Art of Medicine
Jan 2020

Worlds Apart

Tamera Means, MD, MHS
AMA J Ethics. 2020;22(1):E63-65. doi: 10.1001/amajethics.2020.63.


Two photographs of caregivers walking through a Honduran jungle to visit patients in their homes literally and figuratively represent barriers to health care access.


Walking miles on Honduran dirt roads and climbing densely forested, steep hills, our team experienced first hand the physical and geographical barriers to health care. We made our way to rural homes of patients unable to make this journey. Clearing the woods, we entered an open field and paused to observe the enormity of the mountain terrain we had just traversed.

Figure 1. The Journey to a Rural Patient’s Home


After one week of caring for patients, our pharmaceutical and other medical supplies almost depleted, we found our congestive heart failure patient at the bottom of a mountain, his wheezing granddaughter at his side. We were prepared for him, but his granddaughter—diagnosed for the first time—was unexpected. We treated both with our limited supply of medication, and, despite our help, their futures would remain uncertain. We left our desire to do more unsated, our heads full of more questions than answers.

Figure 2. Jungle Trail


My hope remains that, through times of persistent uncertainty and resource scarcity, we health professionals find our niche and try to help, both locally and globally.


AMA J Ethics. 2020;22(1):E63-65.



Conflict of Interest Disclosure

The author(s) had no conflicts of interest to disclose.

The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.