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About Roatan


									                                     CLÍNICA ESPERANZA

I.   Background Information
     A. About Roatán
     The largest and most populous of the Bay Islands, Roatán is
     located approximately 35 miles off the northern coast of the
     mainland of Honduras and is 30 miles long and 2 miles wide.
     Current estimates place the island’s population around 80,000
     people. Due to its history, Roatán has immense cultural
     diversity, with people of Hispanic, European, Garifuna,
     Caribbean, and Indian descent inhabiting the island. In recent
     years, immigration from North America and mainland
     Honduras has increased tremendously due to the growing
     tourist industry on the island. This diversity has led to a mix
     of Spanish and English languages spoken in Roatán, as well
     as an island culture distinctly different from the rest of
     mainland Honduras.

     Despite its beautiful beaches, world-class scuba diving, and dramatic growth over the last
     decade, Roatán still lacks modern infrastructure. The first electric pole was erected on the island
     less than twenty years ago, and even today, many residents of Roatán still face daily hardships
     resulting from lack of running water and electricity. The economic disparities on the island
     become more apparent when one travels away from the western part of the island, which is
     where tourists are predominantly located.

     West End, a sleepy little strip in the tourist area of Roatán, has been likened to Cancun, Mexico,
     in its early days. One can walk the entire sandy road of West End in about twenty minutes,
     passing local dive shops, small restaurants, and internet cafes on one side and the sparkling blue
     waters of the Caribbean on the other. English signs dominate the landscape, and one can feel
     worlds away from the rest of mainland Honduras. Just a few miles away, however, is Coxen
     Hole, the capital of Roatán and home to many of the island’s impoverished residents. Between
     Coxen Hole and West End is Sandy Bay, a neighborhood on the northwest coast of Roatán. The
     residents of Sandy Bay represent a diverse population of mixed Islanders, mainlanders, and
     North American ex-patriots, and it is in this small community that Clínica Esperanza is located.
B. About Roatán’s health care system
As one of the nation’s smallest medical districts, Roatán receives a minimal allocation of the
government’s health care funding, even though an incredibly diverse patient population and 35-
mile geographical separation from specialty centers on the mainland magnify its health
problems. Health care for the general public in Roatán centers around the government-funded
municipal hospital in Coxen Hole, Hospital Roatán. This facility, built in 1991, seldom has
running water, proper drainage, or an adequate supply of needed medications. Despite the
efforts of the compassionate local medical staff, the practice of medicine in this facility is
challenging, given the immense health care needs.

Roatán’s health care system is two-tiered, consisting of the overburdened government facilities
such as the public hospital and clinics (Centro de Salud) on one end, which are free or very
affordable to the poor but lacking in resources, and privately owned clinics and a private hospital
located in Coxen Hole on the other end. The price differential between the public and private
health care clinics is immense; a typical consultation fee in a private clinic is approximately 300
lempiras (US$15). With an average income of US$5-7/day, the majority of Roatán’s residents
would never be able to afford health care in the private facilities. Furthermore, resources (such
as a C.T. scanner) or practice standards that resemble what one might find in North America or
Europe do not exist. Those who can afford to go to the mainland or to the U.S. for a higher level
of care. Those who are unable to afford this expense simply do without.

C. About Clínica Esperanza
Clínica Esperanza began in 2002 on the kitchen table of Peggy
Stranges, a U.S.-trained RN who made Roatán her home in 2001.
Prior to her move to Honduras, “Miss Peggy” (as she’s known on the
island) had made frequent trips to Roatán for almost two decades as
part of dental brigades from her home state of Ohio. Although she
had never planned to open a medical clinic in Roatán, word spread
that a nurse was living in Sandy Bay, and soon residents of the local
community began to appear at her door for treatment of acute
medical issues. When demand exceeded the resources of her kitchen
table, Miss Peggy moved the “clinic” to the apartment beneath her
home. When demand exceeded resources of her one-bedroom
apartment, Miss Peggy moved operation Clínica Esperanza (now a
full-fledged clinic with multiple health care volunteers, medications,
& equipment) to space donated by the Son Rise Calvary Church in Sandy Bay. When demand
once again exceeded the resources of her two treatment rooms and pharmacy at the Son Rise
Hotel, Miss Peggy started to look elsewhere.

                                    CLÍNICA ESPERANZA, PAGE 2
                                            In part due to the difficulties effecting change within
                                            the municipal system and the increased needs of the
                                            people, a vision was developed to build a state-of-
                                            the-art health care facility with full-spectrum
                                            inpatient and outpatient services accessible to all
                                            Roatán residents, regardless of income status. In
                                            2006, construction began on donated land to provide
                                            a permanent home for Clínica Esperanza and the
                                            addition of obstetric and pediatric inpatient services.
                                            Although construction continues at the site, the
                                            ambulatory medicine and dental portion of the
                                            facility opened its new doors in February 2007.

Due to the generosity of some of the local residents, Miss Peggy
was able to bring Dr. Raymond Cherington, an esteemed
Honduran physician born in Roatán, on board in June 2005 as the
clinic’s medical director and attending physician. Dr. Alvaro
Sanchez, a pediatric dentist from Guatemala, and Dr. Colin
Glenn, an American dentist with years of missionary service
throughout Central America, currently staff the dental office 4
days out of the week. Dr. Rafael Solis, a Honduran pediatrician,
also work with us on staff. In addition, Dr. Patrick Connell, a
board-certified emergency physician from Arizona, spends
approximately six months per year in Roatán, serving as the
clinic’s volunteer administrative and medical advisor.

Clínica Esperanza is successful because of the shared vision of its supporters. Operating purely
on donations, Clínica Esperanza has attracted volunteers from all over the island, North America,
and even Europe. The contributions of time, money, and labor of many Roatán residents and
volunteers from all over the world are the clinic’s lifeblood. Volunteers from a wide variety of
backgrounds and talents are welcomed and have run the spectrum of pre-medical students,
medical students, residents, physicians, nurses, paramedics, pharmacists, dentists, social workers,
medical translators, Fulbright scholars, public health experts, and non-medical personnel such as
construction workers and computer experts. During 2010, over 150 individuals volunteered at
Clínica Esperanza, which equates to over 18,000 volunteer hours. These included nurses,
doctors, dentists, and a variety of other helpers. In addition, the clinic receives assistance from
many repeat volunteers, both locally and in the United States.

                                       The clinic currently serves many of the low-income and
                                       underserved residents of Sandy Bay and other areas of the
                                       island and is the primary medical provider for
                                       approximately 1,500 patients. It is one of several
                                       healthcare facilities belonging to the Bay Islands
                                       Community Health Association, created by Miss Peggy
                                       and other medical professionals to provide optimal health
                                       care to all residents of Roatán and the Bay Islands,

                                    CLÍNICA ESPERANZA, PAGE 3
regardless of socioeconomic status. Sixty percent (60%) of patients are children, thirty percent
(30%) are adult females, and another ten percent (10%) are adult males. While some patients do
speak English, most are monolingual Spanish-speaking. On average, 200 patients are evaluated
in the clinic each week, representing about 10,000 patient visits/year.

D. About the clinical practice
Clinical medicine in Roatán is not surprisingly a bit different from
what one might encounter in North America. An appointment
system does not exist at Clínica Esperanza; patients simply arrive
before the clinic opens at 8:00 am and are triaged and seen that
same day – a true version of open access scheduling!

Common clinical complaints have their roots in the diseases of
poverty and the environment. Dehydration from diarrheal illnesses
                          is the leading cause of death in children
                          under 5 years of age in Honduras.
                          Dermatologic diseases such as scabies,
                          fungal infections, and impetigo abound, as
                          well as gastrointestinal diseases such as
                          malnutrition and parasitic infections. Other maladies not usually seen
                          in North America include malaria, dengue fever, and machete wounds.
Many common complaints in the United States also exist in Roatán: viral infections, urinary tract
infections, HIV, tuberculosis, burns, abscesses, lacerations, respiratory infections, and sexually
transmitted illnesses, to name a few. Chronic illnesses such as diabetes mellitus, asthma, and
hypertension are also rampant, although they may remain undiagnosed in many of the island’s
impoverished population.

In Roatán, one does not have ready access to laboratory and imaging
studies, although this is now improving. Clínica Esperanza can do a very
limited number of labs, and labs can be obtained from the public hospital
in Coxen Hole as well as in the laboratory at Anthony’s Key Resort’s
Cornerstone Clinic in Sandy Bay. Simple tests such as CBC’s, blood
smears for malaria, and stool studies are fairly inexpensive, although
others such as thyroid function tests are prohibitively expensive to the
poor patient. Patients requiring radiography can be sent into Coxen Hole
or to Anthony’s Key Resort, assuming they have money for transportation
and for the cost of the studies. Ultrasound is available at Clínica
Esperanza, assuming the availability of a technician. Those needing higher-level care such as
CT scans, echocardiograms, or specialty consultation must be referred to the mainland, which is
expensive and often delays care.

Thus, clinicians will do well to hone their history taking and physical exam skills, relying on
their eyes, ears, and hands as principal tools to arrive at a diagnosis and treatment plan.
Ancillary studies are a luxury most of the time. And although medications from the World
Health Organization are becoming a more regular occurrence, treatment is often limited by

                                    CLÍNICA ESPERANZA, PAGE 4
   whatever pharmaceuticals are on hand. Treatment for community-acquired pneumonia in the
   United States is governed by evidence-based algorithms. In Roatán, it’s based on the antibiotics
   that are currently in stock.

II. Details about the Rotation
   A. Short-term Rotations
   Residents and medical students in their earlier stages of training spend time working in triage,
   pharmacy, and consultation with the clinic’s attending physicians. The focus of this is to
   familiarize students with the importance of triage, medication knowledge, and direct patient care.

   Final year residents operate fairly independently, although supervision and consultation with Dr.
   Raymond, the clinic’s permanent attending physician, is provided and recommended for all
   residents in training.

   Attending physicians/specialists work side-by-side with the clinic’s attending physicians. When
   specialists come, we ask that you alert us ahead of time (I think that they aleready notify us of
   their specialty in their application and it is written on the calendar or do I need to do more with
   this? What do we need?) so that we are able to keep track of patients that are in need of your
   services. Often times, specialists are only available to patients if they travel to the mainland.
   Therefore, when we know a specialist is coming, we try to keep track of patients that are in need
   of your services in order to maximize your help. (insert this statement in place of the current

   Nursing students may give injections, do wound dressings, and assist with other procedures
   depending on their degree of experience. Premed students may occasionally shadow doctors but
   will primarily be involved in other aspects of the clinic, rather that direct patient care.

   All students residents, and other volunteers take part in daily mini-grand rounds prior to starting
   patient care for the day.

   B. Costs
   Estimated costs for a month-long elective range between $1500-$2500. You will be responsible
   for your flight to Roatán ($500-$900), food and local transportation ($300-$500), and housing
   ($400-$800). Housing costs can vary quite a bit depending on location and living arrangement
   (shared vs. single); likewise, food costs can run the gamut, depending on whether you choose to
   cook, eat at local restaurants, or eat out. For further information on food considerations, check
   out the Volunteer Grocery List. Clínica Esperanza is located in Sandy Bay, a roughly 10-15
   minute car ride away from West End and West Bay. Restaurants and apartments are plentiful in
   West End and tend to cater towards tourists. Volunteers are encouraged to stay in Sandy Bay,
   living among the locals for a more realistic experience. We will do our best to recommend
   and/or arrange housing, based on your preferences. Laundry services are available for $4-5/load

                                       CLÍNICA ESPERANZA, PAGE 5
depending on your housing arrangements (some have laundry facilities, otherwise we use Ed’s
Laundry through the clinic).

C. Transportation
Air travel from the United States to Roatán ranges from around $500 to $900 round-trip. Many
airlines now fly direct into Roatán (airport code RTB), eliminating a stopover in mainland
Honduras; these include TACA (Unless I am mistaken, TACA does not come direct),
Continental, Delta, and American Airlines (Nor does American). Flights direct to Roatán are
generally more plentiful and less expensive if you are departing/returning on a Saturday, Sunday,
or Thursday. If you choose to fly to the mainland first, you will need to purchase a connecting
flight from your city of departure (preferably San Pedro Sula, SAP) into Roatán. There are
multiple flights daily on Islena, Sosa, and Atlantic Airlines (all roughly the same in price), but
please note that the domestic planes are much smaller and may have weight limits different from
international flights. Kayak, Cheaptickets, and Travelocity are all excellent airfare search

If you notify us of your date of arrival, airline, flight number and time of arrival in Roatán, we
will pick you up or you can arrange an airport pick-up with Enrique Valdez by contacting him
directly at or 9918-0766 (cell phone). His website is He is
a good friend of Peggy’s who also runs a tour business on the island. He has a gold minivan and
charges $10/1 person; $15/2-4 people; $25/5-6 people. Either way, please make sure that the
volunteer coordinator,, has your travel information at least 30
days prior to your arrival so that we can schedule your pick up.

Once in Roatán, you can easily get around the island by taxi or colectivo (shared taxi/bus). The
clinic is located on the main road in Sandy Bay at km marking 10, between the SonRise Mission
and Anthony’s Key Resort. A 10 minute taxi ride from Sandy Bay to either West End or Coxen
Hole will range from L25-30 per person. Colectivos (buses) are slightly cheaper, L15-20, but
they can get quite full at times. Colectivos run only during the day, while taxis will run into the
night; however, rates do go up slightly after dark so remember to negotiate a rate before getting
in the car. Taxis do travel to West Bay, but you should expect to pay at least L100 (or $5.00) per
person, one way. Transportation can be hard to come by in the early morning if coming from
West Bay. During the day it isn’t a problem as there are often water taxis as well as taxis. Keep
in mind that taxi rates do go up slightly after dark. Rental cars (range from $30-$60/day) and
scooters are available though not recommended, given the frequent accidents and the multitude
of inexpensive ground transportation options with taxis and minivan buses.

D. What to Bring
Professional Items:
    Copies of your medical license and diploma- brings these with and email them to the
       clinic at least 2 months prior to arrival (These are a requirement of the Honduran
       government and are absolutely essential documents)
    Copy of your board certificate (if you have finished residency training)
    Stethoscope

                                    CLÍNICA ESPERANZA, PAGE 6
      Medical handbook (such as Washington Manual or Harriet Lane, etc.)

Health Items:
    Any chronic medications you require, as they may be unavailable in Roatán. Please
       contact your insurance carrier at least one month prior to departure to obtain sufficient
       amounts of medication, as there may be insurance restrictions on quantity dispensed.
    Insect repellent with at least 20% DEET. There are a lot of mosquitoes, particularly after
       rainy season ends in late February, and dengue and malaria are common. Fortunately,
       malaria in Roatán is chloroquine-sensitive, and P. falciparum is rarely found on the
       island. Malaria prophylaxis is recommended as well as proper insect protection at all
       times. Chloroquine is the mainstay of prophylaxis in Roatán; please note that you need to
       begin taking it one week PRIOR to departure and continue for 4 weeks after return home.
    You should have all of your regular immunizations including tetanus booster and
       Hepatitis B (series of 3 over 6 months). 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 interaction with animals on a
       regular basis.
    The CDC website lists additional recommended vaccines.

Miscellaneous Items (optional):
    Snorkel, mask, and fins if you intend to do any snorkeling. Rentals are expensive.
    Scuba equipment, if you have it
    Small portable flashlight (as the electricity is bound to go off at least once during your
    Laptop computer and USB drive (there is wireless internet available at the clinic before
       and after clinic hours as well as on Miss Peggy’s porch)

Travel Items:
    For U.S. citizens, your passport must be valid for at least six months after you plan to
       leave Honduras.
    On the declaration form that you complete on the plane, please check “Other” for
       “Reason for Travel” and write in “Volunteer.” As you pass through customs a 90 day
       visa will be put in your passport. Do NOT lose your visa as it will be a $200 fine upon
       exiting without it.
    Please note that there is departure tax of $38.00 when you leave the country. This tax can
       be paid in U.S. dollars or lempiras (but not credit cards or travelers’ checks). Make sure
       to set this aside from the beginning as the ATMs can often be out of money or without
    Evacuation insurance. We do recommend evacuation insurance; there are several
       companies that provide this service.

                                     CLÍNICA ESPERANZA, PAGE 7

Money Items:
   US$1 = approximately 18 lempiras
   U.S. dollars are accepted throughout Roatán, although you will likely want to change
      some money into lempiras for taxi fares and small purchases. You can do this at the
      clinic or you can use your U.S. dollars at most stores and they will give you change in
      lempiras. It is helpful to bring small (preferably newer) bills like ones, fives and tens
      with you as larger bills are hard to get change for.
   ATMs are available at the airport, grocery stores, and in West End. This is probably the
      easiest way of obtaining money while down here. However, do not wait until the last
      minute to use the ATM, because it will be these times that the machines are out of money
      or out of order.
   Travelers’ checks and credit cards are accepted at the more expensive restaurants, hotels,
      and dive shops. Please note, however, that most stores charge a 16% surcharge for using
      credit cards.

Medical Donations:
   Clínica Esperanza operates entirely on donations, so in the weeks before you leave, it is
      very helpful to collect supplies to bring to the clinic. If you are interested in bringing
      medical supplies, check out our website and facebook page ahead of time to find out what
      items are most needed. Medications that are soon to expire are fine, but please do not
      bring expired items, and if at all possible, bring generic medications as they will be more
      easily obtained in the future. If you bring sample medications, please break down your
      samples ahead of time and leave the “excess” paper behind. If you have any questions in
      regards to medical donations don’t hesitate to email the volunteer coordinator at and she will forward your email as appropriate.
   Clínica Esperanza is a non-profit, 501c3 organization, and donations can be tax
      deductible. Please see our website ( for more details. If you
      would like to make a donation, you can either donate online via the links on our webist
      and facebook page or you may send a check to “Mission Roatán,” a tax-exempt U.S.
      501c3 that provides 100% of the funds to the clinic. Please make the check payable to
      “Mission Roatán” and write “Clínica Esperanza” in the subject line on the lower left of
      your check. Send to:
                                     MISSION ROATAN
                                     P.O. BOX 472
                                     Mahomet, IL 61853 (Is this address correct or should it be a
                             N.Y. address?)

Important Contact Information:

                                       CLÍNICA ESPERANZA, PAGE 8
      In the event that you need to reach Peggy, you may contact her at the following phone
       number: 011-504-9885-1044 (from the U.S.). Please do not call unless it is urgent as
       Peggy’s time is limited and the volunteer coordinator can answer most questions or find
       the answer for you.

E. Reading List
Much of your training will occur “on the job,” although we do recommend a few key articles and
books to read before your elective in Roatán. The Spirit Catches You and You Fall Down, by
Anne Fadiman, is a poignant account of the cross-cultural clash between the Hmong community
and the American physicians who cared for a young Hmong child with epilepsy. Mountains
Beyond Mountains, by Tracy Kidder, traces the inspirational life story of Dr. Paul Farmer and the
establishment of his health charity organization, Partners in Health. Schechtman and Levin’s
article entitled “Preparing for Medical Work in the Developing World” offers practical tips for
finding and evaluating overseas medical opportunities, obtaining appropriate procedural or
tropical medicine training before departure, and locating resources to prepare for a specific
destination. The clinic is well-stocked with medical text references donated by prior volunteers,
but it is highly recommended that you bring any frequently used portable tools such as a PDA or
medical Spanish handbook for use at point of care. Internet access is usually available in Roatán
and the clinic has access to Up To Date, so you can research pretty much anything, during or
after clinic hours.

F. Things to Do
Roatán is located in the heart of the Caribbean and is blessed with beautiful weather nearly year-
round. Listed below is just the tip of the iceberg; please see the following websites for more
     Beaches: West Bay Beach is easily the most beautiful beach on the island and was noted
        as the 7th most beautiful beach in the world by “Leisure Living Magazine.” Easiest way
        to get there is to catch a water taxi from West End for 50 lempiras. Half Moon Bay
        Beach right in West End is pretty as well. A word of caveat: Sand flies can be quite
        annoying, so you best be prepared and wear repellant when you are out.
     Snorkeling: Multiple excellent spots in West Bay, West End, and Sandy Bay. Bring your
        gear or rent a set in town for about $10/day.
     Scuba diving: The Bay Islands boasts some of the most inexpensive but pretty dive sites
        in the world. If you have are not certified but have the time and interest, Roatán is a great
        place to learn and you can get certified in as quickly as two-three days. Octopus Dive
        School is located in Sandy Bay very close to the clinic with excellent divemasters. In
        West End, there are a number of reputable dive shops, all charging around $30-$40/dive.
     Gumbalimba Park: Make a day of it at Gumbalimba Park- walk the gardens, hold parrots
        and monkeys, zip-line through the trees, and SNUBA dive to 20+ ft in the crystal clear
        waters of the Caribbean.
     Other activities include Butterfly Gardens, Botanical Gardens, Kayaking, Iguana Farm,
        and Underwater Museum to name a few.

                                     CLÍNICA ESPERANZA, PAGE 9
Application Process
If you have read through this web site and feel as if you would like
to experience volunteering your time in Roatan at Clinica
Esperanza, please send your application, which you can find under
the volunteer tab on this site, to our volunteer coordinator at

Non-Professional volunteers: Please read this site for basic
information. Individual volunteers are being asked to donate their time for a minimum of one month, a
maximum of four volunteers at a time, so please let us know your time preference as soon as possible. All
non professional volunteers are required to pay an education fee of $500 per month that helps to sustain
the clinic. Volunteers are sometimes sponsored by their churches or they receive donations from their
families or friends. You will find a payment “button’on the homepage of this site. The non-
physician’s application can be found at the volunteer’s tab on this site. Besides your application, we
will need your complete flight itinerary. This should include airline, arrival time and flight
number. We will also need to know if you will need to be met at the airport and where you will
be staying while you are in Roatan .
Physician Residents: Please read this site for basic information. If you are interested in
applying for a medical rotation at the clinic, please fill out the application form found under the
volunteer tab on the website. The purpose of the form is to allow us to gain a better idea of your
interests and goals for the rotation, as well as the specific skills you will bring to the elective.
Besides your application, we will need your complete flight itinerary. This should include airline,
arrival time and flight number. We will also need to know if you will need to be met at the
airport and where you will be staying.

Professional Volunteers (Board Certified Physician, Dentist, Audiologist, RN etc): Please
read this site for basic information. You will find a physician’s application at the volunteer’s tab
on this site. Honduras’ Ministry of Health requires that professional medical volunteers submit
copies of their diplomas and current licenses in their field to If you
need to consult with someone with professional related questions, please contact Dr. Grace Yu
at Besides your application, we will need your complete flight itinerary.
This should include airline, arrival time and flight number. We will also need to know if you will
need to be met at the airport and where you will be staying.

All applications, arrival information, the name of the place where you will be staying and any
questions that you have, can be sent to our volunteer coordinator at It is our hope that your time at Clínica Esperanza will be an
eye-opening, life-changing experience that will enrich both your personal and professional lives.

                                      CLÍNICA ESPERANZA, PAGE 10

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