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.
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.
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.
Today when I arrived at the Centro de Salud, the nurse who has taken me on said that today I could come with her on a vaccinating trip. Which was very exciting. Every day 1 or 2 of the nurses from the Centro go literally door to door through the town of Santiago Atitlan to vaccinate children who are behind in their vaccines. Here is what happened:
The nurse, who is wearing traditional dress for Atitlan, and an assistant put on their outfits from the Ministry of Health which consist of a bright orange hat and navy vest emblazened with the ministry seal.
And then we set out, we walk a few blocks from the Centro de Salud to the spot where they had left off that morning. We walk down an alley-way which is barely wide enough for one person and the nurse knocks and yells “VACUNA!” (VACCINE!)
The door opens and inside are a man, a woman weaving and a now very scared looking 5 year old boy. The next part of the conversation takes place in the Tzutujil language, but clearly the father says to the boy “Do you want a vaccine?” and the boy says a very definite no. The nurse holds out an uninflated green balloon that he’ll get as a bribe, and so (unlike children we encountered later), he didn’t run away, or scream. He just put on his bravest look until it was over and he safely had his balloon.
And then we continue on down the street, offering Vacunas and having children eye us suspiciously, like the opposite of the ice cream man.
So today was the end of my first week volunteering in the Santiago Centro de Salud (government run clinic) here in Guatemala. My Spanish is a bit rusty, and there is a whole new system of documentation to learn so I was surprised when as soon as I arrived the nurses said they had a big job for me.
Apparently they get donations for the clinic, mostly from the US, and the boxes are all labeled in English. Nearly everyone who works at the clinic is bilingual in Spanish and the native language T’zutujil, but hardly anyone speaks enough English to decipher the boxes. So my first big job was explaining for each box and tube, “Tylenol PM-tiene acetaminofen y benadryl tambien.” 
Over the weekend I’ll be putting together a list of medications in Spanish and English for the clinic to keep. But from now on when I bring or process donations in the states I’ll make sure that they are labeled in the language of the country they are going to. Such a small step to go from a meaningless and potentially dangerous action to a useful donation.
Travelers to Asian cities (or much of the developing world) know the site (and smell!) of the ubiquitous ‘Auto-rickshaw’ — a three wheeled taxi used for short trips around typically urban areas. Delhi, Mumbai, and dozens of other uber-urban are swarming with 2-stroke, 4-stroke, natural gas, and diesel models:
The Auto-Rickshaw - a staple of daily life in South Asia.
Imagine my surprise when I landed in Guatemala to find the streets of Santiago filled with Auto-Rickshaws! Here they’re called Tuk-Tuks and bear more than a resemblance to the Auto-Rickshaws on the other side of the planet:
Both are made by the Indian company Bajaj - a massive company whose distribution network extends from India to Central America, South America, Asia, and Africa. Most of the Global South seems to be Bajaj’s market - an icon of one upwordly mobile nation is becoming that of many more…
Good or bad, pros or cons, globalization is happening. Of course the streets here in Guatemala are filled with Toyota Trucks made in the Americas, Toyota sedans from Japan, US made school buses, Hyudais and Nissans from Asia, Fords from up north and even some BMWs and Mercedes from Germany. As the Chinese and Indian economies evolve I think we’ll see more Bajaj products around the world, and it won’t be long before we see the $2500 car, the Tata ‘Nano’, here in Central America.
I think it also won’t be long before we see Guatemalan products in India - what do you think? Do you know of other similar stories of a shrinking planet?
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