Clinica Esperanza
Welcome Packet
Welcome to the clinic! We’re so happy to have you here. To help things run a bit more
smoothly during your time with us, we’ve put together this manual. Please take some
time to review this information before your arrival. We will be very happy to answer any
questions you may have, and we’ll do our best to keep this information up to date. There
is also a website www.clinicaesperanza.com and a Facebook group “Peggy’s
Volunteers” that you can join. Our website especially has a lot of background
information on the clinic and the island, and is definitely recommended reading.
Before You Come:
Travel to Honduras:
You need a current passport that will not expire within the next 6 months. You do not
need a visa to Honduras if you are coming from the States, Canada or the E.U. When
you enter the country you will get a stamp for either 30 or 90 days for a tourist visa. If
you are planning to stay longer than 30 days please ask for the 90 day stamp at
immigration. On the immigration form where it asks the purpose of your visit, put
“other” and write in volunteer. Also, there is an exit tax to leave the country of $34.04,
remember to set this amount aside for your trip home. This can be paid in lempiras or
dollars but CASH ONLY, so no checks/travelers checks/credit cards. Please remember
to check with your government and the local Honduran Embassy for more updated
information.
Health Information:
We recommend a travel medicine visit before coming. Bring a supply of your own
prescription medications as many meds are not available in the same form that we have in
the U.S. You should have all of your regular immunizations including tetanus booster
and Hepatitis B (series of 3 over 6 months). The CDC website www.cdc.gov lists
additional recommended vaccines. Hepatitis A (a 2 dose series 6 months apart) is
definitely recommended, as is a typhoid vaccine. The Rabies vaccine is available as well,
and is particularly important for people who would be interacting with animals on a
regular basis.
Malaria prophylaxis is strongly recommended, usually chloroquine, which you need to
start 1 week before your trip and continue for 4 weeks after arriving back home. Dengue
is also prevalent on the island, so bring plenty of insect repellent.
Sunburns are also a common complaint for visitors, be sure to bring an adequate supply
of sunscreen and protective wear.
We also do recommend evacuation insurance. There are several companies that provide
this service. If you are planning on diving, it may also be worth it to get additional dive
insurance.
www.travelguard.com/travelinsurance/products/MedEvac.asp
www.medjetassist.com
www.globalunderwriters.com
www.totaltravelinsurance.com – This is a clearing house website that lists multiple
different plans. I would recommend still contacting the companies directly to set up your
policy but this will have some comparative quotes.
Travel and Health Information specifically for Honduras:
http://wwwn.cdc.gov/travel/destinationHonduras.aspx
http://www.voyage.gc.ca/countries_pays/report_rapport-eng.asp?id=121000
Volunteering Information:
There are two types of volunteers in the clinic. “Medical professionals” include residents
and attending physicians, RNs, and other medical specialists. These medical volunteers
will need to send us a copy of their diplomas and license in order to work in the clinic.
Please send us a scanned copy at least 2 months prior to your visit. You can either scan
the documents directly or take a photo of them and send us the photo. This is a
requirement of the Honduran government and is absolutely essential documentation.
Volunteers who are not healthcare professionals include undergraduates, medical and
nursing students (students in their clinical rotations will be precepted by medical staff and
cannot see patients on their own), and layperson volunteers of many types. Volunteers
are expected to make a commitment to the clinic for 1 month, and to make a donation to
the clinic of $500. We also have an application form that needs to be filled out by our
volunteer staff. If you are applying for credit from this experience and need an
evaluation, please notify us before you come, bring a copy of the evaluation with you and
give it to us early in your trip. Do not give it directly to the MDs. This helps to ensure
timely completion of your paperwork.
Donations:
We welcome any donations that you are able to bring. Medications should have at least 6
months to their expiration date. Please check with us if you have any medication related
questions on a case by case basis. We can always use vitamins (especially infant drops),
ibuprofen/Tylenol, cough and cold preparations, tooth brushes and paste, and other
medical supplies such as gauze, bandages, etc. We also see a large number of patients
with high blood pressure and diabetes, and medications for this condition are in high
demand. Please check our website for an updated list or contact us by email for specific
questions.
General Information:
Permanent Clinic Staff:
Dr. Raymond Cherington - Medical Director, Family Practice Physician
Miss Peggy Stranges – Founder, Nurse, general operations of the clinic. She is often very
busy and does not see patients herself, but is the coordinator for all the work we do here.
Cherry Kay – Head nurse
Dr. Rafael Solis - Pediatrician
Angely Solis Gil - Reception
Karla Reyes Webster – Reception, Triage, Medication dispensing
Alison Medence – Administrator
Jorge Archila – Dentist
Permanent Clinical Volunteers:
Dr. Patrick Connell – Medical Advisor
Pauline Sampson, RN - (staff nurse), Coordinates volunteers in clinic, organizes
donations and supplies
Wenda Sage NP – PAP smears, works in pharmacy, organizes supplies and donations
Linda Millaire – volunteer coordinator
Anna Smith – volunteer education director
Short-Term Volunteer Positions:
Triage – checking in patients, getting vitals and a chief complaint
Physicians – here for 1 month at a time, a mix between adult, pediatrics, ER, and FP
doctors. We also sometimes have specialists who volunteer, in those cases we like to
know in advance what they will be doing so we can keep track of patients in need of their
services. We have both residents and attendings who volunteer.
Pharmacy – this is one of the most essential jobs in clinic, filling medication orders and
dispensing meds, while keeping track of the medications in stock.
There are also some special projects that come up at varying times during the year,
coordinated by Miss Peggy and Pauline. We work within the community and the local
schools on multiple health education projects every year.
Medical students and nurse practitioner students in their clinical years can see patients
under the supervision of a licensed physician. Nursing students may give injections, do
wound dressings and assist with other procedures depending on their degree of
experience. Preclinical students may occasionally shadow doctors but will primarily be
involved in other aspects of the clinic, rather than direct patient care.
How to Get Here:
The Clinic is located on the main road from Coxen Hole to West End, in Sandy Bay. It is
on the side of the road opposite the ocean, across from the Sonrise Mission and
Anthony’s Key (for locals, next to the Ferreteria).
If you are staying in Sandy Bay the clinic is a short walk up a big hill.
If you are in West End, West Bay or another area, you will most likely take either a taxi
or a bus. The taxis on the island operate in 2 ways – private, which is much more
expensive, or “colectivo” which means you will be sharing a taxi and the driver will stop
to pick up others along the way, as many as the car will hold. This option is the usual but
it is important to clarify with your driver that you want colectivo service or else they will
charge you private rates. It takes about 10 minutes to get from West End to the clinic,
and usually costs about 20-25 lempiras ($1.25). If you pay in dollars it’s a little more –
usually $2, and another tip is to negotiate price before you get into the taxi. Tell the
driver you are going to Sandy Bay, Clinica Miss Peggy. There are also public buses that
stop in West End and Sandy Bay which are cheaper but more crowded. They cost about
15 lempiras. Buses only run during the day, taxis run later but rates definitely go up after
dark.
How the Clinic Works:
Patients arrive at the clinic starting at around 6 AM to get in line and be triaged. Nursing
staff and triage staff arrive at 7:30 am and patients are checked in by the triage team. The
patients are then seen by the medical staff. Doctors usually arrive at 8 am to start seeing
patients. We are now using a computer system for charting so after seeing a patient you
will enter a note, print and sign it and put it into paper chart. The charts are then given to
the pharmacy staff, who fill any medication orders and then dispense the meds with
instructions to the patients.
Most patients speak Spanish though native Islanders speak English (about 70/30%).
There are some people in the clinic who can help translate, particularly Cherry Kay (the
head nurse in the clinic) and the registration clerk (Angely). It is very helpful to have
some basic medical Spanish as often these people are busy and you might have to wait to
get help translating.
Clinic Hours: Support staff is expected to arrive by 7:30 am, and doctors / clinical staff
by 8 AM. The clinic is only open in the morning but depending on the day patients can
be seen late into the afternoon, especially on Mondays when it tends to be fairly busy.
We usually finish around 1-2 pm, and it helps to have a snack and some water on hand.
Some local women sell snacks outside the clinic in the morning, and there is a
microwave, fridge, and coffee maker at the clinic.
**Volunteers are also expected to participate in other projects at the clinic and in the
community that take place after regular clinic hours. You will be informed of those
commitments in advance, but you can expect a few afternoons/week to run later than the
clinic hours. There are also some evening events which we strongly encourage you to
attend. This helps us, and more importantly the community which we serve, and it also
adds a great deal to your experience on the island.
Tests and Procedures available in Clinic:
Blood sugar – done at triage
Urine dips (bags and catheters available for peds patients)
Urine pregnancy
Suturing
Nebulizer treatments
I&Ds
Injections for vitamins, abx (depending on med availability), tetanus (for wounds)
Ultrasounds – depending on presence of skilled provider but the machine is here
ECG
Labs – malaria, strep, HIV, monospot rapid tests.
Referrals:
There are often specialists that come to the island for brief mission trips, and we keep
lists of patients who will need to see them during their stay. Check with Peggy or other
permanent staff about upcoming specialist visits for non-urgent referrals.
Urgent referrals are decided on a case-by-case basis, discuss with Dr. Raymond, Dr.
Patrick, or Peggy for more information as needed.
Labs:
We do not yet have a functioning lab at the clinic, for patients who need more extensive
lab work, there is an order form that can be filled out and given to the patients. They can
either go to Anthony’s Key Resort where there is another private clinic with lab facilities
or to the Public Hospital in Coxen Hole. This is very helpful especially for fever patients
to get a CBC, malaria smear and dengue serology. X-rays are available at the public
hospital and at AKR. Patients do have to pay out of pocket for these labs so consider
carefully what is really necessary.
Frequent Diagnosis
Pediatrics:
General information: Most children get multivitamins (1 month supply, and prenatal
vitamins for girls > 13 yo) when they come to the clinic. We also sometimes have
toothbrushes available. Regular immunizations are given at the public hospital, and there
is a very high rate of vaccination on the island.
URI – We usually do have some cough and cold medicines for children, as in the
states usually treated w/ supportive care for children < 6 yo. For babies you can
prescribe a bulb suction (“peria”). We also have normal saline here, or parents
can also either buy it OTC or mix their own.
Asthma/ RAD – fairly common among our patient population. The clinic has
some nebulizers on site for treatments during the clinic visit. Asthma medication
availability is more variable. We almost always have some form of steroids, and
sometimes we have albuterol inhalers in stock, we usually don’t have masks/
spacers but one can be improvised with a plastic cup w/ a hole in it. For severe
asthmatics who are too young to cooperate w/ an inhaler, we occasionally will
give out nebulizers. It is always important to check that the patient has electricity
available to run the machine, and one of the permanent clinic staff (usually Carla)
will take down all the details of how to find this person to be sure to get the
machine back.
Parasitic infections – Commonly ascaris, hookworm, giardia is also prevalent.
Stool tests (examen de heces) are available but some doctors treat empirically.
For young children, it is important to treat with both a paralytic (piperazine 75
mg/kg) and an additional medication (albendazole or mebendazole) to prevent
complications of treatment such as worm ileus.
Skin infections – a very common complaint for both children and adults. Many
kids will have insect bites that become superinfected, and there is also a fairly
high rate of eczema on the island
Scabies - endemic on the island. For scabies, we treat patients with scabicide
lotion, and it’s important to remember to treat the whole family (at least whoever
sleeps in the same bed as the patient) and to discuss washing of bedding/clothing.
For families with few resources, it also works to keep clothing away from human
skin for 3 days and the mites will die.
Diarrhea/dehydration – very common complaint, we encourage frequent use of
oral rehydration therapy especially for small children
Fevers – remember to keep malaria and dengue on the differential in addition to
all the other common reasons we see fevers. Labs are available on the island at
either Anthony’s Key or the public hospital and you can check a CBC, Dengue
IgM, and malaria smear, and have pts bring back the results.
Adults: :
General information: Patients are triaged first and their vital signs and fasting blood
sugars are recorded in the computer. Most patients get multivitamins (1 month supply)
when they come to the clinic if above age 35. For women of childbearing age (including
and especially teenagers) we give prenatal vitamins. Most require medication refills for
the below complaints. - The medications provided to the patient must be available at the
pharmacy and there are times when some are not available. Check with the pharmacy in
clinic prior to prescribing. If the pharmacy does not have that medication, see if an
alternative is available. If not, you can write a prescription for the medication and give it
to the patient.
HTN
Diabetes
Musculoskeletal complaints (back pain, etc)
UTI
Pregnancy
Parasites – Albendazole 400 mg po x 1 for presumptive diagnosis, q day x 3 days
for known diagnosis.
Skin infection/rash
URI
We again welcome you to the team and greatly appreciate your help in the clinic. When
you arrive we will review many of these details with you again. Please do not hesitate to
ask us questions. Often, the way we do things here is different from what you’re used to
at home, so touch base with one of the permanent staff if you have any concerns or
questions. It’s always better to ask, we are happy to help.
We look forward to working with you!