Post Medical Mission to Honduras

Let me begin by expressing my continuous gratitude to Dr. Sarah Jones for inviting me to join the KP Napa-Solano Global Health trip.  In addition, I am thankful to Drs Symkowick & O’Connell for allowing me to participate in this amazing experience.  Drs Stecker & Chen for being yourselves, which is fabulous, OF COURSE!  Indiana University team (Dr. Javier Sevilla-Martir, Dr. Daniel Gomes, & Enrica), ENLACE, Interpreters (Enrica, Carole & Ivan), Honduran residing in Texas (Dr. Juan Vasquez), our 1st Global Health Sub-Intern Medical Student, Angela Rodgers,the beautiful local Hondurans & last but certainly not least, Dr Symkowick’s wife, Leigh (an Art Teacher) & kids (Marta, Gabe & Louisa).  It was an honor working side-by-side with a multidisciplinary team, (Physicians, Medical Student, Dentists, Periodontist, Interpreters, Teacher, Kids & myself, an admin), assisting in any way possible for the short time we had in Honduras.  

In the beginning of the trip, I was hesitant in regards to how may I help during the trip since I’m not a physician, medical student, Dentist, etc.  My primary role was to take photos, (which I love doing), however, one can take so many photos in a day.  The first village was busy and Dr. Juan Vasquez, a Honduran who lives in Texas slowly asked for assistance, then the Periodontist, Dr. Gomes and the local Dentists asked for my help as well.  My hesitation was over!  I felt very useful after the first village.  

Our hosts, Israel Gonzalez, Clinic Resident Administrator & Dr. Floripe Hernandez who runs Clinica Dr. David Randall Williams were extremely hospitable, welcoming & helpful.  Israel provided in depth education to our team about the village communities every evening.  Love him!  

Chicho offered his lending hands with a smile throughout our entire stay.  And Ivan, (Israel & Dr. Floripe's son), and wife, Carole were excellent interpreters.  

The 4 outlying villages our team visited are beautifully located up on the mountains which ranged from 20 - 45 minutes from home-base, (driving 5-10 mph in a narrow uphill dirt road).  The communities were welcoming and very friendly.  

We made 4 home visits to patients who were unable to make it to our location & assisted with 3 home stove installations.  Soccer clinic with the local kids were led by the Symkowick kids & Dr. Vasquez.  Final day in Taulabe were physicals with eye exams & dental screens to two very big group of school kids in the clinic.

Our multidisciplinary team worked very well together as if we’ve known each other for several years.  For me, the trip was bonding & highly rewarding.  

I look forward to future invitation(s) with the KP Napa-Solano Global Health Program, especially Honduras!

- Jojo Delacruz Garces (Gilberto)
  Family Medicine Residency Assistant
  Kaiser Permanente Napa-Solano  

Por los ojos de los niños

When asked about this trip to Honduras, Marta, 14, shared that it had been a "really great experience".  She and her brother Gabe and sister Louisa, had never traveled out of the U.S. before now.  They were skeptical that they could help the medical team and nervous about their Spanish. Marta noted that "lots of people I know talk about helping the people of the third world, and we got the chance to actually meet people in poor villages in Honduras."

Marta, Gabe and Louisa helped organize the medicines for the physician that was dispensing them.

They helped Leigh (their Mom) draw pictures with the children of the villages.  From the smiles on their faces, both the local children and Louisa, Gabe and Marta understood each other well and really enjoyed their mornings.  Tessa started a game of "Pato, Pato, gonzo" (duck, duck, goose).  Everyone had fun with and laughter could be heard throughout the village.

Marta said she really enjoyed playing soccer each day with the children near the clinic.  She felt that everyone playing really loves the game.

Everyone, local kids, visiting kids (she and Gabe and Louisa), clinic staff and local ENLACE workers (ChIcho and Ivan), and adult team members, united in a common purpose.  Everyone laughed, joked, cheered, high-dived, and hugged.  She felt "close to all of them" in these games.

Marta, Gabe and Louisa all hope to return to help a "Brigada" team in Honduras "soon".  Overall "this has been a really great trip Mom and Dad".

- Matt

Lacing together our week in Honduras

This group from IU and KP and Honduras,  Hondurenos, doctors, translators, dentists, teachers, futbolistas (soccer players), led by Dr Javier Sevilla and Dr Sarah Jones, has shared a wonderful week.  Israel Hernandez, a lifelong friend of Dr Sevilla and husband of Doctor(a) Floripe Hernandez, full time doctor at the Las Lajas clinic where the group stayed, expertly organized our Brigada ("brigade") trips to four villages.

Together we helped many people with both common conditions for US healthcare workers and more unusual problems as well.  

Many of us were energized by the care Dr Sevilla and Dr Juan Vasquez, a Hondereno who lives in Texas with his family, took to teach us about the Honduran health system.  When we treated villagers for chronic conditions we referred them to the local health center or non-profit Hospital Evangelista that we had toured on our first day in country.

ENLACE leaders Dr Sevilla, Israel Hernandez, and KP Global Health Leaders, Dr Sarah Jones and Dr Tessa Stecker, prodded the group for new ideas for future Brigadas.  Many mentioned ideas for education including Charlas (little health talks) o ferias (health fairs).  We hatched plans for dental health and nutrition sessions, overuse injury sessions and chronic low back pain.We learned about a more efficient wood cooking stove that produces far less interior smoke and as a result fewer respiratory infections.  The group is thinking about ways to finance more stoves.

- Matt

Universal Language

Universal language

While language assists with communication, it doesn't define it. This week as our multinational team has gotten to know one another and worked with the Honduran community, we've seen countless examples of cross-cultural communication despite the lack of language fluency.

Marta, Gabe, and Louisa are perhaps the most skilled in navigating the language barrier.  They help to lead the soccer clinic every afternoon using the international language of sport to weave a beautiful tapestry of laughter, play, and compassion.  On the lawn outside our "clinic" they lead a team of children in "pato, pato, ganso" - duck, duck, goose.  Marta kneels gently to console a child who's crying next to the garden.

Leigh uses the stroke of a pen and her warm smile of encouragement to narrow the language gap. Her "flock" of Honduran children sit calmly amongst the bustle of the clinic, drawing pictures and coloring.  Their joy and excitement is palpable as they share their artistic creations.

High fives, hugs, and hand shakes punctuate our daily interactions.  As we observe one another and work with one another, we develop our own language - words, gestures, and body language convey gratitude, compassion, understanding, and joy.

As we gather around the table every evening to share our thoughts of the day and ideas for continued improvement, interpreters strategically position themselves around the table to ensure all can understand the conversation.

Spanish language classes embolden us to try new phrases and words.  Sarah leads the team in describing the next day's events in Spanish, impressively recording the schedule in Spanish on the white board. The morning yoga lesson is led by Rossan in Spanish.

In a few short days, this team has formed and managed to work together effectively and efficiently.  Our language barriers have begun to melt away as we find new ways to communicate and share in this incredible experience.

- Tessa

QI in action

QI in action - A pill sorting case study

Two tables of medications lay before us. The task was seemingly simple - separate the medications into individual packets to improve clinic flow in our pop-up rural outreach clinics.
On the white board emerged a list of medications and common doses. Sarah and Juan took the lead putting the list together, occasionally conferring with the rest of the team to fine tune doses depending on the condition and Honduran specifications.

We each spread out over two tables choosing the bottles we would separate. As we opened bottles of metformin, multivitamins, and metoprolol an array of colorful pills filled the tables. Each person developed a strategy for counting and bagging. Murmurs of counting were heard as mini rows of pills and assembly lines formed.

Our work flow was punctuated by laughter and the beats of Latin music. Perhaps the most efficient of our work crew were the youngest members - they didn't take breaks; they had the most discipline and focus; and a friendly competition fueled their productivity.  Some team members designated themselves labelers - ensuring that labeled medication bags were readily available as pill sorters finished their batches.
As our mini bag supply ran low, a mini scavenger team deployed and found a box of pill bottles.  The next challenge: labeling the bottles. But this challenge was easily defeated by team Eau de Deet.  Post its, an extra batch of pens, and strategic placement of labels inside the pill bottles became the solution.  To ensure equitable health literacy medication instructions were simplified.  Each person found a role and willingly changed roles as dictated by the team's needs.

It's rare to find a team who works together naturally and seamlessly, finding solutions together, not letting unanticipated challenges derail their progress.  There was no mandate to improve the quality of our work flow; rather we refined our process as we encountered challenges, always keeping in mind our end goal - to provide the best quality care to the people we would serve over the next week.  As we closed the last of the boxes for transport the next morning I felt a combination of excitement and calm - this team was ready for whatever challenges lay ahead.

- Tessa