One of the adventures of travel is the ability to experience things outside of your comfort zone. There can be many first-time experiences as you discover your new surroundings. Some firsts are anticipated or even expected while some catch you by surprise. Some first experiences are lost in the sheer monotony of the repeated experience. I really don't remember the first time I realized that an ant was crawling up my arm as it is an everyday, frequent experience in this new environment. While there are far fewer first-time experiences these days, I have had a few notable ones recently.
While seeing patients in a remote village, I performed my first full pelvic exam on a woman while she was lying in a hammock in a dark Maya hut using a headlamp for light:
When out in the villages, we often see patients in an open room or out under an open thatched roof. If we cannot find a private area for an exam, we will climb into the back of the Land Cruiser and use the back bench seats while covering the windows with sheets. During my encounter with this woman, I realized that I really needed to do a pelvic exam to rule out some concerning things based on her symptoms. She refused to be examined in the Land Cruiser and said that she would only let me examine her in her own home. So a medical student and I set out to follow her across the village. We eventually came to her thatched roof hut. It was a typical Maya hut with no electricity, no windows and with hammocks strung from post to post that function as both couches, chairs and beds. She was much more comfortable in her own hammock and home and although technically challenging, she allowed me to do an adequate exam. Definitely a first for me.
In the remote villages, transportation is an important factor in our delivery of healthcare and sometimes I am amazed by the people's ability to get around despite the lack of vehicles or decent roads. Seeing a wheelbarrow ambulance was definitely a first for me:
While out in another remote village, a woman came to the clinic where we were seeing patients and asked me to come and see her mother-in-law because she was too sick to walk. Again, a medical student and I gathered up some medical equipment and walked across the village to a Maya hut. When we arrived, many of the family had gathered around an elderly woman lying on a wooden platform bed. She had been hospitalized in Punta Gorda several weeks earlier with abdominal pain but they did not know what was causing it so they sent her home and told her to come back into town when a radiologist came down from Belize City (once a month) with an ultrasound. That appointment was still several days away when her abdominal pain began increasing and she developed a fever. The family debated taking her into Punta Gorda but knew we were coming the next day and so decided to wait for us to evaluate her. On exam, she had a temperature of 102 with a low blood pressure, high pulse and what we call an acute abdomen - tender with guarding as well as rebound tenderness. She definitely needed surgery. I was also able to feel a large, firm mass in the right lower quadrant of her belly. We needed to get her to a surgeon right away.
This village is so remote that there is not a road that goes into it. After a almost 2 hour drive, we park the Land Cruiser and have to carry all of our medications and clinic supplies across a river and then a half mile into town. I told the family that if they were able to get her to our Land Cruiser then we would take her into Punta Gorda to the hospital where she could then be loaded in an ambulance for the 2 1/2 hour drive north to Dangriga where there is a surgeon. I was not quite sure how they were going to do it but as we were carrying our things out of the village, here they come pushing her in a wheelbarrow. Her sons pushed her all the way to the river and then carried her across to our Land Cruiser. We were able to put her in the front seat and take her into the hospital for care.
Another first-time has nothing to do with medicine but is equally notable in my book. It is my first experience of gourmet food in Belize:
Hopefully no local Belizeans will read this and take offense because there are some fabulous cooks around here and rice and beans from them is definitely better than rice and beans from an average cook. Also, while I love the hot, corn tortillas they make on an open fire in the villages, I have missed a variety of foods and complex flavors. It can be very depressing trying to buy groceries or plan meals as the largest grocery store in the whole district is about the size of a convenient store in the U.S. There are plenty of bananas and pineapples but there are few vegetables and basically produce is only sold at the open air market on Monday, Wednesday, Friday and Saturday mornings. The boys will often talk about the restaurants they wish we could go to or the familiar foods they are craving. After the first month, I have not allowed myself to think about food from the U.S. and have worked on learning to make cookies and treats with what we have here and perfecting my Belizean rice and beans.
Then Juan came to visit. Juan is our chef friend from the U.S. who has been living in Honduras for the past 6 months volunteering at an orphanage. He has made us wonderful meals in the past and I wrote him several months ago about my cooking quandary and asked his advice. He caught the ferry from Honduras over to Independence, Belize and then rode a bus into Punta Gorda for a visit this week. We have really enjoyed showing him some of Belize and I love his reaction to our food situation. We of course fed him rice and beans his first evening here and then the next day while I was at clinic, he and Will walked into town to shop for food. Even he was amazed by our limited supply of food choices but took the challenge in stride and made us a wonderful gourmet meal for dinner tonight. I was able to find a bottle of wine in town to serve in our one wine glass and we had quite the feast: mac 'n' cheese fritters topped with roasted whole onions covered in coconut curry sauce. A first for Belize but it was awesome and beats rice and beans any day!!!
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