Honduras: Cuban-Trained Garifuna Doctors Supported in Hospital Expansion Drive
Diane Appelbaum and Hope Bastian
Honduran President José Manuel Zelaya Rosales, Minister of Health Elsa Palou, representatives of the Honduran Medical Association, and Cuban ambassador to Honduras Juan Carlos Hernández gathered recently in Ciriboya, an isolated indigenous community in La Mosquitia region of Honduras, to celebrate the expansion of services at the first Garifuna Community Hospital. The community hospital, inaugurated in December 2007, is the headquarters from which local graduates of Cuba’s Latin American Medical School (ELAM) carry out their health promotion work. The Garifuna Community Hospital, staffed by a mixed team of Cuban and Cuban-trained Honduran doctors, currently consists of two outpatient examining rooms, labor and delivery rooms, a six-bed observation ward, pediatrics, dentistry and pharmacy services. This month, thanks to a donation of x-ray, ultrasound and clinical laboratory equipment by the Cuban government, the hospital now has on-site diagnostic capabilities that were previously unavailable in the region.
|Dr Pérez examines a patient in Honduras
’Photos by Diane Appelbaum
The Garifuna Community Hospital in Ciriboya is the cornerstone project of the Luaga Hatuadi Waduheñu Foundation (“For the Health of our People” in the Garifuna language). The Foundation was started in 1999 by a group of Garifuna students, led by Wendy Pérez and Luther Castillo, who were studying medicine in Cuba. They spent their summer vacations at home identifying the health problems in their community and started the Foundation to address these needs. The establishment of a community hospital in an area of the country that has long lacked vital health infrastructure is one of the great achievements of the Foundation’s short history.
MEDICC is one of several international organizations, including Global Links and the Sacramento (California) Labor Council, supporting the Foundation’s work. In July, MEDICC’s US Director Diane Appelbaum and Financial Director Jerrontay Foster visited Ciriboya, where they previewed the hospital’s new facilities and accompanied Drs Pérez and Castillo on home visits in the community.
|Cuban Engineers Ernesto Aróstegui Guerra
and Pedro Vega Sánchez with Dr Castillo
The Foundation’s work has made a significant impact on the health of the Garifuna people in La Mosquitia. In its first five years, the project treated more than 12,000 people. Meticulously kept epidemiologic records reflect improved health indicators in all of the communities being served by the project. “Our successes are measurable,” affirms Dr Castillo, who graduated from ELAM in 2005. “I would say that our biggest accomplishments have been decreasing infant and maternal mortality, and decreasing pathology from chronic diseases such as hypertension and diabetes.”
The hospital is continuing to grow and offer new services that have never been available in the La Mosquitia. Looking ahead, Foundation members are hoping to guarantee the sustainability of the project by further expanding the role and responsibility of the Honduran government. In the coming months, the third phase of construction will begin at the community hospital. A new wing will house two surgical theatres, a pediatric ward, a physical therapy unit, a special area for integrative medicine, and a medical education area with library. Two Cuban engineers, Ernesto Aróstegui Guerra and Pedro Vega Sánchez, are already in Ciriboya preparing to build the new wing
Cuban Collaboration Brings Family Medicine Residencies to Ciriboya
Since May 2007, Cuba has offered the ELAM-trained Garifuna doctors a family medicine residency program through which they can continue their medical training while working in their community. The program, divided into six-week rotations, is taught by Cuban and Honduran specialists. “We invite the Honduran doctors to share what they’ve learned. Some accept and some don’t,” says Dr. Elisio Peñas, head of the Cuban Medical Brigade in Ciriboya. As well as rotating through the hospital, the residents staff health centers in 12 remote villages where they must do research to identify and propose solutions to a pressing community health problem.
|Aldo Tarbin Avila Lino (far right) with kids
in the community.
Dr Pérez is now in her second year of this demanding family medicine residency. Like the other nine students in the program, in addition to working in the Ciriboya hospital, Dr Pérez acts as the “guardian of health,” responsible for providing primary care, under the supervision of a Cuban physician, in four communities: Iriona Viejo, San José la Punta, La Curva and Iriona Puerto. In these four communities she is responsible for about 3,000 residents. Dr Pérez sees patients in the hospital in the mornings and makes house calls in the afternoons. Days are set aside in her schedule for well-baby checkups and for visiting patients in hospital at home care. Every three months, she makes house calls to patients with chronic conditions. “For most people here, the first doctors they ever saw were Cubans,” she says. “Because they had such positive experiences with the Cuban doctors, they have more confidence in me because I was trained in Cuba – and of course also because I am Garifuna; I am one of them,” she says of her experience.
|Nursing students take a break from studies at
Luaga Hatuadi Waduheñu Foundation office
in La Ceiba
Dr Pérez has also become a mentor and role model to several young people in the community. One young man in particular, Aldo Tarbin Avila Lino, has been assisting Dr Pérez for almost a year, dispensing vitamins, carrying supplies, and helping with health education. Dr Pérez hopes that the experience will motivate Aldo to continue his education and perhaps pursue a health-related occupation. This informal mentoring is also an important part the Foundation’s community work, she says.
Connecting Communities for the Future
In addition to the hospital, the Foundation has several projects to support young people interested in entering the health professions. The goal of these projects is to develop sufficient local talent to staff the infrastructure that has been built and to replace the Cuban doctors who will eventually leave the community. Another important goal is to connect Garifuna in larger towns and cities, such as La Ceiba, with those who live in smaller and more remote communities.
“It is not enough to do what we are doing in Ciriboya if it is not known and embraced by the larger Garifuna population,” says Dr Castillo. “We are finding ways to spread the word so people can understand why we are doing what we are doing.”
|Dr Pérez sorting medicine donations in
La Ceiba office.
|Garifuna ELAM graduates Wendy Pérez (l)
and Luther Castillo (r), members of the group
of students who founded “For the Health of
our People¨, at the house where Cuban
medical personnel live in Ciriboya.
One such project, in cooperation with the Garifuna Student Association, provides weekly tutoring sessions for 30 Garifuna nursing students studying in La Ceiba. In exchange for the academic support, the nursing students volunteer in remote villages accompanying physicians on home visits. All of these activities keep the nursing students active in the communities where they grew up and to which, hopefully, they will return once they complete their training. In another project, current ELAM students Cheny Dolmi and Melvin Thomas Ruiz organize summer educational programs for Garifuna students who hope to study medicine in Cuba. Currently, 86 Garifuna students are studying health-related fields in Cuba. This fall, 20 Garifuna students will begin their first year of medical school at ELAM.
This year, a new pilot project will prepare 10 Garifuna students to study technical health professions (x-ray, laboratory, dental technologists) in Cuba. “Hopefully, this will be a model for other countries,” says Dr. Castillo. “We first announced this opportunity in the remote communities, and we had 34 applicants. Of these, we chose 10 and brought them to La Ceiba for three months of intensive preparatory classes. We are supporting these students with room, board, and classes, because they have absolutely no financial resources. We want to prepare them well so that they have a better chance of success in Cuba.” The first of these students have begun classes in Cuba.
The Foundation has also done extensive work cultivating international ties. Each month, the Foundation receives visits from US and Honduran organizations and individuals who work with the Cuban doctors providing medications and supplies. The Foundation also has cooperative arrangements with several US universities, including Johns Hopkins; University of California, San Francisco (UCSF); Charles Drew University of Medicine and Science; and Emory University School of Medicine; which send delegations of health professionals and students to learn about the Foundation’s projects and philosophy, and to work and conduct research under the Foundation’s guidance.
Dr. Castillo emphasizes that the most important challenge ahead for the Foundation is to assure sustainability. When asked to identify the organization’s greatest needs he laughs, “Everything! People thought we were crazy to create a hospital without funds, and now we have a hospital; we staff 12 remote health posts; we supply needed medications to the population; we offer a family medicine residency program in the communities. The key thing now is to cultivate enough support to keep it all going.”
Honduras: “The Doctor Who Became Public Enemy #1”
"For believing health to be a human right, Dr. Castillo has put his own life at risk." The Doctor Who Became Public Enemy #1 First published Jul 09, 2009 Robert Huish [Bio] Assistant Professor of international development studies, Dalhousie University. Dr. Luther Castillo’s voice is heard across Cuba every night. From somewhere in Honduras, Dr. Castillo calls into the television program Mesa Redonda (The Roundtable), a nightly news and opinion program broadcast out of Havana. Using his cell phone, and the cell phones of others, he tells Cubans about the military coup in his homeland. He talks about how the situation is unfolding from the point of view of those who need medical care as a result of the military’s brutality.
Before the coup, Dr. Castillo had been the Director of International Cooperation
in the Honduran Foreign Ministry. His job was to build cooperative partnerships
to bring much-needed medical services to the poorer regions of the country. Now
he’s switching from cell phone to cell phone and sleeping where he can, because
the military has marked him=2
0as public enemy number one.
On July 3, the OAS Inter-American Commission on Human Rights added Dr.
Castillo’s name to a list of persons whose lives are at risk because of the
coup. On July 7, we learned that the Honduran army plans to arrest and detain
Dr. Castillo. If he resists, their orders are to shoot him where he stands.
And for what? Before he joined the Honduran Foreign Ministry, Dr. Castillo operated the only free clinic in Honduras’s Garifuna region, the place where he was born. A coastal region populated almost entirely by indigenous peoples, the Garifuna rarely gets attention from journalists, doctors, teachers, or other important members of society. What it does get is preventable diseases, illiteracy, and rampant poverty. After receiving a medical scholarship from Cuba’s Latin American School of Medicine in 1999, Dr. Castillo returned to the Garifuna to build the clinic. Today, it provides affordable and accessible health-care services to 20,000 people. The local community considers this a saving grace. The military considers it the sort of socialist insubordination that must be wiped out. For believing health to be a human right, Dr. Castillo has put his own life at risk. His ideas are also under threat. Relations between the Garifuna and the government have never been good. Under the coup, things could get even worse. The minority Garifuna, like many minorities in the Americas, tend to get mistreated by the army. The military government’s targeting of a pioneer of universal health care is alarming and requires international reaction. The international community’s apathy towards the Garifuna as just another poor minority, not worthy of our attention, is just as upsetting. We cannot tolerate this sort of bullying. We must demand that Dr. Castillo appear on the T.V. tomorrow, and the day after, and the day after that. Our refusal to ignore him will keep him alive. If we turn our backs, who can say what will happen to him. We must demand our own institutions, and anyone else that has a stake in Honduras, help to ensure that Dr. Castillo makes it to tomorrow. We cannot ignore his need, nor can we ignore the reasons why his life is in danger.