Suchergebnisse

Guatemala is one of the first countries in the Americas to establish community health worker (CHW) programs, and CHWs have served a central role in both large‐scale national programs and small‐scale nongovernmental organization (NGO) projects. The role of CHWs, including their training, responsibilities, and idealized identities, has never been uniform, and has fluctuated over time in response to changing international health paradigms, national socioeconomic and political processes, and local‐level power structures and expectations of the position. In this paper, I examine the changing nature of CHWs in the Central Highlands of Guatemala by focusing on the case of the Behrhorst Clinic in Chimaltenango, Guatemala. The Behrhorst Clinic was one of the first to implement a CHW program in Guatemala, and is one of the few NGOs in the region to operate continuously since the 1960s, providing a unique case study to examine the history and transformation of CHWs in three distinct sociopolitical periods: the Primary Health Care era (1960s–1970s); the sociopolitical violence (1970s–1980s); and the aftermath of the violence (1980s–2000s). This longitudinal analysis of the Behrhorst health promoter program highlights central, ongoing issues facing CHW programs in Guatemala and beyond including: the political susceptibility of community participation and empowerment programs; community participation and representation; and the long‐term and intergenerational impact of CHW positions that function as a mechanism for socioeconomic advancement through the provision of curative services.

Background: Depression is the largest contributor to non-fatal health loss globally and the majority of this burden occurs in low- and middle-income countries. Yet, estimates of prevalence rates and severity in these contexts may be uncertain due to limited screening, lack of mental health providers, and stigma around mental disorders which may prevent individuals from seeking care. In Guatemala, estimates of depression vary, due in part to the range of screening and diagnostic instruments used and diversity of sample populations. Most studies emphasize personal experiences with violence as a predictor of depression in Guatemala, although high rates of inequality, discrimination, and resource scarcity in the country potentially play a role. Aims: In this study, we examine factors associated with depression severity categories measured with the Personal Health Questionnaire 9 (PHQ-9) among a random sample of women in a small urban community in the Central Highlands of Guatemala. Methods: Participants were recruited through a randomized sample of households in a small urban community. Participants completed a questionnaire which included questions on demographics, illness history, food insecurity, and the PHQ-9. In total, 101 women were included in the analysis. Results: Food insecurity, 2-week symptom reporting, and experiencing susto are associated with higher depression severity categories. Conclusion: This research highlights need for more research on factors related to the prevalence and severity of mental disorders, and the relationship between mental disorders and cultural constructs of distress, particularly in areas like Guatemala with limited mental health services.

This article examines children and youth's future orientation in rural Guatemala by examining their reports of activities of adults and children in present and future households. A total of 690 students in a small town in highland Guatemala completed a household task attribution form that listed 29 tasks in seven domains (domestic chores, care for children, household decisions, responsibilities, household purchases, work for money, development) with four gendered household figures (man, woman, boy, girl). Using cultural consensus analysis, we analyze patterns of agreement and variation in responses to determine the existence of shared cultural models and gendered submodels in both time periods. Taking a gendered and intergenerational relationality perspective, we focus on the ways that future orientations reflect, (re)produce, and contest contemporary gender norms. Reports of task distributions in the present reflect "traditional" gender norms divided along "productive" and "reproductive" lines. While male participants' conceptions of the future largely reproduced these structures, female participants appeared willing to increase their own domestic work to foster greater gender equality among their children.

ABSTRACTThe predominant hypothesis regarding the ecology of body image suggests that contexts of food insecurity foster positive evaluations of and preferences for fat bodies as they symbolize wealth, social and reproductive success, strength, beauty, and fertility. Yet, there are few studies that empirically test this relationship or examine how experiences of food insecurity influence perceptions of thin bodies. In this study, we examine the ecology of body norms among a group of primary schoolchildren in a semirural community in the Central Highlands of Guatemala. Specifically, we test the hypotheses that food insecurity predicts fat‐positive or thin‐negative evaluations of children's body size or, conversely, that food security predicts thin‐positive or fat‐negative evaluations. Utilizing a characteristic attribution task to measure positive and negative evaluations of average, thin, and fat bodies, we measure the strength of preference and prejudice for each body size. While we find a strong preference for average bodies and prejudice against both thin and fat bodies overall, food insecurity predicts children having very negative evaluations of thin bodies. These results suggest a different interpretation of the ecology of body norms as, rather than fostering fat‐positive evaluations, food insecurity exaggerates biases toward thin bodies.

John S Luque,1 Jonathan N Maupin,2 Daron G Ferris,3,4 Wendy S Guevara Condorhuaman4 1Department of Public Health Sciences, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, 2School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, 3Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, USA; 4CerviCusco, Cusco, Peru Background: Peru is characterized by high cervical cancer incidence and mortality rates. The country also experiences significant gaps in quality cervical cancer screening coverage for the population.Objective: This descriptive mixed methods study conducted in Cusco, Peru, aimed to assess the attitudes and perceptions of medical staff, health care workers, and patients toward a cervical cancer screening program that included both clinic-based and community outreach services conducted by a nongovernmental organization clinic (CerviCusco). The study also explored patient knowledge and attitudes around cervical cancer and about the human papillomavirus (HPV) to inform patient education efforts.Methods: The study employed structured interviews with key informants (n=16) primarily from CerviCusco, which provides cervical cancer prevention, screening, diagnosis and treatment services, and surveys with a sample of patients (n=30) receiving services at the clinic and at screening campaigns.Results: The majority of key informant medical staff participants felt that the general public had a very negative view of government health services. One theme running throughout the interviews was the perception that the general population lacked a culture of preventive health care and would wait until symptoms were severe before seeking treatment. Regarding services that were received by patients at CerviCusco, the participants responded that the prices were reasonable and more affordable than some private clinics. Patients attending the rural health campaigns liked that the services were free and of good quality.Conclusion: CerviCusco has demonstrated its capacity to provide screening outreach campaigns to populations who had not previously had access to liquid-based cytology services. The finding that patients had generally low levels of knowledge about cervical cancer and the HPV vaccine prompted the development of culturally and linguistically appropriate educational and promotional materials to improve the educational component of the periodic campaigns conducted primarily in rural areas of Andean Peru. Keywords: Pap test, rapid assessment, global health, screening programs, outreach, South America

Privatization and the New Medical Pluralism provides ethnographic accounts of the effects of healthcare privatization for indigenous Maya people in Guatemala. This volume will greatly interest scholars in anthropology, global health, and public policy by offering insight into the challenges, opportunities, and inequalities the Maya people face.