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Doctors Embark on Medical Mission

Participants, leaders reflect on 2000 trip, return to Honduras.

When Joaquin Quezada came to America to visit his daughter he didn’t expect a religious experience.

But after going through traumas in his native Honduras, and seeing the contrast of life in America, Quezada had a revelation.

“Truly God lives in America,” he said.

Quezada was one of hundreds of men treated two years ago in the Virginia Hospital Center’s medical mission to Honduras. Each year the hospital sends doctors, surgeons, nurses, and assistants, along with hundreds of thousands of dollars worth of medicines and medical supplies, to treat people like Quezada, who would otherwise never receive medical attention they need. Last year’s mission was canceled after the Sept. 11 terrorist attacks.

Barry Byer, the hospital’s chief of family practice, initiated the missions, funding them through Crosslink International, a group dedicated to equipping medical outreach programs around the world. Crosslink is still a major sponsor of the mission to Honduras.

“I was loving so much being a facilitator and a provider,” said Byer, “I decided I wanted to go on a mission myself.” He began asking people at the hospital if they would be interested, and before he knew it, 39 people were ready to go.

So Byer began looking for an appropriate location, and Honduras became the site. Since then, the relationship between mission organizers and the Honduran government has continued to strengthen, and the mission has been more efficient and productive each year.

THIS YEAR’S TEAM returned to Tegucigalpa, Honduras on Nov. 9, but on Nov. 7, a few team members gathered at the hospital to recount some of their experiences from their last trip.

Palacios came to talk about how the mission affected her father’s life. Doctors had removed a football-sized tumor from his chest, a procedure that doctors in Honduras would have been unwilling to perform, even if Quezada had been able to afford it. But the free care from the visiting Virginia doctors allowed him to regain enough strength to make the trip to America to visit his daughters.

Cases like Quezada’s are common, said Ramon Custodio, Minister for Political Affairs at the Embassy of Honduras in Washington, D.C.

Honduras faces many challenges as a developing country, said Custodio. “Honduras is a country in route to being a more developed country than what we are,” he said. But in the meantime, the medical mission is providing essential services for some of the most disadvantaged people in the Western Hemisphere.

In fact, so many Hondurans are in desperate need of care, soldiers from the Honduran army had to accompany the team this year, just to manage the enormous crowds. The people were never aggressive, and doctors said they never feared for their safety. But the measures were necessary, they said, to maintain order and ensure that they could treat as many patients as possible.

DUCT TAPE, FLASHLIGHTS, and extra batteries are often on the list of supplies for a construction project, but Kenneth Mason and Talal Munasifi said those pieces of equipment were also essential to the medical team during their stay in Honduras.

Mason and Munasifi, two of the surgeons on the medical mission, recalled some of the challenges they faced two years ago and looked forward to the upcoming trip. “Duct tape was the single most important piece of equipment,” said Mason. Not for surgery, of course; but before they could begin operating, doctors often had to make repairs to the facilities, even taping doors to the wall to make sure they would not fall off their hinges during surgery.

“It’s a tremendous job to try to resource that group,” said Linda Cook, Executive Director of Crosslink International. Shipment of supplies began more than a week before the medical team was scheduled to arrive. Cook said a 40-foot container, the size of a tractor-trailer, full of supplies needed to arrive a week before the medical team, so that materials would be organized and ready when doctors arrived.

After removing Quezada’s tumor on the last mission, Mason said that confidence waned momentarily. The tumor was so large, surgeons cut a large portion of skin and even had to remove several ribs.

With such an invasive surgery, Mason said he was afraid Quezada would be left with disfiguring scars. But Munasifi, a plastic surgeon, put their minds at ease with a remark that has since become famous around the hospital: “There is no defect I cannot cover.”

DOCTORS FOUGHT EXHAUSTION to work as many hours as possible this year. The day began around 6 a.m. with breakfast. Each team member then packed two lunches, one to give to either a soldier or a translator. The surgical team boarded a bus around 7 a.m. for a short ride to the local hospital. The bus then returned to pick up the primary care, pediatric, physical therapy, eyecare, and pharmacy teams for a ride to community centers in the surrounding countryside.

Tegucigalpa sits in a valley surrounded by steep mountains. The bus ride, sometimes 30 to 45 minutes long, took the team up steep, rugged roads to get to the poorest areas outside the city.

Lunch breaks were scheduled for just thirty minutes around 12:30, but “most of us never had a half hour for lunch,” according to Hallinger. Instead, they ate as quickly as possible so they could return to treating patients. It was important to make things run as smoothly as possible. “We were thinking every minute counted,” said Byer.

Four people worked at triage and patient flow, walking up and down the lines of patients to determine which people needed immediate assistance. The triage team then gave each one a color-coded card to help doctors identify and treat the problems more quickly. Everything had to be streamlined. Even counting pills at the pharmacy area would have wasted valuable time and reduced the number of patients treated. So the team arrived with medication already measured and placed in Ziplock bags that could be quickly distributed.

But no matter how fast they worked, it was impossible to treat everyone. With hundreds of people lined up each day, many had to be turned away.

“It was extremely difficult turning people away at the end of the day,” said Hallinger. “That was really tough.”

“It was painful,” said Byer. “That’s why we worked so hard and stayed so long. We stayed as long as we could.”

SIMPLE TO SEVERE cases confronted the team this year.

“It seems like every single day we had emergencies come in,” said Hallinger. She recalled one man who limped to the mission being supported by two others, because he had received a gunshot wound to the hip five days earlier and had not yet been treated.

Hallinger immediately called for the emergency room specialist, who treated the man on the spot. The E.R. doctor stayed so busy treating emergency wounds and injuries, the mission eventually ran out of suture materials. “We didn’t anticipate so many emergency situations,” said Hallinger.

Performing major surgery was especially challenging considering the facilities and the types of ailments. Scott Spagnoli, a surgeon who treated patients this year and taught medical residents at the Tegucigalpa teaching hospital, operated on a man with advanced cancer of the larynx, a procedure he rarely performs in Arlington due to the availability of radiation and chemotherapy. Equipment at the hospital wasn’t exactly state-of-the-art, he said. “I used a very big scalpel. I felt kind of like Zorro.”

When doctors didn’t have to play superhero, they treated a steady stream of non-emergency cases. Doctors treated some children in Honduras who had been suffering for years from problems that in America are cured with first aid cream or a 20-minute visit to the doctor. “They would have headaches and we would give them Tylenol or ibuprofen and relieve their suffering for a day or a week or a month,” said Gunter. He treated many children with skin infections and fungal infections that he said had “gone horribly wrong,” but which were easily cured.

That meant Gunter got to tell many worried mothers that their children were going to be all right. “That just meant so much to them to hear those words: ‘You’re doing a great job, your kid is okay,’” he said. “It was awesome.”

EMOTIONS RAN HIGH throughout the mission. Byer and Gunter both recalled seeing an 8 year old boy who could not walk due to cerebral palsy. His family never had been able to provide him with a wheelchair and often had to leave the boy lying on the dirt floor of their home while his mother worked. But the medical team had a chair that fit the child.

“They put the kid in the wheelchair, and the mom just burst into tears,” Gunter recalled.

“We were all crying,” said Byer. “It was a very moving experience.”

Emotional responses from parents were common. “They were so appreciative that we were there,” said Byer. “And when we saw that, it made us work even harder and faster so we could process more people.”

Hallinger recalled the attitudes of the student translators with whom she worked. “The students said, ‘Thank you so much for coming to our country and helping our people,’ even though they weren’t the ones receiving the eyeglasses and the medical care,” she said. “They were very happy that we were helping their countrymen.”

NEVER LETTING UP, team members began preparing for next year’s mission even before getting on the plane to come home. Byer booked an entire hotel, all 12 suites, for a week beginning Nov. 1, 2003.

“On the flight back we were planning,” said Gunter. “We were already breaking it down for next year. It starts now. It starts the day we get back.”

Thinking back on the experience from her home in Great Falls, Hallinger said she saw Virginia differently. “I don’t know why it just struck me,” she said, “I think all of us felt that way when we came home. We were so grateful for what we have in our own lives and our country.”

Byer agreed. “You love to go and you love to do it, but you love the United States of America for what it provides people,” he said. “There’s so much in terms of food and shelter and the health care. And it really makes your heart go out to the people who don’t have those opportunities.”

“Up here, I’m just one surgeon out of thousands,” said Mason. In Northern Virginia, his patients can choose from plenty of hospitals. But in Honduras, it’s different. “If I didn’t come down there, those people wouldn’t get the surgery,” he said.