Milpa Medicine

(a temporary note about the photos in this gallery – they are all watermarked as “Olintepeque.”  That is not correct, because these were taking in Patzibal, Chichicastenango, El Quiche, Guatemala.  I will replace these photos with correctly marked photos as time permits within the next day or two)

In November 2016 Wendy and Sara, students in the University of Texas Medical Branch Physician’s Assistant program, worked for several days in a very rural clinic set in the tiny little central highlands village of Patzibal, Chichicastenango.  The clinic, run by a North American by the name of Sally York, is buried deep in the “milpa,” which as every Guatemalan knows is an agricultural plot of land that can range in size from a few square yards to many acres.  In Guatemala, what that generally translates to is a corn patch or field.

Clients who come to this clinic are the campesinos, or as they are more likely to call themselves, agricultores, who live in the surrounding villages in this far-flung section of the municipal of Chichicastenango.  For the vast majority of these families, though, titles that suggest they are “farmers” or “farm workers” usually doesn’t quite capture what they do.

Almost all families, to explain, supplement their diet through production of some amount of corn to dry and grind into masa, or dough, for tortillas This is more a tradition and cultural artifact than a means of income, however, because few families own more than a very small plot of land, and even for those who do own more than a fraction of an acre, growing corn is not rentable, or profitable.  Indeed, depending on the cost of imported corn or the possibility of a bad year with too much or too little rain or too many gallinas ciegas (blind hens, as grub worms are called) or other insects or plant disease, growing corn can easily result in an overall financial loss.  So almost no families engage only or even primarily in subsistence agriculture in this part of Guatemala, and very few families have enough land for food production activities to make more than a modest contribution to family income.

Rather, families tend to support themselves with a collection of micro-industries.  Men may work as day laborers for larger land-holders, or as occasional laborers for various businesses in Chichicastenango or other towns.  Some number will have regular employment working as teachers or as relatively successful comerciantes, but that’s relatively rare.

Women, on the other hand, may engage in piece work in the home, making tourist items for the market, or may be fortunate enough to find a job working in one or another little store or industry in the large pueblo of Chichicastenango.  A much larger percentage work as domestics in the homes of more wealthy neighbors – for a proverbial “Señora” (‘proverbial’ because if you ask who they clean house and do laundry for, they shrug and point loosely one direction or another, and answer “Una señora.”)   Most of the families also have one or another connection to the market, having a market booth themselves, or working in somebody else’s market booth, or working as an “ambulante,” a vendor who walks through the market with their wares on their arms, or head, or backs, or all three.  And a significant number of families receive a modicum of remesas, or remittances, from relatives living and working in the US.

In any event, with rare exception, it is generally an understatement to say these are not wealthy people, and absolutely many of them are despicably poor – to the point that I frequently wonder how they get by, and what hidden source of income they might have.  In research I did a while back, I interviewed a large number of families who appeared to have an annual income of well under $1,000.  And more recently – last summer – I did some home visits with other UTMB students in which we visited homes in which family income appeared to be well under that amount, running as low as $20 per month.  That’s obviously not enough to live on, even with no house payment or significant rent.  But somehow, mysteriously, they manage not only to scrape by, but to maintain an admirable sense of dignity and in most cases to project the appearance of being happy.

Anyway, as for the week-long UTMB clinic in Patzibal in November, it turned out to be very busy on one day, the day of a regularly scheduled clinic maintained by Ms. York, but not so busy on other days.  So in the future the UTMB clinical rotations will very likely work in that clinic on that one day, then work in other sites around Chichicastenango the remainder of the week.

That’s good.  I have been in Patzibal many times, but never had the pleasure of visiting this clinic or meeting Sally York, who has become rather famous in this corner of the Central Highlands.  I’ll try very hard to correct that situation in my upcoming trip in February, when I’ll spend a week in Chichi with the next UTMB clinical rotation.