Las Mercedes Environment

·         The clinic is set in a beautiful back drop in the mountains in Intibuca Department (province)

·         Patient travel extremely far, often in the heat, walking up to 3+ hours to get to the clinic and wait several hours to be seen.  One patient arrived on homemade crutches and others came with 3-6 children in tow, the little ones often were in cloth slings on their mothers back

·         Community is extremely grateful and generous.  Some patients brought gifts of appreciation from the little they have including plantains, potatoes, and eggs.

·         Incredible fresh food, which women worked all day to prepare for us, in addition to completing their own family obligations. 

·         Extremely hard working people,  sometimes working up to 70 years of age in the field with very little complaints

·         Seeing  5 year olds working with the machetes at 6 in the morning

·         Students were thankful to have clinic as housing quarters with flush toilets, as previous students did not have those luxury 

·         After a few days, the students got used to not having electricity and eating dinner by headlamp

·         The cold shower and occasional lack of water, broadened their horizons regarding resource limitations that many in the world face

·         Got used to sleeping when dark and up with daylight.  There was an hour of daylight to explore the community before getting starting with breakfast and treating patients for the day

·         Stars were brightest they have ever seen

·         Driving on unpaved twisting, mountainous roads  can be scary, but our experience driver Nehemiah always gets us to our destination safely

·         The community had a lot of dogs that serve as guard dogs and they view the animals differently than we do.  It left many of us missing our furry friends at home. 

Perspectives about Patient Care

·         Challenged both acute and chronic evaluative skills

·         Adjustment to performing vitals.  In the US there is a reliance for basic assessments on equipment and these skills were done manual: blood pressure, heart rate, x ray, lab/blood work

·         Focus education on health maintenance:  ie drinking water, body mechanics, brushing teeth, and general hygiene

·         Create appropriate education tools based on the resources that are available in the community and the variable literacy of the patients

·         Difficultly communicating with patients, even for the Spanish speakers, because of the patient’s limited health literacy and knowledge of how the body works.   Additionally, they often refer back to the chief complaint and struggle to describe symptoms in a way that we understand them. 

·         Improved Spanish skills; even those that started with a very limited vocabulary became comfortable interacting with patients after a few days.   Working on Spanish was mentally exhausting and we often turned in for the night around 8-9pm, after waking up at 5am.

·         Different diagnoses seen: shingles, hydrocele, cataracts, ruptured tympanic membrane, trisomy 21 (Down’s syndrome), Bell’s palsy, lupus, unstable angina,  RC tendonopathy, seizure, pneumonia, asthma, low back pain, hypothyroidism,  fungal issues, scabies, impetigo, lice, reflux

Thursday April 4th

This morning was started with another great meal as we are preparing to head out to the Chorti, a local village of the Maya people.  We will update more pictures and information from the clinic days later this evening, but we are having a great experience.

Updates from the week-Friday

Friday March 29^th

A 5:30am wake-up call got our day started so we could get the bus packed up and head to Las Mercedes.  Some endured the cold showers which really woke them up and got their day going.  Today is a beautiful day, after a colder than expected night.  On the way to Las Mercedes, we stopped at La Esparanza Hospital to see the local facilities.  It was quite eye opening to see limited access and the need for patients to bring their own blood, linens, and medical supplies for surgery.  During our stop we had a tour of the hospital with the head nurse and she was able to share some information regarding her training.  She completed 5 years of schooling at one of only three Universities that trains professional nurses.  The majority of the practical nurses receive only one year of training and some have only completed education through the 6^th grade.  Currently, there are not any males that are trained as professional nurses, but a program has recently started to train male practical nurses.  For each of the four areas of the hospital, there is one head nurse and 2-3 practical nurses.  Since we arrived on Good Friday, the hospital was not at crowded as it typically is, and there was only one head nurses covering the entire hospital.   Others were surprised how little it cost ($10) to deliver a baby and $50 to have a C section, but how high that cost is to the local community.   The medical school training is very similar to that of the training in the states, a 5 year integrated program which includes an internship in their last year and most end up becoming a generalist as opposed to the majority of MD end up with a specialization.  Similarly to the internship for the MD programs, the last year of nursing training is also an internship and this is a year of service that they are assigned to.  Since the medical school and nursing school are designed similarly, it helps foster a great relationship between the physicians and nurses. 

Updates from the Week-Thursday

Thursday March 28^th

We finally arrived in Honduras on our second attempt!  The people at Delta were very nice getting us rebooked on Thursday after our flight was cancelled Wednesday and things went smoothly with check in, since we had a practice run the previous day.  There was a delay on our flight leaving Thursday and we questioned if we were every going to make it on our way.  After an hour and a half of sitting on the plane, as a light on the wing was being fixed, the plane took off.  The lay-over in Atlanta went without incident and landed in Honduras to beautiful (but slightly breezy) weather.  All of our bags arrived and we settled in at the Heifer house with Gloria and her sister Norma.  The evening was spent packaging the medication into appropriate patient doses and enjoying some great local food and learning interesting facts about each other.  The doses were sorted by hand, counting the pills out and labeling the medications in preparation for patients at the clinic.

More Clinic and Arrival in Copan

How many lives has the Duke team touched this week as they delivered basic health care services inside a hospital in the rural Honduran town of Las Mercedes? The team has seen about 430 patients so far - incredible.

On Monday, the team saw 130 patients and completed clinic yesterday with another 50 patients.

The team packed their bags and left for Copan today. They have arrived safely and are relaxing tonight in the hotel. Tomorrow, the team will have one last full day of clinic in Copan before a day of touring and heading back to the U.S.

Exploring the area

Las Mercedes

 

Seeing patients at the clinic

Hundreds of Patients Receive Care at Clinic

Over the last few days, the Duke team of nursing and medical students have been incredibly busy delivering basic health care services to the Honduran community of Las Mercedes and surrounding areas.

On Saturday, the team saw 115 patients. On Sunday, the team saw 135 patients. Team lead Dr. Denis Diaz says the students are enjoying themselves, learning a lot, and are excited to have the chance to make their contribution to the local community.

Dr. Diaz says third year Duke medical student Ramon has really been a shining star and doing so well with the patients. As a result, the team opened up an additional room so he could see even more patients on his own, under the guidance of Diaz and Dr. Penny Cooper.

More patients are coming to the clinic to be seen today, and the team will have another 2 full days of clinic --- one more in Las Mercedes and another one in Copan later this week.

Team Prepares for Arrival of First Patients in Las Mercedes

The Duke Exploring Medicine team arrived in Las Mercedes early Friday morning. The small  rural community will be their home-site for coming days as they see patients inside the clinic. 

The students arrive in Las Mercedes with all their bags.

The clinic where the team will see patients.

The beautiful view.

Upon arriving, Rosa and the team set up the pharmacy -- antibiotics, painkillers etc., plus other basic health supplies like toothbrushes, shampoo and soap. Yesterday afternoon, dozens of Honduran families started to arrive at the clinic to be seen by members of the team. For some team members who were on the trip in previous years, it was a wonderful reunion with the locals.

Rosa setting up the pharmacy at the clinic.

The Duke team reunites with the locals.

Yesterday, the team spent a half day doing clinic -- seeing dozens of patients. Last night, members from the Duke team went to a Good Friday service at church.

Today, the team is spending the full day at the clinic seeing patients. It will be a long day, but a rewarding one.

Honduran families arriving at the clinic.

The clinic opened in 2009, thanks to the efforts of Duke faculty member Dennis Clements and a team of partners from Duke and Honduras. LEARN MORE about the clinic and the annual Exploring Medicine student service trip to Honduras. 

Team Arrives Safely

The team (and all their bags) arrived safely in Honduras today! They had a nice meal and are resting before their big first day tomorrow in Las Mercedes. The team hopes to get an early start, so they can set up the more than 1,000 pounds of supplies they brought from Durham before patients arrive at the clinic.

Meet the Group

Anderson Garrett

My name is Anderson Garrett and I am currently in the Adult Oncology Nurse Practitioner program at Duke University School of Nursing.  I have been an oncology nurse for 3  years, working on an inpatient oncology unit at Duke Hospital.  I live with my husband and out "furry daughter" Ella, a 4.5 year old miniature Yorkie, in Cary.  I have a great interest in service, mission, and volunteer work; both in NC and abroad.  I'm excited to start this journey to Honduras and to help make a difference in other's lives.  I am thankful for my family, friends, and fellow members on the trip who have made this possible.  I can't wait to share the adventure!

Dawn Driesner

Hola, it's Dawn here.  I am the faculty member from Duke Physical Therapy School and have really enjoyed working with the Exploring Medicine trip for several years.  I'm excited about returning to Honduras to provide health care and education to the local communities. This experience has helped not only with my Spanish (which is still very limited), but also with increasing my cultural competency and improving care in a multi-disciplinary approach to areas that are typically undeserved regarding access to health care.

Ramon Ruberte Thiele

Hey, amigo!  My name is Ramon and I am a third year medical student at Duke.  Born and raised in Puerto Rico, my nontraditional path toward medicine has always been driven by my desire to help others.  I look forward to serving the people of Honduras and learning more about their culture.  Can't wait to be a part of this amazing experience with a wonderful group of people!

First Airport Trip!!

Still in Raleigh

After one attempt at getting to Honduras that was derailed by mechanical issues on the plane, we are resting up to try again tomorrow.  The bags are still packed and ready to go, so we should have a quicker and smoother go at it tomorrow after our "dress rehearsal" today.  Let's hope that this is not like the moving Groundhogs Day, fingers crossed!

Heading out!

Everything is packed away and we are heading out, it's an early morning here (or late night depending on how you look at it).  We are all meeting at Duke and then heading to the airport.  Once we are in Honduras there will be updates periodically, but we will not have internet access while we are up in the mountains.  I am posting a few pictures from previous years of the clinic in Las Mercedes so you have an idea of where we will be!!

Packing day in pictures!

Packing Day!!

Everyone is getting ready in preparation to head to Honduras on Wednesday March 27th.  Today, we all meet at the School of Nursing to gather the medication, hygiene and school supplies, and additional items that we will be taking with us to provide care to the communities of Honduras.  To maximize the amount of supplies that can be brought, all the items are removed from the traditional bulky packaging and consolidated.  Thank you to everyone who helped with the fundraising and contribution of supplies, the residents will be extremely grateful at the outpouring of generosity!

Dawn

Welcome to Exploring Medicine 2013

The purpose of the course Exploring Medicine is to promote understanding of  the cultural background of the people of Honduras and how that impacts the delivery of medical care. Throughout the semester, topics were discussed to facilitate understanding of how art, history, literature, music, geography, ethics and religion influence the practice of medicine in the Latin American culture. The classes provides a multidisciplinary faculty from Duke and UNC and included time working on medical Spanish to improve the understanding of the culture and facilitate encounters and interactions with Hispanic patients in our own environment. The trip focuses on areas of rural Honduras and provides global outreach through Duke Global Medicine.  Join in following us during out trip!!

Dawn Driesner