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Adding Value to Medical School Trainingby Glenna Picton Through the Shoulder to Shoulder Foundation, groups of medical students travel to a remote village to staff a health clinic serving the Santa Ana villagers. The students work in conjunction with the Honduran Ministry of Health. 
Dr. Jeff Pierce examines a young patient in Santa Ana, Honduras. When Dr. Jeff Pierce (BCM 2004) thinks about Santa Ana, Honduras, he thinks about the time he helped a young boy with congenital cataracts see the chalk board for the first time. "It sounds simple, but we gave him his first pair of sunglasses to reduce the glare. With the glasses, he could see more clearly," said Pierce, a volunteer physician with Baylor College of Medicine's Shoulder to Shoulder Foundation. Since his third year of medical school at Baylor, Pierce has made repeated trips to the small village to improve health services and provide clinical care for underserved people living in a rural, resource-poor area. "One year during a visit to a nearby village, we encountered a woman with a probable diagnosis of Parkinson's disease that was greatly impacting her quality of life," said Pierce. "We were able to confirm the diagnosis and start to get her, and her family, the support they needed." Pierce was motivated by these and similar experiences to return as often as possible as a medical student and resident, even though each visit required that he raise approximately $1,200 to cover his travel, board and food expenses. Since becoming a family physician in Santa Rosa, Calif., Pierce has returned twice to teach the medical students who travel with the group. Baylor's department of family and community medicine supported these trips. Through Shoulder to Shoulder, groups of medical students travel to the remote village to staff a health clinic serving the Santa Ana villagers. The students work in conjunction with the Honduran Ministry of Health. "This community lacks reasonable access to health care. Our medical students have to take a real leadership role in providing clinical care," said Dr. Robert Parkerson, president of Baylor's Shoulder to Shoulder Foundation and an associate professor of family and community medicine at BCM. "They truly become better doctors." Shoulder to Shoulder's start at BCM
BCM faculty physician Dr. Fareer Khan When Parkerson arrived at Baylor in 1998, his main assignment was to orchestrate international affairs in the department of family and community medicine. Academic coordinator Rosa Contreras was brought on a year later to help out. "We wanted to locate a developing country where students and residents could provide ongoing care," said Parkerson, who is now vice chair of international health in the department. "We also wanted to teach them how to make a positive, long-term impact on health care." In 2000, Parkersons' colleagues from a similar program at the University of Cincinnati initiated a meeting between community health leaders from Santa Ana and the BCM group. The first group of Baylor Shoulder to Shoulder volunteers began providing care in Santa Ana in February 2001. They have returned every year. Structure of programThe program is an elective rotation for medical students. Students get experience providing clinical care to the Santa Ana villagers and are assigned public health projects. They complete a week of preparatory classes prior to the two-week service in Santa Ana and have a week to follow up on assigned public health projects back in the United States. Most students are in their third and fourth years of medical school. However, some first-year students have volunteered in the past. On the groundSanta Ana is a small village of 800 people located in the mountains of Western Honduras, bordering El Salvador. There is an adequate water supply and electricity. Recently, they've even gotten phone services. Every year in October and April, the group of students travels to the village to staff the medical clinic. "The trip down there is a sequence of events," said Parkerson. "From the capital city of Tegucigalpa, it's an eight-hour trip to the village. The trip includes travel on an un-air-conditioned bus and in the back of a truck on unpaved, mountainous roads." 
Alumnus Dr. Tim Ruttan and resident Dr. Diana Grair In the program's beginning years, the clinic operated out of a local school, which also served as the medical students' dormitory and cafeteria. Over the last three years, the group has raised funds to build a permanent health care clinic. It is currently under construction but the group is able to see patients there. American physicians, hospitals and drug companies stock the local pharmacy with donations. The medical students staff the pharmacy and counsel patients. The group sees about 1,000 patients during the two-week stay in Santa Ana, Parkerson estimates. However, they serve an area of 10,000 people, which includes the surrounding villages. "The villagers anticipate our arrival weeks in advance," said Parkerson. "They walk three and four hours to be seen by the medical students when we are in town." The medical students see patients mostly for primary care issues related to respiratory, diarrhea, skin and sexually and gynecological-related conditions. Some patients are seen for more serious, advanced-stage diseases including tuberculosis, tropical illnesses, goiters, protozoan and parasitic diseases, malnutrition and cancer. Faculty members travel with the group and oversee each patient for whom the medical students care. "The medical students encounter difficult challenges they would not face back at home," Parkerson said. "They must think through them at the community level in a resource-restricted area. This adds deep value to their medical school training." Public health component
Other BCM students provide care to villagers. In addition to providing much-needed clinical care, the students also work on public health projects that promote preventative health in the community. "The villagers are extremely proactive about improving their health care," said Pierce. "That is another strong point about the program. We work together with the local community, and we are able to really see a difference." Most of these projects include visits to one of the approximate 20 surrounding villages to give educational discussions on various health topics, such as reproductive and sexual health, women's health, nutrition and personal hygiene. Next year, the group will develop plans for a cervical cancer screening program for local women. Parkerson said one recent project has had a huge impact on the community—the development of a cooking stove that uses one third of the amount of firewood used in a traditional stove. Called the Justa Stove, it has reduced the amount of in-home smoke inhalation by providing a chimney to remove smoke from the interior of the house. The standard stoves do not have the mechanism to emit smoke outside the house. Next steps, progressSince the initial 2001 trip, the Foundation has expanded to include optometrists from the University of Houston, dental students from The University of Texas Dental Branch, graduate students from The University of Texas School of Public Health in Houston and Rice University students. One Rice University business student who recently participated was able to help the villagers develop a business plan to make more affordable Justa Stoves, using materials made locally. In 2007, the Foundation hired a full-time doctor, Dr. Carol Gomez of Colomoncagua, Honduras, to staff the medical clinic. "Before bringing on a full-time physician, there was no doctor in the village. The community had access to one licensed vocational-trained nurse who staffed a Ministry of Health clinic that provided vaccine resources and prenatal care," said Parkerson. "The closest hospital is five hours away by truck in La Esperanza or two hours away in El Salvador. The villagers cannot travel to El Salvador during the rainy season because of bad roads." The group has seen a decrease in patients with advanced-stage diseases since bringing on the full-time physician, Parkerson said. "We are hoping to partner more formally with the Ministry of Health to continue this decrease." Shoulder to Shoulder has made important progress improving health care service within Santa Ana. More funding is needed to support completion of housing for Dr. Gomez and provide much-needed supplies, including an ambulance. The group also has plans to build a dormitory for the students. Impact on students"I have not come across one student who has not been completely enthused to participate in this program," said Parkerson. "This has an incredible impact on them personally and professionally." 
A permanent health clinic is under construction in Santa Ana, Honduras. |
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Volume 5, Issue 1, Winter 2009 |
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