We maintained our friendship with Natalia and Chonita over the years - always checking on how they were doing and making small talk whenever we made a site visit, but when we came back to Santiago in August of 2007 for a full year, we began to see much more of Natalia, Chonita, and Chonita’s little brother, Domingo. Each time, Natalia told me more about her situation, including the seriousness of her husband’s condition and the lack of support from her family and in-laws. She had heard about a rehab program which had been successful for some other notorious Santiago alcoholics, and she wanted to send her husband, Max to this program. I sat quietly, thinking about her roundabout request for a loan of Q1200 ($160) for the three months of rehab while I watched little Chonita and Domingo, clearly underfed, devour six bananas in one sitting. I then agreed to the request and told her that she didn’t have to pay me back; but of course, Natalia continued offering to do a variety of things on my behalf.
Three months later, Max returned to his family and I finally met him. He had noticeable symptoms of liver damage and lots of unexplained pain, but he was extremely grateful to everyone. He began attending Alcoholics Anonymous or his family’s church on a nightly basis and has since been actively working or searching for work and providing for his family. He is now almost eight months sober.
Through Natalia’s “volunteer” work, I realized that she had a special skill with a measuring tape and a good eye for textile quality. Apparently, Natalia had spent a few years working in a sweatshop in Guatemala City. So, when the IHF’s Just Apparel project was in need of a quality control manager, she was a perfect fit (and of course the project pays her a living wage and ensure a relaxed working environment!). She has been working as a leader with Just Apparel since April and her family is now making a consistent living wage. Chonita has started school, the family moved into a new house in the government funded Post Hurricane Stan reconstruction site (yes, they were victims of the 2005 mudslide as well), and Max is contributing to the family instead of taking from it.
While this is a story of one family, it is representative of the kinds of long-term relationships that stem from the long-term partnership model of the IHF. These relationships are not only valuable in and of themselves (for all parties involved); they also allow us to move beyond generalities and demographics into unique stories and respond to the specific needs of specific people. These small steps and individual stories each contribute to a larger process of empowerment and grassroots change.
We met Natalia in 2005 when the IHF was working primarily with children in Santiago Atitlan. Natalia was the mother of one of the youngest children we received in the after school program and one of the biggest pains in my neck. Chonita, then 2.5 years old, was always crying, screaming, and hitting the other children. Despite the fact that her older cousins were always there to help her, she was never pleased. Finally, I got the chance to speak with her mother, Natalia, one of the best female Spanish speakers in this predominantly Tzutujil speaking community (most women in the community don’t understand the national language of Spanish). Natalia told me that Chonita didn’t talk much yet, but when she did, she was always complaining about how much her tummy hurt. “Ok, why don’t we just take her over to the hospitalito and have her stool tested?” I said with a knowing tone. I myself had just tested positive for giardia, a common parasite in the area. “No,” Natalia said, “We just don’t have enough money.” I proceeded to convince her not to worry about it that the Hospitalito was sponsored by other foreigners and they would give her a significant discount. She was only persuaded when I promised to accompany her and Chonita to the hospital. While we were in the waiting room, Natalia explained why it was that didn’t have enough money — her husband was one of the town drunks and drug addicts and he stole from her every time she had a few quetzales — he even stole her clothes and sold them for money!
After the positive parasite diagnosis came back, the final cost of the test, consultation and medicine was Q12 (about $1.60). Natalia only had Q2 to her name (about $0.27), so I told her not to worry about it and paid the tab without thinking twice. I then made sure I explained thoroughly to Natalia how to avoid contracting parasites yet again.
The next day she brought me two frog keychains made out of beads. She told me that she had made them for me since she couldn’t pay me back in cash. Maybe, she argued, I could sell them in the United States for more and make some money. Over the next few weeks, Chonita quickly became my favorite among the kids. She was always laughing, playing, and giving out hugs.
The IHF has just released its Summer 2008 newsletter. Check it out.
There is nothing quite like waking up in a new place, around people you’ve only just met, expecting to start your first day of work, and realizing that your stomach is so cramped up it hurts to be awake, let alone move. It happened to me shortly after I arrived in Santiago Atitlan, Guatemala, and I survived, but allow me to explain what transpired before I knew that I would be ok.
I drank some water, lied down, and texted Heidi, the Just Apparel project manager that I would be working with. “I’m not feeling so great, I’m just going to lie down a bit longer,” I wrote. I didn’t want to be a chore on my first day. 30 minutes later I threw up the water, and 30 minutes after that I dry heaved because there was nothing left in my stomach to throw up. By that point I had called Heidi, but I still didn’t want to be a pain, and I figured it had to be a virus that would pass.
Sadly, though I suppose this makes for a better story, it did not pass that easily, for the rest of the morning my stomach would not stop hurting and I would periodically throw up/dry heave. At one point Heidi was checking on me and I went into the bathroom to dry heave some more. Heidi made the executive decision that it was time to go to the hospitalito. I was reassured that the Hospitalito was a good place and filled with American volunteers. I thought back to my 19-year-old roommate’s spring break trip to Latin America where she had been asked to administer shots and other drugs for the first time. “Don’t let me have a ‘doctor’ like that,” I thought.
When I got to the hospitalito, they had a lot of difficulty finding my shrunken, dehydrated veins, and may have stuck me a couple times before they could get the IV in, but otherwise I received very good care. It turns out I had giardia, a nasty parasite that was attacking my stomach and intestines. I was sent home with some Flagyll medication, which does wonders to kill the parasites, but tastes terrible. Within a couple days I was out and running again, and I finally Ihad my first day of work.
It’s striking how easy it is for a comparatively wealthy volunteer from the US to contract a parasitic infection, get treatment, and get back to business, while so many children around here have chronic intestinal problems. Giardia is just a part of life for the population of Santiago. Clean water is hard to come by, and it’s certainly not cheap. The sewage system here is rudimentary, and in the outlying areas, latrines are far from universally available. I suppose people’s bodies get used to parasites (any doctors who can confirm that in the comments?), but after what I went through, it’s hard to imagine.
I’ve learned that if you come from the right place you can get sick in a foreign country, around people you barely know, and live to smile about it… though you might want to wait till the stomach cramps go away to laugh - it hurts a lot less.
Katie
This morning Heidi and I were talking to the lawyer who’s helping us out with the legal formation of the Just Apparel Partner Artisans’ group. Specifically, we were discussing the contracts that we had asked him to draw up between the artisans’ association and Dolores, our general manager, and Natalia, our quality control specialist. Natalia works for JA part time at an hourly wage of 10 quetzales, which is more than double what she made when she worked at a textile factory in Guatemala City and about one and a half times the Guatemalan minimum wage computed hourly. We expressed that we were hoping to formalize that relationship and give Natalia the benefit of being a contractually employed worker. And that’s when we stumbled inadvertently into the labyrinthine mess that is Guatemalan labor law.
You see, if I understand our conversation correctly, there’s no such thing as a part-time job in Guatemala. The minimum wage is not computed hourly, but rather monthly, and there’s no provision for someone who works less than eight hours a day six days a week to earn a prorated salary that varies by hours worked. That monthly minimum salary is Q.1310 ($175). But, naturally, there’s also a government-mandated “bonificacion incentivo” (incentive bonus) that each worker has to receive. The last time I checked, a mandatory bonus isn’t an incentive. It’s a raise. So that brings the monthly salary to Q.1560 ($210). In addition to the mandatory monthly bonus, the law also requires a mandatory bi-annual bonus of one month’s salary. So, for every twelve months of work, the law requires fourteen months of salary. That means that over the course of a year, a worker is legally entitled to Q.21840 ($2950).
Now, from the perspective of the US, that sounds pitifully small, right? A family of six (average for Guatemala) with two workers would still only earn $3.70 per person per day, which isn’t exactly the makings of a life of material comfort. As someone working to promote grassroots development efforts in Guatemala, I would love nothing more than to see everyone here earning more than the minimum wage. There’s just one catch. With all the bonuses and the like, the Guatemalan minimum wage comes out to be 118% of the estimated 2007 GDP per capita. As a point of comparison, if the US were to mandate a minimum wage that large, the minimum annual salary would be $54,100. Using the 55-hour work week that’s common in Guatemala, that would compute to a minimum hourly wage of around $18.90, or 2.75 times the federal minimum wage once it rises this summer.
Given the level of income inequality in Guatemala (the wealthiest 10% of Guatemalans earn over 43% of the country’s income), it’s currently impossible for everyone who works to earn minimum wage. There’s simply no way. It appears that the Guatemalan state may have let its good intentions get ahead of what is realistically possible. I have to ask if perhaps it wouldn’t be better for the government here to lower the minimum wage a little, allow for an hourly minimum wage for part-time employment, and bring a larger percentage of the population into the formal labor force, thereby at least granting those people basic labor rights, even if they weren’t earning an exceptional salary.
On a public health mission I went to the town market with two municipality officials and one of the centro de salud staff to see what recommendations we could make. Santiago´s market appeared to me fairly typical for a market in Central America. Crowded, full of people sitting on the floor selling fruits, nuts, crabs, fish, fish heads, and pretty much anything else that you could need. 
But on this trip, we focused on the stands that sell food. Picture a booth at a carnival or farmer´s market where you can buy a plate of tortillas, beans and rice. Or soup and a soda.
The town of Santiago is starting a new program in improve the sanitation of the market so our task was to go from stand to stand and make suggestions to them about how they could prepare food more safely. At every stand we asked to see their official permit allowing them to sell food, and the ‘Tarjetas de Salud’ (health cards) which every employee is supposed to carry stating that they have tested negative for TB. And at almost every stand people told us ‘Oh yes, we have those, but we keep them at home.’ I was actually surprised at how many store owners told us honestly ‘No, we don’t have those.’
The other recommendations were pretty basic. My major contribution was to point out that no one had any real way to wash their hands (definitely needed my master’s to notice that one) and that maybe the best place to store the vegetables wasn’t on the ground.
But here is the really funny thing: When I got back home I realized that the stands we visited probably weren’t the main threat to public health in the market. A much greater nidus for infection and vermin is probably the unrefrigerated fish, fruits and vegetables sitting on the ground. And those are the poorest vendors, who don’t pay license fees and who couldn’t afford to if they were charged. So I wrote my notes up for the centro de salud and in it I explained this, but it is a hard line to walk because on the one hand I don’t want suggest taking away the livelihood of the poorest people in the market, but reforming the rules for who can sit on the floor and sell without doing so would require money from somewhere.
Ma’jo’n is the Tzutujil word for ‘there isn’t any’ and this week it’s been the most common word I’ve heard at the centro de salud.
Coming from the US there are things that I don’t understand immediately about health care here. The centro de salud is a government run organization, and every week sends its requisition forms in requesting the medicines that they need. But they don’t actually always get them. In fact, a good percentage of the common medicines we give out daily we are currently out of. We have been out of albendazol syrup (for treating parasites in kids too little to take pills) since I arrived. This week we ran out of amoxicilin pills, trimethoprim pills and syrup. In fact the only antibiotics we have are donated amoxicilin syrup, donated cipro, and a few courses of a cephalosporin. We ran out of folic acid last week (which we need to give to every pregnant woman) but were luckily able to get some donated.
The donations come from private organizations such as Save the Children, and I honestly don’t know what the centro de salud would do without such donations. But running a clinic with donated medicines has its problems. For one thing, the doctors never know what they have to offer. For another, there coordination between supply and demand is far from perfect. While we have very little in the way of antibiotics we have quite a lot of alka selzer, zyrtec and osteo bi flex.
I want to share something that made my day. The mail a few days ago carried a letter and a donation (fairly standard for our growing non-profit) - what took all of us by surprise was the source of this very generous donation.
Two third grade classes, from Cresskil, New Jersey held a donation drive to support our partnership work in Ecuador. Ms. Regan and her classes held a penny donation drive as part of their community service work:
“One small penny can change the lives of many”
So 3rd graders, thank you for your generous donation - we know it will change the lives of many in Yambiro, Ecuador. Further, I’m sure your community service will change your own lives. We’re all proud of you and the global citizens you are becoming; we all have something to learn from your hard work….
So after 10 houses and 3 kids vaccinated it almost time to return to the centro de salud. We stop at one more house and a woman standing nearby sees us, takes off running and returns running, pulling behind her a very reluctant 4 year old. He digs his heels in, but his mother prevails delivering him and his vaccination card to us with a flourish. The nurse takes care of him and then does something remarkably resourceful. Frequently after they get a vaccine kids will have a slight temperature, part of the body developing an immune response as it is supposed to. But to keep them comfortable its generally recommended that they can have tylenol. Now this mother did not have any tylenol so the nurse I was with took the sterile wrapper from the syringe she had just used, dropped 2 tablets in it, folded it over and had a clean bag of tylenol to give the mother. I was impressed.
So as we head from house to house spreading the joy of vaccines to the small children I learn a few things about the public health system here in Guatemala.
First off, unlike in the US, vaccination here is not an obligation. Rates of vaccination for polio and measles are in the 50-60 percent range in this district. (The WHO estimates that for all of Guatemala the numbers are closer to 91 percent for measles and 85 for polio). In contrast, in the US rates are around 92 or 93 percent.
So in a country where the government sends people door to door to give vaccines and balloons out I am surprised when a few of the households we stop at state that they do not want the vaccine. I ask why expecting an answer that involves government conspiracy, or as at home, fear of long range developmental side effects. But the nurse I am with says that no, the families just think the vaccines cause fevers and they do not want them.
This, she says, is a population we need to work more with.
RSS
