Eleven years ago over Christmas I was feeling ill in my stomach. I had to be convinced to go to an emergency room. I drove myself up there. Seven hours later I was waking up in an operating recovery room with the loss of about sixteen inches of large intestines and my appendix and the gain of a colostomy bag. I had a perforated bowel. Who knew? The colostomy bag was successfully reversed some two months later, thank God. Then about five years ago, I was diagnosed with kidney cancer. A kidney along with the cancer was removed, and I have not had any further difficulties. My first thought in reflecting on those experiences is how grueling and anxiety provoking were those periods of my life. My second thought, a little less self-pitying, is to be grateful for the treatment that in both instances saved my life. Imagine how fortunate I am. Two professional surgeons with years of training and experience were readily available to cut out significant organs from my body. I had health insurance to cover the extreme cost of such an important intervention. It is an incredible world we live in when such highly specialized skilled services can be channeled with ease in order to benefit someone who suffers great physical discomfort even to the risk of death.
But, this is not so the world over, and it is certainly not the case for us here in this isolated and often forgotten territory of Honduras. For people here, there simply is no access to surgery. The closest hospital might be six hours away. Even so, the surgery may not be available there and the cost would be absolutely prohibitive. Many simply have to accept living with great discomfort, and in some cases there are much worse consequences including shortened life-spans. Having lived in a land of such fortune as the United States, it bears heavy on one’s conscience to witness such inequity. Some might shrug their shoulders and say that things are the way they are, and there is little to do to change it. Others find it unacceptable to shrug their shoulders, but instead shoulder the burden. They provide the witness that the inequity does not need to be.
Such a witness is Dr. Rolando Rolandelli and his surgical team from Unidad Hospitalia Móvil de Latino América (UHMLA). Sixteen persons (four surgeons, three anesthesiologists, one assisting physician, three recovery nurses, three operating nurses, one floating nurse, and one translator) came to La Esperanza, HN to provide gastro-intestinal surgeries through the week of March 20 through March 26. They united their good-will with Shoulder to Shoulder and the hospital surgery team and staff. They performed sixty-two procedures (50 surgeries and 12 office procedures). For these sixty-two persons this was not even the most remote possibility, and yet it has happened. Many of these persons literally owe their lives to this incredible undertaking.
“The only thing necessary for the triumph of evil is that good men (sic) do nothing.”
It is not clear who first said this, but John F. Kennedy often cited it. It is a very interesting quote in its premise. It does not attribute the triumph of evil to a lack of good persons, but rather to the lack of good persons’ actions. Most of us are good, but too few of us actually act. Dr. Rolandelli and his team do not accept the inevitability of inequality. They are unwilling to do nothing. What they did, and what they continue to do, actually changes the world. It is not our goodness that is laudatory; it is the willingness to act. Perhaps someday even the people who live in the Frontera of Intibucá will also not need to accept living in physical discomfort and the threat of death when the resources to treat them are readily available in other parts of the world.
There are at least sixty-two persons who have benefitted because a few good-willed persons did not accept inequality.
To discover more about UHMLA, or to become a good person of action, go to
Facebook: https://www.facebook.com/UHMLA/?fref=ts
Website: http://www.uhmla.com/
photos courtesy of UHMLA via Facebook page
What A View!!
It is certainly one of the most spectacular vistas in all of Honduras, if not the world. Sitting outside the clinic at Pinares, or at the school where Virginia Commonwealth University and Fairfax Family Practice Centers house their brigades, one looks northwest toward the expansive Honduran mountain ranges of Lempira, Ocotepeque, and Copan. As busy as one might be, as anxious as one might feel, as pressing as agendas present themselves, it seems impossible not to be drawn into the profound tranquility the majesty of these ancient mountains generously gift to the viewer. And yet few are privileged to benefit from this inspirational, rejuvenating, life-affirming view. No tourists travel here. Those who enjoy the grandeur of this place also live here and seldom leave. They fail to recognize the unique beauty as it is, for them, commonplace, and they have no means to make comparison. Along the road, just below the school and the clinic, a few well-kept homes, an underutilized lodge-style hotel, and a roadside restaurant, are the only signs of inhabitants in this otherwise virgin-looking land. But there are many who live here. They have settled deep within the curves and crevices of the mountainous terrain; hidden by it, almost having become part of it, they generally go unnoticed by the rest of the world. It is so easy to pass them by along the highway, here paved, but soon only gravel, and winding down to other more obvious towns and populations. Mostly they are passed by, and like the mountains they offer no complaint. For what is present, for what is beautiful, and for what is hidden, it is all easily missed, save for those who are willing to take the time to discover.
Virginia Commonwealth University and Fairfax Family Practice Centers have taken that time. Seventeen brigade participants were recently here. Though I’m certain that they thoroughly enjoyed the view from their clinic where they offered medical care and from the school where they were housed, they also, once again explored the crevices and curves of the mountain terrain to meet people where they live. They visited schools and implemented the CHI (Children’s Health Initiative) program. They visited the small aldeas and the homes nestled among the mountains. If these persons, like the tremendous view, are often ignored, unseen, or missed, that is not the case for VCU / FFPCS. Apart from the excellent medical care, apart from the attention and aide in development and education, and apart from the commitment to maintaining a presence at the health clinic, VCU / FFPCS offer the dignity of relationship. The view is very much appreciated.
Unfortunately due to an extremely heavy schedule, Laura and I did not meet up with them until their last evening at the clinic and the school. We participated in a very critical meeting with the brigade leaders and the local leaders from the health committee. The meeting was a bit intense. It was focused on how VCU / FFPCS in collaboration with Shoulder to Shoulder and our contract with the Honduran Ministry of Health can open up regular medical care in the humble Pinares clinic. It’s a challenging topic because everyone’s resources are stretched. As the meeting progressed I found my attention drawn to the breathtaking view of the mountains. It gave me a sense of security and hope in the midst of a challenging conversation. I also focused on a horse belonging to one of the health committee leaders, tied to a tree just to my right and part of the view into the expansive horizon. He seemed unconcerned and unaffected by our conversation. Still, somehow he seemed to possess a greater wisdom. He so well belonged to this place. He evoked a sense of security and pride, and somehow observing him I was convinced that all things will be well.
The meeting ended with a sense of hope that we would all do our best to see that the communities in and around the Pinares clinic would continue to benefit from an ongoing relationship with Shoulder to Shoulder and VCU / FFPCS. After the meeting the community leader untied his horse, mounted him, and headed off to his home. Beneath that incredible horizon, the horse found his way among the winding, mountain paths. Those familiar paths are known to few others than those who live there. I would be lost, perhaps even afraid, but the horse is steady and sure. VCU / FFPCS have also travelled along many of those same paths. In the end, this willingness to accompany persons upon the familiar paths of their lives is the only way to generate hope.
It is all such an amazing view!
SANTA LUCIA HOMECOMING!
by Candace Kugel, FNP, CNM
editor’s note Ed Zuroweste, his wife Candace Kugel, and staff and students from Johns Hopkins University have been coming to Honduras with Shoulder to Shoulder for many years. They hoped to form a medical brigade this year, but unfortunately did not encounter sufficient commitment to make the trip meaningful. But Ed and Candace still decided to visit. They also brought a friend, Sandra Grotberg, who did some violence prevention training in the local communities. Ed and Candace also did some amazing things while they were here. Laura and I were so grateful to meet them and learn from their experience. Sometimes trips down memory lane leave us disappointed in the journey, as all things change and, most often, the changes are not those we envisioned. Gratitude takes humility. Candace’s reflection on 16 years of involvement with Shoulder to Shoulder and her and Ed’s fateful intersection with Honduran families, give us pause to stand in awe of the miracles generated from goodwill and integrity. Their witness is a sincere embodiment of what it means to work ‘shoulder to shoulder.’
During a recent visit to Santa Lucia, we had opportunity to spend time seeing patients with the young doctor at the Centro de Salud. As seasoned preceptors, we were happy to see that he approached children gently and with a smile, provided abundant patient education and prescribed antibiotics and other medications judiciously. The best thing about this doctor, however, was that he was someone we had known since he was a shy, gangly kid — Rigoberto, the fourth child of Don Beto Marquez, the once Santa Lucia maintenance director, now watchman, and his wife Deisy.
My husband (and family doctor) Ed Zuroweste and I mark the time we have known the Marquez family—and our tenure with Shoulder to Shoulder—by the age of their son Fernando, now 16. On Ed’s first Shoulder to Shoulder trip in 1999, he accompanied two medical students—one Honduran and one American—to the Marquez family home to attend Deisy’s labor and birth of their ninth child. The Honduran medical student was beaming with joy at the wonder of his first birth experience. He was overjoyed and in tears when the parents asked if he would allow them the honor of naming the baby after him—Fernando.
Since then our countless trips to Intibucá have always included a social call to the Marquez family in addition to the usual work of patient care, student supervision, home visits, and midwife and community education projects. Over time we developed strong connections to both our “Honduran family” and to the communities served by Shoulder to Shoulder. Returning in February 2016 was something of a homecoming for both of us since two years had passed since Ed’s last trip and I had not been to Intibucá since 2009. This trip, the first time without students, gave us opportunity to visit, catch up on recent changes in the organization, the community of Santa Lucia, and our friends there.
On our arrival the clinic was clean, calm and operating smoothly and we were introduced to staff. Shoulder to Shoulder now supports well over a hundred employees in the country and although groups continue to come in large numbers, their service contributions increasingly represent more of a valuable and necessary assistance than a crutch to the permanent infrastructure. My feeling of not being essential, rather than hurting my feelings, reminded and assured me of the goal of creating a sustainable program that would eventually function independently.
The town of Santa Lucia itself was familiar and the changes that we noticed were subtle, yet significant, signs of modernization—more cars and trucks, taxis (!), Maria’s “Cafeteria Cincinnati,” other new businesses, the paving of the town center, colorfully painted homes, and a general air of tidiness. Lest we find ourselves too comfy, however, our digs at the clinic had no electricity and no water when we arrived, and we were told not to expect internet access during our stay.
Watching Rigoberto in action both in the clinic and in the community allowed us both to feel the full impact of realizing the sueňo that has motivated us over the years to support this mission. We were aware that he had completed his medical training and was well into his year-long servicio social in Santa Lucia, but experiencing the embodiment of that monumental accomplishment was particularly gratifying. And when that body is a smart, caring young man with an easy smile, it was enough to stir up something akin to parental pride.