During February 2004, I traveled to La Cuenca to volunteer with Un Mundo in the local health center.  At the time, I was a fourth-year medical student.  I had long been interested in international health, and had spent two years in West Africa as a Peace Corps Volunteer.  I decided to join Un Mundo because I was looking for a well-organized grass-roots organization, within a couple of time zones of home, in a politically stable country, where I could potentially contribute despite the small amount of time I had available.  My eventual goal was not only to learn about the community and do good work during my month in Honduras, but also to establish the groundwork for future trips.

The basic set-up in El Pital is a small health center with a simple exam room, pharmacy room, vaccination room, waiting room, file room, and bathroom.  It is furnished with running water and electricity as well as some great murals (thanks to Un Mundo’s Campesino mural project!).  The medications in the pharmacy are provided for free by the Honduran government.  They include a limited supply of basic antibiotics (amoxicillin, Bactrim), anti-parasitic and anti-helminthic medicines, aspirin, tylenol, ibuprofen, antifungal creams, albuterol, multivitamins and iron pills, oral contraceptives and Depo-Provera, and the occasional antihypertensive or diuretic or antihyperglycemic.  There is also a good supply of childhood vaccines, kept safe in the vaccination-room fridge.

On a day-to-day basis, the clinic is run by a woman with one year of “nursing” training who travels to El Pital each morning; she’s somewhere between the level of a CNA and an LN in terms of training, and does stellar work with the resources she’s been given.  In addition to caring for the steady stream of patients, she keeps busy making posters, promoting vaccines, and updating epidemiologic charts for the area.  There is also a local doctor (a Cuban doctor, at the time I was there) who visits once a week.  Any complicated cases get sent to La Ceiba, the major town about 45 minutes down the mountain, for care at the regional public hospital.  Villagers are expected to pay a small sum for consultations at the clinic, but medications are free.

During my time in El Pital, I split my days between doing clinical work and exploring the community.  As I was only a fourth-year medical student, I felt that I had only limited clinical expertise.  Nonetheless, I found that I provided both help and moral support for the nurse, and did in fact know things that she didn’t.  I saw a large variety of cases, ranging from the standard blood pressure control to the exotic cutaneous leishmaniasis.  Some of the cases definitely pushed the limits of my knowledge, especially considering the limited diagnostic facilities!  I was also frequently challenged by local Spanish health-care words, but the nurse was great at translating into more standard Spanish.

In the afternoons, I visited homes in the community, spoke with members of the local health center advisory committee, shadowed the Cuban doctor in Jutiapa (a town 30 minutes up the mountain), conducted basic health education classes, and translated health information packets from English into Spanish.  This aspect of my daily life was just as important to me as the clinical work.  I saw it as a necessary backbone for any future work in the community.

I lived with the Lobos, a delightfully warm and friendly extended family who live across the river from the health center.  From them I learned the ins and outs of the community, local slang, and how to make tortillas.  I also formed friendships with some of the other gringos who were concurrently volunteering for Un Mundo; Kate Venner, in particular, was incredibly welcoming and helpful.  She not only got me oriented, but quickly directed me to where I could be most useful.

I was very impressed by the community’s willingness to welcome strangers, their interest in learning about their own health, and their commitment to their children’s health.  I was uplifted by the amount of support the government gave to this rural clinic, which served over 1000 people in El Pital and surrounding communities.  I was amazed, though, by the lack of access to what I consider basic diagnostic modalities (e.g., glucometers and sphygnomoters, both of which were absent from the clinic at the time I was there).  I was also frustrated by the lack of certain “basic” medications such as broad-spectrum antibiotics and diabetes medications.  Finally, I noticed a significant number of major projects which could be undertaken by future volunteers:  basic water and sanitation projects (latrine building, well-digging, etc.); basic health education projects (especially about HIV, tuberculosis, and diarrheal illnesses); and expansion of women’s health facilities (e.g., provision of monthly pelvic exams/pap smears).  Of note, the very impressive women’s cooperative (run by Rosario Lobo) provides a rather captive and interested audience for health education, and work with them could provide a satisfying short-term project for future health volunteers.

The month ended much too quickly, and since leaving I have been incessantly plotting how to return.  Unluckily, I am currently in my residency in Emergency Medicine so I have limited free time in which to travel for the time being.  Hopefully, though, work with El Pital will become a mainstay of my long-term medical career.   I would strongly encourage other health professionals to consider a short- or long-term visit to the area.  Anyone with questions is welcome to contact me for further information.

 Megan Ranney, MD

Dept of Emergency Medicine, Rhode Island Hospital/Brown University, Providence, RI