Thoughts on medicine in Honduras

A large part of the global health experience lies in learning about other countries’ medical systems. We were fortunate enough to have a few doctors from Honduras working alongside us, including Dr. Fabricio, who shared with us some humbling statistics about medical training in Honduras. Honduran doctors get a vast wealth of experience during their residency programs-- Fabricio had delivered thousands of babies in his training, including one night shift during which he delivered 22! I feel like our program has a good share of OB training in comparison to many others here in the US, but I will likely deliver a mere 70-80 babies by the time I finish residency. I was lucky enough to sit next to Fabricio while seeing patients each day in clinic, and he was so kind, knowledgeable, and thorough in caring for each person he saw, and understood the dynamics of barriers to healthcare in the community in a way that I certainly did not grasp. 

Honduras has a total of 16,000 fully trained doctors, but only 6,000 of them are currently employed providing direct medical care. This is largely due to the lack of resources and infrastructure to support them. And yet Honduras clearly has a desperate need for more medical services for its people. Part of this gap is served by foreign medical brigades like ours-- 40% of health care in Honduras is provided by international medical organizations. It was hard for me to reconcile this fact with the number of doctors who were out of work-- it seemed like if all trained Honduran doctors were employed in health care, then the healthcare gap would largely be closed. Unfortunately, the barrier seems to be medical supplies and equipment, not necessarily healthcare personnel. In this, we were able to aid by bringing down medicines, vitamins, and basic healthcare supplies. However, as with many international missions, it seemed a short term solution to a long term problem, though we tried our best to connect patients to longer term care when indicated. It was humbling to think of all the training the Honduran doctors had and all the energy, passion, and sleepless hours they put into it-- and then that ultimately, many of them are unable to serve the patients they love, many of whom still desperately need medical care. I left feeling grateful that I am able to serve my patients here with the abundant resources that we have, and wondering what steps can be taken to ensure more equal access to healthcare supplies across the globe, specifically in Honduras. I don’t have much of an answer yet. I don’t know if our bringing supplies down is hindering or helping the process-- it certainly helps meet a direct immediate need, but would the Honduran government feel more pressure to build a more complete healthcare infrastructure in Honduras without the presence of foreign medical aid? It’s hard to know for certain. In the meantime, I will appreciate the ease I have of getting a patient in to see a specialist here, or even running simple lab work, and remember the gratifying patient encounters and small help we were able to provide, albeit briefly, in Honduras.

Joanna Ingebritsen, R3, KP Napa Solano

Remembering together

         Our wonderful team of co-residents, faculty, and dedicated family members and I were able to experience the joy of providing medical care in the Taulabe region of Honduras 2 weeks ago. The memory of our trip will forever be colored by the pain of losing one of our dear friends and colleagues in the preceding days, Ethan Sellers, whose moving poems can be found below.

            I’ll never be able to write like Ethan, so for a more profound emotional expression of the doctor-patient relationship on prior Honduras trips, I’d encourage you to read his writings. While we were all experiencing the initial phases of grief during the trip, we were united in our shared experience-- something Ethan would have appreciated, I think. We found joy and humor in thinking of him being here a year prior and excitedly yelling “Cheque leque panqueque” and playing with all the children-- something he did with gusto with all the children in the residency program whenever he had the chance. I could also picture him every time I knelt down to check a patient’s feet, or each time I stopped writing notes and just sat and listened as a patient shared their story. Everyone we met was so generous with their time, patience, and in sharing their lives with us. The exam space was in some ways more intimate than at home-- we were invited into the local church to set up our clinic, and then had the chance to sit directly facing our patients without the barrier of a computer screen. It was truly family medicine in the best way, as mothers would come in with 2-3 children at a time, and we would address each family member individually before summing up the collective plan, with each child patiently waiting for their turn to be examined. We also saw older couples coming in together. Whenever I asked which patient the family would like to start with, it was always the youngest-- and in couples, each person inevitably pointed to their partner, demonstrating the selfless nature of the patients we were lucky enough to meet and serve.

            I could see why Ethan loved coming here-- I did too, and I think the experience, while painful, was healing to some degree in picturing him in his element amongst the welcoming people here.

Joanna Ingebritsen, R3, KP Napa Solano

Honduras Reflections

A few reflections on our trip in no particular order:

1. We are both enabled and limited by the extensive resources we are used to at home. While I am extremely grateful that I can (usually) access whatever medicines, diagnostic tests, and specialists I want for my patients, it was a challenge to switch my expectations in a setting with extremely limited resources. While at times this was frustrating, it did help remind me the importance of the simple things such as anticipatory guidance, diet, lifestyle changes which can often seem like an afterthought in a busy clinic but can have a huge impact on patients regardless of their resources.
2. It was humbling to realize that Honduras has many physicians who, for political and economic reasons are unemployed or under-employed. While many of our patients expressed gratitude that we were there to help, I felt very mixed emotions thinking about all the doctors within the country who would be happy to do this work if they had the funding or resources to do so.
3.  I was grateful for the experience of working both with co-residents and faculty, whom I grew closer with during this experience, as well as with new team-members.  We had a large group, often several dozen people and it was daunting to think of organizing a meal, much less a clinic and numerous projects with this many people over a short period of time, but I was amazed at how smoothly everything went. I think the elements of our team that led to success were:
1. commitment to common goals- everyone at times put aside their personal preferences in order to make things run more smoothly
2. learning from past experience- While for many of us this was the first time on this trip, our group took seriously the lessons learned from prior groups' experiences
3. constant reflection and striving for improvement- our daily wrap-ups included not only a summary of the day’s events, but reflection on what went well, and what could be improved (for example communication between physicians and pharmacy about medications, flow of patients from one station to the next, etc. With this practice I noticed changes made each day that led to smoother and more effective clinic practices.
4. waterslides never get old 

-Sean

Arriving in Honduras

1.         Arriving in Honduras was a jarring experience. We had all recently learned of the unexpected loss of a friend and colleague and this was weighing heavily on us as stumbled out of our red-eye flight and into the crowded San Pedro Sula airport. It was there we re-connected with the rest of our travel companions and where I first met our jefe, Dr. Javier. His warmth was immediately comforting, The perfect balance of condolences and bright optimism. It was here I realized how glad I was to be with a group of friends sharing common goals and experiences. The drive to Taulabe was a blur interrupted only by a wonderful and generous meal hosted by Javier’s sister, Cecia. The rest of the day was spent unpacking and preparing for the week ahead. Plans of morning yoga and running quickly faded as I fell into the deepest sleep I had experienced for months. Waking the next day with renewed clarity it felt as though the previous 48hrs had been a dream. We spent the day getting to know each other, preparing medications and supplies and discussing the details of our mobile clinic, with physician consult, dental/fluoride treatment, pharmacy, and children’s activity stations while a subset planned for an Advanced Life Support in Obstetrics course they would be leading in Tegucigalpa, several hours away. It was exciting to see our teammates of all ages and varied experiences take on and embrace their roles and once again I was reminded how lucky I was to be part of this group.                                          -Sean

For Ethan

The day we left for Honduras we received the devastating news that our beloved Ethan - friend and co-resident who recently graduated passed away suddenly. He was in Honduras last year on this same trip. We grieved together and remembered him as a group and we felt his presence so strongly through the week. This is a poem written in his honor. 

Ethan -

Here you were and here you are

We return to this place and see your foot prints

You have left not tracks but meandering streams, rivulets and waterfalls

Like those we pass in the green mountains, surrounded by wild ginger, coffee and plantains

Alive with movement, permeating, nourishing

And the darkness of tragedy becomes the rich, loamy compost from which new growth springs

This is something you understood better than most

How life and death walk hand in hand,

The beauty and closeness that emerges in the face of challenge

The opportunity that comes with pain

You are so present here and within us all

And we thank you

Kaitlin Best PGY3