Brought to you by the students of the University of Cincinnati College of Medicine
By Gina Cano
In April of this year I had the privilege of traveling to Honduras as part of the Global Health Elective at the University of Cincinnati. I had wanted to experience this trip since I learned about the opportunity my first year of medical school. The trip was both a challenging and rewarding experience, and I encourage everyone to participate in a foreign medical trip. You never know what you might encounter along the way.
Foreign medical brigades can be motivated by very different goals and activities. Often they are a short-term activity that aims to provide acute care for a certain area. This trip was organized through Shoulder to Shoulder (Hombro a Hombro). The organization is a non-profit NGO in Honduras founded in the 1990’s through a collaborative project by the University of Cincinnati and community leaders in Honduras aimed at providing sustainable health care for residents of the area. Since then, Shoulder to Shoulder has grown considerably and now has partnerships with over 10 universities in the U.S. While the long-term care of the patients in the area is provided by Honduran doctors, nurses, and health promoters, short-term brigades come several times a year to assist in field clinics for the surrounding rural communities and to help cover call for the 24 hour urgent care clinic in Santa Lucia where we stayed. This model not only ensures that the residents of the area will continue to have access to care when the brigade leaves but also provides assistance and rest for the health care providers who regularly care for them.
In order to prepare for the trip, we packed everything needed for 2 weeks in a carry-on so we could each check a bin full of medical (and not-so medical supplies) for the clinic and other activities. This limitation was my first reminder that I would not have access to everything I am used to in the U.S. It is a privilege to receive medical training in the U.S., but it is also a great challenge to practice medicine when you don’t have bulging white coat pockets and an unlimited amount of tests and supplies.
Our brigade was made up of several attending physicians, residents, a pharmacist, and both medical and pharmacy students. We were also accompanied by nine interpreters from a bilingual high school in La Ceiba, a coastal region in Honduras. These young students not only provided their interpretive services but also allowed us to see a different part of their country through their eyes. Together we traveled to the state of Intibucá, a poor rural mountainous area along the border with El Salvador. Life in Intibucá is not easy. Many of the locals survive only by raising animals on the difficult-to-cultivate land. Transportation is only by the few rough and unpaved roads.
We spent most of our days running field clinics in the smaller communities that lacked a health center. We would set up small workstations in one-room schools or in a local shop or home. Supplies (including our lunches) had to be brought in each day. Our group patient load varied, we would see as few as 15 or as many as 70 patients in a day. At certain field clinics, we ran diabetes, hypertension, or prenatal care clubs where we educated patient through skits or direct patient participation. We even had the participants in the diabetes club check one another’s feet.
Thanks to Spanish classes in high school and college, as well as a summer spent in El Salvador, I was able to communicate with my patients in Spanish. While my patients often had a wide variety of concerns, frequently the complaints (e.g. difficulty sleeping, headaches, abdominal pain, etc.) were related to the difficult living and working conditions. One patient, a 17-year old girl who walked an hour and a half to school each way (an even more impressive feat when you consider the unpaved mountain roads) came in feeling dizzy. The cause of her distress was likely dehydration; she had eaten and drank little throughout the day and was feeling lightheaded on her way home. Another patient, a woman presenting with tension headaches, had been forced to leave half her children in the US (where she worked two separate jobs) in order to return to the rest of her family in Honduras.
April is generally considered part of the dry season in Honduras but we frequently encountered muddy roads and unusually high amounts of rain. One day we weren’t even sure we would reach the community where we were going to have a field clinic; the trucks couldn’t pass one particularly steep and muddy stretch. Instead of turning around we all jumped down and walked part of the way. By the time the trucks could again pass our feet were covered with mud. Many more patients than anticipated arrived that day to see us. Our trek had certainly been worth it.
In that moment I was reminded of a common Buddhist parable:
“Tanzan and Ekido were once traveling together down a muddy road. A heavy rain was still falling. Coming around a bend, they met a lovely girl in a silk kimono and sash, unable to cross the intersection.
‘Come on, girl’ said Tanzan at once. Lifting her in his arms, he carried her over the mud.
Ekido did not speak again until that night when they reached a lodging temple. Then he no longer could restrain himself.
‘We monks don’t go near females,’ he told Tanzan, ‘especially not young and lovely ones. It is dangerous. Why did you do that?’
‘I left the girl there,’ said Tanzan. ‘Are you still carrying her?’”
Sometimes reaching out to help can be dangerous and unsettling especially if those we are helping come from a different background. To make matters more complex, the patients themselves may be in a difficult or unsafe situation. However this trip taught me that even if I feel less than prepared or do not entirely understand where someone is coming from, there is still a lot I can do to help them find healing and a better situation. That help may take the form of a quick medical fix but more often it involves simply listening and being open to go wherever a muddy road may take you.
As I start my career in Family Medicine at Christ Hospital here in Cincinnati, I will have the opportunity to return to those same roads this October. The Christ Hospital/UC Family Medicine program sends residents to Honduras at least once during their training. Beyond that opportunity, I hope to continue to be involved in global health throughout my career, and I plan on providing care to the Cincinnati Latino population even after residency.
Reflections on a Medical Mission Trip to Honduras
Copyright © 2012 Mentis
About the Author:
Gina Cano is a first-year family medicine resident