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How do aid doctors work in world's most murderous nation?

Source: Thomson Reuters Foundation - Thu, 22 Nov 2012 07:47 PM
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By Anastasia Moloney

It’s taken medical charity Doctors Without Borders a year and a half to gain the trust of people living on what are arguably the world’s most dangerous streets in the Honduran capital of Tegucigalpa.

Honduras has the highest murder rate in the world, with 82.1 murders per 100,000 people, according to the United Nations 2011 Global Study on Homicide.

The cocaine trade is blamed for much of the violence and drug turf wars in the Central American nation. Roughly 80 percent of cocaine entering the United States is transported through Honduras.  

Through painstaking efforts, medical teams from Doctors Without Borders (also known as Medecins Sans Frontieres or MSF) have managed to gain access and are providing on-the-spot treatment to people living in Tegucigalpa’s patchwork of crack dens, slums and rubbish dumps.

“It’s incredibly difficult to work in Tegucigalpa. It’s small and fragmented. Its corners and streets are controlled by different gangs,” Laurence Gaubert, head of MSF’s mission in Honduras, told AlertNet.

“We’ve gained the respect from this population. Acceptance takes time. It’s a step-by-step approach and a long process,” she added.


Simply setting up a clinic in slum areas to provide first aid and treat common injuries like gun and knife wounds, as well as helping drug addicts and rape survivors, wouldn’t work, Gaubert says.

What’s needed is to be physically present on the street and to talk to people - from glue sniffers, crack addicts, alcoholics, rubbish recyclers, prostitutes and pregnant teenagers to the homeless and HIV/AIDS sufferers.

“We need to be seen going in every day,” said Gaubert. “The secret is being visible and keeping neutrality and patient confidentially. If you’re not visible, it creates doubt about what you are doing.”

Since March 2011, a team of MSF doctors, social workers and psychologists have been crisscrossing downtown Tegucigalpa as part of a five-year project to reach the capital’s most needy and vulnerable, including residents of neighbourhoods controlled by gangs.

They try to persuade drug addicts, alcoholics and others to go to a hospital or clinic if they need to.

“We wanted to reach the most vulnerable and poorest, to have access to those people with the highest exposure of violence and detect emergencies,” said Gaubert. “Then if need be, refer them and help them get care at local hospitals and medical centres.”

On the street, doctors diagnose the people they meet and provide first aid - cleaning up, bandaging and stitching wounds, for example. Psychologists provide counselling.

Early next year, MSF plans to step up its vaccination programme, providing immunisations against hepatitis on the street.

From January to September this year, MSF's mobile team conducted 4,500 medical visits on Tegucigalpa’s streets, including 850 mental health consultations. Around 600 victims of violence were treated or referred to medical centres, including 68 cases of sexual violence.


The homeless and others living in downtown Tegucigalpa struggle to access any type of free health care, MSF says.

Ambulances no longer enter the most dangerous neighbourhoods and the capital’s only public emergency room is “completely overwhelmed”. Drug use among the homeless is widespread, but there are no detox centres nearby.

Worse still, some health centres have closed because they cannot pay extortion money demanded by local gangs, and some employees leave because medical facilities can’t ensure their safety, MSF says.

And state-run help for survivors of sexual violence is virtually non-existent.

The morning-after pill has been prohibited since 2009 and abortion is banned in Honduras on any grounds.

Growing violence in Honduras has pushed humanitarian organisations to leave or cut back their operations. In January, the U.S. government pulled out all its Peace Corps volunteers from Honduras over security concerns.

While MSF remains undeterred, keeping safe on the streets is a permanent issue for its staff and they are not immune from violence.

“Honduras is probably the hardest place I’ve worked in because you can’t predict what will happen,” said Gaubert, who has worked with MSF for 15 years, including in countries experiencing conflict like Democratic Republic of Congo.

“You need to be aware what’s happening around you at all times. Police are present in some areas but not in the most violent ones,” she said.

As a precaution, when walking the streets of Tegucigalpa, MSF staff are never more than five metres apart. Restaurants and bars have been identified where they can seek shelter if trouble kicks off.

Since MSF started its outreach work in Tegucigalpa nearly two years ago, the team has found itself caught up in four violent incidents, including gunfire.

“You can be at the wrong place at the wrong time. It has happened. But that’s not actually that much if you consider we go out on the streets every day,” Gaubert said.

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