We believe in cure and prevent to

transform. Women and childrens teaching

us to believe. Development Project in

charge

Integrated Development Project Prevention for transformation

ASSADE – San Andrés Itzapa, Chimaltenango Guatemala, Central America

Association for health and development (ASSADE), is a guatemalan NGO located in the highlands, specifically in San Andrés Itzapa, Chimaltenango. A region with 33,000 inhabitants, where 90% belongs to the mayan ethnicity ‘kaqchikel’. Close to 75% of popolutation living in poverty, and near to 35% in extreme poverty, it means when people survive with less than a dollar per day and they don’t have access to cover the basic needs. ASSADE born with the dream of a women who worked 25 years in the public health system of Guatemala, during the civil war in the country that last for 36 years, in 1980; her brother, a doctor who she admired was murdered. After that moment, she noticed a lot of changes in the public health system, the transition to from dictatorship to democracy makes the health system will deploring, reaching ruin. In 2004 she decided to fund ASSADE, a non governmental and non profit organization, dedicated to promoting health and sustainable development, quality and social justice, especially in the maternal and child group living in poverty and extreme poverty. Her biggest dream is to built a entire health center to cover all people who need it, she wants to name the center after her brother, and she hopes not to die before seeing his dream come true. ASSADE bases its actions on the belief that health care is a constitutive right of human beings and to address the psycho-social needs of individuals, families and communities. We understand development as the possibility that the different groups, ethnicities and cultures are free agents of their own destiny to economic, social and political level, with the ultimate aim the realization of women and men. ASSADE began as a only primary health clinic for two years, then it was possible to creat a very tiny pharmacy. Nowadays ASSADE has four clinics, two of them function in regular daily bases, one clinic to different purposes, once a month for example we have a day dedicated to the gynecological branch (pap testing, IUD method, ultrasounds, cryotherapy) or sometimes with volunteers of other specialties like physicology, physiotherapy, pediatrics, cardiology, among others. The other clinic will be for dental care, it was possible thanks to DOCARE International, we still haven’t opened for resources but we hope in a near future it will be ready. ASSADE has a pharmacy, a recovery room, a warehouse, dining room and an office. We still pay rent for the facilities, because we don’t have resources to buy land and begin construction of the center. ASSADE is formed by a group of six people. ASSADE covers around 900 people monthly, people only pay a donation fee for consultation and meds according to their possibilities. Guatemala has a population of over fifteen million people, of which more than half are indigenous and poor. The country faces countless problems, and decades of war and instability has not made a difference – until now. Guatemalan society is stagnant, where the problems are known, but almost nothing is done about it. Any relief effort is disorganized, top-down, and paints a meager picture for the future state of the country. In addition, the societal dynamic is dehumanized where selfish crimes are thought of instead of work. Social welfare, which includes group work and capitalizes on the close society of Guatemala, is a far cry away. It is, however, the indisputable solution to such a complicated and long list of problems. In a country where the long list of problems is only getting larger, an era of complacency is seen as permanent. In a quasi-lawless society, corrupt politicians and leaders of narcotraffic organizations are respected more than non-profit organizations. Lives of crime are romanticized more than those based on education. The population blames the current state of crisis and anarchy for their problems, but never attributes causes to these problems. Fortunately, this crippling era has created something truly amazing in people- the birth of creativity, where people find it in their best interest to develop strategies and find solutions to transform the social, economic, and environmental standard of a dying Guatemala.

Almost two decades after the civil war ended, it has become clear that the status-quo is not working. A vast change in perspective is necessary to achieve a transformation that will make a real difference. The current health care system in our country is deplorable, exclusionary, and inaccessible. It prioritizes health as a final product without consideration of the environmental and monetary costs. Ironically, this hurts healthcare even more. For many years, ASSADE has been developing this change in perspective in the highlands, San Andrés Itzapa, Chimaltenango. A vertical transition of gender, socio-cultural, economic, and environmental conditions in San Andres recognizes that change is possible and obtainable. We work tirelessly to create a physical, social, and mental norm for the people; a right we feel is one of their basic human right. In 2011 we started working on prevention, that we believe is very important to cover and implement a project in the communities. We realise that is quite necessary to reach progress and human well being, through years we identified three prevailing conditions: respiratory problems, gastrointestinal problems and malnutrition. We looked for the real causes and started working on this, that’s how the prevention project was born. The Integrated Development project in San Andrés. To understand what the project is about, we will share you a short story.

We want you to meet Lesbia Micá, she is an indigenous women of the community Vistas de San Lorenzo, in San Andrés Itzapa, located in the highlands of Guatemala. She has 4 childrens, a 3 boys and a girl. She lives in small land property of her mother in law. As most of the families in the region, the family of Lesbia have access to water one hour every two days, unfortunately the water of the region isn’t drinkable, comes directly from the rivers with high levels of contamination. Her childs suffer from constant diarrhea and serious gastrointestinal infections (second cause of death in childrens under 7 years old in the region). She as an adult suffer less, but even so, at least three times a year she contracts an intestinal infection.

Photos from two points of the main rivers at San Andrés Itzapa near to the collection base for community Vistas de San Lorenzo, photos taken after rain season. Rivers in the región as used as a dump because the governamental service of waste disposal only covers 1% of the population, and the rest by private services, this only reach the 8% of population. One of the main reason of the low percentage is the cost. Lesbia’s husban is a farmer with an income of US$ 2 per day, so they used to cover the greatest need (food), as they live far from the river they get rid of the garbage burning it or throwing in the cesspool.

First stage of the project, considering the evidence of the water problem in the region, ASSADE donated a water purifier to Lesbia’s family, also teach them how to use it and give it maintenance. Lesbia atended during two month once a week to receive trainings related to the water problem, related diseases, prevention mesuares, cycle of water, general hygiene, and environmental conservation. Also she atended for six months to DOCARE-ASSADE clinic to do medical monitoring, evaluating her and her kids.

In the next photos, you will see Lesbia disinfecting the bucket of her new water purifier. ASSADE works with groups of indigenous women helping them to improve their living conditions. We gave Lesbia’s family a ecological water purifier, so she and her family can have access to drinkable water, as a right as human been deserves. The filter has a capacity of 20 liters, and is possible to introduce any kind of water (rain, rivers, pipes) inside and have a safe water to cover the need (tested in Guatemala), and lowing the rates of suffering of gastrointestinal problems related with the consume of no drinkable water.

Desinfection of the bucket is made with soap and chlorine, and then it need to be dry naturally. At

the first day she doesn’t need to desinfect the filter unit, but in three months from that date she

will need to make a maintenance of the unit and bucket. The unit need to be washed only with clean

water, no soap, no chlorine, also not to receive the natural light; all this can produce to block the

coloidal silver effect in the unit.

For six months childrens under 12 years old

together with the mother, are checked in

aspects like: episodes of diarrhea,

gastrointestinal infections, parasites,

nutrition, weight, length, etc. Also, the doctor

with students do visit to the families in their

houses. All that is done after each family

receive the training and the water filter. Field

monitoring include personal and occupational

hygiene, and conditions of the device.

Photos of Lesbia putting water in the filter and the filter is ready to use. Is very easy to assambly, do maintenance and use. ASSADE works with group of women, that mean that first we stablished a group of women with the common needs, at the beginning women join with fear, but with the mental image of receiving a benefit, turns out that the guatemalan government bases its projects in giving away things. As the conditions of living of the women are precarious, they see that an alternative to cover they needs. It took a long time to change that mind, awareness of that kind of solutions only helps in a timely manner, but not a long term solution; or the solution isn’t based in the real problem, only cover the impact of that. Then the groups start working as an alternative to introduced women to another environment beyond the rol of mother-wife, we realize that starting within our homes and our community there are differents problems involved, over time women notous that the group in itself have a whole meaning, an space of expression, an space of trust, of understanding, we think that every women at the group in differents moments reach the feeling of belonging, that is awesome, because all their lives they were taught that they only are to have childs and take care of their homes, that they don’t have a voice or right to choose in the macho culture, the group complete change their ways to see life.

Lesbia opening the filter unit, a unit made of sawdust and clay, with three different layers in which the water will pass, and finally is cover with coloidal silver (bactericide). It has a useful life of two years. So, Lesbia was trained to make a saving plan to cover the need to replace the unit when she need it, and can continue using the filter.

About 3 million guatemalans lack

access to improved water and nearly

6 million have no sanitation. Only

15% has potable water and only 5%

makes wastewater treatment. The

ecological filter works by gravity and

their tiny pores trap solids including

cysts of parasites and removes fecal

coliform bacteria that cause diarrhea,

cholera an other diseases linked to

contaminated water.

Lesbia also uses an open fire to cook, other risk for the health of all family, specially she and her childrens, that passed at least nine hours every day inside the room they used to cook. Places like this are linked to respiratory problems, also burns and burning eyes. Respiratory problems are the first cause of death in the region, specially in kids under seven years old. As one of the biggest problems, ASSADE helps to built a clean stoves, as a second stage of the project.

Open fire

Open fire is more common

way to cook in the región

of San Andrés Itzapa. At

least 80% of the

population use it. In first

place because firewood is

a fuel very easy to get,

nowadays in the region

there are no enviromental

laws, so some families buy

the firewood or dedicated

working hours to get it.

The first photo is what a

open fire is. Know it as the

three stones fire by the

mayan culture. For them

its represents the start of

life.

The photo below the first

one is how’s look Lesbia’s

kitchen normally. As can

be seen the walls are black

near to fire, in this case she

make an space between

ceiling and walls so the

smoke can gets out, even

so the smoke in the room

is insupportable. The

flames are a constant risk

for Lesbia and her

childrens. She only can

cook one thing at the time.

The space isn’t the ideal

hygiene.

In Guatemala, 65% of

deforestation due to the

use for cooking.

Changing…

As a cohesive group, all the

activities we carried out

with a team work spirit. In

the first photo, the process

of building the new stove

for Lesbia. Her group

mates help all the process.

Lesbia already receive for

two months training

related to cook with open

fire, linked diseases, ways

of heat transfer,

environmental

conservation, cooking

hygine, cultural significant

of fire, how to confront

the change of the way she

cooks that will change all

her life style.

The new stove is portable,

it is manufactured in the

workshop so we can

eliminated the old way of

cooking and built the new

one without waiting of

drying process, and Lesbia

can start using it until

finish the construction. It

uses three times less

firewood, the fire chamber

optimizes the fuel, is

possible to cook two

things at the same time,

used the griddle to make

‘tortillas’, it has two wings

to cover the absense of

tables toe at in the

families, it has a chimney

driving 99% of smoke out

side, also child protection.

And it has a harmony with

the mayan culture.

The extreme poverty of families prevents them from eating full diets which meet even minimal nutritional standards. Only having access to meager amounts of the same food every day leads directly to malnutrition and stagnant development in children. In the region, that is base on agriculture, they grow corn and black beans, main ingredients of the regular diet in Guatemala. Food availability is one of the factors that influence the quantity and quality of the products consumed by a family. Children and women need a more varied diet. The immediate solution that ASSADE has implemented is alternative gardens and small raising hens farms, which work as an effective tool for the family to produce and consume low-cost, healthy food. In addition, the family is able to work together to produce food and future food security. This type of garden or farm and crop establishment is directly related to the needs and preferences of each family, always working as a group. At first, ASSADE works with groups of women, specially in training, in a wide range of training. From healt-related issues to ‘how to work in groups?’, covering communication skills, dispute resolution, gender violence, physcological and emotional issues, team work, a big variety of tools only to work in a group. Food availity is part of the third stage of the project, in other cases the group have chosen to make handicrafts and stablish a little bussines, home hygiene products, food, this will depend on the group. The whole idea is the economical empowerment of women, transfering tools that they can be able to apply on their daily bases to reach a complete welfare of their family, group and community.

In the photos, to the left a women of the first group that ASSADE worked with, using hydroponics to grow lettuce and cellery. To the right, the second group of women in the little hen farm that they stablished. Below a group of women preparing desinfectant for floors and bathrooms.

We realize that big part of women empowerment sojourn

to the capabilities that they may development to transform

the environment, also in the meantime they are taking

ground in the society as a ‘women is capable to do serious

changes in life’; not only for what it represents to society,

but also for what it represents to them, as an individuals.

Other important thing in the idea of creating and working a group, is the construction of alternatives for living as a women, recovery all the rights as a humans they deserve, and empowerment themselves. We confront the fact that one of the things that stop us from development is violence, also we teach and learn, we start as students and then become teachers, we always are learning. So, the groups exist as an space of expression and trust for women, to discuss around all the topics-problem that need to confront, in differents levels, space that allows them to recover their rights, practicing in their households and community, a group able to do political impact, inspired on protect and promote women beyond the alienating role, considering the environment, freedom, dignity and social peace to change lives, an space to share suffering. ASSADE created this idea of working with women groups, based that they can exist as a community union that can allow an alternative to look for progress and change lives, a sustainable long term alternative.

The education component of the project emphasizes the betterment of environment, health, and quality of life through grassroots knowledge. The education component is divided into two lines of action: The first line attempts to create economic stability for families. It establishes a business designed, organized and managed by the project participants. Decisions are made in group dialogue, avoiding inter-group complications. In addition, ASSADE guides them with the creation of the business and

acts as an advisory board, which is especially important during the early stages of creation. The second line educates families in higher goals of autonomy and empowerment. It consists of workshops whose themes are chosen through discussion and by the members of the project (including both the participants and the ASSADE staff). On our part, we wish to address the issues which we believe are crippling rural life, as well as issues that arise in discussion. In particular, health issues and the importance of hand hygiene, dental hygiene and family planning, social and psychological issues such as self-esteem and gender violence, environmental preservation and economic issues such as the importance of saving are topics which are emphasized. These issues are proposed to the group in the same way which any other member may propose a topic that interests them. Both topics must be discussed and approved by the group before being carried out.

Training to make desinfectant

Training to make purses with recycled

plastic.

The dynamics of the trainings and workshops are also horizontal (they are run in a discussion, almost Socratic seminar, format). Keeping in mind that academic knowledge cannot replace empirical knowledge, the leaders of the discussion tread carefully with respect and openness. The training should form a harmonious workshop that transcends the myth of the dichotomy "wisdom" vs. "Ignorance". Because of this, we try to avoid teacher-student structure and the vertical transfer of academic content. The more formal content is discovered experientially through elements of reality in which we live. In the photos, a group of women working in a workshop of cooperation. The education component also sets real life, approachable role models and goals (for example, proposing solutions to improve their living conditions significantly). This methodology is based on the fact that cooperative relations within a group may in many cases meet such targets to improve living conditions.

We encourage groups of women to take the tools that they have after time of training and lead it to the community, like other group of women, schools, and other groups. In the photo to the left, a training in a school of basic hygiene and how to avoid gastrointestinal deseases. At the end, we believe that the education component is the most important one in all the project. ASSADE doesn’t have any kind of support (national or international), we only carried out this project with individual donations.

Since 2012 we had worked with 52 families (100 adults, 188 childrens) with this project, at this moment we are working with a new group of 26 women, where Lesbia belongs and we are facing the second stage of the project, and we hope in a few months can start with the third stage.

ASSADE emphasizes the training as the key to development, these women are trained in differents areas so they can fase reality and search for solutions, and improve their living condition. They receive workshops of self esteem, gender violence, hygiene issues, team work, communication, dispute resolution, projects organization and planning, environmental, culture, political influence, and economy; basically education to transformation. In the photo, the new group of women of the community ‘San Lorenzo’, in the graduation of a psychological training. In ASSADE, we believe in community cohesion as a solution to finding sustainable development. These women taught us to believe. The students coming through DOCARE International help us out in the project, we included them in the activities of the project. Some cases they were involved in some implementation stage of the project, like giving the filters to the family and did the accompaniment with ASSADE.

In this cases students received a quick training on the function of the water filter, the process to desinfection and maintenance, so they can support families in the communities at the time to implement the ecological filters. At the same time they can practice Spanish skills. On the photos above, two students resolve doubts about the desinfection process and supervise the good assembly of the device.

We believe that for students can have a

integrated experience of their rotations, is

quiet important that they recognize in the

field aspects like: population living

conditions, rivers and dumps conditions,

customs and traditions. We are convinced

that this way they will be understand better,

of a more informative perspective the daily

clinc work, also can know about Guatemala.

Also some students can be with the team of ASSADE in the construction of the new saving stoves, receiving a quick training of this and going to the community to help, direct or supervise the process.

Other times, the students help out with the educational component of the project, teaching topics related with health to groups of women. They prepare the material and conduct the workshops for this purpose. In photos below, students giving a workshop of diseases related to lack of hygiene and using no drinkable water.

Photo on the left, students learning how to make ‘tortillas’ in a traditional way in a ‘comal’ with open fire. This also let the students know about how is to pass a few minutes inside the places dedicated to cook where women and childrens pass a lot of time of the day.

Regularly most of the groups with ASSADE works are located from a consider distance of the center of San Andrés, that means that for them isn’t easy to get a inmediate health care in case of emergencies. For that reason, one of the activities that we carried out is about teaching first aid to women in the communities. Selecting a few women that wanna participate in this, also be part of a “attention brigada” to help all the people in the community. The women learn about how to treat wounds or burns, take the blood presuare, take temperatura, hear the lungs, CPR, and other important aspects than can be useful for them.

In the photos above, students giving a workshop of hygiene measures and reconizing most common emergencie cases in the community.

In the pictures above, to the left: students of DOCARE giving a lecture about diarrhea and how to avoid it in home. To the right, a profesional nurses of Spain giving a workshop of CPR.

Picture on the left, students of DOCARE International sharing the most commons meds, it uses and recomendations, with a group of women. Helping to train seven women to stablish the “attention brigade” in the community.

On the photos above, students of DOCARE. At the left, teaching how to take care of a wound or burn. To the right, students giving a donation to the group of women “La Nueva Esperanza”. A pack of first aid supplies so they can start equipping a medicine cabinet that will be benefit to the community. The project is planned to last a year, unfortunately we don’t have financial support of any organization, only carried out the project with individual donors and with the help of all volunteers that come to ASSADE. As result of that in some cases the project can be extended for two years or less, in the meatime we are looking to raise funds to complete all stages with the groups. At the end of the project our goal is that women's groups remain on sustainable development and on its own can keep looking for the good life for their families and communities. If you are interested in know more or support the project you can put in contact with the development project in charge in ASSADE, Julio Letona, at assadeguate@gmail.com / julzlet86@yahoo.com for more information. You can visit the page of the project: http://assadeproyectointegraldedesarrollo.webmium.com/homepage---in-english

ASSADE – Asociación para la Salud y el Desarrollo www.assade.org / (502) 5200-5627 / assadeguate@gmail.com

Guatemala, Central America