marine commodities.
Through his work
with that project,
Dr. Nochetto
realized DAN had
an opportunity to
help not only the
harvesting divers but
also the hyperbaric
medicine community
worldwide. There
in La Ceiba was a
tragic laboratory,
an opportunity for
physicians and other
medical professionals
to be exposed to
more — and more
severe — cases of
decompression
sickness (DCS) than
most hyperbaric
doctors see in their lifetimes.
So in 2012 Nochetto started the DAN Emergency
Dive Medicine Rotation, through which doctors
would visit Clinica La Bendición and gain invaluable
experience treating injured divers. To date, the
program’s participants have been Marcelo Tam, RN,
of Brazil; Evan Kornacki, EMT, CHT, of Texas; and
Helena Horak, M.D., of California. The following is Dr.
Horak’s account of her time at the clinic.
Out of 11 divers, two were dead and six were
paralyzed. These were the patients Elmer Mejía, M.D.,
saw in a two-week period at Clinica La Bendición in
La Ceiba, Honduras. As an emergency physician in the
last year of my training, I traveled nearly 2,000 miles
to see patients with severe DCS, an emergency that
occurs only rarely in the United States. Although I
ultimately learned how to treat DCS, I also gained an
appreciation for the complex challenges the Miskito
fisherman divers face and the tenuous financial
condition of the medical clinic that provides their care.
As a recreational diver, I love Honduran waters. Roatan
and Utila, the best-known dive spots, attract thousands
of visitors each year. With visibility that exceeds 100 feet,
enchanting coral formations and prodigious schools of
fish, these waters are mesmerizing. In Roatan I saw a
spiny lobster fearlessly waggling his antennae — he was
untouchable in the protected marine reserve. His less-
fortunate relatives farther out in the ocean are the targets
of the lobster industry.
The lobster boats
that supply the
seafood industry
in the United
States rely on the
work of Miskito
Indians, natives
of the Caribbean
coasts of Honduras
and Nicaragua.
The profiles of
these divers are
superhuman: Each
one routinely dives
to 90-130 feet as
many as 12-16
times a day to catch
lobster. Often they
are on the surface
for only minutes
between dives, and
they rarely if ever conduct decompression stops. The
boat owners provide only rudimentary equipment: a
cylinder, a regulator, a mask and fins. A length of rope
serves in place of a BCD. There are no depth gauges or
wetsuits, and dive computers are unheard-of luxuries.
As a consequence of the risks they take, the incidence of
DCS among the Miskito Indian divers is unprecedented.
Clinica La Bendición is a small refuge for injured
Miskito Indian divers as well as the residents of La
Ceiba; its name means “the blessing” in Spanish. The
clinic was founded by Dr. Elmer Mejía, who originally
learned dive medicine while working as a medic in the
Honduran navy, operating the hyperbaric chamber
in Roatan through the Episcopal Church. When the
chamber closed, Mejía went to medical school in
Tegucigalpa, the capital of Honduras, but his heart was
with the divers. A different hyperbaric chamber was
donated to his clinic, and he drove a truck with the
chamber from Virginia to Honduras. The clinic is a
family operation: Mejía’s wife is a nurse there, and his
brother runs the chamber and sleeps at the clinic as
improvised nighttime security.
My first patient in the clinic was Oscar. Five feet
tall with a thin frame, he was 33 years old and had
been diving for eight years. With boundless energy, he
gregariously chatted about his two children, who were
three and five. Oscar was harvesting lobster to make
some extra money for their education. The divers
earn $2.50 per pound of lobster, and a productive
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87
THE BOAT OWNERS PROVIDE ONLY
RUDIMENTARY EQUIPMENT:
A CYLINDER,
A REGULATOR, A MASK AND FINS.
A LENGTH OF ROPE SERVES IN PLACE
OF A BCD. THERE ARE NO DEPTH GAUGES
OR WETSUITS, AND DIVE COMPUTERS
ARE UNHEARD-OF LUXURIES.
A lobster diver surfaces
unable to move his legs.
