Week 3: Soaking rain, collapsing roads, interviews and a little sunshine

19 06 2010

Week 3 blog

Overall, it has been amazing to see the destructive power of nature. It has been cooler (not the sweat fest of the first week) but it has rained heavily every day, causing rivers to swell, bridges to flood and trees to slide in the mud into the road. I understand more why many women prefer to stay home for their deliveries unfortunately. Highlights: Wed/Thurs/Friday. By day:

Sunday: Went on a long walk by myself (in daylight in public places) down toward las Sepulturas again. After a few more errands in town, I worked to wrap up my study IRB stuff by prepping the documents for UNC. Fortunately, I chose to do this early given that soon after the power went out. But I had a lot of time to read (Henrietta Lacks down, David’s Sedaris’ Naked almost finished). Nada mucho aqui

Monday: Most of the team when to do their monthly audit of the clinic (I missed this unfortunately), but I worked some with Kenia, prepared the questionnaire for copying and decided to go home to do more work as it was almost too quiet at the office. Although I had not done this before, I translated the learning agreement UNC wants me to use to establish my role and needs a little more. Sadly, it took away (lots of big words to translate) and my presenting it to my preceptor here was rather unceremonial, but it’s done and at least I can say we have a contract.

Tuesday: Not so good. Hardly slept at night (with the beginnings of a headache) and awoke with the continual pounding tension headache. I prepared to go to Cabanas, where one of the health centers is to see it, but felt so terrible that I asked to work on other stuff at home. If headaches weren’t the norm for me, I might have feared dengue fever or something, however, I am now equipped with different medications to knock it (and sometimes me) out. After retreating to lie completely flat to rest, I awoke after a 3 hour nap and set back to work analyzing medical record data. Of course, it down poured from 2pm on and my internet went out, so I eventually ventured in the rain to check email/skype my boyfriend (so sad how I get so dependent on internet!) But honestly, paying to go to the internet place is a whole lot cheaper than him calling me, though I don’t like to be out after dark here. However, in the rain no one else does either, so it was probably more safe since the rain was so nasty.

Wednesday: The original plan was to go to Las Flores, a health center definitely in rural areas but the incessant rain made that impossible. For this I arrived at work at 8:30 like I was told, though none of the usual people I worked with came in until 10. Part of it was that Honduras was playing in the World Cup at 5:30am. In the mean time, I did some quick food shopping, internet surfing and caught up with the rest of the staff such as our receptionist and our everything/gofer women, who can get you copies and coffee and keeps the place clean (I feel indebted a little to her since she brought us all really yummy pupusas during my first big meeting, my first real taste of Honduras). Time is so flexible here that although the time I am told and the time when most arrive do not always match, I can’t complain living 7 minutes away on foot (I originally thought I was to go through 7,000 paper records at the clinic ~40-1hour away by public transit).

When all did arrive, the new plan was to go back to Cabanas (I don’t know if they had to leave early the day before or what) which was good, since we drove out there and I got to meet the health promoter and walk around with him as he checked up on the pregnant women. In the process, I crossed two foot bridges, one next to the “road” bridge that had lots of swift muddy water traversing it; with tons of middle school aged boys playing in the water (if they lost their footing it may have been a little disastrous). At least that bridge worked well. The second however reminded me of all those movies where the board will give out a when someone steps in the middle, leaving the protagonist dangling momentarily or worse. I clung to the sides with my hands on the chain-linked fence walling in the bridge and somewhat held my breath (made it across safely twice though!). Of course, it did not take too long before the rains came again, heavy and soaking everyone around us (me, I was draped stylishly in a blue poncho which did attract a few stares though for a place that rains half the year, I am a little surprised people are not always prepared if they can afford an umbrella). I almost wish I brought my rain boots but Tevas work great.  After meeting back with the team, we slowly worked our way back to town, dropping off each member at their house as it poured. It was a good soup night with a good sleep.

Thursday: Finally some sun. The plan was to meet at 7, me in front of my house as part of the road leads to up to Agua Calientes (“Hot Waters/Springs”). By 7:30, the truck showed with just one team member, Hugo, who said the way by my house was impassible and we were to go the other. The ride was beautiful and moving well until we stopped with a bunch of other cars. Due to copious rain and poor construction, part of the road eroded from underneath, leaving a “natural dirt bridge” less than 6 feet wide with only 2 feet of a dirt arc, with the rest eroded for a 10 foot drop. Traffic on both sides was backed up with no one but motorcycles passing. After a little photo shoot, we decided that there was no point sticking around so we loaded up our 4-wheel drive truck and headed back, taking a few hitchhikers back to Copan Ruinas (sort of a nice courtesy if you have a pickup truck). Without much to do back at the office, I taught the staff to use PivotTable in Excel (which I only learned here!). I think that will be the most sustaining impact I will have above all my work, since they all marveled and basically were saying, “ we have been doing lots of stuff by hand and with calculators and it would just take a few clicks…” so maybe efficiency will go up. After a long lunch and a bit of shopping, we returned to the office where I decided to return home to work more on the computer with the benefit of programs in English. All in all, a beautiful day, ended with a cool evening jog around the area.

The remains of the eroded road to Agua Caliente

so thin!

Not wide enough for a truck on the only road to AC

Friday: LOOOONNNNNGGG day. At 7:30 we prepared to go to Rio Amarillo to do another Health Center check. Honestly, Kenia runs a tight ship and every center gets a through audit monthly with a meeting at the end of the day reviewing their findings and plans/compromises/requirements for improvement. I think this comes from the fact that part of getting paid is by meeting certain coverage requirements (i.e. all known pregnant women getting a prenatal check). Given the privatization and fee-for-service system we have in the states, we are not nearly as attentive to quality measures unless you want reimbursements from Medicare/Medicaid ( as there are some incentive plans for doctors offices that have electronic records and meet certain goals, or hospitals do get a more serious audit, but not as frequently as here). Nonetheless, despite of the lack of all meds, some of these women seem better off here than the poor in the states! (and that’s really sad to say)

Just to say, getting there was a little challenge. After seeing remains of the mudslide that had covered 30-40 of road, I understood why we were bound to the office Thursday. We slowly went through the area since it was really a one-lane road due to a bulldozer moving debris, with huge banana trucks needing to pass through. But the blockage did not last long and off we went.

Think of this next time you eat a banana

"hey bessy, do yoooou think we can take him? He's surrounded!"

Friday was the first day I really got in a lot of interviews with women who were waiting in the clinic. I was surprised how many volunteered (and I really expressed that it was voluntary-especially to the staff so they hopefully would not coerce people), but it was a good day for advancing my study. Yet, it’s a biased sample because these are women who actually come to the clinic and engage in the health care there whereas the people of most interest are in the hills, with limited access. At one point (4pm), a coworker said we would be done in an hour so I didn’t push to go through the town and out to get more interviews. However, he was sorely wrong. They didn’t start the audit review meeting with the staff until 6ish (informative but really boring) and we did not leave until 7:30pm (dark, which in areas with few lights or painted lines on the road is ominous). By 8:10 or so I was dropped off at the house and came home to chicken soup I made the day before. A little internet and Scrubs and then off to bed I went!

Inside Rio Amarillo clinic

Free routine vaccinations at Rio Amarillo

Lots of horses in this part of Honduras

Saturday: Slept in. Big shopping day, after hitting the bank, buying a few souvenirs and getting lots of food (I hate feeling like I am always running out of things too quickly). Other errands, including carrying eggs in little bags while walking careful, kept me coming back and forth from my apartment to town (aka up and down my big hill to my place) but all in all a productive day. Plus, I booked a guided horseback riding trip to a nearby indigenous village as a tourist event of the week. Only $16 for a 3 hour ride/trip! More on that next time though (with pictures!)

Thanks for reading! I know I go on…but it would not sound like me if it didn’t, right?

– Kaitlin Rawluk

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3 responses

22 06 2010
Bonnie

Dear Kaitlin,
Yes, it does sound like you…but I enjoy every word. What adventures! Please, please be careful when you are out and about. Time is flying…it sounds like you are getting a lot accomplished. Can’t wait to see you on top of a horse. Love, Bonnie

23 06 2010
Michael

Kaitlin,

We are heading to Copan July 9-11 and my mentor, Dra. Duron, said we would be able to stop by to see you wherever you are. Please email me (michael.catalino@gmail.com) so we can work out the details. It would be neat to see the clinic. Dra. Duron has a clinic in Copan she set up a few years ago. Will Dr. Clements be there? Will anyone else from Duke be there? Email me so we can work things out.

Nos vemos!
Michael

25 06 2010
Priscilla

Kate: Please be careful with the walks. Your blogs are great. Take good care of yourself. Love you.

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