We awoke at 7am the next morning and, after a breakfast of tortillas, refried beans, eggs, cheese and coffee, piled into the van with a member of the Honduran military who was to serve as our guard for the trip. The drive to Tablones took almost three hours on a steep dirt road, past sharp turns where it seemed we would plunge off the side of the mountain into the forest below (this has actually happened on a previous Honduran medical trip; see this New York Times article.)
We spent the next five days providing medical care in one of the poorest counties in Honduras. As a nurse in an extremely resource-rich hospital in the U.S., it was a shock to try to operate without the ability to do basic lab testing or x-rays, and the diagnostic process was much more basic, more focused on physical exam (by necessity), and much less interesting.
Hundreds of patients lined up to see our doctors, dentists, and optometrists. In the "medical building" (one room of the elementary school we set up shop in), the retired ICU physician, ER resident, and a couple rotating local doctors listened to patient complaints of headaches, backaches, and "mal de orin" (burning with urination, as far as I could tell). We dispensed thousands of Tylenol and Albendazole (antiparasitic) prescriptions, which patients would run out of in a week at most.
Among the more interesting presentations we saw were dermatological concerns such as advanced fungal infections, including in the fingernails, and one toddler with impetigo that had spread to his ear.
On our second day, a woman in her 70's in severe respiratory distress hobbled through the door and sat in the schoolchair, breathing into a hankerchief, her wheezes audible from across the table. This was a woman who would have been admitted to the ICU in the states and had a chest xray, labs, BiPAP (a form of breathing support) and a multitude of expensive testing done. We pleaded with her to accept a ride to the nearest hospital two hours away in Gracias as she sat plugged into the portable nebulizer machine, her oxygen saturation hovering in the mid-80's, but she refused. She received continuous breathing treatments until her wheezing abated and was discharged with horrendous vitals and prescriptions for steroids and antibiotics.
She came back two days later as instructed for follow up, breathing shallowly with mild wheezes but otherwise stable. This woman who I had fully expected to collapse in front of me two days ago was alive, and, if not "well" per se, at least able to find her way back to the clinic independently, which is more than I could say for some of my patients who receive many more interventions at home.
When we weren't seeing patients, we slept, watched football games, and bantered with the neighborhood kids in the building that housed the actual town clinic, which was empty for the week. The power went out intermittently, and on the second to last day we ran out of water. I took pity on one of the skinny local dogs and fed him my leftover tortillas, marveling at how he could be alive with his ribs sticking out so far he looked like a skeleton.
Despite having mixed feelings about the medical work we did, I had a great time with our group. Sleeping on mats on the floor with four people to a room, flushing toilets with buckets of water, and eating all your meals together is a great way to bond. For that reason alone, I would consider going on another similar trip.