Chagas disease affects about 300,000 poor and isolated Hondurans - 5% of the country's population.
International staff: 34
National staff: 30
Poverty, rural isolation and the devastation of Hurricane Mitch in 1998 have all taken their toll on the health of the people of Honduras, the second poorest country in Central America after Nicaragua. MSF works on post-emergency projects, primary health care and prevention and treatment of sexually transmitted diseases (STDs) and AIDS. The organization also treats and works to prevent Chagas disease, a rare and often fatal illness that is endemic in some parts of the country.
Over the last year, MSF has launched several new programs targeting South American Trypanosomiasis, or Chagas disease, which affects about 300,000 poor and isolated Hondurans - about 5% of the country's six million people. MSF coordinates its work with the Ministry of Health's (MOH) National Chagas Program. Projects in MontaÃ?±a de la Flor and Yoro treat Chagas patients and work to eradicate or reduce the key vectors carrying the parasite, the small insects rhodnius prolixus and triatoma dimidiata.
The earlier the infection is detected, the more effective the treatment, so MSF concentrates on children. The Yoro project helps children under five. In MontaÃ?±a de la Flor, treatment for children under 13 is being tested. Patients take one or two pills of Benznidazol a day for two months.
"The problem is that communities are very scattered and some are very far away from health centers," says Manuel Duce, a field coordinator for the program. "So people are being trained in each community to supply patients with the drug, under the supervision of medical staff."
Both Benznidazol and Nifurtimox, the other key Chagas drug, are difficult to come by: The former is no longer available in the country and the latter is no longer produced. MSF bought the remaining stock of 750,000 tablets of Nifurtimox to use in Honduras as a second-line drug for children under 13 who have strong side effects when treated with Benznidazol. The drug is also used in clinical trials to treat Human African Trypanosomiasis (sleeping sickness).
On the level of prevention, MSF-organized teams visit communities to check for insects in walls, straw roofs or dirt tracks. This is followed by fumigation of homes and external areas with insecticide. A community surveillance system then watches for the possible return of insects.
After Hurricane Mitch
MSF has entered a new phase of its post-emergency work, focusing on long-term efforts to decrease malnutrition. In the southern province of Choluteca, MSF trained local doctors and nurses and linked them with village volunteer networks to improve early detection and treatment of children with chronic malnutrition.
Protocols put in place in Choluteca have become the foundation for nationwide procedures. Now MSF is focusing on improving the local diet by improving corn and bean production, creating family gardens and encouraging production of eggs to improve the quality of the daily diet of children. Other post-Mitch work rehabilitating medical facilities in Tegucigalpa and La Ceiba drew to a close in mid-2000.
AIDS and urban health care
Honduras has the highest incidence of HIV/AIDS infections and deaths in all of Central America - over 13,000 cases were confirmed by the Honduran MOH between 1986 and early 2000. In Tegucigalpa and La Ceiba, MSF has STD case management projects designed to reduce transmission of STDs and HIV among excluded people and improve care for patients. MSF donates drugs to treat opportunistic diseases and STDs. In La Ceiba, MSF has produced a self-study guide to encourage AIDS/STD prevention among 9-12 year-old children. This effort reached about 3,000 young people in 15 public schools in 1999.
MSF also supports a new health center in the Tegucigalpa slum area El Carrizal. The clinic, which opened in January 2000, serves about 40,000 people.
In the north-central towns of Yoro and Olanchito, MSF has mother and child health care programs designed for children under five. The organization also helped build a "casa materna" next to the hospital in Yoro to host women with high-risk pregnancies and births.
A project serving some 20,000 Garifunas and Ladinos (groups living on the Atlantic coast and in the interior, respectively) closed in July 1999 because of insecurity in the region. Three Honduran doctors are carrying on the work in the five area health centers where MSF had been working.
MSF first intervened in Honduras in 1974.