The Alabama Honduran Medical Educational Network (AHMEN), a North Alabama Conference Advance Special, has had a presence in Honduras since shortly after hurricane Mitch devastated Honduras in 1998. At first, our early teams concentrated on medical care always with a strong Christian emphasis. Over the years, AHMEN has broadened these areas of effort while keeping our core values. In constant motion, AHMEN has worked in many geographical areas of the country, and on many projects.
There had been a slow but steady march by AHMEN along the north coast of Honduras. By 2005, AHMEN was firmly planted in places like Limón, Icoteas, Plan de Flores and as far eastward as Punta Piedra, Cusuna and Ciriboya. There were even medical teams going as far as the Garifuna village of Tocamacho and Pueblo Nuevo. Some AHMEN members looked beyond these areas toward the Department of Gracias a Dios and La Moskitia. La Moskitia is the ancestral home of the Miskito and Pech indigenous tribes. For hundreds of years, these people have been the pawns of whatever political winds happened to be blowing. Regardless of politics, the people of La Moskitia rarely benefit from any changes that affected the larger population centers of the country. This includes the huge influx of American NGOs and missionaries that still come to Honduras annually.
Some AHMEN members took the giant steps to begin holding medical clinics in locations that medical teams had never visited before. What’s more, they began to return to the same locations regularly and dependably. Although sometimes only once or twice a year, AHMEN expanded and maintained its footprint. We now include areas far from the usual mission sites, including areas where healthcare is essentially unavailable. A few AHMEN members began to push the envelope each year. At present, the furthest outpost for AHMEN medical clinics is the Miskito village of Las Marias, located some six or seven hours up the Río Plátano. There we find ourselves at the limit of accessibility because of time, distance and cost. Finding a staff of first-rate medical and non-medical personnel to join our team for two weeks has never been easy. However, the La Moskitia team has made the trip into the rainforest at least once each year for over eight years. We have always found the right mix of people for the job.
This year, the La Moskitia team was the largest group ever to make the trek. With 23 team members from eight different US states and three different countries, everything was on a larger scale. Travel into La Moskitia requires more planning and work than for most mission teams. We must bring virtually everything with us. Travel and lodging had to be pre-arranged in an area without telephones or internet. Dropping a team this size in the lap of a small jungle hostel required that we bring our own water and food. After years of dealing with the same boat captains and hotel owners, we have developed relationships that have served us well. This year, there were few surprises.
We rented five trucks, loaded all our baggage and supplies, and pointed our caravan east toward La Ceiba. In another first for the La Moskitia team, we had a wedding en route. Prearranged in January, Joe Downs and Burton Carter were married by Pastor Mario Miralda in the lovely garden at our usual stop: the gas station-restaurant in Tela. It was a simple but beautiful ceremony, full of special meaning for this couple and our team.
Arriving in La Ceiba and the Cruzadas compound, we found that our medication and supplies shipped on the AHMEN Spring container had not yet arrived from Puerto Castilla. We drove on to Helen’s Resort in Sambo Creek where eventually everyone was able to relax. The next day was reserved for final preparations for the long march into La Moskitia, a 10-12 hour drive. Part of the team shopped for all our needed provisions. In La Ceiba we picked up two more team members, both Honduran physicians. We did the obligatory visiting, packed pills and laid out plans for the rest of the trip. At Helen’s we also did medical evaluations of Jack’s Honduran family and his sweet Downs child, including an ultrasound. There was time enough for relaxing on the beach, meals and getting to know each other better.
We were back on the road very early the next morning for the start of our longest travel day. Although there were backup plans, we needed to make it all the way to the Miskito village of Raista. That meant we had to travel to the end of all possible ground travel. Then we would load everything into large powered canoes and travel an additional two hours through a network of rivers, marshes and large lagoons, to arrive safely in daylight at Doña Elma’s hotel. Keeping the team together and moving was like herding cats. Even the briefest stop took longer than expected. We were able to top-off our provisions and needed supplies. Thankfully, there were no mechanical issues along the way. Even the dirt roads that composed most of our journey were in decent shape. Our Cuban dentist Dr. Elisio Peña met us in Ciriboya as usual. CHIMES had arranged for 2000 doses of dental anesthetic for his use. We were able to avoid much of the driving on the beach since a new road through the agricultural areas and cattle ranches brought us quickly into Tocamacho and soon to Pueblo Nuevo. No balsas, no getting stuck on the beach, and no trucks lost in the surf. Don Arnulfo, our usual boat driver, was waiting for us at the river’s edge in Pueblo Nuevo. Julia Aracely from Buena Vista would be with us again on this trip. It is always wonderful to see old friends again.
Everything was loaded into the canoes and we began the two-hour ride to Raista, a small Moskito village on a narrow strip of land between the Caribbean Sea and Ibans Lagoon. Everyone had their first exposure to the water-world that is the coastal savannah of the Mosquito Coast. Doña Cecilia and her staff warmly greeted us at the hotel in Raista. Everyone was able to shower, have a nice meal and settle in before our first clinic the next day.
Doña Elma’s hotel, now run by Cecilia, has been open for quite a few years. The hotel was built as a hostel during the brief eco-tourism boom in La Moskitia. Business was good for a while. When the world economy tanked, and the drug violence started, tourism died. The cattle industry in Honduras was beginning to spread, and with it the need for more pasture. Clear-cutting of forest and “slash-and-burn” tactics became the norm. Rainforest and jungle were being lost at alarming rates. With the loss of habitat and increased population in La Moskitia, the wildlife was decimated. No longer is it common to see the huge flocks of birds in roosting-trees along the rivers. Doña Elma’s husband lost his life as a result of his environmental activism. The cattle industry continues to expand in La Moskitia to the detriment of the indigenous people and ecology of the Río Plátano basin.
Our first medical clinic started early the next morning. What a quality team we had! With an abundance of experienced care providers, a huge amount of medication, a sophisticated clinical lab, and even a portable ultrasound machine, we were arguably the preeminent health care team anywhere east of La Ceiba. Patients came from all the villages in the area for care. There are no longer any doctors near Raista. We were the only source of healthcare and medication for many hours in any direction. We worked hard this first clinic day. Starting the next day we would travel to much more remote areas.
Our trip up the Río Plátano in the Biosphere Reserve would require three boats to safely accommodate the team and all our supplies. We were primed for the ride up river Plátano, the only highway in the rainforest. Passing Indian home sites and cattle watering on the riverbanks told the story of changes in this supposedly protected UNESCO World Heritage Site. The Reserve is the largest area of contiguous tropical rainforest outside the Amazon. We would occasionally stop to stretch our legs on the riverbank and enjoy some coconut milk picked by our Miskito guides. Further up river, the river became so shallow in places that we had to get out of the canoes to drag the loaded boats over the shoals. Along the river, the terrain gradually changed from coastal mangrove swamps to high, jungle-covered mountains. Despite the evident changes to the environment, we were still able to see and identify many different species of tropical birds including flocks of parrots and toucans. Having knowledgeable bird watchers on the team was an added bonus. Finally, we arrived at Las Marias, the last village on the Río Plátano reachable by motorized canoes. From this point travel is only by foot or by poling small dugout pitantes through the boulder-strewn river now entirely bordered by steep jungled hills and mountains.
Las Marias is home for Miskito and Pech Indians and a small minority of Mestizos. Except for a few generators there were scant amenities. Doña Diana’s hostel in Las Marias is certainly not the Hilton but considering where we were it was quite comfortable. With more than 20 team members as well as boat crews, we filled all available beds as well as a few in another hostel a short walk down river. Much to our relief, there were mosquito nets on all the beds! We brought all the food for our team to be prepared by the kitchen staff. Some of the team planned the menus for each meal. Even though we were deep in the jungle, we hoped for a different diet than the traditional rice, beans and tortillas. Green vegetables and fruit are not part of normal fare in Las Marias. In prior years, our clinics were held in the local schoolhouse. Our medical and dental staff, pharmacy and lab operated with compassion and efficiency providing care for acute and chronic problems. Our dentist did preventative fluoride treatment on many of the children in the village. As usual, the main task for the dentist was pulling badly decayed or broken teeth. This team had a higher percentage of Spanish speakers than any in the past. Our need for translation was kept to a minimum while, more importantly, allowing better doctor-patient communications. Our clinic lab had the ability to aid in diagnosis through fast and accurate testing for many diseases. Additionally, advances in point-of-care diagnostic testing allowed us to treat our patients with more safety than ever before, and to generate new data which will allow safer treatment of malaria in La Moskitia. As usual, we knew the importance of continued therapy for chronic illnesses. Our pharmacy carried an extremely large amount of medication for chronic illnesses like hypertension and diabetes. We were able to provide these patients with enough medicine for many months. We could also provide therapy for just about any acute illness we might expect to encounter. Patient education was an important duty of the pharmacy team. Not only must each prescription be accurately filled, but also each patient must understand exactly how each medication is to be taken. Patient compliance is always an issue for short-term clinics. We made this an important area of effort. Complete patient instructions are mandatory and must be understood by the patients to be safe and effective.
As in past years, drinking water for the team was a concern. Several years ago, we began to use a Sawyer 0.02 micron filter to provide safe drinking water for the team. With a team as large as ours, we could not have hauled enough water in 5-gallon carboys. With temperatures hovering at 99 degrees almost every day, and heat indices well over 110 degrees, the team needed large quantities of safe water. Our water system provided all we needed, and more. Water quality is a contributor to, and indicator of, the overall health of a community. This year the La Moskitia team begin a campaign to educate local people about the need clean drinking water. We provided more than 50 Sawyer water filter systems to families in the village. Each of the water filters could provide safe water for an additional two families. Our water team covered the area teaching about this important health issue. Each filter system was given to a family that agreed to share the water with their neighbors. Each family was given a copy of the AHMEN’s “Worms and Germs” monograph. The “Dirty Water” video on an iPad was also a valuable tool. An initial survey of each home where the filters were installed was completed. This survey gave us baseline information about the water supply each family was using before their new filter. This would enable us appropriate follow up at our next visit. Water sources were tested for pesticides and lead contamination as well as the presence of coliform bacteria. Not surprisingly, several water sources showed evidence of fecal contamination. We also introduced a method to assess overall family health over time as a result of Sawyer filter use. Las Marias is a great test area for this approach. This is an isolated area with extensive family interconnections and is more matriarchal than other areas. All these traits are possible indicators of a willingness to change their family water source to improve the family’s health.
We held two days of clinic in Las Marias. Our third day we had planned a trip two hours further up the Río Plátano to the site of huge pre-Columbian petroglyphs. We would revisit the small Pech Indian village up river. On a previous visit we met a young deaf Pech girl. Because of that meeting, Jaimy is now a student at the AHMEN sponsored school for the deaf in Plan de Flores.
For all those living in the jungle, rivers dictate much of life. Water level in the rivers determines the ability to travel or for colectivo canoes to resupply villages. The days of total independence in the jungle are probably past. The water was far too low to make the trip upriver. Only small pitantes would be able to travel further upriver so we cancelled the trip to the petroglyphs. We decided to leave Las Marias one day early and return to Raista for a day of relaxation in the relative comfort of Doña Elma’s. The beach, showers and flush toilets can be powerful incentives.
The trip back downriver was faster by a couple of hours. Returning to Raista almost felt like going home. One passenger on the boat was to be the guest of honor the next day; a hog for the pig-roast prepared by Elisio the dentist. This has become a tradition on this rip and pigs in the canoes are now a normal occurrence on the downhill run. The next day, while the pig was roasting, was a chance for time on the beach and exploring the area. That evening the feast was laid out in the courtyard on a long table and everyone had a great meal. Afterward we were treated to an exhibition of traditional Miskito dancing by local women and musicians from Raista. Soon everyone was dancing and showing their skill at dancing the traditional Punta. Not quite like the Garifuna punta in terms of rhythms and dance moves, it was easy to see that there has been substantial trans-cultural interaction. After a time, the bonfire burned down and it was time to get ready for our final clinic in Raista the next day. The crowds came early and we were very busy all day. This clinic ran more smoothly than the others. We were now comfortable with what we were doing and we were more efficient. We were beginning to run short of some of our supplies and medication after seeing so many patients.
On every trip we find at least one very sick or injured patient. This trip was no exception. In Las Marias it was a young girl with a very high fever and no obvious source that we watched in our hotel over night while she received IV fluids and antipyretics. In Raista a teenage girl presented with severe abdominal pain. She was obviously quite ill. An ultrasound indicated a small bowel obstruction, which is unusual in this age group. When the child vomited, we saw the reason for the obstruction. She vomited handfuls of long parasitic worms. Almost every patient we see is treated for intestinal parasites. “Worms” are an extremely common complaint in rural Honduras as in other third world countries. To see worms being vomited was rather shocking for some of our team and even to the locals. It was a great teaching moment for the importance of water quality and hand washing. The sick child could possibly have needed surgery to alleviate her intestinal obstruction. Despite two surgeons on our team, this was something we could not address in Raista. She needed to be transferred to a hospital with safe surgical capabilities. After a telephone consultation to a hospital in La Ceiba, medication for nausea, IV fluids and a dose of anti-parasite medicine, she was loaded into a boat with her mother and taken to La Ceiba. Our Honduran surgeon, Dra. Marcela Pineda, and Mario accompanied her. She was admitted and appropriately treated at the Atlántida hospital by physicians well known to our Honduran surgeon. The child did well without needing surgery.
The next morning, we boarded the canoes to start the journey home. Our leftover supplies and medication were to be donated to local healthcare facilities. We were all ready for the long trip out of La Moskitia. Once on the mainland, we dropped off medication for the hospital in Palacios, said goodbye to Dr. Elisio in Ciriboya, and settled in for the long uneventful ride back to Helen’s. Helen’s is like the home base for several AHMEN teams, a place to relax and start the steps back home. Time on the beach, relaxing in a pool or a hammock or just snoozing in the air conditioning, it was just what we needed. Some of the team spent a few hours at one of the local hot springs and zip lines. The zip line was the best they had ever been on, they said. Watching near- boiling water forcing its way out of a mountainside was not to be missed. This was a great rest day and one we will repeat in years to come. Hot springs, massages and zip lines on a mountain in the jungle!
Dr. Kevin Guifarro, one of our Honduran doctors, from Utila, invited our entire team to join his family for lunch at their palm oil plantation near Tela. We drove through huge groves of palms and finally arrived at the family’s lovely hilltop home. Kevin’s family was like so many Hondurans we have met over the years. They showed their appreciation of the work done by organizations like ours by sharing a respite of friendly comfort and fellowship. A BBQ under a giant mango tree was a great place to make new friends and make another small step toward home. We thanked them for their hospitality and for the efforts, skills and professionalism of their son. Having Honduran healthcare professional on our mission trips adds so much to our efforts and our success.
We soon arrived in El Progreso and the Casa Blanca hotel. Tomorrow night we would be in our own beds. The 2016 edition of April in La Moskitia was a success. Our team proved to be highly skilled in countless ways and was unwavering in its primary goal; to work to improve the lives and health in this underserved part of Honduras and to show God’s Love to a forgotten people in their endangered homeland.