Guatemala: Poverty and geography limit access to care

International staff: 21

National staff: 35

Most Guatemalans have limited access to health care because they lack means or live in rural areas where health care services are minimal. MSF works in both urban and rural settings to treat and prevent AIDS, improve primary health care and address the health care needs of the vulnerable and excluded.

Attacking the problem of AIDS

MSF works with children, young people and adults to raise awareness of AIDS, a growing problem in this country of 11 million people. In both Guatemala City and Quetzaltenango, the second largest city, MSF has developed self-study AIDS prevention guides for schools and has undertaken public information and awareness campaigns. The organization trains local health workers in universal precautions and an approach to STDs that emphasizes patient confidentiality, counseling and partner tracing. MSF also provides nursing care and pharmacy management in two private hospices, the Marco Antonio hospice in Guatemala City and the San Jose hospice just outside the city.

In Coatepeque, in Quetzaltenango province, MSF offers medical support and supplies drugs to an AIDS outpatient clinic. Teams also work with local medical staff on HIV/AIDS case management and opportunistic disease treatment protocols. MSF is helping to create a reference network of HIV/AIDS specialists. Through the ACCESS campaign (see page 14), the organization is pushing for lower-cost drugs for AIDS sufferers.

"Prevention activities are aimed at the general public, but we also work with specific high risk groups such as sex workers," explains Olaf Valverde, one of the MSF coordinators in the country. "At the same time, MSF is making a big effort to improve diagnosis and treatment of AIDS patients."

Caring for street children

The country's gross inequality in income distribution (5% of the population owns 85% of the wealth) has meant that many people - and in particular many young people - have fallen through the cracks. In Guatemala City, MSF worked with street children aged 14-24 at "Rescate" (Rescue), a day center established in 1997 with the local NGO Casa Allianza. In Rescate, the team provided medical care - about 200 consultations per month - and psychological assistance.

Although the need to redefine the project meant that "Rescate" was closed earlier this year, MSF will continue to provide medical and psychological care through a new health center, which opened in June. Adolescents will be the focus, with special attention given to young mothers and their children. MSF is also working to set up a reference network of medical specialists and social workers to extend the range of care available and the network of support. In addition, teams will go into the streets to identify those young people who need help.

To prevent children from ending up on the street in the first place, in 1997 MSF started a medical and psychological support program for children and families in Lomas de Santa Faz, a slum area of Guatemala City. The MSF team makes home visits to try and strengthen relationships between mothers and children. In addition, around 40 children attend the "Casa del Patojo" (Children's House), a medical day center set up in 1999. Children here receive both psychological support and medical attention for at least three months.

People in Lomas de Santa Faz also requested help setting up a community day care center for children who need a place to stay while their parents work, or who no longer meet the medical and psychological criteria of "Casa del Patojo" but need a place to stay during the day. This center will open in late 2000.

Primary health care

MSF also runs several primary health care programs, one in the rural region of Izabal in eastern Guatemala, and another in Champerico, on the Pacific Ocean. In Izabal, the team works in the town of Frontera to improve preventive and curative services and the management of the health district. This project serves about 30,000 people. In early 2000, MSF launched a similar program in Champerico, where the last decade has seen a sharp increase in poverty due in part to the closure of the port and the railway. Another primary care program in Barillas, in Huehuetenango province, was phased out in February 2000.

In summer 2000, MSF finished the emergency sanitation and disease-control work it began in late 1998 in the aftermath of Hurricane Mitch.

MSF has been working in Guatemala since 1986.