A response to the new parish co-administrators' ideology of volunteerism

When I’ve asked the health promoters to respond to the questions, “What do you want, what do you need to do your work well,” the answers I hear are as follows: “We need more medicines. We need more trainings. We need more autonomy and more material resources. We need to receive compensation for our work.”

It may seem to some that these are grand demands. And of course providing all these requests at once and in full might prove unsafe for patients and be detrimental to the credibility of the health promoter program, were resources or medicines to be used inappropriately. Nonetheless, as grand as these demands might seem, they are also quite simple, and quite logical. The felt needs of people who are trying to help their communities have been expressed quite clearly to me—as a person who has been accompanying them daily in their work and collaborating closely with them to support and expand their existing activities. These needs are echoed, in one form or another, regardless of whom you ask among the senior and graduated health promoters. On the other hand, even the most superior health promoters are afraid to ask or demand what they know very well is their due—they feel unfree to express themselves to the people with the most authority in the local system of symbolic power and political economy, that is, administrators and other caciques in the parish hierarchy.

So, I am at times upset by immodest, cultural relativist claims that stress cultural difference, when the real differences seen in the communities here are those of poverty—poverty of financial resources, poverty of opportunities, poverty of education, and so on. These claims—much accepted in traditional development thought because they make the work easier, lowering the standard of care and justifying sometimes horrifying outcomes—are all the more irksome when one realizes who is stressing these “cultural” differences. These explanations erase and suppress—sometimes after obligatory acknowledgment—the fact that these “cultural” differences are more a product of generations of “unfree, desperate, and short” lives and ways of being. The people laying these “ideological landmines” (“Things are just slow down here,” “it has to come from them, not from us,” “that’s not sustainable,” “you are not here to do anything, your job is only to learn”) would have us believe, in some degree, that impoverished Maya communities in rural Guatemala are inhabiting a different political and economic universe than us U.S. Americans. We thereby run the risk of forgetting that our lives of luxury and endless opportunity are based on hundreds of years of oppression and violence against indigenous peoples.

To make development, social justice, and socioeconomic rights-building efforts work, we certainly must work in concert with people and communities. If we insist “radically” that all efforts for community development must come from the oppressed and marginalized with no intervention or assistance from us, I think we are making a huge mistake. Doing so would be to waste the symbolic and financial capital that we enjoy as powerful people in a deeply stratified world—and the health promoters, like other impoverished and marginalized people elsewhere, are very aware of our power and of the wastage of that power: Vicente recently said to me, “You will buy these things for the training session, because you have money”; the graduated health promoters’ response to Elena’s presentation of the topic of family planning amounted to, “We want family planning methods, and women in our communities want it, but until you help put these methods within our reach, it is pointless to talk about this issue.” If we choose not to listen to oppressed and marginalized peoples’ opinions and protestations that those of us who have power and money should consider it an obligation to use these resources to help them struggle for their rights and for more just lives, then we run the risk of taking a comfortable seat in our liberal leather armchairs, munching on popcorn as we watch the lives of the poor unfold and pat ourselves on the back for “witnessing” and doing development “work.” We run the risk of being so keen on listening and learning that we become deaf and impotent, recapitulating the theme of foreign invaders taking more than they are giving in return.

If anything, the health promoters insist that we NOT remain seated, that we get up and walk with them towards more just realities. The graduated health promoters exude hope and love when they speak of past volunteers who have "fought" (“luchó mucho por nosotros y por nuestras comunidades”) for their cause. The health promoters are credible, inspiring people who speak on behalf of their communities, and they have reproached us for not doing everything in our power (and we do have a lot of power) to get them the means to get what they need to take care of their neighbors. I cannot say in good faith that I am upholding the pillar of subsidiarity if I do not heed their rather clearly expressed, felt needs.

A case we saw in San Andrés

N.S., a 30-month-old boy, is seen during a follow-up house visit for failure to thrive. At this visit, he weighs 18 lbs, 12 oz. He was first seen 6 weeks previously, when he was just recovering from a 1-week bout of diarrhea, and his weight at that time was 16 lbs, 8 oz. His mother relates that N.S. began standing up and taking a few steps about 3 months ago; now, he is able to walk unassisted but cannot yet run. He says "mama," but no other words. The heart, lung, thyroid and abdominal exams are unremarkable. The boy's 8-month-old sister weighs 16 lbs. These are the household's only children. Both N.S.'s mother and father are present during the visit. When asked why she thinks N.S. is not growing well, his mother replies, "Last month he had diarrhea. Now he does not have diarrhea, but I give him food and he does not like to eat. He only eats one or two tortillas with salt. He likes Incaparina, but I only give it to him sometimes." The family lives in a resettlement community--families were moved from a plantation to this new location following landslides that destroyed all of their houses; the new land was purchased by the Catholic parish in San Lucas Tolimán. The community recently had unpurified, running water installed in all of the houses. In this community, there is a government-sponsored daycare for children 5+ years that provides two meals daily; there are mixed reports from community members and daycare caretakers regarding rate of attendance and family's usage of these free meals. There are biannual deworming treatments in the community.

-What are the possible ("social" or "environmental") etiologies of failure to thrive in N.S.? How do we figure out how likely these etiologies are, and how big an impact they are having on the growth of N.S.?

-What would be some strategies to tackling the possible etiologies of failure to thrive in this case?

-What should we be doing with respect to N.S.'s sister and protecting her growth and development?