Differences in Healthcare

The San Ignacio Community Hospital has opened my eyes to many things. Particularly the differences in medical cases, the past couple of months have involved a continuing rise in dengue cases which is due to contamination in closed spaces. Cases range from mild to severe, however, I have seen more mild cases come into the hospital that are able to recover in a few weeks time. The doctors have asked me whether viral infections are carried in a similar fashion as being mosquito-driven back in Tennessee and I have had to explain that it is a tropical occurrence rather than widespread. It is eye opening to see how location and being in a tropical climate creates the risk of exposure to viruses in such a different way through a mosquito host.

Amputations

I have also continued to see many patients in need of amputation referrals. Due to poor hygiene and lack of sterilization, many of miniscule wounds become an infection site that continue to spread until the wound needs amputation. Patients at times come into the hospital for wound cleaning and sterilization that is offered on a weekly basis. However, some patients that do not care for wounds properly or come into the hospital. Although I believe educational material could help this issue with infection sights, many doctors associate limb amputation with the saturation of diabetes patients in the country.

Overarching Healthcare due to Belizean Economy

An evident difference is that public healthcare in Belize is a lifeline for all diagnoses. Whereas in America we are referred to specialist physicians for more specialized care, public healthcare in Belize is free of charge and serves as primary care in many specialty areas. One of our patients this week had a metal shard in his eye for a week, experiencing continued pain and redness. Instead of sending the patient to an ophthalmologist, the attending doctor asked for my assistance on dissecting the metal shard from the cornea. This practice was a surprise to me, but I was happy to see the patient’s relief upon the metal shard being taken away from his eye. Patient care like this is often seen from general doctors as many patients that seek healthcare from public entities do not have the funds to pay for a private practice.

Iguana Conservation Project

During the weekend I was able to visit the Iguana Conservation Project located in San Ignacio. The reason for this center is to protect and conserve endangered species. The center has take in Iguanas with injuries that can no longer survive in the wild as well as mates that produce eggs at the center and are later taken back into the wild. An interesting thing I learned from our guide was the change in tail pattern iguanas have when their tail is cut off and it regrows (the pattern is no longer the same and appears darker).  I was able to hold baby iguanas and older iguanas at the center. Surprisingly, if you hold out leaves to an iguana, they will rapidly eat it a lot faster that I thought!

The month of September marked a season of celebration in Belize! St. George’s Caye Day happened on September 10th which commemorates victory over Spaniard forces in 1798. During the ceremony I attended, they made sure to mention the joint effort between all those involved during this victory including British settlers and slaves. Shining light on the unity of Belize’s multicultural population. After the mayor’s speech in San Ignacio, a parade followed.

Social Work

During the past couple of weeks I worked with social work. Social workers in Belize are separated by district. Since I live in San Ignacio, Belize- I am apart of the Cayo district. Mrs. Flowers is the social worker of my district and she was able to inform me about her work over the course of a week. Her work includes counseling domestic cases, teenage pregnancy, food insecurity, and her primary focus is HIV documentation and prevention. Whereas, HIV medication would likely be the concern of a physician in the USA, in Belize it is the responsibility of a social worker. Social workers here do routine check ins through phone calls, give refills, home visits, and even deliver medications in the city and go as far as the outer villages of Cayo in other for their patients to continue treatment.

We also had a conversation regarding food insecurity and how as a social worker, she petitions families in need to obtain aid from the Belizean government for groceries. However, she noted that even though she is a social worker, her paperwork is not always seen in a timely manner and there are often delays and setbacks in receiving funding. She expressed to me that if there was one thing she could do out of her career someday was to begin a foundation that targets food insecurity here in Belize. Despite her passion for this, she explained to me that beginning a program like that would not be self sustaining in the long run.

I joined the social worker and one of the managers on a mobile clinic day and was able to visit the homes of people who needed medications taken to their homes. Most of the time, people who need medications delivered are in need of transportation. Due to the economy in Belize it is often times difficult to travel distance due to the cost of transportation which limits locals access to resources. An important thing to note is that public healthcare exists and even medication to treat patients at these public facilities are free of charge, however, the financial hardships locals face make it hard to attain these resources.

Another challenge faced is trying to communicate with patients who are HIV positive and refuse treatment. Even though medicating HIV ahead of becoming AIDS can be life changing, many deny treatment. This is due to prevalent stigmas in regard to an HIV positive test and the risk of others finding out. I found this interesting as medication has the potential to exponentially lengthen someone’s life and stopping the progression of the disease.

Independence Day

September 21st marked independence day here in Belize. Interestingly enough, Belize was still part of British rule up until 1981. It is even more fascinating that when I first arrived to Belize at the beginning of August, the currency still had Queen Elizabeth II pictured and soon after my arrival the government began issuing new currency with new public figures. Although Belize is no longer a British colony, it seems that the country continues to acknowledge longstanding British rule and many locals live to tell their experience of political and economical change due to the independence gained in 1981.

During this celebration many locals hosted parties at their homes, attended the parade, and viewed fireworks as a community. I was able to watch the parade and even spotted some of my patients along the way! The sweet thing about living in such a close knit community is that even when I am not at the hospital, I see patients around town or even at church. During the parade a little boy ran up to me as he pointed me out to his mom saying “it’s the doctor!”

Although I never would’ve imagined it, I am slowly starting to become a familiar face in the community. To many in the San Ignacio community, I am now considered family.

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.

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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.