crunchy time

Rotation #7 is finale, complete, no more. Where oh where does the time go? Raise your glasses folks, one more rotation to go (reconstructive plastic surgery, it's decided) and one intense 3-week study period, board examinations, and the light at the end of the tunnel is shining bright! It's amazing.... two months ago I was living in Belize, two years ago I never thought this day would come.

I'm barely starting to freak out but it has happened here and there. It's more important to stay focused and just take one day at a time with one foot in front of the other moving slowly towards d-day.... graduation and boards!

This week marks the last examination for rotations that I will take, almost the last busywork assignments, and the last push to finish research and get serious about studying. Just after this week, I'll take a one-week leave to New York to breathe, regroup, be refreshed with brotherly love, and kick back. After that... so long folks! See you in 10 weeks!

What's next?

Back in the U.S.... back to reality... back to Western medicine. I'm knee deep in immunizations, well-child, strep throat assays, and crying children who are fearful of the "white coat". I completed a 3-week course in inpatient pediatrics at Highland Park and loved the experience. The hospitalist group gave me full autonomy to see newborns, provide medical clearance to inpatient pediatric psych patients, consult on pediatrics in the ED, and of course, round on our inpatient peds. The staff and I got along great and I really felt as if I were on my own. Now, I'm in outpatient peds and it's a whole different world. The parents are MUCH more involved, the kids are MUCH less willing, and I just don't love it to be honest. Two more weeks and I'm outta there!

Upcoming..
My last rotation has finally been chosen! Reconstructive plastic surgery with Dr. Howard at Evanston... whoohoo! Check out his recent blog from a trip abroad to Haiti to help out in their medical disaster. http://www.northshore.org/about-us/press/homepage-features/haiti-blog.aspx
I think we'll get along just peachy keen.

June 4th - graduation - the light at the end of the tunnel is actually in sight.
June 23rd - anticipated board exams. YIKES! Not ready to think about that yet.


In the meantime, I'm loving being back in Chicago and especially loving the warmer weather that is approaching. I've had a lot of late-night thoughts about where to live, where to apply for jobs, and what to do in my life after school. So many decisions but it'll eventually all play out whether I plan it or not!

Another day in the life of a PA student... to be continued.

Day 27 - 29/1/10

In the past few days, the rainforest has shined its colors for us. The mornings have been slow in clinic since nobody leaves their home when it rains. It makes sense though... would you leave if you had to walk a couple miles in the pouring rain? They say afternoon delight, and in Belize our delight is a few hours of sunshine! By the time dusk hits, the rain follows shortly after. You get pretty used to it down here because it's still warm so you dry off at rapid speed.

Last night was our last group dinner together. Our grub of choice was a small, hidden restaurant called Earth Runnin's Cafe and Bukut Bar. The owner, Giovanni is another Rastafarian gentleman who stocked the bar up with a live reggae band... I was in heaven. The menu, if you're wondering, was grilled fish and papaya daiquiris - delicious again.

Not much has been going on down here though outside of a few crazy moments. We all know it's the last week and I think the consensus is to savor every bit of it. Two days ago, Nurse Paulina from the Belize Family Life Association (BFLA) brought us a large pan of gibnut that she had marinated over night. Gibnut, also known as the Paca, is a nocturnal rodent that is supposedly very fun to hunt for. I dared to try a little bit of it and it tasted very similar to pork. I can't say I'll search for it very hard when I'm home but it was nice to have tasted once!
Yesterday in clinic, one of our two patients was a young female who is living in Belize for a year on a mission trip and she got a bug bite a week ago. (and the plot thickens) It looked like a botfly bite!! For any of you who don't know, botfly was the one bug I was dreading before my trip down here. They lay their larvae underneath your skin and the procedure to get it out is not so appealing. Unfortunately for me, fortunately for the patient, it was too early to try to get the botfly larva out from under her skin. We treated her with some antibiotics to cover infection and instructed her to apply Vaseline daily in a thick layer to try to suffocate the larva first. GROSS HUH?

TODAY'S THE LAST DAY OF WORK.... ahh! I'm spending the morning at Belize Center for Visually Impaired (BCVI) and then the crew heads out to discover a Mayan chocolate "factory" and have our last official lunch together. We're kicking it around town tonight and packing and then the bus out to Independence (heading north) leaves at 8am. We'll catch a ferry from there and spend the rest of Saturday into Sunday in Placencia. It's bittersweet really but I know that this last month was one-of-a-kind and next month will bring it's own new set of adventures so I can't complain one single bit.

SEE YOU ALL IN TWO DAYS!!! Don't get excited or anything... ;)

Day 23 - 25/1/10

Lidocaine... check.
Surgical gloves... check.
Second pair of surgical gloves since the first pair was too old and ripped in half... check.
Suture kit sterilized one year ago... check.
Scalpel... check!

It was a cooler day in Belize as we trekked out to San Jose (remember the hour long rocky, bumpy, safari-like van ride?). This time we weren't spending all day doing school physicals and instead we ran the clinic. Despite the fact that we hadn't been there in two months, it was quite slow. A 21-year old man named Criscencio strolled in around 1100 though and made my day. The only thing he complained of was a bump on his back that he had for a year and he just didn't like it. After very careful examination :) the diagnosis was a cyst and after explaining what the procedure was, he agreed to have it removed. So in a back area that was only closed off by two drapes that left a perfect viewing crack, I had him lie prone and I started. With Pete (the actual doctor) standing behind me, I administed a local, "sterile draped" him with iodine and gauze, and made the first cut. There were a few complications such as the suture breaking multiple places while trying to throw sutures, the sterile field not exactly staying sterile, and not the most ideal of surgical environments but he's still alive and in just a few weeks, he will be equipped with a sweet scar! I did tell him that if he has any problems or complications, he is going to have to come to Chicago so I can check it out!! :)

I almost forgot how much I love surgery...

Day 21 & 22 - 23/1/10-24/1/10

Saturday morning started around 5:30am with enough time to make a pot of coffee, shower, pack up our bags and be at the dock by 7am. The Gulf was quite calm allowing us to make it out to the island, 40 miles due east of Punta Gorda, in just over an hour. The Sapodilla Cayes (pronounced "Keys") was our destination and a beautiful one at that. There are fourteen sand and mangrove cayes that make up the Sapodilla Cayes and we were shacked up on just one of them. The Cayes lie at the southernmost tip of the Belize Barrier Reef (which I discovered is one of the longest areas of intact reef that runs from Mexico to southern Belize). The water was crystal clear, emerald green colored and refreshing every time we dipped in, minus the salt. We filled up Saturday with snorkeling adventures out at some of the other cayes, lunch on the beach, exploring from the boat, and of course, one of my favorites... fishing! (I didn't catch anything except a rock, sadness.) As we were heading back in, our tour guide extraordinaire Roberto caught a large Junefish - HUGE!!! So we made it back to the home island for fresh sashimi, a taste of sea urchin that we snatched off the side of the dock and cut open to try, and an absolutely gorgeous sunset. Oh! And we met Otto, the groundskeeper originally from Chicago! He was a unique man to say the least... already living on the island in solitude for a month now and will be staying until November. Needless to say, I'm not sure he was prepared for 17 additional people to arrive and make noise. Dinner was steamed fish, grilled shrimp kabobs, fried plantains and garlic bread... mmm! The night topped off with coconut rum punch beside a beachside campfire.
The island was covered with these small little cabanas to sleep in, a large stone house with multiple oceanside bedrooms, and another building with the kitchen, bathroom, and a few more beds. That's it folks! Just us, palm trees, and the waves. I opted to sleep au naturale out in a hammock and it was one of the best night of sleeping I have had in awhile. Granted I woke up about every 1.5 hours, BUT I fell asleep under the stars, woke up under the stars, had a constant lullaby of waves, and was outside so how could I complain? No one else could figure out how to get comfortable in the hammock so on top of it all, I had peace and quiet too!! I woke up around 5:30am just at the crack of dawn in plenty of time to sip on some coffee and watch the sunrise. We had a slow morning of more snorkeling, naps in the hammocks, and a boat ride home where we spotted two manatees playing beside us in the boat.

Highlights of the weekend...
1. Island life... don't worry, be happy. Toto would agree
2. Falling asleep in a hammock beneath the stars
3. Stingrays swimming alongside me, sea turtles diving below, schools of Dory-like fish... best snorkeling EVER!
4. Trying sea urchin, the freshest I think I will ever have
5. Catching starfish
6. Waking up in a hammock beneath the stars
7. The sound of crashing waves 24/7
8. Fresh sashimi dockside, served with a splash of lime
9. Did I mention the hammocks?
10. Being in the company of 14 amazing new friends, the best local tour guide and Toto.


ONE WEEK LEFT, I cannot believe it...

DAY 19 - 21/1/10 (finally got the dates correct)

Another day out on the mobiles, this time we rode about an hour and fifteen minutes out to Barranco. It's a smaller village with approximately 200 people. We pulled into the village, honking of course to let everyone know the doctors had arrived, and there were people waiting for us at the clinic grounds. Our team saw patients non-stop until 1:00pm in a very small, 3-room, sticky sweet aka HOT clinic! It was a lot of fun actually despite sweating through our scrubs. We saw children with colds and conjunctivitis, men with prostatitis and dizziness, and women who were pregnant, sick, or just needed some Ibuprofen, as well as the usual hypertensives and diabetics. Afterwards, one of the local homes made us a traditional Garifuna meal which consisted of (surprise, surprise) rice and beans plus chicken, fish and this dish called hudut - mashed up plantains that have been formed into a dough-like material served with coconut milk. Another tasty lunch. [Note... the Garifuna are one type of people that live down here in the villages. We've met Mayans, East Indians, Creoles, Menonites, and the Spanish.] The day was topped off by driving down to the coast off Barranco where the water was crystal clean and you could see all the way out to Guatemala. We had to grab a quick photo shoot and then piled back in the van for a rocky ride home. Another night of cooking together and the girls took over the living room and danced the night away to the Dirty Dancing movie... "Nobody puts Baby in the corner"!!

Yesterday was a blast of a day as well. The clinic was busier than ever and the afternoon was a special treat for me! Nurse Betty asked me anyone would go on a home visit with her to check out one of the elderly women who they thought might have "rectal bleeding". I jumped on the opportunity since the last home visit I ventured out on was a blessing in disguise! Directions to this lady's home went as follows: Go to the "Cool Spot (the name of any bar in town is called "so-and-so's cool spot" like Roy's Cool Spot or Carlos' Cool Spot or Wanda's Cool Spot), turn left at the first road after the cool spot. Turn right at the first road and she's across from the futbol field. Let me tell you there are four houses down that last little dirt road so we drove along hanging out the window and asking the locals if Miss Camella lived there or not. We found her though and she was not in good shape. Thankfully for me, she did NOT have rectal bleeding but she did have a pretty nasty urinary tract infection that might have attacked her kidneys this far in the game. So I equipped her with some antibiotics, changed her regular medications to proper dosages and eliminated the ones that I didn't think she really needed. We ran back to the pharmacy, loaded up the drugs, and headed back over. I'm not going to lie.. it was a little nerve racking to have full responsibility for this little old frail lady and have Nurse Betty just nodding her head to whatever I said. I'll head back over next week and in the meantime, cross your fingers that she gets better every day until then!! :) After the home visit, I headed to one of the schools and since most of the physicals were already completed, I just played with the kids and taught them how to use a stethescope to listen to their own hearts. JOY!

Here are the Kodak moments!

Day 17 - 18/1/10

Phew.. I'm exhausted!
Imagine holding on to the window ledge for dear life for an hour plus in a 10-12 person van as you drive on one of the rockiest, holiest, roughest roads ever. The only good thing about the ride was the scenery... pure jungle in every direction you looked. We made it into San Jose safely, a village of about 800 people. 7 hours later, 85 school physicals for 3-7 year olds completed, 6 very very tired PA's! And then we somehow thought it was a good idea to hit another 4-mile run today!
Phew is an understatement.

The kids were a blast today though... some of them were quite the little hams. They were so thrilled to have their picture taken and then they would run up to you afterwards and want to see the picture and giggle their heads off! It is impossible to be in a bad mood when you are around them. The principal of the school took us up to the top of this mountain/hill afterwards to show us the village from afar. It was more than beautiful. I'm at a loss of words to describe it.

ps it's HOT here and it's not just me! I love it on the weekends and I still love it more than being in the chilly winter of Chicago but it is difficult to do a proper physical on someone when you're sweaty! I really cannot complain though can I?





Hope you enjoy these little munchkins as much as I did!

Day 14 & 15 - 16/1/10-17/1/10

Disclaimer: BRACE YOURSELF - I'm catching up on three days!

There's something about Mother Nature that captures me and makes me forget about the rest of the world. There is not a worry to be had when you're surrounded in a setting so serene, so picture-perfect, so indescribable. I thought I had witnessed this when I lived up in Michigan. The sky in the upper peninsula is speckled with so many stars that you feel as is you have your own personal nightlight. The world is quiet up there, the smell of the outdoors beats any other.....
...and then I spent the weekend on the Sarstun river that borders Belize and Guatemala and I have found a new favorite, hands down.

Friday afternoon, perfect sunny, hot weather and we headed out on a 40-minute choppy ride across the Gulf of Honduras with Roberto (our tour guide extraordinaire) and Toto (the captain's second mate aboard) to our destination, Rio Sarstun. One of the best parts of this entire weekend was being able to finally practice my Spanish!! I cannot say I did a great job but I was able to do basic translations for the crew at the eco-lodge and in Livingston bartering for souvenirs, as well as holding my own through 3 games of 15-ball (similar to 9-ball) with the locals at the only bar on the river.

Back to the Mother Nature part that I fell head over heels for...
Lodging was a simple eco-lodge, which sat on the edge of the Sartstun, that supported some of the locals. It consisted of 4 bedrooms with 2 bunk beds in each, screened windows, scorpions on the wall (JK but we did have one scorpion visit one of the bedrooms...), lights that came on/turned off whenever the generator was working, and running water as long as Mario pumped some that morning. It wasn't what I would call rustic, in fact it was pretty luxurious to be roughing it, but it still had the feel of being outside. I'm still waiting to be able to sleep outside under the stars in a hammock...


We arrived, busted out the kayaks and went exploring, took a hike up into the jungle to see an untrekked, never explored cenote up in the jungle (unreal.) and then headed back to the lodge. After an amazing meal called TAPADO (a local specialty stew of crab, shrimp and fish ready to dissemble with coconut milk and plantains served with rice and tortillas), we headed up to a bar to try out the local beverages (rum & gallo beer). It was fun but the best part was the ride home on the boat, in pitch black with no lights except the stars above to guide us. The water was still except for our wake. The reflection of the treeline helped guide the boat from running straight into land. The only sounds you heard was the break in water and a random critter talking in the jungle. If you know me, you know that I did not want to get off the boat at this point.


Night one - woke up with a few bug bites at the crack of dawn, enjoyed a cup of coffee while the others woke up, and called it good.


Saturday we started the day off with an authentic breakfast of beans, eggs, queso, plantains, and tortillas followed by a short boat ride out to Playa Blanca... a beautiful white beach with hammocks sprung between every pair of trees, beautiful water to swim in, and Toto welcoming us with COCOLOCO's (coconuts cracked open and topped off with rum - mmm!). We spent the day walking along the beach, napping in hammocks, playing beach volleyball, and tubing in the water aka very hard work! After a beach BBQ, we headed into Livingston (tourist center of Guatemala) to support the Guatemalan economy. Afterwards we all headed home to the lodge for another tasty meal, this time of PACHAY (fish and herbs steamed in a banana leaf served with the standard rice and tortillas) and a night of socializing.


Night two - woke up with a thousand bug bites way before the crack of dawn, itching my skin straight off. Attack of the bed bugs. So I'm dosed up on antihistamines and anti-itch cream for the next couple of days but I suppose better someone who's used to roughing it outdoors than someone who is scared of bugs!


Another authentic breakfast this morning, a scorpion visitor in one of the bedrooms, and a boat ride down the Moho River in Belize to search for howler monkeys, iguanas, and crocs. We only saw iguanas but that's better than nothing!


Towards the end of the Moho River, we crossed paths with the CottonTree Lodge - another eco-lodge that looks amazing to stay at whenever I visit Belize again. The grounds of the lodge are home to a cotton tree - a natural giant beauty of Belize.. you can see us standing in front of just the base of the tree below.











And now we're home... it was amazing. I never want to leave the jungle... Who wants to come back here with me?

DAY 13 - 15/1/10

IT'S WARM!!! It's crazy how that all changed over night but we actually had a beautiful day yesterday! The morning was pretty rainy on the way out to the village but a little drizzle never hurt anyone. Unfortunately, once we arrived at Blue Creek's village clinic, we were not greeted with very many patients. I saw one man who walked in with x-rays in hand and didn't speak much language (he spoke Ketchi). Who needs a lightbox when you can read x-rays in natural sunlight? He turned out to have chronic interstitial pulmonary disease with an acute exacerbation of pneumonia. This sounds impressive but it really wasn't all my doing.. multiple diagnoses from multiple providers over time! I just helped group everything together and get him on some maintenance treatment. He was one cool cat though especially hunting him down later in the day to return his umbrella he left behind.










The rest of the day was spent playing with the kids across the road at the school. They were a huge hit!! They played volleyball and loved the frisbee during each of their breaks! Let me tell you.. these kids are truly the biggest blessing down here.









Just as we were leaving, we stopped by a Mayan culture center and found out that they bottle honey from three local districts (Toledo - where we live, Cayo, and somewhere else I cannot remember). I'm taking orders for some of the best honey you've ever had fyi.










ps Chef Kate made dinner for the crew... coconut curry chicken with kahlalu, sauteed veggies, roasted potatoes, and plantains... mmmmm!!! I'm getting good at this improv menu!

Belize this morning, Guatemala this afternoon! Morning clinic, education meeting and then we're off to Sarstun, Guatemala for a little adventurous weekend! We're heading out with Roberto (local Punta Gorda tour guide) for an all-inclusive hiking, tubing, touring, river riding, hot falls, eco lodge type of excursion! I'm really excited mostly because I get to add another country to my list of newly growing international destinations (up to 2!).

Kate

Day 11 - 13/1/10

Three little boys in Cuxlin Ha village who demanded that I take their picture... of course, I said yes!! :)







BRRRRR!!!!

It is not the tropical, warm, sunny weather that I thought it would be down here and according to the locals, they're freezing too! In all reality, it's only been down to the 60's which I know, I know, is still warmer than the temperatures that are hitting most of the United States... but come on! I'm in Central America! We're all crossing our fingers that since the weeks are chilly and not quite as sunny as we'd like, that the weekends will make up for it!

This week was a touch busier than last week which is a nice change! We still spend the mornings in the clinic catching hypertension and controlling diabetes on top of itching from scabies, head lice, and other random rashes. The afternoons are either out on mobiles to the villages or at the schools performing physicals for screening. Gang 2 ventured out to San Marcos village and then spent 2 days at Little Flower school and the clinic. The nights have been rainy so far this week but us crazy tourists still manage to get out and have some fun! Last night we stopped in to a local restuarant called Marian's and listened to a drum band. Those of us who have no pride learned how to do the local dance called the Punta (free lessons for all when I return!!). The food was great aka your typical rice, beans, curry chicken, plantains. Tonight the crew has decided to make a classic American breakfast for dinner (it should be a nice change).

Although the kids down here are not quite as sassy as most American children, they sure know how to crack you up and force a smile out of you. I thought I'd give you a taste of a couple of the munchkins that have won over my heart this week! There was even a little infant with cleft palate - go speech pathology!!! Sad news though, this little one cannot receive proper healthcare to correct the cleft lip until 25 other people nearby need similar services - that's the only way a surgeon will come! That could take a looooong time :(.