grasping tightly

As the nostalgia has worn off and we are all settled back into our present realities, I am grasping tightly to Honduras. The memories, the bonds formed, and the way we've all changed will fade- if we let it. In fighting forgetfulness and complacency, I find it most helpful to reflect with my new friends and share the experience with old friends. Katherine, Steph, and I ran into Kendra on Trent, it was bitter-sweet as she was preparing to return to Las Mercedes. I occasionally run into other team members and it has solidified that what happens in Honduras does not stay in Honduras- we are all a little different. In hopes of capturing how we each have been changed, our student veteran and adjunct blogger, Wendy, shares her thoughts after two years in Las Mercedes.



"...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

to our leaders

Hit the ground running would be an understatement for our first week back. Multiple end of the year presentations, exams, and projects welcomed us home. I keep finding myself twisting assignments to include something I learned or experienced in Honduras. How can I correlate the use of hyperbaric treatments for ischemic wounds AND our experiences in Honduras within the same assignment? Oh I’ve tried, and I am thankful for this blog as it is currently serves as my personal outlet of expression.

I am writing from my front porch, suspended in my new hammock, fresh from Honduras. A SmartCar just drove past, a family is going for an afternoon stroll, the manicured lawns are green and kids are walking home from school carrying Dora the Explorer and Princess backpacks. It feels like a different world. Sometimes we forget what is outside of our little sphere. For the first time, ever, I am thankful for student loans. I can’t fathom education not being an option; in fact I am beginning to wonder if I am becoming a glutton for school as I ponder MSN programs. The blessing of education and options has challenged me. I was just in another country caring for families where the children would be lucky to reach the 6th grade, meanwhile I was in fact learning from Duke’s best. So not only am I privileged to attend school, but I am blessed with phenomenal instructors. Speaking of phenomenal instructors, we realize that our experience during these two weeks and the preparation which preceded them only took place because of the leaders who orchestrated every last detail, including the flexible ones.

Dennis, Penny, Rey and Bob. Your dedication to this community is difficult to describe. I couldn’t begin to understand the weight of your investments in Las Mercedes until I felt it.

Thank you Dennis, for supplying an absurd amount of insight, into everything. I now know how fast a mosquito can fly, the amount the temperature changes with every 1000 feet of elevation, and I can differentiate between staph and strep skin infections. You run a tight clinic, even while sick, with a smile on your face. Rey. What can you even say to Rey? You have a unique way, with patients and life. Thank you for the laughs, for sharing yourself, and taking time with each of us. We are all better for knowing you.

To Penny, thank you for being so intentional in your teaching. You challenged us clinically and personally. Your transparency in sharing your experiences was a great encouragement, thanks for investing in us. Rosa, we loved seeing you outside of the classroom and working with patients. You earned patient trust in the midst of complicated situations, you are sensitive and compassionate beyond words. And of course, a big thank you for being patient with all of our Spanglish.

Bob, while you were physically with us for half the trip, we felt your presence the entire time. We could see your hands all over the pharmacy and enjoyed ‘Bob stories’ from previous years. Thank you for developing a seamless system.



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).

I could write more on my own behalf and that of my friends, but please know that we are grateful to you for your investment in all of us, we will use it well.

"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!

Recovering and Reflecting

Now that we have officially been stateside for a few days, my mind has had much more time to reflect on our travels (and my body has had some time to recover from GI and URI bugs acquired abroad). I will admit that as I sat in my first class on Monday, my head was reeling with thoughts of all the patients we had seen and the areas we had traveled to - what a shock to be be sitting in front of a PowerPoint again! As I share some of these reflections, I hope this posts finds all of the Exploring Medicine team settling back into their respective school routines and feeling as lucky as I do to have met and worked with you all.

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.

More to come!

Dear Friends and Family,

Thank you so very much for all of your support and kind thoughts as we were traveling. We arrived home safely back at RDU late Saturday night (some might call it Sunday morning by the time we got into bed).

Our last day in Honduras was just as busy as all the days preceding it. We spent the morning in a small community outside of Copan seeing patients and distributing the last of the medicines that we brought along with us. We saw about 30 families which worked out to roughly 65-70 people, bringing our grand total to about 500 patients! The community's culture and health care needs were noticeably different then those that we saw in Las Mercedes. We saw a lot of skin issues, impetigo specifically, a variety of acute illnesses complicated by malnutrition and of course, tos (cough).

The oral hygiene was much better here than in Las Mercedes. In Las Mercedes it was not at all uncommon to see large visible cavities in young children, several missing teeth in young adults, and little to no teeth in older adults. Here in this community, most of the younger adults still had most of their teeth and there was even evidence of available and utilized cosmetic dental work.

Although still in Honduras and still Spanish, several of us struggled with the spanish that was spoken in this smaller community outside of Copan. The accent, dialect and vocabulary left several of us seeking out our expert team of native speakers. (Thanks Rosa, Rey, and Jorge!)

Despite all the challenges, we saw all the members of the community that wanted to participate in the clinic by about lunchtime. It was perfect timing for a short drive down the road to yet another fantastic hot Honduran meal. Chicken, beef, pork with rice and beans and salsa or a delicious soup with roasted chicken on the side. All of which was of course served with the freshest most delicious tortillas.

Our afternoon was completed with either an opportunity to zip line through the Honduran landscape or to take a well-deserved nap back at the hotel. We finished our last night in Honduras with a group dinner downtown Copan.

Our trip has been such a success! We saw over 500 patients, distributed hundreds of toothbrushes, soaps, shampoos, Vitamins and thousands of dollars worth of medication. As students, we have learned so much being here in this beautiful place working with a population so different and yet so similar to the one that we are surrounded by every day. We invite you to continue to follow the blog as we each reflect back on our trip and how this experience will change how we will practice medicine in each of our disciplines.

Keep reading, there is more to come.

Home!!

We are all safe and leaving for the airport at 5 am tomorrow. See you all soon!

On the Road to Copan

It took us about 7 hours on a winding road in a blue-painted school bus to get from Las Mercedes to Copan. The drive, albeit a bit cramped, was gorgeous. The temperature varied so much from the top of the mountain to the valley of Copan. We would go from all the windows being open to all the windows closing to all the windows being open again as we traveled the full spectrum of elevation today. The long drive afforded us the time to bond a bit more, and provided some time for reflection on this huge adventure we are all experiencing.

It is impossible to capture the full picture of what is going on here in the snapshots we are passing along in these blog posts. As students, we are learning so much from each other and from the Professors that are leading our experience here. As we have said before, the interdisciplinary experience has been invaluable. We have been able to assess patients from each of our perspectives to offer a comprehensive plan of care for the patients that incorporates each of our strengths. Additionally, this year we have three native spanish speakers on our trip which has proven to be an invaluable resource for several very complex psychosocial issues with our patients that have come up.

The pill bottles at home that are so easy for us to open have been quiet a challenge for us here. The concept of pushing down and turning the bottle cap has been an interesting concept to teach our patients here. There have been times when Rosa, Jorge or Rey have been the only source for success in teaching the concept. That and the simile of preparing a tortilla.

From the perspective of the ABSN students, we have had several opportunities to practice our maternity skills here. We have felt and measured many a fundus over here. And we have been able to trouble-shoot with new moms issues with breastfeeding. Helen Gordon would be proud.

We are often reminded of the importance of having a cultural guide along with us as we navigate our experience here in Honduras. Gloria and Heifer International have been such a gracious hosts to our learning experience here in Honduras. Our many many thanks to her for all of her guidance as we continue to build and lend support to the members of Las Mercedes.

After the long drive, we arrived ahead of schedule in Copan. We had hot showers for the first time in 6 days. Who knew hot water could be so amazing? We sat down to dinner to be surprised by Bob, one of the legacies of the Honduran team. He flew in to surprise us here in Copan. It was a grand surprise.

Tomorrow is a day off. We spend the morning in the Mayan ruins and the afternoon horseback riding. Friday we are back at work presenting our health promotional topics of oral hygiene, hydration, body mechanics, and handwashing to another rural community a short bus ride from Copan.

Thank you again for all the thoughts and support that is coming our way.

To all of our family and friends:

We miss you and love you very much.

And a special Happy Birthday to Rosa's daughter Natalie.

Monday, Tuesday, Wednesday

Many apologies to those who have been worried about the lag in posting. It has been a crazy couple of days and the blogging has gotten a little away from us.... but this should help catch you up with what is going on here:

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

Wednesday

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.

Clinic Day 3

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

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.

To Bob- Your presence is dearly missed here in the Clinic. Everyone wants you to rest assure that somehow the pharmacia is functioning fairly smoothly, but not the same without you. There is has been talk about posting your name over the door of the pharmacia and possibly a portrait to commemorate your presence here. And Penny says that the Cow says hello. The bus is “bye”!

-The ABSN Team

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

Dr. Clements phoned this morning from Las Mercedes to say everything is going well. The weather has been beautiful! (Last year's trip had to Las Mercedes had to be shortened due to rains ... it's difficult to navigate tortuous, muddy mountain roads in a school bus) At anyrate, clinic is running smoothly and everyone appears to be learning a great deal.

Entries to the blog by the students are text only. Once the team gets to Copan Ruinas photos will be uploaded since the internet connection is faster there.

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 5^th 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.

We hope that all is well in the states and will continue to keep you posted on our time in La Esperanza, thanks to our high-tech aircard that Dr. Clements found.

Last night we slept in the Heifer International retreat center in Tegucigalpa. We repacked medicines, had our last clean shower, and prepared for our travels to the mountains. This morning we left at 7 am for Las Mercedes, stopping in La Esperanza. We toured the hospital where we will refer patients we are unable to treat in the Las Mercedes clinic. Afterwards, we spent some time in the market and enjoyed Maria’s bean and egg tortilla lunch. We rode several more hours up the mountain and arrived in Las Mercedes at 3pm, to be welcomed by the community.

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.

Las Mercedes

Dr. Clements called from Las Mercedes to say they arrived safely after stopping in La Esperanza to visit the clinic and the market. They will attempt to post to the blog from their location but it is unclear if that will be possible. All is going well!

This morning the team has awoken early to what is likely a cold shower, a delicious hot meal and a day of traveling in the bus. Dr. Clements called to say the bus is "fired up" and the team is about to load up and move out. The route takes the group out of Tegucigalpa NW to Siguatepeque then more sw into La Esperanza in the state of Intibuca'. Las Mercedes is about 1 hour NW of La Esperanza via dirt and gravel mountain roads. The group should stop in La Esperanza to visit the medical clinic and then visit the market in town before ending up in Las Mercedes. Anticipate an arrival around 3pm Honduran time.

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!

I received a voice mail message from Dr. Clements. All 21 people in the group arrived in Tegucigalpa Honduras safely ...as did all the luggage. They are likely now in Villa Gracia, the "camp" run by Tim and Gloria Wheeler of Heifer International. This site is outside of town up in the nw portion of the mountains surrounding the capital. More posts to come as I receive word, or the bloggers on the team gain access (sporadic)... but for now everything seems to be on cruise control. bob

They're off!!

Good morning! My name's Bob Streilein and I help coordinate the Exploring Medicine course and culminating trip. I met the team this fine, brisk , still dark, morning at 3:30AM in front of one of the employee parking decks. The scheduled time to congregate was 3:45AM with a departure for the airport at 4AM. The enthusiasm evident despite the hour bodes well for this year's experience.

Everyone made it to the meeting point .... at the designated time ... with their assigned bags AND passports on time!!! The caravan of cars loaded with luggage and team members departed for the airport at 4:01AM. Dr. Clements will call me from Tegucigalpa, Honduras upon their arrival around mid day.

Cheers to all the family and friends who have enabled yet another year of Exploring Medicine to occur. More to follow....

T minus 10 hours

Hola! Me llamo es Katherine. I am a senior nursing student at Duke University and will be a part of the team who has taken on the pleasure of updating the blog with descriptions of our work and service in Honduras. During my first undergraduate experience, I pursued a degree in International Studies and did some international work for an environmental NGO in New Zealand. After that, I found myself in the back-country of Utah working with at-risk adolescents and adults in a wilderness therapy program. As an invested nursing student, I am really looking forward to merging my experiences in global health and therapeutic communication with the solid nursing foundation I have been given at Duke. My hope is that these things will help me overcome my language barrier, my Spanish skills are quite basic, and enable me to contribute to the patients we will work with in the clinic and the communities that we will visit. Please feel free to share this blog with all who are interested in tracking our experiences, as well as to leave comments, questions, and encouragement!

To catch you all up to speed: the past few months have been full of excitement and learning for our upcoming trip to Honduras and now we can say that the time is finally here! We are all packed (OK, I'll admit I am still getting a few things together) and are departing from North Carolina bright and early tomorrow morning.

We ended our didactic portion of this experience last weekend with discussing "all things clinic related". We had the pleasure of watching some of our more fluent speakers practice typical patient care scenarios in a team approach: one medical student, one nursing student, and one physical therapy student. With Rey acting as a variety of different Hondurans, it was both educational and hilarious! Some of the common issues that we will see were also revisited and that gave us an opportunity to delve back into discussing some of the ethical issues involved with short term medical outreach trips. As we have learned, we will collaborate as a team to provide care and education that will have a lasting effect vs. finding an immediate fix that will make us "feel good" without any real value for our patients. Our aim is to deliver the same patient-centered and holistic care that we strive to focus on in our respective practices at home.

On Saturday, we all gathered at the School of Nursing to pack the donated and collected supplies of the following varieties:

medicines, dental supplies, hygiene items, school supplies, and more. It was so amazing to see how much people were willing to contribute and we are all thrilled and thankful to see the bags stuffed to their gills! On behalf of the whole team, we would like to give a HUGE shout out and THANK YOU to Wesley Howard and his West Virginia University School of Dentistry Class of 2013, who collected money to provide us with 700 Oral B toothbrushes and 700 tubes of Crest toothpaste. These dental supplies will make a huge impact on the overall health of many Hondurans! Gracias! We also had many family members come to help us pack and count supplies and we could not have done the job so efficiently without them. Thank you all as well! I hope that everyone can take a few minutes to peruse through some of the pictures and videos of our packing day.

It is time to savor a few last minutes with my creature comforts, but I wish you all a great 2 weeks. A last side note for those going and our loved ones at home: I recently read in a magazine that on April 3rd and 4th the Earth will pass between the sun and Saturn, leaving us with a telescope-free view of the ringed planet. This only happens once every 3o years, so don't forget to check it out and think of your loved ones who are in Honduras looking at that same bright sky!

Hasta luego Duke

Friends and family, professors, classmates, employers, etc..... We will be out of touch, unaccountable, and generally busy between the following times. Departing RDU @ 06:00am, March 30. Returning RDU @ 10:37pm, April 9. Should you miss us, please continue to follow our blog. :)

...the team continued

Meet Dennis... I am fortunate enough to be able to travel with all these young energetic and idealistic students to stay with a wonderful group of people who live in the mountains of Honduras who are poor in material wealth but rich in personal and community wealth. It is a wonderful opportunity to be able for both groups (the students and the locals) to share what is important to themselves and help each other understand what in life is important. As a professor of Pediatrics and Global Health I am delighted to be able to share my knowledge and experience to help both groups better understand that we are all one people and our problems are similar - just on a different scale. Except for money and the opportunity for education the people in the mountains are just like us. May we both learn from this, and help the world to be both more inter-related and emotionally and physically healthier.

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! Me llamo es Stephanie. I am in my last semester at the school of nursing. I am so excited at the opportunity to go to beautiful Honduras and be a part of this ongoing interdisciplinary relationship with the people of Las Mercedes. One of the primary reasons why I chose Duke for my nursing education is for this opportunity to participate in Global health endeavors. I truly hope to spend my life working in under-served global communities like this one.

Hola! My name is Jennifer. I am in the family nurse practitioner program. I currently work as a registered nurse on a neurology unit. In the future I hope to work in infectious disease and HIV. I hope I will be able to go abroad and do this work. I am really looking forward to going to Honduras to provide health care and education. I think this expereince and studying Spanish will be extremely beneficial!

Hola! My name is Janhavi and I am a third year medical student. As a kid, my family moved from 6 different countries and I attended 10 different schools growing up. I have tried to travel as an "adult" independently, but I have always avoided Latin America due to my poor Spanish speaking skills. I hope that this trip will help form a basic foundation for Spanish and that I can experience the unique problems in a small part of Honduras. I am so excited to be going with such an awesome group!!!

Hi! I am Christiane London and am very excited about going to Honduras! I am looking forward to improving the language and cultural communications with the people from Central America and hope to use that in practice, both as a nurse and nurse practitioner. ¡Hasta Luego!

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!

My name is Josh. I am an accelerated BSN student at Duke University School of Nursing. I am excited to be participating in this cultural immersion experience because I believe that there is a great deal to learn and experience in other countries, and a vast number of people that need help. As a student, I have much to learn and look forward to working with and learning from others who share similar interests in international healthcare.

Buenas, yo me llamo Rey. I am one of the veterans of this trip. I have been involved in the Honduras course and trip since the inception in 1995 and prior to this with the Duke Chapel Mission Group from 1992 to 1998. I am a "Physician Assistant" which retired from the US. Navy in 1992 after 24 years in service. From that date I worked at Duke Orphopaedic/Plastic Surgery until 2008. Now I am working at the State Hospital in Butner,NC. Our groups have been involved with Heifer International and I support them on there efforts to help the people in Honduras. Hasta luego.

Hola! Me llamo Donna! I'm a third year medical student from Northern Virginia. I know this trip will be life-changing! Since the beginning of medical school, I've aspired to work in underserved communities. I can only hope that I give back a fraction of what I know I'll gain from serving this amazing community. There is so much to learn from treating people with different backgrounds and cultures. The class we have been taking has built my anticipation since January, and I am looking forward to practicing my rusty-Spanish speaking skills. It will be an honor to be immersed in their culture helping out as much as possible!

Introducing the team…

Every Tuesday we meet and learn together. In addition to more didactic lessons, we work in small groups to practice Spanish and develop teaching vignettes to promote understanding of common preventable conditions. As we work together, we each bring refreshing and challenging perspectives from our own disciplines and personal experience.

Hopefully, in sharing a bit of our aspirations and personality here, you will find much more than an interdisciplinary team. This week, meet Wendy, Dawn, Jorge, and Brett.

Hola! My name is Wendy Zhang. I am a MS3+ medical student in my second year of research. I was lucky to go on this trip last year and am looking forward to this year's trip to experience some continuity in global healthcare. It would be an understatement to say I had a blast last year on this trip! I was born in China and lived in Mexico for 2.5 of my pre-teen years where I fell in love with the Hispanic culture. Global health has always been an interest of mine and I hope to incorporate what I learn from these experiences into my future practice in medicine.

Hola, its Dawn here. I am the faculty member from the physical therapy school and am really excited about this opportunity to provide services to the people of Honduras. This experience will both help me interact more effectively in my current practice with other cultures and allow me to provide direction for the students that are also participating, so they can connect with patients in a more culturally sensitive manner.Wish me luck in using my Spanish, this two month crash course has challenged me.

Hola, mi nombre es Jorge! I am a third year medical student at the Duke SOM and was born and raised in Cuba. One of my main career interests is working with underrepresented populations. The main reason I’m interested in participating in the trip to Honduras is because as a doctor, I envision myself working part-time in South America. This trip will serve as an opportunity to build and cultivate these interests! In my spare time I enjoy long walks by the beach, candle-lit dinners, and long naps!

Hola! My name is Brett. I am a Physical Therapy student at Duke and have been interested in Latin American culture since my first Spanish class in high school. I am very excited about my first trip to central America.

Global Health, the new kid on the Block

We continued our preparation for Honduras today with a lecture from Dr. Clements on the emergence and importance of Global Health. Since 1997 Global health has emerged as an area of study, research and practice that strives for equity in health. It has become an interdisciplinary effort to address trans-national health issues, population based prevention, and provide some level of clinical care and treatment.

The scope of the global health challenge includes infectious disease, chronic diseases, environmental threats, social determinants and health systems strengthening.

As technology continues to reduce the barriers of globalization, global health is the future face of public health.