Hombro a Hombro

So, now onto the organization that we were working with....

As Andrea wrote in the first entry of this blog, the trip we embarked upon was the culmination of a class--a cross-cultural and international exploration of maternal and infant care in the Americas. We read articles and books about various methods for establishing health care in countries outside of the United States. We attempted to grapple with the ethics of health care in a variety of settings and the balance between the prerogatives of the medicine and the unique needs of a community.

The semester-long preparation helped to lay the groundwork for entering into the spirit and work of Shoulder to Shoulder (known as Hombro a Hombro in Honduras).

Here is the link to the Shoulder to Shoulder website once again if anyone is interested on learning more about the projects, history, or needs of the organization:
http://www.shouldertoshoulder.org/history.html

As a member of a brigade, here is what I learned about Shoulder to Shoulder:

The organization was founded on the principle that it is better to become immersed in a community and develop a model of care that is contoured to the individual nature of a particular place rather than create a program that can be exported to a multitude of different countries. This is a marked difference from other programs and NGO's that work to meet a wider pool of need. The growth and development of Hombro a Hombro since 1996 has lead to a greater continuity of care, which in turn has helped foster an increased use and trust of the health care services. Correspondingly, the communities in the area surrounding Santa Lucia have seen improvements in many different aspects of their health and living situations.

Shoulder to Shoulder's role in Initbuca has recently shifted. The cause of this shift is a contract with the Honduran government. As part of this contract, Shoulder to Shoulder is now responsible for an increased number of health care clinics. Also, supplying clinics with medications and supplies is no longer donation dependent, rather donations supplement what the organization is able to purchase. Furthermore, another goal of Hombro a Hombro is closer to being met. Shoulder to Shoulder is working to achieve (Honduran) self-sustainability. With this contract, the organization is better able to hire and contract doctors and nurses to serve within the community for longer than year or several month stints. Ultimately, Shoulder to Shoulder does not see itself as an organization dependent on the work and donations of medical students, nursing students, nurses, doctors, dentists, and other health care practitioners from other countries, but rather an organization that is led by Hondurans with Honduran health care practitioners taking over the predominate roles.

Shoulder to Shoulder works not only to deal with medical emergencies and urgent care at its main clinic in Santa Lucia but also helps with primary care and prevention through the staffing of community health clinics and the use of volunteer health care practitioners in brigades. There is also work with education, the implementation of water filters, and soon a program for the installation of cleaner burning cook-stoves. The people who work with Hombro a Hombro are also interested in collecting and maintaining a thorough collection of data. The organization has been responsible for collecting census information and is starting to develop databases to track the health trends and areas of concern for the communities and people who utilize the health clinics.

What role did we UPenn students play?

Shoulder to Shoulder frequently has groups of health care practitioners coming to their home clinic in Santa Lucia. These groups are called brigades. Depending on the training, interests, and experience of the members of the brigade, the coordinators of Shoulder to Shoulder design a program of activities that help to meet the needs of the organization. While the clinics are fully functional when there are no brigades, the brigades help to supplement the care that people receive. Often, brigades see women and children for primary care. Brigades also are able to see a higher volume of patients than can be seen on any given day at the main health centers.

As a group of 15 practitioners and practitioners-in-training, our group was responsible for working in the Santa Lucia clinic, observing in outside clinics, seeing children for primary care as part of the Children's Healthcare Initiative (CHIs), screening women for cervical cancer, and teaching and meeting with Honduran health promoters and midwives. We worked with this organization for two weeks and were able to see many of the programs that have been developed by Shoulder to Shoulder in action. Not only did we have the perspectives of the members of the Shoulder to Shoulder organization to guide us through our experiences, but we were able to speak with people, like lay midwives, who have seen changes in the way in which members of community are accessing health care.

More about our work to come.....