Dr. Marco Giannotti: The Emotions Behind The Mask

Saint Anthony of Padua Mission to Honduras – A Proposal for Improving Continuity of Medical Care & Creation of a Mobile Medical Unit (MMU) of Service 

As the Saint Anthony of Padua Mission completes it’s tenth mission to Honduras, we continue to learn from & improve on our previous missions serving the neediest in the villages of the areas we serve. The missions’ efforts continue to improve the lives of those living in the more remote areas outside of Trujillo, Honduras.

This past mission marked my first return since 2019 as well as my first mission with the main mission being based entirely at La Colonia.

Having been on previous missions where we had split up between La Colonia, El Mirador and Esperancita, I immediately recognized the benefits of being centrally located in one village. Storage in the newly built room adjacent to the computer room has made organizing and setting up both medical and dental much more efficient. While humid conditions will always be present in Honduras, at La Colonia the stored equipment will not be subject to salt air conditions (as they were at the hanger). This will hopefully help prolong the life of the various things we need to serve the people of this mission. The ability to wire all of La Colonia for generator powered electricity eliminates the unpredictability of outages which are not uncommon on a day-to-day basis on the mountain. While medical can generally work around an outage, dental cannot. Generator power will continue to be a crucial part of keeping the mission in action during the short four days we are there. A big thing I noticed was that logistics was not “thinned out” by having to be at different villages on differing parts of the mountain. This allowed them to focus on practically every aspect of the mission. As I said before, the logistics crew is an amazing group of individuals who work tirelessly behind the scenes to keep every aspect of the mission going. Finally, the water project continued as a large part of the mission with huge gains being made in the distribution of clean water to the neediest on various parts of the mountain.

It appeared to me that organizing visits to the medical and dental teams based on “village days” seemed to work quite well.

That many patients (averaging approximately 100 per day per team) were able to make their way down to see the medical & dental teams without any issues. Centralization of the pharmacy along with medical & near dental was quite helpful. In one specific example, a patient had walked from Las Brisas in need of significant dental care. This patient suffered from significant hypertension which would not have allowed her to receive the dental care she desperately needed while we were there. After speaking with Victor Hugo, he relayed to me what blood pressure parameters he would need to complete the dental work, & he asked me to bring her immediately to him once those parameters were reached. She was treated with rapid acting anti-hyper tensive agents & monitored by our nursing team in medical during this time. After 40 minutes, her pressure had normalized, & Victor Hugo was able to complete his work. This was a victory achieved through the coordination of care between medical and dental & is just one of several examples I witnessed during this mission.

From a medical perspective, having all the doctors in the same location allowed for better care of our patients overall.

As we have seen over the years we have ranged from a single doctor for an entire mission (as in 2023 with Dr. Hunter who was amazing), to a total of four physicians which we had on this mission. Most of the physician make up is primary care or some form of specialty which provides primary care as well. Having all 4 physicians on this past trip in the same location facilitated the ability of us to consult one another about specific issues as we often do in our clinical practice at home. This same interaction was experienced between physicians & nurses. We often dealt with children or pediatric patients where doses need to be adjusted. These are clinical situations that physicians who mainly treat adults do not see daily. Having physicians present who could help with treating patients of various ages was a great help. The overall interaction between physicians, nurses, pharmacy & translators on this mission was honestly the best I have ever seen. Without citing more examples, I can attest to the fact that significant positive clinical impacts were made to scores of patients of all ages. We are no longer just treating “aches & pains”. We are treating hypertension, diabetes, respiratory conditions, skin conditions as well as GI/Parasite issues. On this mission we utilized glucometers, ultrasound machines, & even ran basic EKG tracings thanks to Dr. Romero. Serial breathing treatments were performed in both adults & children with one child having received a total of 6 treatments over the course of several days after presenting with significant respiratory issues.

Such efforts over the years have truly made a difference in the lives of our patients in Honduras & we continue to improve our efforts over the last 10 years of service to this area of Honduras. 

My experience on this trip based on the success of the “one location” set up has made me think about two other critical aspects of this mission. 

1. How do we continue to provide treatments for chronic illness in our patients once we leave? 

2. How are we able to serve those who are unable to make the trek down the mountain to see us at La Colonia?   

We have now come to realize that there are indeed numerous patients who used to receive care directly in their village up until 2019 & now no longer receive the care they need.  Most of these patients are older patients or patients who have physical limitations which don’t allow for simply walking to be treated at La Colonia.

On my very first mission trip to Honduras, I was able to perform several home visits right in La Colonia.  Serving in the clinics really had opened my eyes to the plight of our patients from both a medical as well socio-economic perspective.  But home visits open an entire window into the world of how our patients truly live. 

Our intake missionaries provide us with absolutely the best possible information prior to us seeing the patients.  They remain a critical part of our care and understanding of these patients.  Being able to see into the actual living conditions of our patients, however, provides additional perspective into things which may not be visible to us during a clinic visit.

How Can the Honduras Mission at St. Anthony’s Continue to Provide Medical Care After the Mission is Complete? 

Being able to bring a pharmacy to be able to treat a wide range of medical issues during mission has been truly a blessing.  Over her decade of service to the mission, our pharmacist Cathy Neill has worked on various order sets through “Blessings International” which we purchase our medications through.  She has been steadfast & caring as well as meticulous in her organization of pharmacy which is no easy task.   

The medications we provide work well while the patients are taking the medications we prescribe as appropriate.  But what happens after we leave? 

Invariably, the patients we treat do well for a certain period (which is a blessing), but eventually run out of medication & subsequently their condition deteriorates back to pre-treatment levels.  Last year, the mission was challenged by the fact that customs made it very difficult for the medications to pass directly through the airport.  This challenge has now been overcome thanks to Franklin Marsan, & sending medications to our needed location directly should (hopefully) no longer be an issue. 

A significant positive that dental has seen over the years, is that since routine dental cleanings were initiated on mission, the number of extractions needed has decreased.  Dental cleanings & teaching of dental hygiene as such has had a direct & positive impact on the dental health of the population we serve.  The dental team has seen a direct correlation in that fewer dental extractions have been needed since the dental cleanings were begun.  Data regarding medical missions indicates that there are obvious benefits to continuing medications after the mission is complete.  Some data in fact shows that there may even be negative effects if medication is discontinued suddenly. 

At the end of this proposal, I have included an article from “Annals of Global Health”.  The article titled “A Review of Hypertension and Diabetes Protocols for Medical Service Trips (MST’s) in Latin America and the Caribbean” Is a primer for this goal.  I have highlighted a few key points that may help us move forward.  

After much discussion with Deacon Dan Dragone, my goal has now become one of how we can continue medical care throughout the year (specifically for chronic illnesses such as diabetes and hypertension) for our patients.  Thereby having a longer lasting positive impact the way the dental team has noted.  I have begun coordinating with Franklin Marsan, Deacon Dan and others with regards to this idea.  Having access to the Blessings International website will allow us to order needed medications throughout the year (perhaps once a quarter) to ship medications to a point of contact that could help distribute the medications to those who need continued care.  After speaking with Franklin, he has indicated that our growing relationship with La Finca may help with this process.   

This goal is not an easy task, but I truly believe it can be achieved. 

If so, we can enhance & prolong the positive results we achieve on our mission.  This will add to Deacon Dan’s goal of “Honduras 365”.   This is a work in progress, & I will keep the mission appraised of our progress as we prepare for the next trip.   

Creating a Mobile Medical Unit (MMU) to Care for Remote Patients During the St. Anthony’s Mission to Honduras 

This point brings me to main crux of my proposal to the Honduras Mission core team.  The request to create a permanent mobile medical unit (MMU) to provide medical evaluation, care & other necessary items to remote villages to those who cannot make the journey to La Colonia during the mission.   

During the 2024 mission, we were able to put together a medical team which travelled with a driver and a local resident to guide us to the homes of those who needed care that could not travel to La Colonia. 

This year, a list was given to the medical team  with specific requests for visits from several residents of each individual village.  Each day, we made an individual trip to Las Brisas, El Mirador and Esperancita.  This was done after the “morning rush” of the main clinic at La Colonia.  The medical team during this experimental year consisted of a physician (myself) as well as a nurse (Joey Chapman) who specializes as a trauma nurse.   

When discussions for the MMU began, Joey began putting together a travelling pack of medications, IV bags along with angiocaths & IV tubing, wound cleaning & dressing kits, along with a glucometer & strips for glucose testing.  A nebulizer machine was also brough along with albuterol for respiratory treatments.  We brought our stethoscopes, blood pressure cuffs & pulse oximeters for the initial assessment/triage of each patient/family we encountered.  We were not sure what to expect as far as imaging needs so the ultrasound was left in the main clinic at La Colonia should it be needed by the main clinic physicians.  Additionally, Joey packed a bit of clothing/flip flops & various items that might be needed by the villagers.  In the end, we discovered this was greatly appreciated & needed by those we treated. 

Our first visit was to the village of Las Brisas, which by comparison to the other villages was probably the most challenging to maneuver through (by truck and foot) and in the most difficult condition. 

We learned quickly that walking in these villages can be quite physical & getting to the various homes can be somewhat of a challenge, especially when the weather turns to rain.  We completed several visits & treated multiple patients with needed medications.  Because it was our first foray into the villages, we realized we needed to bring a larger supply of various medications.  We took notes of each visit & what was needed or missing.  We also developed a plan for family members of those who needed the medications that were coming to La Colonia the next day, to find either me or Joey so that we could fill a prescription or item that was needed to bring back to their family member.   We both learned a lot about the needs for a MMU during the very first few visits. 

During our return from Las Brisas, we were asked to stop at a woman’s home who had recently overcome Dengue fever. 

Upon our arrival we found her resting in a dilapidated hammock, & upon examination found her to be quite short of breath & with a lower oxygenation concentration than normal.  After our assessment, a breathing treatment was performed & she had significant improvement with a return to normal oxygen saturation.  We told her that we would come back the next day for a second treatment.  Despite this, she felt so good after her home visit that she walked to La Colonia the next day for the second treatment.  During that time, we were able to give her a brand-new hammock to sleep on.  This was such a positive not only for her medical care but her overall well-being as well.  She could finally get a better night’s sleep on a brand-new hammock. 

The second day at El Mirador brought us a lot of information about not only the water mission but also about the conditions of a few of the patients that could not make the journey from Mirador to La Colonia. 

Upon arriving at the top of the mountain we encountered the team responsible for the water project.  Until now, villagers have been relying on river water as their sole source of water for consumption & bathing.  Almost always there are cows, chickens & other animals defecating in the very same water, & the potential for significant disease is great.

The water project is probably the least visible part of the mission.  When we arrived at the top near El Mirador, we were fortunate enough to stop & visit with the team that is making this part of the mission a reality.  Clean water is something we all take for granted here at home.  Even when the power is out after a hurricane, most of us have clean drinking water for all our needs.  The need for clean water has been at the forefront of this mission although seemingly not as much in the forefront as medical, dental & catechetical.  Seeing the water team in action was a blessing, & for the first time in 40 years, villagers are getting clean water delivered right to their homes.   

After we met the water team and saw their dedicated work in extremely difficult conditions, I was absolutely assured of God’s work through everyone in this mission. 

The incredible & physically difficult work they are doing is not seen by all of us, which is why I wanted to share it.  They are enthusiastic about the work they are doing & truly have Jesus’ spirit in their hearts.   

After visiting with the water project team, we headed to the main village of El Mirador. 

Hector (our amazing driver) was watching the weather closely as daytime heating was beginning to churn out thunderstorms.  We made multiple visits to homes that needed care.  The weather then turned sour, & we were forced to return to La Colonia.  The trek back was not easy, but Hector (and the grace of God) got us back safely.  The MMU learned all about putting chains on truck tires & driving down a dirt road in in first gear during a Honduran rainstorm. 

The final trip for the mobile unit was to Esperancita during our last day on mission. 

This day we encountered a woman who had a deep would infection that had not received any medical care for weeks on end.  When we arrived to assess her, she was comfortable & welcomed us into her home.  She could not explain how the wound occurred except that she “hit her leg”.  We triaged her & evaluated her for diabetes which did not appear to be present.  The wound was cleaned & treated, plus we taught the patient how to properly clean & debride the wound so that it could heal better.  The MMU left her dressings & supplies so that she could properly take care of her wound.  

Before the mission was complete, were also visited with the local midwife who lives on the mountain. 

She has made over 250 deliveries in the mountain conditions & is known as “La Partera”.  After visiting her, she told us that she had been completely out of supplies for deliveries for some time.  Upon our return to La Colonia on the last day, packages were prepared with supplies for deliveries including gauze, gloves, water basins, baby clothing & blankets.  These were brought back to her by locals who were helping the mission.  Had we not gone up the mountain that day, we never would have known of her needs.   

This year marks my fourth trip to the medical mission in Honduras. 

Our mission has always adapted to the needs of our Honduran brethren & continues to do so.  This first year, the MMU was able to visit 15 homes in the various villages our mission serves.  This would have not been possible but though the coordination or leadership, logistics, & the local people in the villages we serve. 

I pray that we can serve even more of those in need during future missions.  This is why the creation of a mobile medical unit is so important to me.  The need for additional equipment such as a portable EKG machine as well as a second ultrasound machine which can travel will be helpful to provide necessary care.  I have many ideas for the MMU & next year’s mission outside of this project & will present those ideas as we come close to the next mission.   I hope & pray that this proposal helps to add to the excellent care we are already providing in Honduras.  I feel that a mobile medical unit will enhance the care we are already providing & will complement the centralized model of care at La Colonia.