ENLACE Foundation – Gealina Dun-Melli, MD

Written by Gealina Dun-Melli, MD, PGY-3 at the Kaiser Permanente Napa-Solano Family Medicine Residency Program while on Global Health rotation with ENLACE Foundation in Taulabe, Honduras in July 2018

Today was our first day of clinic in El Diviso! Kaiser Permanente has been coming to this area for the past few years with the help of Don Israel and Dr. Javier Sevilla. We were joined by multiple community physicians, la Doctora Ester and Doctor Fabricio and Dentista Gabby. We are very lucky to have these community relationships as they have helped us maintain connections with the community so we can hopefully make some lasting changes outside of our single week.

Things I’ve learned so far (among other things):

• Finding vegetables in Honduras is hard. We attempted to talk to patients about healthy eating (comer saludable) which we found to be more difficult than we thought in this community. They often have rice (arroz), tortillas, frijoles (beans), occasionally chicken (pollo) and potatoes (papas) for meals. When asked about vegetables (verduras), they reported it was difficult to get vegetables. They do have access to sodas (frescos) and chips (churros) and it seems that they often prefer…these over spending the money on fruits and vegetables. Yet it seems that buying vegetables in town may be cheaper than the sodas/juices and chips.
• There were many young women who are pregnant (embarazada), but there is no desire to have a conversation about contraception (contracepción). According to some of our local physicians, sometimes the men/husbands pressure the women not to use contraception. There is not a lot of education regarding the natural rhythm method and general preconception counseling is limited. The women seem very shy and timid about the subject.
• The health care system in Honduras is bottlenecked by residency training. Medical students have 8 years of study after high school, and then they have 2 years of required service – one intern year similar to what we have in the US and then a year or service to the government during which they can be sent to any regional hospital. This means that people are at least 28 years old by the time they are able to practice on their own. After this, they are considered a General Practitioner. Most people want to go to residency, however there are limited spots for <50% of graduates. Many go abroad for residency, but >40% of physicians are listed as unemployed. Some statistics suggest that 40% of Honduras’s health care is provided by volunteer medical brigades like ours. Whether this is helping the system or enabling a broken system, it is hard to say.
• Our most common diagnoses include: Parasite treatment (tratamiento para parasitos, both for active infection and prophylaxis), well child visits (niño saludable), hypertension (hipertensión), dermatitis (skin rash), cold symptoms (gripe), headache (dolor de cabeza), and acute pharyngitis (faingitis aguda), reflux (reflujo).

For those who come in the future, I hope these tidbits help enlighten you so you arrive less ignorant than I did. The people here are very grateful for our time and care and we are privileged to be given the opportunity to affect these lives!

Gealina Dun
Family Medicine Resident
Class of 2019, PGY-3

P.S. Read Ethan’s entry from today – it’s a beautiful poem that reflects many of our sentiments I don’t have his skill to express!