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.
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
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
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.
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,
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
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
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.
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
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.
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.
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