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.