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In Belize automobile horns are used as a form of communication that can mean anything from "just so you know that I am behind you" to "I am selling something you don’t want to miss." As we drove through San Marcos Sister Marion announced our arrival by blaring the horn and in our wake the inhabitants of the thatch houses rushed toward the road to investigate. I couldn’t help laughing as she informed everyone within shouting range that "the doctor is here."
Although San Marcos is very close to Punta Gorda Town, it is well known as the Toledo District village with the most severe health problems. Similar to many of the villages in Toledo District, the people of San Marcos have not conformed to the western practice of using latrines. San Marcos is especially bad and thus the nickname for the village refers to the human feces that litter the ground. Ironically enough, the sanitation problems within the village discourage many of the local public health workers from visiting the village. This "house call" was probably the first time a doctor had visited the village since the Cholera epidemic struck three years prior.
An appointment with one of the three doctors in Toledo usually requires a trip to PG and an all day wait in the crowded halls of the hospital. Needless to say, people materialized out of the woodwork to see the doctor. After our procession through town, we stopped the car at the village health post - a small cement building containing nothing more than the local insect population. Before we could open the doors to unload our medical paraphernalia, the car was surrounded by Mayan schoolchildren who had recently finished classes for the day, their big brown eyes watching our every move.
As the line formed out the door, we started to examine patients as efficiently as possible. Our posse consisted of: Dr. Raymond Ford, a pediatrician from Charlottesville; Sister Marion Joseph, a nurse practitioner who maintains a clinic in the neighboring village of Big Falls; Dominga Choco, a Kek’chi Mayan woman who has worked with Sister Marion for 13 years. She functions as a nurse and an invaluable translator; and myself, an EMT. Chicken Pox had recently swept the village and thus many of the children had severe secondary skin infections. Other common ailments included Otitis, parasites, fever, lesions and malnutrition. Luckily, the doctor traveled with a supply of vitamins, a luxury most families cannot afford.
Although the people of San Marcos were fortunate to have a doctor visit that day, on most days they are not so lucky. Four villages within the Toledo District of Belize are staffed by a nurse – the remaining 32 villages receive very little continuous care. A few of the villages have midwives and skilled bush doctors who are adept at treating certain ailments such as snakebites. There are also Community Health Care Workers who were trained to care for minor ailments working in 18 of the villages, however they have not had any refresher training since 1991 and have consequently lost their confidence to administer treatment. Despite the hard work of the various health care workers, many villagers who are sick or injured, such as the ones we saw in San Marcos, are left with no one to turn to.
Rather than being discouraged by what I have found here, most of my work has been very encouraging. Primary care is one of the principal initiatives of the government recently voted into power and Toledo has been identified as an area of concern. The man who coordinates the Community Health Care Workers was recently asked by the Minister of Health to outline what is necessary to revamp the program, including training 10 new health care workers. I am assisting him with this proposal as well as helping him to prepare a workshop for the existing health care workers. Most importantly, I have had several discussions with the new District Medical Officer for Toledo regarding his perspective on the District’s needs and how we could help. He is very excited by the prospect of Plenty International taking an active role in improving health conditions in southern Belize.
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