1. Honduran Health Alliance What: Women’s Healthcare and Education When: annually in July Where: Southern Honduras Since when? Started in 2003, annual trips since 2004 Website: http://med.unc.edu/hha/http://med.unc.edu/hha/ Me: Amy Marietta, MD/MPH Candidate 2012 amy.marietta@gmail.com

2. Objectives Brief history of the Honduran Health Alliance Program strengths and best practices Challenges Future growth Q & A

3. History Organization formed in 2003 by three UNC medical students Formally recognized UNC student group with faculty advisor UNC medical students, public health students, and physician preceptors spend one month in rural Honduras for health education and a week-long clinic 1st student group arrived Summer 2004 July 2012 team will be the 9th group of students to participate in the program

4. Program Structure Health education in rural communities Week-long women’s health clinic Medical teams comprised of rising MS2 and MS4, supervised by family medicine and OB/GYN attendings and rising PGY3 family medicine residents

5. Clinical Services Well woman exam Pap smears Breast exam Family planning (condoms, OCPs, depo- Provera®, IUD, natural FP) Urinalysis and treatment for UTI c/o Wet prep/syndromic dx and treatment of cervicitis/vaginitis

7. Why rural Honduras? 74% of Honduras’s poor live in rural areas Las Comunidades Unidas ASHONPLAFA Why Cervical Cancer? Cervical cancer is #1 cause of cancer death among women in Honduras Community needs assessment Ability to screen and refer for treatment

8. Program Accomplishments In 2011: 300 patients seen at clinic 216 pap smears 14 women referred for follow-up 28 health education charlas conducted Since 2004: 600 unduplicated women served 32 women treated for cervical dysplasia and/or cancer Over 90 student and resident participants

9. Strength #1: Student Training and Preparation Spring semester course for rising MS2 students Medical school elective credit All students proficient in Spanish Public health students teach medical students about effective health education Rising MS4s get practice modeling/mentoring Rising MS2s learn clinical skills in women‘s health

10. Strength #2: Community Partnerships Las Comunidades Unidas Promotores de Salud ASHONPLAFA (Local Planned Parenthood)

11. Strength #3: Emphasis on Education Community health education sessions (charlas) Topics: family planning, cervical cancer prevention, sexually transmitted diseases, and gender-based violence Public health and prevention invaluable components of the program

12. Strength #4: Ensuring Follow-up and Treatment Follow-up and treatment costs for all positive cervical cancer screens and transportation to ASHONPLAFA are covered by HHA through a special fund paid for through program fees Community health promoters ensure that women receive these essential services

13. Strength #5: Sticking to our Mission “To collaborate with local communities in order to provide annual cervical cancer screenings, give health education charlas, and provide family planning resources.”

14. Challenges and Opportunities #1 Sustainability Funding sources In-country resources Working collaboratively with local providers Education and outreach Training and development for community health educators #2 Maximizing our Impact Expanding to previously un- served communities Reaching women at highest risk Addressing developing health needs in the communities

15. #3 Balancing education and service Program expansion vs. limiting clinical time Intensity of the experience Time for building relationships Cross-cultural learning and exchange Meeting the expectations of medical students and residents #4 Staying true to our mission while still meeting the needs of the community Breast masses and uterine prolapse: women’s health problems we have yet to effectively address Health needs of children and men How to manage unexpected clinical findings if we don’t have the resources to follow-up

16. Future Growth Incorporate previously unscreened communities into the project Work collaboratively with existing government health posts to provide services to women identified as high-risk Explore alternatives for cytology reading Continue to include public health students and resident physicians as program leaders and participants Explore clinical solutions to increasingly common clinical presentations, such as uterine prolapse Support the training and development of community health educators Continue to promote dialogue among students, community members, and faculty about difficult cases and the ethical dilemmas innate to working in a resource-poor country.

17. Questions? Thanks! Please feel free to email with comments, questions, or suggestions. amy.marietta@gmail.com