'A Lot of Need Here'

[Second in a three-part series on giving]

The room is a prison-like cubicle with a door and a single window grated with black iron bars, barren except for a couple of plastic-backed metal chairs and a small mattress lying at an angle on the floor. Dr. Brian Poelzer, stethoscope slung around his neck, seems downright at home in this concrete shell that today serves as a clinic. The 47-year-old Kamloops physician has just sent home a middle-aged man who was complaining of chronic headaches but had no other discernible symptoms. One thing was certain from the brief consultation: the man’s diet is desperately poor in nutrition. Poelzer gives him a bottle of vitamin supplements — a bit of a crapshoot he admits, but worth a shot.

Voices in at least three different languages reverberate off the bare walls and floors of the building. Down below on the streets of San Pablo La Laguna, there’s a clamor of excitement as a mob of barefoot, dirt-smudged children play between the open sewer gutters among empty pop bottles and chips bags. 

Curiously the atmosphere seems festive, as though a train of circus wagons has just arrived in town. In this case the circus performers are a bunch of medical professionals from Canada: B.C. nurses Fearon Blair, Myrna Quinn, Pam Rorie and Robyn Stetsko, massage therapist Barb Bishop, and GPs Poelzer, Jill Peacock, and Kyle Waldman. They’re all here in San Pablo La Laguna, Guatemala, 6,000 kilometres away from a snowy Canadian winter, volunteering for a small, B.C.-based non-profit group called Medicos En Accion formed back in 2001.

A block away from the clinic the street is more or less deserted, winding through town and descending to the shores of Lago de Atitlan, sparkling like an emerald in the afternoon sun. Despite the town’s disheveled appearance, you couldn’t find a more idyllic location, perched on a hillside and surrounded by verdant coffee plantations. Such scenic beauty is the reason, a few kilometres down the lakeshore in San Marcos, wealthy Ladinos from the capital have built mansions and crystal-gazing Euro-travelers and gringos have opened massage centres and yoga retreats. All of this highlights one of Guatemala’s most striking features: staggering wealth rubbing shoulders with grinding poverty.

Down to basics

“Are you ready for another one?” Pam Rorie calls out from downstairs.

“Yup, send ’em up,” Poelzer replies.

Soon he is placing a welcoming hand on the arm of his next patient, Rosa, extending a greeting in halting Spanish.

“Buenas dia. My name is . . . uh. Mi llamo es Dr. Poelzer.”

What the 46-year-old physician lacks in linguistic virtuosity he makes up for with a compassionate avuncular manner.

Rosa, a strikingly beautiful woman, thinks she was born around 1976, but doesn’t know for sure. At four feet, 10 inches tops, she is petite even by the standards of the slightly built indigenous Tzutuhil Mayans who form the majority in San Pablo.

Poelzer turns to his interpreter, or rather one of his interpreters. A number of linguistic hurdles stand between the doctor and a reliable diagnosis. First a bilingual San Pablo local translates from Tzutuhil into Spanish. Then someone else interprets into English. One can only wonder how the message evolves after these language gymnastics are performed.

Rosa presents with some ambiguous but common symptoms: chronic headaches and abdominal pains.

“Ask her if the pain increases after she eats or drinks,” Poelzer says, waiting for his question to be relayed into Tzutuhil.

A brief dialogue ensues between Rosa and the interpreter, after which the conversation is distilled into a simple “Si,” or “Yes.”

“How about when she goes to the bathroom?”

“Yes.” Rosa looks downward shyly.

“How long has she had this pain?”

“Two months, mas ou menos, more or less.”

This back and forth carries on as Poelzer struggles to decipher the odd morsel of Spanish. Finally he asks her to lie down on the mattress for an examination.

Rosa rolls up her huipil (the brightly coloured tunic that distinguishes her cultural roots) to expose a brown, muscular belly. She tenses when Poelzer presses her abdomen on the right side. Poelzer nods to himself, thinking aloud, “Could be gastrointestinal, but it’s probably a urinary infection.”

Poelzer inquires about her diet and learns that Rosa’s daily liquid intake consists of two weak cups of coffee filtered from beans her husband purloins from the plantation every day, a meagre perk for this backbreaking work at the plantation.

“If you don’t drink water, you don’t urinate and if you don’t urinate you don’t flush out the toxins,” Poelzer tells his patient, mocking a stern fatherly demeanor.

This is medicine at its most basic. Stripped of the high-tech diagnostic tools and laboratory support we take for granted back home, the doctor’s most valuable asset is an ability to see and hear.

‘A lot of need here’

Rosa gathers her brood and waits while Poelzer heads to the outdoor patio where a mobile pharmacy has been established. Nearby patients stare wide-eyed at the overflowing duffel bags of pharmaceuticals like kids cruising a candy store.

“This is the kind of place we’ve been looking for. There’s a lot of need here and you can tell there’s not a lot of access to health care or education,” Poelzer says. What he really means is that it’s the kind of place where water-borne parasites flow from the taps, where sewage treatment is an unfamiliar concept, where thanks to the mysteries of the global economy bottled water is more expensive than pop, and where campaneros working in the plantations subsist on a nutritionally bankrupt diet of coffee and tortillas.

Of the country’s nearly 13 million citizens, an estimated 60 per cent are indigenous Mayan and the rest are Ladino, a mix of Mayan and Spanish blood. Among the poor, malnutrition is rampant. Though plantations producing crops as varied as pineapples and peas are everywhere, little of this produce ends up in their kitchens. Lack of potable water leads to the double whammy of dehydration and gastrointestinal disease. According to the World Health Organization, five to six out of every 100 Guatemalan children die before the age of five. In Canada the rate of infant mortality is less than one percent. The Guatemalan government spends roughly $86 (US) per year per capita whereas our government spends $2,163 (US) per capita. But health statistics are cold and don’t say much about the day-to-day struggles and triumphs of people’s lives.

Nicholas Preston, a Canadian resource management consultant, has been living in Guatemala for two years working on development projects in the Lake Atitlan region and has his own blunt appraisal of San Pablo.

“In San Pablo sanitation is nearly non-existent. Human feces are a walking hazard. Most people defecate in the coffee plantations above town or in the streets at night. Most of the garbage also makes its way to the coffee plantations,” Preston says.

How much effect?

To make matters worse, literacy rates are low and political corruption, intimidation and bribery create a quagmire that can easily bog down the best intentions of even the most dedicated development worker. Past mayors have opted to green-light expensive mega-projects that generate a bigger cut, or what Guatemalans refer to as ‘mordida’, for the mayor and his relatives.

So when Medicos en Accion wades into this public health basket case, its volunteers come face-to-face with the pitfalls and drawbacks of short-term humanitarian relief.

There’s no doubt Poelzer and the other doctors and nurses have been well received by the folks of San Pablo. But as soon as you begin to unravel the multi-layered problems of a town like San Pablo, you can’t help but question the efficacy, and even the naïvete, of parachuting into a village for a few days of medical philanthropy when the social, economic and political problems run deep and dirty.

What happens after foreign doctors board the plane for the comforts of home and the free antibiotics have run dry? The drinking water will still be contaminated, the diet poor and the town’s poor residents still crowded on the lowest rung of Guatemala’s socio-economic ladder.

Guatemala has always been an attractive getaway for Canadian volunteers. Every year hundreds of them, under the auspices of dozens of different organizations, come to work here. There are evangelical Christian school-building brigades that come with the caveat, convert first and we’ll help you later, as well as crack teams of plastic surgeons helping kids with facial deformities. The country’s appeal is complex; it has a certain ‘third world’ exoticism while not totally lacking North American amenities and comforts. If you choose, you can stay in a hotel that would rival a five-star property in Canada while doing your altruistic duty.

Dr. Andy Hira, a political scientist from Simon Fraser University who specializes in Latin American development, has recently published a book titled Development Projects For The New Millennium. He is less than charitable in his assessment of most short-term aid and relief projects, and for that matter, the entire ‘development industry’. He believes humanitarian aid is best applied in disaster relief situations, be it or war or a devastating hurricane. Adversely, he likens a two-week volunteer blitz to sunny Guatemala as a form of medical tourism that does more to assuage North American middle-class guilt than it does to effect meaningful change in developing countries. Doling out antibiotics that do nothing to address the root cause of disease and sickness amounts to a Band-Aid at best.

“You’re not going to gain the trust of locals in two weeks let alone five years. In my opinion the best thing you can do is help local people organize so that they can make demands on their own government,” Hira says. Call it the give-a-man-a-fish-and-you-feed-him-for-a-day, teach-a-man-to-fish-and-you-feed-him-for-life school of development thought.

Long term change?

The presence of foreigners can make it easier for the host government to abdicate its own social responsibilities.

What’s worse, humanitarian groups often show up with unaffordable, unsustainable, distinctly first-world solutions that simply fizzle out after the funding dries up and the expertise goes home. Such was the case in San Pablo a few years back when a high-tech water treatment plant was constructed courtesy of foreign aid dollars but the village couldn’t afford the expensive maintenance bills. The project was mothballed.

As for Poelzer, he’s motivated by a love of travel and a desire to parlay his medical experience into some sort of humanitarian enterprise. However the controversy and debate surrounding development work is not lost on him.

“I’ve thought about this a lot. Is it worthwhile what we’re doing, parachuting in with drugs and North American solutions?” he says. “But if you have someone who’s been suffering from a bladder infection for six months, yes, you can make a difference in their lives.”

Nurse Fearon Blair seems well suited to work in developing countries and displays the easy adaptability of a seasoned world traveler, but this is her first overseas volunteer mission. She shares Poelzer’s dual motives for taking part, but the thrill of working in a foreign country is tempered with nagging doubts.

“I was frustrated by the fact that there are so many large problems like sewage and drinking water that require long-term solutions and that’s hard to do in two weeks,” Blair says. Despite her reservations, she already feels a certain affinity with the folks of San Pablo and hopes to return with the group next spring.

Medicos En Accion—its mission and mandate—is a work in progress and probably always will be. Recognizing the limitations of humanitarian relief, the team hopes to build a long-term relationship with San Pablo. That’s the nature of the game. But let’s face it, none of these Canadians would be here if they thought it was hopeless.

For people like Poelzer, Blair and Just, it boils down to a simple choice. You can choose to shrug your shoulders, succumb to apathy, do nothing and retreat into a cynical shell. Or you can try to give something back, however little that something may be.

Vancouver Island journalist Andrew Findlay is an occasional contributor to The Tyee whose pieces have appeared in the Vancouver Sun and many other publications.

Yesterday: Charity: What Gives?. British Columbians are Scrooges when it comes to charity. But science says giving makes us happy.

Tomorrow: The Blended Family Bonanza: A doting uncle wonders at the mounds of stuff his niece and nephew get for Christmas.