Wednesday, August 28, 2019

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

Tuesday, August 27, 2019

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

Sunday, August 4, 2019

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

Pensando


We have now been back for a few weeks from Honduras. It was my first trip and the 8th trip since the beginning of this partnership between ENLACE and Kaiser Napa-Solano Residency. In preparing for the trip I didn’t quite know what to expect. We spent a year preparing under Emily’s guidance – fundraising, learning and planning. Learning about many of the challenges Honduras faces it is easy to feel overwhelmed. How can we meaningfully engage in 1 short week? True – a week is so short. But returning from that week now I am left with awe at the power of teamwork. It was truly a wonderful team.

It was such a privilege to work with Dr. Sevilla, Dr. Fabricio, Dra Floripe, Don Israel and the rest of the ENLACE team. There is amazing work being done every day to improve the lives of those living in and around Las Lajas and it was very cool to get to participate in that. Our group came down brimming with enthusiasm and inspiration. Progress is made by a series of small changes and I was struck by the ways improvements are being made each trip. We set up clinics in the churches in Palmichel Carmen and El Diviso and locals lined up each day to seek medical and dental care. The clinics, which had many moving parts, ran smoothly with everyone assigned to a position and implementing tools and building on lessons learned from prior trips. The under 18 crowd (Symkowicks, Millers and Deborah’s son Finn) was amazing! From running the pharmacy, to dental health education and fluoride treatments, to slime production and entertainment for waiting kids we were lucky to have such an inspired group of young folks. This year we were also excited to have Kathleen Deegan PhD, RDN (Emily’s mom!) come down to lead nutrition assessments. I got to be a part of this team and we conducted interviews to gather information about dietary staples, this year focusing on women and risk factors for anemia, but with plans to expand this project in the future.

Overall it was an amazing experience and I am so grateful that our residency program has the opportunity to participate in global health work. It was really special to go down with the entire class of residents, faculty, families, and inspired community members. Huge thank you to our incredible global health leaders Tessa Stecker and Emily Fisher!

Kaitlin Best PGY3

Tuesday, September 11, 2018


Estufas




Honduras is an exceptionally beautiful country: green covers literally everything! The scenery comes in stark contrast to the conditions some of our patients were living in. Bare dirt floors, flimsy wooden slats for walls, and aluminum for roofs in some of the poorer villages were not uncommon. Before ENLACE, most families cooked with wood burning stoves in their homes, causing respiratory illness and leading to emergency room visits for asthma attacks.

With ENLACE and Don Israel’s design, many of these families now have clean-burning stoves. We had the privilege to install 2 of these stoves which require significantly less wood, and pipe the smoke out of the house. Requiring a simple concrete frame, a clay tube, and dirt dug from the owner’s yard, these simple stoves have dramatically reduced the rate of respiratory illness in the communities where they have been installed.  Earnestly asking about each component of the stove, I fell in to Don Israel’s joke when he told me the water we added at the end was the most important part. Eager to understand the construction, I asked why. He smiles and says ‘because it feels the best on your hands” as he massages the water into the dirt to make hard clay. Just another day’s work!

Emily Fisher
Community Medicine and Global Health Fellow


Regresso



I have been lucky enough to have traveled to many different countries for work and vacation. This trip, however, marks the first time I get to go back to the same place twice. The last time I was here, I had by 6month old daughter in tow and it’s not until this trip that I realized how much that had given me tunnel vision. I missed my daughter dearly this time, but I noticed the beautiful surroundings a little more clearly, interacted with the local team more closely.
Being my second time, I could really settle in to familiar surroundings. Improved Spanish helped a lot tambien! At first, the poverty is all you can see. But this time, I was more able to appreciate the incredible welcome, the care with which Don Israel(our host dad for all intents and purposes) shepherded us up and down the mountains, the kindness with which he treated all the villagers, and a surprisingly wicked sense of humor. The smiling faces of the children ecstatic to receive a calcomania(sticker), and the crazy good footwork of the kids who schooled me at futbol were and added bonus!  I look forward to a third visit to this amazing country and the continuing shift in perspective that each trip brings.



Emily Fisher
Community Medicine and Global Health Fellow