A Visit to Vixben

VIXBEN, GUATEMALA – In this mountainous town about 90 minutes outside of Quetzeltenango, Guatemala’s biggest Western Highland city, life carries on much as it has for decades. When there’s work – and lately there hasn’t been much – men toil in the fields, reaping maize or beans, in their best months collecting about $120. The women stay home, looking after their 8-10 children that is typical of these tiny, mostly indigenous Mayan communities that pepper the Western Highlands. Their days are full of making tortillas and finding creative solutions to have their meager food rations last longer.

An isolated agricultural outpost high in the hills, Vixben is similar to many of the other indigenous communities that are a focus of Obama’s Global Health Initiative. Those who live here have done so for generations, many barely speak Spanish, and traditional Mayan beliefs still wield phenomenal sway.

There is, for instance, the belief in the “ojo,” the phenomenon that you can get sick if a neighbor or acquaintance gives you a bad look. For the small group of health care workers in Vixben’s tiny medical center, this particular belief is enormously dangerous.

Children here are overwhelmingly malnourished and frequently get diarrhea, either from their tortilla-heavy diets or from the filthy drinking water. But the mothers often don’t bring in their children to the health center, believing their kids instead have fell victim to the “mal ojo.”

By the time they realize it’s more serious, the children have already lost so much weight that it’s difficult to counter.

There are other Mayan beliefs that persist, which are challenging to health care workers. In Vixben, villagers have long discussed approving a measure that would chlorinate their water to rid it of contamination, mostly E. coli.

But Guatemala’s indigenous, especially in the Western Highlands, fell victim to the worst persecution during the country’s violent three-decade-long civil war. More than 200,000 people were killed, the majority of whom were indigenous Mayans. Though the peace accords were signed in 1996 and some advances have been made, discrimination continues. An overwhelming percentage of indigenous communities can’t read or write, so their access to information is limited. Thus their faith that authority figures, and other outsider, have their best interests at heart is severely capped.

So despite many heated discussions, the villagers of Vixben have time and again decided against chlorinating their water supply.

“They say, ‘why would we put chlorine in our water when we don’t consume chlorine?’” said Marta Pacasa, a nurse here working for a clinic run by the Guatemala's Ministry of Health.

Some women simply don’t come in to the health center at all, preferring to consult their own traditional healers. To make inroads with these isolated communities, Guatemala’s Ministry of Health in conjunction with foreign donors such as USAID and an array of non-profits has pioneered the concept of “mother leaders.”

The idea is that selected local indigenous women work as liaisons between the healh services and the community, speaking to them in their native languages and offering the power and comfort of a familiar, trusted face.

On a recent day, the tiny center was quiet as it was a holiday for the local saint and most everyone had gone to look at the parade. But Rosalina Clemente Mendez, 34, had come in for three-year-old Veronica’s vaccine. Over the years, indigenous mothers have become increasingly comfortable and aware of the importance of vaccines. Health care workers try to capitalize on these moments to identify and target other concerns.

Veronica was hauled into a makeshift scale, a brightly-woven traditional cloth strung from a beam on the porch. The child weighed nearly 5 pounds less than the recommended weight of just over 22 pounds for a girl of her age.

“Her weight is very low,” Alejandra Gomez, one of the clinic’s local “madres lider,” counseled. “Is she eating?”

“Yes,” Mendez answered in a low voice. “She eats when she wants to, and she doesn’t when she doesn’t want to.”

“The girl isn’t growing as she should be,” replied Gomez, an elderly woman in traditional clothes and a soft but firm voice.

Later, Mendez explained what she feeds her three children: always tortillas, of course, but eggs and beans in the morning and rice for lunch. Dinners, when they come, are normally plain tortillas.

But there hasn’t been much work lately, so her husband has only been paid for two days a week, bringing in Q100, or just over $12 every seven days. Her husband also is in charge of the shopping, so she, like many other indigenous women, makes do with what she's given.

Mendez said she likes interacting with Gomez, who she knows from the community, and is someone she feels she can trust. The idea of mother leaders is something GHI through USAID and its cooperating partners are trying to capitalize on because they have seen how it works, officials said.

Already Mendez said she had learned at least one important tip from her interactions with Gomez and the other health workers.

“I don’t give the little one coffee,” she said shyly. “It’s not good for her.”

In Guatemala, a country that partly runs on coffee – though most of the good beans are exported and most locals drink the cheap instant version – this is a break-through. Back in Quetzaltenango, the biggest city of the Western Highlands, a nutritionist told me many mothers give their infants coffee before they even turn six months old.

So as health care, development, and aid workers have learned, it is often these seemingly small breakthroughs – for example, not giving children coffee – that can have a big impact, even though it’s not solving the country’s biggest troubles of resounding poverty and entrenched inequality.