About The Author:
Catherine McCurdy trained as a physician assistant at the MEDEX Northwest program at University of Washington in Seattle. She has worked as a primary care physician assistant since 1981 at Vally Wide Health Systems in Colorado where she has been recognized repeatedly for her services in the rural community.
Ms. McCurdy has volunteered her services as a PA multiple times in Honduras since 2004 and recently supplemented her international work by taking the International Medicine Certificate Program at Institute for International Medicine in Kansas City, Missouri
I am a family practice physician assistant with nearly 30 years experience working in the community health center environment, providing care to the underserved of Colorado.
Like many providers involved in international medicine, I had a personal experience of a profound nature that created the desire and opportunity to work outside the comfort of my job. In 2004 I was disabled by a back injury and during my recovery I promised to fulfill my dream of working in a developing Latin American country.
By chance I read about The Carolina Honduras Health Foundation and in the fall of that year I was taking my first trip to Honduras with them.
The Carolina Honduras Health Foundation was founded in 1987 by Dr Henry Gibson and provides free medical and dental care to the residents of Limon and Icoteas. The population of this part of the north coast of Honduras is primarily Garifuna, an indigenous population who are thought to be descendants of black slaves from the West Indies. Their isolation has kept many culturally unique characteristics intact, including the language, which is still widely spoken. The trip to these small villages is a daylong bumpy and dusty van ride from San Pedro Sula. As a member of a team of volunteers I provided care 24 hours a day for the community as well as for the nearyly 30 orphans housed nearby.
After that first trip, I continued to return to Honduras once or twice a year staying anywhere from two to four weeks. I returned several times to Limon and Icotoes as well as Roatan and Olanchito, Honduras.
During these trips, I had the opportunity provide care to inmates at a state prison, to residents of a nursing home, and to back-pack in supplies to villages isolated by recent flooding. In the village of Hicacca on the Rio Aguan, we conducted clinic, the first for this village, in a school building. Patient exams and treatments were carried out on benches or the floor. Of the many Hondurans we treated, one stands out in my memory. A 90-year-old gentleman who had been living in abandoned buildings found his way to clinic late in the day. He was emaciated and very weak. We provided some IV fluids, food and vitamins. With no family for support we promised to send a care package after leaving. It seemed so little an offering, but the best we could do for him.
Each time I returned home from Honduras my desire to work in these communities grew. I wanted to understand more fully my potential impact on the health of the people I served. In 2010 I attended the intensive training program at the Institute of International Medicine in Kansas City, Missouri. This program offered me exactly what I needed to learn about public health strategies and clinical medicine related to health care in underdeveloped nations. It also gave me the incentive to try something a bit more challenging. I applied for and was accepted to their International Medicine Certificate program. I requested the rural rotation in Ahuas, Gracias a Dios, Honduras.
In June of this year, after several months of planning, I made my most recent journey to Honduras. My destination was the region of La Moskitia and the village of Ahuas. I spent nearly 3 months working with two physicians, husband and wife, at Clinica Morava, a hospital and clinic serving the indigenous Miskito population. I had a room above the surgical suite, I shared meals with the physician’s family, and I worked day and night caring for ill and injured patients of the region. In reflecting on this experience I can say it was the single most challenging experience of my career.
Ahuas is situated on the Rio Patuca in La Moskitia. This is the most sparsely populated area in Central America and is a lowland forest and savannah in the extreme northeast of Honduras. The many rivers and streams leading to the Atlantic provide the primary mode of travel and commerce, what little there is. Access to health care is difficult if not impossible for the the indigenous Moskitio living here as they are among the poorest in Honduras. The average annual income is about 1 dollar a day.
Patients arrive at the hospital after walking hours or even days. They must look to strangers or distant family members for food and shelter while waiting for care. I worked in Ahuas and in Caurquira, a small coastal village, taking care of patients with snakebites, tuberculosis, and paralysis from decompression injuries, cancer and diabetes. Delaying care till the last minute is common, knowing that an arduous and dangerous trip would be necessary to seek care. A 14-year-old boy was brought into the hospital after suffering from episodes of fever, weakness, and pain. He had lost several pounds recently. The most likely diagnosis, malaria, is not what we diagnosed. Instead we found he had leukemia. What we offered was transfusions and a meal a day at the hospital.
What he needed was specialty care in La Ceiba. The family simply could not risk the livelihood of the entire family to provide the frequent and prolonged care their son would need. He and his family eventually made the difficult decision to return home, a 2 days journey by boat . More often than I care to count, patients came seeking care having waited too long with their illness or injury. It seemed that too many patients had to return home with the realization that there was nothing else to be done.
I have yet to come to terms with the extreme poverty and it’s affect on the health of the people I cared for. As my mentor in Ahuas said, “imagine having diabetes but no medication to treat it with, or cancer without pain medications”. It is inconceivable that a patient in my practice would accept anything but the best medicine, the most advanced testing, or the most highly regarded consultant, regardless of the cost when faced with the illness and injury the people of Honduras experience every day. I do know I will return to Honduras and I hope each time I will make some contribution to reversing the cycle of poverty and ill health. They deserve the best.
Taking risks is the life experience of the people of Honduras. They risk the safety and health of the family to find food, livelihood, and health care. Each of us can take a small step beyond our boundaries of comfort to provide care to people like the Miskito of Ahuas. It is a small risk to join an organization that provides opportunities to serve those in poverty. PAGH is a great place to start learning about those opportunities.
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