San Jose Partners
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We are a sustainable community development project out of the University of Rochester Department of Family Medicine and we are glad you have found us! Our Department has partnered with a rural community in Southwest Honduras called San Jose San Marcos de la Sierra. We started working with this community in 2005 and have made great strides improving the health of the local population through a collaborative approach to rural development. Although we are physicians by training, much of our efforts in San Jose are non-medical in nature. For the San Jose community members, lack of safe water and under-nutrition cause more ill health than does their limited access to curative health care. We realize this and create solutions to address the problems, even when the solutions are outside our comfort zone. The Spring 2021 Trip Report is now available.
Philosophy and Overview of Interventions
Spring 2021 Trip canceled due to COVID
Fall 2020 Trip canceled due to COVID
Update on Helping the Hungry of San Jose Visit this link to learn more and watch a video of the food distribution
Donate online to the Department of Family Medicine Global Health Fund via URMC on-line using your credit card
May 2020 trip and the Fall 2020 trip canceled due to COVID lock down We are working with the San Jose community to help support them. Recently, our sister organization, Unitarian Church of Rochester, send money down to purchase "safety kits" to help the local people reduce their chance of becomming infected. They wanted these kits. Many San Jose residents are struggling to get food. Reports are that many people are going hungry. We are doing our best to assess the extent of this crisis and exploring ways to get food to the most needy. |
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As you peruse our site, if you are as excited by our work as we are, please consider supporting us financially. We encourage you to visit our Donate page. Even if you cannot financially support our efforts in San Jose at this time, consider doing all your Amazon shopping through our link to Amazon. By clicking on our Amazon link, 4% of your purchase price is donated by Amazon to San Jose Partners. That 4% donation costs you nothing, Amazon pays it.
Update: Honduras Trip Fall 2019
We recently returned from the Fall 2019 trip. The entire trip went very smoothly and much was accomplished. We have enlisted the help of a new person to oversee projects while we are not there. We are happy to report that projects are getting completed at a rapid rate. Within 2 weeks of leaving San Jose, all parts we purchased for 16 cookstove were ready to be installed! This trip we had the pleasure of a new dentist joining us, Dr. Roger Carroll. He did a great job and helped so many people. To learn more about this trip, read our trip report. Thank you for your continued support. We could not do this without your help.
Update: Honduras Trip Spring 2019
This trip we were fortunate enough to have two dentists! Our Director of Dentistry, Lina Vega, and Edith Gonzalez. They were very busy helping people who almost never have access to dental care. The clinic was very busy with many sick patients. We believe we helped a number of people. The usual rural development projects continue. We did decide to end the micro-finance project for now, given the difficulty we were having collecting outstanding loans. We brought back 40 lbs of coffee from area farmers in our mini "farm-to-table" project. Once roasted, the 40 lbs of coffee was sold within 2 hours here at Highland Family Medicine.
Below is a reflection from Matt Rivera on a case he handled in the clinic. We hope the story helps you consider more deeply the world in which we live.
Vitamins
The 17th Century Catholic priest and patron saint of charity Vincent de Paul encouraged us, “Go to the poor, you will find God.” I had a hard time finding God in the clinic room on the balmy morning of May 17th, 2019 in Honduras. A boy of 12 who looked 7 or 8 stood in front of me with his shirt off, revealing his ribs and bony arms. He was pigeon chested and had an umbilical hernia. His left shoulder and hip cocked up higher than the right because of scoliosis. His mouth drooped open and his eyes stared off blankly as his mother asked what could be done for his worsening shortness of breath and intolerance of exercise. He did not really seem to understand what was going on.
His mother told me he was born with a hole in his heart, but it had never been repaired. He had gotten more averse to walking uphill or running, and he often got short of breath when he did so. She did not like to let him go outside because she was afraid his breathing would get worse. The left lower side of his chest visibly heaved with each beat of his heart, and the harsh turbulent flow of blood produced a palpable thrill. With my stethoscope, I could hear the loud blowing murmur caused by the opening in his heart. Further examination showed that the boy had an undescended right testicle, and the foreskin of his penis was malformed as well. His mother said he often strained when urinating. Fortunately, I did not hear fluid building on his lungs or see swelling in his legs… inevitable sequelae of his heart condition if left untreated.
In the United States, his heart defect would have been screened for at birth, and the child would have been closely followed by specialists. His undescended testicle and foreskin would have been easily corrected. Early intervention programs would have helped with his developmental delay, and braces would have been available to help correct his pigeon chest. This child had none of these resources. A boy in poor health from a family poor economically was definitely here on this hot mountainside in Honduras, but God seemed precariously absent along with any sense of justice. His mother asked me what could I do for him, and I felt so lost because the answer echoing in my mind was, “Nothing.” We had inhalers in our pharmacy, but these would not help his shortness of breath. There was no way of knowing how well or poorly his heart was functioning. The child needed an echocardiogram, and a pediatric cardiologist would have to interpret the studies. Moreover, the only hospitals with the specialized equipment to do pediatric open heart surgery were in Tegucigalpa, and his family did not have the resources for travel and lodging to go to the capital for the surgery… or pay for the surgery.
His mother and I talked about the possibility of medical brigades being able to provide some of the services her son needed. I encouraged her to take the boy to a pediatrician in La Esperanza, several hours away. I relayed the unfortunate news that without intervention, her son’s condition would likely continue to decline. He would become more deconditioned to exercise because his heart would not be able to keep up. There was no way of telling how soon or how slowly this process would take place. I tried to offer some encouragement though that he needed to be allowed to be a child. She should encourage him to play outdoors and take rests when he did get short of breath. “Lo mas importante es que tiene que ser un niño” – the most important thing is that he has to be a child.
I hoped that this advice would be helpful to her and encouraging to hear. The boy should not be treated as an invalid and kept inside or away from others. He had to be allowed to engage as much as possible despite the shortness of breath. Even this advice seemed hollow and unsatisfactory to me. I expressed to his mother that I was sorry we could not be more help or give more satisfying answers, and I asked her if she had any other concerns. “What about vitamins?” I smiled and felt some relief. There was something I could take care of! We were able to send him home with a supply of vitamins, and his mother smiled as she accepted them from the pharmacy. I was able to lend her some advice and a concerned ear… and the vitamins. I am not sure if I will ever see the boy again, who was my patient for such a short time, but he left a lasting impact on me. He made me think about how pervasive and disruptive injustice and inequity are in the world. In a week’s time we would be taking a flight back to Rochester where all of these medical problems could be corrected, and here there did not seem like a viable solution. God was hard to find that morning, but I think I was able to see a flicker of hope the simple request for vitamins. In that moment, the boy’s mother and I shared a smile of mutual gratitude. She was grateful for the help and listening ear, and I was grateful that I found something, however small, I could help with.
Matthew Rivera
Update: Honduras Trip Fall 2018
We recently returned from our Fall 2018 trip to Honduras. We got so much accomplished! All the usual projects continue to move forward. Cook stoves, pilas, latrines and water filters continue to be built or distributed to the San Jose community. We reconnected with a distant community called el Salitre and hopefully can expand our interventions there. We had a video crew with us for a few days who made a great video about what we do in San Jose. New middle school scholars applied in the hopes they can continue their studies beyond 6th grade. We are exploring ways to help area farmers improve their coffee crop and make more for their coffee. A focus group was held with community members as we improve our micro-loan program. We also had a real medical emergency in the clinic along with the day-to-day medical care of sick people. Check back in a couple weeks to view the trip report to get all the details.
Update: Honduras Trip May 2018
We recently returned from the May 2018 trip to San Jose. A great group of people worked very hard and got much accomplished. One new idea we are exploring to help combat poverty is to find new markets for local coffee growers. We also found a regional group that helps farmers improve the quality of their coffee crop, even to the point of growing organic coffee. Reducing poverty is one of the most difficult problems to address, but there can be no health in areas with severe poverty.
A video was made in May of a severely disabled girl we have been trying to help. She lives in the village of Portillon, about a 2 hour walk from the main village. Her family struggles terribly to support this girl. A children's home a few hours away in another parto of Honduras is trying to raise money to have this girl live with them. Consider watching the video. It is moving and helps us realize just how hard life is for people living with disabilities. Video. This link will take you away from SanJosePartners.org. Video2
2017 Fund Raising Auction
Every December we hold a small auction in our office. Staff members make hand crafted items and others within the office bid on each item. We raised a bit over $1,500 this year! It is a great deal of fun seeing how creative people we work with every day can be. Some of the items can be viewed on-line. 2017 GH Auction
Fall 2017 Trip Update
The Fall trip to San Jose Honduras went very well. We of course saw patients in the clinic, educated students, and took applications for new scholars. There were many other activities that are chronicled in the Fall 2017 trip report. Trip members were very moved by some of the realities of how hard life can be for many people in our world. During the trip we tried our hand at Crowdfunding. Although we did not meet our goal, we raised money to help further our activities in San Jose. Thanks to everyone who donated!
Fall 2017 Photo Journal
A few more photos from the most recent trip can be viewed here.
Spring 2017 Update
The Spring 2017 Trip Report is available for viewing. Many great interventions took place, including a survey on Alcohol use in the area. You may also want to find out about how chicks are used at deliveries by traditional midwives.
Fall 2016 Update
The Fall 2016 Trip Report is available for viewing. Five residents, one medical student, a Nurse Practitioner, a community activist, and one Department attending physician returned to Rochester in mid November after two weeks of hard work in San Jose. It was a great trip with much accomplished! Read more about all of our activities in the trip report.
Spring 2016 Update
News from the May 2016 Brigade
Eight people from the US were joined by four Honduran interpreters for the May brigade. The trip went very well. The trip report should be available by the middle of June. Below are stories of clinical cases from the trip report.
--The patient we reported on previously, with the complete heart block, continues to do well, but his heart rate remains in the 30's and he has limited abilities for physical activity. He cannot afford a pacemaker so he remains symptomatic.
--On our last day in San Jose, as we were beginning to pack up the pharmacy and clinic, a boy presented with a significant burn to his left arm. The mother reported he had briefly passed out and fell into the fire. As the photo demonstrates, this was a significant third degree burn. We recommended to the mother that after we dressed the wound she take him to the hospital in Esperanza. The burn was extensive enough that debridement under anesthesia would be needed. She stated she could not go to Esperanza. The cost was too great. She had no place to stay there. And she did not have anyone to care for the rest of the family. We were left with dressing the wound, starting prophylactic antibiotics, and significant education about complications to watch for.
--My patient is a 55 year old female with chief complaint of bilateral knee pain ongoing for the past 10 years. Achy, 6/10 worse throughout the day, no trauma or falls. Differential were many, but most likely we suspected it’s due to chronic osteoarithitis. We decided to administer joint steroid injection to both of her knees. The story only begins from here.
I also noted a rash on her nose which had been present for the past three years. On further evaluation it was noted the rash had been increasing in size, sometimes would bleed. It was devastating to find out nothing had ever been done nor was she seen by any other doctor till now. Of course high on my list is cancer, including Basal Cell Carcinoma.
In the US I had just finished Dermatology were biopsies were easily obtained and performed at the bedside and sent to pathology. After sharing the news, patient reminded me of other necessities her family would have to give up in order to do any more tests. Including food for the next day, not able to look after her grandchildren or even giving up one year of saving for medical treatment.
The session came to an end shortly and the patient was given steroid injections and sent on her way, with referral for skin biopsy at one of the city hospitals. Not knowing if she will ever get further care, I moved on, deep inside feeling unsettled and hurt by the first world privileges I have back at home, none of which can be used to help my patient right now.
Nidun Daniel
Fund raising
Silent Auction
We held a silent auction recently in our Department to raise funds for Honduras. The items for auction were mainly created by Department members.
Christmas Wreaths
Recent graduate Rachel Long, MD, and her father donated 35 home made wreaths that were sold to raise funds for Honduras.
Fall 2015 Update
News from the October 2015 Brigade
Representatives from the Department of Family Medicine returned to the US on October 28th after spending 13 days in Honduras. The trip report should be ready in a few weeks. Below is a summary of some highlights from the trip.
Two MD faculty, one retired NP faculty, three family medicine residents, and one UR 4th year medical student comprised the group. We were joined by four Honduran interpreters. The 11 of us squeezed into the small three bedroom volunteer house. As always, the group was very busy with clinic work, home visits, multiple projects, and meetings filling the days. The group did a great job!
Clinic
The clinic was steady busy. Many URIs and headaches were the baseline. Reports of worms were common. A few cases of scabies presented. A number of joint injections were given. A laceration repair was done. One 24 year old woman had a seizure while in the clinic. A young man with schizophrenia we know continues to struggle with his disease and does not take his medicines regularly. A man we diagnosed with complete heart block in May was unable to afford a pacemaker so he continues to walk around with a heart rate of 35. A girl of about 8 presented with a significant laceration below her knee cap. We had a concern the patellar tendon was severed so we helped pay for a local owner of a pickup truck to transport the girl to a government hospital which is about one hour away.
Home Visits
We had a couple interesting home visits. One lady developed a significant infection to her foot and could not walk to the clinic. Group members walked the 40 minutes to her home and assessed and treated her. After a few days she was feeling well enough to walk up to the clinic to be reassessed.
An elderly man was traveling to our area to visit family. He could not make it all the way to his destination so he slept in someone's house for the night. He reported seeing a caterpillar on the wall and woke up in the morning with a significant burning rash on one side of his body. There are caterpillars in the area that can cause a severe chemical burn to the skin, but we believe the man had a severe case of shingles.
Scholarship
We checked in with the existing scholars, and took applications for new scholars that will enable 6th graders to attend 7th grade starting in February. Unfortunately, the majority of graduating 6th graders cannot afford to attend 7th grade. Our scholarship program enables the best students who come from poor homes to get additional education.
The tutor we support continues to help area students be successful. Unfortunately, we have been unable to find another tutor who can help with English classes. English language classes are required, but no one in the area speaks English so our scholarship students struggle.
Teaching
Brigade members made the 1.5 hour hike to the community of Portillon to work with the school children. The Unitarian Church tangram curriculum was revisited. Classes on puberty and sex education for the older children was well received, with the children having excellent questions and supporting a great learning environment.
Microfinance
An entire day was filled with microfinance. Both beginner and advanced classes were offered. Class members had great questions/comments and were very involved. Then began the long process of hearing business proposals and deciding on which projects should be funded versus denied. We only loan out as much money as was returned from the loans from six months ago that were repaid this trip. The repayment process occurred throughout the two weeks we were there.
Rural Development Projects
The selling of water filters, and the construction of cook stoves, latrines, and pilas has slowed over the past year, but we may have made some progress on increasing these rates. We are expanding these interventions into two new communities: Rancho and Salitre. Both communities have motivated members who are pushing hard to obtain these interventions that can improve the quality of their lives and their health. The necessary materials are on-site to at least start the interventions. We do need additional funding to reach as many homes as are interested. Filter sales during the brigade were brisk. Since last reported, 6 new cook stoves, 7 pilas, and 1 latrine have been built, along with 26 filter sales.
Agriculture
We imported many thousands of heirloom vegetable seeds last year. The Rancho school caretaker has been experimenting with these seeds and had great results with most of the seeds. Our hope is for these seeds to be spread to all interested inhabitants so people's daily diet can be more varied and more nutritious.
The largest fish farm we support has been struggling with a jealous neighbor constantly cutting the water hoses that bring necessary water to the fish farm. Multiple meetings were held in an effort to resolve this issue.
Summary
This group worked very well together and everyone worked very hard. We accomplished much and had a great time. Please consider supporting our efforts so we can continue these good works. Visit the Donate page to learn how.
Rancho caretaker with example of radish
Chanh and Mary teaching micro-finance class
Liz, Ryan, and Mary on a home visit to help an elderly gentleman
Spring 2015 Update
The May Brigade was a great success! The University of Rochester medical student, Joshua Back, has done a great job over the past six months while living and volunteering in San Jose. Below are some highlights
- Dental: Lina Vega, DDS, was on the Brigade and was extremely busy providing curative dental care. She also checked in on Josh's work strengthening the fluoride rinse program
- Medical Clinic: The clinic was comfortably busy. We were able to work with the new Community Health Worker, Anna, who runs the San Jose clinic two days a week under the auspices of Shoulder to Shoulder.
- Education: This program area was very busy all Brigade. Meetings with existing scholars, student education, and teacher education filled much of the time for many in the group.
- Microfinance: This was a great trip for the microfinance group. They had a high percentage of loan repayments and were able to fund all new loans from the repayments. Both beginner and advanced business classes were presented.
- Parteras and Health Volunteers: A very helpful focus group meeting occurred about unwanted young mother pregnancies. The Trip report will provide more details.
- Home Surveys: Josh completed 60 home surveys and data analysis is just beginning. This study should really help us better understand San Jose, and the needs of community members.
- Cook stoves, Latrines, and Water Filters: We met with two communities that are not part of our current project area, Rancho and Salitre, about expanding these interventions into their communities. We are hopeful this can happen. It is always reassuring to our group to realize just how valued our interventions are, that others really want to benefit.
We expect the May 2015 Trip Report will be available on-line by mid June. This will provide more details about the above mentioned activities, along with much more. Thanks to everyone for their continued support of our Global Health Program.
Sarah Porter working with teachers
Fall-Winter 2014 Update
The October brigade was a great success! We accomplished so much in these very busy two weeks. Probably the most exciting update is we have a University of Rochester 4th year medical student spending the next 10 months in San Jose. Joshua Back will be performing home surveys as well as increasing the pace of implementation for our other projects.
We have posted a few stories from the trip below. Consider viewing our trip report for more information on the Fall 2014 trip.
A young child and intractable seizures
A year ago we shared the story of a four year old girl whose parents raced across the hillside paths carrying their seizing daughter in their arms. We were able to quickly stop her seizure with an injectable medication, but it was clear that she had been suffering continuing brain damage with each subsequent seizure. We faced the tough decision of what to do to control her seizures going forward, after the brigade returned to the states. Although unconventional, we decided to teach her parents how to administer the injections in the case of a prolonged seizure, provided them with vials of the medication and carefully written instructions detailing how to prepare and administer the seizure medication. In contrast, this year the family arrives at clinic almost unnoticed, with a sense of poise and quiet confidence so absent last year. In the exam room, her father carefully unwraps the laminated instructions that we had given him last year and that the family carries with them wherever they go. They've used it twice he says. Both seizures occurred when she was sick, lasted 15-20 min, and responded quickly to medication. She seems completely transformed from last year, a reeling ball of giggles when approached with a tickling finger and speaking in full sentences when the tickling finally stops. Her father no longer worries if she will survive, but now he asks what can be done to catch her up and ready her for kindergarten.
Slope of poo
There's a romanticism I'm prone to surrendering to when I watch children run easily through these grassy mountainside foot paths. The winding ways and deep forest short cuts to their aunts, grandparents, and friends are worn deep into their minds – an integral part of their understanding of life. I walk their paths as a stranger attempting to not loose myself on the unfamiliar slopes, over come with the beauty of this countryside. Inevitably, glimpses of the harshness of this existence snap me back to a more grounded reality. Clothes lines filled with worn rags, children playing with broken pieces of a wooden chair, a quick glance of two mattress-less bed frames for a family of seven. At times the reality check comes as an olfactory assault – the strong unmistakable smell of urine and human feces stretch a 10' up-slope of path leading to a home. The do-to lists seem insurmountable in this world of pervasive need, but we caution our tendency towards pessimism with a generational approach to community development. This year's micro-finance loans, when placed in the right hands, will lead to sufficient beds, food, and school uniforms in 3-5 years. This year' scholarship recipients, if properly supported, will go on to find employment previously unattainable and bring new skills back to their communities. In the mean time, we continue to work with community members' more immediate needs - improved cook stoves, water projects, and latrines for schools and homes. A tour through the communities of Las Delicias lead me up a familiar fence-lined rocky slope to a home where Manuel showed us a recently constructed latrine, one of many in the past few months. As we left the home I looked back down the slope and realized both why it was familiar and why I hadn't initially placed it among my memories – its distinctive smell and accompanying disease potential had been moved, contained within a deep pit, returning odorlessly deep into the earth, replaced by fresh air.
Elderly home visit
“Would you mind, do you have time? There's a couple just up the road. He's broken his waist and she's dying of a fever that won't quit.” We've just returned from a 10 hr hike and tour of recent projects, but she's right, we do have time. Their son-in-law greets us at the road and leads us back through a grove of mango and calabash trees. A scant frame of a man lays flat under mounds of blankets and a walker stands next the bed – altogether out of place and otherworldly in this bare world of concrete and rough hewn wood. He wants us to know he's been in this bed for an entire year. He had broken his hip after a fall and was lucky enough to get surgical correction, placing a metal plate. However, his family could not afford the weekly trips to the city for his physical therapy and, now a year later, his leg still doesn't bend well. He wants to sit but he can't and he is in pain all the time. A quick physical assessment reveals a body atrophied at all points, barely more than a skeleton, but still trying so hard to be mobile. I think of what happens to a patient who fractures their hip in the States – 5 days in bed requires weeks of inpatient rehabilitation and painful physical therapy. How does one begin to rehabilitate after 12 months in bed and with no therapist to guide the process? We review exercises that he can do to improve mobility and we prescribe medications for controlling pain. His face livens, filled with a new sense of hope, but we know that without infrastructure for true rehabilitation, he will likely not walk on his own again. We walk home in the darkness, our path clear in the moonlight, a new understanding of "resource poor" settling silently on our shoulders.
One small daily commute for scholars, one insurmountable hike for the gringo
It is 6am and I find myself climbing the ascending road alongside one of the best high school students in the scholarship program. She is on her way school, a trip that started an hour before she encountered me and will continue for another hour more until she reaches the school in San Marcos. I consider myself a pretty good hiker, having walked all over San Jose during this brigade, but I am fighting with every ounce of energy just to keep up. At some point just before reaching the middle of the hill, I find myself actually matching her steps, momentarily restoring my ego her causal steps had just trampled. And then I realize that she only slowed because she is studying from her English notebook at the same time as she is climbing this seemingly insurmountable hill. The terrain here is so treacherous that I consider myself blessed every time I return to the volunteer house with all my limbs intact. But she has to study on this walk because it is hard to find enough time to study in between her twice daily two hour commutes. Any of us thinking back to our twenty minute bus rides to school can only admire the obstacles that these students overcome every day. Meeting these students over the past week has solidified for me how our scholarship program opens the door of possibility for these students and how their shared mix of hard work, perseverance, and optimism enables them to take hold of the opportunity.
Micro-loan receipients with receipt of repayment in full
