Belize

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Aldous Huxley wrote in Beyond The Mexique Bay (1934) “If the world had any ends Belize would be one of them. It is not on the way from anywhere, to anywhere else. It is all but uninhabited.” Huxley was one of the few adventurers, more than 80 years ago, to visit what at that time was one of the most remote corners of the British Empire. I met him at a UCSF school of medicine conference shortly before he died.

My daughter has been a devoted scuba diver since her teens, and searches the world’s waters to the best places to dive. That broght her to Belize, and when she found it possible to cash in from a silicon valley job, she and her husband John moved to San Pedro, Belize, on the world’s longest N/S reef. So between Huxly and Amy I simply had to go there, though without my daughter’s advice I would have forgotten Huxley.

Belize today is sparsely populated by 395,000 inhabitants spread over 8,867 square miles; the population density is the lowest in Central America and one of the lowest in the world. : less than 20 / sq mil. Honduras 9 million) AREA 8,867 mi² 2017382,444 ( by comparison, Guatemala 17 million,

Once known as British Honduras, Its unique culture and history make it both attractive and exotic for expatriates, especially from the USA.The mainland, while less developed for tourism, produces plentiful meat, dairy products, and fruits and vegetables. Farther upland toward Guatemala are dense jungles, a pine highland, pyramids and temples – many not yet excavated.

The Mayan civilization of more than a million people was centered in the area from 250-900 AD. Belize gained its independence from Great Britain on 21 September 1981 under the Peoples Party Government led by Prime Minister George Cadie Price, who launched the movement for self-government with the formation of the People’s Committee on 31 December 1949 after the British Colonial rulers devalued the British Honduras Dollar bringing much economic hardship on the colony’s residents.

The Population is very diverse, made up of a multiplicity of cultures, speaking many languages. English is the official language required in obligatory K-8 grades. Spanish is widely spoken by the largest ethnic group therefore most people are bilingual in both English and Spanish; many speak and understand local Creole, or Kriol.

Census 2010 49 % mestizo; 23% creole ; 7% garifuna (African)

5 % white; 6% mixed; 3.6 % menonite ( german)

The Menonites. Despite small numbers, are very significant. Beginning in 1958, they settled in mainland Belize, at the invitation of the government, which hoped to promote their agriculture and stock industries. The land was sold at bargain prices, in isolated inland areas. The Menonites gradually divided into two groups, those who hold to traditional ways, and those who adopt modern farming and husbandry practices. ( The locals wryly call the latter group ‘Mechanites!’ )

Some 4000 mainland Menonites contribute greatly to the carpentry, engineering and agriculture of Belize. .They produce milk, cheese, beans, corn, melons, honey, chicken, and eggs and meat, There are more cattle than people in the country. They are also skilled in manufacturing hardwook furnitureand homes. In San Pedro, on Ambergriss Caye (Key), for example, they hold a very popular Farmer’s Market once a week, where local merchants and residents load up on Menonite products. On the other hand some eco activists complain the Menonites disregard the environment leading to large scale deforestation.

Territorial Conflict with Guatemala is longstanding. The border is quite porous, so that people are able to cross into Belize to escape conditions in Guatemala and elsewhere in Central America, attracted by the stable economy and government. There has long been a fixed exchange rate between the $Bz and $US at 2:1.
Many immigrants move into communities of trasients, like one I visited called Progresso, and thereafter gradually enter the workforce without citizenship. It may be that the relative stablity and attractiveness of Belize contribute to the many decades old conflict with a notoriously corrupt and failed Guatemala that continues to claim Belize as its own. While Mexico (Yucatan , Quintana Roo) borders Belize there is no similar conflict, or signigficant similar transborder migration.

In each of the recurring U N votes on the Guatemala claims to sovereignity over Belize, the United States abstained, thereby giving the Guatemalan government some hope that it would retain United States backing. Finally, in November 1980, with Guatemala completely isolated, the UN passed a resolution that demanded the independence of Belize, with all its territory intact, before the next session of the UN in 1981. The UN called on Britain to continue defending the new nation of Belize. It also called on all member countries to offer their assistance.

A last serious attempt was made to reach an agreement with Guatemala prior to the independence of Belize. The Belizean representatives to the talks made no concessions, and a proposal, called the Heads of Agreement, was initialed on March 11, 1981. But the Guatemalan government refused to ratify the agreement and withdrew from negotiations. Meanwhile, in Belize pro Guatemalan opposition existed. It engaged in violent demonstrations with four deaths, and many injuries. A state of emergency was declared. However, the opposition offered no real alternatives to Independence, which came on September 21, 1981, without any agreement with Guatemala A recent Guatemalan referendum, a foregone conclusion, confirmed their belief that Belize is national territory. The Belize governor is proposing a Belizian referendum to approve submitting the dispute (again) to an international court. He argues that, as before, Belize sovereignity will be verified. Signs and billboards in the countryside declare: YADAT TU WE… Creole for THIS IS OURS!

Languages

English is the official language “used in all domains of public life”, including the government, the legal system, the media, and education

Kriol is English colored Creole

Spanish is the home language of 2/3 but English is spoken by 80%

54% speak Spanish well, and 52 % speak English most can be considered literate..

44% kriol, 10% Maya 3%\ German, 3% Garifuna

Religion

Catholic 40% Protestant 32% Pentecostal 8% 7th day  adventist 5 % Menonite 3.7 % all others 20 %

Currency The Belize Dollar, $Bz is fixed at 1/2 $ US In effect, like Panama, the currency therefore is the $US. This provides stablility and avoids the temptation to devaluation that a national floating currency offers.

Therefore, visitors are not likely to find prices for food and lodging in Belize a bargain. In San Pedro, the main city on Ambergris Island, prices are roughly those of coastal USA. On the other hand, cost of day to day living is attractive especially to retired people,who find both the climate and the culture very appealing. There is an uncommon but universal courtesy and grace in relationships that is not often found elsewhere. Nonetheless, the average San Pedro resident in fully intenet connected and agile.

In the media, Belize seems to be often painted darkly for violemce especially around Belize City, said to have high crime and murder rates. Nonetheless, that is not the case in the tourist heavy areas. My daughter and her husband live in San Pedro , on Ambergriss Island and have never had problems there. We went to the inland cities without any trouble anywhere; and, of course, had no problem at a mountain equestrian resort. Except for the infamous botfly! I never saw, never heard, a single mosquito…but, collected quite a few botfly bites whose vector is… the female mosquito! Even now , a week later, I can count 80 or 90 little inflammed nodules, the nests of what is an intradermal maggot! It is a long story, perhaps, but may be of interest to some. I’ll append it to the end of this post.

Government

Belize is a Commonwealth nation, a parlimentary democracy based on the British monarchic model of self government under a ministerial system. In January 1964. The official name of the territory was changed from British Honduras to Belize in  June 1973. Full independence was granted on 21 September 1981. By Comparison, the Cayman Islands remain a British Crown Colony, are smaller and more densely populated.

In many places today there are strong indigenous movements. Yet in Belize they seem relatively mild, most often taking the form of criticism or rejection of values found in the so called developed world. As an example see below some comments on modern medicine and technology by a Belezian native healer:

From A Belizewan Medicine Man: Peter Singfield
Xaibe Village

Singfield is not an admirer of the titled elite or their practices: In general, his observations reflect a common reaction of indigenous people to the way of life among the more dominant cultures. He is a part of a widespread rebellion within the indigenous worlds of the Americas… from Alaska to Patagonia… they rebel against, resent and reject the abuse, arrogance and ignorance of moderns. In many cases outrage among indigenous peoples today is far more hostile and violent than Springfield’s which is merely quite critical and dismissive. His website contains a long list of ailments he has cured without modern medical means. Some quotes:

Doctors and scientists do not mix. ( dont mix in, don’t get it) I believe they are among the most ignorant segment of the human species. Ignorance defined here is unwillingness to learn. They should lynch the Lawyers first then the Doctors.

“Clear cutting of virgin jungle for raising Beef of poor quality pays well when selling to the pet food industry so a green peace idiot can feed a cat or dog — the child they never had in a world so screwed up it is not conducive to raising of human children.Green Peacers — may they all end up where they belong — in Hell!!

At some point you must personally decide which side of the humanity fence you are. Modern World or Salt of this world.I don’t want to know the world you live in — and really am not interested in the problem with diseases you have. They come from life style –

If you walk with me your eyes will be opened — do you really want that??

My Friend !!!

Conceptions
Are but receptions
Of our Fantasies

Which can be
The monopoly
Of our fear

Then — what of reality ???
Do we banish with a cheer
All our feasibility ???

Oh !!
Comfort me
My fantasy

All is not right!
Feel my fright
Of this!!
Our cold reality

Life Expectancy: Despite very limited access to medical care (Singfield might say because of it), and despite lockstep media reports of violence and death, longevity has remained remarkably stable always. For example since 1975 it has changed very little, unlike some places in the USA.

1975–1980 68.6
1980–1985 70.4
1985–1990 71.5
1990–1995 70.6
1995–2000 68.6
2000–2005 68.5
2005–2010 69.5
2010–2015 69.8

Source: UN World Population Prospects

A Visit to Mountain Equestrian Tours (MET)

My daughter Amy organized a trip to MET. The owner is a Californian who began 30 years ago to build an eco friendly dude ranch. Today it is eminently accessable by a flight from Houston to Belize City, where the dude is met by the owner’s son in law, David, for a 90 minute drive directly to MET. On the way an optional visit to a zoo or a meal, or shopping can be elected.

The ranch itself is at once rustic and elegant. For example, there is no electricity except for charging electronic devices. Light is provided by kerosene lamps and candles at evening meals. I usually left the kerosene lamp in my cabin on and found them suprisingly long lasting and soothing. The windows were open to air, and the beds mosquitoe netted, although I didn’t ever see a mosquito. Never; but more later on that! . (In the Panama Canal Zone 1954-5 I also never ever, saw a fly or a mosquitoe, thanks to draining of swampy areas and .. very likely… DDT. )

The second morining we went on a half day horseback ride, very comfortably, at least for me because the experience is not new. The following day was devoted to an all day ride, which leads me to write about:

Two pesky Belize flies: The Botfly and Sandfly

Myiasis is the parasitic infestation of the body of a live animal, usually a mammal, by fly larvae . Some species grow in the flesh of their hosts, while others grow in the intestines.

The three major families of flies encountered in myiasis can be divided into two groups for comparison of host-location strategies: (1) Oestridae; and (2) Calliphoridae and Sacrophagidae. The former are all obligate parasites, the latter include obligate and primary facultative parasites. In the Oestridae, the majority of Cuterebrinae deposit their eggs at sites likely to be visited by the host, whereas the majority of Oestrinae, Hypodermatinae and Gasterophilinae deposit their eggs or larvae directly onto the host.  https://www.tandfonline.com/doi/abs/10.1080/00034983.1995.11812964

The botfly, also known as gadfly ( Sorry Mr Socrates but the appelation does seem apt!) is transmitted on the wings of a mosquito; warmed by the host’s skin, the botfly egg hatches and burrows in, growing into a larva, or less kindly, a maggot. A swollen nodule develops causing severe itching, but it is almost impossible to scratch to death! The larva breathes through a tiny tube, which, fortunately, can be blocked with heavy ointment like petroleum jelly. Otherwise the larva matures and in a few weeks a new bot fly is released. Note: one way to control the Bott is to seed sterile male flies in the infested area. In that case the female eggs are sterile and merely itchy more like an ordinary mosquto bite.

Sandflies (aka sandfleas or no-see-ums) are common in mangrove swamp areas and sandy beaches. They also cause bites which don’t seem to heal, but a heavy ointment will suffocate the mites. To control the sandflies, beaches are often raked daily, and controlled by exposing them to the heat of the sun.

Lieshmaniasis is a more unusual problem caused by sandfly bites, and may cause sores, leaving scars.   The Screworm is a related burrowing larva seen locally.

The day was beautiful. The horseback ride itself was uneventful, except for an oversight of my own. I have diabetes, and use Basal ( long acting) insulin, rarely adding a fast acting dose. Breakfast was early, fast, and light, and I had eaten nothing since. Moreover I was having too good a time to think about my blood glucose. But A lifelong time indulgence of mine is physical activity. It is my drug of choice. Several times I have forgotten that strenuous excercise can burn a lot of glucose, leading to low Blood Glucose Level, and related symptoms. In that case I don’t remember that I’m burning glucose quite fast until I become weak.

At the end of the ride we had to climb down about 600 ft to a waterfall. By the time I got there I felt very weak, understood the reason, and laid down on a rock to eat a couple of granola bars while the rest of the folks went swimming. In a half hour I felt well and climbed uneventfully back up the hill. Problem solved, right? Wrong. I didn’t realize was that while I rested I was being bitten by mosquitoes. I didn’t hear, see, or feel them. Not one.

My ride home was uneventful though onarrival, I encountered one of those events that often happen to a physician in such circumstances. At least it has happened to me often. The owner’s teen aged son drove a station wagon home.. He crossed a bridge too fast, lost control and rolled the vehicle into a creek, about a 15 ft drop. Fortunately the depth of water was only a bout 1 1/2 ft. The wagon was totatlled, landing on its passenger side while people hung from seat belts. Jeff, one of the passengers managed to crawl up and reach the driver side windows, break them, and push the door up and open so the rest of the passengers could un-clip to climb up and out.

But he hurt his shoulder somehow in the crash. and complained of ill defined numbness of his arm and hand; the shoulder was painful. That evening after supper, as darkness fell, the owner– whose son and wife were devastated by events– asked me to look at Jeff’s shoulder.

The shoulder was not deformed, nor was the clavicle. There was tenderness to direct palpation anteriorly, but diffusely, and the shoulder could be passively moved through a nearly full range of motion with little increased pain. No discoloration or break in the skin. The arm and hand were intact in every sense, without deformity, weakness, loss of sensation, or limited strength.
They were considering driving to a hospital in Belize City, or more optimally in Merida, Mexico, to be sure there was nothing serious. That would, of course, be an all night effort, an Xray, and— if an MRI were available it would likely be put to use with, I expect, little benefit except that someone has to pay for such expensive stuff!

So I bit the bullet, and explained that it seemed unlikely there was a fracture; there was no dislocation; no sensory loss, or circulatory deficit. I suggested that in such circumstances an icepack was ideal, with a makeshift sling. If there did happen to be a minor fracture a delay of a few days would not be problematic. The next morning he was almost totally asymptomatic. Amen.


How do you do Mr Maggott! . Within a couple of days I discovered more than 40 slightly swollen red itchy spots on my trunk, abdomen, and extremities. They were caused by botfly larvae nesting cozily in my skin. In travels over much of the globe, Panama, the Phillippines, Mexico and South America, and in practice since 1955 I had never met the botfly. .

A brief on-line excursion will offer more than most anyone wants to know about these little devils. The eggs are transmitted by mosquitoes and hatch in the warmth of the host’s skin. The larva burrow in and develpe in the skin, while breathing through tiny tubules poked up from their intradermal nests. If allowed to mature for several weeks they become ugly little grubs and can leave the nest.

In Beliz most such D hominis infestations are handled by individuals themselves. They usually suffocate the larva by the application of occlusive substances (eg, nail polish, petroleum jelly) .  24–48 h after application, the larva begins to deflate, collapsing its retrorse spines. The larva can then be expelled by applying pressure around the cavity to extract it, or by the use of a snake-venom extractor. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)70146-5/fulltext#back-bib1

Since my own infestation was relatively early, I got good results from self treatment. I didn’t have enough scientific curiosity to let these maggots mature for six weeks until I could pull them out by their ugly little faces to examine them closely!

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