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Notes from the Field


Saskia Bunge-Montes is a Celgene fellow at the Center for Global Health, and will be making regular working visits to the clinic. Saskia is from Guatemala originally, and is passionate about making change in how healthcare is delivered throughout the country. Through these posts, she shares in her work and experiences in Guatemala in her own words.  

August 2015 - Saskia Bunge-Montes, MD

This summer I had the opportunity to travel back to the Center of Human Development in El Trifinio, Guatemala. This rural region in southwest Guatemala is about 5 hours away from Guatemala City and has more than 20 communities that are mostly reached by dirt roads. There are no real maps of the area and the last population census was done in 2002, so we don’t really know how many people live in the area or basic demographic characteristics of groups we want to serve. So, to provide better services in our community outreach programs and clinic it was decided that maps and a census of the area were needed.

I was part of the group that organized this project and was tasked with the job of training surveyors and local project coordinator in Guatemala. This was an exciting opportunity since I had been looking forward to working more closely with community members since I first visited the site a year ago. One of the goals of the the project is to incorporate community members and have them participate in the mapping. We hired four young surveyors aged 19-24 who lived in different local communities. One of them is a single mom, the second is a lawyer-in-training, the third just finished school, and the fourth is a secretary-in-training. These four young surveyors were happy with the offer of temporary employment and were very eager to learn about using the GPS and Palm Pilots we were using for the project.

We also hired a project coordinator, a young local pastor who is also studying business administration on the weekends. I wanted someone with a sense of leadership, who was able to speak easily with community leaders and was eager to learn, so he was the perfect person for the job. As a pastor he was an excellent and natural communicator and helped create a good environment amongst team with the surveyors and community leaders. A pastor in this area holds a position of distinction and is a trusted and respected person; having someone like him at the forefront helped when approaching community leaders. This was especially helpful since we were starting the project in the middle of a very controversial and heated election season in Guatemala, and tensions were high in these communities. For two weeks we approached community leaders and told them of our project and assured them that they would be getting the resulting maps and census data for their communities too. This was very good news to many of them because there have been projects in the past were people have gathered data from their communities but failed to communicate any findings back to them. We had community leaders appoint community members as guides or participate themselves with the survey. A community leader or an appointed guide accompanied each of our four surveyors in the communities, presenting the surveyor at the household and assuring that leaders knew about and approved this project. We’ve been successfully surveying for over eight weeks now and the team of surveyors and coordinator are doing an excellent job. I’ve loved being part of this process and seeing how motivated local leaders are and excited to be included. Through my conversations with leaders I’ve learned that maps and census data can empower these communities much more than I initially thought they could. I look forward to going back and being able to relate our findings back to the people that really want and need them most.

May 2015 - Saskia Bunge-Montes, MD

I’ve had the opportunity to visit the Center for Human Development in Guatemala three times over the past year. Every time I come here, I’m in awe of the families that live and work in this area. This dry, hot, secluded land is scattered with people living with little to no access to water. I am constantly struck by what they do here with so little, out of necessity. Every time I’m at the site I have the opportunity to spend the week tagging along with the nurses to maternal-infant care groups, individual house visits, and sometimes see patients at the clinic, too. I have enriching interactions with a variety of people in the area including nurses, engineers, plantation workers, mothers, infants, and traditional birth attendants – to name a few. Over the course of my visits, each person I’ve encountered has provided me with more insight into the community and surrounding area.

From an outsider’s perspective, this area seems geographically and culturally diverse, and therefore lacking one community identity. It’s a community is defined in part by the businesses that surround it. Within the same small area there are a mix of socioeconomic levels, a mix of ethnicities (indígenas, ladinos and mestizos) and a mix of cultural influences that make it hard to generalize the community as a whole.

This area derives some identity from its close proximity to the Mexican border. Additionally, there are three different Guatemalan states (San Marcos, Quetzaltenango and Retalhuleu) that converge in this area – giving it its name “El Trifinio.” It is an isolated area that is still heavily influenced by the surrounding cities and the active commerce that bustles through. Perhaps surprisingly, even the most remote homes have a radio, TV, or cellphone, so although they may be isolated, they are by no means disconnected.

One situation in particular made me realize how diverse even small groups within the community can be. At a recent maternal-infant care group, one of our community nurses asked a group of women what they would do if their child had a fever. The variability in answers surprised me. In my experience working in rural communities in Guatemala, I have observed some communities with “western” influenced responses, and other communities that reflect more traditional practices in their responses. This group had both. In response to the question of fever, one mother mentioned she would rub the child with alcohol and remove his clothes, or take him to the curandera. Another mother said she had seen on the Internet (on her phone) the correct dose of acetaminophen to give her child. Yet another woman said she’d probably take her child to a clinic first. So, in this small group of six women we had a range of answers that revealed the diversity of perspectives that are found in this area.

Community identity and diversity play an important role in health seeking behavior and health education. Both factors impact our clinic and our community outreach projects. The more we know about the community the better we’ll be able to serve the families that reside within it. I look forward to future visits and to better understanding the dynamics that shape their lives.

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