At the brink of a new era for education
In her eighth and final year of medical school in Honduras, Eimy Barahona volunteered to do a year of residency at the hospital in Puerto Lempira, the capital city of the country’s most remote region, Gracias a Dios. While much of Honduras is mountainous, Gracias a Dios is a sparsely populated region filled with rain forests and lagoons on Honduras’s eastern coast on the Caribbean Sea. The only access to the region is by plane, and within the state much travel takes place by canoe.
As a medical student in the country’s capital of Tegucigalpa, Eimy had often seen patients coming in from Honduras’s remote areas with medical problems and diseases that were well-advanced and should have been treated sooner. The difficulty and expense of travel in Honduras is especially apparent in Gracias a Dios, where flights to the region cost $500. Medical personnel at the regional hospital in Puerto Lempira would often see patients who had traveled six hours or more by foot and canoe to get to the hospital.
Impelled to try to address the lack of access to medical care, Eimy and other doctors in Puerto Lempira began volunteering to visit some of the more remote parts of the municipality. They provided basic medical training, medicines, and even obtained some prosthetics (amputations being a fairly common injury among the fishermen). But, as Eimy states, “the year passed very quickly, and we were faced with asking ourselves ‘what can we do to maintain this?’”
Apart from geography and travel challenges, providing medical attention to Hondurans is further hampered by the fact that the country — which is the size of Pennsylvania and has a population 10 million — has one of the lowest levels of health personnel in Central America with just 14 doctors per 10,000 residents. (For comparison, the US has two-and-a-half times as many doctors per capita.)
Eimy had often seen patients coming in from Honduras’s remote areas with medical problems and diseases that were well-advanced and should have been treated sooner.
Barahona began working with three other medical professionals — Dr. Brian Erazo, Dr. Juan Carlos, and nutritionist Melissa Arteaga — to explore ways to deliver medical care to Hondurans. As they worked to research what Barahona calls “their crazy idea”, they reached out to organizations in Costa Rica, Guatemala, and Argentina to learn about community medical programs in those countries.
Out of this research, Telesan was formed and in 2019 a grant from the European Union allowed them to begin operation. The mission of Telesan is straightforward: give underserved remote communities in Honduras access to medical help and specialists. Accomplishing this is anything but straightforward.
Telesan links villages with regional hospitals and medical specialists in Tegucigalpa by providing solar panels, internet access, cell phones, and computers. Personnel in the community working with the Telesan program are trained to use a computer, log onto the platform, collect and share patient histories, and initiate medical consultations.
Patients are then seen virtually by a doctor who can recommend a course of treatment based on the equipment and medicine available to them in their village, or make a referral for a telehealth consultation with a specialist on the faculty of the medical school at The National Autonomous University of Honduras. Medical students at the University receive academic credit by participating in consultations, providing a key resource for the network.
As Barahona states, “Telesan creates the opportunity to address medical issues – whether [someone] needs the expertise of a pediatrician, neurologist, obstetrician, or another speciality.” Equipment, including dermoscopes that photograph the skin, and another that photographs the retina and attaches to a cell phone, allow patients to receive help remotely.
Another way Telesan is impacting access to healthcare in Honduras is through their education and training classes. Everyone in the Telesan network can participate in the weekly program in which specialists discuss problems that might be seen by care providers in the community. One week an obstetrician might discuss complications with pregnancy, and the next an endocrinologist might share their insights.
To date, Telesan has set-up 50 telehealth programs that span 13 of the country’s 18 departamentos, or regions. And they have relationships with doctors representing 25 medical specialties. The organization has a staff of 8 and is currently working on adding 6 more telehealth units. More than 400 volunteers support the organization, including medical specialists, family doctors, nurses, nutritionists, and other health professionals. Telesan’s four founders are still involved with the organization, although Dr. Baharona is currently in Europe completing a Masters in Public, Environmental and Occupational Health.
As Telesan has expanded, so has their relationship with the Honduran government. While Telesan’s work has been well-received and encouraged by the communities and government officials they’ve worked with, Baharona reports that it’s also a challenge to continue moving forward when there are frequent changes in government administration and personnel.
Telesan’s other significant challenge is funding. They have received support from many sources including the World Health Organization, Pan American Health Organization, Inter-American Development Bank, and others. Baharona states that their current projects are funded, but continuing to grow will require additional funding, and because of that seeking out financial support is a constant focus.
Asked what she envisions for the “crazy idea” that she and her co-founders dreamt of years ago, Eimy Barahona states, “I hope to see telehealth implemented nationwide that will require systemic change due to [the country’s] lack of doctors and infrastructure.” And, ultimately, she hopes that “someday everyone studying medicine can study telehealth as a part of their academic studies.”
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