Medical Mission 2012
  

Good morning Dick.  It’s another beautiful morning in Tegucigalpa, Honduras.  It’s about 0330 hours as I begin to write the story of the recently completed medical/dental/nutritional survey assessment team trip to La Montana de la Flor (MDLF).  All four (4) projects in Honduras are finished or in the last stages of completion.  The homes in Nueva Capital have been completed and the families have moved in.  The many kids in that area that received school and other supplies are very happy.  The water project in El Picacho in the Municipality of San Luis, Comayagua is nearing completion.  In a few short days this village will have clean potable water to their simple homes.  What a beautiful thing for this village.

Planning for this year’s brigade to MDLF began shortly after I returned to the USA last April 2011.   Before the team left the area last year, Dr’s Kemmer and Coello were talking about a return visit to study the kids that had a completed health assessment survey.  The dates for last year’s brigade were 27 April 2011 – 1 April 2011.

I met with Dr. Teri Kemmer a PhD. Professor at South Dakota State University, Brookings, South Dakota 2 or 3 different times in the summer and early fall.  She was excited to return to MDLF.  I was in communication with Dr. Miquel Coello one of the coordinators of the MedRed mission brigades at Joint Task Force Bravo (JTFB) Soto Cano air base outside of Comayagua.  He also was excited to return to MDLF but expressed the blunt reality that JTFB may not be able to return to this pristine area with the Medical Element  program.  The US military were (and still are) facing budget cuts and Dr. Coello was not sure how cuts would affect this valuable training process (MedRed/Medical Element).  Dr. Coello stayed in contact with Dr. Kemmer and me.

With the uncertainty of JTFB’s involvement Dr. Kemmer and myself began planning a medical/dental/nutritional assessment team trip to MDLF for early in 2012.  The previous mission to MDLF did not include a dental element which is and was badly needed.  It included only 1 and ½ days of general clinic which both Dr.’s Kemmer and Coello agreed should be expanded to make this needed health and assessment available to more people.  And so the planning started.  Mission Honduras LeMars (MHL) has had many medical and dental teams in MDLF.  MHL has all of the elements necessary to provide medical and dental care to this area.  In the past trips (MHL) we would treat about 1,000 people and take the med team to certain areas making it easier for the villagers to get to the daily clinic.

MDLF is an area in the northeast region of Francisco Morazon.  It is home to the indigenous Tolupan (Xicaque) people.  There are 5 tribes in this area.  Roughly 3000 of these magnificent people are still living in this area.  The Tolupan have one over-all chief and other sub-chiefs and villages elders.  It is an area that has been ignored over the ages.  MHL has been providing medical and dental care to this area and these indigenous since 2005.  MHL has also provided thousands of boxes of bags that contain rice, soy, dehydrated vegetables and vitamins to these people during their yearly food gap.  2012 will be no exception. MHL has a container of food currently in port at Port Cortez going through the customs review.

Dr. Kemmer and I continued our planning.  Based on her university schedule and concern for continuing rains in the area (if the rains are heavy, like they had been, it would be a no-go!).  The period of 5 March through 14 March 2012 was selected.  This would also help the university student team with maximizing their out of class time.  Dr. Coello was kept involved of these decisions via e-mail.  Dr. Kemmer would recruit students interested in being members of the nutritional assessment survey teams.  MHL would recruit physicians, dentists, nurses, pharmacists, general helpers, experienced translator, cooks, and various other logistical personnel needed to complete a mission for 5-6 days in MDLF.  This process did not take long.  Most people recruited have been team members on previous MHL teams, although there were new faces that would join us.  This is always good and it turned out to be very true.

I traveled to Tegucigapla, Honduras on 27 December to begin the planning processes for 4 teams.  Of course the team trip to MDLF (which is usually the most demanding and it didn’t let me down) along with 3 other trips to various areas in Honduras.  These would be teams made up of high school students and their chaperones.  These were:  Bishop Heelan Catholic School, Sioux City, Ia.; Gehlen Catholic School, LeMars, Ia.; and St. Thomas More Catholic School, Rapid City, South Dakota.  As mentioned earlier, their mission would be building homes and working on a rural water project.  At my side during this entire process and period was my friend Julio Rivera, son of chief Tomas, Tolupan chief.  Julio would join me on all 4 teams.  He has become a very valuable team member.  He is our lead coordinator for traveling to and treating the Tolupan in MDLF.

I was able to keep meeting with Dr. Coello in Tegucigalpa during January 2012 and he felt that it would be possible for JTFB to once again lead this process under the MedRed program at JTFB.  I became excited because I know the assets JTFB can bring to the theatre.  Dr. Kemmer was also in communication with Dr. Coello.  And so the planning kept evolving.  Approval for those medical and dental professionals that would provide medical care to the Tolupan was received from the Minister of Health (MoH) with the help of Ms. Marta Sosa and the Cerro de Plata Foundation.  Unfortunately many brigades providing medical care to Honduras never bother with this process.

Julio, Angel Paz and I traveled to MDLF on 2 January 2012 to meet with the chief representatives of the  5 tribes of Tolupan.  Our purpose was to describe the proposed medical/dental/nutritional assessment team trip on March 2012, and receive their approval to bring a large team to this area.  Last year Julio and I had previous meetings with the chief of MDLF and talked about another trip in 2012.  They gave their approval then, but it is important to keep them updated.  We would also do an inventory of medicines JTFB did not use last year and that had been kept in the health center in Orica.  This inventory would be given to Dr. Coello.

It was during this visit that we found that the La Ceiba area, our base area of operations, had not had water for over 7 months.  The tubes were all cracked and with the heavy rains the system collapsed.  MHL sent Angel Paz back to the area with Julio and he completed a study of what was needed to repair the water system.  MHL gave permission for this project and it was completed within 10 days once we got the materiel to the area.  Over 2.2 km’s of new trenches, water pipes, valves and so forth.  The community was very appreciative.    I cannot imagine doing this mission without some form of running water, and even then, it was logistically difficult.

The goals Dr.’s Kemmer and Coello and I wanted to achieve during this mission were:  1. Expand the daily clinic sites to 5 villages; 2. Make every attempt to locate those children surveyed last year and re-evaluate them after 1 year; 3. Provide general dental cares to as many people as possible; and 4 expand the nutritional survey assessment to 4 days (this would also happen daily at the general clinic site) and make a real determined effort to get to areas that we could not visit last year.  We were able to achieve most of these as I will explain later, but not all of them.  It is equally important to know that these goals also had to take into consideration JTFB and their many different elements that they bring as part of the MedRed training program.  This also was an evolving process.

Joint Task Force Bravo, Soto Cano airbase, Comaygua.  The JTFB force was under the command of Lt. Col. William  Fecke, deputy commander of the Medical Element.  Capt. Virginia Aguilar was the main MedRed planner.  This JTFB team had members from the Joint Security Forces (JSF) which provided security for the mission, Army Forces Battalion (ARFOR) 1 or 2 members of the Navy logistical unit and many US Air Force personnel.  These forces consisted of various medical professional and communications experts.  Others involved with this mission were:  Honduras Army, Honduras Air Force, professional staff members of the Honduran Military Hospital (2 doctors would be with the nutritional assessment teams).  On the 3^rd day of the mission, JTFB Commander Col. Ross Brown visited the clinic site in San Juan.  He was accompanied by the USAID Honduran Mission Director.  His name was William Brands.  I had a brief meet with them to shake hands etc.  Dr. Teri Kemmer has a team of 11.  We had translators from Nuestro Pequeno Hermanos and Hermanas, along with Fausto, his son Noslin, Angel, cooks and etc.  Also, the Minister of Health (MoH)

On 14 February 2012, Julio and I met Dr. Coello, Capt. Virginia Aguilar and various other military personnel in Tegucigalpa.  We would travel to MDLF for a site visit.  This pre-site visit looks at all the issues associated with providing this type of mission in the area of MDLF.  Each military professional along on the team this day would provide crucial information about this mission before a final approval could be obtained from the base commander.  It was a long day, but a successful day.  It was a few days after this trip that Dr. Coello informed me that JTFB would do the mission.  Then it really began.

I am not sure of the exact numbers on this team, but it approached 70.  MHL had 11 doctors, dentists, and other medical professionals; 8 translators, 3 cooks, and other helpers (to include Julio Rivera); Dr. Kemmer had a team of 11, and JTFB brought the others.  MHL was prepared to provide mattresses, bedding, pillows, and others to 30 people each night, and JTFB would provide for the others.  MHL would also be able to provide food to over 45 people daily.  Most JTFB personnel would eat MRE’s.  We provided 2 generator’s, JTFB had 1 for their excellent communication area.  We would use all 4 buildings for sleeping quarters at night, and JTFB set-up 2 large military tents for most of their people.  This camp was quite the site each day.  At the end of the day everyone had a place to sleep. 

As previously coordinated with JTFB, MHL would leave Tegucigalpa at 7 am on 6 March 2012.  JTFB would convoy from Soto Cano airbase on the same date at about the same time.  MHL would arrive ahead of the convoy.  Julio and I had previously made 4 trips to MDLF carrying needed supplies and equipment for this mission so much of our supplies and equipment was already in place.  MHL rented a Toyota bus to take the main group of people and I would drive a Toyota 4-wheel drive vehicle (donated by Raul Rivera a friend) filled with food, bags and etc.  Julio would leave from Sulaco with the cooks, stoves, food and other supplies using the MHL truck.  

We left Tegucigalpa in a light rain which worried me.  It would be a 4 hour ride to MDLF.  We would pick up some of our team members along the way.  It would rain, quit and then rain again.  I was in touch with Dr. Coello by cell phone.  They left on time, but did have tire troubles on 1 of the vehicles which would cause a small delay.  We met Julio in Acote where he was filling the truck with more food to take to La Ceiba, MDLF.  It continued to rain.  Julio went ahead, the bus went second and I was in back.  The road was muddy and slippery.  At some of the rivers the bus could cross, but at other spots the team had to get off the bus.  The back of the bus was filled with bags of supplies and personnel gear brought from the USA.  With the team members off the bus, it was lighter and would be able to pass.  The process happened 6 or 7 times north of Acote.  It was a long slow ride.  Unfortunately, about ¼ km from La Ceiba, the bus was not able to turn in the road with a large dip and then back up the mountain because of the rain and mud.  This was as far as the bus got.  We off loaded the team, bags and with the truck I was driving we carried some team members, others walked and we carried the bags to La Ceiba. The bus was able to turn around.  I do not know how he did it, but he did.  Freddie Sosa was his name and he has helped us in the past with transportation.  Had the road been dry I think the bus would have made it to La Ceiba.

I had not had any communication with Dr. Coello for some time, and with the continued rain, I was worried that they may not be able to get to MDLF.  The team members would begin to unpack the bags and Julio and I decided to escort Freddie and the bus back to Acote.  He would have no problem returning to Tegucigalpa.  He would return to Acote on 12 March 2012 to pick up the team.  About 8 km’s north of Acote we met the JTFB convoy on the road.  I was relieved to see them.  I do not remember the exact number of vehicles in the convoy but 8-10 with Humvees, 2 large 5-ton style trucks, MoH trucks and a couple of vans.  It was very impressive watching them convoy along the road from Acote to La Ceiba.  Dr. Coello told us that they had a long delay after a tire problem.  In all, the JTFB traveled 10 hours on bad, muddy and rain filled roads.  They also experience trouble getting 1 or 2 of the vans up the mountain and had to pull then through area with 1 of the Humvees. After they arrived in La Ceiba, it would take them a couple of hours to set-up their operations.  Julio and I continued on to Acote with the bus, and then returned in the dark to LaCeiba.  It was abuzz with movements. 

Dr. Kemmer held a short briefing on the household survey assessment.  She, along with Dr. Coello, Col. Fecke , Capt. Aquilar  and I would discuss how the next day would work.  This would happen every morning or even throughout the day if problems developed. We had already agreed that trying to get to villages that we did not get to last year would require too much time, staff and then we may not see that many patients.  This would be true for the general clinic each day. 

JTFB would be on-site for 4 complete days.  Julio Rivera, our Tolupan friend was in agreement with this change, and had previously talked with the village leaders.  They were also in agreement.  So for the general medical and dental clinics the schedule would be:

Day 1:  LaCeiba, El Puerto, Ojo de Agua, Higuerito

Day 2: Montenegro, Guaruma, Yerba Buene and Monterey

Day 3: San Juan, La Lima, Lagunas

Day 4: Tamagazapa, Las Brisas, Cerritos and La Pena

Day 5: Mission Honduras LeMars would have a clinic in Lavenderos

The main purpose of this mission was to study the nutrition of Tolupan children 6 months to under age 5 (even if only by 1 day).  The study was lead by Dr. Teri Kemmer, a PhD Nutritionist at South Dakota State University in Brooking, South Dakota.  A very detailed survey was conducted at the home or hut site.  This survey covered the family, children, income, education, food access, food eaten, lack of food, medical care, income, how many pregnancies, how many babies died and many other questions.  Each of the homes were evaluated for type of structure, size, types of floor, type of roof, number of rooms, how food was cooked, access to any form of latrine, did the house have lights or water.  Of course many had neither lights nor water, but some around San Juan did have electricity.  Each team carried a GPS.  The latitude, longitude and elevation were recorded.  Elevation would be very important during the medical study of the children when looking at hemoglobin levels.

We would have 3-4 teams in the field each day visiting specific homes and children.  Each team would have a translator, nurse or medic, a person to do the survey (usually the translator) guide, a medical doctor to do a medical evaluation.  Others would also be along to help carry the gear.  Each team would have to carry a shore board (for measuring the children) a special backpack which would carry most of the medical equipment needed for the study and tests.  Each member would carry water and MRE’s for food.  

Each of these teams had to be transported to an area where they could begin the walk to the home or village.  On days 3 and 4 day we would move approximately 50 people, and sometimes more.  It was difficult from a logistical point, but we got it done.

The survey would cover 1 targeted child in each house.  These had been previously selected by Dr. Kemmer under some scientific manner.  Each of the targeted children would have the following tests:

1.       Hemoglobin using a hemacue

2.       Iron level

3.       Lead level

4.       Zinc  level

5.       A hair sample that would show various growth trends

Blood filter paper would be used for most of these tests.  The targeted child would be weighed and measured for height.  These would be compared to WHO standards.  A middle upper arm circumference (MUAC) measurement would also be used and checked against WHO standards.  These standards use Z scores (either + or -) from the median to help determine levels of malnutrition.  Of course other medical information must also be used.  The survey had very specific medical questions that the doctors would check during the medical evaluation of the survey.

If other children living in the home were between the 6 months and under age 5 they would have a hemoglobin level, height, and weight and MUAC evaluation.  The mother would also have a hemoglobin level taken along with a MUAC evaluation.  Based on the study, the doctor would prescribe medicine like iron etc.  The family also received parasite medicine according to standards.  Each family received tooth brushes, soap, new shoes if we had them, and in some cases specific food that team members had brought along.

The general clinic was set-up as follows:

1.       A preventive medicine clinic.  Here 20 or so people would be given a 15 minute or so talk about hygiene, water, cooking etc. This was usually done by the JTFB staff.   It was here that they would receive vitamins, toothbrushes, and soap.

2.       Each person, family etc. would then proceed to 2-3 triage stations.  Each station was staffed by JTFB personnel. It was here that patients were also provided medicine or were sent to see the doctor for further consultation.

3.       From here, the patients that had children between 6 months and under age 5 would be sent to a nutrition station.  Here all kids would be weighed, measured and have a MUAC measurement.  All readings would be compared to WHO standards.  It was here that many kids got new clothes that were not distributed from the last student trip.  They came in handy.  Dr. Kemmer had brought tubs of shoes she had purchased at Wal-Mart.  They also came in handy.  They had also been passed out during the survey site visits.

4.       Edgar from the clinic in San Juan was also there to provide any vaccinations the kids needed.

5.       From here the patients went to the general clinic, or in some cases to the pharmacy since the triage teams had determined they did not need to see a doctor.

6.       The general clinic had 4 doctors with translator if needed.  The doctor from San Juan health center also helped each day and, therefore, was heavily involved with the nutritional problems the team saw.

7.       Dr. Kemmer was in charge of the nutrition station.  The same type of survey conducted at the household site was also conducted here.  She told me she saw much more malnutrition this year versus last year.  She also provided many sachets of PlumpyNut to the mother of the children with severe or moderate malnutrition.  She also provided instructions for using PlumpyNut and stressed that the RUF (ready to use food) PlumpyNut be used in addition to the child’s normal food.  It is not substitute.  I think this was understood. The mothers were instructed to return to the health center in San Juan to be checked by the doctor.  She would provide a complete list of all kids surveyed and especially those that had been referred to the doctor in San Juan. MHL left many cases of PlumpyNut at the San Juan health center for the doctor to use as appropriate.

The dental clinic was set-up in each of the villages the general doctors saw patients.  The clinic had 2 dentists, 1 dental helper with a 2^nd  helper on days 3 and 4 in San Juan and then day 5 in Lavendaros.   This area had not had a dentist do evaluations for over 3 years, so this dental care was really needed.  Many of these dental patients also saw the general medical doctors.

JTFB had made the commitment to provide 4 days of full clinic and the nutritional survey assessment.  MHL would stay 1 additional day and do a medical/dental clinic in Lavendaros, but not the nutritional survey.  This had been done in the village during the four previous days.  On 11 March 2012, JTFB packed up and returned to their base in Soto Cano.  Dr. Kemmer’s team also left with them.  MHL would pack up on 12 March and team members would return to Tegucigalpa or their homes in Honduras.  The group would have a small get-together in Tegucigalpa the evening of 13 March 2012 before they all returned home on 14 March 2012.  A number of JTFB and Honduran personnel also attended.

I cannot stress the importance of the nutritional assessments done in the area.  Dr. Kemmer told me that 167 children between 6 months and under age 5 were studied.  She has since sent me the list and I am trying to get it to the doctor in San Juan so that he can follow-up with these patients.  She also said she saw many sad cases of malnutrition and without further intervention who knows what might happen. We cannot make the families take these children to Hospital Esquela.  We did have 3 or 4 other cases that had to be referred to Tegucigapla, and those patients went to receive further care.  I will follow up with Julio Rivera about these patients.

For the patients seen and treated:  JTFB Med/Red portion for 4 days had 968 patients.  This includes medical, dental and nutritional. On day 5 MHL treated 205 medical patients and 42 dental patients for a total of 247.  The combined patients seen and treated therefore, is 1215 for 5 days.  As mentioned above, 167 children had the nutritional survey, the dentists saw well over 200 people and pulled over 500 teeth. Talking with Julio later he told me the tribes were very thankful that the team gave their time and effort to help the Tolupan of MDLF.

Many people are to be thanked for making this mission so successful.  I also want to say thanks for the excellent translators we had for the various team functions.  This is so important and this mission had many great people translating for us. For fear of leaving out someone, I will thank the over-all unit.  So, thanks to:

Joint Task Force Bravo (JTFB) at Soto Cano airbase and its many professional men and women

South Dakota State University and its school of nutrition, Brookings, South Dakota

Mission Honduras LeMars, LeMars, Iowa

Honduran Military:  Air Force, Army and Military hospital professional men and women

Minister of Health, Honduras

Cerro de Plata Foundation, Honduras

Illich Foundation, Honduras

Nuestros Pequeno Hermano y Hermana

And many other friends that provided service behind the scenes daily

I plan to keep in touch with Dr. Miguel Coello and Dr. Kemmer.  They are incredible people and great contacts. 

I struggle with the answers to the problems of malnutrition and under nutrition in MDLF. It is obvious that something must to be done from an educational and health promotion level so that these people can reduce their dependence on outside groups that continue providing food, medicines and other support.  MHL and others can then help support these efforts.  Dr.’s Kemmer and Coello both stressed to me that at the meeting with the Honduran MoH, USAID and others at the conclusion of the mission, all parties agreed that some form of intervention in this area (MDLF) along with others in Honduras is needed.  Apparently the World Bank and another large Central American bank discussed with these officials a program where Sprinkles could be provided the vulnerable populations (like the Tolupan) in Honduras.  Sprinkles are sachets (like small packets of sugar) which contain a blend of micronutrients in a powder form which is sprinkled onto food typically prepared by these populations.  Many vitamins and minerals are provided.  You can read more about Sprinkles at Sprinkles Global Health Initiative. 

Talking further with Dr. Kemmer, she said that at this meeting no definitive plan was decided let alone how to finance a large program like this in Honduras.  She is also processing all the data from the recently completed mission and then will provide more data to the MoH on the nutritional status of the Tolupan in Montana de la Flor.  I will continue to talk with both Dr. Kemmer and Dr. Coello.

This mission was months in the planning and without dedicated people leading the process it would not have happened.  This is the 2nd year that JTFB has assisted in this area which I think is a credit to the Med/Red program conducted through Soto Cano airbase.  I know my brother Dick (MHL) is very proud of all the professional men and women that volunteered through Mission Honduras and South Dakota State University as am I.  We are equally proud of the men and women of JTFB.  They are a credit to the USA in their work ethic and dedication to doing their job.  It has been nice working with them, and I know that many will be re-deployed to various parts of the world to continue serving the mission of the US Military.  I wish them safe travel.

When I return to the USA I plan to meet with Dr. Kemmer and discuss this mission.  I am not certain which direction this program will take in the future.  I also hope to meet with Dr. Coello before leaving  Honduras, but in today’s world we are only a cell phone call or e-mail away.  I will also be talking with my brother Dick about our continued involvement with the Tolupan indigenous of la Montana de la Flor.

I am always grateful to work with and be around amazing people.  This experience marks another successful chapter in this process.  I wish everyone well.  May God bless and peace.

Mr. Francis

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