I’m back at the house after a long day… have a big headache and the neighborhood dogs are out and about for their daily bark fest.  There must be 6 or so dogs that bark back and forth between 6-8 PM every evening, tonight they seem to be really excited about something.   

So today was a long day.   I had some meetings so that I could tell people of my findings from my time here.  I managed to eat a roti today and had a “double” for breakfast.  Both were really delicious.  I still have some roti left over for dinner.  I am pretty tired tonight and have headache, so I think I going to stay home and get to bed early tonight and get ready for the beach tomorrow.  I can’t wait for the beach!!!  

Last night I went out to lime with one of the other foundation people and the pharmacist who manages the warehouse that stocks and distributes the medications for the entire country.  He took us to this great Indian restaurant, perhaps the best I have ever been to.  Then he had a contact a Queens Park Oval, which is the largest cricket ground in the West Indies.  Because of his contact we were able to walk into the stadium  right up to the grounds and look at it from the field.  It was pretty immense, it houses ~30,000 people.  It reminded me of a baseball stadium.  He taught me a little more about cricket and about Brian Lara who is a famous cricket player from Trinidad.  He has retired but still lives in Port of Spain.  It was very cool to get to see while I was here, since cricket is so big here.    Oh, and to “lime” simply means to “hang out”.

Manny did it again last night, huh?  Good for you Tricia.  Thanks to everyone who expressed interest in the nursery.  I promise to post the address, I just want to call tomorrow and find out who we should we direct the packages to.    And thanks to everyone for looking at my blog and taking an interest in my trip.  It has been fun to write the posts. 

Ok, so I have two full days left in Trinidad and have not eaten a Roti/Bake and Shark, nor do I have a tan. It’s been a lot of work since I have been here, but it has been an amazing experience. Today was a lecture day, I again gave hours of lectures to the same group of pharmacists. Today we spent 2 hours on adherence, 1 hour on HIV resistance, 1.5 hours on pharmacists role in HIV care, and 1 hour on pediatric HIV. Needless to say, I learned a lot putting these talks together, but I was really happy to hear from the attendees at the end of the day how much they learned during the talks. They asked a ton of really great questions and seem really excited about working on some of the things we have talked about. Some of the pharmacists here are really trying to break into clinical pharmacy activities, the concept of a clinical pharmacist is somewhat of a new one for them, but I think HIV would be a good avenue to use as a model for clinical services. At the end of the program today, I had to hand out fancy certificates that I had signed to the participants. In return they presented me with a certificate of appreciation and thanked me for my visit. I felt verklempt when they gave it to me, because they were so appreciative. Of course I was not considered the “Chief Guest”, like someone I know, but they certainly have treated me very well here.

Yesterday I visited a pharmacy in Sangre Grande. The pharmacy houses the national poison control center and the pharmacists even organize and attend grand rounds. They seem to be very interested in developing clinical pharmacy services there. They also treated me very well, I was invited to the home of the pharmacy director this weekend, they provided me with lunch and plenty to drink, and I was given a huge bag of exotic citrus fruits. I think I might stay here…

Tonight we are going out to “lime” with one of the pharmacists here who is an expert in Trinidad culture. I am not quite sure what it means to lime, but I am sure I will have it figured out by the end of the night. Overall this has been a great experience; I have had the opportunity to meet some wonderful people. Even if I get Dengue, which I feel like I will after the 15+ mosquito bites I have been the victim of, this has been a worthwhile experience.

I just received another bite on my kneecap. It has made my entire knee swollen and hot. I need to go upstairs and put on some deet.

Today was an interesting day… on my travels to and from the hospital/clinic I visited, I was able to enjoy some 80s music. I can’t get over how many people love 80s music here. The driver this morning and afternoon was playing loads of it, including some Kool and the Gang (personal favorite), Lionel Richie, Stevie Wonder, Simply Red, Michael Bolton (3 times in a row, I almost jumped out of the car), Cyndi Lauper, etc.

During the day, I reviewed some dosing for some pediatric patients and talked to the pharmacists about adherence. Then I went briefly to an HIV orphanage, kids are placed there after they are abandoned at birth or after their parents die. The home is the Cyril Ross Nursery and houses ~40 HIV positive kids between 3 years old and 22 years old. I took one look at the medication room which was organized perfectly and talked to a couple staff members. They seem to run a very tight ship there and the kids seem to do quite well. Apparently all of the kids can tell you the names and doses of all of their HIV medications, pretty impressive, as many of the adult patients at home cannot do the same. Meds are administered twice daily and most of the kids are taking tablets instead of syrups. During the day the kids go to school with the “regular” kids and then come home for dinner and activities. They have a very dedicated staff and seem to be cared for very well. There were three kids who were not a school today and they generally looked very well. One little girl, who was maybe three, seemed like she was not as developed as appropriate for her age. Her muscle tone appeared pretty weak and I don’t think she was walking yet, just crawling. She crawled over to me and we played for a bit. I asked her to find her ears, her nose, her eyes, her hair, etc… she loved the attention and smiled a lot. The boys who were home were content to watch “Stuart Little’ and had little use for me. I was very impressed with the place and saddened at the same time. I think I am going to gather some stuff when I get home and send them a box, apparently the kids are in need to clothes and other necessities. Let me know if you want to kick in a package of underwear or something.

To make this a sandwich post “uplifting-sad-uplifting”, “80s music-HIV orphans-monday night football”, I will end by saying the Bills will be playing the Browns on Monday Night Football this season. We should get some tickets for the game and plan a good tailgate party at Ralph Wilson.

Watching the Indians-Sox game all the way in Trinidad.  Those dirty pig Red Sox!!! Ugh, Manny does it again!!  Sickening…  I’m going to watch cricket instead.  Here are a few pics from my travels that I was able to upload. 

Yesterday morning I flew to Tobago. Its the only domestic flight that Trinidad has. In the airport the cricket match was on TV, it was very interesting to watch. It took about 20 minutes to get to Tobago by air. There is also a ferry, with a fast ferry (2.5 hours) and a slow ferry (5 hours). When I arrived, I walked around and found a hotel. I got a room, which I didn’t have a good feeling about, so I decided to look around some more. So my adventure began as I walked through the area of Crown Point. I was looking for the beach and some food. I found the beach and some friendly “Tobago”ans long the way. Being that I was by myself, I didn’t think it would be best to talk a walking tour of Crown Point, as I was making many “friends” along the way. So I wandered into the nicest looking hotel I could find, which had a private beach, and took up residence there instead. I had to pay more than I would have liked, but I figured this was my best bet as it had a really nice room, pools, and a beautiful beach. I only had one night in Tobago and decided to make the most of it. I had lunch and a couple of delicious drinks. I heard the waiter tell the bartender to put an extra shot of alcohol in my drinks, so I only had two and two was plenty. When I was checking into my hotel I met a younger couple from England and we all bought tickets to go out on one of the glass bottom boats. We paid 90 TT ($15 US) to go out. When we arrived at the beach we were expecting the boat to be docked at the beach, but instead had to walk out to the boat. I had my bag with me that had all my wallet, my ipod, my camera, and my phone, so I had to hold it about my head to get out there. The boat “Cool Runnings”, had seen better days, the ladder to get on was pretty splintered up and the boat was painted red, green and yellow with a picture of Ziggy Marley on the side of it. Over the loud reggae music that was on the boat I could hear was my Uncle Paul saying “Ya man” which he had been saying before I left for Trinidad. The crew of the boat was 3-4 twenty year old guys. They took us to look at the corals in Buccoo Reef and the fish which was pretty cool. At this point you could get out and snorkel but I chose not to and was content to look from the glass on board. The next stop on the tour was the Nylon Pool, which is in a spot in the middle of the ocean where the water is only 3 feet deep. We were able to get out and walk/swim around for a while, which I chose to do. Apparently if you swim in the nylon pool, you are rejuvenated and you feel 10 years younger. Overall, the boat trip was an interesting experience. The guys on the boat broke almost every rule in Boating 101. I was in the back of the boat and so was the extra gas and oil tank. These guys were lighting a cigarette next to the tanks every 5 minutes. One was actually pouring oil into one of the tanks, it ran all over his hands and the tank and then he lit a cigarette. Needless to say, I was glad to reach land again. After that I had some dinner, watched Seinfeld for a while, and fell asleep very early as I was exhausted from the week.

Today, I arrived back in Port of Spain and am at the house for the day. Its nice to not have to do much today. I think I am going to watch the Yankees-Red Sox game tonight.

So far so good here. Today I gave 4 talks (6 hours worth) to some pharmacists (about 20) around the country that are involved or who may be involved in HIV care. I had a sore throat from talking all day but I think it went well overall. The pharmacists really seemed interested in listening to the talks.

Tomorrow I am flying to Tobago for the night. It was only $24 each way from Trinidad. I am really looking forward to going. Tobago is the more touristy island of the two with plenty of beaches. Unfortunately, I don’t think there is going to be much sun. It has been quite rainy here all week and they are calling for clouds and possibly rain tomorrow. I just want a little tan… is that so much to ask for? Maybe I should take a few cipro tonight? Also, I have not made a hotel reservation yet, it will be an adventure to find one. I have heard there are some within walking distance from the hotel.

Gopal had asked how we get around Trinidad. We have two drivers that take us around to where we need to go. They work for the Foundation M-F and drive us all around the country. One of them loves 80s music and he likes to play it loud. When he is waiting for us, you can tell he has arrived, as you can hear music booming from his car. We were at dinner the other night and he was waiting outside and you could hear UB40s “Red Red Wine” as loud as possible outside. There are also “route taxi’s” and basically they are taxis that drive along a certain route and just pick up passengers as they go along. I’m not such a fan of the route taxis as it usually involves being crunched in with some other people.

Traffic here is horrible, in general. Everyone has a car and there are not many highways, so it takes a while to get around. Gas here is very cheap and usually each member of the family has a car. Its pretty interesting because nobody carpools either, so there is quite a bit of air pollution. There are so many cars on the highway and only one person riding in each one. Not to mention people here drive like maniacs and there are not many seatbelts in the cars that I have been riding in. I had a near death experience on Tuesday when a gas tanker truck tried to mash us into a cement wall. I managed to survive, but I suffered from 8 or so mosquito bites on one leg yesterday when I was walking around the hospital. Dengue Fever here I come….

I have met some very nice people here so far, but look forward to seeing everyone at home too. I am excited to have Haley, Lynsey, and Andrew for the Yankees-Indians Series at the end of April.

Talk to you all soon!

I just got back to Port of Spain and there is a gecko in my bathroom…. He looks just as terrified of me as I am of him.

So it’s 85 degrees, I am sitting next to the pool, drinking a rum punch, eating some delicious coconut curry chicken, listening to Hotel California being played on a steel pan drum…. Do you see where I am going with this?

I am really enjoying my time here. The work that I am doing is very interesting. Today I was able to talk to the new HIV pharmacist (as of today) and adherence nurse, along with some doctors, and nursing students about HIV adherence. I have learned that HIV has not really been taught in the pharmacy school here until now, so the pharmacist’s knowledge about HIV is pretty limited. Like the US, there is a pharmacist shortage here. The pharmacy I have been in for the last couple days is very short staffed. The government has “fixed” this problem by importing pharmacists from the Philippines, they have 8 in total. They tried to have pharmacists on rounds, but had to pull them away due to staffing constraints. In addition, there is little acceptance of pharmacists from the doctors, so the pharmacists are pretty limited on what they can do. The pharmacy is pretty cool, I guess I was expecting something a little less like what we have in the States.

Everyone here is very nice, the doctors and pharmacists I have been working have been great to me. Tonight I am in San Fernando again which is in the Southwest region of Trinidad. San Fernando is next to a large oil refinery named Point-a-Pierre, and there a lot of oil men from different countries at the hotel I am staying at. The city itself is the second largest in Trinidad. At the hospital they just built a new HIV clinic and the view from the clinic is amazing. I have pictures that I can upload when I get back to Port of Spain tomorrow.

Last night, I got to talk and see Ursula via skype, talked to Theresa via skype, and talked to and saw Aunt Marlene and Uncle Paul via skype who than three-way’d my mom/dad and sister.

Ok, I need to finish my rum punch now. Uhmmm… what I meant to say, was that I need to finish my work now.

Hello All,

Today was my first official day of work. It started at the Ministry of Health where I learned about the issues related to HIV scale up. I also visited one site where 80% of the HIV positive “Trinnies” receive their care. There is a push to decentralize treatment from this one site in the North (Port of Spain) as its not feasible for all of the patients in to obtain treatment there. There are many roadblocks that have been encountered in the process. I met with the pharmacist today that works in the clinic that treats 4000 patients today, who was very nice and knowledgeable about HIV and its treatment. Each clinic that I will be visiting seems to have its own set of issues in terms of scale up. Either they don’t know what patients are on what meds, the patients are on the wrong doses/combinations, or they don’t have any medications in stock so patients go without. I will be visiting the first of the clinics for the next couple days. Tomorrow morning I will leave for San Fernando, which is the second largest city in Trinidad and stay until Thursday.

Otherwise everything is going well. I have spent a lot of time with the other Clinton Foundation people here. They are very hard working and motivated. They spent most of the weekend working. We went to Chaguaramus (pronounced like only Austin Powers can) yesterday. Apparently it was a US military base in WWII. Now its a harbor with a yacht club. I was impressed to see many yachts from New England and Maryland parked in the harbor. Tonight we are going to dinner with Colleen who is the regional manager for the Caribbean and in town for a few days.

This weekend I think I am going to take a trip to Tobago!

Back to work for now…

I’m here!

I met one of the Clinton Foundation people, Sarah, who was waiting for me at the house. She gave me a cell phone so I can communicate with them and call home PRN.

Anway, tomorrow I will get to sleep in and pick up some groceries and maybe even take a trip to the beach with Sarah.