Surgery and Forest Fires

Forest fire on the ranch from a short distance away.

Baking a cake with three sisters and another volunteer.

Enjoying a weekend in Tegucigalpa for the going away party of three volunteers who finished their year(s) of service this month.

This week I began my first official work week on my own, without my fellow volunteer nurse, Tiffany, by my side. All went well, and with each day I gain more confidence in my Spanish and nursing care, and pleasure out of my work. Each Wednesday is spent at the school completing the yearly Well-Child checks on all the children, or as many as we can get though in the morning. I help assess the height, weight, vital signs, and test the vision of each child before they see the doctor. I think it is wonderful that NPH offers such good preventative healthcare in addition to caring for many chronically ill children. Tiffany and I have also been planning and presenting lectures to the medical staff each week on different nursing care topics, such as how to administer medications, start IVs, what is Hypertension?, and Diabetes, knowledge of medications that we are dispensing in the clinic, etc. The majority of the nurses who work here have only a high school nursing licensure with a very basic healthcare education. Therefore, I am glad to put my bachelor's degree to use to help provide continuing education for these nurses since many of them carry great responsibility in their healthcare roles.

This weekend was also my first weekend being on-call for the clinic and any medical emergency that might arise. We have a Doctor on-call, whom we can contact with any questions and there is a Honduran nurse who is in the clinic day and night with the kids. However, I still feel a lot of responsibility and a little nervous being the only licensed healthcare employee here for over 400 people. I get to walk around with a pretty official looking radio, I come into the clinic to assess new patients, and am available for questions or to help out with whatever is needed. Last night, for example, one of the children had to go to the hospital, so I stayed to manage the clinic while the other nurse accompanied the child to Tegucigalpa.

Another new addition to my last few weeks has been getting to know my Hogar of 22 girls, ages 10-14 years old. All the children here are divided up into groups of 20-30 kids, based on their age and developmental level and they live with that group in individual buildings called Hogars. The volunteers here have essentially two jobs. We all work our day jobs during the week, as teacher, nurse, office personnel, etc. and then we have an evening and weekend job, spending time in Hogar with our assigned group of kids and supporting their caregivers. The two hours that I am with them each night is spent finishing up chores, eating dinner, brushing teeth, and changing into pajamas. In the little time that is left before lights out, they love it when I bring stories to read or a new board game to play. I am really excited to have this age group of kids because they still love to play and have fun. They can be very loud and crazy at times. They love attention and hugs, and are great to practice Spanish with. Over this year, my patience will be tested as well, as I try to earn their respect and work with the attitude that comes with this age. I look forward to getting to know each one of them individually and trying to be a good positive role model in their lives.

Maybe one of the most interesting memories of the past two weeks was getting to assist with surgery and fight a forest fire all in the same day. Here at the ranch we have one of the most advanced surgery centers in the whole country of Honduras donated by an Orthopedic surgeon and his family from Minnesota. They come down about 4 times a year for about 10 days at a time to perform surgery for the people here. While the medical teams aren't here, the center mostly goes unused. However occasionally we have a retired surgeon from Tegucigalpa who comes once every couple weeks to perform some basic topical surgeries and cyst removals. Being one of only 2 RNs here, I had the fun pleasure of assisting in the surgeries, such as holding the retractors or cutting the stitches.

Meanwhile… we are in the very dry season here in Honduras and forest fires are not uncommon. Many Saturdays, the boys at the Ranch are out early in the morning working to clear a 6-10 foot area of brush along the entire perimeter of the Ranch.  However, despite their prevention efforts, the most recent fire did enter onto Ranch property. One night when I was leaving Hogar, there was a crowd standing along the sidewalk, watching the ridge of the hillside blazing. Some of the younger girls were crying because many of the older boys, their brothers, had already been sent up to the fire to start trying to put it out. I returned to the volunteer house to grab my camera and headlamp, and ventured out with two other volunteers to get in on the action and see what a forest fire looks like up-close and personal. About a mile up the hill we got to the scene. For those of you who have never had the adventure of fighting a forest fire with limited training and resources, here is what you do… you try to find a big, preferably still leafy branch, and beat the fire until it mostly goes out. If that doesn't work, you holler at the kid running around with a hose and water tank on his back. By the time we got there the flames had died down, and it was mostly just a vast area of charred ground on all sides, with isolated bushes and tree trunks still burning. I was trying not to melt my tennis shoes on the smoldering ground. The ash and smoke was thick in the air. It was quite an adrenaline rush, especially to be the only woman there working alongside all the other male Pequenos and employees.

One last funny little cultural idiom… pertaining to teeth brushing. Contrary to the majority of Latin America, there is a fervent passion for brushing teeth here. The kids must brush their teeth 3-4 times a day. It is not uncommon to see a child walking around with their toothbrush in their back pocket, or an employee walking around the office brushing their teeth after lunch, as if it is nothing strange at all. I'm not sure how this trend began, but I must say, I think our kids as a whole have the healthiest teeth in all of Honduras.

Coffee at Bedtime

Even though it has been just a few weeks since I have written, I feel like so much has happened and time has just flown by. I am starting to feel the Ranch becoming my new home. Sometimes it is actually easy to forget that I am in Honduras until some funny cultural difference strikes me and brings me back to reality. One night, all the kids were out on the basketball courts for dinner with the normal chaos that ensues when you put 350 kids together of all ages. We sat in the dark eating our dinner… the (dreaded) favorite, Sopa de menudo, which is a chicken broth soup with all the internal organs and left over parts of the chicken (liver, heart, and kidneys included). The kids are especially excited if they get a chicken foot in their bowl to suck on.  After our meal there was a giant caldron of coffee boiling over a fire. And sure enough, a little while later, the coffee (with 30 pounds of sugar in it) was served out to all the kids, big and small, and they loved it! This was one of those cultural moments when I just had to laugh and say “why wouldn’t you serve coffee to a bunch of small children right before their bedtime?”

As part of our orientation last week, we got to take a trip to the nearest town called Talanga, 30 minutes by bus from here. We visited the Comedor Infantil, a lunch soup kitchen for impoverished children 2-10 years old who would maybe not receive any meals otherwise. It is a project that was started 1 year ago by a Passionist volunteer and will now be supported by NPH and coordinated by one of our own new volunteers. It was a very valuable trip to get to see how other children live outside of the Ranch. While the children here at NPH don’t get to live with their families, they have all their basic needs provided for them, and limitless possibilities in education, such as the opportunity to attend high school and college if they so choose.

It seems like several times a week there is some sort of special event. On weekends there is always something going on, from movie nights to talent shows and dance competitions. The kids will choreograph a dance routine in small groups and perform it in front of everyone. As a whole, they can all dance impressively well, and even the little ones can really move their hips while dancing Punta. By the end of the night, it is not uncommon to have a small child asleep in your lap. Recently we had the Graduation celebration for all the graduating kids from kindergarten up to university, before the start of school this coming week. Thursday we celebrated the Patron Saint of Honduras, Suyapa, starting with a giant procession and a catholic mass at 7am. Last Sunday was Visitors Day where all the kids who have any extended family or even parents who cannot or are not allowed to care for them come and see their children for a day. This happens 3-4 times a year. As volunteers we are in charge of all the kids who do not get visitors for that day, and try to make it as fun for them as possible, with swimming, field games, cake, and movie watching.

Monday marked the start of my actual job training, and to be quite honest, it has been a bit overwhelming. Orienting to a new nursing role is difficult. It is even harder and sometimes just downright frustrating to be doing it in another language that I am still trying to understand. Besides our Health Coordinator and one Doctor, I am one of two licensed nurses here. To summarize my job description, I am in charge of running the External Clinic at the Ranch. I walk 15 minutes to work from our volunteer house to the entrance of the ranch where the clinic is located. I get there at 7am and by then there is already a line of about 30 people waiting to be seen. These patients may travel for 2-3 hours by foot and by bus to get to the clinic by 5 or 6am to receive an affordable medical consult. We charge $1.50 for the visit, and all medications are $1. We also have a full functioning laboratory in which patients can have all sorts of affordable blood tests taken and results analyzed on the spot by our Microbiologist. Because we only have one Medical doctor and she must work in the internal clinic in the afternoons seeing the Ranch children, we only allow 20 patients a day to be seen at the external clinic. One of the hardest parts of the job is to turn someone away after they have already paid the bus fare and possibly traveled many miles to get here, starting in the wee hours of the morning. Upon arrival to the clinic first twenty patients receive a number on a first-come-first-serve basis, and some may wait 6 hours until they are seen. That is just how the Honduran health system works.

My job varies slightly every day depending on what other help we have in the clinic. I help admit the patients, find their charts, take vital signs and a short history or reason for the visit, and do patient care such as wound care procedures or taking out stitches. I also help to fill the medication prescriptions that the doctor writes in our little on-site pharmacy. Now you may all be thinking, “well Heather is not a Pharmacist,” and that was exactly my thought as well. According to our US standards, this would not seem exceedingly safe, and even much less so when I can’t be present and there are two young assistants with no formal medical training are left in charge. Therefore I am now on a quest to try to relearn everything that I have forgotten from my nursing pharmacology class to better educate both myself and others to make this a safer system. I am excited to gain from this clinic experience many different leadership and administrative skills that I did not expect to come away with, but will ultimately be glad to have.

I would just like to thank everyone who has been sending me emails and encouraging notes over the last 6 weeks here. It is very helpful to know that I am so loved and supported by my friends and family!

 Children from Talanga at the Comedor Infantil, playing before lunch time.

The view from our volunteer house in the early morning.