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Contributions from
the Column
Tribune
Failed poverty reduction: making poor users pay can result in their becoming even poorer
Guatemalan health promoters, Hurricane Stan and day-to-day life
Puzzling trade issues for Brazil’s government after the failure of import substitution
Why cultural industries matter for the development of poor countries
12/2005
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[ Universal health care ]
Tested promoters
In the villages of Guatemala, cooperative groups provide basic medical services. They play an indispensable role – as becomes evident, for instance, when natural disasters such as Hurricane Stan strike the region. Just as importantly, however, their grassroots activities help to reduce misery on a daily basis – for instance, by taking care of tooth aches.
[ By Katja Maurer ]
Hurricane Stan hit Guatemala in October. Among the badly affected settlements were several villages, in which medico international has been sponsoring community-based health care services for more than three years. When the natural disaster struck, it proved a blessing for these villages that they housed people with medical knowledge and solid team experience. These local health promoters rely on a basic training and are able to provide fundamental services. Some of them have specialised on dental problems.
One might wonder: What are dental health promoters, mere peasants with some medical expertise, good for in times of a hurricane calamity? Well, they can do a lot in support of the people. All of them are well versed in first aid. Moreover, they are part of a social infrastructure. In 18 badly affected villages on the coast, they joined the emergency teams composed by the other health promoters. On top of providing first aid, they also took charge of distributing relief materials and made sure that communication with the outside world went on. Today, they are checking their villages for particular risks and are preparing reconstruction plans better designed to cope with floods, landslides and all the other challenges posed by hurricanes.
Indeed, the health promoters in rural Guatemala have had more than their share of experience with catastrophes. Their work began during the civil war of the 1980s – a conflict which was later described as “genocidal” by German law professor Christian Tomuschat in a report to the United Nations. The army destroyed hundreds of settlements and murdered the population. Some refugees survived in “secret villages” or in camps in neighbouring Mexico. They had to secure their livelihoods without the help of governmental structures. Back then, health care promoters played a crucial role. They provided basic treatment and spread rudimentary medical knowledge.
After genocide
Since the end of the civil war, these activities have been carried on by ACCSS (Asociación Coordinadora Comunitaria de Servicios para la Salud), a non-governmental organisation which coordinates cooperative health services. ACCSS supports reconstruction efforts at the community level.
A key component of these efforts is a dental health programme, which runs rural dental stations. This programme provides villagers with access to adequate treatment. Many of them, after all, cannot afford the services provided by university-trained dentists.
Moreover, racism persists in Guatemalan society. Indígenas who go to “white” dentists only too often end up having their teeth pulled – without any diagnosis, without further treatment, or advice on how to take care of their teeth. By the time they turn 30, many of Guatemala’s marginalised people have no teeth at all anymore. Whenever they laugh, they cannot but reveal their poverty.
Citizens of rich countries tend to believe that dental care is a luxury item rather than a basic need. But as everyone will know from personal experience, a tooth ache is hard to live with. Moreover, healthy teeth are both a prerequisite for and a result of good nutrition. While dental fillings may not figure on the list of the United Nations’ Millennium Development Goals, adequate dental care is nonetheless essential for poor people.
The staff at the dental stations in Guatemala is composed of villagers. They do not have university degrees, but they have undergone basic training. They know how to insert simple fillings or remove rotten teeth properly. Dental promoters can take care of more than 90 percent of all common ailments. They also know enough about dental care to explain to other villagers how to prevent suffering.
The services provided at the dental stations are based on trilateral agreements between ACCSS, the promoters, and the respective municipality. The municipality chooses the promoter applicants provides the site for the building, and helps construct the station. The qualifications that dental promoters must have are also specified. They are trained in anatomy, tooth preservation, cavity removal, preparing fillings and prevention. They also have an understanding of accounting and keeping inventories. The promoters manage the dental stations and keep a part of the modest patient fees as a wage and for covering their costs.
There should be governmental approval for such promoters. However, the authorities in Guatemala have so far refused to do so. They are under pressure from academically-trained dentists, who fear for their monopoly. At least, the dental stations are allowed to remain in operation unhampered. French experts have confirmed that they are doing excellent work.
The promoters themselves benefit from their additional qualification. Training opens up new perspectives for them. Native American peasants are doing skilled work in a field normally reserved for doctors. Some dental promoters in Guatemala are not only proud of what they have achieved for their communities. Rather, they have acquired additional qualifications and degrees on top of their dental skills. One young woman has even become the first dental promoter to move on to university, where she is studying dentistry. Rosita is the pride and joy of her team.
For the villages, the dental stations are a sign that they are moving up the social ladder. After years of suffering and persecution, these stations promise humane standards of living. “Somos Personas” (“we are people”) is one of the mottos the promoters identify with. They understand that this message is important in the daily lives of the rural poor – and not just when a hurricane has devastated the region.
Katja Maurer
directs the Press and Public Relations Department at medico international in Frankfurt. medico supports the healthcare programme described above with its own funds as well as support from the European Union.
maurer@medico.de
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