There's a person in there

This one's for my mom, who at this moment is at home in Victoria crying after they delayed her hip-replacement surgery for two more months this morning because of her low iron count.
I'm sure it seemed like a perfectly logical decision in the mind of hematologist Dr. X, who has never met my mother. And it probably made sense to Dr. Y as well,  the orthopedic surgeon who has also never met my mother.
Unfortunately for her, the news was completely devastating. She was supposed to be having her surgery next week, and on Sunday we'd joked about how she only had 11 more sleeps.
I'm a guilt-ridden daughter at this distance when my 87-year-old  mother has a setback like this and the best I can do is buy more Claro minutes to make sure I can call her regularly. I have to take that into account when reflecting on how angry I am about how things are playing out for my mother, because it could just be that what's really troubling me is that I'm far away and can't really do a damn thing to help her.
Even allowing for that, however, I still think this turn of events highlights the huge divide that separates  people needing integrated medical care and the segmented, depersonalized system we've got that can't possibly provide it.
One of the doctors caring for my mother thinks it might be all the Advil she was taking for the pain that caused her iron to drop to a level that has now increased the risk of excessive bleeding during surgery.
Maybe. But they've known for the last 10 days that her iron levels were  low. Yet nobody did anything to change that, or counsel my mother as to why that might be so. This morning, the specialist's office phoned to cancel her surgery because of her low iron, but even now nobody is telling her anything about how she's supposed to correct that.
I'm a strong supporter of the Canadian public health care system. The fact that my old mom can have publicly funded hip-replacement surgery in her local hospital at her age is a testament to what is right about our system, even allowing for some long (and painful) waits for surgery.
But Mom's latest problem isn't about long wait lists. It's about the way we get divided into parts for the purposes of medical care, to the point that doctors start to forget there's a  human being tucked away in that medical file.
I'd like to meet the doctor who could have told my mom to her face that her surgery was being cancelled. She's been waiting and waiting, and has managed the intensifying pain these past few weeks only by focusing relentlessly on her coming surgery date.
No doctor could have looked into her pain-filled, hopeful eyes and told her sorry, she'd have to wait two more months because the pain-killers she'd been using to be able to hang in through the long wait for surgery had caused her iron levels to drop -  and that even though they'd known about that for 10 days, no one had taken the initiative to do something about that.
Alas, nobody had to look her in the eye and give her the bad news.. Nobody even had to meet her. She just got the news by phone, passed on by an empathetic but powerless woman who works for the surgeon. My mother is essentially a file number sent to various specialists with busy schedules, who have no clue of the impact of their decisions on the lives of those whose lives are hanging in the balance.
Mom told me she'd been crying all day when I called her tonight. But I know her well enough to expect that even by tomorrow, she'll have her chin up and be preparing to soldier through these next two months in whatever way she can. She's just that kind of person.
That doesn't make any of this right, though. Just because she can take it doesn't mean she should have to.
She's put in her time waiting. She did what good Canadians do: She looked after her health for many, many decades, and never complained when she learned she'd have to get in line for her hip surgery.
And this is where it gets her. In her time of greatest medical  need, my mother deserved better than to be shunted aside by strangers for whom she was no more than a set of  lab results.

Hungry for attention

The tortilla masters: Carina and Sofia

Yesterday I climbed up to the smoky little half-kitchen that's tucked into an attic-size space at the Copan guardaria to help a couple of the girls make tortillas.
I'd had visions of everyone being fed and ready for a fast visit to the playground when I first arrived, seeing as I needed to get back to work. But it was soon obvious that wasn't going to happen.
I don't much like the tortilla room, as there's always smoke hanging heavy in the air from the little "eco-friendly" wood stove that I'm sure would be great if it only had a chimney. But it seemed anti-social to say no when invited along.
The girls whipped my butt with their tortilla skills. One, age 10, has been making tortillas for more than six years. She smacked the corn dough quickly between her palms and made perfect, smooth-sided circles every time.
The other, 15, is already assuming a motherly role at the children's home, as do all the older girls. She smiled at me indulgently as I handed over my scruffy looking tortillas for her to cook on the wood stove, lapsing into her teenage self only long enough to remind me that I'd promised to bring her a pair of earrings one day soon.
As we patted out the dough, more children made their way up the dark concrete stairs leading to the tortilla room. We got to talking and joking about this and that, and suddenly I realized that we were having a Kitchen Chat. I remember my own kids loving the relaxed conversations that can happen in kitchens when everybody's preparing food together, and it was revelatory to see this group of kids falling happily into the same kind of easy banter.
I've spent many months now thinking about how I might get more stuff for the 25 children who live at Angelitos Felices - toilets that flushed, showers that worked, diapers for the little ones so there wouldn't always be poo on the floor,  more food, better clothes, shoes that fit.
But the more I get to know the kids, the more I realize that what they want more than anything is my time. They don't pay much mind to their thread-bare clothes, lack of toys, ridiculously wrecked footware or painfully monotonous daily diets. But they sure do like having somebody who hangs out with them.
I've been going up there every Sunday to spend time with them, but I missed two weekends recently when my spouse and I took a small holiday to Guatemala. Man, the kids lambasted me for that when I showed up on Tuesday to say hello, which is how I ended up guilted into a lunch-time play date two days later.
It's hard for a North American parent to conceive of just how little adult attention these kids get. We typically start thinking about our children's well-being before they're even out of the womb, and for the most part will spend several hours a week for many, many years engaged in activities on behalf of our child.
These kids get the basics, but that's about it. They eat, they sleep, and some of them go to school. Sometimes they go outside to play, although not often. At least the water-system renos we did at the home last month has given them functioning bathrooms.
You can't fault the weary caregivers for not spending more time with the children. They're working for slave wages, if they even get paid at all. At any given time there's just one woman on duty in the home, and she doesn't have a moment for anything other than the endless chores that pile up like the mountains of dirty laundry generated by the kids.
Nor can you fault the woman who owns Angelitos (although much of the community would like to). She might not be running the kind of place that any of us would want to imagine a child growing up in, but at least she's putting a roof over these kids' heads in the absence of any consistent operating funds. People in Copan spend a lot of time gossiping about how somebody ought to do something about the home, but only the young American woman who recently opened an alternative day care appears to be actually doing anything significant.
So in the meantime, it's Angelitos or nothing. I have to believe that better days lie ahead for the abandoned and abused children of Honduras, but right now there are more than 20 children and young people living in Angelitos and they're not going anywhere. Whatever might happen in the long-term to improve things for kids like them, these kids are stuck in this moment.
I regularly hear from travellers asking me how they can help the children of Angelitos. People have big hearts and they really do want to make a difference.
There's no end of ways to do that for this gang, who have so little. But as long as you're coming this way, spare a thought for just making time to hang out with them. Somebody with the time to care is the real luxury item in these kids' lives. 

In the land of big cows and gleaming rest stops

Three of my work buddies from the Comision de Accion Social Menonita  just came back from the World Dairy Expo in Madison, Wisconsin - their first trip to the United States.
As you might expect, the trip blew them away. Like all good travellers, they took a ton of photos, and it was great to share their experiences yesterday as they flipped through the large collection of classic tourist shots they took on their journey.
Several of them were of rest stops along the highway. I have to admit, it's been a long time since I've given much consideration to the glory of American rest stops, but the guys were captivated by them and I get that.
"Look at this! They have these all along the roads," exclaimed one of them as he pointed to a particularly clean and tidy example somewhere between Spooner and Madison. "Nobody works there, and anyone can just pull in and use them!"

They'd gone on the trip with the encouragement of a Spooner veterinarian, Dr. Allen Pederson, who comes to Copan Ruinas a couple times a year through the Seattle-based Christian Veterinary Mission. CASM does a lot of work with rural farmers that includes encouraging them to diversify their subsistence livelihoods with a dairy cow or two, and Allen figured the CASM gang would get a lot out of the grand spectacle that is the World Dairy Expo. (That and the fact that a purpose for travel appears to make it much easier for a Honduran trying for a coveted U.S. visitor's visa.)
Sure enough, those U.S. cows made a big impression on the guys, especially the $25,000 Holstein that's capable of producing an astounding 90 litres of milk a day. That's roughly 11 times more than a Honduran dairy cow produces. Even an average dairy cow in the U.S. produces40 litres or more a day.
But that's not really surprising given that a Honduran cow never sees the scientifically designed diet, careful breeding, hormones or vet care that's just part of life for a commercial dairy cow in the U.S. Here, the farmers with more resources might grow "super grass" that the international aid organizations have introduced to the country, but a lot of the tough little mixed-breed cows around Copan just get by on whatever they can scrounge up in the fields.
I asked the guys what they liked best about their visit. The October chill, said one, who admits to never having liked the heat of Honduras despite growing up here. The fall colours in the woods, said another. Trees do lose their leaves in Honduras, but they just kind of shrivel up and turn brown. This fellow was enchanted by the rich oranges, reds and yellows that anyone from a cold country recognizes as a familiar herald to winter.
Did they like the food? Not much. They were travelling on a budget that was well below shoestring, having forked over the equivalent of a month's salary for their $600 airfares that left them with barely any spending money for the actual trip. That meant eating as cheaply as they could - sandwiches at Subway, fast-food burgers.
"Everything was with bread," declared one fellow, who found the diet monotonous. I got a quiet laugh out of that - I guess my buddies are oblivious to the monotony of their own daily diets of beans, tortillas, and those  sweetened hot-dog-style buns that everyone dips in their morning and afternoon coffees.
The cultivated pine forests charmed one of the guys, who sees much potential for similar forests in Honduras. Pine grows well here and is ready for harvest in 10 years because of the warm climate, compared to 40 years in Wisconsin. But I come from a land that's in the process of losing most of its pine forests to the voracious pine beetle, and I suspect the damage being caused by a similar beetle right now in the forests of Honduras will ultimately bring about the same devastation here as climate change alters the environment.
It's too bad the boys had barely a week to enjoy the sights, because there's nothing more valuable than seeing another culture in action when it comes to clarifying what's good and bad about your own culture. Were I a person with the money to invest in a new future for Honduras, I would launch a massive exchange program that sent Hondurans to work and study in developed countries, where they could learn that ambicion isn't always a bad thing and better governance is possible.
But for now, at least the guys know that good roads and rest stops exist. That's a start.

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.