Going Global

The Going Global blog is an opportunity for emergency physicians to share their experiences practicing and teaching outside the United States. Submit an article about your experience to EMN at emn@lww.com. Be sure to include a brief biography and photographs of the authors. Photos taken during time spent abroad are also welcome, and should be 300 dpi and in jpg, tif, or gif format.

This blog was started by the emergency medicine residents of Palmetto Health Richland in Columbia, SC, who travel the globe on medical missions. The program is under the direction of Thomas Cook, MD, who oversees one of more than 40 academic departments of emergency medicine that sponsors Global International Emergency Medicine Fellowships.

Monday, November 11, 2013

A Week of Hard but Rewarding Work in Honduras
By Mara Levitt, MD, & Ashley Davis, MD
Honduras, a Central American country bordered by Guatemala, El Salvador, and Nicaragua, is home to more than eight million people, and produces minerals, coffee, tropical fruit and sugar cane. The capital, Tegucigalpa, is divided into 18 departments; we traveled to Intibuca.
Honduras has the highest rate of homicide in the world. The water supply and sanitation varies from modernized water treatment systems to basic systems, from sewer systems to latrines and basic septic pits. A lack of maintenance leads to poor water quality, and residents’ health varies depending on whether they live in urban or rural areas, but overall is poor. The average life span is 70 years old.
We had personal guards escort us out of the city of San Pedro Sula until we reached La Esperanza, a more remote and less dangerous part of Honduras. Our mission was sponsored by Medico (www.medico.org), which provides medical care to the underserved areas of Honduras and Nicaragua. Established locations in each country are sponsored by local patrons.
We were stationed in the community of Monte Verde. Three nuns were the leaders of this community, and have welcomed MEDICO for many years. Three residents, one family practitioner, one critical care pulmonologist, two emergency physicians, many nurses, paramedics, and translators took the trip. We stayed in small rooms with our teammates, and ate the local foods that were prepared for us daily. Warm water was sparse, bug bites in abundance, and bonding at its best!
The main clinic was in the town center near the church, school, and house for the nuns, who are the matriarchs of this village. We were able to treat hundreds of people a day, many of whom walked six or more hours to receive medical care.
The majority of our cases were skin ailments and malnutrition. We were able to give nearly everyone vitamins from our well stocked pharmacy and to treat most other diseases we encountered. Sometimes, however, we had to improvise. One patient had multiple warts on his arms and hands for which we had no treatment. The next best thing? Duct tape.
We also saw a textbook case of pityriasis rosea, and many patients with scabies and lice. Hygiene was very poor, and the large majority of the population did not have clean running water. The Sisters had a protein-rich nutritional supplement that we gave each child in addition to multivitamins, soap, and shampoo.
The dental clinic was the place to be! It was always busy. The dentists would easily see up to 100 patients a day and pull hundreds of teeth over the whole week. One dentist in particular, Charlie, took the time to teach each of us the pearls of dentistry. We were able to perform extractions, dental blocks, and countless intraoral sutures. It was a tremendous learning experience. The Hondurans overall had terrible teeth because they have no dental care or education.
Even very young children had multiple cavities and missing teeth. It is probably because of a local treat, which is flavored ice in Ziploc bags that the children suck on all day. Nurses spent time teaching the importance of brushing and flossing. Despite all the bad teeth, there was one young man who did have a perfect set of teeth.
Medico has many missions in addition to its dental and medical teams. Several ongoing projects in Monte Verde include planting crops, a clean water project, and providing basic needs to school children such as uniforms, book bags, shoes, pencils, and paper.
A water tank was made possible with Medico’s support. The water tank was presented a Medico volunteer (sixth from left) in honor of her son who was a past volunteer and had recently passed away. They sang songs of praise and worship in thanks for this project.
The people of Monte Verde are extremely resilient. They walked miles up and down clay hills in flip-flops with children strapped to them. The day before we arrived, they worked tirelessly to cut a path so that we could pass through more easily.
Through education and hands-on instruction, the people of Monte Verde were able to create a small garden of fresh fruits and vegetables. This project aims to provide the community with resources to expand their diet beyond rice, beans, potatoes, and bananas.
It was a week full of hard work, but you can't go on a trip like this without a little fun! We spent the last day at Lake Yojoa. It is a beautiful lake with spectacular views!
A group of us went ziplining. It was fantastic. The last line was straight across a huge waterfall with a rainbow. Words cannot describe the beauty of Honduras. Some of us were scared, but we all made it across safely.
We traveled into San Pedro Sula for an afternoon of shopping at the market after our morning by the lake. There were tons of local gifts and food including a row of women making fresh tortillas on hot stoves.
This was an amazing experience! We would like to thank everyone who made this unforgettable trip possible. Our lives and careers have been forever changed by our experiences.

Dr. Levitt, left, attended the University of South Florida School of Medicine in Tampa. She was graduated from the class of 2013 at Palmetto Health. Dr. Davis attended the University of South Carolina School of Medicine. She is a member of the class of 2014 at Palmetto Health.