Men's Health, Day 1

Saturday, July 7th was our first Men's Health workshop, something I've been organizing with the Foro Nacional de SIDA. We did half of the full workshop yesterday, and will do the other half next Saturday. In a nutshell, it went great! We had about 20 people show up (more than I expected, we had quite a full house) and they were all very enthusiastic.

At about 8:30am, Mary and I went to the OFRANEH Office to start setting up chairs for the workshop. We were ostensibly supposed to start at 9, but I had worked over an hour of leeway into the schedule since I assumed we would probably be starting about an hour late. People started to shop up around 9:30. By 10:00 most of the participants had arrived, and we got started.

Mary started us off with Lenguaje de Hombre (Man's Language), an activity about slang words used in the street, and why we use them.

After that, I ran a game called ¡Diga la Verdad, Hombre! (Tell the Truth, Man!) where participants had to answer questions about HIV, condom use and sexuality and then scramble to change seats, musical chairs style (there was always one less seat than the number of participants).

After a short break, I ran another activity called Chicas Calientes (literally Hot Girls, but it's a double entendre because caliente can also mean horny). The guys really got into this (because there were 8 scantily clad women posted up on the wall), and learned about the chain of transmission and how it's not possible to tell if someone has HIV only by looking at them.

Mary continued with Fluidos Pegajosos (Sticky Fluids), a lesson on which fluids transmit HIV, and the different situations and actions that carry risk of transmitting the infection.

Alan's kids really wanted to participate in the activities; I distracted them with my camera. They loved to pose for pictures.

While Kenny set up for the last activity, I did a quick activity called Si Da, No Da (a play on SIDA, the spanish acronym for AIDS).

Lastly, Kenny (one of my counterparts at FONASIDA) did Póngase el Sombrero (Put on the Sombrero) a lesson in how to use a condom properly. First 10 volunteers had to organize the steps to properly use a condom. Then, Kenny demonstrated the proper way to put on/remove a condom, and lastly the whole class practiced with plantains.

We got a lot of really positive feedback from the participants, and they all said they would come again next week, and bring their friends! I'm not exactly sure how we'll fit more people if that does happen, but I figure that's a good problem to have.

After the workshop, Mary and I were in need of some R&R, so we went to a beachside restaurant/hostel outside of Trujillo called Casa Kiwi (it's owned by New Zealanders). We met up with Johnny, and Irish med student who has been volunteering with Agua Pura down in Choluteca. We swam, watched the sunset, and played with an enormous starfish.

Herman the Gecko

Herman the Gecko
Originally uploaded by StormyPetrel

A quick word on bugs: They are everywhere. I always equated the tropics with big, marvelous looking bugs, but that's not the case here in Trujillo. Bugs are pretty much the same size here as in the States, just here there's about 100 times more of them, and almost all of them bite. Needless to say, I hate them. I wish horrible, painful deaths and all small, black, winged pests that invade my house to bite my flesh and suck my blood.

Which brings me to geckos. Geckos are everywhere in Honduras, and I love them. They're adorable yellow-green translucent lizards that scurry around your house at night, eating bugs. The eating bugs part is why I love them. Anything that reduces the population of mosquitos, flies, sand flies, ants, and the million other pests we have in Honduras is a friend of mine.

Geckos only come out at night. During the day, they find little cracks and crevices and nooks and crannies to hide in. My apartment, being almost completely bare, has few good hiding places for geckos.

Earlier this week, I was putting away some clean dishes when something moved inside the tupperware dish I had just picked up. It was a gecko! I guess my dish rack was the best hiding place he could find. I quickly snapped a top onto the tupperware, and looked inside.

He was a cute little guy, and the first gecko I'd seen in my apartment. I wasn't going to keep him in the tupperware as a pet (how the heck would I be able to get enough bugs to keep him fed?) but I did hold him long enough to take some pictures and name him Herman. After a while I let Herman go, and he scurried off to hide behind some shelves. I saw him again that night, running along the wall, chasing down the few bugs that managed to squeeze in through the screens covering my windows.

Geckos make a very distinctive (and loud) chirping sound from time to time. At night sometimes I hear Herman chirping away in my kitchen. It makes me happy to hear the call of my friend and ally in my never ending war against bugs.

Health in Trujillo, Colón, Honduras

The Three Goals of Peace Corps

1. To help the people of interested countries and areas in meeting their needs for trained workers;
2. To help promote a better understanding of Americans on the part of the peoples served;
3. To help promote a better understanding of other peoples on the part of Americans.

The Twin Goals of the Health Project

1. HIV/AIDS Prevention
2. Child Survival
   

The Health Project of Peace Corps Honduras has two main goals: Child Survival (decreasing infant/child mortality and by extension maternal mortality as well) and HIV/AIDS prevention (preventing new cases of HIV and preventing existing cases of HIV from advancing to AIDS). When I arrived in Trujillo, I wanted to get a sense of what the public health situation was as it relates to these two goals. Doing so might help me prioritize certain projects, but more than that, it would allow me to increase your understanding (Peace Corps goal #3) of the public health challenges facing Trujillo, the Department of Colón, and Honduras in general.

Goal #1: HIV/AIDS Prevention

Right now, there are approximately 1,200,000 people living with HIV in the United States. That is about 0.6% of the population. In Honduras, there are at least 63,000 people living with HIV, or about 1.5% percent of the population. That's nearly triple the rate of the U.S., and is probably more due to chronic underreporting of cases. Unfortunately, I haven't been able to get data about people living with HIV in Colón or Trujillo, but if I can find the data, I'll post an update.

	People Living with HIV/AIDS	Average New Cases of HIV Per Year (2004 – 2006)	% Of HIV Cases Receiving ARV Therapy	Condom Use
USA	1,200,000 (0.6%)	14 per 100,000 People	70.1%	15.7%
Honduras	63,000 (1.5%)		35.0%	5.0%
Colón		26 per 10,000 People		7.5%
Trujillo		34 per 10,000 People

From 2004-2006, there was an average of 14 new cases of HIV per 100,000 people in the U.S. In Colon and Trujillo (and probably Honduras overall, but I couldn't find the data) the rate is an order of magnitude greater: 26 per 10,000 people in Colón, and 34 per 10,000 people in Trujillo.

According to UNAIDS, 70.1% of HIV cases in the U.S. are receiving Anti-Retroviral (ARV) therapy. It's half that rate in Honduras, only 35%.

What about prevention? If one is sexually active, the best way to reduce the risk of infection is by using a condom each and every time one has sex. In the United States, the percentage of sexually active adults who reported using a condom every time they have sex was 15.7%. (Note, this survey interviewed both single and coupled people.) In Honduras, that rate is less than a third of the U.S., only 5%. Colón actually has the highest rate of condom use among all departments, at 7.5%.

A few years ago, Honduras passed La Ley Especial de VIH/SIDA (The Special HIV/AIDS Law) guaranteeing rights for people living with HIV, explicitly outlawing discrimination, mandating free and low cost confidential testing at health centers, and also recommending that health professionals encourage all pregnant women to get tested for HIV. In Colón, pregnant women have made up an increasing percentage of the new cases of HIV, from 11% in 2003 to 28.3% in 2006. This increase could be due to the increased efforts to detect HIV in pregnant women, or it could be for other reasons (for example, unfaithful husbands infecting their wives).

Number of New Cases that are Pregnant Women (% of Total New Cases)

	2003	2004	2005	2006
Colón	11 (11%)	18 (22.5%)	12 (23%)	15 (28.3%)

Goal #2: Child Survival

Infant and Child Mortality is one of the best indicators of the overall state of public health in a country. One reason why is because so many factors influence the health of a child: nutrition, water and sanitation infrastructure, education and health of the parents, and access to prenatal care, to name a few.

	Neonatal Mortality	Infant Mortality	Childhood Mortality
USA	4.6 (2003)	6.9 (2003)
Honduras	18	29	37
Colón	13	27	37
Trujillo	17

Neonatal Mortality refers to death within the first month after birth. Infant Mortality is death within the first year, and Childhood Mortality is death before the fifth birthday. In the U.S. Neonatal Mortality is at about 4.6 deaths per 1,000 live births. Infant Mortality is 6.9 deaths per 1,000 live births. In Honduras the rates are much higher: Neonatal Mortality of 18 per 1,000 live births, and Infant Mortality of 27 per 1,000 live births. But the most alarming statistic is childhood mortality: 37 per 1,000 live births. Stated another way, 1 in every 25 babies don't live to see their fifth birthday.

	Diarrhea		Pneumonia
	<1 Year Old	1-4 Years Old	<1 Year Old	1-4 Years Old
USA	0.97%
Colón	2477 (33%)	4314 (13%)	827 (11%)	1353 (4%)
Trujillo	405 (28%)	797 (13%)	76 (5%)	181 (3%)

Of course, just because a child lives doesn't mean he is healthy. A variety of ailments affect Honduran children, most common among them Diarrhea and Respiratory Infections. In the U.S., fewer than 1% of kids under the age of 5 are brought to hospitals or clinics because of diarrhea. The only statistics I could find on childhood pneumonia or respiratory infections in the U.S. are from the 1930's, probably because the rate is so low that it's not even on the public health radar anymore. Here in Trujillo, and in Colón, that's not the case at all. In Colón, 33% of infants and 13% of children aged 1-4 are brought to hospitals or clinics for diarrhea. The rates are almost the same in Trujillo. 11% of infants in Colón are seen for pneumonia or severe respiratory infections. The rate is lower in Trujillo, but still high (5% or 1 in every 20 infants).

Malnutrition is also a significant problem among children. I'm fond of showing this graphic at diarrhea prevention classes about the relationship between diarrhea and malnutrition.







I couldn't find specific data on malnutrition, but there were statistics on anemia (iron deficiency) which is an indicator of malnutrition. In the U.S., anemia among children was 2.9% in 1985. In Honduras, that rate is 37.3%, and Colón has the highest rate of childhood anemia in the entire country at 45.2%. Nearly half of all children in Colón have a measurable iron deficiency.

Anemia in Children

	Total	Mild	Moderate	Severe
USA	2.9% (1985)
Honduras	37.3%	23.0%	13.5%	0.7%
Colón	45.2%	27.3%	16.4%	1.5%

Anemia in Women

	Total	Mild	Moderate	Severe
USA	20%
Honduras	18.7%	16.0%	2.3%	0.4%
Colón	22.1%	18.8%	2.7%	0.6%

It's interesting to note that the rates of anemia among women of childbearing age (15-35) are roughly the same in Honduras and the U.S. A variety of factors could contribute to this. The high rate of diarrhea in children, for one. A lack of knowledge about childhood nutrition could be another reason.

New Digs

The View from my Apartment
Originally uploaded by StormyPetrel

Happy 4th of July everyone! To be honest, I didn't even realize the significance of today's date until one of my sitemates called me to make independence day dinner plans.

This weekend I moved into my own apartment. It's a spacious 1 bedroom about a block and a half from where I lived with a host family. It's on the top of a hill, and has a great view from the roof to the Northeast.

Trying to furnish my apartment revealed an unexpected quirk with Honduran cost of living. While it's normally very inexpensive to live in Honduras, the cost of furnishing an apartment is far greater than in the States.

First off, apartments generally do not come with stoves or refrigerators, things that are pretty standard in most rental apartments back home. On top of that, there is almost no second hand market in Honduras. And when things are sold second hand, they're nearly as expensive as new goods.

Our moving in allowance is about $225. That would be more than enough for me to get the basics for an apartment in SF because I could get most stuff for free or next to nothing off of craigslist. But here in Honduras, a stove cost me $175 and a refrigerator $80 and wait, I've already used up my moving in allowance. Admittedly, the stove is a luxury item, but I am going to go crazy (not to mention have a heart attack) if I can't take control of my diet. It's been nothing but fried, fried, fried, boiled, fried, fried, fried...you get the picture.

So, I've spend a bit of my own savings on some other apartment necessities, but the place is still practically bare. Next month, I'll use some of my monthly living allowance to buy lumber and I'll build some furniture. I'm looking forward to the project...