Sweat beads under my heavy cotton ADAWA teeshirt, granted graciously but unceremoniously to me minutes before our meeting with the local clinic workers and community leaders. 'It may help for you to look official,' Don Ramiro explained; 'it will show the community that you're not from the government or any other organization; you're just here with us, to help us.'
I shift in my hard plastic chair and glance at Don Ramiro, waiting for his signal. The mid-morning heat is quickly becoming oppressive in this modest concrete office the local government permits the association use of, in place of Santa Lucia Lachua's subpar 'community center'- a lumpy dirt pavilion with a tin roof (and no chairs).
I glance down at the questions I've prepared for this meeting, called by Don Ramiro on my behalf, to gather information about the community's health needs. As he gestures dramatically and makes what Tara and I can only guess are further assurances of our good intentions in the distinctive Q'eqchi' that is the native, primary, and often only language of his community members, my confidence falters. In a country brutalized by a 30-year-long civil war, where the mere suspicion of dissent was enough to endanger one's life, indigenous communities are not known for their willingness to openly and honestly complain about the government's failures. I steel myself for silence and prepare to spend the next three hours subtly prodding participants for the information I need.
Don Ramiro turns to me and breaks into a grin that illuminates his round face. "Alright, then. You can start with the questions." I smile at the thirty stern faces in front of me, some nodding in acknowledgment, some unmoving with eyes cast to the floor, and begin. "I'm interested in learning about the medical care you provide to your communities, and any struggles you may face in trying to provide it. Is anyone interested in speaking about this?"
Don Mario clears his throat. A thin, wiry man clutching a red backpack on his lap, Don Mario has been giving Don Ramiro his rapt attention, nodding throughout the lengthy introduction and jotting down notes as he listens. He raises a hand in the air, pushes a smudged pair of glasses up the bridge of his nose, and begins.
"There are 22 FCs (community health workers) working in 10 clinics, serving 34 communities. We are paid Q500 ($62.50) per month to work in the clinics. Depending on the size of the community, we have support from a doctor, nurse, or practical nurse. Some communities have a nurse every day, others only once a month. Clinics in smaller communities are open one or two days a week, or whenever someone needs care. In most clinics, FCs provide all the direct patient care. Sometimes we have enough medications to treat the conditions that are hurting our community; sometimes we don't.
Our jobs were difficult before, but in November, the candidate we voted against won the local elections. To punish us, he stopped paying our salaries, stopped giving us money for medication, and locked all the clinics. We still see patients when they need us, and give them whatever medications we have left. We could lose our jobs if they found out, but we do it because our community needs us. We found out today that the clinics will open again, but only half of the FCs will have jobs. We'll only have 11 people to care for the 12,700 members of our community."
As Don Mario speaks, the sea of somber faces begins to awaken. Other FCs nod their heads vigorously, murmur in agreement, and interject with complaints of their own. Don Ramiro can barely keep pace with his translation as clinic workers and local leaders from 18 different rural villages echo the same anger, sense of abandonment, and concern for the communities they serve. Far from being met with silence, I am confronted with a room full of people eagerly vying for their turn to be heard.
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While I initially signed on to collaborate with ADAWA under the auspice of supporting public health, my new role in the project is significantly more expansive. I will be working with an association comprised of 400 members of the indigenous community to coordinate projects that bring long-term, sustainable development to a highly marginalized region. The underlying, central focus of the projects we implement is to empower each community to take responsibility for its own progress, improve cooperation between the region's 34 communities (where competition for scarce resources leads to strife), and develop strong local leaders that can advocate for and advance the development of the region from within.
While informative, that explanation does little to paint a picture of what ADAWA is actually doing to accomplish our goals. It also fails to explain the context of where we operate, why the support is needed there, and how we aim to accomplish our goals. I'll address the where and why first, as both are irretrievably intertwined.
Working in health, human services, and nonprofit, marginalization is a word I have heard and used often throughout my career. Marginalization is oppression accomplished through social, political, and economic exclusion. Every nonprofit I've worked for, both in the US and Guatemala, has expressed a commitment to 'empowering the marginalized.' But beyond the rhetoric, beyond the feel-good mission statements justifying our work, what does it mean to be marginalized?
mar·gin·al·ize: to put (or keep) someone in a powerless or unimportant position within a society or group. (thank you, Merriam-webster.com!)
Americas Quarterly completed their updated Social Inclusion Index in 2013, scoring 16 Latin American countries on their progress (or lack thereof) towards social inclusion. In AQ's words,
"At its most basic, social inclusion is about opportunity: it represents the combined factors necessary for an individual to enjoy a safe, productive life as a fully integrated member of society—irrespective of race, ethnicity, gender, or sexual orientation... including the factors that allow for a citizen to express himself or herself to demand change and a reasonably accountable government that will respond to those demands.
This touches on a wide range of factors that... encompass, of course, economic growth, social spending, reduction of poverty, access to education and other social services, and access to formal employment. Also included are measures for the respect for basic human, political and civil rights, as well as the extent to which citizens participate in civil society and the perceived responsiveness of government."
Social inclusion is essentially the opposite of marginalization. By all accounts, Guatemala boasts one of the most marginalized populations in the Western Hemisphere. Indigenous Maya comprise well over 40% of the nation's population, but are routinely denied access (inclusion) to quality education, healthcare, and opportunities for economic advancement; they are treated as second-class citizens and largely ignored within the political process. As a result, 75% of the nation's indigenous population remains impoverished.
As expected, Guatemala (which also ranks 131 out of 187 countries on the UN's Human Development Index, comparing literacy, life expectancy, education, and overall standards of living worldwide) performed poorly on the AQ's index. Of the 16 countries surveyed, Guatemala ranked last in overall social inclusion as well as women's rights. This is no surprise in a country that boasts some of the highest levels of chronic malnutrition and government corruption, and lowest gender equality and literacy levels, in the Western hemisphere.
In order to begin to understand how nearly half a country's citizens can remain so oppressed while others advance, the region's history must be addressed. From the arrival of the conquistadors and the Spanish empire in the early 1500's, the Maya have been subjugated, brutalized, enslaved, and oppressed by one group after another. Early European settlers and later US-based companies like United Fruit Co. bought up large swaths of land for coffee and fruit plantations, creating a system of indentured servitude for most indigenous Guatemalans and cementing their place in an already racially stratified society.
A CIA-backed military coup in the 1950's sent democratically elected president Jacobo Arbenz- whose recent land reform had redistributed uncultivated, privately-owned land to the working poor- into exile, and plunged the country into a 30-year civil war. The military waged war against leftist guerrillas, mostly indigenous Guatemalans, who aimed to overthrow the military government and return to a democratic governance that would give the indigenous community equal rights and opportunities for advancement. Anyone who expressed dissent, showed an interest in their own civil rights, or participated in any sort of community organization could be labeled as a guerrilla and slaughtered at will. 200,000 died during the conflict, with hundreds of thousands more displaced. Entire villages were brutally massacred and razed to the ground as part of a governmental policy of genocide against the Maya. While peace accords were signed in 1996, the country remains deeply affected.
Despite increased awareness and advocacy for indigenous rights and a growing body of indigenous activists, the corrupt but powerful government, still backed by an elite aristocratic minority, have done a remarkable job of ensuring that entire swaths of the country remain uneducated, disempowered, and struggling to survive. The simple truth is, and always has been, that an organized, empowered indigenous community is too strong a threat to those that hold the reins of economic and political power in Guatemala.
This is what marginalizaton is, and how it happens. But what does it look like for the hundreds of thousands of Guatemalans affected by it?
It looks like most rural communities within the poorest departments of Quiché and Alta Verapaz, where only 20% of indigenous children enroll in primary school (completing, on average, 2.1 years of formal education before dropping out). Communities where 50% of mothers have had their first child before the age of 17, and have lost or likely will lose at least one child to an entirely preventable and treatable illness like pneumonia or diarrhea; where chronic malnutrition rates remain high due to a lack of education and basic medical services, despite access to arable land and a favorable growing climate.
It looks like the many places far from the country's bustling capital without accessible, paved roads; without access to uncontaminated water for drinking and bathing; without educational and economic prospects. Places where elected officials can penalize a whole region for exercising their constitutional right to vote freely, and deny them the opportunity to receive basic services they desperately need.
It looks like a place where indigenous legislators make up a mere 13.9% of Congress, though they represent over half the population. A place where previous attempts at organizing and empowering locally from within have resulted in government destruction of property and the brutal murder of community leaders, leaving deep psychological scars on every member of the community.
It looks like a place where entire communities sit in wait for either the government or foreign charities to come and 'save' them, because they do not believe they are capable of advancing from within. A place where the long-awaited 'savior' NGOs run development initiatives for a year and then leave, turning responsibility and control over to community members, only to see them abandoned because, as we heard time and time again during our visit to the area, "we had no leaders here to run it."
It looks like our community:
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| A main road in Santa Lucia Lachua, where ADAWA is based. (The recently paved Northern Transversal highway passes through town but is only used for travel in/out of the region). |
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| A mother washes her children's laundry using water from a makeshift 'well'- a hole dug into the ground, sides reinforced with mud and plywood, that captures rainwater and runoff from a nearby contaminated stream. This 'well' also serves as a source of drinking water for the family. |
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| The outhouse at Santa Lucia Lachua's only school, which serves students from 1st through 7th grade (though many drop out before that). This basic concrete and tin outhouse is actually more advanced than the open-air, thatch-roof, 'hole-in-the-ground' latrines utilized by even the comparatively well-to-do families in the community. |
