By Lydia Trupe
George Washington University
Summer 2011 Global Impact Fellow
"The problem with public health is that everything costs money." On one of our first few days in Centro de Salud Integral Zoe in Tegucigalpa, Honduras, we sat around an office with one of the head ophthalmologists, filing medical records. They don't have electronic medical records because, Dr. Flores comments, "that would cost money." Money, space, equipment, doctors--all of these were limited resources in Honduras. However, as I would soon learn, limited access to these resources was not the only barrier to care in the country.
As a student of public health, the product of a medical family, and a seasoned traveler, I thought that there was very little that would surprise me when I walked into a Honduran clinic. However, what I learned that month in Honduras was just how much I didn't know.
I spent one month in Tegucigalpa, Honduras, in June of 2011. During that time, I would learn, among other things, how to take visual acuity screenings, how to use an autorefractor, and how to correctly identify a cataract alongside the local eye doctors. More importantly, though, I met countless incredible people, and it was their stories that taught me the most of all.
El Centro de Salud Integral Zoe is a small, nondescript building on the outskirts of Honduras' bustling capital. Inside, a small brigade of employees in brightly colored polo shirts efficiently choreographs the seemingly hectic action. The entire first floor of the three-floor building is taken up by the ophthalmology department, and the center of the room is filled with long rows of chairs that frequently spill out into the hot Honduran sun. Every morning, patients line up at 6:00 AM outside the clinic gates, and patients are generally seen on a "first come, first served" basis. While working in the clinic, I or one the other volunteers would help the staff members with taking visual acuity screenings and using the autorefractor on each patient before they were shuffled off to see one of ophthalmologists. Other staff members and volunteers ran around, bringing patient files down from the storage room, dilating pupils, assisting patients to La Optica (the optical shop), and other various activities. The entire process seemed chaotic, but somehow everyone ended up where they needed to be.
Inside the cool reprieve of the ophthalmologist’s office, Dr. Flores would instruct us on how to insert eye drops into each patients’ eyes, check their eyes for cataracts, and conduct visual acuity screenings. He would teach us about the proper diagnosis of glaucoma and diabetic retinopathy, and in between he would tell us stories of patients he had met and what had inspired him to work in medicine.
The days in Honduras we most looked forward to were las Brigadas, when we would pile into the back of an old white Land Rover, driven by the clinic’s optometrist, Brigada director, and all-around wealth of knowledge, Victor. On our drives through the Honduran mountainside, Victor would teach us about the history and culture of his country. All of these lessons were conducted entirely in Spanish, as Victor’s English was minimal. I found my Spanish quickly improving.
We would drive along dusty mountain roads to rural villages settled along the ocean. Our makeshift outreaches were set up in schools or churches, and we would spend long days working in the sticky heat to serve the long lines of patients.
With each brigada, our process became more efficient: two volunteers to check visual acuity, one volunteer to use the autorefractor, two volunteers to distribute eyeglasses. Victor would examine every single patient to provide diagnosis, treatment, and determine whether they needed to come back to the clinic for cataract surgery. The phrase “para donde van las patitas,”which we asked for every one of the hundreds of visual acuity screenings, became etched into my brain.
Occasionally, these brigadas took place not in small villages, but in urban slums on the rocky edges of Tegucigalpa. We left each one with memories of exceptionally special patients and countless stories. One brigada in particular sticks out to me though. On nearly every brigada, we would arrive at 7:00 AM to lines of people wrapped around the building awaiting our arrival. On one especially hot morning in the southern village of Choluteca, we arrived at the brigada, just Victor and I along with one other volunteer, to find our makeshift clinic completely empty. Victor told us that, occasionally, because of certain barriers in the Honduran bureaucracy, the radio announcements for the brigadas were not heard in all of the Honduran communities. I wondered why we did not just pack up our equipment and leave. But Victor said that he knew for certain of one family that planned on coming to the brigada that day. We waited all day in the sweltering heat of the abandoned school—no fans, no air conditioning, and no people or buildings for miles. At around 4:00 PM, a rattling pickup truck pulled into the gravel driveway. A family of four wandered into the vacant schoolroom, a young man in a dusty sombrero leading his aging mother, who walked with slow, deliberate steps in old leather sandals. A young girl in bottle cap glasses clasped the hand of her mother and followed timidly through the door. Victor spoke with the family for a long time before we began testing their vision. When their visit was over, he assured them that he would be back in one week’s time to pick them and take them to the clinic for the cataract surgery that the mother desperately needed. Hugs were exchanged, and the family departed. We packed up our box of glasses and headed back towards Tegucigalpa. I was struck by Victor’s dedication to each patient’s well being. In a place like Honduras, where resources are incredibly limited, each individual can make a tremendous difference in the lives of many.