G is for Guatemala but also for...

Bienvenidos y Welcome a nuestro blog. Somos cuatro estudiantes de la Escuela Andaluza de Salud Pública. Somos chicas que representamos diferentes países (Albania, Estados Unidos y España) y hablaremos de diferentes temas de equidad. Dos de nosotras escribirán los posts del blog en inglés y dos en español para darles la mejor experiencia escribiendo en nuestros idiomas preferidos.

We have started this blog with an idea that is an integral part of Public Health. The word that has been used mostly in our classes here has been “equidad". When I began to think of the blog post I would make for this I started to reflect on the English translation of the word. Equality did not sound as though it encompassed the ideas that “equidad” brings. To me health equity seems to be a more appropriate translation. As much as equality seems to be a value that is ideal it seems to me that equity is what is needed.

This idea of equity reminds me of an experience I had while living in Guatemala. I was working in San Mateo Ixtatán, Huehuetenango, Guatemala. Truly, the middle of nowhere in the mountains of Guatemala near the border with Mexico. I was working as a Latin American literature and English teacher at a small school run by an NGO. I had been there for about 5 months when the administration informed the teachers that our salaries would be late that month. The transfers were late and they were in a very tight financial situation so we would have to wait up to a week to receive our monthly salary. This normally wouldn’t be an issue but I travelled to Guatemala City that month so when I found out I had about 10 Quetzales (approximately $1.30 USD) to live off of for the next week or so. Food was rather inexpensive and buying fruits and vegetables at the local market would still leave me with 5 Quetzales but what I desperately needed and did not have access to was clean drinking water. The administration had told us to drink only bottled water but a large jug of water cost 4 Quetzales and I wanted to have (a very small amount of) emergency money.

Looking back now I should have simply bought that water and just dealt with a situation if it arose but coming from the United States, it did not occur to me that drinking even a small amount of water from the tap would have repercussions. My family is originally from El Salvador and growing up I would go quite often and we were always told to be careful with the water. We would brush our teeth with it, and it would inevitably get in your mouth if you showered, but nothing would really come of it. It was always just advice like not going out with your hair wet, or wearing an extra sweater, almost like preventative advice. It was only a few days after I had drank some water to take some medicine that I started to feel ill. I have had food poisoning and other gastrointestinal ailments but NOTHING like this. My symptoms were all over the place- immense bloating, vomiting and diarrhea, essentially, the works. I initially thought I had eaten something bad and it would go away on its own.  After two weeks of worsening symptoms, the local teachers suggested I go to the local health center approximately 2 kilometers away.

I went with a colleague of mine to wait in line until I was seen. 4 hours later, I lay down on the dingy exam bed and begin to tell the medical school student ( I later found out she was in her second year of medical school and was assisting in a rotation here and had never been outside of Guatemala City) my symptoms. She quickly tells me that I am eating too much spicy food (I am not) and too much acid in my diet (not really) and that her diagnosis is that I have gastroenteritis. I tell her that that cannot be the case- the diarrhea, the bloating, it has to be something serious. She quickly gives me a Maalox generic and tells me to go home.

To make a long story short, I found out a week and a half later that I had Giardia. Giardia is a parasite that lives in the intestine that comes from drinking contaminated water. I confirmed this two ways- 1) I am lucky enough that my brother and father are both physicians. I called my brother who is an Internist and told him my symptoms and he instantly knew what I had (mostly because he gotten it also on a trip to India) and 2) A colleague of mine was worried and had me visit her father. He is a General Practitioner but was trained by USAID Epidemiologists and had a small lab in his office. After submitting a sample, sure enough he confirmed what my brother had said. (I even got to look at the darn thing)

I thought of all the situations that led me to receive my treatment to cure myself- my brother that is a physician, the community doctor who was trained by USAID, access to anti-parasitic pills, money (finally I did receive my money) to pay for those pills. I also thought about the decision that I had made that led me to where I was, but mostly, I thought about what if I didn’t have any of those resources. No access, no money, no knowledge, no ability to question.

I went back to the health center and told the medical student my actual diagnosis. She was sorry but also told me that she sees people with such worse ailments that she felt bad but was glad and also expecting me to figure it out on my own. In the end, I don’t blame her. She needs to dedicate her time and resources to helping those that do not have the knowledge or resources that I have been blessed with.

- J. Nuila