I am back in Moyogalpa now as my country mouse days are over for the moment. Our first day with everyone back at work was quite productive and it was decided that we should look into a new office space. Previously the office was in the hospital in Moyogalpa, which made it central and easier to meet with people such as hospital administration or health authorities. So we went on a field trip to investigate some of the unused rooms the hospital had to offer. The first one we looked at is conveniently located just across from my consult room, is spacious and has a few adjoining rooms that would allow for some privacy and windows that brighten up the space. Previously it was the X-Ray room, but due to budget restrictions it has not been used for over 10 years. Currently it is the home to a colony of about 40 bats (rough estimate by our operations manager)! When we first opened the door to take a look at the room we saw 3 bats flying around a few hanging. Tabby was the only brave on of the group to go in further and I tried to follow until I saw several more swooping across. Tony kept away at the first sight of the bats and stood guard in the hall. I made a few valiant attempts to go in as I was curious to see how many bats were living there, Tabby made it all the way in even to peek into the other rooms. After we composed ourselves, aka stood up straight, we went to speak to the head nurse who took us back to the room, walked right in without flinching or even noticing the 7 bats flying about her head. This may be the Canadian city girl coming out of me again, but I feel there may be a slight health concern having a room full of bats in a hospital. There were a few other rooms in the hospital that we might be able to use and which may not require moving large equipment or communities of animals in the process. Currently we are still looking into what is the best option before we decide on a new bat cave, I mean office.
Dodging bats in search of a new office wasn’t the only excitement at work this week. A few acute cases passed through the clinic to see me rather than going to the Centro de Salud or the hospital. I had one patient come in to have their stitches removed and if I was not interested in doing so they were going to take them out with a razor. As such I got to remove my first set of stitches. Also this week I decided to bite the bullet and do my first turno. A turno is a full 24-hour shift that the doctors who work at the hospital do once or twice a week. In my personal, sleep-loving opinion I think it is a bit crazy (batty, if you will). In terms of people I want very well rested – Emergency Room doctors and air-traffic controllers would likely top the list. However in the perspective of learning and having the opportunity to work as equals with my medical peers here I decided to do a turno. I worked in Los Angeles during the day, attending 18 patients then biked back to Moyogalpa for a quick bite before changing and joining the on-call nurse and doctor for the night. Things started off pretty slow, the nurse had me writing out care protocols for various in-patients and I received some good natured teasing as she and the doctor joked about sending me on the barco to Rivas. The barco is a small wooden powerboat used to bring patients to Rivas, the town across the lake, in emergency cases. This was fine until later in the evening when a patient actually needed to be transferred to Rivas and my colleagues this looked at each other and said ‘we might actually have to send her in the barco’! In the end the other doctor decided to accompany the patient and left the nurse and I to take care of the hospital. Throughout the evening we had 4 patients arrive and a total of 11 in-patients, including 3 that were admitted while I was working. I was able to assist both the nurse and the doctor in their shift duties and learned quite a bit. I also managed to entertain the patients and their families during rounds as I tried to take the vitals of a visitor who happened to be lying in one of the unoccupied beds. In the early morning I assisted the doctor to drain an abscess on an infant. Originally the doctor thought I should be in charge but we made a deal that it would be better he do the one on the little person and I would take over for the next time. By morning I was exhausted and after only taking a 20 minute cat nap vowed that the next time I will either stay awake the entire time or sleep when the other doctor tells me to.
It has been a really great learning experience to be able to work so closely with the other medical professionals here on the island. I have found the nurses and doctors extremely open to natural medicine and willing to work with me and teach me from their own experience. Not only do the doctors and nurses refer me patients, sometimes even during morning rounds with the in-patients which is always surprising, but also many come in themselves or send in their family. I also feel very comfortable in accepting my own limitations as a physician and being able to go to any of the doctors or nurses to ask what their protocol is for a certain condition or to be able to refer the patients for an acute intervention. It is one of the aspects of the medical system here that seems to be more developed than the system back home and one we could learn a lot from in terms of working together.
The Saturday before last was a presentation on medicinal plants at the Cocibolca. The presentation was organized by Maria, a friend who is currently living at the Cocibolca, and Nadine, a friend who works with a project that provides physio and occupational therapy to children and adults with special needs, and pre-natal classes. The presentation was very informative as it focused on plants that were local and that were easily incorporated into the lives of people here, as well as it was very interactive, as Maria and Nadine made sure to get people asking questions and sharing what they knew about plants and food. It was a really positive day as I got to listen to a very well put together presentation, learned about some local plants and saw some ideas the people here had to help improve the health of themselves and their community. Sunday I was able to explore a little of the community on the other side of Moyogalpa that I don’t know very well with Laura and Gary. We stopped by the lake to take in the view and then went to the lesser known fresh water springs for a swim in the pools there. This week I needed to stop into by the bike technicians to fill my front tire and the man working there decided to take a look at my back brakes. At first I wasn’t even sure I wanted him touching the brakes on the Red Rocket, but now that I can actually stop and slow down on hills I am really appreciating his tinkering and bolt tightening. This weekend has been quite calm as I am still catching up on lost sleep and am a bit lazy when it rains and tend to stay hidden inside.