Category: Health

As I am writing this, Laura and I are on vacation in the US. We have, as always, an incredibly packed agenda. We started out in Denver, three days, in order to visit Laura’s son Gregory, my cousin Kevin and his wife Dolores, and their son Alex, who will be joining us for three months in August as a volunteer at the bilingual school. We also managed to tour the Rocky Mountain National Park at 13,000 feet. Breathtaking! Now we are in the greater Springfield, MA area to catch up with family and friends. So in four days we’ve traveled over 3000 miles. Everything has happened exactly as we planned it. Just this morning I realized that is what is putting me just a little on edge. There haven’t been any surprises. I’m not used to everything falling together as planned. I’m thinking something is wrong.

Efficiency is so highly valued in the US. But sometimes it is the unexpected, and the way we end up dealing with it, that identifies and marks us.

Virginia Commonwealth University, Fairfax Family Practice Centers, and the organization SAGE (Student and Global Community Engagement) that they have founded recently visited the clinic they built and sustain in Pinares, San Marcos de la Sierra, Honduras. They came with a thirty person team. Though that was a bit large for them and presented a challenge, they have done this so many times they have learned all the routines. They know what to pack. They know what to expect. In the week they were here, they managed to visit many of the outlining communities and assess the health needs of the children living there. They provided medical and dental consults, physical therapy, and a mission to maintain clean water in the small communities. They do incredible work with precise planning and expertise; a model of efficiency at its finest. Still, this is Honduras, so something will have to go wrong.

It was not a desperate phone call, but our brigade coordinator, Moises, had a hint of urgency in his voice when he told us the brigade was running out of meds only half way through their week. It wouldn’t be a problem, we planned on visiting anyway. We would pick up the meds they needed at one of our main clinics, and if we couldn’t find everything they needed, we could drive them to La Esperanza where they could purchase them. But before he hung up the phone he also told us a five year old had to be transported to the hospital in La Esperanza. He had a broken arm. Also not a problem, we could get him there.

None of that was expected, but still it was a relatively easy fix. We got most of the meds. Chris and Logan would travel with us to La Esperanza to pick up the remaining meds. Our doctor/translator Jose would accompany our young man with the broken arm and his mother to the hospital. The hospital is always busy, and I worried that it might be all day, if not until the next, before they actually treated the broken arm. But we dropped the three of them off at the hospital and asked for a telephone call to update us. We found the remaining meds, and to my surprise got the telephone call that the arm had been cast. Dr. Jose also realized they might be waiting forever. He simply asked them to show him where the plaster was and he cast the arm himself. Everything was done within a few hours and we were on our way back to Pinares, mother and son in the back seat of the pickup with Jose, Chris, and Logan riding in the bed. This might not have been the most conventional means for supplying meds or setting a broken arm, but all things considered, rather efficient for Honduran standards. But then we offered mother and son a ride back to their home.

They had walked in the morning to the clinic at Pinares. She said it had taken them two hours, which is more than the typical “one hour” pat answer to that question. In fact, it took me almost an hour to arrive at their home in the car. Admittedly the car is not that much faster than walking considering the terrain over which we travelled, but walking this could not have been less than three hours. Now think about this. A mother walking with her five-year-old son, walking for three hours up and down mountains and over rocky terrain, walking with her son whose broken arm is neither set nor cast, and now perhaps we can understand why efficiency is not necessarily a prized value here. Their response was nothing more than gratitude.

VCU, FFPCS, and SAGE have once again done tremendous work at the clinic in Pinares. They prepared themselves well and followed an ambitious schedule. But it was what they did on the fly, for which there are no plans, that exemplified their unique style of compassion.

Most of my life I’ve kind of hung around at the same altitude, give or take about 1000 feet. I suspect that is mostly the case for anyone living in the US. Our elevations don’t vary tremendously from day to day or hour to hour. That is not the case here in Honduras where everywhere you look there is the remnant of another volcano standing in your path. Almost every Saturday morning I wake up at 1624 feet in Concepción. I get on a packed bus with thirty some other people, at least as many backpacks, and sometimes a chicken or two and begin to climb. About one hour and forty-five minutes later, having traveled along 34 miles of road a total distance of 22 miles, I find myself in La Esperanza at 5577 feet. It’s colder and clearer, the air much thinner, and the whole world seems changed. On Monday morning, I do the reverse, shedding layers of clothing on the way down. Everything changes in the rapidity of ascents and descents.

Rapid changes in elevation is what best seems to describe Maine-Dartmouth’s experience on their recent medical brigade to Colomoncagua, Intibucá. It’s safe to say they started out at or about sea level in Maine. Because of the irregularity of flights from Maine to Boston to Tegucigalpa, their odyssey lasted almost two full days, and, by the time they caught up to us in La Esperanza, they were exhausted. Flying in and out of the heavens, they were diverted from their final destination in Tegucigalpa to return to almost sea level at San Pedro Sula. Back in the air quickly thank God, they arrived at Tegucigalpa, 3248 feet, where Shoulder to Shoulder was waiting for them. Up and down a few dozen times more in an escort van, they finally got to the highest city in Honduras, La Esperanza at 5577 feet. Oddly, the weather they experienced, the damp and penetrating cold, might have reminded them of the late April weather of Maine that they had just left behind. There only for one night, their elevation changed drastically again, falling about four-thousand feet to arrive in Concepción. After a brief bathroom break and tour of our main clinic in Concepción, they winded back up another mountain pass to finally settle in Colomoncagua at 2576 feet. Talk about a roller coaster.

Laura and I usually spend a good deal of time with brigades on their way in and their way out. We hear about their expectations on going in and share in their reflections as they leave. We might get a half day with them at their work site, but we’re busy taking pictures and they’re busy seeing patients. We did see Maine-Dartmouth on their way in. But we wouldn’t be available on their way out as we were already committed to important meetings. Because we would miss them on their way out, we decided to spend the weekend with them in Colomoncagua. We were so pleased that we got such a close up view of their rich experience.

The varied elevations, their varied experiences, and their varied characters and personalities weaved and waved in and out of their time together. But without diversity, harmony cannot be achieved. José was born and raised in El Salvador, a literal rock’s toss away from where we were, but Barbara had never been on a medical mission trip and spoke no Spanish. But their voices blended in a theme of service and compassion. We witnessed them working among the simple townspeople at the San Marcos clinic. They had come from so far away, had traversed high peaks and low valleys, and yet they all seemed as if they belonged. Laura and I felt privileged to be part of this concerto of care.

The next day was yet an entirely different experience.   It was Sunday, it was May Day, it was Nancy’s birthday, and it was certainly time for fun. After a great breakfast and a visit to the local market where hand crafted leather belts, woven shoulder bags, and other local goods were purchased, we headed out to see the beauty pristinely hidden within nature. The waterfall dominates the natural amphitheater where the stone walls rise majestically above us. One further elevation to consider and explore. I watched them all under the curtain of the water’s fall. They surrendered to the experience of the moment, defined and enhanced by it, elevated to great heights and plunged to great depths. It is all so very enriching.

Linda Johnson, NP, the leader of the University of Wyoming brigade experience in Agua Salada, has just been recognized by the university in the reception of the Faculty Award for Internationalization. Congratulations Linda!!  Read about it at http://www.uwyo.edu/uw/news/2016/04/uws-linda-johnson-honored-for-work-in-honduras.html.

Wyoming University has been coming to the small village of Agua Salada for many years. They built the clinic there and have developed a very rich and meaningful relationship with the local people. Generally they see a great many people while they are here, sometimes as many as 100 a day. The service that they offer is stellar. They are busy from start to finish with little time to relax or reflect.

They were in Agua Salada this past Holy Week. This brigade did not unfold in the same way as past brigades. In deference to Lemony Snicket and Jim Carrie, we experienced a series of unfortunate incidents. Shoulder to Shoulder was a bit taxed this year with eight groups arriving in the month of February. This was an all-hands-on-deck experience. Whereas, we were often very challenged, stretched, and stressed, we managed without making any major mistakes. However, we did not follow-up to insure that the promotion of the Wyoming brigade had taken place in Agua Salada. It was also Holy Week. Everyone, including our staff, has Holy Week off. So Wyoming had a very slow start and they did not see the tremendous numbers of people that they had in past visits.

We were very apologetic, and because we have a long-standing, fruitful relationship with Wyoming, they were very graceful and forgiving in their response. Also, because it was Holy Week, Laura and I had more time to be present to the brigade. We were able to spend almost the entire day with them on Thursday. They were seeing patients, perhaps less than on pervious brigades, but they were busy. The mood was light while we were there, everyone seemed grateful for the opportunity to be there. On this particular day, the brigade welcomed the parteras (midwives) for an appreciation lunch. The oldest midwife from the community was present. Her sense of joy in being received by the brigade was extremely moving. Later in the day, we sat down to a meeting with the local health committee, and the Shoulder to Shoulder health promoter and nurse for the area. In the meeting that sense of mutual respect and appreciation seemed to deepen. The sharing in terms of what Wyoming could do to foster the ongoing health work within the community deepened an already secure relationship. I’m not certain, but I was beginning to have the feeling that the brigade’s less hectic experience was forging something even greater. Wyoming will be back in November and they will see a lot of patients again. They will return, perhaps, with even a greater appreciation for the value of the relationships they built and sustain. It only takes money to build a clinic. It only takes medical professionals and supplies to offer medical care. It takes so much more to fully invest oneself into the lives and world of others. Perhaps the series of unfortunate events had a fateful purpose.

Laura and I also traveled with the Wyoming brigade to Tegucigalpa for their flight out. On the night before their flight, we sat down to share in reflection on the participants’ experiences. Gratitude was a major theme; gratitude for the time and space to come to know the people of Agua Salada. The other theme present was the feeling that everyone had offered quality health care. I understood this as meaning that the service was offered with integrity and compassion.

I suspect that Wyoming brings their medical students to Honduras and Agua Salada in order to equip them with a Global Health Care experience. But this is not a box to be checked off on your resume of life. It is not accomplished by simply being there and doing the expected work. The satisfaction of coming to know another person from another culture in a foreign environment requires the willingness to give time, space, and respect. Wyoming sees a great many patients, but the real value they offer is in the quality of these encounters, and not their quantity.