Flooded roads, fried laptops and lots of IRB time

13 06 2010

Hello friends

Sorry for some much time since the last post. It’s not so much that I have been gallivanting around the country-side as is that I have been on the computer lots, when power and internet can be utilized. But it has been an interesting week…

Last Sunday

Mimi (my landlord and an ex-pat for 20 years) made me breakfast with homemade pancakes and then we set out on her usual Sunday walk. Ordinarily, she takes this route with her husband on Sunday mornings but since he was out of the country, I accompanied her. The fun part is that we walked to La Sepulturas, which is part of the ruins (but pretty much free) but was the sort of suburbs of Copan Ruinas where the craftsmen and other middle class lived. Of course, I forgot my camera, but pictures of those ruins will come. It was quiet and no one was there but us, so it was a nice little treasure. The afternoon was not too exciting after but at least I got one tourist thing under my belt.

Monday

Met with Kenia (my Honduran preceptor) about the questionnaire I developed. They essentially want me to interview people across the 4 municipalities. Although I thought of this project as something the next student would do, given what seemed to be a major IRB project (IRB=the board that approves what I can and cannot do), I thought wrong. In part, this was paved for me as my prior project, a manual chart review, was not enough work as they had information on electronic files and the weeks of work would be reduced to days. So with a refined questionnaire in hand, I returned to my apartment to start the IRB process for the rest of the day, dropping off laundry in the meantime and buying a pupusa (yummy fat tortilla stuffed with beans or whatever else you want and covered with a pickled-beet stained vegetable slaw). That began Day 1 of IRB docs

Tuesday

Working from home, not too exciting, though still refining what I needed in a verbal consent and sort of getting misdirected with what they needed/wanted. Sometimes I would lose internet or power but I steadily translated documents. The more interesting aspect was that I was home and got a call from the Association Copan office asking me to come in. It was 4 o’clock at this point and they closed at 5, so I had to basically drop what I was doing (though it was joyous after sitting all day). I felt like I was called to the principal’s office since the secretary did not explain. Nonetheless, they called because Ricardo was passing through town and wanted to meet me and check in. Ricardo was the first person in Honduras contacted about my project, a friend of Dr. Clements and is the director of Association Copan (as well as an archeologist of some fame in the field). Sadly, he was in town only a short while because he had to return to the capital for a family tragedy (a kidnapping and ransom of an in-law without a happy ending). Makes you appreciate what you have. Liz, my other major contact/coordinator for this process, also was at the meeting with Ricardo. She kindly invited me to dinner, where family from the states was in town and they were having a gathering. It was nice to eat a meal with others, having some wine and talking (in English) about all kinds of things. Of course, half way through the power went out and the meal was by candlelight, but this is what I have come to expect here. Eventually the power returned and it signaled a good time to go home.

However, I did learn that there was officially going to be no power for most of Wednesday. Given my desire to get all the paperwork in asap and get the ball rolling, I decided to take advantage of the current power and internet capabilities and finish/submit my documents to the IRB. This took until 4am, but I figured I could sleep through the power outage.

Wednesday

As mentioned, largely sleeping, feeling like a resident after a call night somewhat. Without much power. I read lots of The Immortal Life of Henrietta Lacks, a must read for anyone in research, the sciences, or just living/working in healthcare in the South. Mimi invited me over for dinner that night (largely candle light due to flickering power), which was nice. Even without the power, the weather has been more tolerable, so my lack of ceiling fan for a time was fine (or I am just adjusting!)

Thursday

In efforts to engage more at the office of MANCORSARIC and develop “face-time,” (as well as vacating for the cleaning woman to come-which feels decadent) I brought my laptop to the office and continued to review/analyze electronic records. Usually, I have not done much work there given the limited space, but it was fortuitous for many reasons. One, the team had a meeting all day, so one of the rooms was afforded more space. Two, the coworkers including my mentor invited me to lunch with them, allowing me to get to know them and they me a little better (plus we all got the daily special which was cheaper than most menu items). Third, I basically had tech support when my laptop screen went blank. For whatever reason, be it the changing power levels here (and my inconsistent use of a surge protector), or the heat, my Duke-issued laptop screen when irreversibly blank. After trying a couple of different things, Manuel, who works on a different project but fairly tech savvy, plugged it into another monitor and voila, the work I had spent time on the last 2 weeks was still there. Supposedly, this has happened before to another student’s computer. I think I might have broken down and cried had it not been that the office did have an extra monitor because a computer tower was out being fixed. (Getting a new or used monitor here is like asking for a fresh New York bagel in the boonies of NC). Luckily, my work has not been terribly impeded and they even let me bring it home (where I actually contact the outside world), but my mobility to work at home or the office is now limited. But I still got lemonade from lemons.

Friday

Bringing dry foods to help combat malnutrition

The most exciting! Another benefit from Face-time Thursday was that I learned team members were going to check out one of the 10 health centers on Friday. Putting my IRB monotony aside, I jumped at the chance to see what they do. This felt like really seeing more of Honduras. Myself and two members from the office walked down to where all the MANCORSARIC vehicles are parked and hopped in a pickup with a backseat and headed for the clinic. En route, we picked up 2 other office workers who live on the way to the clinic (as it would have been silly to come all the way to just go back out). At the clinic, we loaded up the van with 36 boxes of vegetable medley (lentil vegetable dry mix) with the USAID (agency for international development) stamped on the box. We then began the hour-long dirt road journey to Rio Negro, after waiting for some Honduran road traffic to pass.

Honduran road block, as a line of cows pass the clinic with cowboys at their heels

Along the way, we passed another Health center, Cabanas but only stopped to deliver some contraceptives (for family planning as they are hard to get in general). We passed over as dilapidated cement bridge with water flowing over it. Fortunately, the truck went over it with ease but it reminded me of the annual flooding back home and stories of cars floating down river by attempting to drive through it. Nevertheless, we continued on a curvy, dirt road to the clinic.

The clinic was rather basic, with cement floors, no screens, and different rooms for waiting, being seen, medical records, “pharmacy” and a computer. The walls were well utilized however. In patient areas, there were several posters explaining vaccines, contraception, what to do with child pneumonia/diarrhea, even lots of info about H1N1 awareness. Granted, many have not finished past elementary school so literacy is limited but they highlighted the main issues. What I really liked was a board with a hand-drawn map of Rio Negro and the surrounding “aldeas” or small towns with boxes marked for where a child under 5 or a pregnant woman lived. Also, high risk people with chronic diseases (specifically diabetes, high blood pressure, epilepsy, and mental health issues) were flagged by colored push pins. No names, but some numbers. I was surprised in an area with 12 high BP people, there were 5 epileptics, which begs the question of why so many. It made me think of how useful that might be in the states to EMTs though maybe they already do.

Map of high risk patients by type

Rio Negro’s pharmacy. I did see phenytoin, reminding me of first year of med school and our Problems in Pharmacology lab

Part of their H1N1 strategy for education

All the team members upon arrival had dispersed to different posts, each reviewing something particular. Although most Americans thinks private is always better than public health care, I will admit that they audited the clinic very closely, and they do this EVERY MONTH. Some went through medical records, others reviewed logs with the health promoter/nurse. Not many patients came in at this time but everything was under a microscope. Although I understood that they had a lot of work to do before attempting to leave by 3 to beat the rains, they did leave carrying all the lentil boxes in by one worker at the clinic, which involved 1-2 boxes at a time up a water eroded hill. He, however, was very kind to me and brought me around Rio Negro for part of the time to get a sense of the place and talk to some pregnant women, sort of scouting for my interview project. We came back a little before 3 to find the team leader reviewing all that the team found (most had formal check lists) and reported their percentages of achievement (like clinic births, vaccinations etc). It’s funny since last week the health center workers came in to Copan Ruinas to report many of those things, but they were being thoroughly checked out. The audit went past 3 and it was already raining by the time we left. For fear of not being able to cross the already overflowing bridge in Cabanas, our leader Hector took to the road rather fiercely. Sitting in the backseat of the cab was much like the back of the school bus on a rough road, so I sat wedged with 2 other team members in the back trying not to hit the ceiling with our heads. Yet, bouncing around did not make me as nervous as going around curves with not much shoulder dropping off to step hills. At one point, we were in a patch of red mud with a fallen motorcycle in front of us. No one was hurt but getting the motorcycle out of the mud proved tricky. In other cases we would have just passed them but this was on a hill where we were slowly fish-tailing toward the motorcycle so if we tried to pass, we may have hit them. Eventually, we could pass, watching behind as the motorcycle continuously struggled to get up hill in the red mud. We did make it to the bridge before the waters got too high and safely back to Copan, though with the rain still pouring down. Fortunately, I had my poncho and teva sandals (both great for rain) and was able to make it home, stopping at the little grocery store on the way. Soon at home, dry and fed, I called home when there was power and watched a bootleg copy of Duplicity, something rather American for such a Honduran day.

Saturday

I did finally hang out with the peace corp volunteer, Kyla, who also works with MANCORSARIC, having a licuado and meeting another volunteer living 5 hours away in the boonies without internet. I hate to seem so American but I was getting rather impatient since it was taking more than 20 minutes for my licuado (basically fruit blended with orange juice) and the place was empty (and Kyla had called me while I was still sleeping in so I had not had anything to eat figuring we would do lunch soon). Blame it on hunger, but I thought they forgot about me. However, when we did ask, it was because they ran out of bananas so they went to the market to get more fruit. Rather typical I am told here, rather than say “we are out.” However, the people who own the restaurant are Kyla’s homestay parents, so I hope I did not ruffle too much, especially when the girl tried to overcharge me and I corrected her since I did not get a smoothie, which has ice cream (as a lactose intolerant person I would not get) which was the price she quoted me. Having errands to run, I kindly excused myself to Kyla and her friend and went on to the market, buying my own bananas (~6 cents a piece) and other veggies.  More rain kept me indoors (thankful for a steady roof) and continued to get work down on the IRB, so hopefully I can get rolling on the project this upcoming week, when we repeat Friday’s adventure 4 more times at other clinics.

Until next time…

Fresh Milk anyone? Basically across the street from my casita

– Kaitlin Rawluk

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One response

17 06 2010
Michael

I am coming to Copan!

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