North Carolinians' 20-Year Health Mission in Choluteca

In 1988, a delegation from the Episcopal Diocese of North Carolina visited southern Honduras, in the mountains near Choluteca, with the goal of working with the Roman Catholic Church there to develop sustainability in the region. The Honduran people in six villages formed the United Communities in 1989 and began such "sustainability" projects as organizing cooperatives and purchasing land on which they built grain silos. They also appointed health promoters in each community to provide wellness education; because access to doctors is severely limited, the promoters also try to assess if someone's condition is treatable by local methods, can be helped by over-the-counter medications, or needs treatment by a doctor/hospital in Choluteca (very difficult journey). Their initial training was provided by an international grant from the Roman Catholic Churches in Canada, Spain and France.

The North Carolina diocesan health mission began in the 1990's, originally administered by Church of the Nativity in Raleigh and now by St. Stephen's Episcopal Church in Durham. It provides four services: 1. Health education for local Promoters. The United Communities asked the health mission to do continuing education after the original group training them moved on to a different location. For example, one year the mission brought blood pressure cuffs and otoscopes, and trained the Promoters how to use them. 2. Medical clinics. Residents see a mission medical professional and can receive both prescription medications such as antibiotics and hard-to-come-by over-the-counter items that are collected (and packed) by the churches. 3. Hands-on training for the local health promoters. They work in the clinics in partnership with the mission medical professionals. 4. Dental clinics and training, which now includes such services as the application of fluoride varnish to the teeth of school children in the region (thanks to St. Luke's in Salisbury, NC, for their contributions) and tooth extractions, and the distribution of toothpaste and toothbrushes.

This area of Honduras was particularly hard-hit in 1998 by Hurricane Mitch, one of the deadliest on record with over 11,000 people killed and 8,000 missing; Honduras suffered the most casualties and damage, and it has yet to fully recover. The health mission now provides a small part in the on-going recovery and the continuing goal of sustainability. The Mission also uses the Millennium Development Goals of the United Nations, which have been adopted by the Episcopal Church, as guidelines.

In the months prior to departure, the mission supporters gather over-the-counter medications such as ibuprofen, Tylenol, vitamins, and antacids, and put them in sealable baggies, 30 pills each. Several “pill-packing” sessions are held at Church of the Nativity in Raleigh to prepare these supplies. They will be dispensed from the clinics, along with personal items such as shampoos and soaps also collected by the various congregations. Patients will be sent to the pharmacies for other needed medications, such as antibiotics, ointments, anti-fungal treatments, and first aid supplies. The congregations also collect eyeglasses, which are dispensed by the United Communities as their own project during clinics.

The 2010 health mission participants, totaling 30 people, will fly to Tegucigalpa from North Carolina, Georgia, Ohio, and California. Each missionary is responsible for two checked suitcases of 50 pounds each filled with the supplies for clinics and pharmacies that had been collected over the previous months. The missionaries carry all personal items in backpacks or other small baggage that can be carried on the plane. They will board a bus for the 3-hour trip from Tegucigalpa to the mission headquarters in El Corpus, a small colonial town with cobblestone streets. Juana Lainez of El Corpus is the Honduran coordinator, and she arranges accommodations with El Corpus families, travel, and scheduling for training and clinics.

The four mission participant categories are medical personnel, interpreters, pharmacy workers, and "go-fers” ("ayudantes.”) Saturday and Sunday will be spent setting up the pharmacy and clinics in Madrigales (a 45-minute truck ride up the mountain) and providing training for the local health promoters from Las Communidades Unidas (El Corpus is not part of the United Communities). Many promoters have deep knowledge of local medicinal herbs and healing practices (they have given classes on local medicinal plants to the Mission people, who found the information very valuable). The mission training classes usually cover public health issues and some diagnostic information. Promoters will spend the week working alongside Mission personnel in the clinics and pharmacies as consultants, observers, and students.

Over the years, the Madrigales location has developed from an open space to several permanent buildings with electricity and running water that are used for many purposes throughout the year. Sunday morning, about a third of the missionaries travel by truck to Los Terreros, an even more remote village which has no electricity or running water. Clinics in both places will be held Monday through Friday, with the mission’s medical personnel consulting with the Health Promoters in collaboration with interpreters, assisted by “go-phers.” Each location has a “pharmacy” where patients can pick up medications and supplies not provided in the clinics themselves.

The patients from the United Communities have time in the clinic to confer with both medical personnel and Health Promoters. Many of their health issues result from the hard life in the mountains, where they must walk long distances over rocky roads that are dusty or muddy, depending on the season, while carrying heavy loads, and where they do hard manual labor every day. There are many cases of arthritis, headaches, dry skin, breathing problems and coughs (since much of their cooking is done indoors over fires, exposure to smoke contributes greatly to these conditions). Infections are common, as well as skin diseases. Medical personnel and health promoters have even stitched wounds and removed bot fly larvae.

The Madrigales crew leaves from El Corpus every morning at 7:30, returning at 4pm. The truck ride up and back is for many participants a special part of the day – the mountains are very beautiful. Each evening the missionaries gather for meetings and de-briefings; because of cell phone technology, there is now much better communication between El Corpus, Madrigales, and Los Terreros. The Los Terreros people return to El Corpus on Friday, and that evening everyone attends a fiesta provided by their hosts (the Los Terreros people will have already participated in their farewell fiesta Thursday night, so they get two parties!) And Saturday, after another three-hour bus ride, the missionaries spend an afternoon in Tegucigalpa and one night in a hotel before returning to the United States late Sunday night, January 17. They will have seen over 1,500 patients, dispensed hundreds of pounds of medications, and provided ongoing training and education for the people and health promoters. Since 2001, the mission has seen about 12,500 patients. 218 people have participated in the mission as physicians, nurses, physician assistants, nurse practitioners, dentists, dental assistants, pharmacy workers, interpreters, and go-fers. And as soon as the 2010 missionaries return, they will start planning for January 2011.