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