Rich Man, Poor Man

Mural, in Memoria of those killed during Guatemala's Civil War

At a glance, Guatemala is a rich country.  Rich with Mayan culture.  Rich with indigenous peoples.  Rich with language.  Rich with natural beauty.  Rich with natural resources.  Rich with agriculture.  Guatemalans possess diversity in language and its people, as exemplified by its 24 languages of its indigenous peoples (principally Kiche, Kaqchikel, Q'eqchi, and Mam) still spoken today and with its more than 50% indigenous population.  Backstrap weaving is a craft still passed down from generation to generation of women; and its beauty is displayed in it's regional styles of huipiles.  Coffee is its #1 export and ranks just behind Colombia as the 2nd producer of high grade coffee in the world.  Followed by sugar and bananas.  Guatemala is the largest producer of cardamom in the world.  Gold is abundant in the western highlands, followed by silver, steel, iron.

Los Pajaros -- Santiago Atitlan's signature huipil style

Solola Market

Chichicastenango style of huipil

So how is it that nearly 60% of the population lives in poverty, with at least 20% in extreme poverty?  That more than 50% of the population earn less than $2 a day, and 15% of the population earn less than $1 a day? 

The answer is gross inequalities and injustices at the expense of the marginalized indigenous population.  The wealthiest 20% of the population consume more than 50% of the GDP.  Two percent of landowners own nearly 70% of Guatemalan soil -- leaving Guatemala as a country with one of the most unequal wealth distributions in the Western hemisphere.

The Steps of Iglesia Santo Tomas

Traditional Chichicastenango dress, corte = skirt

The political history of Guatemala has been a long and tortured one.  Corruption and greed, the driving forces.  In the 1920's, repression and oppression of the indigenous people became more evident.  The indigent population was forced off their native lands as outside interests made their way into Guatemala.  In 1954, Arbenz the democratically elected president who had its marginalized people's interest in mind entered the scene; and for once Guatemala's future looked potentially hopeful.  His claim to fame: major land reforms that redistributed the land among the poor.  Later accused by the U.S. government (Nixon) of being Communist, Arbenz was forced from his presidency, opening the way for more repressive governments and a Civil War that lasted more than 30 years.  The result: the death of more than 200,000 Guatemalan citizens by the government a little change in the plight of the largely indigenous nation.

Picop - how Guatemalans roll

Traje tipica of the men of Solola

And while many crooked Guatemalan politicians played a significant role in these injustices, Americans have also tainted their hands with the blood and sweat of these people.  The U.S. is the world's largest coffee drinking country, to whom over half of Guatemala's coffee is exported.  (Please buy Fair Trade only!)  The U.S. has gold mining operations in the country, along with Canada, both of whom are under investigation for human rights abuses and violations.  With headlines implicating Glamis Gold: Glamis Gold Accused of Violating Indigenous Rights, Death Threats in Guatemala Against Community Leaders Opposing the Mining Operations of Glamis Gold, a Canadian/US Mining Company.

The hustle and bustle of Chichicastenango Market

Gringo tourist trap

And the U.S. government played a primary role in the overthrow of Jacobo Arbenz, possibly one of the first hopes of justice and equality for the Guatemalan people in its recent history.  Why?  Because he threatened the business security of the United Fruit Company, the US based company that claimed most of Guatemala's land in the 1950's for the production of bananas.  Reacting to the threat of land reform, and capitalizing on the fear of Communism during this time, the U.S.'s CIA led a coup to overthrow Arbenz in 1954.  (Very interesting video on this: http://www.youtube.com/watch?v=rNG6xzQu1Mw&feature=related).

Maria displays Santiago Atitlan huipil

For me, living among the Mam Mayans in Concepcion and knowing all this made it difficult for me to be proud to be an American.  Even during my time in Concepcion, a protest was organized against the mining in the Western Highlands, in the department of San Marcos, and Antonina asked why my country found the mining justified.  I shook my head in shame and disgust.  Again, greed and government corruption are the driving forces.

Solola market: Nicolas (farmer) and his wife (weaver)

What is likely clear in my photos is what drew me to Guatemala in the first place -- their richness.  That in the face of adversity, they have been able to preserve the Mayan identity that could so easily slip away from them.  While there is likely a bitter tone in my writing, this blogpost is really geared to inform you about what may not be known about this little neighboring country.

If you're still curious, here is a little more: 

• http://www.voiceofamountain.com/ (website of documentary)
• Silence on the Mountain (beautifully written book about Guatemala's civil war)
• http://www.youtube.com/watch?v=rNG6xzQu1Mw&feature=related  (political events during Jacobo Arbenz' presidency)

Concepcion...Life

Life in Conce is simple, leaving me with plenty of time to think or rest my mind without too many distractions.  The days were easy.  Wake up.  Eat two eggs sunny side up with rice and salt.  My morning walk into the hills and into the center of town.  Then get ready for prenatal consults, which occurred unpredictably.

Trash filled creek bank on the way to town

On days with Antonina, I was asked to cook lunch -- specifically typical food of the Philippines.  And so on my second week here, it was my turn to feed the midwives, with Beef Asado, Chicken Adobo, and Chicken Tinola.  The market in the center of town closes at 12pm, at which time the center is empty and fresh vegetables are hard to find, unless you want to make the 10 minute microbus ride to the next town, which I often did not.  More time away from the clinic meant less time with potential patients.

My modified Chicken Adobo

Ofelia watches me cook

Chicken Tinola made with Huisquiles (Sayotes)

On days when I didn't cook, we subsisted on corn in every shape and form:  atol,  a drink made from cooked corn grains for a morning and afternoon snack; as tamales, wrapped in corn leaves to give it more flavor; and as tortillas, hand shaped and pressed.  And if that were not enough for carbohydrates, potatoes and rice came on the side.  A fervent Atkin's Diet follower's nightmare.  Potatoes are in abundance here because it is the heartiest crop in this area of Guatemala.  Many times meals consisted of tamales, rice, and potatoes, with picante on the side.  Many of those times I just craved a big chunk of meat.

Santos cooks tortillas on the plancha

In the washroom of the birth center there is a cement structure that resembles a small closet, with a door 3 1/2 feet tall, which in order to enter forces you to nearly come to your knees.  It is a chuj, or temascal, a structure that is found at the homes of all the people of Concepcion Chiquirichapa; though normally it is constructed apart from the home.  According to what I've read, the chuj has been in existence for many thousands of years, since before Spanish colonization.  And now there are few areas in Meso America where they are still common, other than existing for the novelty enjoyed by many tourists.  In the Mam area near Xela though, they are commonly used for general hygiene and to insure good health.  In the state of Chiapas, Mexico temascals are used in a similar way to the Native American sweatlodge.

In the casa de comadronas, the chuj, is offered to prenatal, laboring, and postpartum patients.  Newborn babies enter the chuj as well.  It's use is said to relieve the discomfort of the first trimester, to provide strength to the woman in labor, and to rapidly heal the postpartum patient's uterus and help her to regain strength.  (The patient not the uterus.)  Azucena also noted that for women who have poor healing below or who suffered a placental or perineal complication during childbirth, the midwife would often blow steam onto the vagina, after tossing water onto the coals.  I, myself, never witnessed this.

The chuj is the small structure beside the house, dug into the ground

A small fire is prepared, after which a large tin of water is heated by the fire.  After all the smoke exits the chuj and the fire has heated up the porous rocks that hover above it, it is ready to be used.  Those who enter, enter naked and leave a large blanket and towel outside the door to prevent their body from experiencing shock from the two extremes of hot and cold.  Black soap is used to cleanse the body.  If someone has pains, the soap is used to massage.  (The midwives here often use gentle massage with the patients to rid of "belly" pains.)

Inside the chuj

Antonina invited me to enter the chuj, or bano as she calls it, with her one night.  Though not the one at the clinic but the one at her home just yards away.  While, the chuj at ACAM fits three people comfortably, Antonina's fits 5 or 6 comfortably.  Shy and awkward, I asked if we went in nude and she stated yes.  Skeptical that she understood me, "Not even in our underwear?"  "Dana, you have the same body parts I do.  Don't be scared."  And so we went and I left my insecurities behind.  We bathed ourselves with the "jabon negro" and a loofa and poured hot water from the tin to rinse our bodies.  Antonina told me to turn around and comfortably grabbed a loofa and began cleansing my back.  I felt like a child and was reminded of how nice it felt to be pampered by my own mother when I was young.  Then she threw water on the hot porous rocks to create steam and began to blow steam at my body.  Didn't quite understand it at the time, but I didn't question it.

Antonina prepares the chuj

When we exited, a gust of cold wind hit my side and I felt dizzy, drunk even.  Inside, in her bedroom, the bed was stacked with blankets which were folded open ready to receive.  And so, I layed there, with Antonina by my side, warmed by the wool, until we were ready.  Her husband and daughter-in-law catered to our needs, bringing water and tea then let us rest.  After what seemed to be 30 minutes, we headed back to the maternity house.  Oddly enough, the whole experience was a very intimate one with Antonina -- the invitation which communicated trust and comfort in my presence -- and the manner in which she cared for me which was unmistakeably maternal.  It quickly became natural to me to refer to her as my Mayan Mama.

The Lovely Comadrona Cristina

It was Antonina who decided to turn the camera lens on me.  After 2 weeks of photographing each midwife, she decided it was my turn.  And so she brought me her traje tipica, in the traditional Concepcion weaving style, and dressed me up like a doll.  And with the invitation to the chuj in her home...To a party at the home of her sister...To the wedding of her granddaughter, Antonina unknowingly initiated me into her Concepcion community.  Antonina had fully embraced me -- an unforgettably wonderful and warm gesture.

Concepcion's Traditional Huipil and Corte

Azucena's traje

My Concepcion community

Healing Hands



Life and Death Mural in the town's center

The comadronas of ACAM are well connected.  They speak highly and frequently of health providers in the United Status who 1) help obtain funding through grants, 2) offer their own expertise during day or week-long medical volunteerships, 3) Donate medical supplies and clothing, and 4) often times when here, Provide trainings to the midwives.  Most of their volunteers come through acquaintances of Nikki May, a certified nurse midwife in Massachussets, to whom the midwives refer every day as though she were their holy savior.  Of course that's an exxageration, but...Perhaps she is.

The Mayans have had a long tradition of midwifery.  Some communities have the good fortune of passing on this tradition to the younger generations, who can replace them as they grow older.  The Mam area of Quetzaltenango is one such place.  The youngest midwife at ACAM is 15 years old.  The oldest 76.  And unlike the United Status where to be a midwife, the cost can be exhorbitant, here the education is free.  After a year of theory and a year of practicum, the midwives begin tending to birthing women.  They learn about complementary medicine, such as herbal teas first –recipes that have been passed down from their mothers and grandmothers.  Preservation of this craft is very important to them.  

Herbal Salves at ACAM

I am astounded by their practice since this is the first time I have seen natural birth take place in the way I was taught during Doula training.  Women walk around most times until they are 10cm dilated.  Birthing women eat whatever pleases them and drink teas during labor.  They are told sometimes to climb the steps in ACAM to help the labor process.  And through it all, they are courageous and strong.  Hospital San Juan de Dios, the public hospital in Xela, doesn´t charge for childbirth.  But many women in the Area Mam don't have the same trust in the hospital that they have in the comadronas in their community, where they are willing to pay Q400 (50USD).  Each midwife earns Q100 (13USD) each shift they work; and most work just one per week, totaling an income of 13USD per week.

My Portraits of the Midwives - I couldn't resist making them laugh

The midwives are warm, generous, welcoming, and wise.  They boast that I am a very agreeable American, willing to eat everything they offer me; unlike with other foreigners with whom they are nervous and worry over them because of their very high needs.  It's selfish, but it warms my heart to hear that I will be missed by them.  They say they have grown accustomed to me being here and will be sad to see me go.  There is no doubt that I will feel that sadness as well, since they have become my family.

Donas Santos Mendez, Cristina, Emelda, Azucena, Antonina (From left to right)

Dona Antonina´s Beginning

Antonina's own experience began when she was pregnant with her 3rd child who was in breech position.  The midwife performed manual external version of the baby -- a process by which a midwife turns a baby gently but firmly using her hands positioned on the mother's belly -- to correct the position.  (Technology and fear of being sued have convinced many American doctors that they are incapable of doing the same, so they usually defer to a cesarean in cases like this.)  The midwife then instructed Antonina to do the same on her own, if the baby was restless and stubborn enough to turn himself around again.  And so she did.  For her this was a very empowering moment in which she realized that she is capable of healing with her own hands.

She tended to her first patient in the home, when no comadronas could be found in the community.  With no formal training, her experience was limited to past invitations by neighbors to see the birth of a family member.  And yet SHE was now at the helm of the childbirth of a dear friend.  When her friend´s pains came stronger and more frequently, the husband asked, ¨Antonina, you will be the one to receive our baby.  Please help us.¨  Reluctant to do so at first, she directed family members to get a Schiller (razor), bedsheets, towels, and hot water.  And in an instant, she held a newborn she had helped birth, in her hands for the first time.  News spread in the community.  And as a consequence, the flow of requests have been consistent for nearly 30 years.  Antonina works 3 of the 7 shifts, and from what I see, is the midwife whom the patients most request.  And during her shifts, I have been lucky to play a big role in births.

Midwives : My Maya Mama Antonina, Cristina, Ofelia

 

Maria's Childbirth

Antonina and Ofelia were the receiving midwives on this day.  Antonina spent many hours by the mother-to-be´s side, coaching her through contractions, offering herbal tea to help reduce the pain, and recounting birth stories to the mother and family who all sat in the birthing room.  It was a time of celebrating life.  Despite the work she had done, it was me Antonina called for to tend to the mom as childbirth was impending.  And so she proceeded to take off her gown, gowned me, helped me with the ties, and reminded me of what I needed to do.  In Mam, she then stated to Ofelia also gowned, ¨Dana is going to be the one to receive the baby.¨ For a second time, I was graced with the generosity of Antonina to share the experience – to allow me to be the one to lay my hands on the baby in the moment when he breathes his first breath – and to welcome him into the World.  With more assurance than the first birth, I severed the connection between Mom and baby which no longer pulsed, wiped him clean, measured him, then dressed him for mom to embrace.  She tenderly touched him fascinated by his small nose, small ears, small mouth, small hands; as did her husband, who hovered closely above the two, inhaling every moment.  Her mother and grandmother also stood by her side, hand in hand with Maria, praying thanks in Mam – expressing gratitude for her strength through labor and hoping for her healing in the coming days and weeks.  To experience this ceremonious moment and long standing Mayan tradition among these women -- those who cared for her day to day, and those with healing hands, I was humbled.  And in realizing this, I nearly cried.

Each midwife here has their own story of how they came to be chosen, by God, to pursue this profession.  They all concur that it is a calling.  I guess I´m partly here to understand if it is mine.

The Lovely Affectionate, Dona Margarita



Finally Among Mayan Midwives

Nuestra Madre Tierra - Mural in the center of town

I began planning my trip to Guatemala more than a year ago when I became restless with my job.  I contacted many organizations and clinics, including Primeros Pasos, Midwives for Midwives, and XelaAid.  In 2005 I met a Peace Corps volunteer who told me that he was working with midwives in San Martin.  He promised to tell them about my interest in working with them.  We kept in touch through email and I later received a message stating that they had extended an invitation for me to come work and stay with them.  Unfortunately, the email came just two days before I was leaving the country.  And that was that.

The day I met the ACAM midwives was a fortunate one.  My XelaAid contact, Luis Enrique de Leon, director of the clinic in San Martin, drove me to Concepcion Chiquirichapa.  He had given them no warning and when we arrived they were busy with a patient who needed an ultrasound, to confirm that one of her twins did not die in the womb.   The clinic only has bare minimum supplies.  After the business of getting her seen in San Martin, Luis and I sat down with Dona Azucena, President of ACAM and Dona Antonina, Vice President.  We talked for a while and I laid out my goals for working with them and offered them to come up with a list of projects they need assistance with.  So they agreed to have me and offered a place to stay and homecooked meals.  And on my first night here I assisted with my first birth, whose story I talk about at the end.

  

Where I live

La Iglesia Catolica - View from ACAM

Technicolor Cemetery

 I've been here now since the beginning of March and am just now blogging.  With my computer out of commission and their computer's internet very spotty, I'm typing this on Matt's Kindle.  Crazy.  I am living in Barrio Nuevo, Concepcion Chiquirichapa, a small pueblo about 30 minutes from the city.  This is where the clinic is located.  Here life is rich with culture, color, and  community and so has been my experience living in this traditional Mam Mayan town.

La Casa de Comadronas

Examination Room

ACAM is the Association of Comadronas in the Area Mam.  The clinic is a beautiful house that hosts Computer classes, English classes, community meetings, patient consults (prenatal, postnatal, and general) and of course, births.  I teach the comadronas English when there is a short moment to do so and even taught one girl Algebra since no one here was able to help. Teaching Algebra in Spanish isnt easy.  Two weeks ago we hosted a large meeting of women's groups from all over the region on el Dia de las Mujeres -- when three visiting American professors led a discussion about the problems the women see in the local environment and offered ideas on how to protect their precious Madre Tierra.    These groups are a means to empower women to effect change in their communities.  You can see how this place is special. 

La Hermosa Comadrona Santos

Comadrona Ofelia examines a patient

The consult room is very simple.  There is also a small closet full of donated medicines...our pharmacy, a waiting room, three birthing rooms, a kitchen, a medicinal herbs cabinet, the large salon where meetings are held, computer room, office, five bathrooms, the midwives bedroom (they rotate staying 24 hours, two at a time), and three more bedrooms for visiting guests like myself.  And even the traditional sauna called temazcal, or in Mam, chuj, in which some moms enter while in labor or after childbirth.

I began seeing consults immediately with Antonina who quickly became my favorite and to whom I refer now as my Mayan Mama.  She insisted immediately that I examine the prenatal patients and tell her my impression.  Since I have no experience in checking the baby's position, I mostly pretended and was self-assured with my touch, palpating the baby's head (I was at least able to do that...most of the time), checking the baby's heartrate with a fetoscope or doppler, then checking her blood pressure and her weight.  Antonina continues to offer tips on how to be more attuned to how the baby feels in utero but I continue to have trouble sensing where his or her arms and legs are.

Mi paseo

The pace is slow here and the days are tranquil.  Before my computer died I spent my nights 

watching an episode or two of Grey.s Anatomy (Yes. Greys Anatomy) or a bootlegged copy of American movies I bought at the market in Xela.  Now I am left with playing Scrabble on this Kindle.  And I just finished reading for the second time (Yes...I read something in its entirety) The Red Tent, which fictionalizes the biblical life of a midwife, Dinah, daughter of Jacob.  I loved it this time too.  I've also made it a routine of mine to go on walks-hikes around the community and up into the hills.  But when I'm really lucky, a birth keeps us occupied at night...and this was the case my first night living in Concepcion. 

Mercado en el Centro de Concepcion

Luisa's Childbirth

Dona Antonina looking at me plainly and sternly said "Come closer Dana.  You're going to catch the baby."  I sort of looked at her blankly and hesitated to step forward.  To this she challenged me with "What's wrong, are you scared?"  I stepped up to the woman's side and held the fleece blanket in my hands.  But even as the head of hair began bulging I wondered if maybe she misunderstood my birth assisting experience and I stood dumbfounded.  The baby's head came first.  Antonina had no time to entertain my awkwardness so she reached for the baby and with a swift lateral pass the baby was in my arms.  Receiving a newborn in this context, in the house of midwives, is unlike receiving a baby when I worked in the NICU --  where tension, anxiety, and fear hangs in the air.  Here the healthy newborn was wide-eyed and the thick ropy pulsing cord that sustained him in his mama's womb was still attached.  After a few moments I was instructed to care for the cord; tie it, clamp it, cut it, and then he was free and making his own way.  I wiped the baby, caked in vernix and blood, to encourage the familiar lusty cry that signals new life.  Antonina assumed reponsibility of caring for the baby while I was tasked with helping the mom birth the placenta.  I stood at the woman's side massaging her uterus with my left hand and holding the cut umbilical cord with my right.  The intact placenta didnt need a lot of coaxing and in seconds mom was free of it.  She sunk into the pillow in exhaustion.

It all happened quickly and it was incredibly exciting for me -- like an initiation into the world of babycatching.  I remember thinking- I think I'll like it here.

A large Batik that hangs in the Clinic

Vamos a divertirnos

While my first priority here certainly has been my work in a community clinic (with improving my Spanish conversational skills a close second), playful adventures have also been a must.  My Spanish Immersion school I.C.A. did an incredible job of planning daily activities Monday through Saturday.   Unfortunately, I was stubbornly anti-social during my 2 weeks of classes, after which I set aside my snobbery and went on the Saturday hike to Volcan Santa Maria.  

Volcan Santa Maria in the hazy distance

The summit, where Evangelists are holding a service

Praying for the Deceased

Volcan Santa Maria hovers peacefully over Xela (unlike it's volatile offspring nearby Volcan Santiaguito which erupts every 30 minutes or so).  After resuming a yoga practice upon arrival here and consequently overestimating my physical ability and endurance (Note to self: 12 sessions of yoga in 2 weeks after a several month sabbatical from exercise does not = being back in shape), I ignorantly committed to the climb.  Honestly the climb for me was a painful struggle of leg cramps and wheezing, as older women in flip flops carrying babies and anything else they could carry to make me look bad whizzed by.  Needless to say, the hike was well worth the following 2 days of debilitation.

Curious about the Gringos

Mensajes en las piedras

Hermosa sonrisa

Our descent through crops at the base of the volcano; in the distance a woman and child carrying firewood on their heads

Mateo arrived the first week of February.  The RSB graciously gave him permission to work in Guatemala for the month.  Lucky for me.  On weekdays, we were both managing busy schedules, but found ourselves on mini adventures on the weekends.  Through climbing blogs, Mateo discovered a local climbing spot just a short hike outside of Xela.  We opted to do some reconnaissance at Volcan Cerro Quemado.

Hike with Mateo to Volcan Cerro Quemado

Searching for rockclimbing spots

The base of the rock

The challenge

Along the hike to Volcan Cerro Quemado, is a side road which takes you to Los Vahos, thermal steam rooms fed by the vapors of this volcano.  The hike offers an incredible view of Xela and weaves past beautifully cultivated land.  Then at trail's end is your reward -- being enveloped by eucalyptus-infused steam.  Aaah!

A relaxation and changing room ajoins the steam room

Red in the face from 45 min of volcanic steam

No visit to Guatemala is complete without a visit to the popular and picturesque lake, Lago Atitlan.  For a pre-Dia de San Valentin weekend, Mateo and I made our way by chickenbus to Jaibalito, where we stayed at the luxurious hotel, Casa del Mundo.  The hotel is carved into a steep cliff, with accommodations on varying levels.  Making your way around the hotel grounds is better than any stair stepper.  We enjoyed an afternoon of napping in the sun and an evening of family style dining and cocktails with the other guests; then topped the night off in an outdoor wood-stove heated hot tub overlooking the lake.  Total relaxation!

Breakfast at Lago Atitlan

Panajachel's lake-side view

Catching a lancha to the town of Jaibalito

Casa del Mundo patio.  After arriving Matt dove off the higher ledge for a quick dip in the lake, which by the way was freezing.

My nap in the sun

Casa del Mundo's private dock

View of Volcan San Pedro from outside our room

Beautiful woodwork

View of Volcan Toliman and Volcan Atitlan

Hotel office and private room

On Sunday, I ventured off to the famously congested Chichicastenango market where I snapped some photos with my film camera (which is why they are not shown here), while Mateo joined a group of Guatemalan rockclimbers for a day of climbing in the nearby New-Age town of San Marcos.  After one more night at the lake in San Pedro la Laguna, we were hardly satisfied to return to urban living, but were summoned back to our work obligations -- Matt to Guatemala City for a couple days of meetings and me back to Xela for the week of Papanicolaous.

Mateo's view from the rockface during his climb