Monday, April 26, 1999

Mitch's memories linger

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Disease not the only obstacle for UC medical team

BY SAUNDRA AMRHEIN
The Cincinnati Enquirer

Maria Inez Acotsa, whose husband was slain and who was left homeless by Mitch, wonders how to care for daughter Soyla, 10, and her four other children. (Gary Landers photos) | ZOOM |

        LA LIMA, Honduras — The fingerprints of Hurricane Mitch can still be seen near this Honduran city. Six months after the storm pummeled Central America, bridges lie in rubble and tent camps house the homeless.

        But Amy Cassedy is searching for the invisible scars left by the killer storm. The 37-year-old University of Cincinnati research associate and assistant sociology professor from Batesville, Ind., is looking for villagers suffering from post-traumatic stress disorder.

        She's with a group of 60 UC doctors and volunteers with nonprofit Shoulder to Shoulder Inc., a humanitarian group. The team is in Honduras for two weeks, six months after the hurricane, to treat illnesses triggered by the storm. The group expects 10,000 patients, many suffering from malaria, dengue fever and malnutrition.

        Instead, they see about 5,000 patients — most complaining of such less-than-tropical illnesses as arthritis, upper respiratory problems, cancer and AIDS.

        It has left the students frustrated with their inability to provide long-term medical solutions in this impoverished country where doctors are rare outside of cities and there is just one hospital bed for every 1,125 people.

        Amy is about to test the limits of her own strength.

        She and Pilar Valencia, a professor of Spanish at Northern Kentucky University, visit a homeless shelter in La Lima.

        They hold forms, ready to pencil in the appropriate numbers about frequency of loss of sleep, appetite or weight. The results will be scanned into a computer in Cincinnati when returns, and then sent back to doctors in Honduras.

        At the shelter, roosters and half-naked children greet them at the entrance. Dison Valladares emerges from one of the shelters. The one-room units, which may house five or six people, have 132 square feet of floor space, the size of a large walk-in closet. The shelters lack both electricity and plumbing.

        He is the coordinator of the camp, which is run by the Association of Evangelistic Churches in Honduras. Thirty-two families live in this camp. An estimated 140 people are wedged between a soccer field on one side and the garbage-strewn Chamelecon River on the other.

        Mr. Valladeres tells visitors how the dwellers lost their homes in the storm. How they were moved here from shelters in schools after classes resumed March 1.

        At the end of the first row of houses, 23-year-old Maria Inez Acosta worries her youngest child might die. Jose David is 5 months old, suffering from diarrhea and vomiting. Maria was left alone with her five children after her husband was murdered a year ago in Mexico en route to find work in the United States. The storm left her and her children homeless.

        “There's too many kids and not enough help and not enough income for my children,” she tells doctors. Her dark brown eyes droop. She wearily rests her head in her hands.

        As Amy talks to the women, the acrid smell of human excrement on one of the plastic walls, baking in the noon sun, chokes her. Large green flies swarm around, biting her.

        She and Pilar return that night to the Hotel Plaza Victoria in El Progreso, about 10 miles away, visibly shaken. They have far more information than their survey forms can hold.

        “This is the worst I've ever seen,” Amy says, her face ashen and sweaty in the light of a candle. Outside, the city streets are black, without electricity. The hydroelectric dam near town is short on water in this dry season.

        “We talked to six people. And I can tell you right now, at least four of those six” have post-traumatic stress.

Hurricane Mitch damaged the walls of Guadelupe Barrientos' home (rear) in San Jose, and she has no money to make repairs. | ZOOM |

        At dawn the next morning, her fifth day in Honduras, Amy enters the hotel lobby, which is abandoned except for a potted palm and a tired, red-eyed clerk behind the mahogany desk. She is still upset about her experience in the camp.

        “I don't know if people have just forgotten about them,” she says. “I'm not sure who's deciding why particular brigades got to certain areas.

        “If they haven't seen doctors roll by (the homeless camp) and the folks in Urraco have seen them every couple months, why?”

        She starts to cry and heads for the door. “I'm sorry. I didn't want to do this. I'm trying to be a researcher,” she says with a weak laugh, making a fist, signifying strength. “But this was just ... whew.”

Fear of rain
        Amy's frustration with the overwhelming and deep-seated problems of Honduras are echoed by several UC medical students during their stay.

        They came to mend the wounds of those who suffered Mitch's wrath in late October. But the young, future doctors are learning the difficulty of making a permanent difference here. For most of their patients, life went from difficult to impossible after the hurricane.

        So much is outside the students' control. Medical training in Cincinnati cannot prepare them for the challenges of fixing destroyed houses, finding their patients jobs, securing seeds to replant — or preventing another hurricane.

        Rosa Elena Gonzales trembles when it rains. During Mitch, the San Jose woman crouched in the corner of her house with her eight children as two mud brick walls and part of the roof collapsed in on them. During a brief question-and-answer survey with UC medical students, Rosa tells her fears of more storms to 25-year-old Heather Owens of Clermont County and the others.

        As it does for her neighbors in the mountain village of San Jose, the rain dredges up horrible memories and ushers in dread of what's to come.

        Everyone's heard the forecast on the radio, and they're afraid: 14 hurricanes this year; seven possibly as powerful as Mitch.

        After the rain stopped that late October night, repaired the house herself but lost her cornfields. The 38-year-old woman became a widow before the hurricane last year when her husband was murdered during a bar fight. Now she has no way to feed her children once donated food runs out.

        “I feel sad because my children don't have their father,” she says, breaking into tears.

        and the UC group sit frozen on their wooden chairs.

        Seconds pass and one of the doctors stands up and puts a hand on arm to comfort her. “Lo siento,” he says. I'm sorry.

        later says she can't get that visit out of her mind.

        “I can't imagine going through a hurricane, let alone without my husband and with eight kids.”

"The smoke in the air'
        The stars of Orion's sword drip like pearls down the night sky in San Jose while Saturn glows behind the mountain's silhouette like a blood-shot eye. But what Honduran medical student Saura Fortin notices is the odor.

        “You can smell the air, can't you,” says the 21-year-old student who attends Honduras' only college, the National Autonomous University in Tegucigalpa. “The smoke in the air. That's why there are so many problems, because all the women use wood-burning stoves in their houses.”

        Doctors and medical students spend much of their stay treating adults and children with upper respiratory problems. The cause, they say, is the adobe, wood-burning stoves that generally sit unvented in the same rooms where villagers live and sleep.

        It's tough to see the suffering in her country, says. But the trip is extremely important for young Honduran medical students like herself and six others who are on this mission.

        “I have classmates who are very rich and have never seen anything like this before,” says who says she is from a middle-class family. “You have to feel the pain and see it to be able to relate. Sometimes when you're in the city, you tend to forget.”

When the drugs run out
        As the early rains of Hurricane Mitch hit Honduras back in October, Ambrocio Martinez was packed in the back of a pickup truck with 18 other people, including his four sons. In the heavy rain, the truck slid, flew off a bridge and slammed into cement, tells

        The 64-year-old farmer was thrown from the truck. Two people were killed. stayed in the hospital for 22 days.

        “He can't smell anymore, he can't taste anymore, and he gets blurry vision when he works hard,” says, consulting with a UC attending physician.

        As talks to the doctor, removes his brown cowboy hat and covers his face, which is creased with a 20-year-old machete scar that runs from his nose to his left ear. His head droops to the blue-green school table where he sits.

        The man likely has arthritis of the spine. In the United States, doctors could have performed surgery or joint replacement. But that cannot happen here.

        “What do you want to do?” the doctor asks

        “Give him some pain medicine,” she says. “I don't know if there's anything we can do for the loss of smell.”

        They decide to prescribe an anti-inflammatory drug and pain medicine.

        collects his pills and joins his wife on the dirt street. The return home is a two-hour journey.

        sits slumped on a school bench and slaps the desk.

        “It's like a Band-Aid,” she says of her care. “Because we're going to be gone in two weeks. Say we give them a month's worth of medicine. What do they do when it runs out?”

With an audience, fourth-year medical student Bob Bibbitt sutres the leg of a patient at the San Jose medical clinic. | ZOOM |

A trip made worthwhile
        Amid the frustration and squalor, the UC team saw signs it had made some difference in the villages it visited.

        Students preached the public health virtues of clean water, soap and the need to prevent dehydration. They learned to diagnose illnesses and injuries. They also learned to improvise. For instance, as tubes of anti-fungal cream — a vital treatment for common foot problems — ran out, students made a lotion by dissolving yeast infection pills in water.

        And then there was Melvin.

        The 5-year-old boy was brought into the clinic by his mother one day, near death. Already stricken with pneumonia, Melvin had suffered a severe asthma attack.

        UC Dr. Doug Smucker cleared a space for him on a table and laid him down. Melvin's eyes stared blankly, then rolled back into his head.

        Doctors scrambled to find an inhaler for the boy. Within minutes he pepped up. Dr. Smucker, an attending physician, gave him an antibiotic. But Melvin needed more. He needed to be taken back down the mountain to the hospital in El Progreso.

        One of the UC team's Honduran contacts happened to be in San Jose, checking on the group, and was about to depart. Dr. Smucker jumped on the chance and put Melvin and his mother on the truck. He gave the mother, Maria Valderramos, 200 lempiras — the equivalent of about $14 — for the journey back up the mountain when Melvin was better.

        Two days later, Melvin returned. This time, he was walking around, his mother at his side with a big smile on her face. She came to say thank you.

        “There's Melvin! There's Melvin!” the students and doctors called to each other.

        Melvin clutched his lollipop and stared wide-eyed, not understanding the fuss around him.

        Saving the small boy “made the whole trip worthwhile,” Dr. Smucker said.

"You have to come back'
        The truck carrying Dr. Smucker and eight others of the UC team back to El Progreso from San Jose jockeys down the mountainside. The cool air washes their faces and arms.

        Dr. Smucker surveys the undulating mountain slopes spilling out from under the truck and the narrow rocky road that carries them.

        He makes a mental note to himself to find a walker and makeshift wheelchair for two women in San Jose.

        He hopes to return. So, too, do others from this UC team. Someday, they might come back to set up a permanent clinic.

        Maybe at that time, their frustration and feelings of futility will be quenched.

        Until then, Dr. Smucker says, sometimes you feel like all you do is hand out Ibuprofins all day.

        Then there are times when you save a boy's life.

        “That's why you have to come back, again and again and again and again.”

       

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