Saturday, March 14, 2015

The gringos invade - a medical brigade

Last Sunday at Mass here in Plan Grande I heard that a medical brigade was going to be at the Health Center between Plan Grande and Concepcion on Thursday and Friday.  I later saw a sign advertising the arrival of “Medicos de Palmerola.”

I wondered if they would be a medical team from the US base at Palmerola (now called Soto Cano). The history of that base is another story – a sad reflection of US policy in Central America in the 1980s where the US supported oppressive regimes in Guatemala, El Salvador, and Honduras and supported the contras against the government of Nicaragua. It’s a bloody page on US policy.

After thinking this over, I decided to drop by on Thursday and see what was happening.

Sure enough, there were “gringo” doctors and nurses and other military personnel – about 35 US military in all, together with some Honduras civilian medical personnel and a number of Honduran soldiers and military police.

There were some Spanish speakers among the US soldiers, but most had only rudimentary Spanish. So there were young people from a bilingual high school in Santa Rosa assisting them. I decided to offer my translation services.

I ended up helping with the distribution of vitamins after the groups received a talk on preventive medicine. I mostly helped the young soldiers determine the ages of the children as well as ask if the women were pregnant or not – especially since the brigade was also giving deworming medication (which must not be given to pregnant or nursing women).

I knew a lot of the people who came and I tried to make clear to them that I was not giving out the medicine (since they might want special attention from someone they knew). I also did my usual kidding around with folks as well as trying to cover over my mistake of asking a little overweight woman if she was pregnant. And, as a joke I asked a young guy if he was pregnant; without batting an eye, he asked me the same question, noting my gut.

I also asked a few young women if they were pregnant. When they said no, I said, “That’s good. Don’t let the guys take advantage of you.” They took it well, without showing any offense.

The presentation on preventive medicine – germs, washing hands, good food preparation, and more - seemed to me to have a few problems in relation to the people here.
The soldier talked about good drinking water – using bleach, boiling, or buying bottled water. He noted the importance of exercise for health. The presentation ended with him showing the image of the healthy person — a male, who looked more life more a city person than a campesino.

I mentioned a few of my concerns  on the second day and the captain downplayed the buying of bottled water. I also noted to him that there are few overweight people in the countryside since they walk so much and work hard.

Thursday night I had decided to write out my concerns and give it to him toward the end of the day. He was grateful since he noted that he often asked people to evaluate what he was saying but no one ever had.

In my note, I also shared a few other concerns.

A few of the people come from communities that have no water system and so the people seek water wherever they can find it. Others have water systems but the source of the water has been contaminated. Water is a long-term community problem that needs community solutions, as well as individual preventative measures like boiling.

Also, what is the point in giving out vitamins without serious explanation of what are the nutritional needs of people and how to meet them? This, of course, is a long-term issue, especially in light of the poverty diets of most people here that consist almost entirely of corn tortillas and beans – with few vegetables.

I was also concerned about the seemingly indiscriminate distribution of de-worming medicine. Of course it was not given to pregnant or nursing mothers. But on Thursday a woman mentioned that her son had gotten de-worming medicine earlier this week at the very clinic where the brigade was. So I began to wonder if there were more kids who were getting double doses of de-worming medication.  Is that dangerous? Or is it just a poor use of resources? I mentioned this on Friday morning and the captain doing the talk told people that if they had recently been de-wormed they should not get the medicine again.

I’m glad that I could share my concerns and that someone listened with respect. That is not always the case.

But still I have my concerns about these and other medical brigades.

There were probably over 600 people who went through the talk on preventive medicine and then went to a consultation with a medical doctor or to the dental clinic where they were extracting teeth. My guess is that several hundred got teeth pulled.

The problem is that there is no consistent ongoing medical and dental care for the people. Yes there are government health centers in the municipal centers and in some rural areas. But they are often poorly equipped and have minimal personnel.

The Honduran government is supposed to provide medicine to the clinics several times a year – but most clinics have almost no medicine and are lucky to get government medicine shipments once a year or less. The Candelaria clinic’s two nurses are paid by the municipal government. That is good. Where there are only nationally-funded staff, they often are several months behind in wages.

The public health system is severely broken here – and something needs to be done. The medical infrastructure, with Honduran employees and oversight, needs to be built up so that consistent on-gong care can be made available for the poor.

Another concern I have is that some brigades come in and do not involve local medical personnel or do not know the on-the-ground situation.

This raises a number of problems. First of all, if local medical personnel is not involved or is involved only peripherally this might give the people the idea that local doctors and nurse aren’t good and that the foreigners are the ones who come in and heal them.

That is unfortunate and can lead to serious problems – especially if areas get dependent on foreigners coming.

Another problem is the lack of coordination, duplication of services, and perhaps some serious medical problems. There were some efforts to this and the local director of the health ministry was present both days.

Still there seem to be problems. I think of the case mentioned above of children and others who had just received deworming medicine and were being offered another dose. Fortunately, that was dealt with on the second day.

But on Thursday one pregnant woman told me that she had already received a month of pre-natal vitamins. That isn’t a problem but may be a duplication of services. In my note to the military person I noted that there are several pre-natal and neo-natal programs in the area, including one financed by US AID.

I also have some concern about the possible politicization of aid – especially by local politicians and political parties, but that is for another post. I think this was largely avoided in this case – though the mayor was there the first day, especially when the head of the US troops arrived in a helicopter. Yet I do think the mayor is really interested in the well-being of the people and is trying to improve their lives – through education, health, and infrastructure.

There is another major concern I have, which I won’t address here, is how these type of activities have created a sense of dependency on outsiders and government officials and have minimized the importance of personal initiative and community organization. That’s another set of blog post.

But my final concern is the militarization of health and other services.

I know this is coming from my reading about or seeing the use of military in medical and other aid projects during the wars in Viet Nam and El Salvador as attempts to “win the hearts and minds of the people.” These were often overt ways of using aid for propaganda purposes in situations of war and civil strife that were meant to provide support for oppressive regimes.

I don’t equate Honduras with wartime Viet Nam or El Salvador, but the question needs to be addressed.

But why is that the military has access to medical supplies and personnel that are not available to civilians?

Also, could these efforts be ways of promoting the militarization of society? In the midst of a great national debate here in Honduras about the use of military in police functions and even the creation of a Military Police Force, what is the message the people are getting with these campaigns?

One military person personal asked me of my opinion on the military in Honduras. He may have been talking about the US military presence in Honduras (which I oppose) but I spoke more about the militarization of society and the seeking of military solutions to problems that need other major structural solutions, especially a judicial and police system that responds to crimes. I referred him to The Locust Effect by Gary A. Haugen and Victor Boutros, a book which has helped me understand and analyze the problem of violence here.

What I really appreciated was the opportunity to talk about a difficult subject with someone who is in the military and the respect he gave me, though he may have disagreed with me.

Finally, I must say that it was good that the people in the zone had an opportunity for some medical attention. They really want and need that. One young woman told me that she had walked three hours to get there. Others had taken a bus. And the kids from Plan Grande had walked 30 minutes to get there. They had a talk about dental hygiene and, I think, got tooth brushes. They also listened to the preventive medicine talk which the captain revised for his audience.

I do not deny that there are serious medical needs. But how should they be addressed?

A few months ago, a dentist and I wrote up a proposal for a local clinic or the poor and presented it to a US group financing a clinic near La Entrada – about an hour north of here. She knew them from the clinic there and from a visit to the US she made last year. We have to revisit this proposal soon and see what can be done.


Randall Mullins said...

Thank you for your commentary and for your good work there Padre Juan. All that you write sounds so identical to the issues we faced in Lempira in the 1980s, except that in those days Palmerola was full of US troops and there were 11, I believe, airfields in the country capable of landing large transport planes.
Randall Mullins, Memphis TN

John (Juancito) Donaghy said...

Thanks for your kind words, Randall, and for the historical perspective.

By the way, I'm not a padre - in any sense of the word. Just a lay missionary.

Sharon said...

An interesting account of a medical brigade - thanks for sharing. Prior to doing my PhD (for which your input was most valuable!) I was a nurse and a volunteer, and it was my experience with medical volunteering that directly led to my current academic journey. Although I haven't looked in any depth at brigades led by the military, your concerns echo many of those I raised in my Master's thesis, which can be read here, and in a paper I had published last year (I can send you a non-pay-walled version if you are interested). It is especially good that you were able to share your concerns and have them listened to, that is encouraging.