10 April 2014

Honduras Health Centers: Atima

Health Center of Atima
Atima seemed like a very progressive city. The treatment plant was built in 2012 and had an effluent water turbidity of about 0.2 NTU. That’s a pretty big step considering just over a year ago, they didn’t have a water treatment system.

Carmen Mendoza who has worked at the Atima Health center for two months spoke to us about changes in health since the treatment plant was built. They’re trying a new “decentralized” health model that aims to prevent unhealthy practices rather than simply treating the symptoms. The model also targets children under age 5, pregnant women and women who have recently given birth. I think it’s great that they’re trying to educate people about the importance of clean water. (Before going to Honduras, I hadn’t even realized what an issue this was!) They’re also building a new maternity ward that should be finished in March and they will hire new doctors for this.

The health center at Atima also treats water for surrounding villages, which is where most of the diarrhea cases come from for a variety of reasons, among them being the fact that the people in the villages haven’t followed health advice and to them clear water is clean water. It must be pretty frustrating to understand how important it is to have clean water, and to tell others about it, only to have them ignore you.

Within the first six months of 2012, there were 250 cases of diarrhea (so a projected yearly number of 500 cases), and in 2013 there were a total of 405 cases. Hopefully it’s not just coincidence that there was a decrease of almost 20% in the cases of diarrhea, but we would need more data to see if this trend continues.

There are probably a number of reasons that there wasn’t a greater change in the number of diarrhea cases. Even if people are getting clean water, they could be practicing unhygienic habits which can also make them ill. Also turbid water is not the only reason people get diarrhea. But even a small change is better than no change!

To be honest, I was really impressed with Atima. The treatment plant was obviously well run, and they are taking great strides towards improving health education. It’s crazy to think that just over a year ago, they didn’t even have a treatment plant and now they probably have some of the cleanest water in Honduras.

- Felice Chan

Honduras Health Centers: San Nicolás


We went to the health center in San Nicolás on a cloudy Wednesday morning. It was toward the edge of town, off of a cross street from the main paved road. The health center here is a CESAMO, a health center run by doctors, as opposed to a CESAR, which is run by nurses. When we got there, we found that the two doctors who run the health center were on vacation. In their place was Guillermo Flores, a capable nurse who was heading the center for the time being (and looking very busy doing it). He had little time to talk, but in the moments he had, he gave us a fluid narrative of water-related health in San Nicolás.

He emphasized how interconnected the problem is, with both social and practical factors. For reasons of poverty, people are not able to afford bottled water, so they will use untreated tap water, and sometimes river water. Water from rivers is especially dangerous due to contamination resulting from poor sanitation. Further, people store rain water during the dry season, which provides a breeding ground for mosquitoes that carry dengue and malaria.

Sr. Flores was quick to point out that, while water is clearly a problem, health problems like diarrhea have a broad array of sources. He cited, for example, that parasitic worms can be transmitted from the soil into the body through bare feet. Likewise, food can also be a route for infection, and it is difficult to differentiate.

In all, he was excited about the treatment plant, and felt that it would be a benefit to the community. He cited many cases of Hepatitis A due to water contamination, as well as less visible effects. For example, mothers preparing formula for their babies will sometimes use dirty water, causing them to fall ill. Hearing about the many issues related to the lack of clean water, we are delighted that the AguaClara treatment plant was recently inaugurated in San Nicolás.

The social aspect of health seems to be taking on greater importance in the approach of Honduran health workers. It seemed that all of the health centers we visited had active outreach and education programs, with San Nicolás being no exception. As we were leaving, Sr. Flores asked us if the people of the municipality had welcomed us well. We were a little surprised by this question, but he explained that the health center puts on a local television program to educate the community about various health issues. Most recently, they had aired a program on welcoming foreigners. If the incredible welcome we received in San Nicolás had anything to do with the television program, then we have good reason to be exceptionally hopeful about the effect of the program on the future of health in San Nicolás.

- William Pennock

Honduras Health Centers: Támara and Marcala

Támara was the first town that we visited on the trip that had an AguaClara plant. It was inaugurated in June 2008 and serves a population of 3500. After a delicious lunch at Doña Reina’s, which included a juice made with AguaClara water, a young boy from the community led several of us to the health center. We were warned that the health center might be closed – some days it would close as early as 10 a.m. on weekdays. It was after 1 p.m. on a Thursday when we visited.

As anticipated, the health center was closed when we got there. Roger, one of our drivers, opened the gate and walked in to see if anyone was still there and available. Two women were still doing paperwork three hours after the health center had closed for that day, but one of the nurses was willing to talk to us for half an hour.

The nurse praised the AguaClara plant and the plant operators, saying that they had the best water in the area and that diarrhea cases had definitely decreased since the construction of the AguaClara plant. Medical students from the National University of Honduras visit Támara to study the connection between clean water and illness and give seminars about the water treatment process and the importance of sanitation. These medical students report that they see people getting sick everywhere, but there is a significantly lower level of illness in Támara.

Támara—Poster relating clean water to public health
One the reasons that young children still get sick – among other prevalent health problems – is that parents don’t clean their children’s pacifiers and bottles, so the issue is not the water but cleanliness practices. There is also a spike in diarrhea cases during Holy Week (Easter) because people tend to travel more and drink the unclean water in other places.

Two days later, we visited Marcala, which is known for its coffee. The AguaClara plant serves 2500 to 2800 households and was inaugurated in July 2008. Although the health center was closed because it was a Saturday, we were able to talk to Wilmer, one of the senior plant operators.

The water used to be so dirty that people wouldn’t be able to brush their teeth with it, and he estimated that over 90% of the population cannot afford to buy bottled water. Since the town began using the AguaClara plant, cases of diarrhea and water-borne diseases have decreased. Both the health center and Agua y Desarrollo Comunitario (ADEC), a NGO that gives technical expertise in water and sanitation, monitor the drinking water quality and chlorine levels.

- Theresa Chu

Honduras Health Centers: Jesús de Otoro

Health Center of Jesús de Otoro

Jesús de Otoro was a uniquely interesting city as it had three different water treatment systems: JAPOE, Santa Cruz, and Rurales. JAPOE has a FIME treatment system, and in the near future, Santa Cruz will have an AguaClara plant, and Rurales will have a FIME plant. The water systems weren’t entirely divided up by area – sometimes people could choose which one they had, and some had service from more than one water system. Overall, further development of quality water systems and community awareness is still needed, but the efforts being made were very impressive and promising.

The president of JAPOE said that the health center reported that cases of diarrhea had gone down by 4% this year. Generally, people had been drinking primarily bottled water but had begun to drink from the tap more. The health center also reported that 60% of the population is connected to the water system. They found that the widespread system improves community involvement and awareness of health issues, but some people were more willing to pay for cable than higher quality water. The general understanding of water contamination and water-related health appears to be very limited. In an effort to mitigate this, as part of a national initiative, the health office started a new program at the beginning of last year to improve education and prevention. They chose to concentrate on pregnant women, women who have just given birth, and children under 5 years of age. They have set an impressive example for two other nearby municipalities.


We were able to perform a few interviews in the area. At a small store, a 6-year resident of Jesús de Otoro reported having both JAPOE and Santa Cruz service, but preferred the treated JAPOE water to the untreated Santa Cruz water. The consumer found the price for JAPOE service fair but that for Santa Cruz unfair. The consumer reported that they knew of people without JAPOE who use Santa Cruz for all their needs, some boil the water but some do not. There are a notable number of cases of diarrhea and vomiting, possibly in part due to the contamination of the system by wastewater. At another house, we were told there were no health problems associated with the water, but that there is too much chlorine in the water, which residents could taste.