Originally published in Synapse on May 12, 1988. Dr. Isabel Estrada is a Guatemalan pediatrician who has lived in exile in Belgium for the past seven years.
Like many other Guatemalans who have spoken out against the repression and continuing failure of their government to address the people’s fundamental needs for food, housing, and health care, Estrada was forced to leave when her life was threatened by paramilitary forces.
Estrada has family in Guatemala who could be punished for her activities abroad so she travels and speaks under a pseudonym.
UCSF was fortunate to host a well-attended noon lecture by Estrada on April 8, as part of a national speaking tour sponsored by the Guatemala Health Rights Support Project. Afterwards, we spoke with Estrada and Margaret Harris, director of the Support Project, based in Washington, D.C.
Synapse: What led to your decision to speak out against the social and political aspects of what you were seeing in your country?
Estrada: Although I had been well aware of the problems in Guatemala for many years, I eventually came to the conclusion that participating in conferences and seminars on health doesn’t really solve anything.
So I began to write articles and speak on the radio about health.
But in a country like Guatemala, health problems, especially childhood malnutrition, are intimately linked to economic issues, issues of low salaries, and political issues.
In speaking about health, I spoke about these social problems too.
These clinics used to be free, but as the health budget has been cut, they now charge a small fee for service. Outside Guatemala City, the situation is very different.
As you go farther from the capital, health services become more and more scarce. Most of the children, 82 percent of those under five years old, suffer from malnutrition, and so are very susceptible to infectious diseases.
Synapse: I know that the U.S. Agency for International Development contributes lots of money for developing services for the rural areas, as do many private organizations doing health care work.
Why is it that despite all this effort and money, there is so little health care in the rural areas?
Estrada: Unfortunately, the aid from these groups is not enough to meet the government’s need, and the proportion of the Guatemalan budget dedicated to health has shrunk each year.
Also, most of the AID money is for family planning. This should have some positive impact on the health of women, but for the most part it provides only contraceptives and sterilization.
UNICEF has given lots of money for immunization, but for various reasons the vaccination campaigns that take place once a year are not able to reach the whole population.
For example, only 49 percent of the population at risk was vaccinated against polio and DPT, 29 percent against measles, and 33 percent against tuberculosis.
So you can see, the coverage really is poor.
It was these activities that led to my being labeled a communist. The word “communist” in Guatemala is almost a death sentence; it is a word that they use deliberately to shut people up, to keep them from protesting, from investigating and spreading information. It functions as a way to keep people quiet.
When I received repeated direct death threats, it was time to leave the country.
Synapse: What kind of health services are available for the poor rural and urban population of Guatemala? If a child gets sick, for example, where would he or she go for care?
One of the obstacles to achieving higher coverage is that many mothers don’t bring their children to be vaccinated because they believe that the vaccine contains drugs to sterilize them.
Similarly, mothers often are afraid to get medicines themselves from clinics for fear they contain sterilizing agents.
Family planning programs missing the mark
Synapse: It would seem that, with so much malnutrition and poverty, family planning would be welcomed. Could you talk about the role family planning plays, and why people are suspicious of it?
Estrada: Most of the services are concentrated in the capital. Some facilities have a huge demand, so a mother might have to wait an entire morning for her child to be seen. There are also pediatric hospitals, staffed with well qualified pediatricians, but they too are overloaded and doctors can spend only a few minutes with a sick child.
The subject of family planning in Third World countries is complex. I am not opposed to family planning; I think it’s a right of a couple to plan their family.
What often happens is that women are abused because they don’t know what is being done to them.
Guatemala, and especially the Indian population, has been used as a laboratory to experiment with new drugs and procedures, the effects of which may be irreversible.
The women aren’t informed of what is being done; many times they discover that they are sterile but don’t know exactly when they were sterilized. This has made people afraid to visit a clinic or take medicines.
Guatemala is not an overpopulated country. The problem is more economic: families are unable to feed their children, not because they have too many children, but because of the low salaries they receive.
The word “communist” in Guatemala is almost a death sentence; it is a word that they use deliberately to shut people up, to keep them from protesting. from investigating and spreading information.
In the countryside, families can’t grow enough food on their tiny plots of land steep on the hillsides, while the coffee growers have plenty of the best land.
I have friends with six children who are all well fed, well educated, and healthy, while there are other families with only two or three children who are malnourished.
So the problem is much more profound than just the number of children.
Synapse: What do you think Guatemala’s future will be? It seems that President Cerezo is losing his already tenuous hold on the government, as seen in the rising death squad activities.
Estrada: Clearly it is really the army governing Guatemala through a civilian president who is very docile, because he shares their ideology. He published a pamphlet called “The Army: An Alternative,” which concluded that it is not possible to govern without the collaboration of the army. In his official speeches he thanks the army for the “democracy” they have brought
If the Arias accords [signed by the presidents of five Central American nations last year] were fulfilled as written, there would be some possibility for democracy in the country. But the army denies that there is even a conflict.
Margaret Harris: While the peace talks were taking place in Madrid, the army was beginning its “end of year counter-insurgency campaign,” which meant bombing civilian populations in the highlands.
This campaign has continued through the beginning of 1988 and has included some of the largest military offensives ever in Guatemalan history. None of this came out in the mainstream U.S. press, but it’s very well documented.
Synapse: What can we do as medical personnel and U.S. citizens to help improve the health of the people of Guatemala?
Estrada: There are several things that can be done. Perhaps the most important is to understand what’s happening in our country, and to learn why.
This could mean reading or visiting Guatemala to travel, work or study. It’s important to realize that the understanding you will get depends very much on which group you go with, or whose publications you read.
Giving money to programs and organizations that provide material aid and training for health personnel is a small thing that you can do, but very useful.
And everyone, not only students in the health professions but the public in general, can oppose aid that goes toward the war, and try to get aid for health programs.
If international aid were truly geared toward the well-being of the people, it should begin with cutting off military aid.
Aid for health care is really just negated by the other type of aid that keeps the war going.
