AHMEN/CHIMES
Medical Mission
to La Moskitia
April 2012
The eastern most Department in Honduras, Gracias a Dios, is
like the far Frontier to most citizens. Most
Hondurans will never get there. There
are only one or two roads into the Department, and only a couple of towns with
more than a few thousand people. There
are only a few landing strips and none of them are paved; not even the one in
the largest town of Puerto Lempira. The
area is populated mostly by members of several indigenous Indian tribes. The areas known as La Moskitia, but American authors and screenwriters have morphed
that to The Mosquito Coast. The Miskito
Indians live along the Caribbean, in the coastal savannahs and back into the
dense rainforests known as the Rio Plátano Biosphere. This is an underserved area of the
country. There are NGOs that work
further east through Puerto Lempira, but travel to the area around Ibans Lagoon
and the Rio Plátano is too difficult and time consuming for most American
mission teams.
This was the fifth time
we have traveled to La Moskitia. Our April
2012 team was composed of members of previous years’ AHMEN/CHIMES teams, plus a
few new faces. The members were handpicked
based on previous medical mission experience and recommendations. The eldest and youngest team members were separated by more than
fifty years, and easily as much in terms of life experiences. Doctors, dentists, nurses, students, filmmakers,
retirees and a warehouseman all joined in for the endeavor. Our trips to La Moskitia are naturally longer
than the other AHMEN and CHIMES activities.
It takes two full days of travel just to get to where all roads end. From
the place where we park our trucks and board long canoes for another few hours of
travel to the jumping off point for the rest of the trip.
Planning for this trip started six months before departure. Because both CHIMES and AHMEN strongly
support several other projects in Honduras, we bring more supplies, medications
and equipment than most teams. We are
one of the major supporters of the Garifuna Hospital in Ciriboya. All team members contributed to the cost of
these necessities. Being a primarily
medical endeavor, we demonstrate God’s love through caring for the health of
the people we meet there, and show a side of Americans they may never see. Because of the expertise of our staff, this
team carries more sophisticated medications than most medical mission
teams. Our goal is to be able to treat almost
every condition we come upon, and leave patients with sufficient medication for
their chronic illnesses to last for an extended period. As the AHMEN/CHIMES network expands we make
referrals to specialists and other AHMEN teams for services we can not provide.
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| Luke Allen and Jen Swarr maintained the team computers |
The need for maintenance of complete
and accurate medical records for each patient we care for has become paramount
over the past couple of years. The
Republic of Honduras has begun to require records of patients seen at some
established medical missions. It is only
a matter of time before all mission teams will be required to do so. Anticipating this, and more importantly, to
increase the safety and efficiency of the care we provide, the April 2012
AHMEN/CHIMES mission to La Moskitia was the first to maintain a digital medical
record on every patient. The Microsoft
Access database took several months to design and write. Laptops were donated to AHMEN at no cost and
training will soon begin for subsequent teams to efficiently use the AHMEN
database. The use of the DB required
bringing extra and specialized equipment to use in areas without electricity.
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| Dr. Luther Harry accepts an EKG machine for the Ciriboya Hospital |
As the date of departure for Honduras approached, supplies
and equipment were distributed to other team members across the country to
lessen airline baggage fees. For
instance, medications had been shipped to Sacramento and pill bottles were
shipped to Rochester, NY. The majority
of equipment departed from Alabama, including and EKG machine to be donated to the Garifuna Hospital in Ciriboya.. We
all met in San Pedro Sula, loaded four pickups with people and gear and turned
east for our first day on the road. We
spent our first night a Helen’s Resort in Sambo Creek and left at dawn for
Iriona where the roads end. We crossed
the first river via
balsas and started
the drive along the beach toward Pueblo Nuevo.
There had been little rain making the fine sand rather difficult to
negotiate. After getting stuck in the
sand a couple of times, helping a broken-down
colectivo and avoiding further balsas,
we finally arrived at the last river’s edge in Garifuna village of
Pueblo Nuevo and left our vehicles. We
crossed the final river with all our equipment and spent our second night at
the La Moskitia Hotel in Palacios.
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| Beyond the roads, travel on the beach to Pueblo Nuevo |
Early next morning we loaded all our baggage into two 40-foot
canoes and travelled a couple of hours to the Miskito village of Raista located
on the half mile wide strip of land that separates the ocean from the fresh
waters of Ibans Lagoon. As on our last
trip, we stayed at Doña Elma’s
hotel. A comfortable hotel suffering in
the distressed economy and nearly absent eco-tourism trade, there were no other
guests. The quality of Doña Elma’s cooking was as good as
ever. We held our first clinic that
afternoon after starting our generator and setting up the computers and local
area computer network. We saw our last
patient as the sun set. As usual, almost all of
our patients were women and children. People
in the coastal villages have access to increasing amounts of city goods,
American type soft drinks, junk food, cigarettes, alcohol etc. With changes in their diets away from traditional
foods, the incidence of diabetes and hypertension has notably increased. The children appeared healthy and happy with only
rare indications of nutritional deficiencies.
Miskito children have quick smiles and trusting demeanors.
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| Early morning on the river |
Very early the next
morning, our team loaded into three large river canoes for the journey up the
Rio Plátano into the Biosphere. Our
destination was the Indian village of Las Marias, some fifty miles upriver. Because rainfall had been light, the river
levels were low and we were concerned that overloading two canoes would make it
impossible to get across the many shoals far upriver. We continued across Ibans Lagoon and entered
the canal that links it to Brus Lagoon.
The canal was dug many years ago and is a main corridor for travel along
the coast in the area. As narrow as
10-12 feet in places, it snakes through dense mangrove swamp, flooded jungle
and open coastal savannah. Like a scene
from the African Queen, we rode through a tunnel of green, punctuated by
orchids and lilies, bromeliads and water birds.
Other travellers poled and squeezed by in their small dugout Cayucos.
Suddenly the green canopy above us opened and we had reached the mouth
of the Rio Plátano. Two hundred feet
wide here, the banks were impassible jungle as far as you can see. In the year since we were last here, it was
obvious that loggers and clear-cutters had been working hard in places. Land was being cleared for grazing. Cattle are now an important cash source, and
although logging is prohibited, the forest and jungle are paying the price of
loss of eco-tourism dollars.
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| Traversing the canal from Ibans Lagoon to the Rio Plátano |
We
travelled up river for hours watching for animals on the bank and tropical
birds above. We stopped occasionally on
a sandy bank to stretch our legs. The
weather was not nearly as hot
as in the past and passing clouds made the tropical sun bearable. We passed countless small Miskito homes, simple
thatched roofs covering an open elevated platform. A few had walls or metal roofs. All had kids at river’s edge swimming or just
watching the strangers pass by. Women
stood waist deep in the river doing their laundry using an overturned dugout
canoe as a wash board. Clothing was laid
on the sand or over nearby bushes to dry in the sun.
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| A picturesque home at river's edge |
The river narrowed and
the water became shallower. Huge downed
trees in the river confirmed of the power of the flooding produced by tropical
rains far away. All homes are built well
above all high water marks. A young man stood
in the bow of each of our canoes warning the driver of snags below the
surface. Occasionally, he would have to
jump out to pull the boat across a shallow area. At times, all the passengers also had to help
pull the heavy canoes. The water was
cool and the current was strong. Soon
the mountains became larger and the current even faster as we neared Las
Marias. The bare rock pinnacle of Pico de
Damas Mountain was now visible. Indian
families in their canoes passed by loaded with plantains, kids and pigs and
dogs. Soon, we were securing the canoes
at the hotel and carrying everything up the steep bank.
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| Nine children live in this wall-less traditional Miskito home. |
Several buildings
built on stilts made up the compound.
Wood plank walkways joined the building.
A small kitchen building behind the common room and a new outhouse completed
the layout. The rooms are very small; and
each bed has a mosquito net above it.
The roof is thatched and thoughts of Chagas disease ran through my
head. We would have two days of clinics
here. AHMEN is the only medical brigade
ever to go here. Most in Las Marias had
not seen a doctor since our last visit one year ago. The hotel had had no guests since then, and
the clear cutting on jungle for cattle grazing was blatantly obvious. The entire compound was enclosed in a barbed
wire fence as cattle grazed nearby. We
walked to the village center through the clear-cut that was once pristine
jungle. The village was the same except for
new construction at the nearly 100 year-old Moravian church. There were beans drying in the yard or on
rooftops, and pigs and chickens going about their serious businesses. Dinner this first night was wild pig, along
with the obligatory beans, rice, tortillas and plantains. We were promised a chocolate cake for the
next day. What a magical place this is,
where chocolate literally grows on trees just a few yards from the kitchen.
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| Dr. Baison Centrano examines a patient |
The
clinics were to be held at the local school.
The classroom walls were plastered with posters and pictures like any
elementary school in the U.S. Murals of
local wildlife history had been painted on the walls depicting toucans,
monkeys, snakes and the strange petroglyphs that were once drawing cards for
adventurous eco-tourists. Each patient was triaged and their demographic and medical
information entered into the AHMEN database on one of the donated laptops. Most people knew their age, but their date of
birth was another matter. Many older
folks had no idea of their age. Fewer
still knew their National ID number. We
set up the pharmacy and four doctor stations in the classrooms. Our medical staff included two American
physicians, a Honduran physician trained in Cuba, and an American physician
assistant.
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| Our pharmacy was staffed by experienced nurses |
Four nurses ran the
pharmacy. For safety, it was important
to have skilled medical personnel working the pharmacy. The
Garifuna dentist set up in the school’s kitchen shed and pulled almost 200
teeth over these two days. Our computer network was activated and we were
able to use the database all day with minimal problems. We were able to keep all our batteries
charged and when a network problem occurred, it was quickly fixed. It was beta testing of the AHMEN Database in
a live-fire situation. When patients
were seen by our doctors, their previously entered demographic and triage
information was displayed on their computer screens. The doctor entered his examination findings
and diagnosis and then inputted any needed prescriptions for each patient. These prescriptions were automatically
displayed on the computer screens in the pharmacy, where the prescription was
filled. Each prescription was checked
and careful instructions for use were given.
All prescriptions were dispensed in child resistant containers in a
further attempt to increase the safety of AHMEN’s medical clinics. As a backup, a paper record for each patient
was also produced in case of a computer failure.
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| A grandmother and nurse makes for excellent care for a sick child |
Las Marias is a small
town but word spread quickly that there were doctors in town. Patients came from outlying areas on foot,
horseback and by canoe. We saw several
patients after closing that had walked for hours to be seen. There is always room for just one more. Local people speak Spanish here, although the
very young and very old only speak Miskito.
In Las Marias hypertension and diabetes are uncommon. Junk food is not common fare as it is
expensive to bring it so far up the river.
We were curious about an extremely ill infant we had seen during our
last visit. We had treated this child as
aggressively as we could and we were pleased to hear that she had survived, but
dismayed to find that the baby had died after being dropped on her head by her
mother some months later.
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| This 6 foot crocodile was one of several we spotted along the river |
Early the next morning we reloaded the canoes and returned
downriver. The river was higher after a
rainy night, and the trip was fast and easy.
When we entered Ibans Lagoon we saw that the large lake was a sea of
white-capped waves, each one splashing into the canoe. We were getting drenched as were our
computers, cameras and all our gear.
Then, to make matters worse, we ran out of gas. We were in real danger of swamping although
the water was only about four feet deep.
We were finally able to make it to shore, buy some gas and return to
Raista for another clinic.
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| Our dentist pulled hundreds of teeth |
The second clinic in Raista was very busy. Life is hard in this area and almost everyone
had back pain and headache. Everyone
requested vitamins and worm medicine. No
one had been treated for parasites since the last time an AHMEN clinic had come to the
village. We saw many hypertensives and
diabetics and luckily we had a large supply of appropriate medications. Another common complaint is poor vision. These villages are too remote to hold an
eyeglass clinic there. The large amount
of equipment and supplies required
can safely be carried no closer than Palacios, two hours away. We referred many people to an upcoming AHMEN
eyeglass team to be held there later this summer.
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| Dr. Tom Arnold greets an old man in a clinic |
The next day we
packed up and went to the village of Limonales, some three hours away up the
nearby Rio Tinto Negro. Limonales is a
Ladino village but there are many Indians there too. It has as different feel than the other
villages we visited. This village just
doesn’t feel as happy as the others.
People take less care of their surroundings. There were seven or eight horses tied in the
schoolyard. There was some new
construction in progress there, new baños at the school and other projects. Our clinic was again held in the school. This was the fourth or fifth time we had been
to Limonales and we remembered many people from prior visits. Again there were very few men requesting to
be seen, perhaps they were all working.
Moms with all their children dressed in their best waited patiently to
be seen. We saw many looking for answers
to medical problems caused by their difficult life. Simple Tylenol and Advil can make a great
difference when you have nothing.
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| Sometimes waiting is too hard |
The weather on this trip was much different from usual; not
nearly as hot. It was really quite
comfortable. In the past, we have hauled
many five gallon bottles of purified water with us. For this trip, we had
purchased a Sawyer water filter capable of filtering local water to make it
safe for us to drink. The 0.02 micron
filter will remove pathogens including bacteria, parasites and even viruses at
a rate fast enough that we never had a shortage of safe water for team use, and
for use in the pharmacy and cooking. The
water filter was a great success, not having to haul large, heavy carboys of
water everywhere increases our mobility, decreased our expenses, and made our
work easier.
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| A child in Raista |
At the close of our clinic in Limonales, we reloaded the
boats and returned to Palacios. We would
start the long journey back to the city in the morning. We re-sorted all our medications and supplies
which would be donated to the Garifuna hospital in Ciriboya. Some material was set aside to be stored in
La Ceiba for our next medical trip in August.
Once more we loaded the boats to cross the river back to Pueblo
Nuevo. We held an impromptu mini-clinic
there treating another twenty of so kids for worms and skin infection. When the trucks were loaded we set off along
the beach, back through Tocomacho and Sangrelaya. There were no balsas on the return trip so we
travelled faster. The erosion of the
beach continues at an alarming rate. The
buffer of dunes and coastal mangrove forest that protects the tiny Garifuna
villages is disappearing. The next large
storm or hurricane could disappear these villages that have stood for well over
a hundred years. The lighthouse that
marked Capo Camarones is gone and the pieces are now sea covered. The strip of land between the river and the
sea is as narrow as 100 feet in places.
Things will be very different here, very soon.
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| A large cayuco carved from a single tree |
We returned to Helen’s in Sambo Creek and met with a group
of Garifuna doctors from Ciriboya. We transferred
a large amount of medication to them.
The next day we had a chance to do a little sightseeing in the area and
a chance to do a little tourist shopping after dropping off equipment in La
Ceiba. Some of the team went up the
spectacular rocky canyon of the Rio Cangrejal that borders Pico Bonito National
Park. We drove to El Progresso and had
dinner at Delmer Montoya’s home. As
usual, his parents were gracious hosts.
We returned to the U.S. the next morning, glad to be going home, and sad
to be leaving Honduras.
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| Dr. Ben Coplan |
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| Pico de Damas |
