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Words for September 4

But the poor person does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent. The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited proletariat, robbed of the fruit of their labor and despoiled of their humanity. Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order.

[Gustavo Gutierrez, Peruvian theologian, priest, and social activist]

With these words, Padre Gutierrez challenged an oppressive social order, calling for a liberation theology and preferential option for the poor, but it appears social inequalities are only rising in Latin America – the region Gutierrez is from and where I work. These days, these words ring in my ears.

We have a lot of work to do.

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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 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.

On the boring details.

The Destination:

Tomorrow morning I will fly to Miami, then on to Tegucigalpa, Honduras. From there, a bus will take us south to Choluteca, then another east to El Corpus. The roads will be windy and bumpy, it will be 100 degrees or hotter, and I’ll probably have a chicken or someone’s baby in my lap.

The Project:

I’m working with a project called the Honduran Health Alliance (HHA). HHA’s mission is:

To collaborate with local communities in order to provide annual cervical cancer screenings, give health education charlas, and provide family planning resources.”

In summer 2011, our group (consisting of myself and a number of UNC medical students and attendings) will travel to small villages throughout southern Honduras where the extent of the existing healthcare system is lay health advisers and nurses with minimal training. We’ll provide health education workshops, cervical cancer screenings (pap smears), and family planning services.

The Trip:

This week’s goals are three-fold:

  1. To coordinate logistics for the summer and meet with the local health promoters to determine a strategy the summer’s project. I respect this program because of it’s community-driven nature, and these meetings will be crucial to ensure that our project is meeting community needs and not our own agenda.
  2. To conduct qualitative research for my colleague’s master’s paper. She is attempting to answer the question, “how can we increase access to HHA’s services to more at-risk women?” We will conduct focus groups and in-depth interviews with health promoters, women who have attended clinic, and women who have not, in order to determine barriers and determine the way forward that will expand our services to the women who need it most.
  3. To hang out. To become familiar. To soak it in. It can be tough to enter into a new community and build relationships and trust in a limited amount of time. By traveling this week with someone who has worked in these communities before, I hope to connect and make some headway on that front before jumping in next June.

And now, to sleep. See you in Honduras!