“Reflections on Honduras: A Medical Mission”
Day 1I got picked up today at 4:28am by Lisa Hall, Tom (her husband) and Debbie Folden. The ride to Reagan was not surprisingly, very quick at this ridiculous hour. We met Yogin at the airport who had heroically finished a late shift at Shady Grove, went home and packed, and then drove to the airport. Moments later, we met with Nicole Vetere and Nick. Unfortunately, we soon heard that Nicole's dad, an ob/gyn from New York, was caught in NY due to a work standstill at American Airlines. Anyway, we got to the airport with plenty of time and had an uneventful trip to Miami. We all had to pack lightly since we were all asked to carry a second bag to Honduras full of medical equipment. So, we had a lot of stuff to lug around. After a long layover, we finally boarded our plane to Honduras. The airport that we were to fly into got closed a couple of weeks ago because of a really bad plane crash. Apparently, the airport in Tegucigalpa is considered one of the most treacherous airports internationally because it is in the mountains and the runways are short. So, instead, we flew into San Pedro Sula. The drive to Tegucigalpa was only supposed to be 3 hours, but, somehow it took us nearly 6 hours. It was really awful. We finally got to the hotel 18 hours after we left home. It was a very tedious day. Despite the hazard, we are all hoping to leave out of Tegucigalpa on our return--- we may take a puddle jumper if necessary to avoid the interminable bus ride. Anyway, we got to the hotel, and I was really pleased to know that we have airconditioning and it is clean. It is definitely NOT fancy, but, it will suffice. I have already seen how poor the country is, and I am very grateful for this. We were hungry, so we went downstairs to the restaurant in the hotel. I ordered a tuna sandwich-- the only problem is that you can't eat raw vegetables or fruits that cannot be peeled because of the risk of infection. Well, the sandwich first came with lettuce and tomato. The people are really nice, but, do not speak much English. I asked to get one without the vegetables. They made me a new one---- but, the tuna salad had veggies in it. Great time to start a diet. The wait staff was really nice though. I gave up and went upstairs. Anyway, I was desperate for a shower. One major problem--- absolutely no hot water--- NONE. Cold and hot feel exactly the same, and it is wicked cold. But I took a shower anyway and I felt much better. I put on my jammies and I started to write this email when a knock came out my door. Debbie Folden was at my door--- she was crying and laughing at the same time--- she went into her room and saw a gecko---- she started to scream and panic and came to me to help her. She got the hotel staff to come and chase it out of her room and now she is afraid to go to bed! It was all very funny. Even funnier is that she tipped the guy so well for rescuing her that we are all convinced that they will start planting geckos in her room. Tomorrow morning starts our real work. We are waking early and going to the villages to see patients. I am told we have 250 people already scheduled for tomorrow. It will be busy. I hope I get to do a couple of mitzvahs (good deeds) for some needy people. Day 2 Well, it was awesome to get a good night sleep. I, in particular, had a great night because I was busy chuckling about the gecko incident. Debbie did not sleep as well. We all met in the dining room for breakfast at 7am--- they had plantains, lots of fresh fruit (that we could eat because it was peeled--- like papaya, pineapple, melons), bread, cheese.... It was good. Coffee is excellent. We met for a short inspirational meeting and then departed in vans to the clinic in El Rosario. Jim Shero bravely drove this huge van with standard transmission thru the very narrow streets of Tegucigalpa. The drivers here rival anything I have ever seen, even in NY or Boston. Anyway, this particular clinic is sponsored all year round by St Pauls. They pay for the fulltime Honduran doctor (who gets $8000 per year), all the medications, repairs to the clinic, and all the other staffing. The see an average of about 80 patients per day, and more like 400 on the days that there are American physicians in town. The word got out for several weeks prior to our arrival that we will be in town. I think that most people come to make sure that they are not missing something big, and they come out to be social. We arrived at the clinic after patients had already begun to arrive--- we quickly set up stations--- a desk with two chairs, a piece of paper for the patient's "chart" and torn scraps of paper to write prescriptions. Patients were triaged by some of the clinic staff and the rest of our team from St Pauls with the assistance of some interpreters. Then, the patients would be delivered to your little cubicle. In reality, the clinic is housed in an aging stucco/concrete building with almost no windows. There is a large room---- maybe 40 feet by 30 feet--- it is divided into a sitting area with benches and cubicles--- areas that are about 4 feet by 4 feet surrounded by plastic shower curtains. In this room, there were no less than 200 people for most of the day. The place was absolutely stifling--- we were drenched with sweat within minutes of being there. Oddly enough, many of the Hondurans were wearing long sleeves, sweaters, and even jackets. Anyway, there is a consultation room which the resident physician uses to see patients, and a small dental room. There is a pharmacy area filled with all sorts of medications--- some bizarre--- like meloxicam and levsin, but, mostly vitamins and paracetamol (acetaminophen). The patients keep coming to you---- sometimes as singles, but mostly as families. The charge is 35 limpirio (about $1.80) to be seen, but, if you do not have it, you don't have to pay. So, people come in hoards. Much of what I saw today were younger people with fairly chronic problems--- like headaches (maybe vision related---- NO one in the entire country appears to wear glasses), back pain (lots of manual labor), and chronic coughs. But, I also saw a couple of cases that were heart wrenching--- 1--- 60 year old man with hematuria---- he had an indwelling foley--- maybe prostate ca or bph---- he's been to the hospital (where you refer people who need immediate workups)--- and is scheduled for surgery in EIGHT months. 2----9 month old child with strabismus and horrible nystagmus and what appeared to be nutritional deficiencies--- ophthalmology had told her that they could do nothing and to return in 2 years for follow-up 3---60 year old man with cataracts, 40 year old woman with pterygiums--- lots of vision problems with no resources at all available...... 4. no meds to treat diabetics. no anticonvulsants for the seizure patient. no beta's and no blood work. just the decision that if you had a patient truly sick enough, you would need to get them in a cab and to the hospital. crazy. 5. one woman with absolutely debilitating plantar fasciitis and the worst shoes imaginable. No money to buy new shoes. I tried to show her my shoes so that she would see what kind of support she would need---- she asked me if she could have them. I had a translator and I told her I wanted to give the patient money to buy shoes--- the translator told me I can't because of the repercussion when other patients hear that people are giving out money..... Still--- I was so moved by this poor woman (probably because I've had plantar fasciitis)--- that we made her promise to leave the clinic immediately if I gave her money--- she said yes. So, I gave her money and she gave me such a big hug, that all the patients started to stare to find out why.... Lots more cases--- I'll get Nicole, Yogin, Debbie and and Jim to share more... We worked the clinic for about 4 hours--- when we were done, we had each seen at least 30 patients a piece. All the patients left with something---- everyone wanted a prescription or some intervention. Most got vitamins. Some got iron or calcium, and lots of paracetamol. In general, the patients were extremely grateful for the time and caring. Caroline and Lisa were wonderfully thoughtful and brought stickers, pens and gum for the children. A parishioner from St Pauls had sent a large box of lollipops. So, when school got out (across the road from the clinic), the children were all over at the clinic, visiting with us. Caroline and Michelle (Jim's daughter), in particular appear to be magnets for the children. The kids got lots of treats from the group and we all had great fun with the kids. As Jim had wisely observed, it was amazing to see how well adjusted and happy these children are despite the fact that they are lacking for so many things. We conjectured that perhaps they don't know what they are missing. A great lesson to learn watching them---- they were so content with the company of each other and overjoyed with something as simple as a sticker. When we finished our clinic work, we helped unpack about 500 pounds of medical supplies that had either been bought or donated. We needed to separate out stuff for the hospital and what would stay behind in the clinic. There is a great desire among the clinic staff to keep as much a possible because they are so needy. But, if you look around, there is absolutely no place to put anything. The shelves are overflowing with things--- not that there is too much stuff, just, not enough space. Nick (Nicole's beau) and Tom (Lisa Hall's hubby) and a couple of the other men on the trip are preparing for construction work. They plan to put in new lighting and fans in the clinic and build new benches. They will be doing that tomorrow as we staff another clinic. Hopefully, we will be able to enjoy the new fans on Wednesday when we return to El Rosario. It sounds like a very necessary upgrade. Patrick, Nicole's dad finally arrived tonight, in time for dinner. We are looking forward to working with him tomorrow. Poopak and Serge--- we wish you were here. Good night guys--- I'm whipped. Day 3 Today was an awesome day, from start to finish. So much good stuff. SO much laughing. And, great interactions with the Hondurans. I am chilling out with our group, drinking a Port Royal Honduran beer, and writing to all of you. Argghhhhh--------another frrrrrrrrrrreeeeeeeeeeeezzzzzzzzzzzzzzing cold shower. I'm not getting used to that. But, it certainly wakes you up! Breakfast began again at around 7am---it's funny--- you'd think that people would come later each day, but everyone was pretty prompt today--- I guess we all figured out that breakfast is good. Another great cup of coffee and platanos (plaintains to you gringos). We were scheduled to leave for the Medical Brigade this morning at 8am, but, our chaperones and the nursing assistant students were stuck in Honduran traffic (no medicines, lots of unemployment, no glasses, but everyone has a cellphone and lots of cars on the road). Anyway, we entertained ourselves by shopping in the farmacia next door. I truly feel the plight of the Hondurans for putting up with the miserable quality lipstick I purchased. (LOL...) We finally acquired our companions and boarded the van. Unfortunately, we had only one van available to us today, so all 15 of us crammed in with all of our medications and equipment. Rather sardine-like. We pulled over after about 10 minutes to fill with diesel and I realized that there was room in the van with the locals. So, my mother not having raised a fool, I jumped ship immediately and got very comfy in the other van. Aside from the obvious benefit of avoid thrombosis, I got a great opportunity to chat at length with Sherrie Wade, the program organizer from St Pauls, and with Jo-Annie, who is the local coordinator of the Clinic at El Rosario and the local mayor. The day I met Jo-Annie, she was wearing Shady Grove scrubs---- how cool is that? Anyway, Jo-Annie shared a lot of history behind the funding of the clinic and the history of the local politics. The clinic began as a completely subsidized venture of StPauls, but, now gets a yearly grant from StPauls, and is able to raise the balance. What is specifically amazing about the clinic is it's ability to acquire medications. It has a very extensive network of connections and now is a major referral center for the local politicians to get their own medications. Apparently, with the cleverness of Jo-Annie with Sherrie's support, the El Rosario clinic is unique in that it is the only independent clinic that partners with the health ministry. For example, today--- our team left the clinics to go on a Medical Brigade to an area that would not even qualify as underserved since it had never been served. The medications were donated by the government--- rarely do they do such a thing, but, there is a trust that has been developed between the groups. Apparently, there is quite a problem with the integrity of some groups who try to personally benefit from these interactions. We had quite a treacherous drive thru the mountains, some on dirt roads. We passed multiple packs of cows on the road and had multiple other distractions on the road. I prayed quite a bit today for our safety. Fortunately, we arrived safely, and sooner than we had expected. We drove into a very remote village (and yet--- I STILL had cellphone coverage----AMAZING!). The complex we pulled into had a small playground, a small basketball court, some housing surrounding. We finally arrived at a school which was mostly open air, with some tin roofs and a couple of outhouse toilet stalls. The locals were pretty curious about what was going on and came and gathered around us (not unlike when Dorothy lands in Munchkin land). We unloaded the trucks and set up our pharmacy and our exam rooms in the school. I helped with the pharmacy, and again, I was very struck at some of the bizarre medications that we had--- like two hefty bags full of omnicef and a crate full of bactrim suspension and tablets. We were almost out of albendazole, limited on paracetamol for children, almost no benadryl, and no topical antifungals. But, it was really good to see what we had so I knew what I could give out today. I found vitamin A--- I thought that we be good for all the people with vision complaints (can't hurt, right?). I found folic acid and I tried to remember to give that out to women who were in childbearing age in case they got pregnant. I still am looking for uses for the omnicef. We all got aggressive about giving out Gripex today--- (it's a cold preparation, probably like dayquil--- but, we're all a little unsure about this since the box was entirely in Russian). Anyway--- we'll need to get this in the Pyxis since we are all digging it now. The patients today were incredible. I had several patients who had walked for miles over the mountains to come to see us since they had NEVER seen a physician in their entire lives. I actually was afraid to do too much to most of them because some had lived until age 70+ without a physician mucking it up. Still---- it seems that some are unnecessarily suffering with arthritis, headaches, chronic coughs, etc. Today, I had the assistance of Jesus. Jesus is one of the most amazing guys I have met. His family emigrated to the US when he was a child of age 8--- he was schooled in the States, and went to college. He worked hard, made a lot of money. His family truly lives the American dream--- they have worked their way to living in a very exclusive neighborhood in North Miami. Jesus decided that he wanted to return to his homeland and give back. So, 6 months ago, he returned to Honduras and now is an English teacher and benefactor of this community. He is an incredible advocate, has a wonderful sense of humor and just sees the world the right way. He is all about the children. Anyway, Jesus helped me chug thru 30 patients in about 3 hours. Many of the patients, like yesterday, came only to have been seen by a physician. Most looked for some relief from the chronic symptoms. I looked for every opportunity to give out that darn omnicef--- I was really psyched to find a cellulitis and a pharyngitis. Now we have only about 800 boxes of omnicef left. The interesting patients of my day-- 1--- 82 year old man with almost no problems. He asked for something for arthritis. God is really looking out for him. You couldn't help but keep thinking how it could be possible for this man to survive so long with almost no illnesses. He was absolutely charming. 2---- the 50 year old man who came in with debilitating left flank pain. As it turned out, he had fallen out of a tree 3 weeks ago--- he could barely move, and his family had taken him to the hospital for treatment. He was unable to pay for any treatment--- his family took him home without getting any care whatsoever. He had spent about 1 week laid up, weak and dizzy--- I think this guy survived a splenic injury with rib fractures--- on exam he was still very tender and clearly in distress--- he nearly cried when I gave him medications. Jesus told me that the man said he understood and felt the presence of God with our arrival. I was nearly in tears myself. 3----the 60 year old woman who clearly understood the medical system--- she actually was on digoxin, atenolol, calcium, aspirin, and multivitamins, and was out of all of them. I had everything but dig--- so, she asked me for anything for acid reflux. She left with 5 prescriptions filled--- fortunately for her, she has learned how to stay healthy. It was all, in all, a phenomenal experience. We were very pleased and began to pack up, and at exactly that moment, the sky ripped apart into a torrential downpour. It was an epic-type rainfall and we got to see all the places that the roof leaks. It wasn't long before everyone of the schoolhouse rooms were flooded. We hung out for the 30 minutes of the storm because we were all too scared to go downhill, thru the mountains in the van stuffed with 15 people on the treacherous roads. The delay gave me time to negotiate with Jo-annie and the director of all the Catholic Medical Charities in Honduras to provide medications, like some paracetemol and bacitracin for the first-aid kit for the school. This was actually quite controversial, and since the CMC had donated the medications, we had to abide by her ruling. Meanwhile, Jesus and the school principal had begged for items--- eventually, (since I am so skilled in the art of nagging), she succumbed and gave up a few boxes of medications. I felt very good about this, but, I clearly understand the need to carefully parcel out medications when there is so limited a supply. We left the complex, and proceeded to Valle de Angeles, Ciudad de Turistas---- the Valley of Angels-- City of Tourism. It was a quaint area with multiple restaurants and nice shops and galleries. We had a phenomenal meal--- (courtesy of Dr Patrick Vetere---- thank you again!). I do not think I ever remember laughing so hard at a restaurant before---- but, the table I sat at had Yogin, Debbie, Jim and Michele, Caroline, myself, and a bunch of the StPauls veteran who had been to the restaurant before. They clearly knew what they wanted to order and thought they were ordering for all of us---- well, there was definitely a breakdown in communication. We waited and waited for our order and could not understand how it could possibly take so long since the restaurant had emptied out by then. Well, somehow, we had ordered enough food for a minimum of 25 people---- after about 1 hour of waiting, the platters kept coming to our table and did not stop..... it was hilarious. We brought troughs of food back to the hotel. Afterwards, we proceeded to shop----- Yogin demonstrated his tremendous bargaining ability--- he literally put the money in the hand of the vendor and walked out with a hammock---- the guy just stood there, shaking his head in amazement while trying to reach his jefe (that's boss) on the phone. Unbelievable. Great shopping, lots of laughs, and cameraderie. We are really enjoying each other. I was desperate for another shower, and braced myself for another chilly experience. What a great surprise---- they fixed my water--- and I had a warm shower. Life is not good---- it's great. Day 4 So, I’m writing this on Word tonight because the internet is down. In reality, I’ve been shocked at how functional communication has been---- I’m always able to call out and receive calls, and this is my first problem with the internet. That said, the lights did go out several times on us in the airport while we were in immigration, which was truly terrifying. Today was a very busy and well-organized day. We started the day by touring Hospital Escuela (Hospital School). This is the public hospital of Tegucigalpa, and houses the medical school. I’ve got lots of pictures---words will not do this justice. The building is about 60 years old, and clearly has never been improved since then. There are multiple broken windows--- for which I was actually grateful--- there does not appear to be any form of ventilation in the hospital aside from windows. So, the hospital building is ‘open air’--- which means to say it is full of traffic, full of flies, and I am certain that dogs walk thru, although I did not see any. (I got a bunch of dogs circulating thru my exam room this afternoon during our Medical Brigade). The building is packed with people, there is a lot of crowding, and there appears to be very long waits for everything. The ED was particularly spartan and antiquated--- there were very few privacy curtains and almost no staff around. The ED functions similar to our EDs of yesteryear--- medicine, surgery, ob/gyn, pediatrics, ortho, etc, are all divided up by a triage nurse to different units. There were too few staff around in the units to discuss much. All in all, again, another reason to be grateful for what we have. We returned to El Rosario to the St Pauls clinic. Today, it was SO much better, thanks to efforts of our construction crew--- which included Tom Hall and Nick Evanich. Now, we had some air movement with the fans. And, it was surprising to realize how dark it must have been because we were well illuminated today, and it made a world of difference. Anyway, we were more efficient since we had learned the drill and were quickly able to chug thru about 200 patients. Which was necessary---- we soon took our show on the road to an area only about 10 minutes away, but, what could have been a different world. The ride to the site of our brigade was incredible--- you couldn’t have created a worse road if you tried--- it was really full of really sharp rocks--- we kept thinking we were going to puncture a tire--- that did not happen, but, on the ride up, we started hearing pretty ominous sounds--- and, sure enough, the spare tire rolled out from under the car and loosened up a pipe or two. That said, Jim safely drove us home. The clinic we set up at the school was amazing. There were hundreds of patients hanging out on the road. We set up really quickly--- made sure we had plenty of gripex and vitamins, and dug in. I had the privilege of working with Cathleen as my nurse and Maria as a translator and we really whipped thru the patients--- by the end of the afternoon, I had seen 50 patients myself. Most just wanted vitamins or paracetamol, but, I definitely tripped over a few needy people today.- 1) Several febrile children, some with bronchiolitis, some with otitis media 2) A 42 year old woman with right breast pain—I was mortified to examine her breast to find the breast as rock solid, tender and very large. She told me that only 1 month ago she had noticed pain, and went to the hospital—they told her she had cancer, and needs chemo--- she is scheduled to start in several weeks, but had debilitating pain. It was so clear that this woman has very advanced disease---- it was quite depressing to know that I couldn’t provide any additional care. 3) A 70-year-old woman who had a fall 3 months ago--- she must have had an epidural hematoma--- she was complaining of head pain and nausea/wobbly gait. She had a huge defect (burrhole?) in her skull. I think she was dilantin toxic---- Anyway… the list can go on, but, it starts to get redundant. What is amazing is how many people are so very needy, and how grateful they are for such a small amount of intervention. It is really a privilege to be able to help. |
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