Reaching Out: Payton Johnson -- Reflection

This summer, four University of Michigan women's swimmers took time away from their personal lives by traveling to parts of Central America and the Caribbean to give aid to others. The second account in a four-part series is written by former Michigan swimmer Payton Johnson (2005-09), who was stationed in Costa Rica and Honduras as part of Duke University's Engineering World Health (EWH) Summer Institute.The writing will be released in five parts, one each day this week. So check back for updates each day!

Part 1 -- Going to Central America

After completing my four years of collegiate athletic eligibility swimming for the University of Michigan women's swimming and diving team, I was faced with my first summer with no training obligations. Suddenly, I had the time to conduct research, travel the world, or participate in any internship I was offered. With my interest in medicine and a background in biomedical engineering, I applied for and was accepted into the 2009 Duke University Engineering World Health (EWH) Summer Institute in Central America. The mission of the EWH is to couple engineering expertise with donations in order to aid hospitals in economically depressed communities throughout the world. The Summer Institute then gives support to these communities by sending trained student engineers to provide technical assistance.

My summer was all that I hoped for and so much more. From this experience, I learned how to overcome cultural, lingual, economic, and political barriers in addition to developing relationships with people from around the world. For the two months that I was in Central America, I studied Spanish, was trained in repairing medical equipment, experienced new cultures, found myself in the center of political turmoil, and traveled throughout the countries in circumstances that were far different than a University of Michigan swimming team trip!

Immediately, we were plunged into cultural emersion, staying in a Spanish home, taking local buses, and exploring in the evenings for internet cafes for our only links to the outer world. The first month I was in San Jose, Costa Rica, with 30 other students taking intensive Spanish classes and technical training classes as well as working in local hospitals. On the weekend, we were free to travel the country. The first weekend, the entire class went white-water rafting in the Pacuare River. The following weekends, I went to Tortugero, where I hiked and boated through the jungle; Cahuita, where I snorkeled through reefs, went surfing, and laid on the beach; and Arenal, where I saw lava flow down the largest active volcano in the country.

For the second month, I was stationed in Olanchito, Honduras, a remote small town accessible only by bus, with one other student, Cathy Weitenbeck. Together, we worked at the Anibal Murillo Escobar Hospital (HAME) taking inventory of the hospital, conducting preventative equipment maintenance, training local staff and fixing any broken equipment in the hospital. Again, we were on our own to explore the countryside, cities and beaches on the weekends. Because of the current Honduran political instability, we found ourselves in the midst of some of the turmoil as we forged through protests and road blocks as we made the public bus ride trips (which sometimes means four hours of standing room only) to places such as Yoro, the Copan Ruins, the Bay Island of Utila, and the beach town of Tela.

Part 2 -- Meeting J and the Hospital

Once we arrived in Honduras, Cathy and I stayed in the house of Professor Martiza Quezada and promptly reported for work on Monday, July 13, 2009. On our first day of work, Cathy and I showed up at HAME at 8 am. When we arrived at the hospital the staff seemed unaware of who we were or why we were there -- although they had hosted students from this program for the past two years. Despite this odd first response, Cathy and I found the maintenance person that we were supposed to work with -- I will call him 'J.' We introduced ourselves to J and he proceeded to show us around the hospital. In addition, Cathy and I introduced ourselves to the Director and explained that we were there to provide any and all help needed, that was within our abilities.

The blistering heat left Cathy and I sweaty and exhausted, but we remained excited on our first day. Working alongside J, we fixed a water cooler and a broken power plug for a computer - not exactly medical equipment but at least we were helping. Afterwards, while we sat by the fan in J's office, he told us 'no trabaja a hoy' and we thought he simply meant there was no work to do that day -- which I thought was impossible because I saw a graveyard of broken equipment in a backroom. And so we spent most of the day sitting under the trees listening and talking to people. I thought it was entertaining that everyone always said 'Oh, Obama!!!' to us when they discovered we were from the USA. After many hours of siesta, we were able to find the one person in the hospital that spoke English and he told us that 'en huelga' ''a word that had been said to us many times that day'' meant 'ON STRIKE'. And suddenly we understood why all the doctors, nurses, administrative staff, and maintenance personnel were not working -- although emergency services were still ongoing. From the local news, we had discovered that the public school teachers of Honduras were on strike but apparently our hospital was too.

Throughout that first week, we continued to face more challenges. By the third day of our home stay, Cathy and I were both suffering from traveler's diarrhea, vomiting, and dehydration. That Tuesday we only made it two hours at the hospital before having to return to our house and retire to the bathroom. But by Wednesday, I was feeling better, so I went alone to the hospital while Cathy stayed back and tried to recover.

I started taking inventory in an effort to find the broken equipment and identify departments that needed the most work. Through my adventures that day and the multiple days afterwards, we made many friends with the staff and became acquainted with the hospital. Slowly but surely, we found broken equipment, functioning machines that needed preventative maintenance, and identified problematic areas within the hospital. We learned about the lack of sanitation in the hospital -- in the blood drawing room of the laboratory there was bloody gauze scattered on the floor; in the pediatrics ward we found mice droppings, vomit, and dirty syringes behind shelves; and throughout the hospital there were no toilet seats, toilet paper, or hand soap anywhere to be found.

Part 3 -- Honduras and Hospital Background

From speaking with administrators, we learned about the effects of the current political instability. The government is charged with running the public health system in Honduras and therefore all supplies, equipment, and medicines received by the hospital must be provided by the government. They were on a quarterly rationing of everything the government gives them. Every three months, the hospitals of Honduras desperately await the next shipment of supplies. Since the coup of President Manuel Zelaya we were informed that the HAME was only receiving 60-70 percent of its normal aid -- and that was only a month after the instability began, before the European Union and the United States of America had cut off aid. Each evening around the kitchen table, we would hear these current political problems debated with Martiza and her family or whatever friends stopped by. I could write an entire article about the challenges of getting news regarding the political tensions. I have an entirely new perspective on the news as released to us in the U.S. verses the local, British, Canadian or South American news media we followed.

Because developing world hospitals have limited budget and resources they rely heavily on donations and aid from other countries. But unfortunately, much of the equipment that is donated is out-of-warranty, in poor condition and with no accompanying manuals. We spent days opening multiple nebulizers to clean them, check the motors, and clean the filters. We found defibrillators that no longer had a functioning monitor therefore putting patients at risk because the doctors could not determine the voltage being delivered. Aspirators had broken floater valves therefore allowing backflow into the pump, which damaged the pump, clogged the filters, and contaminated the machine. Because manuals were often missing, sometimes because the staff did not realize their importance (especially when written in English), we spent whole days walking to internet cafes to obtain manuals, print them, and return them to the hospital.

The recent GE donations were an exception at HAME. In November 2008, GE donated to HAME brand new X-ray machines, anesthesia machines, an ultrasound, and multiple bedside monitors with EKG, pulse oximetry, and blood pressure measurement capabilities. In addition, all the equipment was received with Spanish manuals that instructed users how to operate the machine, conduct preventative maintenance, identify errors, and provided contact information of company maintenance personnel. The anesthesia machines even had instructional DVDs to teach the nurses how to operate the machine.

The donations received completely transformed the hospital and brought modern technology that met all the standards of worldwide healthcare (put out by the World Health Organization, also known as the WHO) to the staff. Since I hope someday to work for the WHO or a similar organization this has given me an opportunity to actually see how important their standards are and how they are used in real world settings.

Part 4 -- Helping Out, Pepsi and Meeting Dilma

Once finished with inventory, and at the same time as conducting preventive maintenance, Cathy and I began to fix the broken medical equipment we had found. We replaced a capacitor in a hot plate needed in the laboratory; fixed a broken latch on a centrifuge; and resoldered spliced wires on an aspirator machine used in the Operating Room. Often times, the parts we needed for our equipment though were not available in Olanchito. In order to obtain the parts we needed we often had to travel to the large cities of La Ceiba and San Pedro Sula. We were very fortunate that the two students from our program in San Pedro Sula were able to help us by finding our parts and often times purchasing them for us -- with the help of the head technician at their hospital.

There was much work to do in the hospital, but Cathy and I made an effort to take time to get to know the hospital staff. The pace of work in Honduras is much more relaxed and we often spent a few hours in the afternoons drinking Pepsi and sharing stories about family and friends back home with the nurses and doctors. Cathy and I became particularly close with the head nurse of the OR, Dilma Martel. Every once in while she would invite us over for dinner and we would spend the evening chatting with her and her husband and playing with her two daughters. Also, with her help, we were able to create a floor plan of the hospital that we gave to the Director on our last day of work. By the end of the stay we were close friends with Dilma and the OR staff and we had been able to witness three cesarean sections.

Despite the rough start to our trip, by the end of our stay we knew much of the hospital staff and we were receiving broken equipment from nurses from all departments. On our last day of work we were thrown two large parties by the hospital staff. We were given certificates and t-shirts; drank Pepsi and ate lots of cake; and said our thank yous and good byes. When we had first arrived at HAME we were unsure of the difference we could make and felt lost and frustrated with the many roadblocks we initially had faced. But by the end of our trip, we realized that although we hadn't radically changed the hospital we had still made a difference. Just by being there we showed the hospital the importance of care for their equipment, were able to fix their broken equipment and care for their used machines.

Part 5 -- Reflection

And from the hospital we learned much. I learned about the disparities in developing world healthcare and problems faced with donations. And I was exposed to the family-oriented culture of Honduras and the importance of relationships. While this was the most challenging experience I have ever had, it was also my most rewarding.

When I returned to the US, I decided to accompany my mother, a practicing OB/GYN, to the local hospital in my hometown of Champaign, Ill. I noted all of the state-of-the-art equipment installed, the cleanliness of the rooms, and the calming quiet of the hallways and waiting rooms. But what was lacking in my opinion was the camaraderie, generosity, and caring that I witnessed in Honduras. Even while on strike, the doctors and nurses of the emergency and maternity departments worked round the clock to serve their patients. The employees of the hospital were friendly -- always saying hello to each other, asking patients if they needed helping finding their way, and always having a smile on their face despite the hardships they faced and the resources they badly needed but always lacked. Whether during a busy day of surgeries or a lazy day of watching news, the staff spent time with each other sharing stories and laughs. To them, it was not just a job.

As an expectant future physician, I hope that I can bring to my work this same sense of human camaraderie and passion for my work. I will always remember the lessons that I have learned in Honduras and I anticipate continuing humanitarian work throughout the world, no matter what profession I choose.