Monthly news magazine for Roatan,
Utila & Guanaja
April, 2005 Vol.3 No. 4
 
Calendar Style
Bay Islands Voice Updates:
feature story / editorial / local news / business

Written by Jaime Johnston, Photos by Thomas Tomczyk

Under the Microscope

Examining the State of Bay Islands
Health Care

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. images/ad-palmetto-1.jpg
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."

Therapy for substance abuse or other emotional problems is not available through government health care. There are several private and volunteer counselors who have observed patterns in the state of mental health in the department. A 12-year resident of Roatan, Kim Dueffort, a mental health counselor licensed in the US, occasionally counsels couples, families and children on the island. "Over the years, I have seen the local population become more educated on the value of counseling," said Dueffort who mainly deals with children's learning troubles, domestic abuse and marital problems. "I have observed that local people have always been interested in their children being well and healthy, many times above themselves."
On Utila, Dr. McVay observed a high rate of emotional stress in female patients. "Women here don't self-medicate with alcohol or drugs," said Dr. McVay. "There is a significant amount of anxiety among the female islander population."
According to Eldia Leticia Hernandez of the DGIC Statistical Planning Office there were nine reported suicides in the Bay Islands in 2004. Neryeda Castillo Saldiran is a psychologist who volunteers her services in Coxen Hole. Over the last three years, she most commonly treats patients with depression. "There are a lot stresses in families with domestic abuse and drug addiction. I try to focus my patients on making decisions in their lives and setting goals to bring themselves through the depression," said Saldiran.
Some patients suffer from depression due to medical problems. Saldiran also counsels patients who are HIV positive and is on staff at the Coordination Unit for HIV/AIDS which operates an education program based in Coxen Hole. The group is funded by the International Development Bank, part of the PMAIB initiative. "Our objective is not to push testing, but to educate to change the attitudes and behaviors toward a healthy lifestyle," said Saldiran. According to Saldiran, there are no current figures for HIV/AIDS cases or transmission rates for the department. A major effort is focused on training medical personnel to properly record the test results for reporting to the Ministry of Public Health. The unit works closely with the Siempre Unidos Clinic in Punta Gorda which provides HIV/AIDS treatment for the department. "People don't have to worry about confidentiality because we are all professionals," said Saldiran.
According to Valerie Nelson, head of Familia Saludable in Coxen Hole, Honduras has the second highest HIV transmission rate per capita in the Western Hemisphere. Familia Saludable is a non-profit group funded by a Canadian organization, Dawn Land Children's Health Care Foundation. The office provides HIV/AIDS counseling, testing and educational sessions throughout the island. It also focuses on mother-child transmission. "Pregnant women need to understand how important it is to get tested," said Nelson who provides confidential testing and counseling. "There are people who test positive who never show up for treatment. There is a lack of understanding." According to Nelson, treatment is available on the island, but patients are concerned about the social stigma of being HIV positive or diagnosed with AIDS.
There are no HIV/AIDS information centers on Guanaja or Utila, but programs in Roatan have helped out with education. "They come over and talk to people about prevention and educate them. Here on the island, we don't have one person who is dedicated to educational programs," said Dr. Humphreys of Guanaja.
There were 1,015 HIV/AIDS test consultations last year - 908 of those patients proceeded with testing. 4% of people tested were found to carry the virus. Nine were pregnant women. With many Bay Islanders taking their HIV tests on the mainland, or not getting tested at all, these numbers don't reflect the reality of HIV infections in the island department. There are reported 6,000 HIV carriers in La Ceiba, roughly 4% of the city's population and, according to Dr. Gonzales, the percentage rates on Roatan are likely higher. As an example, in the last 800 births at the Roatan Hospital, two came from HIV positive mothers.
According to RH records, only 43.9% of women who gave birth at Roatan Hospital in 2004 had four or more doctor's visits. The hospital plans to implement a program for pregnant women to improve the coverage of pre-natal care. Littlest Angels in Coxen Hole tends to newborns in need of medical attention or social assistance. The non-profit group also conducts pre-natal education to pregnant women. "One of our biggest problems is premature births," said Delia Jones, Head Nurse at RH for the last 10 years. 15.6% of births were to women 18 years old and younger. According to Jones, this figure has decreased from last year.
Bay Islands infant mortality was 8.45 per 1,000 live births in 2004, down from 19.77 per 1,000 live births in 2003. This is much better than the country's average of 42 per 1,000 (2002). The last case of a mother dying during delivery at the Roatan hospital happened over a year ago and, according to Dr. Gonzales, was an isolated case. In children aged five years or younger, the leading medical problems in the department were diarrhea, bronchitis and common colds. These accounted for 64% of all child consultations at RH for 2004.images/ad-palmetto-1.jpg
Among other problems for children under 5, malaria prompted 115 pediatric patients to RH. Malaria has been endemic in Honduras since the 1950s. "We saw a wave of malaria in January - up to two patients every day," said Dr. Duarte. For 2004, Guanaja recorded the highest adult malaria rate in the department with 37 cases per 1,000 inhabitants. This is followed by Roatan Municipal, JSG and Utila which had minimal incidences. According to the World Health Organization, Honduras registered 35,122 cases in 2000. Southern-bordering Nicaragua has observed a downward trend with malaria cases decreasing 67.8% over the last six years.
In cases of classic dengue, endemic in Honduras since 1998, Honduras reports higher numbers than Guatemala, while dengue cases in Nicaragua have quadrupled since 1998. On the Bay Islands, Roatan Municipality reported 68 cases of classic dengue per 10,000 inhabitants. This is much higher than the other three municipalities which reported minimal cases. "We need more programs that teach people about water sanitation and how to avoid mosquitoes to prevent insect-borne diseases," said Dr. Duarte.
Dr. Duarte sees other prevention and educational programs as essential for island health care. She hopes to implement programs for nutrition, parenting, self-esteem, hygiene and garbage disposal at the Dr. Polo Galindo Clinic. "I see from the population that they need something that they can do for themselves," said Dr. Duarte.
In addition to programs, there are many areas in the department's health care that are lacking. Dr. Humphreys cites the need for extended care hours for the residents of Guanaja. "The government only pays our salaries until 3pm each day. But people need care almost all of the time. I've been fighting for the clinic to be open until 11pm, but that would require another physician and at least one more nurse. Right now, there aren't resources for that," said Dr. Humphreys, who adds that medicinal shortages on Guanaja are at their worst in recent years.
The department also lack major equipment: CT scan, MRI, echocardiogram and endoscopic equipment. "For all of these services, you have to go to La Ceiba," said Dr. Duarte. According to WHO, there are 26 blood banks and 29 blood collection centers in Honduras. The Bay Islands do not have a blood bank or a blood collection centre. They must rely on Red Cross blood sent by air from San Pedro Sula by request. In the event of an emergency need for blood, donors are canvassed at the time of need. Currently, there is no emergency medical evacuation or intensive care unit available in the department.
However, health care will soon have a boost in Utila, as the central government is funding the construction of a new clinic in Utila due to be completed by end of April. "It's more of a mini-hospital," said Bodden, who noted that the funding structure of the new facility would most likely parallel that of the existing clinic. The new clinic is expected to house a maternity ward and an overnight room for in-patients; currently, neither service is offered on Utila. According to Director of Department Health Dr. Medina, the central government has been considering a new hospital for the Bay Islands since 2002, but no progress has been made. "As islanders, we should push for improvement. If we can have a modern airport, we should have a better hospital," said Dr. Medina.

  TOP: Father Faro visits in-patients at Roatan Hospital. ABOVE LEFT: Workers constructing Utila’s new Health Center. ABOVE RIGHT: Recipient of a new wheelchair, donated to local diabetics and patients in need by First Lady Aguas Ocaña de Maduro.
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Third Annual BI Triathlon by Thomas Tomczyk, Managing Editor
  images/ad-palmetto-1.jpg

How Safe is Roatan?
A String of Home Invasions Alert Residents

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.

On February 19, Mannix's family home was invaded by two armed men. Nanny Juana Reyes and Sara's one-year old son were held at knife and gunpoint; the culprits left the West Bay house with computers, cameras and jewelry. Two suspects were apprehended by police a week later in French Harbour. According to Mannix, the men were in possession of stolen goods and are now awaiting trial.
The inadequate police presence on the east side of Roatan makes the residents there especially vulnerable to crime. In mid-February, on the shores of Port Royal, two masked, armed men broke into a houseboat and robbed three Americans. The robbery turned violent and one of the Americans shot and killed one of the intruders. Police apprehended the second suspect, but released him after victims were unable to identify him. According to Barahona, the four DGIC officers based in Coxen Hole conduct the criminal investigations on Roatan, but have limited resources. "We don't have the special fingerprinting identification methods. This is not the United States," said Barahona.
According to Rosa Daneila Hendrix, President of the Community Federation for the Bay Islands, the Patronato has plans for the construction of a DGIC investigation headquarters near La Colonia de los Maestros. "It's not just the Americans who are suffering. We are suffering too. We have a plan to watch ourselves, to defend ourselves," said Hendrix. Last year, the central government donated Lps. 500,000 to the project, funds derived from a drug seizure. According to Hendrix, the Japanese Embassy also pledged money to the project and Julio Galindo donated land outside of Coxen Hole.

Access Tightened at Cruise Ship Dock

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.

There are kids who are looking for a way to earn money instead of getting into drugs or bad things," said Francisco."That money was a big help to the family, but I have to keep him home now." According to Silvestri, there is a day program in Coxen Hole with food and games for children found loitering at the cruise ship dock. Ian Drysdale, a West End business owner, is concerned that the illegal vendors will relocate to West End. "We will now face a bigger problem on our hands, which will reflect in a decrease in sales for those legally established businesses that pay taxes and have operating permits," said Drysdale who is organizing a business owners association for West End. Drysdale suggests that the association can approach the Tourist and Municipal police forces to assist in West End if problems develop.
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Specialized Solutions by Jaime Johnston
Growing Needs for Specialist Care Exceed Current Bay Islands Resources

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.

  Waiting area at Roatan Hosptial after hours.

In the Bay Islands Department, there are five full-time specialist physicians providing care to an estimated 85,000 patients. All five are staffed at the Roatan Hospital: surgeon, gynecologist, pediatrician, orthopedic specialist and internal medicine specialist. In addition there is one other volunteer pediatrician at a pediatric clinic at the hospital run by Global Healing, an American non-profit organization. Clinics on Utila and Guanaja have family practice physicians only. Jackie Woods Medical Centre in Coxen Hole has a part-time psychologist and a part-time dermatologist.
This is not enough and in many cases, patients end-up with referrals to the coast for specialist consultations. Travel costs are high and for many patients, the trip is not feasible. Over the years the gap of specialist care has been partially bridged by visiting international volunteer groups.
One group of South Carolina & Virginia specialists coming to the Bay Islands since 1993 conducted a week-long clinic at Jackie Woods Medical Center beginning January 29. The 11-person team included two surgeons, one anesthetist, a pediatrician and several nurses who lend a hand with projects at local clinics and schools. On average, the pediatrician saw 40-50 children each day. "Over the week, we conducted 35 surgeries," said Jean Sabbock, R.N.
The gynecological surgeon, Dr. Philip Klim, performed most surgeries, many dealing with tubal ligations, cyst removal and biopsies. The group also supervised two medical students from Tegucigalpa who assisted during surgeries. The students' bilingualism was an asset for the members who didn't speak Spanish.
"There are three dimensions to this trip: medicine, evaluation and construction," said Sabbock, whose husband Dr. Michael Sabbock performed the general surgeries at the clinic. This year was only the second time that the group focused on women's health care. Sabbock indicates that they will try to find other needed specialists to come next year.
A group of Ohio dentists returned this year to perform community work. Since 1995, they have conducted free dental clinics annually. The trips began when the group first came to Honduras in 1989, working in clinics on the mainland. One of the volunteers, Peggy Stranges, has since moved to Roatan and operates a free clinic in Sandy Bay. Stranges coordinates the on-site logistics for the Ohio State team to travel to Roatan each year. The team is responsible for their transportation expenses and the supplies they bring. Donations from the Rotary of Columbus and the Ohio State University dental school help offset the costs. In addition, the team accepted corporate donations of medicines and supplies. "Everyone packs an extra bag and we tote supplies like that," said Dr. Pete Larsen, an oral surgeon from Columbus, "We brought 10,000 tablets of Ibuprofen and also some portable chairs to leave here."

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