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.
Needs of the Community
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. 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 from the Duke Chapel congregation and funding from local Rotary International clubs will cover most project costs for a simple building with a concrete floor, running water, and electricity. 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.
OBJECTIVES AND PROGRESS
One major aspect of this project that needs to be addressed is how we are going to provide power to the clinic. In order to develop an efficient system we had to decide what appliances we need and in what quantities, assess how much power is required for these appliances, and what type of equipment would best serve these determined needs. Here is the system that we decided on:
We are charged with designing a comprehensive water system for the clinic. For ease in design, we have divided this aspect of the project into two sub-components: (1) the piping inside the clinic and filtration system and (2) the outside latrine and disposal of waste.
So far, we’ve designed a footprint for the building, and decided to use columns for support of the roof structure. The exterior walls and the columns will be built with CMU’s, each being 8″x8″x16″, and the interior walls will be constructed using clay or mud bricks, each being 4″x4″x8″. We’ll use strip footing under the exterior walls and spread footing under the columns. The roof will be made of corrugated material, with certain sections made of translucent material. Next, we’ll need to design the specifics on the footings, columns, and exterior walls like dimensions and reinforcement, and finally we’ll have to create a timeline/schedule for construction.