Explorando Medicina 2011
Thursday, April 28, 2011
grasping tightly
"...Having had the opportunity to see Honduras twice, I’m also amazed at how many things had changed in a year and also at how many things stayed the same. A year ago in Las Mercedes, there was no electricity for miles around, no “western” flushing toilets, no showerhead that was more than waist-high, (and no ginormous spiders…). The clinic didn’t have painted walls or tiled floors or a working kitchen. These were luxuries, though still elusive to the people in those communities, that greeted us this year when we arrived. It’s amazing how these comforts that we so take for granted here can change your experiences in Las Mercedes; for instance, you really come to appreciate those flushing bathrooms situated in tiled lit rooms at 2am in the morning when 5-6 of you are sick with a GI bug.
But the things that haven’t changed are also striking. The women still get up at 3am to start breakfast, the men (and children) at 4am before heading to “el campo” or the fields to work. The majority of children still only get 6 years of education before joining the work force at age 12-14; a handful get an additional 2 years by walking 2-4 hours on the mountain road to the regional school that offers those extra years of education; and very rarely does a young student get the opportunity or monetary fund to attend a technical university (to become a teacher, nurse, etc.) in La Esperanza, the closest town that also houses the nearest hospital. Almost everyone we see during our 5 days in Las Mercedes still has chronic back/shoulder/neck/knee/leg pain, headaches and dizziness from dehydration, chronic cough from working with pesticides or dust in the air or smoke in their houses from lack of a chimney. These hardships that few of us can imagine enduring for as long as they have and that initially gave us pause when we first heard them from the people we were treating start becoming matter-of-fact with each family you meet. For them, it’s simply how life is, and for you, it becomes “normal” to treat people whose symptoms result mainly from environmental factors.
The really difficult moments come when you meet families who, on top of the normal trials and hardships of daily living, are also met with the tragedy of illness. Last year, there was a woman who had never owned shoes in her 60-some years and a questionable case of child abuse in a little girl who came in with a subconjunctival hemorrhage. This year, there was a 58 year old man with asthma and bilateral wheezing that even a medical student couldn’t miss who worked in the fields and who couldn’t afford rescue inhalers; on top of this, his wife was battling symptoms of senility. There was also the mother with a baby who likely had trisomy 13 or some other syndromic disorder who came seeking help. Then there was the man who admitted to alcoholism who was sobering up from having drunk 2L of the local moonshine 2 nights ago, who had 4 children at home – the youngest only a few years old.
These stories make it hard going back to Honduras. Not because I’m confronted by sad experiences, but because of the helplessness I feel sometimes. But it’s because of these lessons and experiences and interactions that make me a better person and that will make me a better healthcare provider. I’ve learned there’s a big change in perspective that comes with global outreach (for if there’s anything that will cure a student’s obsession and compulsion over past letter grades and exam scores, it’s meeting people with real problems and hardships AND seeing them deal with it)...." -Wendy
Friday, April 15, 2011
to our leaders
And to the PT, Dawn. Thank you for breaking things down for us, what you saw instantly took some of us 20 minutes of explanation to sort of understand. Your humility in teaching makes you all the more effective. Thank you. (The dance lessons were also appreciated).
Wednesday, April 13, 2011
"Wherever you go, Tigo!"
"Wherever you go...Tigo!" - the slogan we designated to Tigo, the brand of our trusty modem after testing its powers in the mountains of las Merecedes. These pictures of Josh and Step as the 3 of us tried our first posting says it all. Now you all can see just what it took to make a connection to home!
Tuesday, April 12, 2011
Recovering and Reflecting
Although it was unfortunate to be sick during out last few days in Copan, it did give me the opportunity to do some contemplating about the work we had done on this trip before we departed. In doing so, I began to wonder what it would be like to return to the states having seen the large disparity between what it means to have "little access to resources". As a nursing student who is now rotating in an emergency department, I think this is a valuable perspective to have because while it does not change the situations for the patients experiencing that disparity it did highlight the importance of one major component of all health care disciplines: EDUCATION. Because of our short term presence in Honduras, it quickly became clear that to have any lasting impact within these communities you must learn to relate and clearly educate people on practical ways to incorporate health care practices and prevention into their daily lives. While patient education and health promotion is something I have practiced in nursing school, the experiences in las Mercedes and with other communities has given a whole new weight to the importance, as well as new perspectives in how to approach this in an individualized way. I have not worked a shift yet, but I am looking forward to bridging these lessons with my practice here in Durham.
While reflecting over these past few days, I have also found a some time to be really proud of all that we accomplished as a team. I know the statistics have already been listed on how many patients we saw and what supplies were distributed, but there are no numbers that can describe the way that the students came together as a team. Those who were strong in Spanish practiced extreme patience and leadership in teaching the rest and those being taught were invested and courageous enough to really put it to use. There was such a sense of desire to contribute and that fostered a comfort and openness for us to be truly vulnerable. This vulnerability is what I believe allowed us to learn so much from each other and I can only hope that we will all remember that good feeling as we approach team communication and interdisciplinary care here at home.
My mind continually keeps drifting back to a question some of my nursing peers had asked me on our last night out in Copan: what are 3 highs and lows for this trip? The lows were really quite easy to think of considering some of the physical ailments I had experienced, but I had to think very intentionally to come up with only a few highs out of so many amazing learning and life experiences. My first, was just the opportunity to truly be a part of a group again...to sleep on a school house floor with 20 other adults, to wake up at the same time and move through our day together, to learn and laugh together, and at the end of it all to trudge up a hill in the dark to wake up and do it all again. The second high was a particular hike that just our student group took down to a river on our last day at the las Mercedes clinic. Not because it was beautiful, but because there was such a feeling of acceptance and membership in this community. As we walked, the kids ran along with us, played in the water, held the hands of our group members and learned broken English phrases. Our work in the clinic was over at the point of this hike, but this moment in time captured the reality that we had been able to penetrate the invisible barrier between us all and come together, both as a team and with the community. The third high shared on this night was actually a personal triumph. In my practice so far as a nursing student, I take a lot of pride in being able to connect with people in a way that I don't always see other providers take a moment to do. With my background in wilderness therapy and communication, I often feel that if I couldn't do this it would greatly effect the overall outcome of the care I was delivering. With no solid experience with speaking Spanish, I naturally felt a bit crippled during my first few patient interactions in Honduras...as if one of my senses had been taken away. In those critical moments I realized a few things that enabled me to move on: that a smile is universal, that we communicate in so many different ways other than speaking, that most of our patients didn't care if we spoke great Spanish but did care if we were trying to speak to them, and that it never hurts to laugh at your own mistakes. Because that moment allowed me to invest more, to CONNECT, and to eventually feel like I could understand and communicate in basic Spanish, it was certainly one of my highs for the trip.
These are merely a few of the reflections I have had since our return and I am sure there will be many more as I continue to relish in the memories of our trip. We learned today that our reunion dinner is scheduled for the 19th and I am sure I am not alone in saying that it will be nice to return to the group living...if only for a night. I also look forward to the sharing of photos - the ABSN team hopes to get more on the blog soon. As always, thanks for following our travels. I hope that this blog has allowed you to feel that in some way you shared this unique experience with us.
Sunday, April 10, 2011
More to come!
Friday, April 8, 2011
Wednesday, April 6, 2011
On the Road to Copan
Monday, Tuesday, Wednesday
Monday and Tuesday (aka Clincic days 4 and 5) included many patient visits, approximately 125 per day, but also allowed for time for us to better understand Las Mercedes and the environment in which our patients live and work.
A little background- Las Mercedes is part of a co-op, which includes 13 communities in the Intebuca region. The co-op was formed 15 years ago with goals to improve education, health, and bolster economic progress for the communities. It is with this co-op and Heifer International that the clinic has been built.
Regino, the President of Las Mercedes (who personally donated his land for the building of the clinic) gave us a brief walking tour around Las Mercedes. And by walking tour, I mean a HIKE. During this hike we began to see our patients beyond their pathology and see their lives as well. Patients told us they walked 4 hours to get to the clinic, that only is beyond imaginable, but the paths are steep, rocky, and wind through mountains.
Not only is the terrain difficult to traverse, but the homes tell much of the patient’s story as well.
Our most common patient would complain of tos, dolor de cuerpo, dolor de cabeza, dolor de estomago (cough, headache, body ache, stomach ache). When we visited their homes we saw the wood burning ovens which filled their homes with smoke (cough), we saw them working all day in the fields with more coffee on board than water (headache, bodyache), and then we saw the sanitation and impossibility for cleanliness, making way for parasites (stomach ache). Walking and talking with Regino provided us much insight into what we were seeing in the clinic every day.
As an aside, Monday night we were walking up the hill to go to bed and saw a lot of smoke from across the ravine to a neighboring village, Belen. A few of us gathered together and told Regino about the fire, eager to help in any way possible. We all grabbed some headlamps and quickly began walking around the mountainside for a better view to see what was happening. We found a good look out point and Regino told us that it was ok. We didn’t know how to respond, the entire mountainside appeared to be on fire and we were doing nothing, and he said it was ok.
We all just watched the fire burn the side of the mountain. It was such an emotional experience to watch fire destroy a piece of the mountain. We worried so much about the people that might somehow need help on the other side of the ravine. What we were told that night was that it was very common to have fires this time of year when it was so hot and the land was so dry. The fire itself was in a different community, a few hours walk from where we were. It would be the community’s responsibility to handle the fire. It was too far for us to really get involved. We eventually walked back down to our Honduran home to fret over what we had seen. What we later learned, after so much fretting, was that it was actually a controlled burn for the upcoming planting of maize
It is Wednesday, and we have completed our work in Las Mercedes and hit the road to Copan. We ended up treating nearly 550 patients in the four and a half days of clinic! Dr. Clements further explained that that worked out to about 120 patients per person there!
It has been a great experience for us all. Seeing and treating many different ailments, truly working together as an interdisciplinary team, and growing to understand the culture of the community. Last evening, we had a going away ceremony with the people of community. It was held in the church, across the way from the clinic, and people of all ages attended to thank us for our help and to wish us well in our endeavors in Copan and back home. The ceremony consisted of a few people of the community participating in thanking us for our service, followed by songs from the children. We also performed songs and skits that we had prepared. The closing of the ceremony was from the President of Las Mercedes, and he was very gracious for all that we had accomplished on our trip and done for their community over the last few years. It was a very special moment.
Currently, we are on the road to Copan. It was a very early morning due to the long journey we had ahead of us. More to come from Copan.
Monday, April 4, 2011
Clinic Day 3
Since today was Sunday, we all arose an hour later and were pleasantly surprised with French toast. After another delicious meal (and seriously, they are all amazing), we all decided to go to church with the rest of the La Esperanza community. It was wonderful to be welcomed in and to have the opportunity to see the way that others gather and celebrate their beliefs. Many found the service to be simplistic and beautiful, and it was interesting to observe the mixing of old cultural practices with new social acceptances. For example, traditionally the men and the women of the community sit on different sides of the church. However, when Gloria, a validated female member of this community and our partner with Heifer International, invited some of the female members of our group and of the community to sit in the empty seats on the men’s side, there was an acceptance to this progression.
In past years, Sunday has been a low patient flow day at the clinic, but when we exited the church doors we were greeted by a very long line of people. Today we mostly saw members of the Belin community and despite the shorter workday, we were able to see 125 patients. Since the group as a whole is speaking more fluently and confidently we were split into 5 smaller teams which enabled us to increase the amount of patients that we can see. We all received the praise and feedback that everyone is investing a lot into improving their language skills. As students, we are feeling that we have reached a higher level of awareness on how to educate and communicate in a culturally aware way, as well as how to approach increasing the level of continuity for those who have little resources (again, we return to the concept of how we can really make a difference in these circumstances). It appears that delivering this type of care is not only more empowering for our patients, but also for us as providers. In staying within the realm of continuity of care, I was relieved that Penny also prescribed “2 cats in each eye when necessary” to a patient today.
After dinner tonight, during our usual pow-wow time, we had a very unique and intriguing conversation about the academic programs and individual backgrounds that each of us bring to the table. Since we are working as an interdisciplinary team, the ABSN students had suggested that doing so would allow us to be more efficient and aware in our approaches to patient care. For 2 hours we discussed the focus of our studies, our clinical training processes, our ambitions, and the barriers and challenges that exist with in our respective professions. It was truly a learning experience to be grateful for and just another reminder of how special each and every one of the students and faculty on this trip are.
At the exact moment of writing this, we are all in the schoolhouse that we sleep in. There are many card games happening in the background as well as several different genres of snoring. A few are searching for Saturn amidst the clouds outside of our quarters and others are journaling and reading. No matter what the late night activity is, it is guaranteed that we will all sleep hard today and awake ready and willing for another incredible day of learning and living.
Buenos noches,
Team ABSN
Sunday, April 3, 2011
Clinical Day 2
Today was a great experience filled with treating over 150 patients. We have treated nearly 400 patients within our first two days of clinic, and still have three days left in Las Mercedes.
Within the day we took a small break for a delicious lunch and discussion with a young Honduran lady named Teresa. She is actively pursuing her passion to become a nurse. She said that she has always wanted to be a nurse and want to help her community, and she is accomplishing her goals. She is a very driven individual, and has had the fortune to be supported by her family and friends. As a group, who has come down here for several years, we have recognized her drive to succeed and have helped to support her in that. Today, we “passed the gift,” much in line with Heifer International’s core value in supporting the community achievements. The group presented her with a stethoscope…something she did not have, and has definitely needed. “This will serving my patients on Monday!” she exclaimed. It was a very emotional moment for her as well as all of us, as she has truly defied all odds and accomplished her primary goal of becoming a nurse, and hopes to take the position in this clinic as a permanent nurse in the clinic.
Each evening, after dinner, we have a post-clinical conference and share interesting interactions with the patients or one another. One story told this evening in our daily post-clinical conference was one of a patient in need of physical therapy, but in order for the therapist to begin working with the patient, it was necessary to ask the gentleman to please remove his machete from his waist.
Another story that was told was one of a patient in need of some eye drops and being told in Spanish that she needed to put two cats in her eyes instead of two drops in her eyes (for those of you who do not speak Spanish, cat is gato and drops are gotas). We are all working on our Spanish and getting better everyday, even though sometimes it involves a village laughing with us as we refine the art.
One incredibly touching story came in the form of a tiny barely-2-month-old baby. The baby was gently cradled in his mother’s arms, wrapped in white and blue infant garb. He was sleeping peacefully. He had a head full of hair nestled above his ears. But where a normal nose would have been was instead a severe cleft palate/cleft plate deformity (essentially a lack of a hard palate which prevented him from feeding from his mother’s breast and necessitated the use of a dropper). Where normal 5-fingered hands would be, were replaced by mis-shapen ones that lacked middle fingers. Where normal legs would be, were replaced by flaps of flesh (almost as if he was a thalidomide baby). He had a heart murmur and likely had mental retardation as part of the syndrome he had (perhaps trisomy 13 or 19). The mother had come hoping to find that we could offer some therapy. Her eyes were teary, as Gloria (our Heifer representative) explained that we could unfortunately do nothing for her child, that we could not make him like one of her other 3 healthy children who were shyly hiding behind her back. Gloria held her hand and counseled to the mother that neither her nor her husband had done anything wrong, that sometimes, rarely, a baby is born with deformities that the body would in most other situations catch and abort naturally, and that the family could only do what they were doing now and love him the best they could with the time they had together. It’s always unfortunate and heartbreaking whenever a situation such as this happens in the US. But it’s so much more so when you witness it happening to a family in a poor mountain community. But this wasn’t just another sad story. Because what you learn in this community is not another lesson in pity or feeling sorry for a group of people, but how the community lives in the face of hardship, and how they stay strong. Despite the sad nature of this story, we still talked about how beautiful her baby was when he smiled, and how he loved the water and baths, and how the mother had the support of the matriarch of the community.
- Wendy
Shout out to Mike and Olive – Hope all is well. Love and miss you guys, Wendy
Sunday in Las Mercedes
Saturday, April 2, 2011
Clinic Day 1
Day Two: Las Mercedes Clinic Day 1
This morning we woke up between 4 and 6 am, depending on whether our mattress deflated, how loud the roosters crowed, and whether or not we were motivated to shower before everyone else. Our shower is a three wall cement box with a pvc pipe delivering water, its amazing.
During breakfast we franticly brushed up on our Spanish and reviewed the clinic process. We were separated into groups of 3-4, 4 groups would see patients in Clinic rooms 1-4 and the 5th group ran the Pharmacia.
We began clinic promptly at 8 am, as a bus of patients had arrived from EL Rosario and were waiting outside. In the morning our patients were mostly women and children, often about 5-6 per family, including grandma, aunts, mothers, nephews, nieces, and cousins. During the afternoon clinic we saw more men individually and their pathologies were vastly different from the morning. The morning presentation was a variety of dermatitis, mostly scabies. In the afternoon the men presented with more musculoskeletal trauma and chronic repercussions from labor in the fields.
During the afternoon I was able to see one of the CO-OP leaders, he presented with radiating pain from a rash in his axilla, a reddened eye from cement trauma, a fungal infection on both feet, he also had parasites. We found his rash to be Varicella Zoster and thankfully and were able to provide him with Acyclovir and Ibuprofen, we treated the eye infection with eye drops to irrigate and relieve some of the irritation, we provided Ketoconazole for his fungal infection, and Mebendazole for the parasites. This was one my favorite cases because I felt like we could help him with every concern he had, otherwise the Zoster could be diffuse and he would be without relief.
One challenge that we all voiced at some point throughout the day reminded us of home: How do we ensure that the patient follows through with our recommendations?? It is the classic problem of health promotion that we have all addressed in the US. We recommend that someone stops smoking, that they lose weight, eat less salt, exercise differently—and yet America’s most preventable health concerns persist. Hondurans are no different. While there was probably only one patient with a BMI over 23, their BP is incredible, we still found that a few preventable conditions persist.
Multiple times we found ourselves emphasizes that drinking water would help with headaches, nausea, and vertigo- really, it will! But nonetheless their personal barriers persist. One group had an “ah ha” moment with a woman who had been admitted to the Hospital in La Esperanza last week with severe dehydration, she received IV fluids and realized that her headache went away, one of our classmates explained the connection between the fluids and headache and the patient responded with “ohhh.” Breakthrough moments with prevention are the best feeling, because parasite meds will run out, but patient understanding is invaluable.
Friday, April 1, 2011
Day 1
Tegucigalpa to Las Mercedes
Some thoughts and observations from the hospital tour:
- the hospital was packed, lined with patients waiting to be seen
- the physical therapy clinic was well stocked with equipment and we were all surprised by the level of care the physical therapist was able to provide
- the hospital primarily cares for traumas, obstetrics, and pediatric, and various neurological deficits
- paper files lined the hallways, open to walking traffic, dating back 20+ years
- meals and basic care needs are met by family
- the hospital sees about 7000 inpatients and 13000 external consults
- the greatest barrier to care is travel expense and accessibility, meanwhile Xrays cost 50 cents to 1 dollar apiece
- the greatest reasons for neonatal admissions is poor prenatal care and mother malnutrition
Some observations and thoughts from the market and town of La Esperanza:
-There were so many dogs around town and all in such poor health. Horribly skinny, tumors, clear evidence of just having puppies
-lots of trash on the road
-no traffic lights, drivers driving very fast, no clear order to traffic
-huge availability of fresh produce
-lots of handmade good for sale
-people of all ages out and about in the street. Community supervision of children.
Beyond the information we were able to gather from our brief encounters in specific communities, we also took the time to observe and contemplate the trends seen from the windows of our bus. Even from the plane ride in, you could see that the landscape was quite barren from deforestation and the harvesting of other resources, making the populations who live in them very vunerable to the elements. There is a thick layer of smog covering most areas, which is a huge indicator for health as most people are exposed to some variety of outdoor labor, be it for their job or for sustaining their families at home. Roadside we saw a large amount of trash, even as we moved into the rural areas. There were many differences in the way of living in the different settings, with urban life revolving more around merchandise and rural life consisting of much more labor-intensive duties.
These were important learning opportunities for our group to have before our first encounters with the patients of the clinic. If we can aim to understand where people are coming from and what resources are available to them, we have the opportunity to be more aware of how their health beliefs and experiences have been shaped. It is evident that the communities we have seen thus far make do with what resources they have, meaning that some of the things we saw that seemed to be “missing” to us simply did not make the cut on the list of priorities. In comparison to life in the United States where the environment is a product of the people that live in it, the Hondurans are a product of the environment that they live in.
-written by: team absn honduras (josh, katherine, cory, steph)
Shout Outs!!
Zhang family, Nichols Family, CBR Lab, and Olive: I miss you all and hope everything is going well. I barely survived an encounter from a BIG spider. – Wendy
Christianne family: Hola! I hope you guys are enjoying yourselves and just wanted to let you know I was thinking about you. - Christianne
Hello Leslie! Hope you are having fun without me. I miss you, I love you. – Brett
Donna is missing Fortune, Family and Friends. Love and miss you all!
Hello to Amitoz! Love and Miss you!
From Jen: To all my friends and Family: love and miss you!
From the whole Honduras team—Hello and a shout out to all our families. Thank you for your thoughts and prayers.
Penny says hello to Touche and the puppy.
Ray says hello to Claudia.
Hola Lakony! I miss you dearly. Hello to my friends and family. Hope you all are doing well. Love Steph
Hey fam!! I miss you guys and can’t wait to see all the little babies when I get home. Can the boys say Honduras yet?? – Bear
Ethan and Jethro: I hope you both are eating whatever food your hearts desire while I’m away. Missing you both greatly and feeling very appreciative of our little family! Smiths, Wilkinsons, and Geyers: Things are going great and I can’t wait to tell you all about the trip. Love to you all – Katherine
Josh says hello to family and friends. Love and miss y’all.
Hola a las clases de espanol de Rosa. Espero que estan disfrutando su descanso de Rosa. Estudia mucho.
Thursday, March 31, 2011
Las Mercedes
Wednesday, March 30, 2011
Llegamos!!!
We have arrived…it went a little something like this:
-We met at 3:30 am at Duke and loaded all 21 people and 25+ bags of supplies (medicine, school supplies, glasses, soap, etc)
-We departed RDU Airport to Tegucigalpa, Honduras by way of Houston, TX
-We arrived in Tegucigalpa around noon and took the Heifer International shuttle to the compound
-Ate a fantastic lunch prepared by the generous hosts
-Had a couple hours to siesta and tour the compound
-Began re-packing medications in preparation for our days in the clinic in Las Mercedes
-At 6 pm we had dinner (chicken, rice, grilled root vegetables, homemade banana bread, and homemade tortillas)
-We immediately returned to the medications to finish individualizing
-Exhausted…turning in
Expected departure tomorrow at 7 am for Las Mercedes!!!
All is well!
They're off!!
Tuesday, March 29, 2011
T minus 10 hours
Hasta luego Duke
Wednesday, March 23, 2011
...the team continued
Hola! My name is Jamie, I am in my last year of the cardiovascular Adult Nurse Practitioner program. I currently work as an RN on a cardiothoracic unit. Since the beginning of my nursing career I've had an ambition to travel to places that have greater health disparities and challanges than we'll ever know. Hopefully this will be the first of many trips. I've enjoyed the class preparation of learning Spanish and about the culture of Honduras. I am very excited to be able to participate in this trip with such a great group of people. I know the people of Honduras will provided me with a life changing experience, which is way more than I will be able to provide them.
Hola! Mi nombre es Colleen. I am a second year Physical Therapy student, and I am incredibly excited about this opportunity to serve the Hondurans! I have always had an interest in global health and I am eager to learn first hand how the practice of physical therapy can play into that. Hopefully, this will be a beginning to a lifetime challenge of international medical service!