Hi All,
I'm in the midst of a 2 month mission with MSF/Doctors Without Borders to explore the health situation all over Honduras. With my partner Edgardo (who I met in Uganda in 2006!) and a driver, we're visiting all of the hospitals in the country, some smaller health centers, community leaders, other "actors" in health ... And looking at what might be good interventions for MSF future projects.
So far, it's been fascinating!
The country is lovely: rolling hillsides of banana trees, sugar cane, corn, "African Palms," seaside communities. Highrises and places where horses still do much of the work. Claro phone satellite dishes on top of tin roofs and communal wood fires and cooking ovens. Eating fresh fish and shrimp/conch every day along with fresh hot rolls sweetened with coconut oil. Edgardo tucked into a bowl of stewed iguana (yes, I had a taste - not bad) and iguana eggs. Birds of prey that look like small vultures scour the fields for dinner. There are pine forests and cactus and pine forests. Herds of cattle graze on the sides of roads and amble down the middle of traffic.
People have been very friendly everywhere and certainly stare at our Toyota Land Cruiser covered with the doll figures in the picture (MSF has long worked here with the street population, HIV, violence, etc).
So far we've been mostly in the north/Caribbean coast and the past few days have been meeting with Garifuna leaders. Garifuna are ethnically different than native Indian/Spanish mixed folks - they were originally black African slaves taken to the island of St Vincent, escaped and settled all along the Carib coast of Central America. They retain their own language, customs, music (Punta) and traditions. Our interest is to see if they have unique health needs - as a people, they are reputed to be more sexually active, have higher STI and HIV rates and have more young pregnancies (as young as 12 and 13). From their perspective, they are simply more open about speaking of sexuality. However, government statistics show double the rates of STI/HIV as the regular population and a UNICEF study showed average age for boys and girls becoming sexually active is NINE.
It's also been interesting to see the conditions of and in the hospitals. The two main tertiary care hospitals are huge, sprawling, disorganized, smelly, and would be a nightmare to try to become involved in. Both hospitals' ERs are chaotic, patients lying on gurneys lining the hallways unattended with blood hanging, open wounds, smell of infection, no cardiac monitors or IV pumps, crowded, no triage, armed men everywhere ... A real mess.
Yet, here in Tela, their 10 yr old hospital is clean, neat, good equipment in working order, new mattresses, paint ... The only thing I can attribute the difference to is leadership. Management that cares, is engaged and involved, with vision and pride in quality of services and facilities.
So far the ideas we have are three:
1. Provide HPV vaccine to children age 10/11. There was one pilot program of about 30,000 doses done a couple years ago, but the government doesn't have the funding to continue. We feel this would have a HUGE impact on the health of the next generation and an organization like MSF could pull it off ...
2. A smaller community hospital Puerto Cortes has new leadership and desire to fix up their neglected facility. With a staff who is eager for improvement, and without a lot of bureaucratic hang ups, we could rehab their ER, provide equipment and training plus get involved in their newly created Adolescent program so we could touch on all aspects of Sexual and Reproductive Health.
3. Provide an interim physical space for a large hospital Pediatric ER - they are in the process of rebuilding but have no plans for what to do with the patients while the construction is being done (they say 6 months, but realistically 2 years!). We could provide modular spaces or inflatables, take over the care and improve systems, training, etc. and have a hand in the construction of the remodel. Then once they are ready to move back into the renovated space, they would have had a couple years "doing it right" and would keep those new ideas and systems as MSF withdraws.
These are just ideas we're throwing out as we move along our journey. It will be up to the coordination team and Geneva to make decisions about next steps.
Now it's Holy Week and the country is on vacation. We're taking advantage of being on the coast to enjoy a few days of rest. We'll do the same in our next weeks - work 5 or 6 days and have a day off in a lovely spot: Copan, where there are Mayan ruins on the border with Guatemala and the islands to the south off the Pacific Coast bordering El Salvador. What a wonderful adventure this is!
I'll be home soon, ready to have a lovely summer in Seattle. Hope all's well in your world.
Much love,
Sue
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