HONDURAS, a Latin American nation of seven million people, is one of the poorest countries in the world. Located between Guatemala and El Salvador to the north and Nicaragua to the south, it has the Caribbean coast on the east and a short stretch of the Pacific Ocean on the west. More than half of its people live in poverty; an estimated one million lack access to clean water and about 1.8 million, basic sanitation. A public health care system is virtually absent, and so is the political will to establish such a system. All these have led to a health crisis, especially in the rural areas. This is compounded by the devastating effects of Hurricane Mitch, which left hundreds of thousands homeless in 1998.
Nuevo Paraiso, a small village in the south-west, presents a microcosm of all the problems facing the country. Trying to make a difference here is MDJunior, a unique student-run non-profit organisation based in the United States (see box). Nuevo Paraiso is about an hour’s drive from the airport in Tegucigalpa, the capital, on a landscape of dusty, winding roads and concrete dwellings of the city which soon make way for sparsely located small houses in the countryside.
The introductions between the student-volunteers and their mentors were made on the bus ride, and more introductions followed on reaching the place in the evening, this time with the local hosts and organisers. Ninety-four per cent of Hondurans speak only Spanish, but our hosts were all bilingual and communicated with ease in both English and Spanish. We were also helped by six students from the local community high school who remained with us throughout the mission. The hope is that the experience will inspire these students to take up a career in health care and ultimately fill the void in their own communities. Most villages in the area lack access to medical attention within a four-hour walk.
The rest of the evening was spent unpacking the seemingly endless boxes of supplies, including medical and dental care supplies and donations of clothing, books and crayons. If the prospect of having them all sorted out and organised appeared daunting, we seemed to have a continuous supply of energy that night, probably because of the excitement of staying in a new place, making new friends and opening the medical clinics the following day. With everyone pitching in, as part of different groups, the empty shelves were stockpiled quickly and the boxes emptied out.
Early next morning we donned our spirit-wear, MDJunior T-shirts, with pride and enthusiasm, and set out in our trucks heavily laden with suitcases labelled pharmacy, dentistry, donations, and so on. The bags contained lice shampoo, scabies lotion, parasite pills, vitamins, paracetamol and bags filled with toothpaste, toothbrushes, combs, shampoo, stickers, and the like.
As the trucks turned the corner to the school, we could see people lined up even before the school buildings came into view. About 63 per cent of rural Hondurans are seen by health-care professionals only at medical missions. This state of affairs is a reflection of the socio-political situation in Honduras, which the World Bank and the International Monetary Fund declared as one of the heavily indebted poor countries in 2005 and made eligible for debt relief. Sixty-three per cent of the population lives below the poverty line and about one-third is unemployed or underemployed.
Historically, the economy of Honduras has depended on the export of bananas and coffee. It has now diversified and expanded its export base to include apparel and automobile wire harnessing. Nearly half of Honduras’ economic activity is directly tied to the U.S., with exports to the U.S. accounting for 30 per cent of its GDP and remittances for another 20 per cent.
Politics has been characterised by a two-party system since about 1920, dominated by the Liberal Party and the National Party. Only now the country has achieved some political stability following the crisis brought about by the ouster, in a coup, of President Jose Manuel Zelaya in June 2009. In January 2010, Porfirio Lobo Sosa took over as the democratically elected President, and the next presidential and congressional elections will be held in November 2013.
One of the challenges before Sosa is controlling crime. According to the United Nations Office on Drugs and Crime, Honduras has the highest rate of intentional homicide in the world, with 6,239 intentional homicides, or 82.1 per 100,000 of population, in 2010. The Honduran military has been deployed in some parts of the country to support the national police.
Honduras, the second poorest country in Central America, also suffers from extraordinarily unequal distribution of income as well as high underemployment. Honduras is particularly susceptible to natural disasters such as hurricanes, flooding and earthquakes. Drought and forest fires are also common. The country is yet to recover from Hurricane Mitch, which caused such massive and widespread destruction that it reversed the progress that had been made by the country in 50 years. Mitch obliterated about 70-80 per cent of the crops and transportation infrastructure, including nearly all bridges and secondary roads, and the total loss was estimated at $3 billion. At the school, we set up the triage station near the entrance. The dentists took the stage, the doctors got their own consulting rooms, and the pharmacy took a room of its own. This was a relatively lavish setting compared with the other places we would go to in the next few days. We unloaded the heavily laden suitcases and lugged them to the various stations set up for the many local residents who were waiting eagerly to see us. As the families started coming through, what struck one was the fact that most of them were mothers with little children. In Nuevo Paraiso, children constitute 40 per cent of the population and 52 per cent of them are part of single-mother families. These women struggle to raise their large families in the face of abject poverty.
One mother took her seat in front of the doctor and started crying, tears streaming down her cheeks. Her three children were visibly upset seeing their mother in tears. Despite the language barrier, the raw emotions were clear for everyone to see. It turned out that she had been thrown out of her home by her husband just that morning and had no place to go. Domestic violence against Honduran women goes largely unreported. After her emotional outburst, this mother thanked us for listening to her and said that she would go back home that evening. We felt deficient in that we could do nothing for her other than listen to her.
Infectious diseases
Most of the people had problems such as intestinal parasitic infections, respiratory infections, diarrhoea, and fungal skin infections. As the end of the day arrived, our suitcases were emptied.
In all, our team completed five full days of service: three days of medical clinics around Nuevo Paraiso and two days in neighbouring Flor Azul, executing public health projects.
Flor Azul is a village with a small population of about 300, located in the state/region of El Paraiso, about two hours from Tegucigalpa. This remote mountainside village suffers extreme droughts followed by disastrous floods. The people are extremely poor, and employment is usually temporary and comes during the cane-picking season. There is no electricity or water. They bring water on donkeys from over three kilometres away. We laid concrete floors in a couple of homes that were accessible only by steep dirt roads that grow treacherous in the rain. The layer of concrete decreases the transmission of germs from the mud floor and reduces the incidence of parasitic infestations and diarrhoea.
One of the homes belonged to a young couple with a four-year-old boy. As the volunteers set out to mix cement in the open, under the burning sun, they ran out of water. The man in the family set out with his donkey to collect water from a passing stream that was about an hour away. Accessibility to water, potable or otherwise, is a big problem in these areas, as is the case with most parts of Honduras. By the end of the day, the laying of the concrete floor was done and the young couple was extremely grateful for it. “I never thought I would be putting a floor in someone’s house, but it was a fun experience. Although it was a lot of hard work, it was nice to know that at the end of the day you accomplished something meaningful, or stopped the cycle of repeated infections,” said one student.
“It truly was an eye-opening experience to see how these people lived; it made me realise how much I have and how thankful I am for everything I have. The family didn’t even have clean water or very much food,” said another student.
Juan Carlos, one of the local Honduran volunteers, commented: “These families are not simply receiving ibuprofen or a Tylenol tablet, they are receiving concrete floors through our public health initiatives, they are receiving material donations such as beds and clothes, they are receiving education about sanitation, hydration and nutrition. You are not just giving them medicine; you’re giving the people hope.”
It was hot and sticky by the time we were done for the day and we had to pack up to get back to the quarters before sundown. We left with a smile on our lips and a dream fulfilled, albeit small.
Hondurans are known to be a warm, cheerful, friendly and welcoming people and so they were with the foreign students in the post-dinner cards session—television and video games are non-existent in this part of the world. It was as though they had known each other for a long time, and the mission trips each day brought them closer together. The children of Honduras reminded us of hope. They were very happy despite the suffering, illness and hardship they had to deal with every day. They were innocent and light-hearted and seemed to have endless joy in their lives. We went to change their lives, instead we returned changed for life. It dawned on us that the experience in Honduras impacted us more than we could ever have hoped to help Honduras.
Dr Deepa Mukundan is a paediatric infectious diseases physician who practises in Toledo, Ohio, United States. She is also Associate Professor at the University of Toledo College of Medicine.
Shaurya (Shaun) Verma is a senior at Milton High School, in Atlanta, Georgia, U.S. A 2012 Youth Services of America’s Wofford Award recipient for his distinguished service, Shaun is the founder & president of MDJunior, a student-run 501(C)3 non-profit organisation. His email: shaun@Mdjr.org
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