GH2DP Outreach Trip to Yoro, Honduras

Today is day one of our outreach trip to rural Yoro, Honduras, on a medical and public health outreach trip with VCU's Global Health and Health Disparities Program (GH2DP). 

The U.S. contingent of our group left early this morning and has arrived in San Pedro Sula. In addition to our group we have approximately 950 pounds of gear and supplies we will transport to Olanchito and organize tonight.

Our plan is to meet the rest of our group and transport our team and supplies up to the rural, mountainous village of La Hicaca tomorrow. From here we will stage our medical and public health outreach work.

VCU GH2DP Outreach Trip to Yoro: Pictures Published

Outreach group in La Hicaca 

An overview of our recent outreach trip to Yoro, Honduras has been published on the GH2DP website and can be found here. A slideshow of pictures from the trip can be found here.

Distributing water filters, Lomitas

Dental clinic, La Hicaca

Engineers Without Borders students with water test plates

Medicine clinic, La Hicaca

Medicine clinic, La Hicaca

Medicine clinic, Lomitas

VCU GH2DP Honduras Group's Work Featured by VCU's Division of Community Engagement

Earlier this month our group traveled to the Yoro area of northern Honduras to meet with our community partners and ministry of health officials and to lay the groundwork for our June 2014 trip. The VCU Division of Community Engagement is now featuring our work on their site (this can be found here).

Also, the VCU undergraduate chapter of Engineers Without Borders was awarded a Quest Innovation Fund grant to support their development of novel rain catchment technology for use in Yoro. Congratulations to all of the students involved in this project!!!

VCU GH2DP Honduras Trip: A Day in the Mountains

Hiking to Chorro Viento

Yesterday we got up early and left Olanchito to drive out to the rural, mountainous area where the people we serve live. This is a large area that consists of 17 villages and roughly 2,000 people. Because of logistical issues we have only visited 2 of these villages in the past (La Hicaca and Lomitas) and have coordinated with our community partners to have people from the outlying villages come see us in these places. Practically speaking, this means that some people have to walk 6 hours (each way) over mountains in the hot sun (it's typically in June and we are near the equator = hot, hot, hot) just to see us in clinic.

We were excited yesterday to have the opportunity to visits a few additional villages we have never

En route to Chorro Viento

been to: La Culatta and Chorro Viento. Our primary goal was to assess older water catchment infrastructure and to see if a new chlorination project is feasible and acceptable to people living in areas that would be served by the new technology.

We could drive to La Culatta but had to hike out to Chorro Viento; this was a 30 minute "walk," at least for people living in the area. For us it was more like 60 minutes and was as strenuous as any serious hike I have ever been on in the United States. Keep in mind this was the easiest village to reach and it's January-far cooler than June. I have always respected the mental and physical toughness of people living in the area but this has given me profound new respect. It is not uncommon to see a woman in her 70s walk 3-6 hours to come see us wearing what amounts to plastic shower sandals; I am confidant I could not keep pace with these women.

When we reached Chorro Viento we also got to see a project that was created in partnership with a group from the European Union: a working turbine that supplied power to this village. This is the only village in the region with power and was made possible by their proximity to a local river/ waterfall. The project was incredible and people in the village had enormous pride in the

Cistern in La Culatta; there are 4 of these
in the region supplying water to 5 of the
17 villages we serve; the water is not
safe to drink but a new chlorination
project may be able to provide clean water 

technology. What was truly amazing is the power poles-every bit as large as those found in the US-were carried up the mountain by people from the village. No heavy equipment could reach the village so the poles were planted by hand. The work must have been unbelievably strenuous.

People do so much with so little in the area, and a little really
does go a long way. I left yesterday with a renewed sense of admiration for the people living in the area and with a strong desire to do more to help people in the region. We are hopeful we can continue the many productive partnerships we have established in the region to help improve the health of its people. It is a great privilege to be able to come here, to be welcomed into the communities, and to be given the opportunity to help.

The region has traditionally had a problem with poor indoor
air quality related to poor stove ventilation in homes. Many homes have
now had improved ventilation systems installed and are
effectively ventilating smoke from homes

We also brought enough anti-worm medication
to provide another dose to everyone living
in the region (this is part of a long-term longitudinal
regional project to decrease the intestinal
worm burden) 

VCU GH2DP Honduras Trip: A Day of Meetings in Olanchito

Meeting with the local Minister of health and his staff

Our first full day in Olanchito was a whirlwind but very productive.

We met with the local Minister of health and his staff and discussed our work to date and future collaboration.

Meeting with our local community partners

We then met with our local community partners and thereafter with staff from the Pico Bonita Foundation. We discussed collaboration on new water chlorination systems that can provide clean drinking water to 5 of the 17 villages we serve; we are very excited about this potential project.

Meeting with the Pico Bonita Foundation

Today we are traveling to the mountains and will be hiking out to several villages (Chorro Viento and La Culata) to meet with people and investigate old water procurement infrastructure. Will then meet with our community partners in La Hicaca.

More to come!

VCU Global Health & Health Disparities Program (GH2DP) featured on School of Medicine Website

The VCU Global Health & Health Disparities Program (GH2DP) and our first graduate (Dr. Jeff Wang) are featured on the VCU School of Medicine's website (the story can be found here). Congrats Jeff!!!

The GH2DP residency track exists within VCU's Internal Medicine Residency Program and is designed to give particularly interested and motivated residents robust opportunities focused on global health. Residents have both domestic and international clinical opportunities focused on serving underserved populations, and are responsible for graduate level coursework, independent study and quality improvement and research projects, as well.

Dr. Jeff Wang examines a patient in La Hicaca, Honduras

We are looking forward to expanding our work to include motivated medical students this upcoming year; this program is known as the "GH2DP Student Scholars Program."

Providing global health education and experience to students and residents is only one facet of GH2DP's activities. Fundamentally, the GH2DP exists to improve the health of underserved populations. Our primary focus is on a series of 17 villages in northern Honduras with approximately 2,000 people with little to no access to care.

Dr. Wang supervising water filter assembly,
La Hicaca, Honduras

You can find out more about GH2DP here.

More on the VCU Global Health Symposium

VCU Global Health Symposium speakers

More on the recent First Annual VCU Global Health Symposium can be found on the university's global education website here.

The meeting took place on Saturday, April 27th, and brought together students, residents and faculty from across the university. One of the key goals of the meeting was to provide a platform for sharing ideas, networking and developing the framework for future collaboration. The meeting featured short talks focused on research at both the community and international levels, and a poster session.

Our group (the VCU Global Health and Health Disparities Program, or GH2DP) provides both medical care and public health interventions to approximately 2,000 people living across 17 villages in rural Honduras. As a result of the VCU Global Health Symposium we have new contacts and new ideas including improving mental health services in the region as well as clean water infrastructure. 

Ethical Issues in Global Health Outreach Work: A Call for Formalized Medical Student Education

VCU Medical Students Assessing a Patient in Coyoles, Honduras

This is an interesting article published earlier this year by Timothy Lahey in the journal Academic Medicine. In this perspective piece Lahey discusses some of the ethical issues associated with short-term global health outreach work, especially as faced by medical students. He outlines the key components of a medical school curriculum in global health, noting this is important for all learners as "global rightly includes local because healing the sick has the same worth in inner-city Detroit as it does on the outskirts of Dar es Salaam, even if geography and culture alter the manifestations of illness and need."

Lahey notes that the principles of biomedical research should can be applied to global health outreach work: nonmaleficence, beneficence, patient autonomy and justice. Short-term medical trips are rife with pitfalls in all of these areas, as providers often provide sub-standard care without understanding the health needs of the population they are serving, or the greater context of the health pressures faced by these communities or the health disparities that drive illness.

Lahey notes a medical curriculum for global health must include an exploration of health disparities, and notes that faculty mentorship and post-trip debriefing are important components of medical student education in global health.

Over the past 6 years working on short-term medical relief missions in Honduras I personally have struggled with many of the issues Lahey brings up, and have watched many medical students and residents struggle with these issues, as well. Our group has worked to address these issues via close community partnerships, an emphasis on high-yield public health interventions, and providing logistical support to help bolster the longitudinal health efforts of the local ministry of health (find out more about the evolution of our program here).

 In terms of working with students, we have found the following:

1) Pre-trip counseling/ education of learners is essential
2) Providing learners a context for their work (e.g., how their work contributes to the longitudinal/ overall health work performed by the group) is critical
3) Continuous 'checking in' with learners/ helping learners process their experience before, during and after the brigades is very important

As "global health" truly includes addressing health issues/ disparities both internationally and domestically, Lahey's call for integration of global health education into medical school curricula is an excellent one. This 'call' should be extended to residents' curricula, as well.