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Help for Honduras

As their yellow school bus crawled up the Honduran mountainside, the passengers could see the line from a half mile away.

Outside the walls of a school, more than 400 people had gathered on this early Tuesday morning. Many of them were children. Many of them were suffering from scabies, lice, or neglected wounds. All of them were suffering from a general lack of medical care.

The place they called home, Los Pinos, is an impoverished community that largely did not exist until 1998, when Hurricane Mitch devastated the nearby Honduran capital of Tegucigalpa and turned this area into a refuge for about 10,000 displaced people. Los Pinos did not have the infrastructure to support its new residents, and even now, more than a decade later, it still does not have running water, sewer, or proper septic systems.

This was not the typical destination for a busload of college students on spring break, but for 11 second-year students from the UNC Eshelman School of Pharmacy, spring break 2009 was anything but your typical fun-in-the-sun getaway.

The students were part of a medical relief mission from the University of North Carolina at Chapel Hill. The group, consisted of students, faculty, and volunteers, provided aid to underserved communities in and around Tegucigalpa from March 5 to 13. They treated more than 1,700 people, distributed about a ton of medical supplies, delivered food to more than thirty-five needy families, and provided school supplies, book bags, clothes, and toys to hundreds of children.

“This is something I wanted to do before I got to pharmacy school,” says Yunji Kim, one of the pharmacy students who went on the trip. “I was just glad that there was an opportunity for us to do it.”

“They need me down there”

Honduras is the third poorest country in Latin America and the Caribbean, with more than half of its people living in poverty. In the rural areas, where more than 50 percent of Hondurans reside, about a quarter of the population has no access to safe drinking water and 45 percent lack adequate sanitation facilities.

“The division between the haves and have-nots is very striking,” says Christine Walko, PharmD, an assistant professor at the UNC Eshelman School of Pharmacy who went on the mission as a volunteer pharmacist. “You would have the large president’s house right next to a tiny little shack. They do have a mall. They do have prosperous sections, but it’s just odd because it’s interspersed with these very, very poor areas that don’t even have running water.”

Honduras’ healthcare situation reflects the country’s financial problems and sharp social-economic divide. Its per capita expenditure on health is about 3.5 percent of what the United States spends. More than 80 percent of the population is uninsured, and about 30 percent receives no health care at all. Even for the people who can afford treatment, the care they receive at hospitals and clinics is subpar due to a shortage of medical supplies, equipment, and personnel.

Comparing the Standard of Health Care
Honduras USA
Physicians per 10,000 people 6
Pharmaceutical personnel per 10,000 people 1
Nursing and midwifery personnel per 10,000 people 13
Per capita total expenditure on health $91
Percentage of GDP spent on health 7.5%
15.2% (2005)
Life expectancy at birth (male/female), in years 67/73 (2006) 75/80 (2006)
Healthy life expectancy at birth (male/female), in years 56/61 (2003) 67/71 (2003)
Probability of dying under 5 (per 1,000 live births) 27

Source: World Health Organization

The students on the relief mission got a first-hand look at the state of Honduran health care when they visited two hospitals in Tegucigalpa.

“I went into an oncology ward for men, and it was something you see in a horror movie, where you just see a bunch of beds in a room, and people look like they are there waiting to die,” Kim says. “We asked them, ‘Do you know what kind of cancer you have?’ and they said, ‘I don’t know. I just know I have cancer.’ One of the patients, we asked him, ‘When do you think you’ll be leaving?’ He said, ‘I don’t know, but I’m leaving tomorrow to practice my goodbyes.’

“I think a lot of patients kind of knew what their outcomes were, and they couldn’t afford any more medicine.”

As bad as the conditions are in Honduras, they are actually an improvement from 2000, when Jean Davison, MSN, RN, FNP-C, visited the country for the first time. She was a masters student in the UNC School of Nursing at the time, and the surgeon she worked with on one of her clinical rotations invited her on a relief mission to Honduras. Upon arrival, she found a country whose infrastructure had been devastated two years before by the 180 mph winds of Hurricane Mitch, the deadliest Atlantic hurricane in almost 220 years. The hurricane killed more than 11,000 in Central America, including 7,000 in Honduras, and left the country with $3.8 billion of damages.

“I remember when I first came back, it was almost like I was depressed because I thought, ‘They need me down there,’ ” says Davison, now a clinical assistant professor at the School of Nursing. “It was like being taken out of a society where you knew you were making a difference in these people’s lives.”

Davison didn’t stay away for long. She has been part of six relief missions to Honduras since then, first as a student, later as a volunteer, and now as a team leader. She has also led missions to other needy parts of the world, including Romania, the West Bank of Israel, and post-Katrina New Orleans. In 2002, she created the nonprofit organization Compassion Med International to make it easier to find funding and volunteers for the trips. In 2003, the first year Davison led a team to Honduras, she had a group of seven, all medical professionals. That number has grown steadily since. She took students with her for the first time in 2007, when she began offering the Honduras mission as part of an independent-study course in the School of Nursing.

Walko joined the mission for the first time in 2008 as one of three pharmacists in the group. It was the first time she had been to a third-world country, and the experience left such a strong impression on her that not only did she volunteer for the trip again this year, she also took time at the end of her lectures to tell her pharmacy students why they should give up their spring break and pay about $1,500 to sign up for the mission.

“She was telling us about it and left some pamphlets about it,” says Megan Fontana, one of the students who signed up for the trip this year. “I was incredibly interested from that moment. I kind of got hooked right from there.”

Fontana wasn’t the only one. In fact, pharmacy students made up the majority of the 20 students who went on the trip, and Davison had to turn away a few who wanted to go so that she would have enough nursing students in the group. She ended up taking a team of 34, consisted of students and volunteer doctors, nurses, nurse practitioners, and pharmacists.

“Actually, I couldn’t take more than 34 people because we go everywhere in a bus, and that’s the limit you can fit in a bus,” Davison says.

The large number made it possible to split the group into two teams to serve two communities each day. In addition, Davison says having so many pharmacy students made life easier for the volunteer pharmacists, who usually have to fill four or five prescriptions for every sick patient that comes to the clinic.

“In the past, the pharmacists always ran the pharmacy, but they worked with volunteers that acted as pharmacy techs that were not really trained,” Davison says. “So both the pharmacists said this year that the trip was so much easier for them and so much more enjoyable.”

This year’s group was also able to provide more pharmacy consultation because several of the pharmacy students spoke Spanish. That added dimension also enriched those students’ experience. For instance, Sherif El-Refai got the chance to spend some time working in triage, talking to patients to find out what their ailments were, an aspect of health care he doesn’t get much exposure to at the School. His Spanish skills also enabled him to chat more with patients.

“Most of the time, I would be in the pharmacy and I give them something and tell them, ‘This is your medicine and this is what you need to do,’ and then they’ll just keep talking because they just want to chit-chat,” he says. “This one elderly woman, she was just telling me about her kids, how her daughter is going to engineering school, and how she’s going to miss her.”

“They will line up and they will wait patiently”

This year’s relief team brought to Honduras more than 60 suitcases of medicines and supplies, which the students helped collect through donation drives at the School and from other sources. Once in Tegucigalpa, the group set up base in a church that is tightly intertwined with the surrounding community. The pastor, Moises Chino, moved to Honduras from Mexico to preach and to teach. His ministry, Iglesia Misionera de Cristo, operates a clinic offering affordable care. He also runs a nutrition program for malnourished children, a feeding program for poor families, and a micro-lending program to help women who want to stay in Honduras but have no income start small businesses.

Davison first met Chino in 2000 on her first relief mission to Honduras, and he has played a key role in helping her with the logistics of setting up relief operations in Tegucigalpa. Women from the church cooked food for the relief workers every day, and Chino used his connections to help ensure the group’s safety, a top priority in a high-crime city.

“He knows a lot of the local gang leaders, as well as the police, so they kind of looked out for us the whole time that we were there and made sure that we stayed safe,” Walko says.

The clinics usually ran from 9:00 a.m. to about 5:00 p.m. Patients would first go to a triage area, where workers determined whether they needed to see a doctor or if they were just there to get the free vitamins and anti-parasitic medications, which the team gave out to everyone. The patients then received their prescriptions on note cards and proceeded to the pharmacy area, where the volunteer pharmacists and pharmacy students had their suitcases of drugs laid out, ready to dispense medications.

Davison says that kind of crowd isn’t atypical for really needy areas such as Los Pinos.

“When the people in these communities hear that somebody is coming, they will line up and they will wait patiently until they are seen,” she says. “If we get there at 7 o’clock, 8 o’clock in the morning, many times there’s a line all the way out that just keeps going and going. So you walk in to set up, and you are already overwhelmed because you know there are so many people that need to be seen.”

Aside from the number of patients, relief workers also had to cope with the lack of supplies at the clinic sites. They usually operated out of a school or a church that was, in Walko’s words, “pretty much just a cement building that they clear everything out of.” At some places, the workers didn’t have scales, so they had to estimate children’s weight to determine the right dose.

“There were places where we didn’t have running water, where we had to bring all our own water to dissolve the medication in,” Walko says. “There would be dogs running around the pharmacy. That was not the best situation. It was pretty rustic, but the patients make it quite worthwhile for us.”

Memorable experiences

The relief workers brought back plenty of stories and pictures of the patients they treated: the woman in Los Pinos with a year-old leg injury that had turned into a giant ulcer because she didn’t have access to medical care; the 2-year-old, asthma-stricken boy in Nuevos Horizontes who got better instantly and fell asleep in his mother’s lap when Walko treated him with a nebulizer; the paraplegic with bedsores and infected wounds who couldn’t make it to the clinic (so the relief workers went to him); the woman who wept when she received a home visit because she didn’t expect anyone would bring help to her doorstep; the toothless old lady who flashed a big gummy smile and hugged the pharmacists and students after they ground up her anti-parasitic medication for her.

The students’ time outside the clinics proved memorable as well. On their fourth day in Tegucigalpa, each relief worker adopted a child from a poor family for a day. They went out to lunch at either McDonald’s or Pizza Hut — a special treat for the kids — and bonded over hamburgers and pepperoni-and-cheese pizzas.

“A lot of them saved food for their brothers and sisters,” pharmacy student Cindy Arocena says. “They stopped eating after a while, and then when we asked them, ‘Are you full?’ there was one kid that said, ‘No, I want to take this to my sister.’ ”

Later that day, the relief workers went to the communities that many of their kids were from to deliver food to needy families. They delivered more than 35 food packages — large plastic bags that contained $30 worth of food, including a lot of raw ingredients such as rice, sugar, and flour, which was enough to feed a family of five for a week.

“One of the food packets that went out in one of these really rural, very poor areas, the woman, when she saw the students bringing the packets, said they were angels because she had run out of everything to eat, and she had four children,” Davison says. “And she just burst out crying. It made such a difference in that family’s life to now have a week’s supply of food.”

The experience had a powerful impact on the students as well as they saw up close the poverty in which their adopted kids lived: tiny, crowded one-room shacks made of thin sheets of tin or wood, often smaller than a 10-by-12-foot office and some without running water. In one such house, El-Refai found a single mother with 10 kids.

While many students on the trip were shocked to see such poverty, it was a familiar sight for El-Refai. He lived in Cairo, Egypt, before moving to New York in second grade. He has made frequent trips back to Egypt and has also been to other countries, including Saudi Arabia and Palestine. Those experiences exposed him to the kind of poverty he witnessed in Tegucigalpa, or even worse. In fact, he signed up for the Honduras mission in part because he wants to set up similar relief efforts in Egypt after he graduates and thought this trip would help prepare him for that undertaking.

“Even if it’s a different language and culture, the needs are still the same; people are still trying to get enough food to feed their families,” El-Refai says. “They are very sick. They try to find help but don’t have the means to get it. It’s the same type of situation.”

Arocena also was no stranger to what she saw in Tegucigalpa, having grown up in a poor family in the Philippines. She remembers being one of the kids receiving free supplies from missionaries. On the Honduras mission, she found herself playing the opposite role.

“In the Philippines, we also have missionaries that come there,” she says. “When I was younger, I didn’t really understand what’s going on, why they are here. I always just thought of it as free stuff.

“But in Honduras, it was a different thing. Knowing that we were actually doing something for them that they need, that they would never have otherwise, it was just amazing.”

Despite the living conditions, however, the students say the spirits of the people they encountered in Honduras, particularly the kids, did not betray the poverty that surrounded them.

“The poverty, you can see it based on the physical features and how much people actually have, but you don’t see it in their spirits, which is really interesting,” Fontana says. “They are not constantly like, ‘Oh, woe is me.’ They have a good spirit about them, so you don’t instinctively think they are in poverty.”

Later in the week, the relief workers helped with the church’s feeding program for malnourished kids and gave clothes to the children who came, including many of the ones they had adopted. At the end of the trip, when the kids showed their appreciation with a song-and-dance show, a lot of them were wearing the clothes they had received from the relief team.

“So it was kind of like coming full circle, and it made you realize what an impact you had just on this one child and their life,” Davison says. “And what was fun about that was that the kids were just so grateful. They were so appreciative. During the program, when they weren’t singing, they would run up and sit on the lap of the person who had adopted them.”

“When they were doing their program, I was crying,” Arocena says. “I was bawling because this might be the last time I’m ever going to see this kid again.”

After the trip

Just as Arocena thought about what would happen to her adopted kid after she left, many of the other relief workers also wondered about the future of the people they met.

In Walko’s case, she’s doing something to help improve the future for one of those people. While delivering food packages during the 2008 mission, she met Rosa Gomez and her 13-year-old daughter, Paola. She saw them again on this year’s trip, and she stays in touch with them through Chino, who has access to e-mail.

“[Paola] has a speech impediment and doesn’t speak a whole lot, but she would always try to sit next to me and just look at me and smile,” Walko says. “I couldn’t say much in Spanish. I offered her chocolate once, and she looked at me and said, ‘Thank you.’ I said, ‘Aha, I caught you! You know some English!’ ”

Paola’s father was an alcoholic — “Every time we saw him, he was passed out in a corner in the middle of the day,” Walko says — so Rosa did what she could to take care of the family, but they could not afford further education for Paola, who has to go to a special school because of her speech impediment.

“It’s $27 a month, so I said, ‘I’ll pay for it,’ ” Walko says. “That’s something easy that I can do that will make an impact for them.’ ”

Providing for a child’s education is just one way Walko is trying to help the Honduran people beyond the relief mission. Instead of trying to revamp the entire system in Honduras, she looks for realistic ways she can help make an impact. For instance, she wants to find a way in the future to make HPV vaccine available to the people there, as cervical cancer is a common cause of death among Honduran women, mainly due to the lack of screening and vaccination.

Walko will also get a chance to see Paola again as she has decided to continue volunteering for the Honduras mission. Whenever she goes to the grocery store now, she keeps an eye out for sales on supplies for the next trip.

“It touches everyone in a different way,” Walko says about the experience in Honduras. “How you decide to keep it a part of your life — whether it’s telling someone else or being a part of it in the future — is up to each individual. I think I kind of got sucked in now. It’s what I’m going to do every year. I think it’s a great thing to offer to our students. I already have a lot of people who are excited about it next year.”

Walko is not alone in her endeavor to do more to help. Just as Davison’s first trip to Honduras prompted her to keep going back, this year’s mission had a similar impact on many of the first-timers. Arocena says she and another student have talked about going back to Honduras in four years to try to find their adopted kids again. Walko says some of the students have gotten involved in groups that help Honduran children. Many of the students intend to sign up for future relief efforts, and they are spreading the word about Davison’s mission trips.

“Anybody who is able to do it, I really recommend it,” El-Refai says. “Before I went, even though I was really excited to go, I was like, ‘When I do this, I’m not going to have a spring break.’ But honestly, it was probably one of the most fun, memorable spring breaks I’ve had.”