Promesa Promesa DelegationDelegationJuly 2009July 2009

By: Susan Cotton & Katy TroyerBy: Susan Cotton & Katy Troyer

Tesoro Nueva Esperanza, Patulul, Tesoro Nueva Esperanza, Patulul, SuchitepequezSuchitepequez

Tesorito has 177 families, Tesorito has 177 families, 932 people, and 30 people 932 people, and 30 people in the US not counting 15 in the US not counting 15 that have already returnedthat have already returned

The clinic is opened 3pm-The clinic is opened 3pm-5pm Monday to Saturday. 5pm Monday to Saturday.

Gabriel is the main health Gabriel is the main health promoter but was absent promoter but was absent during our visit.during our visit.

There are also 4 new health There are also 4 new health vigilantes (2 men and 2 vigilantes (2 men and 2 women) that were presentwomen) that were present

Antonio of CPR lives in Antonio of CPR lives in Tesorito and accompanied Tesorito and accompanied us during the visitus during the visit

Objective 1: Payments to Health Objective 1: Payments to Health WorkersWorkers

We witnessed Susan hand We witnessed Susan hand over the DJPC/Promesa over the DJPC/Promesa checks to Domingo in the checks to Domingo in the CPR office CPR office

Domingo pays the health Domingo pays the health promoters in each promoters in each community every 4 months. community every 4 months. The main staff member in The main staff member in each community receives a each community receives a check in his/her name and check in his/her name and then distributes the salaries then distributes the salaries to their co-workers. to their co-workers.

Objective 2: Emergency Objective 2: Emergency Transportation FundsTransportation Funds

Only the family of man that died in a construction accident in Only the family of man that died in a construction accident in Phoenix last year received aid to bring his remains back to Phoenix last year received aid to bring his remains back to Guatemala. Guatemala.

Under the current system, funds are distributed according to a Under the current system, funds are distributed according to a family’s need. The money is kept in the capital, and the family family’s need. The money is kept in the capital, and the family gets reimbursed after their emergency trip once the main gets reimbursed after their emergency trip once the main office has approved it. office has approved it.

Due to Ila having to approve emergency transportation funds Due to Ila having to approve emergency transportation funds from Tuscon, FEW of the communities we visited had used from Tuscon, FEW of the communities we visited had used their transportation funds. The promotors are very reluctant to their transportation funds. The promotors are very reluctant to use it since they have to get approval.use it since they have to get approval.

Other emergency medical costs include supplies and Other emergency medical costs include supplies and medicines at the public hospitals, but they cannot be covered medicines at the public hospitals, but they cannot be covered with these funds.with these funds.

People can stay for free at the CPR office in the capital. People can stay for free at the CPR office in the capital.

Objective 3: Trainings for Health Objective 3: Trainings for Health PromotersPromoters

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

Objective 4: MedicineObjective 4: Medicine There are 3 types of medicine at There are 3 types of medicine at

the health clinic:the health clinic: The Ministry of Health has free The Ministry of Health has free

medicine and re-stocks medicine and re-stocks monthly, but only certain monthly, but only certain promoters have authorization promoters have authorization to distribute it. to distribute it.

The medicine that Ila`s project The medicine that Ila`s project brings down every year is free brings down every year is free and stays in the botiquin for and stays in the botiquin for future use at no charge. future use at no charge.

The medicine bought with The medicine bought with money donated from money donated from DJPC/Promesa is managed in DJPC/Promesa is managed in the botiquin and sold a little the botiquin and sold a little above cost to patients to help above cost to patients to help with sustainability. It's much with sustainability. It's much less expensive than in a less expensive than in a pharmacy. pharmacy.

Objective 5: Annual visit by Objective 5: Annual visit by Promesa delegationPromesa delegation

We assisted with 80 health consults in a day and a half. We assisted with 80 health consults in a day and a half. The major health problems that we saw during the The major health problems that we saw during the

consults were: Gastritis, pink-eye, ring worm, amoebas consults were: Gastritis, pink-eye, ring worm, amoebas and other parasites, flu and colds, arthritis, anemia, eye and other parasites, flu and colds, arthritis, anemia, eye infections, some malnutrition in kids, high blood infections, some malnutrition in kids, high blood pressure, high blood sugar, minor injuries from accidents pressure, high blood sugar, minor injuries from accidents (ganado, car, wrist), menopause, asthma, tooth decay & (ganado, car, wrist), menopause, asthma, tooth decay & abscesses, and menstrual cramps. abscesses, and menstrual cramps.

We participated in Ila`s meeting with the Tesorito We participated in Ila`s meeting with the Tesorito authorities on Friday. She asked questions to fill out her authorities on Friday. She asked questions to fill out her report, and we had an opportunity to ask them questions.report, and we had an opportunity to ask them questions.

Afterwards we attended a community meeting in which Afterwards we attended a community meeting in which Ila and us addressed the crowd and they played Ila and us addressed the crowd and they played marimba afterwards. marimba afterwards.

Inspiring Observations Inspiring Observations There is definitely a need for the health clinic in Tesorito, There is definitely a need for the health clinic in Tesorito,

and the community is very grateful for it.and the community is very grateful for it. The extra medical care provided by the promotors The extra medical care provided by the promotors

funded by Promesa takes care of unmet needs that the funded by Promesa takes care of unmet needs that the Health Ministry just can’t address or overlooks.Health Ministry just can’t address or overlooks.

There is a tremendous amount of trust between Tesorito There is a tremendous amount of trust between Tesorito and Ila’s project and Caminos due to the long-term and Ila’s project and Caminos due to the long-term relationship that began during accompaniment.relationship that began during accompaniment.

The situation of the community seems more hopeful. The situation of the community seems more hopeful. They are more involved in civil society such as the paved They are more involved in civil society such as the paved road, new basico school, etc.road, new basico school, etc.

The dedication of the health promotors is inspiring The dedication of the health promotors is inspiring especially considering their very modest stipend and the especially considering their very modest stipend and the obstacles they face. obstacles they face.

Concerns: The Dental ClinicConcerns: The Dental Clinic The dental clinic has been abandoned and all of the 5 people 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 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. 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 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. 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 Prevention is key in dental health but not sustainable if people will not pay for it.not pay for it.

In August a Dentist from Tuscon came down to Tesorito and other In August a Dentist from Tuscon came down to Tesorito and other communities for 3 days to provide much needed dental work: 77 communities for 3 days to provide much needed dental work: 77 patients, 10 cleanings, 49 fillings, and 91 extractions in total. This is patients, 10 cleanings, 49 fillings, and 91 extractions in total. This is just the tip of the iceberg. The dentist donated $500 of supplies.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 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 back. For example offering a Q200 monthly stipend for a dentist to work ½ day a week in Tesorito (Saturday probably). work ½ day a week in Tesorito (Saturday probably). Pedro and Pedro and Antonio can extract molars and fill cavities. Antonio can extract molars and fill cavities. Francisco in Union Francisco in Union Victoria is also trained. Maybe doing a health camapign around oral Victoria is also trained. Maybe doing a health camapign around oral health in the community would get it back on track. health in the community would get it back on track.

Dental ClinicDental Clinic

Concerns: Eye CareConcerns: Eye Care There is a great need for eye There is a great need for eye

consults. People have to pay consults. People have to pay their own way to visit Pro-ciego, their own way to visit Pro-ciego, a private clinic in the capital, so a private clinic in the capital, so they rarely go.they rarely go.

We would like to use the We would like to use the emergency transportation funds emergency transportation funds for consults outside of Tesorito, for consults outside of Tesorito, but it conflicts with Ila`s system. but it conflicts with Ila`s system. If we manage the program If we manage the program ourselves, we could change it.ourselves, we could change it.

3 women from Tesorito 3 women from Tesorito (including Magdalena, Susan`s (including Magdalena, Susan`s host mother) went to Venezuela host mother) went to Venezuela for eye operations with for eye operations with coordination from the previous coordination from the previous alcalde. They were very alcalde. They were very reluctant to talk about it.reluctant to talk about it.

Concerns: Emergency Concerns: Emergency TransportationTransportation

There is a need for health There is a need for health promotors to accompany promotors to accompany patients to the capital due to patients to the capital due to language and cultural language and cultural barriers.barriers.

There is also a need for There is also a need for transportation funds to transportation funds to private clinics outside of private clinics outside of Tesorito in Patulul or the Tesorito in Patulul or the capital although it may not capital although it may not be an emergency. be an emergency.

Transportation funds cannot Transportation funds cannot be currently used to pay for be currently used to pay for medicine and supplies at medicine and supplies at public hospitals.public hospitals.

Side NoteSide Note

While traveling in Nebaj we saw While traveling in Nebaj we saw many eletrical towers across many eletrical towers across

the mountaintops that will the mountaintops that will eventually carry electricity from eventually carry electricity from the recently built hydroelectric the recently built hydroelectric dam near Jua to the exterior dam near Jua to the exterior (Mexico). Most small villages (Mexico). Most small villages along the power route will not along the power route will not

receive much needed receive much needed electricity from the project. electricity from the project.

Landowners were paid a one Landowners were paid a one time fee of Q7,000 to sell their time fee of Q7,000 to sell their

land for the towers. Most land for the towers. Most villages were very uninformed villages were very uninformed

about the project. More about the project. More research and a possible future research and a possible future delegation is needed on this delegation is needed on this

issue.issue.

Recommendations Recommendations Promesa is worth continuing not only for the huge need in the Promesa is worth continuing not only for the huge need in the

community, but also because we have a strong link to Tesorito.community, but also because we have a strong link to Tesorito. However, the current structure (Ila’s project) in some ways weakens However, the current structure (Ila’s project) in some ways weakens

the autonomy of indigenous health promotors creating more the autonomy of indigenous health promotors creating more dependency instead of solidarity. Other options are available and dependency instead of solidarity. Other options are available and worth exploring:worth exploring:

We could raise money for St. Michael’s general fund for all 22 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 CPR communities, because it’s a pain for Ila to keep a separate accounting system for Tesorito. accounting system for Tesorito.

Or Caminos could manage Tesorito and possibly the 2 other Or Caminos could manage Tesorito and possibly the 2 other CPRs in the south, communicating directly with Domingo at the CPRs in the south, communicating directly with Domingo at the CPR office in the capitalCPR office in the capital

Or we could give to the St. Michael’s general fund and just focus Or we could give to the St. Michael’s general fund and just focus on the dental clinic. on the dental clinic.

If we want Promesa to truly reflect the principles of Caminos/DJPC, 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 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 such as a volunteer health accompanier?), but this requires a lot of resources like volunteers and trips down there.resources like volunteers and trips down there.

THANK-YOU CAMINOS FOR GIVING US THANK-YOU CAMINOS FOR GIVING US THIS WONDERFUL OPPORTUNITY TO THIS WONDERFUL OPPORTUNITY TO

VISIT TESORITO!VISIT TESORITO!