Belize City Research Articles

Book Review: From South Central to Southside: Gang Transnationalism, Masculinity, and Disorganized Violence in Belize City , By Adam Baird From South Central to Southside: Gang Transnationalism, Masculinity, and Disorganized Violence in Belize City. By BairdAdam. Philadelphia, PA: Temple University Press, 2024, 187 pp., $29.95 (paper); $94.50 (cloth).

Book Review: <i>From South Central to Southside: Gang Transnationalism, Masculinity, and Disorganized Violence in Belize City</i> , By Adam Baird From South Central to Southside: Gang Transnationalism, Masculinity, and Disorganized Violence in Belize City. By BairdAdam. Philadelphia, PA: Temple University Press, 2024, 187 pp., $29.95 (paper); $94.50 (cloth).

The Racialization of Food: “Indian Corn”, Disgust, and the Development of Underdevelopment in Depression-Era British Honduras

This paper explores the co-constitution of systems of social distinction, culinary habits, and political economies. During the Depression in British Honduras (Belize), unemployment, hunger, and malnutrition ignited panic, unrest, and uprising. At the same time, agents of a mahogany company and the colonial government displaced an entire Maya farming community. Why was Maya farming not considered a pillar of the colony’s economy? For more than a century, colonial administrators had made scarce attempts to stimulate domestic food production and distribution, and stimulating corn production was not even considered. Corn had become racialized, called “Indian corn”, and was considered disgusting, unhealthy, and the cause of high Indian mortality rates. A visceral disgust for corn was hard to disentangle from British disgust for Indians more generally. The racialization of corn emerged alongside and reinforced colonial economic policies of structural underdevelopment, all of which ensured that when Belize City residents were standing in food lines, the abundant harvests of Indian corn were nowhere within reach.

Techno–Enviro–Economic Feasibility Assessment of Family-Scale Solar Still (F-SSS) Desalination Plant in Central American and Caribbean Sites for Sustainable Clean Water Supply

The viability of the family-scale solar still (F-SSS) desalination plant in nine low- and middle-income Central American and Caribbean sites, with improper water treatment facilities and supply networks, has been analyzed and reported in detail. The sizing of the desalination plant was done based on the still’s performance, clean water requirement and solar radiation potential. The still’s performance was estimated using an experimentally validated thermodynamic model. Annual desalinated water productivity per still was about 979.0 L (highest) and 836.0 L (lowest) in Port-au-Prince and Belize City, respectively. The lowest and highest potable water production price was observed in Havana (19.75 to 20.22 USD/m3) and Port-au-Prince (59.23 to 60.62 USD/m3) due to their low and high local interest rates, respectively. The decarbonization potential of the F-SSS desalination plant with a 25-year lifetime ranged between 37 and 641 tons of CO2 emission. The specific CO2 generated was found to be the least and highest in San Salvador (4.24 to 4.34 g/L of desalinated water) and Port-au-Price (13.70 to 14.04 g/L of desalinated water), respectively. The energy, finance payback time and sustainability index of the F-SSS desalination plant ranged between 0.59 and 0.67 years, 1.2 and 18.0 months, and 1.03 and 1.04, respectively. The performance, economic and environmental aspects revealed positive signs on the applicability of the F-SSS desalination plant in Central American and Caribbean sites for reliable and sustainable clean water supply. However, this process can be ratified if the concerned governments implement a reasonable subsidy, as is the case with other renewable energy systems.

Perception of parents on barriers and facilitators of treatment outcomes among children and adolescents attending psychotherapy services in a primary health care centre in Belize

Background: The study assessed the perception of parents on barriers and facilitators treatment outcomes among children and adolescents attending psychotherapy services in a primary health care centre. Methods: A cross sectional descriptive study using both quantitative and qualitative methods. The quantitative method used retrospective review of records of 65 children and adolescent clients who accessed psychotherapy services between January 2022 and December 2023 at Port Loyola Health Centre in Belize city. The qualitative method used in-depth interviews of twenty parents of the patients randomly selected from the clinic registers. Univariate and bivariate analyses was used for the quantitative data while thematic analysis was used for the qualitative data. Results: 25 (38.5%) of the patients completed their treatment and 34 (52.3%) dropped out, with half dropped out after the first visit. The identified parental perceived barriers and facilitators are organized into four main themes. The first theme was related to knowledge and understanding of mental health problems by the parents which showed that respondents had good knowledge about mental health problems. The second theme identified attitudes towards treatment as a major factor to completion of treatment. The third theme was related to structural factors like transportation cost and parents’ work schedule identified as key barriers. The fourth theme was related to inconvenient appointment time and lack of flexibility in the scheduling of appointment at the clinic. Conclusions: The study highlights key areas of interventions to minimize barriers to completion of treatment among children accessing mental health services.

Characterization of Emergency Department Poisoning Epidemiology in Belize

Objective: Little is known about the epidemiology of poisonings in Belize. The purpose of this study was to characterize poisonings presenting to Karl Heusner Memorial Hospital, Department of Accident and Emergency in Belize City, Belize. Methods: Charts were reviewed for patients with possible toxicologic exposures, presenting between May 31, 2016 – December 31, 2018. Variables of interest included patient age and sex, type and route of poisoning, reason for exposure, and disposition. Results: Of the 60,310 patient visits during the study period, 768 patients, 1.3%, presented after a toxicologic exposure. The age distribution of poisoned patients varied with the largest proportion being between 19-30 years of age, 29.3%. There was a male predominance of patients, 60.4%. Approximately 44% of all poisonings involved ethanol only. Marijuana was the most common drug of abuse. Other common inhalation and ingested exposures included cleaning agents, household agents, acetaminophen, NSAIDs, pesticides, organophosphates, sedating medications, antibiotics, and ciguatera poisoning. Nearly 48 % of intoxication cases were due to intentional abuse, while about eight percent were from suicide attempts. Of identified poisoned patients, 84.4% were ultimately discharged, 13.8% were admitted, 1.6% were “self-discharged,” 0.13% were transferred, and 0.13% died. Conclusions: This study illustrates that poisoning is an important cause of Accident and Emergency visits in Belize, whose patterns may differ from those in other countries. Understanding the current state of poisonings in Belize can aid in the development of treatment protocols, antidote stocking, and educational activities for poisoning prevention.

A Single Centre Quality Improvement Project for Tuberculosis Preventive Therapy in People Living with HIV

Persons living with HIV should receive tuberculosis preventive therapy at least once in their lifetimes. Current practice at the Matron Roberts Polyclinic II (Belize City, Belize) is of a six-month course of isoniazid in combination with pyridoxine. A medical records audit was conducted for April 2021 with the objective of analyzing the initiation and completion of tuberculosis preventive therapy for people living with HIV seen in the polyclinic. This study was inconclusive due to a lack of standardization of the tuberculosis screening methods used, varied duration of tuberculosis preventive therapy and inconsistencies found in the documentation of the progress and completion of tuberculosis preventive therapy. In order to address these areas, a quality improvement project was conducted utilizing the Plan, Do, Study, Act methodology. The objectives were standardizing the tuberculosis screening methodology, the duration of therapy and the documentation. The following measures were taken: 1) four-question screening was standardized as the method of choice for tuberculosis screening; 2) tuberculosis preventive therapy was established as a six-month duration of isoniazid and pyridoxine; and 3) a documentation insert was added to the clinical notes to document tuberculosis screening and the progress of tuberculosis preventive therapy, among other parameters. Of the targets measured during the three months of the project, the outcomes were: 1) an average usage rate of 74.4% of the documentation insert; and 2) an average rate of initiation or continuation of tuberculosis preventive therapy of 64.3% for persons living with HIV seen over the duration of the project.

Analysis of the spatial and temporal patterns in land use land cover in Belize city from 1991 to 2021

Analysis of the spatial and temporal patterns in land use land cover in Belize city from 1991 to 2021

The financial toxicity of chemotherapy in Belize.

e24007 Background: In low- and middle-income countries (LMICs) such as Belize, large fractions of healthcare costs are borne directly by patients. In these settings of minimal insurance coverage and a fragmented healthcare system, evaluating the extent of financial toxicity is paramount to understanding direct barriers to care delivery. We surveyed Belizean cancer patients in 2022 who were receiving chemotherapy at the only public oncology clinic in the country, established at the Karl Heusner Memorial Hospital (KHMH) in 2018, to quantify financial toxicity. Methods: A convenience sample of patients at the KHMH oncology clinic were surveyed between February and March 2022. Patients who consented during their infusion appointment were given a tablet with a 21-question survey (English or Spanish). This survey was developed from the FACT-G and COST tools adapted specifically for LMIC settings. Answers were on a 5-point Likert scale. We provide descriptive statistics of the population and survey responses. Results: Median age of survey participants (n = 32) was 51 (IQR 43 – 62), 84% were female and 53% unemployed. 71% were uninsured. Those insured were covered by the Belizean government’s National Health Insurance which does not include oncologic care. Most patients (72%) had traveled from another district for treatment at the clinic in Belize City. Cancer types represented were breast (42%), gastrointestinal (27%), gynecologic (27%), and lymphoma (4%); 75% of patients had either stage 3 or 4 disease. 56% agreed with the statement “I am having financial problems with cancer treatment,” 31% disagreed, and 13% neither agreed nor disagreed. Patients were allowed to indicate multiple contributors to financial hardship during treatment, with costs of chemotherapy cited most often (50% of patients), followed by transportation costs (38%), hospital fees (22%), food (12%), and housing (9%). 25% of respondents agreed with the prompt “It is difficult to come to all of my appointments,” with transportation being the most cited reason (88%). Conclusions: In our survey, more than half of Belizean cancer patients on chemotherapy reported financial hardship with their treatment. Drivers of toxicity were the cost of chemotherapy and travel. Our sample, predominately female, unemployed, uninsured, and from less wealthy districts, had sociodemographic factors that suggest a high risk for financial toxicity during cancer treatment. Though limited by the small sample size, this study prompts further investigation and more precise quantification of financial toxicity in Belize. These preliminary data have begun conversations within the Ministry of Health for inclusion of chemotherapy under the covered medications list by public health institutions.

Cancer Demographics and Time-to-Care in Belize.

Belize is a middle-income Caribbean country with poorly described cancer epidemiology and no comprehensive cancer care capacity. In 2018, GO, Inc., a US-based NGO, partnered with the Ministry of Health and the national hospital in Belize City to create the first public oncology clinic in the country. Here, we report demographics from the clinic and describe time intervals to care milestones to allow for public health targeting of gaps. Using paper charts and a mobile health platform, we performed a retrospective chart review at the Karl Heusner Memorial Hospital (KHMH) clinic from 2018 to 2022. During this time period, 465 patients with cancer presented to the clinic. Breast cancer (28%) and cervical cancer (12%) were most common. Most patients (68%) presented with stage 3 or 4 disease and were uninsured (78%) and unemployed (79%). Only 21% of patients ever started curative intent treatment. Median time from patient-reported symptoms to a biopsy or treatment was 130 and 189 days. For the most common cancer, breast, similar times were seen at 140 and 178 days. Time intervals at the clinic: <30 days from initial visit to biopsy (if not previously performed) and <30 days to starting chemotherapy. This study reports the first clinic-based cancer statistics for Belize. Many patients have months between symptom onset and treatment. In this setting, the clinic has built infrastructure allowing for minimal delays in care despite an underserved population. This further affirms the need for infrastructure investment and early detection programs to improve outcomes in Belize.

Evaluating the Clinical Impact of a Novel Pediatric Emergency Medicine Curriculum on Asthma Outcomes in Belize.

Respiratory-related complaints prompt most pediatric visits to Karl Heusner Memorial Hospital Authority's (KHMHA) Emergency Department (ED) in Belize. We developed and taught a novel pediatric respiratory emergencies module for generalist practitioners there. We assessed the curriculum's clinical impact on pediatric asthma emergency management. This study assesses the clinical impact of a pediatric emergency medicine curriculum on management of pediatric asthma emergencies at KHMHA in Belize City, Belize. We conducted a randomized chart review of pediatric (aged 2-16 y) visits for asthma-related diagnosis at the KHMHA ED between 2015 and 2018 to assess the training module's clinical impact. Primary outcomes included time to albuterol and steroids. Secondary outcomes included clinical scoring tool (Pediatric Respiratory Assessment Measure [PRAM]) usage, ED length of stay, usage of chest radiography, return visit within 7 days, and hospital admission rates. Kaplan-Meier survival analysis and Cox proportional hazard regression were used. Two hundred eighty-three pediatric asthma-related diagnoses met our inclusion criteria. The patients treated by trained and untrained physician groups were demographically and clinically similar. The time to albuterol was significantly faster in the trained (intervention) group compared with the untrained (control) physician group when evaluating baseline of the group posttraining (P < 0.05). However, the time to steroids did not reach statistical significance posttraining (P = 0.93). The PRAM score utilization significantly increased among both control group and intervention group. The untrained physician group was more likely to use chest radiography or admit patients. The trained physician group had higher return visit rates within 7 days and shorter ED length of stay, but this did not reach statistical significance. The curriculum positively impacted clinical outcomes leading to earlier albuterol administration, increased PRAM score use, obtaining less chest radiographs, and decreased admission rates. The timeliness of systemic steroid administration was unaffected.

The Ambivalence of Autonomy: Skills, Trust, Tactics, and Status on a Construction Site in Belize

Abstract This article focuses on the autonomy of construction workers informally employed in Belize City, Belize, as emerging from the labor processes and material conditions that characterize construction work in this ethnographic setting. I argue that the notion of ambivalence can be fruitfully applied in order to understand how autonomy acts in contradictory ways in reproducing the relationships amongst workers, and between them and their contractors. In a context characterized by personal relationships, minimized managerial control, and flexible employment, the article employs an ethnography of the workplace which focuses on the role of trust, status and tactics used by builders to their own advantage, in order to show the relevance of their autonomy for how they meaningfully engage with their work, with each other and their employers. The article asks how workers differentially positioned within the skills‐based hierarchy of the workplace act ambivalently, simultaneously reinforcing and negating their unequal place within it while striving to make their conditions less precarious.

Epidemiological and Clinical Characteristics of Acute Dengue Virus Infections Detected through Acute Febrile Illness Surveillance, Belize 2020.

The Acute Febrile Illness (AFI) Surveillance Network in Belize is a country-wide active surveillance program aimed at diagnosing vector-borne, respiratory, and enteric pathogens among patients presenting to 11 participating hospitals and clinics with new onset fever. This study describes the epidemiology of dengue virus (DENV) infections in Belize diagnosed through AFI surveillance in 2020. Of the 894 patients enrolled and PCR-tested for DENV in this period, 44 DENV-positive cases (5%) were identified. All four DENV serotypes were detected, with two cases testing positive for DENV serotype 4, which is the first report of this serotype in Belize since 2004. The majority of DENV cases (66%) were diagnosed in the Belize District, which contains the largest urban center in the country (Belize City). Positive cases were detected between January 2020 and September 2020, with the majority (89%) diagnosed during the dry season between January and April, unlike years prior when cases were more often diagnosed during the wet season. Clinical signs and symptoms varied slightly between DENV serotypes. Active surveillance of DENV among AFI cases provides insight into the epidemiologic and clinical characteristics of DENV in Belize. This information is important for informing public health interventions to mitigate DENV transmission.

Social Emotional Learning Competencies in Belize Children: Psychometric Validation Through Exploratory Structural Equation Modeling.

In the nation of Belize, and in particular the south side of Belize City, the main metropolitan area of the nation, significant economic disparities have led to child and adolescent exposure to high rates of violent crime, gang activity, unsafe neighborhoods, sexual, and physical violence. Problems associated with poor Social-Emotional Character Development are especially prevalent among boys. Consequently, valid culture-relevant measures are required that identify problematic behavior for policy-based intervention and evaluation of educational programs designed to ameliorate this problem. The present study demonstrates the application of Exploratory Structural Equation Modeling to existing measures through the investigation of structural validity and generalizability of the Social-Emotional and Character Development Scale with a large sample of children from schools in Belize (N = 1,877, Ages 10–13). Exploratory structural equation modeling results demonstrate the original factor correlations were reduced, providing less biased estimates than confirmatory factor analysis (CFA). Moreover, a multi-group Exploratory Structural Equation Modeling analysis illuminates significant differences between latent factor scores of males and females for most factors. Using this newer factor analytic procedure, original factors are reconceptualized to better situate the Social Emotional Character Development Scales into the larger body of Social-Emotional Learning (SEL) competencies literature.

Educational intervention for the reduction of intestinal parasitism in children under 5 years of age. Belize City, 2021

Introduction: Intestinal parasitism represents a serious health problem worldwide, affecting both developed and underdeveloped countries, with more than one billion people infected by various types of parasites. Methods: The study focused on improving knowledge of parasitic diseases in mothers of children under five years of age through an educational program in a public clinic in Belize. A baseline survey was conducted, education was implemented, knowledge was reassessed, and participants' confidentiality and informed consent were guaranteed. Result and discussion: The educational intervention significantly improved their knowledge of intestinal parasitosis, increasing from 77.5% to 95% in key areas. This highlights the effectiveness of educational interventions in health promotion. Conclusions: Most of the mothers in the sample were between 20 and 29 years old with high school education, and initially had limited knowledge about intestinal parasites, but after the educational intervention, their understanding in all topics assessed improved significantly, demonstrating the effectiveness of the program.

Macroalgae reveal nitrogen enrichment and elevated N:P ratios on the Belize Barrier Reef

Macroalgae reveal nitrogen enrichment and elevated N:P ratios on the Belize Barrier Reef

Planning and Preparation for Cruising Infrastructure: Cuba as a Case Study

The cruise line industry (CLI) provides an opportunity to rapidly improve national (and regional) economies in destinations. However, lack of planning and proper preparation by destination authorities and the cruise industry can have significant impacts on the local community, commerce, and environment. This paper identifies and quantifies near-shore challenges between the national authorities and the CLI that include port facility preparedness and the potential stresses on local infrastructure. These key parameters used to quantify the impact of the CLI on established destinations can potentially become part of the analysis, negotiation, and communication between all parties involved (government, business, and tourists) as part of the contribution to ensure sustainable CLI destinations. The Port of Havana, Cuba was selected as the study site and was compared against similar cruise line destinations around the Meso-American region (Philipsburg, Sint Maarten, Belize City, Belize, and Progreso, Mexico). The Port of Havana’s natural infrastructure and the carriage available for the incoming ship (i.e., nautical charting) appear to be adequate for welcoming increased cruise ship traffic. The main concerns are the potential toll on local resources including the impact on port traffic and the local infrastructure required to support tourists once they depart the ship.

‘Belmopan. A New Capital for a New Nation’ State, Nation and Ethnicity at the Time of Independence

In Belize, a project for building a new capital emerged in the early 1960s, just after the ravages of Hurricane Hattie, which had destroyed much of the colonial capital, Belize City. According to the common narrative, Belmopan was the answer to a natural threat. But this article will show that it was also a political strategy, intended to give the country a new, modern face, the symbol of a young nation on the road to independence (1981). One of the issues of this post‐colonial state is the definition of a national ‘us’ and the place of ethnic groups inherited from the British colonial administration's policy of ‘divide and rule’. The article shows that the politicisation of ethnicity entails neither its integration in the state nor its institutionalisation by the parties, but rather the emergence of ‘citizenship from below’.

244 HIV Testing History, Testing Interest, and HIV Risk-Taking Behaviors Among Adult Accident and Emergency Department Patients in Belize City

244 HIV Testing History, Testing Interest, and HIV Risk-Taking Behaviors Among Adult Accident and Emergency Department Patients in Belize City

194 The Performance of Sepsis Screening Tools in an Urban Emergency Department in Belize

194 The Performance of Sepsis Screening Tools in an Urban Emergency Department in Belize

“Man a Kill a Man for Nutin”: Gang Transnationalism, Masculinities, and Violence in Belize City

Belize has one of the highest homicide rates in the world; however, the gangs at the heart of this violence have rarely been studied. Using a masculinities lens and original empirical data, this article explores how Blood and Crip “gang transnationalism” from the United States of America flourished in Belize City. Gang transnationalism is understood as a “transnational masculinity” that makes cultural connections between local settings of urban exclusion. On one hand, social terrains in Belize City generated masculine vulnerabilities to the foreign gang as an identity package with the power to reconfigure positions of subordination; on the other, the establishment of male gang practices with a distinct hegemonic shape, galvanized violence and a patriarchy of the streets in already marginalized communities. This article adds a new body of work on gangs in Belize, and gang transnationalism, whilst contributing to theoretical discussions around the global to local dynamics of hegemonic masculinities discussed by Connell and Messerschmidt (2005) and Messerschmidt (2018).