Written by Julio Letona, ASSADE;
The public health care structure in Guatemala can be thought of in terms of a three-step stair: the first step (1st level of care) being the most direct and root-based. The first level of care takes place inside communities, where health care begins. The second step (2nd level of care) should address cases not detected in the first step. Health concerns that are not treated in the second step should go directly to the third step (3rd level of care). The third step is focused on medical specialties and chronic conditions. For successful care, these three steps must be connected and work together.
Unfortunately, the first step of the healthcare structure in Guatemala does not exist. This level is supposed to involve early detection, including but not limited to preventative actions. The first step relies on connections from family and community care. Every culture has a different understanding of the healthcare process. In a country with great cultural diversity, these differences should not be overlooked. The remaining steps of healthcare suffer from problems related to a large disparity in access to health care, resulting in a gap of health coverage that exceeds 40% of the population. Government investment in general development (education, health, nutrition, living and social) clearly exposes this disparity: US$0.90 for non-Mayans and US$0.30 for Mayans.
To further explore one of the biggest problems in Guatemalan healthcare we must answer: Why is the first step nonexistent? When facing such a complex context of injustices, it is common to have more questions than answers. Discrimination excluded certain communities from adequate access to health care. The difference in the number of health workers between rural and urban areas reflects the lack of healthcare attention in rural areas: at most, there are three workers for every ten thousand inhabitants in rural areas compared with twenty-five workers for every ten thousand inhabitants in urban areas. The underestimation of Mayan medicine, derived from serious, long-term ethnic problems, results in a health care system based solely on Western Medicine although more than half of the population is Mayan. The lack of investment towards development in indigenous areas disables communities to build capacity and forge fundamental rights. For decades, the government has concentrated on response, trying to repair damage after it happens. Generally, the only option has been to cure rather than to prevent. Fierce corruption and the lack of will at the governmental level to make a real change exacerbates the problem. These issues make what should be a universal right something inaccessible.
The truth is that the three steps are from different stairs. Guatemala’s health care structure has a long history of superficial attempts, putting a small band-aid on the structure, to make invisible the lack, and therefore the need, of the first level of care. We are convinced that the permanent crisis in our healthcare structure is due to the non-existence of the first step.
ASSADE’s goal is to repair the broken, disconnected, uneven, narrow, and inefficient health care system. After more than fifteen years, we have gained meaningful knowledge from our communities and learned life-changing lessons that have inspired and led us to better understand the healthcare system structure and develop various approaches to solving healthcare problems. We aim to honor the right to indigenous health.
ASSADE listens to and learns from the community, allowing us to build, establish, care, nourish, and sustain a healthcare model based on the specific needs and desires of the people. We believe that community health grows not linearly like stairs, but spirally like the shell of a snail, beginning at the family level. Under this model, the first level of care provides families and communities with the opportunity to get involved in the healthcare process. This is essential to support the inherent resilience capacity of communities in which grassroots platforms are created to identify, discuss, and develop solutions to various problems.
The first step of developing sustainable and effective healthcare systems is to create something unique and adequate that encourages the community to embrace healthcare on a deeper, meaningful, and personal level. Secondly, communities must become capable of solving health problems through a multidisciplinary and multifaceted approach that results in a genuine motivation and effort to discover solutions. Through this, communities will foster a social framework of well-being where individuals have access to an invaluable human right: healthcare. When the seed of awareness is planted in a fertile soil of interconnectedness and watered with empowerment and education, the fruit that is community health emerges and individuals regain their right to healthcare.
At ASSADE, we combine the first and second step to create a comprehensive healthcare model capable of adapting and transforming according to community needs, thoughts, and feelings. We recognize the dynamic, changing, and evolving spiral that is this vital human right and will continue to work to break destructive cycles and confront the next challenge.
History is something to remember and have present each day, and we treasure these memories because of their important lessons regarding the right to health and its relation to other essential rights in communities that have also been so violated and wounded. Here is where a light, community health, is born. In the midst of darkness, it shows the path for a healthy community to develop, reach autonomy, and define their own destiny.
We firmly believe that the following ingredients are necessary to build an adequate health care system: community health as the heart of the structure, the inclusion of traditional medicine, a proper foundation, participatory and comprehensive organization, a well-maintained relationship with nature, justice, equality, respect, humanism, and love.