Honduran and nicaraguan moskitia
SOCIAL ASPECTS (summary: for full text see Appendix I)
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SOCIAL ASPECTS (summary: for full text see Appendix I)A Brief Overview of the Moskitia RegionAn adequate understanding of both the socioeconomic conditions and health problems of Miskito lobster divers requires a general overview of the socioeconomic and cultural conditions of the Miskito people of Honduras and Nicaragua. The general patterns in both countries are quite similar, though not identical, and both similarities and differences are determinant to the diver’s situation and to any actions that may be proposed to improve it. Many of the Moskitia’s socioeconomic problems derive from, or are intensified by, its isolation. The region's geographical isolation has been a key factor in its historical development since prior to colonial times and continues to be so in the present. Isolation permitted the indigenous groups within it to remain culturally strong and with a well-developed sense of territorial identity. Both are ever-present elements in their struggle to become incorporated into national development schemes while at the same time attempting to maintain their ethic and territorial differentiation. The isolation of the Honduran Moskitia is greater than that of Nicaragua, and there are no large-scale industries established in the area. As a result, there are fewer economic opportunities for the population, and diving is more important to its local economy. The greater isolation of the Nicaraguan Moskitia compared to that of Honduras has been affected by three principal factors in recent decades: Sandinista rule and the ensuing Counterrevolutionary War during the 1980’s Establishment of the Autonomous regions of the Atlantic Coast Establishment of the lobster processing industry
Communities In Both Honduras and Nicaragua, divers usually come from small communities along the coast, though the economic benefits of diving attract men from distant settlements inland also. This seems to be more frequent in Honduras, where a greater number of navigable rivers and a more extensive lagoon system facilitate communication between the interior and the coast. These communities are usually small, traditional villages, located near the waterways and lacking the basic services of potable water, electricity, health centers, etc.. Houses are generally built of wood, constructed on stilts to minimize the effects of periodic flooding, and have roofs of zinc sheeting. Economy The Miskito are in a transition process between subsistence and market economies. Miskito participation in the national market economies is still quite limited. To a great extent, their everyday lives depend on the traditional hunting – fishing – gathering practices of their ancestors, complemented by small-scale agriculture. The traditional gender-based division of labor is still prevalent in most areas of production, like agriculture and fishing, and its principles are often applied to other, non-traditional areas. Sharing or trading foodstuffs and other goods among neighbors and extended family groups, and labor exchange practices, known as pana – pana, are still quite viable and effective practices within the communities. In diving, as in agriculture, it is common to see members of one community or family group working together or assuming obligations as a group. Children begin participating in productive work at an early age. This practice is usually justified by necessity and often results in the limitation of children’s access to education and in their early incorporation into activities such as lobster fishing. The supply of consumer goods to the Moskitia is quite inefficient, mainly due to poor transportation. Nicaragua has road connections between the major commercial centers and the region, though they are poorly maintained and become virtually impassable during the periods of heavy rains. Increased government presence in the area, especially in Nicaragua, has begun providing essential services to the less isolated communities. However, it has been the lobster industry that has contributed the most to the incorporation of the Miskito to a market economy, as it has become the single most important source of cash income for the region. Agriculture Traditionally, for the Miskito, agriculture has been a complementary activity to their hunting, fishing and gathering, primarily pursued as a source of carbohydrates. The soil of the Moskitia is, for the most part, unsuited for agriculture, but the people are able to keep agricultural plots located along riverbeds, where the more fertile soil deposited by periodic flooding can be found. Here they cultivate mainly a variety of tubers and bananas. Informal and formal education It is necessary to analyze Miskito education in terms of both informal and formal teaching, as both are important to their society and have a direct bearing on diving activities. For these purposes, informal education is taken to include all teaching – learning processes based on tradition or on the transmission of knowledge acquired from direct experience and socialization; formal education is that derived from such processes when they are institutionally – defined by the State, Church, etc. It must be noted that formal education originates outside of the Miskito traditional cultural context and often enters into contradiction with it. Initially, informal education takes place in the home, and during the early stages of child development it is mostly under the responsibility of women. Children participate in productive activities through the performance of household chores and begin acquiring the basic principles of hunting -fishing, while at the same time assimilating considerable knowledge of the natural world. Within the households, children enjoy the freedom to listen to adults and observe them without hindrance, acquiring important social knowledge and models, while at the same time assimilating Miskito culture and world-view. This, of course, includes the notions of the spiritual world that permeate all of Miskito life and are determinant to the concepts of health and illness that later help define their explanation of diving accidents and their attitudes to diver safety. The freedom that children experience also exposes them, in a very intense manner, to key social models from an early age. They assimilate examples of conduct considered expected or acceptable within the community, but are also exposed to role models that prove to be negative for their future development. Without a doubt, the most preoccupying of these are those related with the consumption of alcohol and drugs. Alcohol consumption is quite common among the male population, and drugs, especially marihuana, cocaine and crack, have become rather common among the younger males. The communities are quite aware of the dangers of such substance abuse, but at the same time have come to consider it “normal” and even expected behavior for divers. I Photo 7 : Young Divers nsofar as diving associated conduct is concerned, negative models are unfortunately abundant and common. At an early age, children adopt the notion prevalent among both adults and youngsters, that becoming a diver is the only viable option for earning a living. Teachers complain that this marks their attitude towards education in a very negative way, as it leads to a reasoning that minimizes the importance of formal education. Basically, they come to think, “If I am to become a diver, what use does schooling have for me?” Many youngsters begin working in diving-related activities at an early age, sometimes in their early teens. They have come to see this as an inevitable choice in life, so that they assume even the hazards as unavoidable parts of their future. For example, a young boy, standing by the beach where a group of disabled former divers walked with marked difficulty, speculated on his future as a diver saying: “When I’m older and can no longer walk….” Formal education is difficult to obtain in the Moskitia. There are not enough schools and teachers, and the quality of the education they provide is poor; most communities only have schools offering the first levels of primary education. There are few opportunities for children to go on to secondary education, and only Nicaragua offers the possibility to access university education within the Moskitia. The fact that the formal educational system operates in Spanish and makes little concessions to Miskito language and culture is a further obstacle to improving Miskito education. This situation points to the urgent need to present any diver training program in the Miskito language. Low formal educational levels have definite negative effects on diver health. The study's survey of 416 divers from the Nicaraguan industrial fishery showed that most have an average education of between third and fourth grade level (69% finished primary, only 18% secondary or beyond). As a result, the elementary physical and health principles involved in diving are absent from their frames of reference. Lacking such knowledge, they can only understand diving-related phenomena in terms of their traditional worldview, which provides them with non-scientific, magical and spiritual explanations for their diving experience, including decompression-related accidents. Low educational levels, a limitation to traditional world-view, the linguistic barrier, and negative attitudes derived from socialization, all combine to generate a resistance to adequate training. Many diver-training programs have had low levels of participation; often the divers prefer to not participate or leave early in order to continue with their normal habits of rest and drink before their next job. There have also been cases in which cultural resistance surfaces in the form of community leaders telling the divers not to believe the trainers because tradition is clear in saying that diving accidents are spirit-caused, and not due to physical and physiological factors. Community healthcare Miskito views on health, illness and healthcare are derived from two different cultural paradigms: traditional culture and western cultural notions based on clinical medical principles. The two views are often contradictory, yet they come to be integrated to some degree in everyday practice. For most ailments, people follow a definite, culturally established and regulated hierarchy of options that establish the appropriate type of healer and treatment that is to be sought. Usually, the first consultation is done in or around the home, and results in the application of herb-based remedies or the advice to visit a traditional healer. Consulting a sukia is the next option; they heal through both plant knowledge and spiritual power. Many Miskitos are willing to spend a considerable amount of time and resources to visit a sukia of renown who may live a considerable distance from their communities. Oftentimes, the consultation of practitioners of clinical medicine is the last resort for a patient. It is important to note that, besides doctors and nurses, these include lesser specialists like pharmacists and unlicensed medicine vendors who also diagnose and prescribe, usually at a lower cost than proper medical consultation and treatment. Traditional health and healthcare Miskito world-view ascribes spiritual and magical causes to illness. The universe is divided into a supernatural realm, populated by spirit beings, and the terrestrial realm where mankind dwells. Tutelary spirits are perceived as “owning,” and thus governing, natural elements and resources. Cultural knowledge about spirits is expressed in an intricate series of myths, stories and beliefs that establish a series of norms governing mankind’s attitudes and behavior towards nature and the resources needed for subsistence. These norms, which essentially establish a relationship of reciprocity between mankind and the spirits, require humans to maintain a harmonious relationship with nature, avoiding depredation and waste, and thus assuring an adequate supply of resources for the communities and their members. The transgression of these norms results in illness or even death. Illnesses caused by spirits are often culture-bound afflictions over which only traditional healers are seen to have any effect. Since health and illness are so closely linked to the spirit realm, Miskito health specialists, both sukia and others, must possess the knowledge of the realm and how mankind can interact with it. Every Miskito knows what actions must be undertaken to prevent being affected or possessed by spirits. In many cases, these are simple actions like avoiding certain places frequented by spirits, or wearing certain garments or objects considered protective. Some divers, for example, believe that wearing women’s underwear will ward off the Liwa underwater. The Liwa (Liwa Mairin), the spirit owner of the watery realm who is often represented as a mermaid, is of particular importance to the understanding of lobster divers’ health problems. In traditional, subsistence based Miskito culture, the Liwa safeguards resources obtained from water, ensuring that they are used in a sustainable manner. Any transgression to her norms results in illness or death. The divers are well aware that commercial level exploitation is excessive, and thus a transgression: sometimes divers refer to their work as “stealing from the Liwa.” Viewed in this manner, commercial diving will inevitably provoke the Liwa’s sanction. Her image is so strong that divers suffering from nitrogen-induced hallucinations often tell of seeing her in the depths, just prior to the onset of their symptoms. Clinical healthcare Clinical healthcare in the Moskitia is scarce and difficult to access. Some of the larger communities have local healthcare centers attended by nurses. They are part of national healthcare services depending on the local Ministries of Health and are poorly equipped, often lack the necessary medicines and are seldom visited by doctors. Public service medical doctors are available only in the few hospitals of the Moskitia; there are some private practitioners in the major population centers. Medicines are available free or at a reduced cost in local health centers and hospitals. The lack of economic resources limits the population’s access to healthcare. Though state-run clinics offer free or reduced-cost attention, visiting them implies considerable expense for patients coming in from distant communities. Clinical Healthcare Available to Divers The following chart summarizes the clinical care available to divers in the RAAN and the Honduran Moskitia Table 6. Clinical Care Available to Divers in the RAAN
Only the clinics that have decompression chambers have reached some level of specialization in the treatment of diver injuries. In other clinics, diver care is a part of the normal, non-specialized attention given to patients. Nuevo Amanecer Hospital in Nicaragua, and the Moravian Hospital (Ahuas) and the CESAMO (Caukira) in Honduras are the only clinics that have trained some of their staff in hyperbaric medical care and in physiotherapy. The three clinics have received aid from foreign institutions in the form of training and equipment. Some private practitioners also attend divers. Doctors in the more specialized centers feel that this is improper and even dangerous. At the private clinics, divers are usually prescribed medicines to minimize discomfort, ease pain and reduce symptoms. Drugs and alcohol: a health and social problem Excessive consumption of alcohol and drugs, particularly cocaine, crack and marihuana, has become a serious health and social hazard to the Moskitia. This type of abuse is common among males, more prevalent among the younger generations and sometimes starting in early adolescence. By all reports, such substance abuse is also quite common among divers. Alcohol abuse among Miskito males is common and has even been registered in historical texts. Rum is readily available in the communities and there also seems to be some minor illegal distilling activities; with the introduction of canned beer, this drink has increased its sales. Alcohol induced violence, including within homes, is a problem often cited by community leaders. However, unlike the western parts of Honduras and Nicaragua, it is not common to see public displays of drunkenness. Alcohol is consumed quickly and in large quantities, with the express purpose of reaching inebriation; it is also common for men to go on “binges,” drinking bouts lasting anywhere from a couple of days to several months. The isolation of the Moskitia region has turned it into one thoroughfare for drug traffic from South America. Significant quantities of cocaine and some marihuana are reported to come through the region on the way to markets in the US and Europe. Smaller quantities of cocaine paste are also available locally, where it is processed into crack, a job that has been assumed by women. Though doubtless there are local drug distribution networks, the Miskito are probably not directly involved in international drug trade. It is common however to hear of Miskito fishermen finding packs of cocaine – sometimes weighing a few hundred kilos - floating at sea or washed up on shore. These may have been abandoned on the high seas by traffickers when approached by a Coastguard boat or similar, but there is also conjecture that this may represent a deliberate strategy by the traffickers. Cartel operatives move through the area recovering the drugs, by force or by paying a nominal price, so as to keep them moving north. On at least one occasion purchase of drugs was made with false currency leading to a wariness in the Puerto Cabezas area of "Sandy Bay Dollars". It is commonly held that some communities have prospered economically when their members have been lucky enough to find a floating drug pack. Some go as far as saying that certain local village-level authorities levy a sort of tariff on drug money to finance communal work. The stories, however, reveal that a double standard has developed in the communities. Everyone agrees that drugs and drug money are a serious problem for the communities, yet at the same time they all project a wish for finding a drug pack and see it as the windfall, similar to winning the lottery, that could solve their economic problems overnight. Drug and alcohol abuse is also a major problem among divers, and figures as a major factor contributing to accidents. Alcohol and marihuana figure almost exclusively in these cases. It is commonly held that divers consume both during work, though it was not possible to establish to what extent this is true. Long hours of extenuating work, an excessive number of immersions and the cold of the deep take a quick toll on divers’ bodies. Many claim that drugs and alcohol help them “dive better,” that is to say, to withstand the rigors of their work and diminish the pain they often feel. Liquor is sold without restriction throughout the Moskitia, and drugs are apparently obtained with ease. In Puerto Cabezas, drug peddlers (typically women) are said to mingle with the crowd gathered on the pier to bid farewell to departing lobster boats. None of the disabled divers interviewed in the current study accepted being under the influence of either drugs or alcohol when their accident occurred. Yet they were almost unanimous in saying that most of their friends did abuse. Doctors at the various clinics agree that the abuse level while diving is high. On the other hand, boat Captains claim that drug taking does not occur - at least on their ships - because they do not allow it. Nonetheless, some divers have claimed that the Captains themselves will provide them with liquor to help them withstand the exertion of work and the minor symptoms of inadequate decompression, and sometimes as a reward for a good day’s catch. Drug and liquor problems among divers are not limited to their time at sea. They are notorious for going on drinking bouts as soon as they dock, many of them consuming marihuana and / or smoking crack at the same time. Sexually transmitted diseases Doctors at the various clinics report an increasing incidence of sexually transmitted diseases, including venereal diseases like gonorrhea and syphilis as well as AIDS. The high incidence is owed to three factors: an early initiation into sexual practices, combined with a cultural pattern of frequent changes of sexual partners (including the practice of serial polygamy) a lack of sexual education, aggravated by a traditional health framework that does not include the existence of bacteria and ascribes spiritual or magical causes to diseases, including those transmitted by contagion high mobility of the male population, especially among those who work at sea Health Problems of Miskito Lobster Divers Miskito lobster divers face serious health problems because of improper diving practices that lead to frequent decompression accidents. Many divers have become disabled as a result of such accidents. Diver disability ranges from weakness in joints or limbs to full paralysis; a small percentage has lung affections. Some limited medical studies have shown close to one hundred percent of divers showing symptoms of neurological damage - presumably due to inadequate decompression. Most of the divers interviewed in the current study claimed to have suffered at least some of the typical symptoms of the 'bends'. The first occurrences of the problem began with the introduction of SCUBA gear and access to greater depths in the 1970´s. Twenty years later some minor improvement can be noted, mainly due to training programs in the Honduran Moskitia. Nonetheless, many of the working conditions that caused accidents in the early days have not changed, and some, like the number of immersions and the depths being reached, have even intensified. Miskito lobster divers are still at very high risk. Depletion of lobster resources has forced the fleet to take divers further out to sea, to fish at greater depths. As a result, diving accidents have become common, especially those related to improper decompression. The number of divers affected by the “golpe”, as decompression accidents are known among them, is difficult to establish, as no full census has been made, but it certainly runs into many hundreds. The Association for the Integration of the Disabled into Society in Puerto Cabezas estimates some 1500 disabled ex divers in the RAAN alone. A number of conditions and circumstances, ranging from labor conditions and defective equipment to diver perceptions and attitudes, have an effect on the conditions leading to accidents and on their frequency and severity. These are analyzed in summary form in the following paragraphs. Depth Depletion of lobster reserves in the shallow waters near the coast has forced the industrial fleet to fish in deeper waters. Inadequately equipped divers can find themselves out of air at depths of twenty fathoms or more, and are forced to ascend rapidly, without a chance for decompression. Almost no divers carry a depth gauge; they are forced to estimate depth through changes in luminosity and color, and so are less able to estimate their risk. Alterations of sensory perception through drug / alcohol use could be an important element in making this risk even greater. Number of dives and rest between dives Since both ship Captains and divers are paid according to the amount of lobster they catch, increasing the number of immersions improves the chance of better earnings. Internationally approved diving tables recommend no more than four immersions per day, with adequate rest periods between each. Miskito divers are regularly going to depth eight to twelve times per day. This places them in a high-risk position that greatly increases the possibility of decompression accidents. Inadequate / defective equipment Most divers work with only the minimum equipment necessary to submerge: mask, fins, tank, regulator and harness. Almost none of them have depth or tank pressure gauges and only a few have diving watches. Much of the equipment in use is in disrepair and routine maintenance is minimal. In Nicaragua many decades-old tanks can be found that are still in use and have never been through a hydrostatic test. The divers often complain that the tanks that they use are filled with residue that frequently clogs their regulator, suddenly cutting off their air supply and forcing them to perform an emergency ascent without adequate decompression. Many tanks do not have properly working O-ring seals. The lack of these seals causes tanks to leak and regulators to function improperly. Lacking tank pressure gauges, watches and other such instruments, divers must estimate how much air remains in their tanks. Leaking O-rings make their estimates less accurate, increasing the possibility of their having to make emergency ascents. A
Lack of adequate training Most divers have not received any training at all. This is particularly the case in Nicaragua, where fewer training programs have been mounted than in Honduras. Divers usually learn their trade when they start working as cayuqueros, (canoers) acquiring a few tips from experienced divers, then borrowing equipment for practice. Due to their lack of training, they are unfamiliar with some of the most elementary concepts and practices of diving. Divers also lack adequate knowledge of first-aid techniques that can be applied after one of their number has had an accident. It is particularly relevant that many do not know about in-water recompression, as this technique, if applied promptly, can reverse the effects of an improper decompression. First aid The severity of the effects of diving accidents can be reduced considerably in two ways: a) if divers are given proper first aid, and b) if they are transferred to a decompression chamber as quickly as possible. Most divers, ship Captains and sailors know of the existence of first-aid techniques but do not apply them out of lack of technical knowledge and of the necessary equipment. Often, divers who have had an accident will simply be told to lie down and rest, and maybe receive an analgesic or a drink to reduce the symptoms. The rest period may last only as long as the diver needs to feel well enough to dive again. “Well enough” does not necessarily imply an absence of symptoms. Doctors agree that administering oxygen after an accident helps the body get rid of excess nitrogen and reduces the severity of the consequences of improper decompression. However, few ships carry it and there has been none available for artesanal divers in their work centers on the Miskito Cays or personnel trained in its application. Some divers claim that the few ships that do carry oxygen end up using it for welding. Ship Captains have expressed that they would be willing to carry oxygen and apply first-aid techniques if they received the proper training18. Diver perception and attitudes Divers are aware of the dimensions of the risks they take from a very personal, experiential point of view. Lack of training and a low educational level prevent them from perceiving the risks they take with a better understanding of their causes and the possible remedial actions they can take. This situation generates a resistance to training that is manifested in low attendance and high desertion from training courses. Nonetheless, they are aware of their acute need for training, demand it constantly, and realize that they would have fewer accidents if they were trained better. One factor that affects diver health and safety to a considerable extent is the notion that accidents are part of the job and are thus considered “normal.” Divers tell, for example, that in the early days of industrial diving, bleeding from ruptured eardrums was taken to mark a man finally “becoming a diver.” This acceptance prevents divers from realizing the true dimensions of the risks they take, and often prevents them from taking the necessary measures to prevent accidents or reduce their severity. Uncertain labor conditions The lack of adequate legal definition of the divers’ labor status also affects their health, as boat owners are expected to assume the costs for medical treatment. Labor laws in both Honduras and Nicaragua establish employer’s responsibilities in case of accidents at work. The laws are unclear and poorly enforced, and offer many loopholes; and the legal procedures for establishing claims are complicated and costly. Divers in Honduras do not enjoy the benefits of Social Security. Some Nicaraguan divers in Puerto Cabezas are affiliated to the Instituto Nicaraguense de Seguridad Social (INSS). However, the benefits that they derive from this are limited, as the coverage offered by the Insituto is quite limited in the Atlantic Coast. Disabled Divers Disabled divers suffer the consequences of their situation psychologically and socially, as well as physically. Medical and social institutions, including those at community and family levels, have failed to address the problems of disabled divers adequately. Almost one hundred percent of disabled divers have serious problems becoming reintegrated socially and productively. The percentage of disabled divers receiving some sort of medical treatment, including physiotherapy is considerably low, and what programs do exist have a high desertion rate. Depression is quite common among these divers, and generally produces a lowering of self-esteem and feelings of inadequacy. Since many injuries affect the spine, disabled divers often suffer sexual impotence, a condition that worsens their already weakened psychological and emotional state. Socially, disabled divers also develop feelings of inadequacy. Those who can work, usually return to agricultural work, which seldom can provide them with a cash income and brings with it a drop in social prestige. Those divers with lesser disabilities attempt to go back to sea in some position related to diving. Some attempt to dive again, working shorter stints as industrial divers, or in lesser depths, as free divers; others return as cooks, canoers, or in any of the complementary jobs available. In one exemplary case in Sandy Bay, Nicaragua, a paraplegic man has returned to sea as the Captain of a sailboat, though he has to be carried on deck and must be strapped in while he works. There is potential to involve disabled divers in workshops to maintain SCUBA equipment and also to carry out hydrostatic testing, if external funding support could be identified for this. Women in households with disabled members frequently have to assume leadership in domestic production and may recur to extreme measures, like turning to prostitution. Children and youngsters must also assume more prominent roles in their domestic economies, usually sacrificing the opportunity for education. In these cases, young males predictably see lobster diving as their best option. Directory: archive -> website00967A -> WEB -> DOC archive -> Gary C. Kessler archive -> Tossups center of the known universe open 1998 Combined packet of Tennessee I and utc blue archive -> PriceWaterhouseCoopers Archive 148 linear feet in 98 record cartons and 4 flat boxes. Biography/History archive -> In this issue archive -> United states archive -> - archive -> The Tropical Rainfall Potential (TRaP) Technique. 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