GUATEMALA - LAND OF CONTRASTS by William Hartel

Guatemala is the third largest country in Central American, with an area approximately the size (but not the shape) of the state of Tennessee. Our team of 20 included physicians, nurses, a physician assistant and several construction volunteers. We landed in Guatemala City, the country’s largest city and took a four hour bus ride to Quetzaltenango, the country’s second most populous city (about 300,000). Xela (Shay-la), as the town is referred to by natives, lies at the crest of a volcanic ridge, near the peak known as Volcan Tucana. 

The country was first inhabited by humans approximately 11,000 years ago, but don’t tell that to the Lutheran Minister who arranged this volunteer trip. He is convinced that Adam and Eve were put on Earth about 3000 years ago. According to anthropologists, there were a lot more people on Earth than just those two back then. Like, a whole, whole lot more. One thousand years BC (about the time Adam and Eve supposedly debuted) the Mayan region of Central America was the most populated civilization on earth, home to tens of millions.

In the early 1500’s, about the time that Columbus was bungling his way through the Caribbean (convinced he had reached Japan), Pedro Alvarado entered the town of Xela on the western edge of what is now Guatemala and proceeded to “save” millions of souls by wiping out 96% of them (he gave them a choice – Catholicism or death – unfortunately they didn’t speak the same language so today that might be considered a “trick question”)

There are still millions of Mayans spread throughout the America’s speaking no fewer than 30 distinct dialects – so distinct that a member of one region can not reliably communicate with a member of a band on the other side of a mountain a couple of miles away.

The most commonly spoken Mayan language today is spelled like that cheese egg concoction real men don’t eat - Quiche, pronounced Key-Chay. This is the dialect spoken in the village of Chajabal (Cha-ha-ball) where our clinic was located. The daily 4 mile bus ride from Xela to Chajabal took more than an hour, ascending a single lane muddy “road” with a dozen hairpin switchbacks from an elevation of 7500 feet to 9500 feet over the distance of just 4 miles (10% grade). Most mornings the view from the precipice was astounding, fog as thick and white as the fluffiest rain cloud rising off the valley floor to take a more reasonable place in the sky, although I admit I often had my eyes closed in an attempt to avoid the view down the steep mountainside. The minister asked us to pray that we remained safely on the road. I was hopeful that the driver kept his eyes open as he prayed.

We arrived at Chajabol on Sunday morning to set up the clinic facilities. We were met by thunderous drumming of the hundred or so parishioners to welcome us, shaking hands, grabbing our arms, bowing. Children giggled and pointed at the sight of their white faced visitors. Mayans are very short people – most are five feet or less. I was the tallest in our group of 20 and felt as though I was being studied.

To speak with the patients required me to ask my question in English to be translated into Spanish and then translated into Quiche then back again – the simple question “Are you pregnant?” took almost a minute to get the answer. My “clinic” was rudimentary – a 60watt bulb hung from the ceiling, a patient sat in a student desk raised on cinder blocks. I stood facing the patient to provide care, leaning over the desk portion – to this day my back still has not forgiven me. I had a battery powered head lamp, 2 gallons of bleach and four surgical instruments. No suction, no water but we did have chickens... Yes, chickens, roaming the church grounds, stopped in to investigate. There were always fewer chicken visitors in the afternoon sessions, which may be related to the wonderful chicken tamales we were served every day for lunch.

The pain tolerance seems much higher for the Mayans than for Americans of similar age. There is very little tobacco or alcohol use in the village. The main dental problem was the extremely high intake of sweetened beverages – coffee is traditionally served with 4or more teaspoons of sugar but soda is the main beverage. The water is generally not potable so soda is preferred… by all ages, from age 2-60. I saw a number of infants drinking Coke from a baby bottle.

I am continually offered suggestions by the medical doctors and support staff on how I should be doing my job - “You should be teaching them how to brush their teeth,” “You should have brought floss for them,” “You should be telling them not to drink so much soda – tell them to drink water.” Teaching them to brush would take 30 minutes per patient due to the translation issues, floss would certainly be used in their weavings, and asking them to buy bottled water, which costs more than soda, would surely be ignored. The line of patients out the door – numbering more than 30 at any given time – indicated to me that the patients were far more interested in having painful teeth removed than listening to a lecture from some stranger. Oh, and I was told to counsel the Mayans that “candy is bad…” That would be a hard sell there, since candy is sold at absolutely every store in Guatemala, from the hardware store to the grade school bookstore. One other item I noticed for sale at almost every store (and in the front hallway of most of the homes in Chajabal) were the toothbrushes and toothpaste distributed by visiting dentists (including this one).

Patients were given postage-stamp sized piece of colored paper with a number in an attempt to provide some sort of order. Perhaps they did not understand the system or decided, as a group, to ignore it, lining up and waiting patiently, some as long as 4 hours. By the third day the ground was littered with colorful scraps giving the appearance of confetti tossed at New Years and the system was abandoned. 

We were told to be very careful to avoid certain foods and not to drink the water, but even with those precautions, most of our team members came down with diarrhea one day or another. I was sick on the third day and was only able to see half the normal number of patients – 15 rather than 30. (One of our construction workers bragged to me that he never gets sick. “I eat whatever I want to keep my strength up. Construction is hard work, physically demanding, not like dentistry.” He suggested that the best way to treat my malady, I should actually “eat more food, not less… to flush my system out. Like plumbing. But, remember, sickness is God’s way of telling you that you have strayed somehow” The next day I saw him standing at the front desk, shivering, wrapped in a bed sheet with chocolate-colored stains of obvious origin asking for a fresh set of linens and maid service. He was pale, weak and smelled like he stepped in a big pile of dog doo when he strayed off God’s chosen path. I invited him to join us for breakfast – “you know, clean out those pipes.” I guess he didn’t hear me because he skipped that meal and the next.

In the clinic, it was not usual for the patients to spit blood on the concrete floor and, after just a few patients, there was a large bloody pool which people merely stepped over to get to the seat, usually before I’d had a chance to wipe it down.

The minister who arranged the trip made many derogatory remarks about the Mayan people, referring to them as “backward. I mentioned that the Mayans had invented a highly accurate calendar, detailed astronomical charts, agriculture, writing and mathematics thousands of years ago with no help from the Europeans. He laughed dismissively “Is that what you think?” 

He shook his head as he scanned a river bed littered with trash. “Such filthy people. Look at how they treat their land.” There were disposable diapers, Walmart boxes, soda cans, McDonalds bags, KFC buckets and hundreds of soda cans and bottles. “You know, we try and try to share the blessings of our advanced civilization and they can’t be bothered to find a trash can,” said the minister. I pointed out that all the trash that filled the river bed was the result of those “blessings” we had shared so generously with them.

He was forced to reconsider his opinion that the Mayans stupid when the construction crew encountered a problem, transporting a ton of wet concrete from the basement of the school they were building to the first floor. The Americans attempted (unsuccessfully) to build an elaborate pulley system to lift the material, wasting a full day. They were discussing the challenge over lunch but could not come up with a solution. They were ready to abandon the task entirely but, upon returning to the construction site, they were shocked to find that entire ton of concrete had been delivered to the work site in under an hour. A miracle! All it took was twenty or so “uneducated” Mayan men to each made ten trips carrying the concrete in small buckets. The contractors congratulated the men, through the interpreters, for solving the problem all by themselves. “God helps those who help themselves,” the foreman said. It took a several minutes to get that concept across. A moment passed before one of the sweaty Mayans asked the foreman “If you knew the concrete was needed up here, why did you mix it down there?” Good question. No answer.