The Forgotten District

This past week Bill and I went up to Belize City to attend the Belize Medical and Dental Association International Congress.  It was two days of medical education lectures for physicians practicing in Belize as well as Guatemala and the Quintana Roo area of Mexico.  It was nice to see the advances being made in medical care in Belize and there were some very well presented lectures in English as well as in Spanish.  The care in Belize City is still decades behind that of the U.S. in many ways but there are some good, very intelligent physicians working hard to make a difference.

We had the opportunity to meet an American doctor and her husband who are running another mission clinic in the northern part of Belize.  Although the north is far more developed, has a very different culture being so close to Mexico and has much more access to care, it was great to spend some time together.  Even though they are from Indiana, there was great camaraderie and a good exchange of ideas.  Their clinic is better outfitted than ours and they gave us some stateside contacts that might be helpful for us.  We live a bit more rustic and quite a bit more isolated than they do but she is jealous of my clothes dryer!  (Something I requested of Hillside before we came.). They have 3 girls - the oldest is Caelan's age and the youngest is Quinn's age and the boys enjoyed visiting with them over dinner.  

What was striking from the conference was the number of foreign physicians practicing in Belize - particularly Cuban and Guatemalan.  Belize does not have a medical school and has traditionally relied on the goodwill of Cuba to provide primary care physicians and more recently to train Belizean physicians.  It creates huge barriers in communication as the official language in Belize is English and the street language is Creole and unfortunately the Cuban physicians speak very little English.

The other striking thing was, like we experienced in rural U.S., the distribution of healthcare is not equitable.  The southern Toledo district covers an area of 1795 square miles and a population of over 30,500 but with only a handful of primary care physicians (including Bill and I).  Many of these people have very little or no access to the healthcare centered around Belize City.  Unfortunately, the people responsible for the healthcare decisions in the Ministry of Health do not seem to understand the access problems faced by those in the Toledo district.  For one of our patients in the village of Dolores to access care, they have to walk about 1 hour to the village of Otoxha where they can catch the Monday, Wednesday, Friday or Saturday bus at 4:30 am for a 2+ hour bus ride to Punta Gorda.  They have no access out of the village to care on Tuesday, Thursday or Sundays.  As I have mentioned before, if they need an x-ray, they have to take another bus about 2 1/2 - 3 hours north to Dangriga.  All the specialty care is centered around Belize City and Belmopan, 6 - 8 hours by bus north of Punta Gorda.  We have given many people bus fares for the trip north but they still have to come up with a place to stay as well as food to eat.  We have known these things for quite a while but our time at the conference in Belize City solidified our concerns - the Toledo district is really "the Forgotten District."