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Bring me that horizon...
For me the sea has always been where I turn for inspiration, solace, and wonder. The night I was born I breathed thick salt air and first heard the sound of long Pacific swells rolling onto whispering sand, and from that day my life was held forever in the sea’s net of wonders. My mom and dad were living in a beach motel in Southern California while my dad did his medical residency, and my first steps were on the sand and behind my dad as he made hospital rounds and home visits to patients. I can never remember any time in my life when I wanted to be anything except a doctor and a marine naturalist, and thanks to my parents, extraordinary mentors and opportunities I became a marine biologist and a doctor and have had experiences in both fields that make me grateful to be alive just for one of those moments.
My favorite thing about the sea is that it is not lonely; in the sea I feel connected by the water to millions of people around the world. I imagine millions of people of a thousand colors and languages and religions and nations all floating together in the sea’s embrace and connected across thousands of miles by one continuous, unbroken sea. When we float in the vast sea, only a little of it is holding us up, but that small part is connected to an unimaginably vast and powerful body of water. In the same way, this is how a people are strong. When we say ‘a sea of humanity’ we acknowledge that humanity–all of us together–are as powerful as the sea, which is always waiting to show what it can do.
Like every wave, every life is unique and beautiful, something I have experienced time and again through this voyage. In 2011 we saw our
Fighting bedsores on a dying patient we inherited at the Asilo
10,000th patient, and although I am very proud of how many people have received care through Floating Doctors, what I am most proud of in 2011 was that as we expanded our project, we always stayed committed to the individual patient. Time and again, this has ultimately led to our being able to do more for more people than we originally anticipated and I have faith that we will remain committed to the single, individual patient as continue our voyage.
Long before I was old enough to venture over the horizon the last lands and seas had long since been charted, but fortunately the frontiers of health and the sea of humanity offer an endless horizon. Looking out over the Pacific horizon so many years ago I never envisioned that my greatest loves would one day combine in a mobile medical relief team exploring frontiers of health across the living ocean that washes all shores equally. I had no idea HOW I would pursue these two passions, I only knew with certainty that if I did not have them both in my life, I would never be happy, and so I would look out over the water or read Jacques Cousteau or trail after my dad on rounds, and dream of adventures on distant seas and future patients I would see and help.
First clinic in the new Panga (before we built a canopy)
Repairing torn stitches in Labadie
But all the time a voice was urging me to move forward, always there was another voice…darker, more ancient; a more primitive vocabulary but it didn’t need sophisticated words…it has raw fear, self-loathing, shame, narcissism, and petty angst and selfishness. This voice, all my life, has whispered under my dreams, telling me I will never become a doctor, and never see the seas I spent my childhood dreaming of. Sometimes it spoke with other people’s voices, like during the year we struggled to rebuild Southern Wind after she had been donated to us and some people scoffed and said we would never make it, and it would never work, and we would all be killed and waste all the support we gathered…but here we are. Sky and I lived with fear as a constant companion for the whole tenuous first year of our project, when so often it hung by a thread, but (especially with my sister beside me and many hands outstretched to help us keep going) we were able to move forward, one foot in front of the other, and now here we are…going on a mobile clinic in the morning, more than 600 mobile clinics into our voyage.
La Sabana in the mountains
I know now that this pessimistic voice I’ve always had spoke from feeling not good enough somehow to deserve attaining my dreams, and although as I got older (and continue to get older) the voice got fainter and fainter (I pretty much ignore it on autopilot now…most of the time), it took many years before I could–as my wise sister says–”Allow myself to succeed” without it being a struggle. We are always our own harshest critics and unforgiving judges, but as they saying goes: ‘You never know if you can climb the mountain until you try (REALLY try).’ And as a wise man said, is it really that frightening to succeed, and is it really, in the grand scheme of things, so terrible to fail? And there is always the third option (my favorite): sometimes when you fall, you find out you can fly (or learn how really, really quickly)–especially if hands are outstretched to help you stay in the air, and your ego (and the dark voice inside us) allows you accept the help that is offered.
The kindness and generosity I have seen people show towards us and to others fills me with hope that the daunting
La Sabana in the mountains
challenges of our time can be survived. I am immensely proud of what my crew, friends and family, and all our volunteers and supporters have made possible, and incredibly grateful to be able to be a part of this voyage and to have shared it with such extraordinary people.
Even with all its faults, earth is a beautiful planet, and humanity, despite its many, many faults, is heroic. There are heroes all around us; it has been a great honor to work alongside so many of them.
“The world is a fine place, and worth fighting for.”
Check out these pictures; some of my favorite moments captured in 2011.
Please click on any of the photos to activate the slide viewer.
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Building a wheelchair bridge for a girl with CP
When I last posted in June, a couple of months in, we had just started to really connect with the various subcultures in the Bocas Province, and some situations we quickly identified for interventional projects were as yet beyond our reach. Now we have many more friends and contacts in the community, and we can tackle much more ambitious projects for far less cost.
We have:
• Partnered with local group Operation Safe Water to help transport and install raincatcher systems at local schools when we run clinics
• Arranged CPR certification for the fire department
• Worked with the Ministry of Education to train local high school students as trainers for health education in the community and give them medical work experience by participating in our mobile clinics
• Created pictorial and written information sheets on health issues we have identified and that we make available at our clinics
• Gathered and data-entered over 600 patient health data sets and begun doing surveillance of our own interventions and identifying health issues from the data to help guide our mission activities
• Microfinanced patient transports to care on the mainland and chaperoned them in the hospital system (many Ngobe don’t speak Spanish, and are VERY shy, so they easily fall through cracks in systems)
• Connected with an indigenous Curandero to identify and investigate the plants he uses medicinally and are helping him develop his small botanical laboratory always keeping a lookout for.
• Arranged and executed a CPR and First Aid Seminar for the cruising community in Bocas
• Partnered with the Mayor’s Office to run mobile clinics in conjunction with the government visits to the community
• Partnered with the local Lion’s Club to work in a community they support and help supply the neonatal support unit they built with Direct Relief International suppliesAnd, as always, sometimes we find situations that are just not right. Por ejemplo…
Unacceptable for a 14 year old in a wheelchair
While I was in California, Dr. Barney found out about a 14-year-old girl with what turned out to be undiagnosed cerebral palsy in a small squatter’s community called La Solucion. I have been told it used to be where the airport is now (right next to a mangrove swamp), and when they built the airport the community moved out onto shacks built on stilts over the mangrove mud.
She comes to land at most twice a year…land is about 100 feet away over the sewage-contaminated swamp (all the homes
She has rarely, in many years, been to shore
have outhouses and sink drains that drain directly into the water below). She has never gone to school…she has a wheelchair, but rarely uses it because she has nowhere to go; she has to be carried over the dangerous footbridge by her grandfather, and she is too big now for him to carry (Noah noticed he has drop-foot also…potentially a serious falling hazard, especially if you are carrying your 14-y.o granddaughter over a wet slippery footbridge). She is COVERED in bug bites…she can’t really swat bugs away or keep moving to keep them off her, and she lives in an open unscreened house on stilts over mangroves.
Her grandparents have always thought they were at fault for her CP because she fell out of bed at 6 months (though she had never crawled, which makes me think it probably was CP at birth)…they have carried that burden and they always worried they would get in trouble if the hospital found out, so they have indicated that she has never seen a doctor.
If I were a Hollywood writer writing for some medical drama, my editor would probably throw me out of the building for it being so unbelievably challenging emotionally and physically…but this is real life…this is somebody’s actual life. Sometimes people ask if I miss ‘the real world’…let me tell you, it looks pretty real from where I’m standing.
Driving pilings into the sewage muck of La Solucion
We said we would build her a walkway, and now—6 months into our time in the community—we called on the community to help and EVERY level of Bocas society came together to make it happen. Mangrove posts from an indigenous community, lumber and funds and food from local Panamanians and expats, help from boat owners, crew on other boats, locals from La Solucion, local taxi drivers, local restaraunts…at the last minute we even had no trouble rounding up 2 sledgehammers (one from the fire department and one from the fish market, which I sometimes haunt in the afternoons when the fishing canoes come in).
Everyone gave a little (some more than a little), and in 5 hours we sank thirty 10-foot mangrove tree trunks 7 feet into the mud, from the shore all the way to her grandparents’ house. The walkway went on in the next few days, and then this little girl went to shore (we still have some work to do to finish the walkway and make it safer for a wheelchair). I asked if there was anything in particular she wanted to do on shore (which she can see, 100 feet away) and she said ‘Quiero pasier’—‘I just want to go.’
planking the wheelchair walkway
This is my favorite, favorite kind of project…one where the whole community comes together when it learns about a situation like this. When the walkway is done, it will have been done right, with the right material (always seek expert advice) to make it last for many years. No matter what, this girl’s life is going to be changed forever—and here’s the best part: total cost for all the lumber, food for the volunteers actually building the walkway, gas to go pick up the posts from another island, hardware, etc: less than $1000.
There’s opportunities for helping, constantly around us…when we are alone we can help in small ways…but mira aqui, look what we can do when we all come together! Poco a poco para cambiar el mundo.
Please click on any of the images to activate the slide show viewer.
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It has been two months since I have been able to put words to page although this is not for lack of content or consideration but rather the inability to put thoughts into meaning. In that time period we have left Haiti, seen old friends in Jamaica, and crossed the remainder of the Caribbean Sea to Panama. All amazing accomplishments that should be noted, written about, and reflected upon- yet every time I open the computer to a blank white WORD page I sit paralyzed. It’s as if all of the experiences and work bottle neck themselves in my head and leave a connection with my hands useless.I thought this time that leaving Haiti would be easy, knowing that we would return again, to have seen the faces that I love and know that they are well, and yet in reality it was much harder than the last. To see a little boy that I love with all of my heart playing by the tree where I last left him was a joy but leaving him once again at the same tree eats at me… having him not there the next time we return will break me, and yet when I sit back and think about, having him still there may be just as bad. The never ending tail chasing ‘whats worse’ game that plays in my mind. It seems at times to me that my heart will never win when it comes to my time in Haiti—I will always be pulled back and tormented away. The sights, sounds, and deaths get no easier the second time around- they still work their way in, nuzzle themselves into my soul, and trouble my moonlit nights on the water. As we left Haiti I sat on our back deck for as long as the light would allow my eyes sight with my heart being crushed and simultaneously elated that we were pulling away from the shores not knowing if the tears I was shedding were for her, for me, or for those I was once again leaving behind.
The transit that lay ahead of me turned into 5 of the most memorable days of my life- flat calm and beautiful the seas opened themselves and the life that dwells deep within its blue waters to us. We spent the days spotting whales, dolphins, endless fish, whale sharks, and sharks with an elation that only wildlife can bring. I felt my heart being drawn into the
dark blue that lay beneath our keel, the salt water starting to become part of my blood, her vastness a part of my soul, and perhaps on this transit I truly became a sailor. As I walk down the docks now I feel her calling to me- beckoning me into her wildness and away from the safety of solid land. To trade stability for freedom and schedule for adventure- to stand on our bow with salt laced air in my face and dolphins underneath my feet. To undo our lines and sail into the never ending splendor that is the open ocean.I had dreamed of Panama from the start of my involvement in this project – it always seemed so wild and distant to me. It has not failed to disappoint either- the people, the
jungles, and the islands have opened themselves and embraced our project like no place we have been before. The unending kindness of the people here leaves me speechless as it seems that there is nothing that they won’t do to make ‘us’ happen. Free Dockage from the Bocas Marina and Yacht Club, amazing Fashion Show/Fundraisers from the Calypso Cantina, Wednesday night girls night with some amazing women. The community has thrown its heart open to us and is literally making our project here possible. So much of what I have constantly had to worry about has been lifted from my shoulders allowing me to immerse myself in our clinics. I am humbled, once again, by the generosity of others.I find myself loving my life – on the precipice of my 30th year I am thankful beyond all reason for the life I get to lead. I wake up every morning, usually no one is up yet, and I drink my coffee overlooking one of the most stunning bays in the Caribbean. I awake my crew and head off to a distant shore, often feeling like I have stepped back hundreds of
years in time, and spend my days making peoples’ lives better, making their pain stop, quieting the worried minds of mothers and the crying of babies. And all too often people tell me that it’s so amazing what we do—my only reply is, nope, it’s amazing what I get to do. I am surrounded by suffering and pain and beauty and wonder. My heart is broken and lifted twisted and torn and I would change none of it. My cup runeth over. I am haunted and changed and the luckiest girl I know. -
Here in the darkened back room she sits like a stone- hands shoved under her small thighs, eyes fixed on the worn floor. The muffled noise of the other children playing drifts in like waves through the slatted window– but in this room everything is still. I sit with my hand on her back reminding myself that I am the adult and strong one here– it is not my turn to cry. I watch as the tears run down her nose making perfect circles of darkness on her dirty pants. “I just don’t like it when they look at me while I’m in the shower, but it only happened once”…”It mostly happens to the other girls”. I hear this from all 6 of them….”The boys here hit us”….”we are worked from morning until night and I’m tired”….The room spins as I hold back the choking sobs that are clawing their way up my throat. A knock at the door and a bidding from the house mother and she’s gone– off to the kitchen to prepare lunch for the 23 other orphans. I watch as she pulls herself together, she is 9, she should not know how to hide pain like this. All 6 girls have claimed abuse over the past two hours and here we are left – 2 shells left shocked into silence. I can not show emotion, I can not allow the owners of this hell to see that I know what kinds of evil the night brings here.
Our allotted time is up and we are escorted out under a the watchful eyes of those in charge searching our faces for any sort of recognition “do we know?” “How much did they tell”. The girls pull at my arms as we leave… am I coming back, when, when, when? “Bye Sky, Bye Sky, when are you coming back”? I can see the pleading behind their words… don’t leave me here, please don’t leave me here. I promise them I will do everything that I can.
We get into the car unable to speak , unable to file away what we just saw and heard, left stricken by what people are capible of. They will not allow me access to the girls, I asked to take them once a week– for the first time on this trip there is suddenly “proper procedures” that take months that have to be followed before I can spend any time with these forgotten no named little girls. There is no one for us to turn to. A barrier put in between that has been so far impossible to traverse around– they are money makers who have been taught to shut their mouths for if they speak they are given up to the streets and the ugliness of the sex trade. I have fought to see them, fought to come back… they have my phone number and they call still pleading asking for my return. At night I think of them laying stone faced in their pathetically pink painted bunk beds scared of any noise in the night and what it will bring.
This is the ugliness of humanity- I see it as I toss and turn in my own bed- their hushed tones narrating the visions of their experiences haunting me into wakefulness………..
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Holly and I finally face the task of completely clearing out, organizing, and restocking our medical go-bags
This week saw the first heavy, 3 day long pouring rain for several weeks (of course, while we are trying to load the boat and finish our preparations for departure) and the tying off of many threads we have been following for months…we closed up our clinic in Oakridge, packing everything up and saying hasta luego a mi pacientes. Un momento muy difficile. Thank goodness we plan to return to open the clinic permanently as a satellite clinic, open every day with a doctor and staff on site even when Southern Wind is working elsewhere. Knowing we are coming back after this voyage, and knowing that with what we learned and the relationships we forged on Roatan, we can and will open that clinic, makes it much easier to say farewell. Instead, we say (we are going to Haiti, after all) aur revoir.
We finished off a lot of rainy day projects inside the boat (there are always, always more
Capt. Ed cutting a new gasket for our 671 GM engine pan...doin' it old school
projects), and got down to the business of prepping to load—that means taking every item out of its storage onboard, condensing everything, repacking all our medical go-bags (thank you Dr. Holly!), and most important: we took delivery of our 5 pallets of material left over in Miami from our last mission to Haiti (thank you Gary, Donna, and everyone at Roatan Rotary!), and our 40-foot container from Direct Relief International, packed with medicine and equipment for the clinics in the island and distributed the material to 5 clinics and the public hospital on the island.
And the unloading begins...
This is a crowning moment for Sky. To get this container in, it required over 1,000 emails between Sky, the shipping company, Direct Relief International, Joseph Natale from Fundacion Heart Ventures, the customs office, the customs broker, Roatan Rotary, a cross-country trucking company and a local trucking company in Miami and another in Roatan, the warehouse in Miami with our 5 leftover pallets, the Ministry of Health in Honduras, 6 different clinics on Roatan, and Cepudo (a Honduran NGO on the mainland).
Roatan Public Hospital emergency room with the floor up to fix the backed up sewer
The difficulty is not in sending down material—anyone can order a container and have it
Gary and Sky picking up the pallets Rotary helped us bring in
shipped down here…but not without enormous import fees. It is sending down material and getting it cleared through customs as donated material without $30,000 worth of customs duties applied that is difficult, not to mention that we wanted to create a conduit so that we could send containers on a regular basis. One time is easy…to set it up to be sustainable is way, way more difficult. It took more than anyone else will ever know to get it set up by Sky, but I will always know and always be impressed how much the people you already love and admire can still amaze you.
Holly checking the pile earmarked for the Pandytown Centro de Salud
In a few months I will begin contacting the clinics again, finding out their needs and getting another request for DRI and container number 2…
Our staging area for the distribution to the clinics--thank you Gary and Donna for letting us use the tents!!!! Lifesavers!
Our aid station at the triathlon finish line
In the midst of all this, we still see patients, provided the medical service for the Bay Islands Triathalon (including the kayaks monitoring the swimmers during the first leg), and Dr. Holly—whose training
heading out...some swimmers were really struggling, and a few got lost and started to swim to Guatemala, but thankfully no one went under and didn't come back up
includes major scene accident management—provided 2 days of training for the Fire Department, following up the training provided by our volunteer Sirin last year.
Maintaining head control as Johel comes out
Dr. Holly showed the firemen a particular extrication trick—when you have a patient with suspected spinal injury from a car accident, you can extract the patient through the back window by lowering the front seat, sliding the board in through the back window and taking the patient straight out. Since we have the use of Gary and Donna’s open jeep, we could simulate the extraction without having to smash a car’s back window. We are nothing if not adaptable.
The weather is looking good for this weekend (pouring rain now)…high pressure pushing down, maybe keeping the low centers at bay over our projected route. Loading the IV fluids tomorrow and the next day…Finish securing the boat for sea…provisioning….and a last good night’s sleep.
Then give me that horizon.
Photos of patients used with patients’ express permission.
Photos of unloading and interior boat construction (pretty much most of the nice-looking photos) courtesy of Dan Chomistek
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Fred scanning for an eyeglass perscription
Last week we had an awesome experience—in the midst of our last weeks of preparation for our mission to Haiti, we are continuing to open our Oakridge clinic. Pretty hectic—clinic by day, boat work by afternoon and evening, and computer work late into the night…but totally worth opening the clinic not only because we had a full patient list right away, but also because we had some very welcome visitors to the Oakridge clinic on Wednesday.
Optometrists from Manteca Rotary Club in California’s Central Valley came to our clinic
The glasses Manteca Rotary brought with them--not bad looking glasses!
and provided prescriptions and eyeglasses to 40 or more people in one morning’s work. They were cool—came in, knew exactly what to do, had obviously done it before and saw as many people as humanly possible in the time allowed. Exactly the kind of group I love to work with; the maximum effect with the minimum fuss.
One thing that made their work really efficient was the little device they had with them—it was a Welch-Allyn device for scanning and identifying patients’ eye prescriptions. When I heard optometrists were coming, we pulled out and dusted off the traditional optometrist machine sitting in the clinic building we use, but the device they had with them made it
Renee testing a patient's glasses perscription
look like a piece of obsolete medieval torture equipment. Fred, the optometrist scanned patients, gave them their prescriptions, and Renee (the former club president) gave them their glasses—both reading and distance.
If one of those were on station somewhere for a month, I think it could do about 2,000-3,000 patients. That is an INSTANT, huge increase in someone’s quality of life. Apparently the units are affordable, easy to learn to use, and of course small and portable. We have GOT to try and get one of those.
It was great being back in clinic—plus, we have Dr. Holly with us as well. We picked her
Welch-Allyn presents...the medical tools of the 21st century. I want one really, really badly to take to our destinations.
up at the airport in San Pedro Sula on our way back from Copan. She is an Accident and Emergency Room doctor and Tropical Medicine specialist from the UK, and will be working with us for 3 months before joining the Flying Doctors in Africa. It was wonderful to have so much help in clinic; Donna from Roatan Rotary was with us, Sky was running the front desk, Noah was doing his Thursday physio sessions. I love it when the clinic is humming; ultrasounds and minor ops, consults…love it.
Our container from Direct Relief comes soon…can’t wait to distribute it among the clinics (and pack the 350 cases of IV fluids onboard to take to Haiti for the cholera relief). So much to do in these last
Our walk-in consult list after being open for 10 minutes
weeks…just like the first time, we went, except this time we have already done it and have substantially continued to rebuild our ship ever since we set sail. We are better equipped and more experienced than our first trip, and that was a success.
I am confident, a little scared (if you aren’t scared of the ocean then you have no business going out on it), and excited to return to Haiti. It’ll be an 800-mile, uphill (upwind and up current) trip but with the right weather window we can do it. Still have a lot to do first, but it is getting done every day…and probably will be right up to the day we leave!
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His right hand took the most injury because he was using it to defend himself
As we were closing up shop after a busy clinic day in Oakridge, we got a call from the Roatan Zoo—one of the new keepers had been badly mauled by one of the monkeys while cleaning the enclosure. Oh man…after a late night working on the computer and a CRAZY day in clinic I was looking forward to lying down for a while, but when the call comes for help, you have to help–so we grabbed our minor surgery bag and some antibiotics and headed over.
Apparently, the victim had been employed there about two months, and was working (as usual) with the main keeper, who had been with the zoo
On arrival we found he had been bitten about 40 times on the legs, hands and arms
for 5 years. They had been in the cages together many times before, and had no problems, but this time the head keeper stepped out to grab some additional cleaning supplies and one of the monkeys decided to challenge the new guy.
While with the head keeper, he had been safe—the head keeper’s place in the monkey society was well established (as boss), so the new keeper got a free pass. But when he was left on his own, one of the males just went for him. He was knocked to the ground and savaged, bitten and clawed all over his legs and his arms and hands; the monkey actually went for his face—all the wounds on his arms and hands are classic defensive wounds. Fortunately the head keeper heard the commotion, ran back and pulled the monkey off (the monkey immediately submitted to the head keeper).
The male in question had been horribly abused in its previous home; it had come to the zoo nearly dead…now it is in fine form; I guess it feels strong enough to challenge newcomers in its little kingdom. Everyone always looks at monkeys and goes ‘Awwww….how cute.” And it is true, with their little human faces and adorable antics, they are pretty fun—but they are also wild animals with motivations all their own, and with lots of strength, agility, speed and teeth and claws!
One tough hombre...he was smiling when we arrived, but I gave him a shot for pain before we started
When we got there, the poor guy was a little shocky, covered in blood, dried monkey saliva, and dirt and debris from the bottom of the monkey enclosure. He was so filthy and crusted that we couldn’t even see where the wounds were. Pretty bad scenario from an infection point of view; monkeys have fangs that can bite pretty deep and inoculate your tissues with their raw sewage-like saliva (pretty similar to human saliva, probably).
I immediately gave him an injection of ceftriaxone and an injection for pain. We used a garden hose (the water at this resort/zoo is filtered and potable) to soak off the filth and dried blood as it would have taken more gauze than we had with us, and been more painful. The hose helped gently soak open the dirty scabs over the wounds, and let them bleed out a little to help clean them. Finally we could see the wounds—lots of them, probably around 40 bites and claw marks. If he hadn’t been wearing jeans, I think he would have lost half the skin on his legs, and if he hadn’t had his arms up in front of his face things would have been a whole lot worse.
After disinfecting and irrigating all the wounds, we salved them with antibiotic ointment, dressed them, and gave him oral antibiotics and painkillers, and fresh bandages for his family to change for him if he got wet. We also started him on acyclovir, an antiviral given as prophylaxis for monkey bites. The next day, all his wounds were clean and dry except for his right hand and left forearm, which were very swollen (and pus was expressed from the hand). We added a second, stronger antibiotic and got him to start bathing his wounds in hot soapy water a few times a day.
Gave an injection of ceftriaxone (antibiotic) as well as tramadol for pain
It worked—his swelling went down and his wounds are healing nicely. Never a dull moment practicing medicine in the tropics, but most of all I liked that we were able to bring care to his home. The house call is still my favorite consult.
When I was a kid I watched my dad do house calls in Los Angeles…practicing Alaskan small-town doctor medicine in a big city. In my folks’ house, as long as I can remember, there is an old print of a painting of a doctor, circa 1830ish, on horseback with a lantern and black medical bag in the dead of night, riding slowly through a driving rainstorm. There’s no adrenaline rush about the figure; the doctor is not flying down the road, coat trailing behind and sparks flashing from the horse’s shoes on the cobbles.
Rolled Gauze to hold the 4x4s on and to cover all the small scratches
Instead, the doctor looks cold and wet—can barely see his face behind his upturned collar, peering head through the dimly lit night. He has the air of one doing a job that he is doing because he has no choice, because it is who he is. It would never occur to him that someone else should be the one to go out in the night and go help a sick patient. He goes, and gets cold and wet and more tired (he must be a critical care doctor), because to him, that is what a doctor does. It isn’t even a sacrifice, just a part of his core being. I always felt like that picture captured some of the essence of what being a doctor means to me.
All photos of patients are depicted with consent of the patients.
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95 Degrees Training In Brush Gear With 95 Percent Humidity
“Superinfermera”
Here in Honduras, as it was in Haiti, on any given day my crew are usually spread out at several locations, and when I find out later the details of what they have been doing, I am always astonished. Today we recognize the awesomeness of the work done by nurse and instructor Sirin Petch. By the time we had been here about a week, we learned that the single fire station on Roatan had not been given much formal training, and Sirin agreed to work with Maddie to provide training in emergency response. Nearly every day for almost two months, Sirin worked with the firecrews to provide training in airway management, scene assessment, lifting and immobilization, choking, and other techniques necessary for EMS response. Some of them had joined the department when they were 14, but few had been able to get formal training. The firemen are paid very little (they have to buy oxygen for the ambulance out of their own money), and they work hard.
Sirin first asked the Firemen what they would be most interested in learning, and looked at the resources that were available and would be the most useful instruction for work here in Roatan, and then provided training. Maddie was instrumental in helping communication, plus she is a naturally gifted teacher, and later they were joined by Zach, one of the pilots on the emergency helicopter, and Yolanda, a paramedic from Montana volunteering for a couple of months on the helicopter.
Sirin and her team trained the fire crews, went on night calls with them, and even after Yolanda and Maddie had gone home, Sirin continued with the firemen. Near the end of Sirin’s time with us (for now?), an incident occurred that says a lot about the relationship Sirin created with the Bomberos. I got a phone call to transport a patient on the helicopter to the mainland, so I made my way to the landing field, prepped the gear in the helicopter and waited for the Fire Department ambulance to bring a patient with suspected barbituate overdose. The ambulance arrived, the doors were kicked open, and out jumps Sirin and the firemen, who hand off the patient to me on the helicopter.
On the way back to the station, Sirin and the firemen got a call for a woman in full arrest. Sirens blazing, they arrived at a house surrounded by wailing family members. A larger woman in her 40s had a full arrest, in a house at the top of a 30-foot embankment. Using the techniques Sirin had taught, they put her on an immobilization board, inserted an airway, maneuvered her down the hill to the ambulance and raced to the hospital. They worked hard to resuscitate the woman, both in the ambulance and the hospital, but eventually had to call time of death. Sirin helped arrange the body and deal with the distraught family thronging the hospital corridor, then she and the Bomberos headed back to the Fire Station, only to be diverted to a brush fire. They gave Sirin a brush jacket and sped off to a banana plantation, arriving as it burned itself out. Scrambling up the smoking, scorched earth, they made sure the fire was completely extinguished, then returned to base.
Beyond the skills and training that she made available to the firemen, I believe that Sirin gave them something much more valuable. They looked at what Sirin knew, and her professionalism, and saw its value. She earned their respect (not always easy for female professionals in Latin America) and their friendship, and helped inspire them and motivate them to want more training and to seek it out. They have asked Sirin to send EMS instruction books and have increased their physical training (Noah has worked with them in the gym and done lifting and transferring instruction with them, and a few days ago I boxed with another).I am very, very proud of the work at the Fire station, and very proud to have seen Sirin rise to such a challenge. Long after we are gone, I hope the knowledge and professional pride she left behind will continue to grow and help people.
