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.