Goals:

1. Create a sustainable system of health care in Santa Cruz La Laguna, which will serve as a model for subsequent systems around Lake Atitlán.

2. Sponsor global health education and Medical Spanish courses for students, residents, and practicing physicians, as a means of sustaining the project financially.

3. Develop an ongoing program of medical specialist intervention via monthly specialty clinics at the health care facility in Santa Cruz La Laguna.

4. Provide medical consultations for health care issues via the Internet.

Santa Cruz La Laguna is located on the north side of Lake Atitlán, which is located in the West Central Highlands of Guatemala. Lake Atitlan, approximately 13 miles by 8 miles, sits one mile above the sea, and is surrounded by three magnificent volcanoes.

Historical Background

The municipality of Santa Cruz La Laguna is comprised of five communities, with the pueblo of Santa Cruz, being both the largest and the seat of the municipal government. The total population of the municipality of Santa Cruz La Laguna is approximately 5,000, with the population of the pueblo of Santa Cruz being approximately 1,800.

Because of its geographical location, situated in treacherous mountain terrain, there are no roads to or from the town, making Santa Cruz accessible only by foot or by boat. Panajachel, which is the closest urban center and the gateway to the rest of the country, is a 20-minute motorboat ride from Santa Cruz. Sololá, which is the capitol of the Department of Sololá, is located above Panajachel, and it is either a 15-minute bus or pick-up truck ride from Panajachel or a 5-hour hike from Santa Cruz.

Because of its lack of accessibility to the rest of the country, Santa Cruz has been left behind in terms of economic development and social services. Educational and health services are the poorest in all of the Department of Sololá. And Santa Cruz ranks at the bottom in terms of literacy rate, with 73.4% of the population currently illiterate. This is a marked improvement from the 90% illiteracy rate of only a few years ago, but Santa Cruz still suffers from the lowest literacy rate in the entire Lake area.

Santa Cruz also ranks number 1 in infant and maternal mortality. Health services, until the interventions by Mayan Medical Aid, were practically nonexistent, with only a minimally trained itinerant nurse, who worked in the health center 3 to 4 days per week. Although a new health post was built several years ago, like so many projects in Guatemala, there were no funds for equipment or staff, leaving the clinic building virtually empty and of little utility.

Socioeconomic Considerations

The population of Santa Cruz is 99.5% Mayan indigenous. The town was settled in approximately 1540. And for centuries, the people have farmed and fished for their subsistence, growing a small variety of foods, such as corn, beans, squash, green onions, and coffee.

Today, many residents continue to subsist in this manner, although more and more the economy is fueled primarily by money earned from two other sources: 1) working at manual labor for the construction of homes for foreign owners, and 2) working for the few small hotels that have sprung up along the lake shore over the past 10 years. Additionally, the women of Santa Cruz are very good weavers, and efforts are now being made to help market the weavings as a means to help supplement income for families.

Nevertheless, the general population is uneducated, with the average man having completed only 2 or 3 years of schooling, and most women having had little or no formal education. Until very recently, only 3 or 4 students each year, out of four hundred, had completed any sort of secondary or professional training.

The primary language spoken in Santa Cruz is Kaqchikel, one of the many Mayan dialects native to Guatemala. Spanish is spoken as a second language, although most women do not speak any Spanish at all due to their lack of education. English is not spoken by any of the local people, although there is a growing interest in learning English among students and young adults.

Santa Cruz has no market and no services, such as a post office or bank. Other than those health care workers associated with Mayan Medical Aid, there are no doctors and no dentists. Moreover, there are no stores, except for a few small “tiendas,” which only sell basic items. Food shopping, paying electric bills, and general commerce, all require a boat ride to Panajachel, which costs 4 Quetzales or approximately 60¢ U.S. each way. This fare, although low by U.S. standards, is a great deal of money for the local people, who only earn - on average - 150 Quetzales or $20 U.S. per week.

Electricity was brought to Santa Cruz approximately 8 years ago. But there is still no public phone service, except for cell phones, which are expensive, in a relative sense, for the populace to use.

Education

The town of Santa Cruz La Laguna has one public primary / pre-primary school. In total, there are 12 classrooms. Yet, the physical condition of the school is grim.

There are no public school facilities in Santa Cruz beyond the 6th grade, though efforts are being made to form a secondary school. As such, if students wish to continue their education beyond primary school, they must travel to another town by boat to attend classes. Thus, the cost of higher education must also include travel and / or living expenses, making it financially prohibitive to almost all students.

Children enter the educational system after age 5. They begin with pre-primary classes, and then, they move from first through the sixth grade. Many students spend more than one year in each grade, and it is not unusual to have a 10-year-old in first grade or a 16-year-old in sixth grade.

Free public education ends with graduation from sixth grade. “Básico,” or middle school, is the second level of education and is a three-year program. High school or “Diversificado” follows, and it is organized into specific career paths, such as teacher training, nurse training, bookkeeping / secretarial training, and the like. University training is the last rung on the educational ladder, but is virtually out of reach to those who live and grow-up in Santa Cruz.

The school currently enrolls approximately 406 students in the primary school. Due to a population increase and a growing higher regard for education, the school enrollment has doubled over the past 5 years. More children are going to school and staying in school. This year approximately 40 students will graduate from the 6th grade, whereas in 1998, only 3 students made it that far in the educational system.

The number of teachers varies each year depending upon who is in political office at the time and how persistent the school is in demanding their rights to have enough teachers assigned to their school. The teaching staff consists of 50% permanent and 50% contracted teachers. Permanent teachers return each year, whereas the contracted staff changes each year. In some years, there is a month or more delay before contracted teachers are allocated by the Ministry of Education, and the town never knows for sure exactly how many will be allocated each year, making teacher training, program planning, and student/staff assignments most difficult.

The primary school was built when the town was much smaller. The classrooms, bathrooms, and kitchen facilities are inadequate for the current school population. Over the past few years, town leaders have been able to locate funds to help make needed, but minimal, repairs to existing bathrooms and classrooms. Still, the bathrooms barely function, windows are broken, and the kitchen has no real cooking or clean-up facilities. An outside group raised money to paint half of the classrooms, construct bulletin boards and cabinets for all classrooms, and, generally, improve the appearance of the school. Though much more is needed, the school is much better than it was.

The Project

Mayan Medical Aid has begun to form a sustainable, health care system with our initial project in Santa Cruz La Laguna. To date, we have taken the first steps not only toward modernizing health care for the people of Santa Cruz, but also in the direction of cooperating both with the Guatemalan Ministry of Health and the newly refurbished hospital across the Lake in Santiago Atitlán.

Additionally, we are in the process of arranging a relationships with medical schools in the United States. The purpose of such a relationship is multifaceted. On the one hand, it will sponsor education for students, residents, and practicing physicians. On the other, it will provide medical consultations via the Internet. The first group of students will arrive to help with our Pediatric Project in June 2005.

The clinic in Santa Cruz La Laguna also will be the model for demonstrating what digital technology can do in a rural atmosphere for an impoverished people. It will have the capability for Internet communication with respect to 1) x-rays, 2) pictures of patients with rashes or other maladies, 3) electronic medical records, 4) Internet access to medical information, and 5) e-mail and voice communication with the United States. In short, the clinic in Santa Cruz La Laguna will be distant medical clinic in association with medical schools in the U.S., wherein specialists and educators from the schools can read the X-rays and consult on patients with a wide variety of ailments.

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