“On the Road to Guiamaca:” Mission Work in Honduras
In honor of International Year of the Nurse and Midwife, hear from AANP member Cathy M. St. Pierre, PhD, APRN, FNP-BC, FAANP, chair of the AANP International Committee and co-chair of the International Specialty Practice Group (SPG), on her experience delivering health care in Honduras:
“For the past two years, I have traveled to Guaimaca, Honduras, to participate in a medical mission. Honduras is one of the poorest countries in Latin America. The medical clinic that we traveled to is located in the town of Guiamaca, which has a population of 30,000 people. ‘The clinic,’ as it is known, serves the people of Guiamaca as well as the surrounding mountainous villages. This clinic sees about 200 patients per week and provides both medical and dental care services. It is dependent on the arrival of medical/dental brigades to help work in the clinic. Guiamaca is a small town where the annual income is about $4,000 per year. Health care providers are scarce at the clinic, and they rely on volunteers who visit for a short time to help to provide medical care for the patients who come to this clinic.
“The clinic was developed and is run by a dynamic nurse practitioner (NP), Sister Maria Ceballos, who started this clinic 17 years ago. Ceballos is a family/adult NP who is the primary provider of care at the clinic. She is a member of the Dominican Sisters of the Presentation. Ceballos was trained as a nurse in Rome, Italy, and became a family NP after completing a certificate program at the University of San Antonio, Texas. She earned her Master of Science degree in Nursing at American University in Washington D.C. She worked in two different migrant clinics on the Texas-Mexico border and in Washington D.C. before being sent to Honduras as a missionary in 2001. In addition to this, Ceballos is a trained and certified as a chaplain. She is an amazing professional who strives daily to meet the physical needs of all ages in Guaimaca and the surrounding communities. She has boundless energy and is always trying to expand clinic options. Once you meet Ceballos, you will be impressed with all that she has done and continues to do for this community. We joke and say, ‘You can’t say no to Sister Maria.’ You just want to help!
“Each day, the patients arrive early and take a seat outside of the clinic. They are seen and triaged by one of the trained nursing assistants. Patients are then assigned to a provider based upon which providers are in the clinic and their area of expertise. Since I have expertise in treating chronic pain with Battlefield Acupuncture (BFA), my days were filled seeing patients with chronic pain. It was exciting for me to see patients who found relief from BFA in a short period of time. Some of the same patients I saw one year earlier returned a year later to see me for treatment. In general, the patients arrived with chronic pain levels of, on average, six or seven out of 10. After treatment, the pain levels decreased to zero to two out of 10. Word spread in the community about BFA for pain, and as a result, more patients arrived each day.
“One day, a man who I had treated the year before returned for BFA treatment for his back pain. Through an interpreter, he informed me that the treatment I had given him one year ago in a single visit actually reduced his daily pain for six months! This year, he returned with his two sons, who also came requesting BFA treatment for their musculoskeletal pain. All of them work long hours doing manual labor on a coffee plantation. They were all pleased with the BFA treatment results and returned the following day with coffee from their plantation as a thank you for the care! I was very touched by their gesture of kindness. In order to support sustainable treatment using BFA, I worked with Ceballos and one of the clinic nurses to teach them how to do BFA. I also provided them with books and protocols regarding using BFA for treatment. In addition, I have committed to providing the clinic with BFA needles, as needed. In a poor country like Honduras, it is not possible to order the supplies needed to perform BFA, and the current mail system is not reliable for sending packages. Therefore, their supply is currently dependent on my being able to purchase BFA needles and mailing them to Ceballos, in care of her ‘Mother house’ in Dighton, Massachusetts. It was heartwarming to work with this population, who are very appreciative of the care received.
“The clinic also has a small on-site pharmacy. Ceballos has trained a local young nurse to dispense medications to the patients. When you work in an underserved community, you become very flexible and adaptable to meet the needs of your patients. For example, I worked with a patient who had hypertension and was in need of a refill of her medications. I wrote for the medication and sent her to the pharmacy. However, our lay pharmacist quickly informed me that we did not have the needed medication to dispense. After perusing the shelf with the hypertensive medications available, we settled on giving the patient a new hypertensive medication (for her) in the same category as her previous prescription: an angiotensin-converting enzyme (ACE) inhibitor. The pharmacy is totally dependent on donations, and most volunteers coming to this clinic from the United States bring drugs purchased through Blessing International. We were able to bring four large suitcases full of supplies for the clinic. The money for the supplies we brought was generously donated through fundraising efforts and private donations from the Lexington, Massachusetts, Catholic community. When they run out of supplies at the clinic, they cannot obtain any more until another medical brigade arrives with supplies.
“Ceballos’s staff at the clinic are mostly local women from the community who are interested in learning health care tasks. Occasionally, she has staff who come from the capital city of Tegucigalpa, Honduras. Currently, there is a pediatrician who works at the clinic three days a week and commutes from Tegucigalpa. This city is approximately one and a half hours from Guiamaca, and the roads are a mix of paved and dirt surfaces. It is not an easy commute. The closest hospital is also located in Telgucigalpa. With my expertise in homeopathy, I was able to assess and prescribe some homeopathic remedies for treatment. Ceballos also has experience in treating with homeopathy, so we got to collaborate and decide on a plan of care. It was a nice and effective way to treat patients with a treatment that can be effective and inexpensive and is unlikely to cause any harm to the patient.
“While at the clinic, many patients came in complaining of peripheral neuropathy in the lower extremities. They were experiencing significant pain and numbness. We assessed them and decided it would be worthwhile to try using a topical homeopathic cream known as Fibro Cream. I would have the patient apply it directly to the affected limb(s) and wait to see if it would help relieve the pain. The majority of the time, it worked quickly, and the patient was pleased with the results, so they were sent home with some of this cream. In addition to providing care in the clinic, Ceballos and I made a couple of home visits. One was up in the mountains to see and treat an elderly gentleman who was in chronic pain due to contracting Guillain-Barré syndrome as a result of an insect bite. He lives with his family on the edge of the mountain. The other home visit was to treat a young man with Type 1 diabetes and severe extremity pain.
“When one spends time in the clinic, it is clear that the staff act as one family and work well together. It was really heartwarming to return this year and be greeted by the same staff, who work hard and appreciated the help. The mother of one of the health center staff members made lunch for all of us daily! We paid a very small fee for some lovely, fresh Honduran food. The clinic closes its doors for lunch and everyone sits and eats together like family. This is a Spanish speaking community and my Spanish is weak, so it was necessary for a translator to work with me. The first year, I was able to get a translator who was bilingual and interested in going into medicine after he finished his degree. Therefore, he was interested in learning medicine, so it was an enriching week as we learned from each other.
“During our visit in 2019, our ‘brigade of 14’ was invited to attend a Honduran wedding between two of the clinic’s employees. It was such a lovely experience to participate in their wedding and reception. It is apparent that the community supports each other, and while we were there, the people made us feel like family. It was a beautiful wedding and a heartwarming experience for all of us. The presence and support of family is instrumental to the health of this community, and we witnessed this daily at the clinic. Returning this year, we found out that the couple, then celebrating their first anniversary, were now expecting their first child. We also just found out a month ago that they had a healthy baby girl!
“Many of the community’s children may not be able to go to school for very long due to poverty and have to quit to work on the coffee plantation to help their families. Also, a lot of young women are not able to attend school for a variety of reasons, including pregnancy. Ceballos and her religious order committed to creating a school for girls. With funding from a variety of private and religious organizations, they were able to raise funds to start a boarding school for girls aged 10 to 18. The application process is competitive and, as a result, the school currently has approximately 50 girls enrolled per year. Each student attends on a full scholarship, and after graduation, some of these young women have been able to attend college. The students are taught by both nuns and lay teachers. The Sisters also reside on the grounds of the school. It is amazing to see the beautiful school and how happy the students are. These young women live in many of the mountainous communities around Guiamaca, arriving at school each Monday morning and returning home each weekend. Some of them walk several miles early Monday morning to get to a bus that will take them to school. In addition to academics, they are also learning to cook and do crafts like knitting, beading and more. These skills provide them with a way to earn money from home. The school and the students are very impressive. Due to this educational opportunity, some of these young women are able to attend and graduate from college.
“Participating in this medical mission was a great and enriching experience. If you are at all interested in participating in this mission, I invite you to learn more!.”
Join the Celebration: International Year of the Nurse and Midwife
The World Health Assembly has designated 2020 as the International Year of the Nurse and the Midwife. The American Association of Nurse Practitioners® (AANP) is committed to building awareness of the role of nurses and advanced practice registered nurses (APRNs) and is working to develop the next generation of nursing leaders through training and leadership opportunities. AANP is pleased to announce its participation and encourages you to get involved!
Thank you to Dr. St. Pierre for her invaluable assistance with this article.