Monday, August 27, 2007
What are we doing here?
Sometimes it feels like the parish’s role here is to let gringos come for a few weeks and feel good about the work that they are doing for poor Guatemalans, without focusing on or facilitating efforts to do anything substantial to empower people.
One of the long-term volunteers who has been involved in coordinating the activities of short-term volunteer groups has told us that he has noticed, on several occasions, groups being instructed to move bags of dirt or rubble back to the location from which they had been moved by another group just the week before. (If you’ve ever been on a community service trip that involved construction work or other physical labor, you know how disappointing—and maddening—it would be to discover such a sham.)
In our case, the parish’s vacation-volunteerism system has created a situation where we live alone in a huge house in downtown San Lucas, and, as a result, we have little access to more rural, impoverished communities and indigenous households, making it difficult to get to know people on a day-to-day basis. There are plenty of opportunities to get to know Ladinos who live relatively comfortably in downtown San Lucas, but almost no opportunities to get to know indigenous people, besides the few health promoters we’ve been introduced to. I thought I was coming here to live with people and to walk with people, not to live and walk in a parallel world and make myself feel good at the same time.
A lot of money is being poured into the ideas (or pockets) of a few people, and the suffering of the great majority goes mostly ignored. For instance, the heads of all the major parish projects have risen in socioeconomic status from humble, impoverished backgrounds to very comfortable lifestyles. It is confusing and frustrating that the parish can find the money to pay a few people such generous salaries and yet, the community health promoters, who are essentially the first-responders and the only primary healthcare providers for many people, are not paid. This really limits what they can achieve because they themselves are living in the same impoverished situation as their neighbors. Since they are not remunerated for their activities, they cannot do much as health promoters because most of their time and energy is taken up trying to find scarce day labor positions to feed and house their own families. These well-trained health promoters and community organizers would find it almost impossible to take time off from work in order to fully implement any project that we could potentially help them develop. Community service is fine and dandy for people who have a steady income, but it is foolish to expect people who are struggling to survive below the poverty line to take time away from jobs that pay $4 per day (for 8 or more hours of physically grueling agricultural work) to “volunteer” or “give back” to their communities in any substantial way.
Right now, it feels like the options are: A. to go back home; B. to move to another house with a host family; or C. just take things as they are and just have a good time, just try to enjoy a year off here. The problem with A is that we’ve only been here a month—not quite enough time to know if things will get better—and we’ve already invested so much time and effort into this year. The logistics of going back would be difficult, too, about as complicated as the logistics of coming down here. I would probably have to start school again, Elena would have to get a job, we’d have to find an apartment. It would also be giving up on something too easily, on something that was so important to us, instead of trying to problem solve and figure out how to make things work.
The problem with B is that we are here under the auspices of the parish, and we’ve already paid for our housing for the year. So we run risk of kicking off another flurry of parish politics and petty dispute, not to mention spending more money that we don’t really have.
The problem with C is that we would feel completely useless – as we do now – if not feeling like bad people. We came down here to do something meaningful and that’s not what we’re doing right now. We could be traveling every weekend or going away, or we could be going out and partying, but then in a couple of months we would probably find ourselves in the same situation, asking, “What are we doing here?”
Ultimately maybe the solution is to focus less on ourselves and our own subjective experience here, and to remind ourselves that other people are suffering and that was why we came here. Hopefully, thinking like this will force us to try to find a way to alleviate that suffering, instead of just feeling disappointed or sad because our experience here is not what we had expected it to be.
Wednesday, August 22, 2007
"Oh yes, wait a minute Mr. Postman..."
"wai-ai-ai-ait Mr. Postman..."
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Since the Guatemalan postal service has been described as "unreliable," we've found a way to ensure that your packages and letters get to us safe and sound (yay!).
Instead of addressing your mail directly to us in Guatemala, you can save money on international postage and ensure peace of mind by mailing it to the San Lucas Mission Office in New Ulm, Minnesota. Just call the Minnesota office at 507-359-2966 and ask to speak to Kathy Huebert, who will be able to put you in touch with the next group of short-term volunteers willing to bring a package down for us in their suitcase :)
Things we would love to get in the mail:
1. letters and cards (it's so nice to get a hand-written note once in a while)
2. insect repellant (they don't sell it here, and we're getting eaten alive!)
3. cookies (enough said)
4. dvds (we would looove to have something to watch on Shom's laptop! We don't have a TV, there is no movie theater or movie rental store in town, and the only dvds they sell in the town market are pirated copies of karate movies, horror movies, cartoons, and soft porn... So, if you have the ability to burn dvds or you want to get rid of an old movie, send it our way!)
Monday, August 20, 2007
Day-Tripping
In addition to the church and the market, Shom and I also made the trek up to Pascual Abaj, an ancient carved stone icon that has been a Mayan worship site for thousands of years (left). Ceremonies are held there for all sorts of things: to bless a marriage, to pray for a good harvest or to give thanks for a good harvest, or to remedy a problem such as preventing thieves from stealing your corn. According to our guidebook, these ceremonies usually take place at odd hours of the day or night and tourists are unlikely to witness such a ceremony taking place. We must have had great luck, though, because when we got to the top of the hill there was a ceremony taking place (above)! Obviously it was difficult to understand what exactly was going on, especially since the ceremony was in K’iche’ (the Mayan language spoken in the area), but suffice it to say that it was an amazing thing to witness.
Wednesday, August 15, 2007
T.I.G.
Suffice it to say that after many “TIA” moments of our own, Shom and I now have a new way of dealing with the absurdity that is daily life in Guatemala. Any time we begin to feel frustrated or perplexed or incredulous by the things going on around us, we simply shake our heads and say, “TIG… This Is Guatemala.”
In addition to our TIG coping mechanism, we’ve also compiled a list of lessons learned about life in Guatemala. In the hopes that this may provide some comic relief for you folks back home, I would like to share it with you…
1. Don’t worry about being on time for anything. Odds are that even if you’re three hours late… you’ll be half an hour early.
2. Don’t underestimate the power of amoebas: brush your teeth with bottled water.
3. If you do get amoebas, thank your lucky stars that A., you’re engaged to a medical student who can diagnose your ailment, and B., in Guatemala you don’t need a doctor’s prescription to buy antibiotics from a pharmacist.
4. Never walk down the street without looking at the ground, or else you’re bound to wind up with your foot in a pile of shit.
5. Don’t hang your laundry out in an open field to dry during the rainy season.
Monday, August 13, 2007
Parish Politics, Accompaniers, and Santiago Atitlán
In other news, we’ve met a few new folks this weekend. On Saturday, we spent literally the entire morning chatting with Aaron and Becky, who are “accompaniers” with the Brethren Volunteer Service and whom Julie Windsor Mitchell met on UCM’s most recent trip to San Lucas Tolimán. The title of their positions is a hold-over from Central America’s civil wars, when First World volunteers were placed as witnesses in communities at risk of attack by military or paramilitary groups. The violence in Guatemala officially ended in 1996, but a steady stream of volunteers has continued to fill Aaron and Becky’s positions to serve as witnesses to ongoing processes of poverty and marginalization and to help in the establishment and maintenance of a variety of community development projects. They live in a small village high up in the mountains called Unión Victoria, which, once an abandoned plantation, was the site where two communities of Ixil and K’iche’ Mayas were resettled during the civil war. They told us that neither internet nor a reliable cell phone signal are available in Unión Victoria, so they come down to San Lucas Tolimán every couple of weeks to relax, recharge and download episodes of The Office on iTunes. In any case, they seem to be quite authentically living with the people the way that they live, and I hope to learn a great deal more about their experiences—and maybe even visit their community some time.
On Sunday, we tagged along with a couple going to Santiago Atitlán, a fascinating community a little west of San Lucas on the lake. We visited the church and memorial to Fr. Stan (A’plas) Rother, an Oklahoman Catholic priest who learned Tzutujil and was assassinated by “desconocidos” (masked men, who likely were working on behalf of the military) for his commitment to his indigenous parishioners in 1981. Later, we visited Santiago’s famous cofradía (lay brotherhood) to Maximón, an indigenous demigod who I think represents St. Simon during most of the year and then comes to represent Judas during Holy Week. There is an interesting and relatively quick chapter on this town in a book called Unfinished Conquest.
Another interesting thing about Santiago Atitlán is that it is one of the last remaining towns in Guatemala where the men still wear their traditional ¨traje.¨ Men´s traje in Santiago Atitlán consists of hand-woven blue striped pants, often hand-embroidered with images of birds. The pants don´t have a zipper or a waistband, but are held up by a long sash that is wrapped around the waist a number of times and tied in front. Elena being Elena, she took a bunch of photos while we were in Santiago. To the right, you can see some men in their traditional pants, walking up the steps of the church on their way to mass.
In other news, it has come to my attention that my blog entries are too ¨medical¨for some folks, so I have created a new blog called ¨Social Justice & Medicine in Guatemala.¨ This blog was created so that I could continue developing and maintaining a critical, resocialized perspective (that is, ranting) about my experiences without inconveniencing (or boring to death) people who just want to know how we're doing, for Chrissake. So, to find out how Elena and I are doing, keep reading this blog; to find out what I secretly think to myself, go to www.socialjusticemedicine.blogspot.com.
Saturday, August 11, 2007
Chalet Atitlán?
Doña Roli and her husband are criollo, (the Spanish word for “creole”). Criollo is a term that refers to the racial and cultural identity of those Guatemalans who can trace their ancestral lineage directly back to Spain. Criollos are racially Caucasian, and make up the country’s very small upper class of landowners and politicians. Indeed, Shom and I are staying in one of three houses they own in San Lucas Tolimán.
There are two other terms used in Guatemala to describe race. Indígena (indigenous) refers to people of Mayan descent. Depending on whose statistics you read, approximately 60 to 75% of Guatemala’s population is indígena, and from what I’ve seen so far, it seems to me that this race category is also synonymous with extreme poverty.
Ladino is the term used in Guatemala to describe people of mixed heritage, those who count among their ancestors both indigenous Mayans and Spanish conquistadors. Ladino can also be used to describe those indigenous Guatemalans who adopt the dominant culture developed through Spanish colonial and U.S. influence in the country. From what I’ve observed, Ladinos socioeconomic status ranges from very poor to middle class.
I came to Guatemala to live and work as a volunteer with the impoverished Mayan people of San Lucas. While I am very grateful for our new home and the generosity of our benefactor, I can´t help but feel a bit awkward living in this “chalet” as Doña Roli straight-facedly referred to it yesterday.
Thursday, August 9, 2007
The vitality of practice, the importance of language
So far we’ve been here 4 days and have spent them mainly introducing ourselves to individuals involved in the preventive health program. At the moment, I have more to reflect on from last weekend, when we accompanied Peter on his patient visits in Santiago Sacatepéquez.
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Two house calls in particular stand out in my mind. The first was to the home of an elderly diabetic woman, whom, after walking down a path of cracked cement and (in my case, anyway) nearly tumbling down a short dirt incline, we found sitting in a dark back room with a piece of blue cloth wrapped lightly around one foot. As we entered and took the seats that were invariably offered us by our gracious hosts during house calls, I noted an oddly pungent odor that, when the blue cloth was gently removed by the patient’s daughter, turned out to be the smell of rotting flesh. Her great toe was almost entirely detached from her foot by black gangrene, and her other toes appeared similarly infected, swollen or dying; particularly concerning was the redness and swelling in her foot and ankle, suggestive of soft tissue involvement and evolving osteomyelitis. The second was to the home of an elderly couple—the day before, Peter had been telling me about the woman, who has Parkinson’s, but ultimately it was the case of the man that captured my attention. He watched us from bed, his gaunt frame and features appearing at least 10 years older than his stated age of 63. He told Peter that he had been experiencing up to 15 bright red, bloody bowel movements a day for several months now and described dizziness and fatigue, both symptoms of anemia which indicated the severity of his bleeding. Bright red blood per rectum, as it is known in U.S. emergency departments and hospital wards, has a fairly extensive differential, but the subacute onset, progressive symptoms and accompanying anorexia and weight loss in this elderly patient made colon cancer the leading diagnosis. In both of these cases, the patient had endured fairly concerning symptoms for astonishing periods of time, and, despite Peter’s insistence that there was little that he could do, both patients resisted the idea of going to one of the regional public hospitals.
These examples spurred a cascade of thoughts about structural violence and the multiple manifestations of resultant marginalities in the lives of these two people. The first was an older woman with diabetes that, due to the lack of access to medical care generated by socioeconomic and cultural marginalization, remained undiagnosed until Peter recently began taking random finger-stick blood glucose measurements in the community. I am almost certain that the metabolic derangements associated with the disease had already wreaked havoc in the form of end-organ damage prior to this most recent, and more evident, complication. Similarly, this same socioeconomic and cultural marginalization generated a well-founded reluctance to go to a hospital where doctors would communicate in a difficult language (that is, if they communicated at all) and explain little about unfamiliar and thus frightening therapeutic options (that is, if they did indeed present them as options, or if they presented any possible therapies at all, for that matter). Moreover, if the patient did ultimately make it to the hospital, the inaccessibility of the antibiotics that would be the standard of care in the United States (either due to absolute absence or relative lack of access due to cost) would necessitate a more extensive surgical debridement (and subsequently increased disability) to effect a lasting cure. Moreover, the significance of disability in this context—a context that itself is generated and conditioned by poverty—was apparent in my own difficulty getting to her room. Similarly, the second patient was a 63-year-old man who, not having received a single screening colonoscopy, flexible sigmoidoscopy, or even a simple rectal exam and fecal occult blood test (strongly recommended by the US Preventive Services Taskforce for anyone 50-years-old and above), now had what was probably flagrantly symptomatic colorectal cancer that had, given the severity of his bleeding, likely metastasized already and become virtually untreatable. Moreover, because he had never had a cardiovascular work-up or even a lipid panel (cholesterol, etc.), for that matter, and because he had never been on lipid-lowering or other cardioprotective therapy (other than the antioxidants that Peter gives many of his patients), it was possible that he had underlying coronary artery disease that put him at high risk of a heart attack given the degree of his symptoms of anemia. If he did overcome his understandable resistance to going to the hospital, he would be treated by surgeons and medical doctors who definitely lack the proper resources and who probably also lack adequate training to be treating him. When people here say they are afraid to go to the hospital because that is where one goes to die, that assessment may be very accurate indeed.
My medical and public health education takes on new meaning here. Ironically, the importance of what I have learned thus far becomes vividly apparent in a context where much of it cannot (yet) be put into practice. The insights from my meager personal study of social theory and anthropology take on a special vitality here. It is sometimes difficult, even for someone who strives to think and act in terms of social justice, to make sense of perspectives like that presented in the essays in Pathologies of Power if one is sitting at a desk in downtown Chicago, blocks away from a world-class hospital; this difference, I think, is what Paul Farmer refers to as “the vitality of practice.”
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Wicha is the Kaqchikel woman from Santiago Sacatepéquez who has taken it upon herself to organize, facilitate and otherwise assist Peter’s clinics and house calls there. She is an interesting person, and I hope to say more when I have spent more time around her—and when I speak enough Kaqchikel to understand her better.
This last point is an interesting one. When I had originally emailed Peter, I had introduced myself as a medical and public health student interested in learning a bit of Kaqchikel—he replied with what he describes as an “unforgiving” email that I absolutely had to learn the language before pretending to do any good, lasting work. I have argued similarly at Northwestern about the importance of health care practitioners in the U.S. learning Spanish, so I could understand where he was coming from, even if I did not understand the details of the situation that informed his perspective. The two days in Santiago Sacatepéquez and our interactions with Wicha made evident—even though I was a bit reluctant to admit it at first—the fact that I need to learn Kaqchikel.
When we had walked around on Saturday making house calls, there were numerous occasions when we were walking up a hill and Wicha would break the relative silence in Kaqchikel. Peter would smile and say something in response, and a brief conversation would ensue. Only on occasion did we speak in Spanish—and when we did, it was really just me asking Peter questions in a language that Wicha would understand; she would walk a few steps ahead, listening but saying little. On Sunday, when we were sitting in the cofradía, Elena leaned over and asked Wicha a question in Spanish. Elena’s Spanish is not yet perfect, but, nonetheless, on the basis of my experience with gringos and shoddy translations in other contexts, I found the question to be entirely intelligible, both in terms of grammatical structure and pronunciation. Wicha listened to the question twice, and turned to me, asking, “¿Qué dice?” (“What did she say?”) Similarly, on our last house call for the weekend on Sunday, Peter had Wicha and me go down to the square to buy gauze at a pharmacy—Peter first asked Wicha, who hesitantly pointed at me to ask if I could go with her. On our long walk down the hill to the pharmacy, our conversation was notably absent—I asked a question or two and Wicha responded with yes or no answers, and I got the sense that my Spanish was difficult for her and that it would have been much easier in Kaqchikel. On our bus ride home that afternoon, Peter noted that Wicha hates speaking Spanish. I understand now what Peter means when he says the dynamic and perspective rendered in Kaqchikel are completely different. I have quite a bit of work to do if I hope to do meaningful and useful work here.
Tuesday, August 7, 2007
I never thought I´d say this...
Today was our second day in San Lucas Tolimán, and Shom and I spent the morning at the elementary school in Porvenir, a settlement just outside of San Lucas. We went with three community health promoters to the school for a few reasons: we administered fluoride treatments to all the children, gave out toothbrushes, checked every single mouth to record whether they had ¨many cavities,¨ ¨few cavities,¨ or ¨no cavities,¨ and talked about the importance of brushing your teeth to avoid said cavities.
Sunday, August 5, 2007
Going to San Lucas Tolimán...supposedly
Saturday, August 4, 2007
Wardrobe Economics
Imagine you are an indigenous Kaqchikel Maya woman like Sabina. If you go to your village market, the average price you can expect to pay for a new huipil (traditional Mayan shirt) is about 800 quetzales (~$110.00 U.S. dollars).
If, to cut costs, you decide to weave your own huipil on a backstrap loom like the one on the left, the average amount of money you will spend on materials is about 600 quetzales (~$80.00). Keep in mind, however, that to make this huipil will take you between 1 and 3 months, depending on how intricate the pattern is, and whether or not you have a day job.
If you can’t afford to weave your own, your next cheapest option is to buy a second-hand huipil at the village market. This will cost you about 300 quetzales (~$40.00).
Also don’t forget that you will also need to dress your bottom half. If you want to buy a new corte (traditional Mayan skirt), this will cost about 400 quetzales, (~$55.00). Second hand cortes run about 200 quetzales (~$30.00). As a woman, you will not know how to weave our own corte, because this type of fabric is traditionally woven by Mayan men, who use a different (much larger) loom called a treadle loom, shown on the right. According to Sabina, the loom for making cortes is operated by using both hands and your foot. Weaving fabric on this loom requires significant bending of the torso back and forth, left and right (which becomes difficult if not impossible if you are a Mayan woman with a sleeping baby strapped to your back). This offers an explanation for why Mayan girls learn to weave huipiles from their mothers, and Mayan boys learn to weave cortes from their fathers.
By comparison, the average price of a brand new western-style blouse or t-shirt sold in a Guatemalan village market is about 25 quetzales (~$3.50). If, to be frugal, you decide to buy it second hand, you can expect to pay about 10 quetzales (~$1.50).
When you stop to consider the fact that Guatemala is an impoverished country where the average per capita income is $2,400.00 (U.S. dollars), it quickly becomes clear why someone might choose a one-dollar t-shirt over a one-hundred-dollar huipil.
Thursday, August 2, 2007
Sunset Photos
Coffee, clothing, class & culture
Maybe it’s advertising, maybe it’s globalization. Whatever the answer, this is an interesting phenomenon that I don’t really understand, but there you have it.
As I mentioned in an earlier blog post, this city is literally crawling with tourists. The other day, while reading our guidebook, I discovered the reason why: there are 75 Spanish language schools for foreigners in Antigua. My school is Ixchel Spanish School, and each afternoon I meet with my teacher, Sabina, for three hours of one-on-one instruction. Studying with Sabina is doing wonders for my Spanish. It has also been an interesting cultural experience. Sabina is a Kaqchikel Maya woman. She does not, however, wear the traditional Mayan “traje” (clothing) of a “huipil” (woven shirt covering the shoulders) and “corte” (long, ankle-length wrap-around skirt) that you can see in the illustration to the right. Sabina is an indigenous woman full of contradictions. She comes from the village of San Antonio Aguas Calientes, famous for its high quality Mayan woven textiles, and she even does her own weaving at home and sells her handicrafts for supplementary income. Simultaneously, however, she wears western clothing with plunging necklines and form-fitting pants. Sabina speaks the Kaqchikel language – in fact it is her native language, but earns her living as a Spanish teacher. I asked her about indigenous Mayan religious traditions and she described the shamans as “brujas” (witches).
In Guatemala, being indigenous is associated with being poor. It is interesting, then, that a Mayan woman with seven siblings, whose parents undoubtedly supported their family on their wages as underpaid agricultural workers, has educated herself and found a relatively well-paying job as a teacher, while at the same time casting off her indigenous clothing –worn proudly by her ancestors for thousands of years – for a wardrobe that suits her socioeconomic aspirations—however futile they may be given the glass ceiling that hinders the social mobility of all those who share her dark complexion.