In "Back to the Future," a science-fiction adventure film, teenager Marty McFly is sent back in time to 1955 and meets his future parents in high school. Marty accidentally attracts his future mother's romantic interest and must repair the damage to history by causing his parents-to-be to fall in love.

I thought of this movie as I spent time on a medical mission team in Honduras, which is a small, poor country (about the size of Tennessee) in Central America comprised of approximately seven million people. More than two million Honduran people have no access to basic health services, many of them children. The Friends of Barnabas Foundation has reached approximately 11 percent of those without any access to medical services. Much has been done, but more work is needed.

My experience there was like a real-life "patient safe" simulation lab in local villages. We screened more than 700 patients for general medical needs, treated minor acute illnesses, and made referrals to specialists only as needed. This was accomplished at no cost to the government or patients. I readily admit no JCAHO, lawyers, OSHA, or EMR made life much easier.

No patient anywhere will experience great clinical and customer skills if they are not safe. Safety must come first. For example, on the first day of our traveling clinic we had four providers requesting medications in the same room with crying infants. The situation made my "internal smoke detector" go off immediately. The next day we assigned two folks medication dispensing duties and then completed one provider's requests at a time.  When anyone had a question, we stopped and asked each other. By stopping, validating, and verifying, we avoided four possible mistakes.

In the following days, I experienced several cases that reminded me our clinical skills as respiratory therapists are always the foundation of good care, not technology. For example, as I began to review metered dose inhaler techniques with one woman, I asked her to show me how she used her MDI. She held the canister upside down and didn't pause between breaths. 

 I also had to rely on fundamental clinic assessment skills for all age groups who came through the clinic. I distracted one 2-year-old boy by wiggling my finger in front of him while auscultating, and this helped me get a "quiet" listen.

My clinical problem-solver hat came in handy when I identified indoor smoke from cooking exposure as a source of a patient's upper respiratory infection.

So my challenge is for us consider how to provide entry access and use our solid foundation of clinical skills to attend to basic medical needs as an alternative to our traditional overcrowded, overworked expensive emergency room "primary clinics." The ability to see a high volume of patients is a critical requirement not just in a third world country, but here in the U.S. where 37 million people are uninsured and 30 million are underinsured. Volunteering in Honduras gave me a glimpse of how health care can work without defensive medicine's inflated ordering practices and well-intended - but now out of control - oversight agencies.