Written by Jaime Johnston, Photos by Thomas Tomczyk

Health care in the Bay Islands is burdened with gaps in staff, medicines and equipment. Clinics are constantly short-staffed and understocked in essential medications. Inter-island travel is so expensive that most residents of Utila and Guanaja don't even use the department's hospital.
In Honduras' 18 departments, there are an average of 8.8 physicians per 10,000 inhabitants; in the Bay Islands however, there are only an estimated three doctors per 10,000. Many health professionals from the mainland hesitate to move to the islands. "It is difficult to find qualified personnel who want to come to the island from the coast because the cost of living is so high and they will be away from their families," said Dr. Martha Medina, Director of Health for the Bay Islands Department.
In 2002, the World Health Organization (WHO) reported that health expenditures represented 6.1% of Honduras' GDP. As the Bay Islands' cases of Diabetes, HIV and Malaria rise, several local physicians suggest that patient care isn't being met by government resources.
Located in Roatan's capital, the department's 33 bed hospital is staffed with 11 physicians, ten professional nurses and 33 auxiliary nurses who tend an average of 300 patients daily. In 2004, the two hospital surgeons conducted 500 major surgeries and 126 minor surgeries.
The hospital houses a laboratory headed by a microbiologist and staffed by two technicians. There are five specialist physicians and also a pediatric clinic sponsored by American NGO Global Healing. Patients are required to get referrals from their family doctor to see any specialist and then their name is put on a waiting list.
In 2004, the hospital observed a 3.7% decrease of inpatients. "It's all about lack of space for beds. We need a better place than what we have," said Dr. Medina. In 2004, the average patient stay was three days and the hospital operated at an average occupancy of 71%.
Roatan has government-funded clinics in French Harbor and Oak Ridge, and several private practice and NGO-assisted clinics across the island. These, along with many international volunteers rotating through the island, supplement the department's health care as provided by the central government.
In Guanaja, two clinics provide basic medical care. One is located in Savannah Bight and the other is on Bonacca Cay, the population center of the municipality. Bonacca's Lita Wheeler Clinic is headed by Dr. Keith Humphreys who started working there in 1993, four years after it began operation. The clinic serves 50-60 patients daily and according to Dr. Humphreys, the only staff physician, case load increases to up to 80 daily during the rainy season.
The Lita Wheeler Clinic has nine employees, including two professional nurses and one laboratory technician. In 1999, the year after Hurricane Mitch, the British Embassy donated the funds for a laboratory which helps the clinic operate more independently. "Communications in the department are very deficient for health care. In the case of Guanaja, most people don't use the department's hospital [in Roatan]. If they can't get something here, then have to go to La Ceiba," said Dr. Humphreys. There are no specialists on the island, but several times annually different American physicians come through and give consultations in orthopedics and optometry.
Utila also receives volunteer medical assistance. Twice annually, the island of Utila is visited by a volunteer "brigade" from the coast which helps provide needed medical care. "We need more doctors, more supplies. Over here, it's difficult because we don't get a lot of help," said Lance Bodden, Board President of the Utila Health Center.
The Health Center opened in early 2000 with a unique funding structure. According to Bodden, the central government covers the cost of two nurses' salaries and a percentage of medication. "The government provides us with vaccinations for children, worm medicine and some basics, but after that, we are on our own," said Bodden. The center charges a Lps. 100 consulting fee to cover costs of rent, utility bills, supplies and part of salaries.
With one full-time doctor, three nurses and a dentist on staff, the clinic treats an average of 12 patients daily. "We've got about 8,500 people living here between the local population and the tourists and we've only got two doctors," said Bodden.
An alternative to the government supported health center is the Utila Community Clinic, also located in Sandy Bay. A three-year volunteer at the UCC, Dr. John McVay D.O., 51, says that ear problems, skin infections and diarrhea are the most common of the problems he treats among his patients.
According to Karina Barahona, a nurse at Utila's Health Center, skin infections and many gastrointestinal problems are linked with quality of water supply. In 2004 at the Roatan Hospital, intestinal parasites accounted for 1,190 adult consultations and another 602 were attributed to diarrhea.
"People need to learn about clean water supplies and garbage disposal. There is a connection between public health and living conditions," said Dr. Zeni Duarte of Dr. Polo Galindo Clinic in Punta Gorda. In addition, 292 patients in Roatan and 20% of female patients who visit the Utila Health Center are treated for vaginal infections, an ailment Barahona also attributes to water problems. "Women should be washing themselves with purified water," said Barahona.
Other environmental stresses cause a volume of infections. Barahona indicated that respiratory infections were the top reported problem for patients in 2004. This is a pattern in all three islands. Roatan Hospital treated 939 adult cases of bronchitis and asthma in 2004. Guanaja alone reported 264 adult cases of bronchopneumonia, compared to only 82 cases in Roatan Municipal. "We see a lot of upper respiratory infections. These cases are caused by environmental factors. The cay itself is so cluttered and everything spreads quickly," said Dr. Humphreys.
In addition to environment, lifestyle is a determinant for health problems in the Bay Islands. Eating habits are a key part of prevention and treatment of illness. "People here tend to eat a lot of fried and salty foods and the sugar intake is very high," said Dr. Zeni Duarte, "This can lead to many different health problems, including diabetes and hypertension." In 2004, 778 adult consultations at Roatan Hospital were diabetes-related. Another 1,230 were due to hypertension. WHO reported 81,000 Honduran cases of diabetes in 2000 and projects 269,000 cases by 2030. This is the third highest rate in Central America.
"It is Diabetes and Hypertension that are the biggest medical problems in the department," Dr. Jose Roberto Gonzales, Director of RH. As testing becomes widespread and more cases emerge, the department's resources are being stretched to support patients. According to Dr. Jacqueline Wood of RH, the hospital struggles to supply insulin and blood pressure medication on a consistent basis which adds a burden to patients who can't afford to buy it from an outside pharmacy. "It happens frequently that we don't have any insulin to dispense and diabetics need it every day. It costs $30 USD for a two-week supply," said Dr. Wood.
The insulin supply is not the only shortfall in the department's health care. Resources are funneled to cover basic care, leaving little room for other programs. "We have a big drug problem in Roatan," said Dr. Jackie Wood, "The most we can do at the hospital [for substance addiction] is to hydrate the patient, give them vitamins and a diuretic and offer them some guidance." There are currently no drug treatment programs available in the department.
In 1993-97, Terry Zapata served as Guanaja Mayor. During this time, there was a small program to help those addicted to drugs. "There were a number of boys who needed help and the municipal arranged for them to go through a treatment program on the mainland," said Dr. Humphreys. "The problem was that when they would come back to the island, they would return to their old lifestyles and behaviors." In the past year, Dr. Humphreys has observed an increase in pregnant women using drugs in Guanaja, leading to malnourishment in newborns.
According to Karina Barahona, cocaine, marijuana and crack are the drugs most often used by the local population in Utila. "There is a lack of control on the part of central government," said Barahona. There is some misconception about the availability and legality of these drugs among some of the islands visitors. "At times, tourists ask for [illegal] drugs at our center."
For alcohol addiction, an Alcoholics Anonymous program operates out of Coxen Hole and Roatan's Sandy Bay with several meetings weekly. According to Paul Cullen, a therapist specializing in Drug and Alcohol counseling, addiction is frequently the self-medication of a past problem. "It starts with the psychological dependency and leads also to a physical dependency," said Cullen. Last year, Cullen and his wife Sarah, also a therapist, moved to Roatan from Manchester, England to begin a practice. "From what we've seen and heard, there is a need for us here."

Concerns about crime, in particular, violent home invasions of Roatan residents, have dominated Roatan-related chat groups and online messages boards since late February. Even though many people feel that crime on the Bay Islands is increasing, there are few groups that track the problem. One source of crime statistics is the DGIC Statistics and Planning Office in Tegucigalpa which reported 11 home invasions and 226 robberies in the Bay Islands Department in 2004. The number of reported robberies increased from 148 in 2003 and 130 in 2002.
On February 28, CANATURH-BI provided another forum for discussing security issues by opening their meeting to the public and allowing residents to meet with local officials. "I have learned that, after 14 years of living here, if I don't want to live in a gated community, then I need to have a watchman," said Phil Weir, a Roatan real estate agent, "You have to realize that this island's police works are hampered by budgets." The police have two vehicles and almost no presence east of the airport in tourist places such as Parrot Tree, Fantasy Island, or Coco View. "People here seem to think that the police have a lot and they do not," said Jaime Barahona, Chief of Roatan Tourist Police, about the island's 85 police officers.
Linda Brown of First Bight talked at the meeting about her recent robbery. On December 22, 2004, four armed men entered her home and held her and her employee captive for 30 minutes. They attempted to take Brown from her home, but she managed to escape to a "safe room" and sounded the alarms. The robbers left in her vehicle with $4,000 of stolen property. According to Brown, she and her husband collected evidence from her home for the police, still, no one has been charged. Since the robbery, the Browns have installed video cameras, sensor alarms on their property and hired full time armed guard. "I still don't feel safe," said Brown.
Sara Mannix, an English business owner and another recent robbery victim, encouraged the public to donate to the police force.

Groups of cruise ship vendors, tour operators and drivers were cleared from the cruise ship dock area in Coxen Hole on March 7. The action was a coordinated effort between Roatan Municipal, the Cruise Committee and CANATURH-BI. According to CANATURH-BI President Romeo Silvestri, major cruise lines were filing complaints with the municipality about vendors harassing their passengers outside the dock area. "We were trying to place order. No one has the right to sell without a permit," said Silvestri.
Vendors are required to purchase a municipal permit to sell their goods within the outdoor market area across from the dock. Tour operators must have a permit and an insurance policy to enter the dock gates to transport passengers.
In the past, those without the qualifications stood outside the dock area and solicited business from passengers that left the gated area. "Passengers were being verbally attacked by these vendors. Also, the outside people were undercutting prices so that the legitimate operators were losing business and that's not fair to people who are operating with the proper permits," said Silvestri. A 400m no-loitering zone around the cruise ship dock was set up.
Not everyone has welcomed the changes. Rachel Francisco, a tour guide with the Cruise Committee's Tour Guide Association, has a son who lost his "unofficial guide" job after the rules came into effect. "We travel from Oak Ridge where there is not a lot of work.

On January 31, the annual dental clinic was conducted at the Sunrise Hotel in Sandy Bay. The group was comprised of 14 volunteers, six of whom were part of the first team that landed in 1995. Over the week-long clinic, the surgeons, dentists and hygienists saw over 400 patients. "What we are treating is a mix of restorations and extractions. We don't extract anything that can be restored. Proper hygiene is the most help; over the years, I have really seen the dental IQ of this island increase," said Dr. Larsen.
The Polo Galindo Clinic in Punta Gorda hosts a rotation of specialists every month. The specialists are organized through From the Heart Foundation, an American organization. "We get 1-2 specialists a month and they tend to complement each other," Dr. Zeni Duarte of Polo Galindo Clinic. The volunteers pay their own transportation and food and the clinic provides housing for the duration of the stay. The upcoming specialists are always advertised in advance and the clinic experiences an increase in patient numbers. "On a normal day, we see about 20 patients. When we have free check-ups, there are about 50 each day," said Dr. Duarte.
Although physicians stay for up to one month, many specialists continue to contribute after they return home. In one such case, a consultations via email helped a 9-year old boy with a rare skin disease. After sending photographs through email to a dermatologist in the United States, doctors were able to diagnose dermatomiosytis. The clinic has managed treatment for boy for the last two years. "There are cases where the patients can't afford to travel to the coast to see a specialist and we do everything we can to provide an alternative," said Dr. Duarte.
A variety of specialists rotate through the clinics throughout the islands, but there is a growing demand for full-time specialists in different fields. "They really need more than one internist for the whole department. There is no neurosurgeon, or ophthalmologist," said Dr. Keith Humphreys, head physician at Guanaja's Lita Wheeler Clinic since 1993.

Read past issues of
Bay Islands VOICE

No. 4
May 8 2003

Vol2 No. 2
Jan.29 2004

Vol2 No. 3
Feb.12 2004

Vol3 No. 3
March 2005