Photo: The adorable and very loud parrots that fill the air with squawks at 7 every morning.

In clinic today, we had some interesting patients --

A 53-year-old Garifuna woman came in with an incisional hernia -- no problem, we'll repair it. However, she also complained of vertigo, and asked us if it was due to "wind in the head." I was intrigued by this comment. In traditional Chinese medicine, wind is one of the elements that can cause imbalances and subsequent health problems. However, I think the idea of wind as this woman was talking about was different. Dr. Pott told me that it is a fairly common Garifuna belief that wind, or air, can actually get in a person's head, or shoulder, or other body part, and cause problems.

A young man in his 20's came in for followup on several huge gashes he had acquired during a machete fight. The man was in good spirits, considering a 6-inch wound on his head, a 10-inch wound across his shoulder blade that unfortunately was infected and oozing, and a healing thumb which looked like it had nearly been cut off.

A 10-year-old diabetic girl came in with a ganglion cyst on the top of her foot. The cyst was not so interesting, but when I looked down at her hands in her lap, her right hand had 2 thumbs. I had seen this in textbooks before, but never on a real patient.

One thing I have grown to love here in Belize is Marie Sharp’s habanero pepper sauce. Belizeans call it simply “pepper.” It’s the hot sauce of the country, and it’s everywhere, in every restaurant and corner store. I eat it every day. Over the course of the last 7 months, I’ve worked my way up from Mild, to Hot, to Fiery Hot, to Belizean Heat, to Not for Wimps, and recently graduated to the hottest of the hot, named BEWARE Comatose Heat Level. The label states the following:

Keep out of reach of children. Avoid contact with eyes or skin. Got water? Do not play tricks on the weak or elderly with this sauce.

At this point, I think the nerve endings in my taste buds are singed down to little nerve stubs. As a devoted Marie Sharp’s fan, I visited the Marie Sharp’s factory over the weekend, where they make all the varieties of pepper sauce, as well as jams and juices. I got to taste various ones, such as banana jam, pineapple jam, and coconut spread. Delicious!

Some days, it seems like nothing happens. Yesterday, it seemed like everything happened. First thing in the morning, I teleconferenced in to grand rounds at Rochester General Hospital for a fascinating case presentation on sarcoidosis. Two doctors at the hospital here attended with me.

Then, I assisted on surgeries with Dr. Pott, one of which was an open cholecystectomy (gall bladder removal). Although I saw many cholecystectomies during my Surgery rotation last year in medical school, they were all done laparoscopically. Yesterday was the first time I saw it done as an open procedure (we don’t have laparoscopy here in Dangriga), and seeing the internal organs rekindled my wonder and fascination with the human body and general surgery.

In the afternoon I drove to Belmopan, the capital of Belize, to meet with the CEO of the Ministry of Health, Dr. Peter Allen. This meeting was incredibly productive for me. For the first time, I felt like my services were actually welcomed in Belize. From the day I arrived in Belize, I had the impression that the doctors and staff at the hospital didn’t really want the telemed program I’m trying to implement. Early in the project, one of the people I needed help and cooperation from most seemed set on working against me. I won't go into details, but suffice it to say I was encountering unnecessary barriers. One important one was that I was told I couldn’t see patients unless they were referred by a Belizean doctor. And getting referrals from doctors here is like pulling teeth. My project seemed doomed in this context. As a result, I spent much of the last few months feeling frustrated, like my hands were tied, like I wasn’t making any impact.

However, Dr. Allen informed me that there is no need for doctors here to be involved in order to do a telemed consult. This changes everything! My project as I had imagined it in the beginning is actually possible after all. Dr. Allen gave me the OK to set up clinic here at the hospital, to triage patients for telemed consultation. This could dramatically increase the use of telemed, because although doctors are less than enthusiastic about telemed, patients are desperate for it. Sometimes when I’m walking around the hospital in my scrubs, especially if I have a stethoscope around my neck, people waiting in hallways are begging me to see their family member, and when I tell them I’m a medical student and not a doctor, they don’t care.

I only wish I had met with Dr. Allen earlier in my fellowship, because at this point I only have 2 months left here. However, I’m going to make the most of these next 2 months. And, over the last seven months, I have succeeded in building relationships with hospital staff, and likely, over time they will warm up to telemed once their patients start requesting it.

Finally, at the end of the day yesterday, I was able to obtain some x-rays to send to a Rochester surgeon, for a desperate young woman that we’re trying to bring to Rochester for a surgery to save her leg. That story, to be continued...

Photo: Workers loading oranges from a smaller truck into a larger truck. The scent of fresh citrus wafts through the air!

Yesterday in clinic I saw a 3-year-old boy who had been developing normally until he was a year and a half, then started regressing back developmentally, to younger and younger stages. Essentially he’s becoming brain damaged, but we don’t know why. Some of the causes for this scenario are treatable. However, in Belize we don’t have the available tests to determine which disorder this patient has, and therefore we can’t advise any treatment. It quickly became clear that the reason the pediatrician had referred this patient to our clinic was so that we would deliver the news that there was nothing we could offer the patient, not even a diagnosis. If we were in the States, the patient would have a battery of tests and most likely we could find out what he has, and whether it’s treatable. Here, the parents will have to live with not knowing what is wrong with their child, and not being able to do anything about it.

In good news, this morning we teleconferenced in to Grand Rounds at Rochester General Hospital. Teleconferencing in to Grand Rounds gives doctors here the opportunity to attend lectures by leading experts in Medicine, something they would not otherwise have access to. After stalling many times in previous weeks trying to get this program started, today was a big success, with 11 doctors and nurses attending! This was a much higher turnout than I had expected, and the doctors I surveyed thought the lecture was very interesting and useful.

Photos: Left: Rasta man, Belize City

Right: Bare-throated tiger heron, running to hide behind a pile of dirt.

Photo: Nurse sharks in Hol Chan Marine Reserve, Belize

Last week was my birthday, and to celebrate, I swam with sharks. I went to the island of Caye Caulker on Saturday, and from there, went scuba diving and snorkeling. Among hundreds of fish, I saw 4 types of stingrays, and the sharks in the photo. Belize has the second largest barrier reef in the world, and the coral is truly beautiful.

I’ve been emailing with the CEO of the Ministry of Health of Belize, to try to move telemed forward here from the political side of things. I was surprised and pleased to discover that he’s very supportive of the project, and wants to meet with me to discuss how we can overcome some of the barriers I’ve been facing in integrating it into the healthcare system here.