San José, Costa Rica, since 1956

In understaffed and ill-equipped Honduran hospital, death often wins

SAN PEDRO SULA, Honduras – Rain beat down on the roof of Mario Catarino Rivas Hospital as patients spilled in with wounds from car crashes, machete strikes, gunshots to the face.

It was a slow Friday evening in the emergency room, said staff members used to pools of blood on its floors and its stacks upon stacks of gurneys waiting to accommodate all of the injured.

“It never ends,” said Dr. Rosa Romero, a general practitioner who has worked at the hospital for 27 years. “Each day more and more come.”

Honduras is currently the world’s most deadly country outside of a war zone, with an annual murder rate of 86 per 100,000 people. Here, in its second city and business hub, the rate this year to date has been a staggering 106 per 100,000.

Helping fuel San Pedro Sula’s violence is weak and corrupt law enforcement – only 5 percent of murders in a two-month period this summer were investigated, according to a recent report – and the fact that the city lies some 48 kilometers (30 miles) from the country’s Caribbean coast, an important transit point for drug cartels moving cocaine north to Mexico.

The city is also home to Honduras’ highest concentration of gang members. The largest two gangs, the Mara Salvatrucha 13 and Barrio 18, have more than 1,000 members each in San Pedro Sula, and they battle incessantly for territory and control in the dirt streets ringing the city.

Of the dozen or so beds in the hospital’s surgical waiting area, three held men with gunshot wounds – one of whom was guarded by a member of the Honduran National Police. A tube in his chest led to a machine that was aspirating blood from his lungs. He refused to give his name, but, between agitated breaths, acknowledged that he was being accused of robbery.

“He’s a gang member,” said Dr. Laura Machado. “I don’t know which one he belongs to, nor do I even want to know because here we treat all people.”

Machado, one of only two doctors in the emergency department that night, said that in a typical week staff handle up to 15 patients with gunshot wounds.

“We treat a ton of people involved in the gangs and they survive,” she said. “It’s the innocent people who die fast.”

Machado, her round face framed by square, dark glasses, was aided by several fourth-year medical students in caring for the wounded. The students handle most of the frontline duties in the emergency room, acting as both nurses and doctors. Only 28 years old, Machado had a sisterly way with them, gently patting their heads now and then in support.

Mario Catarino Rivas is a public hospital, and in many ways its surgical emergency department represents the end of the line for patients who need to see specialists but are too poor to go anywhere else. It is severely underequipped, lacking even such basic medications as morphine. Patients’ family members are tasked with acting as nurses and orderlies, washing blood from their loved ones’ bodies and beds, and running off to buy medications – if they can afford them – from a nearby pharmacy.

Just as Machado’s shift came to an end at 7 p.m., a pickup pulled up to the doors. Wheeled in was a man whose left eye was gone, as well as the entire socket, leaving just a gaping hole of mottled flesh and blood.

Machado and her team of students calmly gathered around him, checking his vital signs. They placed bandages and gauze over the cavity to try to stem the bleeding to the degree that they could.

Once the patient was deemed stable, Machado went home to study. She had an exam in hospital management coming up. The man’s injury, however, would be indicative of what was to come the rest of the night – the fruits of excessive and indiscriminate violence.

“One ends up becoming accustomed to it,” said Romero, the general practitioner who replaced Machado. “It’s not that we are insensitive, it’s that we have seen so much that nothing surprises us anymore.”

The man with the missing eye, Melvin Rivera, normally spent his days washing cars, but the rain had kept him from working that day, said his brother José Rivera.  He was drinking at a storefront bar when someone shot him in the face with a rifle, said José, who was with him at the time.

“He didn’t have problems with anyone,” José said. “The only problem he had was with alcohol.”

Rivera was still drunk and agitated, meaning that doctors could not perform surgery immediately. Throughout the night, he stood up and pawed at the bandages around his face as his brothers grabbed his arms and legs in an effort to try and keep him still. When his bandages became sodden again with blood, they helped replace them, wearing latex gloves and wincing in anguish and disbelief each time they saw his face anew.

Nearing midnight, a woman was wheeled in with a crescent-shaped gash in her forehead, and her ear split open. Her daughter-in-law said she had been attacked with a machete by a neighbor; apparently, her mother-in-law’s cows had eaten the neighbor’s roses. The neighbor had also shot the woman’s husband, said the daughter-in-law, who asked not to be identified.

A medical student stood over the injured woman for hours, stitching her forehead and ear. The woman would have to wait until the next day to see a neurologist who could determine how badly her skull had been fractured and whether her brain had been damaged.

The early morning hours brought fewer patients, and gurneys were cleared as patients went into surgery. Others quietly died. Without the benefit of monitoring machines, their family members frantically alerted doctors that they had stopped breathing. All three patients who died that night belonged in intensive care, doctors said, but space in that unit was limited to just a few beds, which were full.

Just before sunrise, a woman in a black shawl wailed as she stroked the forehead of her dead son. He’d been shot in the back of the head by gang members. He was most likely a gang member himself.

Before following her son’s body to the morgue, the woman leaned over and kissed the forehead of the man lying in the adjacent bed. He said his name was Wilmer Matute, and he was waiting on an appendectomy. He, too, had arrived with a police escort, because he was currently in jail, serving a five-year sentence for murder.

“She told me that I got to pray to God to change my life,” he said in English.

In the gray light of morning, blood was mopped up and beds washed down. Medical student Daniel Meza, 24, stitched the forehead of an elderly man – another machete attack. 

“If this isn’t the most violent place, it’s close,” Meza said. “Often they don’t even make it here. They just kill them. In the morgue, it’s a mountain of people.”

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