Expert: Nonprofit Organization Medical Brigades Supply Care to Community Honduras

Pharmacy Times met with Shawn Riser Taylor, PharmD, CPP, CDCES, professor and chair, Wingate University School of Pharmacy, and clinical pharmacist, Appalachian Mountain Community Health Centers, to discuss the work that the nonprofit clinic, Community Alliance of Guachipilincito, does for a community in Honduras. She emphasizes the importance of sustainable programming and community involvement while practicing cultural humility. Taylor also highlights how the organization as well as its medical brigades are funded and run.

Timestamps

0:00:00 - 0:01:44: Introduction — Shawn Riser Taylor and non-profit organization, how it operates, and mission
0:01:44 - 0:08:01: The Honduran community, challenges residents face, and the common medical conditions
0:08:02 - 0:10:02: How residents are involved in services
0:10:03 - 0:12:18: Typical brigade day — the routine and what is accomplished
0:12:19 - 0:15:05: How first-time brigade members prepared, important info to know

0:15:06 - 0:17:30: Biggest challenges and changes going forward

0:17:31 - 0:19:00: Closing thoughts

Shawn Taylor: I am Shawn Taylor. I am [a] professor and chair at Wingate University in North Carolina, and I have our satellite campus and Hendersonville, North Carolina, which is in the western part of the state. I practice at Appalachian Mountain Health, which is a community health center in western North Carolina.

Pharmacy Times: Can you provide an overview of the non-profit organization and what your goal is, as well as what work is done in Honduras? How is it funded?

Taylor: So, I'm part of an organization called the Community Alliance of Guachipilincito very long name, we shorten that a little bit to help folks be able to say [it] that aren't comfortable with [speaking] Spanish, so we call itGuachi—is the community that we're in. That is our specific clinic that we are part of, but we are under the larger umbrella of Shoulder to Shoulder, which is a nonprofit organization that is a 501(c)3 here in the US, and then also has an organization in Honduras called Hombro a Hombro—which [translates to] Shoulder to Shoulder in Spanish—and that organization has 100 full-time employees on the grounds there. Then most of the work that's accomplished from folks on the state side in the US are volunteers, either long-term or short-term, and as far as funding it, the larger organization receives grants for different initiatives and programs that they're running, however, for us as the larger Community Alliance of Guachi, we rely strictly on fundraising and donors to support our efforts there.

Pharmacy Times: Describe the community where you provide services, some challenges the residents face, and what medical conditions are frequently seen.

Taylor: Our programming in Guachipilincito is really threefold, so we provide medical care, nutrition services, and scholarships as a way to increase the amount of education that folks who want to pursue are able to obtain. So, the community is about 400 residents, It's very rural, so we are in the southwestern corner of Honduras—if you look at it on a map, it is close to the El Salvador border. Mostly farming, corn farming, agriculture is the primary occupation in the area and folks are able to go to school in the community to sixth grade, so there is a school [that teaches] kindergarten through sixth grade. Folks that want to go beyond the sixth grade have to travel to a different community, the schooling is still free, but they have to start paying for supplies and transportation, so we provide funding for kids that want to go beyond the sixth grade.

We have a nutrition program that is for women who are pregnant, women who are breastfeeding, and children under the age of 5. Once they are age five, they're getting at least 1 meal a day at school, but prior to that—just to kind of capture adequate nutrition and promote growth—we have a nutrition program that provides supplements monthly to those pregnant lactating women and then family. So, I have kids under the age of 5, and then those children come in and they are assessed for weight and height on a growth chart, and we get that information back in the States that way we can identify anybody who may be as falling off the growth curve.

And then the third part of our programming is the medical work, and that's really accomplished by these 3 brigades that go down with mostly volunteers from the US in February, June, and October. So, about every 4 months, we are sending down an interdisciplinary group of physicians, pharmacists, nurse practitioners, nurses, physician's assistants, lots of learners, and all of those disciplines as well. So many of us are taking down students, and that's when we carry out probably what people most typically think of a brigade in a country like [Honduras].

So, we have a free-standing clinic that we establish, [and] we order most of our medications and our supplies within the country. A big part of this organization is to have a focus on sustainable programming, so [we’re] not bringing down things that can't be replicated in our absence. And so, we set up clinic we it's a really traditional space—like us going to a provider practice here in the US—[where] folks come in, they get intake with our RN staff, with our nursing staff, so they get their vitals, and we reconcile their medications and chief complaints. We do screenings for diabetes for those that qualify, we do screenings for depression for all of our patients, and then they see the provider—so it could be a physician's assistant, nurse practitioner, [or] physician—and then after they have that consultation, they land in the pharmacy. So, that's where I would be working often with student learners, and we are able to get their medications prepared [and] we provide them with 4 months of medications. Until the next time that we return, each person gets Teach-Back counseling—so they sit down 1-on-1 with a pharmacist or pharmacy student—and through use of the interpreters that we have that are working alongside all of us that are fluent Spanish speakers, we do a lot of education, whether that's the pharmacological piece or the nonpharmacological and have them repeat back [to] just make sure what they retained is adequate because we're not going to be there in a week for a callback if there's a question or [adverse events]. So it's a pretty extensive appointment.

We see—probably the most common condition—musculoskeletal pain, so, that is from kind of [the] wear and tear folks that are working in the fields [get]. And then we have a handful of folks that have hypertension and diabetes, so we emphasize the nonpharmacological pieces of managing those diseases, and then we also have a formulary of medication. We make sure that we've got a registry of folks that have those chronic diseases, so we know who we're going down to see. If somebody doesn't show up to the clinic, we can try to find them while we're there during that week. And then when they are able to come in, we can give them full medication until we come back.

I guess some of the nuances of practicing in a place like [Honduras] is we don't have all of the amenities that we are used to, so there are probably 60 medications that we have on our formulary that we're able to access. Of course, we could bring down more things, but those things may not be readily available in the community if the person needed more medication, or they lost their medications. So, we try to just keep up with things that we know that they can access if they needed to, or—as you know—we've just experienced a pandemic, we're not able to go down for 2 years, there’s still access to the therapies we've started along. We don't have a laboratory, we don't have imaging, so the diagnostic piece of things is really reliant on the patient interview and the physical exam that our providers are completing to really get a full picture. And if we do need more information, there are ways we can refer patients to other hospitals [or] other facilities that are in neighboring communities, but that presents challenges as far as transportation and then paying a cash price—I think it's less than 5% of people in Honduras have [some] type of medical insurance—so everything's really paid for out of pocket. And so, even sometimes when we want those additional tests and diagnostics, they're not always the easiest to achieve. And then, the community is very mountainous so the terrain is pretty unforgiving, and for some of our folks, just making it to the clinic where we practice is challenging enough, but adding another layer of going to another town may be more of a walk, bus ride, or a whole day experience to get a simple diagnostic test, as we would see it in the US, it's not always easy to achieve.

Pharmacy Times: Are residents involved in assisting with services? If so, how are they able to help?

Taylor: We have a local health committee that has new members on it every single year that's in this community, and they meet monthly and facilitate carrying out some of the nutrition and scholarship programs in our absence…we have a funded position of someone who is local in the area, and she's our community health liaison. And so, she's the liaison between what's happening on the ground and communicates back to us back in the US [and] comes to all of our board meetings monthly, keeps us up to date with like those height and weight checks…so, she's really kind of the conduit between the local community and us that the local health committee—which has the president, vice president, secretary, treasurer, and typical components of a committee—they help to influence things that are needed.

So as an example, a couple of years ago, they asked if we could revisit the nutrition that folks were receiving monthly and [if there] would there be a way to have different foods. So, whatever the foods were, the kids didn't like [what] we were providing at that point in time. So, we collaborated with a registered dietician just to make sure we were selecting things that had the adequate nutrition for that age group, and then with their preferences, balanced with what the dietician was selling us kids this age need [and] we came up with a new plan. So, they do work really closely with us in that regard.

When we're in the community, a lot of times we have to go out into peoples’ homes—so people that can't make the trek all the way into the clinic—and so the committee will help serve as our guides, get us to those patients as they're obviously way more familiar with the terrain and how to get to different folks’ homes, so they are very much involved in influencing our decisions. We are mostly relying on our community health liaison to get the information from them [and] back to us, and vice versa.

Taylor: We have a really lovely facility, our dorms are on-site at the clinic so oftentimes all medical folks will be sleeping in tents and mattresses and things in various places, but we have a really well-designed structure.

We wake up in the morning, and we have a cook that makes breakfast for us—it's this wonderful spread of traditional Honduran food, fresh fruits, and delicious coffee—and so, we start our day all at a table together. It would be all the folks in those different disciplines from the US, our community health liaison, several people that are part of coordinating our brigade for the week, as well as all of our interpreters. And so, we kind of prep for the day and have a huddle…[to discuss] what's coming in, is it going to be a day of more [focused on] chronic diseases, do we have a lot of home visits, is it a day that we're going to do child well-checks, and all the kids from the school are going to come up and come through the clinics, that's another part of our week…so [we] prep for our day and talk about where everyone’s going to be in their different stations.

And then as much as we can, us preceptors and faculty kind of sit back and really try to let our learners facilitate the triage, the consultation, and then the pharmacy, and then we all sit just at kind of a consult table. During each transition, the learner comes to the consult table and transfers over to the next person in that that line or that flow, and then we're all there to offer our expertise. Many of us have been done before, so we can talk about different cultural considerations or feasibility of different plans, and then [take] a break midday, we have a lunch—it's the largest meal of the day, so it's a big lunch and a coffee—and kind of recap on what we've done for the day. then the afternoon is more or less the same as what the morning was.

And we typically see in a week…about 100 adult patients and then somewhere around 50 children that come in for just well-child checks, growth chart plotting, that sort of thing.

Pharmacy Times: How are first-time brigade members prepared for the trip? What is important information they should know prior to traveling to Honduras?

Taylor: Especially when we have a lot of learners, we really utilize our technology, because we are across many different universities and states—mostly on the east coast at this point. But we use Zoom, and we do a couple check-ins about 2 to 3 months out of the trip and we talk about things like cultural humility. So, what does it mean to drop into a place where you aren't familiar, and not that you have to be the expert of that place, but how can you be humble and receptive to learning about dietary intake, or maybe some nonpharmacological, traditional medicine interventions that you've never heard of that maybe work for those folks? So, [we] just kind of [discuss] being open and receptive to what you're hearing.

We have a session on overview of what is health care like in Honduras and what can [newcomers] expect, what is being provided in the country from a government standpoint, what does it look like to go to a private clinic, how does that infrastructure work, and how do we fit into it to really complement it—and not duplicate services that already exist. We have some readings that we do, 1 is just about immigration to the US and just kind of the journey that folks may take along that path, and then the other is about [how to] really check ourselves to make sure we're not doing these types of trips for our own fulfillment, but that we are actually providing a needed service that is complementary to what exists or supplements what exists in this area of Honduras, and doesn't try to take over or replicate something that's already working really well. So, we talk a lot about that.

And then, of course, common conditions that we're seeing there that may be different, as well as that lack of access to all these diagnostics—so, there's no lab you can send a patient to and call them back the next day—and determine the treatment plan. It's a little bit less information, or a different way to gather information than maybe we're traditionally used to. [We] talk about the medications that exist, how we get those medications, why we have those medications, why some of them are medications, maybe we don't typically prescribe anymore in the US because maybe we have newer agents—especially like in a diabetes space—but it's not sustainable to do some of these therapies down [in Honduras]. So have really rich conversation—especially with the learners, the first-time that they're going down just to make sure they know what they're dropping into, but also helping them to understand that they can have some grace with themselves and it's okay [to not] know everything, [and to] just be receptive to what's happening in the culture that they are going to spend a week in.

Pharmacy Times: What are the most challenging aspects of the work you do in Honduras, and is there anything you would like to do differently going forward?

Taylor: When I ask this of students, they—by and large—have just the most incredible experience when they take this trip, but they always say, “I wish you could have told me how hot it was going to be!” But that's the 1feedback that I always get from students, and I tell them, “Well, I told you to bring a fan and wear clothes that are wicking, and make sure that you're staying hydrated the whole time.” They're like, “Yeah, but you just really can't explain how hot you're going to be.” So, most of our days are 90 degrees [or higher]. Some of the times of year we go are [during] the rainy season so it cools down at night, and other times it's the dry season, so there’s that stagnant heat all night. It is not the most comfortable space to drop into, so that's probably what the students would say they wish I had told them more of. But they can never really elicit any feedback I could have given them that could have really prepared them to drop into.

For our organization as a whole, probably the most challenging thing is keeping up with our fundraising and making sure that we have enough funding to accomplish all of our objectives. So again, the nutrition scholarship or the programs that we are fully funding, the medical brigade weekly trips that we're taking, those are all funded by the people that are going down. So, we're not asking for any support for that. But you know, we have the community health liaison, we have a building that needs upkeep, and so, when it was established, it was easier to fundraise for this physical thing—like there's a building being built, there's a structure, there'll be a picture that comes back—and now we're in the space of just having to maintain the services. Similar to [the US, the] cost of things has gone up [in Honduras], so the nutrition program is a little bit more expensive because the food is more expensive to facilitate. Sometimes the scholarship is more expensive, depending on what supplies that the students need, and that's just based on the course of study that they have selected. And so, I think fundraising is probably our biggest challenge.

We struggled during [the] COVID [pandemic], probably like most nonprofit organizations, because it was hard to have in-person fundraising and we were relying on the virtual, [and] that made it challenging. We're just now to the point where we can get back to having some of our in-person fundraisers again, so hopefully, we are in good shape to continue our services and carrying out our mission in Guachi.

Taylor: I think that for people that are looking to do this type of work or are interested in it, what I found was really helpful was to just have conversations with other people that have been on similar trips and are in similar organizations to really understand what's the mission of the organization, and [if] that is something that speaks to you.

And then the other thing I would say is [to think and ask] the question of “Is this organization sustainable?” Because as much as we love going down and being part of this, the ideal goal—inevitably—would be that we can pull out of this completely and we don't need to physically be there, and the services could still function so that…we're not creating this dependency [where] we have to necessarily be there. So, I think if you find an organization [where] the mission speaks to you, and you feel like this is a really sustainable, community-influenced operation that really serves a need but also doesn't rely on [people] coming in and kind of being the saving grace of the community. I think that's something to really think about.

And talk to other people that have been on trips, because there are people that have great experiences, and there are folks that maybe…haven't had a good experience, and learning about that before getting involved with the organization [can be important].