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