On Monday,  Dr. Sanchez gave us two talks on Tropical Diseases in Guatemala & Antibiotic Resistance. I will spare you from having to see photos of spaghetti-like intestinal worms that have been pooped out and the various skin rashes and other gross things. I think that Dr. Sanchez's lecture really emphasized how much health, disease, language, culture (and economy) are really intertwined (the name of the class!). I thought it was especially interesting how tourism and emigration/immigration (especially problematic in Guatemala as a result of war and poverty and migrant workers) contributes to the spread of disease. All of these things have socioeconomic consequences. Plus, migrant workers have poor living conditions (unclean, crowded) which leads to the spread of even more communicable diseases.

He also said something interesting about Dengue fever, Chikungunya and the Zika virus. These are all very similar diseases and spread by a type of mosquito called Aedes aegypti. They have the same symptoms, but each one to differing severity. So doctors look at the symptoms and diagnose it based on whether there's more of a fever than joint pain, etc. THEN there's Zika, which is a fairly new disease (been around for 2 years). Again, there are very similar symptoms, but no definitive biomedical test. So it's only diagnosed when you have the right symptoms and the doctors have ruled out Chikunguya and Dengue!

Dr. Sanchez also scared us all away from ever ever EVER eating street food (though half the group didn't need convincing after getting an intestinal bacteria on the first day LOL) and washing our face and brushing our teeth with pure water. Some people were even nervous about taking a shower because what if a drop of contaminated water goes into our mouth and gives us horrible diarrhea haha. But after hearing what the sick people went through, I would be extra wary too.

Dr. Sanchez giving his lecture on Antibiotic Resistance

This was the last slide of his presentation. It says "Thank you for your attention" LOL What a funny guy

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On Tuesday, we had a tour of a local NGO called Primeros Pasos, which works to "improve the quality of life in rural communities [of the Palajunoj Valley] through integrated health education programs and access to medical services." I really loved how they focused so much on sustainability and empowering local residents (esp. by giving them opportunities to become more active in the NGO). While they do provide medical attention, which is an acute need, their main goal is more long-term: to improve health through education <-- sooooooooo important in global health but just in general of making the world a better place.

Anyways, from what I saw, I really liked what they do and how they think and would even considering volunteering there during my gap year. They actively fight against the #whitesaviorcomplex and cultivate cultural humility; it's not about voluntourism or altourism, but real volunteerism and altruism! AAAH idk I just really appreciated everything they had to say there.

The first thing you see when you get to the NGO

Map of the different communities in the Palajunoj Valley. I had to ask my Spanish teacher how to pronounce that...

The dentist's office within the compound

Examination Room

Lab

Cute murals everywhere!!

After lunch, we had a tour of Public General Hospital San Juan de Dios, the public hospital in Xela. This would be the 3rd tier in the health system (health posts --> health centers --> district hospital --> specialized referral hospitals). There was a HUGE difference between what we saw earlier in the morning at Primeros Pasos and here. And although this is considered one of the large hospitals in Guatemala, I thought it was fairly small and humble. I don't know if anyone else felt this way, but I thought it all looked a little run-down and dilapidated. I really got the sense of what Dr. Sanchez was saying about how the health system is in the worst state in his 35 years of working in the public sector. Maybe I was primed to think that way, but I was really surprised (? that's not the right word) at how much they were lacking. I had read about it in my research and heard about it from teachers, doctors, and the Somos Hermanos staff, but seeing it in person was very... different. Much more poignant.

But there was something else that really made this entire experience kind of awful. We were this large group of foreigners just gawking at people in the hospital (which is already an unpleasant experience for them). We were also a large group so I just felt like we were in the way. I tried my best to smile at people and acknowledge them. I felt really uncomfortable the whole time, but I'm glad we discussed it afterwards and kind of debriefed. I definitely wasn't the only person to feel that way, but I also feel like our visit and our outrage will spur us into action which will make it worth it. I also think there's a large cultural difference when it comes to privacy and we were more outraged because we're not used to that kind of lack of privacy. But anyways, I digress.

The main entrance to the hospital

I don't think this is that important, but I got a kick out of seeing it because in my Business French class, my professor put such a HUGE emphasis on organigrammes. I knew they existed, but I had never really seen anyone who uses organigrammes so I had to take a picture and send it to her :P

They have signs translated into two Mayan dialects that are widely used in this area. Unfortunately, because this is a district hospital, people who come from very far away don't necessarily speak these languages so they are at a disadvantage. At the same time, I don't know how plausible it is to have someone for each of the 22 languages at all times...

Obligatory group picture!

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On Wednesday we watched Estrellas de la Linea, which was about a group of prostitutes from Guatemala City (Guate) who decided to make a soccer team and compete in local tournaments. These prostitutes are all from "La Linea," which is apparently where people who are worth less than trash go. These women prostitute themselves without pimps, so they have some sense of liberty. There was a lot of public backlash, especially from the parents of the teams they played. The first field in which they played, they were kicked out due to the outcry and parents demanded that they change the turf in case there was any blood or sweat that was contaminated with AIDS. Despite the outrage, they also gained a significant amount of fame and international support. Guatemalatravels.net even sponsored their tour and other prostitute soccer teams started appearing worldwide.

In the beginning of the film, one of the women, Valeria, said that this soccer team was a way of getting attention because no one would care if a group of prostitutes marched on the Presidential Palace. But by making this team and getting press, they wanted to advocate for women's rights, especially for protection from gender-based violence and less police harassment of immigrant women. She exclaimed that before prostitutes, we are mothers and women first. Even though they didn't successfully revolutionize gender politics in Guatemala and they weren't respected as athletes and public opinion about prostitutes didn't change, I think it was worth it. They had those little moments of victory and self-confidence and helping each other and being able to visit Tikal and other parts of Guatemala which would have been out of the question otherwise.

It also made me think about why people choose this kind of life. For some people, as we talked about during the discussion, sex work can be empowering, a way of reclaiming sexuality for themselves. But sex work is also dangerous because of its inextricable link to human trafficking and the high incidence of femicide in Guatemala (Guatemala was actually one of the first countries to adopt this as a legal term, presumably because of its prevalence). And at least in this movie, a lot of these women seemed to have to other choice; they had a history of being sexually abused or assaulted; others were kicked out by their family; etc.

Finally, I found it very interesting how religious these women were. It was heartbreaking to hear them talk about how they know they are sinning and how God doesn't like what they're doing, but they have no choice. To know that they are so convicted in their beliefs yet they feel that they have to do this kind of work... I will never fully understand the inner turmoil that must cause. Despite the frustrations and apparent lack of success, I am so glad I watched this movie because it really humanized this group of people that are so often seen as dirty and less than.

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On Thursday Dr. Fredy came and spoke to us about Design and Function of the Guatemalan Health System and the Role of NGOs in Guatemala & Diabetes in Guatemala. His first lecture basically confirmed 75% of my group's research which was that health in Guatemala shouldn't be this bad, but it does as a direct result of such pervasive inequality and rampant corruption. In theory, the government provides healthcare because it's believed to be a universal right. However, in reality, 75% of the cost is out-of-pocket for patients and 18% of the population have no access at all. That translates to roughly 3 million people in Guatemala alone who have ZERO access to healthcare. We wouldn't know the exact number though because the government is so screwed up that the last census was taken in 2002....

His second lecture was also interesting because he started off by saying that, contrary to popular belief, diabetes is not just a disease of the rich. About 80% of diabetes mellitus incidences occurs in Low and Middle Income Countries (LMIC). In Guatemala, diabetes is, at least in part, caused/exacerbated by remittances from and cultural attitudes towards the USA. Family in Los Estados will send money and say "Hey treat the kids out to some McDonalds" and, because things from "America" are so highly valued, they see it as a good thing. Obviously this is only one example, but that's how remittances contribute to disease. The other problem with diabetes in LMIC is that people either don't know they have diabetes or, if they do know, treatment is either physically or financially inaccessible. As a result, 80% of diabetes-related deaths occur in LIC (that's a lot). In Guatemala, specifically, a big problem is that people who get treated for their diabetes think they can stop taking their medication when the symptoms disappear. This is a result of both lack of education and lack of money (if there are no symptoms, it's not an immediate problem so their limited financial resources can be used elsewhere). Are you guys seeing a theme here? Corruption, inequality, lack of education. That's basically what I've garnered from all the research I've done.

Dr. Fredy speaks with his eyebrows and his hands as much as he does with his mouth. He's very energetic!

At the end of Dr. Fredy's lecture, Dr. Quinn introduced us to Joe Herrold, one of the co-founders of Somos Hermanos. I talked to him for a while about my what my career path should look like given what I want to do, how the heck I'm going to pay for medical school, etc. He gave me a lot of advice and told me that I shouldn't listen to people who say I have to go into primary care or what have you if I want to work with low-income populations. He also assured me that whatever path I choose, as long as I'm passionate and hard-working, I can make it happen; so if I wanted, I can incorporate medicine, education, public policy, and social innovation into one career. He literally said do whatever the **** I want. LOL But yea. I really appreciated everything he told me and I'm a little bit less unsure about going to medical school now :P