Clinica Esperanza

Posted by Jillian Main, MD (a second year Ob/Gyn resident from Kaiser Permanente, San Francisco serving a global health elective at Clinica Esperanza in Roatan, Honduras).

Upon arrival to Clinica Esperanza, I was impressed with how new and fully stocked the clinic was.  I have worked at clinics in Guatemala, Mexico, and Ecuador, and this was by far the most modern and comfortable.  There were ample gloves, hand gel, towels, gowns, medications and medical supplies, which led to a safe practicing environment for both the patients and practitioners.

The patient population was made up mostly of the local colonies of the poor immigrants who settled on the islands after the major Honduras hurricanes.  These “towns” are called “La Colonias.”  The average income is about $3,200 per family/year and they have very little access to healthcare.  There is one public hospital, at which I had the opportunity to work, and it has virtually no financial support.  There is no drinking water, toilet paper, or soap, and the wards are made up of 8-10 people in a room of beds without curtains.  It only costs the patients fifty cents per visit, but they may end up waiting all day without ever seeing the doctor.  Therefore, there is a huge local support for Clinica Esperanza.

My experience was mostly based in the clinic.  They have a new Labor and Delivery (L&D) ward, which is still awaiting licensing, so it is not yet open.  I worked from 8 am – 2 pm daily, seeing both routine gyn and obstetric patients, but also the more sub-specialized Ob/Gyn patients.  I managed many teen pregnancies, gestational diabetes, pregnancies complicated by malaria, multiple missed abortions and outpatient management of pyelonephritis in pregnancy.  I also saw several patients with secondary amenorrhea, in which I had to decide if a certain lab, which would I would normally reflexively order in the US, was worth the cost of one month’s salary.  I had to rely on my history and physical to make the diagnoses and could only use labs as supplementary.

There is a strong need for women’s healthcare and advocacy in Honduras and I hope I was able to educate both the patients and the permanent clinic employees on how to better address these issues.  I plan on working from the US to help involve a clinic based Ob/Gyn attending for more difficult cases and to help organize the infrastructure of the L&D.  I plan on returning next March during my elective time to continue these goals.  It was overall a great experience and one I would recommend to any second year or above Ob/Gyn resident.