Sanitation has been a perennial problem in poor municipalities such as San Juan de Limay. Casa Baltimore has encouraged and supported the construction of safe and sanitary outhouses. These outhouses cost about $400 each to build and are very important both in the village and in outlying pueblos around Limay. 
The July, 2005 delegation traveled into the mountains above Limay to visit the village of El Zapote where a number of letrinas had been buildt for families there. The people of the village expressed such wonderful appreciation as delegation members talked with them and toured houses where the latrines had been constructed.