June 22nd, 2022 by Mark
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On the Island of Roatan, Clinica Esperanza is located in Sandy Bay near West End.  This is where we spent most of our time.  A few times during my stay, I was able to go to the other side of the island for various volunteer clinical activities.  In my previous posts, I showed mostly the clinical side of my time in Honduras, so for this last post, I thought I would show the other side!

First, let’s talk about the accommodations.  We stayed at the Refuge which is affordable, pretty low-key basic housing. There is a small pool and the 2 bedroom apartment we were in has 2 single beds in each room, a basic kitchen and living space with couches and a 4 chair table, and a cute little balcony.  In this space my daughter and I played countless card games (most of which I lost), made cookies, beans, rice, quesadillas, pb&j sandwiches, and just sat and talked about our day.  Open windows and fans kept the heat bearable and at night we used the bedroom swamp coolers which kept the room nice and cool.
 
While the accommodations were adequate and cute, and a great price, the best part of the Refuge was the VanZee family.  Nic and his family are AMAZING and really make you feel welcome.  We enjoyed wonderful dinners and stories, smores and songs around a campfire, a talent show night, and so much more.  Their children love to interact and play and really help to pass the time.  In addition to just being great hosts, they also help you take advantage of the opportunities the island has.  They help arrange excursions and tell you where to find the best discounts.  With their help we were able to do some really fun and exciting things.

Now, I have had comments and conversations with others who feel like one should never do touristy things when you are going to volunteer.  I remember one student of mine said we should work sunup to sundown and then go to bed to do it again the next day.  I do agree that you should not use volunteering as an excuse for tourism.  However, I feel that to really get to know a people and a culture you need to explore it outside of the clinical world.  I also feel like part of supporting the people you are working with is helping to build the economy.  That means souvenirs,  excursions, local restaurants, etc.  Finally, I also feel that relaxing and having some fun is also good for mental health and wellness and can keep you from burning out.  So in that light, when the VanZees suggested or offered activities after clinic or on weekends, we tried to take advantage of them!
 
One of these adventures included scuba diving for the first time.  Nic even made sure we were ready by giving us a quick prep course in the pool!  The water, reef, and sea life of Roatan are outstanding.  Scuba diving was definitely worth it, but even just snorkeling off the beach I could spend all day in the water!  We saw a sea turtle, lion fish, hermit crabs, and all sorts of other fun things.  We also went ziplining, hung out with monkeys and exotic birds, did some local karaoke, explored the shops and museums, and tried the local cuisine just off the beach.  Being a bit on the shy/timid side, had the VanZees not helped guide us to and through some of these activities, I’m sure we would have missed out on a lot of these incredible activities that Roatan had to offer.
 
All in all, a great trip of learning, serving, and island exploration!  Even without these after-hour activity options, I would definitely recommend volunteering with Clinica Esperanza, but the VanZees and the fun side of the island certainly helped round out the experience. I can’t wait to go back!
 

June 19th, 2022 by Mark
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In medicine, like many other fields, you typically wear a lot of hats.  When working in remote or underserved areas, this is especially true!  Our first week here, the pediatrician was out sick, so one of the general doctors took his place in that part of the clinic.  Carla, one of the clinic nurses, does triage in the early morning, community visits later in the morning, and then teaches prenatal classes in the afternoon.  Other nurses bounce between helping in triage, pharmacy, and treatment rooms.  In the small New Life Clinic in Oak Ridge, where I worked this week, the one and only nurse acts as the MA, Nurse, and Pharmacy tech.  This is pretty typical, and does not even go into all the stocking, cleaning, and ordering hats that people have to put on.  But cooperative, collaborative team work is what gets the job done!
 
In my time in Roatan, I also have worn many hats.  Certainly that of doctor, as I saw patients in the community in the morning and in the clinic in the afternoon, and even at the partner clinic on the far side of the island mentioned above.  I also helped in triage, procedures, teaching, stocking the pharmacy, supervising students, transportation, loading and unloading trucks and vans, and more.
 
I think it is important whether in your home town or abroad, that regardless of your official role or title, you are willing to help out no matter what or where (as long as it is not outside your training/abilities!).  That means you are willing to sweep up a mess, take out the trash, or fill any other small or large need that is required.  Not only does this make you a good team member, but it also just feels good!
 
I finished up my time here yesterday and am headed home soon.  I will try to post once more about some of the fun we had in the evenings/weekends once I get back, but even without the “vacation” part of this trip, I would definitely do it again and hope to be back regularly.  Wonderful clinic, wonderful people, wonderful experience!

June 14th, 2022 by Mark
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Ms. Peggy, the founder here at Clinica Esperanza, is very adamant that everyone learns from one another.  That means she expects both volunteers, like me, and long term staff to both teach and to learn.  This happens formally every day from 11:45-noon like clock work.  1 person or group is assigned every day to teach a simple 10-15 minute lesson on any topic of interest.  Peggy’s commitment to teaching and learning could be seen during the time of COVID when there were no volunteers at the clinic and the staff had to man the teaching role continuously.  Despite a few requests to put it on hold until the volunteers came back, Peggy pushed on and kept it going!  Topics range from tropical diseases like Dengue, Malaria, or Chagas disease, to practical matters like wound irrigation or deciding when an xray is necessary and when it is not (that was mine!).
 
But teaching and learning goes far beyond the formal 15 min daily assignment. Staff and volunteers ask each other for help or clarification on any variety of issue or topic!  This atmosphere of collaboration and humble cooperation, I think, is due to Peggy’s continual focus on teaching and learning.  As a volunteer here, I have the opportunity to learn a lot from the local doctors, pharmacists and staff.  I have learned a lot about the process of running a clinic, how they order and organize medications and office supplies, working collaboratively with the community, local dosing differences and so much more.  I have also had the opportunity to teach some skills I have that some of the other volunteers or staff physicians are not as comfortable with: suturing, nail removal, casting, etc.  For instance, one of the local docs here was very comfortable making plaster casts, but the clinic only had casting tape – a whole different animal.  He had done his best and made a cast that had worked very well for about 3 weeks, but was getting uncomfortable for the patient and he did not really like the end result as well as other casts he had done with plaster. I was able to help him and another doc there learn how to remove the cast easily with a cast saw and then I showed them how to put on the cast with cast tape (including proper padding).  I put down the first layer, and then he put on the second layer.  When all was said and done, the cast turned out great and the local doc felt much more comfortable using the casting tape that the clinic had in supply on future patients.

June 10th, 2022 by Mark
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Roatan is beautiful.  Beautiful ocean, beaches, jungles, and beautiful people.  As we have traveled to remote villages over the last 3 days I have enjoyed looking out at the scenery and people we pass.  I also admire…and somewhat fear…the long thin winding roads that connect the Calle Principal with the rest of the villages.
 

These long winding roads also make me pause to consider just how difficult it is for some people to access the food, work, and health care needs that they have.  Many do not have cars or motorcycles, so they have to rely on the kindness of others to help them when travel is needed.  This is one of the reasons that Clinica Esperanza extends their care from the clinic in Sandy Bay to the remove villages.  When we see something we do not have supplies for in the villages we talk to them about when and how to get to the clinic.  It is amazing to see Carla work her connections with the pastors and other volunteers and good people of the island to make it work for the patients.

Today, we were missing a driver to take us (not all the clinic staff drive).  So with some hesitation, I was able to fill that role and cautiously navigated the winding roads of Roatan to our community site today.  We were able to bring care to many that do not have easy access, and to refer to the clinic a few patients that need extra care – plus reinforce to them why it is important.

My daughter, who I was able to bring with me on this mission trip, made a special friend who loved to have her heart listened to and just chat it up!  They had a special bond!And speaking of winding…Nic found this little friend trying to wind its way into breakfast this morning!  We thought it was just a milk snake…but we were cautious in case we were wrong.  Then, when we had time to look it up…we were wrong! Roatan coral snake…Poisonous!  Glad Nic was so careful!

June 9th, 2022 by Mark
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The trip to Honduras was a little bumpy…

• Early flight (1am) from Vegas to Miami
• 2 attempts to take off from Miami…both failed
  • 1st: Mechanical Problem
  • 2nd: Broken Runway in Roatan! (how often do you hear that happening!?!)

But the 1st rule of Global Medicine is Flexibility!  So we stayed 2 nights in Miami and tried again Monday…with success this time!  So we arrived Monday, just 2 days late, for our service and learning trip to Roatan.  We were welcomed warmly at the Refuge and the clinic founder had a birthday celebration (Happy Birthday Peggy!) so we had a great first day!
 

Tuesday we started out going into the community and returned and did it again on Wednesday.  Between the 2 days, we saw ~100 patients and met some wonderful volunteers and community leaders.  While waiting for the truck ride home I did some magic for the children in the community which is always a big hit (or at least I have fun!).

After the community outreach, we returned today to the clinic and I was oriented to their system and met some great staff.  Clinica Esperanza really works hard to make a difference in the community in a sustainable, culturally appropriate way.  Just as one example, years ago there was a boy that visited the clinic as a patient, showed interest in medicine and was nurtured and guided by Ms. Peggy and others.  Now that boy is one of the doctors that works there!  Talk about impact!  They have a simple but effective EMR and run the pharmacy very well to assure quality medicines are stocked and delivered.
 
After a few afternoon patients and teaching a student how to remove a nail, we returned to the Refuge for a great meal and some card games!
 
Can’t wait to see what the rest of the time brings!

June 1st, 2022 by INMED
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Hello! My name is Mark Wardle. I am a Practicing Physician, and I’m starting my INMED service-learning experience at Clinica Esperanza in Honduras beginning in June 2022.