By Judd Bazzel, MD
Posted on September 18, 2011 – When Jerry Boyle asked me last year if I would organize and lead a medical mission to Honduras, I said yes-I had no idea what I was getting myself into. I had never been on a medical mission and only visited other countries for vacation, but I was up for a challenge.
To better understand the challenges, you should know that Honduras is a very poor country where the average annual income is less than $1000 US. The public school system is nearly non-existent and health care is reserved for the few who can afford it. It is not uncommon for people needing surgery or other procedures to be turned away from hospitals because they cannot pay in advance. Some public hospitals are so over-crowded, that they use one bed for two people.
I recruited from both within and outside the company to assemble a clinical team of doctors, dentists, and nurses. No one I asked hesitated or said no. I was fortunate to have Benjamin Sohr, our Director of Strategic Planning, to help me work through the details of this huge undertaking. As my logistical counterpart, he provided oversight of the operational aspects while I developed a formulary and ordered medications and supplies. We finalized the last details as we boarded the plane.
Over twenty people participated: four doctors, one nurse practitioner, two dentists, five nurses, and a host of logistical people including the mastermind of the endeavor, Jerry Boyle. We arrived at the Nashville International Airport at 4 AM and began to check over thirty bags of supplies and medications. Several hours later, we landed in Tegucigalpa, Honduras, known for having a dangerously short airport runway and being nestled between two mountains. After an eerily easy trip through customs and a three hour bus ride we arrived exhausted at our accommodations provided by Olancho Aid, a faith-based organization dedicated to improving the conditions in the Honduran state of Olancho. The next day was spent sorting pills, packing bags, and getting mentally prepared for the week ahead.
Each day, we boarded t
he bus and travelled to a different village to hold clinics. Some villages were relatively close while others were over two hours away by bus. Upon arrival, we would set up our mobile clinic in either a church or school. Most days, there was a line of over 100 patients waiting when the team arrived; some people had walked hours to be seen. The patients would good-naturedly wait as we constructed our triage area, clinic, dental suite, vision screening station and pharmacy. Once the doors were opened there was no mad dash to get in, but just an orderly procession of very appreciative people, always with the elderly of the community always first in line to be seen.
As a clinician, I knew about some of the more unusual things to expect: malaria, Dengue fever, amebiasis, but these turned out to be the exception rather than the rule. Most of our patients simply wanted vitamins or had simple complaints such as cough from perpetually being in such a dusty environment. Most of the children simply wanted to be held or played with. Amidst these patients with minor complaints, however, were those with significant illnesses. Skin cancers were removed, malaria was treated, and a definitive plan of care including surgery most likely to occur in the United States was created for a young man with a serious heart defect. Regardless of how much we did or didn’t do, our efforts were appreciated; this is something that we, as correctional health care providers, don’t always see. I must admit, it was refreshing to push deliberate indifference to the back of my mind for a while and give people both what they wanted as well as what they needed, which in Honduras, are often the same thing.
We treated over 1800 patients in five days, all without advertising! Our patients ranged from newborns to nearly a century old. The children rarely cried; in fact, I never heard a child make a disparaging sound even during dental extractions. Most if not all of them walked away smiling. They are not a stoic people by any means, just tough! There were no charges for our services and no one was turned away; however, the Hondurans we treated did not want to take without giving, even if all they had to give was a hug. To call it a hug just doesn’t do the gesture justice as they were usually bear hugs. You got the point; they appreciated you. I remember a little boy who needed glasses and handed over a one Lempira note to pay for them. This is equivalent to a US nickel, but it was everything he had in the world. He was willing to give it up to be able to see more clearly. Of course, we gave him back his money, gave him a hug and sent him on his way back home. We had good days.
One day, some colleagues and I broke away with a smaller group and saw patients in a Honduran prison. The prison is staffed by two nurses; physicians come in sporadically and on a volunteer basis. No one asked for a bottom bunk or an extra mattress. No one asked for peanut butter instead of bologna. They asked for the essentials for health; nothing more and nothing less. They smiled despite the conditions. They thanked us despite the circumstance. It was truly a humbling and eye-opening experience. I wish I could have shared that experience with all my correctional health care colleagues in the United States. The doctor and nurse who accompanied me both work in corrections, and they were as taken back as I was by the accepting nature of the patients there as well as the stark conditions. Meals were typically small portions of rice, beans, and tortillas served 3 times a day. There was no running water for bathing, so showers came from the sky in the form of rain. Trustees became honorary guards complete with weapons, and the inmates were often left to police themselves in their pods as the guards rarely, if ever, went inside this secure perimeter. We all agreed that if the citizens incarcerated in U.S. jails and prisons could tour the facility in Honduras, grievances would fall to zero.
Much of what we treated was out of our control, so at the end of the day, did we really make a difference? If the little boy with heart disease gets his best chance at a full life because we took a week out of our lives to go to the middle-of-nowhere in Honduras, then, yes, we made a difference.
There is another side of this equation, however. I’m not the same man, doctor, husband or father that I was before I went down there. No matter how you answer the question, Did we really make a difference? the patients made a difference for the better in me.
I’m not going to lie and say that I don’t cry a little when I think of some of the things I saw there. Certainly, I’m not going to lie and say I didn’t shed a tear as I sat in my air-conditioned office in Tennessee and drank my clean water as I wrote this, but, they are tears of mixed emotions-joy, shame, appreciation but, most importantly, hope. Did we do everything correctly? I’m sure we did not, but we learned from our mistakes and that will make the trip better next year. That’s right-we all had such an amazing experience, this will be an annual event. Will I be there? Try and stop me.
Judd Bazzel MD is the Deputy Chief Medical Officer for Correct Care Solutions. Dr. Bazzel travels the country helping to improve the quality of correctional health care and now travels to Central America for the same purpose.
