Multicultural Multidisciplinary Medicine: Duke Supports Building of Health Clinic in Rural Honduras

Published February 21, 2008 under Research News

By Nancy E. Oates

Every year for the past seven, Dennis Clements, MD, along with faculty and staff from the Schools of Medicine, Nursing, and the Environment, has taken a handful of medical and nursing students on a 10-day getaway to the mountains of Honduras.

They pack a variety of medicines and live out of a duffle bag, bedding down for the night in sleeping bags on a concrete floor. They start their day when the roosters rouse them at the cusp of dawn, treating the routine health problems of villagers who would otherwise have to walk a full day to the closest medical facility. Their campsite clinic ends when the sun goes down. They have no access to electricity.

“The latrine is outside; the shower is the best you can do in the mountains whenever you can get water, and hopefully nobody is looking,” Clements says. Yet he and the students return to Duke with renewed energy, mindful of why they want a career in healthcare.

But the week long clinic, part of the “Exploring Medicine in Other Cultures” course at Duke, is only a stopgap measure to improve the health of the villagers. “When I take students down, we can treat small traumas and give three months worth of vitamins and check people’s blood pressure,” says Clements. “But so much of what we see is chronic illness. We can’t do a lot about that in 10 days.”

That will soon change. Clements has been helping to generate interest from local Honduran government agencies, mission groups and officials at the hospital in La Esperanza to construct a rudimentary cinderblock building, staffed by a nurse, which would become a permanent clinic. Last year, the villagers petitioned the government for a building that would cost about $20,000 to build. Seed funds raised by students and faculty in previous years, coupled with donations from Rotary International, a commitment form the Duke chapter of Engineers Without Borders (EWB), and a $10,000 gift from the Duke Chapel congregation, has put the dream within reach.

Lucy Worth, director of development and administration at Duke Chapel, says the offering committee looks for projects that follow the theoretical framework of the Beatitudes. The donation was one of the Chapel congregation’s larger gifts.

“We were quite taken with Dr. Clements’ proposal,” Worth says.

The proposed building will have a concrete floor, and windows with wood shutters, but no electricity. Engineers Without Borders will design a system for running water. Local Rotary clubs (RTP Club and Sunrise Club of Chapel Hill) and a partner club in Honduras have committed to raise substantial funds to provide equipment and supplies for the facility as well as some of the infrastructure for sanitation once the building plans and equipment needs are finalized. 
Students in Duke’s EWB chapter have applied for a seed grant from the Environmental Protection Agency as part of a national sustainable design competition sponsored by the EPA, called P3 (People, Prosperity and the Planet). David Schaad, PhD, faculty adviser for Duke - EWB, is optimistic that the Duke students will be selected in May as one of the 42 teams to receive a $10,000 seed grant and become eligible for the $75,000 P3 Award to implement their design solutions. The students will go to Honduras this summer to assess where to place the clinic, where the water will come from, how to purify it, the best design for handling wastewater, and possibilities for energy recovery from the system.

DukeEngage has contributed some funding and may be interested in offering work on the project as a DukeEngage experience.

“It’s pretty amazing for students to conceptualize something, and then actually build it,” Schaad says. “You learn a lot about yourself and your ability to participate in another community, and your shortcomings and limitations. Your failures can be as instructive as your successes.”
Clements hopes that medical and nursing students will continue to travel to Honduras to provide health care for many more years. “It is truly a life-changing experience for them,” he says.

Linda Lee, PhD, the associate director of the Clinical Research Training Program, agrees. She has been involved in the educational component of the class for many years and will return to Honduras this spring with the students to act as a project manager. “It is a poor country, but we spend time talking with and listening to patients. They feed us, and we visit their homes. We are part of their lives for a few days and we learn about what their lives are like,” she says. “To have people living in poor circumstances teach us is a really good experience. The immersion in another culture, and being totally removed from our own, gives us all a chance to reflect on our professions and our lives.”