Reflections on an accident

There was a pickup accident outside San Lucas last Sunday. The pickup truck belongs to somebody in Sololá, and the driver was doing a favor for the owner by taking the car out. Apparently it was the first time this driver had ever taken people in a pickup, plus it was a different type of pickup—a little higher than most. The car came down to Quixayá, and on its way back up towards San Lucas, it started to swerve, and the people started grabbing hold of each other and screaming. There was an oncoming car, and the driver swerved away and smashed into a volcanic rockface. The vehicle didn’t turn over, but people were thrown out of the pickup. The pickup was full. 18 of the passengers were so badly injured that the parish clinic referred them out to the larger hospitals in Sololá (14) and Escuintla (4).

Another pickup on its way from San Lucas towards Cocales slowed down at Quixayá to inform people that there had been a crash, “y que parece que son su gente” (“it looks like they are your people”). Vicente and his wife Gloria were at home and got news that their family members had been in the pickup that crashed. They went up to the scene of the accident. Gloria’s mom hurt her head—a flap of skin on her forehead and scalp was avulsed away, and she was bleeding a lot, as you might expect. They took her to Sololá immediately, but they couldn’t do the right studies there (head trauma), so they then referred her to Roosevelt, the government hospital in the capital. Her first CT wasn’t read until the next day, but thankfully it was negative, at least for an acute bleed. As of today, she has not spoken yet, and she is currently unconscious, but it seems that she was more conscious before (looking around, moving a little bit), so she may be medically sedated for some reason. Vicente said that Dr. Tun (the parish clinic doctor) said he was worried that she had broken her neck. Gloria’s sister’s 8-month-old girl was also in the crash, and she was sent immediately from SLT to the IGSS hospital in the capital, but this may have more to do with the fact that they have IGSS coverage than with the actual severity of her injuries (IGSS stands for Instituto Guatemalteco de Seguridad Social, and is basically a government-administrated, employer-funded health insurance system). Apparently one whole side of the baby’s face got swollen, especially her eye. Today Vicente said that they got news that there is a fracture in her skull, but it is unclear to me where. Either way, this sounds serious.

Paul Farmer talks about how the shitty roads and crappy tap-taps in rural Haiti cause lots of accidents that ruin lives, and how these risks (the risk of being in an accident, and of not being able to navigate or adjust well to the sequelae thereof) is disproportionately high amongst the rural poor. I have been trying to figure out if this most recent accident is similar. Can what happened on Sunday be interpreted in a critical anthropological perspective; can the impact on peoples’ lives be placed in the context of poverty and marginalization?

The difficulty I have been having with contextualizing the accident is that it was so random that Vicente’s family members happened to be on that particular pickup. There are many people who travel on pickups and camionetas (chicken buses), many of which pass by Quixayá every day. It just seemed like what happened to Vicente’s family was out of horrible chance. I suppose that because Vicente and all the people who live in the rural areas here, including me and Elena now, have this same baseline risk, it seems random that some people get hurt and others do not. But the fact is that Vicente and his family would not have the same baseline risk if they were commuting in Chicago—I do not fear for my life every time I am faced with the prospect of taking the CTA trains and busses in Chicago. But Vicente is definitely afraid of camionetas, to the point of insisting that we not take them. When I asked Rosa, a health promoter from Pampojila (the community where we live), if there were less deaths in the colonia after the highway was paved (thinking that she would say yes, because more people could get to the San Lucas hospital on time now), she said no, there are more deaths because the cars crash and sometimes even run over people. The risks related to automobile accidents here are so widespread that they become normalized for me, someone who is living here and thereby taking on, to some small degree, the risks that are a daily part of life for people here. There is a reason that “traumotología” is such a popularly claimed medical specialty here—the majority of the population in this country is not riding around in their own car with a valid license, and that is why there is so much automobile accident-related trauma (and why it is lucrative to be a traumatologist). A long, integrated process of poverty and marginalization have made it normal to ride around the Guatemalan highlands standing up in the back of a small pickup truck that struggles to move uphill under the weight of the other 20 people standing with you; the same process has created inadequate numbers of corrupt traffic police and allowed many people, including many drivers of public transportation, to drive without a license.

And these same processes have made emergency and rehabilitative medical care relatively or absolutely inaccessible to most people in our communities here. So for instance, Vicente’s mother-in-law needed a head CT immediately, and she probably didn’t get it for another 4-5 hours; when she finally got it, her husband had to pay 400 Quetzales (two weeks’ salary for a campesino around here) for it. Nobody should ever have to pay to see a doctor or get diagnostic tests or medicine. But this is only the last part of a long sequence of problems.