The Vaccine Chronicles part I

It has come to my attention that many of my readers  (and facebook friends) are under the impression that I on some kind of permanent vacation out here and all I do is traipse around various beaches developing nothing but a deep tan and a strong affinity for fried fish.

I hate to break it to you, but that is only partially true. At least for now. The past few months here have been a combination of traveling for pleasure, traveling for work, and chillin in Olancho doing sporadic projects here in my site.  But the random work stuff is just not nearly as exciting to write about. And the pictures are wayyy lame…

As far as “work” goes, lately I’ve been dividing my time between my two assigned counterparts: the elementary school and the Centro de Salud public health clinic. I usually work on random projects of different kinds with each group, depending on who is doing what and who wants my help. As I’ve said before, this is NOT  a 9-5 sort of deal. I have a lot of flexibility and I get to pick and choose what projects I want to throw myself on.

Just this past week I was asked to help the nurses at the CdS with a vaccine campaign. The goal was to get all 11-year-olds vaccinated against tetanus and do boosters for all kids under 5. We also gave something called sabine and neumococo which I think is something like meningitis and some elderly qualify for high blood pressure or asthma shots (can you tell I am not a nurse?).

Before you even ask, no, I did not administer any vaccines myself. Yes,  this is a third world country but they still don’t let untrained bozos such as myself stick people with needles – no matter how understaffed they are. And, they really  really are. I worked on the books mostly. Updating records, starting new records, whiting-out the mistakes from the last round of records.

The whole process is  muy interesante and I liked getting to see nearly all the families and young mothers in town. Even if it meant we had to make our small talk over the screams and hollers of the children they brought to see us. It also confirmed for me the fact that every single person in this town knows me (or of me) even if I have never met them. My reputation precedes me…

It’s astounding how willing the mothers are to inject their kids with whatever is being passed out at the time.  It seems like many Hondurans equate shots with good health. And why not? By definition they prevent disease, which in turn, promotes longevity.  However they seem to think that a vaccine – of any kind – is a guarantee that they will be healthy for a while. Not everyone mind you, but a lot of people seem to have this attitude.

So when the pick-up truck with the loud speaker drives through town announcing that the health center is giving away free shots, every mother in town comes running, sometimes from kilometers away, with all of their children in tow. They approach me, who is sitting behind a stack of binders and clipboards with charts dating back to 1996. They tell me the ages of  all of their children and ask eagerly “what shots can we get? My kids haven’t had any in a while and I think they need some. What about vitamins? Can you inject them with a shot of vitamins?”.

The first couple days of the campaign we were stationed outside of the municipalidad. From 8 am till 4 pm a team of three nurses, and two note-takers (me)  sat at a fold-out table and did business first come, first serve.  There was no money involved or insurance cards or anything terribly complicated. We simply took down names and dispensed tears and screams one at a time. I was assigned the task of looking up each child’s record in a fat folder full of charts based on their name and neighborhood of birth.

***Sidenote -  this is how small our town is: we don’t even need birthdates or ID numbers to locate a kid’s record. In most cases, there were only 10-20 babies born each year for each barrio in town. So identifying them in the archaic paperwork system is a cinch. It’s deciphering the scribble handwriting that becomes the hard part…***

Most of the families that showed up were already on a first-name basis with one of the nurses or myself. Or, more likely, all of us.  If the child was born here in El Real or a surrounding aldea, then the mothers have identical fold out cards which presumably tracked their vaccination history and gave them a written reminder for the next check-up. The cards have several little boxes that get checked by a nurse when something is administered. But most of the cards that I saw were covered in illegible dates and medicine names that had been written and erased, many times over. And as the week went on, I discovered the plethora of errors in this disorganized system. Que raro, no?

For example, a young mother walked up to the table, with three children right behind her. She handed me three wrinkly  blue and yellow tarjetas de vacunicacion and looked at me expectantly to announce which kid would be receiving which shots. Since the boxes were completely illegible  and scratched out by the scribes before me,  I passed it on to the reigning nurse to get a second opinion. She gave it a once-over then a slight shrug, and declared that if we can’t figure out what was given last time, we’ll just re-do them “just to be sure”. I was horrified by this, thinking about what my med-school friends back home would say. To me, it seemed dangerous and negligent. But that’s probably just be because I grew up in a time where vaccine-phobia swept the US causing parents to over-scrutinize anything in a syringe. So I held my tongue and decided it was best to let the nurses call the shots (no pun intended).  After all, they have been doing this for a lot longer than I have – and there haven’t been any three-headed babies yet…

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Another little qualm I have with the whole process is the overall lack of privacy afforded to anyone coming to get vaccinated.  In our attempt to handle to crowds efficiently, the nurses can often be taking care of several customers at a time.  And they will shout medical info, ages, and current medications across the table to me or the other note-taker. Within earshort of everyone else crowded around no less. I could totally tell that some of the older ladies did not like being asked their ages out loud in front of a group of onlookers.  But the nurses were too busy holding down flailing toddlers to worry about their pena. Also when older women had to get a shot, they often had to unbutton their blouses half-way or all the way down so they could expose their forearm. While everyone in line looked on! Perhaps to them it wasn’t a big deal, but I still felt embarrassed for them. (Speaking of exposure,  don’t even get me started on the number of exposed breasts I have seen the past week. Public breast-feeding is a running joke among Peace Corps volunteers because literally everywhere you look, you could find a woman breastfeeding. Literally anywhere. But that is definitely just something you get used to.)

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On several occasions, parents presented us with vaccine cards and paper records from the US and then the nurses turned to me to translate the things. I tried my best to decipher what shots were already given before they were moved here from the states. So far I’ve seen several such cards from Florida, two from Louisiana, and one from Georgia. Is it weird that I looked at these papers with a sense of nostalgia? a sense of longing?  Longing to read something in English, even though it is in the crazy language of doctor’s acronyms, dates and multi-syllabic diseases that I had never heard of.  But they were orderly, computerized, and digitized with rational chronology in mind.

It sounds strange but during a week of chaos and nonsensical paperwork, it was something that was familiar to me. I looked at the letterhead of each page, wondering if I had ever been there or knew anyone in that small town in Louisiana. I recognized the fuzzy black lines of the charts that gave away how many times it had been copied and re-copied at some random doctors office. I then imagined the formal waiting room with magazines on clear glass coffee tables and nurses in latex gloves with clear jars of band-aids and gauze  – all things that we definitely do not have at our lemonade-stand of a doctors office.

{sigh}

That’s precisely when I started to really miss the US and it’s order and structure (not for the first time, obvs). And not just in the ways of medical facilities. Transportation, sanitation, communication. Everything that falls in the orderly system to which I am accustomed. I even miss the way the airline boarding agent calls your seating section and everyone lines up calmly and gets on the plane one by one. (This due to the fact that I almost got trampled last week trying the get on the last Discovery bus headed for Olancho. There were a limited number of seats and a huge crowd of people trying to get home after Semana Santa. Some woman in gnarly heels nearly took off my small toenail in her efforts to box me out of line and I hope she trips on her ridiculous orange stilettos)

Sometimes this laid-back country delights me with its easy-going nature. But other times, like oh I dunno, working with live pathogens, it astounds me. I’m sure as I continue to do more hands-on projects at the Centro de Salud I will get used to they way they do things. I have to, right?

Starting this Monday is the second week of vaccine brigade where we will be hitting up the local elementary school to finish off the 11-year-old’s there. I’m pretty sure I’ll be helping out for that as well, probably doing the same job as before. That is, if I don’t decide to go to the beach for the week instead…

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kidding.

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I hope everyone out there has a good week and a great Cinco de Mayo!

Before you go, The Unrelated Picture of the Day:

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This would be Gracie, my adorable four-year-old neighbor playing with Bernice. Gracie comes over to hang out every once in a while and she and the bunny had a lot of fun in the front yard Saturday morning. (although once back inside, Bernice hid under the fridge for the rest of the day. Can’t imagine why…)

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Paz,

-Sarita