Rain and Geckos

 

It is definitely rainy season here.  Every night we have large storms and torrential rains.  The rivers are full and in many places there is standing water.  As we drive out to the villages, the streams that we crossed previously are much larger and sometimes flowing quite briskly.  We had to cancel one mobile clinic this week as the river was too swollen to cross into Blue Creek.  

Bill's team trying to cross into a village by foot with the gear for clinic since the footbridge was flooded.

I thought I was doing well adjusting to the tropics and the amount of pests that accompany it.  I am good at looking for lines of ants and spraying for them everyday.  Caelan and I even went after the army ants last weekend who had decided to nest in our front door and were successful at rooting most of them out.  However, tonight I am not so sure it I am being a good sport.  We have geckos in our house which live up where our walls meet the ceiling as well as behind the kitchen cabinets and I have thought they were cute and helpful in keeping the bug count down in our house.  The guy in the kitchen even likes poking his head out now and then and talking to me.  Several litters must have hatched recently though and over the past couple of days there have been small geckos everywhere in the house.  Tonight as I was doing laundry, one actually dropped down on my neck and I have to say that I no longer think they are cute.  To top it off, I have had 3 large (2 - 2 1/2 inch) cockroaches fly at me in the kitchen this evening.  My goal now is to train Louis to go after any of these if they are within his reach.  He has caught one gecko and one cockroach for me so far!  The geckos can stay high up on the walls, off me and we can again achieve a balance in our ecosystem.

      Gecko baby

We have been enjoying some of the local foods.  It is the start of breadfruit season and I have fried it up for the boys like I remembered having it on San Andres.  They really like it as well.  They do have ketchup here which makes it all the better!  The nutrition conditions here are interesting and as varied as the many cultures that live here together.  In Punta Gorda (the town of 6,000 in which we live) food is not always plentiful but there is not a lot of true malnutrition and actually there is a percentage of obese people in the Guarifana population (African-American).  My guess is it is because they eat so many starchy foods - the fish is scarce since it the bay was over fished and their diet consists of a lot of plantains, rice, beans, some roots and bread fruit (also very starchy).  They also fry a good bit of this food in coconut oil (which is homemade frequently).  We see a large amount of diabetes and hypertension in these people.  The Mayan villages are very different with a large amount of malnutrition in the children.  Fortunately they all breastfeed for 1-2 years but then after that, the kids fall off the growth curve!  There are few vegetables in Belize but the villages have none - existing off of mainly rice, corn (tortillas) and beans that they grow.  It is amazing at how small/short and skinny some of the kids are.  There have been several times that I thought that a child was 3 or 4 years old to find out they were 9 or 10!  We are working with the Belizean Ministry of Health to implement a nutrition supplement called Incaparina (from Mexico) for these kids.  Not sure exactly all the ingredient but at least the kids do like the taste of it and it does seem to help in their growth.  Interestingly enough, there is also a large amount of type 2 diabetes in the villages as well.

Last Friday I was on mobile clinic in San Felipe and had an interesting experience.  A woman came to area where we were set up and asked if the doctor could come to the house to see her mother who could not walk.  We take charts with us into the villages so I found hers, grabbed my stethoscope and a blood pressure cuff, left the medical students to see the patients who had gathered and went with Rudy (our driver) to her house.  We drove to the other side of the village, parked and then started our walk to her house.  We had to cross one stream on a 2 x 4 board, walk a ways through ankle-deep mud past other huts and then cross another stream on a footbridge to get to the house.  I have to admit that by this time I was a bit apprehensive about what I was going to find.  The house was made of wood slats and a thatched roof.  Her mother was putting on her shirt as we walked in (the older women as well as children often go shirtless in the villages) and shuffled slowly across the dirt floor on a walker.   Most people sleep in hammocks but the older couple had a simple wooden bed with a threadbare quilt spread neatly across it.  A wheelchair sat in the corner but she was not using it.  Her chart said that she has a history of documented spinal stenosis which was causing her to slowly lose her mobility.  She had had some type of injection (undocumented) in her back in the government hospital which gave her no relief.  Surgery would be the best treatment but is not an option as it is not available.  Once we were there, the daughter asked me to see her father as well.  Both of them are 88 years old, very thin and looked frail but they were clean after their bath in the stream that morning.  The daughter spoke English and was able to translate to Mayan for me.  They sat on the edge of the bed so that I could examine them.  Their blood pressure and pulse was great and their hearts and lungs sounded good as well.  On exam, they both were still surprisingly strong despite significant osteoarthritis in his knees and hips and pain from her spinal stenosis and significant scoliosis.  In fact, in a country where life expectancy is lower than ours, I was very impressed with how well they were doing.  The mother only asked for Tylenol to help with her pain and the father asked for Ibuprofen to take occasionally for his osteoarthritis.  Walking back to our mobile clinic I realized that despite my muddy feet and sandals, it had been a very positive experience to see inside their world and to offer them something small that we daily take for granted in the U.S. but made a difference for them.  It was also hard not to think about their positive outlook of the same diseases that we often see approached completely differently by patients in the U.S. and how despite their surroundings, they maintained a quality of life that is often lost in similar circumstances in the U.S.