Fighting Crime
A
microessay by Dr. David Black
http://hondurasmd.org
What I do to fight crime in Honduras? Are your proud of what you do?
My answer: (Responding to idea from Honduras_living listerv subject late July 2010)
As a retired (do not receive fee for service) doc, I do the following, none of which are "flashy."
An abiding question that "dogged me" from my arrival in Honduras was, "Specifically how do corrupt governments keep their people under subjection?" I quickly learned. By keeping the people sick, i.e., not "really" making medical care available and by keeping their people uneducated.
Gang prevention
Males, the world over, do not do well without "something to do." As young people, lonely males form gangs in order to obtain an identity.
My action: I do everything I can to encourage inter village futbol(soccer). I do this by actively drawing enthusiastic attention to those programs within the communities in my catchment area in the Cuenca of the Rio Cangreja--Herradura, El Naranjo, special attention to Las Mangas, La Muralla, El Pital, Los Limpios.
As adults, idle males often become alcoholics. Men do not do well idle.
My action: I have not found a way to help in this area.
Care for chronic diseases
My action: I have become a credible RELIABLE source of health care for those who wish to receive treatment for chronic diseases--asthma (more children than adults), hypertension, diabetes, arthritis (with special attention to preventing gastrointestinal bleeds), care of depressed and some patients with thought disorders.
Consistency, i.e, I appear on "almost all" Monday and Wednesday mornings about 6.30 a.m. till shortly after 11.30. (I am very flattered that, even when I am late, patients will wait at the side of the road for ride to clinic. They say, "We knew you would come!")
When patients tell me that I should not come "every Monday or Wednesday especially if I am tired," I say, "That's what everybody does in this country. I am hereto show you a way to have a better life. Be reliable! Do whatyou say you will do WHEN you say you will do it, and that will be a step toward a better community!
Two very faithful, enthusiastic, engaging Honduran young men, (whom I met when I first arrived in Ceiba10 years ago). who faithfully serve as community development workers. One has been with me for 8 years, the other for 2.5 years, (though I have known both for the entire 10 years as well).
Yes, they work directly with me as I see patients. In this way, the patients meet them. On a case by case basis, one of these may visit a patient in a village where I cannot climb. (arthritis, mine!)
They maintain social contact with families who do not come to clinic with theirs and their children's illnesses until there is a crisis associated with their having "run out of meds." Yes, I put these people on my Yahoo calendar, so I am reminded that these people will be "almost out" of their medicines.
Alberto and Juan FIND sick people. (I go to their homes when appropriate, or arrangements are made for transportation to clinic.)They find people who have "bad fracture setting" results, non union of broken bones, frequently from injuries when they have been struck with a car/truck while walking or riding a bicycle. Juan found a young man who had been hit by a truck along the road, with major loss of use of his right arm, etc. Another, arranged for a 13 year old with an open wound to her trachea communicating directly to the air, so dust went directly into her lungs without being filtered by the nose.
I arrange for definitive care for these people, usually by a visiting surgery brigade. I am available for post op care. (I do not expect Honduran doctors who are trying to make a living, to attend to these cases "free." I know from my own Stateside experience that it frequently costs more to help people who have not maintained their health. With the severe problems, a local surgeon "works with me" at a reduced rate.)
Government Centros de Salud (Health Center) is unreliable.. I use the same, or very similar medications, as the Centros de Salud uses. Therefore, when the Centro de Salud does have the medicine the patient needs, they can obtain their meds there.
I actively praise good care done by Honduran docs and nurses.
Interaction with children.
In my experience most children are terrified of a doctor's office and being examined.
I am very gratified to see that within the past five years, only "new patient" children are frightened.
How do I do this? First of all, the child remains in the mother's arms, usually with the head over the mother's shoulder.
Secondly, I show the child that the stethoscope does not hurt his mother. Then I touch the stethoscope to the child's foot, then hand, then chest. (Yes, they lose their courage if I listen "too long.")
Thirdly, I almost NEVER give a child an injection. Giving ANYONE an injection is usually CONTRAindicated for any reason. (I have adult patients who are thrilled when they "qualify for an injection!) The child's mother administers any medicine the child does need to take "on the spot."
Education
I ATTEMPT to strengthen the educational system only partial success.
I have a uniform program, funded by donors in the States, to provide uniforms so that all of the children in a 'given village or two" can attend school. Yes, they can get "special permission" not to wear a uniform, but what kid wants to be different! School supplies are also provided.
All of this is done under the direct supervision of Juan and Alberto to prevent the "circus like" atmosphere of the many brigades who come to Honduras. If a parent can pay for his/her child's uniform, they are permitted to obtain it at the same reduced price that a lady in another community negotiates with a La Ceiba clothing store! If parents can pay "a little," that is accepted. If nothing, gratis. My tendency is always to "give too much," so the Honduran community development workers attend to these things.
This is no circus giveaway. Only those truly in need receive. I have concentrated on providing "near complete" help for a village or two, just to keep US "encouraged" that we have truly "made a very tiny dent."
This is what I am doing to prevent crime. In every community there is a "child or two" who want to "march to a different drummer."
A scholarship program for university students not successful. I was not successful in establishing a scholarship program for university students. The donor was faithful for 4 years. Not a single student completed a course of study. It seems that is just too large a "jump" to go from campo to the university.
We have had considerably more success in paying transportation costs for students at the government trade school system INFOP. Actually the quality of what the kids learn is great; there are not nearly enough spaces.
But there are several who now have regular jobs, but not all. The source of desire for education seems to be the child's parents/grandparents.
I try to facilitate VALUES instruction and modeling by young Honduran men. Juan has organized youth clubs in 3 of the communities. Information about drugs, smoking, alcohol is provided. "Don't lie, cheat, or 'go with girls who do.'
Condoms are available confidentially for free; use is encouraged if abstinence is not practiced. Birth control pills/injections, purchased from ASHON PLAFA are provided confidentially in the 2 rooms of my "clinic." These were previously in the pulperias, but this was "too public." Nobody "outside" knows if the person got some Tylenol or a birth control injection.
Make the check payable to Congressional District Programs,
and VERY IMPORTANT, in the description, write: Foundation Esperanza: Account F1432352. Foundation Esperanza is a charitable program of the Congressional District Programs, a US 501(c)(3) Public Charity, Tax ID 65-0970090.
Do NOT put my name on the check or money order.
Send the check or money order to:
Congressional District Programs
6201 Leesburg Pike, Suite 405
Falls Church, VA 22044-2201