Unofficial Refugee Work in Chiapas, Mexico


In the late 1970's and early 1980's 150,000 Guatemalans - mostly indigenous people, fled into Chiapas, Mexico. Many settled into the jungles or more westerly around the town of Motozintla.

 Near Motozintla de Mendoza, Mexico

In 1983 a friend and I traveled to Chiapas to provide health care to the refugee community there and to train lay health workers from among their community. This was a little dicey because at the time the government of Mexico was not allowing any outside organizations other than the UN High Commission on Refugees to travel to the area. Services at the camps were provided by three organizations - the Catholic Church, a private Mexican organization, and the UNHCR. We were in an area which had a small dispensary but no professional staff. If anyone inquired we were just "tourists". Several foreigners had been arrested and deported for assisting the refugee communities.

Refugee Child, Chiapas

The refugees in this community were mostly from the northern highlands and were mostly indigenous Mayan. Among them, three different dialects were spoken, and many did not speak Spanish.

Our introduction to the politics of Chiapas was immediate. Upon our arrival we were told that there was to be a demonstration the following day because a protester had been shot and killed two weeks before. He had been protesting the last local elections, during which, we were told, anyone could cast their ballot at the army garrison - downstairs for the incumbent, upstairs for the opponent...

Since the politics of Chiapas were quickly beginning to look like those of neighboring Guatemala, we prepared to provide first aid for major trauma in the sanctuary of one of the churches. The next day dawned to find heavily armed soldiers on the rooftops throughout town. Fortunately the demonstration never came about.

Soldiers on the Roof

Learning to Help

We quickly set about training eight of the refugees as "CHW's" - community health workers. They were all bright, enthusiastic, and very eager to learn

The eight health workers represented the three dialects spoken by the refugees in our area, and one was a Latina. All spoke and read Spanish, having had about three years of formal schooling on average. Our "Bible" was Where There is No Doctor, published by the Hesperian Foundation, and its companion publication, Helping Health Workers Learn. These are excellent resources, and we brought enough copies of Donde No Hay Doctor so that each CHW could have their own copy. Another book always in great demand in a society in which women's health information is in short supply is Nuestras Cuerpas, Nuestras Vidas - the Spanish version of Our Bodies, Ourselves.

Kids vividly remembered the burning of the village of Acul, a beautiful spot I had visited several years before. I expected medical health problems, but was foolishly not expecting the amount of depression I found. Women who were afraid to wear their traditional clothing in this new place would tell of putting it on and crying themselves to sleep at night.

Acul Burning

CHW Class

One of the first things we trained the CHW's to do was to make oral rehydration solution for the kids with diarrhea. They could then teach the mothers in their native tongue. Teaching the CHW's to take temperatures meant first teaching the concept of decimals.

We were privileged to have access to materials developed for CHW programs within Guatemala called "Materiales Maria Maya". These consisted of posters which could be used by the CHW's in educational settings. They were designed showing typical scenes of Mayan life - but scenes related to health issues. Rather than "teaching at" the people in attendance, these posters were used to initiate discussion of a particular topic

What Affects Growth of Corn? Of Kids?

For example, the CHW could ask what was the difference between the two corn plants, leading to discussion about the needs of corn to be healthy. Then the conversation could be directed towards the two children. Information and knowledge already present in the community can be emphasized and expanded upon, rather than "flowing down from" an outsider

I had the opportunity to diagnose and treat many acute infections, as well as minor injuries, malaria, typhoid fever, onchocerciasis. The amount of malnutrition was severe - anemia was very common. One elderly woman (how old? - "who Knows" she said) came in saying she felt "like ants" were crawling all over her arms and legs. She acknowledged that she had eaten very little but tortillas for over two years. Fearing a combined B-vitamin deficiency I gave her some multivitamins. She returned a week later, gave me a hug, and thanked me for "giving her life back". We made sure the local relief workers aimed a little extra food her way.

Woman with Pellagra

The woman holding the child had a rash on her arms, neck, nose, and lips - only in sun-exposed areas. Having eaten mostly corn for years, she was suffering from pellagra, a niacin-deficiency disease.

Most of the kids had severe roundworm infestations. This would cause them bloated bellies, headaches, abdominal pain, and in one case, a bowel obstruction.

Refugee Kids

Making Posters

Making nutrition education posters, for both the community and the CHW's.

Medical records strived to maintain anonymity for security reasons. Patient instructions were written, but because many could not read, were also drawn with colored pencils as tablets or spoons related to dawn, midday, afternoon, or night.

Medical Records

The Mayans have a system of hot and cold diseases and always asked whether their medicine should be taken with hot or cold water. Before I realized this my response of "it doesn't matter" was met with a look of uncertainty (probably uncertain that I knew anything at all...). For illnesses for which I had not figured out a better answer, I at least started responding that it should be taken with "which ever will give it the most force against the illness". That seemed to be a satisfactory answer.

We take a lot for granted when it is easily come by... The wood shop started by the local church was very helpful in making us crutches. These they figured out on their own - for the second set we helped them design adjustable ones.

Carpenter with "homemade" crutches.

My experiences working with this community solidified my appreciation for these people and their dedication to their families and communities. The healthcare provided was a band-aid only. The training, hopefully, has served them well.

© 2000 Dr. Stephen Blythe