Dr . Thomas – the elusive Hillside director who would scarcely return my e-mails prior to the trip and provided precious little information about the experience prior to my arrival – arrives at the clinic and I promptly introduce myself . She has a stern demeanor despite her wildly curly hair and bright pink sweater , and mostly ignores Jillian , the students and me . She does manage to produce a map of the villages served by Hillside on her iPad and shares that , as well as a copy of our schedules for the next two weeks , with Jillian and me . Shortly thereafter , one of the students , Charlotte , approaches me with a patient to staff . Charlotte is lovely — all big smiles and dimples and an English accent — and I settle quite confidently into the precepting role . I can see Dr . Thomas eyeing me from the charts on her desk as I help Charlotte come up with the differential for dysphagia in a 30-something-year-old female , and know she ’ s sizing me up . I keep waiting for Dr . Thomas to jump in and cut me off or correct me , but it doesn ’ t happen . By the end of our discussion , Dr . Thomas re-directs her full attention back on her charts , which I claim as a silent victory .
Aside from my intermittent coughing attacks and scarlet letter of a facemask , the rest of the day goes by without a hitch as we see patients of all ages with anything from headaches to diabetes to amenorrhea . Jillian frequently consults me on adult diagnoses and meds ( she ’ s a pediatrician ) and Andrew ( also a pediatrician ) hits me up for the newest changes with the lipid guidelines . I ’ m feeling useful , despite my trouble incorporating tropical diseases I ’ ve never seen before into my differentials .
1330 . Clinic is finally over and a select few of us pack up and head out to a local school where we give a demonstration on dental hygiene and apply fluoride varnish to the children ’ s teeth . The schoolhouse is a run-down concrete building with 26 crisply uniformed Belizean pupils under 14 . The Hillside students do the education piece with a giant denture-like set of teeth and ACME-sized toothbrush , to which we sing Andrew ’ s intellectual progeny ( to the “ Row , row , row your boat ” melody ): “ Brush , brush , brush your teeth , brush them every day ! Brush them , brush them , brush them , brush them , brush the germs away .” The younger kids are faintly amused , but the older kids – forget it . They think the giant teeth are stupid . I rather agree .
1700 . Jillian helps with the slicing as I make a zucchini and tomato linguine for dinner . Luckily someone left some oregano behind , which fills the room with its earthy perfume as it hits the pan . Over dinner , I lament my upcoming “ overnight ,” where our group takes the Hillside trucks out to remote village locations and sets up clinic for the day . The students clued me in on the quaint sleeping arrangements ( an old 1-inch foam pad over concrete ) and the bathroom situation ( none ).
1830 . The dreaded tropical disease presentation , we find out , is actually to be assembled by the students and presented to us . Before dinner , I convince Jillian to do some internet and book searching with me so that we can nod reassuringly during the talk , and maybe find a few decent pimp questions along the way . She reluctantly agrees , and we delve into disgusting pics of face-eating leishmaniasis and the dilated heart of Chagas disease . I discover why dengue causes thrombocytopenia ( immune complexes ) and use this as a brilliant pimp question . We head back up to the tree house , relieved . Fearing my impending lack of rest , I quickly pack up Jillian ’ s small bookbag with two sets of scrubs , pajamas , baby wipes ( aka Belizean shower ), deodorant , a headlamp , iodine tablets and my camera before heading under the mosquito net for the night . I set my watch for 0645 and tell myself tomorrow can ’ t be worse than mid-summer in rural Nicaragua .
Day # 4 , The Camp-out , Part I
When there are only horror stories , it ’ s hard to look forward to the “ camp out .” The students recount tales of long , sweaty days in a hot room without running water as you treat up to 60 patients in a village and then have to sleep on a 1-inch-thick strip of old foam over concrete with bugs crawling over every inch of you until you get up at zero dark thirty and do it again the next day , completely exhausted . I try not to look exceedingly overwhelmed , despite the fact that the flu is still in full force , and I have since developed bilateral otitis media ( a double ear infection ) at 30 years of age . The clinic pharmacist hooks me up with some expired amoxicillin and I only hope that I regain hearing in my right ear by the following day .
0745 . We gather around the two white clinic vans labeled “ Hillside ” and help Rudy , our driver , load giant plastic bins of medical supplies and medicines into the overhead bin on the van . It takes a little finagling , but with two people we can get the bin onto the spare tire on the back door , and then spin one side of the bin up towards Rudy , who ’ s standing on top of the van and he-manning the giant tubs into the overhead compartment . Luckily for us , he has a very specific plan of what goes where , and by 0815 , we are packed up and ready to head out for Dolores , a small village about three hours away in an area so remote , the Ministry of Health doesn ’ t even bother . I spend most of the ride staving off coughing attacks with my trusty bag of cough drops and my water bottle , while Lori , the head physical therapist , navigates her way through the dirt roads riddled with deep , muddy potholes . We mostly drive through jungle , but pass a number of small villages , one of which is settled by Belizean Mennonites , who don the typical conservative frocks and white hair bonnets but are famous for their ability to import goods from all over the world due to their tax-exempt status . Lori says their general stores house everything from guitars to electronics , right here in the jungle .
We make a short stop in Santa Theresa to pick up the medical charts for the patients in Dolores and Oxotaca , the villages where we will be seeing patients over the next couple of days . We meet a local Peace Corps volunteer who helps out in the clinic and stands barefoot on a bench pinning up her hand-drawn map of the village and its proximity to every water source and every existing latrine . Her hope is to help further develop the sanitation system of the village with more latrines . We take advantage of the clinic ’ s running water and use the bathroom facilities before we head on to Dolores . We arrive 2.5 hours later to a small village with large thatch roofed
( continued on page 30 )
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