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After four days of breathlessly trying to keep up, I met Freddy Ruiz, a small, quiet man who picked his way carefully through the chaos and asked if I was Mark and if I took care of children. I said I was, and he asked if I would come to his orphanage.

My team was more than happy to get rid of me. After three days of martyrdom to a nonstop onslaught I was probably painful to have around. It didn’t matter what or how much any of us did. In many ways the nurse practitioners would do fine and maybe a little better than me.

Almost everyone else on the mission had already taken tours of this or that or a beach day or been shopping for native crafts.

There was something very likable and reassuring about Freddy, but my attitude after being held hostage and made to practice pediatrics in a concrete coop for three days was not good. Why didn’t this guy Freddy just pile his kids into a truck and have them wait in the forty-cent one-lempira line like everyone else?

Freddy’s orphanage was only about thirty minutes away, but I felt better and better with every mile put between me and Escuela JFK. Halfway there it became clear that Freddy thought I was a dentist.

“No, Freddy, I fix just about everything except teeth.”

I was invited to see the orphanage anyway: twelve houses with about five to six children and a set of foster parents in each sprinkled over about ten acres of citrus groves. The biggest building was a school with paper and books and art all over the place. There was a giant vegetable garden and a barn with cows and goats and a chicken coop.

It was owned by the Catholic Church, but Freddy was quick to point out, “You don’t have to have Catholicism to be a child here.”

Since Freddy had taken over, the children at the orphanage were no longer available for adoption. They had only been able to place two or three of the younger children a year anyway, and the rest of the kids and staff just sat around feeling like unwanted failures. Now all the kids went to high school and beyond. They all had jobs and tutors. The comparison with the kids I was seeing back at our clinic, where less than 10 percent were going on to high school, was stark. One thing a Honduran child might consider to get ahead would be to lose his parents and find a way to get into Freddy’s orphanage.

A hasty clinic session was arranged. I was ushered into a clean, nicely set up exam room with an office, where, one at a time, children with charts and coherent problems and histories appeared with a bilingual nurse who knew what medications were available.

There were two girls with complex congenital heart disease who had never been seen by a cardiologist. Neither was doing well. Both had a chance of being helped if we could get them to Boston or Miami for catheterization. It turned out that wasn’t out of the question and that a note from me would help. I taught them how to make a paste out of aspirin to get rid of warts. I saw about ten kids and started scheming with Freddy and his nurse about getting the useful leftover equipment and medications from the mission to end up in their health center rather than somewhere else.

I stayed in touch with Freddy for several years afterward. One of the girls with congenital heart disease did well after an operation in Miami. The other had had too much blood going through her lungs for too long and would have a shortened life.

By the time I got back to the hellhole I had helped to create at Escuela JFK it was late in the day. John, one of the translators, was in my room with a stethoscope around his neck, putting it on one well-looking child after another.

“All these kids with coughs who don’t look sick, which is most of them, I listen to their chest and then give them 250 milligrams of amoxicillin, which is what the nurse practitioners told me to do. We had to do something. They seem happy with it, especially since they don’t have to stand in the pharmacy line.”

“If you turn the stethoscope around, the earpieces and your ear canals will line up better and you’ll hear more,” I said.

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