Hello everyone!

The past couple of weeks I have been working with public health as well as the outpatient department which include general doctor consultations.

Public Health

Public health in Belize is in charge of outreach and health safety, while interning with them they informed me of the “New World screwworm” which has been affecting not only Belizean pets, but also citizens. We have already had two hospitalizations at our very own hospital. In efforts to reduce cases and keep contamination isolated I participated in a campaign with public health officers in our district. We walked door to door informing citizens about how the New World screwworm lays eggs in open wounds of pets like dogs and cat but can also do the same with humans. The fly looks like a normal house fly here in Belize, but the eggs it lays in wounds can be fatal and deadly as they become worms and spread.

During the campaign I was able to meet many locals and even met a family who has lived in the USA for over 40 years. Another issue public health explained to me was the ongoing sewage and plumbing problem. Due to Cayo district not having an underground sewage system, sewage passes by the sidewalks and often backs up at homes due to the lack of licensed laborers. One of the major issues is that the sewage falls into one of the major rivers in this district which contaminates the water people use to bathe in, do laundry, and swim. Mrs. Armstrong recently was appointed to work in Cayo district and is currently working on a proposal to create an underground sewage system that will eliminate contamination, smell, and increase efficiency. We mostly did inspections and gave out educational materials in Benque which is a town in Belize with a dominant Hispanic population.

OPD

In the outpatient department we are starting to see dengue cases spike. Dengue is a viral infection spread through the bite of the  Aedes aegypti mosquito. Although this virus is not spread person to person, an infected person being in the same household can lead to a mosquito becoming infected and spreading the virus to the rest of their family. The public health department provides mosquito nets to reduce the risk of infection. Ironically, I often get asked if dengue is prevalent in the USA as it is here. However, I believe the few cases we have a year are usually due to people who travel abroad and bring the virus over from the tropics.

Additionally we have also been seeing a surge of salmonella in our district. Many cases of nausea and diarrhea have led to positive salmonella tests. This has made me question whether there is food contamination or if it is due to undercooked meats.

–

Horseback Riding 

Apart from my internship I also went horse back riding for the first time this month. I was able to ride my horse alongside the Macal River and enjoy the peacefulness of nature. I even saw monkeys and toucans while I was riding!

During the past couple of weeks at the San Ignacio Community Hospital, I rotated through the maternity ward and outpatient care.

Maternity

When I first arrived at the maternity ward the OBGYN, Dr. Rivas, explained everything I had to know about maternity in Belize. Dr. Rivas explained that pregnant women in Belize are an extremely protected class, hence, they are closely monitored and even admitted into observation at the first sign of any possible complications during pregnancy. This is done to prevent liability if something is overlooked during a patient’s pregnancy. Although I did not see any births occur, I did see many admissions over the course of the week due to preeclampsia and Braxton Hicks contractions.

Additionally, nurse Bautista, a midwife from Guatemala who has practiced in Belize for over 15 years let me know that in the public health care system of Belize, there is no option for epidurals during delivery. Due to the lack of resources, women giving birth have no option for epidurals or any type of anesthesia. This is not only because epidurals are not cost effective, but also because the supplies to do so are not supplied- even if a patient were to pay out of pocket.

Outpatient

Outpatient care at the San Ignacio Community Hospital is very holistic. Whereas you would possibly go to a general physician in the United States and be referred to a specialist, general outpatient care in Belize treats all areas. Although a specialist referral may be given to patients with long term medical issues, immediate concerns and prescription refills are always given answers during these general consults. I addressed this to the physicians, and they were surprised upon me telling them that referrals would be required for most patients in which they would have to wait for months and possibly even up to a year to be seen in the United States. They told me that if they were able to medicate and treat their patient’s condition in the moment- why would they prolong the process?

It is also important to note that public healthcare in Belize is completely free, including labs, x-rays, and even pharmacy services. Luxuries like seeing a specialist for a condition come with a heavy price tag. The average individual in Belize makes around $200 USD weekly, when factoring basic living expenses- little money can be used leisurely. Outpatient care sees patients that you would typically be seen referred to gynecology, orthopedics, internal medicine, rheumatology, and cardiology to name a few.

Inclusive Healthcare

My favorite part from the past couple weeks is realizing that a language barrier in Belize is nonexistent despite its community being so diverse. Although Belize’s official language is English, habitants of this country speak many different languages and most are multilingual (Spanish, Creole, German, Chinese, etc.). However, everyone finds a way to be able to understand each other, often by learning the three dominant languages of the country which are English, Spanish, and Creole. Slowing speech down, facial expressions, and using hand gestures help when communicating.

During my time in outpatient this week I met three physicians from Cuba that were contracted to work in Belize by the government. They shared with me how they feel insecure speaking to patients in English since they’ve only been exposed to it for a year, but their effort to communicate with patients in any language they come in speaking is evident. They have even learned to speak English during their short time here to be able to communicate directly with patients in the language they feel most comfortable- whether Spanish or English. Their willingness to adapt and address patients adds a layer of compassion for the patients they are treating.