Tom Owen's Island

Well we're back from an amazing weekend. Left Friday afternoon and headed out to Tom Owen's Island in Sapodilla Cayes. Just relaxed and had a delicious dinner of stew chicken, mash potatoes and rice and beans. Later we set up a bonfire and made smores. Saturday morning we got up and went snorkeling around the island. Then took the boat out to do some tubing and finally ended the day by doing some fishing and island hopping. That's when I got the picture of the starfish. For dinner Saturday night we has lobster, conch, and grouper that we caught and barbecued. It was so good. Another bonfire and more smores ensued. This morning we just relaxed on the island before heading home.

The island is tiny and we were the only people on it. You can see every side of it from the middle. There's a main house with 3 bedrooms and 3 cabanas out on the island with beds in them. It was a fun time but I'm glad to be back to running water and flush toilets. Not to mention I'm getting ready to head home. It'll be a decently short week: mobile clinics Monday and Tuesday, Clinic here on Wednesday, half-day in Barranco on Thursday (ending with Thanksgiving dinner), and a half day on Friday.

See you all in a week or two!

Settlement Day

On November 19, Belize will celebrate the anniversary of the arrival of 500 Garifunas to the country in 1823. A national holiday, Garifuna Settlement Day, is celebrated with food, song and dance throughout Belize, but mainly in the southern areas. From their infectious music and dancing to their colorful clothing, Garifunas have no doubt left their blueprint on the Caribbean and Central America.

HISTORY

While Garifuna Settlement Day remembers the exodus of the Garifunas to Belize in 1823, their history dates back to nearly 200 hundred years before, to the year 1635. This was the year when two Spanish ships carrying African slaves for transport to their buyers were shipwrecked off the coast of Saint Vincent. Soon the Yellow Caribs were created, a mixture of African, Venezuelan Caribs and the indigenous island group called Arawaks. By 1750, a new race called the Garifuna was born - a combination of African, Arawaks and the Yellow Caribs - and which remains to this day. The Garifunas are sometimes called Black Caribs and Garinagu as well.

In 1797, after decades of fighting the British invading forces, many Garifunas were deported to the Bay Islands of Honduras while some remained. Some of the deported Garifunas, unhappy with their small area to live, pleaded with the Spanish authorities to allow them to live on the mainland. Soon they were employed as soldiers and spread throughout the region. Today, approximately 98,000 Garifunas live in Honduras, and in coastal regions of Nicaragua, Belize and Guatemala.

CULTURE

The Garifunas' strong African and Carib roots allow their culture to thrive, with very little change throughout the centuries. Garifunas, depending on their region, speak English, Spanish or Igneri, a Garifuna dialect with Arahuaco, Swahili, French and Bantu roots, or all three.

Music and dance are a huge part of their culture. Punta, a Garifunan secular class of music and dance, recreates the cock and hen mating dance. Its movements are composed of the intense shuffling of the feet and the quick motion of the hips and buttocks, while the upper torso remains still. The music is generally accompanied by two drums, rattles and conch shell trumpets.

Guatemala

The whole group went over to Guatemala today. We spent the morning laying out on Playa Blanco enjoying the sun and the sand. Roberto BBQ'd some chicken and grilled some hotdogs for us. We played a little beach volleyball too. It was awesome. I could have stayed there all day. Afterwards we headed to the Seven Altars which is a series of waterfalls. Unfortunately rain has been scarce so the waterfalls we more like trickles, but we had fun anyway. I went up to jump off the falls into the pool below and ended up being pulled down by Adam (jump raped). After the falls we rode over to Livingston to do some shopping and just see a little of Guatemala. Got back tonight after 8 hours out with Roberto and we're all completely beat. I'm almost ready for bed right now and it's only twenty to seven.

I'm starting to get some color which is nice. Not enough to avoid the "Hey white girls" comments though. Monday starts week 3 in Belize. We have a holiday on Thursday and I personally plan on doing absolutely nothing all day. Aside from the Adam, Becky and I get to go hang out with old people on Wednesday and help them exercise and take their blood pressures; should be interesting... Next weekend is the big trip to Sapodilla Cayes. Can't wait! If this weekend is any indication the caliber of the next trip we're going to have a blast.

Anyhoo, Adam is whipping up some delicious smelling chicken parmesan again. Time to eat!

It's the Freakin' Weekend Baby

So despite all the previous talk we stayed in town this weekend. Yesterday Hailey, Mirek, Liz, I, and 2 of the nurses went out with Roberto on his boat the "Wild Thing" to go snorkeling at Snake Cayes, search for dolphins and manatees in the mangroves, and go tubing. It was so much fun. I saw hundreds of fish and am really excited to dive now. Parrot fish, barracuda, etc. I even held 2 starfish and saw dozens more. It was incredible. Unfortunately I neglected to reapply sunscreen so I am paying for the whole adventure dearly, but I still had a blast. After snorkeling we went to an island to eat lunch (bologna sandwiches, apple, plantain chips, and a fig newton-like bar made with pineapple). The snake cayes are known for the red-tailed boa so Roberto found us some to see and HOLD. Liz has pictures of all of us so I have to make sure I get those from here to share. We searched for manatees and dolphins for a long time but came up with nothing so we headed back towards town to go tubing. When I say tubing I mean just like at home only this was on the ocean, with twin outboard motors, and a tube the size of a love-seat. I wiped out pretty good after staying on through 5-6 ridiculous turns.

Last night we had comfort food again for dinner (vegetable soup and grilled cheese) then packed 10 of us in the van once again to head into PG. THe whole country is celebrating Garifuna settlement this coming week (actually holiday on thursday) so there was a battle of the drums last night. So cool. I have some pictures and a video that I'll post when I get home.

Today it's off to Guatemala for cliff jumping, waterfalls, and shopping. Then back to clinic on Monday.

Tchao!

Scorpion

Bet you can't guess the first thing I saw when I set up the pharmacy at the mobile clinic this morning... a scorpion. He even had a friend with him on the floor. Thankfully after a few photo-ops, Adam and Mirek took it upon themselves to kill them and Maria was kind enough to throw them out. Clinic went well after that - extremely busy though. We saw 63 patients in about 4 hours with 1 pharmacist (me). It was insane. I'm going to miss the autonomy I have here. I can change scripts if we don't have a drug or the amount seems incorrect; every prescriber listens intently to my recommendations. Coming back to the U.S. is going to be rough.

After clinic we went to dinner at Gomier's. This guy moved to Belize from St. Lucia in 1996 and opened his restaurant in 1997. He's big into health food: vegetarian, makes his own tofu and soy milk. Amazing story teller too. He told us tons about his life and his adventures, he likes and dislikes, his theories and thoughts about life and about health. He's an amazing man and an even more amazing cook. I had the vegetarian lasagna which was spectacular, the curried fish was delicious as well. Also tried his chocolate ice cream. And the whole meal cost me a whopping US$10. And afterward he picked fresh lemon grass for us to take home and make tea. He also showed us his dreadlocks that he has been growing since 1980. The end of his hair is older than I am. It's taller than he is and we could pass it around the table. The ends are dark brown while the top is stark white. We're heading back there next Tuesday for cooking lessons.

The plans for this weekend now include snorkeling, drumming and Guatemala. Next weekend we'll attempt the dives the following weekend at Sapodilla Cayes.

Wednesday

Well we’re halfway through another week in Belize. It’s hard to believe I’ve been here this long already. Monday was a mobile clinic to Blue Creek – we had a pretty late start as usual but things got up and running smoothly enough. Hailey and I were masters in the pharmacy yet again. And no worries about the creek flooding this time :-D Monday night we relaxed and Adam made Mac ‘n’ Cheese with BBQ chicken for dinner which was really good comfort food after a long day. We also watched the Hangover after dinner (pirated movies rock).

Tuesday was mobile day in Big Falls, but Christy and I were in charge of teaching kids about hand-washing and general health all day. We started with little kids: kindergarten and first grade in the morning then worked with older kids in the afternoon (up to 6^th grade or so – they use the British system here so I have no clue how old some of these kids are). We had an amazing Belizean lunch at a buffet called Coleman’s in Big Falls – curry chicken, kahune cabbage, beans and rice, fried plantains, and bread pudding. We did have some excitement on Tuesday in clinic. A volunteer from the Mennonite church stopped by with a pre patellar abscess that we incised and drained and then gave him some ceftriaxone. Then in the morning before lunch we had a little boy who needed to be transported to PG via “ambulance” because he was having trouble breathing. It was a big snafu though… no equipment, no meds, the doc was rushing people inappropriately. Tuesday night we needed to get away so we went to Marian’s for dinner. The ride in we fit 9 people in a mini-van that traveled about 5 miles an hour the whole way there – but for US$4 roundtrip we couldn’t go wrong. Marian cooks delicious food – fish, veggies, and help yourself to Belikens. The restaurant is also right on the ocean with tables on the balcony overlooking the water.

Today we had clinic here. Nothing too exciting to tell you the truth. Ran into town to try and order meds but didn’t have all the right information. Yummy lunch and dinner yet again – care of Miss Janice and Adam respectively. Now we’re watching I Love You Man. Tomorrow night we’re going to Gomier’s for dinner which should be amazing and I think we’re planning to do a cooking class with him next week.

Internet might be up tomorrow – could be awesome!

Saturday

Got up this morning after a glorious night sleeping – I actually had to use a blanket. Unfortunately the sun is super bright here in the morning so I didn’t really get to sleep in much (I know, I know, I never do anyway…). We all went into town and had breakfast at Grace’s. They have these fried dough things called Fry Jacks that are amazing! They’re kinda like elephant ears and you dip them in either jelly or beans. We didn’t try the bean combo, but I can see how it would be good. After breakfast we drove to Lubaantun: Place of Fallen Rocks which is a nearby site of Mayan Ruins. I rode in the back of the pickup with Hailey, Meredith, and Liz. Actually we were all in the back of the truck for every trip today. At the ruins we had a guide show us around and tell us all about the site. It was really quite amazing to hear all about the history and the excavation because our guide actually worked on the digs. After the ruins we drove to Blue Creek which is the place where the bridge flooded this week. We took a small hike to a dock and hung out there to have lunch. A bunch of us jumped off the dock into the water which was amazingly refreshing. It was nice and cool and clean. The current was ridiculously strong though. We tried to swim up to the waterfalls but couldn’t make it. It got to the point where we were swimming and not getting anywhere. This evening we had delicious taco salad for dinner – care of Adam yet again. We’re getting ready to head over to the bar in a few and relax for the night. Internet is shotty yet again so I’m sure this post will be late.

P.s. I really, really, really like reading email so you should send me one!!!

Internet is Not so Hot

Good Morning - just wanted to update on the whole internet situation. we haven't had a connection for 5 days now and I don't see it getting fixed anytime soon. So posts will continue to be sporadic. There are a few internet cafes in town so hopefully I get on at one of those. I'm teaching hygiene and health at a school in Big Falls today with Christy and we had some downtime so they let us use the internet. My inbox was completely flooded, however not with fun emails from friends - soooooo:

SEND ME EMAILS PLEASE!!!

End of Week 1

It’s the end of week one. I was up in the pharmacy for clinic this morning. Lots of chronic medications – metformin, glyburide (glibenclamide), simvastatin, amlodipine. The toughest part today was trying to figure out how to provide meds for everyone that needed them when we hardly had enough of anything. It was pretty busy upstairs too. We’re supposed to have one of the PA students up with us, but they keep calling them back down. It’s kind of annoying actually. I really like that everyone is willing to learn from pharmacy and to teach us the clinical/diagnosis aspect of everything they see. But it would be nice to be able to give them more information about pharmacy up in the pharmacy. Hopefully next week is better…

After clinic and finishing up pharmacy work (evals, home meds, etc) we road into town to go to dinner at Grace’s and watch a cultural talent show put on by the highschool teachers. John and Mary Pat and 3 of the nurses joined us for dinner (p.s. major drama within the nursing group). The show was good, very funny, but really long. We were having tons of fun living vicariously through 15 year olds. The show was really sexual though…

Tomorrow we’re doing breakfast at grace’s then heading to Blue Creek/Lubaantun/RioBlanco. Sunday is hopefully still dive day, keep your fingers crossed that Ida is passed by then.

Internet is back in action so I may be able to update more often!

Did I mention that Andy fell last night and hurt his neck, practically broke it actually. He’s been in a soft collar all day, poor guy. Still managed to cook us lunch though.

Day 4 - Tuesdaay

Well it’s day 4 in Belize and we went to our first mobile clinic today. We went out to San Marcos which is about 30 minutes from the clinic. We left after 8am – which was way late, but that’s kinda the way it is here. Hailey and I were in charge of the pharmacy which was placed on a pile of 2x4’s. We got 2 boxes and 2 bags of drugs from the Ministry of Health which consisted of a lot of amoxicillin, sulfa, some APAP, and hydrocortisone along with a few other random drugs. Hailey and I took turns running the pharmacy and consulting with the PA students. IT was great being able to offer suggestions to the other students not just based on clinical guidelines but also based on what was available. We’ve also been lucky enough that the PA students haven’t really written prescriptions before so we’ve been making them into better Rx writers: allergies and dx included on every script.

About halfway through the day the kids got off school for lunch and then they came back again after school was out. They are all ridiculously adorable and fun to talk to. They’re really interested in our names and what we’re doing. They also like to talk about us in Mayan so we can’t understand them. It’s really cute. They’re also huge hams and love to smile for the camera.

After the clinic we came back and changed and got a ride into town to have dinner at Grace’s. I got the shrimp fajita with a side of white rice and stew beans (which is different from beans and rice). Dinner was delicious. My dinner mate – Renauldo the Lizard – hung out above me for most of the meal. Then we walked around and caught a bus that got us maybe a quarter of the way back and then had to walk the rest of the way. Second night in a row with a decent work out.

Tomorrow I’m downstairs in the clinic in the morning and then upstairs in the pharmacy for the evening clinic. We’re planning to bike into town in the afternoon between clinics to take a dip and pick up some chips for guac when we make it tomorrow.

Time for fruity drinks with the group (p.s. these people are awesome).

Day 3 - Orientation

Woke up early – as per usual – showered and had breakfast. We went to the market at 8am for produce. Packed 10 people into the car – there will be more like 12 people in there tomorrow for our first mobile clinic. We had a little extra time while we were down there so we checked out a few supermarkets too. When we got back to the clinic it was orientation all morning. I still need to manage to write something up for everyone about good old Dr. Dick. But anyhoo. Hailey and I got to check out the pharmacy (air conditioning!!!) and talk with John and Maria about our goals for the rotation. I’m still a little lost as to what exactly goes on day-to-day, but I guess I’ll learn it as we go.

We got a quick glance at the hospital and polyclinic in PG this afternoon. Also got to check out the Coral House Inn – we’ll be there a lot, I guarantee it. They charge BZ$10 to use the pool and wi-fi, and the bar is on your honor. More grocery shopping was also done this afternoon – we spent a whopping US$40 for groceries for 8 people. I can currently smell our coconut curry chicken baking in the oven. I’ll let you know how it turns out.

Liz, Hailey, Becky, me and Merik biked 6 miles into PG tonight to jump off the dock and swim in the ocean. It was like bath water it was so warm. Then we went all the way into PG to pick up some rum for the group and biked back to the clinic. I can definitely say I’ve had my workout for the day. But jumping in the ocean off the dock was a great experience – I’d do it again in an instant, I’d just take the bus into town instead…. :-D

John has managed to set up a dive for the 4 of us who are certified. We’ve got a divemaster lined up to work with Liz and I so I think things will be good and I’m pretty excited about it. The plan is to head out this weekend to the Cayes and dive from there on a day trip. We’ve got to work out the details but I think everything will go well. I’ve really adopted the Belizean idea of “go with the flow”. There’s no reason to get worked up about things down here. It’ll all work out in the end.

Internet is still spotty, by the way. We have 1 computer with access. So I may or may not be able to post this tonight, but I hope I’ll get to soon.

Day 2 a day late

I had the best continental breakfast I have ever had in my life this morning: A huge glass of OJ and a made to order egg sandwich. We had no troubles at all this morning. Made it to the airport with plenty of time to spare. Security went fine (I did have to surrender my safety scissors ☹ ). Once we got let out onto the airstrip Hailey, Merik and I boarded a 6 passenger plane. That’s right six passengers (pictures to come). It was only the 3 of us and the pilot. The entire flight was 50 minutes over the coast of Belize. It was gorgeous. Ran into a little ran along the way (which managed to make it into the plane on Hailey’s side), but nothing too serious. At the airstrip in PG we met Aprill. She’s the student coordinator at Hillside. She was born and raised in PG. She doesn’t look it, but she speaks Creole with the best of them. I’m considering asking for some lessons. The Creole dialect apparently came from the East Indians that settled in this area and lost their language, creating the Creole instead. It’s still difficult for me to understand most of the time, but I can catch bits and pieces. Aprill got us all to Hillside safe and sound and showed us around a little. We were the first ones here so we staked out our rooms and got settled while meeting Dr. Dick and John and Mary Pat. Dr. Dick deserves his own entry, so I’ll write more on him later…

John and Mary Pat took us up to the Bazaar held by the nuns. We had delicious, although mysteriously flavored, ice cream. Saw the church and school and hung with the locals for a while. Once back at the dorm we had PB and Gooseberry Jelly sandwiches so we could take our chloroquine. Hailey and I checked out the student log then ventured out on a walk down the road. Not 15 minutes later: downpour. We walked back to the clinic completely soaked. On the way we did meet a nice women who lives at the end of the road who invited us down to use her pool whenever we want. More students arrived at about 4pm – 4 girls in PA school at Marquette. We seem to get along with them pretty well. Aprill arranged for pizza to be delivered for dinner which was amazing! Then Meredith (med student here with Dr. Dick) told us about the local bar so we decided to head down for a drink. Meredith and Adam (medical resident from Indiana/St. Louis) arrived around 6pm. We befriended an adorable (although not quite as cute as Atty or Sprout) kitten at the bar, along with a couple stray dogs. Hailey and I both drank for a grand total of US$5 tonight – did I mention I love this country?

Tomorrow starts orientation. We get to go to the market in the morning and tour the polyclinic in town in the afternoon. We may also check out a mass at the cemetery in the afternoon too. We’ve already got a ton of plans for things to do throughout the week and I can’t wait to try all the places in and around PG. We’re planning on heading out to an island for the second weekend we’re here with Aprill’s husband. We’ll get the entire place to ourselves and the snorkeling is rumored to be amazing. I’ve also found 2 other divers in the group. Merik is Advanced Open Water certified and Liz just finished her Open Water certification a week ago – so with any luck John can get us a good deal on a couple of 2 tank dives.

Well, it’s 10pm and we’ve got a fairly early morning – especially with 16 people getting up in the morning. Expect more soon!

Did I mention no internet? That’s why this was late, sorry!

Arduous Journey

I kinda guessed this journey might be off to an interesting adventure when our first flight was canceled before we even got to Minnesota. Thankfully American was nice and got us rescheduled on a 0705 flight. So, at 0400 this morning we woke up and had an amazing fresh coffee cake compliments of Jason (Hailey's stepdad). At the airport we were lucky enough to run in Kris Jetzer who got us amazing seats on our first flight. After a nice 1 hour and 49 minute nap - we landed in Dallas and spent the next 3 hours walking around. On the bright side - the bar at Bennigan's was showing the Badger game, so we got to see the game up until half time. The flight from Dallas to Belize City was delayed about 15 minutes because it was being inspected by "security". Once in the air we were excited again to be leaving the country. Touching down in Belize it was a blamy 78 degrees farenheit (I need to work on my ability to convert from celsius...). Once through the ridiculous clulster that was immigration and customs we stood in line for at least 45 minutes waiting at the Tropic Air counter to get our flight to Punta Gorda. There was this one guy working the counter who was extremely nice and helpful. He took our bags, helped us get our flight - really took care of us. After all this waiting, it started down-pouring and our plane decided not to come to the airport... So with some help from the extremely nice staff we ran into another student headed to the clinic too (I'm actually sitting in the hotel talking with him and Hailey). We got a ride to the Global Village Hotel in Belize City where the staff was also extremely helpful and got us into the hotel safely. With the free internet up and running, Hailey and I headed out in search of dinner. Attempting not to get run over (Belize has no sidewalks) and avoiding the hooligans at the local bar, we ducked into a chinese restaurant about a block from the hotel. There was ordered our food and had our first Belikens (Belizean beer). Also got to see our first lizard on the wall there. Walked back to the hotel again trying not to get run over and ran into some people we had met at the Belize International Airport. First thing she said, "Where'd you get the beer?". The entire hotel lobby is full of people we met at the airport who also had their flights canceled. So we ate dinner with them. Now we've been chilling in the hotel talking with the other student. We've got a flight to Punta Gorda in the morning - 1030 and will hopefully not have any further troubles. It's been a very interesting trip so far and we're only on the first day. I can't wait for the rest.

Packing

I'm currently living on a couch in the living room of "my" apt. It's tough not having your own space and trying to pack up things for the month you're not going to be in the country while at the same time deciding what you're bringing to Belize and how you're going to find everything you need in the mean time. I feel like I'm in this strange limbo. This isn't really my apt, it's not even my couch, and yet it's my bedroom. I've commandeered a space behind the couch too that currently holds the disaster that is my attempt at packing. I'm such an organized person that I can't even look at the mess behind the couch without shuddering. I have no clue where to start, and with T-minus three days to departure I need to get to work on packing: NOW. I've resolved to keep it simple - not take more than I need - not over pack. I'm limiting my luggage to 2 medium bags and 1 carry-on. I think I can manage... right? Most of you know me and my packing abilities (or lack thereof) - any comments? :-D

Reflection

I think the thing I am most apprehensive about is just being “on my own” in a foreign country. I’ve never traveled abroad before; I’ve barely traveled within the U.S. without my parents, and never without a large group of friends. I know I’ll have Hailey and John and Mary Pat which is helping to calm my fears quite a bit. But there’s still a part of me that is nervous to be in another country so far away from the familiar. I suppose it could be excitement as well. This is one of the greatest opportunities that have ever been presented to me. Not only am I going to a beautiful country with amazing people; I also get to experience a completely different style of health care and learn and grow from those experiences. Hopefully I can bring the knowledge I gain at Hillside Clinic back to Wisconsin and share it with others to help us to realize the awesome advantages we have here and to acknowledge ways in which our practice could is different from other practices (both for the better and for the worse). I guess I’d have to say that that is really what my overall goal is for this rotation. I want to experience a different perspective on medicine and patient care and then find the best ways to apply that experience once I get home. Because what good is it to travel to an exotic location if you can’t learn something to share once you get back.

On the topic of goals I’m very interested in prescribing patterns in Belize (and any foreign country for that matter), especially in the context of differing disease burdens. I remember learning that many of the commonly seen disease states in the U.S. are beginning to be more prevalent in other countries (diabetes, hypertension, hyperlipidemia), but I know there will be a diverse new set of illnesses in Belize that I may or may not have encountered before. I feel like our schooling, while adequate for practice in the U.S., lacks a thorough base of tropical diseases and health in foreign countries in general. I’m not sure if I’m entirely prepared to work with “novel” illnesses, but I know I’m ready for the challenge they’re sure to present. This is another place where I feel extremely lucky to have John and Mary Pat as my preceptors. Their extensive work in Mexico and Belize is sure to come in handy and help Hailey and I to learn more and see more than we might have with other preceptors.

Speaking of John and Mary Pat I again feel fortunate that they are coming along to Belize. I’ve had the chance to meet John (and give him his influenza vaccine) and even in the short time he was back at the pharmacy I’ve learned a ton. To top off his amazing wealth of knowledge, he’s spectacularly funny and easy to talk to and get along with. And while I haven’t yet met Mary Pat I’m sure she’ll add another fascinating layer to the dynamic of the trip.

Of course, while my main goal focuses on health care and pharmacy, I also hope to learn more about the culture and the people of Belize. I’ve already heard interesting stories of weekend trips, adventures with translators, and multitudes of new friends. And it isn’t only the people of Belize who can provide me with another dimension to my education. My fellow colleagues at the clinic may also be from other countries. Not only will the health care in Belize itself be different, but the way in which each of them practices will most likely vary from both my own idea of health care and that of the people of Belize. The many dimensions to this trip will make for a gratifying experience if approached with the right frame of mind. I’m planning to head into the venture with a completely open-mind, practically a blank slate (tabula rasa), to ensure that I have the greatest ability to gather and apply new information. At the same time I hope that those around me will find some of my knowledge and practices useful as well, and will take them back to their homes to share.

Ultimately I believe that this experience is about sharing all forms of knowledge. It is an amazing opportunity that I hope will present itself many more times in my life as I continue to shape my career and my practice.