Tin Do and Natasha Marston went to Honduras and spent time working with the indiginous population, the Lenca Indians. They learnt about many of the problems unique to indigenous people and talk about some of them here

We went to Honduras to provide healthcare services and learn about the medical situation, as members of a delegation of medical students with Witness for Peace. We expected to see poor patients with minimal access to health care, a dearth of medical supplies, and the medical consequences of Hurricane Mitch.

The Lenca Indians are an indigenous group of people that we provided care to. We felt that we'd got more than we bargained for; we saw desperation among normally docile women, who shoved their children towards us and pushed aside friends and neighbours for an
opportunity to express their concerns about their children's health as well as their own. Medical clinics were often staffed with one inadequately trained healthcare worker in charge of the health of an entire community.

Clinics

The clinics we provided were usually held at local schools and were often filled with malnourished children, some looking much smaller than they should have for their age. Mothers, in desperate need of nourishment and health care themselves, often lamented about how they could not afford medical care, much less provide the family with food, clothing, and shelter. We gave basic care, as we had scant resources and clinical facilities.

For seriously ill patients we would do our best--for example, feeding a severely dehydrated child a simple electrolyte solution. With help from local community leaders, we were able to send some of these patients to the nearest hospital (about one to two hours away by car), where they would arrive with no money and would receive care of unknown quality. A further frustration was that when patients were sent to hospitals without telephones or any means of communication, we could not find out what had happened to them. Sadly, situations such as these were the norm.

The problems Lenca Indians face

Honduras has a similar history to many other Latin American countries and shares their sociological problems. Like its neighbours, Honduras has developed over the past few centuries along Western economic lines. This has created problems for its indigenous groups. Consequently, the Lenca Indians exist outside of modern institutional settings such as Western medical clinics and hospitals. We found that most of the 50 000 remaining Lenca Indians speak only Spanish and have acculturated into the predominant Mestizo culture. One old healer sadly told us that this has resulted in a way of life in which few have managed to maintain their native language and the traditional medical practices of their ancestors. As this healer's generation dies out, the new generation of healers tends to give traditional medicines without fully understanding the proper doses and usages that the elders once knew. Young Lenca Indians are nowadays more affected by television and radio from North America, further cutting off their ties to their ancestors' culture. A non-Lenca Indian doctor, with whom we worked, has been trying to maintain and teach the locals native medical practices, such as using eucalyptus leaves for colds and papaya or garlic as antiparasitic agents. Indigenous practices are a living library of social and scientific knowledge. We saw first hand that as the Lenca Indians' culture disappears, so does a trove of medical knowledge.

Dependency on the land

The Lenca Indians' traditional healing methods and medicinal cures are mainly derived from plants; Lenca Indians are highly dependent on the natural environment. Driving through the Honduran highlands, we noticed that once lush forests have now become vast areas of barren desolate land. As deforestation in Honduras proceeds at a rate of about 1000 km² per year, many of these plants may no longer be available to use as drugs. A local community activist noted that with the loss of these resources and the body of knowledge developed from them, the Lenca Indians increasingly depend on Western drugs such as antibiotics and antipyretics. These drugs are scarce, however, in rural mountainous regions that are practically inaccessible due to poor road conditions, poor healthcare infrastructure, and limited funds for the procurement of services and drugs. Caught between two worlds, the Lenca Indians are in effect falling into the crack.

In poor health

The predictable result is that the health of the Lenca Indians is deteriorating, even in relation to the already low standard in Honduras. Of the indigenous children under 14 years of age, 95% are malnourished compared with 39% in the general Honduran population. Childhood vaccination rates stand at approximately 60% of indigenous children compared with 90% in Honduras as a whole. A total of 68 out of every 100 indigenous people born will die of infectious diseases. The average life expectancy of an indigenous person is around 40, while an average Honduran can expect to live to 69, and a North American to 79.

ESTEBAN FELIX/APashz301sa

Although health care for the poor is theoretically subsidised by the Honduran government, the budget of $44 (£27; a42) per person per year leaves many needs unmet. According to many of our patients, a clinic visit often means a round trip of 8 to 10 hours and costs $1-2, which is still too much for an indigenous family earning $200-400 per year. Once patients arrive, they often receive inadequate treatment due to lack of supplies, medicines, and properly trained healthcare workers. We saw lots of problems that could have been easily relieved--such as children with painful tooth abscesses who could not afford the $3 to go to the dentist, so they came to us.

Hope for future generations

Sadly, Honduras has not only a lack of resources but poor distribution of its existing resources; it is not unique. As doctors and healthcare providers, it is our responsibility to educate ourselves about the forces that deny health care to so many poor and disenfranchised people around the world. Two weeks spent in the Honduran countryside gave us a better understanding of our role as medical care providers. The experience allowed us to appreciate the traditions of medical practice that have long provided cures to ailments that have stricken the indigenous peoples of Honduras. Looking into the eyes of the children, we saw little hope for what is in store for them in the future. In their eyes, we were able to be that small bit of hope, albeit for only a few days in their country. We hope that after bearing witness to the dire social and medical situations in Honduras, we will become more conscientious in our own paths as doctors. This way we can achieve a world that is more equitable in health and wellbeing for all people; a world in which the children of the Lenca Indians can grow up without fear of malnutrition, disease, and early death; a world in which they can in fact thrive.

Further information, facts, and figures

Pan American Health Organization. Health in the Americas. Washington, DC: PAHO, 1998. www.paho.org/english/HIA1998/ Honduras.pdf www.paho.org/English/SHA/ prflHON.htm (accessed 10 Jan 2003).

Witness for Peace--www.witnessforpeace.org