Welcome to Ahuas and the Clinica Evangelica Morava! We are happy to have you here and truly hope your stay with us will be memorable, satisfying, and educational. To help you achieve this, we have put together a list of things that will be helpful for you to know before you arrive. If you are planning to come– please read through this “packet” carefully and let us know if you have any questions.

INMED Public Health intern out for home visits with Tomasa

INMED Public Health intern out for home visits with Tomasa

Bathrooms
Community Relations
Dress
Drinking Water
Electricity
Food
Guest Quarters
Insects, Malaria, and General Health
Internet
Language
Laundry
The Libraries
Money
Moral Living
Phone
Relationships with Long Term Staff
Schedule and Free Time
Travel and Transport

Grey water procedure (for dry season.)  Leave bowl in sink to collect water, and dump in bucket when close to full.  Use water in bucket to flush the toilet.

Grey water procedure (for dry season.) Leave bowl in sink to collect water, and dump in bucket when close to full. Use water in bucket to flush the toilet.

Bathroom

Please throw all toilet paper and feminine products into the wastebasket in the bathrooms. Plumbing is easily clogged. As of May 2013, many of our buildings do not yet enjoy running water the majority of the day, at least during dry season. For those buildings affected, we fill up large buckets while there is running water to use throughout the rest of the day. To conserve water, we typically only flush the toilet for solid waste. To flush a toilet with no running water, you simply pour water with the scooper from the large bucket. Please let someone know if cleaning service or maintenance is required.

Community Relations

We encourage you to take walks into nearby villages as possible. The friendly greeting “Naksa” (“hello”) is welcome at any hour. You may be asked by indivuals for help (food/ money/ clothes/ etc….). Please do not give out money, scholarships, or even clothing without asking Dr. Ovelio or Benno. Generous visitors can sometimes inadvertently cause problems for those who follow or those who work here full time.

Dress

Most of the hospital staff wear scrubs, which are very comfortable especially in the warm climate. You will find that while most women here wear skirts (at or below the knee), pants and capris are also appropriate. However, shorts for women (especially short shorts) are not. Dress is casual, modest, and neat.

Our solar panals

Our solar panals

Drinking water

As of May, 2013, we do not have potable water in the clinic. We hope this will be resolved in a few months. In the meantime, bring a water bottle, and fill it up either at Dr. Ovelio’s or Dr. Benno’s house.  Depending on the time of year, sometimes our water supply is also limited. Please try to be conservative with water use.

Electricity

The clinic is blessed to have power 24/7. The power is provided by solar panels and is limited, with backup by diesel generator. Please do not use electric appliances unnecessarily. When you are not using a light, please turn it off. This helps us keep our batteries charged. When the batteries are too low, the generator needs to be turned on and this is an extra expense for the clinic. Please be considerate of others’ needs. Outdoor lighting around the hospital compound is limited, and you will find it helpful to bring a flashlight and extra batteries to use at night. The outlets here are the same as the States, 120 volt a.c.– you will not need an adapter for your appliances.

Typical meal

Typical meal

Food

Meals are typically eaten family style around the dinner table in the Marx’s or Dr. Ovelio’s home. We will try to provide healthy and ample meals. Although as a rule we cannot cater to individual tastes, we will try to be sensitive to your needs. If you require special foods, please bring them along. If you have dietary needs (diabetes, etc.), please let us know as we want to help you stay healthy. Meals are based on foods available to us here in Honduras, but some extras (like maple syrup, crystal lite, peanut butter, chocolate chips) are more available in the States and are always a treat. We ask all visitors to contribute $12/person/day to offset the cost of guest quarter lodging with laundry, and meals.

Guest room above the OR

Guest room above the OR

Guest quarters

Living arrangements depend on how many other guests we have during the time of your stay, and/or the size of your team. Most of the time however, you will have your own room either in one of the doctor’s houses or above the OR. Mosquito nets, linens, a towel, and a pillow are provided. You will be given a key for your room. Please be aware that the bathroom and central living area are not secure and you are cautioned to keep your valuables locked up. Please ask Dr. Benno for the use of a more secure “safe” for any larger sums of money and passports. Be aware of your belongings and try not to be too conspicuous. Please keep your living quarters tidy. If food is left out, ants or roaches will find it. We ask all visitors to contribute $12/person/night to offset the cost of lodging and meals.

Insects, Malaria and General Health

We do have insects here—but they vary depending on rainy or dry season. Repellent is advised. Mosquito bed nets are provided– you should use them. Malaria is endemic in this area and we frequently treat patients at the clinic with malaria (P. vivax only). It is important to research which malaria prophylactic medication will be best for you and acquire it while still in the US (as most prophylaxis requires that you start taking it before arriving in country) The CDC has some very useful information in choosing a prophylaxis: http://www.cdc.gov/malaria/travelers/drugs.html Chloroquine is inexpensive in Honduras. Attend to cuts and scrapes, as they can become easily infected here. Depending on the time of year, grass bugs can be a real problem, causing severe itching usually in areas where there is constricting clothing—socks, underwear, bras. Geckos are our friends! They keep the cockroach population down.

The modem that gives us internet.  (And this page in it's developing staged ;))

The modem that gives us internet. (And this page in it’s developing stages ;))

Internet

As of May 2013, the only internet infrastructure in Ahuas is via 3G wireless service. There are no land connections and consequently no WIFI. If you have a smart phone or Ipad with 3G capabilities, you will be able to buy a SIM card here ($3-4) and a 3G plan from the local cell company. (There are MANY plans but to give you an idea it’s $20 for a 1 month 5 gb plan.) If you want to bring a lap top, you can buy a “modem” (Do this in La Ceiba before leaving for La Mosquitia) It looks like a usb memory stick that comes with a sim card inside that you buy time and data for in the same manner as the sim card for your phone or Ipad. If you are only here for a short time you might find it more amenable to take a vacation from the internet, knowing that the long term staff have access to internet in cases of emergency.

Language

If Spanish is your second language, you are in good company!  Here in La Mosquitia– Spanish is almost everyone’s second language! Most of the Hondurans here are indigenous Miskito- and speak Miskito as their first language, with varying degrees of Spanish ability. While all the clinic staff speak Spanish, they, as well as almost all of our patients are more comfortable in Miskito. Keep this in mind when talking with patients. Even if you are explaining something clearly in Spanish, they might have a hard time understanding. Patience and a positive attitude will go a long way! We are all learning!

Laundry

Service is provided by the clinic. Laundry should be given to any of the Clinic cleaning staff. Clothes are dried by sun and wind, sometimes upstairs in an attic during rainy season, and hopefully will not mold first! Or you can do your laundry yourself under Dr. Benno’s house (ask for schedule and instructions  please). Try to air dry your towels so they won’t become musty and mildewed. Laundry soap can be purchased here in Ahuas.

Dr. Benno in the doctor's "lounge" with medical library behind/ to the side of him.

Dr. Benno in the doctor’s “lounge” with medical library behind/ to the side of him.

The Libraries

The CEM is home to both a modest medical and general library. While you are to sure to find some good reads here, bringing books to read and leave behind is very appreciated by the long term staff and future visitors! For students: If you are debating whether or not to pack the 10 lbs textbook you have come to love– its always a good idea to ask Dr. Benno. There is equal chance that we need it or already have it. We do benefit greatly from a subscription (by grant) to UpToDate available on the Marxes computer and iPad.

Money

Honduras’ currency is the Lempira (roughly 20L= $1.  Check here for current rates.) There are NO banks, ATMs, money changers, or really, any financial services in Ahuas. All of the Lempiras you would like to spend while here, you should bring with you– either exchanging or using an ATM at the international airport you fly into . (Note if you are coming from Puerto Lempira- there is NO ATM there either. You will be able to get money from your ATM card at the towns’ one bank, but only after waiting in line 2-3 hours.) We ask all visitors to contribute $12/person/day to offset the cost of maintenance of lodging and meals. The best way for you to pay this is to bring the money with you in cash; either clean/ newer US Dollars or Lempiras (the banks don’t accept marked or torn bills). The best way to bring money into Honduras for use in Ahuas is to bring the money in with you in cash—US dollars—but use your judgment where to keep it, like a money belt, front pocket wallet, hidden purse. There are other ways to exchange money into Lempiras, but it is much more complicated and can often take four weeks when cashing a check, etc.

Moral Living

As you are affiliated with the Clinic, we expect all visitors to adhere to the moral standards of the local Christian culture. Some of these are pretty standard to any Christian setting: Non-married individuals of opposite genders will be housed separately and should leave room for Jesus between them at all times (or, two feet and a Bible, if you will) and recreational drug use will not be tolerated. Other behaviors, while not inherently sinful, would be considered so by almost any Honduran Evangelical who saw you doing them. For that reason we ask you to refrain completely from smoking and drinking alcohol, remove any conspicuous facial piercings, and cover tattoos if feasible.

Phone

If you have a Ipad or Laptop with internet, you will find that Skype works pretty well here. If you will only be here for a short time, but is important for you to be able to make or receive calls to the US (and if your phone (smart or otherwise) has a removable sim card) you will be able to buy a sim card here ($3-4) and then buy minutes to call the US ($1.5 for an hour through Tigo). Cell phones are relatively cheap in Honduras. In fact the Clinic may have an extra one (donated by previous visitors) that can be used during your stay here- ask us if we have an extra for your use before you come.  Additional minutes (“saldo”) can be purchased right here in Ahuas.

Relationships with Long Term Staff

We are so excited to have visitors come to the clinic to support and partner with us and with God in the work that He is doing here! That said, please remember that you are coming to partner and support, and not to “fix” the clinic, Ahuas, or Honduras. While you are here, especially if you are working in patient care, you will probably notice many differences in how we provide care here vs. how you are used to providing care in the States. Unless a patient’s life is in imminent danger, questions and suggestions about patient care are better addressed in the doctor’s lounge, nurses station, or over a meal. While sometimes staff may be unaware of current recommendations, often it is the case that “evidence based practice” is based on evidence acquired in settings very different from our own. While medical and nursing staff may be aware of current recommendations, we have sometimes found that our method is better suited to our situation. Or, as is often the the case, we are aware of current recommendations and would like to meet them, however we simply lack the resources to do so. On the other hand, if there are updates or plausible alternate treatments or management  it may be your responsibility to address them. Because there are so many reasons for differences in care, it is best to raise concerns and suggestions in contexts where those differences can be discussed thoughtfully and thoroughly. We thank you in advance for your service, humility and consideration!

Visitors relaxing on a hot afternoon on the Marx' veranda

Visitors relaxing on a hot afternoon on the Marx’ veranda

Schedule and Free Time

Clinic/ hospital staff generally follow the following schedule:

0630- Breakfast
0700- Staff devotions at Nurses’ Station
0730- Hospital rounds
0830- Out-patient Clinic
1230- Lunch and free time
1400- Out-patient Clinic as necessary, emergencies, surgeries
1800- Dinner and free time until bed

The out-patient clinic is closed Saturday afternoon and Sunday, leaving more free time during the weekend provided there are no emergencies (A sucking chest wound inflicted by machette made us late for church last week- you never know in La Mosquitia!!) Free time is typically spent reading on the porch swing/ hammock/ lawn chairs on the veranda of the Marx’s home, working on side projects, going for walks to the surrounding towns/ savannah, participating in the daily 4pm volley ball game or other sports with local youth, or playing board or card games (our game library includes Rummy Cube, Uno, Phase 10, Dominos, Yahtzee, and Skipbo. Additions are always welcome!) Occasionally, there will be time for outings. These may be an added expense.

Travel and Transport

While Ahuas has some roads (all gravel/dirt) they are not connected to any major highway system in Central America making transportation of people and supplies rather challenging  Hence most local travel is via dugout/ speedboat (“lancha”) on rivers and lagoons, or via small airplane as with MAF. Visitors such as yourself are vital to help bring both sorely needed equipment and supplies for the clinic, as well as the occasional creature comfort for long term staff. Please get in touch with us as soon as you have your travel arrangements settled so we can help you pack!! Often this will include us mailing things to your US address, so don’t leave it until the last moment. Thanks for your help.

.