Earwax in Honduras

Cerumen impactions are epidemic in Honduras. Our experience, both in isolated villages and major cities leads us to believe that deafness secondary to completely occluded external auricular canals is commonplace throughout the country.

While the etiology of this problem is obscure, its remedy is straightforward. Once the blockage of the ear canal is removed, hearing is restored and the patient benefits.

The removal of a cerumen impaction that may have been present for decades is a tedious and time consuming process. Busy practitioners who are seeing up to 100 patients during a single clinic do not have the time to clean all the blocked ear canals that they identify.

However, it is not difficult to train the college student members of a Global Medical Brigade to do much, if not all, of the work required to remove a giant earwax plug.

We suggest that an earwax station be set up in a treatment room near a practitioner who is experienced and comfortable with participating in and supervising the process.

Equipment for Earwax Station:

• Debrox/earwax softener
  
• 20cc syringes
  
• Variety of IV catheters 16/18/20 gauge
  
• Tubing from a "butterfly" IV with the needle cut off
  
• *Lighted ear curettes*
  
• 4x4's
  
• Access to otoscope
  
• Basin
  
• Hydrogen peroxide and water (preferably warm water—could even be warmed by the sun in plastic bottles)
  
• Plastic bags to contain the water draining from the ear
  

Note: Some patients will find the ear cleaning process difficult to complete. The Brigade should carry sufficient Debrox/Cerumenex to give these folks some to take home, though mineral oil may be an alternative.

Day 5--Friday, March 27--Tegucigalpa

On our final clinic day we travelled to the capital of Honduras, Tegucigalpa, and took over the clinic associated with the police department.



This was by far the nicest place we set up shop... we had actual exam rooms complete with air conditioning and even a bathroom. Unfortuately, it was the only working commode so we had people trooping through our exam room to use it. This time I was partnered with Peter. It was a relatively small room, so by the time you had Peter and me, both of our interpreters, the ear guys, Eric & Vincent, and Cassie plus a few families of patients... it was crowded.

(Melody, Susan, Peter, Cassie, Vincent, Ian, and Eric)

Interacting with our patients:

Melody attracts the young ones.




Peter and Vicent are captivated.


Ian and a young family. Thank goodness for Ian, his spanish was a great benefit.

At the end of the day we emptied our bags and donated the supplies to the clinic. They were so thankful. State run hospitals and clinics suffer from a derth of supplies and equipment.


Our group this year:


Can't wait 'til next year!

Day 4--Thursday 3/26--Danli

Danli is one of the culturally and ecomonically important cities in the area we were serving this trip. We set up in the Lions Club facility. A cinder block building with poor ventilation.



The providers we split into groups of two. On this day, I was paired with a Cuba doctor, who spoke no english and my spanish is redimentary at best. However, she was awesome to work with and we found communication not nearly as difficult as we thought it might be--gestures go a long way.


My student companions:

(Susan, Ian, and Cassie)
Our bound continued to grow as the days passed.


(Cassie and Eric)
Cassie, Eric, and Ian were just delightful--as were all the students--however, these were among my greatest support system.

Unfortunately, because we were split into different rooms, I had little interaction with Peter, Norma, Greg, or Kathy, except when one of us sought out the others for consultation. Poor Peter and Norma were in the least ventilated room--a literal sweat box!

The Dental Team--hard at work:




Interacting with the locals:

This little boy stole the show--he sang, he smiled, and he played. He captivated us all.


Cassie and the local kids. I swear the kids were as drawn to Cassie as she was to them.

Day 3--Wednesday 3/25--Hoya Grande

Waiting for room assignments at the Hoya Grande School
Up into the mountains once more to the village of Hoya Grande. This was our biggest day, in terms of patients seen, nearly 500 people were seen by the medical staff alone.


(Triage is ready)


(The educational staff is ready)
The educational staff presented health information to the locals about the importance of hand washing, brushing your teeth, etc.


(Pharmacy is settling in)
One of the most useful innovations of the trip was the posting of one of the pharmacy staff, Eric, a pharmacy tech by trade and pre-med student, amongst the providers to keep us up-to-date on medications we had available for our patients.

Perhaps on of the most profound efffects we have is the distribution of parasite medications (as the water sources are used for everything-thus drinking water is contaminated) and vitamins to every patient.


Norma is set to go. As you can see we have erected our privacy chamber once again.


Peter and Melody chat with one of the students while awaiting the onslaught of patients


Greg and his interpreter are setting out their game plan.


Susan and her interpreter, Ian, have bounded and are ready to go. This was the day I encountered my first truly tropical disease; I saw a young man with a parasitic lesion in his eye which we believe was "River Blindness"--you'll have to look that one up, it's amazing and complex. Ian and I saw 70 patients this day.

Some of the locals:

Unlike in America, the patients dress up in their very best clothing to see the medical staff.








The community of Hoya Grande




Day is done:


(this little boy was so vivacious and he loved being in pictures--the students celebrate making it through a very tough day)


Norma and Kathy discuss their day as we prepare to head back to the compound. Kathy (another ER nurse) has seen 79 patients.

We arrived back home after 8 pm and still had to eat and prepare for the next day.

Day 2--Tuesday 3/24--Dining & Peter's Birthday

Dining on the brigades is always interesting. The staff at the retreat center fixed us wonderful meals, which were served buffet style.


Mealtime is a time to gather, socialize, and make new friends.


This is the second year that Peter celebrated his birthday in Honduras. The staff decorated the dining area and prepared several cakes. It was a grand celebration, I only wish I had pictures of the actual birthday party.

Day 2--Tuesday 3/24--El Tulle

Having sorted our meds, packed everything up, trained the triage team, and paired up with student interpreters, we were ready for our first day clinic. So, we loaded into the buses and drove 1 1/2 to 2 hours up into the hills for big day... to a on room schoolhouse. Triage, pharmacy, and the dentists worked in the schoolyard, while the medical providers took over the classroom. We hung two shower curtains using wire hangers from the rafters to create a privacy space for those patients requiring "maximum exposure" and rearranged the student desks to be used as exam tables.

This is the El Tulle School:


Here we are with our interpreters:

Medical Providers: Norma Young, Greg Higgins, Kathy Halloran, Susan & Peter Beoris
Our Interpreters: Yolanda, Ian, Melody, Lizzette, and Sara

Peter and Melody are ready for business:


Susan and Ian are working on building a relationship:


Open for Business--
Pharmacy on the left & Dentists on the right:



Norma & Yolanda didn't waste any time--


And we're off and running, while the line is getting longer. Typically, families are seen as a single unit, each provider takes a whole family at a time.



This is Cassie (our newest unofficially adopted daughter), she's hanging with the local boys:


After seeing nearly 300 people we packed up and headed for home. We still have to repack meds, meet with the interpreters, have a debriefing, and train the new gang that will be rotating into Triage/Intake on the next day. Oh, and be ready to hit the ground running for another day clinic early in the morning. Sleep is sometimes short.

Day 1--Traveling to Honduras

Talk about a long day. We flew from Medford to San Francisco then to LAX. Then at 2 am we boarded Taca Airlines and headed to El Salvadore. TACA was pretty cool... roomy, great service, no extra little charges, and efficient.

So, we hung out in El Salvadore for about an hour then boarded out plane and landed in Tegucigalpa shortly after 8 am. We were met by the GMB staff and driven to our home away from home. It was once a Honduran Presidential Retreat.




It was pretty cool there with the exception of this one really rude goose whom you didn't dare make eye contact with or he'd try to take you down. Anyway, after we arrived at the palace/retreat the five of us (older adult medical providers) were escorted to our room. Notice I said "room", complete with 3 sets of bunk beds. Talk about a kick, it was like being kids again. We laid in our bunks and giggled like little kids. However, it was great fun and everyone got along well.