Un toque de Honduras – Geoff Winder, MD

Written by Geoff Winder, MD, PGY3 at Kaiser Permanente Napa-Solano Family Medicine Program while on Global Health rotation with ENLACE Foundation in Las Lajas, Taulabé, Honduras in July 2016.

While climbing the road to El Diviso yesterday morning, our little silver bullet of a rented van sputtered its wheels against the rocky ruts worn deep into the ruddy soil. Fifteen eager volunteers from across Honduras and the States (and one from Switzerland) had packed in shoulder to sweaty DEET-soaked shoulder. Violeta dug her fingers into Eric’s arm as the momentum around a now familiar curve weighed heavily across our back (the fifth) row. Moments later Lago Yojoa made its brief appearance below, framed amid sloping hillsides and, at the northern horizon, the hazy peaks of one of two transcontinental mountain ranges.

At some point along this daily trek, I’ve no doubt that each of us contemplated in some manner the beauty of the countryside around us…I suppose Violeta may have spent more time contemplating her mortality, but clearly there’s value in that too ;).

Un toque more than five days in, we’ve collected more memories, moments and marvels than one could possibly hope to record with pen, paper or blog post. And at least in my case, I’m learning to deal with a certain amount of (happy) fatigue after long mornings seeing patients in our pop-up clinic within the El Divíso iglésia and full afternoons throwing our hands, minds and sometimes dance moves (in Tessa’s case) into an incredible array of projects already transforming the under resourced village.

Amid the nonstop clamor – and this will be no surprise to those who know them – I continue to be amazed at my co-residents innate adaptability and the intuitive ease with which they connect to patients and their families across cultures, across linguistic barriers, and across fly-strewn tables covered with handwritten visit summaries of a family of seven. A sample smattering of memories might include Elise wetting and packing soil into a newly installed high(er) efficiency stove, Violeta riling up a class of elementary school niños in with a lesson about preventing los piojos (lice…), or, of course, any hundreds to thousands examples of Tessa’s limitless energy and enthusiasm acting as both the pilot light and DuraFlame (secondary shoutout to a Joelle obsession) when the last licks of energy begin to flicker in the late afternoon lull.

I count myself fortunate to be surrounded by a unique, varied but singularly dedicated crew of providers – and not simply in the medical sense, though they are most certainly that too.

With that, and with fatigue creeping (and a nice helping of my trademarked run-on-sentences), I’ll just go ahead and leave you with a certain other classic toque of Honduras – shamelessly adorable niño portraits. Hasta el próximo.

Cambios Incrementados

Though a week has passed since our return to California, I’ve found myself with precious little time for reflection on the innumerable experiences we shared in Honduras. Within three days of our return, I was again jumping on an early morning flight en route to Kansas City to join our Kaiser Napa-Solano team at the AAFP National Conference. Chatting with prospective applicants, whose passion for righting the wrongs of health disparity was so often worn right on their sleeves (or occasionally just below their name badges), perhaps I shouldn’t have been surprised to find our conversations looping back around to Honduras so often. As such, these discussions became an unexpected, and welcome, venue for reflection.

Into each short clinic encounter, every family and patient brought with them untold experiences, tales and stories of their own – informing their lives, medical conditions and the prism through which they understood their own health. That I was able to share in just a day of so many of their lives is a privilege I will always hold in a special place. And yet among all of these encounters, my mind – and with it my conversations in Kansas City – continues/d to return to one particular instance that in many ways exemplifies the incredible difference our partnership with ENLACE can make in the lives and communities we seek to reach.

Tuesday in El Diviso, my second patient of the morning strode to the table from the church pew on which he had been waiting. My translator and I both greeted him before we all settled into our seats at the fly-covered table, our hands absently swatting them away. I reviewed his vitals; wnl, confirmed his name; Biblical, and his age; appearing quite a bit younger than his stated 23 years, something I can certainly relate to. It took only a few pointed questions to discern what had been troubling the young patient. He went on to describe “un dolor del estómago que duro much años…también me duelen los testículos – pero sólo en el lado izquierdo.” To paraphrase, he had been suffering for about 5 years with intermittent LLQ abdominal pain, with radiation to the testicles/scrotum worsened/exacerbated by lifting, bending, or any significantly tasking physical activity. On further conversation, he mentioned he had been unable to find work due to his limiting symptoms. Finally, with a resounding affirmative response when asked if he had recognizes any mass or protrusion in the groin or testicles, I let him know my initial assessment straight away. “Sospecho que tenga una hernia / I suspect you have a hernia.” Undaunted, he responded with a vigorous nod – “Creo que sí.”

After running the story by our ever-ready-wonder-Doc, Javier, we escorted the patient to the lower level of our makeshift Church turned clinic for a private exam. It took only a moment to confirm the suspicion; a large, left-sided sliding inguinal hernia. Thankfully no evidence current or historical of incarceration, but it was clear that he needed surgical correction. However, within the Honduran health care system, he would no doubt encounter significant – if not precluding – barriers. If he were able to come up with the money (a big IF within such a socioeconomically depressed community), Javier explained it would likely be months to a year before the surgery would likely take place. Having already lost 5 years of labor and income with his first child on its way, and in distinct danger of an emergent incarceration, we all agreed months to a year was too long to risk.

As such, Javier sprang into action. Recalling that our indefatigable team member Gaby (a highly skilled and generous Honduran Dentist currently practicing pro-bono in the surrounding communities) currently happened to be hosting an American, Pediatric Surgeon friend and colleague, Javier wasted no time in tapping Gaby on the shoulder between her many extractions that day. The Pediatric Surgeon would be performing surgery all week at the local hospital, a ways down the main highway once descended from the hilltop village (a many hours long walk, all told). Within 15-20 minutes, Gaby had spoken with her friend, who agreed to the surgery despite our young patients decidedly non-Pediatric age range (his youthful appearance once again serving him well :). A few additional minutes later and the patient was climbing into the passenger seat of another of our team members truck, and they were away down the winding road to the hospital for consultation.

Less than 24 hours later, the hernia repair was completed at no cost to the patient (thanks to the benevolence of the Surgeon and some added donations from our amazing team). What could have been months of continued pain, risk of emergent and potentially life-threatening injury, and continued lost wages for a young, newly forming family had been averted. Had our ENLACE and Kaiser team not been present to see this young patient, it is impossible to predict how differently this story could have developed.

Although I was only a small cog in the wheel that brought positive change to the lives of this patient, his family and their community, I am proud to have been provided the opportunity to do so. Most lasting change is made in small, incremental steps. That day, however, what was a small step for our team engendered a life changing difference.

We continued to receive updates on his recovery over the course of the week; all positive.

Taking the time now to reflect on our short time in Honduras, I am struck by how many similar stories and instances must have occurred of which I remain unaware. In some ways, our experience is not unique – indeed, I would prefer it not to be – and rather live in the knowledge that small steps and incremental changes being made throughout the world by like-minded people and teams such as our own can make such significant, and continual, positive differences in the lives of those who need it most.

Until next time Honduras!…in the meantime, here are some more photos to keep the memories fresh.