Sunday, November 26, 2017

Do Better.



Over the course of an easy conversation some time ago, a good friend shared a tidbit with me.  In the moment, it seemed silly...no more than entertaining, really.  I certainly did not consider it to be anything that would have a lasting effect on me.  Little did I know...

My friend's sister had been late to return a phone call.  When she connected with her friend, of course she apologized.  The recipient of the apology stated simply, "Do better."  For some reason those two little words wedged themselves into my brain, and have shaped countless decisions and actions ever since...in what ways / words / actions can I do better ?  


So it is with the hope of inspiring a little bit of Do Better that I share my experiences of my first trip with Operation Walk Denver:  San Pedro Sula, Honduras:  Fall 2017.  Craig has been kind enough to let me "ghost write" on his blog.  You can read more about the work of this incredibly worthwhile organization on his previous posts, or visit their Facebook page.  And please, please, please support the cause !  


T 9/26 + W 9/27:



Our drive from Steamboat-- eastbound on I-70 Tuesday afternoon.
I've been looking forward to this trip for months.
Our flight left DIA at 11:59 PM 9/26, so Wednesday had already begun by the time the landing gear was safely tucked away and we were in the air.  I slept (fitfully) all the way to Miami -- I reluctantly mention that the economy seats on our American Airlines Airbus A319 were not at all comfortable.  But no worries...plenty of time for a nap during our hours-long layover in Miami.  Coffee first, though.  Attention !  Last chance for Starbucks !  I also had a Cortadito, the Cuban coffee drink that's not only fun to drink but fun to say.  In a word:  delicious.  It went down too quickly and I wanted 10 more.


Life does go on without Starbucks !

Arrived safe and sound in San Pedro Sula mid-afternoon (CST).  Collected our bags and dragged everything through customs without a hitch.  On the other side, we're greeted by several members of our brigade who arrived earlier in the week.  They have been waiting for us and also for several surgeons who were arriving from Houston.  Like obedient children, we load onto the air-conditioned bus and head into the city (about 6 miles away).  

The trip from the airport was an assault to my eyes and my heart.  I grew up with Woodsy Owl, whose public service announcements implored both kids and adults to, "Give a Hoot.  Don't Pollute!"  The preschool I went to even built a large-scale Woodsy Owl float for a parade (replete with a chicken wire frame owl that we covered in papier mache.)  Had Woodsy ever traveled to Honduras, he would have been nothing less than broken-hearted by the amount of litter and garbage.  It's not just bits and scraps here and there.  It's piles and it's everywhere.  My first impression was of a city that hasn't yet decided if it's coming or going -- has something recently been dismantled or is the site in the process of being constructed?  It wasn't always obvious.  I learn later that municipal trash collection is offered in areas considered to be middle-class or better, but for poor areas, the waste is thrown everywhere, and then later raked into piles, although nothing seems to be done with the piles.  If you litter...please stop.  


Ramon Villeda Morales International Airport, San Pedro Sula, Honduras.
Headed from the airport to the hotel.

A respite is offered by our comfortable room at the Hilton Princess, where we are advised to spend the afternoon resting, as the opportunity would cease once the mission kicked into high gear the next day.  Craig and I unpack and putz a bit...movement felt good after having done so much sitting over the past 24 hours.  Then to the hotel bar for libations and a little something to eat.  Our timing was perfect, as we had the opportunity to meet Laura, a very friendly American from Mississippi who reps for a wholesale tire company -- both Chiquita (bananas) and Dole (pineapples) are clients.  Laura makes a trip to San Pedro Sula and the surrounding countryside once a year.  She was having a happy hour before getting picked up for dinner at the new home of a local friend...a big wig in Honduras with a lot of money and a security detail.  We bade her safe travels to and from and looked forward to hearing all about it the next morning at breakfast.  


   The view to the southwest from our hotel room.                       
Th 9/28

Breakfast at the hotel.  Coffee con leche is delicious.  The spread of food is impressive -- made me wish I liked to eat breakfast.  We were happy to see Laura come in -- she had an enjoyable evening and described the house, which had taken 6 years to build, as wall-to-wall marble.  I can only imagine.  It's difficult to make sense of the extraordinary divide between rich and poor.  An estimated 60 - 80% of Hondurans live in poverty -- on less than $2/day.


For the duration of our trip, travel to and from the hospital (about 8 blocks one way) was by bus -- Mayan Tours took excellent care of us.  We were not permitted to travel by any other means.  Members of our group who chose to do any "sight-seeing" near the hotel were encouraged to be in a group of no less that 6 people, never after dark, and always with electronic devices safely concealed.  Crime is such in San Pedro Sula that it's possible to be killed for a cell phone or $20.  At the very least, the victim is typically beaten and may also lose a hand from an efficient and well-placed chop of the ubiquitous machete.  Armed guards are everywhere...at the hospital, hotel, gas stations, banks, stores... 


Craig had to be on the 6:30 bus -- RNs had a busy day ahead doing patient intake surveys.  I had time to linger before the 7:00 bus departed.  I was going to be working primarily in the capacity of sterile processing, but obviously would tend to other tasks as needed prior to the ORs generating dirty surgical instruments.  The trip from the hotel to the hospital mirrored the previous afternoon's drive from the airport.  Abstract traffic patterns, an abundance of litter and trash; and intermittent commerce (mostly fast food stops and clothing stores... and the Pink Pussycat, which is probably exactly what you think it is).  I forgot to mention that not everyone travels by auto or bicycle or motorbike.  Some locals brave the narrow streets in a horse-drawn cart.  I was saddened to notice that the horses are underfed.  



Craig & his PACU "better half," Sarah, who will earn her NP designation in December 2017.

Craig & Sarah with 2 local nurses.  A smile in any language translates easily.

This is Op Walk's first time working at Hospital Leonardo Martinez Valenzuela, so I wanted to provide a little background (http://hondurashealth.wikidot.com):
                          
In 1900, a group of dynamic and philanthropic residents of San Pedro Sula, led by the political governor and commander in arms, Colonel M. Martinez, founded a charitable center and named it North Hospital. Its first director was Dr. George David.  The hospital operated in a wooden house with two floors, located opposite the King Bee cigarette factory.

In September 1904 the governor general political Mondrag├│n Maximilian moved the hospital to the site now occupied, three blocks from where it was founded.  San Pedro Sula's last yellow fever epidemic broke out in 1892, decimating the population of Honduras and claiming many victims, including a young doctor, Leonardo Martinez Valenzuela.  To mark the fourth centenary of the founding of San Pedro Sula, the name North Hospital was replaced by Dr. Leonardo Martinez V., in memory of the distinguished physician who offered his life for science and served the society of San Pedro Sula.

The hospital, considered the most important health center for women and children in the northwestern area of the country, delivers 1000 babies a month.  Honduras is 96% Catholic, and the country has the second-highest rate of teen pregnancy in Latin America (after Bolivia). In this small Central American country, 28% of all pregnancies are of adolescent mothers -- in the northern area, the rate is higher (30 -- 35%).  Dr. Luis S├ínchez, a gynecologist at the hospital, assures that this is a public health problem, and says that the conditions in which these pregnant girls arrive are increasingly precarious due to sexually transmitted diseases, misinformation and abandonment by the men who got them pregnant. (lapress.org)

The campus also houses an assortment of out-patient clinics (dental, X-ray, pediatric cancer, and laboratory were some that I saw).  Patients wait outside in the heat and humidity, sitting on wooden benches or plastic chairs on a shaded platform that is constantly being mopped.  


Patients wait outside for clinic appointments.

The outdoor waiting area is constantly mopped.


Armed guards opened the gates to the campus.  Entering the hospital lobby of left me feeling immediately overwhelmed, and I had to remind myself to take several deep breaths.  There were so many people in the waiting area -- patients and members of their families, hopeful and anticipating that years of pain and debilitation would soon come to an end.  

The entrance gate into the hospital campus.
The waiting room just inside the entrance to the new suite.

Security doors separate the OR suite.


I joined the Cargo Team on the other side of the security doors.  I felt like a fish out of water, as this small group, led by the most efficient and organized person I've ever met, has done this many times and is a well-oiled machine.  Sensing that I really needed to be put to work, Nic offered me the job of locating all of the containers with scrubs packed inside.  That didn't take too long, and in lieu of continuing to be in the way, I went upstairs to see what Craig and his colleagues were up to.  Patient intakes, although necessary, are not very interesting, so I wandered down the hall and ended up helping Sarah with patient BMIs.  

Determining BMI (body mass index) entails obtaining height and weight and doing a quick calculation.  In general, a surgical patient has the likelihood of a better outcome when their BMI is < 30.  Less than 25 is even better.  It translates to fewer complications before, during, and after the procedure.  Once BMIs were charted, patients and their family members sat in plastic chairs in the hallway to wait...and wait...and maybe wait some more...to meet with a surgeon, PA, anesthesiologist, and one of our internists to undergo an in-depth evaluation.  

The patients were polite, gracious, quiet, and accommodating to a fault as I navigated to the best of my ability with limited Spanish.  Luckily, we were blessed with help from a number of local Op Walk volunteers, including a woman with a constant smile who had recently started working in the clinic of a local surgeon (Ticho), who also works closely with Op Walk.  Sendy helped translate, and it wasn't long after meeting her that I wanted to put her in my pocket and bring her home.  I suppose she would miss her 2 young children terribly, though.  As a single mother, her kids are her life.


Me and Sendy.  She's a pistol...with a heart of gold.  
In a nutshell, the process is as follows:  The patients are already under the care of the local health care system, and they arrived with medical charts and X-rays in hand.  Once all of the intakes and evals were completed, the docs and PAs held a Grand Rounds to determine which patients would undergo surgery, which would receive therapeutic intervention in lieu of surgery, and which would go to the top of the list for the next Op Walk trip (the North Carolina chapter will be here in March 2018).  


Grand Rounds offered a closer look into the entire process, which I welcomed, as I am a "systems" person.  Taking heights and weights provided only a brief encounter with each patient, but nevertheless, I felt a sweet and genuine affinity for each one... hoping they would receive the best possible intervention and move forward into a life less restricted by pain and mobility issues.  I will write more about Moses later, but I met him while helping with BMIs when he offered to help translate.  Sendy had walked a patient down the hall to a chair, and another family approached me with a question in Spanish.  I said, "Uno momento, por favor."  Moses came over and said he could help, because he spoke English.  I was struck by his gait, uneven and cumbersome...certainly not what would be expected from a man I would still consider relatively young...early-50s, maybe.  From that moment on, I kept him in my thoughts.

Grand Rounds ended with the decision to perform 2 surgeries that day:  a new hip for an elderly man and 2 new knees for a man in his 30s.  I had the privilege of getting to scrub into the hip case to provide constant retraction once the joint was opened up.  Properly fitting a prosthetic hip entails removing the femur head and cleaning out the empty joint socket with an instrument that closely resembles a spherical cheese grater (it's called a reamer and it operates under battery power), so it's critical that the surrounding soft tissues are kept out of the way.  


The OR suite is a recent addition.  Built specifically for surgical brigades, it opened this past September, and we were the second team to use it.  It has men's and women's locker rooms, 7 ORs, scrub sinks, space for sterile processing activities (2 new autoclaves will be installed soon), a generous storage closet, RN work station, and a spacious PACU.  Two large recovery rooms, several clinical exam rooms, and an additional waiting area are on the second floor. Each OR has AC, as does the sub-sterile corridor, but the small space where we cleaned the instruments did not.  


One of 7 operating rooms in the new addition.

The AC in OR 7 gave us fits during the hip surgery, so it became the designated workspace for setting up instrument pans prior to sterilization.  The ORs were somewhat stark, but were very clean and perfectly adequate:  a back table and a small mayo stand for the scrub; a small table for the circulating RN; and a modern anesthesia machine.  I did learn the next day that suction canisters are cleaned and reused-- the bloody contents emptied down the sinks where we cleaned the instruments.  A nurse in our group wondered out loud what The Joint Commission would make of that.  

Did I help clean instruments after our case was finished ?  No recuerdo (I don't remember).  But Craig & I, and several others were on the last bus back to the hotel.  Jim Boyle (Dr. Dennis' PA) was vigilant, ensuring no one was left behind.  We arrived late to a team dinner in a banquet room, the other members having already eaten and introduced themselves.  I don't mind speaking in front of a group, so I was happy to piggyback on Dr. Dennis' point about the members of Op Walk being willing to raise funds, as all of our travel expenses are generously covered by the organization.  I suggested that everyone consider asking for (or making) a donation in lieu of a birthday or Christmas gift.  

Craig introduced himself and announced that we had brought an assortment of SweetWood jerky to share.  It's made in Steamboat Springs and it's melt-in-your-mouth-delicious.  Thanks Maddie for giving us such a great deal.  It was a hit and was most appreciated. 


Try all of 'em:  Original, Teriyaki, Peppered, Sweet & Hot.
F 9/29

Coffee con leche for breakfast.  Laura heads back home today, so it was nice to have a little time to talk with her.  She suggested that Op Walk could reduce cargo shipping costs by contacting Dole, which sends empty cargo containers back to Honduras from a port in Louisiana.  I hope this is something that will come to fruition in the near future -- these trips are not inexpensive, so saving money on shipping costs would be immensely valuable.  I believe Laura to be an angel of goodwill, and it's not a coincidence that we met her.  She's a gem, and her kind heart is immediately evident.

7:00 bus to the hospital.  Gina arrived yesterday, so first thing on the agenda is for the SPD team to tackle some of the details and get the autoclave going with a Bowie-Dick test, which passed.  We were, however, frustrated to initially learn that we did not have a sink in which to clean and rinse instruments.  Eventually the kinks were worked out, we commandeered a small metal table, and got on with the work of organizing the very small space between the back hallway of the OR suite, which also served as the main (and very heavily trafficked) throughway from the hallway into the main sub-sterile corridor.  Clearly a woman did not design this space !  That's all I'm gonna say...


~ 50 square feet to wash & dry instruments.                              


Edgar & Ivis hard at work !

The double sinks were stainless steel and we had ample hot and cold water.  But the sink height was very low...not at all ergonomic.  We had a full 6' x 8' in which to clean, rinse, and dry instruments.  We made it work.  It's difficult to be even slightly motivated to complain on a trip like this.  

21 surgeries today.  And I met Ivis (Ee-vees).  This beautiful heart volunteered for the last Op Walk Denver trip, and this time she came to help, not in an official capacity... just because she wanted to.  I feel inclined to interject here that during this trip, I have come to consider J-U-S-T to be a four-letter word.  There was nothing that was "just" done.  All activities and actions were intentional and inspired by something, someone. 

In the early spring of 2018 Ivis will finish her studies and clinical work for nursing.  Then she reunites with her 11-year old daughter (currently living with Ivis' aunt) and hopefully obtains employment as a nurse on the day shift at the hospital where she currently works nights.  I hope only for the best for her.  We worked side-by-side each day, and in spite of my limited Spanish and her limited English, we did great work !  And we laughed and sang and danced (a little) and helped each other learn a little more Spanish and English, respectively.  I can confidently say that anyone who met Ivis was immediately taken (smitten) with her.  She is the stereotypical Latina beauty:  tall, slender, long hair, beautiful dark eyes.  Even wearing scrubs she was a knockout.  And she's kind and generous and hard-working and funny to boot.  I miss her and hope our paths will cross again.


                    
                         Ivis ! 


            



Ivis & Karen (co-founder of Helping Hand)
         
I met Milton early on.  He's 5 1/2 years into 8 years of medical school and he's only 21 (students don't earn a bachelor's degree before medical school).  He's fluent in English, and at some point during a conversation, I suggested that he must be very intelligent.  He replied, "Probably."  I loved his attitude...and it was perfectly tempered with a wry sense of humor (my favorite).  He was in and out of the OR suite a lot, so each time I saw him I said, "Hello, Milton." He always returned with, "Hello, Kristen."  When I told him (in Spanish) that my Spanish is "muy poco" he said, "Yes, Kristen.  Your Spanish is very bad."  So I said, "Goodbye, Milton."  I'm motivated to learn more Spanish so that I can read the book Milton recommended:  Esta Noche Dime que me Quieres by Fedrico Moccia.  He said the story made him cry.  


       
                    Me & Milton.










Med students transcribe chart notes into Spanish.

Dinner is pizza and beer by the pool at the hotel.  Perfect.  I can keep my eyes open long enough to drink a beer and eat 2 slices of pizza.

Sa 9/30

It's too early when Craig's alarm starts to chime.  I tell him, "Holy $H!T.  I can't believe I have 3 more days !"  This is meant not as a complaint, but rather to convey how impressed I am that this group of individuals chooses to do this...to step outside of their collective comfort zone and put their best selves forward solely for the benefit of our patients and their loved ones.  It's overwhelming to think about.  The only other time I can recall working this hard was when we stuccoed our straw bale house in 2001.  It required the mental fortitude to focus on the day and once it came to an end, accept that tomorrow would be the same.  Do it all over again until the work is completed and the mess is cleaned up.  I feel immensely privileged to be a part of Operation Walk.  

7:00 bus to the hospital.  We have time to better organize our little space.  Ivis and I make small cards to help us keep all of the pans from each case together.  For example:  each of the pans from a case would get a sunshine card; each of the pans from a different case would get a heart card.  This proves to be a simple, yet very effective tool, and is most helpful when more than one OR finishes surgery at the same time.  


The surgical techs would bring us the instruments from their case.
Our tags helped us keep the instruments organized.
        
20 surgeries today.  We quickly determine that 2 people washing and 1-2 people drying works best.  The room easily accommodates 4 people (4 butts, as my Grandma Frances would say).  More than that introduces some inefficiency; however, anyone who offers to help is not turned away.  Thank you to the moon and back to everyone who washed & dried !


Jason (PA) & Dr. Miner do not slack when drying instruments !

The reps are anxious to reset their pans, so we set up a little satellite area in the hall where they can start sorting and organizing all of the pieces-parts before taking everything into OR 7, where Gina & Jamie (and others) will wrap the pans and then take them to the autoclave.  Washing and drying instruments is definitely the bottle neck, but we are well-staffed and seem to communicate effectively.  Jamie (Hi-may) is a surgical tech at Porter Hospital in Denver.  In addition to being an incredibly hard worker, he's fluent in Spanish and was always willing to help me with more complicated Spanish-to-English or English-to-Spanish translations.  I would happily work with him anytime.


                                                      
                                                                  Jamie enjoying a Rambutan during lunch.

                                   
                EZ to peel, a Rambutan has a texture similar to a grape, but it has a large seed inside.

I had a welcome break when our 4 ORs  all had surgeries in progress, so I went upstairs to see Moses.  He got a new right hip on Friday and was in great spirits, getting only Tylenol for pain.  He was looking forward to being discharged on Sunday and returning to his home in Puerto Cortes.  After encouraging me to learn a little Spanish each day, he told me about his 3 grown children, and I think somewhere in the story he also told me he's married.  He works for a cruise line, earns the majority of his money from tips, and consequently, was anxious to get mended and back to work.  He was handsome, charming, funny, and also fluent in Italian.  He loves his mother and is a perfect example of how you never know another person well enough to form a solid opinion until you invite them to share their story with you.


                           
                                       Me & Moses.


                                            
                                                           Moses & Craig.
I met Isabelle and Abraham later in the day -- both are students at a local English-speaking high school, and each plans to study medicine after graduating.  They belong to a club called Healing Hand (find it on Instagram & Facebook), which was started by two students -- this fact impresses me to no end !  Each member pledges to volunteer at five (?) events, and Isabelle and Abraham had come to serve as translators.  They helped in recovery and PACU, and also picked up towels to dry instruments.  Isabelle was able to go into an OR to observe a surgery, but unfortunately, Abraham was not able to stay late enough.  Before going home, I asked Isabelle to translate so I could communicate to Ivis that she should sleep in the next morning -- get some rest and take care of herself.       

                                                           
A patient is prepped for a new right hip.
Su 10/1

Alarm 5:45 → breakfast → 6:30 bus for Craig & 7:00 bus for me.


16 cases today.  We were to have a few cases Monday, but El Jefe (Dr. Dennis) decided we'll do all of the remaining cases today.  Mentally, I had been looking forward to only 12 or 13 cases today...but I'm adaptable, as a surgical tech should always be.  Thank you to my amazing surgery instructors for always reinforcing the importance of being adaptable -- it's a learned and practiced skill that is useful in an unlimited variety of circumstances. 


Ivis did not sleep in !  She said she would rest the following Wednesday -- she wanted to be at the hospital helping us.  We organized our little space, and then went upstairs to recovery with Gina and Jamie.  When I walked through the doors, everything came together  immediately in my heart and mind... all of these people are the prior days' dishes !  Gina brought stars/stripes bandanas to hand out to patients (she cleaned out the inventory at a surplus store in Denver).  



Unlike hospitals in the US, patients do not have their own room.  They recover on an army cot in a space that could be shared by as many as 30 -- men in one room, women in the other.  Each has a bathroom and a roomy workstation with plenty of electrical outlets (the local nursing students soon claimed them to charge their cell phones).  Each room has air conditioning, although the hallways and waiting areas in the building do not.  The far recovery room has an east-facing wall with several rows of small windows that let in natural light.  Across the street is a funeral home -- I learned there are four in the vicinity.  No doubt they stay busy -- Honduras has the highest murder rate in the world.  


Natural light enters the women's recovery room.                                       
A funeral home is visible from the women's recovery room.                                       
We had time to interact with patients and their families while the physical therapists were busy helping patients stand and walk.  This was an emotional experience for me.  The culture here is extremely gracious -- even a small gesture evokes so much gratitude.  To a certain extent, polite and charming habits and manners have endured long after the end of British colonialism.  I noticed that if I smiled at anyone from Honduras, a smile was returned.  It is not this way in the US...people make an effort to avoid eye contact with a stranger.



Kristin (PT) with a patient.
Gil (PT) with a patient.
Aileen (PT) with a patient.


Katie (PA) & Ivis help a patient stand.
       


Margaret (RN) assists a patient with 2 new knees.



Katie shares a cozy moment with a patient.

Back to work in our "broom closet."  I met Edgar and Wendell later in the day when they stopped by to give Jason Forsythe (Dr. Miner's PA) a bag of Honduran coffee.  At the time, Jason was helping us clean/dry instruments.  When he left to go into the OR, Edgar and Wendell stayed to help.  Both are medical students.  Edgar has completed 8 years and is doing his residency.  Wendell is in his 6th year.  Both are fluent in English.  Edgar commented that learning English opened many opportunities for him.  

For a little while, there was a young woman sitting in the hallway just outside of our space.  She's also in her 6th year of medical school.  She took no initiative to help us -- I suggested to Wendell that she just wanted to be close to Edgar...maybe she had a bit of a crush on him?  Wendell agreed that Edgar was probably a heart breaker -- not due to poor intentions, but because he would be quite the catch.  Both Edgar and Wendell answered with an emphatic "No!" when I asked if either was married.  They explained they were fully committed to their studies...marriage and family would have to wait.  

Edgar's residency has included a recent rotation at a trauma hospital.  His phone holds a collection of grisly photos:  pedestrian / motor-vehicle accidents and complete (or near-complete) amputations due to poor management of a machete (usually in combination with poor management of the user's anger).  Apparently, many accidents occur when friends drink, get into an argument, and pull out their machetes.  I suggested that maybe all party-goers should put his/her machete in the oven.  The host would turn on the oven.  The guests can return the next day to claim their machete, once tempers and machetes have cooled off.



  





Edgar shows our hospitalists his grisly photos.  Craig & Claire... ?






M 10/2

It was good to sleep a little longer this morning.  We were to be at the hospital at 8:30 for group pictures, including video footage taken by Cross Bow Production's drone.  After pictures everyone pitched in wherever help was needed to clean up our work areas and get EVERYTHING packed back into the cargo bins.  Teamwork is essential at every stage, and there were no slackers.  During the entire trip, the teamwork was off the charts.  More than once I have wondered what it would be like to have that each day in the U.S. (not the intensity of the work necessarily, but the willingness of everyone to pitch in rather than sticking their faces in their phones).   

Indispensable local volunteers.  Dr. Ticho is second from left.
Craig and his hens.  We traveled as a group from Denver.
Well-deserved laughter and levity.

Throughout the morning, Peggy escorted small groups of 5 or 6 to visit the maternity ward. Prior to our arrival, she had organized a clothing drive... receiving blankets, onesies, cloth diapers for the newborns.  Many of the families are so poor that they have nothing to swaddle a baby in, so some go home wrapped in newspaper or a dirty towel.  Consider a birthing room in a typical hospital in the U.S.  Now imagine what the opposite must look like:  a large room absent of privacy; baby sleeps on the bed with mom; postpartum exams conducted when needed -- not when conducive to modesty or privacy.  The tired moms were gracious and the babies were absolutely beautiful.  I learned from Peggy on our way out that the entire family chimes in when it's time to choose a name for the child -- another example of the importance of close-knit family here.          

After returning to the hotel, a group of us had lunch in the restaurant.  Mary joined us -- she works for Mayan Tours and was at the hospital each day to help translate.  I was surprised to learn she's only 20 -- she has maturity beyond her years.  She is also very kind and earnest. 

There was a celebration dinner that night, which Mary was attending, but first she was going to go home and get cleaned up.  She was going to take 2 buses...a minimum of 1 1/2 hours.  One of the videographers at the table casually asked how long it took in a taxi (30 minutes) and how much a taxi cost.  L 60 (60 Lempiras)...about $3 US.  I was sitting next to Mary...a small group of us were chatting, and then Jeremy (the videographer) gave her L 60 and told her to take a taxi home so she also had time to rest.  This simple gesture brought tears to her eyes (and to those seated near her).  

Mary & Karen.   

I recently finished reading The Atomic Weight of Love.  At one point in the story, Elizabeth J. Church's protagonist, Meridian Wallace, ponders the "evolutionary implications of kindness:"  She tells the reader, "I thought about how lives bump up against each other, whether for moments of superficial conversation in line at the post office or deeper enmeshment.  How much meaning should be ascribed to knowing a stranger for the moment..."

We had our celebration dinner tonight outside next to the pool.  Once again, the chef prepared wholesome and nourishing deliciousness for our weary minds and bodies.  Jim shared a touching and funny sentiment that his young son had written to him in a birthday card.  I wish I could remember all of it, but I only remember that it ended with, "...have fun!"
It was a good reminder that it's important to include an element of fun, especially when the work is hard.  These trips would not be successful if the team did not experience the joy and happiness associated with the output of so much physical, mental, and emotional energy.

Dr. Dennis honored numerous local team members, without whom these trips would not happen.  They attend to so many details, from tracking the arrival of the cargo to making sure we all stay fed and hydrated at the hospital.  I was touched as I watched Dr. Dennis make the rounds to each person at every table and give a hug, a kiss on the cheek, and a personal "thank you."  He wears his heart on his sleeve and makes it so very, very easy to want to be a part of this... 


SPD crew:  Me, Kevin (Bio-Med), Ivis, Jamie, & Gina.

              
                    Mary & Ivis.
Marc Angerame, MD & Craig, RN
                 
Tu 10/3

No alarm this morning !  And we're going to the beach later today... our first and only trip away from the hotel/hospital shuffle.  Two vans take us north and east (about an hour's drive) to a small resort.  It was beautiful.  But I changed my mind about getting in the water when one of the docs told me he had just found a (presumably) used condom.  I mentioned the trash earlier -- when it rains, which is often, the trash is carried into the rivers, which then empty into the ocean.


Dr. Danes is ready !
  
                           
                                  Not a bad spot for a little R & R.
A pool overlooks the ocean.
I could eat this everyday.  I never tired of fried plantains. 

We had lunch and then Peggy won all of the money in a Poker game.  The other players are demoralized, and with heads hung low, we get back into the vans to head back to the hotel.  We're on our own for dinner.  And then we need to pack, as the trip has come to an end, and Craig and I depart tomorrow morning for a week in Roatan.

Keep in mind that the following is based on my limited experience and the small amount of research I did, but it's what will be on my mind when I leave.  Overall, and with much generalizing, I found the Honduran people to possess a quiet resignation...to the heat and humidity, the waiting, the myriad of ways the government fails to do its part.  However, in spite of the wide-spread poverty, a social structure does exist.  As do kindness and love.  It was apparent that people approach each day with a willing intent to live their lives, to the extent possible, by whatever means are possible.  Take the extras away from a middle-class American and what remains are the same priorities important to the beautiful people of Honduras:  family, friends, work, food, shelter, safety, and health.  

W 10/4


Roatan is the largest bay island off the east coast of the Honduran mainland and boasts the second largest barrier reef in the world (second only to the Great Barrier Reef).  An easy 45 minute flight followed by a short taxi ride, and we arrive at Puerta Azul.  Located in Sandy Bay and owned by an American ex-pat, the thoughtful accommodations and delicious meals provided us with much-needed rest, relaxation, and rejuvenation.  We stayed for 7 nights and then it was time to head back to our real world.  I am already looking forward to another opportunity to work (and play) in Honduras.

A long pier provides access to deeper water & snorkeling.

Our bungalow was just steps from the beach.

  
       The beach at sunset.  

DISCLAIMER:  I am not an official spokesperson for Operation Walk.  This post is based solely on my personal experiences.  Any misrepresentations are unintentional and any errors are mine.                                           


My amazing husband Craig, who inspires me to Do Better.
I left a piece of my heart in Honduras...