The following description of volunteer opportunities at the Centro de Salud Joseph Hutz was written by Cheryl Smalley after her work in Honduras in late 2001and early 2002.

I recently spent four months in Honduras, doing volunteer work as a nurse practitioner at two rural health centers. Both clinics were within 25 miles of La Ceiba, the third largest city in Honduras, located on the north coast.

I am a family practice nurse practitioner from Seattle, Washington, and had the chance to take a few months away from "normal life" and decided to spend the time both improving my Spanish and doing volunteer work in communities that might benefit from my knowledge and energy. I spent most of my weekdays at the two rural health centers, and spent most weekends exlporing the city of La Ceiba and its surrounding. One clinic was in the village of El Pital, about ten miles up the Cangrejal River, a beautiful whitewater river which empties into the Caribbean just east of La Ceiba. The other was in the community of Salado Barra, located within the Cuero y Salado Wildlife Refuge, about thirty miles west of La Ceiba.

Both clinics were staffed by Honduran "nurses" — in one case, a woman with training similar to an LPN and, in the other, a woman with one year of training in rural health care skills. Both of them worked primarily by written protocols, and dispensed a limited formulary of medicines, including basic antibiotics, anti-parasitics, oral and injected contraceptives, and asthma medicines, as well as over-the-counter products such as antacids, vitamins and analgesics.

The patients who came to the clinic were wide-ranging in age and complaints — many of them with an array of routine and minor ailments or concerns, just as might be seen in any family clinic. Of course, there were many gastrointestinal problems attributable to parasites — much more than would be found in a non-tropical or more developed setting — and the poverty of the local people resulted in many problems with basic nutrition and self-care awareness. On occasion I saw more gravely ill patients — usually acute cases of infectious disease, like pneumonia or gastroenteritis, or traumatic injuries, such as machete wounds. Rarely, patients would be referred out to clinics in nearby towns (with electricity and MD staffing) or to the hospital in La Ceiba. But just as often it became clear that the very poor patients had no other resources and depended on the local community clinics as their only option for medical help, their one and only line of defense.

I was able to bring limited supplies of medicines with me to supplement to basic ones supplied to the clinics — a few broad-spectrum antibiotics, oral anti-fungal medicines, and steroid inhalers served me very well in treating problems which would have been resistant to the limited government formulary. But for the most part, I felt that my usefulness was simply in being there to evaluate and treat patients, to support the staff nurse with my knowledge and friendship. And of course to learn more than I could possibly teach from the people I worked with and for.

While I was working at each clinic I stayed in nearby living quarters. At one clinic I stayed with an extended family, the Lobos, just outside the village where I worked. The family compound was at a beautiful spot on the edge of the Cangrejal river, where the family inhabited a cluster of houses and graciously shared what they had with visitors. The accommodations are extremely simple, with meals cooked over a wood fire, nights lit by candle and gaslight, small livestock sharing the space with the people who live there. Dona Margarita, the matriarch of the clan, welcomed all comers with warmth and good humor.

At the other clinic, in the wildlife refuge, I stayed in the building which houses the refuge foundation. It was a woodframe stilted building with two small, simple rooms for visiting volunteers, each room with a cot, a chair, and a few nails on the wall for belongings, and with a shared cookhouse (with a propane cooktop and no refrigeration) on the grounds, where I could prepare meals with food which I brought in every week I was there.

When I arrived in Honduras I spoke some Spanish, learned over the years through travel in Latin America — both speaking and understanding at a low intermediate level. I spent my first month in an immersion course in La Ceiba, which substantially improved my ease in Spanish, although I still am far from being fluent. It was essential for the work to be able to communicate in Spanish to some degree, since neither nurse I worked with spoke English at all. But both nurses were incredibly helpful in "interpreting" for me on the occasions my Spanish was inadequate for dealing with uneducated, rural patients, who sometimes spoke too quickly or very softly or in unfamiliar colloquial terms. They were also very good at paraphrasing my advice to patients, when it seemed useful, in language they might more easily understand. My sense of things was that, for anyone interesting in healthcare volunteering in rural areas, a strong intermediate command of Spanish is the minimum needed to function without a Spanish-English interpreter, and, of course, the more Spanish the better for managing more complex health problems.