Today for the first time I navigated the public health hospital of Honduras with a patient, Delcia.  I had heard nightmarish stories of the care at Mario Rivas, and I now believe them all.  The public health hospital of San Pedro Sula, Mario Rivas was contrary to everything that quality health care should be. 

     Most of us have either been in the hospital, had someone we love in the hospital, or at least had lab and x-ray tests in a hospital.  We expect a certain level of courtesy and respect from these encounters.  Sometimes we have been disappointed.  Imagine the worst experience possible you could have in a hospital.  Now, imagine it twice that bad.  And imagine that every time you go to the hospital this is the treatment that you get.  That is Mario Rivas Hospital.

     Some of us have worked in health care.  Imagine the worst day of work you have ever had.  The waiting rooms filled with cranky, impatient patients, the phone ringing, and you knowing that you can’t possilby provide the quality of care you would like.  Imagine trying to work without even the basic resources that you need.  Now, imagine it twice that bad.  And imagine that every day that you work is like this, day in and day out.  This is also Mario Rivas Hospital. 

     I am writing this late at night as the images from today continue to swirl in my head.  Sleep is impossible.  I think of our greeting from the surly receptionist, who threw, literally threw, the referral slips at us because she couldn’t read them.  I feel my temper rising once again as I remember knocking at the door of Room 11, as instructed, and having the door slammed on me after being told to wait, while inside six nurses giggled and discussed their dinner plans.  I feel the indignation of having the window slammed in my face by the receptionist in x-ray, and the red-hot anger at the verbal and physical abuse inflicted by the x-ray technician on Delcia, the woman who has trusted me to find medical care for her.  I can feel the bordeom of the five hour wait for a simple x-ray, and dispair at thinking we must return again tomorrow to get the lab tests there was no time for today. 

     Other images fill my mind.  The glance into the labor room where ten or twelve women labored alone on plain metal gurneys without matresses or sheets.  The small boy resting on yet another cold metal gurney in x-ray, metal rods sticking through his lower leg, all alone, sleepy, unattended with no side rails on the cot.  The elderly woman trying to push an empty gurney up a steeply sloping sidewalk, while three hospital employees looked on.  The dirty cart in orthopedic emergency, covered in drying cast material, where Delcia was told to lay to be examined.  The peeling paint, the garbage littered patios, and the faces of countless resigned people, who know this is the possibility they can afford for health care. 

  At one point during our time at Mario Rivas I had to leave.  I began to feel physically ill from watching one person after another being treated poorly, waiting resignedly, or simply being ignored.  There is no place for being ill in Mario Rivas, however.  All the bathrooms were locked, save one, which had no water, toilet paper or a toilet seat.  I sat outside, gulping breaths of fresh air, tears running down my cheeks.  Nobody noticed or cared.  Perhaps it was a normal occurrence for someone to sit outside alone crying in this hell. 

     But, in the midst of this horror one person stands out.  In the emergency room, a young Cuban doctor, providing free medical care as part of his training, graciously and gently attended to Delcia, smiled, told her what to expect, explained what he thought was wrong, and directed her to the xray department.  But, after just a few short hours there I wondered what was wrong with him, not what was wrong with the hospital, because I knew that, but what was wrong with him?  I wondered how long it would be before he inevitably became like the rest? 

     Perhaps tomorrow or next week or next month I can reflect more objectively on why this is this way, on why this horrible system continues without any demand for change, on what part my country plays in perpetuating this, on whether I should continue to use this system for our patients or rely instead on volunteer physicians from the US fostering further dependency…..But, tonight I just feel the rawness of these images that refuse to let me sleep. 

Linda Hanson