Ceibas, Tiny Churches, Broken Bones, and Tajaditas de Plátano

"The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little."

- Franklin D. Roosevelt, Inaugural Address, January 20, 1937

These are the words I hear as I listen to Audible's version of The Four Winds by Kristin Hannah while preparing my lunch today. Though spoken at the time of The Great Depression, these words are undoubtedly still relevant today...

I realize this every day at Loma de Luz. Here a patient admitted to the hospital is provided a less-than-twin size bed in a room that he or she shares with 3-4 other patients separated only by curtains. Though the curtains guarantee some degree of privacy, they are still permeable to the sounds and smells that make hospitals less than pleasant. Family members reluctant to leave the sides of their loved ones sleep on the ground or the hard wooden benches in the hallway. But a small bed, thin curtains, and a solid surface are enough. One day when I am on call, there are 4 women in our labor and delivery room with only 2 beds. When we determine one woman is closer to delivery than the other, we kindly ask the latter that she leave the comfort of her bed and walk the hallways or sit in a chair outside the room so the woman who is about to have her baby can deliver in "privacy." She pushes through her labor pains without the standard options for pain control- epidural, laughing gas, and intravenous narcotics. I make a futile effort to offer the soon-to-be mother some relief: a cool, damp washcloth to lay over her forehead. But a few degrees difference is enough. The other day, a patient even told me at his hospital follow up appointment, "Me sentí tratado como un rey," or in English, "I felt treated like a king" as he gave me a hug of appreciation.

Here at Loma de Luz where people have little, "enough" is fit for a king. After all, was our King not begotten in a lowly manger? In just two weeks, I have witnessed the progress that all of those who serve in this hospital have made to provide for those who are in need. I think FDR would be glad to see his words come to fruition here at Loma de Luz, AKA "Hill of Light."

On my route to the beach, I walk amidst a flock of trees whose roots appear to devour the earth beneath them and whose canopies seem to reach endlessly to the sky above. While I contemplate how these trees could belong to an enchanted forest of a well-known fairy tale, or come to life in their debut of Lord of the Rings or Harry Potter, I stare in awe at their complex natural beauty. The ceiba it is called, revered by the ancient Mayans and Aztecs for centuries. According to traditional Mayan beliefs, the ceiba served as the arboreal highway connecting the underworld to the human world to the heavens. It has also been coined, "tree of life," due to its generous production of fruits and seeds and its reliability in marking a territory of abundant water. And though I don't see creatures of the underworld crawling in its roots or angels perching on its branches, it is impossible for me to walk by the ceiba without feeling a sense of awe and wonder.

It is difficult to describe the feeling of safety and refuge that accompanies one as he or she enters the house of God, surrounded by those who share the same faith and speak the same "language." This tiny church with its rose pink exterior is tattooed with the indelible mark of a green cross. It doesn't appear to have a name, though I recognize its identity without pause. In its unassuming exterior appearance, the church assumes a role of the utmost importance within its walls: bringing people together in the real presence of Christ. In a place where much is unknown to me, I find a place I know all too well. I walk through the doors as if I've been here before- I find a seat in a wooden pew, we make the sign of the cross, we pray the words we know bring hope and healing, we listen to the Word of God, and we share in the real presence of Christ. At the end, a woman introduces me to the others as "nuestro hermano," our brother. I think to myself- yes, we are all brothers and sisters, and this is our home.

There are days here when I feel I have "worked my fingers to the bone," and often, it is the bone that works my fingers (for those of you who know me well, this joke should come as no surprise). We see a lot of orthopedic problems here, largely due (I think) to the lack of safety measures and lack of infrastructure here in Honduras. People fall off of motorcycles, get hit by wooden planks, get pushed to the ground by cows. Orthopedics is definitely not my strongest point in medicine, so it has been a humbling and educational experience as I learn how to manage broken bones.

This week brought with it a lot of medically interesting cases and exciting procedures. I diagnosed psoriasis (with the help of my dear friend and Dermatology guru, Abigail), and I played anesthesiologist as I took my first stab at spinal anesthesia (and yes, I was taught by the midwife!). I treated a severe case of immune thrombocytopenia purpura or ITP (a disease in which one's own body attacks his or her platelets leading to widespread bleeding and bruising), and I removed 2 liters of fluid from a woman's chest in a procedure called a thoracentesis. I successfully rotated a baby from the breech to head-down position in a procedure called external cephalic version, allowing the mother to successfully have a normal vaginal birth instead of a C-section for which she was grateful.

Work can be challenging here where resources are limited and staff is short. I found myself sitting by a laboring woman's bedside repeatedly measuring her vital signs and pushing a medicine (phenylephrine) through her IV to increase her blood pressure. I sat at the head of a patient's bed giving her breaths with a bag valve mask for 30 minutes as a last-ditch effort to expand her lungs and remove carbon dioxide from her body with the hope that she would miraculously start breathing on her own again. Placing her on a ventilator was not an option, and unfortunately she passed a way a few hours later. I've had to double- and often triple-check my dosing for medications because there is no pharmacist to correct my mistakes. And I've had to scramble to find the nearest oxygen mask and hook it up myself as a I enter an empty emergency room and see a patient lying in bed with an oxygen saturation in the 60s.

If one doesn't know just how much healthcare is a team sport prior to coming to Loma de Luz, it's impossible not to understand that after spending a couple weeks here. I am so grateful for all of the nurses, respiratory therapists, pharmacists, etc. that care for our mutual patients.

Now, to end things on a lighter note- I've developed an (unhealthy) addiction to tajaditas de plátano (plantain chips) with chili, lime, and salt. Good thing I have this stunning view I can hike to when I need to burn some calories.