What Len is doing while Dr. Sue cures the sick of southern Belize and mentors young doctors from around the globe

Len working on the veranda at the clinic

When I came down I thought I’d slowly find little ways to make myself useful and be supportive of Sue. In fact, it has been one month and I pretty much have a whole year’s worth of projects and initiatives set up. Most of my time is spent focused on Hillside from a business perspective.

I am and will be doing a lot of software/system work for them. I’ve already created systems using a fusion of excel and programming to calculate payroll, and to track the pharmacy inventory. Next up is an overhaul of their student recruitment/admission/matriculation from a process and technology approach. I also plan on working with some of the staff to capture the data hiding out in file cabinets and old ledger books to allow us to analyze trends in care across the 10 years of Hillside’s existence.

I do lots of stuff that ranges from small to large in importance. I’ve been recruited to create PowerPoint presentations for next month’s report to the board in Chicago and for a local tour guide that caters to Hillside students. For September (and maybe October) I will be the Student Schedule Coordinator, substituting for a staff member who will be gone on maternity leave. I arranged for a “focus group” evening with our current students. We had them all over to the house for pizza and a Cranium game and we also debriefed them about their month’s experience. (It felt just like my old advisory groups, just 7 or so years older). Sue and I are active in reaching out to the general PG community to search for the clinic’s next senior administrator. We are starting to advise/lobby the Hillside leadership about some changes in direction for the clinic. We feel very much as partners in the future of this wonderful program.

Besides the Hillside work, I am and will be doing teaching stuff as well. For the fall, I am spending my Wednesday afternoons at PG’s high school tutoring students in math. In a few months I should be one of two coaches for the eight students that will represent PG in the Belizian Math Olymiad. [We are so, going to crush Stann Creek]. In perhaps one of my most fun little undertaking, there is a 24 year old young woman from Washington DC who is down here for two years teaching for her first time at the high school and we are informally meeting weekly to talk teaching. My protégé reminds me a bit of Christina Svenningsen (if you knew both, you’d agree with me). She is very perky and upbeat and interested in everything and is just a lot of fun to work with.

On a personal level, I have been training for a 10K race in the States in October and a half marathon in January. I’m running or cross training 5 days a week before 6:30am (it gets pretty hot and humid after then). I’m also doing almost all of the cooking (and almost none of the dishes). I do most of the shopping (though Sue and I go to the market together usually), most of the internet wrestling at home (I usually lose), and I am the job captain of laundry (I bring it to a local woman who does it for a reasonable fee – and she has a DRYER!). I am the travel agent and do most of the social arranging as well. I pretty much do no making of the bed and I can’t remember actually touching a broom.

In short, I’m happily busy, feeling that I can make a positive difference along the way. Sue and I are starting to find some time for ourselves (we’re getting away two weekends in a row). I am reading more than I have in a long time – maybe a book a week. I also have an armadillo hunting trip planned. It’s a bit complicated to explain, but my Belizian friends are experienced and I hear it tastes like chicken just a little tougher.

Pharmacy Inventory System

Future Dinner??  (Len saw this one crossing a road)

Hiking at the Cockscomb Jaguar Preserve

Sue writing August 23, 2010

Sue swimming in the pool at the bottom of one of the waterfalls

Yesterday, on the way home from Burrell Boom we stopped at Cockscomb Basin Sanctuary, a national jaguar preserve, to do some jungle hiking. We climbed up a 2 Km steep trail to a fabulous view of the Cockscomb Basin with view of the Maya mountains, including Victoria Peak, which at just over 3,000 feet is the second highest mountain in Belize. We then descended a very steep and slippery path to 2 beautiful and isolated waterfalls, one 75 feet tall, with lovely pools that we took a dip in. Len and I agreed that it was one of the best hikes we have ever done and we will need to return to do some more hiking there. There are primitive cabins on the reserve that we might consider staying at as the Reserve is about 2 hours from PG and the road into it is 10 Km of difficult dirt and rock. The car seemed to handle it okay.

Right now I am sitting on our porch having a cup of tea and writing and reading, having gotten done at clinic a little early today. There is a nice breeze, the sun is shining, it is not too humid and the sea is calm. The only problem is I do not have Internet access so I cannot post this to our blog. We will have to try tomorrow at the clinic!

Sue at the summit

Len at the base of the larger waterfall (100 ft?)

We get settled into the "Sea Glass Cottage", our home on the Gulf of Honduras

Sue writing on August 16th:

Our home: The Sea Glass Cottage

Our home is working out very nicely. It is well equipped and the location is perfect, right on the water, with a nice sea breeze most evenings. We have a porch in front with a hammock and chairs. The water pressure in the shower could be better, but there is hot, running water. We have arranged for internet access at the house but it is spotty at best and we have better luck getting access at the clinic. If you email me and I do not respond right away, I am not ignoring you, I just haven’t been able to log on. Laundry is a bit of a challenge. Right now we are paying to have it done at one of two laundry services in town. After 25 years it is difficult not having a washing machine in the house.

We have been eating well; usually cooking at home (Len is doing most of the cooking). We go to the market, usually on Saturdays for fresh vegetables and fruits. The mangos, pineapple, watermelons and avocados are especially good and Len is enamored with Dragon fruit, which is kind of like a large, bright pink Kiwi. We have tried craboo, callilou, plantain and loofah. Bread fruit has just come into season so we will try that soon as well. This weekend we got fresh fish and shrimp at the market. Navigating the fish market is an experience, with its own unwritten rules. The stores in town have everything we need, including tea, which Len points out to me any opportunity that he can (I brought down a year’s worth of tea because the last time we were here it was hard to find).

Our home is right next to Dan and Maria (and their daughter Nicki) which has been a real bonus. We are able to share rides to work, which is especially helpful for them right now as their car has been in the shop for the last 2 weeks waiting for a part (things move slowly down here). Our car is a 13 year old Isuzu Rodeo, stick shift. The 2 back doors and windows are hard to open and the radio does not work, but the air conditioning works well and I am managing a stick shift fairly well. Dan and Maria have had us over for dinner twice and we have reciprocated once. On the other side of the house is the Coral House Inn, a lovely Bed and Breakfast run by Rick and Darla, ex-pats from Idaho. They have been very helpful as they manage our house for the owner so know all the ins and outs of the house. We went to a fund raiser there the other night for a crocodile sanctuary. It featured local drummers and a fire dancer. The woman doing the fire dancing is a PhD student from UCLA who is down here working on her thesis. The husband of the couple who runs the sanctuary used to play guitar with Bob Denver and treated us to some very good folk music (I am not making this up). All the ex-pats down here seem to have a story! This weekend we are heading up to Burrell Boom, a town up north near a “Baboon Sanctuary” (actually black howler monkeys which the locals call baboons) where we hope to do some hiking.

The view of the ocean from our front door

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Sue was destined to own an Izuzu someday

Hillside Clinic and a tricky diagnosis of Leishmaniasis

[Editor's Note:  This post was originally written on the 16th, but it was not until the 24th that we got our act together and got this blog up and running]

Hillside Clinic

Sue Writing on August 16, 2010

Sue Speaking with Women at Salvation Army Retreat

It has now been 2 weeks since we arrived in Punta Gorda (PG), Toledo District, Belize and started working at Hillside Clinic. And it has been a very full 2 weeks. We arrived with a new group of medical and pharmacy students, 6 medical students from the UK and 2 pharmacy students from the US. Len and I started right in the first day, we spent the morning in orientation with the students, meeting the staff, some of whom we know from our previous visits and some new. That afternoon Len and I and Penny (Hillside’s administrator) went to Cuxlin Ha, a Maya village near the clinic which is also a “resort” with a hotel and pool. I had been asked to give a talk to a women’s retreat sponsored by the Belizean Salvation Army. There were about 20 women, mostly in their 40’s or older and they were great. We had a lively discussion ranging from menopause, diabetes, hypertension, heart disease, to thyroid disease, asthma and sickle cell anemia. They had lots of questions, were fairly health savvy and when they realized they had a doctor in front of them who was willing to answer questions and give them information they took full advantage of the opportunity. The rest of the week was spent in the clinic and going on mobiles (mobile health clinics where we go out to more remote villages to see patients rather than the patients coming to us) as well as doing educational presentations with the students.

Sue Precepting Students at Mobile Clinic in Barranco

Last week saw the start of camp, run by Hillside clinic for the children of Eldridgeville, the village outside of PG, in which the clinic is located. Every afternoon for 2 to 3 hours, after spending the morning in clinic, half of the students and a preceptor get to entertain 20 to 30 local children ages 5 through 14. Have I mentioned it is about 90+ degrees and 100% humidity? Camp involved water fights, football (soccer) games, musical “bums” (instead of musical chairs), bobbing for craboo (a local fruit with a sour taste that the kids love) and ended with sweaty and exhausted medical providers and happy children. It continues this week as well.

The Health Building at Barranco where clinic is held

We have seen some interesting patients at clinic. We made the diagnosis of new onset Leishmaniasis, a parasitic disease transmitted by the bite of sand fleas. Unfortunately it is hard to treat, even in the US. One mobile clinic this week was particularly interesting. We went out to a lovely village on a large stream. When we arrived we were immediately asked to make a house call to see a young woman who was bleeding. On exam, in her home (a thatched hut), she was indeed hemorrhaging vaginally. I had a student and our driver transport her to the nearest health facility, a Ministry of Health clinic about 40 minutes from the village where she could be stabilized and transported to the hospital. I then walked back to the health outpost where we were seeing patients and on the way stopped and made another house call on a young girl with Downs who the clinic follows. I made the unfortunate decision to sit on a hammock at her house for which I was rewarded with multiple flea bites which are still bothering me 5 days later.

In the first 2 weeks I have seen 2 children with Downs (not unexpected given that women have children into their 40s), 2 children with cerebral palsy, and one child with a cleft lip and possible congenital heart disease. I have also seen scabies, impetigo, wheezing, colds, shingles, abscesses and cellulitis, lacerations, scorpion bites, lots of type 2 diabetes and hypertension, and started one patient on methotrexate for Rheumatoid Arthritis. In addition, I did an ADHD consult the first week I arrived. Yesterday, Sunday, 8/15/10, a few clinic staff, myself included, drove out to one of the more remote Maya villages for their first annual health fair. It seemed to me to be very successful. There were booths from Hillside, the Ministry of Health, Peace Corps volunteers doing HIV education and 2 or 3 other agencies. There were lots of villagers who had lots of questions. On the way home we stopped at a lovely waterfall to go swimming and for the first time in 2 weeks I actually felt chilled for a short while.

Sue and Len at Hillside Staff party

The staff at the clinic has been very welcoming. We knew some of the staff from previous, including Evert, the grounds manager and all around handy man, Amelia who does the cleaning, Sophia, a Mayan translator, and Rudy, a driver extraordinaire. I always feel more comfortable on mobiles when Rudy is driving. Other staff members include Penny, an American ex-pat who has been here for 14 years, who is the clinic administrator; Betty, an American nurse who has been at the clinic for about a year and does home visits and acts as “house mother” for the students; Aprill, born in Belize to American parents, who does the student scheduling and is very pregnant; Alfia, a young Maya woman who does patient intake and translation who is delightful; Jenny, also Mayan and also lovely, who works in the pharmacy and is planning to go to nursing school; and James, Maurice and Allan who help around the clinic and act as night watchmen. Dan and Maria Thibault, American nurse practitioners down here for 3 to 5 years, are the medical directors of the clinic. In the last year they have done an amazing job of organizing the clinic and the students’ educational experience. This past Saturday the staff arranged a welcome lunch for us and 2 young doctors from the UK, Cristina and Graeme, who will be at the clinic for 3 to 4 months. The lunch was at the home of 2 ex-pat Texans who have renovated a 100 year old home and made it into a Bed and Breakfast on a spectacular piece of property near the clinic. They have a beautiful pool and served a delicious lunch and it was a very pleasant afternoon.

Hiking with Howler Monkeys, Canoeing with Crocs, and Suturing with Tree Cutter Ants

While this is our third weekend here in Belize, it is our first weekend away from Punta Gorda and away from the clinic. We have been meaning to start writing this Blog, but each night we say we will start, the task looks big, the humidity feels a bit draining, and bedtime starts to beckon (it gets dark around 6 pm this far south). So as we sit by the pool at the Black Orchid Inn in Burrell Boom (named after a device used by the logger men that were the first white men to permanently settle in Belize) we are making a belated start to our blog. We promise to backtrack and write about our first three weeks in Belize. Suffice it to say that we have been deeply immersing ourselves in the work of the clinic, intertwining with the diverse set of characters that populate it, and getting settled in.

The Community Baboon Sanctuary (Howler Monkeys are locally called baboons though they are outweighed by their African cousins by over a hundred pounds) is a cooperative of eight Creole villages that have banded together to protect the native monkeys. It is located in the northern central part of Belize. We took a guided tour of a small part of the Sanctuary today and plan on taking a nighttime canoe trip this evening.

Here is Sue's description of the outing: The nature walks are guided by local residents and the Sanctuary is managed by a local council as well (all women apparently because the men did not do a good job running the place). The walk goes through some forest as well a cleared land. We were fortunate to encounter a troupe of about 5 monkeys right away, including 2 juveniles (about 6 months old) and a dominant male. The young were very curious and actually took food (provided by the guide) from our hands. We got a demonstration of the male "howling" as well, provoked by our guide first imitating the calls and then the male responding. Our guide also showed us local medicinal plants, including trees to treat skin fungus and plants that can act as pregnancy tests. Best of all she demonstrated, on her self, how to use soldier ants as sutures, having the ant pinch her skin and then removing the ant body and leaving the head and mandible intact on the skin. I am considering trying this at the clinic the next laceration I have to suture. Tonight we are going on a night canoe trip to look for crocodiles. Guess who's idea that was?!

Okay, it was my idea (Len writing the next day). We spent and hour and a half methodically searching by flashlight for crocodiles on Muscle Creek with the son of the local founder of the Sanctuary as our guide last night. It was a near full moon and it was the only time Sue or I could recall being in a canoe after dark. Nighttime crocodile sighting is done by looking for the small red reflections of the flashlight in their eyes just above the water. It only works if they are facing toward the creek and you are sharp eyed enough to spot them (our guide is, us - not so much so). The setting was great as was the conversation with our host. The crocodiles were fairly uncooperative (from my perspective) or dutifully respectful (from Sue's perspective). We saw one and a half baby crocs, measuring less than a foot. We did hear a rather large crocodile up ahead splash into the water, but we didn't see him. It turns out the rainy season (now) is probably the worst time to go crocodile citing as they get easily hidden in the elongated banks of the swollen creeks and rivers. Maybe we'll return sometime during or after March. Anyone want to join us?