A typical day in the field

A typical day in the field started around 6am. We'd escape from our mosquito-netted beds, get dressed, and meeting in the dining room for breakfast at 6:30 each morning. Around 7am we'd load supplies, medicines, and people onto the flatbed pickup trucks that were our primary form of transportation. With 3 trucks, a lot of gear, and around 20 people, many of us rode to our daily work sites in the back fo the truck, perched upon boxes of medicine, clinging to the side of the truck bed as the drivers navigated the precarious unpaved roads. (It might sound scary, but most of us found it pretty enjoyable; the rush of air provided a pleasant escape from the opressive Honduran heat.)

Once we were all loaded in, the truck caravan would drive over the dusty, pothole-filled mountain roads to a nearby (sometimes, not-so-nearby) village that was without a health center. We used the village's primary school and turned it into a makeshift clinic, focusing on primary care and preventitive medicine. With a little bit of supplies and a lot of ingenuity, we turned classrooms into labs, teacher's desks into examination tables, and school chairs into dentist's chairs.


(Before and After: Classrooms turn into clinics!)

Small groups of children would circulate through various stations with a document that we wrote their results on as they passed through each one. We began with height and weights for each child, calculating their z-scores to check for evidence of malnoursiment or stunting.

Next, students moved on to a really fun station - nursing students taught the children propper tooth-brushing techniques, distributing toothbrushes (which were donated by some of our fabulous friends and family members!), and then applying dental varnish after the childen brushed their teeth. (Professor Maime Guidera and student Kara Cohen were toothbrushing superstars. Here, they animatedly demonstrate their excellent toothbrushing skills for the children.)

Children also had eye exams and had hematocrits done to screen for anemia.

NP students Megan Mariotti and Maggie Senn were, among many other things, great at working with the kids at the hematocrit station.

Just one of their happy customers is pictured at right. (Photo by Heather!)

In a final station, nursing and nurse practitioner students worked along side med students and physicians to review the children's paperwork and do complete physical exams. We also gave preventative medications - Vitamin E and Albendozol, an anti-parasitic medication. The children were sent home with daily chewable multivitamins; those who were anemic received daily multivitamins supplimented with iron. Children under five years of age who presented with evidence of malnourishment were referred to Shoulder to Shoulder's Under 5 Feeding program - a program that brings free, nutritious food to local children. Other problems, such as rashes, skin infections, intestinal upset, and colds, were addressed with the help of the fabulous attending physicians that accompanied us. When present, we talked with the children's mothers as well, educating them about medication administration, giving advice about health concerns, and referring them to the clinic in Santa Lucia if necessary.

After we saw all of the children, we opened up our field clinic to the general population of the village, including everyone from young mothers with babies to weathered farmers.

A small group of students and midwives also focused on cervical cancer screenings and women's health, each day setting up a separate room to take health histories and do cervical exams. (At left - sheets and blankets used to turn a teacher's desk into an exam table) For the cervical exams, we used a method called Visual Inspection with Acetic Acid (VIA), which is an alternative to PAP smear that is well-suited to practice in resource-poor settings. Women who screened positive were referred back to the Shoulder to Shoulder clinic to have colposcopys done.

Personally, the days I was able to focus on women's health care were my favorite. Not only did I learn a lot of skills - like taking a women's health history and conducting a cervical exam entirely in Spanish - but it also seemed like talking with these mothers allowed us to really learn about some of the distinct cultural differences and the realities of life in rural Honduras.

From these days in the field, I also came away with a new appreciation for the importance of primary health care. What's more, I was very satisfied that every preventative measure we took, and every medicine we administered, was based on scientific evidence. We didn't give pediatric vitamins because it's what kids chew in the states; we gave children a one-month supply of vitamins after examining research that demonstrated a distinct improvement in health outcomes in pediatric populations.

Finally, when it came time to leave, I think we all felt assured knowing that the Hombro a Hombro clinic was continuing with it's vital mission in Santa Lucia and the surrounding villages. We didn't provide one-time, episodic care; we provided care that will hopefully insure a healthier future for hundreds of children and their families. We didn't just give people medicine; we tried to educate them about their health, and hopefully sparked an interest that will last a lifetime. I am proud to be a part of something so sustainable. And, as I hope this photo indicates: I'd love to think that we inspired the next generation of Honduran nurses.

Back home!

It feels like ages have passed, but in reality it's only been a little over two weeks since we left for Honduras. I think everyone would agree that the time passed very quickly for all of us... every hot, sweaty, busy moment. :)

We apologize, also, for not being able to post during our trip - our internet access was iffy at best most days. However, we took a ton of photographs and notes, so over the next few days of unpacking and decompressing, we'll post our images and thoughts here to share with all of you.

I'll start off tonight with a little introduction about the Hombro a Hombro clinic that we called "home base" during our trip.


First off, here is an image from Google Earth which has some important points marked. We arrived in San Pedro Sula on Saturday, May 3rd; Our first day we spent driving, reaching as far as La Esperanza the first night. On Sunday, May 4th, we got up, visited the Sunday market, and took a tour of the Hospital at La Esperanza (more on that later!). Then we drove to Santa Lucia and the Hombro a Hombro clinic, which would be our home for the next week and a half.


Notice that the "Hombro a Hombro" clinic, in Santa Lucia, is very close to the country's southwestern border with El Salvador (Marked in yellow on this view). In general, the terrain here is very mountainous, the roads unpaved, and the travel - for those who must go on foot - arduous.


Zooming in over Santa Lucia, you can easily see the multi-colored roofs of the Hombro a Hombro clinic, which sits on top of a hill at the entrance to Santa Lucia (red, brown, and gray rectangular roofs, 2 o'clock in this image). The lower building housed the clinic and the library; the upper building contained the dorms, bathrooms, kitchen, and the residential doctors' quarters.

On the ground now, here is a picture of the front of the clinic:


The clinic has several rooms for seeing patients, as well as a room with an ultrasound and an X-ray machine, a room for surgical procedures, a small lab, two rooms for patient 'recovery', and a dental "wing". In the basement of the clinic, there is a small but lovely library that is free and popular with the local children after school hours.

The clinic is open from 8-12 and 2-4pm Monday - Friday, and 8-12 on Saturday; there is, however, someone who is always "on call," so the clinic is essentially open 24/7 for emergencies. (Many of us spent time working in the clinic or being on call, so I'll write more about that, too!)

Moving upstairs: here's a photo of our somewhat rustic living arrangements in the second floor dorms. They may not look like much, but I can tell you that when we collapsed, exhausted and sweaty, at the end of a long day of work, we were happy to have these bunks.

Outside of the dorms is a big "living room" with lots of tables, chairs, and couches. When we weren't working, we spent a ton of time in this space: eating delicious food, holding meetings, dancing, reading, napping, teaching workshops, playing cards, exercising. Here's a photo of a workshop we held for pregnant women during a Prenatal visit day:


And because I mentioned food, I'll share one last photograph: It's of one of our standard meals at the clinic. I have to say that the food was surprisingly delicious and fresh, especially considering the fact that just a few women ran the kitchen, but they still managed to feed about 40-50 people three times a day. I'm craving their rice and beans as type this!

That's it for now. In the next posts I'll talk about a typical day both in the clinic and out in the field, talk about what we did for fun, share more photographs, and anything else I can think of. Thanks for reading!

The time has come.

After months of preparation, the time has arrived. In a few very short hours (why am I still awake?), we'll finally be boarding our planes to Honduras.

The past few weeks have been incredibly busy for Penn Nursing students and faculty. A few weeks ago, we prepared and presented popular education pieces about diarrhea prevention & treatment, stages of childbirth, and HIV prevention (among others). Afterwards, most of us juggled studying for finals in our other classes with packing and preparation for this trip. And speaking of packing...

Thanks to our amazing and incredibly supportive friends, family, and colleagues, we've raised OVER $3,000 with which we were able to buy a vast array of supplies, including some which have been on the clinics "Wish List" for a very long time. (For example: we're bringing them dopplars, which will be used to listen to fetal heart tones. Very cool!)

Along with the tons of supplies we were able to purchase, we also received bags and bags (and in one case, a truck load!) (Yes, Northampton Community College, I'm talkin' to you!) full of supplies from offices, small business owners, and fellow nurses, nursing students, and faculty. (Please see our list to the right, with just SOME of our generous supporters.)

This outpouring of support has been incredibly humbling; we'll surely be thinking of everyone back home as we each struggle to get our two 50-pound suitcases stuffed to the brim with medical supplies onto the plane tomorrow morning.

Thank you all for helping to get our journey off to an incredible start! Please take the rest of the journey with us as we update this blog with the sights and stories from our travels.

Nos vemos en Honduras! See you in Honduras!