VCU's Global Health & Health Disparities Program/ HOMBRE Team Sets Off for Honduras! [Again!]

Tomorrow our team leaves on our medical and public health brigade to the La Hicaca area of northern Honduras. 

Town of La Hicaca; this is one of the sites
where we see patients in Honduras

Since 2008 we have been serving people across a series of 17 villages in and around the La Hicaca area of rural Honduras. This is the 6th consecutive year where we have held large-scale medical clinics in the region.  

Since the inception of our program (the VCU Global Health & Health Disparities Program, or GH2DP), we have had over 8,000 direct patient encounters, and have helped distribute over 200 water filters (each of which will provide clean drinking water to an entire family for 2+ years). We also have provided de-worming therapy multiple times a year according to WHO standards. 

Traveling to La Hicaca

It is important to note we are absolutely indebted to our community partners (see here for an interview with Father Pedro O'Hagen) as well as our non-profit partners the Honduras Outreach Medical Brigada Relief Effort (HOMBRE) and the Golden Phoenix Foundation. The work we do is a collaborative effort across multiple non-profit organizations and involves myriad professional schools and training programs as well as many independent healthcare professionals. Simply put, there are a lot of moving parts to these brigades!

This year our group includes 5 rising 2nd year medical students, 2 rising 4th year medical students, 2 pharmacy students, 3 internal medicine residents, 2 pediatrics residents, 1 pediatric fellow, 2 nurses, 3 attending physicians, 1 PhD microbiologist among others; all told there will be nearly 30 people in our group. 

Drs. Mason, Bearman and Stevens working on the
water filter program, La Hicaca

There are approximately 2,000 people in the area we serve, most of whom have extremely limited access to healthcare (see here for a study we did in 2011 looking at people’s ability to access care in this area). The nearest public hospital is two and half hours away by truck, making routine (and oftentimes even emergent) access to medical care nearly impossible. For the majority of people we see we function as their only access to healthcare. 

We had a small team 'on the ground' in the area back in January (see here for previous blog entries related to that trip). During the January trip we laid the groundwork for our current brigade, meeting with community partners, defining our mission and navigating logistical issues (what services we will provide, where we will set up the clinics, et cetera). 

Scouting out sites for our medical clinics in Lomitas,
January 2013 (these buildings are where we will hold
clinics for several days during our current brigade)

Although a big component of our work is focused on providing medical care, we have multiple public health programs as well. One of these projects is the aforementioned large-scale water filter program. To date, we have distributed 200 water filters and estimate that approximately 75% of the population in the region now has access to clean drinking water. Our data indicates that these filters have both microbiologic and clinical efficacy, and we have incidence data on diarrheal illness from the Ministry of Health that indicates diarrheal disease has been cut roughly in half since we started this program. More importantly, there has not been a single pediatric death from diarrheal illness in the region over the past 18 months. This year we will distribute another 100 water filters; our ultimate goal is to provide everyone in the area with access to clean water. 

Meeting with local health minister, Olanchito,
January 2013

Another big project for us over this past year has been assessing the impact of indoor air pollution on the health of people in the region; our local partners noted this was a major issue and asked us to do a formal needs assessment. In June of 2012, Audrey Le, now a rising third year medical student at VCU, did a needs assessment looking at indoor air pollution in the region. She found that indoor air pollution was associated with negative health effects, although many people were unaware of the dangers of indoor air pollution. On further examination of the issue this past January, we discovered that indoor air pollution was at least partly related to improperly installed (versus degraded) stove ventilation pipes. On our current brigade Audrey Bowes, a rising second year medical student at VCU, is leading an education program focused on raising awareness of the negative health effects of indoor air pollution and how stoves can be repaired to improve indoor air quality. We are excited about this project and believe it has the potential to significantly improve the health of the people we serve. 

Example of a properly installed ventilation
pipe; many of the pipes we inspected had
gaps between the pipe and either the stove
or wall (via which smoke could escape and
pollute the indoor environment)

An additional project we are doing on this brigade is a survey on Chagas disease that is being led by Dr. Summer Donnovan, a pediatric infectious diseases fellow at VCU; our community partners have identified this as a major issue in the region. Chagas disease is one of the neglected tropical diseases, and is an insect-borne parasitic infection that affects people in the Americas, especially parts of rural Latin America. It is estimated that 11 million people are currently living with this infection, and untreated this disease persists for life. Chagas disease is associated with major morbidity: over time the infection can lead to heart failure and death from arrhythmias, as well as dilatation of the esophagus and colon with attendant gastrointestinal issues.

Finally, we a have a third project that is looking at people's overall satisfaction with, and the limitations of, the care we provide on our brigades. This is a quality improvement project being led by Dr. Jeffrey Wang and Kate Pearson, a rising 4th year VCU medical student. 

We are very excited about this brigade and are hopeful our efforts will improve the health of people living in the region we serve. For anyone interested in our work, please consider following this blog for updates on the brigade. My friend and colleague Dr. Gonzalo Bearman will also be providing updates on the trip (his blog can be found here).