Tuesday, August 2, 2011

The Conference (July 30)

At the hotel in La Ceiba, we woke up well before 5:00am to ensure a spot on the private bus to San Pedro Sula and then to Tegucigalpa. Although more expensive, using the private bus company is much safer than the public busses, involving many security precautions. To begin, a passport for foreigners or national I.D. for Hondurans is necessary to purchase a ticket. Also, luggage is checked-in and can only be retrieved with the proper tags at the destination to protect against theft. Then, we as well as our hand baggage are meticulously searched for weapons before being allowed to board. Finally, a photo is taken of each passenger and is likely run against a database, an act that greatly discourages anyone with a criminal record or outstanding warrants from ever trying to get on the bus. The busses are direct, making no stops, further lowering the risk of assault or criminal infiltration. Our tickets for the ten-hour ride were $25, about twice the cost of public busses.

All of this may seem a bit silly, except that bus violence in Honduras is a real threat—and common. Since Tegucigalpa is the capital city, many tourists, loaded with all of their luggage, go there at the end of their journeys to fly out from the international airport. The early morning busses are even more likely to be filled with tourists, making them especially enticing targets for some of the most dangerous street gangs in the world. For instance, a little over a week ago in Trujillo, a small coastal town of 30,000 people, a 5:00am bus leaving for Tegucigalpa was hijacked by robbers. The bus driver initially ignored the demands of the gunmen, who wanted him to stop the bus so that they could load everyone’s luggage (and wallets and purses) onto another vehicle. Gunmen responded by shooting and killing the driver of the moving bus, and they then turned their weapons on the passengers, killing and wounding many more, including a young child. The dead and wounded were rushed to the hospital in Trujillo, where they were seen by Anjuli and Mindy, an EWH team working at that hospital. Though the danger may seem spread over the size of the country, a per capita relation may bring some perspective. Honduras is home to 8 million people, which is roughly the number of people living in the Chicago metropolitan area. Did Chicago have a fatal bus hijacking last week?

Finally arriving in Tegucigalpa early in the afternoon, the first thing I noticed was the temperate climate. At a high elevation in the mountains, the city enjoys cool weather, though every major rainstorm triggers dangerous mudslides and rockslides on the mountain slopes.

The conference was opened by Cathy Heck, one of the founding members of EWH. “We’re very thankful for the work you all have done this summer and hope that in some way you will keep in touch with us and continue to be involved. We know that all of you are going to do great things, and you are our program’s best ambassadors.”

Her openning was followed by Dr. Malkin, who gave the following address:

“Right now, all of your are in stage five of culture shock, the exciting period when you first begin to reenter what you consider to be normal life: running water, hot showers, people speaking English. The bad news is, this stage doesn’t last long, lasting only to about the point that you pull into your driveway with your mom. ‘Wow!’ you exclaim, ‘The toilet here flushes!’ ‘Yeah, that’s nice’ your family replies. They can’t understand what it’s like for you to be back, and you’ll want to keep telling stories about your experiences long after people no longer care to hear them, which can be very discouraging. This is the sixth typical stage of culture shock.

"So I want to start the conference with two short stories to help you focus now and to get through the difficult times that are coming. I just came here from Guatemala, where EWH does work with a high school program for kids who want to pursue careers in neonatal medicine. I was also there last year, where I met a young girl with jaundice who was born premature. Of course, this can be treated quite easily with biliruben lights, which intensely shine a particular frequency of light at the baby’s yellowed skin, breaking up the toxic substances into components that can be safely handled by the body. Today, that little girl would have been a year and four months old. But she’s not—she died. She died because no one had fixed the problem with bili lights, so there was no way to treat her.

"The second story is also from Guatemala. With the high school program, we visited a clinic in a small village to work and observe some childbirths. Traumatizing to the students was watching a birth which not only was a stillbirth, but which was soon followed by the death of the mother from hemorrhaging. Now, let me ask you, why did she die? Hemorrhaging is the number one cause of childbirth mortality in mothers, and the hemorrhaging itself is usually caused by elevated blood pressure. Early in the pregnancy, when warning signs of future hemorrhaging are detected, the mother can be treated preventatively with a good chance of success, though the treatment cannot be given to mothers who are not at high risk for hemorrhage. But, like so many other clinics throughout Guatemala, this one did not have even a single working blood-pressure cuff. If you can’t diagnose, you can’t treat.

"Now, the tragedy here is not what I want you to take from these stories. Instead, think about the difference you’ve made. I’ve already talked to many groups who repaired bili lights, and that repair is going to save thousands—literally, thousands—of infants. Also, I’ve already spoken to many of you who have repaired blood-pressure cuffs, each of which can prevent the deaths of dozens of women. Remember that when you start having trouble adjusting to home.”

We had many student presentations at this point in the conference, including PowerPoint presentations, videos, scrapbooks, and our posters. This was an exciting opportunity to learn about the experiences of the other groups, and although each group had vastly differing experiences, we were quite able to relate to one another in them. Memorably, one group was almost electrocuted, but luckily only melted their screwdriver instead. Another group, despite following safety precautions, was the victim of faulty wiring, which shorted out and caused a brilliant, sparky explosion “like the Fourth of July”, as the Hondurans said. The electrical current and heat involved were so great that the switch which initiated the ongoing issue of fiery sparks had actually now been melted into the “ON” position. The group then had to scramble for a way to cut power to the shorted circuit.

Other speakers included a man from Mozambique who was representing an international health federation closely allied with the United Nations and the World Health Organization. He expressed great admiration for what EWH was doing and shared with us about the work of his organization. Another speaker presented about a program nearly identical to EWH, but started a few years ago by a student responding to needs he identified by traveling, without any specific plans, to the developing world and working with great success in hospitals there. Now, the two programs are considering joining forces for greater effectiveness. The final speaker of the evening founded and runs a private biomedical engineering school in Honduras, which has just matriculated its first four alumni who are now working in various private companies. He considers the EWH BMET training program, which offers technician training at a very low price, to be a complementary, rather than competitive program, since technicians can perform preventative maintenance and simple repairs, while the engineers perform more specialized tasks.

Roger, Maritza’s nephew, returned that evening from Olanchito to his house in Tegucigalpa, and he came to visit us at the hotel and got to meet the other Summer Institute participants. After a few hours of talking and looking at the city from the roof of the hotel, I slept in Honduras for the last time.



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