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Smita Misra writes

...about her experience while volunteering in Honduras.

Infection and Smiles: My Experience in Honduras

Honduras is a Caribbean country located between Guatemala, Nicaragua, and El Salvador. It is a country of dusty red shingles, wet cobbled streets, and laughter. I went there this past August, to volunteer at Dr. San Manuel Hospital in the town of Gracias, in the department of Lempira. As the plane flew over Honduras, my eyes inhaled the sight of proud green hills and loyal valleys that stretched beyond my sightlines. Just before we started descending, I looked up to see a pearly crescent, basking in the early afternoon sun. Turning to the elderly woman beside me, I said, "Your country is beautiful." She nodded, as if to reply, "Yes, I know." Past customs, baggage collection, and reception, I walked out of Toncontin International Airport. And for the second time, I saw the green hills, this time, albeit, from a different angle. Towering around the capital, it would be sarcasm to call any other structure a skyscraper in the presence of these hills.

That was Tegucigalpa, the capital city. It was the only glimpse I had of the capital before I returned to it, for my flight, three weeks later. We drove about forty minutes to Valle de Angeles, Valley of the Angels. This picturesque town, made up of four streets, was a scene from a movie set. Cobblestone paved your way on steep slants which ran past basket weavers on the right, and restaurants, with wooden hangings above their entrances reading Cafe de Valle, on the left. We received our training in Valle de Angeles; three days later we set off for our respective destinations. Being part of the medical placement, I headed for Gracias, Lempira, staying overnight in La Esperanza, Intibucá.

I reached Gracias amidst rain, clouds, and confusion; stumbling finally into my home-stay, I meet my host. Doña Lidia is a woman that smiles into your heart; her chuckles heave her chest and leave her sighing with tear drops at the corners of her eyes. She is the ultimate sweetheart. I introduced myself to her: "Hola, yo soy Smita." She replied, "Ah, Ednita! Que bonita", nodding, and smiling, of course, straight into my heart. The next morning, I would be starting my placement. Sure, I was nervous.

Needless to say, there was no reason to be.

Dr. San Manuel Hospital is a concrete building with an iron gate that is guarded at all times by four police officers each with two rifles, and one hand gun. Inside the building the floor is tiled, and the rooms are equipped with wooden doors and paper signs. The hospital wards include emergency, paediatrics, surgery, labour and delivery, neonatal, out-patient and in-patient. It is also equipped with a pharmacy and laboratory. I worked predominantly in emergency and occasionally was able to shadow doctors around the hospital to see different cases in the different wards.

From what I have learned during my stay in Honduras, Dr. San Manuel Hospital was not as technologically advanced as the hospitals of the country's two major cities: Tegucigalpa and San Pedro Sula. However, the doctors were equipped with a knowledge and experience that, I learned, were more capable of fighting the root of Honduras' health problems. As one of our supervising physicians, Dr. Ricky Ruiz, told us, "Our biggest enemy in the hospital is, the lack of education. People don't understand health, because they are uneducated."

There were two types of people that came into emergency everyday: those with machete wounds, and pregnant teenagers. The problem with machete wounds was never on how to fix the deep gashes. Instead, the doctors struggled with trying to ensure that infection would not develop. For this reason, many common practices differed, from developed countries. For example, when stitching, a regular stitch may be tied about two or three times in developed nations; however, in Honduras we were taught to tie each stitch six to eight times. The problem with making stitches too tight is that blood clots may form under the skin. The doctors were willing to take this chance over infection. On average, most of the patients took a three hour bus ride to reach the hospital. As a result, patients came too late and with very desperate issues. I saw too many limbs, with dead black flesh and puss-filled pockets resulting from wounds left untreated for two or three weeks. Bacteria had made a feast of these limbs, and the wounds still dripped a dark red blood, three weeks after they had occurred.

In Honduras, patients pay five lempiras, an equivalent of twenty-five cents U.S., for a medical treatment. This includes the consultation and most types of common medication. On rare occasion, the physician will prescribe a drug that is not covered by the basic fee. This is an extra cost for the patient. I encountered one such situation where a woman was prescribed two drugs; one was covered, but the other, penicillin, was not. She came back to Doctor Ricky saying that the penicillin was too expensive costing around thirty lempiras. The doctor was furious and explained that this was her health; if she wanted to live, she had better buy the penicillin. Compared to patient-care practices of the west, the attitude of health care workers will seem harsh. However, this is the only throw of speech that communicates to the vast majority of patients. Doctor Ricky explained the situation to us:

Five lempiras, even for poor Hondurans, is very cheap. This woman needs penicillin and is upset because she has to pay extra. She's too poor, she says, and I don't deny it. Thirty lempiras is expensive, but affordable, and most of all, the medication is important. These people don't understand the importance of health, a result of their lack of education. Now, this woman will not buy the penicillin and will only get the other drug. She thinks that half of the prescription will be enough to cure her. However, come the time of her son's birthday or her daughter's wedding, she will save money to buy a cake that costs one hundred and thirty lempiras. It is this lack of education that we fight at the hospital. Otherwise, we are not a poor country nor are we poor people. Our system and our staff are capable of treating most of the health problems, but, our patients are incapable of understanding.

I thought about the doctor's statement, "These people don't understand the importance of health." So then, who does? Do we, as citizens of the developed nations? My mother gets painful aches from an imbalance of muscle strength in her lower back. The physiotherapist told her that if she does certain exercises three to four times a day, for six weeks, the problem will not recur. Mother-dearest exercises two to three times a week. My friend developed a cough at the end of August. She gave the cough a good shelter for a month before going to the doctor and being prescribed antibiotics for strep throat. To know, yet ignore: it is a simple virus active in all people around the world.

The patients of Honduras came into the emergency ward of Dr. San Manuel Hospital with ulcers, pneumonia, asthma, decapitated limbs, internal and external infections. I watched these men, women and children come into to the hospital and their pain slapped me across the face. They, however, smiled through their tears. Not one, but all patients I met, laughed, and joked about their frustrating situations. Their physical pain didn't infect their smiles.

I sit on a cushioned airport chair on August 23rd 2008, frustrated at having to leave Honduras. Reliving all the memories in my head, I take many exasperated breaths. Looking up from the floor and out the giant windows, I gaze once more at the expansive hills. As if laying a hand on my head as a blessing, they comfort me; and like the local Hondurans, I smile.