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Honduras Spends 80% Less Than the Rest of the World on Health Care

Status of Healthcare in Honduras  

The Archivos de Medicina published an article on the situation of health care in Honduras.  The article was published in Spanish in 2016.  In 2017, it was translated into English, and published in Archives of Medicine.  (links to the articles are below)

Some stricking facts from the study are:

Per Person Spending on Health Care

Honduras spends $101 per person per year on health care. ***

The average in Latin American and the Caribbean is $392 per person.

World average is $628 per person.

Organization for Economic Cooperation and Development (OECD) nations spend $2,880 per



*** Shoulder to Shoulder, under its contract with the Honduran government, receives $19 per person per year to provide medical care.


Availability of Medical Providers

The capital city (Tegucigalpa) had 23.8 doctors per 10,000 inhabitants.

The Department of Intibuca (where Shoulder to Shoulder provides services) has 2 doctors per 10,000 inhabitants.

None of the 18 departments in Honduras meet the minimum indicator of 25 physicians per 10,000 inhabitants as indicated by the regional human resources target.

The unemployment rate among registered doctors is 46%.



Ø  Honduras suffers from a nondefined public health policy;

Ø  Epidemiological surveillance systems are almost non-existent;

Ø  State payments to decentralized entities are not timely

(there are delays of up to one or two years);

Ø  Medical fees have been frozen for more than ten years;

Ø  There is corruption by government and private managers; and

Ø  The economic deficit of the public network of Hospitals exceeded 600 million Euros (33,000 medical centers, laboratories and hospitals run the risk of disappearing).

Links to the articles:

Situación del Sistema de Salud en Honduras y el Nuevo Modelo de Salud Propuesto

Situation of the Health System in Honduras and the New Proposed Health Model (English version)



Every month, the Shoulder to Shoulder Coordinator of Healthcare Services — Dr. Gloria Castro — sends a report to the Ministry of Health which details the Health Services provided in the previous month.

StS provides healthcare to over 70,000 people, in seven (7) municipalities.  The amount we receive from the government is not sufficient.  Receiving only $19 per person leaves us with a huge deficit each year.  


These reports are now posted on the StS website.


Click HERE to read them.  








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The “Marriage” between Brown, VCU, and Wingate Universities

Whoever said “you can’t teach an old dog new tricks”, had never met the travelers from Brown, VCU, and Wingate Universities.  Two weeks ago, Shoulder to Shoulder did something that we had never done before – we merged travelers from THREE universities in order to create ONE brigade group.

The Supervising MDs from VCU (Tommy Ball and Lauren Gorden) and their 2 Residents (Daniel Mendez and Sumni Yang) needed more travelers.

A Resident, Psychiatrist, and volunteer from Brown (Angelina Palombo, Horacio Hojman, and David Weign) needed a group to join.

A Pharmacist and pharmacy students from Wingate (Lisa Brennan, Kalyn Meosky, and Kelly Mansfield) needed to fill prescriptions for providers.

The group of 10 agreed to spend 3 days at Brown’s clinic site (Guachipilincito) and 3 days at VCU’s clinic site (Pinares).

What was the outcome?  A wonderful merging of personalities, abilities, and styles and the provision of medical, psychiatric, educational and pharmaceutical services to hundreds of patients!!


The communities of Guachipilincito, Concepcion, and Pinares all benefited by these 10 strangers coming together to provide services.  They saw patients in clinics, in elementary and high schools, and during home visits.  In Guachi, they attended 165 people; in Pinares, they attended 160 people.  The smiles on the travelers’ faces are proof that the strangers became friends.  How beautiful is that!

Matt and the MAHEC Brigade


by Backpack Matt

The first brigade I worked with as a Shoulder to Shoulder brigade coordinator was MAHEC. They arrived on February 10th and stayed until the 22nd. It was a group of ten people comprised of five doctors, a pharmacist, a pharmacy student, a medical student, a psychiatrist, and the son of one of the doctors. MAHEC stands for Mountain Area Health Education Center and is located in North Carolina. We had a filled itinerary for their stay here, and I spent a lot of time not only organizing and coordinating activities but also confirming and reconfirming them. I think my past experience organizing camps in Malaysia had prepared me well for these tasks. I was used to having people ignore phone calls, agree to something only to forget later, and read messages and not respond. It was challenging, but at the same rewarding to be able to overcome those obstacles and have what I thought was a great brigade.

After about five hours crammed into a bus from the airport, we arrived in La Esperanza where we spent the first night. The following morning I gave a short walking tour of the city and we visited La Gruta which is a religious site that overlooks the city, the public baths (which are a lot nicer than they sound), and the favorite gringo coffee shop La Fuente. Afterwards, we piled back into the bus and made our way to Camasca where they would spend the duration of their time. They were set up in the basement of the Evangelical church, where there were three rooms with bunk beds and a larger common area with tables. Working with us throughout the brigade were Eduardo, a translator, Alan who is Gustavo’s son (Gustavo is the other coordinator), Yeni (pronounced Jenny), and Nila. Yeni was our chef for the week and her experience cooking in restaurants in the U.S. paid off. We ate like kings. Nila assisted Yeni in the kitchen, which normally meant making the tortillas, as well as other general cleaning. They were a fantastic team with whom I spoke and listened to a lot of Spanish.

We followed the same schedule for all of the weekdays. Breakfast would be ready by seven, and by eight we were off to one of two locations. Every day two doctors would be assigned to stay in the health center in Camasca and assist the doctors there with seeing patients. I accompanied them most days as a translator, so that I could be in town for other meetings and because I didn’t trust myself to drive a manual truck. The rest of the brigade would head out into a different community each day to perform house visits. Camasca is an area that is made up of several aldeas (small villages) and the poor quality of roads, coupled with the lack of transportation, makes it difficult for some folks to come into the center of town to receive medical treatment. The psychiatrist, on the other hand, had a slightly different schedule. He wanted to try to reach out to people in town to come talk to him about their problems, something that has rarely, if ever, been offered to the people of Camasca. To get the word out Dr. Tom and I visited the local radio station. We announced his presence in the clinic and talked about a few of the stigmas about mental health. A great resource during this process was Profe Edwin, who spoke more bluntly on the radio. He acknowledged that there was abuse, alcoholism, and drug addiction within the community and here was someone who wanted to help. Although the talk we attempted to organize fell through when the power went out, Dr. Tom was still able to spend two days in the high school working with students in a one on one setting. He told me that there were some powerful stories and he felt inspired to return in August with the next MAHEC brigade with more psychiatrists and to try to set up a more lasting type of support system.

In addition to administering medical care, the brigade had a lot of fun in the community. There were afternoon soccer games on the smaller indoor court with kids in town. Many folks enjoyed walking up to the top of the mountain for the valley views below. Profe Iris had us up for juice and watermelon one evening. We visited the rocks of the sun for a stunning sunset. Dr. Tom and I were invited back on the radio later in the week where we assisted Profe Edwin with a raffle. Dr. Tom would draw the name, announce the number, and hand me the paper. My job was to decipher the name and hometown, and then give a short thanks for participating! Or good luck next time! A few people from home were able to find the link and listen to me obnoxiously rolling my R’s and getting very into the character of radio station host. The most entertaining activity of the week was our trip on Saturday to a waterfall about one hour away. We rented a minibus for the day, packed lunches that Yeni prepared for us, and drove to Colomancagua. The waterfall was part of the river that divides Honduras and El Salvador. Due to the small number of Hondurans that can swim, we had the place all to ourselves. It was a relaxing day off and one of the memorable places I’ve been to in Honduras.

The last day in Camasca was eventful, to say the least. After organizing a farewell dinner for the brigade with all of the Hondurans who had assisted us, I was informed by Dr. Rolyn, who works in the clinic, that it was not sufficient. He said there needed to be a ceremony at the bilingual school. Early the next morning, with the help of the teachers at the bilingual school, we scrambled to put together a small presentation. There was the national anthem, traditional dancing, and handmade thank you cards. We also gave the kids a short talk about washing hands, brushing teeth, and avoiding junk food. Although I’m not a fan of taking the kids away from their learning to appease foreigners, I do think everyone enjoyed themselves. The other big part of the last day in Camasca was a talk at the high school. I had spoken with Profe Edwin ahead of time and he gave me a list of topics to discuss that included values, motivation, drugs and alcohol, sexuality and hygiene. The brigade strategized the night before and came up with some superb ideas to get the kids involved and talking. They handed out statistics written in Spanish on small notecards to the kids, and as a class, we decided if they were true or false. Then we had them write anonymous questions that we answered. I was shocked at the lack of knowledge in some cases. I realized that there aren’t many resources available about these issues, but not having these discussions creates a dangerous gap of information that contributes to things like teenage pregnancy and alcohol and drug use. We made it clear that we were not there to tell kids what to do, but to provide them with as much information as possible so that they can make informed decisions, and know all of the risks associated with them. I do think the students benefited a lot from the talks, just as I know my cheeks were bright red the entire time as I did some of the more sensitive translations.

And just like that, it was time for the brigade to head home. I want to thank Dr. Amy, Dr. Brittney, Dr. Brian, Dr. Kyle, Dr. Rebecca, Irene, Kaitlyn, Caleb, Dr. Tom, and Braxton for their hard work and service to the people of Camasca. We anxiously await their return.



Change Comes with Relationships

Joanne Theobald, MSW, prepared this blog after the recent service trip of the University of Wyoming to Agua Salada, Concepcion, Intibuca. A lot of development work is two steps forward and one step back. But what keeps things going is the amazing synergy of relationships. Resources are always scarce, but the will of those who serve with integrity makes the difference.


Twenty-one members of the University of Wyoming Brigade (including four doctors, one family nurse practitioner, two registered nurses, one social worker, and thirteen students) spent a fun and rewarding third week of November in Agua Salada. As we moved through the week, seeing just shy of 300 patients in the clinic, hiking to approximately 15 homes to provide medical attention to those who cannot walk to consulta at the clinic, teaching water filtration and musculoskeletal care to community members, and awarding scholarships to area students, I was struck by how much has changed since my first trip in 2011, and certainly since 2007 when we first formed a partnership with this community.

Some things in Agua Salada don’t change: the warm sunshine, the amazing green vistas, the excitement of the children when we arrive, the warm welcome we receive, the cacophony of roosters crowing, dogs barking, and birds chirping, even the mild but now predictable conflict and posturing among the patriarchs during community meetings.

First, the obvious: the clinic. It’s difficult to ignore a tall concrete building here. Erected in 2012, it, along with the church and the school, forms the center of Agua Salada. It’s starting to show wear and tear, and it represents a constant reminder of our unfinished business: past attempts at employing local health providers in the clinic so residents could have access year-round to medicine fell by the wayside in 2014 following the disastrous downturn in the Wyoming oil, gas, and coal industries. Our project now barely gets approved from year to precarious year, struggling to hold on to the twice-annual brigade visits until conditions either improve in the state’s budget or we locate other funding.

Second, the changes brought by the march of technology across the frontera. Community meetings are now not only interrupted by a man herding his cows down the road by the clinic, or by an occasional deafening downpour on the tile roof, now it’s cellphones. Many families have a cell phone, having seemingly jumped from the appearance of electricity in the valley in 2010 quickly to the current technological age. Children are less fascinated with our cameras and computers than in years past. But they still laugh uproariously at pictures of themselves at the week’s end slide show. . Technology has transformed our community relationships positively between the Brigades: we share numbers and names, able now to communicate via text, WhatsApp, and Messenger. Finally, a conversation with Paul and Sandy during a visit to the bilingual school in Camasca brought hope that we can follow their lead and utilize the Kolibri/KA Lite and Khan Academy programs in the schools around Agua Salada. What a world changer that would be.

Finally, there’s now a bus that passes through Agua Salada, with a one way trip to Concepcion for adults costing 20 lempira, a hefty price. Hearing the bus pass each morning at 5:10 a.m., I think of Elvis, our first student who received a scholarship, a beca, to move into tenth grade last year, rising in the dark to board this 30 minute transport to colegio in Concepcion. Elvis lives just below the clinic, and his family usually becomes well-known to Brigade participants. He and his two younger brothers, Ariel and Sergio, have always engaged with us, playing cards and games, and his family supports us in so many ways; the septic system for the clinic actually runs through his grandparents’ property. Elvis is studying Informatics, one of three tracks at his colegio. He completes homework on his cellphone in the evenings, very difficult given the weak and inconsistent signal that exists in Agua Salada. He has aspirations of becoming an engineer, and even with the completion of his next two years, he will have greatly increased his chances of being employed at much higher wages than those that don’t attend. As he spoke to the other becados at the November scholarship reunion, he noted the benefits of increased study, admitting that at first meeting others at the school in Conce was daunting, but now he knows he belongs. Each year as we collect Cartas de Gracias from the thirty middle school becados, we see more evidence of change: improved writing skills, and their increasing recognition of the opportunities that  lie before them if they continue their education. Another change in this fourth year of the program? More girls than boys are now nominated by teachers for becas, and this year’s recipient for a tenth grade beca is a very intelligent young woman named Evely. Given all the research regarding the power of women’s education to decrease poverty rates, this is a welcome change indeed.

Elvis with Rolando, his father, at the school in Conce.

One condition that hasn’t changed, but perhaps will, is the lack of coliform-free drinking water in Agua Salada. Water tests conducted in 2013 confirmed the existence of E coli in the local water source. The community is excited to try out four new Sawyer International water filters, which will be placed at four central locations for all community members to use. Members of the local comite will train the community on the use of the long-lasting filters, which are reported to filter enough water for 100 people daily for over 5 years.

Community leaders Sabid and Samy teach water filtration to the community.

And the last change we noticed? The arrival of a beautiful, healthy, 9 pound girl in the community, just a brief two weeks before the November Brigade trip. Her parents have named her Erlinda Melissa, in honor of Linda Johnson, the University’s long-time Brigade director, and of Melissa, one of our most valued interpreters. Sometimes there is no way to express all we have meant to each other through the years, or how we have changed each other. But this comes close.

Erlinda Melissa, with her mother, Blanca.

Old Dogs With New Tricks

Disclaimer: Analogies almost always hobble, limp, and may seem to express things that were unintended. Here, the term “old” should simply be interpreted as meaning experienced; veterans, if you will. The term “dogs” is an unfortunate accident of a well utilized adage that shifts understanding according to individual preference in pets. Had our linguistic history evolved differently, the term might have been replaced with “cat,” or “dolphin,” or any number of anthropomorphized biological entities.


Emely is a third grader at the bilingual school in Camasca. She travels to and from the school a half hour each way with her father Wilson, the van driver, and fourteen other children from Concepcion. Emely was named in honor of Dr. Emily Harrison. Dr. Harrison was recently at the Guachipilincito Clinic with Dr. David McKenna to run yet another successful medical service trip. Dr. Harrison has been faithfully coming here for years. The testament of her commitment is surpassed only by the integrity of the service that she and her teams have achieved within the community. I wonder what accounts for such dedication that has stayed so fresh and empowering.

Dr. Emily Harrison
Dr. Emily Harrison

I meet Emily, as we almost always do with service trips, when they arrive at their hotel in La Esperanza. Most of the small group with her has been to Honduras with Shoulder to Shoulder on earlier trips. Dr. McKenna collaborated with the building of the clinic, has been here many times, and serves on the Board for the continuing mission. His daughter, Madeline, a senior at Notre Dame University, has also been here on many occasions, but I am meeting her for the first time. Robert Ashworth, the pharmacist, is on his third trip. Two resident physicians, Shannon, who has been to Honduras, but not with Shoulder to Shoulder, and Keshia, who has been to Guatemala, complete the team. After putting her gear away in her room, Emily returns to the lobby and sits to my side on a sofa. Her wide, characteristic smile greets me and reminds me of how fortunate I am to count people like Emily as friends.

She engages me with inquiries about what’s been going on since we last were together. “What’s going on for Laura and I personally? What’s new for Shoulder to Shoulder? How is the work with education proceeding?”  Her genuine interest would yield one to believe that she had never been to Honduras before this trip and knew nothing about Shoulder to Shoulder’s work. There is a freshness and enthusiasm present in her manner, like a freshman away from home at college for the first time. But this is not her first rodeo (yet another less than ideal metaphor), and none of this is new to her. The city she has come to, the hotel, her bus ride tomorrow to Concepcion (along newly paved roads), her pick up ride to Guachipilincito (along all too familiar unpaved and treacherous roads), the clinic, the people of the community, and the patients she will see are all old hat. And yet what seems to dominate her interactions with everything that should simply be routine, is the possibility of the new and the innovative; that something exciting and vibrant can spring forth at any moment. That attitude, that firm conviction, is what enlivens and gives meaning to this service.

Dr. McKenna with young patient
Dr. McKenna with young patient

Among these old routines sprout new possibilities. This service trip in October is new. Brown/Wingate has been coming to Honduras twice a year, but this trip is the third trip this year, and the hope is that it will become a regular occurrence toward more sustainable service to the community. Additionally, Shoulder to Shoulder, with funding from Brown has just hired Iris as the Community Development Coordinator. She will work in the community when the service team is not on site to assess the needs of the community, run development and service programs, and provide feedback to Dr. Harrison and the Board as to best practices in maintaining a service mission in Guachipilincito. This development thrills Emily as it has been being planned and talked about for years. Now it has come to be, a realization of that commitment to developing meaningful, empowering service.

Laura and I visit Guachipilincito and the service team on Wednesday. At first glance, it appears pretty much the same as all other service trips. They’re seeing patients. Some of them present serious illnesses and conditions, some are reviewing their management of chronic conditions, and some, as always, have come with complaints of pain that they hope will gain them a prescription for Tylenol. Not much new, or so it seems. We sit down to lunch. Madeline learned yesterday that she was accepted to one of the many medical schools to which she applied. It’s the University of Cincinnati, and that reminds her that Shoulder to Shoulder began because of the work of that university. The more things change, the more they remain the same. But Madeline is so committed to the work that she has been exposed to her whole life that she is considering volunteering at our bilingual school during a gap year. That is certainly something new growing out of the old. It’s reason to celebrate.

Madeline serving her “I’m going to med school” cake
Madeline serving her “I’m going to med school” cake

¡Felicidades! Congratuations, Maddy! We are the change that brings good to our world.