Honduran and nicaraguan moskitia

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Puerto Cabezas

Robert Armington Diving Instructor, Carr Planta San Miguel.

Dr. Humberto Castro Olayo Cámara de descompresión, Hospital Nuevo Amanecer

Baldio Denecio Alberto Disabled diver

Marta Downs Directora, Asociación de Discapacitados de la RAAN

(ODISRAAN)

Elizabeth Enrique President, AMICA (women's organisation)

Edgardo Goff Dive boat captain (Honduran)

Carlos Josse Director, DIPARAAN, Tel: 266 4730 (res) 088 44382 (mob)

Dra. Guadalupe Loáisiga Hospital Nuevo Amanecer

Lic. Silvia Malespín Fisioterapeuta, Clínica de Fisioterapia del MINSA

Dr. Francisco Morles Director SILAIS-RAAN, Tel: 02 82 2216

Balbo Müller Director Proyecto Cayos Miskitos

Adolfo Ocampo Dive boat captain (Honduran)

Dr. Armando Palacios Hospital Nuevo Amanecer

Alejandro Pereira General Manager, INVERSUR (trap boats)

Roni Pont Vice-President, MIKUPIA

Brooklyn Rivera BICU Tel: 0282–2415

Carlos Salgado President, MIKUPIA

Armando Segura Nicaraguan Fisheries Chamber Tel: 088 25350, 278 7091

Fax: 278 7054

Jose Stevens Dive boat sacabuzo (labor agent)

Juana Ma Thompson Vice-President, AMICA (women's organisation)

Felipe Uveda Fisheries Inspector, ADPESCA

John Wayne Ex-lobster diver, equipment and plant maintenance engineer

Sandy Bay
Fco Irresis Principal, Sandy Bay High School

Antonio James and other free divers, Deadman's Bar

HONDURAS
Tegucigalpa

Ing.Arturo Echeverría H Director, DIGEPESCA, Ministerio de Agricultura y Ganadería Tel: 232–8423

Nelson René Marcía Departamento de Estadísticas Económocas, Banco Central de

Honduras

Oswaldo Munguía MOPAWI, Colonia Los Tres Caminos, Tel:237–2864

MOPAWI, Puerto Lempira, Tel: 898–7460

Dra. Fredesvinda Torres Participó en Proyecto Nautilo,Departamento de Epidemiología

Ministerio de Salud, Tel: 237–4343

Corina Valladares Ministerio del Trabajo

La Ceiba
Céleo Alvarez Casildo Director, Organización para el Desarrollo Etnico Comunitario

(ODECO)

Puerto Lempira

Zaida Calderon Administrator, MOPAWI

Pablo Garcia Mejia Committee for the Defense of Human Rights in Honduras

Junior Gomez Diver

Isime Graham Gottfrey Leader, Honduran Miskitu Indian Buzuka Asla Takanka

(HOMIBAT), C/o ACCODIGAD

Corbel Haylock Müller Dive boat Captain, Caukira

Santos Haylock ex-dive boat Captain, Caukira

Damion Kyrington Fisheries Inspector, DIGEPESCA

Celi Laínez Leader, Honduran Miskitu Indian Buzuka Asla Takanka

(HOMIBAT), C/o ACCODIGAD

Walsted Miller Fundador / presidente de PROMEBUZ

C/o MOPAWI, Puerto Lempira

Esmérita Ordóñez Enfermera, CESAMO, Divers' Clinic “Rey Alfonso XIII” ,

Caukira

Joaquin Perez 'bent' diver at Clinic

Cecilio Tatallón Director, Asociación Campesino-Comunitaria para el Desarrollo

Integral del Departamento de Gracias a Dios (ACCODIGAD)

C/o Alcaldía Municipal de Puerto Lempira, Tel: 898–7436

Ahuas
Dra. Norbelle Goff Directora, Hospital Moravo

I Socioeconomic Conditions and Health Problems of Miskito Lobster

Divers in Nicaragua and Honduras - Full text

1. INTRODUCTION
The lobster fishing industry is one of the most important sectors of both Honduran and Nicaraguan export economy. Each country exports more than a million pounds of lobster tails, mainly to the U.S. market. This represents revenues of more than thirty million dollars for each nation. The lobsters are fished from the banks extending off the Atlantic coast northeast of Honduras and east of Nicaragua. Most of the fishing is done by industrial fishing fleets, though in Nicaragua the contribution of artisanal fishermen is considerable. Both use the same fishing methods, extracting the lobsters with divers or by the use of traps known locally as nasas; they differ only in the intensity of their operations.
Most of the lobster fishing is concentrated along the eastern coast of both countries, an area known historically as the Mosquito Coast, or the Moskitia, and home to the Miskito people. The Miskito, who have dived off these coasts for centuries, provide almost all of the divers working with the fleets or independently, as artisanal fishermen. The lobster industry is the main source of employment, and income from diving represents a major portion of the cash inflow to the economy of the Moskitia. In Honduras, a small number of Garifuna, an Afro-American ethnic group living on the central and western parts of the Atlantic coast, also work for the industry as fleet divers and independent artisanal fishermen.
In Honduras and Nicaragua, the Miskito classify lobster divers into three groups: industrials, artisanals and “lung.”The industrials are those who work on the ships that make up the fishing fleets; they use diving gear and work at depths of up to 140 feet. The artisanals are independent divers who receive some support from the industry in order to work; they also use diving gear, but usually work at lesser depths. The lung divers are independent workers who dive without gear at shallow depths; they receive little or no support from the industry.
Depletion of lobster resources has forced the fleet to take divers further out to sea, to fish at grater 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 virtually impossible to establish, as no adequate census has been made.

2. SOCIOECONOMIC CONDITIONS OF LOBSTER DIVERS
A Brief Overview of the Moskitia Region
An adequate understanding of the both socioeconomic conditions and health problems of Miskito lobster divers requires a general overview of the socioeconomic and cultural conditions in 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 Moskitia’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. Its geographical isolation prevented the Spaniards from effectively conquering the area, leaving it free for English occupation (though not colonization). After the Spanish acquired sovereignty over the Moskitia, it remained isolated from Spanish colonial authorities and development. Post-colonial governments of both Nicaragua and Honduras have showed the same attitude of marginalization towards the region and its inhabitants, though the isolation of the Honduran Moskitia is more felt. The region’s historical isolation permitted the indigenous groups within it to remain culturally strong and develop a strong 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 seated in the area. As a result, there are fewer economic opportunities for the population, and diving is more important to its local economy.
The Nicaraguan Moskitia remains considerably isolated, but three factors have made its sociopolitical and economic situation differ greatly from that of Honduras:
 Sandinista rule and the ensuing Counterrevolutionary War during the 80’s

 Establishment of the Autonomous regions in the Atlantic Coast

 Establishment of lobster processing industry

The triumph of the Sandinistas initiated a policy of integration of the Moskitia and the Miskito people into a national socioeconomic scheme in which ethnicity played a markedly secondary role. In response, the Miskitos formed various political organizations whose purpose was to vindicate their rights to land, bilingual education, the recognition of traditional social and political organization, and other rights derived from their ethnic differentiation. These organizations changed with time and became the military groups that, with international support, attempted to overthrow the Sandinista regime during close to a decade.

The war closed without succeeding in the overthrow of the Sandinistas, but it did manage to force them into a drastic change in policy towards the Moskitia and the Miskitos. The most important of the results of this change was the creation of the two Autonomous Regions of the Atlantic Coast, known as the RAAN and RAAS^¹⁹. Their creation also implied important administrative changes that grant Miskito communities a greater participation in the decision-making processes concerning their territory and resources. These processes are highly participative -even to the point of often becoming a hindrance to the goals at hand- but have strengthened local community organizations considerably and given the Miskito a strong sense of participation in local and regional affairs.
All lobster fishing and processing was halted during the decade of war, with the exception of small-scale artisanal fishing for local consumption. This gave the resource a chance to replenish, but placed the Nicaraguan lobster industry at a considerable disadvantage versus its Honduran counterpart. The lobster industry reinitiated activities after war, opening plants in both the RAAN and the RAAS that have generated a considerable demand for goods and services. Many local divers were involved in the armed conflict; others who chose to work during this period could only do so in Honduras. After the war, the local demand for divers increased and became one of the principal sources for cash income in the area.
The exercise in autonomy has had considerable drawbacks, and many Miskito feel that in its present form it is inadequate or insufficient to guarantee their territoriality and the rights to administer their resources. The communities in the RAAN consider that the creation of a Reserve along the northern part of the region, and including the Miskito Keys, is a viable alternative for safeguarding their territory and resources, particularly the lobster, and assuring them the continuity in their direct participation in administration. The process to create the Reserve is well under way, and it has received support from various international institutions. However, it has yet to be legally instituted and it still has no definite management program. Nonetheless, the communities and a number of institutions, both in Nicaragua and internationally, grant it de facto recognition.
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. This sees 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 basic services like potable water, electricity, health centers, etc. Houses are generally built of wood, constructed on stilts to minimize the effects of periodical flooding, and have roofs of zinc sheeting. It is still common, however to find traditional style houses with thatched roofs. The houses are grouped according to extended family groups, and the distribution of land for planting tends to follow this same pattern.
The Moravian Church
The Moravian Church has a strong influence in the Moskitia - the Church began its missionary activities in Nicaragua in the late nineteenth century and in Honduras at the beginning of this century. It found fertile ground in the region, which had not been colonized by Catholic Spain and the religion has become a key element in present day Miskito identity even though it supressed some aspects, like music and dance, of Miskito traditional religion. The Moravian Church works mainly through local Miskito Pastors. Education has been one of their principal concerns, along with health and development. Like other Protestant sects, they hold apocalyptic views which the population sometimes misinterprets, deriving from them an attitude of purposelessness that can be an obstacle to development. Conditions like war or the depletion of a natural resource are often interpreted in terms of this fatalism. Nonetheless, the Moravians are one of the principal driving and unifying forces in the Moskitia and are considered leaders in other areas besides religion, including politics and social issues.

Economy
The Miskito are in a transition process between subsistence and market economies. 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. The extended family groups and the communities constitute a social network that provides the support needed to carry out most economic activity, even beyond the local subsistence network. 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 lobster fishing activities.
Miskito participation in national market economies is still quite limited. They began being introduced it early in the twentieth century, when logging, mining and agroindustrial (banana) enterprises entered the region and incorporated many of them, primarily men, as wage laborers. This same industrial development also introduced processed and manufactured consumer goods to the region, many of which have become staple items in Miskito culture, often substituting or displacing traditionally produced goods. Most of these goods are foodstuffs like grains, flour and lard (which is consumed in large quantities), but also include others like plastics, patent medicines, liquor, and carbonated soft drinks. Though much transportation is still carried out in traditional man or wind powered vessels, outboard and inboard motors are becoming increasingly common, creating an ever-increasing demand for fuel, parts and services. The lack of electrical energy in communities is sometimes remedied by the use of small gasoline driven generators, which also require fuel and maintenance. Battery operated radios and flashlights are also quite common, making batteries one of the more prized commodities in the region.
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 Moskitia, though they are poorly maintained and become virtually impassable during the periods of heavy rains. Air transportation is regular, though the airplanes used do not allow the transportation of heavy or voluminous cargo.
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.
The lobster industry began developing in the ‘70s in both Honduras and Nicaragua, however, its impact has been different in the Moskitia region of each country. Honduras developed the largest fleet in Central America from a very early stage. The industry is centered in the Bay Islands, and only a few ships are based in the Moskitia. Thus, the industry has not generated jobs and other benefits in the area besides those derived from diving. In Nicaragua, the development of the industry was slower, and it came to a standstill during the ten years of armed conflict. Within the last ten years, however, its development has been considerable, and a number of processing plants are operating in the Moskitia region, especially in the areas of Puerto Cabezas, in the RAAN, and corn Island, in the RAAS. Along with the processing plants, other industries have developed to provide complementary goods and services, such as ice, transportation, etc. In consequence, job opportunities and access to goods and services for the Nicaraguan Miskito are better than those of the Honduran Miskito, at least around the two urban centers mentioned above.

Agriculture
Traditionally, for the Miskito agriculture has been a complementary activity to their hunting, fishing and gathering, primarily a source for carbohydrates. They keep agricultural plots where they cultivate primarily a variety of tubers and bananas. Their agricultural work is done following a slash and burn method. However, the increase in population and the deforestation of large extensions of the Moskitia has caused a considerable decrease in agricultural yields and has rendered slash and burn agriculture unsustainable.
The soil of the Moskitia is, for the most part, unsuited for agriculture, so Miskitos must work in plots located along riverbeds, where the more fertile soil deposited by periodic flooding can be found. However, these floods which can be quite severe and on occasion cover vast expanses of the pine savannas, are another obstacle to agricultural production. Other obstacles, like limited access to capital, technology and adequate means for getting products to the countries’ markets make agriculture a limited option for economic development of the Miskito. Nonetheless, they consider agriculture to be one of their better options for cash production, though they are well aware that it would require considerable investments.
Large-scale production of rice may be a viable option for agricultural production in the Moskitia, as the Miskito already cultivate it for their own consumption and would probably the necessary technology for increased production with relative ease. Cultivation of beans and maize is another possible option, mainly due to the high demand in both countries. Other alternative crops would require some experimentation, and attempts have been made, primarily with rice and cacao cultivation. One Miskito NGO in Honduras has had some success with small-scale projects in the cultivation of marañón and processing of its seeds, the cashew nut.
Animal husbandry and cattle raising
Coastal Miskito raise small numbers of animals as a dietary complement to their diet of seafood and occasional game. These include mainly chickens, pigs and cattle. The animals are raised with no technique, and are left to roam freely about the communities, fending for themselves as best they can. In the case of pigs, this represents a major health problem for both animals and humans, as they often feed on human feces.
The Miskito have turned cattle growing into an important secondary economic activity. However, since their cultural background does not include animal husbandry, they lack the methodology to develop it beyond the local market. As is the case with agriculture, they face the obstacles of inadequate lands, lack of capital and techniques, and isolation. The pine savannas do not make adequate grazing lands, as the grasses that grow there are extremely tough and difficult for the cattle to consume. Periodic flooding also represents a grave risk for the animals. Lack of capital and extremely difficult communication with the cattle areas of the interior make it hard to bring in new, improved cattle stock. Nonetheless, some Miskito have managed to acquire better quality animals. The meat is consumed locally, most of it distributed among extended family groups, while a small amount is destined to local sales, providing a source of income. In a society that is undergoing a transition between subsistence and market economies, and does not have –or fully grasp- the benefits of financial practices and institutions, cattle growing is often the most important means for the accumulation of capital: cows are their savings. Thus, when money is needed on short notice, as in the case of family emergencies, the sale of cattle represents the quickest means to acquire the necessary cash.
Hot humid weather, plus the lack of adequate storage and processing techniques make it impossible to produce processed beef derivatives, limiting consumption to fresh cut beef. Likewise, weather conditions and the lack of processing techniques like tanning prevent the use of leather for the production of market goods, or even many utilitarian manufactures. The Miskito produce practically no leather goods, even at a utilitarian level, and they often leave the hides to rot.
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. During this stage, children begin to participate in productive activities through the performance of household chores. They also begin acquiring the basic principles of hunting fishing, while at the same time assimilating considerable knowledge of the natural world. The process of socialization into community and cultural life also begins early. During the day, small children roam and play freely about the community, under the shared tutelage of the adults present in the community, most of which are women, and are often cared for by older children. Within the households, children enjoy a similar freedom. This gives them the opportunity 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, in spite of being acceptable to some degree, 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.
Insofar 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 divers 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 that they assume even the hazards as unavoidable parts of their future lives. 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 old 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 very low; most communities only have schools offering the first levels of primary education. The population is quite disperse, so children must often travel considerable distances –often by pipante-- to get to school; this problem intensifies during the rainy season. And although many parents show an increasing consciousness about the importance of formal education, children face an early pressure from their families and peers to become incorporated into productive activities. 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 major obstacle to improving Miskito education. Though many Miskito, especially the men, are bilingual (Miskito - Spanish) and some are even trilingual (English), most children and many women are basically monolingual. Understandably, the need for adequate bilingual – bicultural education is an important end even delicate issue in Miskito formal education. The linguistic barrier limits the impact of any educational program, and often generates a resistance to any such program not presented in the native tongue. This situation points to the urgent need to present any diver training program in Miskito language.
Low formal educational levels have definite negative effects on diver health, especially on their perception of diving phenomena and their attitude to and understanding of basic diver-training concepts. Though it was not possible to establish precise numbers, it is evident that divers have an average education of between third and fourth grade level. As a result, the elementary physical and health principles involved in diving is 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 worldview, 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 the tradition is clear in saying that diving accidents are spirit-caused, and not due to physical and physiological factors.
Transportation and communication
The geographical and economic isolation of the Moskitia has prevented the development of strong communication links, both within the region and with the western parts of Honduras and Nicaragua, where the economic and development centers and institutions are located.
Within the Moskitia, the waterways still provide the most important means of communication and transportation for the population. This is especially the case in Honduras, where the region is more isolated and has a very complex system of rivers and lagoons that allow navigation from practically one end of the Moskitia to the other. The Miskito have developed and adopted a wide variety of canoes and boats for freshwater and ocean navigation. Ocean transportation takes place close to the coastline, though they do venture into open sea for fishing, even in the smaller cayucos, seafaring canoes moved by oar or sail. In Honduras, medium sized cargo ships bring cargo into the Moskitia from larger ports further west. Except in Puerto Lempira, which has the only docking facility in the area, they usually anchor offshore and unload their cargo onto cayucos. There is more Nicaragua has more large-scale sea traffic in the Nicaraguan Moskitia than Honduras.
Communication and transportation along the waterways has generated a local boatbuilding industry that is among the most important artisanal industries in the region and a key element in lobster fishing. The lobster industry has intensified the need for services in boat building and maintenance. The skills demanded have developed from the base of traditional building of pipantes, single log dugout canoes for navigation in rivers and lagoons, and cayucos, the seafaring version. These two types of canoes, which take more than a year to build, from the time the tree is cut until the hollowing out is completed, are still the most widely used means of transportation in the Moskitia. In Nicaragua, where there are more artisanal fishermen, the Miskito craftsmen learned from Jamaicans how to build duri taras, single mast boats with two sails that are widely used for lobster fishing.
The Atlantic Coast of Nicaragua is linked to the rest of the country by road. This roadway is used for the transportation of people and cargo throughout the year, though transit becomes very difficult during the rainy season. The Honduran Moskitia lacks a road connection to the rest of the country, but it has a road that follows a southern route, along the least flooded areas. This road was of importance during the Nicaraguan war in the 80’s, and has had virtually no maintenance since then, making it a seldom-used route.
Air transportation makes up for the poor terrestrial transportation, and many communities have functional airstrips. Commercial airlines offer regularly scheduled flights between the larger population centers and cities in the interior, and carry passengers as well as smaller cargo. Charter flights on smaller, locally operated airplanes are also available in the region, though their high cost makes them an option resorted to in case of emergencies. Air transportation is expensive and often unreliable, yet it is widely used and is often the only alternative to days-long trips by land and water.
Telecommunications are only available in the main population centers of the Moskitia, and are limited to telephone (unsuitable for e-mail) and fax. The isolation of most communities is overcome through a network of individually owned short-wave radios that interconnects the whole Moskitia on both sides of the Río Coco. The network extends outside of the Moskitia, and often links the region with the capital cities.
3. Socioeconomic situation of Miskito Lobster Divers
General Health Conditions in the Moskitia
Most health problems in the Moskitia derive from poor general sanitation conditions in a hot and humid environment. Gastrointestinal, pulmonary and skin diseases are common, and the high mosquito population provides vectors for the transmission of diseases like malaria and dengue. The lack of adequate healthcare can turn even relatively mild affections into high-risk conditions. Often, other sociocultural factors, like resorting to sukias, the Miskito traditional healers, for the treatment of afflictions they are not prepared to heal, affects Miskito health in a negative way. Under these circumstances, children are at high risk and infant mortality is high.
All communities, with the exception of the core sectors of the main population centers, lack adequate water supplies and waste disposal. Water is normally taken from local watersources such as creeks, which are often contaminated by animal and human waste, and boiling and chlorinating are practiced by only a small segment of the population. Few communities have adequate latrines, and many have none at all; oftentimes the pigs that are left to roam freely eat the feces and thus help keep the communities clean, but become a serious dietary risk.
Houses are often crowded, favoring the transmission of diseases. However, most of them are built on stilts, thus avoiding excessive moisture. Nonetheless, skin ailments, especially fungus infections are common and difficult to treat in the humid climate. Most people sleep under mosquito netting, thus reducing the risk of insect borne infections.
Nutritional needs are satisfied mainly through the traditional means of hunting, gathering and fishing, complemented by subsistence-level cultivation of bananas, tubers and rice, plus some fruit. Industrially produced foodstuffs are available in most communities and have come to be staple items in Miskito diet. These include pastas, processed sauces (tomato), shortening and oil, coffee, flour, sugar and salt, carbonated drinks, etc. The quality of nutrition is affected by the lack of adequate storage, which in so humid a climate sometimes does not even allow short-term preservation of supplies, especially meat and fish. However, this fact reinforces the traditional sharing of foodstuffs through gift, barter or sale, and results in their rather efficient distribution through family and community channels. In the coastal regions, nutrition tends to be better than in the interior, as fishing provides a better supply of protein. Nonetheless, traditional diet is considerably high in carbohydrates and grease.
Child health is affected negatively by inadequate prenatal care. Many women do not follow adequate prenatal control due to the unavailability of medical services in their communities or their low educational level, which prevents them from realizing its importance. They resort to local midwives, who often lack adequate training.

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. The satisfaction of healthcare needs in Miskito communities reflects this dichotomy: they are satisfied by traditional means, including the consultation of sukias, as well as by practitioners trained in clinical medicine, like nurses and doctors. 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. As a second option, the patient may consult someone in the community who knows about herbs and traditional healing; this could simply be someone who has suffered a similar ailment and has acquired an effective cure. 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 worldview 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. Healers who apply herbal cures have an impressive botanical knowledge, yet they too must interact with the spirit owners of the plants they use, as the curing principle is not perceived as an intrinsic property of the plant but rather a power conferred by the spirit. Since illness is often ascribed a magical origin, specialists must also have the knowledge to divine who has cast the spell that made a patient ill, as well as that necessary to counter it.
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.
Illness acquired as punishment from the Liwa can only be cured by sukias. This perception often leads divers to seek out the specialists’ help prior to or in place of clinical medical help. They often seek the sukia during the early stages of their illness, when clinical treatment would be most effective. Doctors attending at hospitals where divers are treated coincide in pointing put that many severe cases of paralysis could be avoided if the divers did not resort first to traditional healers. They have also found that the sukias sometimes recur to drastic, even dangerous treatments^²⁰ in their attempt to overcome the Liwa’s punishment.
The Liwa, then, plays a threefold role in diver health and safety. First, she provides an explanation for decompression and other accidents divers may have. Through her, these events acquire an explanation and so come to “make sense” to the diver and other members of the communities. Secondly, they help define the divers’ ailments: the sukia can determine just how the Liwa has affected the diver in both body and spirit. Finally, since the divers’ ailments can be attributed to a specific spirit, what treatments are required to overcome them is part of the specialized knowledge that sukias have. All of these factors conform a culture-bound healthcare situation that, at least in principle, excludes clinical notions of health and healing. Fortunately, most Miskito are quite able to move between cultural boundaries and can –and often do—recur to both types of explanation and treatments.
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 larger population centers also have pharmacies and stores that, though they are not certified, sell a considerable variety of drugs and medicines, including some, like antibiotics, that are not supposed to be so easily available.
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

HOSPITAL	LOCATION / ADMINISTRATION	DIVER CARE
Nuevo Amanecer	Puerto Cabezas, RAAN, Nicaragua / State run	General care; decompression chamber (only one in RAAN)
SILAIS^²¹	Puerto Cabezas	Physiotherapy clinic
Puerto Lempira	Puerto Lempira, Honduras / State run	General care
Hospital Moravo	Caukira, Honduras / Moravian Church	General care
CESAMO^²²	Caukira, Honduras / State and NGO	Decompression chamber; diver clinic; lodging facilities for families
Hospital Moravo	Ahuas, Honduras / Moravian Church	General care; decompression chamber; physiotherapy center; air transportation; lodging facilities for families
Hospital Baha’i	Palacios, Honduras / Baha’I Church	General care

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-specializad 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. The equipment they have received, including the decompression chambers is generally second-hand, and even discarded, brought from the USA. It is important to note that no state-run clinics are equipped with decompression chambers. The only exception is the CESAMO in Caukira, Honduras, which obtained the chamber through an NGO that runs the clinic and pays the salaries of the attending doctor and nurse.

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, sometimes starting in early adolescence, though drug abuse is more prevalent among the younger generations. By all reports, such substance abuse is also quite common among divers. The presence of drug cartel operatives in the area has intensified the violence normally associated with alcohol and drug abuse. The problem is such that it must be confronted as a long-term issue affecting all of the Miskito, but having a particularly negative effect on lobster 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. Yet, the drinking pattern prevalent in the Moskitia is similar to that observed elsewhere in both countries. 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. It is also commonly held that a hungover drinker needs a few drinks the following day in order to recover. This `practice is often the takeoff point for a drunken binge.
The isolation of Moskitia region has turned it into a thoroughfare for drug traffic from South America. Much cocaine and some marihuana come through the region on the way to markets in the US and Europe. Smaller quantities of cocaine paste are also available. It is locally processed into crack, a job that has been assumed by women, and destined for local sale. Though reportedly are local drug distribution networks, the Miskito are not directly involved in international drug trade. The drug cartels have adopted a strategy for traffic through the area that involves large packs left at high seas to float into the coast. It is common to hear of Miskito fishermen finding such packs –sometimes weighing a few hundred kilos—floating at sea or washed up on shore. Cartel operatives then move through the area recovering the drugs, sometimes purchasing them from the Miskito with false currency, to keep them moving north.
The Miskito are understandably reluctant to speak about drug consumption and traffic in the Moskitia. Much information has been transformed into recent myth, making difficult to obtain precise information. For example, one frequently hears stories like those about grandmothers paddling down the Río Coco with their pipantes loaded with cocaine, or a man going crazy after selling the product of his find at sea, hiding under his mosquito netting every night to count his money to make sure his sons hadn’t stolen it. Nonetheless, 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 problems overnight.
Doctors in the area are worried about the long term health and social effects of drug consumption and commerce in the area. They see the ease with which drugs are found at sea as part of a strategy devised by the drug cartels to ensure unconditional help. Their strategy is twofold. Economically, illegal drug trade presents better possibilities than any legitimate enterprise could ever offer. Easily accessible drugs for local consumption is creating a stratum of addicted youths who are willing to become the cartel’s unconditional allies. In the long run, these people remain marginal to the workforce and become potential social misfits with a high potential for violence.
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 they consume both during work, though it was impossible 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 are said to mingle with the crowd gathered on the pier to bid farewell to departing lobster boats.
None of the disabled divers interviewed 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 considerable. On the other hand, boat Captains claim that it does not happen –at least on their ships—because they do not allow it. Nonetheless, some divers claim 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. Some of them will still be drunk when they embark a few days later, and may even lose the first day’s work while waiting to recover. Ship Captains complain that

They lose money this way and that the divers are so debilitated by days of drinking and lack of sleep that their productivity is considerably reduced.

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 diving accidents. Diver disability ranges from weakness in joints or limbs to full paralysis; a mior percentage has lung affections. Some doctors believe that close to one hundred percent of divers show symptoms of having been affected to some degree by inadequate decompression. A field survey shows that their appreciation is accurate, as most divers claim to have suffered some of the minor symptoms associated with this condition. First occurrences of the problem began with the introduction of scuba gear and access to greater depths in the 1970´s. Twenty years later a minor improvement can be seen, mainly due to training programs in the Honduran Moskitia. Nonetheless, many of the 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
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. We will analyze them 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. None of the divers carry a depth gauge; they are forced to estimate it 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 pounds of lobster tail 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 down eight to twelve times per day. This places them in a high-risk position that drastically increases the possibility of decompression accidents.

Divers have little rest time during their workday. They usually surface after each dive only for the time it takes to strap on another tank. Lack of adequate rest periods prevents the body from releasing the nitrogen accumulated on previous immersions, and the risk of accident increases along with the amount of nitrogen accumulated in their bodies.

Inadequate / defective equipment

All divers work without adequate equipment. They dive with the minimum equipment necessary to submerge: mask, fins, tank, regulator and harness. None of them has depth or tank pressure gauges and only a few have diving watches. Most of the equipment is in disrepair and receives virtually no maintenance. 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 divers having to make emergency ascents.

Air tanks are filled with compressors that are poorly filtered and let in oil and exhaust fumes. Some Captains claim to have changed to electrical, fumeless compressors, but they are a minority. Often fume contamination could be avoided by simply lengthening the exhaust system; oil contamination could be prevented by periodic maintenance including filter changes. After changing tanks, divers often leave their regulator valves open in the cayucos, allowing seawater to enter them. The resulting corrosion forms residue inside the tanks, contaminates the air with which they are filled and weakens them. There are two testing facilities available in Honduras; one belongs to the Navy, the other is located in the Bay Islands. Yet, the lobster fishing companies that own the equipment hardly ever has theirs tested, nor do they have a regular maintenance program for it. Costs and distance make testing inaccessible to divers who own their own equipment.
It is impossible to obtain proper diving gear in the Moskitia. There are none in Nicaragua. Most of the equipment available is second hand, brought in from the US without supervision of its condition. Divers must use the equipment as the companies provide it. They sometimes must undertake minor maintenance tasks, often to be able to use equipment in total disrepair. It is common to see tank harnesses, masks and fins put together haphazardly with pieces of nylon string or wire, or even regulator hoses sealed with adhesive tape.
As it happens with other technical problems affecting the divers, they are aggravated by the lack of personnel trained in maintenance and the lack of available parts. Usually someone in the crew must assume the functions of a technician, learning what he can on the job.

Lack of adequate training

Most divers have not received any training at all. This is particularly the case in Nicaragua, where they have had fewer training programs than in Honduras. Divers usually learn their trade when they start working as cayuqueros, 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. One such practice, for example, can easily prevent ruptured lungs. It consists if simply opening the mouth and trachea during ascent in order to let the compressed air out, preventing it from expanding within the lungs. Most of the decompression accidents divers suffer derive from their lack of knowledge about proper decompression. Many divers are aware of the existence of these techniques and the need to use them, but lack the knowledge necessary to apply them. The knowledge is somewhat complex, as divers must be familiar with time – depth correlation tables that determine how an ascent must be made in order for the body to decompress appropriately. Some boat Captains have been said to discourage their application, as they are time-consuming and reduce divers’ productivity.

Divers also lack adequate knowledge of first-aid techniques that can be applied after a diver has had an accident. It is particularly important that they do not know about in-water recompression, as this technique, if applied promptly, can reverse the effects of an improper decompression. The technique cannot be applied in all cases and it also requires knowledge of timetables and other specific information; applied incorrectly, it can lead to more serious effects, including death. It consists of taking the affected diver back to a certain depth for a specific period of time during which the body becomes recompressed and the accumulated nitrogen again dissolves. Following this, the diver must ascend slowly, making periodic prolonged stops in order to achieve a proper decompression.

First aid

The severity of the effects of diving accidents can be reduced considerably in two ways: a) if they are given proper first aid, and b) getting them 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 lack 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 maybe 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 applying 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 is none available for artisanal divers in their work centers on the Miskito Keys; and there is no personnel trained in its application. Some divers claim that the few ships that do carry oxygen end up using it for welding. Ship Captains claim that they would be willing to carry oxygen and apply first-aid techniques if they received the proper training^²³.
Fist-aid techniques learned in diver training courses have gained more use and acceptability in Honduras, where training has been more extensive. Many Nicaraguan divers claim that they have learned about these techniques, especially in-water recompression, from their Honduran colleagues. However, they are still not generalized practices, and many divers know of them but do not know how to apply them.
Doctors at the clinics are sure that the severity of many accidents could be avoided if the divers were promptly brought in for treatment, preferably within the first twenty four hours. Unfortunately, this is usually not the case. Ship Captains are not always willing to return to port only a few days after having set to sea for the sake of one diver. It is even said that sometimes they prefer to wait “just in case another diver has an accident.” There are also stories of divers being abandoned on shore to fend for themselves after an accident.
It is also a relatively common practice for Captains to send affected divers for treatment in private clinics. Private Doctors in the Moskitia are not trained in hyperbaric medicine, and so are not capable of providing adequate treatment. Sometimes their treatment is limited to a few injections of Vitamin B, but it may include cortisone injections, which sometimes do improve their condition but do not constitute an adequate or complete treatment.
Divers tend to place the responsibility for bringing an affected diver to a clinic on ship Captains, especially in the more severe cases in which monetary compensation may be at stake. However, divers arriving in port with less severe symptoms frequently do not seek treatment.

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. This resistance can even take the form of an unwillingness to accept techniques they know to be effective. In one case, two divers had accidents at the same time; one was paralyzed, the other had pains in his shoulder. The paralyzed man asked to be taken back down for recompression and was able to recover. The other man, even after seeing his friend’s recovery, would not allow to be taken down.

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’s 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.
As it has been pointed out before, divers’ attitudes are deeply rooted in their cultural matrix, as well as being conditioned by other factors like their low educational level and lack of training.

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. These include the coverage of costs of medical treatment and compensations In case of death. The laws are unclear and poorly enforced, and offer many loopholes; and the legal procedures for establishing claims are complicated and costly. The ambiguity of the laws leaves the possibility open for boat owners to decide whether or not to take a diver for treatment, the type of treatment to sought, and its extent and duration. The same applies to the coverage of collateral costs like those for transportation, food and lodging during treatment, medicines, etc., and often includes the costs of family members having to travel to accompany their disabled relatives.

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.
Disabled divers begin to show negative psychological effects immediately upon finding themselves in their new condition. 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. Impotence tends to confirm their vision of themselves as “incomplete men,” and increases their senses of insecurity and inadequacy. Many divers attempt to overcome these feelings by trying to return to the patterns of behavior that were “normal” to them before their accident, unfortunately including alcohol and drug abuse.
Socially, disabled divers also develop feelings of inadequacy. A high percentage of them claim not to have worked since their accident, sometimes for periods of many years. As divers, they belonged to the elite earning group of the Miskito; once unable to work, they are unable to produce an income, and so can no longer see themselves as adequate producers and providers. Those who can work, usually return to agricultural work, which seldom can provide them with of a cash income and brings with it a descent 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 “lung” divers; others return as cooks, cayuqueros, 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 Duri Tara, though he has to be carried on deck and must be strapped in when he works.
Disabled divers are accepted by their families and communities. The Miskito, like all isolated, subsistence level societies, have always had to accommodate disabled members and develop strategies for their assimilation and care. However, their presence often represents a source of stress that can be very difficult to withstand and can lead to the breakdown of support networks. The sudden loss of income forces families often have to develop alternatives for the production of even the most essential commodities. Family and other community networks often provide help, but it is seldom enough to provide all essentials. The breakdown of support networks can intensify a disabled diver’s feelings of depression, and some cases of suicide were reported.
Women in households with disabled members frequently have to assume leadership in domestic production and must often 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.
Even when divers have the support of their families, the care that they receive is inadequate. This is particularly the case with divers suffering from extreme disabilities, particularly quadriplegics, who are unable to move and require constant care. The families of disabled divers receive no training in patient care, and so do not know of specific requirements the divers have or of the techniques they could apply to properly care for them at home. The most notable exception to this are the families of patients attended at the Moravian Hospital in Ahuas. Sometimes the care disabled divers receive at home is barely enough to ensure the diver’s subsistence. In the case of quadriplegics, inadequate home care has led to the death of divers who had become disabled years before. Remaining in one position for long hours in the hot, humid climate of the Moskitia produces sores and ulcers on their skin. Lack of care leads to infections that, without treatment with antibiotics become severe. Doctors complain that families seek clinical care for these cases until it is too late. They agree that adequate home care is the only way to prevent these cases from occurring.
Paralyzed divers or those with lesser affections have little recourse for physiotherapy. In all of the Moskitia only the Hospital in Ahuas, the CESAMO in Caukira and the SILAIS in Puerto Cabezas have the needed facilities. The hospital in Ahuas is adequately equipped, though they have complemented their equipment with many locally built improvisations. It is a policy of the hospital to involve divers’ families in order to ensure the continuity of physiotherapeutic treatment at home and in this way achieve a projection into the communities. The CESAMO in Caukira has a physiotherapy center that is quite functional though in need of more equipment. Like the Hospital in Ahuas, the CESAMO has facilities where divers’ families may lodge while they help care for them. With a family member present, divers tend to remain under treatment at the clinic for longer periods. The SILAIS in Puerto Cabezas is very poorly equipped, though they have two local therapy specialists. They keep good communication with the local Hospital, and attempt to give follow-up physiotherapy to all patients who have received treatment in the clinics or the decompression chamber. However, the specialists complain of a high level of desertion, as it is difficult and costly for divers from distant communities to come in for extended treatment. Many local patients also abandon treatment, as it is a common perception –among divers as well as the rest of the population—that once a patient has recovered some level of mobility he is well enough to discontinue the therapy.
Due to inadequate care at home, divers discontinue to practice the physiotherapeutic exercises they have learned at the clinic. Those few divers who have had the support and motivation to continue exercising have shown considerable improvement in their condition and recovered many motor skills that they had lost.
At present no institutions in the Moskitia have programs or projects for working with disabled divers. The organizations that are trying to find solutions to diver problems concentrate on active divers and touch on the disabled almost inciderntally. The Organización de Discapacitados de la RAAN (ODISRAAN), an institution run by and for the disabled does include a considerable number of divers among its affiliates. It is an NGO with limited capabilities; they have received limited aid from international institutions, including monetary aid and donation of equipment. They mainly offer social support to the disabled and have had a successful program providing wheelchairs and other walking aids. They have their own However, their programs and intentions are not diver-specific, and they attend divers in the same manner in which they attend other disabled people like war veterans.

BIBLIOGRAPHY
World Bank User

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1 Administración de Pesca: the government body responsible under the Ministry of Natural Resources for fisheries administration.

2 Ministerio del Ambiente y Recursos Naturales: the government body responsible under the Ministry of Natural Resources for environmental matters

3 Miskito Kupia: a local non-governmental organization promoting environmentalism and the development of the Nicaraguan Moskitia.

4 Mosquitia Pawisa: a local non-governmental organization promoting the interests of the Honduran Miskito people

5 Non-government organisations

6 Self-Contained Underwater Breathing Apparatus

7 International Center for Oceanic Development of Canada, (fused with CAID, the Canadian Agency for

International Development since 1992)

8 United States Agency for International Development

9 The Garífuna people are descendants of a group of African slaves who were shipwrecked near St Vincent while in transit to the Americas and who subsequently inter-married with the indigenous Indian population

10 The Creole people are descendants of mainly english speaking former African slaves from the American colonies

11 Descendants of indigenous and immigrant African and Spanish peoples

12 Dirección General de Pesca: part of the Ministry of Agriculture and Livestock

13 There is some dispute between different sources about the actual size of the Reserve as indeed also, its legal basis.

14 This is an acceptable treatment for lobsters and shrimp within the processing industry. A number of studies have been made recently including in Cuba and Brazil related to the melanosis (black spot) problem in lobster and different treatments tried, but Sodium metabisulfite dipping remains the method of choice. The international markets accept residual levels of up to 100 ppm in processed product and this limit can be readily complied with.

15 Región Autónoma del Atlántico Norte (RAAN), and Región Autónoma del Atlántico Sur (RAAS)

16 SILAIS: Sistemas Locales de Atención Integral en Salud; a local center in the Nicaraguan National healthcare system

17 CESAMO: Centro de Salud …..¸ a local center in the Honduran National healthcare system; they usually have doctors.

18 Two ships and an artisanal diver work center on the Miskito Cays received oxygen equipment and a short course on its application (attended by more that twenty-five divers and a few ship owners) during the course of our investigation.

19 Región Autónoma del Atlántico Norte (RAAN), and Región Autónoma del Atlántico Sur (RAAS)

20 Photographs of one such treatment involving the provocation of burns at the base of the spine can be seen on the Internet, at suboceansafety.com.

21 SILAIS: Sistemas Locales de Atención Integral en Salud; a local center in the Nicaraguan National healthcare system

22 CESAMO: Centro de Salud …..¸ a local center in the Honduran National healthcare system; they usually have doctors.

23 Two ships and an artisanal diver work center on the Miskito Keys received oxygen equipment and a short course on its application (attended by more that thirty divers and a few ship owners) during the course of our investigation.

1 Ehrhardt, NM & O. Castaño, 1995: Evaluación del estado de explotación de la langosta

espinosa Panulirus argus en Nicaragua. Centro de Investigación de Recursos

Hidrobiológicos, Nicaragua

2 Marsh, TD, 1997. Identification and selected analyses of risk factors to the long term

sustainability of the spiny lobster (Panulirus argus) fishery in the Nicaraguan

Atlantic. MMA Thesis Univ Washington, USA

3 Childress, MJ & WF Hernkind, 1996. The Miskito Coast Marine Reserve Spiny Lobster

Population: Assessment and Recommendatios. App II to USAID/CCC Miskito Coast Marine Reserve Project Document.

4 CIRH female breeding size paper

5 Link between spawning in Nic and fishing in Florida

6 GTA Consultants Inc. 1993. Propuesta para el desarrollo de un plan de administración para

la pesquería langostera de la costa Atlántica de Nicaragua.ICOD-CIDA Canada.

Alevizon, W. 1992. A Preliminary Survey of the Coral reefs and Reef Fisheries of the Miskito Cays, Nicaragua. CCC Gainesville, FL, USA.

Anon. 1996. Evaluación de los Recursos Pesqueros en el Litoral Caribe de Costa Rica. Prog. Caribe JAPDEVA-UNA. Heredia Costa Rica.

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Barnutty, R. et al. 1997. Informe Final sobre los Resultados Obtenidos por el Grupo No.3: Nicaragua, Honduras y Colombia. Taller Regional de Evaluación de la Langosta P.argus, Belice

Barnutty,R. 1997. Informe sobre Crucero de Pesca Comercial de Langosta P.argus Realizado Abordo de la M/N Industrial de Buceo Charly Jr IV en el Mar Caribe de Nicaragua en Fechas de 17 al 30 de Agosto 1997. CIRH Nicaragua.

Barnutty,R. 1997. Esfuerzo Directo de la Flota Industrial y la Caracterización de la Pesca Artesanal de la Langosta del Caribe de Nicaragua. CIRH documento interno.

Barnutty,R. 1998. Informe de la Asistencia de Nicaragua al II Taller Internacional de la Langosta del Caribe, Panulirus argus. Mérida, México

Barnutty,R. 1999. Informe sobre Muestreos Biológicos de Colas de Langosta Realizado en Plantas Procesadoras de Puerto Cabezas y Corn Island en los Meses de Enero y Febrero 1999 y Actualización al mes de Febrero de la Aplicación del Modelo de Conversión al Categoría Comercial a Largos Biológicos. CIRH, Nicaragua.

Barnutty, R. 1999. Análisis del Comportamiento Histórico de la Talla de la Langosta Panulirus argus del Mar Caribe de Nicaragua. CIRH, Nicaragua

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Cruz,R. año. Manual de Métodos de Muestreo para la Evaluación de las Poblaciones de Langosta Espinosa. 2^nd Workshop on the Spiny Lobster Fisheries in the WECAFC Area. Centro de Investig. Marinas, Cuba.

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Moreno, PM. 1998. Adaptación de un Modelo de Conversión de Tallas Industriales a Largos Biológicos para los Datos de las Pesquerías de Langosta y Camarón de Nicaragua. CIRH, Nicaragua.

Phillips, BF et al (Eds) 1994. Spiny Lobster Management. Fishing News Books, UK.

Puga, R.et al.1995. Estado de Explotación y Estructura Poblacional de la Langosta P.argus en Cuba. Rev.Cubana de Invest.Pesq. Jul/Dic 1995

Weinberg, B. 1995. The Battle for the Miskito Coast. Native Americas Magazine.

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