Where We Were

Before I can really get into what a typical day looked like, I think that it might be important to describe where we were and how the work of Shoulder to Shoulder fits into the grand scheme of health care in Honduras.

First some basic geography:



As you can see, Honduras is situated in Central America between Nicaragua, El Salvador, and Guatemala. The area to the north along the coast tends to be frequented by tourists because it is beautiful. The area around Tegucigalpa is where most of the political upheaval happened last year. Honduras is divided into departments. Down south, along the border with El Salvador is Intibuca and this in the department in which both Santa Lucia and Concepcion are located. Intibuca also happens to be the poorest department in Honduras.

We flew into San Pedro Sula because, despite the fact that Tegucigalpa looks like it is closer to Concepcion and Santa Lucia, due to the conditions of the roads, it is not. I think that most of us would agree that while the bus ride from San Pedro Sula to Santa Lucia was long, it was also beautiful. We left the flat, dry lands of pineapple and banana plantations and paved roads for the world of craggy mountains tucked among more mountains, piles of clouds, and roads that were no more than rock and dirt.

In many ways the bus ride was the perfect transition into the towns we would be working in. As we bumped along the rocky roads on the way to Santa Lucia we were getting the picture of the distances and conditions defining access to health care in these communities. When a patient in labor came to Santa Lucia and said, I walked from my home in Magdalena, we knew that meant she had walked up and down 1.7 miles of mountain roads to arrive at the clinic to give birth. If a person came from Santa Teresa, we understood she had left her small town with a three room clinic with no running water and if she was lucky she had been able to catch a 800.00 lempira ride on the back of a truck or if not, had made the three hour trek to the clinic on foot.

Santa Lucia is home to the main Shoulder to Shoulder clinic. It is a town with shops and paved roads that lead to a beautiful plaza. There is a school, a police station, and a government run health clinic. The homes that line the roads through the main parts of town are painted in beautiful oranges, pinks, blues, and greens. Comparitively, the people of Santa Lucia seem to be doing alright economically, although some attribute this to the fact that Shoulder to Shoulder has brought jobs to the community in a myriad of ways.

The Santa Lucia clinic was the first Shoulder to Shoulder clinic to open in Honduras. This clinic serves as the secondary care center. A person who is in need of medical care will first go to their community clinic (which is government run and staffed by at least one nurse). If the situation cannot be managed within that clinic the person is sent onto Santa Lucia. Santa Lucia is able to manage most of the illnesses and medical emergencies that come through the door. The one limiting factor is that there is no surgical center. Those patients whose needs cannot be met at Santa Lucia will be sent onto the next largest hospital in La Esperazna, a good three hours away by truck.

Santa Lucia was where we were for the first week of our time in Honduras.

The second week, we traveled to another town called Concepcion.

Concepcion is like Santa Lucia in that it has the paved roads leading to a plaza. A beautiful white church stands at one corner of the plaza and the center of the plaza is occupied by a basketball court. There are little shops in the center of Concepcion and even an internet cafe. Shoulder to Shoulder has recently built a new clinic along the scale of the Santa Lucia clinic in Concepcion. The clinic in Concepcion is not fully functional as of right now but it is in the process of being staffed. In the meantime, we were able to use it as a site to see patients for primary care visits. For now Concepcion is slated to open as a secondary care center, the limiting factor being once again that there will be no surgeries performed at this clinic. There is talk of maybe, perhaps, one day being able to outfit at least one surgical room in the clinic--although everyone who works with Shoulder to Shoulder realizes not only the financial difficulty but also the logistical difficulties of maintaining a sterile environment in a place were scorpions, frogs, and chickens are frequent guests to the clinic rooms.

While we were based in Santa Lucia and Concepcion, many of the days we were working in outlying towns and communities. There are piles and piles of photos that will give an even better picture of the places we were and those will be up soon.....promise.