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My
Medical Mission Work to Guatemala -2007
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Guatemala,
the country as a whole, is the most “affluent” third world country I
have
visited. However, there is still wide
spread poverty, coupled with high unemployment. Outside of the cities
in the
mountainous areas a farm hand may make $2.50-5.00 a day, where as a
city day
worker may make $5-10 a day. There is also
a shortage of medical professionals.
They may have to work long hours and/or travel to multiple
distant
clinic sites. However, they make “good”
money (compared to the low cost of living). Nurses
make about $9,000 a year and Physicians
make about $18,000.
Our “base camp” was a hotel in Santa Cruz.
We had three clinic days and each clinic day we had three teams
traveling to separate sites. We would
travel 1 – 2 ½ hours to the clinic sites.
Each clinic site (i.e. a school classroom in the middle of a
community)
has been established by HTI. A HTI
physician will visit these sites once or twice a month. So, the number
of
medical patients we had during our clinics was about 20-30 patients a
day. HTI has not had dentists employed to
travel
to areas to clean teeth, fill cavities and pull teeth. So, the big draw
was the
dentists that traveled with each team.
The dentists saw 60-90 patients a day.
They pulled too many teeth to count.
The last day of my particular clinic we had a newly hired HTI
dentist
cleaning teeth.
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Interesting to note, when we went to our
clinics most people
did not speak Spanish they spoke an old Mayan language of Quiche (it
sounds
nothing like Spanish). We needed three workers to communicate with
patients. We placed four chairs
arrangement
into a square. I asked the Spanish
translator a question, he then asked a Quiche translator the same
question,
then the Quiche translator asked the patient that question. And then
the answer
made it back around to me.
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Things that surprised me: (1) Patients did not
want
handouts. They would pay a small amount
for doctor’s visit and the medicines that were prescribed.
(it seems that in
the Mayan culture, the people do not value that which they don't
"pay" for. That is the primary reason for charging.
Secondly, but equally important, is that it prevents creating a welfare
state
among the people with resultant expectations that deprive them of
their
sense of dignity and respectability - see my website for more detailed
explanation). (2) average
height of Guatemalan people was about 4’11” (apparently Mayan ancestry
were
very small people. They do not have
signs of dwarfism, disproportionate limb length, or disproportionate
head
size). (3) I
had two married women (one with 4 children
and the other with 6 children) that were not only taking Depo-Provera
injections for birth control but they were interested in surgical
intervention
for permanent birth control (most cultures believe that you don’t
interfere
with the potential number of pregnancies – God(s) control your fate).
AN E-MAIL EXCHANGE ABOUT THE PEOPLE'S DESIRE TO PAY FOR MEDICAL
SERVICES.
Morning
Melinda,
This
is Marie here, and I am happy to explain
why we ask our patients pay a small fee for medical services. It
began
before we even started doing our medical clinics back in 1990.
Dr. Mike
Kelly is a physician from Oklahoma who was
living and
working in Guatemala at that
time. In
discussions with him about Health Talents' bringing in periodic medical
teams
to help him with his patient load, we reviewed many things, like
medical
problems specific to the Maya, scheduling concerns, etc. Mike
knew the
Maya well since he had been working with them for several years.
Because
of this, he concluded our discussions by insisting that we "let" the
people pay. We, too, were a little shocked at the time, but his
reasoning
was sound.
It seems that in the Mayan culture, the people
do not value that which they don't "pay" for. That is the
primary reason for charging. Secondary to that but equally
important, is that
it prevents creating a welfare state among the people with
resultant expectations that deprive them of their sense of dignity
and
respectability.
Three or four years later we were asked to come
to Nicaragua to talk
about helping a
church there. Because of our experience in Guatemala, we
insisted during our
conversation with church leaders that they charge a small fee.
They were
quite resistant because they had just come out from under a dozen years
of
communism where everything had been free. They told us, "The
people
won't pay." We said, "We believe that this way is the best
way. If you want us to come, you must charge a fee, even if it is
a very
tiny one. We do not want the money...it stays with your church, but you
must
allow people to pay." They reluctantly agreed to a pittance fee.
The second year we went to hold a clinic, I
noticed that the fee they were charging was tripled from what
it had
been the first year. When I asked about it, the answer was
immediate! "We had to do something! After the first clinic,
we
learned that many people had come in pretending to be sick so they
could get
the free medicine, which they then took out in the street and sold!"
A bit more history for you...a few years ago
we
slashed our fee to almost nothing. Our patient load actually went
down. One man was heard saying as he left the clinic one day,
"Man,
this is cheaper than a Coke and a bag of peanuts!"
Our method may not be right for every
population
group in the world, but it is clearly what we need to do in Guatemala. And
I am happy
to explain it to you.
One
thing that is becoming clear to missionaries
all over the world is the need to avoid creating dependency among
people we
serve. Our goal is to "lift up Jesus Christ" as the light of
the world...and let people know that God is the Giver of All Good
Gifts...not
us. It is not our role to play Santa Claus to the
rest of the
world. As good as that might make us feel, it is not helpful
to our
overall purpose for being there.
Hope
this helps.
God
bless and Merry Christmas,
Marie
agee
health
talents international
Great explanation Marie. Lisa
and I would agree. Over the years with all of the various
issues
surrounding Guatemalan history and culture, many organizations have
entered to
provide services and have created a dependency that does need to be
reversed. This is not only an American opinion but an opinion you
hear
quite often from the local people as well. One of our goals is to
ensure
everyone gets medical treatment who present, so we meet with the
churches
and/or communities first to let them know we will charge, but if there
is
someone who cannot pay, we would expect a representative from the
church or the
community to let us know when someone cannot pay. Most of the
people that
are presented to us that cannot pay are either widows, older men, or
women with
children where the husband has left. Everyone else normally have
the
means to pay, you would just never know by looking at them as to us all
Guatemalans are poor, we just do not understand the levels of poverty
in Guatemala.
When we first came Lisa saw a family who
stated they could not pay, so she took them at their word and
afterwards
the church leaders let us know this family was one of the more
well-to-do
families in the area. Thus, now we always defer to the local
churches or
communities to confirm if someone can or cannot pay.
God bless,
Kemmel and Lisa Dunham, American medical
missionaries in Guatemala
Melinda,
Kemmel Dunham sent me this just now about the
explanation I sent. I told him that I realized the one thing I
didn't
address in my note to you was how we treat people who cannot pay.
Of
course, they get treatment, but he explains how that is determined.
Thanks for your asking the question. I sent
my response to everyone because others might have been wondering, too.
God bless,
marie
Created December 13, 2007
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