Food for thought

7/16/18

Gealina Dun

Family Medicine Resident

Class of 2019, PGY-3

We’re back!!

It’s crazy to look back and think of how quickly the week went by and how much we were able to accomplish. Each day was memorable for something different.

Tuesday - We went back to El Diviso and did more work at the school, teaching first aid kits, setting up a tablet touch pad for the school so they can play games and learn English, and building a stove. Total, we saw nearly 100 patients in the community.

Wednesday - First day in Palmichal Carmen! It’s a very different community - it seems slightly more affluent, which you can see because the houses seem more durable and the patients are older. There are more chronic diseases like hypertension and diabetes which we didn’t see as much of in El Diviso.

Thursday - Kelsey and Ethan removed a large lipoma in Doctora Floripe’s clinic! This meant a few of us stayed behind and weren’t as helpful when it came to clinic in town… but it still went well! We managed to see nearly 40 patients despite the late start and again do first aid training, teach about tablet use, and install a stove. We also handed out shoes to the local kids. There was a very long line and the kids were so excited to get new shoes!

Friday - We spent the day at Las Lajas elementary school right down the street from the clinic. There were a lot of kids and I spent the morning helping the team check Hemoglobins of any new children and ones who had been anemic the previous year. We checked over 30 kids and found a lot of anemia! Those who were anemic received multivitamins with iron and the hope is that they will improve in the coming year!

Then we said goodbye to our fantastic team and hosts and packed our bags before heading to Tela beach for rest and debriefing. There, we continued to enjoy each other’s company and the warm Caribbean waters! We celebrated Christina’s birthday as thanks to our fearless leader for organizing our wonderful trip.

So those were the logistics and facts on the trip. Some of the things that stood out are more complicated than what I can say in a summary paragraph.

Here’s more food for thought for future groups:

• Dental Care - the residents were assigned “waiting room talks” to try to educate the community while they were waiting to be seen. We talked about things like hand washing, dental care, and sleep hygiene. My topic was dental care and it is a huge need in this community. Dental had a line every day and they saw 20-30 patients a day doing cleanings, tooth extractions, and fillings! When I would ask the patients whether they brushed their teeth, many of the kids would exclaim “YES!” and say that they brushed their teeth three times a day. However, the evidence seems to point otherwise - as there is a significant burden of pediatric caries in the community. Many houses have running water, but their sinks are outside and not potable. You can see this sink has a sock over the faucet because there are so many minerals and particles in the water that gets collected that they use a sock to filter it. Then they fill the bowls with water to wash their hands. To the left of the photo is a shower, and to the right is the toilet, which is basically surrounded by a cardboard wall. It’s definitely not like the USA where we have sinks easily accessible and can brush our teeth anywhere without worrying about catching a stomach bug.
• 

• Nutrition - I spoke about this already, but it still nags at me that there is not a great source of vegetables among these patients. Sodas (frescos) and chips (churros) are a very popular food source that can be found in pupuserias (convenience stores) in these communities. They are fairly cheap - 18 limpira ($0.75) for a soda and 45 limpira ($1.88) for a bag of chips. The diet tends to consist mostly of rice (arroz), beans (frijoles), and chicken even though vegetables are also very reasonably priced. There was talk about building garden towers so people could grow their own vegetables, and it’s an idea that we are still exploring.
• Sustainability - one of the best things about this medical mission trip is that its model aims to be sustainable. We bring care to patients where they are in the communities (kind of like a home visit) but still refer them to Doctora Floripe in Taulabe so they can follow up and continue to get medicines. It’s not free, but at least it’s a place where they can get care on a sliding scale basis. We also build stoves and try to improve the education system which is hopefully improving the environment in which they live. There are still many ways in which we could help - finding or creating jobs so that people can afford better food and nutrition, afford their medications, and addressing the social determinants of health in addition to the acute care we provide.
• Stoves - The fuel efficient stoves help to improve the lives of these people in many ways. It improves air quality by 80% by decreasing the particles in the air and the amount of carbon monoxide, as well as decreasing fuel use to 20-30% of its original. This means that people are spending less time finding wood, buying fuel, and being sick. These families do have electricity, but they don’t have electric or gas stoves because it would cost more money not only to buy them but to maintain them. These concrete stoves are portable and can move with them if they were to ever need a new home.

This is the stove elevated on bricks. The concrete outside is filled with clay to help insulate the heat.

The hole on the bottom edge of the picture is where the chimney is put. There is a hole in the bottom of the tube so that it can be turned and opened or closed. When it is closed, it allows the stove top to heat up faster by preventing air to flow out and therefore there is not as much cool air moving through the stove.

This is the lid or stove top that gets placed on top a layer of ash. The clay is wet and stamped down to seal it, and the ash is put in a layer to also help seal the stove top down. Because the ash is much finer than the dirt/clay, it acts as a better seal to help prevent smoke from getting out underneath. The design of the stove top also allows heat to move to the bottom and around then into the chimney instead of straight down the middle.  

This is the chimney being placed. The air flow above the chimney allows it draw up the smoke and warm air.

Yay fire!

And here if the finished product! That stove top gets pretty hot so the owner can grind her beans and make coffee and tortillas.

Whew! I feel like I threw a lot of information out there. It’s a wonderful trip and I feel like I was able to contribute to the community without taking too much away from the established system, practice and improve my Spanish language skills, and get to know my teammates and colleagues better. I would definitely do it again and recommend it to any resident interested in seeing how to run a community clinic and establish oneself in a community.

Thank you Honduras! Maybe I’ll see you again next year!