ABSTRACT
PerceptionsofHealthcareinRuralGuatemala:TheK’icheStoryofModern
Medicine
MorganRaley
Director:Dr.LoriBaker,Ph.D.
AmongtheK’icheMayapeopleofMomostenango,aruralcityinhighland
Guatemala,theperceptionsofhealthcarearecomplicated,diverse,andvery
rarelyinvestigatedorassignedappropriatemeaning.Byinterviewingboth
localmedicalprofessionalsandMayanpriestsinthesummerof2013,
researchwasperformedtoseehowtheseculturalperceptionsaffectthe
efficiencyofhealthcareintheregion.Byevaluatingtheseinterviews,itcan
bedemonstratedthattheK’ichepeopleandmodernmedicalprofessionals
havemanyobstaclestoovercomeinordertoachieveaunifiedhealthcare
system,whichisbothinlinewiththegovernment’srecommendationsandis
culturallyapplicable.Whilethesesolutionscouldnotberesolvedwithinthe
limitsoftheresearch,itismyhopethatthegatheredresearchcanbe
accumulatedforfutureendeavorstowardthesegoals.
AP
PPROVEDB
BYDIRECTO
OROFHONO
ORSTHESISS:
Dr.LoriBaaker,Anthroopology
PPROVEDB
BYTHEHON
NORSPROGR
RAM:
AP
Wisely,Director
Drr.AndrewW
DATE:
PERCEPTIONSOFHEALTHCAREINRURALGUATEMALA:
THEK’ICHESTORYOFMODERNMEDICINE
AThesisSubmittedtotheFacultyof
BaylorUniversity
InPartialFulfillmentoftheRequirementsforthe
HonorsProgram
By
MorganRaley
Waco,Texas
May2014
TABLEOFCONTENTS
Acknowledgments......................................................................................................................iii
Dedication………………………………………………………………………………………………..iv
ChapterOne:LiteratureReview………………………………………………………………..1
ChapterTwo:MethodsandMaterials……………………………………………….……..10
ChapterThree:DiscussionandFindings…………………………………………….....…16
ChapterFour:Conclusions……………………………………………………………..……….28
Appendix……………………………………………………………………………………………….31
References….……………………………………………………………………………………….…47
ii
ACKNOWLEDGMENTS
IwouldliketothankDr.GarrettCookforhissupervisionthroughoutthe
researchprocessandhisintroductionintothevillageofMomostenangoand
itswonderfulpeople.Dr.LoriBakerhasbeeninstrumentaltothewriting
processofthisresearchandthroughoutmytimeasanundergraduateat
BaylorUniversitybyinstillingadesiretoseekoutthepeopleoftheworld.
MyresearchgroupwhileinMomostenango,KelliBasset,TylerHale,andEllie
Lastrapeswereallextremelyhelpfulincompilingdata,workingwith
recordingdevices,andgenerallymakingsurethatIknewwheretogo.
Finally,tothepeopleofMomostenangowhoopenedtheirhomesandtheir
storiestomyresearchgroup,Iameternallygratefulfortheexperienceto
knowandtoseetheirexperienceswithinthehealthcareindustry.
iii
DEDICATION
ThisbodyofworkisdedicatedtotheK’icheMayaofGuatemala,totheir
storiesofstruggleandhardshipwithinthehealthcaresysteminhighland
Guatemalaandtotheirhopeforfutureprogress.
iv
CHAPTERONE
LiteratureReview
ThehealthcaresysteminmostCentralAmericancountriesisa
controversialtopicofpublichealthagenciesandgovernmentalorganizations
acrosstheglobe.Withdiverseethnicgroups,largeindigenouspopulations,
traditionalandmodernmedicineworkinginthesamelocation,itisatopic
consideredtobecomplicatedattheveryleast.ThecountryofGuatemalais
situatedverynicelyintothemiddleofthisissue.Withalargeproportionof
thepopulationconsistingofindigenousMayangroups,alongwithvaried
environmentalzonesacrossthecountryandahistoryofdiscrimination,
genocideandwar,theclashofculturalperceptionsofhealthandthe
introductionoftheidealsofwesternmedicinehavecreatedaschismwithin
thecountry.
EmbeddedwithinthiscontroversyaretheMayaoftheGuatemalan
highlands.Tuckedawayinnearly100%indigenouspopulations,these
communitiesavoidsuchcomplicationsofdiscriminationandlackof
understandingoftheirculturalvaluesbyeitheravoidingtheclinicalmedical
settingaltogetherorbyonlyseekingmodernmedicalinterventionindire
circumstances.Traditionalmedicinesandtheideaofhealingritualsand
sacrificesperformedbylocalMayanpriestsisseenasmuchmorelikelyto
1
achieveasuccessfuloutcomethanvisitingthelocalclinic.Notonlyisthere
anunderstandingofthedesiredoutcomeoftraditionalmedicalintervention,
thereisalsononeedtoexplainanentireculturalperceptionoftheworld
whenseekinghealthcarehelpfromMayanpriests.Whileillness,infections,
anddiseasesremainatahighlevelofincidencewithintheregion,the
indigenouspopulationslargelyresistmodernmedicalinterventionsthat
couldpreventsuchhighinstances.Theideaoffutureillnessduetothe
actionsofthepresentisaratherunknownconceptwithintheMayaculture.
Medicalinterventionissoughtwhenthereissomething“wrong”withan
individual,anditisassumedthatattimeswhentheindividualfeelshealthy
thereisnoneedforanytypeofmedicalsupervision(Harvey,2008).Thus,
theideaofcheck‐ups,vaccinationsagainstfuturediseasesandinfections,and
preventativebehavioralmethodsareseentobeillogical,especiallywithin
theconfinesoftheeconomicstandingofthemajorityoftheindigenous
population.
Theriseinincidenceofchronicdiseasesandthesustainedprevalence
ofmalnutritioninthisregionisduetothecombinationofmanyfactors.The
transitionfromlocallygrowncropsbeingthemainsourceofnutritionto
foodswithmuchlargeramountsofsaturatedfatsisalargesourceofhealth
concerns.Increasingincomeswithintheregionthatcomefromthe
expansionofindustrializationandurbanizationhaveledtoachangeindiet
thatisnotnecessarilybeneficialtotheagriculturaleconomywithinthe
2
region,andhasmuchmoreimpactonthenutritionalintakeofthe
community.Combinedwithalackofphysicalactivitywhichindustrialization
brings,chronicmalnutrition,increasedinstancesofobesityandtype2
diabetesandtheproliferationofotherillnessesareanaturalsideeffect
(Little,2012).Suchchronicdiseasesandincreasedprevalence,specifically
withinindigenouspopulationshaveledtoahealthproblemthatcould
seriouslydamagetheinfrastructureofthecountry.
Thewayinwhichmodernmedicineisappliedtoindigenouspeoples
isalargepartoftheconflictwithinthehealthsector.Theclashofcultural
idealsofhealthandwellnessandthemodernmedicaltrendtowards
preventativemeasuresisalargepartoftheschism.Eventheideaofa
“patient”canbeseenasanareaofconflict.Whatcannotbephysicallyseen
orfeltisveryrarelythoughtofasillnesswithinthelargerMayaculture.
Therefore,eventheargumentofmedicalprofessionalsseekingtohelpthose
inthecommunitywhoareillcanbeasourceofconflict,orattheveryleast,a
misunderstanding.Withsuchproblemsincommunicationbetweenthetwo
schoolsofthought,itcanbeeasilyunderstoodwhytheMayaaresohesitant
toparticipateinmodernmedicalpractices(Harvey,2008).Theideaof
medicalprofessionalsbeingculturallycompetentisbecomingapriority
withinthehighlandregions,specificallyamongthosewhodonotalready
identifyasapartoftheindigenousculture.WitheachuniquegroupofMaya,
certainattitudesandactionsmustbelearnedandpracticedinordertobe
3
culturallysalient.Learningwhateachindividualgroupnotonlydefinesas
illnessandworthyoftreatment,butalsowhattraditionalmeansareusedto
combatsuchillnessisaneffectivewaytointegratemodernmedical
techniquesintoagroupwithefficiency.Becausemostgroupswillbe
supplementingwhateverhelptheyreceivefrompublichealthorganizations
andmodernmedicaltechniqueswiththeirowntraditionalmethods,
knowingsuchmeanscanhelptocreateamorecomprehensiveoverviewof
whatisbeingdonetothebodyandhowsuchmeasurescanbebeneficialor
disadvantageouswhenmixedtogether.
Inonestudy,theKaqchikelMayaperceptionof“notbeingattended”
withinthemodernmedicalrealminthedepartmentofSololá,Guatemalais
explored.ItisanexplorationofthepowerlessnessandfearthattheMaya
encounterwhentheyarefacedwiththestruggleofparticipatinginamodern
medicalsystemthathasnobasisintheculture.Thehistoryofdiscrimination
againsttheMayapeoplesinGuatemalahasleftapermanentscaronthe
psycheofthecountry.Thereislittletrustandaslittleinteractionaspossible
betweentheindigenouspopulationandLadinos,ornon‐Maya,within
communities.TheMayapeoplearesoaccustomedtobeingdeniedthesame
accesstocareasotherswithintheirowncountrythatthefearoflessercare,
accompaniedbyalackofculturalunderstandingonthepartofmedical
professionals,allleadstotheideaof“notbeingattended”inhealthcare
settings.Iftheexpectedqualityofcareisnotexperienced,thentheMayan
4
patientcanunderstandablybecomeupsetandbelievetheyarenotreceiving
careatall.Whiletypicalbiomedicalprotocolmightbefollowed,the
perceptionofthisprotocolcangreatlyinfluenceitseffectivenesswithinthe
clinicalsetting.Theideaof“therapeuticexpectations”cangreatlyalterthe
interactionsbetweenculturalideals,creatingconflictwhereitwasnot
intendedandconfusionwhereitwasnotexpected(Berry,2008).
Thecomplexitiescontinuetoincreaseasnon‐government
organizationsandshort‐termmedicaltripsfromwesternculturesare
becomingmorecommoninindigenoussettings.Inonearticle,MayaRoberts
analyzestheeffectsofshort‐termmissiontripstoGuatemala,where
volunteerswithnomedicaltrainingdistributeanyandalldrugstheyhave
broughtwiththeminaone‐dayclinic.Thecomplicationsthatarisefromsuch
asituationarenumerousandoverlapping.Givingunnecessarymedications
toindividuals,confusingtheindigenouspopulation’sperceptionofcertain
medications,andcreatingasituationinwhichallestablishedmedical
systemsinplacecouldbebypassedareallpossibleconsequencesofsuch
situations.Therealtragedyofthesituationisthatthereisnoaccountability
tothepeoplethattheseshort‐termvolunteerscometoserve,astheyleave
thecountrywithinonetotwoweeks,nevertoreturn.Thislackof
accountability,withoutanyrealregulationorcontrolplacedonsuch
programs,canwreakhavocinthesmallMayancommunitiesacrossthe
country.NotonlydotheMayanolongerfeeltheneedtoworkwithinthe
5
establishedmedicalsystemsinplacebecauseoftheaccesstofree
medications,buttheMayaalsobecomedependentuponsuchprogramsto
maintaincertainlevelsofmedicineandmedicalinterventionwithintheir
everydaylives.Dependenciesonsuchthingsasvitamins,evenvitaminsthat
donotnecessarilyneedtobesupplementedpasttheirnormaldiet,cancause
economictroublewithprioritiesshiftingfromfoodpurchasingtomedication
purchasing(Roberts,2006).Suchdependenciesareamplifiedproblems
withinthecommunitybythelackofpharmaceuticalregulationandtraining
withinthecountry.InastudyperformedbyKroegeretal.,itwas
demonstratedthatmanypharmacistsdonotaskthequestionsthat
pharmacistsaretrainedtoask;suchaswhatothermedicationsapatientis
taking,orevenrequireaphysician’sprescriptionformanydrugs.Manyof
theMayapatientsarepurchasingsuchmedicinesasanti‐parasitemedication
inlargequantitiesandusingitinlargerdosesthanrequiredratherthan
attendingregularcheck‐upswithphysicians.Evenwhenextremelyill,many
patientsareseekingtheadviceoftheuntrainedpharmacist,whodoesnot
chargeforaconsultation,overpayingtoconsultaphysician(Kroeger,2001).
Thesectorofsmallnon‐governmentalorganizations(NGOs)isalso
risingwithinGuatemalatoday.Alotoftheproblemsassociatedwithshort‐
termclinicsandprogramscanbeseeninthissector,aswell.Theindigenous
peoplewillgotosuchNGOsratherthangovernmentinstitutions,creatinga
lackofcommunicationbetweentheneedsofthepeopleandthosewithinthe
6
governmentwhoworktomeetthoseneedsandtheneedsofpublichealth
acrossthecountry(Maupin,2009).NGOsaredependentuponthefinancial
assistanceofothers,normallycontributionsfromindividualsintheUnited
Statesandotherdevelopedcountries.Whenfundingislost,thesame
transientnatureofvolunteerclinicsoccurs,leavingthelocalpopulationina
ratherdesperatesituation.WithmostoftheMayapeoplemakingminimum
wageorless,theNGOsandvolunteerclinicsaretheonlywaytheycanafford
medicationsandmedicalcarewhilenotsacrificingotherneeds,suchasfood
andshelter.WhenNGOsleavearegion,theirabsencecanmeancreating
moredirehealthcircumstancesthanthosethatoriginallyexisted(Rohloff,
2011).However,thegovernmentprogramsthatwouldtakeitsplacearenot
necessarilyculturallyrelevantorstableeither,astheydependontheaidof
othernationsandthereelectionofthosewhodirectthem.
ThechangingmissionsofNGOsalsoaffecttheregion,ascertaintypes
ofcareareavailableatonetimeandthenaretradedforotherareasof
concerndeemedclosertowhatthosewhocontributefinanciallydeemas
mostpressingintheregion.Theconfusioncreatedbytheneedtoworkwith
severalNGOsaswellaspublicandprivateclinicsinordertoreceivefullcare
forlifecanbepartlyresponsiblefortheMayahesitancetoparticipatein
modernmedicalpractices.Thebureaucracyinvolvedinobtainingtheproper
care,attheproperlyspecializedclinic,designatedforcertainlanguage
7
groupsandcertainvillagescancreatealotofthefearandmisunderstanding
thatisbecomingtypicalofMayanpopulations.
TheMayathemselvesareworkingtowardsreformintheprocessof
healthcareinthecountry.Whenconflictaroseinthecountryinthe1970s
and1980s,resultinginalargeamountofMayandeaths,NGOswereforcedto
closetheirdoorsforatime.Withgovernment‐sanctionedethnocide
resultinginover200,000deaths,83%ofwhichwereMaya,thegeneral
distrustoftheMayatowardsthegovernmenthasremainedastrongbarrier
toanytypeofeffectivehealthcarereformbeingputintoplace.TheMaya
wereleftinacrisisthathascreatedalastingeffectontheoverallhealthof
thepopulation.TheMayapeopleworkedinmovementsforthe1996Peace
AccordstoincludethedesignationofGuatemalaasamultiethnic,
multilingualcountry.Currently,thegovernmentofGuatemalaisusingthe
PeaceAccordsandothermeanstocreatecontractswithNGOstobringhealth
carereformtothenation(Maupin,2009).
TheMayaarestillworkingtowardsabetterhealthcaresystemwithin
theircommunities,citingdiseasepreventionandpovertyasthemainissues
thatpublichealtheffortsshouldbefocusedon(Green,2009).However,as
thedistrustofthegovernmentremainsandthebureaucracyofNGOsbecome
morecomplex,theoveralllevelofhealthwithinindigenouspopulationswill
continuetodecline.Withsuchissuesastheriseofchronicdiseases,
increasinglevelsofpoverty,prevailingdiscrimination,andlittlegovernment
8
regulationofdistributionofmedication,suchadeclinecanbeexpectedto
persist.Onlylarge‐scalehealthcarereform,ontopoftrainingofhealthcare
professionalsinculturalcompetency,canchangethepatternofhealth.
OnegroupofMayathathavehadverylittlehealthcareresearch
preformedwithintheircultureistheK’icheMaya.Thisgroup,locatedinthe
highlandsofGuatemala,isratherisolatedbutisthelargestgroupwithinthe
Maya.Namedforthelanguagethattheyspeak,theK’ichehavearichcultural
traditionoffestivals,clothing,food,andlanguage.However,eveninthis
remotegroup,theproblemsofthenationalhealthcaresystemhave
disruptedtheireverydaylives.Accesstocleanwaterisscarceandinfection
anddiseaseabound.Povertyisalmostuniversalwithinthegroup,andthey
havelittlerepresentationwithinthelargercommunityofGuatemala.Itisthis
groupofpeoplethatarediscussedinthefollowingpages;theirperceptions
ofthehealthcaresystemthathasbeenputinplacearoundtheirculture,
askingthemtoconformtoastandardizedsystemthathaslittlerelevanceto
theirsociety,andwhattheydeemasmotimportantwithintheideaofpublic
health.BecauseofthelackofinformationontheK’iche,thisresearchwill
hopefullyhelpinthemovementtowardsculturalsalienceofhealthcarein
thecommunity.
9
CHAPTERTWO
MethodsandMaterials
Inordertounderstandthecomplexitiesinvolvedinthemedical
systeminthemunicipalityofMomostenango,locatedintheTotonicapán
departmentofGuatemala,andhowitisrelatedtothenationalhealthcare
system,ourresearchgroupconductedinterviewswithtwolocaldoctors,a
nurse,apharmacist,andaMayanpriestandhiswife,foratotaloffive
interviewsspanningthehealthcaresystem’simpactinthevillage.
Theinterviewswereallconductedinperson,inSpanish,andrecorded
forlatertranslation.Oneofmyresearchpartners,KelliBassett,andI
performedalltranslations,throughoutthefollowingweek.Interviewswere
conductedinSpanishinordertoallowthosebeinginterviewedtoexpress
theirthoughtsintheirnativelanguage.Interviewswereconductedunder
theguidanceofDr.GarrettCook,professorintheAnthropologyDepartment
ofBaylorUniversity,andwereconductedduringthemonthofJulyof2013as
apartofafieldschoolconductedbytheAnthropologyDepartmentofBaylor
University.Throughoutthisbodyofwork,allinterviewparticipantsare
referredtobyuseofpseudonyms,inordertoprotecttheprivacyofthese
individualsandtorespecttheircandidacyandgenerositywiththeresearch
team.Itshouldbenotedthattheviewsexpressedaretheopinionsofthose
10
weinterviewed,andwithinthetimeconstraintsofthestudy,couldnotbe
verifiedstatisticallyorbyalargersampleofthepopulation.However,the
impactoftheseopinionsisstillrelevantwithintheculture,asitisthatofthe
healthcareprofessionalswithintheregion,andthushasalargeimpactonthe
townitself.
MygroupandIsoughttoaskquestionsaboutnotonlythestability,or
lackthereof,ofthemedicalsystemsetinplaceinMomostenango,butalso
aboutpublicandprivateperceptionofthesepracticesandprogramswithin
thecommunity.Inorderforahealthcaresystem’simpactonacommunityto
beproperlyevaluated,itisnecessarytogainbothethnographicand
academicresearchsources.Withbothofthesegoalsinmind,ourinterview
questionswereshapedtoaddressbothoftheseareas.Ourquestionswere
alsoshapedtotheindividual’sexperienceswithinthehealthcaresystem.
Thedoctorsandpharmacistwereaskedaboutproceduresandstatistical
information,whiletheMayanpriestandhiswifewereaskedquestions
pointedtowardtheirpersonalexperiencewithandperceptionofthehealth
caresystem.
AlloftheparticipantswerechosenbecauseoftheirtiestoDr.Garrett
Cook’spastresearchinthearea,orbecausetheywererecommendedtousby
othersinthevillageasasourceofknowledge.Thedoctors,Dr.Perez,a
pediatricianandobstetrician,andDr.Martinez,ageneralpractitioner,were
interviewedattheirrespectiveofficeswithinthetown.Thepharmacist,
11
CallinawasinterviewedattheFarmacíaSantaAnawheresheisemployed.
TheMayanpriestandhiswife,SalvadorandAngelinawereinterviewedat
theirhomeontheedgeoftown.Thenurse,Alejandrawasinterviewedatthe
Mayanpriest’shome,assheisthesisterofSalvador.Herinterviewwasnot
recordedortranscribed,asshepreferredtogivethepaperworkthatthe
organizationsheisemployedbyprovidestoourresearchgroup.Alejandra
worksfortheAsociacióndeAgricultoresparaelDesarrollo“Rachoquel,”in
conjunctionwiththepoliticalpartyUnidadNacionaldeEsperanza,working
inclinicsandgoingtohomesinordertovaccinatechildrenandtofollowthe
vaccineregimendeemednecessarybythegovernmentofGuatemala.The
goalofusingtheselocationswastoallowtheintervieweeaccesstowhatever
materialsandinformationtheydeemedrelevanttothequestionsaskedof
them.Assuch,whileatthehomeofSalvadorandAngelina,theresearch
groupwasabletolearnaboutmanyofthetraditionalmedicinalplantsused
bythefamilyandtheK’icheMayawithintheregion.Thus,whilestudyingthe
formalizedhealthcaresystemintheregion,wewerealsoabletogleansome
ofthefolkmedicineused,aswell.Manyoftheintervieweesandtheir
familiesdiscussedthecombinationoffolkmedicinewithmodernmedicine
prescribedbydoctors.Whiletheeffectsofthiscombinationwouldbevery
interestingtostudy,thatisoutofthescopeofthispaper.However,itshould
benotedthatsucharelationshipdoesexist,andsomeoftheseplantsare
catalogedsubsequently.Witheachplant,theSpanishorK’ichenamewas
12
given,dependingonthewordthewomeninSalvador’sfamilyknew,andthe
medicinalpurposeandpreparationtechniquesweregivenwhenknown.
Becausemanyoftheseplantshavebeenusedformanygenerationsbythe
K’icheMayapeople,manyoftheplantsareknowntohavemedicinal
properties,butthewomeninthefamilywereeitherunawareofsomeoftheir
usesorhowtopreparethem.Thewomenknewonlythattheoldermembers
oftheirfamiliesusedtheplantsintheirearlychildhood.Theoraltraditionof
theseplantshasbeenslowlylosingpiecesasmoreoftheK’ichepeopleprefer
tousemodernmedicineandclinicsratherthanthefolkmedicineoftheir
ancestors.
Asstatedearlier,alloftheinterviewswereconductedthrough
relationshipswithotherswithinMomostenango.Onthefirstdayofourstay
inMomostenango,theresearchgroupwasinvitedtoSalvador’sfamilyhouse
tolearnwhatourbirthdayswouldbewithintheMayancalendarandto
subsequentlyofferupburntsweetsandflowersinfiretoblesstheresearch
experienceandourtimeinthevillage.SalvadorandAngelinaareboth
currentlyworkingwithagroupofpeopletobringabouttherestorationof
thetraditionalMayanwaysofceremonyandculture.Heperformssuch
ritualblessingsasacourtesytoDr.GarrettCook’sstudentsinthehopethat
sucheffortswillaidtheprogram,whichhehopestoturnintoasuccessful
revitalizationmovement.Asitturnedout,thedayoftheceremonywasthe
dayofmyMayanbirthday,orKamey.Accompanyingthisdesignationwasa
13
descriptionofwhatthisdaymeant,adayofprosperityandgivingthanksto
ancestorsforfuturegood.Becauseofthiscoincidence,Iwasaskedtohelp
Salvadorthroughouttheceremonyandtobeginsomeoftheproceedings.
ThisalsomeantIwassplashedwithrosemaryandflower‐waterasecond
timeduringtheprayer.ThiscoincidenceprovedtobemosthelpfulasI
begantohaveseveralconversationswithSalvadorandAngelinabeforeand
aftertheceremony.Throughthebuildingofthisrelationship,Iwasableto
ascertainthemedicaldilemmathefamilycurrentlyfaced,aswellasask
aboutpotentialinterviewswithinthevillage.Salvador’sfamilyknewofthree
clinicswithinthevillage,andIwasabletoconductthetwointerviewsstated
above.ItwasalsothroughthisrelationshipandgrowingfriendshipthatI
learnedofthetraditionalmedicinalplantusesandthatSalvador’ssister,
Alejandra,wasemployedasanurse.Withinsuchanthropologicalfieldwork,
connectionstopeopleareoftheutmostimportanceingainingthetrustof
thosebeinginterviewed.ItwasthroughtheconnectionsofSalvador’sfamily
thattheseinterviewsweremadepossible.Ourrelationshipwiththe
pharmacy,byfrequentingitforstomachmedicineandacetaminophen,also
allowedfortheinterviewwithourpharmacistfriend.Inavillagethesizeof
Momostenango,suchconnectionscanbethecruxofethnographicfieldwork.
Questionswereaskedforbothspecificanswersandgeneralfeelings
abouthealthcareissues,suchaswhatkindsofhealthcareareneeded,what
aretheillnesseswiththemostfrequentincidencesinthearea,whatcanbe
14
donetoimprovetheseillnesses,andotherobjectiveandsubjective
questions.Thesequestionswereaimedatgainingageneralknowledge
abouttheregion’shealthcaresystemandthecommunity’sperceptionofit,
ratherthanpurelyquantifiableinformationtobetested.Thegoalwasto
understandtheculturebehindhealthcareinthearea.Ourgroupthought
thatiftheculturalperceptionsofhealthcarecouldbediscussed,thenthis
couldbeusedtogatherinformationforpossiblelaterstudiesinhowto
improvethehealthcareinthearea,asapartofanappliedanthropology
project.Whileourresearchgroupmaynotbeabletoaddresstheseissues
withinthescopeofourresearch,theresearchitselfmightbeusedasapartof
futureresearchandapplicationsinMomostenango.Ifthecultural
motivationsbehindhealthcarecanbedetermined,thenthepractical
applicationofthosemotivationswillbemuchmoreefficientandculturally
inclusive.Thisisoppositeoftheapplyingthecolonialtechniqueofthepast
ofstandardizedanswerstouniqueproblems.Thuswerethegoalsofour
researchineachinterviewsituation.Atranscriptoftheseinterviews,
translatedintoEnglish,canbefoundintheappendix.
15
CHAPTERTHREE
DiscussionandFindings
Theresultsoftheinterviewwereveryinteresting.Whendiscussing
suchthingsasthebiggestproblemsinhealthcare,manyoftheanswerswere
similar.Thedoctorsbothagreethatmalnutritionandinfections,specifically
parasiticinfections,werethemostprevalentissueswithintheregionandin
Guatemalaasawhole.Whilemalnutritionwasnotdefinedbyeitherdoctor,
itcanbeseenthatsuchmalnutritionmeansthatthetypicaldietofpeoplein
theregionislackinginthenecessarynutrientsinabalanceddiet.Themain
starchstaplecropsareeatenalot,intheformsoftortillasandrice,andfried
chickenisbecomingaculturalphenomenon.Intheprocessofthe
demonstrationeffect,thepeopleintheregionarebeginningtoreplicatethe
dietsofwesternsocieties.Throughoutthemarketplace,friedchickenstands
withFrenchfrieswerebyfarthemostpopularfoodstands,andthenew
pizzashopinthetownwascrowdedwithteensfromthesurrounding
neighborhoods.Forthoseonthefieldschoolwithstomachsnotaccustomed
tolocalfoods,theseplaceswereblessings.However,withtheyoungpeople
ofthetownsupplementingtheirnativedietsofstarchandlittlenutrients
withsuchfoodasfriedchickenandpizza,malnutritioncanbeseenasan
obviousconclusion.Itshouldbenoted,however,thatonlythoseyoung
peoplewhocouldaffordsuchmeals,thoseintheaffluentfamiliesinthe
16
town,wereseenintheseshopsandstands.Forthemajorityofyoungpeople,
suchadietismuchabovetheireconomiccapabilities,meaningthateven
moreoftheirdietismadeupoftwoorthreestaplecropswithlittle
nutrients.Thefamilyatmosphereisveryapparentinthetown,withchildren
andtheirparentsworkingtogetherinstandsinthemarketandstores.That
istosay,itisnotasifthereisneglectinthewaythattheyoungpeopleare
raisedup,however,educationlevelsbeinglowfortheparentalgenerationin
thetown,mixedwithaclimatethatsupportsonlycertaincrops,andthe
economicconditionswithinGuatemalaasawholeforcingthegrowthofcash
cropsintheregionallappeartobefactorsthatinfluencethepoornutritional
statusinthetown.Dr.Perezstatesthatmalnutritionisbasically“theentire
problemofthecountry,”asitstemsfrommanysocioeconomicissuesandit
alsoisaspringboardfromwhichthemajorityofotherillnessesinthe
countrystemfrom.
Othersuchhealthissuesareinfections,whicharealsoextremely
prevalentintheregion.Dr.Perezsaysthatmalnutrition“leadstoinfections,
bothpulmonaryandgastric,andtheseareverybadthings.Thesearethe
thingsthatthepopulationseeksconsultationsforthemost.”Manywounds
becomeinfectedbecauseofthelackofcleandrinkingandbathingwaterin
thetown.Angelina,whohashadanabscessinherleftbreastforthepast
threeyears,hashadthreebiopsiesperformedonthebreast.Each
consecutivebiopsysitehasbecomeinfected,makingthesituationwiththe
17
abscessevenmoredangerous.Whiledoctorsdonotbelievethattheabscess
ismalignant,theyareafraidoftheinfectionandabscesscreatingabigger
problembyspreadingtoherlungsandotherareasofherbody.Thisisjust
oneexampleofinfectionthatcouldpossiblybecombattedbycleanbathing
water.Asitis,thewaterwithwhichAngelinabathesisfromthelocalwater
source,whichisknowntobeunfilteredandasourceofparasites.
PharamacistCallinaalsostatedtheproductsmostsoldattheFarmacíaSanta
Anawereanti‐parasiticmedicines,followedbyvitaminsandantibiotics.
Theseseemstosupportthetheoryofmalnutritionandinfectionbeingthe
twobiggestinstancesofillnessinMomostenango,astheFarmacíaSantaAna
isoneofthebiggestandmostcentralpharmaciesinthetown.
Anotheraspectoftheculturalperceptionofthehealthcaresystem
wasaddressedinourquestionsaboutvaccinations.SalvadorandAngelina
believethatvaccinationsareavitalpartofthehealthoftheirchildren.
However,theystatedthatthereismuchhesitanceformanyparentstotake
theirchildrentotheclinicsbecauseoftheshort‐termsideeffectsthatcertain
vaccinationsmayhaveonthechildren.Thegeneralillfeelingandapathy
thataccompaniesmanyofthemajorvaccinationsfortheregionscaremany
parentsaway,especiallybecausethelong‐termhealthbenefitscannotbe
seenatthetimeofvaccination.Dr.Martinezstatedthatthereare
governmentprogramsinplaceforchildrenuptofiveyearsofagetoreceivea
freeregimenoftherecommendedvaccinations.However,becausemany
18
peopledo
onotuseth
heprogram,whentheyareincorpo
oratedintoprivate
clinics,su
uchashisow
wn,theyhavetowork thevaccinaationsintow
whatever
othertreatmentthechildwasb
broughtintooreceive.W
Whilethisissmuchmoree
expensiveforthepaarent,Dr.Maartinezsayssthattherearemoreop
ptions
availabletothepareentintheprrivatehealth
hsectorthaanthepubliccasfaras
thetypessofvaccinattionsandth
heiradminisstration.Nu
urseAlejand
dra,asaparrt
ofherjob
b,suppliesffamilieswith
hthenecesssarypaperw
worktocom
mpletetheirr
children’svaccinatio
onrecords,aalongwithh
helpfultipsforwheneachshotforr
childrenunderageffivearegiveen.
Figure1:PaamphletusedbytheAsociaacióndeAgricu
ultoresparaeelDesarrollo““Rachoquel”fo
or
utiontofamiliiesintheMom
mostenangom
municipality.
distribu
19
Thesepamphlets,likethatinFigure1,aremeanttopromotethevaccination
ofallchildrenundertheageoffiveforthesixdifferentillnessesthataffect
thepopulationofGuatemalathemostandaredeemednecessarybythe
Guatemalangovernment.ThesevaccinationsincludetheBacillusCalmette‐
Guétinvaccination,orBCG,whichcombatstuberculosis.Thisistobegiven
tochildrenatthetimeofbirth.Thisassumesthatchildrenarebornina
placewherethevaccinationisreadilyavailable.Thenextvaccinationsattwo
months,fourmonthsandsixmonthsarePolioandPentavalent.Pentavalent
isactuallyacombinationoffivevaccinationsinoneinoculation,combatting
diphtheria,tetanus,whoopingcough,hepatitisBandHaemophilusinfluenza
typeB(ImmunizationUNICEF).Attwelvemonths,theMMRvaccineisgiven,
abbreviatedSPRinSpanish,topreventmeasles,mumps,andrubella
(Kaneshiro,2013).Ateighteenmonthsandagainatfouryears,Polio
boostersaretobegiven,andwellastheDPTvaccine,preventingdiphtheria,
pertussis,andtetanus(Diphtheria,2013).Itisalsorecommendedthatthese
vaccinationsbesupplementedwithdosesofVitaminAeverysixmonthsand
ananti‐parasiticdrugeverytwoyears.Thepamphletsaregearedspecifically
towardindigenousMayapopulations,withillustrationsoffamiliesdressedin
traditionalMayanclothingandavaccineregimenthataddressesthehealth
issuesthatmostofthosepopulationswillencounter.Whilethesevaccines
areratherstronglyrecommended,Salvador,Angelina,andbothdoctors
expressedthehesitanceofthegeneralK’ichepopulationspecificallytotake
20
theirchildrentoclinicsinordertoreceivetherecommendedregimen.The
fearthataccompaniesclinicvisitsisexpressedintheideathatchildrenwho
havegonetotheclinicinthepasthavedied.Thestigmaassociatedwiththe
clinicasaplaceofillnessanddeathdoesnothelptoincreasetheseekingof
healthcarebytheMayapeople.
Dr.Perezspokeofthishesitancefrequently,ashestressedthefact
thatmanyK’ichepeopleprefertorelyontraditionalandfolkmedical
techniques.Heestimatedthat“only5outof2,000peoplegotothedoctor.”
Inamunicipalityofapproximately100,000people,thatmeansthatonly
.25%ofthepopulationroutinelyseeksmedicalhelpintheregion,ifDr.
Perez’sstatisticalassumptionsarecorrect.Dr.Perezbelievesthata
compromisebetweenthemodernhealthcaresystemsinGuatemalawiththe
traditionalpracticesoftheMayawouldbeagreatstarttotheresolvingof
thisproblem.Explainingwhatthesevaccinationsmean,inthecultural
contextoftheMaya,wouldhelptoincreasethenumberofchildren
vaccinated,comingintoclinicsforregularcheck‐ups,andhopefullywould
inspiremotherstohavesomeoftheirprenatalcaretakentotheclinics,as
well.Dr.Perezalsostatedthatbysomehowcombiningthepowersofthe
publicandprivatehealthcaresystemsintheregion,thechancesofchanging
thecurrentpatternsofhealthindiseasewouldincreaseevenmore.
Dr.Perez,asapediatricianandobstetrician,wasveryconcerned
abouttheverylargeproportionofthepopulationofpregnantfemaleswho
21
receivednoprenatalcareinclinicsandreliedsolelyonmidwivesduring
childbirth.Theregion’smanydifferentsocialgroupsamplifytheproblem,
eachmaintainingtheirownbeliefsabouthowtraditionalmedicineshouldbe
usedduringpregnancyanddelivery.Midwiveslackformaltrainingmuchof
thetime,andDr.Perezsaystheydon’thavetheabilitytohelppregnant
mothersduringdeliveryifamajorproblemarises.Ifmidwivessuggesteda
simpleultrasound,withoneprenatalandonepostnatalcheck‐uptothe
mothersthattheycarefor,manyofthesecomplicationswouldbediscovered.
Dr.Perezbelievesthatworkingwithmidwives,havingthemidwifebein
controlofthedeliverywhileataclinic,doctorscouldinterveneifandwhen
majorproblemsariseduringchildbirth.Byallowingmidwivestohaveinput
attheclinicandtoworkwithdoctors,perhapsmoreoftheMayawouldfeel
comfortabledeliveringwithavailablemodernmedicaltechniquesavailable.
Workingwithtraditionalmedicinesandremedieswouldalsohelpthe
process.InthewordsofDr.Perez,“Alotofthetimeyouneedtobevery
carefulwhenusingnaturalmedicines,butyoualsoneedtobecarefulwhen
yougiveaprescription,”meaningthatusingnaturalmedicinescanbejustas
helpfulasmodernpharmaceuticalmedicines,andbothshouldbeusedwith
cautionatalltimes.
AngelinaandSalvador’ssisterswereverywillingtosharewhat
knowledgetheyhadofplantusesintraditionalmedicinalpracticesofthe
K’icheMayapeoplethathadbeenpasseddowntothemfromtheirancestors.
22
WhilewaaitingforNu
urseAlejand
dratoarriveeforherintterview,theewomen
werechaattingwitho
ourresearch
hgroupand
dwerekindenoughtossharetheir
limitedknowledgeo
ofwhatthey
ydescribedasoncebeingalargerepertoireof
naturalm
medicinesussedsinceth
hebeginninggoftheK’icheculture.Allofthe
plantscouldbefoun
ndeitherintthefieldinffrontofSalvvador’shom
meorwithin
n
theconfin
nesoftheirkitchen.
Fig
gure2:Photo
osfromleftto
oright,topttobottom:An
nís,Durazno,Ojasde
Eu
ucalypto,Sem
millasdeEuca
alypto,Gramaa,Manzanilla
a,HierbaMoro,Hierba
Bu
uena,andPerricón.PhotoggraphsbyTyylerHale,sen
nior,Anthrop
pology.
Astheyd
describedeaachplant,piicturedabovveinFiguree2,theygavvea
descriptionofitsuseesanditsprreparationss.Whilesom
meofthenaameswere
onlyknow
wninK’ichee,theninep
picturedaboovewerekn
nowninSpaanish,as
well,andcouldbetrranslatedfortheirEngllishnames.A
Anís,oranisseseed,is
23
usedforcolicinbabiesandforstomachpains.Awomanbathesintheleaves
ofthedurazno,orpeach,treeinthedaysleadinguptolaborinorderto
insureasafedelivery.Ojasdeeuclaypto,oreucalyptusleaves,areusedto
combatcoldandflusymptoms,suchasbodyaches.Semillasdeeucalypto,or
eucalyptusseeds,areusedtoclearsinuses.Grama,orBermudagrass,isused
toalleviatekidneyproblems,suchasinfectionandkidneystones.
Manzanilla,orchamomile,isusedtocalmthenerves.Hierbamoro,orblack
nightshade,isusedtocombatanemia.Hierbabuenaandpericón,ormintand
St.John’swortrespectively,arebothusedagainststomachpainsandnausea.
Otherthantheleavesofthepeachtree,alltheotherplantswerecrushedand
boiledinwatertocreateatea.Theabilitiesofthesenaturalmedicinesare
astounding,asIwasabletowitnessfirst‐hand.Afterdrinkingonecupofté
depericón,orSt.John’sworttea,thesymptomsofnauseaandstomachpain
thatIhadexperiencedfortwodayspriorweregonewithinthehour.Itis
clearthatallofthewomenwhodescribedtheseplantstoourresearchgroup,
andwhowerekindenoughtosharesomesamplesoftheseplantswithus,
trustedfullyinthepowerofthesetraditionalmedicinestocureallsortsof
ailments.Whiletheydescribedtheseplantstoourgroup,theydiscovered
myratherirrationalfearofbirdsastheyreleasedthreegrownturkeys,five
chickens,andseveralbabychicksintheyardtobefed.Afterlaughingfor
quitesometimeatthewayinwhichIcringedandbackedmyselfintoawall
inaprotectivestance,theykindlyofferedtheservicesofSalvadoranda
24
healingbathofrosepetalstocuremyselfofthisfear.Allofthewomenwere
muchmorewillingtodiscusssuchmeasuresasthisthantheirexperiences
withinthemodernmedicalrealmofclinicsandpharmaceuticaldrugs.
Furthermore,aswomen,theytrustedtheirbodies,especiallyduring
pregnancy,muchmorecomfortablytothehandsoftheirfamilyratherthan
Dr.Perezandothersatclinicsinthevillage.
Withintheissueofinfantmortality,birthspacingandplanning,and
subsequenthealthofthemotherandchildissexeducation.Dr.Perezstated
thatthereisalackofsexeducationintheregion,asparentsareunwillingto
addresstheissueandareoftenuneducatedthemselves.Becauseofthis,the
amountofteenagepregnanciesisincreasing.Alongwithteenagemothers
beingunawareofthehealthcarethatshouldbegiventotheirchildren,they
areoftenostracizedandevendisownedbytheirfamiliesbecauseofthe
additionalcosttothefamilythatanewchildwouldbring.Whiletheyare
unawareofhowtotakeoftheirchild,chronicmalnutritioncantakeholdin
bothmotherandchild,leadingtosusceptibilitytoamyriadofotherdiseases.
Therootofmanyoftheseproblemsisalackofcommunication
betweenmodernmedicineandtraditionalhealingmethods,andthenotions
ofcurativemedicineratherthanpreventativemedicine,alongwithcultural
understandingofproperandimproperbehaviors.Becauseofthefocuson
illnessthatcanbeseen,thesymptomsratherthantheactualpathologyofthe
illness,theMayapeopletendtodiscounttheideasofpreventativemedicine.
25
Ifanillnesscannotbeseen,takestimetomanifest,orisnotrepresentedin
physicalsymptoms,thentheMayabelievethereisnothingyettobefixed.
Dr.Perezstressestohispatientstheneedforvaccinations,ultrasoundsand
regularcheck‐upsinordertostaveoffillness,buttheconceptdoesnot
exactlytranslateculturally.Whenthediagnosisofautismwasbroughtup,
Dr.Perezsaiditwasrare,buthehadseentwocasesinthemunicipality.Itis
difficultfortheparents,whohaveanunderstandingofillnessassomething
physicalandcanbefixedinacertainmanner,toseeautismassomething
thatdoesnotnecessarilymanifestitselfphysicallyandrequirestherapy
ratherthanmedicine.Whenasked,SalvadorandAngelinasaidtheyhad
neverheardofautism.Itislikelythatthereislittletonoawarenessofsuch
typesofillnesseswithintheMayapopulation,atleasttheywaythatmodern
medicinewoulddefinethem.
PreventioningeneraliswhatbothDr.PerezandDr.Martinezsaid
wouldbetheoneconceptthatcouldchangetheentiredirectionofhealth
careintheregion.Ifitsadvantagescouldsomehowbetranslatedculturally
totheK’icheMayapeoples,thenmanydiseasesandillnessescouldbe
avoidedintheregionandinGuatemalaasawhole.However,evenifsuchan
understandingevolved,withMayatraditionalmethodsandmodernmedical
professionalsworkingtogether,therewouldstillbeobstacles.
Momostenangoisamunicipalityofapproximately100,000peoplewithno
hospital.Withouttheabilitytoperformemergencymedicalproceduresand
26
anyformofmajorsurgery,thenmortalityratesintheregionwillcontinueto
riseasthepopulationgrows.Thisiscoupledwiththefactthatthedoctors
seemunabletoreceiveallofthemedicationtheydeemnecessarytopromote
healthintheregion,andSalvadorandAngelinabothspokeofthepopulation
nothavingaccesstothemedicinethatlargermetropolitanareashaveaccess
to.Theyspokeofvaccinationsreachingthetownexpiredorininsufficient
doses,aswellasbeingsimplythewrongtypeofmedicationthatdoctorsand
clinicsordered.Thishaspromotedthedistrustofthegovernmentandits
healthcareprograms,whichcreatesthecycleoflackofclinicuse,lackof
healtheducation,andincreasingincidencesofinfectiousandchronic
diseasesinthepopulation.Overall,thesystemseemstobeinapositive‐
feedbackloopofpromotingdistrustandloweringefficiencyinitscultural
context.
27
CHAPTERFOUR
Conclusions
ThroughthereviewofliteratureandtheresponsesoftheK’icheMaya
peopleandtheirhealthcareprofessionalsinMomostenango,itcanbeseen
thatthereisaratherlongwaytogotowardshealthcarereformthroughout
theentirecountryofGuatemala.Theperceptionofagenerallackofstandard
healthcareandlackofaccesstoimprovingthissituationcanbeseen
throughouteachinterviewandcomponentofliterature.
Suchinterventionsastheopeningofahospitalwithinthecommunity
andincreasingpublichealtheducationmeasureswouldservetobetterthe
generallevelofpublichealthwithinthecommunity.Othermeasuresthatgo
beyondthespecificscopeofhealthcarewouldbeincreasedaccesstoclean
waternotonlyfordrinkingandcooking,butalsoforbathing,andsometype
ofeconomicreformwithinthecommunitytodecreasethelargelevelof
povertythatpervadestheculture.Oncesuchbasicissuesasincreasedaccess
tohealthyamountsofnutritionandshelteraremet,thenthepossibilityof
interactingatagreaterlevelwithinthehealthcaresystemcanbeachieved.
Thescopeofthisresearchwaslimitedinsizeanddepthbecauseof
constraintsontimeandalackofhealthcareresourceswithinthesmall
villageofMomostenango.However,thisresearchcanserveasastarting
28
pointforfutureresearchintheareaastospecificdiseasesandinfections
withinthecommunityandhowtheywouldworkwithinthesystem.
Areasthatshouldbeexploredwithinfutureworkscouldincludethe
combinationofsocialandeconomicpressuresandtheeffectthattheyhave
onhealthcareefficiency,especiallywithinruralsettings.Whatwasnever
mentionedinanyoftheinterviewswasdiscriminationagainsttheMaya
peopleasareasonfordistrustandfearofpublichealthandgovernment
programs.Thereasonforthislackofexplanationmaysimplylayinthefact
thatallparticipantswerenewlyacquaintedwithourresearchgroup.
However,itappearstobevitaltotheprocessofhealthcarereformthatpast
violenceandgrievancesplayalargepart.Overall,theperceptionofhealth
carecannotbeisolatedfromtheeffectsofotherareasoflifeandtheoverall
historyofacountry.Addingingovernmentandinternationalrelations
furthercomplicatesthematter,alongwiththeincreasingmigrationof
indigenouspopulationstourbancentersandeventoothercountrieswith
greatereconomicprosperity.However,long‐termethnographicresearchcan
helptodeterminehowallofthesesituationsaffecttheK’ichecultureona
long‐termbasis.
Otherareasofresearchmayalsoleadtothepracticalapplicationof
programsandreformwithinthecommunity.Whilethisisoutofthescopeof
anthropologicalethnographicfieldwork,itmaybepossibletocreatereform
withinthecommunitywhilemaintainingtheculturalintegrityoftheK’iche
29
byfirstunderstandingtheculturalconceptionsoftheworldandthe
interactionsandbehaviorsthatthesepeopleperform.
TheK’ichepeopleareanextremelykindandgenerousgroupof
peoplewhowerewillingtosharepartsoftheirliveswithourresearchgroup
inordertoexplaintheirstrugglesandhopes.Itismyhopethattheysomeday
cangainthereformandchangewithintheirhealthcarecommunitythatthey
stronglydesire.
30
APPENDIX
31
TranscriptofInterviews
InterviewwithSalvadorandAngelina
Date:6‐25‐13
Salvador:Naturalmedicineisusedalotandisveryimportantinthecenters
andbarreosofMomostenango.ThereisalotofhepatitisArightnowinthe
town.BarreoSantaCarolinaandSantaAnnaarethetwobarreosmost
affectedbyhepatitisA.ThekidsaremostaffectedbyhepatitisA.Thecause
isdirtywater,specificallywaterusedbybothpeopleandanimals.InSanta
Annatherearemorethan20casesofhepatitisA.Therearetwentypeoplein
thehospitalfromSantaCarolina.Iheardsoonthenews.Thereisa
vaccinationforhepatitisAavailable.Thedoctorscomedoortodoortogive
thevaccine,butpeopleeitherdonotanswerorsictheirdogsonthem.People
donotanswerthedoorbecausepeopledonotunderstandthediseaseorthat
theweatherchangingcausestheillnesses.Thegovernmentgivesalotof
medicinetotheclinics,buttheclinicsdonotgiveitoutuntilthemedicine
expires.Ithinkitwouldbebetterifthegovernmentwouldgivechildrenthe
vaccinesattheschoolswithouttheparentspresenttointerfere.Thelaw
requiresthedoctorstogodoortodoorbecauseparentalconsentisneeded.
Thereasonparentsresisthavingtheirkidsvaccinatedisduetotheshort
termaffectsofvaccinationsuchasstomachpain,headpain,andnotwanting
towalk.
32
Researcher:Haveyouhadanyproblemswithyourownkidshavingshort‐
termeffects?
Salvador:Wedonotwaitforthedoctorstocometoourdoor.Webringour
childrentothemedicalcenter.Wefollowthedoctor'svaccinationschedule
anddonotalterthevaccinationregimen.Whentheygetvaccinationsthereis
sometimesamarkorsomeswellingorpain,butitgoesaway.Wehave
immunizationcards.MysisterworksforUNE[UnidadNacionalde
Esperanza].UNEworksinareascloseandfarfromMomostenangoinorder
tofigureoutwhatthebiggesthealthproblemsareintheseareas.Thebiggest
problemisaccesstogoodmedicine.Thereisplentyofmedicinehere,butnot
therightpeoplehaveaccesstoit,ormostpeopledonotknowhowtoaskfor
it.Therearealotofsicknessestodowithlungs,butthereisnotalotwecan
doaboutit.Therearepeoplewhoworkhere,buttheycannotdoalotabout
theillnesses.Theyworkforpregnantladies,children,andtheelderly.There
arealotofpeoplewhohavelungillnesses.Theguyweusedtobuycandles
fromdiedfromalungdisease.Hisnamewas‐‐‐‐‐‐‐‐‐.Itwasn'tbecausehe
smoked.Itwasthesmokefromthecandlesandofferingsthatkilledhim.The
vaccinesforhepatitisAandBhelpforlungproblems.Therearealotof
arthritisproblemsinMomos.Alotofpeoplewhohavearthritisusenatural
medicine.TheyuseSalviaSantaandtheygotothehotbaths.Theyuse
eucalyptusaswell.Theyusepeachtreeleavesandchilga.Theymakeapulp
outofittorubontheirfeetandotherjointsthatarehurtingthem.Thereis
33
somethingtheyusealotnowattheHealthCenter.Becausetherearealotof
stomachpainsandsubsequentvomitingbecauseofthefoodthatisnot
cookedwell.Therearesomepeoplewhocookwellandtherearesome
peoplewhodon't.Theyuseanisbecausetheeconomyisbadanditis
cheap.Theymakeateaoutofit,addhotwaterandalittlebitofsugarandit
helpswithstomachpain.Youwillnothaveanydiarrheaorstomach
indigestion.Theyalsousepericónandanisdechu‐chuforstomachpains.
Theyaddcinnamonandromerototheteawithanisdechu‐chu.InMomos
thereisalsoalotofcolonillnesses.TheCatholicChurchanddoctorsin
Momosknowofnaturalmedicineaswell:celery,carrots,andgarlic.They
makeabrothoutoftheseingredients.Afteryouputitinabowlanddrinkit,
yourcolonbecomescuredofinflammation.
Researcher:Haveyouheardofautism?
Salvador:Autism?No,Ihaveneverheardofthat.
Salvador:Iamgoingtostarttalkingaboutthecaseofmywife.Shehasa
sicknessinherbreast.Wewenttothedoctor.Thedoctorfirstgaveheralot
ofmedicinethenlatersaiditwouldbebestifshegotamastectomy.[Showed
Dr.GarrettCooktheletterfromthedoctor].
Cook:Thepapersaysthatshehasaninfectionnow.Thisisacertificatefrom
asurgeonhereinMomos.Itissignedby‐‐‐‐‐‐‐‐‐‐‐‐.Thereisaninfectionin
herleftbreast.Italsorecommendsthatshebeevaluatedforamastectomy,
butthatsheisnotrequiredtohaveonerightnow.Thedatethiswassignedis
34
the17thofJune,2013.Rightnowtheyarerecommendingothermedicinesas
well.
Salvador:Sheistakingthemedicine,butitwasveryexpensive.Sonowsheis
takinganothermedicineandwearewaitingtoseeifwewanttodothe
operation.
Researcher:Howmuchdoestheoperationcost?
Salvador:4,000Q[quetzales].Thefirsttimethedoctorsawheritwas700Q.
Cook:Itis700Qforeverydoctor'svisit.
Angelina:[Sheshowsusherinfectedincisionsonherbreasts.]Ithasbeen
twoyearssincewehavestartedseeingdoctors.Ithasbeenthreeyearssince
itbegan.
Salvador:We'vebeentothesamedoctorforthelastmonth.
Cook:Theywenttothedoctorandheprescribedmanytreatments,butthey
wentforthecheaperoption.
Salvador:We'vetriedtreatments,buttheyweren'teffective.Wewenttothe
doctorandhesaidthetreatmentswe'vetriedwerenotworking.Itisavery
seriousconditionnow.
Cook:Itsaysonthepaperitisnotacancer,butaninfectionorabscess.They
areafraidwhateveritismightspreadtoherlungs.Themedicineisobviously
notworking.
Salvador:Itwassupposedtotaketwoyearsforittobecured.Thereare3
typesofmedicines.Oneisaninjection,thesecondistwotypesofpills,anda
35
naturalmedicinecalledcifuela.Itiswhatyouputintotamales.Shecould
onlydrinkwater.Shecouldnotdrinkcoffee,tea,orchile.
Cook:Shehadfivedifferenttreatments.
Salvador:Atfirstitgotbetter,buttheyhadtocutittoreleasethetrapped
puss.Wehadtogobacktothedoctorfortreatment.Itcost700Qtogoback
tothedoctor.Aprofonisthenameofthecurrentmedicineshetakes.They
thoughtitwouldworkreallywellandatfirstitwas,butasyoucantellitis
nolongerworkinganymore.Butwecannotgetanothermedicinebecauseit
istooexpensive.Attheendofoneyear,attheendoftwoyearswewould
waitforittogetbetterandatfirstitwouldbutitneverreallydid.Nowshe
hasaverybadcase.Shecannottakesomemedicationsbecauseoftheheart
medicinesheisonafterthebusaccident.Ithasbeensixyearssincethebus
accident.
Cook:Shehashadheartproblemsforsixyearsandthisinfectionfortwo
years.
Salvador:Mywifeandbabyweresupposedtodieduringthataccident,but
didn't.
Cook:Ok,soitsbeensixyearssincetheaccident,shehashadthisinfection
fortwoyears,andshehasbeentothesamedoctorforeachofherfive
treatmentsandeachtimeshehasgottenalittlebitbetter,butshehasnever
beencured.
Angelina:Thislastmonth'svisitiswhenthedoctorsuggestedamastectomy
36
andthatshouldcureit,butIamnotsosureitwill.
Cook:Ok,buthereitsaystheyarenotsureaboutthemedicineorwhetheror
notsheneedsamastectomy.
Angelina:Itmaybecuredwithamastectomy.
Cook:Yes,buthereitsaysitisaninfection,notcancersothatismuchbetter
becausecancerismuchmoreserious.
Angelina:Yes,butanabscesscanproducecancer.
Salvador:Wearegoingtodoanultrasoundtoseehowthingsare.The
ultrasoundistoseeifitisanabscessorcancer.
Cook:Soisit700Qforjustthevisitandthemedicinecostsmore?
Angelina:No,the700Qisforeverything.
Cook:Soithasbeen3500Qyouhavespentinthelasttwoyears?
Angelina:Thetotalmedicalbillsasofnowhavebeen15,000Q.
Salvador:700Qcoversavisit,ultrasound,andthemedicine.
Cook:Oksheistakinganotherantibiotic,butIhaveneverheardofit.What
otherkindsofcustomshasshedonetohelpit?
Angelina:AtfirstIwastakingnaturalmedicines,thenItookalotofpills.
Cook:Whatisyourdoctorlike?
Angelina:Heisverygoodandwelleducated.Andheworksinthemedical
center.Heisaspecialist.
Salvador:Heisalotmoreexpensive.HeisthedirectoroftheHealthCenter.
ThedoctorisfromMomos.
37
Cook:Whereistheclinic?
Salvador:Idon'tknowtheaddressoff‐hand,butitcanbefoundonline.
Angelina:Ihavetogotothatdoctorformyspecificillness.TherewasashotI
couldhavetakenformyinfection,butitwas600Qandjusttooexpensive.
Peopledieherebecausetheycannotaffordhealthcareandtreatments.There
wasanoutbreakofhepatitisandpeoplediedbecausetheycouldn'taffordthe
vaccines.
Researcher:Dotheyprovidevaccinesonlyforchildren,butnotadults?
Angelina:Nothehepatitisvaccineisnotprovidedforeitherchildrenor
adults.‐‐‐‐‐‐‐‐arevaccinescoveredbythegovernment.Aftervaccinesalot
lesspeopledienow.
InterviewwithDr.Martinez
Date:6‐27‐13
Researcher:WhatdoyouthinkofthehealthcaresysteminGuatemala?
Martinez:Soyouhaveprimary,secondary,andtertiarygroupingsystems.
PrimarypatientscomeandIcangiveadiagnosisandgenerallyresolveit,so
simpleillnesses.ThesecondarypatientsarebeyondwhatIcanresolveand
mustbesenttothehospital.Thepublichealthsystemsaremorecomplete
becausetheyaremoreincorporatedandmoredoctorscanconsulteach
other.Thesystemneedstobemoreequal,moreprofessional,moreefficient,
andmoreaffordable.
38
Researcher:WhatisthemostcommonproblemamongpatientsinMomos?
Martinez:Themostcommonproblemsaremalnutritionandinfection.There
areillnessesherethataresolelyregionalsincepeoplehereworkinhard
laborconditions.Therearealsoalotofinsectsandmosquitoesthatcan
causeillnessesandinfections.ButthatproblemiscommoninGuatemalaasa
whole,notreallyspecifictoMomos.Themostimportantthingisprevention.
Researcher:Aretherealotofpeopleherewhogettheirchildrenvaccinated?
Martinez:Thereisavaccinationprogramwherekidsuptofiveyearsoldget
certainvaccines.Butsomekidsdonotgetthevaccinestheyneedatthe
appropriatetimes,sowhenthosechildrencomeintoprivateclinicswehave
toincorporatethosemissedvaccinestheyneedintotheirregimen.Thereisa
differentbetweenthevaccinesavailabletokidsthroughtheprivateand
publicsystems.
Researcher:Whatisthehealthcareprocedureforepidemicsoroutbreaks?
Martinez:Incasesofhepatitisbothprivateandpublicinstitutionspromote
preventionandtreatment.
Researcher:Isthisclinicprivateorpublic?
Martinez:Itsprivate
Researcher:Howmanypatientsdoyougetroughlyinoneday?
Martinez:Itsrelative.Itvaries.
Researcher:Whatcanthegovernmentdotoimprovethehealthcaresystem?
Martinez:Thegovernmentshouldhaveaprogramthatfinanciallysupportsa
39
womandependingonthenumberofkidsthatshehas.Thereshouldalsobea
programtosupportpeoplewhocannotaffordhealthcareinordertoprovide
allthemedicalservicesapersonneeds.
InterviewwithPharmacistCallina
Date:6‐27‐13
Researcher:Whatproductsdoyouusethemost?
Callina:Anti‐parasiticmedicine,vitamins,andantibiotics.
Researcher:Whatarethemostseriousproblems?
Callina:Malnutrition,thenpulmonaryproblems,andlastparasiticproblems.
Researcher:Howmuchdoproductscost?
Callina:Wehavebothexpensiveandnon‐expensivethings.Theproducts
fromUSAandCentralAmericaaremoreexpensive,whileproductsfrom
Indiaaretheleastexpensive.Forexample,antibioticscancostupto390Q
[quetzales].ThemostexpensiveantibioticsfromIndiaare60Q.
Researchers:Canmostpeopleaffordmedicinefortheirillnesses?
Callina:EvenwiththecheaperdrugsfromIndia,peoplecannotaffordthem.
Sopeoplestockupontheabsolutecheapestdrugsthatcostaround3Qand
hopethatbytakingmoremedicinetheywillbecured.
40
InterviewwithDr.Perez
Date:6‐27‐13
Researcher:Whatdoyouthinkaboutthepublichealthsystemoverallin
Guatemala?
Perez:Therearemanyperspectivesandviewpointsonthistopic,butin
realitythehealthsystemisverybad.Forpublichealthingeneral,the
programsappearwell,buttheorganizationoftheprogramsisbadbecause
sometimesthemedicinesfortheprogramsdon'tarrivewheretheyare
supposedtogo.Inthismanner,thehealthofthepopulationdoesn'tget
better.Mostofthetimethecurativemedicineisgivenratherthanthe
preventativemedicine.MuchoftheproblemsinGuatemalaareabout
preventionandnotaboutcurating.Theyalwaystalkaboutcures,cures,
cures,butthatsystemisbad.Therealsoisn'tasystemthateducatesand
informsthemtobecautious.Alotofpeoplehavetoseethattheycangoto
privatedoctorswhenpublichealthcarefails.Theyneedtostartvisiting
privatedoctors,eventhoughitismoreexpensive,becausethepublichealth
systemisdysfunctional.Thepublichealthsystemissodependentonthe
governmentthatsometimesitonlyfunctionsforpoliticalfavors.The
governmentprogramsarenotfunctional.Forexample,thepresidentchanges
everycoupleofyearsandrightnowthepresidentistryingtotellpeoplenot
togotoprivatedoctors,buttousethepublichealthsystembecausethat's
thebestwaytogivethepublicattention.Inreality,thepopulationisjustvery
41
poor,butthedoctorsdon'thavewhattheyneedtoservethepublic
effectively.Hereit'sdifferent.IhavewhatIneed,Iworkreallyhard,andI
givehelp.Butmostofthetime,I'mnotabletogiveexactlywhattheyneedto
covertheirneedsinthatmoment.Sothewholesystemisbad.
Researcher:What'sthemostprevalentillnessinMomostenango?
Perez:It'sprettymuchthesameeverywhere.Theprimaryillnessis
malnutrition.Thehealthcenterunderestimatesthenumberofmalnourished
people;theycan'tclassifyeveryonewhoismalnourishedasmalnourished.
Butifyougotoprivateclinics,thenumberismuchhigher.Theother
problemsareinfections,pulmonaryillness,skinproblems,andparasites.But
thebiggestproblemismalnutrition.Andthebiggestproblemhereandinall
ofGuatemalaismalnutritionbecauseit'schronicmalnutrition.Thatleadsto
infections,bothpulmonaryandgastric,andtheseareverybadthings.These
arethethingsthatthepopulationseeksconsultationsforthemost.
Perez:Andabigpartofthisispregnantwomenbecausealotofpregnant
womendon'tconsultadoctor,andthisisanationalproblem.Theydon't
haveprenatalorpostnatalconsultations,andthisleadstomalnourished
children.Thisleadstothenationalproblemofmalnutrition,whichis
basicallytheentireproblemofthecountry.
Researcher:Inyouropinion,whatisneededinMomostenangotobetterthe
healthofthepopulation?
Perez:Whatweneedisacompromisebetweenthedifferenttypesof
42
healthcare,andnotaplanorwrite‐up,butanactualcompromiseofaction
betweenthetwo.Thehealthcenterhasalotofprogramsandspecialties,but
theydon'thaveinfluenceonthepopulationbecausethereare,moreorless,
100,000inhabitants.Probablyonly5of2,000peoplegotothedoctor,butin
themedicalcenterthere'sonlyonedoctorandafewhelpers.Ithink,atthe
veryleast,thereshouldbetendoctorsinthehealthcenter.Whatweneedthe
mostinMomostenangoisahospital;ahospitalwithallofthespecialties.
Becausethepublicneedsmoreaccesstoallofthespecialties.
Perez:Also,alotofpregnantwomendiewhilegivingbirth.Thisisbecauseof
thelackofacompleteserviceforpregnantwomen.It'sbecauseofadistrust
ofthehealthcaresystemandalackofinformationaboutultrasoundsand
everythingtheyneedduringapregnancy.Weneedafoundationheretostart
ahospitalbecausewhatwehaveisnotsufficient.Thatwouldalsohelpthe
percentageofpreventativemedicinetoincrease.Mostpeoplejustwant
curativemedicinethantolearnabouttheillnesses.Ahospitalwouldhelpthe
mountainofillnessesinMomostenango.Alotofthecorrelationbetween
illnessanddeathcouldhavebeenhelpedbyprevention.
Researcher:Dopregnantwomennotcometotheclinicbecausetheyuse
naturalmedicine?
Perez:Whathappenswiththisisthattherearealotofdifferentbeliefsinthe
villageshereandalotofthetimetheydonotconsultdoctors.Theyhavealot
moretrustinmidwiveswithintheircommunities.Butalotofthetime,
43
midwiveshavelimitationsanddonotknowaboutpregnancyproblems.It
wouldbebetterifthemidwivessuggestedthatwomengotohospitalsora
clinicwhenthebabyarrives,orattheveryleast,onceortwiceduringtheir
pregnancy,butmanytimestheyjustsayno.Thenthedoctorscouldgive
themanultrasoundorconsultation,butthemidwivescan'tgivethemthat.I
thinkitwouldbeagoodideaforthemidwivestoworkwiththedoctors
duringconsultationsforacompromise.Alotofthetimeyouneedtobevery
carefulwhenusingnaturalmedicines,butyoualsoneedtobecarefulwhen
yougiveaprescription.Alotofthetimestheyjusttellpregnantwomento
drinkwater,butthat'snotsufficient.Alotoftimespregnantwomenonly
comeinwhenthey'resickandthedoctortriestotakecontrolofthe
pregnancy,whichdoesnotworkout.Here,thebesttacticwouldbe
preventionaswell,forthesakeoftheirhealth.Anotherproblemissex
educationbecauseit'saverysensitivetopic.Alotoftimesthereisnottrust
betweenparentsandtheiryouthonthistopic.Theyjustnevertalkaboutit.A
lotoftimeswhengirlsgetpregnant,theirparentscutthemoffbecausethey
don'thavesufficientmoneytosupportthemandtheirbabies.Alotoftimes
thisleadstomalnourishedbabies.Thus,theproblemofmalnutritionis
perpetuatedinthepopulation.
Researcher:IsthereaproblemwithvaccinationsinMomostenango?
Perez:Sometimesfamiliesjustcometogetvaccinesasacurativemeasure,
butthisisworsethanvaccinationsasapreventativemeasureandnotalways
44
doillnesses,suchasvaricella,showup,butalotofillnesseswithvaccinations
areprevalentinthearea.Butalotoffamiliesareworriedaboutvaccinating
theirchildren.Butalotofthistime,theirchildrendiewithoutthe
vaccinations.Thepartofthepopulationthatdoesvaccinatetheirchildren
oftenpreventsdeath,butthereisaportionofthepopulationthatdoesnot
vaccinatetheirchildren.Ithinkthatthegovernmentshouldcomeupwitha
programthatcompromisesbetweenthefamilies'beliefsandthevaccination
oftheirchildren.Forexample,alotofvaccinationsdon'tmakeittovillages,
andwhentheydo,thereisdistrustinthefactthatthegovernmentsendsthe
vaccinations.So,whentheycomeinforvaccinationstherecouldbe
informationaboutwhatthechildrenneedtoeat,andthatcompromiseisa
longwayawayfrombeingthoughtofandactualized.Inmyopinion,the
vaccinesareefficientandthereareplentyofthem,butthat'snotthe
problem.Ibelievearound98%ofchildrenhavehadsometypeof
vaccination.
Researcher:Finally,isthereaproblemwithautismhere?
Perez:Yes,I'veseenthis.It'saverysmallproblem,butthereissomeautism
present.Thebiggestproblemisinformation.Theeducationlevelofthe
publicisverylow,andsothepopulationunderstandsverylittleaboutthis.
Personally,I'veseentwocasesinthetimethatI'veworkedhere.It'svery
hardforthefamiliestoacceptthisdiagnosishere.Becauseyoucan'tseethe
effectsrightaway,it'shardforthemtoacceptthattheyneedtogotolotsof
45
doctorvisits.It'shardtogetthemtocomeinbecausetheythinkthatwhen
childrencomeintotheclinictheydie.Theydon'tunderstandthatthere'snot
acurativemedicineforthis,butratheratherapy.Theissueisreallyhardfor
themtounderstandadiseasethattheycan'tsee.Probablyinthiswholearea
therearemanycasesbutthedoctorsdon'tlookforit.Ifit'snotanimperative
form,thentheydon'trealizeitsautism.Yes,therearetwocasesandthe
familiesaretryingtoworkwiththembutit'sverydifficult.Butyes,thereare
caseshere.
46
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