Our group splits into three groups that go to different cities of La Ceiba, Tela, and Olanchito. Each site has its differences and unique qualities, but we all share the same goal to see as many patients as we can during our week. Months of intense planning and shipments of supplies occur before any of the doctors even set foot on Honduran soil to make sure we can hit the ground running and concentrate on taking care of patients. I have been at the Tela site all three years and this year we had nine physicians at our site and we treated over 600 patients. In total for the three sites we treated 1821 patients.
The physical space to practice medicine in Honduras on this trip is so different from my clinic here in Minnesota. The Tela clinic is housed in a church and my clinic room is a Sunday School room with attendance sheets and cartoon characters taped to the wall. There is no air conditioning, but my room gets a nice cross breeze because it’s a corner room with two walls of windows. We all still routinely sweat through our scrubs the whole day. My room overlooks the busy street below where I catch glimpses of the busy life going on below – trucks blasting advertisements park beneath the windows and provide some music to create a “fiesta” atmosphere for me and my patients, there’s a monkey tied to a second story balcony that watches over the street, women line up at the fried chicken and yucca stand on the curb at lunchtime and the smell wafts up through the glass slatted windows, and a young woman with Down’s Syndrome and her mother sell peeled and cut plantains outside the church door and hug all the doctors on our way into and out of clinic each day.
Patients have typically waited a long time to see us and sometimes they travel far from other places like the cloud forests in the mountains, or they cross borders from Belize and Guatemala. It’s not uncommon to hear from a patient that they came by horse, rode a cart, took a bus, rented a car, or crossed some rivers in a canoe to reach us. Once they are in Tela they will often sleep on the beach or in the streets to wait until they can be seen. As we arrive at the clinic in the mornings there is already a line of patients stretched along the street. Often these patients have been in line for a couple hours. They are all hoping to get in and see us. Some will get in that day and others may have to wait a day or two before they will be seen. The patients themselves would never volunteer the difficulties they went through to see us as it might be perceived as a complaint, and they are always so grateful to be seen despite how much time and effort it takes to get into our treatment rooms.
As I see the lines each morning and pass through the waiting room a couple times a day, the lines don’t ever look any shorter and the density in the waiting room doesn’t seem to lessen. I always have a bit of panic that we won’t get through all the patients and someone will have waited patiently and might not get treated.
We treat the patients in order of severity. The patients with ulcers all get seen first. The severity of venous disease is far from typical by US standards. People come in with their ulcers wrapped in banana leaves, cabbage leaves, dirty rags, and if they are better off, they have some clean gauze around it. The ulcers can be caused by untreated venous insufficiency, diabetes, infectious disease and other rarer reasons. Many times the ulcers are multifactorial and have been present for years, and even decades in many cases. We treat any venous insufficiency that we find and try to clean and dress the ulcers and wounds as best we can. We have some antibiotics to give the patients who have actively infected wounds and we have some dressings to send home with patients in the hope that we will provide a few weeks of clean bandaging. We give lots of instructions on cleansing the wounds with clean potable water and how to keep them clean and moist so they can hopefully start to heal.
Some of the best moments are when a patient with an ulcer that we’ve seen in previous years comes back with a healthy scar covering what used to be a gaping and painful wound. These patients are always smiling, walking taller, hugging, and passing on words of “God bless you” to the care teams. These patients make me hopeful that the ulcer patients we see this year will return next year with a similar look of joy.
Once we get through all the patients with active ulcers we start treating the patients with massive bulging varicosities that look like ropes running down their legs. These are often painful and can throb throughout the day as most people spend the day on their feet during work. These large veins can also cause skin changes that are quite common including lightening or darkening of the skin and hardening of the skin to the point where it feels like thick leather. Our treatments aim to take the diseased veins out of the circulation loop so the blood will be diverted to healthy veins that will bring blood back to the heart without pooling in the legs.
Everyone who is treated at the clinic goes home with a compression stocking over their treated leg. Just like in the US, the treatments will work far better if a compression stocking is worn for at least a few weeks following treatment to keep the vein walls compressed. Most of the patients are quite fashionable and would prefer to have a pair of stockings to wear instead of just one but everyone gracefully accepts that given our limited supplies we can only supply one stocking per patient. Personally, I can’t imagine wearing a thick thigh high compression stocking in the hot humid weather of Tela, but these Honduran women are made of tougher stuff than me. I’ve never seen them break a sweat whereas my clothes look rumpled and damp on a good day in the constant heat.
As we break down clinic at the end of the week there is always a rush to get everything packed up and put in the storage bodega in an organized way so the unpacking is easier for next year. We try to package and tape boxes tightly so the damp and vermin are discouraged from getting into and contaminating our goods saved for the next trip. We’re trying to finish up our last patients, snap a few last photos with friends and our church hosts, and exchange email addresses with our young student friends who help us translate all week. Maria Victoria, the young woman with Down’s Syndrome is always in the church as we are cleaning up and we all get our last hugs from her and her Mom as well.
As we settle into our bus ride to join the other clinic teams back in La Ceiba for our last night in Honduras the conversations dwindle off as we’re all left to our thoughts and reflections on the incredible week we had. Some of us leave Honduras with souvenir bags of coffee beans, a hammock, or an upset stomach, but we all leave with a sense of gratitude for the opportunity to be a part of this trip and a wonderful sense of accomplishment at having left an empty waiting room at the church because every last patient that came to our clinic had been seen and treated to the best of our abilities. And an empty waiting room has never looked so sweet.