Breath Brigade

Physicians’ working vacations help to ease health care deficiencies a world away

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BY Gwen Ericson

EACH SPRING for the past nine years, Mario Castro, MD, MPH, has led a brigade to central Honduras: a troop of medical professionals called the Pulmonary and Allergy Brigade, that is. Their five-day mission: to evaluate and treat hundreds of patients with respiratory disorders.

This volunteer group of doctors, nurses and respiratory therapists provides specialized care to Hondurans that local physicians can’t, either because they lack the training or because medicine and other supplies are limited.

On their medical aid expeditions, Castro’s team has long partnered with teams led by Saint Louis University otolaryngologists Thomas J. Donovan, MD, and John F. Eisenbeis, MD. Recently they were joined by a Washington University team specializing in newborn medicine led by Joan C. Downey, MD, assistant professor of pediatrics, and a group of Washington University heart care specialists led by Victor G. Davila-Roman, MD, professor of medicine in the Cardiovascular Division.

What began as a drop of aid in an ocean of need has created waves with lasting results. The medical teams bring equipment, supplies and medication; they give educational sessions for local physicians; they work with medical students; and they started a medical research project. Not only that, they have helped set in motion construction of a hospital in the district. The new facility, with beds for more than a hundred patients plus surgical and emergency care units, opens this year in June.

Mario Castro, MD, with a Honduran child.

IN THE RANK of the poorest countries in the Western Hemisphere, Honduras stands third behind Haiti and Nicaragua. Its depressed economic status is reflected in health care characterized by deficiency — in medical specialists and nursing professionals and in facilities, modern medications, functional equipment and basic supplies. This lack is felt especially in the isolated rural areas of the country.

The respiratory health of Hondurans suffers from the effects of widespread air pollution. Across the Honduran countryside, tens of thousands of small fires burn as families prepare meals over simple wood-fueled stoves called fogón or chimenea. The stoves often aren’t vented to the outside.

“Families are cooking indoors and heating their houses with firewood, keeping fires going all day,” says Castro, professor of medicine in the Division of Pulmonary and Critical Care Medicine and of pediatrics. “Babies and young children are breathing in the smoke and soot. We see kids with runny eyes, nasal irritation and particulate matter coming from their noses. Many of them are wheezing, coughing and short of breath — all common symptoms of asthma, a significant problem in this area.”

“People walk for days to get to our clinic. And they wait for hours to see us. We never turn anyone away.”
— Mario Castro, MD

The Pulmonary and Allergy Brigade is sponsored by the International Medical Assistance Foundation (IMAF) and the Catholic Medical Association. Castro and other St. Louis-area physicians established the IMAF to help support their medical missions to Juticalpa, a town of about 60,000 in central Honduras.

Juticalpa lies in a mountainous region, and the city spreads out in typical old-world fashion, its streets winding haphazardly toward the community’s hub containing the town square and a church. Although picturesque, Juticalpa’s unpaved streets contribute to lung disorders: older-model vehicles with no emission controls spew exhaust and stir up dust. Moreover, the city has no trash service, so the residents must continually burn their rubbish, adding to the pollution.

“It can be hard to breathe in Juticalpa, and the poor air quality especially affects kids,” Castro says. “Nearly two-thirds of the patients we see during our missions are young children, many with severe asthma.”

A long line of patients awaits the members of the brigade as soon as they arrive at the Hospital San Francisco, a small state-owned facility on the outskirts of Juticalpa. The patients are referred by local doctors for respiratory problems that can’t be treated with medications available in Honduras. By the end of their stay, the team will have seen about 700 patients, funneling them as quickly as possible into and out of cramped clinical quarters.

“People walk for days to get to our clinic,” Castro says. “And they wait for hours to see us. We never turn anyone away. We treat people of all ages, and although we primarily treat respiratory conditions, we also end up treating everything from hypertension to headaches, menopause to mites.”

The Hospital Santo Hermano Pedro in Catacamas

A typical day with the brigade is chaotic, with five or six patients receiving nebulizer treatments, in which they inhale a mist of medications, while other patients are giving their medical history, getting their vitals taken, having a physical exam, or learning to use new drugs. It’s very noisy and very crowded. And that’s during the calm hours.

Castro says that nearly every day brings at least one medical emergency. For example, on the first day of the 2007 medical mission, the volunteers were faced with a premature baby in respiratory distress. Luckily, that year, newborn medicine specialist Downey was with the group. She knew how to rig up a system to deliver lightly pressurized oxygen using just an oxygen tank and supplies you can pick up at a hardware store. Five days later, the baby was breathing on her own.

Last year, cardiologist Davila-Roman joined the mission, bringing a team of heart care specialists to the hospital, which has no cardiologist. The staff of the hospital’s emergency room frequently called on the volunteers for help with critically ill patients with heart complications.

Their missions, though brief, have durable effects. Each year, they offer training to update the skills of local physicians, and increasingly they are finding that returning patients have better control over their medical conditions. The groups also bring in medical students from the local medical school at the Universidad Católica so they can gain valuable experience. In collaboration with this medical school and Esteban González Burchard, MD, and Joshua M. Galanter, MD at the University of California, San Francisco, Castro has helped set up a research program to study the genetic causes of asthma among Hondurans as part of a larger study of asthma genetics in Latino populations.

Recently, Castro, other members of the IMAF, and leaders of Catholic dioceses in Honduras and Fort Worth, began pushing for a new hospital in Olancho, the state in which Juticalpa lies. It was clear to them that the single hospital in Juticalpa was insufficient to serve the half million people of Olancho. Funding from the Honduran government, St. Louis contributors, and the Fort Worth diocese made possible the construction of Hospital Santo Hermano Pedro in the nearby town of Catacamas.

The hospital is set up especially to accommodate groups such as the pulmonary brigade. A permanent staff of doctors and nurses will provide primary care, and medical teams from outside Honduras will provide specialized care. The hospital contains a residential area for the traveling teams to stay in.

“The people we see during the medical missions are so appreciative,” Castro says. “That’s one of the things that keeps us going back every year and why we’ve worked to make permanent improvements. It’s very hard work, but everyone who goes finds it extremely rewarding.”

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