Friday, June 6, 2008

The best laid plans...

... almost always fall through in Belize. A long term volunteer told me today that if you accomplish one thing per day in Belize, you are doing great. I am extra frustrated this morning because I had intended to go speak to a preschool classroom in the Cayo District about disabilities awareness. However, the Ministry of Education announced that school is canceled on Friday for the hell of it last minute. Are you kidding? Welcome to Belize.

I wanted to share a little more about San Ignacio Hospital in this posting. SIH is a small public hospital located on a small hill just outside of the center of town in San Ignacio. There are two other decent sized private hospitals in the San Ignacio and Santa Elena areas, but most lower income residence (meaning the majority) receive their care primarily through SIH. The hosptial has an inpatient ward, an outpatient center, a small pharmacy, and about half a dozen full-time physicians. Most of the MDs are trained in Cuba because there are no medical schools in Belize. The Cayo area lacks many full-time specialists, such as an OB/GYN, mostly due to a lack of funding to pay physicians a decent salary. It is more profitable to work in Belize City.

As far as therapists, from what I have heard there are only two Belizean full-time trained physical therapists in the country. There are several foreign therapist who work in Belize, but they are not Belizean citizens. Again, there are no universities in Belize to train physical therapists; the two mentioned most likely received their training in Guatemala or Mexico. The therapist who works at SIH on Fridays rotates to various area hospitals, probably spreading himself thin. Those who are disabled from birth or recent injury (stroke, motor vehicle accident) will either receive no therapy or over-pay for some untrained individual who might have a medical aide background.

SIH is a decent hospital and now that I am accustomed to my surroundings it really does its job. However, my first impressions were of awe. The buildings are run down with chipping paint, only 3 rooms (the pharmacy, small ED, and administrator's office) are air conditioned, they have none of the typical medical technologies (xray, CT, ultrasound), there is no blood bank, and curiously the majority of meds are given via injections vs oral prescription (due to financial reasons?). The lowest trained nurses perform some involved procedures including dressing changes, injections, and stitches.

This following medical example is for my fellow dorky medical professionals. I apologize in advance to everyone else. One of my frequent patients is a 17 year old boy who does distance biking throughout Belize. He was hit by a car while riding one day, breaking both his left humerus (upper arm) and right clavicle (collar bone). The ED physician sent the boy to another local hospital to receive an xray to identify the breaks. There are no orthopedic surgeons in Cayo and typically this type of break would require surgery to realign the humerus with pins & a plate. However, this is not a cost-worthy procedure for a kid living in the Cayo district. Instead, the MD decided to manually traction the arm and cast it. If the bone did not heal properly, then they would need to re-break the site of the fracture and have the pinning procedure. Fortunately everything healed properly, but this kid has a huge bony callous like I have never seen before. It may take months to resolve.

Needless to say medicine in Belize astounds and inspires me. To the left is a picture of the area I use within the hospital to do my PT thang.


No comments: