As you read this, I am in Gracias, Honduras, an old colonial city located in the mountainous, western region of the country. This is my 11th trip to Clinica Medica San Lucas as part of a Christian mission group that provides charity care. The site was founded in 1994 by Mark Veenstra, MD, an orthopedic surgeon from Kalamazoo, and his wife, Becky. Over the last three decades, the Veenstras have organized and escorted 86 teams of volunteers to Honduras.
Honduras has been in the news as the source of many migrants who have packed up and walked to the Mexican border, seeking a better life in the United States. The two main cities– Tegucigalpa and San Pedro Sula– are crime ridden with large sections under the control of street gangs. Residents and businesses are extorted to pay protection money to the gangs, or, they are killed.
Most of the migrants seeking sanctuary in the U.S. are fleeing for economic reasons, or because they have been terrorized by gangs. Large systemic problems impede economic progress: most homeowners do not have clear title to their property and live at risk of being evicted by other claimants; public schools mandated by law to be open are frequently not operational; municipal water and electric systems only function intermittently.
Successive Honduran governments have failed to address widespread crime and corruption or fix the infrastructure problems. Following elections last year, the immediate past president of Honduras, Juan Orlando Hernandez, was extradited to the US and is currently in prison awaiting trial on drug trafficking charges.
One Michigan-based organization that is working to solve Honduras’ macroeconomic problem is ASJ (Asociacion para una Sociedad Mas Justa). Based in Grand Rapids, ASJ maintains an office in the Honduran capitol of Tegucigalpa to help crime victims, promote clean water, clear land titles, and ensure that public schools are staffed and open.
Meanwhile, in Gracias at Clinica Medica San Lucas, our group of volunteers tackles individual medical problems. Patients from a vast surrounding area are referred to us by local physicians. Some have been waiting months for our arrival, as there are no other treatment options.
The type of surgery we do during our week depends on the surgeons who are part of our team. As an anesthesiologist, I have often accompanied Raghu Elluru, MD, a plastic surgeon who repairs cleft lips and palates, and revises burn scars (burns being a common childhood injury from cooking over open fires). This year, I am joined by a gynecologist, Steve Lown, MD, and Doctor Veenstra and his son, Joshua Veenstra, MD, an orthopedic surgeon also.
Our week will be filled with oophorectomies for gigantic ovarian cysts, hysterectomies for extreme uterine prolapse, and repair of congenital club feet and severed hand tendons from machete wounds.
My week in Honduras, though challenging because of equipment and pharmacy issues, usually goes very fast and is refreshing in several ways. It never fails to rekindle my enthusiasm for medicine.
Here are some of my observations:
- There is no EMR in Honduras, so we spend our time with patients, not with computer screens.
- There are no insurance companies to address.
- Though we work hard, we socialize and take breaks between cases.
- Honduran coffee is good and widely available.
- Honduras has a failed national health system in which care is “free,” but unavailable.
- The patients are truly grateful for our services.
Though we face a constant stream of inevitable problems: power outages, equipment failures, expired medications, security issues, etc., there is a feeling of comradery among the physician, nursing, equipment, translation, and cleaning staffs. We recognize the value of what each team member brings, and we work together to overcome these challenges.
What is really satisfying about my week in Honduras, and the reason I look forward to returning every year, is the practice environment. In Honduras, I find I can really concentrate on providing care for the patient at hand without the distractions imposed upon me by outside forces. It is a reinvigorating week that reminds me of something that is too easy to lose site of at home: In the end, it is all about the patient.
Tom George, MD