Promesa Delegation July 2009

1. Promesa DelegationJuly 2009 By: Susan Cotton & Katy Troyer

2. Tesoro Nueva Esperanza, Patulul, Suchitepequez • Tesorito has 177 families, 932 people, and 30 people in the US not counting 15 that have already returned • The clinic is opened 3pm-5pm Monday to Saturday. • Gabriel is the main health promoter but was absent during our visit. • There are also 4 new health vigilantes (2 men and 2 women) that were present • Antonio of CPR lives in Tesorito and accompanied us during the visit

3. Objective 1: Payments to Health Workers • We witnessed Susan hand over the DJPC/Promesa checks to Domingo in the CPR office • Domingo pays the health promoters in each community every 4 months. The main staff member in each community receives a check in his/her name and then distributes the salaries to their co-workers.

4. Objective 2: Emergency Transportation Funds • Only the family of man that died in a construction accident in Phoenix last year received aid to bring his remains back to Guatemala. • Under the current system, funds are distributed according to a family’s need. The money is kept in the capital, and the family gets reimbursed after their emergency trip once the main office has approved it. • Due to Ila having to approve emergency transportation funds from Tuscon, FEW of the communities we visited had used their transportation funds. The promotors are very reluctant to use it since they have to get approval. • Other emergency medical costs include supplies and medicines at the public hospitals, but they cannot be covered with these funds. • People can stay for free at the CPR office in the capital.

6. Objective 3: Trainings for Health Promoters • Pedro the health vigilante has participated in trainings in general health, medicinal plants, and acupuncture in coordination with ASECSA that the CPR pays for and administers. It's not clear whether DJPC funds were used for these trainings.

7. Objective 4: Medicine • There are 3 types of medicine at the health clinic: • The Ministry of Health has free medicine and re-stocks monthly, but only certain promoters have authorization to distribute it. • The medicine that Ila`s project brings down every year is free and stays in the botiquin for future use at no charge. • The medicine bought with money donated from DJPC/Promesa is managed in the botiquin and sold a little above cost to patients to help with sustainability. It's much less expensive than in a pharmacy.

8. Objective 5: Annual visit by Promesa delegation • We assisted with 80 health consults in a day and a half. • The major health problems that we saw during the consults were: Gastritis, pink-eye, ring worm, amoebas and other parasites, flu and colds, arthritis, anemia, eye infections, some malnutrition in kids, high blood pressure, high blood sugar, minor injuries from accidents (ganado, car, wrist), menopause, asthma, tooth decay & abscesses, and menstrual cramps. • We participated in Ila`s meeting with the Tesorito authorities on Friday. She asked questions to fill out her report, and we had an opportunity to ask them questions. • Afterwards we attended a community meeting in which Ila and us addressed the crowd and they played marimba afterwards.

10. Inspiring Observations • There is definitely a need for the health clinic in Tesorito, and the community is very grateful for it. • The extra medical care provided by the promotors funded by Promesa takes care of unmet needs that the Health Ministry just can’t address or overlooks. • There is a tremendous amount of trust between Tesorito and Ila’s project and Caminos due to the long-term relationship that began during accompaniment. • The situation of the community seems more hopeful. They are more involved in civil society such as the paved road, new basico school, etc. • The dedication of the health promotors is inspiring especially considering their very modest stipend and the obstacles they face.

12. Concerns: The Dental Clinic • The dental clinic has been abandoned and all of the 5 people trained went to the US except for one that works at a nearby finca and doesn`t want to do dental work for free on Saturdays. • The community of Tesorito doesn`t want to pay Q12 for a cleaning and only seek help when they have tooth pain, which is too late. Prevention is key in dental health but not sustainable if people will not pay for it. • In August a Dentist from Tuscon came down to Tesorito and other communities for 3 days to provide much needed dental work: 77 patients, 10 cleanings, 49 fillings, and 91 extractions in total. This is just the tip of the iceberg. The dentist donated $500 of supplies. • Ideas: We`ll have to train others or get the finca worker to come back. For example offering a Q200 monthly stipend for a dentist to work ½ day a week in Tesorito (Saturday probably). Pedro and Antonio can extract molars and fill cavities. Francisco in Union Victoria is also trained. Maybe doing a health camapign around oral health in the community would get it back on track.

13. Dental Clinic

14. Concerns: Eye Care • There is a great need for eye consults. People have to pay their own way to visit Pro-ciego, a private clinic in the capital, so they rarely go. • We would like to use the emergency transportation funds for consults outside of Tesorito, but it conflicts with Ila`s system. If we manage the program ourselves, we could change it. • 3 women from Tesorito (including Magdalena, Susan`s host mother) went to Venezuela for eye operations with coordination from the previous alcalde. They were very reluctant to talk about it.

15. Concerns: Emergency Transportation • There is a need for health promotors to accompany patients to the capital due to language and cultural barriers. • There is also a need for transportation funds to private clinics outside of Tesorito in Patulul or the capital although it may not be an emergency. • Transportation funds cannot be currently used to pay for medicine and supplies at public hospitals.

16. Side Note While traveling in Nebaj we saw many eletrical towers across the mountaintops that will eventually carry electricity from the recently built hydroelectric dam near Jua to the exterior (Mexico). Most small villages along the power route will not receive much needed electricity from the project. Landowners were paid a one time fee of Q7,000 to sell their land for the towers. Most villages were very uninformed about the project. More research and a possible future delegation is needed on this issue.

17. Recommendations • Promesa is worth continuing not only for the huge need in the community, but also because we have a strong link to Tesorito. • However, the current structure (Ila’s project) in some ways weakens the autonomy of indigenous health promotors creating more dependency instead of solidarity. Other options are available and worth exploring: • We could raise money for St. Michael’s general fund for all 22 CPR communities, because it’s a pain for Ila to keep a separate accounting system for Tesorito. • Or Caminos could manage Tesorito and possibly the 2 other CPRs in the south, communicating directly with Domingo at the CPR office in the capital • Or we could give to the St. Michael’s general fund and just focus on the dental clinic. • If we want Promesa to truly reflect the principles of Caminos/DJPC, we have to have a more active role (i.e. more on the ground presence such as a volunteer health accompanier?), but this requires a lot of resources like volunteers and trips down there.

19. THANK-YOU CAMINOS FOR GIVING US THIS WONDERFUL OPPORTUNITY TO VISIT TESORITO!