I also asked my readers to join me on a followup trip a year later, and several of them did. Among them was the Doc of All Tradez, an anesthesiologist from the midwest who turned out to be an absolute pleasure to work with and to get to know. I can say the same of the rest of our anesthesia, surgical, and many other volunteer colleagues.
Now that I’ve wound down my anesthesia career, it’s unlikely that I’ll be returning to NPH Honduras as a volunteer on a medical mission. However, via the income that this online venture delivers, I’m now doing something more powerful than giving them five days of anesthesia services per year.
We are now funding the salary of one full-time on-site Honduran physician for the next year. I have worked with these physicians — there were four of them as of our last trip — and they provide outstanding perioperative care to surgical patients from all over the nation.
I do feel a tinge of guilt for letting my skills and ability to continue serving these patients lapse, but feel great about supporting a physician who will be with them all year long. I appreciate your support as a reader of this site and our joint charitable mission for making this a possibility.
If you are a healthcare professional who works in or near an operating room, One World Surgery would love to have you on an upcoming surgical mission. You can learn more about the one-week opportunities and explore the mission calendar here. I know there is an urgent need for an anesthesiologist starting September 7th, and there are numerous other opportunities posted through the rest of 2019 and well into 2020.
9 Reasons to Go On a Medical Mission and 1 Reason to Not Go
There are 9 reasons to volunteer for a medical mission at One World Surgery in Honduras and 1 reason not to go.
I just returned from a medical mission to Honduras at One World Surgery’s Holy Family Surgery Center, on the same grounds as Nuestro Pequenos Hermanos (NPH) and here is what I learned from my trip.
9 Reasons to Volunteer Your Time
1. Honduras deserves good medical access as much as the rest of the world but little to no access is available.
2. One World Surgery organizes the missions to help the people of Honduras while giving the volunteer a genuine Honduran experience.
3. Honduras suffers from many problems which requires future leaders to help restructure the community and country. The NPH family cares for over 300 future leaders with love and care.
4. Great organizations usually result from a great founders with an equally great mission. Dr. Peter Daly, his wife Lulu, and their team have taken great efforts to make the medical mission experience first class.
5. Honduras has a health care system that struggles to take care of the 9 million people that live in this country. Physicians and nurses who participate directly and indirectly impact the overall health of the entire region.
6. Dr. Merlin Antunez, Medical Director, and his brother, both who were raised by NPH as a result of a family illness, grew up and used their success to help the organization that helped them.
7. The Moscati Center which houses the medical missions provides a very modern and comfortable central location for the members to interact and relax after a long day of work.
8. The surgery performed in the Holy Family Surgery Center will challenge even the most astute clinician.
9. One World Surgery creates a family environment that the entire family can enjoy. They encourage nurses and physician to bring their families to participate in the mission of the organization.
1 Reason NOT to volunteer at One World Surgery in Honduras:
Fear: to quote Game of Thrones, “The Night is Dark and Full of Terrors!”
I cannot argue that traveling abroad carries risks especially traveling in countries declared by the US State department to be a Level 3 Travel Zone which suggests to “reconsider travel.”
Also, foreign countries carry risks of contracting diseases endemic to the region. One World Surgery takes every effort to make this mission safe for the medical and non-medical volunteers by providing safe transportation to and from the airport in addition to providing 24-hour security on the Ranch. I never felt even slightly unsafe.
Honduras Medical Access
When I first signed up for the medical mission I didn’t really know what to expect. I read PoF’s post and knew that it would be hard work but also a memorable experience. Since I had never attended a medical mission before, I didn’t have a solid basis for comparison. After returning from the mission one thing stood clear, the people of Honduras are some the most resilient people in the world.
In the United States emergency medical care is mandated by law known as Emergency Medical Treatment & Labor Act (EMTALA) regardless of the person’s ability to pay. So if you become injured in the U.S. and require life-saving surgery, then you will get the surgery without any assumption of payment.
In Honduras, no such law exists and even if it did the hospital system does not have the resources to pay for such services. The best example, which I can’t quite wrap my head around, come from orthopedic implants. In the U.S., every hospital has access to every modern medical orthopedic device and commands an army of industry representatives at their command to procure anything to complete most emergency and non-emergent surgeries.
Honduras doesn’t. If you need, for example, a femur implant or tibia plate, the patient has to go to a different location to purchase the device and return it to the hospital for implant. If the device doesn’t fit then they will modify it on the fly since there are NO returns.
As a consequence, simple operations often get delayed for months resulting in deformities and infection of which are almost NEVER seen in modern medical world.
One of my patients showed up with a foot that had been damaged for years. The x-ray revealed a very old tibia non-union as a result of never having an operation to correct her injury. She was hobbling around for 10+ years with a floppy foot!
Regardless of your politics, no one deserves this and she was one of countless others who suffer for years and years without complaint until she found Holy Family Surgery Center.
Authentic Honduras Experience Food and Culture
Having no basis for comparison, I can only share what I experienced. The medical mission takes place in Rancho Santa Fe, a rather large Ranch, one hour south of Tegucigalpa. There, the volunteers are housed in the newly constructed Moscati Center complete with modern amenities paying special attention to safety. The Ranch is home to Nuestro Pequeno Hermanos (NPH) home for over 300 children, the elderly and children with special needs. Also, down the road from the Moscati center, a 10 min walk, stands the modern Holy Family Surgery Center(HSFC).
After arriving to Tegucigalpa and taking a short ride, we arrived at the ranch. There we met the staff and became oriented. Soon after we took a tour of the facilities and ranch. The NPH grounds include the numerous houses called Hogars and the names represent who lives in each home.
Since it was Saturday all the children were out playing at special activities due to Mother’s Day. Each location definitely felt different than what I would expect in comparison to the US but according to the children, they were very happy with their homes.
We also visited one of the primary care clinics and a very tranquil, Casa de Abuelos, to meet the more elderly residents. The ranch seemed very large and we walked long enough to build up a sweat and a decent appetite.
After taking a quick snack and water break(purified water at Moscati and Surgery Center) we had the option of attending Saturday Afternoon Catholic Mass.
The outdoor cathedral reminded me of the open masses I have attended in Mexico. The seats were concrete and arranged in a ½ arena. The weather cooperated but it did feel a little warm which didn’t bother the NPH children attending.
The lively music included guitar, keyboards and drums with full participation of all the children. They were kind enough to provide us with a projected screen with all the words to follow along and sing in Spanish. I often struggle to get my kids to participate while in church, I wish they would have been able to attend and feel the amazing spirit when these children sang.
After the readings from the children was a homily by the priest. The Father explained the significance of the sermon in Spanish and then shared what he had said in perfect English.
The children smiled the entire time while laughing and singing. Mass ended with blessing all the mothers for Mother’s Day which looked more like a shower, again with big laughter and participation from the NPH children.
After church, we were served genuine Honduran cuisine skillfully prepared by the permanent cooking staff at the Moscati Center including dishes new to me:
● Empanadas de pollo/carne
● Yuca con chicharron
● Sopa de frijoles con chicharron
● Sopa de mondongo
● Sopa de tortillas
I enjoyed the food and it seems the others did too as many went back for seconds. Unlike Mexican food, Honduran cuisine rarely includes spicy peppers.
After the meal we were treated to a brief history of the Ranch and Surgery center complete with overhead slides and some cold cervezas!
The Future of Honduras
I think there may be a tendency by foreigners visiting the country and ranch to feel sorry for the NPH children living there. All of them definitely have heart breaking stories and had to overcome unthinkable circumstances.
However, NPH made it abundantly clear that these children represent something special and never ever referred to as orphans but as family members.
Likewise, all the adult members either volunteering or working on the ranch are not considered workers but referred to as “Tias” and “Tios” or aunts and uncles. They all have a very close bond to their home and caretakers and asked us to respect this relationship. It seemed very clear everyone at the Ranch felt a very strong sense of pride belonging to this family.
This pride or “orgullo” will drive them through their lives and will guide them to do what is right for their family and country. NPH realizes the importance of this investment into their children by not only providing them with a home and love but also are committed to helping them prosper in whatever they choose to pursue as a career.
In addition to having a school on the property, they also offer six different vocations to help prepare them for the workforce.
Most importantly, if any child chooses to pursue any higher education, NPH will pay for it to whatever end including all the way through medical school!
The next generation of conscientious leaders will come from Rancho Santa Fe. These kids will then hopefully reshape their lives, the lives of others and maybe even the whole country.
First Class Experience due to the Founders
The Dalys founded Holy Family Surgery Center and have since helped found One World Surgery, the parent nonprofit organization. Every great organization begins with a great vision and great leaders. This vision permeates through the campus from the grounds to the surgery center and the amazing attitude and work ethic of the people who run it.
I did not have the pleasure of meeting the Dalys but given what I experienced I know they have a very dedicated and focused vision. The main qualities I witnessed included attention to detail with respect to safe medical care and great facilities.
“We want to continue to attract great volunteers and physicians by providing them with a safe and comfortable place to stay.” According to Dr. Merlin Antunez, the medical director of the Holy Family Surgery Center. “The success and growth of our program depends on keeping our volunteers happy and when they return we welcome them as family.”
The Dalys created exactly what Dr. Antunez articulated, a family environment. When I asked other members of the medical mission why they chose One World Surgery many of them said because it feels safe enough to bring their families.
In our small medical mission, we had 36 volunteers of which 5 were children of the physicians! Also many stated they wanted to return to bring their other children to share the experience.
The Direct and Indirect Impact of the Mission
When I finished my first case in Honduras I didn’t know if the patient with the infected tibia implant would recover since he could still not walk and would require further surgery.
Contrast this to my patient with a rather large neck mass who was constantly uncomfortable and had limited neck movement. Once her surgery ended, I rounded on her the next day and she felt great despite just having had surgery. Her life changed immediately and she will go on to live a normal life.
When speaking with other Honduran volunteers the greater impact of the mission became more clear. My good friend Marcia, one of the Honduran translators, told me her story.
Marcia had broken her wrist in a car accident and had surgery at the public hospital. Soon after her surgery, she developed some complications with pain and swelling. Despite her wrist feeling very hot and twice the size of her other wrist, the staff at the public hospital insisted everything looked fine and did nothing.
Months went by and she lived in agonizing pain which prevented her from sleeping most nights or working. Finally, her sister visited her from Los Angeles, alarmed at what she found, immediately started searching the internet for a miracle.
They found Holy Family Surgery Center. Marcia showed me her wrist and it looked healthy with a large healed scar. “They changed my life and I can’t ever repay them for what they have given back to me.”
Marcia now spends her days working as a dedicated translator for HFSC and always works with a smile on her face knowing that she gets to help other along their journey to recovery.
The cycle of paying forward continues as the story of Marcia repeats itself over and over again as the number of life-changing surgeries grows ~25% year over year. Hearing about all the progress made since the opening of the center in 2009 and have seen what has happened over the past 10 years, I can only imagine how much more growth will take place in the next 10 years.
The First Generation of NPH Pequenos gives back
Merlin and his brother, Osman, didn’t expect to become orphans at such a young age, 5 and 6. Their father, their only parent, developed Parkinson’s disease and could no longer take care of them. He had no choice but send them to an orphanage in Tegucigalpa. After spending their first year there, the NPH ranch had opened and began to accept new children from the overcrowded city.
Arriving at NPH, both were amazed at the new construction which would become their new home. Dr. Merlin spoke of looking at the walls with holes cut out for windows with little else. They knew this would be the first time they would have a solid foundation. Since the compound lacked schools they spent their first couple of years commuting in the back of a pickup truck with several other children to the nearest school one hour away.
Over the years the ranch grew and they eventually built a school and other amenities like an outdoor cathedral, parks, specialized buildings for teaching vocations and clinics. Merlin and his brother witnessed this growth and were raised with love. NPH in an act of love keep true to their promise and helped pay for each of their educations. Merlin became anorthopedic surgeon and Osman became an engineer.
Rather than taking advantage of this gift for personal self-interests and pursuits, Merlin and Osman have dedicated their lives to NPH and One World Surgery by sharing their talents to make the organization even better. I had the pleasure of working with Dr. Merlin for a week and stayed in an amazing facility build by his brother Osman at the Moscati Center. The both continue to contribute to the organization by constantly improving the facilities and working hard to build future leaders.
I had the pleasure of hanging out with my new friends Sarah and Jenn who both had previously attended a medical mission 3 years ago. The spoke of great tales of tarantulas, snakes and unsavory food. I arrived without any expectations and hoped for the best.
I could not be more impressed and amazed by our comfortable accommodations and delicious food. We arrived to the Moscati Center, named after Giuseppe Moscati a canonized saint and physician.
Looking at the architecture from outside impressed me and gave me a sense of what to expect on the inside. Sarah and Jenn were also amazed with the facilities but both missed their spider friend.
The Moscati Center, designed by Osman, takes into consideration modern design to accommodate large groups of people. Our medical mission had 36 volunteers while the previous one had over 90. I felt like I had the whole place to myself given the size of our group.
The center always had bottled water, soda and snacks stocked in the kitchen. Every morning I woke up at 5 am to find a freshly brewed coffee waiting for us. Although it can get quite warm in Honduras during the dry season, I always felt cool lying on a hammock in the shade. I never felt sick nor did anyone on my trip have any issues during the week.
Each night I arrived to my fan-cooled room and slept comfortably without interruption on a firm bed but very nice pillows and bedding. Although they warned us that the water temperature can be an issue, I had the nicest shower each night with plenty of pressure. Each room sleeps 4 people comfortably. Fortunately, I had the best roomies and we thanked each other in the end for being quiet sleepers!
In the end, I felt I had enough privacy and enough social interaction without feeling isolated or overcrowded. This may be different at full capacity, but I am not sure. After every long day, I looked forward to going to my new home to rest and replenish myself.
As a medical volunteer, I spent all my time in the Holy Family Surgery Center. The non-medical volunteer received their assignments the day before through a sign-up sheet.
Looking at their list I was glad I got to work in the center. The non-clinical volunteers told me they had a blast with tasks such as building sidewalks, cleaning buildings or washing pigs!!! Hopefully, they didn’t end up in our Sope!
Every day, the patients arrived at 5:30 am while we arrived at 6 am for a 7 am start. This did actually happen half the time but the other half of the time we need more time to find the necessary equipment and materials to get the day started.
In the U.S., we have an entire department with an army of people preparing the case carts for the next day. In Honduras, the sterilization department was the room next door with many of the staff members cross working many duties. Let’s just say it is amazing how much can be done with limited resources. What an amazing group of people!
We had many opportunities to use our creativity to solve seemingly simple problems. One case required a device to place patients on their side for surgery called a “bean bag.” It had been used the two days before with some trial and error.
On the third day, all the macgyver-ing we tried didn’t work. We asked if they could bring another bag but it was the only one they had. The next shipment due in June “may” have another one we were told but there is no way to know.
Several staff had to lift the patient straight in the air to take this bag out while we looked at another way to make the surgery work. In the end, we found some hip positioners used for a different surgery which did the trick.
The patients in Honduras have different problems than in the United States. They don’t take multiple medications and have multiple comorbidities and definitely do not have BMIs greater than 40 (morbid obesity), but they have challenges not seen in the states.
The vast majority of my patients were orthopedic trauma cases from gunshots or motorcycle accidents which either never received any medical care or they care they did receive made their injury worse. The medical mission surgeons said they have never seen infection or bone misalignment. As a result, they had to not only clean out the bone in less than ideal circumstances but with minimal equipment.
Many of the patients we treated were unable to walk due to their condition or injury. Thanks to the ingenuity of Dr. Merlin’s team and the medical mission they have a chance to walk and work again. Since Honduras has no social safety net, not working can be devastating for the entire family if the person is the only breadwinner. If long hours and creative thinking to help people in great need appeals to you then there are great rewards volunteering for One World Surgery.
It’s a Family Affair
Three of our volunteers were under 13. [PoF: And two of them were mine.] All three received special recognition at the final gathering of our medical mission. I was truly amazed how mature and poised these three young men were in dedication and work ethic.
None ever complained and all three worked hard every day. It inspired me to see them helping out and they genuinely enjoyed it. My only regret comes from not being able to bring my family on this medical mission.
I feel like my children missed out on an education that could never be provided by a public or private school system in the United States. Missing a week of school could easily be made up and I should have not been so worried about truancy. Next time I go I will definitely bring the whole family with me to share in an unparalleled and unique experience.
I recently read a compelling story of Lyndon B. Johnson by Dr. David Jeremiah on his book What Are You Afraid Of? Lyndon comes from Texas and stands at over 6’2” yet when he had a chance to run for the presidency in 1960, he froze.
He was a decorated Naval officer, a U.S. Senator of Texas defeating the active governor of Texas for the seat in 1941. His true motivation since a child was to follow in the footsteps of his hero, Franklin D. Roosevelt, He had the credentials, the pedigree, the presidential look and the experience to run a successful campaign yet despite this advantage he did what 85% of all people do when faced with adversity, he froze.
He doubted himself to the point of fear and hesitation giving his opponent, John F. Kennedy, a commanding head start. I am not saying that he would have won the presidency had he started earlier, but it certainly didn’t help. He settled for vice presidency after conceding to JFK in the democratic primaries and you know the rest.
The key to growth is acknowledging your fear of the unknown and jumping in anyway.” – Jen Sincero
If on the most seemingly confident and well-prepared individuals from our history books can let fear manifest and take over his rational self, imagine us mortals?
I admit when I was flying from Miami to Tegucigalpa and the captain started the approach, I did have a little fear of what was going to happen next.
Well, we landed safely. I went through customs in under 10 mins with my checked bag and arrived in a crowded airport with a wall of people in my path. I was a little taken back and I quickly scanned the crowd only to see the One World Surgery Sign. From this point forward all my fears and doubts quickly melted away.
Don’t let fear hold you back.
On a final note, I had an amazing experience and look forward to participating with One World Surgery in the near future. Thank you Holy Family Surgery Center team, NPH staff, One World Surgery Coordinators, all the medical mission members especially my amazing Pre-op and PACU teams, the brilliant translators, our hosting physicians from Honduras and of course Dr. Merlin, Dr. Daly and Lulu plus our amazing surgeons.
I also would like to thank my wife and family who constantly support me. Finally, I would like to thanks my Anesthesia Colleagues who made practicing medicine in Honduras a pure pleasure.
[PoF: I would like to thank the Doc of All Tradez for answering the call to serve and for sharing his experience with us today. For more from the good doctor, visit his aforementioned blog and check out his podcast, The Physician Negotiator, on which I was an early guest.
For more information on how to volunteer with One World Surgery in Honduras or at their brand new site for primary care in the Dominican Republic, please visit One World Surgery. They are changing lives every single day, and you can be a part of that effort.
For a recap of my family’s first week there, revisit One World Surgery: My Week in Honduras on a Medical Mission. I will say that both communication and supplies were much improved in the one-year interim between my first and second medical mission. They are constantly working to improve the experience for volunteers and patients alike.]
Final Days to Save $300 on WCICON22 Registration
The White Coat Investor Physician Wellness and Financial Literacy Conference, at which I'll be speaking about retirement withdrawal strategies along with several dozen outstanding orators, is taking place in sunny Phoenix, AZ from February 9th to 12th, 2022. Earn up to 17 CME / Dental CE. All in-person attendees must be fully vaccinated against COVID, and there is a comprehensive virtual / online option, as well. Hope to see you at the talks, happy hours, or online at WCICON22!
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Have you participated in a medical mission?