer for a few weeks. I enjoy building relationships with the doctors who help me with my home-visit patients. It’s difficult once they leave and I have to start all over again. With so many people coming and going I’m learning how to get along with all the different kinds of personalities.  It’s also extremely interesting meeting people from all around the world. Lots of students are currently here from the UK. Tomorrow is their last day. Most of us will spend the weekend at a nearby beach called Placencia and then we’ll say our goodbyes.

The new doctors from Texas, Dr. Brown and Dr. Thomas, are here for at least two years. This gives me the opportunity to build a strong relationship with them. Dr Brown and Dr Thomas have been very supportive and enjoyable to learn from. They always make sure to check in with me and see that things are going alright. I don’t feel as overwhelmed as I could be with their continuous support. I’m so glad I feel comfortable asking them any kind of question because I always have so many!

Weekend trip to Lime Caye

Typical Day

Here in Belize there really is no typical day. I’ve found that you make a plan and a few minutes later the plan is changed. I like “going with the flow” so adapting here in Belize hasn’t been too difficult. I try to organize my week and figure out which patients I’m going to see. My plans are quickly changed when I get calls from patients who need me to see them for various reasons. I just go with it. I’ve found you have to be adaptable and flexible being a home visit nurse for 50 or so patients. Let’s just say I’m best friends with sticky notes!

I’ve been spending most of my mornings working at Hillside’s clinic from 8am-noon. In the clinic we have about 4 medical students, 1 doctor, 3 Belizean pharmacy /medical techs, and a student pharmacist. Working closely with the medical students, pharmacists, and doctors has been rewarding in so many ways. They know I’m eager to learn so they’ll discuss patient conditions with me and will grab me to assist with patient care.  In the clinic I’m available for anyone who has questions or if someone needs my assistance. This week I helped by drawing blood, performing EKGs, assisting with PAP smears/vaginal exams, performing wound care, administering injections, and providing diabetic education.

For lunch I usually head over across the street to see our neighbor Charlotte. She feeds me well. Maybe actually too well! I get a large portion of rice, beans, and chicken, which costs about $2.50 U.S. After lunch, I head out for some home visits.

The majority of my patients are 60 years and older.  Common medical diagnoses I see are: cerebral vascular accidents, hypertension, diabetes type II, chronic heart failure, renal failure, chronic obstructive pulmonary disease, osteoarthritis, rheumatoid arthritis, heartburn, and high cholesterol. I have around 50 patients at the moment. I’ve had two patients pass away. Both were in their 90s. I’m finding my job is geared more towards hospice nursing. I do enjoy working with the family and helping the patient feel comfortable during the end of life process. I also find it’s very important to take the time and explain to the patients what exactly is going on with their body. Patients may be told what they’re diagnosed with but many of the times don’t fully understand what is physiologically going on.

I like to see 4-5 patients in the afternoon. I do a full head to toe assessment, which consists of reviewing all their systems. I’ve had 4 months here in Belize to get to know all my patients so I now know what exactly to check on or focus on during their home visit. I’m also responsible for filling patients medications. I give them 35 days worth of each medication. This helps me keep track of the patients’ medication compliance. I’ve found pill boxes have been helping my patients take their medications correctly. I also learned that pill boxes can be extremely confusing to some. Pill boxes and medication compliance could be a blog in itself!

Day Trip to Guatemala

Last Saturday morning I joined the physician assistant, medical, and physical therapy students on a day trip to Guatemala. We woke up early in the morning for our short calm boat ride to Sustoon River. This river creates a natural border between Guatemala and Belize. Before lunch, we parked the boat and hiked in the jungle to see a large sink hole. Our only rule on our hike: "Do not touch anything like a rock or a tree without looking before hand." This is do to the exotic creatures that inhabit the jungle. After the hike we jumped in the water to take a quick swim to cool off. The water was extremely refreshing after working up a sweat. We then took a boat ride to a near by beach called Playa Blanca. I relaxed in a hammock and drank coconut juice. This was just what I needed after a busy week of work. Some of the students played beach volleyball and swam in the sea. We had a delicious lunch on the beach that a local cooked for us. He delivered our food by boat. I ate tortillas, fish, chicken, rice, and vegetables. I might have had 5-6 tortillas, but who's counting? After lunch we jumped in the boat and headed to some waterfalls called "Siete Altares" which translates to seven alters. Although they may not be true waterfalls the water descends across breaks in the river bed making a beautiful path to walk on. At the very end of hike we were welcomed by a gorgeous waterfall. I finally mustered up the courage to jump off the very top!

 Floating along Sustoon River

 Playa Blanca

 Enjoying the weekend!

 Hiking the waterfalls

Group picture at the end of the hike. 

Staff Retreat

Last weekend, we had an overnight staff retreat in Placencia, which is on the coast of Southern Belize. It was a two-hour drive south from the clinic here in Punta Gorda. Last Friday, the entire Belizean staff and I packed into two mobiles. The mobiles we have here at the clinic are usually used to travel to various villages to provide medical care. This time the mobiles were taking a different route! We arrived in Placencia and relaxed a bit before dinner. A few of us took a walk down the beach. At dinner, we all welcomed the two physicians from the U.S. who will be the new directors here at Hillside. They will be taking the place of Dan and Maria. Dan and Maria have been working as FNP with Hillside for three years now. They are now ready to hand things over to Dr. Bill and Dr. Angelia. I will be working closely with both of them. I am always asking questions and like to discuss my patients so they will be getting to know me really well soon!

In Placencia, it happened to be the weekend of Lobsterfest. Placencia Lobsterfest is held the last full weekend in June every year. The festival lasts three days which celebrates the opening of lobster season. During Lobsterfest, restaurants will have lots of tasty lobster dishes from which to choose, musical entertainment, fishing tournaments, games, and local artwork for sale. We followed the loud music and hung out for a bit wandering around and looking at the various arts and crafts for sale. Most of us went to bed early because we had to wake up early for our snorkel trip!

Our snorkel boat was amazing! I enjoyed the two-hour boat ride until we reached an island called Salt Water Caye. It was a beautiful island. The water was so clear. I have snorkeled many times but snorkeling in Belize was one of my favorite times. Some things I saw were an octopus, a scorpion fish (you should search it on Google), and stingray. After snorkeling, we ate lunch then I headed toward to hammock. I watched some of the staff members played volleyball while I ate a coconut in the shade.

Overall, the staff retreat was a blast. It was fun to spend time with my coworkers. Placencia is a great getaway. The beach is so peaceful and there are so many hotels from which to choose, which are RIGHT on the beach. This staff retreat was one of a kind!

 View from my room.

 Hanging out on the beach with Victor! ( Pharmacy tech.)

 Salt Water Caye!

 Our boat for the day.

 Snorkel area.

Virginio! (Pharmacy tech.)

Fully Loaded

I am officially the only nurse here at Hillside! It's definitely been challenging managing around 56 patients, but the doctor and nurse practitioners here at Hillside have been supportive and helpful. Dr. Dan has been working with me on various days to see my patients with me as well. It's been helpful having him around to consult when I have questions about my patients.

Each home-bound patient needs to be seen at least once a month. I found out quickly that I've been seeing many of my patients multiple times a month. For example, patients become ill and/or go to the hospital, family members or the patient have questions, patients’ medications are changed, blood needs to be drawn, etc. My days are long and tiring, but I'm finding it rewarding and I'm constantly
learning new things.

At home visits I am responsible for a full assessment, refilling medications, and educating when needed. A full assessment requires listening, palpating, and/or observing all the patients body systems: respiratory, cardiac, gastrointestinal, genitourinary, neurological, circulatory, and musculoskeletal. I've found that I really enjoy teaching family members and getting them involved with the patients care as well.

On a side note, last week I moved out of the dorms and into the "tree house" where the previous nurses were living. I'm enjoying it up here. The tree house, dorms, and clinic are all yards away from one another. I still visit with the medical and pharmacy students since I've moved out of the dorms. I eat dinner with them almost every night.

I celebrated my birthday with the staff on May 3rd! We went to a restaurant down the road called Anaconda. The owner of the restaurant is originally from the U.S. She has been in Punta Gorda for three years now. We had a traditional Belizean meal: chicken, beans, and coleslaw. It was yummy! After eating we danced for a bit trying to burn off the calories from the cake.

To the left is the student dorms. To the right behind the big tree is the clinic.

The tree house! My home for the next 11 months. 

-Side view-
Bottom floor: Hillside's clinic.
2nd level: Storage, administrators office,  and the medical directors room.
3rd level: popular tanning area for students

  

Health Fair

Hillside has health fairs once a month at different villages in the Toledo district. This Sunday we drove two hours to a village called Otoxha. I had previously visited this particular village one week ago to talk with the alcalde ("chief") of the village, village chair person, community health worker, and school principal to get their approval to visit their village. They were very excited to have us. These health fairs are geared more towards kids and are meant to be fun, but I've found they take lots of work to organize!

At the fair we taught kids how to brush their teeth and floss. We had a plastic model of dentures that the kids could use to demonstrate how they would brush their teeth, which they really enjoyed! We handed out tooth paste, tooth brushes, and floss. We had another station set up teaching kids about nutrition. The medical students made up game where the kids had to place certain foods in the right food group. We also played soccer, jump rope, and tag with the kids teaching them about the importance of exercise. We also had a station for face painting. I personally got really good at painting butterflies that day! We also checked the adults blood sugars and pressures. If we saw any abnormal results we let the person know that in the beginning of May Hillside  would be back in their village for mobile clinic. On mobile clinics we do full assessments of the patients and have many medications and supplies that are needed.

After the health fair ended we drove down the road to have lunch at the alcalde's house. His wife prepared a dish for us called caldo, which means soup in spanish. It's comparable to chicken soup and is usually served with tortillas. It was my first time tasting caldo and I really enjoyed it!

Cultural Day

Today the students and I had a break from clinic work and home visits. In the morning there was a presentation put on by the Belizean staff members here at Hillside. They talked about the different cultures you'll see here in Belize such as East Indian, Garifuna, Mayan, and Creole. After the presentation we drove to Nim Li Punit  to tour the Mayan Ruins. It was interesting to see the open tombs and step pyramids that date back to 700AD. We also saw the second longest carved stela in the Mayan world. 

After the tour we headed to meet the Ixchel Women's group. The Ixchel Women's group gave us a glimpse into their Mayan home and culture. We learned how to grind corn on a stone and make corn tortillas on the traditional comal. They cooked us a traditional Mayan meal which consisted of tortillas, jippy-jappa stew, and chicken. We also had sour sap juice. It's yummy. At the end of lunch we were able to buy some beautiful baskets made by the women woven out of the plant called jippy-jappa.

Then we made our way to Blue Creek. Our Belizean tour guise lead us on a hike to the Blue Creek caves. We hiked through the forest over rocks and hills for about 15 minutes. After reaching the entrance of the cave we fastened our life vests and slipped on our head lamps and entered the darkness. It was an incredible experience having the headlamp as the only source of light in the dark cold cave. It was difficult at times convincing myself that there were no creatures in the water wanting to grab my feet! We swam deep into the cave for about 45 minutes and climbed over multiple tiny waterfalls inside. After our adventure in the cave we had time to swim in the creek and play on the rope swing. 

Overall, cultural day was a success!

Weekend trip: Tom Owens Caye

The students and I planned a trip to Tom Owens Caye, which is beautiful 1 acre coral island in the Sapodilla Cayes reef system - a marine reserve in the Caribbean just off the coast of Belize. Early Saturday morning we took an hour and a half boat ride to the island. After lunch we went out to sea in search of whale sharks. We were prepared to snorkel along side the 47,000 lb fish, but unfortunately we did spot any. We then went snorkeling around the island. We got lucky and found some fisherman throwing some conch off their boat, which attracted a couple eagle sting rays. It was amazing being inches away from the rays. A couple students and I went fishing in the evening. We first caught some fish called bonita and used them as our bait. We ended up catching 2 barracuda that night! We had so much fun that we decided to go fishing early in the morning too. That morning we caught four more barracuda. The owner of the island cooked the fish for us and we had it for lunch along with fried conch, rice, and beans. It was tasty. We also had lots left overs, which we brought home with us. Sunday I spent the day swimming and lounging in a hammock. Around 3 pm we headed back to civilization.

 The view from my room...

 Fishing!

 The fishing crew....

 Hungry eel.

Mobile clinic: Laguna

Today was my first trip on the mobile clinic. We packed up the car with medical supplies and drove about 20 minutes to village called Laguna. The clinic is set up in minutes in a small vacant building. We had medical students, pharmacists, nurse practitioners, and doctors. Sara (a nurse practitioner) and I had some home visits to do around the village. We hiked a couple minutes to see our first patient who is doing well. Her husband came up to me and started complaining of itching and burning on one side of his back, which has been going on for months. We sent him down the clinic and sure enough he was diagnosed with shingles. After leaving their house a women came up to us and stated  her friend was a very sick and we needed to see her if possible. Sara and I agreed and hiked for ten minutes in the heat. I was dripping in sweat! We assessed the sick patient and hiked our way back to the clinic to talk with the doctors about this patients condition. Doctor Phil and his wife Sandy have lots of experience working abroad in places such as Africa. They have been extremely helpful by explaining disease processes and various medical conditions to me. We stayed in the village from 8-noon. Mobile clinic was half day today. The village was beautiful. Lots of houses with thatch roofing. I saw lots of chickens, ducks, cats, dogs, and pigs roaming around. I forgot my camera, but I will be returning to that village soon for follow up home visits.

Hillside Health Care

I survived my first week. Wearing scrubs in 90 degree weather with the humidity has been the biggest challenge for me. I think my body is starting to adapt a bit! I have been heading into town around 8 am with the nurses to start home visits. DM, HTN, and cardiovascular disease are the common issues we see. The PA students saw two cases of Leishmaniasis out in other villages. They brought back pictures to show me. It was interesting to see. I told them about one of my patients who showed me her gallstone she kept from surgery. It was the size of a robins egg! 

The patients and their families have been so welcoming. Right when we enter a patients house we're brought chairs and offered drinks. My favorite drink I discovered here is lime juice. The other day while I was listening to a patients heart a hen came waltzing right inside with her ten chicks following. Already by my feet was a puppy and cat. A couple seconds later two dogs came running into the house after the hen. The house got full quickly! Everyday is full of surprises. 

On Wednesday we had a Women's Health Fair at the park in town. We set up tent and hung up educational posters. We educated women about things such as cervical cancer, breast feeding, and pap smears. Other tents were discussing things such as domestic violence and HIV/AIDS. In the evening, some of the PA students and nurses went to a HOPE meeting. HOPE stands for Helping Elderly People Equally. We did exercises with them, played bingo, and had a discussion about "end of life" and the importance of communicating your needs/wants to family members during that time. 

I have been practicing driving here. It was really helpful knowing how to drive manual before coming. I couldn't imagine learning how to drive stick shift while avoiding pot holes. I have my "drivers test" tomorrow. I'll be checked off by the facilities manager so I can drive the cars by myself and drive students into town when needed.


Down below is a picture of my dorm called Abby's House. It's named after a fourth year medical student who came to volunteer at Hillside. Unfortunately she died in a scuba accident. In her memory they named the dorms after her. 

This is the car I've been driving!