What A View!!

viewfrom pinares

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.

attheclinicpinares
VCU / FFPCS in action

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.
An intense meeting
An intense meeting

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.
A patient horse
A patient horse

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.
Waiting at the clinic
Waiting at the clinic

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.

Rigoberto at the Health Center
Rigoberto at the Health Center

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.
Rigoberto weighing a baby
Rigoberto weighing a baby

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.
Rigoberto and Ed at a local school
Rigoberto and Ed at a local school

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.
Cafe Cincinnati
Cafe Cincinnati

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.
Santa Lucia Street
Santa Lucia Street

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.

Familiarity Breeds…

Aesop is credited with the first use of the idiom ‘familiarity breeds contempt’ as the moral in the fable The Fox and the Lion. This past week I pondered that adage as each morning I drove out to the small village of Guachipilincito to pick up a few of the Brown / Wingate residents and students and transport them to our clinic and our health center in Concepción. The drive is only about seven kilometers either way, and yet it takes over one-half hour out and in. It is not exactly a road as one normally considers a road. The jagged ledge designed to puncture tires, gaping holes, loose gravel, and boulders to be circled about, demand maintaining the vehicle in first gear and four wheel drive for the entire trip. Beyond that, there is the frustrating, anxiety creating long pauses behind herds of cattle or the inability of two vehicles passing in opposite directions. By the end of the week, I knew that Aesop had got it right: my familiarity of the road only heightened my loathing of the trip.
Brown built the clinic in Guachipilincito and has been coming to the secluded village for years. Wingate School of Pharmacy has partnered with them in more recent years. Though for many of the students and residents, their present brigade is their first experience of the town and its residents, for the leaders and the institutions, Guachipilincito is familiar territory. The townsfolk know them and appreciate their visits. Here, familiarity has not bred contempt, but rather something truly amazing that defies a simple explanation.

Breakfast at Guachipilincito
Breakfast at Guachipilincito

Familiarity here seems to have bred a sense of mutual respect and a profound sense of commitment in service. While medical treatment within the local community is the ostensible purpose of the service trip, the team is deeply invested in the wellbeing of the local residents and the larger population. The highly motivated Brown / Wingate team is assessing and treating all the children and adults in the community, offering dental services, feeding children under age 5 years through their nutrition program, and taking a census to discern service needs. Beyond the local community, Brown / Wingate is engaging the wider community. Students, residents, doctors, and other medical professionals are visiting the main clinic and health center in Concepción, working side by side with our Honduran medical staff, professionally sharing and developing more effective, meaningful models of care. At home visits, at the clinic delivering babies, in emergency situations, students and residents see what medical care entails, and Honduran professionals benefit from the knowledge and experience of seasoned and accomplished medical professionals.
In consult with mother and child
In consult with mother and child

A very special aspect of this brigade has been the presence of child psychiatrist, Dr. Horacio Hojman. Originally from Argentina, Dr. Hojman now practices in Rhode Island and Massachusetts. His treatment of Honduran children and adolescents with psychological challenges was ground breaking, as mental illness is not readily discussed in this area of Honduras. Beyond this, he has been offering professional workshops for medical personnel and teachers such that children will find help and support on a continual basis. We certainly hope that this will be only the first of many visits from Dr. Hojman.
Dr Hojman / Professional sharing
Dr Hojman / Professional sharing

Brown / Wingate has committed to three weeks in February for this brigade. Many participants have already left after the first week, yet much more is still planned for the weeks ahead. Another professional sharing day is scheduled and other meaningful work. What marvelous things they have already accomplished in their ardent commitment to a relationship with a small, isolated community in the backwoods of Honduras. The road to get there is challenging, grueling really, but they have not grown contemptuous from the familiarity of the journey. Instead they have recognized that familiarity, coupled with a committed relationship of service, breeds the dawning of hope.
 

Article by: Paul Manship and Angela McCaskill
Photographs courtesy of Paul Manship and Angela McCaskill