Week #4 (4 weeks late!)

Hey everybody!  So as you might have guessed, we are definitely not in Belize anymore.  :(  It is nice to be back home but at the same time, our hearts are being pulled back into service.  The last few days in Belize proved to be some of the blessed times that we had and also stretched us tremendously (particularly me)!  The last few days in Eldridgeville, David continued to tweak vehicles and plumbing.  In the evening, he spent time with one of the night watchmen, Marlin.  He is a young man around 18 years old who has many aspirations and wants to pursue art and music.  David was able to share his faith with Marlin and his cousin too- bonus!  Both young men were incredibly eager to hear and asked him loads of questions.  It was an awesome experience for him.  Another good friend that David made over the course of the month was Evert, the campus handyman.  Evert and his wife asked us to dinner for our last night and we dined on a local delicacy- armadillo.  It looks just like chicken but tastes nothing like it!  David liked it. 



Evert and his family

On his last day, David said he felt like the month just flew by and he wished he could have helped with x, y and z.  The staff at the clinic thought he could fix anything and they were sad to see him go.  He helped them a whole lot and if we ever get to go back I know he will be welcomed with open arms. 

Evert, David and Lesli

As for me, the last week was a growing experience, to say the least.  During the first three weeks, the supervising doctor was Dr Sue, a pediatrician who took me under her wing and was very helpful.  She completed her year of service and left at the end of my third week. 

Dr Sue and David

The clinic is actually run by a husband/wife nurse practitioner team that have been in charge for the past 2 1/2 years.  They just happened to be on vacation those first few weeks.  So as Dr Sue left, the chain of command switched and so did the game rules.  Basically, I became the one in charge of my team and as such had to see all of the patients after the students.  No big deal except some of my patients were in their 60's and 70's, which is just a few decades outside of my normal age range. During the last week we also went on our overnight mobile.  Some of the villages are too far out to be able to drive there, hold clinic, and drive back all in one day.  In those situations, we drive out, hold clinic, have community education at night, sleep somewhere, drive to the next closest village, hold clinic then drive back.  It was an exhausting 2 days.  Once again, I was in charge.  The nurse practitioner went along but was very clear-it's the Sarah show unless I couldn't handle it.  So I saw 125 patients in 2 days. The patient population was almost exclusively women and children with anything from ingrown toenail to be removed to skin infections and type 2 diabetes.  One woman had all the typical symptoms of high blood sugar and when I checked she was 540!  (Normal is less than 120).  All I had was 2 different oral medications to give her.  No insulin, no ability to check any lab work.  I couldn't even give her a blood glucose meter to check her sugars.  All I could do was give her 2 months worth of medications and hope she shows up to the clinic in 6 weeks when they get back around to her village.  We saw so many patients, many of whom weren't even sick.  It was kind of frustrating but I suppose if you have 10 kids and don't have a doctor where you live you might take your kids to see one if they are in town whether they are sick that day or not.  One of the more exciting events that occurred during those two days was the birth of a bouncing baby in the back of our mobile vehicle.  We got word that a woman had been laboring for a long time and our driver was going to take her in to the nearest Polyclinic (a rudimentary hospital).  I sent one of the students to ride along but they didn't even leave her house.  Once they got her in the mobile they realized the baby was nearly out.  The medical student delivered the baby, on the cushions we had slept in the night before.   It was quite a story to tell when we got back. 

Mobile Clinic location in San Vicente

My team: L-R= Becca, pharmacy student; Kristin ,PA student, India, UK medical student; Anya, PA student

Our accommodations for the overnight

Seeing patients

Malnourished child: see the light colored hair?  There are no natural blonde children in Belize

Bad impetigo (skin infection)

Overall, it was a fantastic learning experience.  I not only gained knowledge about typical illnesses in developing countries but also got firsthand experience in the day-to-day running of both local and mobile medical clinics.  My Residency program has asked me to give an International Medicine presentation to my fellow residents next week and has also invited me to speak at Grand Rounds, a conference for practicing physicians and attendings.  I'm not sure why I agreed, but at least it's not until February!  If David and I learned one thing after our month abroad it's that we know we are not done with medical missions.  As soon as we got home, we were ready to go out again.  We aren't sure God is calling us back to Belize but we have no doubts that one day we will call another country home.  Until then, we are doing life, work, church, home repair and enjoying our family and friends when we get to see them.
We thank you for coming along to Belize with us.  We hope that you enjoyed your look into medical missions and pray that we have inspired you to make your hometown your mission field.  When you are ready to expand the playing field, let us know.  We'll be headed somewhere before you know it!
In His Service,
David and Sarah Kelley

Week #3

Hello to all of our blog readers.  We noh wanna kepe u lon so we gonna mek dis shart (Creole for “We don’t want to keep you long so we are going to make this short).  The truth is, we are using some really sketchy internet and wanted to update you but we needed to do it fast!  So we apologize for not including pictures this week, but we promise to make it up to you with next week's.  How’d you do interpreting that?  It’s amazing that it’s basically the same language we speak but so much gets lost when you are talking to people that it’s easy to get confused. 

This week was relatively short for us as we had a three day weekend.  The big event for the week was a Health Fair that we had today, Sunday.  The point of the Health Fairs is to get the people in the villages to come out and interact with us.  We had a tent set up with posters about hygiene, nutrition, common illnesses, good posture and such.  We played lots of games with the kids and gave out loads of toothbrushes, little toys and balloons.  It was a pretty good turnout and besides getting soaked in the rain, we had a great time.

David continues to help where he is needed.  In short, he fixed multiple vehicles, fixed door thresholds that were letting water flood into the pharmacy, fixed leaks in the concrete roofs, and playing soccer with the little ones on Tuesday night, and watching a movie with the kids in town on Friday (we brought in a computer and a projector and played “Sandlot”).  He’s been a huge help to the local staff and I’m not sure they are going to let him go at the end of this week. 

I continued to go on Mobile clinics and doing clinic here this week.  I had a little more autonomy this week in that I was precepting some of the students with pediatric patients and actually staffed the Mobile clinic for the most part one day.  It’s nice to spread the wings a little bit and not have a crash landing. 

Our time here in Belize is coming to a close.  Can’t believe it’s been nearly a month already.  We leave for the States bright and early this coming Saturday, so keeps us in your prayers as we travel back.  All in all, we both have enjoyed our time spent here.  Not exactly what we expected but that’s sometimes a good thing.  It was definitely a great introduction for me to see what goes into making an International medical clinic work.  It won’t be the last trip we go on, that’s for sure!  This will be the last posting here in Belize.  We will write about our final week from Florida and post more pictures.  Until then!

Belize Week 2

It’s hard to believe that our time here in Belize is already half over.  We have been keeping ourselves pretty busy between working with Hillside and seeing the surrounding countryside on our weekends off.  We wrote that last blog entry while resting at a resort in a more “touristy” location within Belize, Placencia.  It is a small seaside town about 1 ½ hours north of where we are staying.  It was a nice, relaxing weekend spent snorkeling around the coral reef off shore and resting in a cabana by the beach.

Monday we were back to Hillside and ready to work again.  David has continued to help weld the hurricane shutter brackets and help around the campus as a general handyman.  He has also been trying to assist Everet, the campus caretaker, in getting some of the vehicles fixed.  Hillside has a limited number of vehicles and when one of them needs repair, it puts the whole operation in a bind.  Apparently, the right automotive parts can be difficult to find as Everet has ordered three different rotors for this truck and none of them have worked.  Be grateful if you live around the corner from an AutoZone!

Looking back over the week, the pervasive theme would have to be cultural awareness.  Through various activities, we gained firsthand knowledge of how Belizeans live, work and play.  You see Belize is every bit as much of a melting pot as North America.  Centuries ago, it was populated by various Mayan tribes, who for whatever reason fled their cities.  Over time, Belize was incorporated into the country of Guatemala.  In fact, even today, certain Guatemalan maps will show Belize within Guatemala.  Belize changed hands multiple times throughout history but most recently was a British colony, which is why Belize is the only country in Central America to have English as the national language.  At some point in time, the Mayans started making their way back into Belize.  There are two main types of Mayans: Mopan and Quechi.  In addition, there are also many East Indians who remain in Belize as the British brought over many of them to be their slaves when they colonized the area.  Besides the Mayans, the largest cultural group is the Creole.  To be considered Creole, you must have some African heritage.  In addition to East Indian slaves, Africans were also shipped over and eventually mixed into the British settlers resulting in the Creole people.  The last main group of people is the Garifuna, an African tribe that fled their country and took refuge in Belize.  Interestingly, there are also small groups of European Mennonites that have also settled in the area.  In the cities, you will find a complete mixture of peoples. Alternatively, in the villages, they tend to be mostly one people group.  For instance, where we are staying in Eldridgeville is an East Indian community.  A village called Barranco is a Garifuna village, San Vicente is Mopan Maya and so on.  As such, each type of village has a different primary language, way of dressing, living and commerce. 

My week started with another mobile clinic, this time our destination was Na Lum Ca,  a Quechi Maya village several hours from Eldridge.  This village was up in the hills and has no electricity or running water.  Most of the villagers earn their living by raising their own crops such as corn and cocao (chocolate).   Raising a crop such as corn for these villagers means clearing a large area from jungle brush with a machete ( usually on a steep hillside), planting the seed by hand, clearing away weeds and regrowth of the brush several times as the corn grows and finally harvesting the corn by hand.  They then dry the corn with the husks on in large piles that they spray with a herbicide made from a certain plant found in the jungle.  Once the corn is dried, they remove the kernels from the cob, again by hand.  The dried kernels are then used to make the mainstay for food: corn tortillas.  This process starts with grinding the kernels on a stone trough.  A rectangular shaped stone is held and pushed back and forth on the trough in a rocking motion to grind the corn into a paste as small amounts of water are added.  This paste is then flattened into tortillas and cooked on a hearth.  Below are a few pictures of me attempting the whole process.

This is how the pro gets it done

This is Cacoa (chocolate).  The chocolate we love starts out as a seed that is harvested, dried and powdered into cocoa.

Mobile clinic that day was a bit on the slow side, so I ended up doing what I do best: playing with kids. 

This little one got a sticker and several silly bands because she sat perfectly still while I attempted to dig three layers of ear wax out of her ears!

Another source of industry for the Mayans is making baskets out of a plant called Jippy joppa. 

The plant is prepared by taking off the spines of each long leaf and then dried into long strands that are bunched together and bound by a small vine.

The bundles are sewn together with the vine in a circular fashion and eventually turn into a beautiful basket. 

David and I also had a chance to visit several villages with another doctor that has been working here since January.  He is in charge of gathering and training appointed healthcare workers for each individual village.  There are dozens of villages just in the Toledo district, connected by very rough dirt roads.  The majority of villagers don’t have vehicles.  Buses do travel to these villages but usually only twice per day and only three days out of each week.  Since there is such limited access to doctors, there is a need for someone in each village to have at least a basic understanding of common medical problems.  On Thursday of this week, he took both David and I out to see about 6 villages, meet the healthcare workers and invite them to a training session.  Very few of the workers have phones and postal service is super slow so it has proven more efficient to simply drive out to each village and invite them personally.  During that day, we saw many different types of villages and homes.  It was a truly eye opening experience.  I don’t have many pictures to share with you but I will do my best to describe to you an average Mayan home.  It is usually a single rectangular building with a dirt floor, thatch roof and wooden slab sides.  They cook indoors on a fire hearth, usually placed in one corner of the room.  This poses many problems, mainly smoke inhalation.  You will usually find a few cooking utensils hung on the wall and perhaps a wooden shelf with a few belongings.  They sleep in hammocks which are strung across the room.  Babies also sleep in a hammock suspended from the ceiling.  The last picture below is a young girl holding her nephew in a baby hammock.  The picture is really out of focus, but if you look closely, you will see a blue band-like part of the sling.  This is used to hang the hammock from the ceiling and also as a means of carrying the baby around.  The band will either be placed across the collar bone of the mother or placed on the forehead. 

A typical village home

A very well-stocked kitchen

Belizean baby carrier

This weekend, we find ourselves in San Ignacio, a town in the north western part of the country near the Guatemalan border.  Yesterday, we went into Guatemala to tour the ancient ruins of the Mayan city Tikal.  It’s truly an amazing place.  Over 8 square miles!  There was a lot to see.  Below is a sampling of some of our favorites.  Tomorrow, we plan on touring ATM, an underwater cave about an hour from San Ignacio.  We will be sure to include pictures of that with next week’s blog.  Then it’s back to Hillside for another week of clinics and welding! 

This is a diorama of Tikal

Looks like just a dirt hill, but underneath all that brush is an ancient building

A building in partial restoration.  See the top that been mostly restored while the bottom is only just started

The view from the top of the above building (this is the exact view that was used in the first Star Wars movie)

The Gran Plaza, where the royals lived

Lastly, I want to leave you with a few pictures of what makes me happy: the kiddos.  David and I brought bubbles, balloons and silly bands with us that I have been giving to the kids that live in Eldridge.  One afternoon I stepped out of the dorm to the road and started blowing up a balloon.  It didn’t take long until the kids started running up the road.

It’s a beautiful country

Belize Adventures, Week 1

Our adventure started early Saturday morning with a phone call from the airline at 5am.  The voicemail went something like this, “Your flight to Belize from Miami has been cancelled.  We have placed you on a different flight leaving out of Dallas.  Your new departure time from Tampa International is 8:30am.” No big deal that our flight was changed, except that originally we were supposed to leave Tampa International at 9:45am.  So instantly, panic sets in.  I’m not sure if many of you have had the pleasure of seeing me in a full out hysterical panic but I imagine it is quite entertaining for a bystander to observe. Unfortunately, David doesn’t get to be an innocent bystander.  Seeing as we are now leaving on a flight over an hour earlier than we thought, we need to leave NOW! Of course, I had waited to start packing for our month long trip until late the evening before we left.  I finally laid down for a few winks at 3:30am and still had multiple little things to pack up.  Basically we threw what we could into the bags and jumped in the car and off we went.  Our friends, Ken and Kendra, drove us in our car so they could have access to it and were gracious enough to agree to care for our dogs and home while we are away.  I finally started to calm down about half way to the airport as I realized whatever wasn’t packed wasn’t necessary and we can buy what we need when we get there.  Ironically, when we arrived at the airport our flight was delayed a little over an hour, so we were back at the original departure time.  The rest of the day of traveling went relatively smoothly.  Since we were routed through Dallas, our arrival into Belize City was later than our original flight so we missed the 2pm flight to Punta Gorda.  Thankfully, there was a 5pm flight with room that we were able to squeeze onto.  Since I’ve never flown with any of my cousins/uncles that fly, this was officially the smallest plane I’ve ever been on.  It took off from Belize City, landed briefly in Placencia to let the tourists off and then on to Punta Gorda to drop off David, me, and a pharmacist from Drake University. The folks from the clinic came to pick us up and eventually we arrived safely to the clinic and lodging site with all our luggage and donated medications (except that David left the laptop case in the small airplane.  Luckily, it’s a small town and we were able to pick it up the next morning).  

                                         Tropic Air Flight from Belize City to Punta Gorda

                                                                View from the plane

                                                      Baggage claim in Punta Gorda

We arrived at the campus of Hillside Health Care International shortly after being picked up in Punta Gorda (PG).  PG is about 6 miles away from Eldrigeville, where the clinic is located.  They have a nice dorm style lodging for the rotating students and volunteers. 

                                                                 Hillside Clinic Campus

                                                                      Hillside Dorm

We arrived about a day earlier than most of the other volunteers but there was a small handful already there for our first night and day.  The next day after our arrival was Sunday.  We decided to visit one of the local churches for a service.  We ended up at a small catholic church and enjoyed a short mass there.  The national language of Belize is English, so we didn’t have any problems understanding the sermon.  Following along with a traditional catholic mass, however, proved to be a little bit of a challenge. 

                                                            The Catholic Church

Later that afternoon, we decided to explore the local area on bicycle, as that was the only mode of transport readily available besides our feet.  We rode into PG and went to a few stores, although most were closed.  David managed to find a Coca Cola, a cheeseburger and some ice-cream.  We made our way back to the dorm and spent the rest of the evening getting acquainted with the other volunteers. 

Riding bicycles

There is a mixture of fourth year Pharmacy students, medical students and Physician Assistant students.  I am actually the only person with a degree, besides the clinic staff.  This first week was more of a week of orienting to how things work in Belize.  Hillside has clinics on the campus daily from 8am-12pm.  Usually there are two teams.  One team mans the clinic and the other team goes out on Mobile Clinic to one of the surrounding villages.  In clinic this week I saw a lot of similar problems to what I would normally see at my clinics in Florida; mostly ear infections, colds, skin infections, rashes, and gastroenteritis.  They do have a lot more scabies here than at home (scabies is basically body lice- little mites that burrow under the skin and cause a very itchy rash).  I went out on one Mobile Clinic to a small village called Cirque Sarco.  It took nearly 2 hours by car, over very bumpy dirt roads to get to the pedestrian bridge.  From there, we had to carry all of our equipment over the bridge and then on about ¼ mile to the village.  Since we are in Belize and it’s the rainforest, it had recently rained and we all got quite muddy on our trip in and back out again.  We set up clinic the village health center, a small concrete building with antiquated examining tables/equipment.  It was quite hot that day and the building had very few windows and certainly no air conditioning.  We saw more basic health care patients, although I am convinced that one of the little old ladies I treated had malaria.  Yes, we are taking malaria prophylaxis.  After clinic, one of the local villagers fed us Caldo, a traditional chicken stew with potatoes.  Then we packed back up and headed back to Eldridgeville and the showers. 

                                                                Bridge to Cirque Sarco

Local women doing laundry

                                                        Cirque Sarco Health Care Center

                                    

                                                                      Exam Room

                                                                          Lunch Stop

                                                 Trekking through the mud in Cirque Sarco

That was pretty much my week in a nutshell.  David and I are realizing that we need to be taking way more pictures, especially of the projects he has been working on.  In one short week, he has removed and fixed a toilet (including the concrete underneath), repaired the clothes drier and fixed one of the clinic’s only working trucks (a feat that NO ONE here could have accomplished.  Everyone said it would have been in the shop for weeks!)  He has also been very obliging in killing various bugs and other things for me and the other girls.  One of the main jobs he’s helping out with is welding brackets onto the window bars for hurricane panels.  He’s not a welder, but if you are even vaguely familiar with the concept, you are qualified. 

We have both been surprised by how much and how little the people have around here.  The clinic is decently equipped and stocked.  While there are some much needed items, they also have just about they truly need to operate.  Laboratory studies are still quite hard to come by.  Besides the clinic, most people seem to have cell phones and are land owners.  But with that said, they live in small, ramshackle houses and buildings and exist on much less than what we would consider poverty level.  In our short week here, we have seen a lot.  We can’t wait for more experiences.  Thanks to everyone who helped us get here.  Your contributions are going to good use.  The clinic was ecstatic over the medicines I brought in.  You are blessing many lives here in Belize.  Here are a few more pictures for you to enjoy.  More to come, we promise!  We would love to hear from you.  We are able to send and receive basic e-mails on most days, but we cannot download or upload attachments, photos etc…  Feel free to e-mail us.  Until next time,

Love, David and Sarah

Skelley1@health.usf.edu

davidfooser@yahoo.com

The clinic entrance

This is the bus stop in Eldridgeville

Some of the local children that I've been blowing bubbles with and playing hide and go seek

A typical Belizean Home