People's hope for prescription drugs goes up in flames

Medicines burn at the dump in Santa Barbara

A tragedy played out late last week at the garbage dump in Santa Barbara, Honduras, where three big truckloads carrying tons of expired pharmaceutical drugs were burned. 

This comes less than a month after another story in the Honduran media about publicly funded prescription drugs valued at almost 13 million lempiras - $660,000 - being thrown out during 2010-11 due to expiration even while countless sick, poor Hondurans waited in vain for the medicines they'd been prescribed but couldn't afford.

You only have to contract dengue fever once to empathize with how miserable life would be if you couldn't afford a few tabs of acetaminophen to get you through the worst of it. And there are a heck of a lot of people in this country who would be in that situation, even though $1.50 will get you 100.

But this is far from being just about pain management after the mosquitoes get you. It's about vast quantities of drugs essential for people's well-being and health - paid for in many cases by international non-profits doing aid work in Honduras - that never make it into the hands of the people they're intended for, or anyone else's hands for that matter. 

You need only spend a few days at the children's home where I help out to get a sense how little access average people have to medicines. There's a public health system of sorts here (although I think it's safe to say that nobody who can afford private care would ever use it) but medicine isn't covered. 

Right now, at least half the kids at the home appear to have impetigo. But even a tube of antibiotic cream to clear up that highly contagious skin condition is a luxury. 

And some of the children clearly have chronic, debilitating health conditions that are much more serious than impetigo. Unfortunately, even if they were ever properly diagnosed - a rare luxury in itself - whatever medications they need wouldn't be available   unless somebody was picking up the bill.

And perhaps the worst of it is that the whole issue of drug expiry is something of a myth. I did a Google search to find out more about drug expiration dates after reading the sad Santa Barbara story this morning, and pulled up no less than a Harvard Medical  School report that puts the lie to this business of expired medicine being ineffective or  dangerous. 

"Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military," notes the 2003 report.  "With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90 per cent of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date."

It turns out that a law was passed in the U.S. in 1979 requiring all drug manufacturers to stamp an expiration date on their products, "the date at which the manufacturer can still guarantee the full potency and safety of the drug." And from that rather arbitrary decision, we can trace a line all the way to 2012 and the foolish decision to burn a warehouse full of drugs that many, many people could have used.

The Harvard report says the potency of drugs do diminish over time, but the expiry date stamped on the package has little relation to when that will actually happen. 

"It's true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date. Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long-lasting as the ones tested by the military."

Alas, nobody in the Honduras health system did the same Google search before calling in the truckers to haul away the "expired" prescription drugs. A tremendous waste of international resources. A tremendous loss to millions of Hondurans who are essentially living without health care. 

It's not always about the money

After eight months in Copan Ruinas, I’m finally getting 10-lempira moto-taxi rides.  It’s a big moment.

Not because of the money, mind you. My experience is that foreigners typically pay two or even three times as much as the locals for a moto-taxi ride here, but we’re still talking a difference of no more than 50 cents or a buck per ride.

But I admit to being bugged by the two-tiered charges these past few months, and am happy for whatever threshold I just crossed that led me to being viewed differently by the moto-taxi guys.  I don’t know what changed, but I’ll take it.

Moto-taxis are the only form of public transportation for getting around Copan Ruinas. They’re small three-wheeled, canvas-topped vehicles that can accommodate two comfortably, but it’s not uncommon to see one labouring up the hills with three adults and a few small children aboard, along with that day’s load of groceries or other supplies from the town centre.

I found the code of the moto-taxis to be something of a mystery when we first moved here. We knew enough from those who had gone before us to ask what the charge would be before we got into the vehicle, but I had no idea how to gauge the prices the drivers gave us. When you come from a place like Canada, a ride from the bus station to your house that costs a couple bucks sounds like a pretty good deal.

So we’d ask, and the drivers would quote us something, but then we’d just get into the taxi and pay whatever the rate was.  Some drivers charged more, some less; if there was a pattern, I couldn’t see it.

But then I started talking to my workmates about what they paid when they took a moto-taxi to work, and realized that I was paying a lot more than the going rate.  I’m no babe in the woods when it comes to being a tourist in a poor country, so I wasn’t exactly surprised by that. Still, it started to grate.

I accepted the two-tiered rates for quite a while as the price for being a comparatively well-off foreigner in an impoverished land.  And fortunately, just as it was really starting to bug me these past few weeks, everything changed and suddenly the drivers were charging me the same rate as everybody else.

I’ve also come to understand that rates are better if you share a ride, as do so many locals. So if you’re willing to stand at the taxi stop for a while and wait for someone else who’s going in your direction, you’ll pay 50 cents instead of a dollar for the ride up the hill. I suspect the drivers didn’t even consider packing other people into the taxi with me in the first few months, so part of the reason I’m getting local rates now could be that the drivers understand that I’m OK with a crowd.

I’ve also learned to refuse rides on occasion, when I know I’m being overcharged. The drivers don’t appear to take it personally – they just don’t give you the ride.  Some will even ask other drivers at the stop if they’re willing to take me for the local rate. Either somebody agrees to and off I go, or I wait for a bit to share a ride with another person going in my direction.

Again, I’m a little embarrassed to be making a fuss over a difference of 50 cents. But I hope at least some of you know how it feels to be indignant over a principle. All I know is that somewhere around the seven-month mark it really started to get to me that I had to pay more solely because I was a gringa.

The drivers charge by the rider, so whenever my partner and I are catching a taxi together I know the rates will be higher.  (I think we also look more gringo-ish when together.) One rainy night when we were returning from San Pedro Sula and the bus got in late, we really wanted to catch a moto-taxi for the short hop home, but ended up walking rather than feel exploited by the record 60-lempira ($3) rate the driver quoted us.  Serves us right for using the bus service frequented by gringos, I guess.

Drivers aren’t getting rich by any means, and only a few of them actually own their own taxis. I think any visitor coming from a country like Canada or the U.S. will find prices extremely reasonable in Copan, and I’m definitely not advocating that tourists start haggling with drivers to drop their rates.

But I’m grateful for whatever made drivers decide I was due for the local rate. It makes me feel like I live here.

One more cup of coffee for the road

The beans are starting to turn red in
La Cuchilla, Santa Rita

This is the time of year when Honduran coffee growers find out what price they can expect for their beans when the harvest starts in November. And right now, the news looks pretty good.

The current international price for Honduran coffee beans is $161 per quintale - 100 pounds.  My co-workers at the Comisión de Acción Social Menonita tell me the make-or-break-it point for the small producers around Copan is $150 a quintale. So getting $11 more is happy news indeed, especially after the bad year local producers had in 2011.

That’s the thing with coffee as your only cash crop: You just never know. There used to be a marketing board of sorts for coffee that kept prices more predictable, but that ended in 2001. Prices now fluctuate from year to year, creating booms and busts for coffee growers.

The big growers ride out the highs and lows. But for small producers a dip in prices makes the difference between eating and going hungry after the harvest ends in February. In three Copan area coffee-growing communities where CASM has a project going on, producers have plots ranging from four to eight acres, and are frighteningly dependent on coffee to cover the year's bills.

A North American might easily drop $2.50 or more on a cup of coffee at any high-end coffee shop in their neighbourhood. Allowing for 40 cups of coffee per pound, the price you pay for the amount of beans used in your cup is about 100 times more than what the grower in Honduras got paid.

Blame some of that on all the middle men that lie between the grower and the consumer. But there’s more to the economics of coffee than that.

World tastes change all the time, swinging from Arabic to Robusta, from mild to dark.  The fate of producers all over the coffee-growing world hangs in the balance, as each country has certain beans that it grows best.

Then there are the many natural disasters that small producers have to worry about, from insects and coffee leaf rust to uncertain weather patterns and poor soil. If there’s plenty of rain in May, that bodes well for a good crop later in the year. But too much rain in September and October can bring all the coffee plants on at once, wreaking havoc on a harvest if pickers end up in short supply.

Even in a just-right year, the small growers around Copan have to rely on pickers from Guatemala, seeing as every Copaneco  with hands – including children as young as seven – has as much work as they can handle during the four busy months of the harvest.  A quarter of the country’s eight million people directly participate in the annual harvest (USDA Foreign Agriculture Service), earning the equivalent of $71 million during those four months.

Honduras was the second-largest exporter of coffee in the world last year, according to last month’s report from the International Coffee Organization. Among the subsistence farmers that CASM works with, coffee is by and large the only crop that generates money.  Even the corn and bean crops they need to feed their families take a back seat to coffee, with many farmers opting to bypass a second planting of vegetables in order to free up time for the hectic coffee harvest.

It’s understandable, but so risky. The project CASM has just launched in the aldeas of La Union II, Guaramal II and Las Flores involves mapping the indicators of when a community is at risk of widespread hunger. It’s clear a mere week into the project that the state of people’s coffee crops is going to be one of the major determinants.

The world drinks an astounding 1.4 billion cups of coffee a day. I’m sure it can’t be good for us. But given the economic disaster that would befall coffee-dependent communities were we to ever shake the habit, just think of it as taking one for the team.

If problems exercise your brain, I'm in a mind marathon

Tearing apart the old bathroom

 I once made the horrible mistake of buying glue traps to deal with a mouse problem. I got up the next morning to the unforgettable sight of a poor dead mouse that had gotten his little paw stuck first, then another paw, then the side of his face.
I'm starting to suspect the water project at the children's home here in Copan might be angry mouse spirits getting back at me for that wrong deed. Every thing I touch up there just seems to stick me tighter into the glue.
The plan was for new bathrooms and a big new water tank so that the Angelitos Felices foster home had decent basic services for the 30 or so children who live there. The mason who took on the project told me he'd have it done in 15 days.
A little over three weeks into the project, the bathrooms are done and the tank's in place, sitting atop a nicely reinforced concrete floor to avoid any risk of 5,000 pounds of water crashing down on sleeping children in the room below. I have to laugh now at how I once thought that would be the most complicated part of the project.

A new front door! Not rotten!

The foster home is a scant four years old, which is unbelievable when you see what a state it's in. Who knew that a door frame could rot out in four short years? Like they say, you get what you pay for, although rumour has it that you can't pin the blame for the shoddy job on the benefactor whose name is on the commemorative plaque outside (like everything else to do with Angelitos, it's complicated).
At any rate, that was the second big surprise once the mason and I got the crushed-children problem sorted out - that virtually every tube, fitting and pipe in the home would need to be replaced. All of them were either undersized, plugged, broken or missing entirely.
There wasn't a single trap on any of the drains or toilets, which certainly went a long way to explaining why the place smelled so bad all the time. The cistern in the street where the city water came in - well, you don't even want to know what that looked like inside, what with a passing dump truck having caved in the metal lid some months before and the hole in the ground catching all kinds of filthy runoff from that point on from the surrounding street.
The cistern had to be drained and rebuilt, as did the water pump that by this point was packed with the mud that had settled a foot deep at the bottom of the cistern. The pipes running from the cistern into the home had to be replaced, as did the pipes in the street connecting the Angelitos water system to the city supply.

Check out that big new water tank and tortilla/beans sink

Weird things kept cropping up. Like the badly built drain pipe above the children's bedroom that poured water into the room whenever it rained. The hole in the floor in the grubby little half-kitchen upstairs, where staff had gotten into the habit of just dumping food waste down onto the property of the increasingly irritated neighbour. The lack of water access in that same cramped attic of a room, which meant staff had to pack dishes and cooking water up and down three steep, dark flights of stairs and through the children's bedroom anytime they were making tortillas and beans (which is to say, daily). That rotting front door, which somehow managed to stick fast at the bottom while dangling loose at the top.
The kitchen water came straight out of the cistern instead of being connected into the rest of the system - a big problem anytime there's insufficient water in the cistern. The outside gutter poured rain water directly onto the ground in front of the home from two stories up, creating a muddy mess and irritating the neighbour on a whole other front.

Renovated downstairs bathroom

Addressing those many issues weren't part of the original plan. But what are you going to do? So we added them in.
This week was supposed to be the week everything came together. Ah, but I should have known better.
The water was supposed to flow into the newly renovated system for the first time on Sunday, but the cistern didn't fill. The work crew had to dig up the street to find the problem.
Then the cistern filled, but the water didn't flow into the home, necessitating a whole other round of digging. On Tuesday, the big tank up top filled for the first time, but a faulty valve that had been overlooked let all the water drain away over night.
Today it almost all came together - the cistern filled, the water flowed into the stone pilas where the clothes are washed. But the staff was so enthusiastic about finally having water to wash the thousand or so pounds of dirty laundry that had built up that they drained the cistern, which meant the tank up top didn't fill and the bathrooms weren't working.
I learned something else today: The pipe that connects the Angelitos system to the city water supply is ridiculously small. So even when the water does flow - every other day in that neighbourhood - it's quite likely not going to be enough for the needs of the home. And wouldn't you know it, using a bigger pipe is prohibited by the municipality.
New project: Get to know the mayor.

I wanna be free - or do I?

I come from a land where you get a parking ticket if your tires are deemed to be too far from the curb. For a while it was illegal to make balloon animals in downtown Victoria, and just this summer the city launched a court battle to stop a woman from taping little posters to telephone poles advertising her cleaning service. 

So it has been very enlightening to move to a place where you are essentially free to do whatever you want. 

The street dogs howl at midnight. The possibly deaf neighbour across the way blasts his radio into the street at 5 a.m.The sidewalk food vendors sell their wares with no fear that a health inspector will ever come by. 

One day I watched a kid digging a huge hole in the asphalt road in front of his house - the main road into town - to get at a broken water pipe. Nobody blinked. You can herd your cattle along the highway, stop your car dead in the middle of a skinny side street to have a conversation with an acquaintance, and make balloon animals until your lungs burst.

There's good and bad to each approach, of course. Victoria often drove me mad with its abundance of rules and vigorous enforcement, but there are times when I do miss the poop-and-scoop bylaw now. I could probably go for a car-idling bylaw in this land where everybody just leaves their trucks to run, or an aggressive anti-litter campaign. And would it be so wrong to have a few ground rules around overly loud car stereos?

 I'm very happy not to be hearing police and fire sirens around the clock anymore, as can happen in a region of 340,000 residents with six police departments, 13 fire departments and an abundance of ambulances.

But I'm sure I'd miss the friendly, competent faces of the Victoria police force in the event that a crime happened to me here. I don't even know how to call the police here in Copan. Based on the stories I've heard about police in Honduras, I'm not even sure I'd want to. (They've started doing lie-detector tests on police in the country to try to root out corruption, and 26 from the first group of 54 failed.)

I think some of us from rule-bound countries find ourselves longing for a land where you'd be free to live the life you choose, for better or worse. But it wasn't until I came to a country where that's essentially true that I started to understand what that really means. 

One thing that’s clear about life without rules is that it's all or nothing. There isn't one set of rules for the "good" people and another for the "bad" - you're all just in there together doing whatever the heck you want. 

In our dreams we might envisage such a world as a place where everybody would simply opt to do the right thing once there was nobody telling them what to do, as if goodness would be a natural fallback position once government got out of the way. In fact, it's everybody for themselves. 

I imagine that any of the 6,000 small businesses in Tegucigalpa that have closed in recent years rather than continue paying costly bribes to scary neighbourhood toughs would be very happy to have their personal freedoms constrained in exchange for proper policing. Extortionists in that city pluck $200 a week out of the hands of hard-working bus drivers on 100 routes, which is quite a price to pay for freedom.

Here in the land of the free, you frequently hear the word impunidad – impunity, used to describe people who do as they please without fear of punishment or consequences. This morning’s newspaper brought the outrageous news of the 60 mayors, 53 vice-mayors, 410 registrars and 17 deputies of the Honduran National Congress who collect their government pay and their share of an additional $90 million a year in salaries for non-existent teaching jobs.

And if you’ve ever doubted that some people will kill with impunity in the land of the free, doubt no more. Honduras has the highest per-capita murder rate in the world, and barely 10 per cent of the crimes are solved.

I’m not saying I want to live where there’s a rule for everything and an official ready to punish you for the slightest deviation from the grid. But time spent in Honduras does tend to take some of the shine off freedom.

A clearcut problem

Corn-field clearcuts around Santa Rita, Copan

What would bring 20 busy coffee producers out to a mid-day meeting on watersheds? The realization that if there's a solution for what's happening to the water supply on their fincas, it will have to come from them.
The meeting was the first in what sounds like a long, slow process to have the Marroquin watershed in the hills above Santa Rita, Copan, declared a protected area.
Some 16,000 families rely on the water that flows from this area. But climate change and the dramatic loss of forest has taken a toll. One producer at the meeting - organized by Honduran NGOs and regional groups working on such problems -  figures his water supply is half of what it was a few years ago. That's a scary development in a country where access to water for crops and consumption is still far from a given in rural communities.
Much has been made in the international press about the loss of forests in Honduras. In the last four years the country has lost more than 33 per cent of its once-abundant forests, triggering problems ranging from mudslides and erosion to flash floods and road washouts.
The effect of deforestation on watersheds is more subtle, yet devastating over the long term. A forested hillside acts like a sponge for absorbing rainwater. Forests not only prevent heavy rains from wreaking havoc as they tear down slopes in a torrent, they retain water long enough that  underground sources can be replenished.
Climate change is already shortening the growing season dramatically in Honduras. Parts of the country lost half their corn and bean crops this summer when the rains didn't come. Old-timers say you used to be able to count on the rainy season arriving like clockwork every May 3; now, it's mid- to late June, and even then farmers can't be sure.
Deforestation is adding to the crisis.
The blame typically gets put on illegal logging, which conjures images of well-organized mahogany thieves smuggling valuable timber out of the country with no thought to the damage they're doing. And yes, that happens.
But the problem is more complicated than that. With almost 70 per cent of the population living in poverty, many of the country's forests are simply being cut down in tiny bits and pieces by millions of people trying to eke out a living.
Look up into the hills from virtually any road in the country and you'll see the endless checkerboard of subsistence corn crops that now grow where trees once stood. Coffee crops prefer shade and in theory are a good fit with forests, but in the higher altitudes where the temperatures are cooler, it's not uncommon to see land clearcut by small producers for coffee as well.
Firewood continues to be a major source of cooking fuel for Hondurans, and not just the poorest families. Propane is expensive when you're going to be slow-cooking beans every few days for hours at a time, so virtually every home has a wood-burning fogon in the kitchen. Poor families from the villages around Copan make the trek into town every day with bundles of firewood scavenged from the hillsides for sale in town.
No doubt each corn farmer, each firewood seller, feels like they're barely making a dent in the forests of Honduras. But the collective damage is significant. Processes like the one to declare the Marroquin watershed a protected area are intended to raise people's awareness of that collective impact, and to make a plan together for what can be done about it.
Nor is logging the only threat. Bathrooms are still something of a luxury in rural Honduras, and sewage collection is even rarer. Coffee growers don't always pay attention to what happens to the toxic runoff from the pulping process. Runoff from animal waste and chemical fertilizers add to the problem.
Honduras has plenty of rules, regulations and laws; what's missing is enforcement. So the mere declaration of a protected zone doesn't mean much on its own. Much of the work at the meeting in Los Planes de La Brea this week involved gathering the names of property owners who have forest land in the watershed, because no solution can come without their co-operation.
The coffee producers agreed on a bigger invitation list for the next meeting later this month, one that includes municipal staff from neighbouring communities as well as public and private landowners in the watershed. With so much at stake, a plan can't come soon enough.