Welcome to My Marathon Life
category: Emilys Guatemala

IMG_3399.jpg

The days go by and somehow I rarely find time to write here. I promised myself a long time ago that I would always write first in my journal where I could be most open, honest, critical, political, annoyed and overjoyed. So you always get at least the second telling, and sometimes it takes a lot of energy for me to do it, again. But also, the last few weeks have been really busy and really interesting, and so over-stimulating that I find myself hiding in books during any free time. Sometimes, actually a lot of times, I find myself standing at our one little window staring out over the growing corn and down into the valley thinking about all the things that have happened and wondering how I will tell them to you. More recently I’ve begun to fear that the stories aren’t really making sense to the audience, that somehow I’ve managed to wade deep enough into what’s happening here that I now suffer a cultural disconnect coming and going. But I’ll do my best to be honest anyway, and from there I just hope you’ll kind of get it. So here was last week:

Monday:

Mondays are generally planning/in-home work days but last week we had an evening community meeting regarding the Emergency Action Plan. The leaders are still trying to figure out the best way to fund this plan, and they like for us to be present at these meetings and to give little speeches as though to say, “Look, the gringos support it, so we should do this!” And we’re cool with that role. We are not, however, no matter how long we are in Guatemala, particularly cool with the way they draw these meetings out for hours on end. I’m currently re-reading the Lord of the Rings series; it’s been about a decade since the first time I read them, and I never watched the movies so I’d forgotten most of the story. But I have this habit of always comparing my life to what I’m reading, and I think I might have just found the perfect term for the meetings: Entmoot. You know, the tree creatures, whose language is unbelievably long so that their meetings going on for days. That’s about about what it feels like. In order to keep us from going crazy, we’ve recently decided to ro-sham-bo (rock, paper, scissors) to see which one of us has to attend the entmoot each time. That means one of us gets to stay home, fix dinner, prepare bath water, and do work or fun things while the other stands in for both of us at the meeting. We’re pretty happy with this system, and everyone here understands that we have to have someone “looking after the house” because, you know, there are ladrones about, and even the Guatemalans want to have dinner ready when they get home from these entmoots. Monday night I lost the ro-sho-bo, and went to the meeting.

A brief story about knitting and bubble gum.

I’ve gotten in the habit of taking my knitting with me, because not only does the meeting take forever, but there is generally an hour or more of sitting about waiting for the thing to start. Luckily, my knitting guru and I outrageously overcalculated the amount of yarn needed for me to knit Fletch’s lopi sweater, so I’ve got balls of warm, soft llama yarn to knit up. I knit myself some fingerless mittens (the light colored one shown below, dark for the Jaimster), and Fletch lost his favorite warm hat so I knit him a new one. Now he wants fingerless mitten as well. The ladies in town never tire of watching me knit, as though it’s some kind of magic. Much like Fletch whipping out his sketchbook and drawing whatever is in the room, it usually turns out to be a good conversation piece. So I sit down in the front of the salon and start knitting, waiting for the entmoot to start. A couple of pre-teen girls across the room make the shhhht noise and hand gesture that means, “Come here,” so I pick up my knitting and go sit with them.

IMG_3367.jpg

IMG_3369.jpgThey ask me about knitting, and we compare it to the much more common crochet they do here. The girls ask lots of questions like, “How do you read this pattern? What does this say right here?” as though the pattern would tell them something important. But it doesn’t, and it’s not that it’s in English, it’s that even an English speaker can’t read the pattern unless he or she knows all the super-secret knitter abbreviations. So then they move on, “How many brothers and sisters do you have?” Thing is, finally, here in Guatemala, 7 siblings is a very reasonable number, after I spent much of my life feeling like my family was absurdly huge. “What are their names? How do you say those names in Spanish? How do you say them in English?” They repeat each name as I say it, in Spanish, and then they try out the English pronunciation. And then they ask me where Jaime is, “He’s working at home and he has to fix dinner.” Very weird, a guy fixing dinner, but something even more curious, “What do you eat?” asked in a way that implies they hadn’t really realized we do eat at all until the very moment the question occurs to them. Tonight we are having veggie burgers, which is a tricky thing to explain. I just tell them beans, and vegetables, “ahh.” That was an acceptable answer. The rain started at the beginning of this interview, and now it’s so loud on the tin roof we’re nearly shouting. It starts hailing, and they teach me how to say hail in Q’anjob’al, saq bat, literally shouting over the din. They ask about weather where I live, and we talk about snow some. Then we have to go back and review this kid thing, which will always come up in every conversation no matter how long we live childless in this community… “Is it really true that you don’t have any kids?” Yes. Pretty weird to them. “How old are you?” So I tell them I’m 25, pretty much ancient for childbearing. I should have at least 5 kids by now, if not more. “How long have you been married?” (for almost 3 years) which then leads to, “So why don’t you have kids if you’ve been married that long?” The standard answer to this question is, “Kids are a lot of work! First I had to finish my studies and then I always wanted to work with Peace Corps. If I get pregnant now they send me home, so maybe we’ll have kids in a few years.” They spend some time calculating this answer, heads nodding as though silently saying, “hmmm, interesting…” but they’re still not sure they understand this answer; local logic does not agree with the words that have come out of my mouth. But in the midst of all the previous questions one of the girls has disappeared, and as I answer this last one thinking, “Reasons to wait 101, for pre-teen girls” she reappears. She shyly places a something in my hand, a big pink knock off of bubble-yum. And now I feel like I’ve passed the test and made it into their secret, gum-chomping girls’ club, or maybe posse would be the better word.

I really enjoy the gum. In the moment there is something humbling about the hospitality of this town, how it’s not just the adults who will always make sure we get something to eat and drink, but even these young girls who will spare 25 centavos between them to get me a piece of gum too. The gum is the kind that fills up your mouth and makes you salivate ridiculously. As a kid I really liked trying to eat all 5 pieces of bubblicious gum at once, and thinking about that, I absentmindedly begin to blow-bubbles, which sends a ripple of giggles through the crowd of older women, most of whom are also chomping gum, sitting around the room watching this interaction they can’t have with me because only their daughters know enough Spanish to put together this never-ending string of questions. A bubble exploded on my face, and remembering the sanitary condition of my hands, or rather lack of, I decide it best to not blow bubbles that require me to pull the gum off my face. But now the women in the crowd are blowing competing bubbles and smiling, and, well, that’s just funny, because they’re 40 and 50 and 60 year old indigenous ladies in traje blowing big pink bubbles. Sometimes I wish I had a spy camera attached to headband so I could take instant funny pictures. Alas, I do not.

Just then, one of the town leaders comes up to shake my hand and sit next to me. The meeting starts, and I’m the first one up to speak, just to let the people know this Emergency Action Plan is a great idea. I do my job to the satisfaction of the town leaders, chomping gum the whole way. I think that probably would’ve made my mother crazy, and it definitely goes against all rules of public speaking I was ever taught, but everyone does it here, so I fit right in. I accidentally chewed until my jaw ached, and I finally spit it out when I snuck out to go to the bathroom.

The End of Knitting and Bubble Gum.

The entmoot went on for hours. I knit as the rain and hail stopped, the sun came out, then the sun set, and men and women kept talking. Apparently the next morning the town was going to have a bit of excitement. According to the Health Committee President, a Swiss aid commission was going to visit town and there was the possibility that the town would get money or projects or equipment or maybe all of the above! There seemed to be a lot of speculation going on. No one knew why they were coming, or how many were coming. They only knew that about 8:30 or so there would be some outsiders visiting the people and they wanted to talk to 12 women, mothers of young children. The town was very suspicious of this singling people out, so they decided together it would be best if everyone came to the health center to see what these people were about and to make sure there wasn’t some miscommunication. They probably wanted to talk to the whole village, and just didn’t know it yet. This was all very funny to me. I had NO CLUE what was going on. I couldn’t get a straight answer from anyone. I wondered briefly why our local supervisor at the health center in town hadn’t bothered to call and tell us any of this, and then realized, he often doesn’t call when I think it would be a good idea, oh well. So I decided to call him and try and get some information. But he didn’t answer. Thus, I remained just as clueless as everyone else. And since the town thought there was a possibility of getting things from these foreigners, someone proposed that there should be a meal prepared for the visitors, as a symbol of appreciation from the people. That led to a great debate amongst the women and the men regarding what food would be fixed. Obviously it would be a variation of chicken soup, but would it be criollo or granja chicken, local or industrial chicken? Should they just buy the food already prepared from the nearest little restaurant about 20 minutes from the village? Which way would be easier, less expensive, a more poignant symbol of the towns appreciation, the better quality meal? So many questions and opinions.

It was dark and cold, and I was hours beyond ready to be home, as most the folks filed out of the hall, but I was stuck with the women still trying to decide whether the chicken should be a local grain fed bird or of the industrial sort, and who had time to get the chicken? I put forth a crazy proposition: that the guys who were on patrol that evening (since all they do is walk around anyway) go pick up the chicken and keep it at one of their houses till the morning when the women would prepare it. “The men will be out anyway, so it makes sense for them to go get it. Then the women won’t have to get up even earlier tomorrow morning since they’ve all got to fix breakfast before they can start making the chicken soup.” The women were puzzled, maybe a little amused by this suggestion. To this Manuel asked, somewhat jokingly, somewhat not, “Emily, why are you always defending the women?” To which I replied, “I’m not defending anyone. We’re talking about collaborating to make a meal. The women are doing all the cooking, and the guys are going to be out anyway. It just seems to me a good way to collaborate, ya know, work together.” He kind of shook his head and went on to other things. I wasn’t sure what was decided in the end, but I figured I’d better get up early because it wouldn’t surprise me if someone came by and wanted me to go with them to pick up a chicken. End of entmoot, finally I got to go home.

Tuesday:

Thankfully, I got up early and no one came to get me for chicken buying. I guess they figured it out on their own. They’d said the visitors would arrive around 8:30, but usually there are lots of announcements over the loud speakers accompanied by siren noises. This morning was no different. The announcements are a sign that everyone is up and going. We still don’t usually understand most of what goes out over the community. I keep thinking if someone here had a sense of humor they would announce directly to our house, “Emily and Jaime come on over, the meetings are starting!” So far, no one has done that. Instead someone whose voice I didn’t recognize, called us asking if we were up and awake and if we could please come to the health center because the European Commision was going to arrive in 20 minutes. Of course we were up and awake and dressed and ready, so we went.

We could see the fancy four by four truck winding up the road toward us. When it stopped, the first person to step out of the vehicle was our supervisor from in town, who we’d been told was not coming. Then two ladina (non-Mayan Guatemalans) ladies stepped out of the truck. This was no Swiss Commision at all. They came into the health center where numerous people from our village had assembled and jumped a mile high with fright when all the fireworks were lit off outside in honor of their arrival. Since this has all happened to us here before, it was really funny to watch someone else who also didn’t have a clue go through the whole routine. The unpleasant looks on their face almost made me laugh, but I had to stifle it so as not to interrupt the welcome speeches.

The women announced that they worked for the Organizacion Panamericana de la Salud, or the OPS, which is a Latin affiliate of the World Health Organization. I kept wondering, where on earth did they get the idea this was a Swiss/European Commission that was coming to give them money and/or gifts? In general, the WHO doesn’t do crazy gift giving, so I didn’t figure the OPS did either. I was right. There were two women. One asked to speak with a group of 12 mothers of young children, the other woman wanted to speak with the newly formed Emergency Action Plan Committee (this wasn’t even planned–I’m so proud of our little community for putting the EAP together just in the knick of time to have it evaluated, totally coincidental). One very soft spoken town leader stood up and asked, “Are you sure you just want to speak to 12 women? We do things together in this community and for that reason all of us have come here this morning to talk to you, as our guests. Are you sure you don’t want to talk to the whole community?” The woman then explained to the best of her ability what a focus group was (for statistition/survey purposes) and that indeed she could only speak to 12 women, though she was impressed that so much of the community came out to meet her and her partner. The town decided that those who were not in the focus groups would sit in the health center and wait for a report of what happened when the groups finished their interviews. Fletch and I decided I would go with the women and he’d go with the EAP committee to see what was this was all about.

IMG_3344.jpgFar from coming to see the community and shower them with gifts, these two committees were formed as focus groups that the OPS interviewed as a way to evaluate health services and health education in the community. There were neither gifts nor money offered to the community. In the women’s group the OPS rep encouraged all the women to talk and participate (as I thought, good luck with that Ma’am; participating isn’t really their thing here). She set up her tapes to record the entire interview and began asking them questions. I did not say a word for the hour and half we were in our little interview room. Well, I did say some words, but only to our supervisor, who was there to translate. These ladies seemed to be in a big hurry, and I was certain no one thought to tell them in advance that a meal was being prepared in their honor. I decided Aurelio needed to be aware of this so he didn’t end the interviews and usher them out and miss the food. When I told him, he looked surprised, and worrried. “I’ll go tell the ladies to hurry! We have to get to another community two hours away after we finish here. Hijole!” This last expression means, “crap!” He ran away and then came back to start translating. These are some questions she asked:

What are the most common illnesses here in you community? She had to ask this question about five different times, rephrasing and re-rephrasing it because the women wanted to talk about pregnancy complications, which is a health issue but not classified as an illness. The answer this woman was looking for was acute respiratory infections and diarrhea. What I found amusing in a way that was comforting, like I’m not the only one frustrated by this, was at one point during this very first of a series of questions she looked at our supervisor who’d come in to act as translator and said, very flustered, “They’re not answering the question?!” All I could think was, “Welcome to my every day life.” Thankfully, for everyone’s sake, they caught on to answering the questions appropriately.

What have the health staff done for the community so your children don’t continue to suffer illness? What institutions other than the Ministry of Health work in your Community? What is their job? What changes have you seen since they began? What was the health situation like in your community years ago?

I was really proud of the ladies here because they jumped right in, excitedly talking about us. “Emily and Jaime work here… They teach us about keeping our houses cleaner, about personal hygiene, hand washing, about better nutrition. They work for…Peace Corps?..Yes, Peace Corps, and they’ve been here almost one year, but they’ll be here for 2 years before they go home… They came here to give us health talks to teach us how to improve our lives… Now we feed our children better because we know we shouldn’t give them just any kind of food you can buy on the street…(at this point, I was thinking, Go, Ladies, GO!)… The difference in the health situation now is that we get the charlas, but some people still don’t change their habits so the illnesses continue, and sometimes mothers don’t come to the health center for advice; children are born malnourished and they keep getting sick because of this malnourishment.”

So the conclusion we’ve reached is that illneses continue because people don’t use the health services or follow the health talk advice, is that right? This was my favorite question ever! All the ladies nodded their heads saying, “Kay tu, kay tu“, which means “That’s it. Yes.”

The woman also asked a series of questions about abuse. I was really interested in hearing what the ladies had to say based on my last post on that very subject. Are there cases of abuse? Does abuse happen here, and if so is there support for the health staff? Is it because of alcohol? Because of drugs? What do you do when women suffer abuse here? What do you do to help that woman?

And the ladies responded, “We’ve heard rumor of cases of abuse.” They all sat, solemnly nodding their heads as the OPS rep asked again But does it happen here? “Yes, it happens here…Alcohol causes abuse, especially to pregnant women, we’ve heard…The nurses help us. They say that we can bring our husbands in for a talk…But they can’t really offer us any kind of support…If we see abuse here, we just try to get the children away from it…If a woman suffers, we can’t really help her, well, we just say we’re sorry…Yes, we tell her we’re sorry she has to suffer this.”

There were more questions, about whether they’d been taught about Sexually Transmitted Diseases, specificaly HIV/AIDS. We haven’t gotten there yet, but we’re on our way. We’re doing STDs and HIV/AIDS after we’ve gotten through family planning: why it might be a good idea; how the reproductive system works to make a baby; what methods are free and available; how those methods work in the reproductive system. And the interview ended asking detailed questions about the health centers hours of operation here and in town: what they do when their kids get sick outside of these hours; about the Emergency Action Plan and how it works; about whether or not they recieve support from the Municipality. One women responded to this last question saying, “I don’t think they know about our health needs, but I think they’d help us if they knew.” Another women, a little older, a little less starry eyed, said, “They make us all kinds of promises during their election campaigns, but they’ve never fulfilled even one of their promises.”

In this meeting I found that for a family to pay for transport to Huehuetenango, to the closest fully equipped hospital, the cost is 700 Quetazales one way, and 2000 Quetzales if the family wants the transport to wait and take them home. This is astronomical for families who make 30Q/day about 3 or 4 days a week, and have to feed their families to boot. Most transports demand up-front payment. This is the main job of the Emergency Action Plan, to have funds ready and available for an emergency. Our municipality has been waiting on the new ambulance to arrive for over a month now. The ambulance would be free to all, but when it arrives, there will be one ambulance for approx. 47,000 people. The trip to Huehue takes about 3 hours from town center to town center. I guess in those six hours we just hope no one else needs emergency transport?

The set-up, funding, organization, and management of the Ministry of Health is really a marvel to me. It is so astoundingly far behind even the most mediocre services offered in the U.S. But I can say with utmost confidence that they’re working on it. We’ve been so fortunate to meet and work with very dedicated, conscientious healthcare providers who constantly do the best with what little they’ve got. It seems that most stall-outs and delays happen due to funding coming from a national level. This is the acute challenge, I imagine, for most third world countries. How do you make what little money you’ve got stretch to all corners of need? This is a challenge for the United States as well (more and more these days), but we’ve got so much more to work with that the problem is largely masked by the infrastructure available to us. When I take the time to sit back and think about these things I’m generally dumbstruck. It is at once overwhelming and one is tempted to ask, “How will they ever overcome this problem?” But I just mentioned the health workers. This is where overwhelming problems need to be broken down to manageable parts. The individual health workers hold this system up, and where the workers are less dedicated and conscientious that’s where the system truly fails. So, in a way, this dilemma really highlights the power of the individual.

Between the interview and lunch, our health committee president came to ask some advice of myself and Jaime. He gathered us around with a few other town leaders and an old woman who’d been sitting in the health center. Then he explained that this woman’s daughter had been hit in the face by the old woman’s grandson and her face was very swollen. Manuel wanted to know if we should transport her to town for a doctor exam. We said we thought that would be a good idea since facial swelling, especially around the eye, can cause blindness if it’s bad enough and not treated. He seemed happy with this response and translated it to the grandma. She looked and him and said, “I already took her to town. They say she’ll be fine.” Manuel looked surprised, “Oh, then we’re done here, ok.” I said, “Wait, wait, wait. Who is the guy that hit her? Is it the woman’s son or her nephew, and why did he hit her?” Manuel looked at me, annoyed with the hold-up, “We don’t know; that doesn’t really matter.” I was not going to let this drop, “If you’re consulting us for health advice, and we’re here to practice PREVENTIVE health, then we need to address this. We need to find out who this guy is. If they leaders want to do something to help this situation, two or three will go talk to this guy and tell him that hitting people just because he feels like it is not acceptable in this community. It’s a matter of health and safety for everyone if we let this continue.” Kuddos to Jaime he totally backed me up on this one in front of Manuel after the big M responded, “We can’t do that. He wouldn’t listen to us anyway.” Jaime told him he thought my suggestion was probably a good idea, or they’d just have to figure out how to transport someone else later for the same problem. “Well, we can’t do that. She’s seen the doctor. We’re done here,” and Manuel literally clapped his hands together and walked away. I didn’t think my suggestion was so unreasonable seeing as how this town has its own citizen patrol and would punish anyone they decided deserved it through vigilante justice. Why, then, is it not acceptable to establish rules against physical abuse in our community? Sometimes I wonder if, when we’re done here and we go home, the guys here will be sort of glad we came, but also a little regretful they ever asked me questions and had to listen to my responses.

We had the opportunity to share a meal with the OPS reps. and talk with them a while. They were really happy about our program and what we’re trying to do. It’s nice to get outside encouragment, but I enjoyed their visit immensely because it finally added legitimacy to something I’ve been trying to get across to these women since I arrived. I always tell them, “You’re thoughts and opinions, your questions and ideas are important! We need to share these out loud in a group. If we work together then we can begin to solve some of our problems and in that way we can enjoy happier, healthier lives.” An international aid organization came, and they wanted to talk to the women, not the whole town, not the town leaders, who are men. They spoke to the women. It was great. After our delicious meal of chicken soup (they went all out for the local, grain fed chicken) and tortillas. We went home to rest for an hour before we had to come back for the women’s charla.

IMG_5868.jpgThat afternoon’s talk was “How Pregnancy Happens”. It was one of the best talks we’ve EVER done here. Fletch had drawn two posters of the female reproductive system, one inside of a body for scale, and a separate close-up diagram. The whole point of the talk was to explain to them what their reproductive system looked like and how it functioned. This is stuff I started learning in fourth grade at 9 years old. Most of the women in the room, some mothers of ten and twelve kids, up to this point didn’t know anything they couldn’t see with their own eyes. So they knew menstruation blood, and pregnancy, and some know what births look like. We did a review on why family planning might be a good idea for young, middle age, and older women. Fletch and I talked about our own decisions regarding family planning and why we don’t have kids yet. Then I told them if they want to begin to try planning their families they needed to know how they get pregnant in the first place. I walked them through the journey of the egg from the ovary through the next menstruation, talking about how blood builds up, like a lot of pillows on a comfy bed, to make a safe place for a child to grow. Then if the egg doesn’t meet up with the man’s seed (literal translation from Spanish), we have a period. I showed them where the baby grows, in the womb, and where their vagina is, and how the man’s penis does not reach into the womb. Their eyes were HUGE. I had everyone’s attention, in a way that pretty much never happens here. I explained a non-pregant cycle, then I went back and explained a pregnancy. When I finished I asked them if they understood it, or if they wanted to see it again. One fiery, little lady (mother of 12) who cracks us up on a regular basis making light of the charlas said in the most serious of tones, “Explain it again, because this is interesting, and it’s not a sin to talk about this.” Go, Matál! So I explained the whole cycle again, without the pregnancy, and then with the pregnancy. I watched their eyes light with comprehension. This was the first time they’d ever seen a thing like this, and suddenly a whole knew world of understanding openend up. I was so excited for them.

I asked them if they had any questions. One woman said, “It’s just that we’re a little embarrassed to talk about this.” I told them that was just fine and normal, but if they had enough confidence to ask their questions in a group rather than one by one later, everyone would end up learning more. We then said, “If you want, if it would make your more comfortable, Jaime can leave and we can ask questions just amongst women.” I loved their response to this! They all agreed, “No, no, no, we like Jaime. He’s good. And it’s cold outside, so he should stay here with us.” :) With that the barage of questions began. How is it then, if only one egg comes out, that sometimes women have twins? Why do some women lose their babies before the baby is fully grown and ready to come out? Why is that the woman only releases one egg and the man releases many? What’s fun to me, maybe for the novelty, is that teaching reproduction to a group of Mayans who basically worship corn means that you can draw reproduction analogies for almost everything from how they plant and cultivate corn. To this last question I said, “If the mother earth is one part of growing corn, we’ll say the woman’s part in making a baby, how many corn seeds to you put in one mound? Just one?” To this they said, “Six or seven seeds.” Exactly, if you put more than one seed in a mound then it’s more likely you’ll get one healthy corn stalk growing out of that mound.” Likewise Family Planning analogies also come from the milpa, or corn plot. “When you grow corn, do you put the mounds very tight and close together, or do you space the mounds out?” They space them out, because if they were tight together the corn stalks would not grow healthy corn, and the earth would be sapped of energy to produce corn. That’s how it works with women and baby-making too! The women really seem to understand these analogies. They stayed in the health center asking questions, for once ignoring their whining, restless kids (the kids were whining and restless with good reason; we’d been there FOREVER, entmoot-style) to ask more questions and get more answers. I answered them until they were all out of inquiries. The talk lasted for some 3 hours, and it was designed as one of the shortest talks we’d ever given. Fletch left early to start preparing dinner while I stayed on.

When I finally came home I was bone-tired. My back hurt for standing so long, my throat hurt from talking so much. It was a satifying day, all in all, but so exhausting. For the last few weeks, after every charla, once the general questions are done, women have begun to usher me into private corners of the health center and ask their personal questions about family planning, so I’ve kind of become a birth control counselor. I really like that. I think it’s immensely rewarding. One of the trickiest things about family planning is that its such an individual decision. Some women have terrible physical problems due to the birth control they use, which scares other women out of trying it at all. Some women don’t have any problems at all and are terrified it’s secretly tearing apart their insides. They want to be comforted, and validated. And in a society like this one, where everyone strives, at least outwardly, for a great deal of equality, encouraging individual-based decision making is a really new concept. But if this, or any, community is going to have success with family planning they need to know their options, and know that it’s ok to use something other than what their neighbor/sister/best-friend is using. Personally the job is challenging because the most popular form of birth control in use here is the shot, depo-provera which women get every 3 months. I, personally, think it’s one of the harshest, most damaging forms of birth control available world-wide, for short and long-term effects on women. But I feel it would be irresponsible to go into reasons why in front of these women, because for many of them it’s the perfect answer. Often they can’t choose what kind of family planning to use as a mutual decision with their spouse. The shot is something completely hidden and incredibly low maintenance with a staggeringly low fail-rate. For lots of them it’s a good choice. Should I bother to tell them about bone density depletion, lack of libido, severe weight fluctuations, and depression that are common side-effects to this method? In other words, should I scare them out of using the injection so they have as many pregnancies as possible, try to raise 10 or 12 kids in abject poverty and die early from illnesses complicated with malnutrition? I think that is unwise. I tell them that some women have bad side-effects from “medicinal” birth controls, and for that reason they need to come to the health center and talk to the nurses about the side effects and what can be done to minimize them or change methods. But that’s all I say. In the states if someone asked me about the shot, I would likely go on a rampage about how I think it should NEVER be used by an independant woman who has so many choices at hand. So in my exhaustion, I was thinking through all of this stuff, and then gave up. I read for a little while about the adventures of hobbits and went to bed because the next day we had two health talks scheduled.

Wednesday:

We’ve been discussing for quite some time the idea of starting the health talks in the school. I’d planned them for the week before this and then had to cancel them to go judge another school-sponsored beauty contest at the big Catholic school in town. The school was celebrating it’s 45th anniversary. It was the first major educational center in the municipality, started by North American priests and nuns. In short, the beauty contest was a bigger deal than teaching kids about health on that particular day, according to our supervisor who was also judging…soo we rescheduled our talk for Wednesday morning. The intro talk we do is, ideally, really fun and interactive. We were looking forward to working with kids because they’re usually tons of fun. Also, we fancy ourselves as being really good with kids, so this was going to be an easy, fun and fast little venture.

HAH! The joke was on us. We went in happy, with lots of energy, and we fell flat on our faces. The warm-up game went alright for first times. Then we did the little skit with participating volunteers. No one laughed. No one seemed to have any reaction at all really. Just a room full of 50 blank stares. But the worst part was yet to come: the review questions. Not a single student would (if they could?) answer one question. We joked, we laughed, we gently teased, we prodded for responses, and there was NOTHING BUT DEAD SILENCE. I broke out into nervous sweats, and Fletch stood back and let me try and keep going as two of us working to get answers from them felt like we were being overbearing. I thought, “Hey, I’ll ask the teacher a simple question to show the kids how it’s done.” The teacher, who participated in the little skit, could not answer a simple review question correctly. The question was something like, “Teacher, since you were a worker like all the other workers, and you earned 30 quetzales a day, why did you have so little money at the end of the week?” The teacher’s character got really bad diarrhea and couldn’t go to work and had to spend money on medicine. The teacher acted that out in the skit, but the teacher couldn’t answer the question?! We made more jokes, tried to cover up our disappointment, attempted to approach the questions differently, passed around a lime and the person who had it was supposed to share his thoughts on the skit. Something as simple as, “It was funny,” or “It was dumb,” would have sufficed. NOTHING WORKED. NO ONE SAID A WORD. NOT ONE SINGLE WORD! I wanted to burrow into the ground and never come out again. We ended up asking the questions and answering for them. Then we gave our closing remarks and left. I felt like I had been pummelled. I can’t adequately describe the my feelings of defeat. And this was something I thought I was good at? I was sweating and shaking and I wanted to lock myself in our house for the rest of the day. It was about noon. We were supposed to come back to the school for another talk the next day at 11.

We had another talk scheduled that day in the neighboring community at 3pm. I tried to read and distract myself entirely until we had to prepare things to go. The charla there was another, ideally, simple and fun talk. It was a scavenger hunt charla where the audience ends up presenting health pros and cons for each item they have to find. It’s a review talk since, at this point, we’d done some 4 months of health talks with them on a wide range of topics. Also, this group has proven itself to be really fun, and participatory, so there was no reason this talk should make me miserable. We started gathering up the materials we needed, and putting on our hiking boots to go. Here I was in the very middle of the week, and I will be completely honest here and you can judge me as you will: I broke down. I literally started bawling uncontrollably. I didn’t want to leave the house. I didn’t want to face another crowd. I felt exhausted and awful at my job and like I just couldn’t stand another two hour session of trying to teach wondering the whole time if they really “got it” or not.

Luckily, we work pretty well as a team. It usually happens that when one of us is really, truely upset about a thing, the other person remains calm and supportive. I was curled up on the bed crying, and Fletch was very matter of fact. “Just stay here and do what you need to do, or don’t do anything. I’ll go give the talk. Just call them and make sure they’re all going to show up before I walk over there, and I’ll go do it on my own, ok?” I stopped crying long enough to make the call, and Fletch set off to give the talk. I felt miserable, thinking about kids who couldn’t answer simple questions, and boys who hit their mothers and aunts and wives, and how this job feels so freaking impossible sometimes. We were scheduled to go to dinner at the house of one of the community leaders that night, at 6, so I knew I had a few hours of sanctuary before I really did have to leave the house again. I fixed a cup of coffee, wrote feverishly in my journal for a few hours, crying off and on. I began to plan a route of escape, a reason to leave town. Sometimes I feel like being here is like holding your breath underwater, and I have to come up for air eventually, i.e. get the hell out of Dodge, or Temux as it were. We were out of money, and pay day was the end of the week, and I thought I could just go all the way to Huehue, instead of the just two hours to the “local” bank. In Huehue I could meet up with some volunteer friends for the best chocolate cake in Guatemala right off the central park, and that might cheer me up some. I let this plan simmer in the back of my mind, quietly debating whether I should come up for air or just try and stick this one out, as my hours of sanctuary came to a close.

Fletch came home from the talk to report that it was indeed a load of fun. I was glad it went well, and though I regretted not having gone, I was mostly relieved that I stayed home. We had to get to Don Simon’s house pronto, as we were already about 20 minutes late–pretty much no big deal to them, though they did tease us about being a little late.

Don Simon, or Cham Ximon as he’s called around here, is definitely one of our favorite town leaders. He so quiet and reserved, but when he speaks, no one in town says a word. They listen. His house is one of the best equipped houses in town, though it’s only one story *gasp* rather than two or three stories high. He welcomed us into his kitchen saying, “My wife and I have talked about having you two over for dinner since you arrived, and we could never decide when to do it. But now that Luis is visiting from the US and you said you wanted to meet him, I think it’s a good time to finally invite you to our home.” I don’t know if you know what I’m talking about when I say this man has sparkly eyes. He has the most tranquil looking face of anyone I’ve met here, yet his eyes glitter as if to indicate some constant, quiet activity, thorough consideration of the matters at hand. At the same time, it seems like no matter the outcome, he’s already at peace with everything that will be decided. We really like being around Ximon. As per our customs, we brought them something as a gift to the hosts, a pan of banana bread that almost didn’t make it to their house. Apparently if one walks the main road with food in hand, they’re trying to sell it. We had a lot of people ask us what we were selling, pretty eager to buy. I guess we know what to do if we need some extra quetzales in the future (just joking…that’s totally against PC regulations :) .

Simon and Anna married when he was 20 and she was 16; together they have 8 children. Neither of them have ever attended a day of school in their life, and while Simon speaks a little bit of Spanish, Anna speaks none at all. They raised their children on the little bit of money they were able to make working on the coffee fincas during harvest, and farming here in the mountains for the other 9 months of the year. Simon said that the coffee finca is where he got his education. The supervisors and bosses liked his work ethic so he got a position as a lower-level supervisor and through that position over the years he learned all the Spanish he knows. He made sure to tell us, “I understand what I hear, just about everything I hear, only I can’t speak it very well. I can only speak a little…For us here, life is hard. There’s a lot of suffering. Anna and I talked and we wanted our children to study because we never studied.” The two share a very deep belief that people must be invested in the betterment of all, within their families and within their communites, and they have spent their married lives working to instill this idea in all their children.

Their son, Luis, would get the prize for World’s Best Immigrant, if such a prize existed. I would nominate him personally. His story is so ideal. Luis lives and works just outside of Portland, Oregon; he works there legally now. He’s had his papers for several years and is waiting for official citizenship in the US before he comes back to Guatemala for good (and yet will always have the option to go back if things go bad again). Luis went to the United States in 1988, when he was 16. Then times were bad, but the worst years of the conflict had passed. He left with a group of Cuotanecos from across the valley, and learned how to speak Chuj so he had someone to talk to in the US. He says he’s worked all 21 years in and around Portland, which is unusual. Most men seem to migrate all over the country following work leads for 5 or 6 year stretches. He arrived in the US and started working. I asked him if he has a home outside the city and he looked at me and said, very matter of fact, “I board with a Mexican family there. I don’t have a home. I send all my money back here. This is my home.” Luis sent so much money back that he was able to send all of his 7 siblings to school. There are two secretaries in the bunch, two school teachers, a doctor, a nurse, and a health technician. The money he sent home also built the comfortable house the family currently lives in. Luis has no degree or official title to go with all his work, but all his siblings do. “Do you think going to the US was kind of like going to school for you, though? Have you learned a lot there?” He agreed that sounded accurate. He’s had quite a few experiences most people in his family can’t even imagine. He’s suffered loneliness and homsickness that trumps us any day. Just like his dad said, “We suffer here. Life is hard.” But Luis was determined that his family have something, and he’s very content with the fact that their accomplishments are his too. “My brother is a doctor. He had to fight for that. I don’t know if you know, but there is a lot of racism here. We’re Mayan, and we have to fight for what we have.” Luis’ demeanor is so similar to Don Simon’s, when they say “fight” it sounds pacifist in nature. They are such gracious but proud people.

After all his siblings finished school and the house was built, with the money he was earning he bought and stocked a rather large store in the center of the main town 40 minutes from here. The store is located right on the square where all public transport picks up passengers, so it sees plenty of business. Luis doesn’t want to stay in the US. He’s never bought a house or a car. He doesn’t have an American wife or girlfriend. He married a girl from here and has a 7 year old son and 1 month old daughter (his last visit was about 10 months ago, go figure). ” There’s no work there now, so I came home to visit. The food tastes better here, and things are less expensive…I’m not going to be in the US much longer, but I’ll stay until I get my citizenship, so I know I can go back if I ever need. Then I’ll move back here. It should take another 2 or 3 years. I want to live in Guatemala. This is my home.”

I think there are so many disastrous immigrant stories, it’s nice to hear of one that was so successful. He managed to improve the quality of life for every single member of his family. And he’s not abandoning them to live a life of comparative luxury in the states; he’s determined to come home. This family in general is pretty cool. In spite of everything they have, Simon and Anna are still involved in all the community events, trying to improve things for everyone else still, because that’s just the way they believe they should live. Simon added at the end of the evening, “I think you two must have good parents too, if they taught you to help people, and here you are with us. We thank you very much for coming here to share in our poverty, to learn about our culture and our lives.” By this time it was almost 9 o’clock. Anna was falling asleep in her chair by the fire. We made some small talk, said our good-byes, then walked back down the road in the dark, quiet of little Temux Grande. It was a happier ending to a difficult, tiring day.

Thursday:

Here I will admit, we were supposed to go back to the school. We busied ourselves with small tasks all morning to not think about it. The thing is, I set these talks up with the director, and he was myseteriously absent the day before. The Asst. Director didn’t seem to understand what was going on in the first place, which made me think, maybe we should just wait until the director is back and I’ll talk to him? Really, I was trying to find every excuse in the world not to go back as I cleaned the house after days of neglect. Then, as happens so frequently, someone unexpectedly stopped by just as we were supposed to be leaving. I took it as a sign. So I admit, I’m no Super-Volunteer. I ditched the school, feeling I had adequete culturally appropriate excuses for not showing up and asking their pardon and starting on a day I was better prepared for the difficulty of the job that is working with kids here. Even after the ridiculously pleasant dinner with Anna, Simon and family, I was experiencing some drowning sensations and considering my plans for escape. Should I stay or should I go?

Then we had a second un-expected visitor (some days they come one after another, like there is a hidden line somewhere, and as one visitor exits the house another visitor comes slowly, smiling up the path to our house). Don Marcos came to announce, much to our surprise, that all his materials were in order, the last bit of sand he was waiting for had arrived, and he was ready to start building his latrine. When could we start? “Tomorrow, of course!” answered Jaime.

At this point I decided I should go to the “local” bank the following day, and be around for the weekend of construction. I wanted to know how the whole thing goes together so I’m clued in when we build our own composting latrine. I just had to hold my breath a little longer and be ok with that. It helped that the week was calming down on it’s own.

Friday:

Running errands here means an entire day of running around, waiting on buses, lugging the food and goods we purchase. You’ve gotta be friendly to everyone you meet, make lots of small talk, suck it up if the micro-bus driver cheats you out of 5 or 10Q for hauling lots of things. I had a relaxing morning and tried to enter my Zen state before leaving the house. Things went relatively smoothly. The sun was shining bright all day. The bus rides were hot. But I got our dinero and food and even found a few rare items like bacon and mozarrella cheese for Friday night pizza and Saturday morning breakfast. yum. I went alone to save some money and so Fletch could work with Don Marcos to lay the concrete for the base of the latrine. By 3 pm we were both home and worn out. Though he told me working with Don Marcos was one of the most tranquila experiences he’s ever had working in Guatemala. “It was amazing. We had all the supplies we needed. When he didn’t have a tool, he took two minutes to run and borrow one from the neighbor. We had all sorts of interesting conversations, but we just worked steady all day. It was great. I think you’ll like it if you come tomorrow.”

Saturday:

And so I found myself, shortly after our tasty, greaseball breakfast of bacon and fried potatos, walking down the road to Don Marcos’ house. We were going to lay the concrete blocks that make the composter boxes. Fletch had informed me this would be a half day job. I’m sure if it had been Fletch and I working alone, it would have been. But it turned out well enough.

I didn’t realize this until we were working but Don Marcos, in his very even-keel manner, was totally stoked to be laying these blocks, “I’ve never had the chance to do this before. No one ever showed me. This is pretty easy,” he said, but you could sense he was excited and pleased. And Fletch was right, the guy is a completely stress free steady working kind of guy. The guys squared off and layed the first layer of block, at which point I had to tell Fletch he needed to make room for me to work also, or I had to go home so I wasn’t bored out of my mind. He let me in to work, and just as things started flying Don Marcos said, “Ok, let’s take a break, we need some atol.” Atol is Mayan energy drink. [I like to think of it as a "corn smoothie". Yuk. -fletch] They drink it mid-morning and mid-afternoon. It can be made of any number of things, rice with sugar and cinamon, toasted and ground wheat with or without sugar–with cocoa powder if one wants to get really fancy–, but most commonly it’s made of corn, sometimes sweet, sometimes not, sometimes with fermented corn. For the record, I hate the fermented corn atol, I enjoy the rice with sugar and cinnamon, and I’ve only heard rumor of the wheat cocoa atol, never had the chance to try it. Fletch and I gave each other a pleading look that said, “But we just got started!” before we made peace with the fact that, we’re working on Guatemala time, baby. So we washed our hands and followed Don Marcos into a shady little room with a table and three chairs. His wife and daughter served us all our atol and a little muffin, and then we sat talking for an hour before going back to work.

IMG_3350.jpg IMG_3351.jpg FanjoyPCV.jpg

Talking with Don Marcos is great, because he likes to talk about absolutely everything that comes to mind, and examine it thoroughly. So while it might have been nice to do a half-day of hard work and then go home, that’s not the way it went down. We had a long atol break full of interesting conversation. Then we worked for another two hours, in such a good groove that we had one more layer of bricks to lay when he announced, “Let’s take a break. It’s time for lunch.” So we washed up again, and went to the same room with a table and three chairs to enjoy an hour long lunch and more lively conversation. We finished up the last layer of block, cleaned up the work area and headed home about 3pm. It was a good day. The weather was perfect for working, cool, but not cold; sunny, but not too hot. There was a tree shading the side I worked on all morning. I was glad I’d stayed around for the weekend after all. But I was once again worn out.

Sunday:

We decided to make it, as God decreed, a day of rest. Sort of. We washed clothes in the morning because there was so much dirty clothing it was spilling out of the bag and all over the floor. We were out of bread, so I made some more. Even days of rest come with a fair amount of work here. But I did some knitting, and reading and catching up on news and coffee drinking, and we went for a run in the afternoon.

The weeks here disappear. I’m always so shocked when we wake up to Friday again. I’ve been absolutely exhausted the last few weeks. This was just a sample of our work. The week before was filled with beauty contests, parties for the health center, the regularly scheduled health talks, drop-in visits. This week was charlas, tons of drop-ins, a birthday party, co-op meeting for the morrales. I wake up tired and go to bed tired, and I sleep like I’m dead inbetween. Lately I started taking vitamin C pills because everyone around is coming down with colds and I’m afraid I have no defenses left being this freaking tired. I think the exhaustion feeds my emotional swings, like the bawling incident after the talk in the school. I need a break. Fortunately, one is on the way. Next week we leave home for a while to meet the new trainees for Rural Home Preventive Health and talk to them about our jobs. Afterwards we’re going to visit the site of some friends, another couple we’ve wanted to visit for months. We will be coming up for air, shortly. Then there’s only one week left before I go home for my little brothers wedding. Yippee! I am exhausted, but overall things are going well. Fletch is his hyperactive self. I don’t know what it would take to beat the guy down, short of a very hard stick. He’s awesome, and it helps, usually, that he’s so energetic.

That, my friends, is life. And once again, it’s Friday.

Posted by: emily



Hide Comments
  1. Mark posted the following on June 5, 2009 at 3:26 pm.

    Emily,

    I think it’s a mistake to withhold information about a particularly dangerous drug. When you’re dealing with uneducated, ignorant people, your obligations to disclosure are greater, not less. One of the first things most of us ask when the MD recommends something is, “What’s the downside”.

    These people don’t understand that, and if they start to make a connection between the drugs and inevitable side effects, what do you think their conclusions will be if/when they discover the Gringos knew this all along and did nothing? If they have a child on their own and that child dies a natural death, you’re free of blame, but if you come into their village and introduce something which subsequently causes them harm, and you knew it could happen and didn’t tell them, how different in their minds will that be from the Conquistadors?

    Reply to Mark
  2. emily posted the following on June 5, 2009 at 6:24 pm.

    I must say it’s hard for me not to be deeply offended by your comment. However, we keep our blog unprotected to allow many people to see it and to encourage dialogue, so I would like to respond to your comment.
    If you read above, you’d see that I did advise the women that any of them, at any time, could suffer adverse effects from using any of the family planning methods offered to them free of charge from the Ministry of Health. I encouraged them to maintain an open dialogue with the health center staff about their dis/satisfaction with the methods they’d chosen to use. That is what personal choice is about. If I went to into detail about the negative effects of every method to the letter as though I’m some disclosure form inside the box–like we have in the US–that would scare these women out of ever trying family planning methods. I think it is misguided to assume that the women here have the reasoning power of an educated woman in the US. Experience has shown me that they do not. That’s not a racist comment, or meant to be derogatory. It’s a fact–the government ignored them for years on end and they received no education whatsoever. Reasoning is not an inborn ability, it’s learned. In fact, reasoning skills are something we are trying to teach our community members, through presenting them with options and presenting things in a manner that encourages them to form opinions about different health topics.
    That said, I also tell them every single time I give them a health talk, “We’re only here to give you information, and to answer your questions. We aren’t here to obligate any of you to do anything. It’s up to all of you to make decisions about how you will live your life.” I feel very strongly that this is where we differ entirely form the conquistadores, and why I found your comparison offensive. Additionally, I have a personal relationship with almost all of the women I work with which gives me a vested interest in their well-being, another significant difference between me and the conquistadores.
    I answer every question they ask to the best of my ability, and that’s my job. I had a woman ask me if Depo-provera was bad for her, and I said it causes many problems in lots of women. I asked her if she had experienced problems. She told me she hadn’t had any problems with it; she was in fact happy with it. Her only worry was that people had said very bad things about the shot. I went on to tell her, if people were saying things about this medication that made her uncomfortable, she could stop taking it at any time and decide on a different method of birth control. In spite of my personal opinion regarding Depo-provera, there are still plenty of women in the US who use it and like it. I have to respect their opinion and their right to decide for themselves what to use.
    My story about counseling women on birth control was to highlight how I have to practice a sensitivity to the situation that I maybe would not have exercised in the US. The readers who know me from home, I hope, would read this as a sign of my personal growth. I feel like it has been an important lesson for me. All women have the right to decide, and it’s not my place to hinder that. I don’t think you’d find a conquistador who’d ever agree to such a statement.

    Reply to emily
    1. Larry in Mazatlan posted the following on June 6, 2009 at 9:29 am.

      Emily

      You should be offended. First off, these are NOT uneducated or ignorant people! I find it so sad that norteamericanos assume that a lack of formal education means somebody is dumb. They know more about life and the land than you or I ever will.

      We retired to Mexico three years ago, in part for the experience. Our “education” has reached the point where I don’t want to go back north. We are the only norteamericanos living in a Mexican neighborhood and we have learned so much. They have taken us in and most seem to enjoy our company. Yes, there are a few who view us as the rich gringos and would just as soon we leave. But they are few and far between.

      As for choice, I think you did exactly what you should have done. People in Latin America have their way of doing things that work for them, have always worked for them, and they see no reason to change it. Your ladies sound much more open to other views than do many of the people up here. As least they listen for the most part, and then make their choice.

      Larry

      Reply to Larry in Mazatlan
      1. Mark posted the following on June 6, 2009 at 10:06 am.

        Larry,

        I’m comfortable repeating my assertion that these people Emily is referring to are both uneducated (no one who is familiar with the realities here would dispute this) and ignorant (which my dictionary defines as ‘lacking in knowledge or training’), which seems obvious to even a casual observer. Contrary to your claim, I did not say they were ‘dumb’. No doubt there are some which know a great deal about many things of which I am ignorant.

        In my original comment I told Emily I thought it was a mistake for her not to fully disclose the dangers of the course of action which she was recommending to these women. In her own words she wrote, “I, personally, think it’s one of the harshest, most damaging forms of birth control available world-wide, for short and long-term effects on women. But I feel it would be irresponsible to go into reasons why in front of these women, because for many of them it’s the perfect answer….”

        I believe we have a greater-not lesser-obligation to our bretheren who are less developed. These people are, in many ways, like children. Their ignorance is not a result of stupidity (that’s a red herring). When I address my children, I must take into consideration their level of education, maturity and awareness. For those less educated, I have to take extra precautions to make them aware of things which the older, more experienced and educated children, might not need reminding of.

        This truth may be offensive to some, but it is the reality of parenting and, as my colleagues who have spent many decades doing mission work, a prudent practice when dealing with indigenous peoples who are unfamiliar with our technology and methods. It’s easy sometimes to think we are above reproach because we are well-intentioned. No doubt the conquistador reference was offensive, but it was intended to ‘prick the conscience’, because the conquistadors no doubt were well-intentioned too.

        Reply to Mark
        1. emily posted the following on June 6, 2009 at 2:11 pm.

          Hmmm, your reference did not “prick my conscious”. I put my heart and soul into the work I do. I try and examine what I’m doing constantly, in order to change it for the better. While I do not deem myself to be “above reproach”, your reference was incredibly offensive, made even worse by the fact that we don’t even know one another. You say, “the conquistadors no doubt were well-intentioned too.” I strongly disagree with that statement. The majority of the conquistadors were looking to find riches, and they enslaved the people of the areas they conquered. They weren’t there to learn about the culture they’d encountered; they came to take what they wanted and change the culture according to their own belief systems. Changing the belief system of a culture is perhaps where missionary work might be akin to the actions of the conquistadors, but I am not here for that work. I am a health educator and a fellow member of my community. I approach both of these positions with respect and care.

          That said, I do feel like our presence is sometimes invasive, but most people in the community tell us on a regular basis they are glad we are here to share with them. They use the word share; not conquer, not dominate, not change, not evangelize. We are here to share with them, and I love it when they say that, because I feel like they do indeed share so much with me.

          Your example of teaching children is incredibly apt. I don’t think the people that I work with are inherently stupid; they’ve never been given the opportunity to learn about health. Like children, what we tell them and how we present it often determines how much they do or do not understand. I don’t think that makes me irresponsible in not telling them everything to the letter. If I had an 8 year old child I wouldn’t detail the dangers of all birth control to him or her either, but I would “start the conversation” as they say.

          Furthermore, I labor over these posts to be as honest as possible in order to share my experiences with my friends and family. I ask that you please be respectful of my thoughts and feelings in your reading and commentary.

          Reply to emily
        2. Mark posted the following on June 6, 2009 at 2:58 pm.

          Emily, I apologize if you were truly offended by my observation, for I certainly did not intend to offend you. We may diverge on the historical perspective, because all the evidence I have seen suggests the conquistadors were serving God and Country, and were amply rewarded for their service with temporal wealth. This is the colonial model, after all, it is how it worked in North America, Africa, the far east, essentially, wherever Christian Europe evangelized and colonized. I’m not making a judgment about the method, only stating the facts as I know them.

          I see in your comments that you do not believe you are here to change their ‘belief system’, by which I believe you mean their theology (because you reference Missionaries negatively), and you obviously believe that is substantially different from urging them to change in other ways (such as their sexual practices). What I see is that we all want them to change, only you believe their current religious practices to be sacrosanct and their health practices to be inferior. If you did not believe them to be so, I suspect you would not attempt to alter them.

          This was my point, that in your own mind you are respecting that which you believe is already sufficient, and urging change where you believe it necessary. The missionaries believe their souls are more important than their temporal lives, and they take the opposite approach, viz., ’saving’ them first, then addressing their physical needs.

          Of course the Conquistadors conquered and enslaved the people and medical mission work is not the same, but I didn’t say it was; I only pointed out that from the perspective of the indigenous people, we Caucasians have been arriving here for centuries with new ideas that often bring hidden or unseen dangers for locals, and that we are aware of these dangers but for reasons that we justify to ourselves, do not disclose them.

          I don’t think I questioned your honesty when writing these points, only the prudence of undertaking a contraceptive evangelism without fully disclosing the risks. There is little to lose by transparency, because all will remember your disclosure; if they discover later the adverse consequences of the drug and learn you did not tell them, then the risk is that subsequent volunteers will be viewed with even greater suspicion. If you really want to find ‘independent women’ here in future generations, I’m sure you want to fully form their consciences of all of the risks of the behavior changes you are advocating.

          I did not imagine that my disagreement would be interpreted as disrespect, or that I should refrain from posting since we have yet to meet in person. My own philosophy is that people should be respected, but opinions should always be open to discussion. By posting publicly and enabling the option for visitors to comment, I assumed you welcomed comment, even if it might differ from your own opinions.

          This is of course your blog, and if you find my posts offensive, you may delete them or request that I not return, and I will respect your wishes.

          Regards,

          Mark

          Reply to Mark
        3. emily posted the following on June 6, 2009 at 5:55 pm.

          I accept your apology, Mark. Thank you.
          I will not password protect the blog, nor will I ask you to refrain from commenting on the posts or from visiting the site, because I too believe that opinions should be open to discussion. I think it’s probably even more important that they’re open for discussion when two people do not agree.

          The difficulty with not knowing one another personally is that online debate becomes a game of words where neither one of us knows who/what lies behind those words. If you knew me personally, as most of the readers of the blog do, you’d know I am a very sensitive person in addition to trying to be very conscientious. Perhaps I’m overly sensitive at times, but I think the root is that I’m passionate about what I do and what I believe. From where I sit, because I don’t know you, I wasn’t able to interpret your comment as a prick of consciousness or simple questioning both because of my personal sensitivities and because of the aggressive and negative connotation that the mention of “conquistadores” holds for me.

          In my teaching here, I do my best to present the audiences with as much information as I feel like they can handle without being overwhelmed. But I go further, always inviting them to question and doubt what I say. They all know they are invited to come talk with me at any time. I look up information if I don’t know the answer. What I am trying to encourage is dialogue, information sharing, and the idea that asking questions is not only alright, but that it’s a great idea. I believe this will pave the way for independent women in the future. I believe that the way I approached the theme and methods of family planning was done to the best of my ability. And it’s not done. I am here for more than a year to continue to help local families access more information on any and all health topics that interest them.

          What I hold sancrosanct is the individual’s right to choose; each individual has to make their own decisions about what they believe and how they will act. To me, it’s interesting how challenging it is to uphold this belief. My time in Peace Corps highlights that difficulty almost on a daily basis. Obviously I have an opinion about how I think people should do things. But it’s not place to make their decisions for them. Remaining neutral is much easier said than done. I try to live what I believe and let that convince whom it will to follow my lead if they deem it good enough for them.

          There are so many ways to do everything, so many situations that beg for alternative thinking. Exchanging ideas and thoughts on various methods is one of my favorite parts of this job. I look forward to hearing your ideas and thoughts in the future. And perhaps we can solve this problem of being strangers? My husband and I will be in the Antigua during the months of July. Email us if you’re interested in meeting up (emrich6@hotmail.com).

          Respectfully,
          Emily

          Reply to emily
        4. Mark posted the following on June 6, 2009 at 8:37 pm.

          I appreciate your response and the time you’ve taken to compose all your replies. I’ve sent you an email and look forward to meeting you next month.

          Mark

          Reply to Mark
  3. Katy posted the following on June 6, 2009 at 7:59 pm.

    Emily, I just spent well over an hour reading every word of your blog post and the subsequent comments. You are doing such an amazing job and I am so proud of you. You are truly an inspiration! I understand your methods of teaching and completely support your decisions. You make conscious, well thought out philosophical choices that are derived from your experiences on the front lines. Keep up the good work!

    Reply to Katy
  4. Ma! posted the following on June 8, 2009 at 7:16 am.

    Yipes! Just reading about your schedule is exhausting. Hugs to you!

    Reply to Ma!
  5. JOH posted the following on June 8, 2009 at 9:22 am.

    Assorted comments:

    1. Thank you for using “roshambo” correctly. (Most people use the South Park definition, which drives me crazy)
    2. Big Pink – the only gum with the breath-pinkening power of ham!
    3. It is indeed amusing that all the old ladies also chew gum
    4. Re: “shot” birth control. I have a friend who uses it, although she has an excuse: most of the other kinds of birth control have bad interactions with all the other medication she is on.

    Unrelated: Last week, I heard a story on the radio about bus drivers in Guatemala…apparently upwards of 70 have been killed on the job this year. Presumably most of that is in the capital, but still, that is pretty scary! Apparently “failure to pay protection money” is a capital offense. :(

    Reply to JOH
    1. emily posted the following on June 8, 2009 at 9:56 am.

      1. Your friend is a perfect example of why I should exercise more restraint in my negative reaction to depo/the shot. For some people it’s what works. We shouldn’t say your friend has an “excuse”; she has reasons for doing what she does. Like I said, personal choice is key in this issue. In general, I’ve had a very unfair bias against medicated birth control because I don’t like taking medicine much at all under any circumstances, and I don’t/haven’t really ever used hormonal birth control. I read a massive book on fertility awareness, pregnancy avoidance/achievement depending on a persons goals. And it’s a book I’d recommend to women and men in the U.S. in a heartbeat, because it’s so enlightening on many levels (Taking Charge of Your Fertility by Toni Weschler). BUT it would INSANE to try and advocate something like that here because of their lack of education, literacy, and gender equality. All those things are pretty key to accessing and properly using the information in the book. I also had many people tell me I was insane for using this book because they just knew I’d be pregnant in a heartbeat. The Peace Corps medical office was also very skeptical, because I get sent home for good if I end up pregnant…. So you see, we should probably all try to be a little more understanding and educated before sharing strong opinions with people on personal topics and preferences? :P :) It’s just so easy to forget that; and I’m very guilty of such memory lapses.
      2. Guate (city) is pretty sketch. We just don’t go there if we can avoid it and we are not allowed to ride public transport in the city at all. It’s a pretty tough situation with no real solutions in sight. But indeed the story you heard seems to have gotten their facts right.
      3. Roshambo.

      Reply to emily
      1. esme posted the following on June 11, 2009 at 11:10 pm.

        Hi Emily –

        I just came across your blog from a post on a listserv for parents with children adopted from Guatemala — I look forward to reading more! Just thought I’d comment on your birth control musings. I’m a midwife, and work in the South Bronx, so spend a lot of time thinking about some of the same issues you do in terms of presenting family planning options. I’m not nearly as opposed to hormonal contraception as you seem to be — the pill, for instance, is arguably a medication that should be offered to *all* women (who don’t have any medical contraindications) for the prevention of ovarian cancer, regardless of their FP needs. And the most recent evidence around Depo is reassuring about the bone loss issues. Still, it is a difficult balancing act, to determine what level of information people are capable of processing. I’d say that *on the whole* the misconceptions about various birth control methods, at least in this country, lean heavily toward a overestimation of increased risk of the method, and underappreciation of the risks of pregnancy. It sounds to me like what you’re doing is helping to correct those misperceptions.

        However, I think it would ALSO be worth exploring the use of natural family planning with your Guatemalan women. NFP can actually be very simple to use in some of it’s various permutations. In fact, at the Contraceptive Technology conference I went to in March, there was a company with a product called “cyclebeads” — a sort of fertility rosary that could easily be duplicated with local materials. Not sure if you’ve already investigated that line of thinking, but thought I’d put it out there if you haven’t. I’m sure others have written about NFP in indigenous communities, although I don’t have any specific references for you at the moment.

        cheers!
        Esme

        Reply to esme
        1. Jim posted the following on June 13, 2009 at 1:22 pm.

          Hi Esme,
          This is actually Emily commenting under Jim’s sign-in name because I’m using his computer. :P
          Thank you for thoughts on the family planning issue. First, I would like to clarify that I am not opposed to hormonal birth control. My personal choice has been to use FAM, from the Toni Weschler book (Taking Charge of Your Fertility) I mentioned that in a previous comment, but it would be absurd to think that method is just the answer for everyone. Speaking of that book, if you’ve not seen or read it, I highly recommend it. It is full of interesting and useful information.
          Jim and I discussed talking about natural family planning, and though we do not exclude it from discussion, so far we have decided to focus on the methods offered from the health center. The idea of and explanation of how NFP works definitely came up in the health talk that explained pregnancy and the cycle of the egg. Why don’t we promote NFP and the beads? From the Weschler book and our own experiences we know that cycle beads are fixed. But a woman’s cycle can vary greatly depending on how regular she is; if she’s gone through any sort of mental, emotional, or physical stress; or if she’s been ill. Malnutrition and spousal abuse are wide spread problems here, and they both directly affect the efficacy of the NFP and the beads. Because beads don’t account for those fluctuations, I think they give a false impression of security. Also, even though the health center DOES give out explanatory pamphlets on the beads, they don’t provide the beads themselves free of charge, and I have no idea where the women would get the cycle beads. While a resourceful American wouldn’t have a problem making their own beads, people here do not think like that. They often wait on solutions to come to them. Checking mucus is a good way to back up the beads, but there are so many body taboos I think it would be very difficult for the women to start checking their mucus for fertility signs.
          That said, many of them do know about NFP as it’s been discussed through their various churches. One male town leader told me, “We really appreciate the information that you give us because through the church we only learn about NFP and what we see is that it doesn’t work very well. Maybe you can space your kids out a little better, but it seems the women always end up with an unplanned pregnancy at some point. It’s just very hard to go through the waiting period.” He and his wife used it, successfully spacing out their children some, but they still ended up six children. She’s given birth the sixth child been diagnosed with diabetes in the last year and they are really trying to prevent her from getting pregnant again for the benefit of the whole family. If what he says is the case, then I would say NFP definitely does some good, because spacing improves the health of both the mother and the child. However, if they really want to be more proactive in planning the number of children they have, or decide they are definitely done with childbearing, they have to know about more than just NFP and the cycle beads, including condoms.
          The problem with condoms is that they’re very, very unpopular amongst the men. One comment we heard second-hand was, “Having sex with a condom is like showering with your clothes on. What’s the point?” Male condoms (which are free, provided by the health center, and could be used in conjunction with NFP) require full participation of the male partner in family planning. This is a problem. In many many cases here the man is opposed to using any method of family planning at all. Having many children is perceived as a demonstration of manhood. It’s also a way of subjugating women. And there is a pervasive belief that if you and your wife use birth control she has more freedom to sleep with other men.
          These are all very complex issues and sum up why we haven’t focused our talks on NFP to this point. I think I will probably continue to consider the matter further. As I said, I use FAM, which is a permutation of NFP, so I do support the idea (though not to the exclusion of hormones). Thanks for your ideas and comments.

          Best,
          Emily

          Reply to Jim
        2. esme posted the following on June 16, 2009 at 7:41 pm.

          Hi again!

          Everything you say about the challenges of NFP makes perfect sense — to me, in the context of Guatemala, I would very much think of it as a method for spacing children, rather than a fail-proof method. Truth is, I haven’t discussed it ONCE in my South Bronx practice! But I do think it is a valuable educational tool, and would love to have the time/context to talk about it more. And yes, I love Taking Charge of Your Fertility — recommend it all the time, although these days mostly for women who are trying to GET pregnant.

          The big problem, as I see it, isn’t in the end really with the various contraceptive methods per se. Yes, there are side effects; yes, there are inconveniences with each method — but when it comes right down to it, I think the primary reasons that people don’t use birth control often have very little to do with the methods themselves. As you clearly articulate — those issues of male resistance and oppression really cannot be addressed by handing out condoms. One thing that I’ve found interesting — if frustrating — as a provider is trying to come at the problem from a different angle. I’ve talked myself blue in the face trying to convince a 16 year old that she really *needs* to use contraception if she doesn’t want to have *another* baby before she graduates (if she ever graduates) from high school — but I mostly feel like that kind of lecturing on my end is, if anything, counterproductive. But it’s so much harder to try to address the bigger picture…

          And, a side note, just because I’m curious — are you functioning as health care providers as well as educators in your town? Do you put in IUDs, for instance? Provide prenatal care? Are there local midwives? Do villagers go into Huehuetenango to give birth, or do they birth at home?

          cheers!
          esme

          Reply to esme
        3. emily posted the following on June 17, 2009 at 1:02 pm.

          Good questions Esme,
          We are not health care providers. My husband is and architect and I’ve got a liberal arts degree with a concentration in Spanish literature; definitely NOT health care providers. We work in conjunction with the Guatemala’s Ministry of Health, which I think is more sustainable anyway. I’ve occassionally wished I had more medical experience and qualifications, but I think they really just need educators at the moment. I mentioned this in the above post, but the ministry of health has been working fairly hard to extend services and qualified personnel. The problem is that people here are not used to having medical assistance. In lots of areas they don’t understand it, or are frightened by it, and distrust it. So we’re here to help the Ministry of Health and the healthcare providers extend their services by educating the people on what the health center will provide for them. We also educate them on WHEN they should and should not seek medical assistance because this is a very basic thing that few people are very certain of here.
          A lot of the time when we do health talks I go discuss things with the nurses first so we can get their messages to the people, let them know what is provided for them through the health center and what exactly the nurses can do here. There are two nurses working in our village at the health post, one is an asst. the other the equivalent of an RN. The RN is qualified to put in the copper T, but does not have the equipment. She’s encouraged me to send women who are interested into the puesto to talk to her. She can either borrow the equipment from the central office in Huehuetenango and do a little copper T campaign, calling in the local women who want them to come and get them over a period of a few days or a week. Or she can request to have someone from Huehue come up and run the copper T campaign. If someone didn’t want to wait he or she could go to Huehue for the T or for either a male or female operation to stop having children. All their medical expenses are free, but the trip is not, and the operations require an overnight in the capital. People here are more day-to-day rather than long-term thinkers, and these expenses feel astronomical to them. So we’ve talked to them about how, while it feels expensive, taking such measures will help them economically by not adding so many children to the family, to clothe and feed and educate. They are just beginning to grasp these concepts, as they’re all very new ways of thinking to them. But it’s one of those things, even if they’re intimidated by or a little frightened of, I can tell they understand what I’m saying and the ideas I’m trying to share. And that’s very important to me.
          As far as pregnancy is concerned, women are most frequently attended by local midwives (we also work with the health center on an education series for the midwives to provide better services/recognize danger signs/practice basic hygiene etc.). Between 98% and 99% of births here take place in the home. Huehue is a long way from here, which makes it expensive for them to rent a car–about 2000Q for people who make 30Q a day when they have work. There is a center two hours from our village that can provide a C-section, though sometimes the women are taken all the way to the capital, Huehue, which is about 3-4 hours in a private vehicle; it’s better equiped in general. Last week our ambulance arrived so getting them to hospital is about to get much easier and less cost-prohibitive for the infirm! Pretty exciting.
          But again, the women are most comfortable doing it the way they’ve always done it, in-home with a midwife. For the majority of pregnancies that’s ok, as long as they get the hygiene issues taken care of. But we’re working on improving this from all angles, working with the families and the midwives.
          It’s great to talk to you about these things. I often say, what strikes me all the time here is not how different it is from the US, but how so many problems are just a matter of degrees. The US has the same problems with better infrastructure. Unfortunately the better infrastructure sometimes just masks the problems so many Americans are unaware of their existence and therefore do not work for change. Teenage girls in South Bronx are probably not terribly different from teenage girls here. I imagine both groups have a very limited view of what their education could do for their future as well as plenty of negative body image issues, lack of body knowledge, as well lack of self-esteem for never being taught they matter. Babies, here just as there, are sometimes had and treasured as a thing to love and be loved by, even when the mother is only 13 or 14 years old, because that love is not coming from anywhere else. Though it has its usefulness when used properly, birth control won’t change any of these issues.
          As for Taking Charge of Your Fertility, don’t hesitate to recommend it as a planning method also if you feel you’ve found a good candidate for it. We are so happy with its effectiveness, and it also feels like when/if we decide, “Ok, it’s time to have kids” things will all be in pretty good working order, no waiting for a cycle to regulate after getting off hormones. We’re both ridiculously analytical and want to know STUFF so her book was a great read for both of us. Also I have a dear friend who has a strong family history of breast cancer from both sides of her family; she’s nearly guaranteed to get it at some point. She uses it with barrier methods just to stay away from hormones and she’s single. She loves it as well. Not a good choice for anyone who just doesn’t want to get pregnant and wants to forget about their cycle entirely, but some people just don’t want to get pregnant and are ok with their periods.
          Also, Toni Weschler came out with a new book for girls/young women called Cycle Savvy. I haven’t gotten my hands on a copy yet, but I’d really like to read it. I might end up getting it for my throng of beautiful little nieces when the time is right (some of them are getting to be not-so-little anymore). I have a lot of respect for the work that woman has done. Likewise, I commend you for the work you’re doing state-side.
          I’d love to hear them if you have more comments or questions. You know where to find us.

          Best,
          Emily

          Reply to emily

Add a Comment