6 February 2011

Dick.  It’s a nice Sunday morning here in Tegucigalpa.  It will be another warm day, much different than you describe in the Midwest.  Well, Dick, here is another report on the mission trip to la Montaña de la Flor with JTFB (Joint Task Force Bravo, Soto Cano, Honduras), SDSU (South Dakota State University, Brookings, S.D.), the Honduran military and members from the Honduras Ministry of Health (MoH) and others. (Task Force Bravo/Health Initiative)

Before I begin this last report to you I must say that Mission Honduras LeMars, its board of directors and all those people that support it, can be very proud of everything that was accomplished on this trip. You all would be proud of Dr. Teri Kemmer and her team of students from South Dakota State University, Brookings, S.D.  You would also be proud of Dr. Miguel Coello and the entire U.S. military and Honduras military contingent from Joint Task Force Bravo. These people were absolutely amazing along with all those from the Honduras Ministry of Health.  A very special thank you as well to all our Honduras’ friends who made this a top priority in their lives, if only for a few days: from the Passionists, who translated, to our cooks and drivers. The very important results of what this team did could not have been accomplished without everyone’s help and cooperation. As the only representative from Mission Honduras LeMars with the team in the mountain, I want to extend my thanks to everyone.

Julio Rivera (eldest Tolupan son of Chief Tomas), Angel Paz (water engineer) and I returned from MDLF on Saturday 22 February after transporting more supplies and materials to MDLF.  We left Angel in La Esperanza where his motorcycle was parked.  On Monday 24 January Julio and I did more shopping for specific supplies, food and others.  Julio left early on Wednesday morning to travel to Sulaco.  He took various items with him.  On Thursday 27 January he would travel to MDLF with Dulce (chief cook), her daughters and granddaughter.  Also along was Jorge, who would help translate.  They would be carrying the big stove we bought for Dulce a few years ago.  The other 2 smaller stoves are already in MDLF.  They would stop in Acote to buy chicken, rice, eggs and much more.  We would also need to buy more food on Saturday at the open market in la Ceiba, MDLF.

I was at the airport to meet Dr. Teri Kemmer (U.S. Army retired – now a professor in ‘Nutrition’) and her team from SDSU.  One of the team members had visa troubles and was not permitted to fly from Omaha.  Her team was 6 members.  Dr.  Miguel Coello and Dr. Jenny (first name) were also there along with personnel from JTFB who would transport her team and other arriving U.S. military personnel to Soto Cano.  They would spend Thursday 27 January sorting items, doing inventory, etc., in preparation for the flights on 28 January to MDLF.

I drove to Talanga to meet Angel and the Passionists’ volunteers that would help translate during the mission.  Carlos from SPS (San Pedro Sula) was also there with the van I had hired to help transport the various teams.  We were worried because the van was really low to the ground.  It was big enough, but…we would have trouble later.  We left Talanga about 10:30 in the morning.  After a brief lunch in Dona Blaca’s village (La Esperanza) we headed over the mountains to Acote.  I had picked up Fausto Andino (English teacher) in El Guante.  My truck was loaded and full of food, supplies, etc.  I could only carry Fausto.  He would miss the first couple days of the new school year, but he said this was important.  We have been taking a different route from this area because the roads are so bad south of Orica and the heavy loads we have been carrying.  It was a 1 hour 15 minute ride to Acote.  I confirmed Julio and Dulce had bought food, etc.  We switched some of the supplies from my truck to the van so we could carry people in the truck box to MDLF. We could not carry all of them.  It was sad.  A very large family had to be left to walk.

Following the van, I was worried it would not get to MDLF.  We had put extra weight in the van so we could carry people in our truck.  The road is being fixed by the coffee association so they can get the large trucks loaded with coffee off the mountain.  Carlos had a lot of trouble getting through some of the deep ruts and bumps, but in the end did make it to la Ceiba.  We would continue to have trouble with transporting the various teams with the van, but if it was not loaded heavily, Carlos could get it done.  In the end, I decided to see if the owner would switch the van for a land cruiser for about the same price, but he refused.  I sent the van back to SPS after only four days.  It just could not get high and especially all the trips we made to La Lima.  Marny’s (Rivera) father Raul had donated his truck for my use during this mission, and we also had our truck.

We arrived on 27 January and Dulce and team had already had most of the kitchen area set-up. We set-up the generators, lights, cords, etc. for the JTFB team which would arrive on Friday 28 January.  We had a nice meal and went to bed early.  It was a long day, but they would get longer.

Friday started off with cloudy and overcast skies, but thankfully no rain.  It was windy.  I also want to say that  Marta Sosa from Cerro de Plata was successful in getting a truck and driver donated for this mission. The organization Unidad de Exencion de Cobertera y Finansa (UECF) donated the truck and driver.  His name was David, and he would become a valuable contribution to the team.  He would bring Dr. Cruz from the MoH’s department of Nutrition to MDLF on Saturday 29 January and then return her to Tegucigalpa late Saturday and then return to MDLF on Sunday and stay until the mission was completed.  Dr. Cruz worked with one of the teams on Saturday.  Dr. Coello said it was very unusual for such a person of her stature to take a trip like this on a Saturday.  I hope to meet with her later in the month with Marta from Cerro de Plata and talk more about the Plumpy Nut (the special food purchased by Mission Honduras LeMars, from the Edesia Co. in Providence, Rhode Island, used primarily with severely malnourished children).  It had rained fairly heavily Friday night so the roads were slippery on Saturday as we all headed out on the mission.  We had 4 trucks the 1^st day.  We could not get to La Lima, which is over 5,000 ft. high, so the mission had to be changed.  We would get to La Lima the next 2 days.

Dr. Coello had told me on 27 January that the 1^st Blackhawk helicopter should lift off from Soto Cano about 9 a.m. on Friday.  It would be about a 30-minute flight.  We were all in position at 9 a.m., but no helicopters.  Many people were standing and sitting around waiting to watch the helicopters land.  I was getting worried; it was 10:30 and no helicopters.  About 5 minutes later the police arrived and then 2 military intelligence officers arrived.  They told me that the San Pedro Sula area had heavy rains the night before and that the Soto Cano valley had heavy fog which forced the lift-off times for the helicopters back.

The 1^st helicopter arrived about 11:10 hours.  JTFB would use 2 Blackhawks and each would make 3 trips to offload personnel and supplies.  It was quite the sight to watch these helicopters come through the mountains.  The LZ (landing zone) was near the former soccer field.  You can see the area in the photos I sent.

After each helicopter flight the materials that had been offloaded had to be taken up the hill to the community center and the other buildings.  We would use all the buildings during the mission.  I know you are familiar with the community center.  We would also use the 2 school buildings to the east and the building below the community center which was originally supposed to be a church.

This was a large group.  The total team consisted of:  16 US military personnel (including doctors, nurses, medics, communications) 10 men, 6 women; 5 Honduras’ military security;  5 Honduran doctors (3 military and 2 civilian) of which 3 were women and 2 were men; Dr. Kemmer’s team had 6 members; I brought 8 translators and, of course, Julio and I; and with Dulce and her family that added 4 more.  Dr. Alveraz from the clinic in Orica and 2 or 3 staff members also were with us most days.  Cecilia and Edgar from the health center in San Juan were also with us.  Obviously, it was very crowded at night.

The sleeping arrangements were:  The men from the military and a few other guys would all stay in the building below the center.  JTFB provided cots for their people.  The military women and Honduran doctors would sleep on cots in the building where we always had the dental clinic. Dulce, Dr. Kemmer and the women from SDSU would sleep in the center.  Those from JTFB had cots.  The translators and others would sleep on mattresses from Mission Honduras LeMars.  MHL provided pillows, blankets, sheets, towels to all except those from JTFB.  I also had to provide these same items for the Honduran military security since these items were not packed at JTFB.   Angel, Fausto, and I slept in the eastern most school.  Julio slept in the pharmacy area.

We would typically sleep 46-48 people every night.  I had 2 generators set-up that provided power to these buildings, although I only had so many lights, but all worked well.  We would ultimately use 45 gallons of gas for the generators.  We had no trouble with these generators.

The U.S. military from Soto Cano would eat MRE’s (meals ready to eat) during their stay in MDLF (although many did join us eating Dulce’s cooked food and coffee).  JTFB brought boxes of MRE’s and hundreds of bottles of water.  I also had 15 larger bottles of water available that people could refill their bottle if they wanted.  All team members would eat MRE’s during the missions into the villages and individual homes during the study.

On the evening of Friday 28 January a general briefing was held for all team members, which outlined the mission for the next few days.  Usually another briefing was held in the morning and then a short sum-up briefing about the day.

The day started at 5 a.m. when I turned the generators on.  We then ate breakfast, MRE’s, and coffee.  And then the teams would leave around 7 to 7:15 each morning.  We would have 3 travel days and then 1 and ½ days of general clinic for all.

This was the first of hopefully many future trips.  As mentioned in previous blogs, 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 led 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, access to food, types of food eaten, lack of food, medical care, income, how many pregnancies, how many babies died and many other questions.  Each of the homes was 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, most 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 5 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) and a special backpack which would carry most of the medical equipment needed for the study and tests.  Each member would carry water and an MRE for food.  We would also have horses to help carry some of the gear.  Many teams would walk for 1-2 hours to visit a home or family, while others had shorter walks. 

Each of these teams had to be transported to an area where they could begin the walk to the home or village.  Each day we would move 40 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.            1. Hemoglobin using a hemocue

2.             2. Iron level

3.             3. Lead level

4.             4. Zinc  level

5.             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 (World Health Organization) 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 the under age 5 category, they also would have a hemoglobin level, height, 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 toothbrushes, soap, new shoes if we had them, and in some cases specific food that team members had brought along.

Dick, at this time I do not know how many kids received this detailed survey.  Dr. Kemmer will prepare a report and will share that with us.  I know we visited many homes and evaluated many kids.

The last day and ½ we offered the people from MDLF an opportunity to attend a general clinic for all ages.  All buildings were used (except for where I slept) and all cots, mattresses, etc. had to be picked up or packed up each morning for general clinic day.

The general clinic was set-up as follows:

1.       A preventative medicine clinic in the building below the center.  Here 20 or so people would be given a 15-minute or so talk about hygiene, water, cookin, etc. This was usually done by the staff at the clinic from Orica.  It was here that they would receive vitamins, toothbrushes, toothpaste, soap, and parasite medicine.

2.       Each person, family, etc. would then proceed to 1 or 2 triage stations.  Each station was staffed by a nurse (both were Majors), medics and a translator.  One of the triage stations had a Honduran doctor.  It was here that we received many requests for dental care.  Dr. Coello and I have been talking about this because each of our previous visits had the same questions asked - When will a dentist come and help?  I hope to talk more with the Honduran doctors and dentists and get a team of dentists into this area soon.

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 Gehlen Catholic Mission Honduras student trip.  They came in handy.  Dr. Kemmer had brought 4 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.       Cecilia and Edgar from the clinic in San Juan were 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 translators, if needed.  3 were Hondurans that spoke English and the other was Col. Holein, the chief U.S. medical doctor at JTFB.

7.       Dr. Alvarez from Orica, and Dr. Arvila did pap smears.  I do not know the number, but considering the sensitivity of the Tolupan women, they felt this service was a great success.

8.       Some of the Plumpy Nut was used by these doctors, but since most of the severe cases of malnutrition had been discussed with Cecilia, it was felt that she and Edgar provide and then monitor the cases from the San Juan clinic. Dr. Kemmer and Dr. Coello provided them with the list of patients needing the valuable food.  It was stressed that the RUF (ready to use food) Plumpy Nut be used in addition to the child’s normal food.  I think this was understood.

The clinic treated 281 patients the 1^st day and 180 the 2^nd day (good for only a half-day). Many cases were referred on to Hospital Esquela in Tegucigalpa.  I personally approved 2 cases that will need help.  Dick, I will talk about these with you another day.

The 1st helicopter was due in at 1 p.m. so we had to start moving supplies and materials to the LZ by noon. We made many trips.  Julio and his crew packed up and headed to Sulaco. The donated truck driven by David took the translators back through Talanga.  Angel, Fausto and I left before the last helicopter arrived.  I had talked with Dr. Coello.  We had a flat tire going back and could not find someone to fix it until the next morning.  We stayed with Fausto. I had contacted all groups to make sure all had returned home or base safely.  Angel and I had the tire fixed the next morning by 6:15 a.m.  We then took the supplies we had in the truck to Esquias.  In Talanga we had the truck washed and cleaned.  It was very dirty.  Here we found that we had another problem with one of the tires.  A steel belt had broken, and, of course, the tire could not be fixed.

I took 3 of the volunteers from Talanga to lunch.  Angel also came.  They talked about the great experience.  I helped a young family that has a 2-month old baby that has deformed feet (club) and some problem with some fingers.  They did not have the $$ to get to Tegus for the appointment.  I also took them with me on my way to Tegucigalpa.  Since I went through Valle de Angeles, I dropped them off in the village. They live about 20 km’s from Valle de Angeles.

I was at the airport yesterday (Saturday, February 5) to say good-bye to Dr. Kemmer and her team.  Dr. Coello was also there. They both said it was a great mission.  I will continue to talk with Dr. Coello and get more facts about the mission.  Dr. Kemmer hopes to contact you, or maybe you could contact her.  She told me that she could come to Le Mars and give you a briefing.

Dick, when I was talking with Dr. Kemmer on Wednesday in MDLF, she told me that of the kids in the age category we targeted (6 months and under age 5) she estimated that 60 % of them were malnourished and or anemic.  Wow!  She will clarify this when she writes her report.

Well, Dick, that’s about that.  It has been a really hard mission, from the planning phase, all the visits, all the movements, problems with vehicles, etc., but it was an incredible mission.  We hope it is just the beginning.  I will continue to meet with Dr. Coello and JTFB so that we can make the next mission even better.  I met some amazing people on this trip.  I think they were all struck by the difficulties these people face.  And, soon, most of these U.S. military personnel will be re-deployed to other areas of the world, and I’m sure they will take their experiences from MDLF with them.

In the end, no one got hurt, no one got sick, and we helped many needy people and now hope to develop a better plan to help these people with the severe nutrition problems they face.  Thanks to Mission Honduras LeMars for giving me the opportunity to do this.  Now it is on to the 3 student trips.  I will talk with you later.

Mr. Francis
 

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