Santa Lucia Health Center

Written March 25th

Sitting in the conference room, children ages 3-10 are running around outside, hanging off of hand rails, climbing on everything they can reach, yelling and crying. Mothers half-heartedly try to keep their own children in line, but are unsuccessful. Men are nowhere in site - only women and children here. Coughing can be heard coming from every corner and one bulletin board catches everyone’s attention: Colera. Apparently, the Secretario de Salud (health) is not currently doing a campaign (compana) for Colera, but it is prevalent enough for this health center to cover a wall with important information about the illness. Colera is parasite that causes people to get severe diarrhea and vomiting, and can cause death very quickly without medical attention (mainly due to dehydration).

On March 10, 2011 the group of 17 salud trainees went to the Centro de Salud (Cesemo) in Santa Lucia to get an idea of how they run and what can be treated there. The Santa Lucia Cesemo is bigger than most Cesemos out in rural communities, but like all the others, only one doctor works at the center. Because only one doctor services the whole clinic, you end up waiting a long time too see him. Women and children walk, sometimes for two hours, from small aldeas all around a health center early in the morning to get in line to see the doctor, and often times the doctor leaves for the day before getting to all the women that are waiting. The doctor in Santa Lucia works from 6 to 10 am, and the clinics are not open on the weekends. An aldea is a small town with 80 to 120 people, mostly all related and usually consists of about 40 houses.

A small girl who looks about two years old and has dark curly hair crawls around on the hard cement floor of the waiting area while being chased by her older sister, who looks about 11. The older sister is wearing a long tie-died t-shirt covered in dust and dirt, and yells at her little sister while chasing her around. Both girls are followed around by their mother who is talking on her cell phone. The whole family is slightly overweight, and when the two-year-old asks from a Coke-a-Cola, you know she is not getting the proper nutrition.

The Secretario do Salud for Honduras sets all the rules and creates and provides training for health centers and NGOs. Within the Secretario de Salud there are three main departments, one of which is services. With in the services department, there are 18 regional departments of health. There are national, regional and area hospital throughout the 18 department. Near Tegucigalpa, there are three national hospitals. Area hospitals usually have only four specialties including internal medicine, surgery and maternal clinics. There are also Cesars and Cesamos throughout the 298 different municipalities that make up the departments. A Cesamo, like this clinic in Santa Lucia, is classified as a center for health that has one doctor on staff, usually has a lab, and can deal with somewhat complicated health problems. A Cesar on the other hand is headed by a nurse and can only handle basic health problems. If someone has a serious health issue, they are sent to one of the area hospitals, or possibly to a regional or national depending on the severity of the injury/disease. In smaller areas, where there is only a Cesar and or a Cesamo, which are both closed on weekends, there is usually a Cliper, which is an emergency center for basic health issues.

Cesars and Cesamos are “free” for people to go to for treatment. But, it actually costs each person 10 Limpira, nine of which is for material and one Limpira goes to Honduras. However, if the person doesn’t have 10 Limpira, they will still get the help they need. What does tend to be an issue for people going to a health center is that they have to pay for pretty much any medication they may need, which for most people from aldeas is way too expensive. The Cesars will give out aspirin, Tylenol, sulfa (for respiratory infections), and contraceptives for free, but everything else has to be paid for out-of-pocket.

In the Santa Lucia clinic, the two main illnesses they see are respiratory infections and strep throat, but the Santa Lucia clinic does not see many of the illness and diseases that are more prevalent in smaller municipalities. Up until three years ago, no cases of malnutrition had ever come up in the area surrounding Santa Lucia, but since then there have been seven case, which the doctor equates to the fact that people have now been trained to identify malnutrition and are actively seeking cases in order to help.

The Santa Lucia clinc, which is larger than most Cesemos throughout Honduras has a file room, which is where patients blood pressure is taking. To the right is a vaccine room with a fridge with all the correct features: thermometer for temperature checks, ice packs, water bottles, and nothing stored in the door of the fridge. The bulletin board next to the vaccine room has what seems to be Winnie the Pooh and Piglet getting vaccines to try and make little kids more comfortable. Next is a stitching room where specific procedures are done followed by a room for nebuliztion and oral treatment for diarrhea. A small pharmacy, dentist office for traveling dentists, and a medical supply room are on the other side of the center. For such a small center, this Cesamo definitely has a lot going on, but each room is only about 10 x 10.

The health set up in Honduras is definitely different than it is in the United States, but there are actually some similarities, too. I think that the Cesamos down here are similar to our public health centers in the states. In Honduras, they are definitely smaller and dirtier, but the waiting in line for hours and lots of times not actually getting to see a doctor sounds very similar to the situation in the states.

There is a very good chance that when I find out my site placement and my counterpart, it will be someone at a health clinic. A counterpart as the word entails is someone that I am partnered with that will help me integrate into my site, and will hopefully also provide me with some insight into possible projects I can do in my site. It was good to see a Cesamo in action so when I get to my site I will have a little bit of an idea what it will be like, although at this point I don’t know what the size of my site will be. I may end up in such a small area that there is only a Cesar!