Montana de la Flor, January, 2009

Overview

A Daily Log: By Doctor David Goo

Tuesday:

The Atlanta team met Frank and Marianne in downtown Tegucigalpa on Tuesday, January 13^th, 2009. Over a cold beer we heard the terrible news about Frank and Dick’s sister. Frank’s pain was easy to see even though in his usual manner he tried to make the best of it.

Wednesday:

We met the rest of the team the next day at the airport, and after our brief hellos and introductions, we were quickly loaded into the big school bus to Esquias, where we would spend the night.

The church we stayed at in Esquias was wild, as there was an all night vigil being held there, in celebration (if not response to) the fiesta being held in town for a two week period of time. The fair was busy with small stalls of food, games of luck and skill, and music. We ate at Tacha’s house, our old friend from El Guante, and it was a great meal, cooked for us by her family who lived across the street. All that night, hundreds of worshippers streamed through the courtyard of the church where we slept. At 0400 loud reports of huge firecrackers shook the building and woke most of us out of whatever sleep we had gotten so far.

Thursday:

We woke the next morning to load the supplies on a large truck, and split into groups so we could fit into our vehicles. New to the trip was Carlos, our driver from San Pedro Sula, and Juan, the father of Illich, a child with an immunodeficiency whom Gehlen had helped come to the US to seek medical care. Other new members included, Bridys, a Honduran volunteer, and Lillian, the daughter of Pacita, a previous cook two year ago. We were two four door pickups, a Landcruiser that held up to twelve with bench type seats in the back, and the large truck with all the supplies. We stopped in El Guante to pick up Bridys and Pauola and then headed up the MDLF. As usual we stopped in El Acote to take a break and happened on another medical mission group holding a clinic there.

We arrived on the mountain to find the roads in terrible condition, but with a little slipping and sliding, and the expert navigation of our drivers we arrived safe and sound. Unpacking the truck we found the school full of many items, including a rotting rat in the back storeroom. We were able to clean out all the supplies in there, and replace them with our bedding, luggage, medical and food supplies. It was a long day but we were able to get prepared for the upcoming days without having to start clinic the same day as we usually do.

The next days are somewhat of a blur but the sequence was the same. Up in the am, clean up your bedding and personal area, eat breakfast, and get ready for patients by 0830. The first day we stayed in Ceiba, the town we were based at, and saw patients, medical and dental. Lunch always provided a needed break in the middle of the day. We finished with patients in the late afternoon, cleaned up and then had dinner. Just after dinner, we would set up our sleeping areas (mattress, mosquito net, sleeping bag, flashlight), and then relax for a while before turning in. Some of the group stayed up later than others and one night we even had a campfire to sit around. The shower situation initially was dismal. It began with a bucket of cold water, splashing it on yourself. However, by the end of the second day, with the electrical and plumbing efforts of Angel, Fausto, Frank and others, we ended up having lukewarm showers coming out of an electrically heated showerhead. What a luxury!

Friday:

The first day we saw about 250 total patients. The last patient of the day was the hardest. A group of people had come from a village four hours away on horseback and wanted to be seen. The group number was around 20. We told them they could be seen the next day, but they insisted we see one of them, a 14 month old baby with trouble breathing. The child was in severe respiratory distress and had a history of asthma. He was on some medication but it had run out. The child had not been able to eat or drink and was very ill. The team gave the child medications and breathing treatments, but they did not seem to be helping much. It was decided to keep the child with the team, feed the family, and give the child repeated breathing treatments. A makeshift mask was fashioned out of bubble wrap, and the child received similar medical care as he would have in any pediatric emergency room in the US, but without oxygen, or backup. A discussion was held whether or not to take the child to Tegucigalpa or not that night. In the US the child would have been admitted to the pediatric intensive care unit, however, this was not available. It was decided to have the family sleep across the street, and watch them carefully throughout the night. In the morning the child was still in distress, but a little better. He was given a few more breathing treatments, and his other medications. Lo and behold by the early afternoon, he was running around and playing, so all had turned out well.

Saturday:

Our second day on the mountain, we hiked up to Monterey, the village where Julio, our guide and host in the MDLF lives with his family. This year we had 3 horses that carried our supplies up to the school house where we held clinic. This was a big improvement over last year when the team had to carry all the supplies ourselves. The team did well getting up the mountain, and only a couple of members struggled some with the steep climbs and slippery paths. They should be proud of the physical accomplishment of holding a clinic so high up in the remote mountains of the MDLF for the second year in a row. The team functioned well again, and we were able to see about 160 patients there. An elderly woman who lived close by was unable to make it to the clinic, so after Frank checked it out, a small team went to investigate at the end of the regular clinic. Down a steep slippery hill we went into a dark house with dirt floors. The woman was lying under a blanket, in a bed with four posts made from sticks, with tattered plastic sheets hanging from them. Gasping to breath, the senora had been bedridden for 8 days, and barely able to eat or drink. Her lungs sounded terrible, and the situation looked grave. Marianne McNeil, an emergency room nurse gave an antibiotic shot (which made the women hop around the bed in pain – giving us hope that she was stronger than she initially looked), some pain medication, antibiotics for the next week, and an inhaler to help her breathing. The interpreter, Philip Goo, had to give the husband the bad news that his wife was very ill, and without further help, might even die. It was a difficult situation for all involved. The team then regrouped, ate a meal of tamales that Julio’s wife had kindly provided for us and then went back down the mountain. Before leaving the mountain, we called Carlos Delgado, MD, one of the founding members of the initial team to MDLF, from Julio’s cell phone atop the mountain( the only place to a get a cell phone signal in that area). It seemed odd to be able to call from a mud shack back to Atlanta, GA dialing directly. We all made it back off the mountain, and in a gesture of kindness, the drivers Juan and Carlos were at the trailhead with a truck to take us the last quarter mile home. It was exhausting, but still a great day. The team that stayed behind saw around 90 medical patients, and Dick the dentist saw his usual 15 or so. That night, we packed all of our medical and dental supplies to go to Lavanderos the next morning.

Sunday:

Lavanderos is small town about 5km away from the school house in Ceiba. They too have a school where we set up the medical and dental clinics. New in the area was a pond full of tilapia. Littered around the pond’s banks were empty Kids Against Hunger bags, the bags of rice and protein that Gehlen provides for these starving families, two new sources of food for the community. We saw about 120 patients that day and had a nice lunch in one of the families’ houses that were near the school. Carlos and Frank had gone to get more gas and water, so after we had seen all the patients, Susan, Philip and I walked most of the way back to Ceiba, stopping to watch the Sunday soccer match along the way. It was nice to see that area on foot, but we were happy to get a ride from the Land Cruiser as it eventually came back up the road. In the evening we had a mass for Frank and Dick’s sister, led by Father Jim Tigges. The ceremony was very moving and emotional for all those present.

Monday:

The team packed up and went to San Juan, the village at the entrance to the MDLF, whose chief is well known, Cipriano Martinez. In San Juan, there is a government run health clinic, and a doctor and health nurse, Cecilia, who both work there. We found over 300 patients waiting there for us when we arrived. Many of the people were from further away, Tolupanes who had walked to get there. The amount of malnutrition and poverty was overwhelming, as were the number of patients. Present as well, were the police of the MDLF, who showed up at the clinic, and asked for all of our names and professions to be written down in a book. Sister Juanita Polak helped with that task. The clinic had many very heartbreaking and interesting patients, which included a man with a huge cancerous hole in his face, a 5 year old with a colostomy covered by a dirty washcloth, a child with “fish skin” disease, asthma, pneumonia, and many others. Lunch was at Cecilia’s home and punctuated by grunting pigs, barking dogs, and chickens in the yard. At the end to the day some of the team rode back to Ceiba with the police (who had befriended us by then – even allowing us to hold their machine guns!), while others stayed back to finish cleaning up and loading the trucks. Back in Ceiba, we sorted more medicines for the next morning’s clinic in Ceiba, and began to pack things up for the trip home.

Tuesday:

In the morning, we saw about 60 patients and began the process of repacking to leave, saying goodbye to our friends, and giving and receiving gifts. We took our usual group picture, and then headed off the mountain. The group stopped in a quaint quiet town of El Tomate (no they don’t grow tomatoes there), where people were watching the inauguration and making all sorts of comments and predictions. Suddenly the MDLF police showed up there, and we waved hello. Unfortunately, the reason they were driving by was that two indigenous women had been raped by a Ladino man, and they were on the way to the major city of Talanga, to file the complaint. Very depressing. Our group, over cold beer and sodas bought at the roadside restaurants said our goodbyes. One group went with Carlos and Juan to Tegucigalpa, and another went back to Esquias. A job well done by all, with love and teamwork. Everyone was safe and sound, and off the mountain in one piece, with a grand total of nearly a thousand patients seen.

Reflections

Dinners and cooks:

Each year a group of dedicated women come to cook for the team. Typically, members of the team tend to get ill from the change in diet they have, and the presence of new bacteria. Montezuma’s Revenge, or Traveler’s Diarrhea infects the GI tract, leading to diarrhea, fever, chills, dehydration and stomach cramps. This was not at all unusual on the previous trips when the group was based in El Guante, where there was running water, electricity, and refrigeration. In fact, the first two mission trips I participated in, multiple members in the group needed antibiotics, and IV fluids, and were incapacitated from working for days at a time.

A true tribute goes to our cooks, Dulce, Lillian, and Fatima. None of the group was ill, and to my knowledge, no team members has ever suffered fever, chills and diarrhea while in the MDLF. This is amazing taking into account the lack of refrigeration (save a large IGLOO cooler), and the huge number of meals that need to be prepared (25 members, 3 meals a day, 6 days). The cooking area is in a 10 x 10 foot room, with propane stoves set up on student’s desk tops, which serve as pantries as well. So much work goes on from morning to night that it is hard to believe it. When the team is dead tired at the end to the day, the cooks are still cooking the evening meal, and then washing dishes when everyone else is finished. Before anyone else gets up in the morning, the cooks are up, making the requisite coffee, and starting the breakfast. And for those vegetarians, a special effort is made in addition. Cooking at times becomes a communal activity and even the drivers help with some of the preparation.

But that is only part of the story. The food is DELICIOUS! Certainly food always is better when you are tired and hungry, yet the food that is prepared by our cooks is truly outstanding. What you are served is true home cooking, infused with the love and care that is instantly noticed on your taste buds. Comfort food, that fills your stomach and soothes your tired body, is the salve that sustained our labors. As with any group, each member was indispensable, but the cooks were essential.

Drivers

Carlos, Juan, Julio, and Mochin.

Two years ago a mission trip nearby in Honduras to the MDLF had fatalities when a truck fell of the road, overturned, and some of the members were injured and others fatally crushed. Traveling in foreign countries is often the most dangerous part of a trip as the National Travel Healthcare Network and Center states …”that the greatest life threatening risks amongst travelers, are not caused by tropical disease, but by accidents and injuries.” Remembering this fact, we need to show appropriate gratitude for our drivers, who know the roads, their dangers, and how to keep us safe. These drivers did more than just drive, they supported the team fully, loading, and unloading, going for water, gas and other supplies while we worked. Transporting patients so they could get advanced care in Tegucigalpa. Juan and Carlos became our fast friends and team mates over the week. As for Julio, our Tolupan guide and host in the MDLF, has made this mission possible over the last five years. He is so much more than a driver, he is the Honduran heart and soul of the mission.