Reports from Honduras

Running water doesn’t exist here. Or, rather, it does, but only very sporadically. Because of this, people store water in large basins called pilas. The idea is to leave your tap on and, when the water does come, it will fill the pila and you’ll have enough water for the day. This water is used for hand washing, bathing, flushing toilets, pretty much everything but drinking. Most pilas are next to outhouses, which means they’re outside. Which means there is standing water. In a malarial and dengue zone. From a public health perspective it’s a frightening, frightening sight. But there’s really not much to be done and, for some reason no one has yet been able to explain to me, pilas are never covered.

So, how do you wash your hands? You go outside, scoop some water up from the pila with a plastic bowl, soap up and pour water over your hands. There are a number of issues here. First, you have to go outside to wash your hands, which makes it very difficult for medical professionals to wash hands between patients due to high patient volume. Second, you’re washing your hands with mosquito larve and other bugs that may have fallen in the pila. Third, there’s an issue of re-contamination of the hands because you must hold the plastic container with the first hand to clean the second and, onc the second is clean, with the second to clean the first. The last problem has to do with the flushing of toilets. Because there is no running water here, to flush toilets you must fill a bucket from the pila and pour it into the toilet. You fill the buckets with the same plastic container you use to wash your hands and the bucket used to flush is kept inside the stall. This means that there is ample chance for fecal contamination of the entire pila. Because of all these constraints to effective hand washing, so far the response to the hand washing system has been highly positive.

Monday morning rolls around and I’ve been assigned to work in the pharmacy. While my main role here is to evaluate the technologies, Baylor is going to put me to use in whatever way they can! Village visits don’t start till Wednesday, so the OB/GYN backpack will stay in a corner for now (except when people pull out extra headlamps, slide sheets, etc. from it). It turns out that two of the exam tables we thought had stirrups for well women exams don’t, so the portable stirrups that come with the OB/GYN backpack have been put to good use as permanent exam table additions. Because there’s no running water in the clinic, I’ve set up the hand washing system between the two OB/GYN rooms. One of our main goals with the system is to monitor water use per hand wash to determine the applicability of the device in areas where water is scarce, so we’ve got a tally system going for each time someone uses the system. I’ll be chatting with people informally to see what they think after they’ve had the chance to use the system and get used to it. But aside from telling them I’ve set up the hand washing system, I haven’t told them much. I didn’t want to explain how the system worked because it’s supposed to be intuitive and I wanted to see how well they used it themselves.

Back to the pharmacy. I’ve been counting pills. So, so many pills. Counting pills and writing labels. I’ve learned to spell acetaminophen and I think that mebendazole (a parasite medication) will forever be a part of my vocabulary. It would have been a great idea to bring down Alex and Tara’s pill counter. As it is, my eyes are strained staring at so many white tablets.

Because I’m not a medical student, I can’t do much in the pharmacy but bag pills. One of my greatest fears was that I would come down here and, because of my lack of training, be useless save for the technologies I brought. In the pharmacy I felt a little bit that way, but I quickly realized that I could make myself useful as an interpreter for those doctors that don’t speak Spanish. Huzzah for being useful!

At 1pm we walk all the way across town, all of five minutes, to the community center that was initially built to act as a meeting place for Shoulder to Shoulder. We’ve got a lovely woman by the name of Nelli who cooks gringo food for us. After every meal we do case conferences, discussing interesting patients. Most of this talk goes over my head, but what I understand is interesting. We return to the clinic to see more patients. We’ve got no end time but instead call it a day when the last patient has gone home.

Speaking of which…patients often get here at 6am, having walked up to two hours from neighboring areas. We open clinic at 8, but people jockey to get a good number in line much earlier. Many of our elderly patients also make this trek. I’m not sure how they do it, especially the return trip in the midday heat. And with unpaved roads (I would twist an ankle).

At 6pm we have dinner, followed by further case conferences. By 8pm, when we finish, it’s dark and the town has shut down save for the gaggle of teenage boys that hang out at the church chatting and listening to music every now and then. We head back to the clinic/our home to watch a movie and call it a night after a full days work. I think I went to be at around 10:15. Earlier than at Rice, that’s for sure.

Stepping off the airplane in San Pedro Sula, Honduras my first thought was: I’ve been away from Latin America for too long. In the back of my mind I remembered, but had not prepared myself for the long lines, the inefficient bureaucracy and the no-paper-in-the-toilet bathrooms. And that was just in the airport. But returning to these things wasn’t a negative. In fact, I felt and still feel incredibly comfortable with these things, sort of like a returning home comfort feeling.

I’ve traveled around Latin America a fair deal. With others and by myself, for fun and for work and for school. In rural areas and in large cities. But never have I experienced anything like a medical brigade, and never have I been anywhere quite like Santa Anna.

For the past 10 years, Baylor Shoulder to Shoulder has been sending a medical brigade of attendings, residents and students to Santa Anna, a highly rural town half in Honduras and half in El Salvador. Part of the brigade provides care I n a clinic in Santa Anna for a week and a half while the other part takes day trips to surrounding villages. Sometimes the brigade practices only family medicine; this time the focus of the trip is on gynecological exams as well. As such, I’ve brought with me two new technologies. The first is a gynecological lab in a backpack that can be taken with us on the numerous village visits we make. The second is a portable hand washing system. It can be taken on village visits or left at the clinic. This device is my baby, the result of a years’ work through a senior design class.

To reach Santa Anna we drove eight hours over bumpy roads, twisting and turning on mountain passageways, passing through various climate regions. Finally, we arrived in a town with one main road, a church, a primary school, and no more than a handful of homes. There are 700 people here, but because most of them live in the hills outside of the main town, it feels like much less. Which is not to say that the town is deserted; chickens and cows roam the streets accompanied by stray dogs and the occasional horse. The climate here is highly tropical: we’ve just entered the rainy season which means short bursts of incredibly forceful storms followed by bright sun and, of course, lots of heat and humidity. It’s like a Houston summer on steroids.

When we arrive Sunday afternoon we look over the building we’ll be working in for the next week and a half. It’s a partially finished concrete structure that Baylor had been working on for a few years now. With the recession, it hasn’t been completed as was expected, so a whole second level has yet to be set up. Eventually, the building will have dorms, indoor showers, etc, but not yet. So we pitch tents (to protect from mosquitoes) on concrete floors, set up colposcopy machines that were a hassle to to bring down, unload medicines and look out at our kingdom.