Los Promotores de Salud

Considering it's been a week since I came down here, I should probably explain a little about my work in Guatemala. I first came to San Lucas 2.5 years ago in order to do my Master's in Public Health research project. The idea was to do a survey of childhood malnutrition in the Mayan communities around our village. Guatemala is itself a very poor country, and the Mayan people are underserved within it. The Maya, who make up about 60% of the population, have been historically discriminated against by the Ladinos (Spanish descendants). Although things have begun to change over the past few years and many Maya are able to get an education and find work in the cities, the majority still live in very poor, rural settings. Diseases of poverty, including malnutrition, are rampant in this population, and are generally ignored by the Guatemalan, Ladino-run government.

The original project both looked at risk factors for malnutrition in our population, as well as began to examine the effect of land redistribution on child growth. The communities we worked in have recently been moved from local fincas (plantations), where they worked effectively as indentured servants, to their own land. Land is a huge issue in Guatemala, and the source of much conflict and war. Currently, most of the arable land in Guatemala is owned by non-Guatemalas (for those of you who know the history, by the fragmented descendants of the United Fruit Company). The lack of land ownership among the Maya is one of the greatest sources of poverty and allows them to be discriminated against and controlled by the land-owning Ladinos.

For my project, I worked with local health promoters of our survey communities. Health promoters, promotores de salud, are members of the communities who undergo a 3-year traing on providing basic medical care and triage to their people. Normally, the promoters do preventive work in the communities, as well as make home visits to sick patients. They also conduct follow-up on chronic disease patients and screen for problems such as anemia, diabetes, and hypertension. Working with a group of these promoters, went door-to-door in our five communities, surveying every child under 5 years old. By going to every house, we were able to discover a lot of the hidden morbidity in the community--illness that did not get brought to the local clinics or the health promoters themselves. This survey revealed high level of malnutrition and many previously unidentified problems.

After my summer in San Lucas, I fell in love with the town and my family, as well as the communities where I worked. I kept coming back to work with the healthy promoters. After the success of our first study, the promoters wanted to expand the survey to encompass all the communities in the area, creating a nutritional surveillance system. Having finished my required medical school classes, I am finally able to come down to San Lucas for an extended time to help them realize this wish.

The process of taking my smaller study and expanding it to a promoter-run surveillence system is not an easy one. For the past week, we've been meeting and discussing the project. It's a pretty painful process that moves a lot slower than I would like, but to be effective in this community I know that I need to play by their own rules. There's a lot of bureaucracy that needs to be dealt with and a lot of people's permission we need to go ahead with the project. Today we finally met with Vicente, the head health promoter, Dominga, his second in command, and Rogelio, a promoter in one of our communities who I've worked with in the past. Flor was also there to help out and serve as a cultural bridge between me and the promoters. We spent a long time going over and modifying our survey and planning our work for the next few weeks (hard at work in the picture below!). Hopefully, after a lot of meetings and waiting, we will start the training and survey process tomorrow!