Who We Are

Description of a Collaborative Health Improvement Program Between
San Jose San Marcos de la Sierra, Intibuca and
Department of Family Medicine – University of Rochester / Hombro a Hombro

In 2003, the Department of Family Medicine at the University of Rochester (Rochester, NY, USA) decided to create a global health program. The goals were to improve the health in a sustainable manner of communities in developing countries and educate medical professionals and others about working with people of different cultures living in resource-poor environments.

The Department decided to partner with Shoulder to Shoulder (S2S, or Hombro a Hombro in Honduras). They had created a clinic in Southwest Honduras about 12 years previously and were looking to expand into others areas of Honduras. In combination with the Honduran Ministry of Health and S2S, we chose to work in the San Marcos area in the state of Intibuca. This is by some reports the poorest county in the poorest state in Honduras. After interviewing multiple communities in the county, we chose San Jose San Marcos de la Sierra.

San Jose is composed of seven villages populated by the aboriginal Lenca Indians. Realizing the San Jose residents are the experts on the problems adversely affecting their health, we spent much of the first two years listening to their advice and observations. Based on this original community assessment, we have collaboratively created solutions to their problems. The San Jose people rank-ordered their problems as follows:

  1. Water
  2. Nutrition
  3. Education
  4. Health care
  5. Poverty

Although the Department is most experienced in medical care, curative medicine will not fix many of the contributors to ill health as identified by the community. Given the real goal is improved health for the community, we expanded our operations beyond traditional “medicine” borders to achieve long term improvements in health. Dr. Stockman, the Director of the Global Health Program, has significant experience in rural improvement activities from 3 years in West Africa. Using his experience as a foundation, various interventions targeted at improving the health of the San Jose people are underway or will be in the future. A brief sampling of a few of the interventions are listed under the Initiatives section.

An important distinction between this program and many other NGO interventions must be high-lighted. The Rochester group realizes they are not the experts and San Jose is not their home. It is the San Jose people who must learn how to improve their own lives so they can become self sufficient. The Rochester group can offer some technical and financial assistance, but the San Jose people must direct interventions and must learn how to construct and maintain all interventions. For example, San Jose residents have been shown how to build improved cook stoves and VIP latrines. They are now self sufficient in their construction.

Basic Philosophy

  • Identify one community for long term partner
    • The community must be motivated, collaborative and have prior success
  • First listen to the community
    • They are the experts, not us, they know their problems
    • Next we explore collaboration
  • Combine the best of their and our talents to solve problems
    • Goal #1: improved health for the community
    • Goal #2: sustainability – sustainable changes may take a generation
  • Low cost, low tech with community doing most of the work
  • In time, expand activities outside initial target community with the help of the target community


Douglas Stockman, MD
Clinical Associate Professor, Department of Family Medicine
Medical Director, Highland Family Medicine
Director, Global and Refugee Health
Department of Family Medicine, University of Rochester
Barbara Gawinski, PhD.
Associate Director, Global and Refugee Health
Department of Family Medicine, University of Rochester