Without a doubt, the 22 medical students who travel to Honduras for 10 days each June make a difference in the lives of the people they treat — providing them with basic clinical care, health education and much more.
But what the Virginia Commonwealth University School of Medicine students learn while treating citizens in one of the poorest countries of the Western Hemisphere can change how they approach medicine, and the direction of their education, going forward.
“The trip is good for medical students to make us aware of how big the medical need is in other countries,” said Ricky Moore, a second-year medical student who went on the 2008 trip to Honduras. “I went into medical school with the hope of doing international medical work when I’m finished, and this experience renewed that spirit.”
Moore traveled to Honduras with the VCU medical student group HOMBRE, or the Honduras Outreach Medical Brigada Relief Effort, which has been leading trips for first-year medical students to rural Honduras for nearly a decade. HOMBRE offers two sites where students can learn: Los Pinares, one of the poorest areas in Honduras, and NPH in Rancho Santa Fe, an orphanage that cares for more than 600 children.
“This does give first-year students a way to maintain that energy, enthusiasm, that sense of caring, the altruism — all those good things that most people come into medicine with,” said Steven Crossman, M.D., Pinares site leader and director of undergraduate medical education for the VCU Department of Family Medicine.
In fact, HOMBRE may provide the students with an even greater appreciation for what they, as future doctors, offer to patients around the world.
“It changes your heart,” said Jeanne Schlesinger, HOMBRE faculty adviser and director of instructional development in the Office of Faculty Affairs in the VCU School of Medicine. “I think it affects the students in a way that will never leave them.”
For Rachel Abbott, who also traveled to Honduras as part of HOMBRE 2008, the trip instilled in her the value of patient communication.
“The most important thing to me was less of the procedures I learned, but the cultural awareness of understanding the different populations that you serve, and the importance of communication,” she said.
Without the technology and equipment that’s readily accessible in the U.S., the students — with the aid of local translators — begin to refine their communication skills and connect with patients.
“When you don’t have an MRI or a CT, you go back to what you do have, which is the relationship with the patient, and that can be very powerful, very healing and very supportive in itself,” Crossman said.
Patrick Mason, M.D., NPH site leader and a pediatric endocrinologist from the VCU School of Medicine Inova Campus who specializes in international adoption, agreed, adding that the mission offers students a new — and beneficial — perspective.
“It’s important to have them understand that medicine is not just what we see in Richmond or Fairfax,” he said. “There’s a whole world out there and the medical needs are very different.”
Working in conditions students ‘may never see again’
To prepare students for the conditions in Honduras, Crossman and Mason lead four, four-hour Saturday seminars detailing Honduran culture and history, health issues, and common medical problems and illness, as well as their diagnoses.
In Honduras, most citizens served by HOMBRE live on less than $2 a day without running water, bathrooms, electricity, cars or books. Many of the houses have dirt floors and thatched roofs.
Depending on the site the students attend, they may see as many as 300 people a day suffering from a wide variety of ailments, including upper respiratory infection, parasites and anemia.
“Students gain a lot of hands-on experience working with diseases at levels that they may never see again,” Mason said. “In the U.S., diseases wouldn’t go to the extent that they do in Honduras. This helps to further their education and develop their knowledge base.”
Students also benefit from a 2:1 student-faculty ratio.
“The students seem to really like the one-on-one student-faculty time, and rotations once or twice a day,” Mason said. “That’s something that you never get anywhere else in your training, and the students really value that.”
They also value the friendships they make with other first-year students, from the time they learn they have been accepted to HOMBRE in August, to fundraisers throughout the year, to teambuilding activities on the ropes course, to finally experiencing a new kind of medical treatment together.
“These are undoubtedly some of my closest friends,” Abbott said. “It was a lot more enjoyable getting to know people throughout the year, and I think that we all came to depend on and trust each other.”
In recent years, HOMBRE has placed a new emphasis on providing health education and conducting health care programs that the community can then adopt and sustain.
“Our whole model is to work toward sustainable partnerships with the whole community so that we can try to do things that are going to ensure betterment of health: water, nutrition, education — in addition to providing clinical resources to provide quality primary care,” Crossman said.
The group’s board of directors — comprised of Crossman, Mason, Schlesinger and former HOMBRE student team members, among others — works closely with the local community to determine its needs and develop projects to address them.
A children’s health initiative targeting youth under age 5 involves working with a nurse who spends all year in the clinic to gather data such as height and weight on more than 300 children, and then provide the nutritionally at-risk with multivitamins and other necessary treatments.
HOMBRE also began a clean water project, providing Honduran citizens with a ceramic water filter and educating them on its benefits and how to use it. With both initiatives, students can document the progress year after year.
“Health, in general, is a stepping stone to taking control of your life,” Moore said. “You need to be healthy before you can become educated. Once that roadblock is out of the way, it’s easier to keep going.”
Crossman said that today’s socially-conscious medical students understand the importance of global health more so than those in years past.
“It’s very clear to this generation how much more we’re interrelated and how what we do impacts the world and vice versa,” he said.
“It’s our medical students who are going to have a big impact on how positive change can happen and shape our planet,” she said. “They have a sense of caring that can’t be measured with standardized test scores. These are the people that I would want to go to as my doctors.”