El Torsalo (the bot fly)

WARNING! THIS POST IS NOT FOR THE FAINT OF HEART (ie – Rory S. and Bret R., do not read, and definitely do not look at the pictures)

Clinic here in Danli tends to be very busy on Mondays and Fridays, while the middle of the week can be fairly quiet. Many of the patients travel a full-day (if not more) to reach the clinic, and therefore, attending the clinic in the middle of the week simply isn’t feasible as it would require missing two days of work. This past Friday was particularly busy… and full of some excellent cases. We had a gentleman with chronic prostatitis (first case of the day), a young kid with fungal infections and superimposed cellulitis and impetigo, as well as a nail extraction for an ingrown toe nail, among many others. However, the case of the day – and possibly the case of the month – was our first case of myiasis – more commonly known as bot fly; or here in Honduras, “el torsalo.” Myiasis is actually an animal or human disease caused by parasitic dipterous fly larvae that feed on the host's necrotic or living tissues. The fly larvae burrown into human flesh, takes up residence, and builds a nice little home. The burrow forms a hard nodule with a soft, fluctuant center through which the larva is able to breath. As such, common mechanisms of removing the larva include covering the opening with raw bacon or Vaseline and waiting for the larva to emerge from its den in an attempt to breath. However, if this fails, there is always the option of using a subcutaneous anesthetic injection and manually removing the larvae from its home.

We had a mid-40 year old female present to the clinic today with a nodule on her back, which had been bothering her for some months now. The nodule was hard and indurated, but the center was soft and fluctuant. She thought she had an infected pimple (espinilla), but she was unsure. Whatever the crater on her back was, we needed to incise it and drain it as it wasn’t going to heal without removing the contents. Without further ado, Dan and I began to prep the lady’s back (of course using sterile technique) in preparation for our excavation. We were suspicious that the nodule might contain a bot fly, but we were not sure. Lo and behold, once I broke skin and opened up the soft center of the crater, the little monster’s head popped out. I quickly grabbed it with my forceps (which was a mistake), because as soon as the larva was out, a rocket of pus shot out of the large abscess on her back. Needless to say, we quickly drained the abscess, packed it, and bandaged the patient up. We were able to provide her with antibiotics to cover the underlying bacterial infection that was brewing, as well as pain medications, and she has returned twice for repacking and dressing changes.

It is incredible that this sort of infection is really not a big deal to the folks living here – it is simply part of life. She was calm and collected the whole time, even when she realized that indeed, a fly larva had made its home in her back and was feeding on her. When we finished the procedure, she thanked us and told us she would be back to have the dressing changed. Not once did she question the diagnosis, nor give indication that she was disturbed by her infection. She was truly a trooper. This again serves as an incredible reminder to just how blessed we are. These are the cases that you hear about in medical school, but are told you will never see because they just don’t occur. Life here is different, and all of those things we shouldn’t see, we are seeing. Hopefully as the country continues to develop, health care will continue to improve, and tropical diseases such as these will become much less common. In the meantime, hand me a scalpel and I'll manually extract the critters!

Danli - the Carbonera

Danli, although not one of the larger cities in Honduras, has the unfortunate claim to a large population of families that have been economically forced to make their homes around the city dump. There are hundreds of families living in homes constructed of adobe, scrap metal, and plastic waste; living with hungry vultures, an immense number of flies and other insects, and the smell of burning trash. Sanitation is essentially non-existent and the living conditions are dismal, and the people who live at the dump are a good reminder of the harsh realities of poverty here in Honduras. However, these people are resilient and proud as they greeted us with smiles. We ran across this sign as evidence of their courage: "Seamos buenos por dentro, pero sin dejar de mostrarlo por fuera" ~ "Let's be good on the inside, even if it doesn't show on the outside."

Danli - The Clinic and the Brigades

We arrived in Danli about a week ago, and after the first night alone in the dorm with one other fellow (Dan - a recent college grad who is currently applying to medical school), we were joined by a group of 10 medical students from the University of Texas Health Science Center in San Antonio (UTHSCSA), and one of their internal medicine attendings, Dr. Lapey. This was a very welcomed surprise, as the clinic is normally managed by only two "physicians," and it allowed for a much easier transition into our work. Lindsay and I have been functioning as full-fledged physicians, but have had the benefit of Dr. Lapey on whom to bounce questions. The first and second year med students from UTHSCSA have been fantastic, and have truly made a huge impact in helping to interview, examine, and diagnose the patients. It has been a team effort for sure, and it has also forced us to refresh ourselves on our medical knowledge so that we can try to help teach them as well. We will be sad to see them leave on Monday :o(

However, that being said, it has been an amazing week with them here. We worked in the clinic on Monday; but on Tuesday, Wednesday, and Thursday, we split the group in half and alternated days working in the clinic and driving to a small surrounding aldea where we set up a medical brigade in the local school building and served the very needy population for three days. Many of the patients would otherwise be unable to access health care, and it was a tremendous opportunity to serve. The Hondurans are beautiful people, and it was a pleasure to serve them in this way.

While the trip has been both eye-opening and rewarding, it has not been free of "flaws." Much like La Ceiba, and Copan before it, we have already had our share of no running water, and we are scheduled to be without electricity most of tomorrow. However, we can take each day as it comes, and it always works out in the end!

The next three weeks will be very different without the other students and Dr. Lapey here to talk with, and to bounce questions off of. However, we are excited about the challenge of serving these people as best we may. It has truly been a God send, however, to have them here this first week to get us acclimated to the project. Praise God for his faithfulness and perfect provision! Our time spent in Copan and La Ceiba learning the language has also really paid off thus far. Thank you again for your support and prayers. We will write more later as things continue to progress.

40 Days and 40 Nights

Well, actually, it was only three days and nights of torrential downpours... but boy was it intense! We live in one of the communities bordering the Cangrejal River, and our neighborhood was essentially floating! Unfortunately, we were unable to take pictures until a day or so after the storm, so the water level had already dropped, but even so, it is impressive. The drainage system here leaves much to be desired. This first picture is the backyard of a bilingual school, and the second shows the fairway of the 18th hole at the local golf course, although it appears to be a lake! Four days post-storm, the waters are down, and everything is back up and running.

Roatan - the Bay Islands

Our time in La Ceiba is quickly coming to an end - we leave tomorrow morning for Danli, where we will spend the next month working at a medical mission clinic. However, we wanted to add one more post before we head off, as we do not know how accessible the internet will be in Danli.

During one of our weekends here, we were able to visit the island of Roatan (largest of the three islands comprising the Bay Islands, known worldwide for excellent scuba diving and snorkeling, and also reported to be the landing place of Christopher Columbus on his fourth and last voyage to the Indies), where we enjoyed a leisurely stay at he beach with snorkeling, kayaking, reading, and relaxing. Fortunately, or perhaps unfortunately, the island people all speak English, so this turned out to be a complete break from our studies! However, that being said, it was a much needed weekend to recharge and get ready for what lies ahead!

Hola otra vez de La Ceiba

Classes are plugging along - but the days are flying by! In the afternoons we are volunteering at the public hospital, which has been very eye-opening. JR spent last week in the E.R. and I was in the labor and delivery ward. Things are very different here as supplies and medicines are very limited. In L & D they are delivering the babies with only gloves as they have no sterile gowns, masks, etc. C-sections are vertical in most cases (depending on the doctor - not on the situation). And anesthetics - forget it - these women are delivering without any pain meds; although lacerations and episiotomies are repaired with local lidocaine.

The E.R. was an incredible experience for JR. Last week he saw an older gentleman with tetanus, a severe hand vs. machete injury resulting in 3 severed tendons, and an accidental electrocution. The poor boy with the hand injury walked three hours to get to the local clinic (Centro de Salud), which fortunately had a visiting American medical mission team with IV supplies. They started an IV before beginning the 3 hour journey in the back of a pick-up truck to the closest hospital (La Ceiba). He was treated that night by the in-house orthopaedist, but it is doubtful that he will regain complete function of his hand. The doctors here are incredibly talented, but unfortunately they are limited by their supplies.

One more week in La Ceiba and then we are off to Danli, a city south of the capital, Tegucigalpa. We hope all is well with you all.
Blessings,
Lindsay and JR