Paul and Laura Manship, Author at Shoulder to Shoulder, Inc.

November 22, 2016August 4, 2023

Deep Roots and New Branches

Laura and I are in our fourth year in Honduras and have been with Shoulder to Shoulder just over two. We’ve seen many changes in that short period of time in Honduras, on the Frontera of Intibucá, and even in Shoulder to Shoulder. We look at our job as trying to steer those changes in such a way that they help the people of the Frontera to better the circumstances of their lives, and ultimately find clear paths to the healthy development of their communities. We do not do this on our own. There are a lot of partners that share in that vision and mission, shouldering the movement toward development. A substantial part of our job then is to keep our partners excited and committed, while at the same time draw others into the mission.

One partner that’s been with us for a very long time is Virginia Commonwealth University (VCU). They have built strong relationships with the people living in and around the small community of Pinares. They built the clinic there and have been visiting the community three times a year for a very long time. Dr. Thomas Ball, recently here to continue the provision of much needed medical care, told us he’s been coming to Pinares for the last ten years. He’s seen some changes too, many more than Laura and I. One for which he is quite pleased is that the road to Pinares is now entirely paved, a hopeful symbol of the healthy development that VCU and StS hope to see continue for Pinares.

The thing that has always impressed me about VCU in its ongoing relationship with the community of Pinares is the stability and sensitivity of commitment. VCU has become a part of the family of Pinares, their home town doctors if you will. A few years ago, I asked a leader why they did not build nicer dormitories for the brigade teams that come regularly. They built a state-of-the-art clinic, but they sleep in tents at a well-worn schoolhouse down the road from the clinic. The answer was that they wanted to live as the people lived while they visited them, and that they preferred to spend their resources on the provision of direct service. That pretty much sums up the sense of commitment in relationship that VCU has invested in the people of Pinares.

Dr. Tommy Ball fistpumping young patient

Even so, VCU has recognized that their mission is not one they can claim as exclusively their own. They have need to call others to share in that mission as it is a long journey of service. They have found a committed partner in Fairfax Family Practice Centers and have founded an NGO, SAGE, to maintain focus and resources in the Pinares communities. Their mission is ongoing because they have been open to the inevitable changes time brings and the need to draw others into the mission.

I saw this in the most recent visit of VCU. The presence and familiarity of VCU as part of the Pinares community is the root for the service that is delivered during the brigade experience. Dr. Ball, with the strength of ten years experience, planned for this November brigade. He thought it would be a very modest and small brigade as it has become harder and harder to find the medical students, and providers to invest in such an experience. But with the rootedness that is the sustained relationship of integrity between VCU and Pinares, new branches have sprung forth. Jamaica Hospital Medical Center had contacted us looking for a brigade experience for residents. We hooked them up with VCU. A young man having just finished high school also contacted us looking for a brigade experience. We hooked him up with VCU. Dr. Ball wanted to bring a pharmacist with the brigade. A young pharmacist from a local CVS answered the call. The small brigade of two physicians and three medical students doubled itself with the addition of four providers from Jamaica Hospital Medical Center, an enthusiastic volunteer, and the CVS pharmacist. The old, the stable, the committed found a new thrust of energy in those willing to join in the mission.

Growth, movement, progress, and development are rooted in committed relationships. Those relationships bring about a sense of familiarity, the comfort of what we like to define as home. VCU has certainly found a home at Pinares among the people they have so faithfully served for years. But years and time imply change and growth. In development there is no place for complacency. We need to search out the new to enhance and enliven our relationships. This road to development is well paved.

October 16, 2016August 4, 2023

Fun and Fulfilling

Over the course of twenty-six years, thousands of individuals and hundreds of professional and academic associations have shouldered the mission of improving the quality of life on the Frontera by visiting Honduras on service trips. They have paved the way for the ongoing provision of quality health care and established the infrastructure to support that ongoing care. Through dedication and commitment, through the sharing of expertise and knowledge, these associations and individuals have uprooted the embedded poverty that denied people basic health care and planted systems of sustainable empowerment. People live longer, healthier, more productive and fulfilling lives in strong communities. These individuals and groups will continue to visit and support and grow this sustainable system of quality health care delivery. Shoulder to Shoulder will support their dedication, commitment, and service.
Shoulder to Shoulder has become an expert in receiving medical professionals and students, sending them out to treat the people, and coordinating that service in relationship to our ongoing heath care service delivery. We’ve done it for so long, it’s become second nature. However, we are yet inexperienced when it comes to receiving and utilizing groups coming specifically to assist us in our evolving mission of education.

Laura and I nervously awaited the arrival of Genesee Valley Presbytery who came to visit us in Camasca. Though they came as a service group, they had no medical expertise and had no intention of providing health care. They came to exclusively work at our bilingual school. Laura and I know how to manage medical teams. Also, the medical teams have an inherent focus on their service in providing health care. But what would this group do, and how would we organize their efforts? In part it was a construction brigade to establish a rain water collection system at the school. In part it was a school brigade where they would offer games and exercises with the children. In part it was a resource brigade to stock and organize the shelves of our library. Their focus was disparate as were their personalities. In speaking to them on their first night in Honduras, I realized they were all different individuals and no one principle gave them a coherent organization. Some were here because they liked construction, some because they enjoyed singing and celebrating with the kids, and still others wanted to catalogue books. How would I do this? How would I herd these cats? My anxiety rose.

It was needless anxiety. I soon realized that there was indeed a common organizing principle to their service mission. It wasn’t a professional principle, though it was clear that the contractors, engineers, musicians, and teachers knew their stuff. It wasn’t so much a drive to realize specific objectives, though they accomplished incredible things. The organizing principle was much more profound than this. They all shared a generous spirit, a willingness to serve no matter what need was encountered, a singular respect for the people they met, and a driving desire to come to know in a meaningful way the children of our school and the people of Camasca. This was what we might call charm and grace. They had loads of it, and in six days they found a place of welcome in the hearts of our children and the people of Camasca.
I could simply focus here on what they accomplished because it impressed me beyond my expectations. They built a quality water collection system in about two days, making me scramble to find additional construction projects to keep them busy. They added six hundred books to our library, and organized a eclectic mess into an efficient store of knowledge and literature. They enlivened and enriched our students with song and spirit each morning. They visited other area schools, gifting them with their presence as well as with books and clothes. This success would certainly have been sufficient, but there was more.

They did it all and had tremendous fun doing it.

“Papa Grande,” aka Adam, played his guitar, sang his songs, and corralled the smiles of our children.
“Gopher,” aka Tony, busied himself in digging holes.
Andy was forever ready with the right tool for the job.
Jeff, the still, but deep waters, was always ready to help.
Bill drew up plans and designs.
Chris may have found a new vocation as a librarian coding books and stacking shelves.
Whitney mastered the troops.
Lori provided for all needs from a bottomless purse.
Jan articulated the sacred privilege of reading.
And as all this business went on, we found time to barb one another with groaning puns. Pat provided the ultimate symbol for this in carrying “Donkey Hotey” back to the states.
We followed Dan’s challenge to us all by “super-sizing” our generosity and realizing the super-sized response in the appreciative embrace of the people of Camasca.

What wondrous things Shoulder to Shoulder has achieved over the course of twenty-five years in the dedication and commitment of professional service teams. True enough. I am certain that just as we have established a sustainable system of quality health care because of the generous service of medical mission teams, so too we will establish quality, sustainable education on the Frontera as we develop relationships with groups and individuals to shoulder this mission. It is always so impressive to see what we have built and accomplished. It is, however, so much more impressive when we find meaningful connections that bind us to the best of who we are. This is grace.

September 11, 2016August 4, 2023

Open Wide

Laura and I at an earlier time in our Honduran experience used to frequently walk by a dental clinic. The dentist there was very friendly and would wave and say hello as we walked by. We’d sometimes see patients going in or coming out. We thought it a bit surreal, however, as many of these patients had very few teeth, and the ones they still had didn’t appear very healthy. One day, the dentist invited us into his clinic. There weren’t any instruments or materials, save for a torturous looking instrument that was obviously designed to yank teeth out. The “dentist,” of course, was not really a dentist, and the “clinic” was not really a clinic. Were we appalled? Well, yes and no.

According to developed world sensitivities, having had professional dental care all our lives, and having been well-trained since youth in the importance of regular brushing and flossing, we would look upon this “dentist” and his “clinic” as archaic and barbaric. Our first reaction might be to call the ADA and have this man’s opportunistic practice closed down. But, this is not a developed world we live in, and perhaps we need to look closer at the context. There is no real dental care here, no programs to teach dental hygiene, and the term ‘dental health’ is an oxymoron. Yet, there are dental issues. People have toothaches. Given such limited resources and options, given a societal consciousness of dental care as pre-professional by developed world standards, what choices really exist? Extractions are the best, if not only, response to bringing relief. There are few voices to cry out against it. In fact there are all sorts of dental brigades that come to Honduras. They’re generally not here to raise the societal consciousness of what constitutes dental health and hygiene. Nor are they here to equip Honduras with the tools and skills to institute systems of periodontal professional care. They are here to pull teeth. So how are these US dentists any better than our friendly “dentist” at his “clinic?” Who is mimicking who? And how would one really go about making dental health a legitimate, sustainable reality in Honduras?

The answer is simple really. All you need is a generation of time and patience, a gargantuan amount of money and resources, professional and technical expertise readily available and disposed to assist, and Hondurans generously taking on an onerous mission that runs opposed to societal structures and practices. Am I being facetious? Well, yes and no.
Jan and Larry Tepe have dedicated themselves to making dental health a legitimate, sustainable reality in Honduras, particularly in the Frontera, for decades. They have garnered and directed the time, money, resources, and professional and technical expertise necessary to reshape the societal consciousness of what dental health is in Honduras. They have given it all away to Hondurans in whom they can do no more than trust will carry on an onerous mission. What a tremendous investment! Has it made a difference?
I suspect when Jan and Larry first started coming to Santa Lucia and Concepción, they did a lot of extractions. Through the decades, they have developed teams of dentists, dental students, dental assistants and hygienists, and other professionals to share in their mission. They also invested in Honduran professionals and dentists to slowly come to an appreciation and sharing of their vision and mission, working shoulder to shoulder. Jan and Larry were recently here again with Beth Deyhle, dental assistant in August. I suspect their time here now was qualitatively different than was their first experiences.

Today, when they come they work alongside two professional competent dentists, Dr. Idalia Ramos in Concepción and Dr. Flor Amaya in Santa Lucia, who run private dental clinics offering care that parallels quality care in the US. For all the years of Jan and Larry’s commitment, Dr. Idalia and Dr. Flor worked as employees of Shoulder to Shoulder. This year, Shoulder to Shoulder enabled the transformation of US subsidized clinics to private, Honduran enterprises. Jan, Larry, and Beth were here to support their work and not to impose their superiority. They are assisting them in obtaining the resources and the competence to manage their practices, and offering them training in promoting their practices as viable and sustainable. Dr. Flor and Dr. Idalia are in turn changing the societal consciousness relative to what constitutes dental health and making it possible for all persons to gain access to quality dental care. The work is not done. Decades have already been committed and further decades will be necessary, but substantial change has already taken place and the foundation is laid for continuing the revolution.

“Open wide!” That’s a loaded phrase, isn’t it? We’ve all heard it, reclining somewhat stiffly back in that odd shaped chair, a bright light blinding us, a bib alligator clipped around our neck, with the masked, white-coated person hovering over us. And we are anxious to what will be found when we open wide and expose ourselves to sharp, probing instruments. But if we do not open wide, if someone doesn’t insist upon it, we see only the surface of things and our remedies for improvement are limited by what is never really looked at or examined. So, perhaps it is best to probe deeper, under the surface and into the cavities where the forces that shape and define us dwell. That does in fact seem to be the work of a dentist. Jan, Larry, and Beth visited our bilingual school while they were with us. Our bilingual school children have benefited from free dental care subsidized by Shoulder to Shoulder for years now. The children smiled for them when they visited; bright beaming smiles of health, well-being, and confidence. All this now because Jan and Larry were not willing to simply look upon the surface. Rather, as the good dentists that they are, they voiced their demand. Open wide!