Hospital Valle de Angeles

Photo courtesy of Honduras Union Mission.

Valle de Angeles Adventist Hospital

By Adan Ramos Lagos, and Yasmalí Teresa Cacique

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Adan Ramos Lagos has a master’s degree in family relations from the University of Montemorelos and a bachelor in theology degree from the Adventist University of Central America. He is currently the president of the Honduran Union (2010-2020). He has served also as field president, director for youth, family, and stewardship ministries, and as a district pastor. He is married to Del Howell, and they have two sons.

Yasmalí Teresa Cacique, M.D., is the medical director of Valle de Angeles Adventist Hospital in Honduras. She is a physician with specialties in internal medicine, urgent care, and administration of health organizations. Until 2018, she was a specialist at the emergency room in the Central University Hospital Antonio María Pineda in the city of Barquisimeto.

The Valle de Angeles Adventist Hospital (HAVA) is a health institution of the Honduras Union Mission of Seventh-day Adventists. Its main offices are located in Los Lirios, Valle de Angeles, Francisco Morazan, about 17 miles from Tegucigalpa, the capital of Honduras.

HAVA’s activities are governed by principles based on the model constitution of the Inter-American Division, General Conference of Seventh-day Adventists. “The hospital has offered its services to the Adventist community and to the entire country since 1974. As of 2019, it had 49 permanent employees and 28 contract employees.”1 A private non-profit institution, with the inherent legal and social responsibilities of the private practice of medicine, its purpose is to provide quality health care and reach out to the community

The mission of the hospital is: To mitigate and relieve human health ailments, improve quality of life and contribute to the Divine purpose of being prosperous in all things and its vision is: To be the Christian hospital in Honduras that promotes in its patients the best state of physical, mental, and spiritual well-being.2

Origins

The Valle de Angeles Adventist Hospital was the brainchild of Pastor Robert Stanley Folkenberg. Appointed president of the Honduran Adventist Mission field for 1970 to 1974, Folkenberg, in addition to being a pastor, was also an aviation pilot, an ability that gave him advantage over his predecessors in field administration. He acquired for the mission, a Cessna 180, which he named E. E. Andross in honor of the first president of the Inter-American Division. Pastor Folkenberg, was the great-grandson of Pastor Andross.3

As soon as Pastor Folkenberg arrived in Honduras, he expressed the desire for building an Adventist medical sanitarium. However, it took him two years to find a suitable location for that purpose and two more years to acquire funds to start to build. In 1974, the construction was in full swing when Pastor Folkenberg was transferred to the Central American Union Mission, whose headquarters were in Guatemala, but despite his departure from Honduras, the construction work continued.

Inaugurations and Developments.

First stage: When the first stage of the construction work on the hospital was completed, the Mid Central American Union administrators thought it a good idea to invite Pastor Robert Pierson, President of the General Conference of Seventh-day Adventists, for the opening ceremony. Until then, no world church president had ever been to Honduras. Previously, on the occasion of the first Central American camp meeting held on the island of Roatan in 1908, Honduras received for the first time the visit of an administrator from the General Conference, Pastor William Spencer, Secretary. The news of the visit of the General Conference President to Honduras raised great expectation. The inauguration date was set for November 17, 1974.

Pastor Charles R. Taylor, education director for the Inter-American Division described the inauguration day: “A 120-bed Adventist Hospital in Valle de Angeles, Honduras, became national headlines on a morning in mid-November when Robert H. Pierson was given the keys to the country by the female governor and the Minister of Education. Pierson was then guided on a tour throughout the facilities.4

The invigorating mountain air seeped down from the pine forests above the 170-acre property that sits at about 4,000 feet above sea level. Five hundred people gathered for the ceremony in front of an octagonal structure, to which four wings have already been built. This is surrounded by staff housing facilities and an extensive maintenance building with a power plant. The master plan shows that four more wings are to be constructed in the future.5

All this was the dream of Pastor Robert S. Folkenberg, becoming a reality…Today, government officials along with the president of the General Conference are able to see the results of an investment of more than USD $300,000.00 with no cost to the denomination. This hospital is the result of the vision and the faith of Pastor Folkenberg, together with the support of many friends from the Adventist church in the United States and of the Honduran Government.6

Among those present were Marco Antonio Lopez and other municipal authorities who had made the land available and had donated the first twelve acres. Other anonymous Adventist donors provided funds to purchase additional land, needed supplies and construction equipment. The government exempted from taxes, all supplies that needed to be imported, including a fleet of 13 vehicles, which took two weeks to travel from the Mexican border with the United States, to the destination in Valle de Angeles. At one critical moment, a Guatemalan colonel, who had been released from slavery of tobacco by a “Five Day plan to Quit Smoking” promoted by Pastor Folkenberg and Frank Mc-Neil, the medical director of the new hospital, was in the right place at the right time to keep the caravan on the move.7

Dr. McNeil, son of an Adventist missionary who had died in a plane crash in Central America, had decided to continue his father's legacy and dedicate his medical ministry to serving in Central America. On the day of the inauguration, Dr. McNeil was awakened at 5:30 am.to deliver a baby.8

The road paving from Tegucigalpa to Valle de Angeles is under way, and the government has promised to include the hospital entrance and its parking lot as a donation. Fred Sherman along with a group of volunteers from Detroit dug the foundations. Paul Conrad from California, spent a whole year directing the construction, sometimes working alone. Maranatha Volunteers International sent a group of 24 persons, under the direction of Van Vander Hewvel to work for a period of three months to get the construction to the stage it was at the time of Pastor Pierson's visit.9

There is still much to do on this project of faith, but God will continue to provide means through those who learn of the needs in Honduras and of this project. The "Fourth Angel," alluding to its contribution to the proclaiming the three angels' message, was Pastor Folkenberg's favorite nickname for the mission plane, on which he had flown many times over Valle de Angeles. A new light now shines with a constant glow in the country where Adventism was first established in the Inter-American Division.” 10

Correspondent Clara Anderson wrote the following note: “Recently seven men from the Lincoln area along with one from North Dakota left Lincoln, Nebraska to join other members of Maranatha Volunteers International in Valle de Angeles in the mountains of Honduras, about 25 miles from the capital, Tegucigalpa. There they will be spending a nice three week “vacation,” working on the construction of a hospital. The men from Lincoln are: Charles Henkelmann, master builder and leader of the group, Marlyn Schwartz and his son Bruce, builders, Don Reeves and Bill Kerin, electricians, Calvin Krueger, floor installer, Winslow Ellis, bricklayer and Ron Carlson, from North Dakota, is just a farmer eager to help.”11

Development between phases

As soon as the hospital opened, staff was involved in supporting the development of the mission as the right arm of evangelism. At a camp meeting that took place in January 1975 in Roatan, Dr. Frank McNeil was invited to give some practical health classes to the attendees.12 In 1978 the Valle de Angeles Hospital, reported good progress despite mayor disadvantages.13 Thanks to this progress, actions were taken to continue with the second phase. Harold Pendry was asked to be in charge of the Hospital's construction. He was joined by Fyrnn J. (Nevis) Pendry from Placerville, California. Both left Laredo, Texas on August 3, 1978.14

Second Phase

When the Valle de Angeles Hospital opened in 1974, it operated for several years as a medical clinic with outpatient and emergency care only. On April 12, 1979 there was a ceremony to inaugurate the second stage, which included the area of surgery and hospitalization. Pastor Folkenberg wrote, “An important milestone for this institution took place on April 12th when Ron McBroom, the financial manager and Dr. Frank McNiel, the medical director, dismounted the sign to change the word ‘Clinic’ to ‘Hospital.’ Twenty four of the 48 beds were occupied, and expected to be full capacity in no time.”15

Crisis at the Hospital

As time passed, the hospital began to gain strength in the health service system in the country. In the late 1980s, discomfort and professional jealousy began to brew in the private health sector. Complaints reached the Honduran Medical College, and foreign medical personnel permits to practice in the country were restricted. This action caused all foreigners serving in the hospital, whether doctors or support staff to leave. The administration, maintenance and development was then turned over to the authorities of the Mid Central American Union.16

While the hospital was under foreign administration, many of the procedures were done free of charge, due to the large amount of support that was received from the United States. Now it was necessary to take actions such as defining a policy for charging patients, and thus make the hospital a self-sustaining institution. This, in addition to the environment created by the medical personnel restrictions previously mentioned, made people gradually withdraw from the hospital's services, which led to the possibility of bankruptcy or to a partial or total closure of the institution.17

In 2007, the hospital was reaching a point of no return from bankruptcy. In a desperate attempt, Pastor Alfredo Argueta, president of the Mid Central American Union Mission spoke to the Inter-American Division administrators seeking their advice regarding the hospital. He was told of an organization called “Adventist Health International” (AHI) which is led by Loma Linda Hospital and assists with consultation, management, and technical assistance to health care institutions operated by the Adventist church, primarily in developing countries. Meanwhile, Pastor Adan Ramos, the president of the Central Honduran Mission and a member of the hospital board, not knowing that Pastor Argueta was in talks with AHI, spoke with Homer Barret, a retired pastor from the United States (who married Berta, a Honduran), about the problem. This with the aim of involving him and establishing if through his contacts in the US, some help could be obtained for the hospital.

Pastor Barret made an exploratory visit to the Valle de Angeles Hospital, and was surprised with the natural beauty of the place, so picturesque and full of pine trees. He told Pastor Ramos that he thought this would be an ideal place to set up a Healthy Lifestyle Center. He had friends in Wildwood, Tennessee, where he had worked for many years and maybe they would be interested in supporting this idea. Pastor Ramos immediately informed Pastor Argueta of this alternative for the hospital and although he showed extreme interest, he told Pastor Ramos that he had already started talks with AHI. The friends of Wildwood, hearing about the crisis the hospital was facing, were willing to sign a 50-year agreement with the union to convert the hospital into a healthy lifestyle training center for all Latin America. Pastor Argueta told Pastor Ramos that a 50-year agreement would not be possible. He was willing to sign a 10-year agreement with an intermediate evaluation after five years. The friends of Wildwood took a long time to respond and Pastor Argueta finally decided to sign a memorandum of understanding with AHI.

AHI Alliance

The memorandum of understanding signed between the Mid Central American Union Mission and Adventist Health International on behalf of the Valle de Angeles Adventist Hospital was for a period of 5 years, from 2008 to 2013. However, things did not go as smoothly as expected. There were some tensions between the union and AHI, as they could not agree on how to get the hospital afloat. By the end of 2010, the debts were unsustainable. Eight months of salaries were owed to employees, there were debts to the suppliers, the facilities were deteriorating, and equipment was obsolete. It had fallen into a vicious circle, for without good equipment doctors did not want to work in the hospital, and without good diagnoses could not be given in the most accurate way. Brave doctors like Dr. Raul Schneider, with a specialty in orthopedics, who arrived at the hospital as an overseas worker, did almost the impossible, working mostly with bare hands, in an effort to keep the operating room functioning. He and his wife felt helpless in such a serious situation, as most of the time there was only one inpatient. Finally, after nine years of serving in Honduras, Dr. Schneider returned to Argentina, his country of origin. The last seven of these nine years were totally dedicated to the Valle de Angeles Adventist Hospital. The first two years, had been spent doing required government social service in Juticalpa, in order to obtain a medical permit that would allow him to practice medicine in the country.

In October 2010, the Inter-American Division restructured the Mid Central American Union. The Unions of Honduras and El Salvador were created. During the distribution of assets of the former union, the new Salvador Union decided to cede all its rights to the Valle de Angeles Adventist Hospital and so it came under the domain and total authority of the Honduran Union. The new Honduran Union administration of Adan Ramos, president, Roberto E. Brown, secretary and Juan Jose Moran, treasurer, after analyzing the sad reality the hospital was encountering, decided that action had to be taken on the matter. The easiest decision was to close the hospital. They considered the risks and implications of such a decision, coming to the conclusion that closing the hospital without a good battle would not be fair, since many brethren in Tegucigalpa still harbored hope that the hospital could somehow be saved. The union administrators decided to fight the battle to save the hospital. If the future strategies did not work, they would at least have arguments to explain to their board why the hospital would have to be closed.

Gradual Resurgence

The first major strategy was to honor employee back wages and a loan was secured for this purpose. An analysis of staff was made, and it was downsized to only essential personnel. Relations with AHI were restored and Drs. Jason and Belen Lohr arrived from California in 2010, to support the hospital. They stayed for three years, returning to the United States in 2013, due to delicate health conditions of Belen's mother. A year before the Lohrs’ left Honduras, AHI sent Drs. Joel and Jennifer Mundall to the Valle de Angeles Adventist Hospital. This last couple proved crucial in coordinating the medical and hospital services.

Little by little the hospital began to show signs of life and slight improvements, but progress was not as expected. The Honduras Union Mission was investing resources in infrastructure and loan instalments but was unable to invest in medical equipment. AHI was paying the salaries of the doctors they had sent. At the time, the hospital had some very committed staff, such as Veronica Alvarado, the hospital administrator, nurse Marta Carpio and Dr. Edinora Brooks Cherenfant who served as the medical director representing the hospital before the Honduras Health Ministry. However, the hospital was beginning to sink into debts again due to expense related to staff salaries.

The union administrators along with AHI, once again analyzed the situation, concluding that a difficult decision had to be made: “Hospital Administration change”. The hospital needed at front a person who had the ability to attract new patients. So, in November 2014, Reynaldo Canales Fuentes was appointed as the general administrator.

Reynaldo had been managing the clinic in Tegucigalpa and had previously worked at the CETEBEDI food company in Costa Rica. Although most of his experience was with marketing food products, his time at the Tegucigalpa clinic had taught him how to manage a medical center. New patients began arriving, remodeling work continued at the hospital, at the staff housing facilities and especially at the laboratories. In addition to this, more medical equipment was obtained, some by means of donations and others through purchase.

Jennifer Mundall, expressed concern for the need of better control on financial affairs, because there was now a greater influx of patients. A Chilean missionary named Cintia Riveros who was serving as a nutritionist mentioned that she had a friend in Chile who had experience in hospital management. The union treasurer Brother Juan Jose contacted Jean Paul Barriga, who was interested in coming to the hospital as a missionary for a one-year term. On March 15, 2017, he arrived in Honduras and immediately started working on the hospital's finances. After that year of voluntary service, the union made arrangements with Jean Paul to stay indefinitely.

In 2017, for the first time in many years, demand for the hospital was greater than capacity. The hospital was forced to turn away patients, mainly those in search of elderly care. This new challenge compelled the administration to think of expanding. Three more rooms were added to the existing 24, and a master plan was drawn up for expansion. This is still a future project, but steps have been taken to secure the necessary funds. In the face of these new challenges, the Valle de Angeles Adventist Hospital foresees a steady growth for the coming ten years, which will allow the institution to position itself as one of the best hospitals in the country both in terms of quality and service.18

Clinic in Tegucigalpa

In 1990, with the goal of attracting patients to HAVA, a property was rented in the Alameda neighborhood and a clinic was opened in Tegucigalpa. This property was located a half block west of the Honduras school. Later in 2003, a larger property was rented in the Las Minitas neighborhood, close to the Argentine embassy.

In 2012, the decision was made to buy a property. Ms. Verónica Alvarado found a property on Ramon Villeda Morales street in the Alameda neighborhood. The Honduran Union Mission purchased the property with the understanding that, what was being paid for rent, would be paid as a monthly installment until the debt was paid. Necessary renovations were made and in January 2013, the inauguration ceremony was held at the new facilities. The clinic in Tegucigalpa has eight medical and two dental offices. The services offered are: laboratory, X-rays, ultrasound, dentistry, ophthalmology, general surgery, internal medicine, gynecology and obstetrics, pediatrics, oncological surgery, orthopedics, traumatology, psychology, psychiatry, otolaryngology, physiotherapy, dermatology, general medical services and outpatient surgery.19

New Alliances

Another important alliance was made on Tuesday, May 28, 2019 2019 when an agreement was signed between the Valle de Angeles Hospital, the Honduran Union Mission and AdventHealth Global Mission Impact (GMI) program. This agreement would allow the Valle de Angeles Adventist Hospital to improve its quality standards and thus project itself in a better way to the community.20

Services

The hospital offers the following services and facilities: Imaging - radiology and ultrasound, surgery and hospitalization for various pathologies, internal medicine, general surgery, pediatrics, gynecology and obstetrics, otolaryngology, urology, neurosurgery, neurology, oncological surgery , pediatric surgery, dermatology, preventive and family medicine, cardiology, pulmonology, nutrition and dietetics, traumatology and orthopedics, peripheral vascular surgery, ophthalmology, psychology, psychiatry, laboratory services, general dentistry, maxillofacial surgery, general medicine in emergency services, healthy living care center, physiotherapy and gym, as well as clinic consultation in Tegucigalpa.21 There are cafeteria services and also the manufacture of bakery products.

The staff includes an excellent nursing department with 39 nursing professionals. Volunteer staff include three permanent missionaries, and visiting volunteers who arrive to facilitate medical brigades. One of the most outstanding brigades is the Otolaryngology brigade which is done with the support of Loma Linda University and is held each year during the month of May.22 This includes both consultation and surgery. HAVA also coordinates medical and dental brigades in different villages and communities in Francisco Morazan with the support of AdventHealth, Kettering Health Network, and others from the US Adventist Hospital Network.23 Data indicates that during the years 2016 to 2019, more than 80 otolaryngology surgeries were carried out annually, with patients paying only for the hospital services, with no charge for the medical services. An average of 1,300 individuals are treated yearly completely free of charge.24

As of 2019, HAVA operated 27 rooms, with one inpatient per room although the rooms have capacity for two beds. Emergency care is available 24 hours a day, seven days a week. The emergency unit has four observation cubicles and an emergency consulting office.25

Since 2018, HAVA and the clinic in Tegucigalpa have provided care for about 13,500 patients annually. The daily average number of hospitalized patients is 24, fourteen of whom are permanent care patients. An average of 281 acute care patients are admitted yearly for medical, surgical, obstetrics and gynecological procedures. HAVA also provides continuing medical education as a certified American Heart Association (AHA) center, serving an average of 130 doctors and other health professionals annually; in this way becoming a reference point for health and for the image of the Adventist Church in Honduras.26

Vision for the Future

Since 2018, the hospital has resumed its original course and has started the process of becoming a center of influence. God allowed the hospital to go through these hard tests for a great purpose. The hospital continues to seek funds that will allow it to do the work of Christ in favor of the most disadvantaged. The help of each person who joins this great dream can make a difference in the lives of thousands of persons.27

The challenges of growth and the strategies for continuous improvement in the quality of care with a social emphasis, strengthens the desire to diversify medical care. The goals include professional training and development, the modernization of buildings and adaptation of spaces for the sustainable fulfillment of the mission and the support of the growth of the church.

The expectation of growth is the impetus for continuing to promote projects, alliances and strategies for the construction of a new building at the Valle de Angeles Adventist Hospital to serve a greater number of patients, consolidate the Healthy lifestyle Center and have classrooms for continuing medical education.

Under a five-year strategic growth plan, it is projected that the clinic in Tegucigalpa will progress from being a clinic to a hospital, with the creation of spaces for outpatient surgeries, and expansion of the imaging department. New services such as gastroenterology and endoscopic studies will be added. The expansion of existing spaces will become a reality if financial help is available.28

Web Facilities

Although HAVA does not have satellite facilities, it does maintain access to the web. The official page is: https://www.havahn.org. There is no official business email but there is an intranet network, where each administrative employee has an email to receive and send messages. For social networks, the official email is mercadeohava@yahoo.com. On Facebook the site that corresponds to Valle de Angeles Adventist Hospital is @hospitaladventistavalledeangeles; on Twitter: @HAVA_HN; on Instagram: @HAVA_HN

Legal And Denominational Names

Legal: Hospital Adventista del Septimo Dia de Valle de Angeles.
Denominational: Hospital Adventista Valle de Angeles (HAVA).
Denominational: Hospital Adventista Valle de Angeles – Clinica Tegucigalpa.

List of Doctors and Administrative Leaders

Founding doctors: Dr. Frank McNeil, Dr. Bernardo Meza Hernandez, Dr. Edinora Cherenfant, Dr. Samuel Ortiz, Dr. Olman Urroz.

Executive and Administrative directors (CEO): Ronald Mc Broom (1974 -1981); Cesar Medina (1981- 1982); Izso Zelaya (1982 -1983); Danny Jones (1983 –1984); Oscar Palacios (1984 – 1986); Pastor Kain (1987); Eneida Quiroz (1987–1989 and 1995–1998); Daniel Castillo (1990 – 1992); Cornelio Corrales (1993 –1995); Jorge Newboll (1998 – 1999); Roberto Solorzano (2000 – 2004); Armando Reyes (2004 –2006); Veronica Alvarado (2006 – 2013); Reynaldo Canales (2014 – ).

Medical Directors (CMO): Dr. Frank Mc Niel (1974 – 1983); Dr. Bernardo Meza Hernandez (1984 – 1993); Dr. Samuel Ortiz (2000 – 2001); Dr. Raul Scheider (2002 – 2011); Dr. Edinora Cherenfant (2011 – ).

Sources

Administrative Committee Minutes 2019. Governing Board, Valle de Angeles Adventist Hospital archives, Francisco Morazan, Honduras.

Anderson Clara. “Correspondent.” ARH, December 26, 1974.

Brigada de otorrinolaringolos atenderán en Hospital Adventista de Valle de Ángeles.” La Tribuna, May 9, 2017. Acessed July 2019. 
https://www.latribuna.hn/2017/05/09/brigada-otorrinolaringolos-atenderan-hospital-adventista-valle-angeles/.

Casique Yasmali. Rental and Property Registries. Tegucigalpa Adventist Clinic, Municipal and institutional archives 2001- 2019, Francisco Morazan, Honduras.

Casique, Yasmali. Strategic Plan of Valle de Angeles Adventist Hospital 2018–2019. Institutional archives, Francisco Morazan, Honduras.

Folkenberg Robert. “Clinic changed to Hospital.” Inter-American News Flashes, July 10, 1979.

Haylock, Tulio R. “Central America moves forward.” Inter-American News Flashes, December 26, 1978.

Human Resources department. Valle de Angeles Adventist Hospital archives 1974–2019, Francisco Morazan, Honduras.

“Plane is named to honor IAD’s first president.” ARH, June 29, 1972.

Sample, Wanda. “To New Post.” ARH, March 29, 1979.

Taylor, Charles. “A new light shines in the Valley of Angels.” ARH, February 13, 1975

Taylor, June. “Camp Meeting is one of four Firsts.” ARH, May 1, 1975.

Notes

  1. Reynaldo Canales, interviewed by the authors, Tegucigalpa, Francisco Morazan, July 29, 2019.

  2. Function and service Manual, Valle de Angeles Adventist Hospital, archives 2001-2019.

  3. “Plane is named to honor IAD’s first president,” ARH, June 29, 1972, 31.

  4. Charles Taylor, “A new light shines in the Valley of Angels,” ARH, February 13, 1975, 18.

  5. Ibid.

  6. Ibid.

  7. Ibid.

  8. Ibid.

  9. Ibid.

  10. Ibid.

  11. Clara Anderson, “Correspondent,” ARH, December 26, 1974, 22-23.

  12. June Taylor, “Camp Meeting is one of four Firsts,” ARH, May 1, 1975, 23.

  13. Tulio R. Haylock, “Central America moves forward,” Inter-American News Flashes, December 26, 1978, 2.

  14. Wanda Sample, “To New Post,” ARH, March 29, 1979, 30.

  15. Robert Folkenberg, “Clinic changed to Hospital,” Inter-American News Flashes, July 10, 1979, 1.

  16. Marta Carpio, interviewed by the authors, Tegucigalpa, Francisco Morazan, July 26, 2019.

  17. Ibid.

  18. Reynaldo Canales, interviewed by the authors, Tegucigalpa, Francisco Morazan, July 29, 2019.

  19. Yasmali Casique, Rental and Property Registries, Tegucigalpa Adventist Clinic, Municipal and institutional archives 2001- 2019.

  20. Jean Paul Barriga, interview by the authors, Tegucigalpa, Francisco Morazan, July 30, 2019.

  21. Operating license, Valle de Angeles Adventist Hospital, General Secretary of Health, Municipal and Institutional Archives 1974-2019.

  22. Brigada de otorrinolaringolos atenderán en Hospital Adventista de Valle de Ángeles.” La Tribuna, May 9, 2017. Accessed July 2019.
    https://www.latribuna.hn/2017/05/09/brigada-otorrinolaringolos-atenderan-hospital-adventista-valle-angeles/

  23. “Hospital Adventista da asistencia a pobladores con médicos brigadistas de EEUU,” La Tribuna, October 13, 2017, accessed July 2019.
    https://www.latribuna.hn/2017/10/13/hospital-adventista-da-asistencia-pobladores-medicos-brigadistas-eeuu/

  24. HR department, Valle de Angeles Adventist Hospital archives, 1972-2019.

  25. Yasmali Casique, Strategic Plan of Valle de Angeles Adventist Hospital, 2018 – 2019 Institutional archives.

  26. Cashier Department, Medical and Statistical Records, 1978 – 2019, Valle de Angeles Adventist Hospital, archives.

  27. Reynaldo Canales, interview by the authors, Tegucigalpa, Francisco Morazan, July 29, 2019.

  28. Administrative Committee minutes 2019, Governing Board, Valle de Angeles Adventist Hospital archives.

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Lagos, Adan Ramos, Yasmalí Teresa Cacique. "Valle de Angeles Adventist Hospital." Encyclopedia of Seventh-day Adventists. January 10, 2021. Accessed January 21, 2021. https://encyclopedia.adventist.org/article?id=9G4L.

Lagos, Adan Ramos, Yasmalí Teresa Cacique. "Valle de Angeles Adventist Hospital." Encyclopedia of Seventh-day Adventists. January 10, 2021. Date of access January 21, 2021, https://encyclopedia.adventist.org/article?id=9G4L.

Lagos, Adan Ramos, Yasmalí Teresa Cacique (2021, January 10). Valle de Angeles Adventist Hospital. Encyclopedia of Seventh-day Adventists. Retrieved January 21, 2021, https://encyclopedia.adventist.org/article?id=9G4L.