“Abre tus ojos” - Open Your Eyes: A Glimpse of Health Care Insecurity in Honduras
Amirah Mobarak
MSc, Health and Rehabilitation Sciences (Health Promotion)
Western University
Feelings of anxiety, uncertainty, and vulnerability regarding one’s ability to access adequate health services can be attributed to healthcare insecurity (Tomsik et al., 2014). With half of the global population unable to obtain essential health services, health insecurity remains a leading concern, particularly in low and middle-income countries (LMICs) (Gama, 2015); World Health Organization, 2017. Living in a country such as Canada, where access to health care is more readily available, it is easy to turn a blind eye to those who are suffering when we are the ones thriving. Acknowledging these differences guided my decision to participate in Western University’s global health brigade to Honduras.
In May of 2019, my interest in health equity and promotion began to form as I had just completed the second year of my undergraduate degree in psychology and health studies. I began to seek opportunities to tackle health and social issues, specifically within at-risk populations and marginalized communities. Before deciding to partake in the Brigade, I was worried about the global perception of “voluntourism” and “performative activism”, an ongoing concern for many global volunteering opportunities. Upon further research, I learned my participation in the Brigades offered comprehensive models to meet sustainable development goals (SDGs) by implementing feasible, community-based solutions.
Honduras’ healthcare system consists of a public and private sector, with the latter governed by “a set of providers offering services paid mostly out-of-pocket” (Bermúdez-Madriz et al., 2011). Despite the country having the same local health authority, geographically, remote communities have been found to experience more significant barriers in accessing healthcare services compared to neighbouring communities in the same region (Pearson et al., 2012). These barriers may require many years of planning and funding to close the equity gap between these communities. Therefore, seven days did not seem like much time when a small group of my peers and I travelled to Choluteca, a rural municipality relatively three hours from Tegucigalpa, Honduras’ capital city. It was not until approximately 500 community members were lined up at the gates of the temporary mobile health clinic set-up in a local school that we realized the magnitude of the problem and the impact we might make.
According to Nouvet (2016), “the desire to ‘do good’ would materialize in forms of action that ‘feel right’ in any context.” I felt assured in our work while my peers and I worked alongside community members to address health education, health sustainability, and infrastructure development. We constructed and executed multiple stations from various healthcare disciplines, including dental and oral hygiene, optometry, pharmacy, physical activity, and general health education, contributing to the universal call to action to achieve a better and sustainable future for all.
In addition to the mobile health clinic, one of my fondest memories of this experience was working side-by-side with the local members who lived in the community to build neighbourhood pipelines to increase access to clean, usable water, and latrines--sanitation facilities often consisting of a toilet and simple water system. Educating community members on building the facilities and directly employing and paying them for their work, provided a steady stream of both health education and income for the long term- implementing health care services and infrastructure within rural communities.
I will never forget a conversation I shared with a 73-year-old woman named Marie who mentioned she could not see her young grandchildren due to age-related vision loss. Unable to receive eye-care in recent years, we had the opportunity to provide a comprehensive eye-exam and give her a pair of glasses that fit her prescription. She responded, “gracias a dios por la vision que tienes, y por la vision que me has dado”, translating to “thank God for the vision you have, and for the vision you have given me”. My conversation with Marie was just one of the many reasons why boarding an airplane and travelling back to Canada was so difficult. The smiles and comfort we created and shared during our time in Choluteca were almost strong enough to conceal the everyday reality of healthcare insecurity within their communities. This experience exposed me to social and health inequities underserved communities face globally, pushing my initiative to further my research in health promotion, specifically within LMICs. As a current MSc student with the hopes of continuing my research with a Ph.D., I hope to assess gaps within health policies and literature on how varying cultures foster environments for different implementation of healthcare services.
I am fortunate and privileged to have had such an opportunity. Although it has been three years since I visited Honduras, I am optimistic that the individuals and families we met and worked with have not forgotten the support we provided, the same way I will forever remember the lessons I learned from them. I can only hope that as future healthcare students, researchers, and general members of society, we continue to look at the varying social determinants which may be impacting health outcomes, to better implement community-based interventions and healthcare services.
References
Bermúdez-Madriz, J. L., Sáenz, M., Muiser, J., & Acosta, M. (2011). Sistema de salud de
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Gama E. (2015). Health Insecurity and Social Protection: Pathways, Gaps, and Their
Implications on Health Outcomes and Poverty. International journal of health policy and management, 5(3), 183–187. https://doi.org/10.15171/ijhpm.2015.203
Nouvet, E. (2016). Extra-ordinary aid and its shadow: the work of gratitude in Nicaraguan
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Pearson, C. A., Stevens, M. P., Sanogo, K., & Bearman, G. M. (2012). Access and Barriers to
Healthcare Vary among Three Neighboring Communities in Northern Honduras. International journal of family medicine, 2012, 298472. https://doi.org/10.1155/2012/298472
Stewart, K.A., Keusch, G. T., Kleinman, A. (2011). Values in global health governance. In
Benatar, S.; Brock, G. (Eds.). Global Health and Global Health Ethics. New York: Cambridge University Press, 304-310.
Tomsik, P. E., Smith, S., Mason, M. J., Zyzanski, S. J., Stange, K. C., Werner, J. J., & Flocke, S.
- (2014). Understanding and measuring health care insecurity. Journal of health care for the poor and underserved, 25(4), 1821–1832. https://doi.org/10.1353/hpu.2014.0180
World Health Organization. (2017). World Bank and WHO: Half the world lacks access to
essential health services, 100 million still pushed into extreme poverty because of health expenses. World Health Organization. Retrieved from https://www.who.int/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses
Photo by David Travis on Unsplash
