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 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 buses 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.
Wednesday, March 12, 2008
Monday, January 28, 2008
An artefact of inequality
There is an old (ancient) centrifuge in Quixayá, donated to the health promoter program. It works. But I don’t know what they would use it for in Quixayá. Vicente seemed to think it was to be used to run bacterial cultures. The lab at the parish clinic doesn’t even run cultures. Vicente said that we could lift the lid and use it as a fan, as the air in the community center in Quixayá tends to get hot and stagnant in the summer. We all had a good laugh.
But seriously…places like Guatemala get our garbage. They get people who are confused and lost, or idealistic and energetic but without any applicable skills. They get our junk—whether or not they want it, need it, or know what to do with it other than put it away and out of sight. So while no diabetic in Quixayá is on metformin (first-line treatment in the States), an old centrifuge collects dust, hidden under a large (and largely unused) examination table in the community center.
But seriously…places like Guatemala get our garbage. They get people who are confused and lost, or idealistic and energetic but without any applicable skills. They get our junk—whether or not they want it, need it, or know what to do with it other than put it away and out of sight. So while no diabetic in Quixayá is on metformin (first-line treatment in the States), an old centrifuge collects dust, hidden under a large (and largely unused) examination table in the community center.
Vitamin B King Kong
Doña Candelaria was told by a local NGO that Rosbin is malnourished. Later, when Lesvia asked Rosbin to hand her a basket that was high on a shelf, he said he could not: “I can’t help you because I am malnourished!” Again, we all had a good laugh.
What is Doña C supposed to do with the information that Rosbin is malnourished, now that he is 7-years-old? Especially when the advice given to her was to take a Vitamin B-complex supplement and “pay attention to how he is eating”?
At least Rosbin can use his malnourishment as an excuse to avoid helping around the house. And this morning at breakfast he was running around the kitchen saying that the vitamin supplement will turn him into King Kong, similar to the effect of spinach on Popeye.
What is Doña C supposed to do with the information that Rosbin is malnourished, now that he is 7-years-old? Especially when the advice given to her was to take a Vitamin B-complex supplement and “pay attention to how he is eating”?
At least Rosbin can use his malnourishment as an excuse to avoid helping around the house. And this morning at breakfast he was running around the kitchen saying that the vitamin supplement will turn him into King Kong, similar to the effect of spinach on Popeye.
Saturday, November 3, 2007
Joia Mukherjee on sustainability
"One criticism often lobbed at PIH is that its projects are not 'sustainable,' said Mukherjee, as the traditional view of a successful development projects is to have it be self-sustaining after the development organization leaves. '[But] we’re global citizens and we’re not leaving. We’re in this together. You don’t exit from humanity,' countered Dr. Mukherjee. 'You don’t have an exit strategy.' The only thing that is truly self-sustaining is entropy, she added.
'If you teach people to fish, then they can fish for a lifetime,' she said, quoting a common sentiment of sustainable development. 'But in fact, if the rivers are dry, and there are no fish, and you have no fishing pole, you can’t learn to fish,' she said."
(PIH E-Bulletin, October 2007)
'If you teach people to fish, then they can fish for a lifetime,' she said, quoting a common sentiment of sustainable development. 'But in fact, if the rivers are dry, and there are no fish, and you have no fishing pole, you can’t learn to fish,' she said."
(PIH E-Bulletin, October 2007)
Wednesday, October 17, 2007
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.
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.
Monday, October 1, 2007
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?
-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?
Friday, September 28, 2007
Subsidiarity
Subsidiarity is one of the four pillars of Catholic social teaching that calls us "to respond to the expressed needs" of the poor and marginalized. Over the past few weeks, Vicente has asked the health promoters to put their heads together to generate a list of ideas that they would like to develop further, and needs that they would like to see fulfilled. Here is a sampling.
Rehabilitate 90% of the cases of child malnutrition through talks, visits, awareness, follow-up, trainings and searching for appropriate technologies for the purpose of treating malnutrition.
Family planning.
Medicines for chronic diseases: epilepsy, asthma, anemia, fecal exams, prenatal visits, general medical consultations.
House visits for 'special children.'
Pap smear clinics.
...and, lastly, my personal favorite:
Visits to people with incurable diseases or people with scarce economic resources; through house visits, people feel happier; and also, monthly clinics because there are patients who have indeed been helped a lot and are recovering from their illness.
Quite a bit of work to do, eh?
Rehabilitate 90% of the cases of child malnutrition through talks, visits, awareness, follow-up, trainings and searching for appropriate technologies for the purpose of treating malnutrition.
Family planning.
Medicines for chronic diseases: epilepsy, asthma, anemia, fecal exams, prenatal visits, general medical consultations.
House visits for 'special children.'
Pap smear clinics.
...and, lastly, my personal favorite:
Visits to people with incurable diseases or people with scarce economic resources; through house visits, people feel happier; and also, monthly clinics because there are patients who have indeed been helped a lot and are recovering from their illness.
Quite a bit of work to do, eh?
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