A Journey to El Guante: Understanding Sustainable Service
by Rashmi Kumar
In May 2012, I embarked on a journey that captured the essence of this proverb. I went to El Guante, Honduras with Global Brigades, a volunteer global health organization. Members and I planned to set up a temporary health clinic furnished with medical supplies from the United States; it was my first time traveling to a foreign country to offer medical aid.
We arrived in Honduras with 40 bulging suitcases full of vitamins, medication, cough syrup and everything else necessary for a mobile pharmacy. Dragging the suitcases through the Atlanta airport, surviving customs, and sorting our supplies, all of us felt that what we had brought was more than what was required. Before our trip, community-needs assessment volunteers sent us a daunting list of medications and the quantities that would be necessary to help provide healthcare to the community. After gathering these items, we felt more than prepared.
This all changed in a matter of hours at the clinic. Assigned to the pharmacy, I filled out 379 plastic bags of prescriptions and dispersed them as crowds of people surrounded the entrance of the classroom that was our makeshift pharmacy. Whatever I had been expecting, nothing prepared me for the flood of patients that visited our clinic on just that first day.
With my rusty Spanish, I tried to strike up a conversation with the incredibly patient people waiting in line. I asked a local about the crowd that had gathered. He told me that he had arrived at 5 a.m. to wait in line. There had not been a medical brigade like ours in El Guante for over six months, and he lived in a neighboring community that had not seen a medical brigade for even longer. Pointing to the pharmacy, he said that he had come on the first day because he wanted to make sure he could get medication for his entire family. Confused, I naively told him that it didn’t matter what day he came on and that he would get the medicine.
At the end of the first day, I realized we had depleted many of the medications that we had brought. Prenatal vitamins were gone, cough syrup vanished rapidly, and those bags that had seemed impossibly heavy were now depressingly light. The man I had talked with had spoken the truth. We could not possibly provide for everyone that came; even those that we had given medication to would run out of it a few months later.
I came to the crushing realization that the immediate relief provided by medical brigades dissipates in the months after the brigade leaves. More so, the community had realized this fact and tried their best to get as much out of each brigade as possible. They were willing to wait in line for hours, to bring their friends and entire family from other towns and to try their best to make our efforts last by rationing medication.
It was easy for me to become discouraged in the face of vast poverty and disease, having seen that international medical clinics only offer temporary services. But it was my realization that medical clinics are not the only way to help treat patients, in a long-term fashion, that made this trip so memorable.
On the last day of my trip, my group helped dig a water pipe as part of an educational activity facilitated by Global Brigades. We dug two football-field lengths of trench in La Concepcion, a town in a remote mountain region, for their new water system. According to the engineers on the project, the goal was to provide the entire village with clean water.
Two months after my return to the US, La Concepcion had clean water and pipelines to every community home; this reduced the frequency of diarrhea and parasitic infections.
By building a water system, we addressed the root of the disease—contaminated water—and the symptoms of an entire population were treated. I thought back to the clinic days when I handed out anti-diarrheal medication in packets of twenty pills. The medication we provided would have lasted a patient two or three weeks. The water system, though, might last many years.
Since my trip, the volunteers and I helped establish new Water and Public Health Brigades that will collaborate with the pre-existing Medical Brigade. Now that I have gained a deeper appreciation for sustainability, I see that these services will help a community thrive long after I have packed my bags.