Saturday, June 9, 2012

Honduras 2012- Day by Day

La Hicaca from above
Day #1, June 2nd, 2012: Departed the USA at the crack of dawn to arrive in San Pedro Sula by noon local time. Per usual, passport control and customs were interminable, delaying our departure from the airport by several hours. Finally, having collected our considerable baggage, boarded the transport bus, and picked up our rental 4x4 trucks we were off for the 5 hour drive to Olanchito. The last 3rd of the trip was in a torrential deluge raising concerns about reaching our destination safe and sound.

Health Center- La Hicaca
After a late arrival and a quick dinner in the Catholic Church boarding house in Olanchito, we pressed on and prepared the mobile pharmacy for the coming week. By 11 PM, we were thoroughly exhausted and turned in after a 20 hour day.

Clinic Registration
Day #2, June 3rd, 2012: Bright eyed and enthusiastic, we packed our bags into the six 4x4 trucks and land cruisers to take us through the valley and up the mountains to La Hicaca. Given the previous night’s cloudburst, the road was muddy and the river was high, making for a nervy crossing. We prevailed and landed in La Hicaca at 11:30 AM. Our phenomenal group of medicals students, pharmacists, nurse and residents promptly unloaded the vehicles, and, after a quick lunch we held our first clinic session, seeing patients from the aldeas of San Felix and El Cruzete. 

By late afternoon, we were off to sample water for bacterial colony counts, from homes with previously installed water filters, as part of our ongoing research efforts.
By 6 pm, we experienced nightfall, darkness and a sense of isolation as no electricity, water or sanitation is available in La Hicaca. Restful sleep was at hand in a humid environment, on a dirty, open windowed school room floor. The school served as our home, headquarters and clinic. La Hicaca at its best.

Patient Care
Day #3, June 4th, 2012: 1st morning in la Hicaca, with sunrise at 5 AM. The roosters and livestock sounded the early morning sun up. The first order of business, after breakfast, was to begin preparing the water filters for distribution. The clinic was slow to begin, however, by the afternoon, it was in full swing. Our exceptional medical students, residents, nurse and pharmacists were up to the challenge.  When the afternoon coffee arrived, prepared by our trusty cook, the jolt of caffeine stimulated us to finish off the clinic in form. The first day’s cases were not beyond the routine and we were successful in launching the mass deworming, point of care hemoglobin checks, and dental varnish projects. Concurrently, our Honduran ministry of health colleagues began cervical PAP smear screening with the 480+ vaginal speculums supplied by the medical team.

By nightfall, we were thoroughly sweaty, exhausted and ready for dinner and bed. When in rural, mountainous Honduras, bedtime is early. With no electricity, what else is there to do?

Jean Rabb, RN- coodinated water filter distribution
Day #4, June 5th, 2012: 2nd full day in La Hicaca.  The evening was best characterized as steamy, made more uncomfortable by a torrential downpour. A hole in the school room roof was discovered, fortunately the flooding was minimal. After a breakfast of delectable pancakes with peanut butter and jelly washed down with strong, black, Honduran coffee, we were fully charged and ready to face the day. The morning’s clinic was busy on both the pediatric and medical sides. The patients were from the aldeas of Santa Maria and El Urraco. During the lunch break, after a quick meal of rice, beans and tortillas, a small group of us set out to collect water filter samples from the homes in La Hicaca. The locals were more than willing to let us invade their homes for our public health pursuits.

Water filter sample testing
The afternoon’s clinic was best characterized as steady yet not overwhelming. The heat was intense. The patients were from the aldeas of Puerto Rico and La Florida. We capitalized on the smaller patient volume to break from the clinic and to set out on an intense, door to door, drinking water sampling mission. By nightfall, we had sampled the water from filters in nearly all of the 50 homes of La Hicaca. We were also making progress on our survey based, indoor air quality research project.

VCU Med Student/Researchers: Audrey Le & Jackie Arquiette   
The day was gratifying. Both the IRB approved water quality and indoor air quality research projects were in full swing.  The clinical program was gathering steam and we were in the groove.

Data entry of clinic patients
Day# 5: June 6, 2012. Despite another stifling and humid evening, we were awake and optimistic for another day in the field. Our research team was off early in the morning to gather the last remaining home water filter samples. The morning’s clinic was steady, with patients from the aldeas of Agua Sarca and La Vega.

In my discussions with the Honduran campesinos, a clear picture of the typical day emerged. As subsistence farmers, they are up before sunrise to cultivate corn, beans and coffee. Swinging a machete in the blinding sun and searing heat is hard work. It is no wonder that repetitive strain injuries and dehydration are common diagnoses. The workday is completed by 3 pm so as to be home to recover for the subsequent day. Bedtime is usually 7-9 pm. A veritable grind by any standard.

Visual acuity and eyeglesses
The afternoon was back to business as usual. Clinic and patient care, this time the patients were from the aldeas of Lomitas and La Culata. Our students, residents, nurse and pharmacists were functioning as a top notch crew. The patients were from the aldeas of Lomitas and La Culata.  An additional 30+ water filters were distributed. By the end of the day the total filter count was 72.

After several days in La Hicaca, we were well aware of the tremendous resilience and patience of Honduran campesinos, willing to walk 2-3 hours each way and then wait in queue for a near eternity to access limited medical care from a transient, medical brigade. Admirable.

Interview with Father Pedro O'Hagan
Day #6, June 7th, 2012: Fatigue set in and the group was slow to rise. We were anticipating a busy day. Black Honduran coffee and pancakes were all that was needed to jump start us.
The day began with a special twist. Drs. Stevens, Mason, Popovich and I sat down for an interview with Padre Pedro O’Hagan to reflect and strategize on our collaborative medical relief effort. The video will be soon available for viewing on this blog and on the VCU Global Health and Health Disparities Program website. Check back.

As always, collaborating with Dr. Stevens
Today’s clinic patients were from the aldeas of Chorro Viento, La Esperanza, Aguacaliente. The volume was steady in the morning and then trailed off by 3:30 pm. This allowed ample time for our research team to complete door by door interviews for the water and indoor air quality research projects in the late afternoon and early evening. By nightfall, we were thoroughly exhausted.

Day #7, June 8th, 2012: Last day in La Hicaca. Per usual, awakened early by the cacophony of the roosters, livestock and dogs. Morale and enthusiasm was unflinching. After a breakfast of peanut butter and jelly and black Honduran coffee, we were back to patient care. The morning clinic proved to be slow with all clinical work completed by 11;45 AM.

At week’s end, we had seen a quarter of the area’s population in the clinic. This included mass deworming and anemia blood sampling of all clinic patients. All children received dental varnish. What transpired was medicine in its most raw form, with an emphasis on clinical skills and medical judgment, devoid of fancy hospitals, advanced diagnostic tests, and specialty care.

2009 Census- La Hicaca and environs
Travel time (walking) to La Hicaca Clinic
La Hicaca
Agua Caliente
40 minutes
La Lima
1 ½ hours
El Cerro
2 ½ hours
Puerto Rico
1 ½ hours
La Culata
2 hours
Chorro Viento
1 ½ hours
La Vega
1 hour
El Urraco
3 ½ hours
1 ½ hours
Agua Sarca
3 hours
Santa Maria
5 hours
La Florida
2 hours
4 hours
San Felix
4 hours
El Portillo (I and II)
I :5  hours; II :  6 hours
1 hour

Other accomplishments included the distribution of 91 new water filters (9 filters shattered in transit). One hundred and seventy new pairs of eyeglasses after visual acuity testing, with 125 pairs of eyeglasses donated to the Health Center in La Hicaca. The dentist saw 50 patients for teeth extractions in one day. The Honduran public health nurses were performed 43 PAP smears with the speculums donated by our group. Over 400+ disposable speculums remain, for the use by local health services to provide PAP smears for the remainder of the year. We donated sizeable quantities of amoxicillin, doxycycine, Tylenol, albendazole, ibuprofen, anti-fungal and steroid creams, enough to last the Health Center for 6-12 months.

By 1 PM, we were packed up, and after a group photo, boarded our 4x4 trucks and land-cruisers to head down the dusty, rocky road, to Olanchito, where water and electricity awaited in the dormitories of the Catholic Church.

Map of La Hicaca et environs- click image to enlarge
On reflection, we feel that this was our most successful brigade to date, despite a lower patient volume. The public health focus and collaborative effort with local authorities and the Catholic Church will ensure longitudinal programs with long lasting impact.

Day 8, June 9th 2012: Awoke at 5 AM to a passing thunderstorm. Within thirty minutes, the rain stopped, allowing several of us to set out on our now traditional Olanchito countryside jogs. The early morning, dirt road, country jog was made surreal by a fresh mist, the breaking sun over the surrounding mountains and the syncopating beats pumping in the headphones of our i-pods.

After a tasty breakfast, we packed our bags, bid our generous hosts a farewell and pushed off for the 5 hour drive back to San Pedro Sula. Uneventful. Back in San Pedro Sula, at the Hilton Hotel, the fatigue of it all set in.

 Our Honduran adventure came to a close. We will be back, as always.

VCU Honduras "Norte" 2012

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