By Shakira Lynn
On May 16, 2015, I began my journey back to Olancho, Honduras on my third mission trip with Mercer on Mission. As the nurse practitioner with this group my primary role is to assist with the assessment and treatment of patients; however, I also work with students to help guide the flow of clinic and patient care. This year our group consisted of nursing, pharmacy, medical, undergraduate and Spanish students from Mercer University. I was also blessed on this particular trip to work alongside another advanced practice nurse, family practice physicians, a pediatrician, a Spanish instructor and a family marriage counselor.
Mercer on Mission provides students with experiences throughout developing countries to provide medical care to patients who would otherwise be unable to receive access to adequate healthcare. In a world where the challenges of poverty, injustice, poor health care and limited access to education are so prevalent, I feel this is my calling. It is my goal to continue making a career investment in the global community of nurse training, mentorship and leadership while striving to impact changes in health systems.
There is a need for both health education and preventive medicine in each of the villages we visited in Honduras. According to the World Health Organization (WHO), there are only about six physicians for every 10,000 people in Honduras therefore nurses typically manage community health centers and provide care. According to German Jimenez, MD , a physician with more than 20 years experience working in Olancho, most nurses in Honduras have not received any formal education or teaching beyond high school. Those nurses who are professionally trained receive one to four years education at the college level and complete a year of public service training in the community before receiving their license.
There are no emergency response teams that work in rural areas surrounding San Esteban, Honduras and the closest health department that can handle urgent cases is in the town of San Esteban which is more than two hours from the remote areas of Vallecito or Toro Muerto, Honduras. The closest hospital with an emergency department is more than six hours away from these villages in Jutigalpa. Access to care is especially challenging for pregnant women, as the closest maternity clinic with labor and delivery capability services is in San Esteban, which is a two hour drive from Vallecito. Most newborns are born at this clinic if the parents are able to plan a trip down several days before the expected delivery date. However, some obstetric emergencies unfortunately end in either maternal or fetal mortality.
Since most people who live in remote areas are unable to visit a healthcare provider, they usually purchase medications at a pharmacy in town. Pharmacies carry a wide variety of medications for patients to purchase without a prescription including antibiotics, oral contraceptives, hypertension medications, non-narcotic pain medications, and injectable insulin. Since taking medications without a healthcare provider can lead to negative patient outcomes patients were advised to seek medical attention.
Most of the roads are unpaved dirt roads with deep potholes and steep banks alongside them. While traveling in Toyota Land Cruisers to Vallecito, there was a single razor wire fence separating the road from the steep mountainside. The road was only wide enough for one vehicle to pass and was frequently blocked either with oncoming motorcycles or stray horses and cows walking across them. The nurses there may visit each clinic once or twice a month to see patients and they travel by motorcycle or all-terrain vehicles (ATVs).
Our team saw a total of 692 patients in just nine clinic days and we were challenged with seeing conditions that aren’t frequently encountered in the United States. We had a full formulary of medications and patients were typically given only a two-week supply of medications, as they were available. A lot of the school-aged children were treated for intestinal parasites, which they had acquired due to poor sanitation. We screened all patients aged 18 and older for diabetes mellitus and found that less than 10 percent of those patients actually had the disease.
Each of my educational experiences thus far has prepared me to be a leader in healthcare. While obtaining my Masters in Nursing degree at Mercer University, I took courses in leadership and global health nursing which has prepared me with skills such as cultural sensitivity and recognition of environmentally driven diseases. While currently matriculating in the Doctorate in Nursing Practice program at the Medical University of South Carolina, I’m learning to practice at the terminal degree level in nursing while promoting health equality in an effort to eliminate health disparities in the communities I serve. It is my goal to continue making a career investment in the global community of nurse training, mentorship and leadership while striving to impact changes in health systems.
Shakira Lynn, MSN, APRN, FNP-C is a student in MUSC's Doctor of Nursing Practice program.