Hey gringo
BMJ 2003; 326 doi: https://doi.org/10.1136/sbmj.030224 (Published 01 February 2003) Cite this as: BMJ 2003;326:030224
- Jenny Hall, fourth year medical student1
Until about three months ago I would have had trouble finding Honduras on a map, so I had no idea what to expect during my summer there. Honduras--the “knee” of Central America--is probably most widely known because of the devastation left by Hurricane Mitch in October 1998. It's the third poorest country in Central America with 53% of the population living below the poverty line.1
Infectious diseases are rampant owing to dirty water, bad hygiene, poor education, and crowded living conditions; this is compounded by poor health practices, even by healthcare professionals. I saw only one sharps box in the hospital, and I'm sure I was the only one using it--everyone else dropped needles on the floor.
Honduran hospitals and health
People have to pay for health care in Honduras, and hospitals are basic. I spent four weeks living in Danli, an agricultural town in the south. I worked in the Gabriela Alvarado Hospital, where even my basic skills were desperately needed. It is the main health facility for a population of over 400 000; it has one operating theatre (about the size of a British hospital side room), two delivery beds, and around 20 beds for inpatients. Food and bed linen aren't provided. Mortality rates are high, which isn't to say that standards of care aren't, but doctors and nurses are demoralised by the usual complaints of long hours and poor pay and are further hindered by the conditions in which they are working. Facilities are worse than inadequate; “aseptic technique” comprises washing your hands every so often and swatting mosquitoes in the operating room.
The hospital was almost prison-like with security guards, metal bars, and gates throughout the corridors. The corridors were windowless and heaving with patients sitting, standing, lying, chatting, moaning, drinking coke from a plastic bag, breastfeeding; the occasional dog; and the odd cockroach.
On my first day, the nurses were on strike because they hadn't been paid for six months, and Honduras was in the middle of an epidemic of dengue fever. After my first day in the emergency room (which was about the size of your bedroom) I felt like an expert in dengue even though I'd never heard of it before.
ESTEBAN FELIX/AP
A 12 year old boy with dengue fever grimaces in pain in Tegucigalpa
My experience was by no means limited to that; if you had diarrhoea, needed an injection, needed stitches put in or taken out, or were going into labour, I was your woman. Until then, every medical procedure I had attempted was done under the beady eye of a senior supervisor, and now I was practically in control of the emergency department--a terrifying but exciting prospect.
Honduras has no equivalents to general practitioners, so everyone goes to the emergency department. This means that a huge amount of doctors' time is taken up with children with diarrhoea. One day we surveyed all the patients with diarrhoea about their housing situation--what their house is made of, how many people live there, what toilet facilities they have, and what their water supply is. Tellingly, not one of them used purified water.
After infections, obstetrics and gynaecology patients probably account for most of the rest of Honduras's healthcare usage. Honduran families tend to be large; it is a strongly roman catholic country making both birth control and abortion illegal. To give birth in hospital costs $5 (£3.13; €4.86) including lunch but still no sheets, but even this is too much for some who attempt to deliver at home, often with disastrous consequences.
I spent a lot of time helping in maternity and delivering babies. But as soon as the general surgeon found out I had been in an operating theatre in the United Kingdom, I became his first assistant. It didn't seem to matter to him that the limit of my experience was holding a retractor. Outside the hospital, as part of a national immunisation campaign, I went into local schools and educated children about preventing, recognising, and treating dengue fever.
Honduran hospitality
The Honduran friends, or rather family, I now have are inspirational people, predominately because of their kindness, friendliness, and unfailing efforts to help those in need. The nurse at the clinic where I lived invited me to her house on my first night when I was feeling rather overwhelmed, and the “housekeeper” took me to her village to meet her family--that was the whole village. I spent the day playing with children, paddling in the river, and dancing to the local radio station. Hondurans love to dance; I managed to keep up with the salsa and merengue, but the “punta” was beyond me--it's like belly dancing, if you didn't start doing it young, you just don't have the muscles and so it's physically impossible. I think I was invited back the next weekend for pure entertainment value. I was also introduced to the mayor and local members of parliament (all of whom tried to arrange a wedding for me) and almost every night a doctor from the hospital would take me out for dinner. I was the local celebrity.
By the end of my time in Danli I had grown close to a lot of people. The day before I left they bought me a cake, the children from the village came to town and everyone gave me presents. I was so touched, they have so little and yet they managed to give me so much. I was heartbroken to leave my Honduran family behind; everyone's eyes had tears in them as I walked away.
Key facts
Population--6 million
Language--Spanish
Capital--Tegucigalpa
Currency--Lemipra
International dialling code--+504
Gringo time
There are many obstacles to overcome if you want to do an elective in this area--Spanish is essential. Organising a placement such as this will be a slow and frustrating process, the best place to start would be the hospitals in Tegucigalpa as this is where the medical school is. Persevere--it will be worth it. And finally, perhaps the best piece of advice I can offer you is regarding the Honduran concept of time. We work on “Gringo time,”--that is, the actual time; they work on “Honduran time,”--that is, when you feel like it.
My summer in Central America was an amazing experience. I don't think that I can exaggerate the benefits of visiting a developing country. I left inspired by the people I had met and felt that, in some small way, I had made a difference to a few people's lives. They certainly made a difference to mine.
Notes
Originally published as: Student BMJ 2003;11:24