JTF-Bravo medical exercise delivers preventive medicine and treatment to two Honduran villages

by Randy Roughton

“This will make you feel better,” Saira Vanesa Blackaus told her 3-year-old son, Tomas, as he cried when U.S. Air Force Maj. Thai Le administered de-worming medicine into his mouth through a syringe.

Le’s preventive medicine section was the first stop for families in the villages of Batalla and Wawina, located about 100 miles apart in the Gracias a Dios Department, during the joint Medical Readiness Training exercise in eastern Honduras. Fifty-five members from Joint Task Force-Bravo Medical Element, including 13 Airmen deployed at Soto Cano Air Base, Honduras, joined the Honduran Ministry of Health and military to share their medical expertise and services at schools in the two towns.

To reach the school in Wawina, Blackaus and her three children walked 30 minutes under the scorching Honduran sun from their home in Waksma. When family members are sick, Wawina residents must travel two hours by boat on the Patuca River to the nearest medical facility in Ahuas. The closest doctor is another hour and a half by car in Puerto Lempira, Gracias a Dios’ capital city.

“It’s hard to see a doctor in our area,” the 30-year-old mother said through an interpreter, Army Spec. Douglas Sanchez. “We don’t have doctors. There is a place we can go that will attend to my children when they get sick, but it costs money, and we don’t have the money.”

Blackaus and her children were among the people who attended a 45-minute introduction on hygiene and other healthy habits by Honduran Command Sgt. Maj. Luis Alonso Dhmani, who was in charge of the Honduran side of preventive medicine. Dhmani visits Honduran villages during the medical exercises. He sees the most extreme cases of poverty and disease in some of the towns.

“There are many communities worse than this,” Dhmani said. “You can see areas slowly improving where there have been MEDRETEs in the past. Without the MEDRETE, there would be much more malnutrition and disease in some of these small, remote villages.”

Since 1993, medical training exercises have treated more than 321,000 medical patients and 65,000 dental patients. In 2011, more than 15,000 patients received dental and medical treatment.

In addition to the general medical exercises, the Medical Element also has a surgical team that performs operations three days a week in nearby communities. The exercise, the fourth in Honduras in the past year, not only helps the element perform its humanitarian mission, but also refines members’ training.

“Without the MEDRETE, there would be much more malnutrition and disease in some of these small, remote villages.” — Honduran Command Sgt. Maj. Luis Alonso Dhmani

“This is a great opportunity for (medical personnel) to get out and practice medicine under some austere conditions,” said Army Col. Matthew Rettke, the JTF-Bravo Medical Element commander. “This is a very remote area, so it trains us on being able to pick up and move and ultimately prepare them for one of our main missions at JTF-Bravo, being able to respond to disasters. Beyond that, we’re getting to see some conditions that we wouldn’t otherwise, whether they’re tropical medicine, routine illnesses or conditions that maybe went untreated, so we’re seeing some pretty bad cases. The third part we gain is the experience of working with our Honduran counterparts, as well as the opportunity to network and gain experience.”

After Dhmani’s talk, the Hondurans lined up for medication, vitamins, bars of soap and toothbrushes. Le, the preventive medicine officer in charge, gave one Wawina boy a high-five after he gave him his medicine.

Some patients left after their preventive medicine visit. Others, who needed more medical attention, were directed to move on to the screening section, located in the first classroom in the nearby school. First Lt. Daniela Feldhausen, a physician assistant, called the screeners “the gatekeepers” to the health care providers’ section.

Tomas played with a stick on a string while his mother waited in the screeners’ line with other mothers who held umbrellas to shield their children from the sun. When the family reached the front of the line, Staff Sgt. Daniel de la Torre, a medical technician, gave Blackaus some hydrocortisone cream for her son’s rash and sent her next door to talk to a doctor about her daughters’ medical issues.

When the family reached the providers’ room, Blackaus talked to Dr. Edwin Eduardo Aldena Corleto, while a group of men brought in an 82-year-old man on a gurney. Doctors had to refer the villager to a hospital through the Ministry of Health when they diagnosed a kidney infection. While Blackaus talked to her doctor, Feldhausen helped Rettke, one of the doctors on duty during the exercise, talk to another Honduran man through an interpreter. Feldhausen assisted Rettke in her first deployment as a physician assistant. She spent the first 15 years of her Air Force career as an enlisted respiratory therapist.

“This is the reason I became a (physician assistant),” Feldhausen said. “I wanted to get out into preventive medicine and experience the world’s different cultures. I wanted something that would allow me to make my thumbprint on the world.

“I’ve been able to see the fruition of all of my training and education. I’m getting to see possible skin disorders and diseases we typically don’t have in the United States, so I’m broadening my medicine skills. It’s also challenging me to work in a more austere location. We’re limited by what labs we have, even back at Soto Cano. So you have to go by your basic medical skills in your treatments and make sure you’re taking care of the patient first. You really have to interact well with the patient and ask the right questions, so it helps my interviewing skills and my general medicine practice skills.”

Doctors prescribe medications for some patients to have filled at the pharmacy in the next classroom, while others move on to dental services. The Blackaus family began their walk home after the pharmacy filled their prescriptions and gave them vitamins and other items.

“I like the medical services the Americans are giving us,” Blackaus said. “We are very grateful.”

The three dentists participating in the exercise were busy with their share of patients, especially during the last two days in Wawina. Usually, the closest dentist is three and a half hours away, in Puerto Lempira. Most of the patients seen by Drs. Wilmer E. Amador, Cesar Cortes and Dania Matamoros were visiting a dentist for the first time.

As Amador approached a young patient, he shook his hand, and said, “Hey, how are you doing? My name is Wilmer. What’s yours?”

“To establish some type of rapport and ease the stress is important, especially for the children,” Amador said.

One patient sat in a gentle headlock on the sidewalk in front of the dental services’ classroom as Amador pulled his tooth. But the JTF-Bravo’s Medical Element liaison officer who has worked medical exercises since the first one more than 19 years ago, says pulling teeth are not the objective.

“I stopped counting pulled teeth a long time ago,” Amador said. “We are not in the business of pulling teeth because we like it. We spend a lot of time with many patients trying to convince them not to extract them.”

Although Amador provided his dental services in the exercise, his main job is coordination of the MEDRETE. He considered the two days in Wawina, where they last visited with a medical exercise in August 2010, as the ideal area and people to benefit from their medical treatments.

“I can assure you that the MEDRETEs are very welcomed by the population, especially in a place like Wawina, where all the (licensed practical nurse) had in her storage warehouse was a little bit of Tylenol,” Amador said. “Historically, we’ve done a lot of good things for the population of the Mosquito Coast. Wawina is a village that’s perfect for this type of effort. It’s very isolated with low access to health care. The Ministry of Health has managed to establish a small clinic with two LPNs, but with very limited resources.”

As Tomas walked home with his mother and sisters, an elderly Honduran woman shook hands with each Airman and Soldier in her path as she left the school, telling them repeatedly, “Buenos dias. Gracias.”

De la Torre, who’d been waiting for a humanitarian mission since he enlisted eight years ago, was talking to the last few patients in the screening area. Later that night, at the Medical Element’s forward operating base, De la Torre reflected on when he was in similar circumstances as a boy like Tomas Blackaus while growing up in Mexico. De la Torre, who is deployed to Soto Cano from Altus Air Force Base, Okla., remembers Americans bringing medical care to his community but never imagined he would one day be one of them.

“To some degree, it feels like home here to me,” he said. “As I see the kids, I see myself because when I was a kid, I saw Americans come to Mexico and help out. I got to wave at the Americans when they came out to give us a piece of candy. So I get to taste a little bit of what they did for me when I was growing up. It hits home.”