From Boone to Honduras: Family Medicine in the Mountains

Emily Moore, DO- PGY3

Before medical school, I spent time in rural Nicaragua doing global health research and volunteering in a small mountain hospital. After returning, I completed an MPH in applied epidemiology before going on to medical school. This summer, I returned to Central America, now as a third-year family medicine resident in Honduras.

Within our first week in Honduras, I evaluated unstable angina, managed diabetic emergencies with glucoses in the 500s, and treated a hypertensive emergency - all while practicing about two hours from the nearest hospital. I also diagnosed the brigade’s first case of shingles, removed perhaps the most impressive piece of cerumen I’ve encountered in residency, and used our tiny portable ultrasound to evaluate kidneys and a shoulder injury. An 80-something-year-old woman also became a little frustrated with me when I wouldn’t send her home with a needle and syringe to perform her own knee injections.

There were also rats in clinic. And a bat.

Somewhere in the middle of all of that, I realized how much I was enjoying myself. The medicine itself wasn’t necessarily unusual; the circumstances were. Managing an emergency feels very different when you have limited medications and diagnostics and the nearest hospital is so far away. I found myself making decisions, adapting to what we had, and trusting my own clinical judgment.

I also realized just how different it felt to be here now than it had in Nicaragua. I taught an undergraduate student interested in PA school how to perform a knee injection, had another resident shadow me to learn the flow of primary care, and, as the only DO on the trip, even got to incorporate OMT.

One of my favorite experiences was a home visit to an older woman with significant pain years after a femoral neck fracture. She could barely walk, and her home was difficult to reach even on foot.

I’ve spent a lot of time thinking about what keeps people from accessing healthcare: cost, transportation, distance, language, cultural barriers, and whether care is available at all. But standing at her home made access feel much more literal. What does access mean when someone who can barely walk has to cross steep, muddy, rocky paths before even reaching the nearest road?

I led our team through the entire visit, doing everything from taking her vitals and checking a point-of-care glucose to developing a plan with the resources we had brought with us. I left feeling useful. More than that, I left energized.

A few days later, I had a very different experience.

We traveled to the most isolated community we had visited. Unlike earlier in the week, when diabetes and hypertension were common, I saw almost none of either. But that didn’t mean the community was healthier.

We saw malnutrition, anemia, significant weight loss, and, repeatedly, depression. The rains hadn’t come as expected. Crops were failing, leaving families without enough food to eat or crops to sell. Patients from adults in their 50s to a 13-year-old described profound hopelessness, often accompanied by physical symptoms.

For the first time during the trip, understanding why someone was sick made me feel less capable of helping them. It was hard not to see the circumstances around us reflected in what patients were bringing into the clinic.

I couldn’t prescribe rainfall. I couldn’t make someone’s crops grow. I couldn’t replace the food or income those crops were supposed to provide.

I could recognize depression and offer appropriate treatment, but medication felt incomplete when so much of what these patients needed was not something I could prescribe.

The day before, one of our psychiatry fellows had talked about how people accumulate moral injuries throughout their lives and how physicians are often asked to witness some of that pain - to listen and, for a moment, help carry some of it.

The next day, I understood what he meant. I couldn’t fix my patients’ circumstances, but I could listen and make sure they didn’t have to carry everything alone.

That didn’t make me any less frustrated by what I couldn’t change, but it did change what I considered helpful. Being useful and being able to fix something aren’t always the same thing.

Stewardship has always guided how I approach public and community health. I try to understand what a community needs, use what is already available, and build things that fit naturally into what is already there to continue benefiting people after I’m gone.

Honduras made me think about what that same principle looks like in clinical medicine, especially when “better” doesn’t necessarily mean fixed.

On our final clinic day, instead of setting up another temporary clinic in a school, I worked in the local health center. When our attending became sick early in the day, I unexpectedly found myself stepping into that role. For the rest of the day, residents and students staffed their patients with me, and I supervised procedures and helped guide clinical decisions.

It was fun. And it felt surprisingly natural.

At our closing ceremony later that day - which somehow lasted four hours-the community repeatedly thanked us not only for coming, but for the years of study and sacrifice that allowed us to be there.

Medical training has required a lot of moving, missing things, and waiting for parts of life to feel more permanent. I had actually been talking with a friend about that exact feeling only a few days earlier. Hearing someone describe those same years as a sacrifice that allowed me to be there with them gave me a different way to look at it. It also made me realize how far my training had brought me.

Somewhere in between all of that were daily walks over the two ridiculously steep hills between our hotel and meals - quickly named Mount Doom and Mount Vesuvius - and an afternoon spent floating around the pool on a giant donut.

Underneath all of it, I’ve been surprised by how much this experience has re-centered me.

So much of my interest in medicine and public health began in Nicaragua. Years later, there was something comforting about coming back to a place that felt familiar and realizing how much had changed in between.