Medical Student and Resident Rotation at Blumenschein Clinic, La Buena Fe de Zacapa, Santa Barbara, Honduras, Central America
Thank you for considering the rotation at Blumenschein rural clinic in Honduras.
We are the primary health care clinic for a large impoverished rural area in north west Honduras. Located in a mostly mountainous region where the primary employment is agriculture. The pay for the average field worker is around $6 per day and the price of gas is about $5 per gallon now.
History:
The Blumenschein Clinic and Christian mission at La Buena Fe were begun in 1957 by Dr John and Marian Blumenschein, plus their 5 young children from Independence , MO. Dr John died at the end of the first year but Marian stayed on and the work continued with her dedication and the support of church members and others. This was a primitive place then, running water meant it was raining and electricity meant there was lightning with that storm., even getting to La Buena Fe was a long ordeal as there were no roads – none to speak of. Yet, here we are today, but with many conveniences that no one could have imagined when Dr John came to this valley, including a paved road right out front.
Today:
The clinic is staffed by 2 nurses that have worked there for over 20 years. February of 2013 we became part of a 5 year government program which places graduating doctors in our clinic for their “social service year”. This year is required by the government prior to residency and/or private practice. This is a great benefit for our patients and visiting students/physicians. There is a small sliding scale fee for the clinic services but no one is denied care or medicine for lack of funds.
Philosophy:
We are a nondenominational Christian based organization and follow basic Christian tenets with regards to our lifestyles and work ethics. Use of alcohol, drugs or tobacco is not allowed while on rotation. We ask participants to dress modestly: shorts to the knees, dresses at least to the knee, no low cut /revealing apparel, scrubs are fine.
Naturally we respect the beliefs of all. We do observe mealtime prayer, but respect the beliefs of others.
Accommodations and Grounds:
Blumenschein Clinic, at La Buena Fe is located about 2 hours southwest of San Pedro Sula which is a large city of approx. 1.3 million people and is the industrial capital of Honduras. We are in a rural area just off the PanAmerican highway on the road to Santa Barbara. The clinic and housing are situated in a fenced compound which is contiguous with the small town of Horconcitos. We are in the department of Santa Barbara, township of Zacapa.
We have recently (2010) built comfortable modern dorms that easily house 8 -10 individuals. We walk about 80 yards to the clinic. And another 40 + yards to Maria’s where we eat our meals. We provide towels and bedding but advise you to bring your own pillow if you have a preference. You should have a robe and flip flops to wear for showering. A small bucket / bag useful for carrying toiletries to the shower.
Clothing should be layered as some evenings are chilly in Feb but usually 50’s are the lowest temperature and may be into the 80’s during the daytime. It is usually humid and will frequently rain so ponchos and water resistant shoes/boots are advised. Closed toe shoes are recommended / preferred as there are ground fungi and parasites that can attach through bear skin contact.
SUGGEST DEET >90% AND SUNSCREEN, HAT FULL BRIM.
CONNECTIVITY:
We usually have internet but not always. Down the road 5-10 min walk there is an “internet” café (no café). This costs about $1 (15-20 Lps) for 30 or 45 min. We usually have signal at the dorms or my patio for wireless internet. International phone – verizon, att have been used before. I have in-country phones that can be used for your time there for a refundable deposit ($25) and you simply put minutes on the phone to use it. Depending on the individual, but some use as few as 250Lps ($12) for the month. The Honduran phone can cost much less to operate than the international packages. Facetime works fairly well when service is good.
Food:
The comedor, or dining room, is in the home of resident of La Buena Fe, Maria and Lucilo. She s very delicious and nutritious meals 3 times daily and can accommodate special needs when advised. We provide clean drinking water and recommend you bring a water bottle / thermos to use.
Cost for 4 weeks :
Fees need to be paid prior to rotation start – personal checks are accepted. Make payable to Blumenschein Clinic Foundation. Mail to:
BCF
c/o Pamela E Stewart MD
2007 Bison Dr
Garden City, KS 67846
Meals $250
Rooms (at La Buena Fe) $200
Transportation in country $250
Airfare usually runs between $500 - $800. American Airlines, Delta, Taca and Continental are the most common. YOU CAN NOT TAKE AEROSOLS even in checked bags- pressurized cans.
On the plane there are immigration papers to fill out. Do not claim more than $500 or there will be a tax. Also, you are a tourist and trip is pleasure. Listing items you are bringing into the country does not need to be very detailed. You may say “personal items $150, medical supplies and equipment $200, that’s it, “personal” usually covers your stuff. THIS MAY CHANGE AND YOU MAY NOT NEED TO DECLARE ANYTHING AS LONG AS IT HAS TO DO WITH YOUR PERSONAL USE AND THE WORK YOU ARE DING IN COUNTRY.
Medications and supplies – you might want to bring gloves and suture sets – sometimes the hospital uses the disposable instruments and if you ask the nurses (or residents) for example, on OB and surgery, sometimes they will save some for you. Suture that is not more than 6 months out of date is fine. If you bring medical “stuff” pack it mixed in with your personal items –
DO NOT HAVE JUST A BAG FULL OF “XYZ” THROWN IN – THAT WILL GET YOU SEARCHED AND STUFF CONFISCATED SOMETIMES.
KEEP PASSPORT ON YOU IN SAFE CARRYING POUCH AND HAVE A COPY STORED ON SITE IN HONDURAS, ONE ALSO WITH FRIENDS OR RELATIVES IN THE USA AND ANOTHER COPY WITH ME. PASSPORT EXPIRATION DATE MUST BE JUNE 2014 OR LATER AS YOU CAN NOT TRAVEL INTO THE COUNTRY IF YOUR PASSPORT EXPIRES WITHIN 3 MONTHS OF YOUR ENTRANCE DATE INTO THE COUNTRY.
SUGGEST YOU BE UPTODATE ON THE USUAL IMMUNIZATIONS. NOTHING SPECIAL IS REQUIRED.
WE DO NOT HAVE A LOT OF MALARIA BUT THERE ARE SEVERAL OPTIONS IF YOU WISH TO TAKE PROPHYLAXIS.
BE SURE YOU ARE ARRIVING INTO SAN PEDRO SULA AND BEFORE 4PM – though delays happen and we will adjust, plan to be there early as possible to allow for our travel time
Depending on the price of gas and trips to villages, transportation may be more. Any personal trips costs (hotel, transport, entrance fees) to ruins, national parks, zoos… are not included in the rotation fee but I will be happy to arrange such if you let me know.
MONEY:
Lempira are the currency- named after an Indian. Exchange rate is around 20:1 lemps:USD. Please bring cash, I will exchange your money for you. $100 and $20 dollar bills with little blemish are needed for exchange.
Rotation Overview:
(Mon – Fri)
7:00 breakfast
8:15 CLINIC
12:00 Lunch
1:15 Clinic
4:30 end Clinic
6:30 Supper
Skill opportunities:
Evaluate, diagnose and treat, acute and chronic disease with mostly your physical exam and history.
Knee injections
IM injections
Suturing
Removals
I&D
Extensive wound care- venous stasis ulcers, chronic
Medical students prepare and give two 30-45 min talks on a medical issue relevant to the tropics and poverty in developing countries. You will give these to the staff so we like to have it something useful to help them treat and diagnose patients, or increase their basic understanding of the topic (new receptor in DM or approach to Hispanics with HTN….)
Will plan for these to be given the 3rd and 4th weeks of the rotation.
I have some book resources on site – family medicine text, dermatology, parasitology, as tropical medicine text… as well as a personal subscription to Up To Date available when there is internet.
Residents prepare M&M at least once during the month and twice if the opportunity presents. Thursday afternoons are the M&M conferences and topic presentations.
I would suggest a Tarascon pocket guide drug book and a good physical diagnosis book to bring with you. If you do not already have a favorite, an excellent physical diagnosis book is: History Taking and Physical Examination: Essentials and Clinical Correlates [Paperback] by Hinthorn and Greenberger, this is available online used cheap (no current printing) and will serve you your whole career.
PERONAL ITEMS:
If you wear contacts you might want to have glasses also as a back up, plus if your eye get irritated. We have a loud rooster and barking dogs – as well as the salamanders and birds on the tin roof, so if you are not a good sleeper you might want a white noise machine and ear plugs to get good sleep.
There is no corner store, no Target, no pharmacy (other than ours), so bring all that you NEED. We will go into town a couple of times while there but it might not be convenient to your need. Gas is very expensive and it takes half a day or more to go so we try to plan to get the maximum use of the gas.
Be Safe:
Keep any expensive appearing articles out of plain view, do not wear costly watches or jewelry, do not flash money, do not carry openly lots of electronics.
Of course be kind, courteous and respectful, we are guests in their country.
2/11/15