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Brigade Leader Handbook
Edited June 2015
Contents Welcome and Introduction CLICK HERE
Our Philosophy of Global Health Volunteering CLICK HERE
History of STS and Brigades CLICK HERE
Honduras Ministry of Health Contract CLICK HERE
Brigade Coordination Process CLICK HERE
Contact Information and Online Resources CLICK HERE
Information on Brigade Fees CLICK HERE
Visitor Policies & Waiver of Liability CLICK HERE
Safety Information CLICK HERE
Advice from Previous Team Leaders CLICK HERE
Discussion Questions for Evening Discussions CLICK HERE
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Welcome and Introduction This handbook recognizes the unique challenges and opportunities for those traveling to, or working in,
Honduras with Shoulder to Shoulder, Inc. (STS) or any other entity. We hope that it will provide you
with valuable information on the remarkable partnership between STS (or Hombro a Hombro in Spanish)
and the Honduran people. We also hope this information helps you recognize the incredible value of
your time and talents as you volunteer with the ongoing work within STS. We hope you feel invested in
the project and are able to serve as a future ambassador of STS.
STS is a Non-Governmental Organization (NGO) that has played a unique role in connecting many
volunteers with work in rural Honduras. STS began at the University of Cincinnati, Department of
Family Medicine from the vision of the then-Residency Director, Dr. Jeff Heck.
Currently the organization is contracted by the Honduran government to provide care to over 69,000
residents of Intibucá. By witnessing and contributing to this unique partnership visiting volunteers are
given a first-hand view into Honduras’ approach to development and healthcare access. To learn more
about STS and the government’s contract, please refer to the section below under “Honduras Ministry
of Health Contract”.
Special thanks to Dr. Andrew Bazemore (currently Director of The American Academy of Family
Physicians Robert Graham Center) who was the original writer (entitled at that time, “Team Leader
Handbook”) and oft-editor of this handbook and to Kate Clitheroe (MPH, Director of Programs &
Research with STS) as well as Dr. Christy O’Dea (Global Health Director at TCH/UC FMP) who have also
taken up the cause of editing this handbook through several editions.
Our Philosophy of Global Health Volunteering
Developing countries typically enjoy a regular stream of energetic and talented health care professionals
traveling to help the poorest communities in any way possible. U.S. health centers and other volunteer
health groups often bring with them eager medical students, residents, nursing students and allied
health students for one to two weeks of medical service. These groups, by virtue of their broad
community representation and influential reputation, often possess the ability to generate widespread
support and raise the funds needed for their charitable endeavors.
Despite the talent, good will and infrastructure for raising
funds and in-kind donations, these short–term efforts rarely
result in significant, sustainable improvement in the health
status of poor communities. The reasons are complex, but a
primary factor is that health centers and other volunteer
groups together with their supportive communities do not
have the understanding, knowledge or experience required
to forge long- term relationships with needy communities
in the developing world.
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A long-term, sustainable relationship opens possibilities for continuity of care, health promotion and
disease prevention. Long-term relationships also lay a foundation for addressing health education,
public health issues, economic development, agricultural development, improvement in schools and
many other activities that impact the health of communities. It is this broader, comprehensive vision of
sustainable community growth that poor communities deeply desire. This is consistent with the
Honduran Ministry of Health priorities to promote community based health care initiatives.
STS with their local presence is able to provide brigades with the foundation for these long-term,
sustainable relationships. Our goal is to continue to develop an effective network of partnerships
between health care professionals from the U.S. and our successful long-term, sustainable health clinics
and programs that work year-round in our Honduran communities. We desire to link the goodwill and
technical capacities of U.S. health centers with the existing projects and everlasting hope of poor rural
Honduran communities, joining forces to work toward improvement of the health status of the poorest
of Honduras. We also hope to inspire U.S. and Honduran health care professionals to work in
underserved communities with an enhanced level of cultural competency that is required for
sustainable change.
Ultimately, it is our goal to link multiple partnerships, forming a network that interacts with each other,
the Honduran government and U.S. organizations to improve the health status of poor, rural
communities in Honduras.
History of STS and Brigades Since the 1990’s, STS has had many individuals travel to, and work in, rural Honduras in the department
(state) of Intibucá. Located southwest, near the El Salvador border, is Santa Lucia. This village was our
initial site for the provision of health care. Progress has been made in the area since the early days
when the roads were dirt and gravel and there was no electricity in the village and no physician within
hours of travel. Other sites of care have been established; many academic medical institutions,
organizations and other professionals offer their time and talents to work in Intibucá in many fields. But
even in the midst of great progress, the health care, dental care, public health, and other needs in this
area remain high.
Our means of meeting many of those needs is working with brigades who work “shoulder to shoulder”
with our friends in Intibucá. As a North American non-governmental organization (NGO), we could/can
do little to implement change and realize success in our mission which is “to work together with our
communities to create and operate sustainable health, nutrition, and education services with equitable
access for everyone” without the support and input of many committed Hondurans and the support and
input of many North Americans who travel to Honduras to provide tangible service. The contract for the
provision of care with the Honduran Ministry of Health also provides long term, continuity solutions for
the care needed in Intibucá.
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Honduras Ministry of Health Contract More information about our clinics can be found at shouldertoshoulder.org under “Healthcare”
In 2008, Shoulder to Shoulder, Inc. (STS) signed a contract with the Honduras Ministry of Health to
provide basic health services to 36,000 people in Intibucá. In April of 2015 the contract was extended to
cover 2 additional municipalities (7 in total), a total coverage area of over 69,000 people.
Under the current contract (“convenio”), STS/Hombro a Hombro operates 6 primary care clinics staffed
with a doctor (CESAMOs), 9 primary care health clinics staffed with a nurse (CESARs), and 3 Child and
Maternal Health clinics and birthing centers. This contract provides financial resources for the
supervision of the employees, provision of supplies and medications, and education of the personnel. In
addition, the public health system that includes the supervision of health promoters falls under the
government contract. The health promoters are active in the communities, making home visits,
following up on high risk families, providing community education, and monitoring for disease outbreak.
The government contract gives brigades a unique opportunity to participate in the health system of the
area. Brigade activities directly contribute to the public health needs of the communities STS serves and
fulfill requirements of the contract. There are opportunities to participate in health fairs, community
clean up days, provision of care at STS-managed health centers, participation in census taking activities,
and evaluation of programs. We are an organization that highly values collaboration. But partnering is
not always easy. It requires commitment, understanding, and flexibility. The brigade work that you do is
not done in isolation, but is already part of STS’s health network. We humbly request your patience in
working within this system.
We encourage you to read the blog article, Culture and Convenio, published on our website to gain a
fuller appreciation of how our Convenio agreement works (shouldertoshoulder.org/blog). The following
is an excerpt:
“The inauguration ceremony of Shoulder to Shoulder’s new Convenio
agreement with the Honduran Ministry of Health [took place] on Tuesday, April
28th in Camasca. This was an amazing occurrence. Overnight, Shoulder to
Shoulder has literally doubled its responsibility in providing health care. Camasca
and Colomoncagua are now included in our system, stretching our coverage
south of Yamaranguila to the El Salvador border, from 37,000 persons to 69,000
persons. Two major clinics, one in Camasca and one in Colomoncagua, a birthing
center in Camasca, and three satellite clinics in Colomoncagua have been
assumed in Shoulder to Shoulder’s health system… This is a phenomenal
expansion. Shoulder to Shoulder is now essentially the exclusive provider of
health care in the Frontera of Intibucá…
Convenio, not easily translated into English, is derived from Latin and
means to come together. The word Covenant is a derivation. Covenant is much
more than a contract. A covenant implies not only the commitment of a task or
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property, but the willingness to give oneself over. This means challenge and
personal transformation. It involves risk, it is difficult, and most of us will avoid
this level of commitment. When divergent cultures are involved, it is wrenching.
Why would anyone enter into a covenant relationship? Because it is the only way
to effect substantive and meaningful change. New convenios found in honest
cultural exchange await as we journey shoulder to shoulder.”
Brigade Coordination Process More information can be found at: shouldertoshoulder.org/our-partners/brigades
Beginning in July of 2015 brigades with Shoulder to Shoulder will be managed entirely by Hombro a Hombro in Honduras. Communications will no longer be mediated through the US. Instead, Brigade Leaders will communicate directly with our on-the-ground staff in Honduras. In order to plan your brigade, please follow these steps:
Contact Laura Manship by email at [email protected] at least 3 to 4 months before your proposed brigade.
Laura will follow up with you by placing a call to you. Please indicate in your initial email your phone number and times you can be available to talk. Laura will gather information from you as to the nature and particulars of your brigade.
The Brigade Team will determine the participant cost for your brigade. This will be calculated according to the variables of size of brigade, length of stay, and transportation needs. It is important to note that the provision of services not customary for a brigade may result in higher per participant cost (see explanation on the following page).
Once the dates of your brigade are finalized and the participant cost is communicated to you, participants may begin to register for the brigade on Shoulder to Shoulder’s website (shouldertoshoulder.org/our-partners/brigades).
In order to complete registration, participants must fill-out the Application, read the Visitor Policies, sign the Waiver of Liability, and pay their Brigade Fee at least 60 days before the brigade’s arrival.
Once the brigade fees are finalized and registration has begun, it will not be possible to extend the length of stay or the size of your brigade without an additional fee being levied.
You will continue to communicate with Laura about the details of your brigade in order to finalize the Brigade Schedule and determine what equipment/supplies (if any) are necessary. Please communicate with Laura if there are any changes or questions.
Your brigade will be welcomed at the airport and during your brigade on-site support will be provided. After your brigade, an evaluation of the process will be completed in order to improve future brigades with Shoulder to Shoulder.
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Contact Information Please feel free to email us with any questions or to arrange a phone call.
Laura and Paul Manship ([email protected]; +504-9605-0174)
Ever Bonilla ([email protected]; +504-9460-1432)
Kate Clitheroe ([email protected]; +504-3209-8247)
Online Resources Visit our main website to learn more about the organization: www.shouldertoshoulder.org
Basic information about brigades can be found at our Main Brigade Page:
http://shouldertoshoulder.org/our-partners/brigades-2
All materials for your Brigade Members can be accessed from our Registration Page at
shouldertoshoulder.org/our-partners/brigades, including:
Brigade Calendar
Visitor Application
Visitor Policies
Evacuation Policy
Waiver of Liability
Payment site for Brigade Fees
Packing List
Customs Letter
Additional information about personal health considerations, what to pack, suggested readings, and
information about the organization as well as about Honduras are available in the Brigade Participant
Handbook, also available online.
Please contact Laura Manship ([email protected]) if you have any additional
questions about Coordinating a Brigade with Shoulder to Shoulder.
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Information on Brigade Fees Fees should be paid no less than 60 days before your arrival at
shouldertoshoulder.force.com/brigadefees
Beginning in July of 2015, Shoulder to Shoulder (in partnership with Hombro a Hombro) will implement
a new fee structure for brigades. Fees will now be based on the individual needs of each brigade in
order to assure that all desired services can be provided at a reasonable cost. With individualized fees,
brigades will only pay for the services provided, therefore lowering costs.
Once the Brigade Leader informs the Honduran Brigade Team of their brigade´s specific needs, a brigade
fee can be calculated. The Brigade Leader will then be asked to sign a Pricing Agreement that specifies
the agreed upon services. The Brigade Leader communicates the applicable fee and registration due
date to brigade participants. Variables that most significantly affect the cost of a brigade include:
number of participants, length of stay, and amount of local travel. Additionally, luxury hotels and added
translators will incur additional costs. In order to give a general idea of what a brigade´s individualized
fees will be, the approximate brigade fees for two common brigades are provided:
Variable Example Brigade #1 Example Brigade #1
Participants 10 – 19 20 – 35
Translators (1 per 3 people) 4 – 7 7 – 12
Length of Brigade 10 days (7 days on-site) 10 days (7 days on-site)
On-Site Travel Moderate (2 – 3 trucks/day) Moderate (3 – 4 trucks/day)
Extra Services NONE NONE
BRIGADE FEE: approx. $1,100/person approx. $900/person
Additionally, all brigades receive the following services (unless hotel upgrades are requested):
• Online application and fees payment process • Travel insurance and 24-hour evacuation service • Well maintained and safe transportation to/from Tegucigalpa • One night in a basic hotel and 3 meals during each trip to/from Tegucigalpa • On-site brigade coordinator (Ever Bonilla or his designee) • Reliable 24/7 security patrol • Simple housing accommodations and associated cleaning staff while on-site • Nutritious and hygienic meals (3 per day), safe drinking water, and snacks • Post-brigade evaluations to improve services and promotions to the STS community
In order to calculate the cost of individual brigades well before travel dates, it is necessary to determine in advance the needs of each brigade. For this reason we ask that Brigade Leaders contact the Honduran Brigade Team at [email protected] at least 90 days before your suggested travel dates. In addition, all fees are to be paid at least 60 days before each brigade. Since fees are partially based on the number of participants, if any individual participant does not pay or decides not to come, the brigade fee may be affected. We will be as flexible as possible in order to accommodate unforeseen delays or cancelations.
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Visitor Policies & Waiver of Liability In order to assure a pleasant, safe, efficiently run, and positive experience for all visitors, we have
revised our Visitor Policies. All brigade participants will be required to read these policies and sign the
Waiver of Liability as an agreement to comply with the policies to the best of their abilities. For your
convenience, the Visitor Policies are provided below as well as online via the link on the Main
Registration Page (shouldertoshoulder.org/our-partners/brigades).
In addition, it is important that you are aware that Shoulder to Shoulder, Inc. / Hombro a Hombro will
register your brigade with the State Department before arrival. This assures that the U.S. Embassy is
aware of your trip and able to assist if necessary.
Lastly, Shoulder to Shoulder, Inc. / Hombro a Hombro will secure travel insurance for anyone traveling
on a sponsored brigade. If you are already required to purchase Travel Insurance by your University,
please inform us immediately. It is important that we are able to care for your group in the case of an
emergency should it arise.
Visitor Policies Shoulder to Shoulder, Inc. (STS) has many visitors who participate in our projects in Honduras and aid in
our mission to strengthen communities in rural Honduras. It is an honor to have you/your group
interested in providing service as part of STS.
These policies apply to any visitor for whom STS takes responsibility, including all non-permanent staff
traveling to Honduras for a set amount of time who use any STS service or facility in Honduras. Visitors
are classified into brigade members, rotators, and long-term volunteers.
Brigade members are those traveling with groups, typically one to two weeks.
Rotators are those staying in Honduras for a month or more to complete a medical rotation.
Long-term Volunteers are those staying for an extended period of time in-country to complete a
designated assignment within the organization.
General
1. Use of any STS facilities/resources is limited to groups or persons who have approval by STS. All
visitor activities requiring STS’s support must be approved by the Honduran Brigade Team.
2. All visitors must sign a Waiver of Liability and submit an application 60 days prior to departure
(online). Information provided on the application will be shared with the other people on your
brigade (if applicable) and internally within STS.
3. STS can accommodate brigades ranging in size from 10-35 people. If the size of your group is
outside of these limits, please contact the Honduran Brigade Team to get special permission
before making any travel plans.
4. Permission for the use of STS assets and personnel for additional projects need to be requested
90 days in advance of need. For example, if shipping a large item to Honduras for use at your
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site, advance notice is required so it does not interfere with operations in Honduras. Those
shipping goods are responsible for paying all fees involved.
Regarding Travel
5. U.S. Passports must have an expiration date of at least 6 months past the brigade’s entry date
into Honduras. A non U.S. Passport holder must obtain a Visa from their home
country/embassy, if required by Honduras for entry. This is the traveler’s responsibility. Late
arrivals due to improper documents will be charged for additional transportation/ personnel
required to accommodate the traveler(s).
6. Flight arrangements are the responsibility of those traveling yet must be approved through the
Honduran Brigade Team. This includes early and late arrivals or departures. Please note:
• Tegucigalpa is the point of entry for all individuals and groups unless approval for a different
point of entry was granted.
• Everyone in a brigade must arrive before 1:30 p.m. on the first day. Arrivals after 1:30 p.m.
must arrive the day before the brigade unless the whole group is arriving late. This will
require staying in the arrival city that night. The brigade leader must clear group late
arrivals with the Honduran Brigade Team 45 days prior to arrival in country.
• Any changes in arrival dates must be approved by the Honduran Brigade Team at least 90
days in advance of the arrival date.
• If an early return date is necessary an additional fee will be incurred for the additional
driver/vehicle (at least $300-400, with a maximum of 3 people due to truck seating
capacity).
7. In the case of an unanticipated late arrival due to flight delays, the Honduran Brigade Team will
determine the safest stop over point between Tegucigalpa and the visitor’s final destination.
Any additional costs incurred are at the visitor’s expense.
8. The Honduran STS Staff is not permitted to provide transportation to any visitors after dark. The
visitor’s schedule will be arranged such that night travel is not necessary nor anticipated. This is
a safety precaution that cannot be waived.
9. Brigade leaders are not authorized to approve any transportation or scheduling changes with
the exception of a dire medical emergency. Onsite STS staff will make changes only when
absolutely necessary.
10. Public transportation is not acceptable for any STS visitor.
Regarding Visitor Fees
11. The Honduran Brigade Team will determine if the standard brigade fee is sufficient to cover the
visitor/group’s individual needs including transportation, food, lodging, translators, and
incidental expenses. If additional funds are necessary, the Honduran Brigade Team will
communicate this to the individual visitor or Brigade Leader at least 90 days in advance. Airfare
is in addition to this fee.
12. All Brigade Fees are due 60 days before the brigade’s arrival date. If any individual does not pay
their by this date, there is a possibility that the Pricing Agreement will require revision or the
Brigade will not be able to take place.
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13. Late cancellations (less than 30 days), will result in a return of only half of the brigade fee due to
the fact that individual fees depend highly on group size. If the visitor cancels with at least 30
days notice they will be refunded their brigade fee minus a 15% administration fee. Medical
emergencies or other extenuating circumstances may be considered differently in this policy.
14. All visitors are responsible for payment of their flight and airport exit fee (about $40 paid by
cash – US Dollars, Lempiras or a combination).
15. All brigade members and rotators will have evacuation insurance included in their brigade fees.
Even if the brigade member has their own insurance, we will also automatically enroll them for
this with the brigade. Long-term volunteers have the option of purchasing STS’s insurance. If
not, the long-term volunteer must submit confirmation of their insurance with its contact
numbers. This documentation must be submitted to the Honduran Brigade Team with the
payment of fees.
16. There will be no support for visitors before or after the dates of a brigade, rotation, or volunteer
assignment. Any visitors staying on site after a brigade will incur additional fees. Visitors
wanting to travel or go sightseeing will do so at their own expense and may be accommodated
only by requesting such travel at least 90 days before the arriving to Honduras.
Other Items
17. For medical brigades wanting to distribute medications, it is necessary to bring personnel
capable of completing this activity. STS can help with the purchase of medications locally as
long as order forms are submitted 6 weeks in advance of your brigade.
18. Internet is rarely available and only limited to email. Do not plan to have any internet access
while in Honduras. Do not plan to be able to do school work, complete medical records, or any
other personal projects that require internet while in Honduras.
19. Persons with special dietary preferences or needs (e.g. gluten intolerance) should not assume
that they can be serviced. There should be a sufficient variety of foods for anyone with special
needs, but any traveler with extraordinary needs should ask in advance about bringing any
necessary food items.
20. Cultural understandings relative to attire vary significantly between the US and Honduras for
both men and women. Please consult with STS staff relative to cultural norms. As a person
representing STS, recommended attire is as follows:
• No informal t-shirts, camisole tank tops, or short shorts when working directly with
community members (during free time or at night is acceptable)
• Shorts and tank tops should be of conservative length and size
• Longer shorts, pants, long skirts and conservative tops are most acceptable
• Scrubs are acceptable when working in STS clinics or any field clinic
Safety Information While Honduras has been featured in the news as a country with substantial turmoil and violence, it is
important to recognize that the majority of issues are associated with drug and gang violence. Foreign
visitors are typically not targeted nor at high risk. We work hard to avoid all high risk situations
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including but not limited to avoiding dangerous locations, public transportation, and spending excess
time in the large cities. Additionally, our clinics are located in a safer part of the country.
Since our beginnings in 1990 we have never had a violent incident involving a visitor. This is due in large
part to the tranquility of Intibucá and to our safety requirements. Still, we remain vigilant with our staff,
visitors and volunteers. Brigades sleep securely in one of our two main clinics, one of our three affiliate
clinics, or in churches with the support of the community. Fieldwork is performed under the supervision
of our Honduran doctors and nurses or American brigade leaders.
When brigades are away from our service areas, they stay in secure hotels and are supervised by
American leaders and Honduras-based brigade coordinators. All brigade members and volunteer staff
are covered by evacuation insurance and registered with the U.S. Department of State before their
trip/volunteer time in Honduras.
Honduras, the United States, and STS remain committed to fostering individual development in a safe
environment. Intibucá provides an excellent volunteer and learning environment with communities that
are in great need of quality medical, education, and other professional volunteers.
Arrival and Departure from Country
San Pedro Sula and El Progreso have more crime. It is for this reason that STS requires that
brigades fly into and out of Tegucigalpa.
Brigade Coordinators have information on flights for arrivals (and departures).
Upon arrival, you will go through Honduras Customs as you exit the airport. They may/may not
check your luggage. Once through, you will be met by a Brigade Coordinator. Travelers are then
escorted to waiting transportation and driven out of Tegucigalpa.
Hombro a Hombro brigade coordinators will be at the airport to oversee all arrivals and
departures. Any issues (e.g. lost luggage) should be directed to them for resolution.
Overnight accommodations are made in smaller, less congested cities en route to Intibucá (e.g.
Siguatepeque or La Esperanza).
Travel after dark is not permitted.
In general, the rural communities of Intibucá are safe for travel. It is recommended that brigade
members always travel in pairs and do not leave the clinic premises after dark.
Police Cooperation
STS works closely with the police force throughout Intibucá. A member of our Brigade Team meets with
regional police representatives on a monthly basis to receive crime updates and create a summary
report. These reports are shared with brigade leaders and are available upon request.
Police report that the overwhelming percentage of violence is due to alcohol, longstanding family feuds,
and domestic violence. Over the last several months, the police have intensified their efforts to reduce
these acts, with particular attention paid to domestic violence and alcohol-related events.
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The police work with local town committees, schools, community leaders, and NGOs to communicate
the latest local issues and how they are addressing criminal activity. Every 24 hours, local police report
the day’s activities to the command center in La Esperanza.
Consular Information & State Department Updates U.S. Department of State Website:
travel.state.gov/content/passports/english/country/honduras.html
Smart Traveler Enrollment Program:
travel.state.gov/content/passports/english/go/step.html Every brigade/volunteer is registered with the United States Department of State.
Tegucigalpa U.S. Embassy Information:
Avenida La Paz in Tegucigalpa, Honduras Telephone: 011-504-2236-9320 or 011-504-2238-5114 For information on services for U.S. citizens, please ask for ext. 4400 Emergency/After Hours: 011-504-2236-8497, ext. 4100 Fax: 011-504-2238-4357, honduras.usembassy.gov
San Pedro Sula Consulate Information:
Banco Atlántida Building (across from Central Park), 11th Floor Telephone: 011-504-2238-5114, ext. 4400 Limited Hours: Monday, Wednesday, Friday 12:00 to 4:00 p.m.
For more information regarding the safety situation in Honduras, or to inquire about joining us in a
brigade or as a volunteer, please contact us at [email protected].
Advice from Previous Team Leaders On the brigades there is usually a team leader who is identified. It is this person’s leadership that helps
coordinate the various aspects of the trip – starting in the U.S. and throughout the time in Honduras.
The following is a list of tips and pointers for brigade leaders.
Set the Tone. Your attitude, manner, and style will set the tone for the rest of the brigade members.
By exhibiting a confident, respectful, and energetic attitude, the brigade members will feel the same.
FLEXIBILITY is key in all aspects of the trip
Make an Effort to Know Brigade Members Individually. During the brigade introduce yourself to
each member of the brigade, and discuss their individual goals for the trip. Think about each individual’s
strengths and weaknesses.
Encourage Teamwork. Consider planning a team building activity early in the brigade to encourage
brigade members to get to know each other. Remind brigade members early and often that all brigade
activities may not involve direct patient care, but that all activities are important to the organization.
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Be available. Reach out to brigade members before the trip, and make sure they know they may
contact you in case of questions or concerns.
Communicate. You are in a unique position to communicate between the on the ground Honduran
staff and the brigade members. Arrange with the Honduran staff to have regular meetings in the
afternoon/evening to discuss details for the following days.
Manage resources well. Because of the limited toilet/bathing water supply, especially during the dry
season (drinking water is always available)
Brigade Planning:
As brigade leader you are the point person for making arrangements with FTI and Honduran
staff. Work with them to assess needs on the ground and possible brigade activities. Expect this
communication to be more frequent as the brigade approaches.
Months prior to the trip, meet with the other team leaders and interested faculty and discuss
possible projects and activities. Designate a point person for each project.
Consider making a provisional schedule. Try to make sure that there are a variety of activities
for brigade participation: clinical activities, public health projects, and home visits. (Consider
use of template seen in Appendix 1)
If a medical brigade, you should strongly consider including medical education for the Honduran
staff in your brigade planning.
Working with Faculty participants, faculty leaders:
Be confidant – act like you know what is happening, and ask for help from your Honduran staff
leader when necessary
Encourage, facilitate, coordinate, problem-solve, and use humor
Listen well, communicate to the group often
Think 1-2 days ahead and frequently communicate plans and schedules with the group
Give the group frequent reminders about working together as a group
Packing:
Inform brigade members about what supplies they will be bringing with them and how much
space they have for their own packing.
Designate an area to collect supplies before packing.
Download and print the required customs letter STS website (click “Brigade Members and
Travelers” at top of main page).
Distribute bins to brigade members, clearly explaining that each is responsible for the bin
assigned to him/her.
Keep a list of what is packed in each bin, and who has each bin.
Organizing the group at the airport:
Organize a head count and check when needed
Stick together as a group through the airports. Timing is often tight for the connections. Gather
after exiting the plane, stick together until the gate.
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At the U.S. transfer airport, may buy water and snacks for the first few hours in Tegucigalpa
Inform everyone that they will need to complete customs forms on the plane, but there is no
need to declare anything on the form.
Getting through customs:
Plan for a few Spanish speakers to be at the front of the line at customs, explain about the
brigade and donated medical supplies.
Identify any missing luggage, check inventory lists, and put in a claim at the airport for any
missing bags. Put the local Brigade Coordinator’s cell phone number on the claim.
If you allow anyone to carry your bags, you must tip them $2-3
As soon as the group is gathered outside of customs, move out into the main airport terminal
and look for STS’s personnel.
Make sure everyone keeps their carry on with them-everything they need for the next 24 hours.
All checked bags may not be seen again until you reach Intibucá.
Once on the ground in Honduras:
Count heads on the bus!
Announce the schedule for the afternoon
About 2-3 hours to Siguatepeque
Lunch in Siguatepeque (good grocery store, sells vanilla - good souvenir)
Another hour to La Esperanza
First night in the hotel:
Check with Honduran brigade coordinator about schedule/dinner
Work with Honduran brigade coordinator to assign hotel rooms
At dinner, discuss schedule for next morning (Breakfast, encourage walk through market, set
time for bus)
Remind all to keep passport and money with them at all times.
On the road into Intibucá you will pass:
Pinares (good place for bathroom break, snacks, purchasing bags of coffee as a souvenir)
Concepcion (one of STS’s larger Child and Maternal Health clinics)
Camasca (where MAHEC works)
Long, unpaved road through the mountains to Santa Lucia, consider Dramamine!
Arrival at your site:
Greet staff first, then discuss plan for unpacking, tours, sleeping quarters, schedule for
afternoon
Be careful about which bins can be unpacked and which should be delivered to clinics, field clinic
sites, etc. before unpacking
Formulate a schedule for first day on-site
Orientation:
Gather the group for clinic tour and orientation. Invite Honduran staff to participate.
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Introduction of all Honduran staff, brigade members, and translators
Ground Rules (see page 32)
Orientation to the government system and forms
Orientation of translators
Services Available On-Site (Note: the following is bound to vary slightly by location):
Each brigade member should be given a small mattress with a pillow, towel and sheets. Those
wanting extra protection from bugs can bring a mosquito net.
Our cleaning staff should clean the rooms periodically during the brigade. Please let the Brigade
Coordinator if this is not happening.
In the larger clinics (Santa Lucia, Concepcion, or Camasca) bathrooms will be dorm-style with
flush toilets and cold water.
In more remote towns there will be “bucket-showers” (four walls with a large bucket of water)
and latrines (use toilet, fill small bucket of water, pour to flush)
Toilet paper should be available (let us know it is not) and other toiletries are available for
purchase in town at most small shops (pulperias)
Three meals daily will be provided, including a semi-heavy breakfast, simple lunch (since most
brigades are in the field), and heavy dinner. Additionally there will be filtered water and snacks
available.
Most towns will have small shops (pulperias) where snacks, juice, and soda can be purchased at
minimal costs ($0.25 - $1)
Since our sites are so close to El Salvador, people are likely to accept dollar bills. However, it
would be better to change about $20 (equals about L. 400) before arriving to make sure you are
able to buy extra items you need and souvenirs. Please note that a L. 500 bill (about $25) is
considered a lot of money so you will need to make sure the shop owner can provide change
before purchasing.
Typically one phone is available to make calls to the U.S. The cost is approximately $0.50 for 15
minutes. Ask the Honduran Brigade Coordinator about purchasing a calling package.
Internet is not available at most sites. If it is available we ask that you restrict your use to emails
only.
Work days
Post schedules each night for following day
Communicate frequently with the group about plans and working together
Scheduling
Communicate each afternoon with the designated Honduran Staff regarding the following day’s
activities. Make sure to discuss transportation and lunch!
When scheduling, make sure that each brigade member has a variety of experiences.
Ensure that each team that goes out has a cell phone with phone numbers in case of
emergency.
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Maintaining Safety for brigade participants
No more than 6 brigade members in the back of a truck, it is preferable to fill up the cab of a
truck, and then put people in the back of a truck
Weekend
Plan something fun for the weekend (skit night, movie night, etc)
Check with Honduran brigade coordinator about possibilities-hike, waterfall, market, other
Evening Discussions
See below for discussion questions.
Think about what to accomplish each evening when the group gathers, have a simple agenda,
ask brigade members to share experiences from the day.
Ask Honduran staff to participate-either presenting a topic or listening and contributing
Work with your faculty to prepare short nightly discussions following a brief case conference.
Some brigade leaders prepare lectures ahead of time or ask members (1-2 people) to prepare
topics: Common medications used in Honduras, Cultural beliefs of Health and Illness in
Honduras, How to work with Interpreters, Common illnesses seen in at the sites, and Dengue
Heading Out:
While we ask that you have your group tidy up their living space, it is not necessary to do any
major cleaning since our cleaning staff will cover this
If you have items to donate (clothes, bug repellant, mosquito nets, etc.), please give them
directly to the Honduran Brigade Coordinator
Giving Tips
Please tip $2-3 if you allow someone to help with your bags at the airport
You are in no way required to tip those helping during your brigade (cooks, translators, cleaning
staff, etc.). However, if you feel inclined to tip please note that $5/person would be a very
generous amount for any one person to tip.
If desired, tips can be collected as a group on the last day and given as a gift to the head cook
who will then distribute to those who have helped her.
Good Bye Party (Despedida)
Work with the Honduran staff to perhaps organize a dinner and dance or other event with the
local committee on the last night of the brigade. This is a good time to thank your cooks and
staff. (Small gifts are always appreciated.)
Extra Items for Medical Brigades
Call Schedule (for medical brigades)
All medical and nursing personnel on the brigade should take call responsibilities. Consider
making a call schedule up before arrival. Decide on times for beginning and ending call. Decide
who will cover emergencies during lunch.
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Schedule one nursing student, one medical student, one resident and one attending to take call.
If there are internal medicine or pediatric residents or attendings, consider adding back up.
One Honduran based physician will be on call, but just as back up as needed.
Consider giving the post-call team a lighter schedule the following day, usually in clinic or off.
Organizing the field clinic (for medical brigades)
It takes roughly 8-10 persons to run a small field clinic, more if the village is very large. Size
should be determined based on estimates of how many persons will attend the clinic (which our
Honduran partners can help to assess in advance)
Delegation needs to be well thought out. Better not to have a first time traveler or cautious
person in charge alone. Usually better to have a technical person and a logistics person. Meet
ahead of time-make others experts like you!
Discussion Questions for Evening Discussions During your time in Honduras many questions will emerge about the country, healthcare system, and
culture. Additionally you may ask yourself about how your experience compares to life in the United
States. In order to get the most out of this experience, it is important to ask as many questions as
possible and to share your thoughts within your brigade group. Ideally each brigade will spend time in
the evenings reflecting over these important topics. The following is a collection of commonly discussed
themes:
About Honduras… 1. What have you noticed that is special about Honduran culture that we may not have in the
United States? What are some of the culture’s strengths? Weaknesses? How can we leverage
the community’s strengths for positive change?
2. Knowing that with development (i.e. roads, communication technologies, etc.) comes additional
crime and violence, is it worth it for these communities to have increased access to health and
education services? What can be done to prevent some of the negative effects of development?
3. Technically healthcare is provided free of charge to all Hondurans, effectively achieving a
version of universal healthcare. Are there any hidden costs within Honduras’ system? What type
of disparities may develop within this system? What other issues exist? Why does the private
system exist if everyone is given free access to the public system? How does this compare to the
United States?
4. How does the multi-level referral model (health workers health outposts larger clinics
emergency clinics regional & national hospitals) differ from that of the United States? Is it
more or less effective to deal with minor issues at the community-level? Is this easier or difficult
to understand and navigate?
5. How does the medical training compare to that of the United States? Is there a similar draw to
specialize and does the country have enough specialists?
6. The Ministry of Health decision to contract out health services to STS is part of a global initiative
to decentralize healthcare. What are some of the pros and cons of this model (think of providers
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proximity to clients, the effect on control over policies and procedures, limits on local services
available)?
About the Brigade Experience… 1. What is one important thing you learned today (or during your time in Honduras)? 2. What is one challenge that you encountered today and how did you overcome it? 3. How do language and cultural barriers affect your ability to deliver quality care? Are there other
forms of communication you are using? Do you find yourself doing your work differently? 4. Compared to your clinical experiences in the United States, what is different about how patients
are cared for in Honduras? Are there things that are better than in the United States? Worse? 5. How do the types of illnesses you have experienced here compare to those you have
experienced in the United States? Which do you believe are the most challenging to this
country? Which do they manage well? 6. Has there been sufficient supplies and medication during your trip? What about certain
equipment or lab tests? How has this affected your ability to deliver quality care?
About Shoulder to Shoulder… 1. What are the benefits and disadvantages that accompany the organization’s formal contract and
association with the Ministry of Health (financial, political, regulatory, etc.)? Do you think the
benefits outweigh the costs? Why is it important to partner with the local government? Are
there situations where this is not the preferred option nor even possible?
2. Can you think of additional ways that brigades can incorporate themselves into STS’s health
programming?
3. What basic issues is the organization addressing? What are they missing? Are there other
programs that you think may be good to implement?
4. In a world where funds are often limited, what are creative ways that organizations like STS can
raise funds to support their mission? Are their local opportunities?
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Please contact Laura Manship ([email protected])
if you have any additional questions about Coordinating a Brigade with
Shoulder to Shoulder.
Additional information about personal health considerations, what to
pack, suggested readings, and information about the organization as
well as about Honduras are available in the Brigade Participant
Handbook, also available online.
