Students Gain Cross-Cultural Insight While Volunteering in Honduras
Story by Meaghan Mormann ’16
Meaghan Mormann’16 was vice president of Illinois Wesleyan’s chapter of Global Brigades
and has traveled to Honduras the past four summers as a volunteer translator. A biology
and Hispanic studies double major at Illinois Wesleyan, Mormann will enter medical
school at Michigan State University in August. In the following essay, Mormann recounts
her remarkable experiences with Global Brigades and its lifesaving work in Honduras.
Assessing Vital Signs
In a tiny community of Las Animas (pop. 120), located five hours outside of the capital
city of Tegucigalpa, hundreds of parasol-bearing Hondurans eagerly await the arrival
of a busload of Illinois Wesleyan students and several physicians in the almost unbearable
morning heat. The line, wrapped around the courtyard, squashes our qualms that a last-minute
change of location, thanks to the previous night’s rain that washed away the roads,
would go unannounced. As quickly as possible, we convert a five-room school into a
temporary medical clinic and ready ourselves for the steady stream of underserved
patients we will meet over the next nine hours.
Dr. Liza Pilch is one of our physicians, and I am her translator. Our morning routine
is interrupted by a shout: “There’s blood! We need a doctor and a translator!” Dr.
Pilch stands, takes my arm and pulls me outside. In the courtyard, a young man, perhaps
25 years old, leans against the post of a small pavilion. A t-shirt tied tightly around
his calf, he appears surprisingly calm. His friend and his wife tell us he’d hit his
foot with the full-force swing of a machete while chopping firewood. His friend half-carried
him to the brigade site, nearly two hours from the scene of the accident.
With a first glance I can’t see where the wound begins or ends. What I can make out,
however, is his bone — white and glistening, jutting out of the top of his foot —
clearly severed and surrounded by dust-covered skin and muscle. He had already lost
about three pints of blood. Without the t-shirt tourniquet, his situation would be
much worse. A team of physicians, nurses, even dentists start an IV of fluids, antibiotics
and pain medications. They sanitize, clean, and close the wound; then stabilize his
foot and his blood pressure in preparation for transport to the nearest hospital,
over two hours away. As a cloud of dust consumes his makeshift ambulance, a pickup
truck bed, the silence screams, “What if the rain hadn’t sent us here?”
While days spent with Global Brigades are rarely this high stress, the stark reality
of lack of access to basic services and needs — including clean water, balanced nutrition,
sanitation services, health insurance and most medical care — makes dire situations
such as this one a constant possibility.
I have traveled to Honduras each June for the past four years with IWU’s chapter of
Global Brigades (GB), an organization focusing in under-resourced areas in Ghana, Nicaragua and Panama
as well as Honduras. GB teaches student volunteers social responsibility while empowering
local communities to make sustainable and holistic changes, with the end goal of combating
and eliminating global health and economic disparities around the world.
Of GB’s nine established brigades (business, dental, engineering, environmental, human
rights, medical, microfinance, public health and water), IWU students have participated
in dental and medical brigades for several years. In December 2015 our first business
brigade went to Honduras, and in June our first ever medical/public health hybrid
brigade treated hundreds of community members and built basic public health facilities
for three families. I have been on brigades with as few as 22 IWU students and as
many as 50. While our group is often comprised of mostly biology majors, many of whom
are part of the pre-medicine track, I have also had the pleasure of traveling with
students majoring in chemistry, business, English, pre-dental, pre-physical therapy,
pre-veterinary or other fields.
Gender Roles and Justin Bieber
Our work starts long before the group gathers at the airport for departure. We begin
organizing, recruiting, and fundraising nearly a year in advance. Each student pays
approximately $1,500 to attend a single brigade and closer to $1,800 for a joint brigade
such as this year’s. Each brigade is also responsible for either recruiting and bringing
healthcare professionals with them or hiring Honduran professionals through GB. Each
brigade needs a minimum of two general practice physicians, two dentists and, ideally,
an OB/GYN. Additional medical staff who can help with patient intake, blood pressure
measurements, blood sugar assessments, wound care, and countless other tasks are major
asset’s in a trip’s success.
Each brigade group is also responsible for collecting the vast majority of the supplies
and medications — valued at about $8,000 — that will be used throughout the duration
of the medical clinic. Local restaurants and stores help us with fundraisers. These
funds generally go towards the cost of supplies and medications we need to gather,
rather than going toward the cost for each individual student to attend.
With the exception of our chapter advisor, Assistant Professor of Nursing Noël Kerr,
who has travelled with us for each of the past four years, the group is entirely student
run. When all the prep work has been finished – money raised, logistics sorted out,
and a million other details have been checked off the list – the brigade finally arrives
in Honduras. The first day involves a community visit in an area in which GB is active.
For many students, this is the first time they have encountered the stark reality
of poverty in rural Honduras, where four in 10 people do not have access to clean
water, and more than half live on less than $1 U.S. dollar per day.
These sterile statistics don’t reveal the warmth of the people, who open their homes
to us with the utmost humility and hospitality, offering bowls of fruit, tea and coffee,
or anything else they have to share. In all of my visits to Honduras, I have been
moved by the spirit of faith, love and joy with which the people conduct their daily
lives, despite enduring hardships most in the U.S. could barely imagine.
This year, the medical half of our brigade was assigned two communities, El Robledal
and Santa Maria San Matias, in the El Paraíso region located in the southeastern portion
of the country. Ours was the first brigade to enter both communities, which is always
GB sends medical brigades into communities first. Medical brigades allow for short-term
resolution of health disparities in communities as well as for emergency situations
to be addressed and remedied. Upon GB’s arrival on the morning, it is not atypical
to face a line of hundreds of individuals already waiting to receive care. Some may
live only five minutes up the road, but many will have travelled much farther, often
having walked an hour or two, to reach the brigade site.
The brigade runs like this: after being checked in at the community volunteers’ intake
station, patients move to the triage station, manned by students, GB personnel and
translators. Triage is often a favorite station of students, whether or not they speak
Spanish, because it is a phenomenal learning opportunity. Here, students have the
opportunity to practice their Spanish skills as well as their patient interview skills.
At the triage station, students take vital signs and ask a list of questions, including
asking women between the ages of 12 and 45 whether they are pregnant or breastfeeding.
This question often comes as a shock to students accustomed to the U.S. cultural norms
surrounding childbirth. Honduras’ predominantly Catholic and patriarchal culture makes
many contraceptive methods frowned upon and, therefore, increases the likelihood very
young women may already be pregnant or mothers. This is one of the many cultural factors
that make these trips so eye opening for IWU students. Before even seeing patient
consults with physicians, students have the opportunity to broaden personal beliefs
and perspectives and to engage in a culture different from that to which they are
accustomed. This is the liberal arts in action. In every single one of my Spanish,
general education, and science courses, IWU professors encourage the liberal arts
mindset of fostering creativity, effective cross-cultural communication, critical
thinking in all situations, a spirit of inquiry and a perpetual desire to learn in
ways beyond traditional classroom knowledge acquisition. By presenting us with cultures,
norms, languages, socioeconomic statuses and so much more that is different from our
own way of living, the GB trips to Honduras provide us with the opportunities to challenge
ourselves, enrich and further personal growth, and reinforce the aspects of the liberal
arts education that are so importantly stressed in the classroom.
After completing the triage station, patients are helped immediately by medical professionals
or pass to the line for general consult, depending on the severity of their condition.
We faced a number of ulcerous wounds this year, which are surprisingly common in Honduras,
especially on the lower extremities due to the lack of proper footwear and the lack
of medical care available when wounds are initially inflicted. Luckily for us, Dr.
Kerr is also a specialist in wound care and has traveled with us on each of my four
brigades. She brings wonderful insight into cultural situations and is an exceptional
resource for working with students in terms of teaching about cultural differences,
competency, medical skills, healthcare systems, and so much more.
In her work with wound patients, Dr. Kerr teaches them how to dress their different
kinds of wounds and ensuring they have an understanding of their condition, the steps
necessary to heal and enough supplies to ensure dressings can be made well into the
healing process to keep the area clean and on the road to recovery. Simultaneously,
she gets students involved in these patient encounters, giving them an equally enriching
opportunity to learn.
Meeting with a general practitioner, each patient receives anti-parasitic medications
to combat the common parasite infections and their related symptoms including stomach
and intestinal distress and bloating, as well as frequent headaches. Additionally,
each patient receives multivitamins, and most receive either acetaminophen or ibuprofen
as appropriate for chronic pain and occasional headaches or other body aches. Beyond
this, patients have the opportunity to discuss their primary symptoms with physicians
and the students shadowing them, and receive the appropriate treatments.
When IWU brings physicians who are English-speaking, an IWU student works closely
with them as their translator — a job I have had the pleasure of holding for three
of my four brigades. In addition, two to three students will shadow each physician,
whether they are Honduran or physicians who traveled with the brigade. This is another
favorite station among IWU students, as they have the ability to obtain hands-on experience
with patient interviewing and patient care, practice Spanish with the patients and/or
physicians, and get any questions answered by the physicians regarding specific patient
cases or regarding diseases and processes as a whole. It also provides students with
insight into the healthcare system of Honduras, as patients often share experiences
with clinics, hospitals, or insurance, or more commonly, the absence of these services.
The doctors with whom IWU students have worked have always been phenomenal teachers
not only through imparting medical knowledge, but also via sharing the cultural competency
and sensitivity skills necessary to work with patients of another culture, perhaps
of a different first language, and even those who have never previously interacted
with a medical professional. For example, on this trip, a young male patient provided
a perfect example of how an understanding and culturally sensitive physician interacts.
This man presented with bilateral ear pain and, upon examining the patient’s ears,
the doctor noticed the patient had a fungal infection. After having the students take
a look at the condition, the doctor explained this sort of infection is generally
only found bilaterally in severely immune-compromised individuals, such as HIV/AIDS
patients or patients undergoing some form of cancer-related treatment. With community
access to cancer treatments nearly non-existent in rural Honduras and because the
man was fairly young, the doctor decided to pursue the possibility the man could be
HIV positive. However, this required discussing a patient’s sexuality and potential
for having contracted a disease with significant ramifications in a crowded consultation
room, in front of a group of students with a different first language, and in a country
in which homosexuality is not accepted.
Despite all of these situational and cultural barriers, the doctor took him aside
and asked if he could discuss a personal matter without passing judgment. Because
of the sensitivity, understanding, and humility of the doctor, the patient astonishingly
felt comfortable enough to disclose his homosexuality. He went on to explain that
he had been tested for HIV about a year ago, but would do so again if his condition
was indicative of a change in his status. To me, this type of interaction would be
difficult to achieve because of the required high level of patient––physician trust,
but the doctors with whom we were working reached such a level within minutes. In
this way, simply observing patient consults was invaluable to us students for understanding
the importance of interacting with patients in a way that encourages trust and respect,
rather than an intimidating hierarchy of power that limits the quality of the relationship
In a similar fashion, the OB/GYN station, with the accompanying social conventions
and cultural norms, presents outstanding opportunities for students to further their
knowledge on a variety of levels. Some aspects of the culture of Honduras, and of
much of Central America, can be best be explained by the ideals of machismo and marianismo. The male role is machismo — the notion that men are strong and powerful providers and protectors. This means
men are generally incredibly devoted to family, loyal to a fault and immensely hard
workers. However, this ideal also perpetuates a power hierarchy that often places
men in the role of the aggressor who can be emotionally, physically, and sexually
dominant. In contrast, marianismo is derived from the name of the Virgin Mary and defines the role of the female who
is pure, maternal, obedient and submissive. This results in women who spend the majority
of their lives within the home and raising the family’s children. However, the double
standard of being both pure and submissive results in illegal abortions, girls as
young as 12 or 13 who are already mothers, and the scarce availability of birth control,
prenatal care and gynecological exams.
With an understanding of the predominant gender roles in many of the communities GB
visits, it becomes apparent why patient-physician interactions proceed the way the
do. For example, it is required that females are asked about the possibility of being
pregnant and breastfeeding beginning at the age of 12. Furthermore, it is quite common
for a male to speak for the family, despite a woman’s presence in the consultation,
and it is often necessary to deliberately address the female and explain the importance
of her answering on her own to obtain her personal interpretation of her health. On
one occasion an older gentleman refused to allow me to translate between the male
physician and himself because I am female. Despite the reality of the physician not
being able to communicate in Spanish, this man lived with entrenched societal norms
that did not allow me, as a woman, to hold a position of such power that could dictate
the outcome of his medical visit.
In situations such as this, it was easy to get angry, to become defensive, and to
demand that I be allowed to translate. However, rather than react in this fashion,
I took a moment to step back from the consultation table, explain what was happening
to the physician, and excuse myself. Because, in that moment, I realized that this
man’s refusal of my translation services was not a reflection on me or on him in any
way, but rather was a reflection of deeply rooted cultural practices that had been
a reality for this patient for the entirety of his 75 years. In this situation, it
was much more important for this man to receive medical care in an atmosphere in which
he was comfortable, than for me to take his cultural views personally and ruin the
possibility of him developing a trusting physician-patient relationship. I ultimately
found a male GB translator to aid in the completion of this patient consult.
This year we had a station that is fairly new to GB and that was brand new for IWU
students. GB is phasing in an optometry station, where sunglasses, reading glasses,
and donated prescription glasses of all varieties can be distributed. Each year a
number of patients face maladies affecting the eyes due to frequent and sustained
exposure to the sun. So, even just having sunglasses to distribute makes an important
impact. However, GB has now gone a step further, allowing us to perform basic eye
tests and auto-refraction to determine patients’ prescriptions and find an appropriate
pair of glasses.
During my brief shift in the optometry station, I watched the gift of sight miraculously
unfold through the simple diagnosis of proper eyeglasses. A young boy came to the
station with his mom, who explained he couldn’t see the board in school. Upon asking
him to read lines on a traditional eye exam chart, he admitted he couldn’t read the
large “E” on the first line, placing his vision off the chart at worse than 20/200.
After completing the auto-refraction, we found his vision to be far worse than anyone
else we had tested. While we didn’t have a pair of glasses with a prescription as
severe as his, we found one pair that was fairly close. As the little boy put them
on, his face lit up in a way I had never before seen. I watched him realize he could
read the “E” and he asked if he could keep going. With each line he was able to read,
my heart became more and more full as I realized how life changing this moment was
for him. His mom began to cry as she thanked us and we watched his vision change from
20/200 to 20/50 in less than 15 minutes. I am so incredibly grateful to have been
a small part of this opportunity and to know that GB will be able to continue to have
a lasting impact on communities in yet another fashion.
Once finished with all physician consults, patients have the opportunity to visit
the dental station. This is another station that often causes anxiety in patients
as the combination of poor dental hygiene due to a lack of supplies, high sugar consumption
due to a lack of clean water, and scarce dental checkups due to a lack of access to
services leads to severe dental situations. The dental station provides two basic
services: fillings and extractions, because the procedures solve many of the patients’
dilemmas including pain, sensitivity, and infections. It is always impressive to me
how strong and stoic these individuals are who are often receiving dental care for
the first time and who are undergoing intense procedures, including aggressive extractions,
with no more than local anesthesia to dull the pain while the patient sits in a school
room desk. Yet, many students love this station as it provides a lot of hands-on opportunities
to learn and understand medical practice and its associated cultural influences.
In this same vein, GB tries to partner medical care with education not only for the
students and professionals volunteering, but also for each and every patient. For
this reason, after all consults, while waiting for their prescriptions to be ready
in the pharmacy, adults go to an adult charla and children go to a kid’s charla. Translating literally to “chat,” in this situation charla refers to a conversational class all patients are required to attend. The adult charla is run by the community volunteers to ensure positive communication, trust, and complete
understanding by all involved. This class is usually centered on some aspect of sexual
health such as STDs and STIs or birth control and family planning methods.
On the other hand, the kid’s charla is always a dental one, and is run exclusively by the students on the brigade. IWU
students have come to realize that songs are one of the most effective ways to grab
a child’s attention, increase participation, and help him or her remember the lesson.
So each year we take a popular song and rewrite a few verses in Spanish with which
to teach the kids how to brush their teeth. For the past two years, we have used our
own rendition of Justin Bieber’s “Baby,” which the kids never get tired of singing.
“Dientes, dientes, dientes, oh
Cepillamos cada día, oh
Dientes, dientes, dientes, oh
Proteger de la bacteria-a
(“Teeth, teeth, teeth, oh
We brush every day, oh
Teeth, teeth, teeth, oh
Protection from bacteria-a)
Cepillamos en circulo-os,
En el frente y en el fondo
Para sonrisas más bonitas
No olvides la lengua
(We brush our teeth in circles
In the front and in the back
For more beautiful smiles
Don’t forget your tongue)”
We also discuss oral hygiene including how many times per day to brush and which foods
are healthy for your teeth and which ones aren’t, provide them with a toothbrush,
toothpaste, and dental floss, brush teeth with them, and give them fluoride treatment
to strengthen their teeth. This station is a ton of fun because the kids get really
engaged and are super excited to bring friends back to the station. We’ve had to start
marking hands with a permanent marker so they can’t keep coming back, although they
still try to wash the marker off their hands, give us different names, and convince
us it’s their first time at the station. If that’s our biggest dilemma, I think the
charla has become quite successful.
Once everyone has attended the proper charla, patients pass to the pharmacy station where they will receive any medications prescribed.
Each prescribed medication is explained in its entirety to ensure even patients who
are unable to read will understand how to take their prescriptions. Once this step
is complete, patients are free to leave the GB clinic.
The medical mission of GB does not end there. Data informatics (DI), which is completed
by each brigade on every patient seen in the community, provides GB with a plethora
of details surrounding each patient’s visit. This information provides insight into
common health problems within each community and can be used to determine which brigades
will follow the medical one into each individual community.
DI often reveals medical trends of a community and, in rural Honduras, the traditional
lifestyle dictates many frequently seen ailments. For example, the lack of clean water
often leads to a number of health issues. Many individuals present with intestinal
parasitic infections from contaminated drinking water. Furthermore, the lack of clean
water often results in other, more easily obtainable beverages being consumed such
as juices and soda. This results in an increased number of dental caries and infections
seen on the medical brigades. Additionally, dirt floors predominate in homes and increase
the prevalence of parasite infections acquired through the skin of bare feet. Stoves
are often placed within the home, which generally has corrugated metal or terra cotta
tiles for roofing. These roofs do not allow for proper ventilation and result in smoke
and cooking residues being easily inhaled. Therefore, respiratory ailments are also
With the ability to identify these common diseases and conditions, GB is able to determine
the traditional pathway of brigades, which involves water and public health brigades
following the initial medical brigade. Water brigades work with engineering brigades
to design and install water-carrying systems that allow homes to have access to sufficient
clean water. After clean water is accessible to a community, a public health brigade
This year was the first year IWU participated in a joint medical-public health brigade
and the first chance I had to join in a public health brigade. Public health brigades
enter into communities and identify families who want to work with GB and local Honduran
masons to improve their living conditions. GB pours concrete floors to eliminate the
dirt floors in the home, builds eco stoves that require less wood, properly ventilates
the home to reduce inhalation of smoke, and builds a hygiene station to provide clean
water accessibility and privacy for personal hygiene. The hygiene station includes
a pila, which is a small personal well that holds clean water for washing dishes or clothing,
and an enclosed toilet and shower with a smaller pila that enables the use of clean water to bathe and use the restroom in a private setting.
These simple infrastructural changes have the potential to change lives by decreasing
the risk for a number of medical issues, providing privacy for and accessibility to
improved hygiene practices, and making a variety of aspects of daily life simpler
from not having to travel miles per day to collect still-contaminated water to being
able to cook without the house filling with smoke.
In the second half of our joint brigade we completed projects for three families.
All the families were constructing hygiene stations and two needed concrete floors
poured. We worked with several local masons who explained each part of the process
to us as we completed the hygiene station and poured and patterned the concrete floors
so the families wouldn’t slip on a smooth surface.
One of the families – a couple in their 90s – best exemplifies the gratification of
working with GB. They repeatedly thanked us for coming and kept reminding us that
everyone on this planet is equal and that we are all brothers and sisters in this
world. They insisted on blessing each of us individually before we departed for home.
I have studied the Spanish language for nearly 15 years in an effort to attain a level
of fluency that enables me to enter into underserved Spanish-speaking communities
domestically and internationally. In addition, I have wanted to be a physician for
as long as I can remember. When I was four years old, my doctor’s kit was plastic
and adorned with Scooby Doo characters. My desire to one day replace this kit with
a real one has never diminished. For this reason, when I decided to attend IWU, I
knew I would study Spanish and biology while following the pre-medical program, and
I knew I needed to seek out opportunities that would allow me to grow throughout my
collegiate journey. I distinctly remember searching through IWU’s list of student
organizations online and finding a brief description of GB. Such a trip immediately
piqued my interest, as my only experiences outside of the United States had been to
other developed countries with cultures quite similar to my own. I immediately was
entranced by the notion of being able to travel to a developing country with a way
of life that would be different from my own that would enable me to engage my passions
for both health care and the Spanish language and its associated cultures.
These passions and my discovery of GB have allowed me to play a role in the augmentation
of community access to health care and public health services, and that reality is
exactly what kept me returning for four years. In Honduras, not only is medical care
often a great physical distance from the individuals who require it, but care and
prophylactic infrastructure is so expensive and unobtainable to the average citizen
that it is not even a consideration when health issues arise. Such dilemmas illuminate
the great divide between ideal health care and the reality many individuals around
the world face.
Such diversity demands innovation to eliminate the ever-prominent scarcities that
exist in worldwide medical access and requires the combination of linguistic, cultural,
and scientific knowledge to lead our society and others to a more inclusive and understanding
approach to medicine. Through work with GB, IWU students such as myself have become
a part of an alliance that has a mutual understanding of today’s world and a common
desire to maintain and respect its diversity. In my opinion, this is why so many of
us keep going back. Of our executive board and the brigade members who travelled this
year, many were inspired on their first trip, a large number were returning for their
second or third years, and four of us were completing our fourth brigade. Through
GB, Honduras opens its doors to students and enables us to see its beauty and its
vulnerabilities in a fashion that encourages us to grow individually and as a group
while also striving to eliminate the related and seemingly entrenched biases that
inhibit the flourishing of our ever-changing world. That is one of the most precious
gifts I have ever received.