Sustainable Health Clinic in Rural Honduras
Sponsoring faculty:
David Schaad (Civil and Environmental Engineering
and Duke Global Health Institute), Linda Lee
(Clinical Research Training Program, Duke
University Medical Center) and Dennis Clements
(Duke Children's Primary Care, Duke Global Health
Institute, and Center for Latin American and
Caribbean Studies)
Proposal prepared by: Varun Gokarn, Neel Vadoothker, Stephanie
Chang, Anna Brown, Ga-Young Joung and Rebecca
Stein
Host organization:
Heifer International, the Honduran Ministry of
Health, and COMIPRONIL (a women’s economic
cooperative)
Funding partner:
Rotary International
Program Location:
Las Mercedes, Honduras
Projected Dates:
June 5th – August 2nd (tentatively)
Proposed number
of students:
10-12 students
DukeEngage Proposal
Honduras EWB Project
June 5 – August 2, 2009
Project Description
Since 1994, the Duke University Medical Center has fielded eleven medical outreach teams to
rural Honduras through an interdisciplinary course titled “Exploring Medicine in Other
Cultures.” The teams have included students, alumni, faculty and staff in a variety of clinical and
nonclinical programs in the Medical and Nursing Schools. The Exploring Medicines clinics have
provided limited short-term outpatient clinical care and health education to several small,
isolated mountain communities near the town of La Esperanza in the Honduran department of
Intibuca. Relationships with the village of Las Mercedes and neighboring communities have
been strengthened through partnership with Heifer Project International, an organization which
aids impoverished rural communities through gifts of livestock and education in sustainable
agriculture.
According to a census conducted in August 2008 by Heifer and the Honduran Ministry of
Health, 66.8% of the families in Las Mercedes, Rio Colorado, Belen, Cedros, Comunidad del
Liquidambar, and Manazapa earn less than 5,000 Lempira (Lps) a year. This equates to an
annual income of $270, or less than a dollar a day. Because of extreme poverty, the subsistence
farmers of the region rarely seek medical care except in emergency cases. The closest hospital is
in the larger town of La Esperanza, which is a 12-hour journey by foot or two hour truck ride;
however, such transportation is limited, relatively costly, and inaccessible to most villagers.
Some medical attention is also available in a small clinic in Rio Grande, a rural community
between Las Mercedes and La Esperanza, but patients often face a three to four hour wait in
addition to traveling time. The inconveniences and expenses associated with even basic care
have deterred many from seeking treatment for non-emergency illnesses, such as open wounds,
chronic disease, and malnutrition. Thus, the free clinics offered by the Exploring Medicines
teams have attracted a high turnout from all of the communities during the ten days they run each
year.
Although the annual outreach model has functioned satisfactorily in the past, a permanent clinic
staffed by a full-time nurse will ensure that the region's villagers have access to care throughout
the year. Such an establishment
will also develop Duke's existing
relationship with the communities
and offer a platform for wellestablished outreach opportunities
to
students
within
the
undergraduate,
medical,
and
nursing schools at Duke. To this
end, Dr. Dennis Clements, chief of
Children's Primary Care at the
DUMC and director of the
Exploring Medicine program, has
gained support from the Honduran
Ministry of Health to build a
government-sponsored clinic in Las
Mercedes. A $10,000 commitment
2008 EWB Team in La Esperanza
from the Duke Chapel congregation
DukeEngage Proposal
Honduras EWB Project
June 5 – August 2, 2009
and funding from local Rotary International clubs will cover most project costs for a simple
cinderblock building with a concrete floor and running water. During the 2007-2008 school
year, Dr. Clements and Dr. Linda Lee invited the Duke chapter of Engineers Without Borders to
join the effort, recognizing its overlap with the EWB-Duke mission. In August 2008, five
students from EWB-Duke traveled to Las Mercedes to conduct a site assessment for the
proposed clinic. They collected topographical surveying data of the designated site, identified a
source of water, priced building materials in La Esperanza, and obtained population statistics of
the region.
The proposed DukeEngage program will involve ten to twelve undergraduates in the design and
construction of a 600 square meter (5,400 square feet) sustainable health clinic in Las Mercedes.
The clinic, envisioned to serve approximately 1,800 people within an 8-km radius, will dedicate
particular attention to infant and maternal health in support of Honduran Ministry of Health
objectives and the Millennium Development Goals. The clinic plans are in part a response to the
solicitation from the Honduras Secretariat of Health as part of its Programa de Mejoramiento del
Nivel de Salud en Honduras (PROMESALUDH), in Request for Proposal document PRE-1619UECF-001-2008. This program of the Secretariat targets the reduction of maternal-infant
mortality in four Departments of Honduras (Intibuca, Lempira, La Paz, and Copan).
The team will be working alongside locals, providing the opportunity for cultural immersion as
well as community involvement. This will ensure that the communities feel invested in the clinic
and are equipped with the knowledge of general maintenance after the team has left. As a
finished product, the health clinic will draw strength from the University's present leadership in
global health and civic engagement to satisfy an established need in rural communities with
inadequate access to medical care.
This interdisciplinary community development project aims to attract highly motivated students
with interests ranging from engineering, appropriate technology, and sustainable development to
poverty, health, indigenous rights, the Spanish language, and Central American cultures. Aside
from the opportunity to contextualize their classroom and extracurricular studies in a real-world
setting, the Duke students who help realize this goal will gain valuable experience in project
management, ethical analysis, and cross-cultural communication.
Project Components and Curricular Involvement
Structural Design
Students from the Pratt School of Engineering and Trinity College will design the clinic, water
supply, and septic system in the spring semester course CE 185 (Engineering Sustainable Design
and Construction), taught by EWB advisor Dr. David Schaad. The clinic will be designed with
the parameters and information collected by the site assessment trip in mind. Students will work
in teams with a client group consisting of Heifer International (Tim and Gloria Wheeler), the
Duke Global Health Institute (Dr. Dennis Clements and Dr. Linda Lee), and the community of
Las Mercedes (Regino Hernandez and Juana Dominguez). They will submit the design
documents for the clinic to the client group for revisions, changes, and modifications. It is
anticipated that at least some of the students participating in the course will travel to Honduras to
build the clinic and see the realization of their design ideas.
DukeEngage Proposal
Honduras EWB Project
June 5 – August 2, 2009
Clinic Construction
Students will be working alongside community members to create concrete masonry units out of
cement and sand, lay PVC pipeline to bring water to the clinic, and set up a septic system for
managing wastewater. Depending on need, they may also install a photovoltaic array to power a
small refrigerator and electric lights and a smoke-diverting adaptation of a traditional stove in the
kitchen. These projects will expose them to key concepts in fluid mechanics, waste management,
and off-grid electricity systems.
Improved Cook Stoves
In most of the traditional wood-frame, tin-roofed homes, respiratory health is compromised by
cook stoves which vent smoke indoors. Heifer has tried to introduce a modern stove equipped
with a metal pipe that diverts the smoke outside the house, but the cost of materials and
installation remains too high for widespread implementation. So far, only one house in Las
Mercedes has this modern stove installed in their house. During the year, students in EWB plan
to research and design a low-cost smoke diverting system that could be integrated with the
existing stoves in the homes. Once in Las Mercedes, and provided there is time, they can test
prototypes and educate the communities on how to replicate and improve the technology locally.
Enrichment Activities
In association with the Exploring Medicine Program, students participating in this DukeEngage
experience will be invited during the 2009 spring semester to attend the seminar series
INTERDIS 422C, which covers culture, language, history, medicine, and religion in Honduras.
During the course of the year, students will be educated on development issues and the culture,
history, and contemporary politics and economy of Honduras. This will include safety and
cultural orientations.
Additionally, while in Honduras, students will take a 4-day break, mid-program, to travel to
Copan, Honduras where they will tour the Mayan Ruins and visit the Chorti Indian Village.
These experiences will provide exposure to the rich cultural heritage of Honduras. The Copan
cultural exchange component will be directed by Ricardo Agurcia, archaeologist,
President/Executive Director of the Copan Association, and Duke alumnus.
Logistics
Transportation
Students will depart the US and arrive in Tegucigalpa on Friday, June 5th. Representatives from
Heifer International will meet the team at the airport and transport them by bus to La Esperanza
(approximate drive time is 3 hours).
Orientation
They will spend their orientation weekend in La Esperanza and will lodge at the Hotel Mina or a
similar residence. Hotel Mina was where the EWB site assessment team stayed in August 2008.
During this weekend, students will become acclimated to the culture, travel to the local market,
and experience Honduran dishes at local eateries. Personnel from Heifer will assist the team in
purchasing local ingredients for meals for the following week.
DukeEngage Proposal
Honduras EWB Project
June 5 – August 2, 2009
Food and Lodging
On Monday morning (June 8th), Heifer will transport students to Las Mercedes (about an hour
drive from La Esperanza), where they will stay and work throughout the week. While in Las
Mercedes, students will live in a community center next to the local school, giving students
opportunity to interact with the communities they are serving. This is where the nursing and
medical students have stayed every April as part of the "Exploring Medicine in Other Cultures"
for the past several years. Juana Dominguez, the wife of the current leader of Las Mercedes, (and
others) will prepare 3 meals a day for the team using the purchased food. On Friday the 11th, the
team will return to La Esperanza using local transportation (regional buses) and will again lodge
at Hotel Mina. Over the weekend, they will purchase food and bottled water for the following
week and return to Las Mercedes via local transportation on Monday. This pattern will be
repeated for the duration of the DukeEngage experience except for the mid-program break in
Copan. The weekends in La Esperanza will allow students time to relax, take a shower (possibly
hot one), plan ahead for the following week, and purchase building materials and food for the
following week. Internet cafes and long distance phone calls will be available in La Esperanza on
a weekly basis.
Supervision and Coordination
An on-site coordinator who is proficient in Spanish and/or engineering will be hired to help
manage the project. This person will be working with full-time staff from Heifer International
and the community leaders of Las Mercedes to provide an enriching, engaging, and fulfilling
experience for all parties involved.
Funding for Clinic Construction
Most building materials will be purchased with funds provided by the Duke Chapel and Rotary
International. This project aligns with Rotary International’s 2008-2009 theme, Make Dreams
Real for the World’s Children; Rotary’s cooperative relationship with the United Nations
Population Fund; and the 1999 Rotary International Statement on Population Growth and
Development. Additionally, Mike Waters, the Rotary Club President of the Research Triangle
Park, has made the Rotary leaders in District 7710 (the local district) aware of this project. They
will all be partnering to submit for Rotary Matching grants later in the year.
Risk Management
Risks are inherent to any community development project in a rural area. As previously stated,
Las Mercedes is about a one hour drive from the hospital in La Esperanza and three or more
hours from Tegucigalpa, which has a large hospital and an international airport. These travel
distances pose a legitimate concern to the welfare of the team, but are risks that will be mitigated
through use of a satellite phone, frequent reminders about safe working practices, vaccinations
against endemic diseases, and other safety precautions to ensure the security of the team. While
the political climate is fairly stable, and crime, terrorism, and violence are not major concerns,
students will be advised to only explore the area in groups of two or more to prevent any
compromising situations. As in many other developing countries, the regional transportation
infrastructure is not ideal. However, the road to La Esperanza is paved, and all roads out of La
Esperanza consist of graded gravel. The regional bus traffic is frequent and relatively
dependable.
DukeEngage Proposal
Honduras EWB Project
June 5 – August 2, 2009
Conclusion
There is significant momentum and support behind this community development project from
the Honduran communities, Duke organizations, and international agencies involved. This is an
excellent opportunity for undergraduate students from diverse educational backgrounds to
engage in experiential service learning, deep cultural immersion, and translation of an original
building design into a finished product. A working collaboration with the Duke Medical Center,
Heifer International, Engineers Without Borders, Rotary International, and the Duke Global
Health Institute, this project will improve the accessibility, quality, and sustainability of health
care in impoverished rural communities in great need of year-round medical attention.
Contacts
Faculty Sponsor
David Schaad, david.schaad@duke.edu, (919) 660-5174, Dept. of CEE, 126 Hudson Hall
Students from Site Assessment Trip
Stephanie Chang, stephanie.h.chang@duke.edu, 2011
Ga-Young Joung, ga-young.joung@duke.edu, 2011
Anna Brown, anna.brown@duke.edu, 2011
Varun Gokarn, varun.gokarn@duke.edu, 2009
Neel Vadoothker, neel.vadoothker@duke.edu, 2009
Heifer International
Tim Wheeler, tim.wheeler@heifer.hn
Global Health Institute
Dr. Dennis Clements, cleme002@mc.duke.edu
Dr. Linda Lee, lee00031@mc.duke.edu