Medicine for the Poor and Sick in Honduras (Part 2)

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Municipalidad de Pimienta

By Thursday morning everyone on the team had finally had a full night’s sleep and breakfast and we were all prepared and waiting in the lobby when the Alcalde’s rented van arrived to pick us up at the hotel.  We met Janice Meyer for the first time and she undertook to introduce everyone to one another. Joining our team of four was Janice, Dr. Raul Ugarte, Janice Meyer and Dr. Ugarte’s son Fernando who was our driver for the day.

This time we proceeded directly north on the Trans American Highway that connects Tegucigalpa with San Pedro Sula and engaged in conversations with one another along the way. We learned of Dr. Ugarte’s personal history as a public health doctor and later as an elected official in Pimienta. It became obvious that Dr. Ugarte was a man of extraordinary integrity in a country with a political culture that is much compromised. He took his role as a public official very seriously and saw himself as not only an example for others to follow but as a reformer.

We learned of the long term relationship Janice Meyer has had with Honduras in General and Dr. Ugarte in particular, having come many times as a volunteer in association with a Health Outreach Group she has been part of through her career as a professor at Washington University in Saint Louis Mo. After many visits to Honduras, administrating volunteer health service for many various NGO’s and such, she settled on Dr. Ugarte as the most reliable and trustworthy person she knew. Her association with his work had roots that went back many years. Janice was also very literate in her bi-lingual skills, acting as a very careful listener and accurate translator.

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The first stop for us was in the small town of Pimienta (pop. 50,000) the town Dr. Ugarte is the Alcalde for. Pimienta is about 30 kilometers south of the large Metropolitan city of San Pedro Sula. The Bodega (or warehouse) that Dr. Ugarte maintains in the town of Pimienta is located inside a compound, surrounded by fences and walls t was spacious and well-appointed and clean. There were very securely locked doors and loading docks where the containers were delivered after clearing customs. While these medicines are not the kind of drugs criminal gangs are interested in obtaining, and there is a lower level of concern about an armed break in, still this is a country that experiences an average of 15 homicides a day, so nothing is really completely safe, just relatively safe.

After a full tour and inspection of the warehouse, we drove into town to the Palacio Municipal and visited inside the Alcalde’s office and had a very frank and revealing discussion about Dr. Ugarte’s administrative system of accountability and record keeping. Here is a man who understands how to create a paper trail to track the chain of possession of not only every carton of medicine but every bottle and every capsule in every bottle. It was truly remarkable how thoroughly he has thought thru the practical steps necessary for creating an accounting for the whereabouts of the donations he is making to his distribution network for our purposes, but as he made it abundantly clear, to create an example for his peers, his government and the new President of Honduras who had recently asked Dr. Ugarte to become his Minister of Health in Honduras because of his reputation for scrupulous supervision and detail. Dr. Ugarte chose not to accept the position as he felt he could accomplish more doing what he’s doing creating an example of how things can be done from the bottom up. As the day came to an end we were delivered tour hotel in San Pedro Sula with an agreement to begin early the next morning Friday, to undertake a tour of selected sites in Dr.Ugarte’s distribution network.

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Our first stop on Friday morning was the Hospital Nacional in San Pedro Sula, which is the large Public hospital. We were introduced to the Hospital Administrator Dr. Jose Armando Ramirez Majia who greeted us and brought us to the outpatient clinic supervisor Dr. Eva Guzman.  Both led us on a tour of those parts of the hospital that were relevant to our inspection of donated medicines, like the pharmacy and the outpatient clinic dispensary.  Here we learned that the hospital is virtually void of any medicines other than those donated by us and a few other outside donation sources. The government has so little resources to direct to caring for the medical needs of the population it was a bit startling to see the shelves in the pharmacy empty of almost everything except the medicines we give Dr. Ugarte to give to them.

 We were surprised to see we had to pass through a military security check point to enter and once inside we found armed military personnel occupying the premises. It was explained to us that before the election of the new President of Honduras, Juan Orlando Hernandez in January, the hospital unions were under the control of the Mobs and were extorting all the employees and even patients and extracting protection money for the right to have a job. The new President had to literally undertake a military take over and occupation of the hospital and muscle the mobs out of the premises in an attempt to reestablish a rule of law in that environment. We were told a few stories of the conditions under which hospital employees were forced to operate under the criminal gangs and the new environment of order and security now being reinstituted.

Everyone on our team was impressed with the sense of urgency and dedication the hospital staff demonstrated as they operated in this transition period but also the respect and admiration they held for Dr. Ugarte. We said goodbye to Drs. Majia and Guzman and headed on our way.

On our way to the next distribution location Dr. Ugarte supervises, we were able to slip momentarily into the Government Customs Yard and snap a few photographs of the site. Photography in this area is restricted and so we were discreet in capturing a few pictures of the area where our Partner Gebende Hande’s containers arrive when they are off loaded from the ship in the Bay of Cortez. It is not unusual for customs personnel to open and inspect not only every single carton but even every single bottle inside of every carton in search of illegal contraband.

 Throughout the day we were led from one clinic to another. In each case we witnessed the same basic fundamental constant of Dr. Ugarte’s system of accountability and documentation of donated medicines in, and careful record keeping of possession and verification of time and personal initials to establish where and when there was a distribution to the end user or patient.

 We heard stories from the medical staff’s in each of a number of locations about the horrendous health conditions that prevail in Honduras. A 25% – 40% diabetes and high blood pressure incidence, unemployment among young people in the 70% range, gang recruitment into violent crime on the increase are creating a sense of hopelessness and despair. One woman in who was the head nurse in a clinic we visited told us in her home town of 50,000 people the local high school had experienced 50 homicides last year and this year alone.

Standing out in the face of this collapsing civil society is the newly elected President and a handful of reformers, among whom Dr. Ugarte is numbered who represent the possibility of a society reestablished on principles of Law and Order. If there is not a strengthening of this movement in Honduras, the future could be very bleak.

We returned to our hotel Friday night and after parting with our hosts we gathered as a team to debrief and prepare ourselves for departure at 5:00 am the next morning. The content of this report is in part the product of our shared resources (photographic and otherwise) after we had spent 4 days traveling to witness the conditions in the urban and rural public health distribution networks of Honduras. It is my opinion that Abandoned Children’s Fund is very well served by the Gift-in-Kind distribution connections we have been able to develop over the last 18 months and any donations we participate in through these recipients are being applied in a manner that serves our mission purpose as a tax-exempt charity.

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