State of the World's Minorities and Indigenous Peoples 2013 - Guatemala

Guatemala has an overall population of 15 million, of which close to 40 per cent identify as indigenous according to official statistics. This includes Maya, Garifuna and Xinca peoples. However, indigenous rights activists put the indigenous figure closer to 61 per cent – a majority. Seventy-five per cent of indigenous Guatemalans live in rural areas, and studies point to a close relationship between location, poverty, ethnicity and poor health.

Fifty-four per cent of Guatemala's population lives in poverty and 13 per cent in extreme poverty. According to the ECLAC, the per capita GDP in 2011 was US$2,303.90. Of that, the state spent 6.9 per cent on health. In real terms this puts Guatemala among the countries with the very lowest expenditure on health in the Americas. Moreover, health resources remain concentrated in urban centres even though 60 per cent of the total national population lives in rural departments.

Studies by the PAHO, have found that the rural departments with the highest concentrations of indigenous peoples display the greatest poverty and extreme poverty indicators, and the poorest health figures. According to the 2011 national survey of living conditions, the overall Guatemala health profile is among the very worst in the western hemisphere.

Painful realities

In 2012, many indigenous communities still lacked access to clean water, adequate sewerage systems, electricity and paved roads. According to the PAHO, less than six per cent of indigenous communities had access to drinkable water.4

To compound the problem, according to the ECLAC in 2010 only 15.4 per cent of mostly indigenous rural households had a sewerage connections compared to 68.4 per cent of mostly non-indigenous urban households. According to INCAP, 79 per cent of indigenous people still used outdoor toilets.[5]

Health professionals conclude that the high incidence of diarrhoea and other intestinal problems among Guatemala's indigenous majority is directly related to the poor quality of water supply and sanitation in indigenous communities.

The PAHO indicates that among multiple implications of this for female health is that carrying heavy loads of water over long distances places strains on women's musculo-skeletal systems. In addition, unsafe water means their families are more prone to intestinal and bacteria-borne diseases.

There is also a high incidence of respiratory infection among indigenous women. This is partly because most indigenous women still cook and heat with firewood rather than gas or electricity. Most houses lack adequate ventilation systems. Only 4 out of every 100 indigenous houses had electricity in 2010 compared to 94 per cent of all urban households. Like the hauling of water, having to carry heavy bundles of fuel wood over long distances also contributes to muscle strains and back problems.

Health and income

The issues of poverty and health have strong links to income levels. In Guatemala, half of the indigenous population (nearly 5 million) continues to be employed in low wage-agriculture.

In 2012, Maya K'iche' activist groups such as Waxaquib Noj indicated that, along with poor pay, the working conditions endured by rural indigenous people continued to leave much to be desired. During the export-oriented coffee or cane harvests, workers live in rough shacks or sheds and sleep crowded together on the floor. These crowded living conditions aid the spread of communicable diseases, particularly respiratory infections such as the often lethal tuberculosis.

Many rural indigenous people survive tenuously on subsistence farming. Rural indigenous women are usually responsible for farming communal holdings.

A historical pattern of – sometimes forcible – land dispossession for agro-industry is a major factor in the continuing disparity between the indigenous population and the rest of Guatemalan society. It is clearly reflected in the area of food sovereignty and health.

During 2012, the Guatemalan Coordinating Committee of NGOs and Cooperatives (CONGCOOP) pointed out that over the last 22 years, the expansion of officially promoted export-oriented monoculture agro-industry and extractive enterprises have forced many rural families to sell their plots of land, leaving them hemmed in on all sides by African palm plantations and polluted water sources.

The National Institute for Agrarian and Rural Studies in Guatemala City estimates that between 2005 and 2010 the area of Guatemala given over to palm oil plantations increased by 146 per cent. As reported in SWM 2012, much of the land acquisition was conducted under arguably questionable circumstances.

Studies by the PAHO indicate that the limited access to land for indigenous female-headed households in Guatemala – coupled in recent years with unprecedented droughts and floods – is largely responsible for a significant malnutrition problem among Guatemala's indigenous Maya children and women, leaving them more vulnerable to illness.

According to the PAHO the prevalence of chronic malnutrition among indigenous Maya children aged five and under was 58.6 per cent in 2008-2009, almost twice the 30.6 per cent rate of non-indigenous children.

Reforms fail

Despite earlier government assurances of change, in late November 2012 an 'integral rural development law' to promote access to land, clean water, soil conservation, food security, financial services, employment and other rights for small rural farmers was once again defeated in Congress. According to IPS News, the bill was defeated due to fierce opposition from large landholders and their Chamber of Agriculture, who see it as an unwelcome attempt at land reform.

Eighty per cent of Guatemala's fertile land now lies in the hands of barely 5 per cent of the population, according to the United Nations Development Programme (UNDP). Meanwhile 80 per cent of the overwhelmingly indigenous Mayan rural dwellers who represent some 61 per cent of the total population remain poor and landless.

Urban indigenous health

In urban areas the majority of indigenous people are either self-employed in the informal sector or run small businesses. Large numbers of indigenous peoples are employed by the export-processing factories known as maquilas, where women make up 80-90 per cent of the labour force, with 54 per cent being between the ages of 15 and 25. Most of this urban employment is low income, demands long working hours and does not provide access to any health insurance, social security or legislative protection.

A significant factor in the issue of disparity between the majority indigenous Maya population and the rest of the society – including in the area of health – is racism and discrimination. According to the Guatemala Times, a November 2012 study conducted by a government commission and a local NGO on workplace discrimination and racism found that more than half of the business owners interviewed admitted paying indigenous people less for their services.

In the various types of urban work where indigenous Maya women are employed they often suffer physical and sexual abuse while receiving just 43 per cent of men's wages. Indigenous women's long working hours, combined with their multiple tasks in relation to domestic responsibilities, can result in chronic fatigue, high stress levels, headaches and frequent colds, as well as other symptoms.

Unhealthy trends

While indigenous people in urban areas may have better access to health services the opposite holds in rural zones where indigenous Maya populations numerically predominate.

At the primary level of care indigenous people must depend on rural health personnel. Travelling physician visits are infrequent. In these rural departments most indigenous Maya communities are remotely located and lack transport services. Getting to a clinic from an isolated village can sometimes entail a sun-baked four-hour walk.

Even when indigenous people do have access to health centres the service is less than ideal. Among the main problems – besides poverty – are ethnic and class discrimination. This especially affects indigenous women, many of whom steadfastly continue to wear traditional Mayan clothing.[6]

In a society that favours a mainstream Latino culture, activists point out that many indigenous Maya women complain about poor treatment by health personnel and/or of not being understood. Indigenous women cite language barriers as a primary problem. Forty per cent of Guatemala's indigenous population speaks one of 20 Mayan languages and many patients do not speak Spanish. The majority of state health workers do not speak or understand indigenous Mayan languages.

This means some indigenous Maya women are often unable to adequately describe their symptoms or understand medical instructions from health staff. The researchers point out that this creates barriers and ill will between the indigenous community and the health centre, preventing other indigenous people from seeking clinical health care in the future.

According to the WHO, one notable complaint by indigenous patients is that most western-oriented services ignore the spiritual and mental side of physical ailments and general health care. Consequently indigenous Maya communities continue to use traditional ancestral medicines and health specialists to meet most of their health care needs.

Cultural disconnects

National Ministry of Public Health surveys have revealed that some symptoms attached to illnesses have no explanation within the concepts of conventional mainstream medicine. However, they are a functional part of the Mayan indigenous health system of Räxk'aslemal (fullness of life). This is characterized by a search for harmonization and balance and includes perceptions of life and death that may differ from western philosophical traditions.

Many indigenous women who have given birth in hospitals have complained about the poor institutional care they have received. This includes feeling abandoned. Women prefer giving birth at home where they have a higher chance of obtaining family and community psychosocial support.

Guatemalan traditional medicine

The principal traditional medicine specialists, such as bonesetters, herbalists and massage therapists, use a variety of medicinal plants, flowers, roots and tree barks, and also make use of animal fats, bones, skins and oils. As elsewhere in the Americas, traditional Mayan medicine is learned through apprenticeships, practice, observation, psychological readings and intuition. The collected knowledge and wisdom is transmitted orally across several generations usually within families.

Birth attendants are crucial. According to the PAHO about 75 per cent of births in rural areas occur in the home, often in poor hygienic conditions with women preferring the services of traditional midwives (comadronas). Unlike purely clinical approaches, traditional birth attendants incorporate traditional beliefs and medicinal plants (e.g. sedative grasses) in their work. This preserves a connection with the natural and supernatural worlds and even the patient's own standing in the community.

This is one reason why indigenous Maya women in Guatemala – as in other indigenous communities of Latin America – tend to exhaust all traditional therapies before seeking conventional treatment. Nevertheless, some traditional midwives lack the training needed to deal with complicated pregnancies and their methods may risk endangering women's lives. ECLAC data indicates that the Guatemala maternal mortality rate of 280 deaths per 100,000 live births (in 2010) is nearly 300 per cent higher than the regional norm of 81. Moreover, within indigenous communities, the PAHO estimates the rate to be even higher. In 2000, the main causes of maternal death were haemorrhage (53.3 per cent), infection (14.4 per cent) and hypertension (12.1 per cent).

There have been officially noted concerns over traditional midwife practices and their links to high levels of maternal mortality in rural areas. However, perhaps even more important is the very close link to poor nutrition and poor pre-natal care. According to the PAHO, about 65 per cent of Guatemalan women do not have prenatal check-ups. The lack of medical care during pregnancy and birth has permanent health consequences for undernourished indigenous women including anaemia, and otherwise preventable genital and urinary infections. On the other hand, indigenous women also claim that health personnel treat both traditional birth attendants and their patients as inferiors, and often do not provide the comadronas with sufficient equipment or training. The sum total is that most cases seen by modern doctors are already in advanced stages of complication, often beyond prevention and frequently incurable.

Traditional medicine is recognized by Guatemala's Constitution as well as by the Acuerdos de Paz (Peace accords) that followed the intensely violent (and arguably genocidal) 1978-85 civil war. It guaranteed compliance with the UN ILO Convention No. 169 on indigenous peoples' rights.[7]

Since 1996, the Ministry of Health has been training midwives in safe birthing techniques. Courses in traditional medicine are also available for non-indigenous health professionals through the Public Health Ministry.

Notes

5. See: http://estadisticas.cepal.org/cepalstat/WEB_CEPALSTAT/PublicacionesEsta….

6. Montenegro, R.A. and Stephens, C., 'Indigenous health in Latin America and the Caribbean', The Lancet vol., 367, no. 9525, 2006, pp. 1859-69.

7. Piox, L.X., 'La medicina tradicional en los sistemas de salud pública: una Mirada desde Guatemala', retrieved June 2013, http://hdrnet.org/606/1/65-485-1-PB.pdf.