I considered snapping a picture on my camera phone of the Dunkin’ Donuts sign at the Tegucigalpa airport, marveling at how American culture had managed to spread its tentacles all the way to Honduras. As we loaded our luggage into six enormous pickup trucks, 10 percent personal belongings and 90 percent supplies for our brigades, I waited for the moment when it became clear that I had entered the Third World. Certainly, Tegucigalpa was like no capital city I had ever seen before: no subways, no skyscrapers, no businessmen clutching their lattes. But what I saw of the city also did little to uphold my stereotype of a developing nation: no vagabonds, no gang fights, no bonfires made of newspaper to endure the freezing nights (we were, after all, in Central America).
Before arriving at our camp, but long after having diverged from the luxurious paved roads of Tegucigalpa, we visited Hogares Pedro Atala, a boarding school for children who would otherwise have been expected to accompany their mothers to prison. Kids from ages 3 to 18 flocked upon our arrival, eager for someone to embrace them and hold their hands. Yet another stereotype — that of the meager, repressed, abandoned orphan — flew out the window; these children simply wanted, both literally and figuratively, to be touched. Seemingly oblivious to the fact that most of us spoke no Spanish, each one grabbed an adult to whom they could show their jungle gym skills or latest art projects. Fourteen-year-old Stephanie gave my brother and me a detailed tour, happily enduring our rusty Spanish for the sake of a somewhat fluid conversation. From the detailed chore schedule on the wall to their bedrooms, crammed with eight bunk beds containing as many stuffed animals as each one could hold, their home was immaculate. Sadly, after what felt like an instant, we gave each child a pair of red Crocs and a handful of candy and had to say goodbye, to which Stephanie replied, “No adios — hasta luego.”
We reached camp exhausted and excited with hours of preparation ahead of us. I wondered immediately how the youngest (8-year-old Eric) and oldest (some volunteers were in their mid-60s) of our group would stay awake to work. I would soon discover that not working was not an option: Diamond earrings came out, sleeves were rolled up, and we dove in. Prescriptions, fluoride, medical and dental tools, cameras, clothes, toys, art supplies, and thousands of red Crocs were divided into thirds; we loaded up for the next day, and 43 drained heads hit 43 pillows. We would later learn, however, that we didn’t know the meaning of the word “tired.”
Six a.m. inevitably came, along with the sun, and we joined our luggage in the backs of the pickup trucks (it would be paradoxical to refer to something so uncomfortable as a “bed”). The drive, straight up a mountain, was no easy task; somewhere between traversing a river and inhaling several fistfuls of dust, it became clear just how remote this brigade site truly was. How many others just like it, I wondered, would remain ignored for decades to come? Just short of three hours later, or “an hour or so” in what affectionately became known as “Honduran Time,” we arrived. The structure was surrounded by nothingness, so I could only imagine how many hours these people, who had already lined up in anticipation, had walked to see us that day. We immediately dispersed to set up our “stations,” most of which involved makeshift tables loaned to us from the patients’ homes.
Upon arrival, each visitor was given an anti-parasite medication before visiting the doctors. Since these cannot be administered to pregnant women, our 8- and 10-year-old resident bilinguals had to overcome their fear of asking awkward questions. Ten-year-old Ilan was incredulous after learning that 18-, 15-, and even 12-year-old girls were pregnant or mothers. After we saw the first couple hundred patients, we paused for lunch and shared other observations, the most notable of which was the lack of diversity in the community. Nearly all of these people seemed to share the same unique face and the same one or two last names. While physical similarities are not uncommon in such isolated populations, we realized that the high occurrence of physical and mental defectiveness was likely a result of extensive inbreeding. After meeting so many mothers who appeared to have had their first child as soon as they hit puberty, I barely allowed myself to consider the unthinkably young age at which they became sexually active.
As happy as I was for the patients we were able to help — many had infections curable with antibiotics or digestive problems treatable with antacids — those whom we could not help affected me infinitely more. One 8-year-old boy presented with a baseball-sized abscess on the back of his head that proved impossible to drain, even after a painful procedure by one of the country’s best surgeons. After speculating that the mass may contain not fluid but actual brain matter, the doctors suggested that the child’s skull plates may have failed to fuse in the womb, leaving him with a condition that could only be repaired by surgery — with tools we did not have, in a sterile environment we could not recreate. A mother in her early 20s brought us her infant son, who had been unable to urinate because of phimosis, or excessive tightness of the foreskin. Luckily, one of the five doctors on the trip happened to be one of University Hospitals’ top urologists, who explained that he would be able to solve the problem by introducing a small slit into the head of the penis. Petrified, the young woman listened as the doctor’s wife translated, and through cascades of tears, two mothers discussed the horrific but essential experience of holding down one’s child while a stranger cuts into him. After several almost-incisions halted by a panic-stricken mother, she decided that the pain, both his and hers, would be unbearable. Despite our best efforts, she was uncompromising in her choice, thanked us anyway, and said goodbye. From cataracts to tumors, more and more ailments presented that we simply could not treat, and more and more individuals returned home with vitamins, Tylenol, and the same daunting problems with which they had arrived.
I proudly jumped from station to station, finally able to view the grander project from a non-medical perspective. While I had spent nearly all day with the doctors at the bottom of the hill, most of the group had been constantly trekking up and down, helping each other with crowd control and delivering lunch to the “pharmacy,” the only station that never got a break. We placed red Crocs on every bare foot and painted fluoride on every rotten tooth, while my brother dripped sweat playing soccer with children while their parents crowded the pharmacy. One woman spent the day snapping Polaroids of the patients as they waited in line, which, never having owned a picture of themselves or their children before, they clutched even more tightly than their medications.
I hesitate to speculate, however, what went on behind the closed doors of the dental station. I like to consider myself a rather strong-stomached student of science. Yet I could not bring myself to investigate the area in which, with minimal Novocaine, dentists yanked dozens of teeth that had decayed from a lifetime of gnawing on sugar cane. My only clues, therefore, were the red gauze-filled mouths of the patients we saw and the agonizingly sore forearms of our two recent dental school graduates. Despite its morbid air, however, the dental station produced some of the happiest and most grateful people of the day. In fact, the only man who explicitly asked for a toothbrush and toothpaste arrived just after we had run out of them, so a dental assistant offered him floss instead. He politely declined, grinned, and revealed a completely empty mouth save for one solitary tooth that he was, apparently, quite intent on keeping.
After the 350th patient came and went, we exhaled and returned to camp, still, somehow, utterly unprepared for what awaited us the following day. Day Two promised a slightly shorter but equally dusty and bumpy ride up the opposite side of the same mountain to a brigade site crawling with expectant guests. After about 45 minutes of nonstop work and a line that was growing in the wrong direction, it became clear that at this pace we would be forced to turn away more than half the people who walked so many hours to see us. We had to shift into overdrive. My cousin, Lee, the doctor I shadowed that day, swiftly eliminated my “assistant” status; he handed me a light and a stethoscope and promised he would be right there if I got stumped. A friendly competition between him and another doctor, who happened to be his father, fueled 600 of the quickest physicals in history. When Lee saw the despondency in my eyes at the haste with which I was forced to help each patient, he assured me that most of these people were generally healthy and the mere experience of being looked over by an “expert” would be gift enough for them.
Healthy, perhaps, but happy, no. The indigence we had seen the previous day was nothing compared to this: simple cuts infected into seeping wounds, children ridden with physical and emotional bruises, and more sewage, saliva, and general filth on individual bodies than I had thought possible. Given the sheer volume of visitors, it was impossible to sort them by necessity or urgency, with one remarkable exception, an example of triage medicine at its finest. A young mother arrived at the end of the line with her three children, all of whom were covered with what looked like infected chicken pox. Her infant son was smothered from head to toe with these sores, which could only be described as biblical, to the point where he could barely maneuver his lips in order to nurse. We rushed the family to the attention of all five doctors, who took one whiff and simultaneously concluded that the problem was bacterial. They cleaned all four of them to the best of their ability and gave the mother as many creams and solutions as they could find, but the baby remained desperate, seemingly days away from death. Lee took one look at his own sons and resolved that he was not going to let a few ambitious germs take the life of this woman’s child. He immediately piled the entire family into one of our trucks (thenceforth referred to as the “infected ride”), and they were driven four hours to Tegucigalpa’s only hospital. Later, during our daily reflections, he would remark that saving that one baby meant more to him than the other thousand patients we saw combined.
That afternoon, a young man brought me his 3-year-old son, whose lips, gums, and tongue were covered in herpetic-like lesions. It was the first time on the entire trip that I had seen a father. Obviously in over my head, I enlisted the help of a doctor and a dentist, who, because she did not speak Spanish, showed me how to train the man to care for his son’s mouth. After days of earnest instructions received with pure apathy, it was boundlessly more gratifying to teach someone who I knew would employ our advice. He coated his son’s mouth with ointment as soon as I laid it in his hands and immediately asked when he could next apply it. He gave one of the only thanks of the day and left, the first visitor in two days without concern for his own health.
After skipping lunch and seeing nearly twice as many patients as we had on Day One, we squeezed into the pickup trucks and began our descent. Somehow, one of the older male patients managed to hitch a ride with us to the village at the foot of the mountain. Owing to the least coherent conversation in history, half because of his senility and half because of our rusty Spanish, our truck’s passengers confidently reported that he was with us because “he had to go see a man about a horse.” Moments after he hopped out, and perfectly punctuating the dejection that was Day Two, we were greeted by the most aggressive rainstorm I have ever encountered. Complaining was not an option, so there was nothing to do but laugh.
If Day One was too physically taxing and Day Two too emotionally depressing, Day Three was the perfect finale. Certainly, poverty prevailed as the driving force behind every ailment, but this community was decidedly different. Many were literate. We also met the village’s own medicine woman, who provided year-round nursing care to the sick and could, therefore, make good use of all the prescriptions and supplies we left behind. I handed my stethoscope to my brother and took his place in the pharmacy, which he warned me would be far less intellectually and emotionally stimulating than the doctors’ station. Indeed, in his experience, visitors had been grabby and impatient, and their contempt at his instructions indicated that the medications likely would be used improperly. As we doled out the remainder of our lice shampoo, fungal cream, and antibiotics, I found that today, at least, this was not the case. Patients waited in a polite and orderly line until their names were called, when they would receive their medications and report to the other interpreters and me for instructions. Each one listened intently, expressing concerns about allergies, jotting notes, and repeating what I said to ensure they understood. Every one said thank you.
We left while it was still light out to make time for our final visit of the trip: a boarding school for teenage boys who were taught specific trade skills so they could one day provide for their siblings. Still in the depths of the remote, mountainous terrain, these boys were all hyper-aware of the unique opportunity with which they had been blessed. They practiced their English with us, gave us a tour of the facility, and sold us hand-ground coffee to fund their education. Each boy maintained that his favorite activity was either working or studying, although when prodded, they agreed to kick around a soccer ball with my brother. And as a proper bookend to our trip, we met Brian, the little brother of boarding school student Stephanie, whom we’d met on the first day. Brian was delighted at the opportunity to send Stephanie an “hola” through one of her teachers who had joined us on the brigades.
As we drove back, I again watched Tegucigalpa appear in the front window. This time, instead of Dunkin’ Donuts behind me, I had three days of hard work. While these ended on a hopeful note, they left me with an awkward sensation, somewhere between pride and guilt. What had we done, really, besides plug a small leak in a surging stream of global health issues? How many of the people we helped would remain sick or get worse? How many people were too sick to even come see us? How many hundreds of thousands of other people throughout the world need this type of care every day, not once a year?
Lee, the president of MedWish, repeated throughout the trip that this mission was as much for us as it was for the people we helped. I nodded every time, acknowledging the rare opportunity to practice medical skills and to pat myself on the back for improving someone’s life, if even just a little bit. Not until I opened my computer and began writing this article did I truly understand what he meant: The first and most important step in solving a global problem is personal awareness. Interestingly, diving directly into the medical school application process has forced me to ponder what the next steps might be. Whether it means spending a week in Honduras every year of my life, opening a MedWish in my home city of Boston, working in a free clinic, or something else entirely, the driving force behind my medical ambitions irreversibly has shifted from the tangible pursuit of science to an abstract acknowledgement of social responsibility. If the other 42 volunteers experienced similar epiphanies, the medical community is headed in the right direction.