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.....
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.
Hola,
We are back in the good old United States (well, some of us....others are still traveling through the beautiful country of Honduras). I know that there have been some people who have been interested in how the trip went, what our days looked like, and what sorts of adventures were had.
Our apologies for not being able to update the blog while we were away. We had spotty internet connections at best and the days were long and full. I can't speak for everyone but I know that I am just now getting around to processing and absorbing the intensity and complexity of working in health care in another country.
Over the next week or so we should have links to photos from the trip and plenty more stories about our work and play with the folks at Shoulder to Shoulder.
Finally, thank you again to everyone who made donations to this trip. The people at Shoulder to Shoulder were impressed with the generosity. We actually had so many donations that we were not only able to take a hefty load of supplies with us and buy a doppler for the clinic, but also have money left over to donate to the organization. So again a big, big thank you
Vayamos!
Waverly
In a little over three months, we'll be embarking on what promises to be a life altering experience, heading off to rural Honduras. We'll have the opportunity to work in a community clinic, participate in health education with local providers of health care, perform community health assessments, and visit health care facilities. All of this will be coordinated by Shoulder to Shoulder, a non-profit organization that has organized medical missions for nearly fifteen years. We hope you have a chance to explore their site and learn all about the wonderful things they accomplish.
With the chill outside, the heat of the rainy season seems far away. But time flies when you're having fun...or hard at work! The next few months we'll be hitting the books to understand many components of the Honduran health care system as well as cultural influences and ethical considerations of volunteering. In addition we will be working on our popular education skills, as we will be educating at the clinic. As if that weren't enough, we must work on our Spanish speaking skills as well. Dios mio!
So, while we get cracking on our papers, projects, and piles of reading, we have a homework assignment for you, too: We need to solicit donations of health care supplies to bring down with us in May. Maybe you aren't able to give, but you know someone who works for a drug company, medical supply business, or drug store? Are you a dentist who could donate a case of toothbrushes and toothpaste? Are you a knitter who could make and donate even a few newborn-sized hats? Every little bit helps!
Please, feel free to pass this list on to anyone and everyone you can think of. Muchisimas gracias for sharing our journey!