How many nurse practitioners can say mule riding is part of their job description? For months at a time, Mary Clark, a nurse practitioner and midwife, exchanges her Bay Area home for the coffee-growing region of southeast Guatemala, bringing health care to underserved communities and, yes, riding mules to reach some remote villages. Clark was my coworker at St. Mary’s Hospital in San Francisco. Last year, I joined her on one of her annual trips for 10 days in Guatemala and learned about the challenges and rewards of healthcare work abroad.
Clark’s recent work in Guatemala centered on coffee bean pickers who have limited access to basic health care and work under difficult conditions. Handpicking coffee beans is strenuous work that involves standing and bending for long hours. The low pay, extreme poverty, and lack of access to basic health care are big struggles for these workers.
During my stay, we visited four villages and saw about 30 people in each community. Our interventions ranged from hypertension and diabetes screening to home visits, prenatal and newborn assessments, and treatment of muscular strains and respiratory infections.
The local midwife in Chanmagua, Doña Julia, is the only traditional practitioner we met. Although she is well-respected and relied upon, Doña Julia is in her 80s, and there is no one to replace her. One day, Clark was asked to help a woman giving birth because Doña Julia was unable to attend. Clark decided it was too risky to deliver this baby and asked the family to go to the nearest hospital. We later found out the woman had a cesarean section at the hospital for a malpositioned baby. Another time, I visited the community clinic to shadow Elfa, a nurse, and I discovered she was the only staff member available for the next two months. Clark and I helped out as much as we could.
Coffee production is dominated by families of mixed European and indigenous descent. According to Clark, coffee bean pickers this year earned a “good” salary of $8 per day, compared to last year’s $3.50.
Social differences are especially apparent in Chanmagua. The coffee industry is a major operation, but coffee bean pickers, who are mostly hired from indigenous communities during harvest season, hold no representation in a coffee cooperative, which is made up of about 190 coffee farmers/landowners. Many of the patients we saw were landowners and their families, but many of the pickers were unaware they could seek our help.
Another challenge is the lack of family planning education, which we were limited in our ability to address. Guatemala is one of the Latin American countries with the smallest use of contraceptives and concurrent high rates of clandestine abortions, according to multiple U.S. journals. On two occasions, we were visited by women with unplanned pregnancies. Given that under Guatemalan law abortion is a crime unless the mother’s life is in danger, we could only provide these women with a prenatal assessment, vitamins, and a referral to the community clinic.
Another discouraging obstacle was the nutritional picture since, besides coffee, not much else is cultivated in the area. Vegetables are unavailable unless people travel to bigger towns to buy them. “Spinach? Broccoli? That doesn’t grow here, and I don’t like vegetables,” a housewife told us. In some patients, we saw signs of malnutrition and symptoms of anemia.
As discouraging as it was to become aware of the problems confronting coffee pickers, the meaningful connections we made with people we met made the trip worthwhile. I believe volunteer work abroad is important because it promotes understanding and tolerance between people of different cultures, an ever- increasing necessity today.