OLANCHO, Honduras –
As she stepped off the bus with her two young daughters in hand, Rosa Chirinos was intent on making it to the village of Bacadilla before the sun’s rays could poke through the vast pocket of pine trees that lined the mountain ridge to the east.
Up the steep, rock-strewn dirt road she went, passing multiple grain fields, cattle and adobe houses until she reached the village. Standing outside the fence of Bacadilla’s school, Marco Aurelio Soto, the young mother and her children weren’t alone. A handful of other villagers from the surrounding areas all descended upon the school, which was to be the site of a Joint Task Force-Bravo Medical Element-sponsored medical readiness training exercise, or MEDRETE.
Although the sun had not fully risen, Chirinos joined about 30 other villagers who formed a line at the school’s entrance in preparation for the start of the MEDRETE, in which the JTF-Bravo MEDEL team would treat more than 800 patients in two days.
The people of Bacadilla and the surrounding region are historically characterized by their hospitality, resilience and progressive spirit, explained Dr. Wilmer Amador, MEDEL liaison officer and a Honduran national. Many of the townspeople even opened their homes to those who walked more than fours the night before to ensure they could get a spot near the front of the line.
“Bacadilla is a very special location because there are approximately seven surrounding villages -- some of the poorest villages in the district of Olancho,” Amador said.
Chirinos and her daughters Leslie, 6, and Lauri, 4, live in poverty. Their interactions with the JTF-Bravo MEDEL team marks the first time that her daughters have been seen by a licensed medical provider. Chirinos is also three months pregnant and has been dealing with a painful tooth for more than a month.
JTF-Bravo has been conducting MEDRETEs throughout Central America since 1993 to provide a variety of medical services to local residents who otherwise would be unable to receive regular medical care. In 23 years, more than 330,000 patients have been treated during MEDRETEs.
Although treating patients’ current medical needs is obviously a priority for any MEDRETE, Amador explained the MEDRETE’s number one goal.
“We use the MEDRETE to bring people in, but really not everyone that comes has a problem that needs to be seen by a provider. Everyone that comes, though, goes through a preventive medicine class which educates them about hand washing, chlorination of the water, waste disposal, vector-borne diseases, etc.,” Amador said. “We’ll also speak about a specific topic during the class that may be unique to the area, and then we hand out multiple vitamins, antacid medications, two bars of soap, explain how to use each product and individualize what we give out based on the configuration of their household -- all under World Health Organization guidelines.”
Plan for Success
Amador, who’s been with the JTF-Bravo MEDEL team for 24 years, is one of five MEDEL liaison officers, and he said 70 percent of their job is coordinating and managing MEDEL’s humanitarian and civic assistance programs -- which MEDRETEs fall under.
MEDRETE location schedules are worked out a year in advance, and while the MEDEL team has visited each Honduran district -- the equivalent of a U.S. state -- in recent years, MEDRETEs are not unique to Honduras. JTF-Bravo has conducted MEDRETEs in Guatemala and Nicaragua in the past six months, and is planning one in Costa Rica in the coming months. Each individual MEDRETE site is selected by the partner nation’s ministry of health organization, based upon which villages need the most support.
“We work hand-in-hand and under the direction of the host nation ministry of health and with the assistance of partner nation medical professionals,” said U.S. Army Col. Douglas Lougee, JTF-Bravo MEDEL commander. “The host nation provides a large number of doctors, nurses and a dentist, as well as important services that we did not provide such as cervical cancer screening.”
Each MEDRETE mission is led by different officer and non-commissioned officer in charge -- including MEDEL officers and NCOs not in the operations section (S3) -- and planning for each mission usually begins about 90 days out. Planning includes everything from what equipment each MEDEL section will bring and what route the team will travel to reach the event site to where personnel will be lodging and if they need a security escort any time during their mission.
“It gives junior officers the opportunity to learn from the experience, which is awesome because I doubt that I’ll ever be in this position again,” said U.S. Army 1st Lt. Jenniffer Rodriguez, MEDEL medical surgical nurse and OIC for the Olancho MEDRETE. “It also gives you perspective on why certain decisions were made, because -- since I’m a nurse -- I would just show up to a MEDRETE and perform, and wonder why certain things happened the way they did or why we were so restricted. It’s also showed me why contingency planning is so important. If something goes wrong, because it always does, we’ve already planned for it.”
During each MEDRETE, partner nation doctors and ministry of health officials work hand-in-hand with MEDEL personnel to help with the patient work load and take care of patients who need follow-on care and referrals. The partner nation military often provides medical professionals and always augments JTF-Bravo Joint Security Forces personnel in their security and patient-flow control efforts. Civilian volunteers also act as translators.
“The success of a MEDRETE is due to the multi-institutional effort it requires,” Amador said. “MEDEL may be the heart and soul -- the engine of the operation -- but we definitely couldn’t do it alone.”
Amador said MEDRETE success is also due to the previous MEDEL members who shaped the way MEDRETEs are now run, and because of the support from the local communities.
“The doctors used to see every single patient that came, but they were completely overwhelmed and didn’t get to see everyone. So we started the screening section to alleviate that problem. Also, the docs used to write out prescriptions on a blank sheet of paper, but you know how doctor’s handwriting is, so one of the pharmacists suggested we print out a formulary sheet and we’ve used that ever since,” Amador said. “We also couldn’t do it without the people of the community who volunteer their time -- and often their homes -- so we can do our mission. For this (Olancho) MEDRETE, the pharmacy is operating out of someone’s house across the street from the actual MEDRETE site. The owners don’t ask for any money to use their space because they’re more than happy to help us out with the care we’re providing.”
While MEDRETEs have helped improve the lives of many Central Americans, they are still a medical “exercise” designed to test and benefit U.S. service members. One of the main functions of a MEDRETE is to provide medical personnel training in the delivery of medical care in austere conditions.
The JTF-Bravo MEDEL team is comprised primarily of U.S. Army Reserve members, many of whom work in the medical field outside of the Army. Rodriguez, who has served in the Reserves for two years, is a registered nurse on her first deployment and said MEDRETEs are all about “getting back to the basics.”
“We have limited resources here, so your assessment skills get tested because you can’t just rely on a machine,” she said. “Asking questions, just refining your skills as a medic or nurse -- basic things that as you get further in your career as a medical professional you kind of forget because there’s so much technology to aid you.”
The current JTF-Bravo MEDEL team’s nine-month rotation will end in November, but not before one more MEDRETE -- the one in Costa Rica.
“This has been such a great experience not only for my Army career, but my nursing career as well,” Rodriguez said. “It’s definitely humbled me, and I feel like I’m more prepared for anything I may encounter in the future.”
Healing Bodies, Winning Hearts and Minds
It’s almost 10 a.m. and Chirinos is nearing the end of her visit to the MEDRETE and Bacadilla. Her daughters are in good health -- and spirits after playing with some of the “abuelitas” manning the preventive dentistry section. Chirinos was registered in the Ministry of Health’s system and given medicine to help with her tooth sensitivity.
Although she has a long journey back home, Chirinos stops to speak to a translator before exiting the school grounds and has her youngest daughter run back and hug one of the U.S. service members.
Chirinos’ daughter doesn’t speak English, but she points at an American flag patch on another service member’s uniform and says “Gracias!”