Two Months after Mitch: DGH in Honduras By Arthur Seiji Hayashi, MD

The 18-hour delay in San Francisco, the overnight lay-over in San Salvador, and the seven-hour ride to our first destination from Tegucigalpa seemed like an appropriate introduction for two family practice residents wishing to "help out" in the Central American country where Hurricane Mitch lingered overhead for seven days.

Upon our arrival at the airport in Tegucigalpa on December 12, 1998, Colleen Townsend and I were met by Neamias, one of the CCD’s (Comisión Cristiana de Desarrollo) many drivers/logisticians. He helped us load 200 pounds of medicines we brought from San Francisco into the mini-van and proceeded to drive us directly to the "zona." Five hours later, we arrived in Quimistan, a small town in the northeast province of Santa Barbara where CCD has its office. There, we met Alba, the office administrator, and waited for a driver to take us to the village of Paso Viejo where a medical brigade had been working since the day before.

Josué, our driver, arrived a few hours later, and we loaded our backpacks and medical supplies on the Toyota pickup. After a two-hour truck ride into the mountains, we arrived in Paso Viejo where we were met by the CCD volunteers and staff at the local school. The CCD field coordinator was Jessica Culley, a recent college graduate with enormous organizational skills. The volunteer team consisted of two nurses, two nurse practitioners and two physicians from the US, as well as a local Regional Health Promoter.

The next morning we rolled up our sleeping bags and laid out our basic equipment to begin our clinic. Dozens of people were already waiting outside. Vilma, our health promoter, registered every patient and elicited the chief complaints. The Spanish-speaking volunteers were paired with non-Spanish speakers, and we began to see patients in the one-room classroom. Karyn and Kit staffed the closet-turned-pharmacy and began to hand out medications, "Una tableta dos veces al día por tres días..." Most people came in with the common diseases of poverty: upper respiratory infections, diarrhea and skin infections. The clinic closed by noon so that the crew could return to Quimistan for New Year’s Eve.

On our drive back from Paso Viejo, we came across an over-turned pickup truck with three policemen staggering out. Just a few minutes before, the truck’s breaks had failed and the driver tried to stop the vehicle by running it into the embankment. We assessed the situation and got to work. One officer was bleeding from multiple lacerations on his face. Another was complaining that he couldn’t move his leg. The third was carefully guarding a practically severed finger tip. Colleen and Kit worked on the facial lacerations while Bob splinted the possible knee fracture. I carefully cleaned the open fracture on his finger. The roadside emergency room worked marvelously. The nearest hospital was two hours away, so we gave each officer an antibiotic shot for their dirty wounds, and one of our trucks was sent ahead to call for help. Later we heard that the officers refused to go to the hospital.

Dr. Arthur S. Hayashi examining an infant in Paso Viejo, Honduras.

The following day, the group took a day off and visited the ruins at Copan. Most of the volunteers had been there for more than two weeks and had been working hard everyday. Colleen and I had arrived at the end of their stay. New Year’s Eve was spent in Quimistan where we feasted on a large turkey and exchanged stories before heading to the New Year’s eve Mass. Firecrackers were going off everywhere in town.

Since Colleen and I arrived during the holidays, we were out of sync with the other brigades. There were no plans for another health brigade for a week. I asked Jessica if it would be possible for Colleen and I to visit a site on our own. Jessica remembered a village called Quebrada Seca that had not been visited by a health care worker for months, even before the hurricane. As we discussed our plans, we recruited Nikki and Kit to stay on longer to join us on this trip. The five of us set out for Quebrada Seca in the afternoon of the first of the year. Máximo, another CCD driver, dropped us off two hours later at the trailhead that would eventually lead us to the village. The trail led us through a beautiful valley. We had to hike for one and a half hours, but it felt even longer since we all carried half our weights on our backs. Several times I contemplated leaving the water or medicines on the trail. Our hike was not made any easier when we encountered a friendly drunk who insisted on escorting us to the village. As our guide staggered along the trail, a handgun fell out of his pocket, but we made it to the village without incident. There we were met by the surprised villagers. Jessica had met the people before and quickly explained the purpose of our visit. Within a few minutes, arrangements were made for our stay and messengers were sent to tell nearby villages about the gringo clinic that would be available the next day.

Quebrada Seca is a small village of about thirty households, but it is very well organized. The village had many cooperative projects including water, sanitation, livestock and coffee. Unfortunately, many of these projects were severely damaged by Hurricane Mitch.

There are four other communities within an hour’s walk of Quebrada Seca from which patients came. The clinic opened promptly at 8:00 a.m. on January 2. As Jessica registered the patients, Colleen and I gave consultations, Kit dispensed the medicines, and Nikki treated minor wounds and gave massage therapy. By the time we left the village the next afternoon, we had seen over 100 patients. That was my first experience with injuries directly caused by Hurricane Mitch. A young man limped into the clinic helped by his father. With further examination by Colleen, it became apparent that he had weakness on the entire left side of his body and had difficulty speaking. He had fallen and hit his head during the heavy rain.

We also met Raúl, an 82 year-old elder at the home where we took our meals. David, his son, mentioned that he has a father who was "dying" so we need not even examine him. We asked David if we could see Raúl to at least offer pain medications, if nothing else.

We entered the dark house with our flashlights and immediately smelled the stench. We found Raúl sitting on the edge of his bed hunched over. His legs were swollen to his knees with pus oozing from large ulcers. He cradled his contracted right arm with a large ulcerating mass. We timidly introduced ourselves and he lifted his head, surprising us with his lively response. He was no where near dying, but was in obvious pain. Despite his blindness and contracted arm, Raúl had been functioning well until he fell and injured his legs during the hurricane. He had been bed-bound ever since. Kit, Nikki and Colleen carefully cleaned Raúl’s wounds, while Jessica and I provided light and clean supplies. After nearly two hours, Raúl’s legs were neatly bandaged, his bed cleaned and he had received a shot of antibiotics. Raúl thanked us profusely while tears welled up in his discolored eyes. Before we left the village the next day, we visited Raúl again. His legs were already visibly less swollen and he raved about the fact that he had slept through the night for the first time in two months. We left his family a bag of medicines along with instructions for his care.

From left to right: Colleen, Jessica, Arthur, Nikki and Kit, hiking to Quebrada Seca, a remote village in Honduras that had not seen a health worker in over six months.

After precariously traversing the river that runs through the valley three times, we met Máximo at the same place he had dropped us off two days earlier. We loaded our gear and arrived back in Quimistan soon after. In Quimistan, we met a group of volunteer civil engineers from the US. They were working with CCD to analyze the soil for various construction projects that would soon replace medical brigades like ours as the main focus of CCD’s post-Mitch work.

We spent the next morning getting ready for our ride back to Tegucigalpa. At the CCD office in Quimistan, we met a volunteer named Merlin. CCD was providing Merlin with a scholarship to go to college in San Pedro Sula. During breaks from school, Merlin volunteered in the region. Juan Ochoa, a former activist for Central American liberation, was our driver back to Tegucigalpa. Kit, Colleen and I bid our farewells and five hours later arrived at the CCD retreat called Montecarmelo.

At the airport the next morning we bid farewell to Kit and made our way to the CCD central office where we met Martha, the coordinator of the medical brigades, and Mark, an aspiring photographer from Boston. Martha drove us through the devastated areas of the capital. Businesses were already operating and the city was congested with people going about their daily routine, but the sight of half-buried cars, water marks near the top of two-story buildings, and washed out bridges made it impossible for us not to imagine the deluge.

After lunch, we thanked Martha and boarded a bus to Choluteca. We arrived in Choluteca late in the afternoon and were met by the CCD staff from the nearby town of Nacaome. Choluteca is a sizable town near the pacific coast along a river with the same name that swelled to several miles wide during the week-long rain. After the water had receded, the course of the Choluteca River had changed, and a "New River" flowed parallel to it. The mud deposited by the flood was baked into dust by the summer sun, already a month old. During our half an hour ride to the CCD office in Nacaome, we passed through very few places untouched by the waters.

Once there, we met the coordinators Carlos and Patricia. They briefed us on the damage sustained by the people in the region and of the relief efforts. Tens of thousands of people had either a partial or total loss of their homes. The majority of homes lost were those of the poor since their adobe houses melted away with the rising water. Most farmers lost entire harvests, but had food left over from prior harvests. This could not sustain them until the next harvest, however, or even provide enough money to buy seeds for the next planting season.

In the morning, we took a tour of Nacaome and the surrounding region. I stood at the edge of the road that was once connected to a large steel and concrete bridge, now a pile of twisted metal 50 yards downstream. I was trying to imagine what this place must have looked like when the river 40 feet below rose to this height. I looked around and realized that the trees and some rooftops were the only things higher than where I was standing. It must have looked like an ocean.

We then packed our belongings again and headed towards the Salvadoran border at Amatillo. But before we reached the border, we made one final stop at a government clinic. The only doctor at the clinic took some of his valuable time to show us data regarding the emerging dengue fever and malaria he has been monitoring since the hurricane. The numbers were still low, but it was obvious that the numbers had been climbing steadily over the past two months.

Mark, Colleen and I thanked the CCD staff at the border and crossed the bridge into El Salvador. Two months after Mitch, I had expected to see a country in mourning. But, as a true testament to human resiliency, people were rebuilding and moving forward with their lives. Villagers already spoke in terms of "before Mitch" and "after Mitch." Yet Mitch will be remembered only as another set back among other natural disasters, armed conflicts and social injustices that plague the region. As most foreigners who visit developing countries would agree, we learned and perhaps took away more than what we were able to give. The experience in Honduras gave me renewed vigor and a fresh perspective, and the work we do at our public hospitals seems even more important now. The resources we have in the US give us the responsibility to create a healthier society for all people.