Monday, July 02, 2012
Health care in a poor country
I'm in Tegucigalpa, the capital, working on a project. At breakfast in the hotel today - tipico, which means eggs, cheese, beans and toast (tortillas for most people) - I was reading the paper and there was a story about 430 doctors who want to work for free. (It was a slightly eerie breakfast, as I think I'm the only guest today.)
They're Hondurans who went to medical school in Cuba. They need to be certified in Honduras and do two years of service before they're allowed to practise. (Their counterparts from Honduran universities only need to do six month of service.)
But there's a catch. The government pays new doctors $310 a month during their period of service. And it doesn't have enough money to pay the 430 new Cuban grads. So for the lack of $133,000 a month, desperately needed medical care isn't available. (That's an oversimplification, because the government is also worried about the future, higher costs of paying those doctors when they're certified.)
On one level, it's not really a choice, at least in the short-term. The Honduras government has a budget of about $3.2 billion, for the army and education and police and health care and everything for 8.2 million people. The B.C. government spends $5.2 billion on elementary and high schools for a population barely half the size. (The reasons that Honduras has so little money rates another post.)
And, in fairness, B.C. takes the same approach, limiting residency placements to save money even though more foreign-trained doctors are keen to practise and need a residency to qualify.
But the system is much worse here. And the problems are much broader. Nursing assistants have been on strike in recent weeks because promised payments have not been made. Interns staged a long strike. Last week, the main hospital in Tegucigalpa cancelled surgeries because it didn't have the chemicals needed to test blood for safety before it was used. Doctors said the problem was that the hospital hasn't been paying suppliers, who won't deliver any more reagents.
It's a mixed public-private system here, and doctors can practise in both. Good luck if you're entirely dependent on the public system. (Which explains the widespread use of plants and herbs for healing in Copan, even in town. When my partner fell and made a mess of her knee, she was offered mango bark to make a antibiotic healing poultice. It seemed to help.)
And good luck if those who are so keen to slash health care spending in Canada get their way. The World Health Organization reports Canada spends 9.2 per cent of GDP on health care. Honduras spends 6.2 per cent.
President Porfirio Lobo criticized the health system Saturday, blamed administrative problems and vowed to sort things out. But with 17 months to go until the next election, he's already a lame duck. Presidents can only serve one four-year term in Honduras, and attention has shifted to this fall's primaries to pick candidates for the parties.
What should happen? Who knows. That's the first lesson from life in a poor country - there are no easy, quick fixes.
Sunday, June 24, 2012
Héctor Delgado came to town, and we missed him
![]() |
| What me missed |
Saturday, June 23, 2012
Thinking of Honduras as an African country
I've been mining the United Nations Human Development Report 2011, which I highly recommend for its exhaustive quantitative comparisons of 185 countries.
There are obvious findings. Northern Europe and North America are good places to live. Most of Africa isn't. And there are broad regional trends. Neighbours will generally be similar in a lot of ways.
Honduras, again based on first looks, seems an outlier.
Take income inequality. The HDR uses the relationship between the average income of the richest 20 per cent and the poorest 20 per cent as one measure.
In Honduras, the average income of the richest group is 30.4 times the income of the poorest. Only Namibia (52.2) and Angola (31) have greater inequality. (Canada's ratio is 5.5.)
That's partly because the poorest 20 per cent are really, really poor. But Honduras still has more in common with African states than its neighbours.
The other data supports the finding. On the Environmental Performance Index, based in 25 indicators across 10 categories, Honduras scores 49.9, on the average for countries with "Medium Human Development." But its peers in the Latin American and Caribbean group score an average 65.2, significantly better.
Honduras is below the medium development group for under-height and underweight children ("stunting and wasting," in the language of the reports. But the rate is almost twice as high as the average for the region.
About 64 per cent of the eligible population is attending high school, a little worse than the average for the medium group. But in Latin America, 90.7 per cent of potential students are in high school.
It's striking, across most measures, that Honduras is out of step with its neighbours and, perhaps, more like countries in Africa.
I'm not sure what that means. But I expect the nature of most things - aid, trade, government relations - is different for African nations than for countries in the Americas. And it might be time to think of Honduras as a lost piece of Africa.
Monday, June 18, 2012
Living in the space between cultures
It was also crazy busy, as we ran from appointment to party to storage locker. (The storage locker, six feet by eight feet, contains the last of our worldly possessions in Canada. After five crime-free months in the murder capital of the world, we returned to find someone had broken into our supposedly secure locker and made off with some clothes - the few things we liked well enough to keep - and a pair of speakers.)
I quickly realized life in Victoria, even after such a short time away, was foreign. We don't rush to appointments in Copan Ruinas. Our lives are self-contained. There are no big stores and few restaurants, so beyond my almost daily walks to Bodega Gloria and the market stalls, life is simple.
And we don't have a car. We rented a nice Ford for our time in Victoria, which was handy. But I was surprised how irritating and unpleasant I found it to have to pile into a big metal box and cope with crowded streets to get anywhere. I missed the sunny, warm strolls to run errands.
It was, in short, a time of culture shock, and a persistent feeling that I didn't belong here.
But the culture shock is just as real in Copan. Language, attitudes, values are almost all strange and unfamiliar. In Honduras, saying someone has 'ambicion' is a term of disapproval. Striving for a better education, house or job is seen as putting yourself above the community. 'Comformismo' is a compliment, praise for the way a person fits in and accepts the values and unwritten rules of society.
In my most recent stint in Spanish classes, the maestra and I spent a while talking about homelessness and mental illness. We shared many of the same views. But she also described a woman in her father's community who walked in the woods at night and began to act more and more oddly. Surely evil spirits are sometimes the explanation for mental illness, she suggested.
I've always felt a bit apart, but it's striking now how much I'm a man without a country.
Which is not a bad thing. Distance gives you perspective on cultures' strong and weak points. As an outsider, I can observe that religion in Honduras can serve, for some, as an excuse for inaction. God gets thanked or blamed for a lot of things, when really people could just try a little harder to make change themselves.
And with the benefit of distance, I have a greater appreciation of philanthropy and "good works" in Canada. There is a tradition of giving, and of service clubs and churches stepping up to help when needed, that is a much greater strength than Canadians recognize.
One of the week's chores was paying my taxes. The endlessly patient accountant who works with me observed that I was probably happier paying taxes after five months in a country where services are non-existent or substandard.
He was right. The 'all taxes are bad' crowd should spend a year in Honduras, where schools are overcrowded, policing ineffectual, the health-care system is struggling and basic infrastructure is crumbling. Those people insisting that Canada must cut health care spending would benefit from a tour of a Honduran hospital. Health spending in Canada is about 9.6 per cent of GDP; Honduras spends about 6.2 per cent. That level of spending translates into more illness, deaths and costs to families.
I don't mind the feeling of being between cultures. And I consider it a good sign that I'm much looking forward to getting home, and back to walking the cobble streets to the market.
Saturday, June 16, 2012
Wise words from the doctor
| Dr. Jody Paterson: 'There's nothing saintly or special about social justice - it's just work.' |
We're back from Honduras for a week, after five months. While it's great to see everyone, we were strongly motivated, because my partner and inspiration, Jody Paterson, was getting an honourary degree from the University of Victoria.
Yesterday was the big day, and it was a big day, from the ceremony and on through the celebrations.
The Times Colonist ran most of her speech today. I recommend it. One of the many things that make Jody such a powerful person is her consistent willingness to ignore all the problems and obstacles and just start working when something needs to be done.
As she told the convocation when talking about working for social justice, "You don't need to be a miracle worler. You just need to be the kind of person who shows up.'
Sunday, June 03, 2012
A few acres of beans and corn, a cow that fell off a cliff: Farming in Honduras
Wednesday, May 30, 2012
Swimming with the happy angels
But today I headed to the piscina to help Jody on an outing with the orphans.
That meant four hours of Spanish school in the morning - I'm back for a two-week stint - then finishing up a report on a security survey of volunteers for Cuso Honduras. (Mostly, they feel pretty safe, despite the country's crime problems. The biggest concerns are around travel, because the roads are dangerous and buses iffy.)
Then I headed out in the very hot midday with a plastic bag of newly purchased towels and banana chips in one hand and a five-litre bottle of some sort of powdered juice in the other. Jody - or Dr. Jody as I now call her - had left earlier to head up the steep hill to the orphanage, or group home, or whatever you want to call it. As it happened, her procession - five kids, plus a woman who lives at the orphanage and her two children - came down the avenue as I emerged from Calle Independencia, our street. They looked a little like orphans because Sunday was haircut day, and the three boys had prison-style buzz cuts.
The pool is nice. We go one day most weekends. It's the pool for one of the hotels, but located about 800 metres away from town, past cantina row, in a little garden with palm trees and hammocks and lounge chairs. Hardly anyone uses it. At night, there's a disco - Papa Changa's - but except for the Bob Marley CDs, it's quiet in the daytime.
Jody had arranged for the orphans to swim for free, but of course the guy at the pool knew nothing about that. So we paid, and they swam with wild enthusiasm. They ranged from one to 12, and some could swim and some were a little freaked by the big pool.
But they were all responsible and no trouble. I had wondered if I would have to rescue someone, but no. I supposed looking after yourself becomes a habit. And they hung in the water for a long time, getting us to toss them around and showing off for each other. Then they ate the banana chips and gulped the powdered drink and the rain came. We waited for a while, then trudged back as torrents ran down the streets.
We'll be back. There are about 25 kids old enough to swim, but you can only take five or six at a time.
I've sure spent a lot of time in swimming pools with kids over the years.
Jody's recent post on the orphanage, worth reading, is here.
Wednesday, May 16, 2012
Two dead pregnant women, and the war on drugs
Bringing the war on drugs - with real armies - to Honduras means more deaths and, at best, that the cocaine route moves on to some other country.
Monday, May 14, 2012
Lost in Translation, or in conference with OCDIH
| Guest today, lunch tomorrow |
Tuesday, May 08, 2012
Starting from scratch in Honduras
![]() |
| From New York Times |
Effectively, create a brand new country within Honduras.
There are obvious perils, as I noted. But once you've lived her for a while, it's hard to dismiss the idea out of hand.
There's an interesting piece in the NYT today on the topic.
Monday, May 07, 2012
The Liberals and the point of no return
There is a day, or maybe a week, when something shifts, and political recovery, already difficult, becomes impossible.
It's not a question of one issue. The casino-licence scandal would have been bad for the NDP administration, for sure, but might have been survivable if it had not messed up so badly on other issues, substituting spin and empty announcements for competent government.
It appears the Liberals might have reached the same desperate point.
The BC Rail scandal will not go away. The government's decision to pay $6 million in legal fees for Dave Basi and Bob Virk appears to be fatal.
Government policy - and the agreement with Basi and Virk - were crystal clear. If they were found not guilty, the government would cover their legal costs. If they weren't, the two would be on the hook. Basi had signed a lien on his home, at the government's demand, as part of a deal.
But, as the BC Rail trial was about to hear potentially damaging testimony, the government cut a deal. It agreed to cover $6 million in legal fees for Basi and Virk. If they pleaded guilty. The special prosecutor also promised no jail time, which would have been expected in a breach of trust case of this magnitude.
The government's position has been that the guilty pleas and the $6-million payment were unrelated.
But that's simply incredible. No matter what clever legal and bureaucratic moves moves were made, the deal was that the government covered the $6 million as part of a deal to get guilty pleas. It appears a government inducement to get guilty pleas and end the trial.
Vaughn Palmer offers a good review of the government's claims - and their weaknesses - here. The government's arguments might impress legal scholars - or 18th-century Jesuits - but average citizens will find them unpersuasive.
Which, like the casino scandal, might not have been determinative.
But the Christy Clark government has not shown competence on other issues. With 11 sitting days left, the Liberals have not yet introduced the bill to repeal the HST, the mea culpa citizens are awaiting. It has floundered on other issues and shown no clear direction.
The polls have been bad for some time. But this week might mark the point at which recovery became impossible
Update:
There is a very good look at the evidence establishing that the $6 million was an inducement to obtain guilty pleas, ending the trial, at The Gazetter's site here.
Thursday, May 03, 2012
Van Dongen raises a good question about the BC Rail scandal legal deal
But Attorney General Shirley Bond's failure to provide answers suggests he might be on to something.
Van Dongen, now a Conservative after leaving the Liberals, asked Bond a straightforward question.
The government's position is that the decision was made by deputy finance minister Graham Whitmarsh, who had the legal ability to release Basi and Virk from their commitment to cover the $6 million if they were found guilty.
But deputy ministers don't have unlimited power to spend taxpayers' dollars.
Van Dongen asked which section of the Financial Administration Act gives the deputy minister the power to make that decision without authorization from cabinet or elected officials.
And Bond couldn't come up with one, although the government surely must have prepared for every possible question on the B.C. Rail scandal.
Van Dongen noted "The act sets out very specific limits for the forgiveness and extinguishments of debts owing the provincial government." That's sensible. A manager shouldn't have the power to let people or companies abandon their debts to the province without checks and balances.
So where in the act is the the deputy minister given the power to forgive a $6 million promise to pay legal fees, he asked?
Bond couldn't, or wouldn't answer, except with an unsupported clam the authority is somewhere in the act.
Maybe she reflected a general government approach of refusing to provide specific answers to any questions.
Or maybe van Dongen has identified a serious legal problem in the B.C. Rail payment.
The ethical problem, of course, remains in any case.
Basi and Virk pleaded guilty to get $6 million to pay their legal fees (and light sentences). If they had not, they would have lost their homes and everything they had.
Without the inducement provided by the provincial government, the trial would have continued.
The appearance - at the least - is that the provincial government paid to persuade the defendants to plead guilty. And that is not how the justice system is supposed to work.
You can read the exchange between Bond and van Dongen here.
Sunday, April 29, 2012
My driving test in 2039
It struck me that if I take a driving test at the same age, it will be in 2039, which seems improbably far away. (I posted the observation on Facebook, and people commented hopefully on the possibility I'd take the test in a solar-powered flying car.)
Then I realized that if our two youngest, Sam and Rachelle, face the same retest at 87, it would be in 2072.
If our youngest grandboy Owen faces a test at the same age, it will be in 2096.
It's my birthday today, so I'm a little more conscious of the passing of time.
But I've never really thought about the prospect of being around in 2039 (accepting that I might not be). The idea that a kid I know and care about will quite likely be waiting on the arrival of the next century is mind-blowing, to use a word that reveals just how long I have been around.
And instructive. I tend to think of the next few years. When I was a corporate guy, running newspapers, I thought of the next few months, the quarterly results being all important. Politicians think in terms of a four-year election cycle, or less if there aren't fixed election dates.
But for our children, and their children, the game is much longer. Logging protected areas to get three or four more years of production won't mean much in 10 or 50 years. Running a deficit to pay today's bills just means a debt that will be due in the future.
Then there are the big issues. Even if climate-change deniers challenge the scientific consensus on causes, the changes ahead are significant. Here in Honduras, they are imminent. People have planted beans and corn on the same days in May for generations, confident the rains would come soon after. If the rain doesn't come, and the crops wither, they go hungry and, perhaps, children die. In the 'developed world,' adaptation and technical responses are possible solutions. Not here, not for the 60 per cent of Hondurans living in poverty.
And there are the trend lines. In Canada, wealth has been increasingly concentrated in a small group, thanks in part to government policies, as I noted here. If that trend continues over decades, the gap will be enormous.
Voter turnout - the ultimate indicator of government legitimacy - has steadily fallen. When will it reach a point that democracy is no longer a credible concept?
It's past time that political parties - and all of us - start to talk about the future we see for our grandchildren.
Thursday, April 26, 2012
The distinct allure of abandoning democracy in Honduran cities
Now I'm not sure the Honduran government's decision to give them a try here is wrong.
The concept is a free-market elitist's dream. Set aside a large parcel of land, big enough for a city with several million inhabitants. Make it, at least figuratively, a walled city separate from the norms and conventions and justice system and laws of the host country.
Suspend democracy and give power to appointed experts who would set up new rules and enforcement systems. (Some basic rights and guarantees would be preserved.)
The common model would see foreign governments, and private companies, help with administration - maybe providing judges or a police force.
The concept is that the cities, by providing stability and safety and shunning corruption, would attract foreign investment. There would be jobs. And people would choose to move to them. The Globe column pitches the idea as creating a little Canada in the middle of Honduras, which is in itself attractive. Equally, it could be described as setting up a little China in the middle of the country, with the state's experts making all the rules.
The idea tends to be embraced by free-market enthusiasts, who counter the undemocratic aspects by noting people can vote with their feet by moving away from the city if they don't like it.
That's not really democracy, nor is it really true. Desperately poor people - and more than 40 per cent of Hondurans live in extreme poverty - grab at any opportunity. Survival takes priority over exercising or demanding democratic rights. Some 700,000 Hondurans are living illegally in the U.S., and every day people try a dangerous journey to a better life, risking robbery, murder and starvation along the way. In the first three months of this year, the U.S. has sent 8,200 people back. (The economy would be devastated if Hondurans didn't head to the U.S. They send about $2.7 billion back to their families here - about 19 per cent of the country's GDP. (Those quick with numbers will note that the entire economic output of this country of 8.3 million people is less than British Columbia spends on health care.))
So claiming that they will leave a charter city if the masters abuse them is just false. (There is a useful post on the perils of model cities here; advocates make their case in this report.)
Democracy is messy and inefficient. But who would the appointed directors of the charter city serve - the citizens, or the companies, largely foreign, whose investment is essential to the city's success?
It's not just a theoretical discussion here. Last year, the Honduran Congress voted to allow Regions Especial de Desarrollo, or REDs. The law clears the way for charter cities.
But all that said, I can't reject the idea out of hand. It is really tough to see a way forward, one that would ease the suffering and give hope to Hondurans, who consider crime, corruption, poverty and bad government the norm, and an inevitability.
Maybe model cities - for all the risks - would offer an alternative that would at least suggest possibilities for the people of this country.
As Bob Dylan said, when you ain't got nothing, you've got nothing to lose.
Friday, April 20, 2012
Byelections not great for Conservatives, or Liberals
Wednesday, April 18, 2012
PIne beetle jobs disaster and government inaction (and secrecy)
Tuesday, April 17, 2012
The strange world of Honduran teachers

There's no end of baffling stories in Honduran newspapers. Today, I read about a three-toed sloth - endangered here - rescued from a San Pedro Sula home where it was being kept, badly, as a pet. It's doing OK. The story was unclear why the people thought a sloth would be a good substitute for a dog.
Thursday, April 12, 2012
The politics of buying dead white men's clothes in Honduras
I bought a T-shirt yesterday, my first clothing purchase in Honduras. It was overdue. We packed the night before we left, weighed our bags and found we had to shed about 20 pounds worth of stuff to make the 50-pound per-person limit. The skimpy wardrobe got skimpier still.
Tuesday, April 10, 2012
Semana Santa in Honduras
We've made it through our first Semana Santa - Easter Week - in Copan Ruinas.
It's a fascinating phenomenon.
For starters, it's the year's big holiday, and much of the country is on the move. The public sector, and some businesses, shut down for the week; most operations just knock off early on Wednesday and don't re-open until Monday.
The tradition is that people travel for a brief break - to the beaches, or back home if they have moved away, or just somewhere different. The main bus terminal in San Pedro Sula handled some 1.3 million people in the week, mostly in the last five days. The roads are jammed, buses packed, prices rise and people crowd into the tourist spots. (That's not just true in Honduras; we avoided Semana Santa travel in Mexico after seeing pictures of beaches we knew as uncrowded staked out with tents from the high-tide line on back.)
And, of course, there is Easter. On Palm Sunday - the week before Easter, for those out of touch - there was a procession to the Catholic church on the square, with everyone carrying big palm branches. (Much more dramatic than the little folded palm crosses I remember from my Anglican youth.)
On Thursday, the night before Good Friday, they decorated two blocks with alfombras - literally carpets, but in this case elaborate scenes created on the street with coloured sawdust. Volunteers started work that night, laying down a base and using stencils to add colours from big bags of dyed sawdust. By about 2 a.m. they had created one block of scenes from the life of Jesus, and another of Mayan symbols. (The alfombras in the big cities are hugely elaborate.)
On Good Friday, there were morning and evening processions. We followed the morning group, which sets out from the church, people in robes carrying draped tables with large sculptures of Christ and the disciples, several hundred others following along. At each of the stations of the cross - 14 here - the procession stops and there is a Bible reading and brief sermon. The stations, on the cobbled streets, were decorated with draperies and a carpet of the long green pine needles that grow on the trees in the hills.
The sun beat down and it was roasting, in the low 30s, and the route led up steep, cobbled hills. It was impressive, especially when a group of women - mothers, obviously - came down from the Barrio Buena Vista carrying a platform with a haunted looking Mary, meeting with the main procession at Station 4, where Jesus meets his mother on the way to Calvary.
The spoken messages at each stop were interesting. The theme seemed to be how messed up Honduras has become - crime, corruption, drugs, alcohol - and that it was time to do something about it. (Though what was less than clear.)
When I watched celebrations from other cities on TV, the Catholic priests were talking about the same things. It appeared to be an orchestrated message, though less than half of Hondurans now identify as Catholic; evangelical churches have made great strides.
The evening procession was smaller, and the last few hundred yards were over the alfombras, scuffling them into obscurity. It was a mix of highly traditional rituals and low-budget technology. For music, a kid was carrying a $50 battery-power boom box, a guy walked in front of him holding a microphone, and a third person - who must have been deaf by the end of the day - walked in front with a giant white megaphone on his shoulder.
There was a fair amount of partying going on during Semana Santa as well. One of the messages in the procession was that people should be spending more time reflecting on Easter's meaning, and less on plans to hit the beach.
The president - Porfiro Lobo - made the same point in a statement as the week began. He urged all Hondurans to use Semana Santa as a time to reflect, and think about what they should and should not do. He suggested strongly he was spending the week at the family ranch doing just that.
But La Prensa found his photo on David Copperfield’s website, posing with the magician after catching his show in Las Vegas. It's a sore point, as many politicians apparently head to Miami and other U.S. destinations for the week, while most people pile into a bus and head to a crowded beach.
By Sunday morning, the sawdust was swept up. By the afternoon, things were back to normal.
But there was a cost to all that rushing around. The accidental death toll from the holiday included 29 people killed on the roads and 18 drownings. About 30 people drown in B.C. in a year. Honduras has twice the population, but 18 in a week shows a certain casualness about life and death that seems a problem down here.




