Photos (taken while kayaking):

Yellow-crowned Night Heron (Nictannasa violacea)(left)

American White Pelican (Pelicanus erythrorhynchos) (right)

Today I had a telemed meeting with InterVol team members in Rochester, to discuss upcoming telemed activities for the new year. Among the things we've got on the agenda, we're planning to teleconference in to Grand Rounds at Rochester General Hospital, so that doctors in Belize can attend these informative sessions. We're also working on more teaching sessions by Rochester faculty, as well as continuing Bob Kane's work in setting up a hospice program here in Belize in conjunction with Rochester and Dangriga high schools.

Today, a staff meeting was scheduled for noon, but after several people showed up late and some not at all, the Chief of Staff rescheduled for 7am tomorrow morning, much to everyone's dismay. Most of those present were Cuban and the whole conversation took place in Spanish, and though much of what was said was fast and barely understandable to me, I did catch the "siete en la manana, manana" part. Because the Chief of Staff is frustrated about the lack of respect she gets from the doctors, she put in her letter of resignation weeks ago. However, the Ministry of Health is delaying the processing of it, because no one is willing to take her place.

On a positive note, this morning Dr. Lewis and I teleconferenced with Dr. Bernstein at Rochester General Hospital, for a consultation on a pediatric patient with post-infectious glomerulonephritis.

Sometimes in the mornings, the sea is calm and looks like glass. This was one of those mornings, so I went out at 6am on my housemate's kayak. I paddled alongside the beach, which eventually becomes a mangrove forest close to the mouth of the Sittee River, where the wildlife is very rich. The fish were jumping, and I saw parrots, pelicans, herons, and many other birds that I haven't had a chance to identify yet. Next time I'll bring my camera!

I'm back in Belize after my Spanish immersion in Guatemala. I now understand most of what I hear and am able to converse in Spanish. I've had a few Spanish conversations today at the hospital, so I will be able to use my new skill.

The hospital is very quiet. There are 3 Cuban doctors and 2 Belizean doctors working at the hospital these days, not including the anaesthesiologists. I'm told that patients here tend to avoid the hospital during holidays, but that we can count on January being very busy, e.g. with diabetic patients trying to get their sugar under control again.

Many doctors in Belize are taking vacation in the upcoming weeks, and because I need these doctors’ participation for my work, I have decided to use these weeks to learn as much Spanish as I can in a language school in Antigua, Guatemala. Being able to communicate with Spanish-speaking patients and doctors will be a great asset in Belize, as well as in the U.S. Although English is the official language in Belize, many Belizeans who live close to the borders of Guatemala and Honduras do not speak English. Also, most of the Cuban doctors who practice in Belize speak very little English.

So far, I've learned a lot of Spanish in several days, and Antigua is truly a delightful and charming town. The streets are all very similar, in Spanish colonial style and cobblestone streets (see photo, above).

Over the weekend I hiked up a nearby active volcano, Volcan de Pacaya (see photo, below). A challenging hike up, it satisfied my life-long desire to see flowing molten lava!

Photo: One of the abandoned vehicles in Hopkins. My housemate is on a local committee for Hopkins beautification and from what he tells me, this van won't be serving as a flower pot much longer.

This week, a man named Bob Kane is in Belize from Rochester. He had the brilliant idea to teach hospice care (end-of-life care) to high school students here and in Rochester. He is working with a local high school in Dangriga to develop the program, and uses telemed to hold teaching sessions with the Belizean students. The students will be providing palliative care (comfort care) to fellow Belizeans who may not have access to care at the end of their lives. Rochester high school students are participating as well, and will be coming here in April to work alongside the Belizean students.

Garifuna Settlement Day was a little anti-climactic. The musician who everyone was excited to see did not come, apparently because the chairman of Hopkins didn't finalize the plans or pay him. People who had bought advanced tickets for $25 were simply out of luck. That's a very typical scenario here in Belize.

My new hobby has become to take photos of all the fascinating things I see here. The biodiversity here is astounding, and today I saw this bare-throated tiger heron near my house (see photo). At first he was sitting high up in a tree, crouching down with his neck folded up, and I thought it was one of the common grackels. But, when he flew down and stretched out his neck he looked completely different.

Photo: Bare-throated tiger heron (Tigrisoma mexicanum)

This Thursday, November 19th, is a major holiday in Belize. It’s Garifuna Settlement Day, commemorating the Garifuna arrival in Belize. Garifuna is one of the cultures of Belize, said to originate in the 1600’s when 2 Spanish ships carrying Nigerian slaves shipwrecked on the island of St. Vincent, in the eastern Caribbean. The Africans intermarried with the Caribbeans who were living on the island, and hence the evolution of the Garifuna people. Years later, the Garifuna settled in Honduras and then Belize after trying to escape the British. The party here has already started, and in Hopkins there is drumming every night this week in celebration. The main event in Hopkins begins the night before the 19th. A well-known musician from Honduras will be performing a concert in Hopkins on Wednesday night, and this will be followed by an entire night of partying. At 6am there will be a re-enactment of the Garifuna arrival by boat on Belize shores. As someone who values sleep, I’m not sure how much of this celebration I will partake in, but I’m looking forward to it nevertheless.

Photo: Red-lored Parrot (Amazona autumnalis), eating berries near my house.

One of my favorite activities here is swimming at sunset. Last night, the sea was fairly calm, no waves crashing. I was standing in about 4-5 feet of water, when suddenly I heard a splash behind me. I looked, but saw nothing. I kept watching, and after a few minutes I saw a large curved mass arcing through the surface of the water. It was clearly the back of some creature, but it was moving too slowly to be a dolphin. Then I realized, I was swimming with a manatee! I had seen one from shore several weeks ago, and it is well-known that they swim here. Hoping to see it again, I swam closer, but apparently it had decided to return to its solitude.

Today, I am attending an all-day educational workshop at the hospital on HIV and tuberculosis. I look forward to finding out how these subjects are addressed here in Belize.

The doctors at Western Regional Hospital, located in Belmopan, the capital of Belize, have been on strike for the past 2 weeks. The reason is that they are frustrated with their lack of functioning equipment, which the government of Belize refuses to replace. At Southern Regional Hospital, where I am, the same equipment problems exist. For example, the one and only x-ray machine here has been broken for the past 6 weeks. A hospital with no x-ray machine hardly seems like a hospital. Not infrequently, an anesthesia machine will suddenly stop working in the middle of a surgery at which point the anesthesiologist will fiddle with it and with some luck, will get it working again. The equipment is so old and obsolete, that when parts break, replacement parts are no longer available because they simply are not being manufactured anymore. For instance, a while back, the tubing on the anesthesia machines cracked, and new tubing was not available. Somebody creatively replaced the broken tube with a nasogastric tube (a tube used to pass through a patient’s nose into his/her stomach for feeding or suction), and this has kept the anesthesia machines functioning for the time being.

One of the projects we (InterVol) are doing here is to assist in repairing broken equipment. Yesterday we had a teleconference meeting with Doran Mix, the technologically-gifted medical student I have referred to in past posts, and Ream Kidane, a biomedical engineer at RGH who has generously offered to come to Belize in March to help fix equipment. Our efforts will likely help, but ideally what needs to happen is that the Belizean government needs to step up and provide medical necessities for its people.

Photo: Ctenosaur (Ctenosaura similis), commonly known as a “Wish Willy”, living near my house, about 2 feet in length.

Last week Dr. Pott and I did an incisional hernia repair on a morbidly obese woman. Along with the repair, we did a panniculectomy, i.e. we removed a large undulating flap of flesh that was hanging down her belly and contributing to her hernia problem. We ended up taking 9 lbs off. My main job was to pull flesh in whatever direction Dr. Pott needed, and I got quite a workout during the course of the surgery, which took about 4 1/2 hours. I hadn’t expected to see much cosmetic surgery in Belize, but the plastic surgery rotation I did before I left Rochester sure came in handy.

Photo: man on porch in San Ignacio, Belize (just thought it looked interesting)...

Today in clinic, I delivered some bad news to a patient. I told him and his wife that he had liver cancer. Three weeks ago, he came to clinic after being referred for gallstones. When I examined him then, his liver felt really rubbery and weird, to use technical terms, and when I showed Dr. Pott, he thought it worthy of an MRI. The guy had been a heavy drinker, and also had signs of chronic illness - temporal wasting, weight loss, etc.

Today, the patient came back with the results of the MRI, which confirmed hepatocellular carcinoma. After Dr. Pott and I had a hushed discussion while examining the MRI, Dr. Pott left the room briefly. I was left with the patient and his wife, and I asked them if they had been told the results of the MRI. They hadn’t. To me, it seemed obvious that the patient needed to be told that he had cancer, so I told the patient and his wife, as compassionately as I could, that he had cancer of the liver. They looked at me, stunned and confused. As a medical student, I probably overstepped my role, to tell them this without the attending doctor in the room. However, I felt that the information should be relayed to the patient and assumed Dr. Pott was about to do just that.

Dr. Pott came back in the room, but didn’t know I had told them the news. He asked the patient to leave the room so he could talk to the wife. After the patient left the room, Dr. Pott told the wife that the patient had liver cancer, for which there was no treatment in Belize, and that he had 6-12 months to live. The woman was clearly holding back tears. Dr. Pott, not knowing that I had already broken the news to the patient, asked the wife how much information she would like him to tell the patient. She replied that she would like him to say he had liver cancer, and that’s all. The patient was called back in the room, and Dr. Pott told him he had liver cancer.

In the U.S., the way this scenario played out would have been a violation of the patient’s right to privacy. Dr. Pott may have had a reason for telling the wife and not the patient the full story, e.g. perhaps Dr. Pott knew the patient well enough to know that the patient wouldn’t want to hear he had cancer and would rather have his wife make all medical decisions. I think this is unlikely. In this culture, it is likely that the way Dr. Pott handled the situation is the norm. In retrospect, before I broke the news, I should have asked the patient how much he wanted to know about his illness. Nonetheless, it was a moving experience, and I will never forget it.

Photo: Man fishing in Hopkins, Belize

I am taking a trip back to Rochester for 4 days. I’m looking forward to cool weather, as the heat index in Belize for September and the first few weeks of October was between 100-110F daily. I’m also excited to have a break from the bugs. In my apartment, no matter how much I scrub the place, there are bugs on me constantly. If I make a sandwich and leave it, or a utensil, on the counter unattended, there will be ants on it within minutes. Ants are in the bed, and on me if I’m in bed! Each morning I wake up with new mosquito bites though I apply DEET bugspray each night.

Admittedly, I’ve been getting frustrated with these physical discomforts, as well as feeling helpless in the face of the poverty that surrounds me. As an example, the family across the road from me, when I was living next to Judy, was selling the daughters for sex in order to put food on the table, (which of course resulted in more babies to feed). In the house I moved to on the north side of Hopkins, another neighbor just started a job cleaning at one of the Hopkins resorts, for what she considers a good wage of about $30Bz/day ($15 US dollars/day) to support herself and her daughter.

Since hotel and flight prices are currently cheap in Cancun, I’m spending a couple days here in Cancun, en route to Rochester. What a way to jolt me out of my third world existence! Cancun is the antithesis to Hopkins. Despite all of the complaints I’ve just detailed above, I’d choose Hopkins over Cancun any day. The people I’ve met in Hopkins are the most open-hearted and generous people I’ve ever come across. Most are down-to-earth, they look me in the eye when they talk to me, and they are genuine in what they say, even if it might offend me. Here in Cancun, humanism has been sacrificed for the sake of commercialism. Yesterday, I was looking at some silver earrings in a market, and when I told the shop-owner that I was going to think about it and maybe come back later, he followed me out of the store and yelled after me, “You’re a liar, you’re all liars!” Then I made the mistake of getting suckered into attending a time-share sales pitch, which was a colossal waste of time and energy. So today, I plan to go to the beach and try to forget about the inequities in the world. I’m already looking forward to returning to Hopkins!

Today, the village (Hopkins) ran out of water. Again. This happens all the time (about once every 1-2 weeks), and the village sometimes goes 4 days with no running water. The water I drink, I buy in 5-gallon jugs. I definitely have a renewed appreciation for clean water since I moved here.

This weekend, I've been invited to a birthday party tonight, and an anniversary party tomorrow night. I'm hoping we'll have water soon, so I can shower first!

Photos: Roadside Hawk (Buteo magnirostris); Great Egret (Casmerodius albus).

Our most recent telemedicine consult has an interesting twist. The patient is a Mayan man who has been having abdominal pain for a long time. He was treated for a bacteria as well as a parasite but has not gotten better. Because he's seen several doctors and they've been unable to help him, the people in his small village think he has a curse on him by a witch-doctor. There are two main families in his village, and the idea that he has a curse on him has repercussions for his entire family, as it is thought that the curse was placed because the family did something wrong. Small villages being what they are, the whole family is feeling shunned. Hopefully, one of the InterVol doctors will diagnose the real problem and we can spare the family this turmoil.

Today, I assisted Dr. Pott with another hernia repair, and Dr. Pott assisted me with the surgical removal of a wart from a woman's leg. I've also been getting practice putting casts on arms, and removing them. We have several kids per week with wrist/elbow/arm fractures.

Friday, the high school debate on the topic “Only those with serious mental illness should have access to health care professionals” went well. The students did a great job presenting their arguments. The team arguing the negative side of the argument won, and the photo (center) shows how excited the students of the winning team were.

Yesterday, I found a new passion, when I SCUBA dove for the first time. A friend in Hopkins, Luckie Nunez, is a SCUBA instructor, and began teaching me and two other of his friends to dive yesterday. After learning some skills in shallow water, we dove 20-25 feet deep in the coral reef off of South Water Caye. It was incredible! The colors and diversity were extraordinary, and the whole experience was otherworldly.

Photos: One of the students presenting her argument in the debate (top); students of the winning team after hearing that they won (center); those of us from Southern Regional Hospital who organized the event: Nurse Funky, Tina Gaud, Matron Valentine, Estella Humphries, Nurse Sinclair (bottom).

Last evening, shortly after I returned home from the hospital, one of my neighbors came running over to my house in a panic. Her nephew had apparently fallen while trying to pull a guava down from a tree, and badly cut his wrist on a piece of glass. When I looked at the boy, who was 12 years old, he had a deep cut and obviously needed to get to the hospital. With a tourniquet wrapped around his arm, I drove them to the hospital where things were quiet, and he was able to get cleaned up and sutured immediately, and he seems to be doing fine.

Today, I worked with Dr. Pott in the OR. We amputated a diabetic woman's finger, which had turned black and was oozing pus from a month-long infection -- not a very different scenario from many diabetic patients I've seen in the States. We had 2 other minor surgeries, one of which was a lymph node biopsy, and Dr. Pott let me do the incision, most of the dissecting, and the suturing. Exciting!

This afternoon Dr. Medieros, a breast surgeon at Rochester General Hospital, gave a teaching session on breast cancer to medical staff, via teleconferencing. The group was small, but people were grateful and found the session valuable.

Today, I gave a lecture on mood disorders (depression and bipolar disorder) to hospital staff. The lecture was scheduled for 1:00 PM, and at 1:10 when no one had shown up, I thought there must not have been any interest, and I almost left. However, the internet connection in the conference room is good (thanks to InterVol and Doran Mix, the med student here over the summer), so I decided to stay and do some work. Around 1:25, the nurse practitioner who had asked me to give the lecture came, and 10 minutes later, the room was packed with 20 people. I should have known -- the lecture was 1:00 PM *Belize time*. So, I gave my teaching session and it went great! The group had such a vivacious sense of humor that by the end, when people were asking questions, everybody was laughing big laughs, several people slapping their thighs. One staff member, as he left, said, “At first the people didn’t want to come, and now they don’t want to leave.”

A few nights ago, I was driving home from yoga around 6 PM. It had just gotten dark, but there was a full moon. I saw something I hadn’t seen before -- hundreds of crabs, crossing the road. Each one was about the size of my palm or slightly larger, and their eyes, sitting atop their eye-stalks, gleamed eerily in the light of the moon. A crustacean blanket across the road, it was impossible to avoid the crunch of a few unlucky ones under my tires. The road was still partially flooded, and suddenly I saw a slithering across the road -- a crocodile! It was probably about 5 feet long, and about 5 feet away from me. I’m glad I wasn’t on my bike that night.

This week is International Mental Health Week. I have been working with the psychiatric nurse practitioners at the hospital to organize activities for the week. Yesterday we had an open house at the hospital, giving out information on general health issues and psychiatric health issues, and we tested blood sugar and blood pressure on people. I must have pricked about 100 fingers. Tomorrow, I will be giving a lecture on mood disorders to the hospital staff. Friday, we are having a debate between two local high school debate teams, on the topic, "Only those with serious mental illness should have care by mental health professionals." I will be the time-keeper and score-keeper. Should be interesting!

The ObGyn team that was here over the week hit the ground running. The team included 3 nurses (Nancy, Vicky, Diana) and one doctor (Dr. Vill) and one administrator (Bernadette). There is an overwhelming need for ObGyn care here and the team had their hands full. Vicki and Diana traveled out to some of the rural villages and provided PAP smears for women there. Nancy worked in Labor and Delivery, and Dr. Vill used a portable ultrasound machine to evaluate prenatal patients and anything else that came her way. Bernadette provided valuable organization and took care of the inevitable paperwork that accompanies patient care.

A few examples of what the team saw: a patient came to Dr. Vill because she had fibroids and wanted an ultrasound. Dr. Vill saw the fibroids, but also found a fetal heart beating at 150 beats per minute! The woman was 17 weeks pregnant and had no idea. Another woman who was 34 weeks pregnant came in to the emergency room with eclampsia, a potentially fatal condition that includes high blood pressure and seizures. Thanks to Dr. Vill’s evaluation, the woman received an immediate c-section which most likely saved her life. In the labor and delivery room, a woman was bleeding profusely after she gave birth, and no one took notice. Luckily Nancy and Dr. Vill were there to diagnose a post-partum bleed and sewed the patient up.

Photos: Dr. Vill doing an ultrasound (top); Patients in line at Southern Regional Hospital, Dangriga -- Bernadette is sitting at the desk organizing the chaos (center); Patients waiting to be seen at the health clinic in Independence (bottom).

--Tina

On Saturday my friend Dianne and I went to a Belizean wedding in San Ignacio (see photo, right). We were invited there by the groom’s brother. I continue to be amazed at the friendliness and open-heartedness of the Belizean people. Even though we didn’t know the bride nor the groom, the family welcomed us with open arms. As the first and last person on the dance-floor, I don’t remember the last time I had so much fun. There were also performances by belly dancers and a woman who danced with fire, twirling flaming torches around while she danced.

This week, I’m working with a team of obstetrics/gynecology specialists from Rochester, who are volunteering their services here for the week. A few poignant, astonishing details about giving birth in Belize: women must bring their own toilet paper to the hospital, to carry with them when they go to the bathroom. They also bring their own towels and give birth in the clothes in which they arrive (i.e. they are not provided hospital gowns). The sheets are not changed in between patients. Actually, there are no sheets, just a mattress. (If you’ve ever seen a childbirth, that detail is truly disturbing.) Today, for the patients who needed oxytocin (a powerful medication that increases the force and frequency of contractions), it was not measured, just eyeballed by the one and only gynecologist at the hospital, a Cuban doctor with questionable desire and/or ability to communicate with his patients or care about their well-being. There are many more such tidbits, some that are even more remarkable. The story about why Cuban doctors are here, I will save for another day.

It’s rainy season here. A couple of days ago, when we got a break in the rain I decided to ride my bike to a neighboring village to go to a yoga class there. The road there was partially flooded, and as I rode through the water, my shoes and feet got wet. I didn’t think anything of it, especially since I was preoccupied by having to put the chain back on my bike 5 or 6 times, as it kept slipping off! The next day, I was seeing patients in the clinic. One man had an ankle problem, and as we were examining his bare feet, I realized there was a stench in the air of dirty feet. But after the patient left, the stench remained. A little later, it dawned on me that it was MY feet that stank! I was horrified when I realized that I was wearing the same shoes that had been drenched in the bacteria-laden floodwater, and this must have been why Dr. Pott had kept glancing at my feet and scrunching up his nose. Not only was I humbled, I learned two valuable lessons: keep your shoes clean, and don’t assume it’s the patient who stinks!

I ate freshly-caught barracuda for dinner last night. My yoga teacher and good friend, Dorman, had been out fishing and gave me three different types of fish he had caught, and I fried one up last night. It was some of the most delicious fish I’ve ever tasted!

Today I was able to complete a telemedicine consultation between a patient in Placencia (southern part of Belize) and a neurosurgeon at Strong Hospital, Dr. Vates. The patient wanted the consultation because he had been told he needed surgery and wanted a second opinion. We were able to transport electronic files of the patient’s MRI to Dr. Vates, who kindly donated his time. It was a good thing, because not only did Dr. Vates recommend surgery, he concluded that the patient is at high risk for paralyzation or death with any minor trauma and thus the patient needs surgery ASAP. The patient is now scheduled for surgery on Monday.

Yesterday evening, I went swimming after a day at the hospital. I was enjoying the sunset, when, BAM! I felt the sting of a jellyfish on my hip. Ouch! As I swam back to shore, I considered the possibilities of how to relieve the sting. I’ve been told of 3: vinegar, windex, or urine. Unfortunately, I didn’t recall having any vinegar or windex... I know what you’re thinking, and believe me, I seriously considered it. Instead, I melted an ice cube on the burning area of my skin, and brainstormed other possible strong chemicals that might alleviate the burn. Marie Sharp's habanero sauce, perhaps? I started making dinner, and suddenly remembered, I did have some balsamic vinegar! I put some on the skin, and the burning and swelling disappeared. Now all that are left are some red lines on my leg that look like chicken scratches.

--Tina

Carnival was last weekend in Belize City! A friend and I hitchhiked and took the bus up to Belize City. Hitchhiking is very common here, and we figured since there were two of us, we'd try. There were many other people hitchhiking as well so we got to meet some interesting people, one of whom was a hitchhiker who said he had fathered many children with different women, and said his name was "Boom-Boom." My friend and I were able to hitch rides for parts of the trip in both directions, but in the end took the bus most of the way, especially since it started raining on us on the way back! The parade was fun -- great costumes and dancing. One of the floats in the parade was for "One Barrel," a popular brand of Belizean rum. In the parades I remember from my American childhood, candy was hrown out to the crowd, but in this one, cups of rum-and-coke were handed out to the crowd!

Yesterday, I was assisting in a hernia repair surgery, when the power went out. This happened twice while the patient was on the operating table. For some reason the backup generators were not working, so the OR was completely dark. For a second I almost panicked for the sake of the patient whose belly was wide open, but then a tiny light emerged from the head of the operating table. The anaesthesiologist was providing a makeshift flashlight using his intubation instrument, which has a light that shines down a patient’s throat when inserting a tube. Genious. But not enough light to finish the surgery. Luckily the lights came back on momentarily, and we completed the surgery. Dr. Pott, the general surgeon, wisely cancelled the next case, which was a cholecystectomy (gall bladder removal). However, the ObGyn doctor needed to do a c-section. As we were scrubbing in, the lights went out again. But this time, they didn’t come back on. Luckily, no incision had been made! Again the anaesthesiologist shed a tiny beam of light so we could at least see the door. I think they had to send the patient by ambulance to the hospital in Belmopan.

--Tina

Scenes from the street in Belize City: a fisherman in his boat at the fish market (left); a fruit stand (right).

Last week, I went with a group of women to Belize City, because one of the women needed a mammogram. For diagnostic tests more complex than an x-ray, such as MRIs, CT scans, or mammograms, patients have to go to a private hospital in Belize City and pay out-of-pocket.

While in Belize City, I went to the public hospital there to see an 18-year-old girl who had been in a motorcycle accident and needed a bone graft, who might benefit from a telemed consult. I was stunned to see that on the entire surgical ward, there was one single container of soap.

In Belize City, we took the opportunity to do

some shopping for things we don't have in the southern part of Belize. I bought luxuries such as chocolate and cheese. And, I bought a used car, for Intervol's use (and my use, while I'm here). Now I can drive to the hospital with AC, without showing up like a drowned rat (see previous post for details)!

Interestingly, there is a significant Mennonite community in Belize. In the photo at right, 2 Mennonite men hauling batteries, of all things.

--Tina

To get from where I live in Hopkins to the hospital in Dangriga, I take a bus, which can get crowded (right)! Most people here handle the heat and humidity with much more grace than I, as my skin is still used to the frigid Rochester air. After the 20-mile bus-ride, there was not a dry spot on my scrubs, generating many oohs and ahhs from the other passengers. I tend to stand out in the crowd here as it is, and stepping off the bus looking like I just stepped out of the shower makes me a yet more comical sight to behold.

A sad event occurred last week. For many years in Hopkins, it was customary to dump one’s trash in the ocean. Some of the village inhabitants still do this, and dirty diapers occasionally wash up on the beach. Didi, a 4-month-old Rottweiler puppy, the youngest of Judy’s family’s 3 dogs, didn’t know better than to pull up dirty diapers that washed up on the beach. Likely, this is how she got sick. Last week she was not her usual perky self and wouldn’t even get up to say hello. We started an IV drip on her and treated her with fluids and metronidazole for presumed parasitic infection. However, despite our best efforts, Didi became septic and passed away Thursday night.

Below, some of the kids in Hopkins during the camp last week.

Yesterday we had a very successful telemed consult for a 4-month-old boy with some neurological deficits. Doran Mix, a 2nd-year med student at the University of Rochester, recruited two pediatric neurologists from the U of R, who generously did the consultation and gave recommendations for next steps in the care of this baby. The pediatrician here, Dr. Lewis, and the baby's mom seemed very pleased.

I must admit the success of this consultation balanced out some frustrations of earlier in the week, when 4 different meetings fell through due to people not showing up. I'm told this is the norm here. On the up-side, it's an opportunity to practice patience.

Judy and I just got done suturing up a woman's leg after a bad bicycle fall. For the rest of the day, we will be helping a volunteer group from Canada run a children's camp here in Hopkins.

And, as a side note, I'm including a picture of the local cuisine: rice and beans with stewed chicken and coleslaw, with Marie Sharp's habanero sauce. Delicious!

--Tina

Tina Gaud here -

Today marks 2 weeks here in Belize for me, and it's been a busy 2 weeks! Along with settling in to my new home in the small village of Hopkins, I've been seeing patients with Nurse Judy Krieg. A native Belizean, she was a critical care nurse in the US for about 20 years before moving back to Belize. Now she runs a health clinic out of her garage. I live next door to her in a rented apartment, and help out in the clinic. There are no doctors in Hopkins, so Judy is the only medical care outside of Dangriga, which is 20 miles away. Among the patients we've seen, one had been stung by a stingray, another had been burned on his face and hand when an oven he was repairing exploded in his face, and another was a local teenager with psychiatric issues.

Last week a group of cardiologists from Miami Beach were giving a free cardiology clinic in Dangriga. We took one of our patients, a 14-year-old boy with heart disease, into Dangriga to get an echocardiogram. We were happy to find out that his heart is holding its own despite having had no medical treatment.

My main purpose here, however, is to see how telemedicine can improve access to healthcare for people living here. I have been meeting the doctors in Dangriga and discussing with them how telemedicine may improve healthcare here, and we are planning educational lectures over telemed as well as consultations with the doctors in Rochester who volunteer with Intervol.

This weekend I've had some time for being a tourist, and yesterday I visited the Mayan ruins at Xunantunich with Judy and her family. Today I had a Spanish lesson with a local elder who is kindly helping me learn Spanish, and then I swam in the Caribbean Sea, which happens to be in my backyard. Tonight I will be having dinner with some friends I've met.

---Tina

View from the front of my house (left), and back yard (below).

Wild black orchid (below)

Xunantunich(below)

InterVol welcomes Tina Gaud to Belize. Tina is a 4th year medical student at the University of Rochester Medical Center. She has generously elected to take a year from her studies and dedicate it to helping develop InterVol's various programs in Belize. She will also help develop the Telemed program which will be used for patient care, physician and nurse education and much more.

Welcome Tina and thank you. We look forward to your blog entries.

Today Cheryl had her surgery. As of 3:00 PM she was awake, in her bed comfortably and was able to get the breathing tube out. Getting out the breathing tube is a very important step because this indicates that the patient is awake enough after the anesthesia and also the breathing tube can be very uncomfortable. Tonight Cheryl will be staying in the Cardio Thoracic Intensive Care Unit. They will get her up into a chair tomorrow morning around 5 AM if everything progresses according to plan. It will then be her surgeon’s decision to transfer her up to our step-down floor 4400 tomorrow morning. There she will stay a few days and recover some more. Once on 4400 another person will be able to follow up with her and make comments on here.

Today some of the staff from the Cardio Thoracic Intensive Care Unit was able to meet Cheryl and start to prepare for tomorrow. Currently Cheryl is on 4400 and is the first surgery in the morning. This means that she will be taken to the operating room around 6:40 AM tomorrow 1/27/09. Her surgery will begin around 7:30 and will last anywhere from 2-3 hours. After her surgery she will come directly to our unit. We explained this to Cheryl and she is aware that she will have a breathing tube in. Cheryl told us that she was able to recognize some of the nurses from pictures that we sent. Also, she stated that she noticed the room she was in from pictures. She said that she wanted to turn around in North Carolina when they ran into some problems as the previous post said; however, she said that she is excited and glad she made it and is ready for surgery. Tomorrow I will make a post to update how she is doing after surgery.

Cheryl and Leona are here and through day 1 of fixing Cheryl's valve. Their trip to Rochester was a little more exciting than desired as customs took longer than expected and they ended up staying in the night in Charlotte. But due to the generous assistance of a gentleman at the US Airways ticket counter and Cindy's neice Kelly, our two visitors were able to get a good night's rest before flying again on Sunday.

We had a big welcome party meet them at the airport including: Barbara, Kara, Bob, Maureen, Ralph, Cindy, and Leah. After getting them settled into their apartment behind Rochester General Hospital, Cindy and Leah gave brought them over to the hospital to start the paperwork with Dr. Gacioch. They are working on getting acclimated to the biting cold we're currently experiencing. Even with the sun out yesterday, it was maybe 10 degrees. It's a good thing we've received the donations of many layers!

Monday began early with a pick up at 6:45am to begin the registration at the hospital. After some more paperwork and waiting, Cheryl became an official patient with her gown, IV and all. And then today's procedure in the cath lab by Dr. Gacioch was pretty painless according to Cheryl. She just wasn't thrilled with the idea of having to lay flat for 4 hours afterwards to let the incision heal. And finally at 2pm they let her have something to eat! Cheryl's been doing great, she even received a surprise visit from the RGH's President, Mark Clement to wish her well tomorrow. Fortuantely there was nothing else left on the agenda for today and she could finally just rest. And she better get it because tomorrow starts early again!

Hello my name is Tony and I am one of the nurses in the Cardio Thoracic Intensive Care Unit at Rochester General Hospital. I was asked to make some comments on our unit. We are a twelve bed unit consisting of many nurses, nurse manager; midlevels consisting of nurse practitioners and physician assistants; patient care technicians; respiratory therapists; house keeping; secretaries and our cardio thoracic surgeons. The staff consists of experienced nurses and many have been at our unit for twenty and thirty years. This year again we were listed on the Thomson Reuters list as one of the top 100 heart programs in the country. It has been the eighth time that we have been nominated for this honor. Our hospital has been nominated again this year as a Magnet Designated Hospital. We are one of approximately 120 hospitals or 2% of the hospitals nation wide to demonstrate this excellent level of nursing care. At the moment we are lucky enough to have a new unit being build that will be opening late 2009 early 2010. We are affiliated with the Cleveland Heart Clinic which is one of the top, if not the top heart clinic in the country. After surgery, Cheryl will be coming from the operating room directly to our unit. We are all excited and ready to give the best cardiac care possible.

Here are Cheryl and her children.  In Cheryl's hand in a beautiful scrapbook put together by the CTICU at Rochester General introducing Cheryl to Rochester, the hospital, and all the doctors and nurses she will meet.

A week from tomorrow (Jan 24th) InterVol is going to have a very special guest visit us.  Ms. Cheryl Ritchie will be coming to Rochester, NY from Belize.  We first met Cheryl on the VMP (Volunteer Medical Professionals) trip to Belize in March 2008.  She walked in to see the cardiologist, Dr. Gerry Gacioch, and looked him straight in the eye and begged him to please help her.  In her hand she carried a CD from Belize City verifying that she had a very debilitating condition called mitral stenosis.

At 32-years-old Cheryl is often short of breath which makes it difficult for a young mother to keep up with her 6 children all under the age of 17.  Mitral stenosis is a narrowing of the mitral valve which limits the amount of blood flow from her heart into her body.  As a child Cheryl had rheumatic fever, an illness easily treated with penicillin and nearly eradicated from the United States since 1950, but a common childhood disease in third world countries.  The rheumatic fever, left untreated led to this condition which is only getting worse.  As the condition is progressing, she only has a few year left for a woman who is otherwise healthy.  In the poor country of Belize her only hope for treatment is to go to Guatemala, but even then she would need a large sum of cash, something difficult to come by.

This is where InterVol and Rochester General come in.  Dr. Gacioch made a promise in March to Cheryl that he would find a way to help her.  And her dream is coming true in a week.  Next Saturday Cheryl, accompanied by her mother, will come to Rochester and have surgery at one of the top heart hospitals in the country.  The entire community is behind her trip and helping her get the treatment she needs.  The hospital is donating all the surgery, physicians time, and equipment needed.  They also have on campus apartments in which Cheryl and her mother will be staying.  Students from The Harley School will stock the cupboards in the apartment and prepare meals for them.  Local nurses are providing winter clothes for these women who have definitely never experienced this cold we've been having.  And the plane tickets have been covered by the Webster Kiwanis Club and the Monroe Country Mites Travel Hockey Team.

So Saturday Cheryl joins us in Rochester.  She will only been in the hospital for a weeks time.  Since she is a beautifully healthy woman, she will make a quick recovery.  After which she will stay in Rochester for 2 additional weeks so she can follow up with the doctors.  And then on February 14th, Valentine's Day, Cheryl outfitted with a new lease on life will return to the loves of her life, her children: Glen, Albert, Christy, Marisa, Clarissa, and Sherilee.

We want to thank everyone who has made this miracle for Cheryl possible!