And we're off (part2)

Friday

Tea time

Thursday.

Madura foot again.....

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.....

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

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

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

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?

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

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.....

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

Machaca Lodge.

I bloody hate sandflies!

Saturday. Snake Cayes snorkelling trip

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

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

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

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....

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!

Oh what a night!

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

Rio to Livingstone

Messing about on the Rio