Penn Nursing - Working Shoulder to Shoulder

A typical day in the clinic...

2008-06-05T18:32:00.007-04:00

... was anything but typical. Going out in the field was only one of the many tasks we were put to during our stay at Hombro a Hombro; on most days, a few students stayed back to help the resident physicians and nurses see the patients that lined up at the door each morning. Penn Nursing students, at varying times, helped with the following range of activities and cases in the clinic:

navigating the impossible, Rolodex-heavy patient information system
rotating nights of being "on call" with fellow students
stitching machete wounds
extracting a live bug from a woman's ear canal
assisting with ultrasounds
hand-developing X-ray films
taking blood and checking hematocrits
checking urine samples for evidence of infection - and to check for pregnancy!
doing full pre-natal checkups
working with a team of physicians and other students to devise comprehensive care plans for acute patients
round-the-clock observation and care for an acutely ill little boy
counseling women coping with domestic abuse and men struggling with alcohol addiction
doing home visits for patients that were unable to visit the clinic
lots of injections and medication administration
a ton of patient education and health advice
catching a baby (congrats, Lindsey!)

... the list could go on and on. Many of us came back to Penn claiming that the things that we were able to see and do and the skills we improved on during our stay in Honduras equaled a semester-long clinical course at home. I think we all realize how incredibly fortunate we are to have been chosen for this trip; now that we've been home for a few weeks and have had time to reflect on our experiences, I think many of us realize, too, that the lessons and skills we learned in our clinical practice in Honduras will stay with us for the rest of our careers.

For me, reflection brings an overwhelming feeling of gratitude. I'm grateful for the work that Shoulder to Shoulder has done, and I'm grateful that I was allowed to be a part of it. I'm grateful that I had such an amazing group of fellow students to work with, to learn from, and to share the experience with.

I would be remiss if I didn't mention one of the the resources I'm most grateful for: our outstanding teachers. Maime and Dawn and the other fabulous midwives on the trip were wonderful mentors, clinical instructors, and travel buddies. (We also learned that they are hilarious comedians and great actors!) The Family Practice physicians that accompanied our group, and the resident physicians as well, were also incredible resources. All-in-all, the atmosphere that these nurses and doctors helped create resulted in a perfect environment for learning clinical and interpersonal skills. As one of my fellow nursing students described it: it was "the safest learning environment I've ever been in." (Above: Maime uses Michelle as a student model to show a local Honduran midwife how to check for edema.)

Finally, I think we also learned a lot from our patients and from our fellow Honduran health care workers. For example, our last two days at the clinic were spent with local lay midwives. We had designed a number of popular education pieces to teach about different topics surrounding childbirth; for all of our preparation, we surely learned as much about midwifery from them as they learned from us.

(Penn Nursing students and faculty with a wonderful group of Honduran lay midwives)

A typical day in the field

2008-05-30T12:36:00.034-04:00

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!

2008-05-20T23:46:00.014-04:00

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.

2008-05-02T23:28:00.010-04:00

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!

Wow.

2008-04-14T10:58:00.003-04:00

You are amazing!

We are excited to report that, in just a few short weeks of fundraising, we have raised almost $1,000 to use for the purchase of supplies for our trip. This is, of course, thanks to YOU - our wonderfully supportive friends, families, and colleagues.

We are humbled and inspired by this awesome show of support.

We can't wait to go shopping for supplies that will help us help others. Stay tuned for photographs of all of the supplies that YOU have helped us purchase!!

One Month To Go!

2008-04-04T14:50:00.006-04:00

I can't believe that in a little over 28 days, we'll be boarding our planes to Honduras! Of course, with our growing excitement comes the growing realization that we have very little time to finish gathering the supplies we need to take with us. (Speaking of supplies - check the updated list of needed items!)

Many people - who don't have an extra case of latex gloves or a box of specula - have shown an interest in donating money to our class so that we can buy the supplies ourselves. We think this is an excellent and efficient way to support our mission!

For those of you who, like me, live half of their lives on the internet, I set up a PayPal account for the class. You can donate as little or as much money you would like. You'll get an email receipt, and so will we. The process takes about 60 seconds, but it will make a world of a difference to us!

Here's how to donate:

1. Log on to PayPal at www.paypal.com.

2. Click on the link at the top left that says "Send Money."

3. On the right hand side, in the "Send Money" box, enter the email address "holshue@nursing.upenn.edu" - that is how the money will be credited to our account!

4. Enter your email and the donation amount, and click "Continue."

5. If you don't have a PayPal account set up, the website may ask for more information so you can create one. And that's it! We will be thrilled when we receive an email notification of your donation.

6. Donors will be recognized here - see the column on the right - and we'll also be sure to send you a token of our appreciation from Honduras.

We'll be collecting money until April 22nd. After that date, we'll take our donations and go shopping - for mosquito bed nets, medical scissors, hand sanitizer - the list is long, and the need is great!

Stay tuned for a report of our fundraising efforts, and to learn more about the popular education projects we're working on to present when we arrive.

As always, muchisimas gracias for your support.

Our blog, featured in the Daily Pennsylvanian!

2008-02-19T18:25:00.004-05:00

Check out today's issue of the Daily Pennsylvanian! Page 5 features a story about our trip and our blogging efforts.
(Read the electronic version here: Daily Pennsylvanian: A trip to heal - and blog.)

To those Penn students and faculty who found out about us through the DP article: Bienvenidos! We hope you enjoy reading about our work, and remember to check back often for updates!

We need YOUR help!

2008-02-01T00:27:00.001-05:00

Hello again!

As I mentioned in my last post, the students in our small group are going to be collecting suitcases full of medical and health care supplies to bring with us to Honduras. Of course, we need all of the help we can get, so I'm posting the tentative list here in the hopes that some of our lovely readers (this means you!) will be inspired to donate supplies.

We are in need of the following...

***APRIL UPDATE*** In addition to the list below, STS has sent out a special request for the following critical supplies:

Alcohol wipes***
Slings***
Sterilization Bags***
Thermometer covers***
Casting tape***
10 cc syringes
Knee Immobilizers
Newborn baby hats
Spacers and Masks for Inhalers
Tennis elbow splints
HP Laser Printer Cartridge (12A Q2612A)
Table paper
Ace Wraps
Nebulizer masks for kids and adults
Leg bags for foleys
2” stockinette
BP cuffs-automatic is preferable
Air casts
Canes
Yankauer suction tubing
Crutches (for small adults)
Thumb spica splints
Lexmark 16 (color) printer cartridges
Cock up wrist splints, all sizes
Condoms

*** Very important!

Original Supply List:

Over-the-counter medications:

Neosporin / Other antibiotic ointments
Tylenol (Adult / Children's / Infant)
Colace
Diarrhea medicine - Lomotil, Pepto-Bismol
Advil
Vitamins (Adult / Women's / Prenatal / Children's / Infant / Chewable)
Robitussin
Sudafed
Aspirin
Nix or Rid (for lice)
Lotromin / Anti-Fungal / Scabies / Ring Worm topicals
Tooth brushes / Small tooth paste / Small mouth washes
Small hand soaps

Women's Health Needs:

Oral Contraceptive Pills
Condoms
Monistat / Gynelotromin
Flagyl zithromax
Medications for treating STIs

Supplies:

Gloves
Tape
Telfa pads
Gauze
Suture kits

Supplies for Birth Kits:

Baby undershirts
Hats & Socks for infants
Receiving Blankets
Scissors (bandage or suturing or other)
Shoe Laces (for cord tying)
Alcohol Swabs
Antibacterial soap (the kind that does not require water!)
Bulb syringes
Paper or Cloth diapers

This list will probably expand as our trip comes closer. In the meantime, we ask you to brainstorm: Do you know anyone who works for a drug company? A medical supply business? A 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?

Please, feel free to pass this list on to anyone and everyone you can think of. We'll appreciate any help we can get!

Thank you SO MUCH for reading, and feel free to use the comments section to brainstorm or give us suggestions for places to solicit donations from...

Hasta Pronto!

Bienvenidos!

2008-01-30T20:29:00.000-05:00

Welcome.

In a little over three short months, we'll be leaving for what promises to be an amazing, life/career/worldview-changing trip to Honduras. Our activities on the ground will be coordinated by Shoulder to Shoulder, a non-profit organization that has organized health-service brigades in Honduras for over a decade. I encourage you to explore their site and learn about all of the wonderful work they facilitate: hopefully it will make you as excited as we are about this opportunity!

But, first things first. We've got a lot of preparation to do in the next three months: a ton of reading, improving our understanding of health disparities in Latin America, building our popular education skills, group teaching projects that we'll hopefully utilize on the ground in Honduras. Y, por supuesto, practicando nuestro Espanol!

I think I speak for all of us (hope that's okay, amigas!) when I say that we want this blog to be as interactive as possible. We'd love to hear your comments, suggestions, questions as we prepare for the journey ahead; when we're in Honduras and travelling via rusty pick-up trucks to the Honduran heartland, muriendo de calor, your thoughts and words will surely become even more precious to us.

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. What better way to show your support for our work than to ship us off in style with desperately-needed items like gloves, medicine, tools, and baby blankets?

Stay tuned for a new post with a list of everything we're hoping to take with us!

Gracias in advance for taking this journey with us.