Story and photos by Leha Byrd, VCU University Public Affairs
When Justo Lorenzo carried his 5-year-old son, Yostin, into a makeshift mobile clinic in a village schoolroom in the La Hicaca area of Honduras, the father was sweaty and scared. The boy, fragile and shirtless, had fallen from a tree while picking mangos and landed on a barbed-wire fence. The tumble left him with a bloody, 2-inch laceration on his back.
Normally, emergency treatment for Yostin might have included a hike down the sweltering Honduras Mountains from the boy’s home in the Yoro region of northern Honduras to a main road. From there, it would be necessary to hope for a random ride or to walk to the medical center in Olanchito, a town that was six hours away by car.
However, that sweltering June day the Virginia Commonwealth University Global Health and Health Disparities Program group was operating nearby as part of its annual nine-day medical clinic. The brigade consists of VCU student pharmacists, medical students and faculty, and nursing faculty, as well as doctors from Inova Fairfax Hospital. The team sanitized Yostin’s wound, bandaged the crying child with gauze, gave his father an antibiotic cream for treatment and advised him to bring the boy back for a follow-up visit the next day.
The entire medical interaction was relatively straightforward and lasted only about 15 minutes, but it represents the type of timely, hands-on care residents of rural Honduras often lack. GH2DP team leaders say the brigade, which is in its 11th year, exists for patients such as Yostin while also serving to introduce medical students to the importance of global health work.
“Our goal is to treat as many residents as we can as often as we can, and we want our students to be part of that,” said Gonzalo Bearman, M.D., one of the GH2DP team leaders and the chair of the Division of Infectious Diseases in VCU’s School of Medicine.
Second-year medical student Ryan Wallace witnessed the incident with Yostin and was struck by what was done so swiftly with so little.
“Even though we couldn’t really do exactly what we would do in the United States, we were able to provide the best care with the given resources,” he said.
Each year, Bearman and Michael Stevens, M.D., lead a medical team to Honduras to provide health care to nearly 900 indigent adults and children. Many are afflicted with the type of disease and discomforts that would go untreated without the visit of the VCU contingent. If not traveling by mule, horse or on the back of an overcrowded pickup truck, some people walk up to six hours to be seen at the mobile clinics.
Honduras is located in Central America between Guatemala and El Salvador to the west and Nicaragua to the south and east. It has a population of about 8.2 million, with many people living a relatively isolated existence in the country’s mountains. Tegucigalpa is the country’s capital and largest city.
Many of the country’s primary health ailments, such as diarrhea and helminths, also known as parasitic worms, are prevalent because so many residents live and work in unsanitary conditions without access to running water. For daily duties such as bathing and washing clothes, rural Hondurans often utilize the same water sources as the country’s animals.
Only one of the 18 villages in Honduras’ La Hicaca area, where VCU’s group typically serves, has electricity and only four have car access. Many residents lack education and find work at a young age harvesting beans and corn in the fields. To compound the harshness of work life, many Honduran homes are little more than shanties with dirt floors that host insects, worms and damp soil that breeds disease.
That’s why the work GH2DP does is so important, said Father Pedro Hernandez O’Hagan, priest for Vector of St. George Catholic Church in Olanchito. Through the mobile Mass services he leads and other initiatives, O’Hagan works with Honduran residents from more than 150 communities. When GH2DP is not there, only one nurse is available in La Hicaca.
“The brigade is such a big help. It gives the nurse support,” he said. “We’re especially grateful that the brigade has taken an interest in this zone, which is the poorest.”
Each day’s clinic included registration, consultation with pharmacists and gastrointestinal and internal medicine doctors and, for patients with poor vision, a chance to pick out a pair of generic reading glasses. For children there was a pediatric stop. Clinic days began around 8 a.m. and ended when either the last patient was seen or when the lack of natural light made reading information forms impossible.
Two of the nine clinic days were spent in the community of Las Lomitas, where approximately 300 patients were seen. After trudging through hilly, muddy, secluded terrain, residents stood in line for hours to register themselves and their children for medical treatment. Because there is little television or telephone access in remote areas of the country, residents are alerted that the brigade is coming to a town near them via pre-planned radio announcements.
Waiting in a long line that snaked through the hot grass did not deter the excitement over GH2DP’s arrival, O’Hagan said.
“They’ve been waiting for this clinic all year long,” he said.
The Los Lomitas clinics were set up in two dank, 15-by-20-foot rooms with no electricity and little air circulation. One room served as an examination area and occasionally a bathroom for urine samples. Brigade members held up both ends of a large tarp in the back of the room when privacy was needed.
A dusty, grassy hill just outside the brick structures was the stage for one of the most important elements of the group’s mission — the demonstration and distribution of new water filtration systems for residents. Prior to the brigade’s arrival, families who had received clay pots to filter their household water were told they would receive updated models. The new, more sophisticated system, an 8-gallon bucket with a detachable spout and water filter, will last residents 10 years as opposed to the two-year life span of the clay pots.
Although slight and soft-spoken, O’Hagan had the full attention of residents as he meticulously explained how to use the filters. In that same mild manner he at times had to quiet the crowd when disagreement was voiced about who would receive them. One filter is given for use by three families, with one person designated to safeguard the filter and allow others access.
Silvia Vasquez Laesperanza, 58, walked two hours to Las Lomitas to get a water filtration device.
When asked what she would have done if she couldn’t get to the GH2DP mobile clinic to retrieve it, the petite grandmother replied through a translator that she would “look further away.”
VCU internal medical resident Jason Cook was one of four medical residents on the trip. Last year, he worked on a chlorination project to help residents such as Laesperanza.
“The big thing is that we’ve been doing tons of research all targeted toward the needs of the community,” Cook said. “You try to come up with something in the classroom, but you’re not sure if it’s going to be effective. But we’re able to go back and retest the water, and talk to people to see if it made a difference.”
In 2015, 80 percent of villagers reported fewer episodes of diarrhea in the past year since the water distribution system was chlorinated, and a statistically significant decrease in E. coli was observed from sampled pre- and post-water chlorination, he said.
At the end of their time at the medical clinic, attendees were given surveys to assess their health status and determine if they had attended previous brigades. The team strategically comprises every aspect of medical outreach needed, including translators, pediatricians, administrators and drivers to navigate the lush but rock-littered Honduras terrain.
Second-year VCU medical student Tim Wills served as a driver and a translator for this year’s trip. As the son of missionaries, Wills said he sees himself doing this type of work long-term.
“I’ve done trips like this in the past and I’ve always wondered what it would be like to attend as a student who has the knowledge to help,” he said. “I see myself as a professional working in a place similar to this, within this type of an established effort.”
The Department of Internal Medicine has a global health and health disparities track for internal medicine residents who, like Wills, have a desire to work in underserved countries. Part of the curriculum includes two health outreach trips to Honduras, the Dominican Republic or Peru.
“The experience students and [medicine] residents have is potentially transformative,” said Stevens, the brigade’s co-leader. “We hope its impact in terms of perspective and experience will lead them to serve underserved people in their future careers.”
Part of students’ experience included humble, Honduran living conditions. Living quarters for the brigade consisted of three schoolrooms at the La Hicaca site. The compound’s only source of running water was an outside cistern used communally for washing clothes and brushing teeth. Sleeping bags, hammocks and tents were used as cushion from the cement floor and protection from the nighttime mosquitoes.
HOMBRE, or the Honduras Outreach Medical Brigade Relief Effort, is the student arm of the brigade that helps send students to Honduras, the Dominican Republic and Peru. Patrick Mason, M.D., works closely with the GH2DP brigade and has helped VCU faculty and students expand HOMBRE into a 501(c)(3) status, nonprofit organization. While working at Inova Fairfax Hospital, he was charged with developing a program to teach pediatric residents about global health. He began working with HOMBRE in 2005 and has been a part of trips each year. Mason is medical director of endocrinology at Quest Diagnostics in Chantilly, Virginia.
Like Stevens, he said GH2DP is designed to steer students’ aspirations toward serving in disadvantaged communities.
“The project has two big missions,” he said. “We want to educate U.S.-based students and teach them about what’s going on other than what they see in Richmond. The other hope is to inspire them to help take care of the world. That really is the global health mission. If we can inspire one or two of them to go that route, that’s helpful.”
GH2DP is funded through donations from various nonprofit organizations and contributions from the VCU Department of Internal Medicine. Donations allow the brigade to purchase items that support its water chlorination and deworming initiatives, as well as other public health campaigns. Students who are part of the global health track are financially sponsored for the trips.
On the final two days of the GH2DP clinics, two local dentists were on-site in La Hicaca. They capitalized on the clinic’s presence by sending patients who needed pain medications, after tooth extractions, to its pharmacy. Set up in the tiny quarters of a two-room building, patients sat in plastic lawn chairs and carried the burden of tilting their head just right for the dentist to perform procedures.
Alba Maria Quesada usually performs dentistry at St. George Clinic in Olanchito and Pedro Antonio Padilla works at the Central Clinic of Arenal. However, because GH2DP was in town they came to La Hicaca in hopes of helping more people.
When asked why she chose to provide dental care in Honduras, Quesada said, “to love and to serve.”
After the dentists leave the mobile clinic, many of the residents they see will not receive any other dental work for some time. The same is true for those who come for medical assistance. Each year, however, the clinics are well-attended, with residents who come annually.
Jean Rabb is a clinical nurse at VCU who has taken seven GH2DP trips. Each year she recognizes community members who have come to the clinic in previous years. She has found that she has developed strong connections with them as individuals.
“That’s a wonderful takeaway,” she said.
Jorge Alexies Aguasarca, 19, is one of those residents. While visiting the clinic last year, he began trembling and sweating profusely. Then he lost consciousness. The brigade was able to get him to the hospital in Olanchito for a brain scan. He was diagnosed with seizures. With help from the brigade, he was given a year’s supply of medicine. “That is one year of treatment which [Aguasarca] wouldn’t have been able to pay for,” O’Hagan said.
A year later, Aguasarca describes his condition as calm.
“I’m very grateful, thankful for what they did for my health,” he said.
Aguasarca’s experience highlights the value of VCU’s steadfast commitment to the region, O’Hagan said, and shows that though GH2DP is not in Honduras all year, the fruit of its efforts endures in its absence.
“Many brigades come, but the VCU brigade chose to stay in this area and create relationships with the residents,” O’Hagan said.
Anyone interested in donating to GH2DP can visit http://gh2dp.vcu.edu/Donate.html for more information.