My Week in Honduras

Pinares, Honduras

So… I am writing this after returning from the mountains of Pinares. It seems surreal to think that I was just there. I’ve been wanting to do a medical mission for quite some time. Things just never seemed to work out. But in October, the stars finally aligned and I was able to sign up for this trip.

A little bit of background. My residency is part of VCU School of Medicine. VCU has had an ongoing relationship with an organization called Shoulder to Shoulder for many years. Shoulder to Shoulder in turn is an organization that has spent a lot of time trying to help the people of Honduras by assisting them with sustainable economic and medical assistance. So as part of this program, they have several clinics established and they have a program for going into schools to do a number of health screenings for kids.

Throughout the year, different schools and different organizations send a brigade of people both medical and non-medical to go out to work both in the clinic and in going out to the schools. VCU sends out a group 3 times a year. Our residency sends a group out in February.

And that’s how I ended up on an amazing journey into a world I never thought I’d see.

S2S

All of this is made possible by an organization called Shoulder to Shoulder. S2S is an organization that was started many years ago.

Their mission is to help the rural poor in Honduras. They go about this in many different ways… they try to incorporate a combination of economic, agricultural, public health, and medical aid. They have set up multiple clinics throughout the country, some scholarships, various public health projects, and coordinate brigades from different organizations in the U.S. They have a group of interns that work with them a year at a time; and they also have a great brigade coordinator named Marvin who helps the brigades set things up and work through issues while in Honduras. They also serve as key liason to the Comite.

The Comite

The Comite is an organization of local community leaders that help guide the direction of aid to the villages in the mountains. They are led by one local leader in particular by the name of Don Quintin. He is a small man with a gentle manner, a tremendous heart, and a smile that can fill an entire room. He is really something special. It’s interesting, because I had the chance to visit his house. To get there I have to take a short… but very steep walk. When I get there, I am soaked and pretty out of breath. I’m also a little shocked. I’m not sure what I expected. But I know that I did not expect him to live in such poverty as well. When I think of political leaders… even in small communities, I tend to picture some degree of corruption; usually a sense that they are ensuring that they are taken care of first and foremost. I don’t know if Don Quintin is in fact lining his pockets, but because there is so little, it doesn’t show… but somehow I do not get that sense. Their house is a few cinder blocks with a clay tiled roof, and all dirt floors. There are 3 rooms; one for the kitchen, one for storage, and one for everyone to sleep in. That’s it. The house is on a small shelf on the side of the mountain that amounts to the size of my family’s living room. It’s truly humbling. From what I have heard, the comite does a lot of good, but can also be somewhat frustrating to work with due to competing interests, self-interest, and an occasional inability to see the big picture. Whatever the specifics and complexities of how the Comite operates, I suspect that Don Quintin is the kind of leader that all of us wished we had in our own communities.

The Team

As I said before, our residency sends several residents every February. Our team is made up of 5 residents, 3 attending physicians, and 4 nurses from our office. We also have 2 docs from Georgetown, 2 volunteers from the free clinic, 10 volunteers from an organization called Thundermist. Thundermist is an organization that has clinics set up to work with the uninsured in the New England area. They were integral in setting up the clinic in Pinares and are a big reason why we are able to do what we do. In addition, we have 5 Honduran translators hired by S2S to help us throughout the trip. So all said and told, we have 41 people in our team.

It’s an eclectic bunch, because we are bringing together 3 groups that knew the people in their own group really really well prior to the trip and having them all work together with the other groups. The first 2 days in country takes a little getting used to for us, but we all end up quickly working very well together. It’s amazing to see what happens when people come to a place with a sense of higher purpose and when they see the need for working together. We all gather together in a town called El Progresso where we stayed for a night, and then took a chartered bus into the mountains for the week.

The Town

Our clinic is in a little town called Pinares, named after the fact that we are surrounded by pine trees. It is a mountain town that is fairly isolated. The closest big town is Esperanza which is still about an hour and a half away. You will likely not find it on a map. Many of the towns in the mountains are not on the maps in fact due to being so isolated. The clinic in this town has been around for many years and is manned by a dentist and occasional brigades. Pinares basically consists of one little rest stop with a small diner attached to a small building that has a few dorms, an outhouse, 2 other little snack shops, and a few small houses… all at a crossroads of 3 dirt roads… plus the clinic. That’s it. That’s the town. The people then live spread out across the area in little isolated huts. Pinares is the very definition of the word sparse. Yet this is still quite a bit better than what is available at other places up here in the mountains.

The drive up to the town… is… an adventure. The first half is quite nice. Beautiful views… friendly people. But once you start climbing the mountains, you enter so many different elevations and different pockets of ecosystems. It’s interesting going from temperatures in the 80’s with lots of heat to immediate 40 degree weather with a stiff breeze. The roads are incredibly bumpy… very dusty… very narrow… with huge drop-offs on the sides. Just getting to Pinares without throwing up feels like a huge achievement.

I’m not going to lie. It takes some getting used to. The town is really really small. And the people there live in very poor conditions. I know it’s trite to say… but we really take a lot for granted in the United States. There is dust everywhere. Everyone in the town is covered in it. At the end of every day it’s hard to imagine not taking a shower to get the dust off. Yet you realize that most of the people here do not have that luxury because they need to conserve water.

The “hotel” that we are staying in is fairly tight. It has 10 rooms with 4 bunks cramped into most of the rooms. Each room has their own bathroom with a shower, a sink, and a toilet. It is a really tight squeeze with fairly unpleasant smells, compounded by the fact that you can’t put your toilet paper in the toilet due to the risk of clogging the septic tanks. However, this is the lap of luxury in comparison to what the people of Pinares live in. It makes you really grateful.

The Clinic

The clinic is a nice building with 2 exam rooms, an OB/Gyn room, a Dentist room, a mini lab, an office, and a mini pharmacy. It is manned throughout the year by a young lady named Nora who is the equivalent of a medical assistant. Then 3 times a month, a brigade of doctors comes to see patients. People for miles around know when we are coming. For 4 days, they pour into the clinic to be seen and to get soap, shampoo, toothpaste, and toothbrushes. In the mornings, you see people waiting outside the clinic hours before the clinic even opens. Some people walk 3 and a half hours just to get there. For the most part, the complaints are fairly simple; lots of headaches, stomach aches, joint aches, and URI’s. In addition, there are many OB/Gyn visits. The hygiene supplies are a big part of what they are coming for. But there are plenty of more difficult situations as well. We saw some significant heart issues; anxiety; tumors; hernias. Things that a 2 room clinic with a few volunteer family docs is just not equipped to handle. When that happens, we write a referral letter for the hospital in La Esperanza, but that isn’t an easy proposition either. It takes money to get to Esperanza and to be seen at the hospital. There are a lot of ways to help cover this, but still… it’s not an easy thing.

The Children’s Health Initiative

There are about 50 kids in the town of Pinares alone. Half of them are school age. There are also many kids throughout the mountain villages.  In addition to providing medical care at the clinic, we send out groups to remote schools and set up a series of stations designed to screen kids for preventative health issues, provide some preventative treatments, and also keep track of their progress.  In all, we end up seeing around 350 kids at these local schools over a 4 day period.

This involves multiple components… it begins with a pretty extensive hike through the mountains… some of these hikes take a significant amount of time and cover very large elevations. Some locations, we end up riding in the truck to get there. The actual work itself goes by quickly and is pretty fun and quick. It’s funny watching the kids approach us shyly… and then begin to warm up to us. But it’s also hard to watch them watch us eat our lunches because they are hungry. It’s a tough duality of being here… so much simplicity and joy… accompanied by so much in the way of sad circumstances…

The People

The people of Los Pinares are truly kind and generous. They have a patience that is unfathomable. They have a happiness that I think many of us in the States would have a hard time truly understanding. I found that every single person I met was eager to greet us and welcome us to their community. I noted that in the States, we are so consumed by this notion of privacy and personal space. I am no different. I certainly have immense walls and barriers up to keep myself isolated. But in spending time here in Honduras, I wonder if we have cost ourselves a sense of community in the process. In the States, you rarely say hello to one another as you pass. Just about everyone I walked past, acknowledged me in some way. In addition, I don’t think I could point out a single act of rudeness on the part of a Honduran person, my entire trip. I can count 10 acts of rudeness in the U.S. in an hour alone. What the hell has happened to us as a country?

The Children

It’s pretty cliché to say that the kids in a particular part of the world are amazing. But it is in fact true that the kids in Honduras are pretty amazing. They all tended to be somewhat shy and stared an awful lot. But once they warmed up to you… they were all so sweet and loving. In Pinares, I’d say 99% of the kids were covered in dirt or dust. Seeing how they lived, it’s no surprise; just because they really had no way to escape the dirt.

The kids in Honduras absolutely LOVED having their pictures taken. They could be all shy and timid, but the minute a camera came out, they seemed to come to life and posed for the camera. Then their favorite part… seeing themselves on camera… just let there be one of them closing their eyes during the camera… they go completely bonkers laughing. It was so cool to watch.

The Food

We had all of our meals throughout the trip taken care of. It was mostly tortillas, beans, eggs, avocado, rice, and chicken. It was actually… quite good… and plentiful. I didn’t get to eat as much of the fruit here as I did in Costa Rica, because the water isn’t as clean. It’s crazy how much we take for granted. For crying out loud, we have water filters in our houses, because we think the water has a “funny” taste. But really… we could drink faucet water all the time and none of us would have to worry about it causing problems. Not true in Honduras.

The ladies who cooked for us in Pinares did so with great hospitality and generosity.  Truly... we ate like kings... when you considered how the rest of the town ate.

The Work

So on a given day, we woke up and had breakfast at 7. Then we either left to go on a CHI or went up to the clinic. There were a lot of people that wanted to take the long hikes to the CHI’s. So I ended up spending most of my time in the clinic.

The clinic is not normally staffed by a doctor. There is a “nurse” who is actually more of a med assistant who is there throughout the year. She triages any immediate issues that come up. When brigades of doctors are there, she opens charts, takes vitals, and cues patients up to be seen.

There is a dentist that comes in from out of town. She usually comes up when the Brigades are here. It’s mostly about tooth extraction. There just isn’t enough time to see everyone and do proper fillings.

During 4 days of operating the clinic, we saw a little more than 300 patients. This is an average of 75 a day with just 2-3 doctors. This also does not include the patients that came through just for dental care. I spent most of my time in the clinic working in the Pharmacy. Part of this was because I speak some Spanish… and the pharmacy requires explaining the medications… how to take them… writing the instructions… and answering any questions. In Pinares… working the pharmacy also involves substituting drugs that the docs WANT to give… with what we actually have in the pharmacy. Sometimes, this is simple… sometimes this takes a lot of creativity. When we ran out of Tylenol… I had to give out children’s liquid Tylenol with instructions to take enough to make a difference.

I also was responsible for giving out goody bags with shampoo, soap, toothpaste, and toothbrushes. This is… a tricky process. People want more… and definitely need more… but then… you have so many more people coming through… and you’re not sure if you’re going to have enough to go around. In fact… on Day 4… we ran out of shampoo and big toothpastes… It was hard to have to tell people that I didn’t have any more shampoo for them… I started giving out toothbrushes by the handful, because it was the only thing I had left… Truthfully… how can you turn down people asking for something as basic as soap, toothpaste, and shampoo?

One of the things I really like about working the clinic is that I get to interact with every single patient that comes through the clinic. I try to find out where they are coming from and what it took for them to get here. I also have to give them instructions on how to use their medicine. This can be a lot more difficult than it would seem. The literacy rate in this part of the country is not great. It requires a lot of creativity.

I also really enjoyed hearing each and every one of their stories. It’s amazing to see the lengths to which people go through to receive healthcare… when it is not readily available. We really do not appreciate our healthcare system.

The work is pretty amazing. Each day is sort of a mix between excitement and nervousness. There is so much uncertainty in terms of what might be coming through the door. There is a constant scrambling on your feet to improvise and make do with what you have. There is a constant search to find the best ways to help each person that walks through the door. There are a ton of really amazing patient encounters and interesting cases… I could end up writing for an entire lifetime on some of those encounters. For now, I think I’ll save them for other posts. Regardless of the specifics… each day is filled with incredible challenges… lots of learning… and tons of work… and a lot of variety.

But the end of each day feels the same… a weird confliction of satisfaction and frustration. Honestly, it’s clear that what we do is a band aid… though I know there are things we are doing that are moving towards long term sustainability… there’s this nagging feeling that we’re not doing enough. It’s hard. I keep telling everyone, I feel like the end of Schindler’s List, when Schindler keeps thinking of more that he could have done. I feel haunted by all the things we couldn’t do. I think about the soap, shampoo, and toothpaste that the people here need. I think about what's left of their shoes. I think about the clothes that do not fit. I think about the meds we did not have. It’s a frustrating feeling. And sometimes, I find myself haunted by it in my dreams.

Heroes

The truth is… it’s not people like us that make a difference in communities like this. It’s the commitment of others that truly have an impact. The highlight of this trip by far was meeting the heroes involved in saving this part of the world.

Isabelle – Isabelle is a controversial figure. She was originally from Pinares… but left the area… somewhere along the way, got married, had kids, and then left her husband. At some point, she went to Israel and worked as a domestic aid… saved up her money… and came back to Los Pinares and opened up a fruit stand. With the money she made and saved, she then turned her fruit stand into a restaurant… recognizing that the crossroads was an ideal stop for people who were traveling to stop, use the bathroom, and get a bit to eat. One day, there was chance encounter with a woman from Thundermist who happened to be traveling through the area with a person from shoulder to shoulder. The two started talking about the need for a medical clinic in the area. At the end of the encounter… a tentative plan was in place to begin talking about setting up a clinic… this resulted in the Comite forming to help the clinic management and the brigades that would be coming through. This resulted in housing for these brigades being set up on the part of Isabelle. This resulted in more jobs being created in the crossroads of Pinares. This resulted in an increase in buses stopping at the crossroads. This is how it came to be that gringos from the U.S. make their way to the remote mountains of Honduras 3 times a year, bringing medical relief, preventative health measures, and a needed infusion of income to the community. Let’s be clear. Isabelle is a businesswoman. She does not do this for charity. She certainly is not paying her employees a king’s ransom or showering her profits amongst the community. Nor do I believe that is what she should do. Her singular focus is the capitalist dream played out. It is everything capitalism is supposed to be able to do. She is… in my mind… an amazing woman.

Marvin – is for all intents and purposes the Shoulder to Shoulder concierge and ambassador. He makes all of the arrangements for the brigades coming through. He oversees so many of S2S’s programs. He picks up brigades and escorts them through the country. He works with the Comite and the various schools that we go to. Nothing would get done without him. All of this wrapped in the biggest smile and heartiest laugh you could ask for.

Don Quintin – Don Quintin is the head of the Comite. He is a small man, but extremely wiry… and with a genuine smile that warms your heart. The Comite is a situation that just seems ripe for corruption… and I’m sure on some level there is some degree of it. These are not elected officials. How these individuals came to be chosen is somewhat dubious. Yet… Don Quintin… is that rare leader these days… one who puts his people first… ahead of his needs. I visited his house… and saw the conditions in which he lived. I felt the gratitude that both he and his wife had for the gringos that came into the community to help. I watched him in the clinic as he kindly, gently, but persuasively managed the crowds that would build around goody bags and any clothes or shoes that we had for the community. I watched as he decided that the outside of the clinic needed to have banana trees planted. Why? To provide shade for those that came to wait. I watched him wait patiently as gringos stayed for hours just to hang around the wireless internet and watch the same sunset a million times… so that he could make sure he locked up behind us to protect the clinic. I watched him as he sat on the porch with us after work… wanting to know how the day went… talking about how beautiful the views were... thanking us for being there. I wish we had more leaders like Don Quintin in the world.

Yuan – Yuan is a college graduate (from an Ivy League School no less) … who has been accepted to Medical School… but decided that in her post-grad year… she would serve 9 months as an intern for S2S. Here is a girl… who bucked her parental concerns about her safety; bucked the safe and secure route of going from one elite school to another… to voluntarily go into an impoverished country… and live on her own… without the comforts of home… and try to get to know a country… and find a way to help. We come and go from our 1 week trips with a lot of fanfare… this girl is doing this every day. It didn’t take long to see that she had developed an invaluable sense of how things get done in Honduras. Having her on the team opened my eyes as to what could happen when a person was willing to make a true commitment to helping a community. Having her working with you on your part of brigade, made that section run a million times smoother just by her presence.  I can't imagine from where this dedication to her fellow man has come.  I couldn’t imagine making the sacrifices that she has made… at that stage of my life… there is no way, I would have had that level of selflessness and commitment to service… I went into the military around the same time of my life that she is doing this and I can tell you, the difference is immeasurable…  I can tell you that what I did pales in comparision to what she is doing now... And to top it all off… she is considering staying another year… for the sake of continuity of the projects run by S2S. She wants to try and continue the momentum that has started with her work... she wants to help instill some sustainability to the S2S projects.  Her genuine care… and love of the people of Honduras is obvious… Her commitment to learning how to make things run more effectively… her ability to incorporate a new group of gringos coming through every few weeks… I can’t even begin to imagine what she will be capable of once she actually has a medical degree. But I am fairly certain… that she is going to be someone that changes the world. And I am proud to know her. I wish I could have been a fraction of that kind of person at her age… and I hope I can be even a fraction of that kind of person, now.

 The Children –

I think in a community that is impoverished and struggling with so many issues… any bright spot becomes that thing that keeps you going… that thing that keeps you from despairing. The children of Los Pinares… were truly amazing. It broke my heart to see how stunted they were from malnutrition and hard work. But, it also convicted my heart to see how happy they seemed to be with the littlest things. I sat down with two of my favorite kids in the world, Nelson and Elsa, … overwhelmed with guilt at not being able to give them anything on this trip… and I told them… next time I came back, I would bring them book bags and shoes… and they beamed from ear to ear and said, Thank you. And it was so moving to see… that just my words were enough to bring them happiness… that they weren’t jaded… or skeptical… or anything like so many of our kids in the States… they were happy to hear that I said I would bring them book bags and shoes. They didn’t care what kind. They didn't care about that the reality was they may never see me.  They were happy just with the promise of book bags and shoes.

I watched Nelson and Elsa every day as they came back from school… and watched as they just started working. Elsa sweeping the inside of the restaurant… cleaning up dishes… moving fast… working hard… no sign of frustration or distaste on her face. I watched as Nelson stood outside all day… hosing down all of the dust… to keep it from kicking up everytime a truck or bus came through… He did this all day… every day… no complaints… no look of unhappiness or irritation… smiling when I said Hi… chatting with me when I talked to him. This is what keeps a community going… The spirit and hope that lives within the kids.

The Future

So I’ve been back from my trip for a week now. And I’m still trying to fully process everything I’ve seen and experienced. Poverty is a lot different when it has a face and a name… and when it involves someone you actually have come to care about. I have been wrestling with feelings of shame and guilt. I wish I could have done more. I wish I had started sooner in my life. I think about all the ways in which we live so wastefully here in the U.S. I think about everything that we complain about here in the States… and get frustrated at all of the trivial things that seem to create such havoc in our lives. And my list of things that fall into the category of “trivial” has expanded considerably. I feel frustrated with people… I find it hard in some respects to talk to people because I have to fight the urge to tell them how much they have to be thankful for. But it’s true. There is so much to be thankful for here in the U.S. and we don’t even bat an eyelash at how much we complain.

I instantly try to formulate a list of things to bring back. I am trying to talk to more and more people about S2S and Honduras… but I find myself also wanting to encourage more people here to seek out ways to help any community. We live in such opulence and we share so little of it.

I am planning on going to work at a Remote Access Medicine Clinic in Southwest, Virginia this summer for 3 days. I am also planning on trying to go back to Honduras in November for 2 weeks and in February again. I am hoping, I can make this a twice a year trip for me.

I find myself obsessed with books about poverty. I feel like I want to understand why we haven’t been able to make this problem go away. In some ways… I feel like this trip has ignited in me... that part of my heart that had first felt God calling me to medicine… not just to serve the community I am in now… but to find ways to serve the greater community of humanity. It’s been a while since I’ve felt really passionate and excited about doing something in a bigger sense. The past few years as I've finished med school and intern year... I've kind of been on auto-pilot just to get through the hoops I have been supposed to accomplish.  But now... I feel like I have a sense of direction that is not about fulfilling necessary evils.  I feel a sense of real purpose again.  Though, I continue to be racked with a constant sense of guilt and a wish that I could do more… I feel like I found the pair of shoes I was meant to wear for a while... and I like the way they fit.