Although Guatemala is the largest economy in Central America, it trails its neighboring countries in almost any social and economical aspect: Its human development index – a composite measure of life expectancy, income and education – is the lowest of any other country in the region. In the department of Quetzaltenango – the area in which Primeros Pasos is located – it is decreasing even further (PNUD 2012). Despite the prevailing poverty in Guatemala, it is often overlooked when it comes to allocating international aid.
Guatemala’s government is divided into three basic levels: national, departmental, and municipal. Guatemala has 22 departments and 330 municipalities. The majority of the population works in the production of corn, vegetables and flowers for home consumption and market supply. Others make their living in quarry work or domestic care. Guatemala’s overall population is 60% indigenous, primarily of Mayan decent. However, in more rural areas such as the Valley, over 98% of the population identifies as indigenous.
In 1954 a U.S. sponsored coup initiated a civil war in Guatemala that lasted over thirty years. The ramifications of this conflict are still being felt by the country and have led to critical shortages in health care professionals, medicine, and health centers throughout the entire country. In Quetzaltenango, most public resources and services are focused within the city center, leaving rural areas without adequate public medical care. Because the public health system does not adequately reach rural areas, there is an increased demand for private care, which has lead to higher prices. About 10 million people, 77 percent of the population, have no Social Security coverage or private insurance. Worst affected by the lack of healthcare are the indigenous Mayan population, who tend to live in rural areas, are extremely poor and have little education. Many use home remedies to treat themselves and have never seen a doctor.
Malnutrition is also a very serious problem across Guatemala. According to USAID, the overall chronic malnutrition rate in Guatemala for children less than five years old is 50 percent, higher than any other country in Central America and higher than many African countries. Consequently, childhood death is all too familiar, as infant mortality accounts for almost 25 percent of all deaths in Guatemala.
The Primeros Pasos Clinic is located in the Palajunoj Valley, just 10 minutes south of the city center of Quetzaltenango by bus. Quetzaltenango, or Xela as it is locally known, is the second largest city in Guatemala with a population of 250,000 urban inhabitants. is situated in the heart of the Sierra Madres Mountains about 125 miles northwest of Guatemala City at an altitude of 8,000 feet. It is home to several schools and universities, and is very important economically, not only for agricultural production, but also for the industrial and commercial activity it develops. The Palajunoj Valley is part of the same municipality and is home to more than 15,000 people, spread throughout 10 communities. Despite its proximity to the urban Xela, the communities are considered rural due to the lack of access to basic services such as running water and healthcare.
The Valley is home to only one public health post that employs one doctor and one nurse. Like most public health centers in Guatemala, they often do not have sufficient resources and many patients must go without care. Without the means to travel to receive health care, many residents of the Valley are left with almost no options to access care.
The top two national causes of morbidity are acute respiratory infections and intestinal parasites. In the Palajunoj Valley, many of these treatable illnesses also become the highest causes of mortality. The main causes of death in Quetzaltenango are pneumonia as a result of respiratory infections and diarrhea. Primeros Pasos seeks to reduce the burden of these illnesses through education and empowerment initiatives, and provision of free or low-cost healthcare services.