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Subirana, Yoro Projects
January to June 2000
Kevin Rodgers and Anne Geroski
Subirana Girls’ Club - “Club de Muchachas”
Goal: To expand access to basic health care services to
residents of isolated rural areas.
From
January, 2000 until June, 2000, Dr. Kevin Rodgers was based at La Clinica Medica de
Subirana, where he attended 883 patient visits. The
patients came from Subirana and surrounding mountain villages, some as far as two days
travel away by foot, muleback, or bus. They
ranged in age from newborns to elders in their eighties, and presented with a wide variety
of conditions, as well as for cancer screening and family planning services. Data on these visits were collected (gender, age,
village of residence, diagnosis, etc.) and submitted in statistical format to the regional
office of the Ministry of Health, with individualized medical records kept at the clinic. Health promotion including prevention of
water-borne diarrheal illnesses, promotion of breastfeeding for at least nine months for
infants, cancer screening (Pap smears and breast self-exams for women), and family
planning were were priorities for integration into patient visits.
In
regard to family planning, available contraceptives such as condoms, IUD’s, oral
contraceptive pills, and injectable depot-medroxyprogesterone were prescribed regularly,
and Dr. Rodgers performed six vasectomies in an effort to introduce acceptance of this
form of family planning to the area.
The
Lennox Foundation support allowed purchase of over $1,000 in pharmaceuticals, and these
were prescribed and dispensed from the Clinica Medica as well as in outlying villages and
house calls during outreach visits. No
patients were refused services and every effort was made to provide for appropriate
medications, but local nurses evaluated the patients’ ability to pay and when
appropriate, a fee of 20 Lempiras (approximately $1.40) was collected for the physician
visit. Also, if possible the cost of the
prescription was collected. (Accounting for
these funds are per Asociacion de Instituciones Evangelicas Hondurenas procedures). These
proceeds help insure the continued viability of the clinic and pharmacy services.
Additionally,
Dr. Rodgers saw patients almost every week at the Ministry of Health clinic in Subirana,
the Centro de Salud Rural, primarily at the prenatal care clinic. Over the period of six months, he attended 165
patient visits there, as well as another 103 patients at the Clinica Medica de Rio
Chiquito, Cortes. Visits at the latter clinic
were primarily intended for well-woman care for Pap smears, family planning, etc.
Home
visits to patients totaled 80, and patient transports (emergency as well as for specialty
care at the regional and central hospitals) totaled 51.
Two deliveries were performed in patients’ homes, and two in the
clinic. The latter two were higher risk
deliveries referred to the clinic by traditional lay midwives who had recently received
the Lennox Foundation-sponsored midwife training which included identification of
higher-risk pregnancies.
In the months of April and May, Dr. Rodgers was able to contribute significant time and the use of the project’s four-wheel-drive vehicle to the annual vaccination campaign. In collaboration with local Ministry of Health personnel from Subirana and surrounding villages, as well as with village health promoters, thousands of children and women were brought up to date on immunizations (polio, tetanus, diphtheria, measles, mumps, rubella, hemophilus influenza type B, and tuberculous meningitis). In many villages, 100% coverage was achieved, and documentation of immunizations was integrated into regional health statistics in all cases.
In May and June, a volunteer occupational therapist and a physical therapist arrived accompanied by several thousand dollars worth of donated equipment such as limb braces, wheelchairs, walkers, and crutches. The Lennox Foundation provided for airfare from their homes in New Mexico to Honduras, as well as for Spanish language training materials for local health personnel. In the months prior to their arrival, Dr. Rodgers had been working to identify physically challenged people living in the area around Subirana, and communicate to these volunteer therapists via email their conditions and likely needs in terms of evaluation and equipment. The therapists were thus able to tailor the list of equipment they brought to the needs of these identified patients. During their two-week stay, they were able to provide evaluations and services to over 20 families with physically challenged members (with conditions such as cerebral palsy, strokes, and hypoxic birth injuries). They demonstrated appropriate positioning to stimulate neurological and muscular development, provided appropriate technology braces and supports, provided anticipatory guidance to parents and care-givers, and training to the clinic’s nurse in evaluation and monitoring of progress.
Goal: Training of local health care personnel who will
provide on-going services.
During
clinic hours at the Clinica Medica de Subirana, daily clinical training in the context of
patient visits occurred with Maria de la Cruz Lopez Rivera, the permanent nurse assigned
to the clinic. The same occurred for the auxiliary nurses who staff the Clinica Medica de
Rio Chiquito. Clinical training focused on prenatal and general obstetrical care occurred
at the Ministry of Health clinic in Subirana with the internship year social service
physician, Dr. Jaquelin Galo, assigned there. Prior
to Dr. Rodgers’ departure, Dr. Galo extended her service in Subirana for another year
beyond her obligatory year of social service.
One
Friday morning a month Dr. Rodgers participated as an instructor in training sessions for
the traditional lay midwives practicing in Subirana and surrounding villages. In
additional to topics related to prenatal care, nutrition, and healthy delivery techniques,
a session on identification of community members with signs and symptoms of tuberculosis
infection was given. This session resulted in several referrals of community members to
the health center for evaluation for possible tuberculosis. This activity was coordinated
with the regional Ministry of Health official in charge of tuberculosis control, Dr.
Reniery Espana.
During the months of March and April, Dr. Rodgers coordinated planning and carrying out a one-week-long formal training session for 18 area traditional lay midwives, only three of whom had had prior formal midwifery training of any duration. The faculty for the course consisted of local public health nurses, the professional nurse from the Clinica Medica de Subirana, and area physicians. The curriculum followed the Ministry of Health guidelines as adapted from the World Health Organization, and included sections on identification of risk, managing a healthy delivery, care for the newborn, care for the post-partum woman, and family planning.
Because 15 of the 18 participants (age range 19-72) had not learned to read, the course content was presented in interactive, experience-based, and skills observation format.The course was approved for certification by the regional Ministry of Health office. Lennox Foundation funding was crucial for providing transportation as well as meals, educational materials, and the delivery kits (gloves, soap, instruments, sterile scalpel blades for cutting the umbilical cords, a cleanable vinyl apron, gauze, etc.) for participants. Funds budgeted for housing for trainees was not needed, as participants all found housing for themselves with friends or relatives in Subirana. Transportation by regular bus service was provided for trainees to the regional hospital in Yoro for an orientation to the delivery room there, and hospital staff also provided talks on promotion of breastfeeding, when and how to get high risk prenatal patients into the hospital for care, etc.
Once or twice a month, morning-long training sessions were also held with the six traditional lay midwives working in the area of Rio Chiquito, Cortes. Dr. Rodgers planned and co-facilitated these sessions with either the permanent public health nurse at the clinic there, or with Ava Clough, MPH, whose health assessment and promotion projects continue in that area for another two years.
Subirana Girls’ Club - “Club de Muchachas”
Goal: Develop and sustain an organization for adolescent
females in and around Subirana, to promote self-esteem, physical fitness, organizational
and group skills, and school continuation. (Public
health goal: promote the physical well-being
of reproductive-age women, and by improving levels of educational attainment among women,
decrease birth rates and improve the health of children.)
Development
of the “Club de Muchachas” de Subirana was eagerly embraced by teachers, medical
professionals, community leaders, and local adolescent girls. Dr. Geroski coordinated the organizational phase
along with key teachers at the local school and with the nurse at the clinic. Initially the activities of the club revolved
around sports such as soccer, but group skills sessions were also held, along with
discussion groups on topics such as women in the workplace, and relationships and delay in
onset of sexual activity. Approximately 20
teenage girls were Club members during the first and second year, and two local women (a
nurse and teacher) are paid for 6-8 hours per week for their planning and facilitation as
group leaders.
The Lennox Foundation funding for medical activities in the community made possible additional donated funds and materials from interested individuals and corporations in the U.S. to help sustain the Club de Muchachas. Title 9 Sports, a women’s athletic apparel company in Seattle, donated sports clothing to the group and featured the group in its 2001 spring merchandise catalog. As a result of this publicity, an individual from Seattle contributed soccer uniforms, cleats, sports socks, and shin pads, which were delivered to Honduras in May and July, 2001. An individual in Maine with an interest in promotion of such women’s groups donated funds for sustaining the salary of the part-time club leaders as well as for expenses such as occasional travel, emergency funds for sports injuries, etc. A second donation was made by this individual to fund the program through the end of 2002.
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Board Members | What's New | Projects | Calendar | Contact Us | History |
Getting Involved
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