Learning about Healthcare in Guatemala
Quetzaltenango (Xela), Guatemala might be one of the best cities in Latin America for learning Spanish. The Lonely Planet describes it somewhat snootily as attracting a "more serious" type of traveler, and it's probably true - the gringos (myself included) seem to make more of a genuine effort to blend in with the local culture. In Xela, partying takes a refreshing backseat to language learning (there were 23 schools at last count), music, dance, and volunteering. On my first day, a blonde American stopped me in the street and asked me, in Spanish, where to find the supermarket. I replied, in Spanish, and we continued about our business, both of us knowing that the interaction might have been much easier if we had both defaulted to our native tongues.
Like many students and young medical professionals, I have traveled on numerous short-term medical volunteer trips in Latin America (in my case, Ecuador, Guatemala, Honduras, Nicaragua, and the Dominican Republic). This time, I had only a small window – a week – to manage to take in the ruins of Tikal, and then somehow backpack my way to the Western side of the country, by plane, bus, and in the end, chicken bus.
However, I’ve wondered lately whether those in North America spend too much time worrying about performing direct patient care on volunteer trips, when a healthy dose of cultural learning might be more appropriate. I took Spanish lessons with Lily at the Pop Wuj School, which also operates a clinic affiliated with Timmy Global Health, a non-government organization (NGO) that operates short-term medical service trips in the area. Then, I took the opportunity to grill my teacher about the Guatemalan healthcare system at every chance I had, while working on my subjunctive tenses.
The Cost of Healthcare in Guatemala
In the private clinics in Quetzaltenango, a consultation with a generalist or a specialist might cost 200-300 quetzals ($25-40US), although she points out that prices aren't exactly regulated. This isn't much, but it is beyond the means of many (most?) poor Guatemalans. Furthermore, very few Guatemalans have health insurance. When I ask how many, she throws out a ballpark estimate: "3 or 4 percent". The medical clinic staffed by volunteers obviously costs less - at Pop Wuj, it's 35 quetzals (about $4US). At others, it may even be free.
Lily estimates that in the public system, a doctor might be paid 12000 quetzals ($1500 US) per month, and that's if they're paid at all. In addition, there is a huge problem with unemployment among trained physicians in Guatemala. Many students continue to enroll, either at the national public medical school in Guatemala City, or one of the many private schools, since medicine is considered an honourable profession for students with mucho esperanza (great hope). Then, six years later (or more, depending on residency), they graduate somewhat disillusioned and with few options, and little money to open a clinic.
With so much unemployment among well-trained local physicians in Guatemala, it's a good question just how pressing a need there is for foreign clinician volunteers at all, even with their great enthusiasm and eternal optimism. And competition with NGOs challenges the ability of poorly paid private doctors to put food on their tables. Es una gran problema, Lily adds.
How do many Guatemalans approach healthcare?
I also wanted to know how the locals in Quetzaltenango viewed and sought out healthcare, and Lily provided me with an instructive anecdote: mal de ojo, apparently a common illness for indigenous Guatemalan babies. Mal de ojo (roughly translated as "evil eye"") is commonly claimed as the cause when an infant becomes ill, presumed to be caused by throngs of well-wishers fawning over the child, passing on their mala vibraciones (bad vibrations) and possibly even their fevers.
But since trained physicians do not believe in mal de ojo, the parents may first seek out a traditional shaman, who provides them with healing plants, teas, and other protections. If this doesn't work, the next stop is likely the local pharmacist. While it might be technically against the law to sell without a prescription, the practice is widespread – everything from acetaminophen to antibiotics is easily available, and far more economical than a physician consultation. And finally, when all else has failed, a Western trained physician is the last line of defense, at great cost.
There was more to ask Lily if it weren't for my flight back to Canada. Count all of the above as things I would have liked to know before volunteering - and knowledge that raised more questions than it answered. In universities (including my own) across North America, predeparture training for clinicians and medical trainees seems to be improving in leaps and bounds, but most often, volunteers still arrive in a host community with the expectation that they will work the following day. How much more cultural understanding would be facilitated by taking just a few unhurried days to learn about the local healthcare system?