Field post: 'Honduras has one of the world's highest rates of urban violence'
It is 3pm and yet another patient is brought to the emergency room with a gunshot wound to the chest. He seems to be in his early twenties. For now, he is talking. From the position of the wound on his chest, it is clear he needs to go immediately to the operating theatre. He has almost certainly been shot in the heart. This makes him one of thousands in Honduras who have suffered the consequences of armed violence.
Since 2010, Honduras has had one of the highest rates of urban violence in the world. Most of the violence we see in the emergency room takes the form of gun and knife injuries, often fatal. The treatment of injuries related to violence is considered by local hospital staff as routine. In the heat and humidity of the emergency room, the stench of blood and sweat hangs in the air.
Drug trafficking and extortion are attributed to the activity of powerful gangs; whole neighbourhoods are said to be controlled by armed groups. There are carjackings, kidnappings, murders and sex crimes. Young men and women and their families seem inextricably caught up in the tragedy of bloodshed. Urban existence is compounded by unemployment and poverty. Local media report on a seemingly continuous loop featuring hospitals struggling to cope with the daily influx of wounded. How then is this a “silent emergency”?
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An emergency is any situation that requires urgent action to deter a threat to an individual’s health or life. Have we become so accustomed to urban violence and the failure to meet the most urgent health needs of communities that we have gone quiet? I had the privilege again this year of being deployed as a British Red Cross surgeon to work with the International Committee of the Red Cross (ICRC) in Honduras. I work in Tegucigalpa, the capital of Honduras, alongside doctors, nurses and medical students who strive day and night to bring the best medical care possible to the injured.
I am astonished every day by the commitment of medical students and interns who carry out tasks in this ICRC-supported hospital – from portering and taking blood, to cleaning and dressing wounds, and documenting exact causes of injury that I need for my research. Surgical teams work 24 hours, operating round the clock on patients. Every piece of equipment is jealously guarded as resources are scarce. They are cleaned, repaired, protected and used again and again. Local humour translates “use once” in English to the Spanish u-s-e o-n-c-e (use 11 times). The standard of care is high, yet the emergency remains. The situation is dire.
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Medical facilities used by most of the population are underfunded and overwhelmed. Outpatient queues extend out of hospital buildings. Patients from the city and surrounding countryside wait hours to be seen. They travel all day from the countryside – on foot or hitchhiking. Beneath the cowboy hats, their skin is tough and burned. The lines on their faces tell their stories. Mothers sleep with their children overnight on the stone floor in corridors, hoping to be first in the morning queues for clinics and pharmacies. As if life is not hard enough, the constant threat of dengue, and now Zika, is a daily reality.
Local doctors and nurses keep working. They are well organised, well informed, resourceful and committed to dealing with the continuous emergency of an overburdened health service. They are not silent, but they are considerate in their thoughts and measured in their comments. They explain the situation to me: there are complex problems here. The most vulnerable are the poor. To address their health, communities need to be safe and they need access to education and employment that pays a regular salary sufficient to feed their families.
The young man shot in the chest survived. He went straight to the operating room. We were ready for him. As usual, the team worked in relative silence and calm. After surgery the doctor explained his injuries quietly to his mother. She was crying silently.
I walk back to a heaving emergency room: the clamour and commotion is deafening. There is nothing silent about this emergency.
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