ICWA@100: When Democracy Doesn’t Work
Kim Conroy on a Honduran village's struggles to open its first health clinic in 1983
Kim Conroy is global career adviser at the Joseph H. Lauder Institute of Management and International Studies at the Wharton School of the University of Pennsylvania. Previously, she was an investigative analyst for Oppenheimer Capital, an emerging markets portfolio manager at J.P. Morgan in New York and an associate at Lloyds Development Capital in London. She received her bachelor’s degree from Dartmouth College in 1976 and MBA from Columbia Business School.
On her ICWA fellowship from 1981 to 1983, Kim investigated political, social and economic issues in Mexico and Central America. She sent this dispatch from a small rural community in southwest Honduras called San Juan Bosco that she got to know before her fellowship. The village leaders tell Kim they’ve become disenchanted with their new democracy, which they blame for a torturous ordeal opening their first health clinic.
SAN JUAN BOSCO, Honduras (March 1983) — The health clinic in this small community isn’t much to look at.
Unpainted wooden benches fill the unlit waiting room. The nurse’s office is barely large enough to fit both her desk and the medical examination table, and a small cupboard stands in a corner half-filled with sundry medicines. For this impoverished farming community in southwest Honduras, however, its recently inaugurated clinic represents one of the greatest social advances the village has made.
Living on a diet of little more than corn tortillas, beans and salt, most of the villagers are malnourished and highly susceptible to sickness. Dysentery, diarrhea and other intestinal infections are the most common illnesses. And among the children—an average of eight per family—polio and malaria are not unusual. Before they had their own clinic, the nearest doctor’s office was a two-hour walk away.
Getting the government to give San Juan Bosco its clinic, however, was an ordeal few villagers will ever forget. For some, it even called into question the very value of democracy. These doubters associate their difficulties with the new, elected government that Honduras has had since January 1982, after more than a decade of military rule.
“You know, after seeing how the Liberal Party, the party in power, tried to use our clinic to forward their political ends, I’d say I preferred the military governments we had before. At least they didn’t play so many childish games with the people,” declared Teresa Torres, president of the village’s health committee.
Teresa is one of the dominant women in the community. She used to be San Juan Bosco’s guardia de salud, or paramedic.
With government-sponsored training in basic health care, she dispensed medicines for common ailments, and sent the more difficult cases to the nearest doctor. Teresa concentrated most of her energies on teaching preventative medicine: that the pigs, cows, and chickens should not be allowed to wander in homes, that people should wash their hands before eating, boil their drinking water and build latrines. She also had the government train the local midwives. (Before that course, the midwives’ general practice was to leave the afterbirth inside the womb and forbid the mother from moving from her bed for eight days following the delivery.)
It was Teresa who organized the village’s health committee and who, as its president, went to the regional capital Choluteca over a year ago to demand the establishment of a clinic in San Juan Bosco. The government’s health officials in Choluteca explained that they could send a nurse only once the community had provided both a workspace for the clinic, complete with furniture and a waiting room, and living quarters for the nurse.
In San Juan Bosco, where few people have more than three changes of clothing, and where the average annual income is less than $1,000, coming up with the money for a clinic required a major effort. Without the money for a new building, the villagers partitioned off one corner of their grain warehouse. To buy furniture, they raised money at charity dances held in the village’s cramped mango jam cannery. It took four months and there still had to be an official inauguration ceremony before the government would send a nurse to work in the clinic.
On inauguration day, a band was hired and an elaborate and expensive meal was prepared in honor of the official delegation. But no one from the government showed up.
The next day, Teresa and the other members of the health committee went to Choluteca. For hours they sat in the Health Ministry’s waiting room. When finally ushered in, they were given short shrift.
“Are you all members of the Liberal Party?” they were asked abruptly by the regional director.
They replied in the negative.
“And what about your president, is she a Liberal?” he continued, looking at Teresa with disapproval.
“I voted for neither the Liberal nor the National Party. I’m not interested in politics,” Teresa replied with indignation.
The committee was told to return to San Juan Bosco, to have the village elect a new, all-Liberal Party health committee. The government officials said that only then would the inauguration be held.
The villagers were furious and unwilling to do as told. Teresa went to the capital city of Tegucigalpa to speak directly with the health minister himself. For three days, she sat in the minister’s waiting room. On the evening of the third day, she was ushered into his office. He assured her that there was nothing to worry about, that the old health committee was good enough and that she just had to be patient.
But back home in San Juan Bosco, another month-and-a-half passed without further news. In desperation, Teresa turned to “non-democratic” methods.
Don Chema, an autocratic old storekeeper in a nearby town, had always been the man to turn to for results when the army was in power because he had military connections. He hadn’t lost his touch. With one phone call to his friend the regional army commander, the 18-month ordeal came to an end. San Juan Bosco’s health clinic began operating two weeks later.
“I kept trying to explain to the government workers,” Teresa recalled, “that health care should not be for the Liberals or the Nationals, or for the followers of any particular party. Health care should be a right guaranteed to all Hondurans.”