Day three of Ciriboya UNAH nurse/med student brigade

Our second day of work started out with an egg run to Iriona so Mirna could make baleadas for breakfast. I went to get the car at the Cubans' house and found Dr Valcárcel at the gate talking with two men whose truck was parked outside. One was bleeding profusely from the hand, and Valcárcel was having a look at it. He insisted we come in for Cuban coffee instead of buying eggs and gave me the Cubans' eggs to take across the street. But Mirna sent me back with orders to buy more eggs—23 wouldn't be enough—and 5 lbs of cheese as well, because you can't make baleadas without cheese. When I got back to the Cubans house the bleeding man was sitting on a chair on the porch with a tourniquet around his arm. "Come in for coffee!" Valcárcel ordered. "Nothing is so important that you can't have coffee first."

I don't even drink coffee. But he obviously wasn't backing down, so we went inside, and had a super-strong, super-sweet, delicious cup of Cuban-style espresso. Valca (as they seem to call him for short) was blasting a tinny "We are the Champions" on his cell phone on the breakfast table. I laughed when I realized it wasn't just a ring tone but actually our intended breakfast music. I told him I liked the song too. Nurse Oneida, heating up some water on the stove next to us, said "I don't know that music" with a slight roll of her eyes. "This is a great group," Valca answered. "You HAVE to know them. QUEEN!"

By the time we had gone to Iriona and back, Mirna had already found a way to feed the students without enough eggs or any cheese. They seemed very content. It would be impossible to complain about her to-die-for flour tortillas, beans, and slightly fewer eggs than planned, but she always aims for perfection.

We headed to the hospital around 8:30. The place was packed with patients, so although we had planned on starting with sort of orientation, the students went upstairs to wait. They were all milling about, so I decided to take advantage of the lull to make them learn how to say a few things in Garifuna (which I myself had learned earlier in the morning and had been practicing on anyone I saw. Guiti Binafi!). Everyone here is bilingual, but even a few words make a huge difference. I roped Luther's brother Lenin into helping me. He gave a great little spontaneous lesson to the 30 students who gathered around in a tight little circle on the balcony to hear. They all got their notebooks out and practiced with each other. Ida biña? Uadiguiati.


Then a kid took my camera away to take pictures "for me." They weren't all that bad. Here's one of the construction of one of the new hospital wings, as seen from the (current) front balcony.

The photographer:

He got my students to help him with his shoots.

Around then Dr. Melvin came upstairs to see if we could change plans, since they were so slammed downstairs, and have the students see patients. The students were delighted to be asked, and immediately went downstairs and incorporated themselves into the team. I mean immediately. By the time downstairs these med students were already diagnosing their patient...

while others observed and helped Dr. Melvin with his consultations:

Three of my students helped this gentleman with his nebulizer. I asked his permission to take the photo, and he asked what I planned to use it for. When I told him it was to let people know about the work of the hospital he said "Of course!"

My students learning from one of the nurses from the community:

Doing intake:

A med student learning from Dr. Beatriz how to clean a patient's infected ear:

Dr. Marilyn treating a patient while one of the student-organizers writes up his notes from the previous patient.

My students filling prescriptions in the pharmacy:

Taking a patient's blood pressure at the intake table:

The same med student cleaning the patient's ear as Dr. Valcárcel supervises:

My students learning from another community nurse:

There were lots of adorable kids around.

With the students' help, the hospital staff managed to see all the patients in time for lunch. They told me that on a regular day with that many patients, they would have been there until 6 before they managed to see everyone.

Back at Mirna's, I saw a boy pulling the most wonderful car toy I think I've ever seen.

Close-up! As you can see, it's actually a tractor-trailer carrying a car.

After lunch, we reconvened in the Cubans' house. The students had a lot of questions for the doctors, about how they paid for the free medicine (a few donations, but mostly through Luther's speaker fees at U.S. universities, where he negotiates pay in kind), what kind of sustainable finance model they were working on for the future (various possibilities including government funding and small fees were discussed), and more. They discussed the APS (the initials in Spanish for Primary Health Care, promoted by the World Health Organization) model "implemented" but not funded but the current government. It's a model that backs universal health reforms and recognizes social exclusion as a cause of illness, and everyone in the room agreed it would be a huge improvement to what exists now. Then, we watched a couple short films; one on the history of the Ciriboya Hospital and another about Cuban-organized international Henry Reeve brigade, focusing on its mission in Haiti following the earthquake.

Dr. Valcárcel and Dra. Beatriz spoke some more, emphasizing their Cuban vision of egalitarian, community-level healthcare. A couple quotes:

Valca: "El médico que sólo sabe de medicina, ni de medicina sabe" (The doctor who only knows medicine doesn't know medicine at all)—referring of course to the need to understand history, political context, structural violence, culture, etc., to be able to understand and treat illness.

Dra. Beatriz: "Cuando la medicina es a base de dinero, a mí no me interesa que no se enfermen; a mí me interesa que se enferman pa que me paguen." (When medical care is based in money, [as a doctor] I won't be interested in making sure people don't get sick; what I want is for people to get sick so they'll pay me)—in reference to the importance of preventive care and its impossibility in a profit-based system.

The students enthusiastically followed along, adding their own comments and observations about what they'd been learning and seeing in practice, and how it contrasted with the kind of practice they were hearing about and seeing here.

When we finished up the long afternoon of discussion and debate, the students went directly to walk on the beach and then get ready for dinner.

We're on the eastern side of the country, so it gets dark earlier here, and fast. Before I knew it this guy had taken my camera again.

Among a dozen others, he took a picture of the Cubans' knight (a gift someone brought from California years ago), and of Dr. Melvin, me and Milton.

After dinner, we all went over to Herman's place. Earlier that morning I'd mentioned that since I had it on my hard drive anyway it would be nice to screen Revolutionary Medicine, Beth Geglia and Jesse Freeston's film about the Hospital in Ciriboya, to the community. Before I knew it Dr. Melvin had arranged to borrow a projector and had asked Herman permission to screen it at his small establishment by the sea (I don't know how to describe it- it's part bar, part beautiful community center). Herman had quickly agreed, and somehow lots of people found out without our having to do any sort of turnout. We were worried it might rain, but the night was lovely. The crowd—community members, UNAH students, and the Cubans—gathered while we were setting up.

It took us a couple tries to get the sound working, and we were good to go.

Several times during the film, when their neighbors, friends and family members appeared, members of the audience let out a collective squeal of delight. Like when our trip hero, Mirna, was featured.

The Cubans watching a scene of a Cuban dentist doing a patient check-up.

The whole group (I know, it's dark).

When the film ended everyone was in high spirits, and folks from the community immediately started drumming. The students were completely engrossed. Garifuna dancing is pretty amazing, and as much as everyone else in Honduras likes to talk about punta as something Honduran, and as good as Hondurans generally are at dancing, I've seen precious few ladino Hondurans dance it well. The rhythm is infectious.

My students were craning their necks for a better view, but trying their best to stay just far enough away so they didn't get dragged into the circle. One of them finally braved it, and did fabulously (she received a healthy round of applause and shouts of approval).

I got dragged out at one point by the guy with the gourd instruments. Although I was hindered by my lack of skin-tight pants, I think I did okay—well enough for the crowd to forgive me anyway. And it was a brutal crowd- several guys got booed, and walked off in mock shame. In the end, the only way most of the students were able to work up the courage to go dance (which they'd clearly been aching to do) was to go into the circle as a large group. They ended up dancing reggaeton to a punta beat (it's what they know) and enjoying themselves thoroughly.