Francis Seivert greets assessment team in Montaña de la Flor

Friday, February 13, 2015

Full Story to be Published Soon

Greetings to all blog readers and supporters of Mission Honduras LeMars Medical / Dental Team 2015.
In the near future please visit for a look at the full story of this year's medical / dental team in Honduras. Many photos will be included with the story. We have chosen to focus most of our attention on the people of Honduras and not as much on the med / dental team.
Thanks for reading our blog during this wonderful expression of care for our fellow human beings. 
School Children Waiting Patiently To See A Doctor

Monday, February 2, 2015

Some Final Thoughts / Feelings Applied


The day dawned rainy, cool.
A slow drizzle shows through the 12 X 12 foot orifice in the outer wall.
It permits us to watch the play ground from the relative shelter of a stairwell.
The children are assembling for the morning session.
They line up in the bleachers that run two sides of the cement basketball floor.
It appears they arrange from youngest to older, left to right, with an angle in the middle where the seats turn a corner.
The kids are under a shelter cover.
A few teachers have umbrellas.
Everywhere, the clothes are brightly colored.
And the children are quiet, docile, still, a Victorian England ideal.
They are kids like kids anywhere.
They run.
They hop.
They holler.
Young teenage girls in uniforms was 3 and 4 to a gaggle, looking at boys from under long lashes.
The young men swagger, aware they're being watched.
Really pretty ordinary.
Except that it's cooler here than Omaha, Nebraska.


The kids come in by class and age.
First, a bit older. Maybe 3rd grade equivalent.
Even in 3rd grade, the ages are as uneven as the heights and weights.
Some are effusive, bubbling over, chatty.
Some look at us with hooded eyes, wary of the Gringas.
A quick assessment shows most are healthy.
Except for their teeth.
Whether it's diet or want of dental care, the state of these children's teeth is appalling.
Maybe it's both.
But from what is becoming clear in the realm of the relationship of dental to physical health, there is a developing crisis here.
And where there is crisis, there is opportunity.


The day warms. So do the children.
She is impossibly small of  stature.
And impossibly big of smile.
“Slight” might be a better word.
She runs up and hold up her arms.
Who can resist?
Who should?
A quick snatch and lift and she's taller than anyone in sight.
The reward for the lifter?
A look of pure delight.


He gazes warily at the triage nurse.
He has his assessment documentation paperwork.
Always paper.
She looks in his eyes; OK.
A swift glance at his skin; good condition.
An experienced finger-grip about the mid upper arm: too skinny!
Heart good, no murmurs.
Lungs clear, no asthma.
Belly soft.
Now for the mouth.
Tongue blade is coaxed between teeth that, clenched, slowly yield.
Tongue and throat in good shape.
Teeth, not so much.
Extensive decay in baby teeth and started in the few adult teeth that are erupting.
A referral to the dental section, a vitamin, and
She's done this before.


The morning is a bit slow as we get organized.
The afternoon is different.
It is now gorgeously warm out.
The team is sheltered from a stiff breeze.
The teachers have hit their strides.
And the children, like children everywhere, are glad for a break from the routine of school.
(...whoever thinks children in a country like Honduras are sniveling, fawningly grateful to sit all day in a classroom doing their sums and working on Palmer-method penmanship lessons doesn't know children; they are alike the world over.)
They scamper about in the sun, running and shouting, lining up only when it is their class's turn.
Lined up, but not silent.
As it should be.


She looked sick.
An experienced ER nurse picked her out from the crown at a glance.
Skin a bit too pale, breathing a bit too fast, nostril out.
A worried look.
She is hustled out of the Routine line for Special attention.
The nurse went over her more thoroughly.
Full vitals set. Temperature was too high.
Head and neck exam ok.
Heart good.
Lungs: a clear difference. Right back mid lung field sounded like someone was opening Velcro right under the stethoscope. The rest of her lungs were clear.
Abdomen was soft.
The rest of her was good.
Mom is with her.
Pneumonia;  the translator ensures Mom knows our thoughts.
An antibiotic is dispensed right now, a dose down the hatch right now.
Acetaminophen and a cough syrup round out the medications.
A few instructions to Mom and she is on her way home.
Lab? Couldn't tell us she was well.
Xray? Couldn't say she didn't have pneumonia.
It's not the well who need the doctor, it's the sick.


The dental clinic labors on.
The load is impossible, the need immense.
Children whose parent is not in attendance are screened for a future procedure.
Those whose parent is here receive advice.
Often, the advice is removal; it's all that can be done.
The parent nods yes, the translator ensuring they know what is intended.
A few shots to numb the jaw; there is no easy way.
Rare is the child who protests; their parent is soothing, holding a hand.
During the extraction, most parents look away.
The children are incredibly well behaved.
They sit as still as any child can.
No spinning, screaming, parent bribing, exchanging a trip to McDonald's for a modicum of compliance.
The tooth, or rather, the tooth remnants are out.
There is very little bleeding.
Acetaminophen, instructions, a gauze pack.
And the parents are truly grateful.
Even the children say “Gratias.”



Last clinic day.
And it proves to have interesting cases still in store.
(Hint: You don't want to be an interesting case. You're welcome.)
“Doc, what do you think about this?”
Coming from one of our nurses, I knew not to expect the usual.
His hair was too light.
His skin lighter than cafe au lait.
His eyes were a light yellow-brown that seemed wrong.
And they moved.
How they moved.
His eyes went independently in every direction.
His eyes moved like an iguana's, all quadrants.
Random nystagmus.
A syndrome.
How was he seeing?
How is his brain processing this random data?
Likely, it is not.
He is likely seeing the world in swift, herky-jerky pictures.
No way for visual centers to be trained.
But there is not much to be done for him, here and nearly everywhere.
But I wonder.
What if Google Glass could adapt it's technology?
We see at 30 frames/second.
Could a fast computer, hooked to a sensor that tracked his eye movements, display the scene that his eyes should be seeing at the peak of their arc?
I think there's a technology potential here.


It is late the final day; just a few children left.
That's when it always happens.
“Doc, would you look at this one?”
“Hey, Doc, this Mom just wants to talk to someone.”


“Buenas tardes. Que passa?” Spanglish. Good afternoon, what's going on?
“He passes out.” she translates.
“Tell me more.”
“He is walking and just passes out.”
“I need to know what she is seeing when he passes out. Does he shake? Is he awake? Has he been hurt? Start over. What does she think?”
The Spirit Catches You And You Fall Down.
He is awake the whole time.
He knows he is going to fall.
He always falls forward.
He never hurts anything beyond scraping his hands.
He's never hit his face.
He's never has a seizure.
He just lays there until Mom helps him up, then he's normal.
No one in the family has seizures.
There are no early cardiac deaths.
He plays football (soccer) just fine.
This never happens with strenuous activity.
It's only been t he last year.
...and so it goes.
His exam is normal, including a normal heart and neurological.
Intellect is at least average, I think higher.
I suspect he is OK; I tell Mom.
Rather, the interpreter carries the message.
I note a vague disappointment in myself that this didn't turn out worse.
That feeling swiftly corrects when my second thought intrudes.
There may well be nothing to do for him if this had been a bad cause.
So, wellness is a cause for celebration.


Swiftly the story comes out. In a disordered jumble, though.
It seems he isn't doing well.
Mom can't get more specific.
“What grade is he in?”
“How is he doing?”
The child stares at us, not disinterested, not interested.
But I'm interested.
His left eye is at half mast.
The eyeballs move normally, though.
Both arms and hand move symmetrically.
Ditto for his legs.
Just a few slurred sounds.
“When did he first speak, say his first word?”
“Cinquo anos.”
“5 years old????”
“Si.” No surprise or consternation.
“When did he first walk?”
“Ses anos.” No alarm.
“6 years?” Certainty is needed. Even the translator looks surprised.
“He is 12?”
“And in 4th grade?”
“Does he read and write?”
I'm doubtful.
“Has he ever seen a doctor?”
“At all?”
“Never at all. Until you.”
I hand over paper and pen.
His first name is Jose, last name ends in “z”. (You won't need more.)
“Escribe su nombre.” Write your name.
Perfectly formed, symmetrically spaced: J s o z
That's it.
“Haga esta problema.” Do this problem.
My last 2 is not very well formed so I correct it with a squiggle.
His solution?
2  +  2
That's it.
Except that he has precisely reproduced my error/correction.
He has my attention.
“Has he injured his head?
2 years ago, he fell off a wall and hit the right side of his head.
After that, his left eye drooped.
And Mom reveals her concern:
“Does he have a rock stuck in his head from the fall?”
She might be right, he may have had a brain bleed, but there is a deeper problem.
The learning disability predated the fall.
I suspect he has a form of cerebral palsy, a birth injury.
I toss my pen on the floor and ask him to get it.
Execution is perfect.
I repeat my clumsiness but add a request to put it on another table.
The pen comes back to me.
I negotiate with his teacher, translator helping.
“Are there any special education resources available?”
“Can we set up a special test and program?”
Having a daughter who is a teacher is going to help.
“Let's do this. Test him in the major domains: math, reading, writing, etc. Then place him in that grade level until he can test to the next grade.”
The conversation was more complex, but the idea is easier here.
There are 12 year olds in 2nd grade because their parents can't afford to send them to school full time.
And I talk to Mom.
“Jose may not be like other kids. But his sight is good, he uses both arms and legs well. He can draw well. He may not be a doctor but he will be able to function and, with the help the school can give him, I suspect he will function well. I don't think medications will help him. I think the school can. And I think he can have a good life.”
Mom departed, smiling, son in tow.
No tests, CT scans, MRIs. Just talking, examining, probing.
And a school that will help.



Today, we are packing to go home.
Yesterday was filled with thanks from the kids, the school, the community.
One can debate our impact.
I can debate it.
But for a least a small group of people here in Honduras, they remember there are Americans who care.
And the Americans remember a group about whom they cared and care.


Another long day, but not so long as we've had!
Leaving is prolonged and chaotic with the kids running all over.
An impossibly small girl is playing with a nurse, alternating listening to each others hearts.
The girl is fascinated by the bright yellow stethoscope.
The conclusion?
The only one you can.
A little girl went home that day the proud owner of a bright yellow functional stethoscope.
Maybe a future nurse?


Descending the mountain by bus brings to mind the complaint the priest lodged with St. Peter.
“I was a priest of God. Yet you gave this low life taxi driver a higher celestial place than me!”
“Father,” came the reply, “When you worked, people slept. When he worked, people prayed.”


The graveyard is cut into the mountainside.
Into rock. The real stuff.
The grave are so shallow, out of necessity and lack of alternatives, families pile stones high to frustrate the vultures.


The capital city looks weird.
After only a week in the mountains, the sight of a city brings out thoughts of chaos.
Where are all these people rushing off to?
Street vendors; how do they make a living/
Disable at intersections.
The occasional dignitary/politician forcing their motorcade of huge SUVs through traffic that is already struggling.
Makes one wonder if the city life is better.....


From the valley, we take a bus trip up (another) mountain.
We visit Santa Lucia.
Beautiful church where a baptism is occurring.
We walk through town.
We are obviously tourists; the inhabitants, invariably polite.
There is an eccentric genius in this area, maintaining a private preserve with walking trails.
A haunted house site with a structure he built from abode as done centuries ago.
An agave plant 8 feet tall and twice as big around.
An area devoted to demonstrating how the 7 continents will live together using sample vegetation.
Small fish ponds with fountains and srays.
A good hike.
The local version of the corner grocery makes a good rest stop.
Then an excellent meal, varied in dishes, high in the mountain.
(All expenses upon leaving the mountain are paid by the individual, not the foundation.)
Placita d'Susy.
Susy's Little Place.
There is a playground for the kids but no attached McDonald's.
The ride is staffed by a young lady in clown getup. She poses for a picture.
We stop for some tourist shopping. The Honduran currency converts 21:1 with a discount for Greenbacks. Local currency seems like play money.
Dusk drops quickly this close to the equator.
We are back at the hotel, showered and ready for bed.



Up too early.
A soft bed seems like too much comfort.
Out we roll anyway, most to shower, some to breakfast, some to Mass.
Church is a short walk away; the sunshine is glorious.
And where we're going...we'd better get a last dose!
72F here, 12F predicted for our arrival in Omaha.
Such thoughts can distract in church.
We enjoy the sun all the more on the walk back.
Final pack, check out, bus, airport.
We are being pulled back into the modern transportation system
For a while there, life was calmer, expectations manageable.
Back to reality, our reality.
And you.



Yours from Honduras;

Sunday, February 1, 2015

Med Team Leaves Honduras

At 1:13 the wheels were up and the medical team cleared the mountains in Tegucigalpa. They are now on their way back to the Midwest and well aware of the weather that will greet them. All agreed it was a wonderful mission trip.

Saturday, January 31, 2015

Final Report from Nueva Capital

30 Enero 2015
0530 hours

Mission Honduras LeMars Medical/Dental team followers.  This will be my final report on the progress of the team as the medical and dental elements were completed yesterday.  It was a very hectic day as usual.  The team continued to provide consults and treatment for approximately 400 children yesterday from Santa Teresa School.  The dental element was extremely busy as well.  Their numbers are included in the above number.  Sadly so many children needing dental care could not be seen and treated by the Dentists.  Each child received de-worming medicine, vitamins, antibiotics and various other medicines.

The team was surprised during the early afternoon by taking a few minutes from their busy day to listen to a young man play the organ.  This young man is blind.  He was first seen by the Heelan team during their first visit to Nueva Capital when they visited his home to take him various health items.  He truly is an amazing story and performs various concerts in the area.  He is well respected.

The team was also surprised when the school had a general assembly in the courtyard to recognize the efforts of the team.  You will see a photo of this in the blog.

After the final patients were seen all medicines and supplies had to be packed for transport to Cerro de Plata.  After all items were packed away the team gathered for a slide presentation by Father Patricio.  This was followed by a wonderful dinner and a general sing along which included all the staff members and young Honduran men working in various projects at the school.  It was incredible and the young men really enjoyed being part of this team.  I'm sure that the team members have various thoughts and emotions about this past week and know that they are leaving behind about 1800 men, women and children that have had their health status improved.  No, this was not rocket science, but the team members saw some incredible challenges both with the patients and the process.

Now a day of rest and then they return to the USA to continue to reflect on this past week.  I stay behind to begin the planning for the next brigade, Gehlen Catholic Mission Honduras.  They will be here in this same location in March where they will build 3 homes and perfom other missions.

Gracias Adios that all team members are healthy.  God bless and peace.

Mr. Francis

Friday, January 30, 2015

One Doctors Journal / Amazing


“My feet hurt. They burn.”
“How long?”
“6 months. Maybe more.”
“Do you have diabetes?”
“What do you take for your diabetes?”
“Metformin. Insulin.”
“How do you know how much insulin to take?”
“Do you check your sugar?”
“How do I do that?”
OK, there wasn't much point to going there.
“How much Metformin do you take?”
“1 gram.”
“When did you last take it.”
“A long time. I can't buy it.”
Blood sugar was 441.
This was not a problem I was going to solve here.
Then I changed my thought.
Informed by another patient from another time, my question became:
What can I do with what I have.
We have Metformin. Just about a bucket full.
A trip to our dispensing pharmacy yielded a bag of Metformin.
He was so thrilled, he proclaimed at the gate to anyone who would listen:
“Look! I couldn't afford 30 days of Metformin. They gave me 6 months!”
I don't know that we made a real difference as measured by US standards, but, to him, someone cared.
And that's why we're here.


Once there was a boy.
All good stories start with “Once there was...”
Once there was a boy.
He was walking along the seashore, occasionally bending over then standing, tossing something.
An older, wiser man came along.
“What are you doing?”
“I'm tossing the starfish back in. The tide left them here. They will die here on the beach. So I am throwing them back.”
“Don't you know? There are a million starfish just on these few miles of beach. You're not making any difference!”
The boy, heedless, bent over and tossed another starfish back in.
“Well, to that starfish, it did!”
And that's why we're here.


I'll break habit for a few minutes.
The stories of patients we are seeing here are made possible by a self-organizing army.
That army is made of nurses.
Admittedly, it is trite and redundant to praise nurses.
Ever see a protest in favor of nuclear war?
The nurses have been manning the access point, the triage area.
There are some 300 “tickets” given per day.
Do the math.
If a physician sees every one of these and we have 4 physicians, at 15 minutes each we'd be done with the first day sometime next week.
So, with physician backing (not that it's needed, but it's good to have everyone on board communicating), the nurses have organized the intake process.
The basic concept is thus: If, in their collective experience,  what the patient needs is something they could do without a physician or can be handled by protocol order (antihelmenthic for weight), they just do it.
The idea is to drive decision making to the level closest to the decision.
This is a deceptively simple concept.
Command-and-control systems have never worked; this one does.
And it is due to people taking responsibility for their professional actions and executing the mission.
And how successful?
Over ½ of the people presenting for care are cared for primarily and only by the nurses.
The physicians make periodic visits to maintain appearances.
But frankly, given the acceptance of the populace and the excellence of the nurses' work, I think it's just vanity.
Which is ok; we have a lot to be vain about!


72 years old.
She had this ache.
That ache.
Legs hurt.
Bowels were slow. Or fast.
In the US, fibromyalgia; a group ripe to get hooked on narcotics.
And narcotizing pain might be ok as long as one can live with the consequences.
But she didn't want narcs and I didn't have any.
So we talked.
She lived at home; no nursing home or assisted living.
How long ago had her mother died?
She didn't; she's 85!
As we talked more, the patient disclosed she was afraid of dying.
And this lead to a conversation in English-Spanish with a translator helping.
We talked about how none of us will get out of this life alive.
We talked about her life to now.
We talked of many things.
But mainly we talked of living.
And, on leaving, she gave us both a hug.
She said she felt better.
And I felt I'd been paid a fortune.


Short of breath.
Oxygen at 92%.
Heart too fast.
Crackles in the right lower lobe.
She had pneumonia.
I didn't need an Xray for that diagnosis.
I did need guidance.
We got her Tylenol.
A breathing treatment.
Oral antibiotics.
We talked to the patient and family about what to do next.
They were clear: antibiotics and take care of the matriarch at home.
With an admonition to goto the hospital if she worsened, we got a week of levofloxacin ready for her.
But how to get her from the clinic to the auto?
We didn't have a wheelchair and there were stairs to mount.
Up show the Bomberos, local Fire Brigade.
They made a Bomberos-chair.
A plastic resin deck chair and a few strong men, a trip up roads and trails and she is at home.
The outcome?
I don't know.


Weak, tired, headache.
I'd heard it all before.
But not from her.
For each patient, you begin anew.
Their telling of their story to you is anew.
Muscles ache.
“Where do you work?”
“At home.”
“How many children?”
They were all in the room with us.
“Is there anyone else at home to help?”
“My husband is dead.”
She was young, just 25.
“I'm sorry to hear that; he must have been young. What happened?”
“Motor vehicle crash.”
Widowed. Young. 4 children.
Her pain was so much more than physical.
All I had to offer was a sympathetic ear.
And with the superb aid of an interpreter, we heard her story.
Sometimes all you can to is listen, witness.
And sometimes, that is enough.


“Las piernas duelan.”
My legs. They hurt.
She was on the far side of 70.
I am sure she had done her fair share of hard work.
Her legs hurt, she tells me, when she has to walk a long way.
How far? When?
Today. A half hour.
She had surprisingly good pulses; blood vessel blockage unlikely, especially with a ½ hour walk!
The varicosities on her legs told another story, long hours on her feet.
Caring for a family?
Working to make tacos, frijoles,sustenance for a family?
I couldn't change her life.
But with an elastic bandage for each leg, I could make her feel better.
And she walked out with a lighter step.


She was slight of build.
Her answers were swift, certain.
In summary, she just wanted to know she was alright.
She was.
So we talked.
“What are you going to do with yourself?”
“Go to university.”
“To study what?”
“What do you want to teach?”
“At what grade level?”
“High school.”
Great goal. And I thought she could do it.
“My daughter teaches in high school.”
“How does she like it?” she asked.
“Loves it and the students love her. When she complained about being short, her students corrected her: 'Miss, you're not short, you're fun-sized.'”
She laughed and got up.
And I made the only useful suggestion I could think of:
“No chicitos (boys).”
She laughed again.
I think she'll make it.


An aside that is far from an aside.
With my skills at Spanish, i'd be sunk without help.
We have translators, interpreters.
What a privilege, to hear these stories.
They help immeasurably.
Of course, there's the nuts and bolts of ensuring I understand what the patient is saying and vice versa.
But there is much more.
I'll leave out names; those here will recognize these people.
I'll add names only  if given permission of the names' owners.
First is the lead translator; she met us at the airport and kept up a lively string of commentary all the way to our Base of Operations. (See Lat/long at the beginning.)
She volunteers her young daughter to help.
Although a bit embarrassed at some of the questions, she helps, especially in the Respiratory section.
There's a woman who works with street people. She helps me understand why people who are homeless return to the streets from a shelter. The streets are home. From her, I get an education on this population that I can apply back home.
And she studies me quickly. She learns my routine instructions so well that I can give the first sentence and she runs with the rest. She's like a macro; I'll work with her any day,
Then there's a familiar tone speaking unfamiliarly. That is clearly an Italian-accented Spanish speaking English flawlessly. (Aside: I love listening to languages and Italian is, to my ear, one of the most beautiful. In Spanish, it's even better.) We work together at the end of a long day. She is clearly tired; I am. But she gamely lies and accepts another patient.
Last and hardly least is a priest who accompanies us.
(OK, who this is is hardly confidential.)
His Spanish is smooth, practiced. And you can tell he's worked with people; my most intimate, embarrassing questions are translated both ways without a hint of judgment. Clearly, the people trust him. As do I.
We clinicians trust these people to help us make the best medical judgment we can for this population  in the circumstances we all find ourselves.
And isn't that what it's all about?


The stories.
What a dream job.
I get to hear stories.
People tell me stories all day long.
What a dream job.
All I have to do is listen



Yours from Honduras;