Honduras: Cuban-Trained Garifuna Doctors Supported in Hospital Expansion Drive
Diane Appelbaum and Hope Bastian
Photos by Diane Appelbaum

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’ Garifuna community.

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 (center).

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.”