A tale of two clinics....

And we're off (part2)

2007-12-15T15:55:00.001-08:00

Friday

Tea time

2007-10-21T04:35:00.000-07:00

Thursday.

Madura foot again.....

2007-10-21T04:09:00.000-07:00

Wednesday
This morning's clinic was dominated by a 50 yo lady's foot. this foot had been a problem for the last 5 years but nobody had really got to the bottom of what was wrong with it. Some thought Leish, some though vascular, now we were thinking mycetoma. sadly all the notes had been appalling and no idea of treatments used were available...not that it matters really as if it is a mycetoma there's little to be done anyway. Photos sent to my tame dermatologist Steve at HTD for comments and bright ideas but none so far sadly. The next two patients were all about the bites. I have to mention at this point that we are not alone....we are being stalked by a man with a camera as Hillside HQ is having a fundraiser and we are to be immortalised on film - moving and still. Anyway the 6yo had bizarre pustules and scarring bites on his legs from playing the the long grass, stop it and they'll stop I reckon....but lets see what Steve has to say on them.... Next there is a lady from Charlton - yes I go halfway around the world and meet a lady from two roads away ! She has also got bites and is an amateur botanist. She describes pulling off the scabs of her bites and locating a thing growing inside, looks under a microscope and draws it. Bot flies I reckon from the picture but there are none there now thankfully. She has lived here for years and dosen't wear repellent or long trousers...mad woman!

Organise my flight back to BC on the way to do the HELPAGE talk with CherryMae which goes well, despite them bringing out high sugar squash and biscuits after a healthy living talk!! Lovely group of old ladies with their hats and tea dresses. One lady I chatted to had had a terrible stroke leaving her hemiplegic, but our physios and her good sense to follow our guidance had got her almost back to normal by 18 months...fantastic news.

The camera crew had held up Evert leaving us stranded on the pavement for the good part of an hour, so only Emma was in clinic! Frantic baking and doily making followed for the party tomorrow....

Invasion of the crabs.....

2007-10-21T02:54:00.000-07:00

Tuesday
Up super early for the mobile clinic today to San Jose as it's a monster trip....but oh no, the Ministry Nurses are all late in town so we get going late as well. Thats the final insult as not all of us could go either, poor Heather stayed behind and did home visits with the nurses. So we all eventually get going and pile in...MAN it's squashed as three of the nurses are rather wide in the rear ! We stop at San Antonio to pick up Sophia and drop off one of the nurses - but then they all disappear for ages again (Grrrrr - Belize time) FINALLY we get going again and 90 minutes later we get there (2 hours later than planned).

San Jose is a lovely village, but its a heiniously busy clinic. The nurses are running a vaccination and postnatal clinic next door, and we get most of those patients with the obligatory cough and colds that they've all got at the moment, but there are other with far more serious complaints. One chap has a terrible shoulder abcess with needs surgical intervention so he will have to go to Belize city, another old chap has a huge upper abdominal mass - probably a gastric tumour. Off to Belize city for him too. I can't get over in words how busy this place is. We are all cramed into one room, there are screams and crying from the clinic next door, the ambient noise is deafening and we have to share one bench as an examination couch! As we're late and didn't bring lunch it's just cake and peanuts for us, and we eventually leave at 4pm exhausted and hungrey. I have 1 photo of San Jose which shows how busy it was !

Home eventually and excitement as we've booked Gomier for dinner - but we have a problem, Andy won't give us a lift in (and we've never asked him before despite them owing us 4 now) and the taxi we booked never turns up. Heather sensibly has been relexing at the Coral Inn all afternoon and just ambles round. Andy eventually takes pity on us 40 minutes later and ferries us in...guilt is great. Veggie lasagne and soya icecream 'fruit' flavour. Nice, but Miss Janices soup was better !

So the crabs......every full moon this time of the year signals a mating frenzy and all the crabs leave their holes onland and make a dash for the sea. Now this doesen't sound so spectaular except there are thousands of them and they're BIG. So big that if you run one over in your car the tyre will burst as the claws dig in and that is the end of the tyre and the crab. Dangerous. They're fast too, but not so tasty.

Ah....Chicken Soup

2007-10-13T12:46:00.001-07:00

Monday.
The talk of the town is Miss Amelia's cousin getting bashed. Thankfully other things happen to take our minds off it - mainly a busy clinic and the 'hysterical' Imelda from Barranco appearing out of the blue. This time she's been talking to her sisters and is now apoplectic about getting diabetes, high blood pressure and pregnant. It turns out she's engaged and having sex but has no idea about getting up the duff, except that her breasts hurt and thats what has worried her. So, we do a full work up, BP and BM and breast exam then send her down to the Family Planning Cemtre in town as we're not allowed to talk about contraception (bah!). Phew. Dr John does a quick teaching session beore trying for the 15th time to send a message to his wife (also a Dr and over in the Far East doing a placement) by email. Then Tah Dah - Miss Janices Chicken Noodle Soup with rice. I am happy happy happy and fall asleep smiling.

Independance Day

2007-10-13T11:50:00.000-07:00

Friday. So we've just had a week off and yet we have Friday off too due to Independence Day.Packing again, but only for the weekend this time thankfully and then we're off on the 8am bus to Placencia. Omar ignores us (again), wonder if he got to the karaoke competition? Hide and seek on the bus. Ghost towns everywhere. Independence (no sign of Victor's car) to get Hokey Pokey water Taxi the final step of the way to P. Radio broadcast by the president - could teach Gordon a thing or two about sound bites. Lawrence and Julia's guesthouse, heed the nurses warnings and go for the one of the beach. Wander up and down the boardwalk - all is closed! apparently there is a mass hangover that is affecting the whole town. Not so great lunch, beach and hammock to relax and dinner at Wendy's . Dreadful Americans at the Purple Space Monkey put everyone of the coffee they crave, even with a black out. Pissed Parrot less bad.

Saturday.
Bad nights sleep as Emma practising her underwater diving techniques whilst asleep in preparation for her PADi course . Early swim then we try to go to Omars for breakfast but he's closed this time, so back to the Space Monkey for bizarre brekkie with fry jacks and butt bacon. Nothing to do bar shop (little to find except Guatemalan stuff) till we find the shell man and get some cute earrings off him. He's a bit lechy tho...Dinner at Omars, creole everything and sadly two loud Yanks appear - but leave eventually. They are particularly vile here - far far worse than Rio Dulce. Back to bed after a skinny dip!

Sunday.
We abandon Emma and catch the 10am boat back to Independence and then the bus back to PG due to lack of anything happening. I stay in the tree house and the others cycle into town. Victor appears and disappears then reappears in camouflage in his Merc. Have a chat, then he goes again back over to the noisy house oddly and spies from the porch. Eventually goes then 30mins later all hell breaks loose and she starts cussing someone loudly for ages, then we hear blood curdling shrieking and shouting, then see someone with a baseball bat and then someone running away. Blimey - who needs Eastenders. Money stolen and Mother in Law bashed - police and finally peace. Wow.

Barranco

2007-10-13T09:29:00.000-07:00

Thursday. Burns girl doing well, old skin removed and immobilized but now traumatised by doctors. Garifuna village at Barranco along a pretty good road for a change. Scruffy compared to the Maya villages and in the main with elderly patients (wearing smart clothes and hats) rather than young kids with fevers. Busy. HTN checks, possible GH disease, and the Maya family which kept me very busy up until lunch with a bad back for mum (well she does have 7 children), worms, nits and the 20yr old daughter has 'hysteria' for which exercise and a job is prescribed by Dr John. Maggotty fish lunch (I didn't find any!) and the sick puppy. Coral Inn is open (hurrah!), relax, rum and funeral. Independance day celebrations in town...we get beers in tree house with ondrea and maire. Wierd dreams!

Has anyone seen my fish?

2007-10-13T09:16:00.000-07:00

Wednesday. Market, Dr John loses his fish whilst we aquire ours....word spreads fast through town and they begin to wonder if he's up to the job.... A deluge of people from San Marco appear suffering from- eczema, headaches, stress and Grandpa with probable Barretts oesophagus/ Ca...no Omeprazole MUPS when you needs them. Indianville also sends a busload in- it's our nearest malaria village but only brings sniffles for this Mum and daughter, the little boy has bronchitis and after a morning of running around with them and picking them up and hugging them alot (they are the cutest kids) I also find out they have LICE! Cue dash to the shower and frantic hairwashing. Lunch is the most awesome banana pudding and and the snake doctor with his herbal cure alls. Having said that he does have a higher cure rate than the hospital......Afternoon nap as heat exhausted - even 2 fans couldn't keep me cool!

No HOPE

2007-09-18T12:47:00.001-07:00

Tuesday

Wierd dreams again last night - anyone would think that I'm on antimalarials - which I'm not (thank God for Dr Behrens). Dr John summons me very early on - what a sweetie, he noticed that I was in a state about the burns girl and went down to the hospital after the Apocalypto showing and checked out how she was getting on. They had deroofed the blisters (?) given her antibiotics an pain relief and bandaged her up an she was asleep when he got there. Unsure about the tetanus though....

So as the mobile clinic is cancelled today and we were unable to convince Miss Joyce to reorganise Monkey River we continue to perfect our masterpices for the HOPE presentation, and create the questionaire for the study on diet and well being. That is until lunchtime when the bomshell is dropped that the HOPE presentation is OFF ! After all our work - now don't get me wrong...these things happen but you have to check out the posters - they are awesome, especially compared with the meagre efforts the other groups managed. Rats. On the up side Dr John LOVED the mobility poster - its his thing you know - old folk and safety, he came over all misty eyed over it, so not all was lost. Not to be put off Farnaz and Rachel wander down to Miss Janice's to get ideas for suitable healthy menus for old folk just in case we can reorganise the talk.

Dinner at Marina's tonight down in town. It's an East Indian place and we pretty much all had Shrimp curry and Dr Kirk and Laura ferry us back home whilst we cross examine her about how an osteopath can also be an MD.

Well Man, bend over.....

2007-09-17T22:11:00.000-07:00

Monday.
Quite a varied clinic this morning. First a little girl with badly infected insect bites, then an 11 year old with DIB located at her throat area with Dr John thought might be subacute tonsils. Next a middle aged large expat Brit running a marine NGO comes for a well man check (his wife gets off more lightly for her well woman check) and painful arc syndrome. He gets his prostate checked by Dr John 'Family Guy' style bent over the couch...man his prostate is deep in and Dr John shoots from the hip.... Next I have a spanish speaking lady - so I have to dash back to the treehouse for my Spanglish notes from my SSM. Not bad consultation although I couldn't remember how the referral process went in English or Spanish so that went a bit wrong but on the whole, I think Marisol would have been pleased...and Dr John was quite impressed. I find out after the clinic finished that Sophia paid me a compliment - she wished I could stay for a year! Wow that's praise especially coming from her.

Afternoon sees us starting our projects for Cherry Mae and we go into full fledged art attack with the posters. Suddenly a Mayan family in headscarves appear below shouting for help so I go and see what's up. They bold up a screaming 2yo with the most awful scalds on her arms. I am torn an shocked - I know I should get wet dressings on her but I'm not allowed to do anything to help according to the clinic so I have to tell them to get to PG ASAP and get a damp towel around her arm. They want we to take them in the van but I have no keys and I don't think Evert would be amused if they came to him, so I have to get them to hitch. That's so shit. I am in bits for the rest of the afternoon and when everyone come by in the evening for Apocalypto I tell them about her and ask whether I did the right thing - because I still not sure if I did.
Apocalypto was grim - I had to leave after 20 minutes as the screaming was terrifying me and made me physically sick. Ian (aged 6) sat all the way through it and had no nightmares either! Mystifying.

Burning Burning Burning

2007-09-17T22:10:00.001-07:00

Machaca Lodge.

I bloody hate sandflies!

2007-09-17T22:08:00.000-07:00

Saturday. Snake Cayes snorkelling trip

I'm so glad I'm a pharmacist...

2007-09-17T21:48:00.000-07:00

I finally got to clerk another patient today; a fisherman with a cervical radiculopathy. Clinic closed really early today on account off all the villages being cut off by the torrential rain we had last night, but Andy the driver at the last minute brought back his daughter with her infected insect bites back for another look see as her chest had got bad and they hadn't managed to get the antibiotics at PG hospital either so nothing had got better and had infact got worse. Now she had coarse crackles thoughout her chest and a fever....the nebuliser than we eventually find doesn't work despite us having located all the tubing and even the drugs and dilutant (which took nearly 15 minutes) so I raid the dispensary. Despite being a card carrying asthmatic she doesn't have an inhaler - so I get one of those and miracles upon miracles find a infant spacer (rare in UK let alone Belize) and some Augmentin syrup to replace the Cephalexin Dr John had wanted and we were all done and taught how to use everything. I hate this having to send sick patients 5 miles into town for drugs we don't have and that even PG may not have for them to bounce back here the next Day no better. We need a full time pharmacist who can advise on available alternatives rather than just a tech good though she is. Failing that a phone connection to Pg to at least check for stock before we send them. Still, this ones sorted at least.

Early finish so we all pack up to head for the swimming pool at Coral Inn BUT IT'S SHUT!! And we're all so sweaty and needy but no go so it's off to the sea to play in Jeff's new inflatable kayak - great fun and super warm water, if a little greasy.... Girls all get pretty for our night out at Earth runnings a haven of architectural charm and funky chairs in an otherwise charmless town...the proprietor is an architect, a singer, a singer and a Rasta with a beautiful voice. Rum and pineapple....happy now....

Otoxcha, so it must be Thursday

2007-09-17T21:29:00.000-07:00

Aghh....the potholes. Thunderstorms aren't just an annoyance, they wash away bridges, flood roads and houses and help the giant lorries create gigantic craters in the dirt roads connecting all the tiny Mayan villages with the outside. Otoxcha is the furthest village that we serve with our mobile and understocked clinic (still no atenolol or any other betablockers and God help anyone with prostatism...) We arrive with the usual fanfare but find instead of a nice clinic building like tuesday we find a decrepit hut, unlocked and filthy. Had to be seen to be believed, even Sophia was shocked and she's seen alot. Still the punters arrive and to spare Sophia for interpreting I take over the BPs and BM seeing as I'm well practised after Wednesday. Oddly only established diabetics get BM's, not those at risk, apparently because we're running out of sticks. Great. And the scales are crap and can vary Dr John's weight by 12 pounds. On the up side there is a useful little chart for Paracetamol and Ibuprofen doses left by some plucky previous British Med Students..pip pip! Lucky we're got some of that then, although we nearly run out again, but its a parasite town today. Scabies and worms for everyone.

Priorities are odd here too. At the last minute a lady appears asking for some antivomiting mediciation for her daughter who had been vomiting for a month solidly all throughout the day and had lost her appetite and lot of weight. So did we visit her home - potential seriously ill person (even if she was pregnant?) No we go off to lunch at a local man's house and tell them to go to PG hospital. Right, like they have transport. Utter madness.

After the chicken soup and tortillas and still with an unpleasent taste in my mouth from this wierd 'service' we provide we hit the one home visit that is booked - an old diabetic lady that lives with her family in a large thatched house. She has a charcot joint so can't walk far, but despite immenent blindness and further damage to her limbs she is still drinking sweet tea and has a Bm of 485 (70-120). So the message has got through here too. Not.

Worst thunderstorm yet. Started early this time at 9pm rather than 2am - guess thats an improvement!

The 3rd Annual Health Fair

2007-09-17T21:06:00.000-07:00

PG takes its health and Christianity very seriously and uses one to reinforce the other really rather well. They have little and alot in common with another...little when you consider how many churches there are compared to the number of clinics and hospitals, and alot when you realise how many volunteers run both compared to locals. Americans run masses here either through the Peace Corps, the Red Cross or various ministries and Hillside of course. Cubans seems to be the driving force behind everything bar radiology at PG hospital but the Taiwanese are just about to try and restore the balance (yes the Taiwanese - I know, like they has a fabulous economy - maybe they know how to do things on a tight budget?)

Anyway back to the fair. This was mainly aimed at the schoolchildren from all of PG's schools in an attempt to catch them early and to take home healthy living messages to their parents to entrench at home. You had to feel for them, the official opening took over an hour of various dignitaries declaring things open and thanking all the sponsors, all whilst the poor kids were standing to attention. Farnaz and myself had been pressganged into being nursing students for the morning and to take BPs and BMs and give information on hypertension and diabetes. No given the choice do you think many kids would be up for having their BM read given that it involved pain and blood....THEY ALL WANTED IT! Bizarre...it must be a magical thing...we did pick up several new potential diabetics in the kids and with the adults and identified some appalling lapses in control in the already diagnosed. The blood pressures were not as poor as I had predicted, but there weren't so many Garifuna adults in attendance. Those that were were definitely on the side of well porky, and the Maya carry all their weight around their middles so are at a huge risk for diabetes...

We had an introduction to the healthcare system in Belize with Cherry-May the Ministry Nurse - very frustrating as so many holes in the service and those that do provide it don't communicate at all so it's really inefficient. Then in the afternoon its back to the clinic for evening surgery and birthday cake as it happened to be Emma's birthday. Damn, no present - we didn't know. Still God appeared to as he put on a most excellent light show for her enjoyment (but sadly forgot to cancel the orchestra which was seriously loud and carried on till the early hours.....)Boo!

First day #2....

2007-09-17T20:51:00.000-07:00

Tuesday.....haven't we done this all before?! No warnings about hurricanes this time happily and we jump on board our mobile chariot picking up Sophia our Mayan interpreter along the way in San Antonio to XXXXX along some of the bumpiest roads in Christendom (NB that is until we did the Otoxcha trip). Deep deep into the jungle we go past little thatched huts of varying vintages and stages of decay, chickens, emaciated dogs, pigs and the odd duck....with schools full of children in matching uniforms all beautifully presented despite the limited washing facilities...ie. the river... Two hours later with a fanfare of horns we arrive at our clinic and set up shop. A steady stream of customers appears and we set to work with only one interpreter and working in pairs to avoid missing anything...always means there is one left out if there are 5 of you though. I reverted to type and helped with the pharmacy side of things, well someone has to! I did see one lady who was convinced she had worms, so we treated her for them as 75% of the population are infested. She was still breast feeding which made matters a bit more complicated. Thank God for the BNF.

We have a new Doc as Dr Laura jumped ship and was spirited away by flying monkeys when the hurricane hit. He is Dr John a retired FP from Wisconsin - a smashing chap, very old school but dying to teach so we can forgive his odd moments of vagueness and selected deafness!

Home James and don't spare the horses!

2007-09-17T20:50:00.001-07:00

Oh what a night!

2007-09-17T20:49:00.001-07:00

A few Jungle Jims, the odd beer, some tacos and then the music started...the rest as they say is history.....

Rio to Livingstone

2007-09-14T11:36:00.001-07:00

Messing about on the Rio

2007-09-14T11:35:00.001-07:00

The Fatman Cometh....

2007-09-14T11:20:00.000-07:00

Casa Perico. Lovely looking place but the bedrooms hide a dark secret....the fatman....!
Farnaz and I were allocted to a huge double room with 3 beds attached to another cabana, but despite having brand new netting on the windows there was an enormous gap above the wall into the eaves between us and the unknown resident next door. We only became aware of this person late at night when we heard eerie repetitive whispering and muttering, shuffling, dragging footsteps pacing up and down the room and other mysterious and frankly scarey sounds that kept awake much of the night. We just had to move, who knows if they could get over the top?! So we get the OK to move to the room behind Heather and Rachel, and finally at breakfast we see the one other resident of Casa P - the fatman; Ray. Conspiracy theorist, obsessive compulsive and all round nutter. I could go on about his theories about the US poisoning everyone with a brand new strain of Mycobacterium, or the benefits of Grapefruitseed extract that the US government is too scared to investigate, or colloidal silver...but, damn I just have. He has stand up arguments with a few people here over the next few days, and you would think that he would be bad for business....he's been there for four months and still askes why there are so many mosquitos around but still dosen't wear long trousers just drapes his net over his large legs, and expansive abdomen. There are quite a few beardy wierdys here in the swamp......

The Road to Rio....

2007-09-07T20:17:00.000-07:00

Thursday. Belize has offcially been spared the Felix and warnings are downgraded to Tropical Storm. PG is all safe but very low on staff as all ran for the hills (metaphorically - Jeff to Dallas, Laura to Houston) so nobody is around to watch over us and as a result we get an official very long weekend. Flores is declared dull despite the sun being extra shiney today and plans made to voyage south to Rio Dulce. Out of the blue I get a message from Ben and Hazel saying that they are en route to Flores... typical! I miss them entirely. No machete men out today, and we make it to the bus terminal in good time and get thrown on a Marie Elena chicken bus (rather than the 1st class coach we were expecting) to Rio. Its a good trip all in all, nice scenery of little and large round lumpy hills that could easily be hiding the next big lost city, mountains and sun with added entertainment by batty dancers and latterly a new looking Zorro film which sadly we miss as a very quick 4 hours later we are poured with the drizzling rain into the wet streets of Rio into the waiting arms of hostel hustlers desparate to get us to Casa Pericco which luckily is where we wanted to go!

The Rain, The Rain.... (with apologies to Iris Murdock)

2007-09-07T20:06:00.000-07:00

Tuesday and Wedneday. And the heavens opened and poured forth. With thunder, lightening and a small gale or two. But nothing special compared to Nicuragua which got moshed by Felix. I´m not really the best person to write about Tuesday as I took a cetirizine for my bites (spelling corrected by Karen a still practising pharmacist) which is supposed to be non drowsy and was monged for the WHOLE day - out of it completely. Did manage to stem the tide that gushed under our hotel door though. Flores was officially a river on a lake - unique!

The others were zip lining and Tikaling....and apart from being held up by men wielding machetes demonstrating about the crappy government (elections are on Sunday) were damn wet when they returned. Films were better though....Little Miss sunshine and Night at a museum.

Team Scarlett

2007-09-06T08:36:00.000-07:00

Panic ensues.....OK if Joyce is scared then it must be bad and the nunnery where Ben and Hazel had been sent for Dean is deemed unsafe. We prevaricate for a while then head off to the airport to see what the flight situation is whilst discussions abound about getting a boat going south (into the path of the hurricane yeh right....) or via bus (coz thats the fastest way out and the roads aren`t gonna be blocked by rain and other cars...OK...). The good news is that there is a flight to Belize City and possible Flores going in 2 and 1/2 hours which we all can get on so we book it (but still prevarications continue!). After waiting what seems like an eternity Jeff reappears with the bus and we go back to pack what we only unpacked the previous day in the fastest time ever then hare back to the airport with the shortest of goodbyes to all the staff that we`ve only just met....Oh I hope they`re gonna be OK - there is literally no where to run to.

Stressed phone calls to relatives occur leaving many of the group in tears, but stiff upper lips return and we board our magic carpet to Belize and beyond after a nasty meal at BC airport whilst the others try and book flights to Houston. One makes it, another doesn`t at the last minute which is a decision greatly regretted later.

I never thought that I would go back to Flores...not because its not nice - it is, it´s just I thought there would never be a good reason to. A mere hour after fleeing Belize City I am there again wandering the streets with clumsy wheeled suitcase in hand trundling over cobbled rocks (too big for stones) taking in vistas long since consigned to memory but none the less very familiar. After some debate over where to stay half the group decamp to ´Los Amigos´ hostel just up the road from a cafe I used to frequent in days of yore, whilst my splinter group head for a hotel which is only slightly more expensive at 4 quid a night but has its own shower, beds and view of the lakeside roadworks (with built in alarm clock for 7am). Despite not sleeping at Los amiogos we spend a significant amount of time there courtesy of the cosy sofas, palm trees, kitten, dogs and fabulous veggie food. MOvies next door...Notes on a scandal...nah don´t fancy it...maybe tomorrow. No-one is bothered about Felix coming here, but we all watch the news obsessively for news of PG. It looks like it is to hit Nicuragua and Honduras first.

Gone with the wind.

2007-09-05T11:35:00.000-07:00

Holy smoke Batman Jeff Fox is there to meet me at the airport! Apparently the message that I wasn`t coming did not get through, but Tropic Air told him that I was coming the day after...now that`s good service. Jeff is a truly lovely chap - tall and gentle about 55 with a beautiful Phillipino wife Ivory who is 37 and mum to Xavier (1) and Ian (5). They are volunteers with the Catholic Mission Board so I better mind my language and anti-Catholic tirades! PG is a tiny place with a triangle for a town square, a strange grid like street plan that isn`t really grid like and lots of shacks that don`t look very wind proof (with only a few bunkers that do). Hillside is a good 5 miles outta town up a hill (odd that) and is a concrete building and a wooden `tree house` which is to be where I am to live with some Leeds medical students (Heather, Fahnaz and Rachel) wheras Emma the other GKT student is above the clinic. We also have Maureen a slightly neurotic Canadian Physio student with us but the nursing students have canceled due to fears about Felix. A rather aborted welcoming party occurs (due to lack of cake or drink) and we head to bed for our early start the next day.

We had been warned that the weather was stormy this time of year but nothing could have prepared us for that nights entertainment....the thunder (ALL night) was SO loud it shook the treehouse, lightning hit trees and felled them taking the phoneline with them, and the wind worked better than the fan to chill an otherwise steamy night. Needless to say even with earplugs and my mossie net I like the others got little sleep, leaving us unprepared for the bad news we were to receive the next day.

Monday started with Joyce the adminstrator cancelling orientation and giving us grave tidings....`Felix is coming and he is now a grade 5 hurricane. PG only has shelters that protect up to grade 3. We cannot protect you and we suggest you take steps to protect yourselves. He will hit Tuesday evening/Wednesday am so you need to be safe by then. And the airport might close.` Oh crap.

How the other half live !

2007-09-05T10:57:00.000-07:00

Belize like most countries is one of contrasts. It seems you are either really rather rich or very poor. The Roes are the former. They are also incredibly welcoming and generous. I am invited to spend the weekend with them visiting their cabana at Honey Camp and at their beach house on St Georges Caye - how could I say no?! A quick call to Tropic Air and my flight is delayed till the next day and a message left on the answer phone at HHc. Honey camp is so cute - its up country towards the Mexican border by a lagoon and consists of some trees, a thatched veranda and a weatherbeaten Airstream type caravan. The storms that followed hurricane Dean did hit here, but not badly and the most damage is to tall trees which aren`t tall any more and the rest are being eaten by huge stripy caterpillers!! We stop off at `Victor`s apparently the best restaurant/ take away in Belize for tortillas, PilBil (spicy pulled pork), shrimp cerviche and a venison thing very yummy...even the cerviche! and a few beers. It seems there is a very relaxed view to drink driving here..... Anyway we go for a swim in the lagoon, not via the pier which is pretty much submerged under the water dumped by Dean, but which provides a playground for Ziggy the Silky Dog to zip up and down on without the need for him to swim (big wooss). Then a few more beers/wine and Roz is flat out in the back of the jeep for the way home happily sozzled! I go out with the kids, the cousins and their boyfriends that night to Old Belize: a terrible tourist trap that exists merely for the cruise liner trade which is a bit light due to the immenent hurricane pitched to hit on Wednesday...everybody is pretty laid back about it so I don`t get worried. I manage to last till 10.30 that night!

The next morning I`m the first up at 6am again and spend some quiet time reading and hanging under a fan in the breeziest part of the house next to a giant smelly vanilla candle...heaven. Then its all hands to the pump and we`re off to the Caye on a speedboat (because everyone has one!) Speeding down the river then over the sea to the cayes everybody is whipped by the warm winds and the dogs get their fur whipped about in a hysterical fashion. The sea is still really muddy from Dean but just as we hit the cayes it changes to azure and become the embodiment of a postcard. The beachhut is reached via a wooden pier with a useful cabana to one side and can sleep about 20. Property is pretty cheap here compared to the UK, Honey Camp would cost about 20K and Ladyville less than my house by some measure. So why do I live in the UK? Less mosquitos I guess! Am already up to 15 bites which are blistering alarmingly.... We eat, drink and are merry than pop over to a nice swimming spot with a shallow sandy bottom and splash around; Roz had her 50th party here with a floating BBQ and 80 friends in the middle of the ocean on a sandbank. Then back on the boat, over a soggy lawn as its rained again watching the hired help fit the storm shutters to the windows to protect against whatever Felix brings. And back to the airport where I finally catch my last flight to PG. It`s been a fantastic start to the elective so far!

And we`re off.......

2007-09-05T10:30:00.000-07:00

I have rarely felt so little excitement about leaving for a trip. There are a few reasons for this; my next door neighbour is rapidly being consumed by her lung cancer which the day before I left made the final trip up to her brain rendering her unusually vague and confused. Less than a week I thought knowing I was to leave the next day and not being able to be there to support John through this last stage. At least the son appeared, summoned by our other neighbours for her swansong.

Then there is the fearful anticipation of the job itself and not being up to the challenge, together with the absolute certainty of being bitten viciously despite all my anti-bug sprays. And the guilt of abandoning Snowbelle (sigh). And just to complicate matters there is a REALLY tight connection time at Houston between my flights which could knacker everything if it does not come off.

So even whilst I am accelerating down the runway leaving England`s green and pleasant land I am still morose, that is until I watch Blades of Glory....man that is a funny film! And I start to lighten up (thank god I hear you cry!) so by the time I get to Houston (having eaten a bizarre interpretation of a chicken tikka massala) I am mentally prepared to push and cajole my way through the system to get my flight....which I do only after being sent the wrong way twice and sprinting through the terminals to make the gate by seconds (phew). And my luggage made it too - incredible.

The air here in Belize has no smell, unlike Africa but is like a warm sweaty blanket enveloping everything...its gonna take some getting used to. Nobody to meet me....not that it matters, two locals check who I`m meeting and Marilyn ( whose sister was married to Mr Roe`s brother for a while) rings them at home to summon them to pick me up - now that`s a small town! Roz plus Viv (one of the quads) appear in a screech of dust and whisk me about quarter of a mile back to their fantastic pad where I meet the others (Nicole also dark haired like Viv, and Lou & Andrea the blond quads). I am relocated swiftly to the Manatee club for a few beers and great Lebanese food (go figure...) and introduced to some of their friends and relatives (who it appears live in the same enclosure as Roz and co.) But my 8.30pm local time (3.20am home time) I am bushed and need bed. I still wake up at 6am - how does that work?!

Lost in Translation

2007-08-29T00:35:00.001-07:00

I've been looking forward to last night for months....and it certainly lived up to expectations...I came home on an enormous high with a giant smile plastered across my face. Trudy said 'So tonight went well then? How was Joseph? Where did you go for drinks then?' I had been excitedly jabbering about seeing Joseph since she moved to mine for a few days. I realised then how easy it was to get things lost in translation.....my date had been a fantastic rollercoaster of emotions and the euphoria I felt......was shared (sadly!) with a few hundred other rapturous souls who had also been with me watching Lee Mead (swoon) perform in Joseph at the Adelphi. God he's good. I've still got a huge smile and a warm fuzzy feeling even now which it has to be said compares extremely favourably against most of the dates I've ever been on, but dosen't quite compare against Hugh Jackman in Oklahoma in 2002. Don't panic Hugh, you are still No.1 in my affections for 'Men who are gorgeous but can't have as they're too famous/married/made-up(Viggo Mortenssen is No.2)' as I had a smile for at least a week after sitting in the second row from the front in very close proximity to his gorgeous half naked and beautiful singingness. Ahhhh. Lee Mead is tied at No.2 with Viggo. The guy selling programs at the theatre was so funny...I had the choice of normal program or a full colour show souvenir featuring ' a free poster of Lee in a loincloth' said in a very camp manner - be still my beating heart! I restrained myself - just.

Hydatid disease.

2007-08-28T04:21:00.000-07:00

Dr Gregory House would have liked this case, a mysterious cause of paraplegia. Irreversible unfortunately.

I'm getting under your skin......

2007-08-28T03:59:00.000-07:00

Sea Urchins....so pretty but oh-so-painful if you accidentally tread on one. Not only does it discharge poison sacs into your skin but the tips of its spines often break off and become embedded there. You can try urinating on the wound (surfers swear by this approach but you JUST never know whether these guys are yanking your chain) or dowsing it in lemon juice, but sadly little works. The spines just have to stay there till the body resorbs them or expels them or fibroses around them, and they HURT. SO.....now I need a burqua, shower hat and armour coated flipflops with verruca socks to avoid the nasties!!

Is Lithuania tropical?

2007-08-28T03:37:00.001-07:00

So there we are...sitting in an emergency clinic in the Hospital for Tropical Diseases and this European lady comes in with some nasty looking itchy blisters that had been popping up over two weeks. 'Where have you been?' we asked expecting some wonderous location...'Lithuania - my home country' was the reply. She had been wondering around a meadow with large plants in it and had thankfully taken a picture of them. Hurrah! Alan Titchmarsh would be so proud of me as I identified the Giant Hogweed (Bearclaw in Dutch) straight away. Nasty plant. Burns and blisters are due to pollen and stuff and can keep appearing for many months after exposure.....keep away...you have been warned!!

Himalayan Mountain Salt

2007-08-28T03:11:00.000-07:00

And then there are the just plain wierdys......such as a 50 year old permatanned eco warrior who had come to clinic on a D-day with the usual going up to 15 times daily and had been for the last few days after eating a dodgy sausage at a Bulgarian Beinsa Duno Dance festival. Only he hadn't pee'd for over 24 hours. This was a bit concerning, but immenant renal damage wasn't going to bother him if it meant having to infuse the wrong sort of salt (as normal saline) into his body. 'Poison' he said 'I won't put that into my body...the only salt I will use is Himalayan Rock salt...its pure you know.....I'll drink some of that in water mixed with honey if you insist but nothing else...no, absolutely not!.' Okay then......

'Himalayan crystal salt is pristine and natural. It consists of the most perfect geometric structure possible in rock crystals, the result of millions of years of compression under the Earth’s surface. Its has precise mesh with our body's inner workings because Himalayan crystal salt contains an almost identical set of elements to those found inside the human body, 84 of the possible 92 trace minerals, in the same proportion as naturally exists in our blood'

I've got chills! they're multiplying....

2007-08-21T02:21:00.000-07:00

'Break-bone fever'

What a fantastically descriptive term for Dengue fever. We've had a few cases of this recently from Thailand and Indonesia and thats exactly how the poor erstwhile holiday makers described their symptoms....terrible fevers, myalgia, aching joints and intolerable malaise. One poor 2nd year medical student was so incapacitated by it that he went all vasovagal and fainted on his Dad in an Underground train. Worst case of green around the gills we've seen so far, especially when he was told he had to be admitted and had an armful of blood taken and an IV put up.... Some are more stoical...like the Bostonian hedge Fund analyst who had come straight from work with symptoms that would have flattened most people and was aghast when told that she needed to stay in hospital overnight on account of the subprime market doing a nose dive and that she needed to be there to monitor the situation! She was so funny - she had literally taken every precaution against biting bugs she could think of (sprays, creams, electronic plug things, bednets, long trousers - not a burqua mind!) and still got the lurgy....all taken with great humour - atta girl! So far no one has had the haemorrhagic version (thankfully) which happens when you get more than one strain of Dengue at once.

Oh yes, and as you can see Dengue is an epidemic in Central America as if I didn't have enough flies to worry about!

Typhoid is on the up if clinic diagnoses are anything to go by. It can be really nasty too....within 4 weeks 20% are dead from multiorgan failure and/or massive GI haemorrhage if untreated. Mostly it seems to be folks back from visiting India. So......if any of you guys are out in India and you start getting terrible but remitting fevers, constipation rather than the squits, no energy to do anything and a bad headache then you might have it...especially if you develop 'rose spots' the next week when the fevers don't subside and you feel even worse. Oh, and you have super infectious poo and can give it to everyone else! Typhoid Mary did this very effectively in the 1900's and killed loads of people - she had to be bunged in the clink to stop the epidemic.

As far as causes of fever go it has to said that Malaria has not been high on the list of eventual diagnoses in the emergency clinic. We've only had two vivax cases which is a bit disappointing! The last chap had come back to clinic after 6 months of no symptoms with a re-emergence of fevers that he had developed after travelling through Thailand, Vietnam, Cambodia and India (where he had to be hospitalised due to a temp of 104 degrees and lost most of his platelets) but had had a negative malaria blood film on his return in March. He was given a bollocking by the SHO who then had to then turn the other cheek when P. vivax parasites were found again this time..... Apparently the Indians had recommended 6 months of chloroquine to clear it but the drugs made his liver and one testicle (!) so painful he stopped it. After the obligatory G6PD test we gave him some primaquine and so hopefully he's cured now.

The advice for malarial prophylaxis has undergone a bit of a revolution recently. The boss of the Travel Clinic Dr Behrens has just published a paper in ...yes you've guessed it...'Malaria'...that rubbishes the idea of taking prophylaxis in predominently P.vivax regions (ie. most of India and Central America) as it's not common, fatal, the drugs are unpleasant and possibly even not very effective at protecting against it (compared to P. falciparum). Excellent. Better go somewhere where I can use up my Mefloquine next year then!

D-day

2007-08-20T13:26:00.000-07:00

Snowbelle has taken to sleeping in my rucksack...maybe in a vain attempt to stop me leaving the country (or to come with me - ah...if only...do they eat cats in Belize?). Unbeknown to her I have obtained a secret weapon to foil her cunning plan....a suitcase!

Everybody at the walk-in clinic is lovely. The nurses and assistants are amazing and have seen it all before so guess the diagnosis even before you've seen the patient - which is slightly unnerving. But they always keep lots of biscuits in the cupboard which are essential cures for Trudy and my hunger pangs which seem to hit earlier and earlier each day...despite the worms and poo, so we forgive them being way cleverer than us! And then there's Richard our SHO. You can just tell he's going to be a great Haematologist when he 'grows up' - he's got that palliative care kind of an approach to patients with a nice kind voice- kind of the opposite to my rather direct questioning style. We operate a kind of 'good cop - bad cop' clerking technique - but it works...although it occasionally wierds the odd one out if they're on their own.
And he keeps chickens!

Back to D-day....which happens seemingly every other day. It comprises of large numbers of patients all suffering with the same complaint. Diarrhoea. (sigh). Make you happy to see the worms - no really... even though the worms are commonly the course of the squits they are the only light at the end of the tunnel......could there be one...could there?!

Of course there are clues to the cause of all the trouble...in theory. We've had several cases of Giardia none of whom had sulphurous burps or fishy offensive watery stools. Periodic cramping abdominal pain and bilious vomiting seems to point to tapeworm overcrowding...but could also be strongyloides. There are the 'diarrhoea asscoiated with fever' patients who are way more complicated and a bit scarey and finally those who have had something nasty, had it treated but whose guts are still suffering post traumatic stress disorder and still not got with the program. They are hard to treat (and go a bit mad - they carry detailed poo diaries with them), so we send them to the clever Gastro doctors!!

D-days are bad. Luckily my cat is very cute!

The worm has turned...

2007-08-20T12:26:00.000-07:00

There are days at this clinic when I am convinced that the whole of London is harbouring unwanted guests. Bot fly larvae, surprise mycobacteria caught 20 years earlier that pop up out of the blue and suddenly paralyse you, hook worm larvae that mistook your foot for a dog's, burrowed under your skin and consigned themselves to travelling under your skin for the rest of their lives to find a way out, and then then are the worms.

Do you remember the song you used to sing as a child?

"Nobody loves me, everybody hates me I'm going to go and eat worms...long thin slimy ones, short fat chewy worms. etc etc"

Well the worm has turned (TV reference there...go on guess....) and the worms are invading us like an episode of Star Trek only its very much on their own terms. I could even be convinced that invasion of the brain in cystercosis was a attempt to mind control us....(Oh God I watch too much House)

Trudy and I have had our eyes truly opened to the apparent world domination of these creatures. They have been coughed up in front of us (Ascaris - round worms), pulled out of bottoms and presented to us (Taenia - tapeworm), shown on radiological scans (Strongyloides - that one's for you Rob), swum across eyes to wave to us (Loa Loa) - (bleugh....sorry need to concentrate again), grown in the spinal canal of one poor British chap and destroyed the spinal cord and column making him paraplegic (hydatid disease) and traced the words 'help us... we're lost' on the back of a rather attractive gap year student (Cutaneous Larva Migrans - OK not strictly a worm at that stage but it grows into one usually!)
How do you escape an enemy that can invade with your food, be carried and inoculated by insects (day and night...damn! looks like the burqua is here to stay), contaminate the water and food if someone has not washed their hands, and attack you whilst you're cooling off in some fresh water in the middle of a blisteringly hot country? OK you don't - you hit them where it hurts and kill them with DRUGS.....if you know they are there.......which you often don't.

Till you cough one up. (Retch)

PS. It was the Two Ronnies !

Bit Bot

2007-08-19T07:00:00.000-07:00

You remember how I was making a big deal about the not wanting to be bitten thing? Well we've had a number of good reasons turns up at the walk-in clinic over the last few days. People with larvae IN THEIR HEADS. Yes, wriggling and generally being really painful and disgusting. The nasty in question is a bot fly larva - dosen't he look friendly?

The worst case was of a university student who had been in Guatemala for three weeks (yes, Guatemala completely surrounds Belize so this is another cause for paranoia!) and came back through customs but neglected to declare that she was carrying SEVEN bot fly larvae in her head. Ah, but she wasn't bitten by a bot fly....oh no...the bot fly gets something else to do all the dirty work. It catches a mosquito or another blood sucking fly in mid air, transfers fertilised eggs onto its victims abdomen, then flies off happy in the knowledge that when the fly lands the eggs will be transferred, hatch and the larvae will burrow under the skin of the new host......clever! These larvae then grow and feed on the blood and skin of the host, and breathe by sticking their tail ends out of an air hole. Luckily this proves to be their undoing as the cure is to cover the air hole with Vaseline for 30 minutes or until the wriggling and thrashing stops and then squeeze the large inflamed 'zit' like lump and force the damn thing out. there is a catch though as it has three rows (or more) or backwards facing spines that try to stop this happening....

So its a burqua minus one hole at the bum plus a plastic showercap for me......

Unleash the leish.....

2007-08-19T06:24:00.000-07:00

Uh oh.....

I've found the first really nasty thing I'm likely to get out in Belize. Now you know how medical students are...they meet a disease for the first time and then start displaying symptoms of it - a kind of medical hypochondria...well this time it could be serious.

We've had a few patients with Leishmaniasis in clinic. One chap - a young kid from Ethiopia has intrigued the experts for months to whether he has a normal cutaneous variant of the disease or a more complicated 'Post kala azar' picture. He doesn't care. All he knows is that the end of his nose has been eaten away and he has something terrible happening all around his mouth that might be signalling that the same might happen there too. Then there was the soldier who had been based in Belize who came back with a large ulcerated and very painful area on his forearm (you can't help but think he got off lightly compared to the boy), and then the beautiful Afghani girl from Pakistan with a giant carbuncle on the end of her nose that just started off with a pink pimple but on biopsy is chock full of Leishmania amastigotes despite weeks of intralesional (yes into the bump) of toxic painful stibogluconate.

And the reason I'm worried? It's carried by sandflies. And I'm very tasty to sandflies (if Fiji was anything to go by), and mosquitoes and most other biting things. Interestingly (well I think so) mothers in the middle east have come up with a way to immunise their children without the need for a western vaccine (which still dosen't exist). They hold the buttocks of their child near a sandfly nest and get them bitten early on in a non-cosmetically dodge place and then the kids are immune for life. I reckon a burqua would do.....with a hole cut in it at buttock level...what d'ya think?

Now if you think I'm overexaggerating and just being a bit of a drama queen about the facial disfigurement then scroll down......this guy didn't get the buttock treatment as he lived in Peru.

Bug Central

2007-08-19T05:04:00.000-07:00

I finally made a decision on the hat...SPF50 and flat packable - sold! Also sold was a very big mosquito net and a double silk sheet thing...all anti bug measures that will hopefully make Belize nights a nibble free zone.....all the more important given what I find out in the coming weeks!

Isn't it funny how just when you are starting to really enjoy your holiday, something happens - oh yes, I had to go back to work. One day I was on a beach in SaltDean near Brighton basking on heated stones gazing inbetween a teenaged wizards adventures and azure skies and swimming in chilled waters and the next I was rudely awoken at 6am for a trip across town to Bug Central.

The first obstacle was how to actually get to The Hospital for Tropical Diseases....underground? overground? .... I chose Wombling free courtesy of a train to Bedford from London Bridge which dropped me at Kings Cross...easy walk from there I thought...its funny how much longer walking is than driving.....30 minutes of route marching got me there...just... with a couple of double backs to find a shabby looking building which houses the clinic around the corner from what seems like the biggest campus in Britain. Everywhere you look is UCL university buildings or hospital...seriously...for 6 blocks in each direction...and more! After finding that my contact had retired and elective partner metamorphosed from a German male to a Dutch beauty named Trudy and been subjected to the usual form filling and traipsing around getting photo ID we were ushered into our first clinic - Leprosy (and rather alot of Leishmaniasis) with the phenomenal Professor Diana Lockwood (complete with cute but huge dangly dragonfly earrings) and the research Dermatology registrar with the best hairdo in the hospital; Stephen Walker. Serious 'fro man!

Leprosy is a seriously terrible disease. Over the next few weeks I saw people with small patches of anaesthetis hypopigmented skin and little else to leprosy technicians from Afghanistan who had caught the disease from their patients and now could not use their hands, to a man with clawed hands and neuropathic damaged feet with bits of toes missing. You can catch it and kill the bacteria fairly easily but the problem is that the tissue that it likes - the Schwann cells that insulate nerves still continue dying and its that which causes the nightmare for the patients. Sometimes its just single nerves or muscles weakness if you're lucky and you've got the tuberculoid form, however if you've got the lepromatous form - it's glove and stocking time and you can't feel anything so you damage everything.

A slightly wierd thing to look for on your travels are people with the outer third of their eyebrows missing...the leprosy does that too....

The waiting......

2007-07-26T04:28:00.000-07:00

Ah the anticipation..........

It is said that a dish is all the better for the waiting...... something I am hoping is true as I imagine all the fun and frolics my partners in crime are indulging in overseas whilst I remain waiting for my elective to begin in waterlogged Blighty. Images of Niger, Thailand, Ghana and Vanuatu flick infront of my eyes juxtapositioned against the sights of Tewkesbury, Gloucester, Oxford and Yorkshire under 3 feet of sewage riddled flood water accessorised with floating swans curiously peering through the ground floor windows of government offices half a mile from the nearest river. Bizarre, but hey the English summer is well known for it's unpredictable nature! Even the weather appears to be operating some kind of jihad.

Still, it does afford me the benefit of far more time than is actually necessary to arrange, rearrange and buy still more unnecessary items for my luggage and sojourn in Belize. I am at present pontificating over the exact specifications of a hat necessary for the tropics. Does one obtain one with the highest sunblockage, the best waterproofing (bearing in mind that Belize during the 'wet' season is one of the wettest places on the planet), one that 'breathes' or just abandon logic to the winds and just buy one made of straw when I get there? Lucky that the weather in England is so predictable and that I don't have to consider my packing for this part of the elective (not!).

I have decided against flipflops as my main choice of footwear abroad following a small shopping trip to Knightsbridge lazily flipflopping around Harrods and Harvey Nicks examining the last of the summer sale detritus and returning to surburbia sans intact skin between my toes (ouch)...back to the tevas I think.