The noise of a large lumbering vehicle off in the distance breaks the stillness of the heavy jungle air. Soon the white-painted roof of a mobile trailer can be seen above the treetops as it makes its way along the dirt road toward the central plaza of a small rural town in Honduras. More villagers leave the house to join the curious already lining up along the roadside. Then someone murmurs: "Ah, today is the day the government is sending an operating room on wheels to remove Doña Matilde's tumor and the doctors are going to look at her grandson who's been sick, too."

Since May 1996, when the project was officially launched, Hondurans in targeted pockets throughout the country are being given their first opportunity to receive badly needed surgery and health care, a dream that before--whether because of the geographical isolation of where they lived, or because the idea would have been beyond their reach economically--would have been all but impossible.

The Mobile Surgery Project, as it is called, is a tripartite arrangement between the Ministry of Public Health of Honduras; the Government's Standing Contingency Committee, called COPECO, which coordinates response to national emergencies; and the office of the Pan American Health Organization (PAHO) in Tegucigalpa, the country's capital.

The project has the potential of reaching some 1.5 million Hondurans--approximately one-third of the country's population--and allowing them to receive health care and follow-up for the most frequent and easily treated medical problems requiring some form of surgery.

Goals for its first year of activities include the performance of 500 outpatient surgical interventions in three of the country's nine health districts. However, if initial response and demand for the services is any indication, that number will probably reach 800, say the project's planners.

The most commonly performed surgeries are those for low-risk conditions that can be easily corrected with minor surgery, such as hernia and removal of gallbladder stones and skin tumors. In addition, the mobile surgical unit also performs major surgeries when it visits towns with small hospitals where patients can receive postoperative care.

According to the project's head, Dr. Jorge Luis Deras, this innovative "surgery on wheels" strategy is performing a valuable service by relieving pressure on and overcrowding in the country's main hospitals and responding to the demand for surgical services in such widely dispersed towns and villages as Ocotepeque, Marcala, Goascorón, Siguatepeque, La Esperanza, and Florida.

The project will also provide assistance along Honduras' border with Guatemala and El Salvador, the latter an area of widescale devastation during El Salvador's protracted civil war of the late 1970s and 1980s. This region is one of the country's most inaccessible, since most roads were destroyed and entire villages disappeared during the 12-year war. Some 80% of the population does not have a clean drinking water supply or adequate sewage disposal systems. Residents here have little hope of receiving regular health care, since the nearest health posts are often miles away over rugged terrain and offer only the most rudimentary of services. Therefore, for the great majority of the rural population, the Mobile Surgery Project is the only option available for either primary or more specialized health interventions.

This type of transborder cooperation benefits all three countries, as each strives to develop effective local health systems responsive to the needs of the population and to fulfill the accords of the Treaty of Central American Social Integration signed by the six Central American heads of state in the capital of El Salvador in March 1995.

The sites the project will visit are selected by the Ministry of Public Health. A medical team then contacts local health personnel to inform them of the visit. They in turn interview prospective candidates for surgery and explain the evaluation and selection process, as well as any other special requirements that must be met to ensure equitable access among those most in need of health services. Then the mobile unit team in Tegucigalpa goes to the town, reviews patient selections, and sets up appointments for surgery during the month.

"The strong suit of this project," notes Dr. Deras, "is that people can plan ahead, they know what to expect, and we can bring closure to their anxieties about a health problem." He adds that, thanks to the teamwork of personnel at local health centers and the community's enthusiastic response, the Ministry of Public Health will be more easily able to expand its operations in these areas.

During its first year of operation, the project's most crucial need is to ensure its own sustainability. Dr. Deras feels that community participation is key, as well as discovering and making maximum use of linkages with other community-level health and development programs.

Equitable access to basic health services is at the very heart of health sector reform, a goal that the Ministry of Health of Honduras, in partnership with PAHO, the Government of Sweden, and others, is working hard to achieve. Municipal councils and their mayors have also signed on to this idea, as their awareness of the relationship between health and socioeconomic development grows. The vitality and innovative nature of community-based ventures like the Mobile Surgery Project are showing just how far the good news can travel once the commitment is there.