From what I’ve learned about Honduras, the area we are traveling to is right along the Caribbean coast with mountains opposite. It sounds quite beautiful. I think it will be challenging to provide care when I speak only a little bit of Spanish, but if past experience has shown me, you can understand a lot with a few words, facial expressions, pointing and the willingness to try. I’m very excited about the trip. 

 
Submitted by Jennifer Drost, OMS IV, on Nov. 2


As always, getting where you want to go on a trip seems to take a really long time—and, of course, getting to the airport at 4:30 a.m. doesn’t help matters. But that is what we did.

Our group consists of a physician (David Drozek, D.O.); an anesthetist from Chillicothe (Pat Clark); a transport nurse for MedFlight based out of Wellston, Ohio (Greg Schano); an ER resident from Doctors Hospital in Columbus (Jason Russell, D.O.); and four medical students from OU-COM (Nick Niemiec, OMS III; Nick Pfleghaar, OMS IV; myself; and Lauren Gutheil, OMS IV). We hauled our personal bags and ten “tubs” of equipment down. This is typical for international programs; never plan on packing more than one bag for yourself!

Once we arrived in San Pedro Sula we jumped onto a mini yellow bus for the three-hour trip to La Ceiba. The countryside was beautiful, but it has been raining for the past couple of weeks, so it was very wet, rainy, muddy, and we crossed over many raging rivers. We made it safely under the auspices of our driver/escort/translator, Sergio. After the long day it was great to relax and head to bed early.

 
Submitted by David Drozek, D.O., on Nov. 3

On Sunday, while I screened surgery patients, the students sorted supplies and medications for the week. They prepared supplies for each planned surgery in different bags ready for use or sterilization.

Beginning Monday, Nov. 3, each student took responsibility for a patient—getting them ready for surgery, starting the IV, helping them into the OR, assisting in the surgery, often doing the final suturing and application of the dressings, then taking the patient to recovery and watching them through the initial recovery phase. If the patient is kept overnight, the students visit the patient the next morning. The students also go over the discharge instructions and give the patients their medications for pain. 

The team has worked together wonderfully, helping wherever needed, cleaning rooms and instruments. The Honduran OR assistant and cleaning lady have been very grateful for our help, especially since we have increased their workload tremendously for the week.

Our team nurse, Greg Schano, has not worked much with D.O.s.  He commented to me about how impressed he is with our students. He said he expected them to be like other med students he has met, who tended to be “proud, aloof and lacking in interpersonal skills.” He said that our students were “real people.”

Because the team is a bit small for what we are doing, I was worried that we didn’t have an OR nurse or tech with experience to help us. Two of our students who plan to pursue surgery residencies and the ER resident have filled the gaps wonderfully managing the OR equipment and keeping the OR flow going.

We have been doing five cases a day. These patients have been sick for so long that their gallbladders were very thick and scarred, making the surgeries among the most difficult I have done. Because of that, many of the surgeries have been stressful and the days long—but no one has complained! Everyone has been extremely helpful and supportive of one another.

 
 
Submitted by Jennifer Drost, OMS IV, on Nov. 7

 
 

We sure are working long days of surgery in Honduras! We spent Sunday preparing for the week. This meant that the ten tubs had to be unpacked, organized and repacked for sterilization. In the operating rooms in the U.S. a lot of things are opened, not used and simply thrown away. It was great that hospitals were willing to donate some of these materials. Gowns, drapes, sponges and towels that have not been contaminated can be re-sterilized and used in this environment. Dr. Drozek and Pat, the anesthetist, saw potential patients to make sure they were healthy enough for surgery. 

Since Monday we have been working really hard. Breakfast is at 6:15 a.m., we head to the hospital at 7 a.m., get prepared and have surgery all day. I think the earliest we’ve gotten done for the day has been about 6 p.m. It is kind of like surgery at home.

I really enjoy surgery, so this has been a lot of fun. What is great as well is that we are able to follow the patient from the time they are in the pre-operative area (inserting the IV and reviewing the medical history) into surgery to assist and through the post-operative period, making sure they are recovering from the surgery and anesthesia.  Each night a few patients remain in the hospital for observation, but they are released early in the morning. 

 
 
Submitted by David Drozek, D.O. on Nov. 11
 

It is Tuesday morning, Nov. 11. We have not had internet access since Saturday, when we left La Ceiba for Hotel Canadien and some rest.

Our ER resident, Dr. Russell, and one student, Nick Pfleghaar spent Saturday morning in an emergency room at the government hospital seeing and treating patients. 

The rest of us rested at the Hotel Canadien, enjoying our first sunshine of the week and the Caribbean beach. Saturday evening our anesthetist and nurse headed back to La Ceiba with Doris Eggenberger, director of Hospital Suizo, to stay the night at her home and catch the early bus to San Pedro Sula for their flight home.

Sunday was another day of relaxation, sunshine and a visit to a small nearby zoo maintained by a friend of mine on his dairy farm. 

Monday the waves and winds caused by hurricane Paloma subsided enough for us to visit the Cayos Cochinos islands and do some snorkeling on the coral reef. I have some friends who live there, and they opened their home and boat dock to us for a few hours of relaxation.

Today the clouds have returned and rain appears imminent. We head back to La Ceiba to hold a post-op clinic and hopefully send this email! We were invited to lunch by the family of two of our earlier surgery patients. We also hope to visit a nice private hospital in La Ceiba today, as time permits.

Tomorrow we head for San Pedro Sula and the students begin their experience with the Honduran medical students.

Cases done in Honduras November 2008

 
Submitted by David Drozek, D.O. on Nov. 12
 

Yesterday (Wednesday, Nov. 12) we traveled from La Ceiba to San Pedro Sula, with a stop in Tela (hometown of OU-COM student, Jose Bustillo, OMS III) for lunch on the beach.

We arrived at Hotel Sula, freshened up and headed for the Universidad Catolica de Honduras (UCH) where we met the director, academic co-director, and our medical student hosts.

We discovered that in the beginning of their fifth year (of seven) of medical school, the students begin taking every fourth night on call, doing a 36-hour shift. Our two Nicks were being hosted by students on call, so they began working last evening. They were allowed to opt out, but they decided to go for the experience. They did a house call late last night, then they began again this morning.

Our team members are situated at the Hospital Mario Catarina Rivas, an 800-bed referral public hospital for the northern half of Honduras. All four students will be on the internal medicine service, making rounds and watching procedures, but they have the opportunity to work in the OR if they like.

Our ER resident, Dr. Russel, will be in the ER during the day today and tomorrow.

Jason did an interview for an Internet news network.  They told him his interview would be on line between 1 and 2 p.m. today (2-3 p.m. in Ohio) at www.telered21.com.  He hopes to get a hardcopy tomorrow.

Submitted by Nick Niemiec, OMS II

My time spent in Honduras allowed me to significantly improve my medical and surgical knowledge base. More importantly, I was able to expand my global perspective of health care. 

During the first week at Hospital Suizo I scrubbed for 12 of the 24 surgeries that we did, and I followed my assigned patients from pre-operation to post-operation exams. This allowed me to improve upon my clinical skills of starting IV’s, intubation and incision closure. I was also able to learn a lot about sterile technique and surgical preparation while working in the operating room. I now feel much better prepared, I’m looking forward to my third-year surgical rotation. 

I enjoyed working with the small team that participated in the trip. Being the only third-year student, there were various opportunities to learn from the experience of the fourth-year students, that of the emergency medicine resident and Dr. Drozek. I was also exposed to a wide variety of pathology, ranging from dengue fever and hepatic encephalopathy to military tuberculosis. I feel that I have left this experience with many pearls for my upcoming rotations. 

Early in the second week we evaluated our patients in the post-operative setting. This allowed us to follow up with our plan of care and insure uncomplicated recovery of our twenty-four patients. The family of one of our patients invited us for a meal at their home to thank us for our service—a great way to wrap up our time at Hospital Suizo!

During the second week of the trip we spent time in one of the government hospitals in the city of San Pedro Sula. This experience demonstrated how much I take for granted regarding the quality and availability of health care in the United States. There were often instances when a particular drug or diagnostic test could not be preformed due to lack of access to technology and pharmaceuticals.   

It was interesting to interact with the Honduran medical students and share in their daily experiences. They are often responsible for the majority of their patients’ care, as the nursing staff is minimal. Due to the lack of technology, they relied on their clinical skills and physical examinations in assessing their patients. This forced me to think twice about the course of patient care. Prior to ordering labs and diagnostic tests I found myself focusing on how they would correlate with our physical findings. This is definitely a skill that will come with experience. I look forward to reflecting on these experiences in Honduras during my third and fourth years of medical school.