MT. HOREB, Honduras – An interprofessional team of 28 Campbell University faculty and students spent Spring Break providing medical care to the people of Honduras in partnership with the North Carolina Baptist Men.
Col. Bill Pickard, chair of clinical research in Campbell’s College of Pharmacy and Health Sciences, lead the interprofessional team and coordinated all of the details for medications, equipment, team assignments, and travel arrangements. The team was hosted by Mike and Ginger Green at the 37 acre NCBM Ministry Center in Honduras – Mount Horeb Baptist Camp.
Interprofessional Care & Learning
The interprofessional team consisted of 7 medical students (6 MS-Is and 1 MS-II), Dr. Charlotte Paolini, chair of family medicine at Campbell, and Dr. Stephen Barlow, physician volunteer and father of MS-I David Barlow; two physical therapy (PT) students and Dr. Marge Taylor, assistant professor of health professional studies; 2 Physician Assistant (PA) students and Mr. Miguel Pineiro, assistant professor of health professional studies; and 11 pharmacy students and Bill Pickard as pharmacy faculty. The team joined in country with 2 Honduran physicians, Dr. Brenda and Dr. Mario.
The team of faculty and students were a mixture of first time medical missionaries and veterans.
“This was my first medical mission, but I served a two year mission for my church as a proselytizing missionary in Cape Verde,” said David Barlow, MS-I. “Serving in Honduras really helped me to see how the things we are learning in school can help and be applied. It is always humbling see people in need or in poverty – they don’t see themselves as in need, and they are happy with what they have – that was a good reminder.”
The four healthcare professions worked together to perform physical examinations of the patients and then develop the treatment plan for each patient. Medical, PA, and PT students enjoyed therapeutics discussions with pharmacy students about how they could treat the patient with the pharmacy resources the team brought with them, and medical students and PT students enjoyed collaborating regarding neuromusculoskeletal evaluations and treatment.
“While working in the pharmacy, it was great being able to ask the pharmacy students questions about mechanism of action (the way the drug works in the body), and have them quiz us on “what would you give this patient with this condition? Why? What would happen if you also gave this medication?” said Monica Gonzales, MS-I. “It was great to come to understand what each profession knows and can do, but more importantly, it was amazing to see what we could accomplish TOGETHER.”
“It was a pleasure to see the comradery that developed between the students over the course of the week,” shared Dr. Paolini. “We split into teams, and provided care at 4 different sites, seeing about 1,200 patients in 5 days as well as a dozen of the staff members working at the Mount Horeb Camp. Four local pastors helped coordinate clinics hosted in their churches and advertised the clinic among the people in their area. The students worked beautifully together and functioned as an interprofessional team without prompting or instruction. They were such a blessing!”
“This was my second year in a row heading to Honduras during spring break,” Tiffany VU, second year pharmacy student (P2). “Having all four of the disciplines – Pharmacy, DO, PA, and PT – on the team gave us all the unique opportunity to explore each other’s profession and have a better understanding of each profession’s role on the healthcare team. When interprofessional teams are able to work together, the patient is the one who wins in the end. It was incredible to me how we were able to mesh together in such a short period of time. Our ultimate goal as future healthcare providers is to provide the best well-rounded care available and this trip is a catalyst towards lifelong relationships in the healthcare field.”
Each team had either Dr. Brenda or Dr. Mario with them to refer extreme cases to in-country resources including the university hospital. The team dispensed 27,000 vitamins and gave many intermuscular antibiotic injections – high doses necessary for effective treatment. The team treated many foot injuries caused by lack of shoes and machetes (used as a primary tool by Hondurans) and trimming and debriding diabetic wounds. Because the team was in the area for a week, patients were able to come back for follow-up treatment including additional rounds of antibiotics and hypertension assessments to ensure the dosing regimens were effective. The PA program also gave basic eye exams and distributed glasses.
Ryan Wheeler, a 4th year pharmacy student (P4), worked out two special regimens for patients during the trip: one, for a pastor’s wife who struggles with hypertension and the team was able to leave her with a year’s worth of drugs; and the second was for an infant who arrived at the clinic on the first day with an amoebic liver abscess.
“An infant came in very lethargic and in obvious distress,” said Wheeler. “The Honduran doctor who examined him wrote a prescription for metronidazole, and while we had the drug, we only had tablets appropriate for an adult dose. We came up with a plan to cut the tablets and then crush it into a powder to be administered in water or food for the infant. As a fourth year student, I had access to Lexicomp, a comprehensive drug database, which helped us get an accurate dose. We cut the tablets into thirds, crushed them into powder, and put the powder in individual dose packets to ease the administration on the family to one packet per meal. We explained the directions to the interpreter who relayed it in Spanish to the family.”
“The plethora of different experiences among the group is what made this trip great,” said Tiffany Vu, P2. “We were split up into two teams, and each team and individual saw something different, which made the stories we shared at the end of each day even more powerful.”
“We also did home visits with a team comprised of medical, physician assistant, and physical therapy students for patients who could not travel to the clinics. We saw incredible pathology including scleroderma (or systemic sclerosis), wounds, a patient in her early 20’s with osteogenesis imperfecta (or brittle bones), and numerous musculoskeletal disorders,” said Dr. Paolini. “Our students did a lot of OMM and also worked with and learned from the PT students and faculty.”
“During house visits, we all contributed to the care of the patient,” said MS-I David Barlow. “During the visit, the students from different disciplines were able to think about how we would help the patient with our knowledge; the combined knowledge of the different professions led to better care for the patients.”
David and his father agree that one of the most memorable experiences was doing a home visit to see a 63 year old woman with very advanced rheumatoid arthritis.
“She needed help doing all of her activities of daily living,” said David. “She needed help sitting up and laying down. It was incredible seeing how her family helped and took care of her. There was nothing we could do to help her, but we were able to pray with her and her family.”
“But, she still made tortillas everyday so that she could continue to contribute to her family,” said Dr. Stephen Barlow, physician volunteer on the trip and David’s father. “The trip reminded me that focusing on service, family and faith brings joy.
Humility and Spirituality
“Much was learned and, as one student said, it was not all medical,” reflected Dr. Paolini.
“My most significant take away from the trip was that Hondurans are more blessed than us,” said PA student Alexandra Miller. “They may not have a nice toilet, running water, a beautiful house with a yard, but that have such strong, beautiful spirits.”
“The group of people that went on this trip was not the same group of people that left. We all were touched in some way by the people we helped, and the love we shared,” continued Miller. “Yes, we saw and treated amazing medical cases, but what we really learned is how to truly love our patients – how to care for them mind, body and spirit. That lesson we will all carry with us wherever God takes us next.”
“We learned how to pray for our patients, should they want that. It was more powerful than I would have ever known,” shared MS-I Monica Gonzales. “It was especially powerful when we prayed for those with depression or incurable conditions. You could see the patient’s face light up when you asked if you could pray with them; it was more than even medicine could do.”
In addition to learning how to connect to their patients spiritually, the team enjoyed individual spiritual growth.
“I really enjoyed the devotionals we had together at night and the opportunities we had to pray together as a group and to pray with the people,” shared MS-I David Barlow. “We were able to pray with the whole group at the last site I worked at – that was a great experience. I believe that whenever we serve our fellowman we show the love of Christ. I know that as a group we were able to show Christ’s love through our service and through prayer.”
“On our last day, we were seeing the last family – 5 children and their mother,” reflected PA student Alexandra Miller. “All 5 children were malnourished severely. Two of the children had amber colored hair from lack of adequate nutrition. The youngest one was 2 years old, but was only the size of maybe an 18 month old. She was lethargic, her hair was falling out, and she had soiled her dress; she was severely dehydrated. Because they were our last patients, we were able to give them the rest of our supply of vitamins. We also gave them rehydration packets. The community members also gave the little girl a clean dress. The family then came into our community prayer before we left. Their strong faith increased my faith – they blessed me – and I will forever carry that with me.”
“The spiritual aspect of the trip was very real and palpable,” said Dr. Paolini. “ Students volunteered to bring the daily devotional without being asked. They also prayed with patients. Discussions in the dorm rooms at night were often about exploring spiritual issues and integrating medicine with spirituality. It was a balm to my spirit!”
The entire interprofessional team agreed the trip was a “mountain top experience”, as MS-II Tyler Iodence shared in the team’s devotion time, full of daily miracles and “God moments” – moments where the team could see or feel God working.
“In Honduras, we were completely unplugged – no emails, text messages, Snapchat, Facebook etc.,” echoed Tiffany Vu, P2. “Without distractions, it was like we were on a mountain, and we became more aware and recognized how much God was working in and around us. It is important to carry this perspective with us all the time. God doesn’t work more in Honduras – we were just able to see it there.”
This is one of the best missions trips I have had the privilege to serve on,” said Dr. Paolini.
“The group relationships, the professional interactions, the growing of faith, and service to the Hondurans in 4 villages – this is what medical missions are all about!” said Col. Pickard.