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On what I am.

I didn’t know it was possible to feel this empty, and yet this full, all at once.

In the 10 days that I recently spent in Guatemala, I was like a thirsty traveler, bending to drink at a fountain and finding instead a fire hydrant – eager to learn, but nearly unable to take in the flood of information, images, and realities that rushed at my face at breakneck speed.

In those 10 days…

I was humbled.

My heart was broken.

I felt overwhelmed and excited and weak and sad and joyful and emptied of so much but full, full, full to the brim with hope.

I’m home in Miami now – the reports and meetings and other mundane follow-up are piled up on my desk, and before tackling them, I’m allowing myself a final moment to reflect on the ways this first real step into my new professional life has affected me. I’ve been bemused to note that what I saw last week weighs more heavily on me now than it did when I was in-country. But I think I’m beginning to understand why.

I work in women’s health. In addition to being an issue I am passionate about, it has also become an obsession for the pundits and the politicians, hotly debated on the campaign trail and in the caucuses. I’ve never really been one for politics, so it should come as no surprise that I find these discussions pedantic and intangible. But after returning to the pre-election barrage after my recent trip south, it is almost to much for me to bear. For me, these few weeks have been an earth-shattering reminder that there is an incredible distance between:

the lofty discourse that is being thrown at us…

…and the gritty places in our communities, nation, and world where the rubber meets the road.

That chasm has never felt greater than after spending a week with the women who suffer in those gritty places, and coming home to the mounting political discourse of the men who hope to lead the most powerful nation on earth.

For example, it feels inhumane to be discussing the definition of rape after holding the hand of a woman who was recently sexually assaulted.

It feels insulting to decide which families matter after meeting children who don’t have one.

It feels misguided to argue over what “side” cares more about the sanctity of life while real, live women are needlessly dying without access to comprehensive reproductive health services…

…especially when the “side” that claims the moral high ground would limit that access even further.

It feels narrow-minded reduce the complexity of womanhood to one small slice of it – reproduction – and to reduce the complexity of that even further by legislating it.

In the gritty places, it has been with grace, humility, and compassion that traditional midwives, feminist nuns, meticulous lawyers, and proud peasant mothers of 10 have taught me the following about what they are, and what I am, too:

I am more than my right to choose.

I am more than a political talking point.

I am a daughter.

I am a future mother (because I want to be, and it will be beautiful.)

I am a woman.

I am a person.

I am fearfully and wonderfully made. (Psalm 139:14)

A mural in San Juan Comalapa, Guatemala, painted with the lyrics of this song by Amapro Ochoa. Rough translation: “Woman, if you grow your own ideas, they will say ugly things about you. That you are not strong, that you are this and that. That when you shut up, you are much more beautiful to them.”

 

On wanderlust.

Sitting here in my hotel room overlooking Mexico City, I’m overwhelmed with gratefulness at having the opportunity not only to be paid to do work I’m passionate about…but also to be able to travel in the process. As a Program Officer for an international NGO, I’ll be traveling throughout Latin America working on women’s health issues. Pinch me, please, somebody.

20120910-231147.jpg

I have updated my google travel map (see below) and will be keeping track of upcoming and recent trips on the Travel tab on my blog.

Somehow as I look at this map, all I can think of is…there is so much more of the world I’m dying to see.

As they say in Honduras…Andale, pues!

On growth.

This March, I had an unexpected opportunity to go back to Honduras – this time for my job in the UNC Office of Global Health.

The trip involved visiting a local NGO and providing technical assistance for their childhood malnutrition projects. We visited field sites in the rural areas around the capital city (Tegucigalpa) to observe a program that consisted of mothers and other caretakers bringing their 0-2 year old children in each month to participate in growth monitoring and growth promotion activities:

Growth monitoring consists of weighing the baby during each visit, and tracking their growth by weight over time. Monitors compare the baby’s weight and growth to standard charts that help them determine whether the child is growing adequately.

Growth monitoring.

Growth promotion consists of providing counseling to the mothers of children who aren’t growing adequately. The counseling helps them identify the causes of inadequate growth (illness, not eating enough, not eating the right things, etc.) and how to remedy those problems so that the child’s growth can get back on track.

Growth promotion.

In Honduras, children don’t typically suffer of acute, severe malnutrition. A child may look relatively healthy, but be suffering from chronic malnutrition that causes their growth to stagnate. Without monitoring their growth regularly – and intervening when necessary – their growth is stunted, and they don’t develop properly.

And so it is with us, I think.

With all that talk about growth all week, it got me thinking about my own growth as a person. How often do I measure my growth, and compare it to where I ought to be? How often do I make a plan regarding how to get back on track?

That trip to Honduras served as such an opportunity to monitor my growth. There were multiple occasions throughout the week when I took pause and stepped back mentally, as if watching myself through a window, and marveled at how much I have learned. How much I have changed. How much I have grown.

I’ve spent the past two years in a rigorous graduate program that many of us describe as a sprint to the finish. The pace and volume of work has been incredible, and the juggling act has captured so much of my attention that I’ve taken little time to reflect on and notice how much I’ve been learning.

But the beauty of growth is that it happens while we aren’t watching. Small, incremental changes aren’t really noticeable hour by hour, or day by day. We face our daily struggles and triumphs, we solve problems, and we learn – not really noticing as we go along that we have actually grown. The danger is that our stagnation can also escape our notice – just as we can grow, we can also stall or even regress in subtle ways that we aren’t aware of.

Being in Honduras this time around felt like pushing “pause” for 10 days and stepping out of my normal life. What I discovered was that my story from the past couple of years is one of immense growth. I felt a degree of confidence I didn’t know I had. Things that were difficult for me a year ago came naturally. Questions I once didn’t know to ask slipped off my tongue easily. Ideas and problems that I’ve discussed and debated in classrooms became real before my eyes – and though I still didn’t know how to solve them, I could talk about them and struggle with them alongside some very, very smart people. And it made me think to myself – by jove, I know things!

Having such an experience 2 months before graduation was such a gift. It made me realize that the challenges are indeed worth it. It is easy to lose sight of that when grad school means being up at 2am formatting references on the 18th draft of a research paper, or scheduling long days filled with back-to-back group meetings. But to take that pause and see how much what I’m learning matters – and to see that I am indeed growing and still have so much more to learn – was motivating and inspiring. I came back with renewed strength and vigor, and I was able to sprint to the finish as hard as I could with a renewed spirit and my head held high with hope.

Literally sprinting through the School of Public Health to turn in our Capstone project deliverables – 30 seconds before they were due.

Alongside some of the most incredible, compassionate, intelligent, and inspiring people I’ve had the pleasure to meet, I will graduate tomorrow. We’ll celebrate (oh yes, we will!) all that we have learned and accomplished together.

Of course – growth is iterative (!), and our stories aren’t yet over.

But we’ll close this chapter knowing we are better than we were when we started, and knowing that yes –

We have grown.

On the magic school bus.

If you grew up in the 90’s like I did, you know exactly what I’m talking about when I mention the words, The Magic School Bus. These words should conjure memories of Ms. Frizzle, her wacky red hair, and the misadventures of her class of students who got more than they bargained for on their many field trips in said bus.

My favorite book from the series: "The Magic School Bus Inside the Human Body."

After spending some time in Central America, I’m convinced that the book’s author, Joanna Cole, has spent significant time there herself…and that the public transit system there convinced her that nothing is impossible for a seemingly ordinary yellow school bus.

Allow me to explain.

Public transport in Honduras looks strangely familiar. Regardless of where you need to go, 9 times out of 10, the way to get there will involve one of these:

The Honduran version of The Magic School Bus.

According to a colleague of mine from the Global Health Advisory Committee at UNC who came to visit our project in Honduras for a few days, and who spent some time in a former life as a worn-out-school bus-salesman (seriously!), when school buses are deemed too old and decrepit to safely transport America’s youth – they get sold to bus driver’s in Central American countries like Honduras. His Honduran contact, Hector, would purchase one several times a year. He’d travel to the US with his handy mechanic, tinker until the bus was up and running again, then make the dangerous drive from Louisville or Cherry Hill or Tulsa (or whatever other school district happened to be selling at the time) back to his home country – sleeping on the worn, vinyl seats at night and paying bribes at the borders along the way.

After seeing what these trusty machines can do long after being deemed unroadworthy…I’m convinced that we in the US give up on them long before they’ve reached their full potential.

Take this bus for example – above the front door, it warns a maximum capacity of 72 persons. During the bumpy ride from Choluteca to El Corpus, I lost count at 109 persons, 32 chickens, 16 oversized sacks of rice, 1 mattress, 12 baskets of tomatoes, and 22 gringo’s Osprey, Northface, and High Sierra packs.

Sardines in a very hot, sweaty can.

I also watched the same bus climb a steep, muddy, rocky incline that no sane Idahoan would ever attempt to climb without huge tires and a lift kit.

Just kidding. No self-respecting Idahoan would ever be seen in a truck as ridiculous as this.

These school buses can ford rivers, make 3-point turns on a narrow mountain road bordered by a cliff, and make excellent time on an 8% grade.

She'll be coming around the mountain when she comes...

But don’t worry, if the magic school bus tilts sideways as it slides down into a ditch – your bus driver will know just what to do…he’ll have all the passengers move to the high side, put the metal to the metal, and work some magic of his own…and rather than rolling over as you assumed would be your fate, you’ll be back on the road (horizontally) in no time.

No picture of that one. Do you really think I would take the time to snap a photo under such circumstances?

And when you’re really lucky and land on a truly tricked out Magic School Bus…you might just get to watch totally rad 1980’s music videos from the U S of A:

Don't recognize her? Click on the photo to find out which 1983 Bonnie Tyler hit serenaded us from Tegucigalpa to Choluteca.

These buses also have more get-up-and-go than one might think. Sometimes if the pick-up truck laden down with gringos in the back is going too slow on the pot-hole infested muddy road…the bus might really show what it is made of and pass said pick-up truck on the grassy “median,” despite oncoming traffic. They don’t call it a “chicken bus” for nothing.

Nothing wakes you up at 5am in the morning like a bumpy ride over pot holes and being passed by a chicken bus at 60 miles per hour.

Yes, I will always look fondly back on those Magic School Bus books and videos. My host mom in Spain was a doppelganger for Miss Frizzle….and the Honduran public transportation would give her fancy yellow bus a run for its money in terms of impressive journeys into the impossible.

On plans – part 2.

A while back, I wrote a post about plans – plans for the culmination of my master’s practicum, which would take place in southern Honduras. It was a bit gratifying to return home this week and re-read that post – though as expected, not all went according to plan…most of it actually did.

Reading my plans felt like reading the story of my time in Honduras before having actually lived it. My plans, expressed through my words, pretty accurately captured what happened – but they lack the color, vibrancy, and warmth of actually living it. Because they say a picture is worth a thousand words….I invite you to re-read the post with me – but this time, with photos, which tell the story far better than I ever could.

Friday, June 24: Don a green bridesmaid dress, walk down the aisle, pose for photos in the eternal Alaskan twilight, eat some wedding cake, and dance the night away at my brother-in-law’s wedding in Anchorage (perhaps only slightly reliving my own wedding almost exactly one year prior.)

I have few pictures of the wedding at this point - but here is a special moment just days before...hiking Hatcher Pass (north of Anchorage) with my hubby in celebration of our 1 year anniversary.

Saturday, June 25: Wake up, wash the smeared makeup from my face and the crusty hairspray from my hair, and board a plane bound for Tegucigalpa, Honduras. Enter the twilight zone of 30+ hours of travel from the far reaches of the inhabitable northern hemisphere to the sweltering jungle that is Central America.

There is no photo of the twilight zone. But I did really enjoy my mimosa and spinach salad in First Class.

Sunday, June 26: Arrive in Tegucigalpa. Ride in a careening taxi through the noise, dirt, and energy of urban Honduras. Sleep off the travel and perhaps, if I’m lucky, meet up with a fellow HBHE at the local Applebee’s (yes, there is an Applebee’s in Tegus. I wonder if their Sizzling Smokehouse Chicken Stack is up to par…)

Jet lag and responsibilities kept me from venturing to Applebee's...but look who came and found me at my lovely Tegus B&B. We bonded and caught up over Pizza Hut delivery pies and 100% Deet.

Monday, June 27: Board a bus and head 5 hours south toward El Corpus with a group of 16 other UNC medical and public health students. I’m sure the first thing I’ll do when I arrive is give my 7-year-old friend Samantha a big abrazo and share a chocobanana, then we’ll all settle in and meet our host families. HHA gives health education talks (charlas) on nutrition, family planning, sexual health, and gender-based violence, so I will spend the first couple of days leading a training for the medical students in preparation for presenting the charla material.

Teaching a practice charla to the women of El Corpus...this astute group of US medical students and Honduran women have correctly identified the proper way steps of putting on a condom.

 

Thursday, June 30: Head for the hills. Our group of 17 will split into groups of 2-3 to head out to the rural communities HHA exists to serve. Although El Corpus itself is a small, sleepy village, it does enjoy the modern conveniences of electricity, spotty running water, cobblestone roads, and a school, several churches, and even a baseball field. We will travel by bus, burro (donkey), and foot to small communities that lack all of these things. There we will stay with the local health promoters (lay health advisers who voluntarily serve their community’s health needs as best they can) and spend several days presenting charlas to the women who live in the communities. I will be traveling to Los Terreros, the most far-flung but largest community, and in addition to charlas, will be conducting in-depth interviews with the women as a part of my qualitative research project for my practicum.

This is where plans diverged a bit...due to fits of nausea and fever that kept me horizontal for 3 days, I did not head for the hills...watching laundry dry from my hammock was about all I had energy for.

 

Monday, July 4: Clinic begins! We will wake up before dawn, board Pedro’s pickup truck, and make the 45-minute journey to Madrigales for clinic each morning. Each day of the week is designated for one of the communities we visited the week before, and women from the assigned community will travel to Madrigales each day to visit the clinic – for many of them, the only time they will see a doctor all year. Women will receive pap smears, family planning services (including a year’s supply of the pill, male/female condoms, and even IUD’s for those who choose), and diagnosing/treatment for STI’s and other gynecological problems. Our makeshift clinic will be set up in a community center, and we will see up to 80 women per day.

The crew on Pedro's truck outside the clinic.

 

Saturday, July 9: On the final day of clinic, we will travel beyond Madrigales to Los Terreros – the community I will have visited the week before. Because it is so far and so many women live there, HHA comes to them and sets up clinic in the local school house.

An exam room in our Los Torreros clinic.

 

Sunday, July 10: After an exhausting couple of weeks, we will have a couple of days to kill. The samples from the pap smears conducted in clinic will be sent to the Planned Parenthood affiliate (ASHONPLAFA) in Choluteca, the nearest city, to be analyzed. In the meantime, our group will spend some time there to check email (it may be our first access to internet since leaving Tegus), enjoy some American fare (ahem, Wendy’s), and air conditioning. We will also likely tour ASHONPLAFA or the HIV testing facility to get a sense of healthcare in slightly more urban Honduras.

Our 2 hour ride to Choluteca in the back of the truck took us through a wicked lightning storm...this is the last photo snapped before the skies really opened up.

 

Tuesday, July 12: We will return to El Corpus and on to Madrigales to assist with some improvements to the building that we use for the clinic – over the past few years, the roof has slowly given out – making clinic very difficult to maintain given that we visit during July, the rainy season in this part of Honduras. We will also hold a small conference for the village health promoters, in which Amy (my travel buddy from March) will present the findings of her research and discuss ways that we can better support and/or train the village health promoters in health care provision for their communities.

Amy and I with the community health promoters at the 2011 Health Promoter's Conference.

I also found some time to climb this mountain - story to be told in a forthcoming post.

Thursday, July 14: The final step for us will be to return to the communities we visited at the beginning of the trip with the women’s pap smear results in hand. Rather than asking hundreds of women to make the grueling journey to return to us to receive their results, we will come to them. For women who need follow-up care, we will leave funds with the local health promoter that will pay for the women’s travel to Choluteca to receive the needed services from ASHONPLAFA. When they do make the journey there for their follow-up visit, HHA will cover the cost of their care.

On results day, I took some time to visit some friends I made back in March. I love this shot of us.

Saturday, July 16: Return to El Corpus for a final night of celebrating the end of our project. I’m sure many tearful goodbyes will be said (and many chocobananas eaten).

With my host family at our farewell fiesta - Juana, Samantha, Pedro, and Andrea.

Sunday July 17: Back to Tegus, back to the States…and on to the next adventure!

So there you have it. Our plans, and how they turned out. We planned. We saw 300 women in our clinic. We learned. We grew. I’ll attempt to share more details about  how things actually went down in the coming weeks…but for now, to celebrate plans and how they sometimes actually work out.

On the ugly.

Here in Honduras, I’ve had the privilege to see some…ugly.

In my last post I wrote about the privilege of experiencing the beauty of this foreign place. It was a fun post to write. I love seeing beautiful things and take even greater joy in sharing them with those of you who aren’t here with me. But when I went to bed that night, it was the ugly that I have seen that was on my mind. And that made me realize some things.

I think I wrote the post about the beauty, in part, because I genuinely wanted to share it. But I think I also wrote it because thinking and writing about the beauty here helped me – rather, allowed me – to forget for a moment about the ugly.

But the ugly is here too, and it is just as real as the beauty. And part of my privilege in being here is to see both.

So in the interest of being honest…

I have seen some ugliness here.

The children with big eyes and copper toned hair that betrays malnourishment…their hunger is ugly.

The men who guard buildings – hotels and banks and wealthy people’s homes – with machine guns and a stern, vigilant gaze…the violence that makes them necessary, and the desperation that leads to violence is ugly.

The mine that has been carved out of the lush mountainside of El Corpus: the heavy machinery that frightens children on their way to the river, the contamination that prevents them from bathing in its cool, refreshing swimming holes and waterfalls, the acrid smell of chemicals that burn your nostrils, the flat muddy expanse that used to be a living green hill,  the the angry bark of the dogs who defend the gold…its greed, contamination, sounds, and smells are ugly.

The 12-year-old who came to our clinic who was sent away from her family at 10 and now lives with her “novio” of 17…her loss of innocence and her powerlessness are ugly.

The healthcare system, with its understaffed rural health posts, which are at times stocked with little more than ibuprofen and a malfunctioning blood pressure cuff, and overrun urban public hospitals that haven’t a prayer of caring for the poor, often illiterate, desperate patients who line up before dawn to be seen…its hopelessness is ugly.

The trash that litters the hillsides, that floats down the streets when the rain turns roads into rivers…it is ugly, too.

Poverty. Powerlessness. Sickness. Shame. Violence. Hunger. Hopelessness. Weariness. Depression. Isolation. Fear. These are among the ugly things that I have seen. But as unpleasant as it is to write about them, to deny them would be to deny the realities and idealize the difficulties faced by the people who live, love, struggle, and survive in the breathtakingly beautiful yet equally oppressive place.

I seek out the beauty. I believe in the beauty. But it doesn’t erase the ugly. And on the hard days, that is what is on my mind when I go to sleep at the end of another beautiful day in Honduras.

On the beauty.

Here in Honduras, I’ve had the privilege to experience beauty.

Some of it is crazy, knock your socks off, stunning beauty, while some of it is subtle, simple, quiet beauty that you have to pay close attention to notice. Some of it is visual, in the verdant green hillsides and the quaint landscape of rustic villages, while some of it is less tangible, and can only be sensed in the stillness of an evening or the kindness of a stranger. And some of it is something else…an example of which I will attempt to share here.

The first day of clinic, we were seeing women from Potreritos, the most far-flung community of the six that we serve. The women of this village have to wake before dawn and travel by foot for hours – through thick brush, steep mountainsides, and rocky, muddy footpaths, to arrive at the clinic site. With the heavy rains in the past week, however, the most dangerous aspect of the journey that day would be fording the engorged river, which holds local fame for drowning a woman who attempted to cross during rainy season last year.

That morning, I spent the hour-long ride in the back of Pedro’s rusty pickup truck soaking in the stunning views of the lush, beautiful countryside and feeling the cool early morning wind in my face…all the while recognizing that the ruggedness of the landscape was lovely from our perch, but that it could be the very thing that could prevent us from accomplishing our mission that day. We arrived to the clinic building and busied ourselves setting up the rooms, recognizing that if nobody arrived, it was all for naught. Given that women normally arrive hours early to claim their place in line, the quiet was foreboding.

And then, over the hill, they came. For me, it is always powerful to see these women all gathered together in one place in the name of their health, but this was different. It wasn’t just the women who came – it was as if the entire village of Potreritos descended upon our clinic. Women and their babies were on horses, led by men wearing jeans and worn cowboy hats. I went to greet them and learned that the river had been too high for the women to safely cross alone, and so the community had come together to make it possible for them to come. The older children stayed behind to watch their younger siblings. The men, most of whom are sustenance farmers, left their fields to lead their horses, which carried the women and their babies, across the river.

A woman I met, who had come to clinic every year for the 8 that HHA has been here, explained it to me like this: “I have 8 children. If I get sick, who will care for them? Who will make sure they grow strong and healthy? My family can only be healthy if I am healthy.” She went on to say, “The road here is long and hard. Many women say no, no I cannot go. I have to stay here to care for my children. I am afraid of the river. And I tell them, no. To care for your children, you must go. You must have this test, how else can you know if you are sick? The river is one thing, but the sickness, it is another. So I bring them with me. Some of the men know this too, that their woman must go, and so they helped us cross the river….because they know we need this and our lives depend on it.”

For me, that morning was beautiful for many reasons.

It was beautiful because of the way it demonstrated community.The women arrived together, and they left together. The younger women came because their older vecinas encouraged them to. On the way there, they spoke about their fears in anticipation of the exam, and on the long trip home I’m certain they compared notes and reassured one another that their results would come back normal. The communal nature of their health care experience this week sits in such stark contrast to my experiences back home – where I drive to my annual appointment alone (likely grumbling if traffic makes my commute take 20 minutes instead of 15), read a magazine in silence in the waiting room, and receive my results in the mail several days later – likely never speaking to anybody, even my closest friends, about my experience.

It was also beautiful because of the role that the men played. So often here, when we discuss the role of men in women’s health, the story I hear is the story of machismo. The story of a debilitating power differential between the men and their women. The story of husbands forbidding their wives from using family planning, forcing her to plan escondida, hiding her pills and taking them after he has gone to sleep…or forcing her tired body to bear 8, 9, sometimes over 10 children she doesn’t have the resources to feed. The story of women who are not allowed to come to the clinic because their husband’s don’t want anybody else – even a doctor – to see her parte. These stories are real and I hear them often – but that morning, it was beautiful to see the other side. It was beautiful and it was hopeful to see their support and participation in the process.

Here in Honduras, I’ve had the privilege to experience beauty. I have a camera full of pictures and a head full of stories to show for it – but sometimes, it is the slight adjustments in my perspective and my perceptions of what life, health, community, gender, power, and love really mean that are most beautiful.

The horses they arrived on, waiting patiently in the "parking lot."


On flexibility.

Ive been in Honduras for 4.5 days now, and have already learned a number of lessons about flexibility.

Rain (we are talking sheet and sheets, creating rivers between cobblestones and soaking those riding in the back of a pickup) happens.

Canceled flights (especially when they are flying into Tegucigalpa, one of the most dangerous international airports in the world) happen.

Turds in the latrine start to jump around and turn out to be toads…yes, that happens.

When cell service in far flung communities dies out, 430 am one way radio announcements for communication happen.

And as I have most recently found out, gastrointestinal distress, too, happens.

While most of the things that have arisen have been mildly humorous, the last one has come as a disappointment. Instead of making the long trek to deliver health education workshops and conduct interviews in Los Terreros, a far away village that requires multiple buses and long hikes, and sometimes donkeys to reach…I am here in El Corpus gulping gatorade and refraining from venturing farther than a few feet from the flush toilet. This is clearly not how I hoped to spend this time, and I have spent much of this morning feeling frustrated and disappointed, given the short time I have to be here. I do not want to waste it this way!

But I remind myself that this too is all part of it. Being flexible doesnt just mean adapting oneself when something inconvenient or funny or strange happens. It also means recognizing your limits. It means taking care of yourself when Honduras wears you down. It means finding a new way to accomplish the tasks you came for. And, hardest of all, it means letting someone else go instead. It means being content knowing that the poor will still receive the service our group came here for, and that matters so much more than the fact that I dont get to be the one to deliver it…at least not today.

On the bright side, Im sitting in an informal internet cafe with the soothing sounds of Lionel Richie singing “Say You, Say Me” ringing in my ears. The young man who works here is practicing his English by singing it at the top of his lungs and asking me questions about North Carolina. He was even nice enough to sell me the sim card right out of his phone to get mine up and running again. It could be worse. And tomorrow is another day.

On the why.

As earlier posts have suggested, my project with HHA focuses on cervical cancer.

Why?

Consider this…

In the US, the rate of cervical cancer death in 2008 (per 100,000 women) was 1.7.

In Honduras, that number was 19.7.

Why?

Consider this…

In the US, the estimated % of women who had been regularly screened was 84%.

In Honduras, that percentage was 26%.

Why does this matter?

In a nutshell, cervical cancer is pretty easy to screen for. Most of the women who read this post will have had a Pap test annually, or at least every 2-3 years, for the majority of their adult lives. Because cervical cancer grows slowly, regular screening makes it pretty darn easy to detect abnormal cells early enough to intervene and treat before the cancer becomes life-threatening. Between the HPV vaccine and the strong screening program here in the US, cervical cancer ranks as the 13th most prevalent cancer among women…while in Honduras, it come in as #1.

WHO map of worldwide cervical cancer mortality. Note that Honduras is dark red. Dark red = bad.

Screening rates in the developing world are much lower than in high-income countries like the United States. While there are certainly a host of other reasons why cervical cancer mortality may be higher (such as access to the HPV vaccine or sexual practices), implementing a screening program is a high impact and relatively low cost way to greatly reduce it. In a rural region like the one we work in, screening is particularly infrequent. Access to medical services is extremely low, and the ability to afford the few services offered even lower. This summer, we hope to provide 400-500 women with Pap smears…something I’ve dreaded (but benefited from!) without so much as a second thought every year since I was 15.

Why do we focus on cervical cancer?

Because by providing free screening and follow-up care, we can make a tangible difference in health outcomes. And that is pretty exciting.

Sources: WHO/ICO Information Centre on Human Papilloma Virus (HPV) and Cervical Cancer: http://www.who.int/hpvcentre/statistics/en/

On plans.

With the project in Honduras quickly approaching, those of us who are a part of HHA are scrambling to get everything in order. We’ve been planning for months, but now, our plans are in super turbo mode. My spare bedroom looks like a medical supply warehouse explosion, my desk is covered with IRB applications, and I’m beginning to envision how I will possibly pack for a journey that will include fly-fishing on an Alaskan river, hiking on glaciers, being a bridesmaid in a formal wedding, and backpacking through Central America, sleeping on hammocks, riding donkeys, and taking bucket baths by the light of a headlamp. (Perhaps I should have mentioned that I’m traveling to Honduras directly from my brother-in-law’s wedding…in Alaska.) I should have reserved my last post on preparing for a trip for this time around – if I thought I had a lot to think about then, I was sure kidding myself. So to reign in the craziness, I plan.

As the trip approaches, I’ve been asked a lot about what I’m actually going to DO while I’m in Honduras. “What are your plans?” they ask. Its a good question. In a mere 3-week trip, we are setting out to accomplish a lot. We have a lot of plans. If there’s anything I’ve learned about working in a developing country, its that nothing goes according to plan…however, the itinerary that we hope to go by is below – in other words, this is the plan:

Friday, June 24: Don a green bridesmaid dress, walk down the aisle, pose for photos in the eternal Alaskan twilight, eat some wedding cake, and dance the night away at my brother-in-law’s wedding in Anchorage (perhaps only slightly reliving my own wedding almost exactly one year prior.

Saturday, June 25: Wake up, wash the smeared makeup from my face and the crusty hairspray from my hair, and board a plane bound for Tegucigalpa, Honduras. Enter the twilight zone of 30+ hours of travel from the far reaches of the inhabitable northern hemisphere to the sweltering jungle that is Central America.

The urban sprawl of Tegucigalpa

Sunday, June 26: Arrive in Tegucigalpa. Ride in a careening taxi through the noise, dirt, and energy of urban Honduras. Sleep off the travel and perhaps, if I’m lucky, meet up with a fellow HBHE at the local Applebee’s (yes, there is an Applebee’s in Tegus. I wonder if their Sizzling Smokehouse Chicken Stack is up to par…)

Monday, June 27: Board a bus and head 5 hours south toward El Corpus with a group of 16 other UNC medical and public health students. I’m sure the first thing I’ll do when I arrive is give my 7-year-old friend Samantha a big abrazo and share a chocobanana, then we’ll all settle in and meet our host families. HHA gives health education talks (charlas) on nutrition, family planning, sexual health, and gender-based violence, so I will spend the first couple of days leading a training for the medical students in preparation for presenting the charla material.

Espeveles - one of the communities our group will travel to.

Thursday, June 30: Head for the hills. Our group of 17 will split into groups of 2-3 to head out to the rural communities HHA exists to serve. Although El Corpus itself is a small, sleepy village, it does enjoy the modern conveniences of electricity, spotty running water, cobblestone roads, and a school, several churches, and even a baseball field. We will travel by bus, burro (donkey), and foot to small communities that lack all of these things. There we will stay with the local health promoters (lay health advisers who voluntarily serve their community’s health needs as best they can) and spend several days presenting charlas to the women who live in the communities. I will be traveling to Los Terreros, the most far-flung but largest community, and in addition to charlas, will be conducting in-depth interviews with the women as a part of my qualitative research project for my practicum.

Sunday, July 3: Return to El Corpus, take a nice shower, brush our teeth, and swap stories…then begin preparing for the week of clinic.

Clinic building in Madrigales

Monday, July 4: Clinic begins! We will wake up before dawn, board Pedro’s pickup truck, and make the 45-minute journey to Madrigales for clinic each morning. Each day of the week is designated for one of the communities we visited the week before, and women from the assigned community will travel to Madrigales each day to visit the clinic – for many of them, the only time they will see a doctor all year. Women will receive pap smears, family planning services (including a year’s supply of the pill, male/female condoms, and even IUD’s for those who choose), and diagnosing/treatment for STI’s and other gynecological problems. Our makeshift clinic will be set up in a community center, and we will see up to 80 women per day.

Saturday, July 9: On the final day of clinic, we will travel beyond Madrigales to Los Terreros – the community I will have visited the week before. Because it is so far and so many women live there, HHA comes to them and sets up clinic in the local school house.

Sunday, July 10: After an exhausting couple of weeks, we will have a couple of days to kill. The samples from the pap smears conducted in clinic will be sent to the Planned Parenthood affiliate (ASHONPLAFA) in Choluteca, the nearest city, to be analyzed. In the meantime, our group will spend some time there to check email (it may be our first access to internet since leaving Tegus), enjoy some American fare (ahem, Wendy’s), and air conditioning. We will also likely tour ASHONPLAFA or the HIV testing facility to get a sense of healthcare in slightly more urban Honduras.

Tuesday, July 12: We will return to El Corpus and on to Madrigales to assist with some improvements to the building that we use for the clinic – over the past few years, the roof has slowly given out – making clinic very difficult to maintain given that we visit during July, the rainy season in this part of Honduras. We will also hold a small conference for the village health promoters, in which Amy (my travel buddy from March) will present the findings of her research and discuss ways that we can better support and/or train the village health promoters in health care provision for their communities.

ASHONPLAFA clinic in Choluteca

Thursday, July 14: The final step for us will be to return to the communities we visited at the beginning of the trip with the women’s pap smear results in hand. Rather than asking hundreds of women to make the grueling journey to return to us to receive their results, we will come to them. For women who need follow-up care, we will leave funds with the local health promoter that will pay for the women’s travel to Choluteca to receive the needed services from ASHONPLAFA. When they do make the journey there for their follow-up visit, HHA will cover the cost of their care.

Saturday, July 16: Return to El Corpus for a final night of celebrating the end of our project. I’m sure many tearful goodbyes will be said (and many chocobananas eaten).

Sunday July 17: Back to Tegus, back to the States…and on to the next adventure!

So there you have it. Our plans. After July 17, I’m sure I’ll be sharing with you all the ways that things didn’t go according to those plans. While that is stressful in some ways, in others, it is a bit liberating to let go. We’ve been planning this for months, but I know that when we arrive, surprises will happen and we’ll have to go with the flow. Our plans will guide us, but our ability to be flexible, resourceful, and cheerful are what will make this a success. At the end of the day, sticking to the plan will not be our measure of success. As long as we engage with the communities responsibly, empower women to make healthy choices, and provide healthcare to a bunch of people who wouldn’t have it otherwise…that is what we truly plan to accomplish, and that is what matters most.

So there you have it. Our plans. Check in with me in August and I’ll tell you what really happened.