National Nurses United

A s nurses observe daily, the health of their patients is inextricably linked to the conditions of larger society, and Honduras is no different. For well over 500 years, a wealthy few have conquered and controlled the region for profit at the expense of the public good. First exploited as a Spanish colony, then by British and United States-based mining, railroad, banana, and (today) maquiladora corporations, nearly 70 percent of Hondurans live in poverty. Half of the nation's citizens survive on less than $1 a day. This legacy of violence and impoverishment has repercussions in all aspects of daily life, especially when it comes to health and healthcare. During the first decade of my research there, starting in 1997, I watched as unregulated private clinics sprang up around cities. Meanwhile, underfunded public hospitals—the only places a majority of Hondurans can afford to go for treatment—fell into decay. The buildings of the premier nationwide teaching hospital, Hospital Escuela, were crumbling, and nurses lacked even the most basic supplies to care for their patients. In 2004, the signing of the Central America Free Trade Agree- ment (CAFTA) in 2004 exacerbated the situation by preventing the sale of generic drugs to Honduran patients in order to ensure higher profits to Big Pharma. With drugs that cost almost as much as they do in the United States, this factor alone has been a death sentence for many. Under Honduran law, only nurses employed in the public sector are allowed to form unions. As such, pri- vatization not only harms patient health; it is a direct attack on patient advocacy as well. So it should be no surprise that Honduran nurses have been at the fore- front of the struggle against privatization; the Nation- al Auxiliary Nurses' Association (ANEAH) is one of the most active unions in Honduras. In 2008 I inter- viewed members of ANEAH who explained to me that they earned around US $170 per month, less than half of the government- declared living wage. In Hospital Escuela, they told me, the normal daytime RN-to-patient ratio on a medical-surgical unit was 1:17. At night, it was not uncommon for one Hospital Escuela RN to be in charge of 60 patients. "Every little thing we have," a hospital nurse told me during a June 18, 2008 conversation with several ANEAH members, "we have be - cause we went out in the streets for it. All our tiny little raises, our uni- forms, are because we went out in the street. They give us one pair of shoes per year at 300 lempiras, and we had to go out and fight for it." This labor militancy was evident in August of that year, when nurses in the capital took to the streets for nine days (elsewhere, even longer) demanding that salary increases promised them the previous year be fulfilled. On the day I spoke with them in 2008, nurses there showed me photos hanging up on the wall of the union hall of themselves carrying signs declaring, "No to the demands of the IMF, World Bank, and Interamerican Development Bank" and "No to the privatization of public services." Then things got even worse. Just a year after my 2008 interview with the nurses, a military coup on June 28, 2009 overthrew the democratically-elected president of Honduras, Manuel Zelaya. Pri- mary coup sponsors included the owner of the monopoly pharma- ceutical corporation in Honduras (who also owns two of the biggest newspapers), the director of two of the largest private Honduran hospitals (himself also the president of a major Honduran bank), and numerous other corporate healthcare executives. Immediately, Honduran citizens, including many nurses, took to the streets to protest. They were met with lethal force by the police and military forces, who sent a steady stream of injured protestors to public hospitals. Inside the hospitals, nurses had to fight to protect their patients, fending off pro-coup doctors who wanted to deny patients care and police who demanded that nurses turn over patients they had already severely wounded for "questioning" (i.e., torture). If nurses weren't already politicized, they were now. Nurses quickly realized that protecting their patients meant not just fight- ing for better hospital conditions; it meant actively opposing a coup- installed government that was directly and violently harming their patients. Both auxiliary (LPN) and professional (RN) nurses began marching together in uniform in daily protests alongside many thousands of citizens. They called themselves "Nurses in Resistance." Like state associations of nurses who make up National Nurses United, bedside RNs even managed to take over their professional organization, Colegio de profesionales de Enfermeria de Honduras, for the first time running a pro-union, resistance slate and winning by a landslide in 2010. Their passionate advocacy in defense of their patients and their democracy earned them leadership roles within the resistance movement, but also put them at great risk. In the year following the coup, nurse union leader Vanessa Yamileth Zepeda and nurse union president Juana Bustillo were both murdered in targeted assassinations. Despite massive resistance to the coup, the combined power of the Honduran military and corporate elite, backed by the U.S. State Department and Department of Defense (which has approximately 14 military bases and installations in Honduras), have managed to prevent a return to democratic rule in Honduras. The two presiden- tial elections that followed the 2009 coup were characterized by mili- tarization and rampant fraud, and have put in place presidents who played central roles in the coup, and for whom privatization is the only policy on the table. This, coupled with impunity for violent crimes carried out during and following the coup, has had a devastat- ing impact on Honduran health. Crime rates have skyrocketed, and for four years Honduras has had the highest homicide rates in the world. Citizens are taking on greater risks to find work, with fewer labor protections. Many are embarking on the immensely dangerous journey through Mexico to find refuge in the United States. Most recently, I spent July 2013 through July 2014 teaching courses on culture and health to nursing students at the National Autonomous University of Honduras (UNAH) and doing fieldwork in the university-affiliated national teaching hospital, Hospital Escuela. What I saw in Hospital Escuela was heartbreaking. Nurses feared walking outside of their unit because they could be assaulted by gang members or harassed by the police or soldiers who regularly patrol the hallways. In the children's section of the hospital, where I focused my research, nurses were so understaffed that they were 16 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G D E C E M B E R 2 0 1 4 Nurses quickly realized that protecting their patients meant not just fighting for better hospital conditions; it meant actively opposing a coup-installed government that was directly and violently harming their patients.

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