we head next door for some gelato , which we ’ ve heard is a musttry . It was , in fact , delicious , and I ate all of my coconut-pineapple concoction . We head to bed around 8 p . m . at my insistence , as the rain pounds our little cabana . I wake at 7 a . m . to a single beam of light shining in between the closed wooden planks on the windows and lean over to slide the windows open .
“ It ’ s sunny ! Get up !” I ’ m already out of bed and getting my swimsuit on . It ’ s been raining nonstop since I arrived in Belize , and thanks to the flu , I haven ’ t felt like moving , eating or really much of anything until this moment . Jillian rolls over and puts her pillow over her face . Once I have the door open and proceed to frolic onto the porch and into the sand , Jillian makes her way out of bed and agrees to breakfast .
The rest of the weekend is lovely — sunny walks on the boardwalk , sleeping to the sounds of the waves , souvenir shopping , yoga on the beach , tropical fruit smoothies and even a morning of snorkeling in the reefs . By the time Sunday afternoon comes and we make our way back to the water taxi , I feel like Jillian has not only forgiven me for poo-pooing her voyage up north idea , but even enjoyed herself . And with a newly rejuvenated roommate , what ’ s not to love ?
Day # 8 , Alone in Corazón
0745 . The village of Corazón is almost as far as Dolores — a bumpy hour and a half ride through the jungle . We ’ re fairly adept at loading the truck now , with two to three girls lifting each of the heaviest three cases of supplies and medicines over our heads and up to Rudy , who stands on the roof of the truck .
“ We got a doc today ?” Rudy asks in his Caribbean accent . I smile and wave in response , and he looks a little worried . Mine is the sole name listed under providers staffing the Corazón clinic , which serves at least six villages in the surrounding area . I have one medical student , two PA students , a pharmacy student and two local nurses as my support staff . I grab a bunch of reference books from the Hillside clinic just before we finish packing up the truck , and hope I have everything covered : a pharmacopoeia for medication dosing , a tropical medicine book , an OB-GYN book and an Oxford guide . I ’ ve been up since 0630 plotting a game plan for today , as I ’ d been told how busy the Corazón clinic could be . I turn around to the girls in the back and deliver my little pep talk . I lay out how we ’ ll organize the clinical areas into waiting , intake , pharmacy , waiting for meds and exam areas , and while the girls are seeing their first patients I will pre-write prescriptions for our most commonly prescribed meds , including Tylenol , Benadryl and ibuprofen . I instruct the girls to write their notes during the patient encounter rather than afterwards , then staff with me , submit the prescriptions to pharmacy and then finish wrapping up the notes and patient encounter . I ask if anyone has any other ideas to speed the day along . They shake their heads and look agreeable with my plan . Somewhat relieved , I turn around and promptly fall asleep .
I awaken to Rudy honking the horn to let the villagers know we ’ ve arrived . We pull up to a single-story , teal-colored concrete building with a tin roof , similar to most of the clinics we ’ ve worked in before . We unload the truck and finish setting up by 1000 , using the multiple wooden benches inside to construct makeshift exam tables and seating areas as we wait for the patients to arrive . The clinic is set in a large expanse of green space , where as usual , wild dogs , chickens , turkeys and pigs and their piglets roam freely past the open clinic doors . The first patients start to trickle in , mostly with typical complaints of headaches for the women ( the Mayan women carry their babies in a cloth carrier on their back worn around their forehead like a headband ), family planning , coughs and colds , rashes and skin infections . Around 12 p . m ., the waiting area starts to back up because the intake nurse and the pharmacy nurse are working double-duty as Mayan interpreters . A heavy rain starts to pour onto the tin roof above us creating a loud roar inside the building , and both patients and providers shout to be heard . A few wild dogs hover coyly under the overhang of the clinic , and no one bothers to shoo them away . Karen , one of the PA students , approaches me to staff a 4-year-old boy with three months of jaundice and poor appetite . She hasn ’ t had her pediatrics rotation yet but feels that he doesn ’ t really look yellow . The mother describes her efforts to “ wash away ” the jaundice with special herbal baths , which hasn ’ t worked for her . I walk over to examine him , and notice a loud heart murmur , signs of anemia and diffuse jaundice . I ’ m worried and start talking through my differential out loud with Karen : G6PD or some other reason for hemolytic anemia , malaria , amoebic liver abscess , viral hepatitis or more rare genetic causes of early liver failure and jaundice in children like primary biliary cirrhosis or Rotor ’ s / Dubin ’ s syndromes . The parents refuse blood work because they prefer to go to Punta Gorda — the big hospital — in two days , because the child ’ s father will be there for another appointment . Despite my insistence , the mom is steadfast . I write out a detailed laboratory requisition and treat the boy empirically for worms , malaria and amebic liver abscess with albendazole , chloroquine and metronidazole , respectively . Hannah , the pharmacy student , and I flip through the pharmacopoeia and tropical medicine book to verify our medication dosing and course . Nervously , I send the boy home and make his mother promise profusely that she will go to Punta Gorda .
We plod through the steady stream of patients who arrive well after our supposed closing time , in an effort not to turn anyone away . Aside from the issue of interpreters , our other major issue we find is lack of private space to do pelvic and genitourinary exams . I make the best of the outdoor bathroom and a flashlight for a pelvic exam , and a rainy outdoor alcove where I give gluteal intramuscular injections . We finish at 3:30 p . m . instead of 2 p . m ., my exhausted crew and I load up the truck . The familiar feeling of trepidation creeps in as we pull away from Corazón . Once again , all I can do is hope .
Dr . Perotta is Medical Director of Adult Congenital Heart Disease and Assistant Professor of Pediatrics at the University of Louisville School of Medicine in the Division of Pediatric Cardiology at Norton Children › s Hospital .
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