San Lucas Toliman is a town of some 25,000 people located on the southern shore of Lake Atitlan, in highland Guatemala. Its primary crop is coffee and the town is surrounded by a series of coffee plantations and affiliated villages that fall within the larger municipality of San Lucas Toliman. The community is made up primarily of descendents of the Maya whose first language is most often the indigenous language, Kaqchiquel.However, most San Lucas residents speak Spanish as well.
San Lucas is materially a very poor community with an estimated percapita income of less than $1,000 (US) per year. Most families are engaged in agricultural labor with an average daily wage about $3 per day.
The health problems in San Lucas directly reflect the poverty of the community. More than one in every 25 infants will die before their first birthday. Malnutrition affects about a quarter of all children and infections, including diarrhea and pneumonia cause widespread suffering and preventable death.
Tuberculosis remains a hidden killer, a cause of chronic lung disease and disability that can affect whole families over a number of years. Trauma, particularly work-related and motor vehicle injuries is also a major contributor to health problems in San Lucas. Children with chronic disorders, such as cerebral palsy, birth defects, and developmental delay have emerged as a surprisingly prevalent and serious health need.
The goal of health effort in San Lucas is to couple broader community development initiatives with health strategies that will ensure that the best preventive and treatment interventions are provided to all those in need. The health initiative in San Lucas is a component of a larger community development program begun more than 40 years ago by the local Catholic parish (parroquia in Spanish), with continued support from the Diocese of New Ulm, Minnesota.
In addition to the health program, the San Lucas Parroquia has engaged in a variety of activities including land distribution, home construction, potable water system construction, and microeconomic projects. The health program has grown substantially over the past few years and now has several components:
This 65-bed facility serves as the primary source of direct health care services for the town. It is focused on providing high quality outpatient services and emergency care for urgent healthproblems.
Approximately 50-100 patients a day are treated at the Clinic. The Clinic is the only health facility open 24 hours per day, 7 days a week. Dr. Rafael Tun, the supervising physician, is native to San Lucas and has been working with the Clinic for almost ten years.
Children requiring intravenous and intensive antibiotic therapy are commonly hospitalized here, as are adults with a variety of chronic disorders. Complicated births are delivered at the clinic as well.
Emergency patients are brought to the clinic for immediate treatment at all hours and can either be admitted to the clinic or transferred to the National Hospital in the departmental (state) capital, Solola, for major surgery or complex interventions.
In the plantations and 22 villages outside of San Lucas, the best way to ensure the delivery of appropriate preventive and therapeutic health care has been through the training of local community citizens as health promoters. This program now serves 17 communities with the hope of expanding into more.
The promoters have basic education but are specially trained in prevention strategies, health education, and the early recognition of serious disorders. They also have the capacity to provide emergency first aid and arrange referral and transport to the Parish clinic in San Lucas. The promoter program is coordinated by the Parish Clinic and the promoters meet and continue their training on a regular basis.
Technical assistance for the Clinic and the promoter program are provided by short-term visits of US-based physicians and medical students. Physicians with specialized expertise, such as general surgery, radiology, and pediatrics, as well as generalists participate in the San Lucas health program on a regular basis.
In addition, medical students and students also spend time with the program, although they work as they would in any US-based hospital or clinic, always under the direct supervision of an attending physician. Students from a variety of medical schools have had remarkable experiences participating in preventive and clinical care as well as learning about the local culture and the determinants of health in resource poor areas of the world. Groups interested in offering services to the community are encouraged to learn more.