Thanks to the Class of 2010’s generous gift I was able to travel to Roatán, Honduras for my 4th year elective. I spent the month teaching local physicians the basics of Point-of-Care Ultrasound (POCUS) at Clínica Esperanza. This clinic, located on Roatán, one of the three Honduran Bay Islands, is resource-limited, with no access to XR, CT or MRI. Ultrasound (US) is the only diagnostic imaging modality available to the physicians in the clinic. Unfortunately US expertise is limited on the island and the physicians are not trained in basic POCUS.
Elizabeth Dearing MD, NUEM ’15 travelled to the clinic in 2015 to lay the ground-work for US education. However, physician turn-over at the clinic is high therefore the group that Dr. Dearing trained had already left by the time I arrived. The current physicians had minimal to no experience using US, including the physician assigned to the OB/GYN patients. An on-going US educational relationship with the clinic is key.
I taught an introductory POCUS lecture and spent 6 hours per day for 3 weeks teaching hands-on US skills at the bedside to two physicians in the clinic. Initially the physicians weren’t sure how to turn on their machines, how to correctly orient the probes or even why they would consider using an US machine. By the end of my time at the clinic, they were successfully identifying intrauterine pregnancies and IUD’s on transvaginal US, checking fetal heart tones, identifying the sex of fetuses, diagnosing biliary colic, renal colic and abdominal aortic aneurysms! We even introduced the bedside diagnosis of pneumonia!
Originally the clinic had 2 small US machines- one point of care unit that was collecting dust and another small but non-portable machine. Shortly before my arrival, the clinic acquired a larger comprehensive machine which a skilled and talented local US tech used one day per week for comprehensive scans. This tech was unfortunately overwhelmed by the volume of scans and unable to complete them in a timely fashion. The introduction of POCUS was fundamental in order to decrease the number of comprehensive scans ordered in order to aid in more rapid diagnosis of time-sensitive conditions.
As a current US fellow, this elective was integral in developing my understanding of teaching US in a resource-limited setting in addition to developing skills in order to teach US novices. This experience also highlighted the importance of a longitudnal continued relationship with the clinic and I plan to return to continue the US education.
Lucky for me, Roatán is also a beautiful Caribbean island therefore downtime was as equally enjoyable. Among many other adventures, I learned to scuba-dive and met a sloth!
Thank you again to the Class of 2010- your generosity will not be forgotten!
Thanks to the generosity of the Class of 2010, I was able to spend my fourth-year elective combining my passions of ultrasound education and international medicine in Roatan, Honduras. I worked directly with the Honduran doctors who provide care to over 100 patients daily at Clinica Esperanza – a clinic that provides pediatric, medicine and obstetric care to the island natives.
The clinic had two ultrasound machines for use. However the Honduran physicians are not instructed in ultrasound during their medical education and training so they were not utilizing the machines available. Each day, I would spend 3 hours in the morning and 3 hours in the afternoon teaching ultrasound while caring for patients.
The Honduran doctor in the morning, Dr. Emma Nova, evaluated all of the obstetric patients. When I arrived she told me the ultrasound wasn’t working because the screen was too dark. I increased the gain and the image improved and she was amazed! When I arrived she did not use the ultrasound in her evaluation of the pregnant patients. Instead she measured uterus size with a tape measure and used a Doppler to assess fetal heart rate. Dr. Nova was a fast learner and when I left she was using the ultrasound to assess fetal heart rate and also to date pregnancies in each trimester. The best part of this was seeing the joy in each mom ‘s face when they saw their babies for the first time!
Dr. Jayleen Coleman was the afternoon Honduran physician. She saw general medical patients and was excited about all aspects of bedside ultrasound. We used the ultrasound to evaluate gallbladder, kidneys, aorta, heart, lungs, DVT – basically anything and everything we could! Because of the broad range of applications, Dr. Jayleen was not independent with any one ultrasound exam. But I know that with more practice she will be able to incorporate point-of-care ultrasound and improve care for her patients at Clinica Esperanza.
While in Roatan, I also hired a local woman, Karina, for individual Spanish lessons. I spent 2 hours a day with her in her home. It was such a pleasure getting to know Karina, her nine-year-old daughter Alice and her dog Molly. It was an experience I will never forget!
For my elective I spent a month at Clinica Esperanza on the Island of Roatan just off the north coast of Honduras. I had a mixed role in the clinic where I spent many of my mornings providing basic primary care, peds and OB consults to some of the 80 patients the clinic sees each morning. The clinic is the primary healthcare provider for over 10,000 island families treating everything from hypertension and diabetes to snake bites and scuba diving injuries.
In the afternoon, I spent time helping the administrative staff of the clinic complete a formal evaluation of the visiting medical student experience. I was responsible for talking to the permanent clinic staff, the visiting medical students as well as community members and small business owners to help assess the status of the current rotation and provide suggestions about how it might be improved. Through this collaborative effort we were able to provide the clinic with many suggestions that will hopefully both improve the visiting medical students' experience and also begin a more thorough discussion of how to best utilize visiting medical professionals and students for the benefit of the clinic and the larger community.
This elective took place at Hospitalito Atitlán, which is located in the town of Santiago Atitlán, Guatemala. This hospital serves approximately 75,000 indigenous Mayan Guatemalans who live along the beautiful Lake Atitlán. It is a clinical elective, with volunteers providing 24 hour solo coverage in the ED. The hospital also provides primary care, prenatal care, and labor and delivery services; last time I was there, they were expanding their capability to provide surgical obstetrics. It is a true emergency medicine elective: the breadth of cases included cardiac arrest, fracture reduction and splinting, deliveries, neonatal resuscitation, pediatric respiratory disease, etc. One of the best aspects of this hospital is that while serving an indigent community in need, the hospital also has the resources so that you as a clinician can provide a high level of care. You are challenged to work independently, without the supervision of an attending, and you must become more thoughtful about your work because the patients cannot afford for you to be wasteful.
Lastly, this hospital is located in a beautiful part of the country. The lakes is surrounded by volcanos, and on my days off I would take a boat across the lake, settle into a hammock, and read a good book while enjoying the most amazing view.