April in La Moskitia

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.

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.    

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. 

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.

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.

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.
  

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.  

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.

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.

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.

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. 

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.

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.

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.

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. 

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. 

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.

Dr. Ben Coplan

Pico de Damas

  

The AHMEN Database Is Ready For Operational Testing

The AHMEN Database

Welcome to the AHMEN Database.  This database was created to allow easier and improved record keeping by AHMEN teams working in Honduras.  With better record keeping, information we obtain will be more accessible to ALL of our teams.  More accurate and complete record keeping will enable better continuity of medical care for the patients we see in our clinics.  In the future, we envision the use of more evolved editions of our database by other NGOs in Honduras.  This will lead to increased efficiency, less waste and less duplication of services.  The complete database will be used in Gracias a Dios, Honduras for the next two weeks in live testing.  It should be ready fir general team usage next month.

This Microsoft Access database was designed for easy data input onsite in Honduras.  Data obtained during AHMEN missions will be added to the data collected by other teams.  The result will be better understanding of the details of what we do in Honduras.  It will serve to answer many questions about who, what and where we work.  As the Honduran Government requires more information about exactly what NGOs are doing in Honduras, this database will be a vehicle to accurately respond to their requests.

The AHMEN Database (AHMENDB) runs on Windows-based computers with MSFT Access 2007 or 2010 database program installed.  AHMEN has acquired several laptop computers for this specific use.  These laptops will be dedicated to the AHMENDB and all will have the required software loaded.  They will be linked to each other using a wireless network.  All data acquired on each trip will be appended to the main AHMENDB upon return to the U.S.  The AHMENDB will not require Internet access while on a mission trips.  In places where there is no electricity, use of the AHMENDB will require a portable generator.  If need be, data can be entered at a later date.

AHMEN has received special assistance in this project from several sources.  This is an extremely complex database which could not have been attempted without the expertise of Mr. Jim Bailie of Cahaba Data, Inc. of Vestavia Hills.  Jim was generous in sharing his skills and knowledge in construction of the large undertaking.  Bill’s Pawn Shop in Jasper generously provided several laptop computers which will be dedicated to this project.  Mr. Mario Giovacchini, a previous AHMEN/CHIMES team member from California provided IT expertise and a server quality laptop.    Without the assistance of all these individuals and organizations, this project would not have been possible. 

There are several parts of the AHMENDB.  Medical teams will use the largest and most complex portions.  There are other parts designed for specific projects and record keeping.  Requests were made of the AHMEN membership for their ideas and needs, and the construction of the database is based on their input.  A database is a fluid vehicle.  Additional parts and particular data needs can be added as new situations or needs arise.

Each team will receive instruction in the use of the AHMENDB and their dedicated AHMEN laptops before their mission.  The AHMENDB administrators will be glad to meet with team members to train them before their departure.   The AHMENDB has been designed so that the possibility of data corruption has been essentially negated.   Currently the AHMENDB has an English version, with Spanish language editions partially completed.  The data input fields are self-explanatory and easy to use.

Tables, Forms and Data Records

A database is a means of storing data, which is information.  It is like a simple Excel spreadsheet, except that it can hold data and store it more efficiently, and is more amenable to producing relevant queries and reports.

All Data is stored in Tables, which look much like spreadsheets.  Forms are interactive computer screens used to place data into the Tables.  Queries are used to find the data arranged like you want, and Reports are printed versions of that data.

Most users of the AHMENDB will nearly always be using Forms.  Information is easily typed into specific areas in the specially designed Forms.  The inputted information is automatically saved into the appropriate Table, where it is available for Queries and Reports.  The Forms have been designed for many different purposes, as you will see.  There are Forms for everything from team membership data to physical examinations and medication inventory.  The AHMENDB will keep track of everything and relate it to all other data.  Your team may use only one or two forms, or quite a few, depending on your mission.

The design of the AHMENDB is such that Data is protected as much as possible.  Most users will not have access to Tables, only Forms.  Once data is entered and auto-saved, it cannot be amended except by the Administrator.  Errors are left in place and corrected after the fact by the Administrator, a simple procedure.  This prevents accidental corruption of the Tables.  Each user will input data into forms on their laptop, which are linked to a server laptop by a local area Wi-Fi network.  The main data tables are stored on the server laptop.

The Start Up Form

You should now be on the opening page of AHMENDB.  There are three groups of buttons and one solo at the bottom.

Group Informational Data:  These five buttons open Forms dealing with the mission team as a whole.  It is OK to click on any of these buttons.  You can return to the Home screen by pressing the Close Form button at any time.

            NGO Data-      Information about your NGO.  There is no need to use this form if your NGO is already listed.  More details can be added as needed.

            Team Data-    Information about YOUR team.  Name, village/town you are based in, team leader, dates in country, and the number of members.  The second part of the form allows you to enter the names of team members and info about them.  There are record navigation bars at the bottoms of all the forms.  Pass your mouse pointer over these arrows and you can see what they are for.

            Village Data- Information about the villages you go to.  This may not be where you are based, but if you go to other towns, you might want to input data for those villages.  This is where you can be of help for other teams with your opinions and observations.

            Base Of Ops-              This form deals with your Base of Operations.  If you spent your entire trip here, tell us about it.  Again, the more information you can provide, the better.  You can also see what others have said about that place.

            Care Providers-     This form is for use by health care providers.  It holds information about our doctors, nurses and other licensed personnel.  It will provide easy contact information when you need it.

Medical and Health Related Projects:  This section of buttons accesses the forms used in medical and vision clinics. 

            Registration and Triage-   This form, in both English and Spanish is for adding patients to the database.  It can be used by medical clinics and non-medical programs.   All demographic information is entered on this Form.  Just ignore the medically related blanks if you don’t need them.  Eventually, all the people that AHMEN interacts with will be in these records.

Hopefully, as other NGOs are offered the use of the AHMEN database, we will have the largest and most data set in Honduras. 

           

Patient Info, Exams, and Prescriptions-        This is the most complex form in the database.  It is actually three forms on one screen where data inputted in the Patient Demographics portion is passed to, and augmented in the Physical Exam form, and Prescriptions Dispensed are written in the third portion. 

Triage personnel will have entered the data in the Demographics portion, as well as vital signs, etc.  The National ID Number cannot be blank.  Use 999999 if it is not known.  The form calculates the patient’s age from the DOB, as well as BMI from weight and height.  There are a few fields which MUST be filled, as you will find.  Dates can be picked off a calendar which appears or entered directly as mm/dd/yyyy. There are a couple of other drop-down menu fields to save typing time and effort.

Physical Exam-        All patients entered into the system by Triage are searchable at the top of the form (Select Patient).  Selecting a patient’s name propagates it to the doctor’s copy of the DB along with the patient’s Triage information, etc.  The patient’s name is displayed in the Exam portion of the form for safety.  The care provider identifies himself in a drop down field and enters the date of this exam as well as the patient’s chief complaint.  He/She can then enter (or default through) the physical exam.  He then adds the Diagnosis and any notes.

Prescriptions Ordered-     The care provider then enters the date of any prescriptions needed like any other Rx.  The provider puts their initials in the Additional Meds field.  Multiple prescriptions for that patient are submitted in the same manner. 

Prescriptions Dispensed-   The pharmacy persons use this full version of the form above.  Knowing the patient name, he fills the prescription ordered by the provider.   The pharmacy person then checks a box to say the Rx makes sense to them; e.g. no tablets for an infant etc.  He will also indicate if the Rx was dispensed in a child-resistant container.  He initials the appropriate space and moves on to the next patient.

Team Medications-                This form is simply an inventory of medications brought by each team. 

Vision Exam-                 This form is specifically designed for use in vision screening examination and for dispensing eyeglasses.  It will eventually be associated with the eyeglass inventory as an aid to inventory control.  This form will require specific training to use.

Educational Projects:     These forms will be improved and expanded as the need arises.  Currently planned additions are Sewing and Woodworking schools.

            Libraries-      Simple information about the library projects we are involved in. 

            Deaf School-     Demographic information on the students there.

            Feeding Kitchen-    Demographics on the children cared for there.  Pictures can be associated with each child with a web cam or added later.  Exact data identification of each child is very important to chart growth, nutrition, special needs etc. 

            SIFAT-     As more field items are suggested, this form will be updated.

            Water Projects-    Tracks installation of clean water projects.  Includes data on type of filter, where installed, type of building (home, school etc.), type of building construction, number of persons served, and who received the filter.

Note to Administrator:

           

You will not be able to change inputted data from any form once it is saved.  If you make an error that you cannot change, send a note to the administrator about what to correct or what to delete. You can always re-enter all the data and have the erroneous data deleted.

An Open Letter to Emelisa Callejas, Consul General of Honduras in Atlanta

Dear Madam Consul,

I am writing to you today to express my anger and disappointment at the recent ill considered, unenlightened, and self-defeating actions of the Honduran Congress.  Their recent attempt to increase the Airport Exit Tax was appropriately vetoed by President Lobo.  Now, passage of the Bill in the Congress (Decree 252-2011) to add a “Security Tax “of $17 per passenger upon entering and again upon leaving Honduras is no more than an attempt to extort money from those who are trying to help the people of Honduras, businesses, and the few remaining tourists brave enough to come to Honduras.

In conversations with you personally at the Consulate in Atlanta, you assured me that the government of Honduras is actively supportive of the work done by the thousands of NGO groups going to Honduras yearly.  In reality, the actions of the Congress seem to be no more than to make us pay more for the privilege of doing the work that your government has neither the ability nor the apparent desire to do.

At $34 per person coming to work in Honduras for the people of Honduras, this amounts to a very large sum of money.  Think about this amount in smaller pieces:  $34 is about what I spend for 2000 children’s vitamins, or enough antibiotic to cure pneumonia in a half dozen children, or treat a sexually transmitted disease in ten adults, or treat a parasitic infection in about sixty people.   This money will now have to be paid as required by the Government and will NOT go to toward the work I do in Honduras.  This does not take into consideration all the NGO workers who may come to realize that they are being used by a seemingly ungrateful Honduran Congress and will stop coming to Honduras at all.

A Security Tax to come the country with the highest murder rate in the world is nothing short of a disincentive to business, tourism and the volunteer communities.  It is high time that the government of Honduras shows that it is indeed in support of the volunteer work being done there, and stops creating obstacles, which, in the end, only harm its citizens. 

I work with an NGO that will send fifteen medical mission teams to Honduras this year alone.  This new tax will decrease our net expenditures for Honduras by about $4000.  When all the NGOs are considered together, this is a very large sum of money that now will not go to the poor of Honduras.   I fear that the finite amount money available to NGOs will rapidly begin to shift to other Central American countries which are more cooperative and do not place such barriers to our generosity and good will.

Please contact President Lobo and ask him to also veto this harmful and ill advised legislation.

Thank you,