By BETSY TAYLOR
Villagers and a volunteer place a latrine on a recently built foundation.
When a dozen Providence Health & Services employees visited the small Guatemalan village of El Soch in February, they installed 38 latrines and hand-washing stations so that families would have a more sanitary environment than the basic outdoor waste disposal sites they had been using. Villagers and the volunteers worked together on the installations and built shelters around each latrine for privacy.
Improving sanitation will reduce the risk of contagious dysentery in a nation where diarrhea is one of the leading causes of death for children under 5. The latrine building initiative is part of the health system's work through its Providence Health International to improve living conditions in eight Guatemalan villages.
The goal of the work is to lower morbidity and mortality rates associated with malnutrition, diarrhea and respiratory illness in children under 5 and to reduce maternal deaths. In addition to sanitary latrines, the efforts include providing access to clean water and clean-burning, well-ventilated stoves, according to Providence Health & Services.
To get the job done, Providence Health International, part of Renton, Wash.-based Providence Health & Services, relies on the health system's employees who take scheduled trips as volunteers. It partners with other U.S. nongovernmental aid and development organizations that have permanent staff in Guatemala including the Christian organization Medical Teams International. Medical Teams International works with local leaders to address the infrastructure needs in El Soch. Local staff in Guatemala includes community health workers, translators and coordinators to manage development projects. Local masons are employed on construction projects.
Face of poverty
Medical Teams International says the face of poverty in Guatemalan villages "is young, indigenous and rural." Guatemala's child mortality rate at 42 per 1,000 live births is the highest in Central America. Child mortality and malnutrition are 50 percent higher among rural and indigenous children, according to the organization. The maternal mortality ratio of 136 per 100,000 live births also is one of the highest in Central America, and it is much higher in rural areas than in the capital and largest city, Guatemala City.
Providence volunteers and a Medical Teams International community health worker, in the red shirt, mix cement and sand to make concrete for the latrine base.
The villages Providence Health International works with — El Soch, Monte Maria, San Pedro Beleju, Pajales, Pajuil, Capilla Chiquita, El Amay and Esquipulas — are a one- to three-hour drive from the city of Chicaman, in a region also called Chicaman that is about 150 miles northwest of Guatemala City. These villages, like many of the villages in the region, lack health services and basic infrastructure, said Aimee Khuu, director for Providence Health International.
Three years ago, Providence Health International, which also distributes medical supplies and donated equipment to mission hospitals, more closely focused its international work. Providence Health International had worked with Medical Teams International in Guatemala before, and it agreed to join with that group in a continuing initiative to address health-related needs and health illiteracy in eight of the 16 villages where Medical Teams International regularly works.
Health promoters
Volunteers and in-country partners have installed 170 stoves in village homes and ensured they are safely ventilated outside to improve the indoor air quality and reduce respiratory illness. Providence Health International and its partners, including local staff from the villages, teach mothers how to use the stoves and how basic sanitation practices, including hand washing, can protect a family's health. There are 168 mothers who take part in a four-year education program. Each provides a weekly educational workshop to another 10 mothers she supports, meaning that 1,680 mothers are educated through the program, Khuu explained.
Village children in El Soch, Guatemala, greet volunteers from Providence Health & Services. R. J. Tripicchio, co-leader of the February latrine building trip, and Debbie Steiner exit the van's sliding center door.
Medical Teams International community health workers provide at-home visits for pregnant women, including education about prenatal care. Teams of medical volunteers from Providence Health & Services also visit the villages to provide medical and dental care. The sum of the work in Guatemala is designed "to make an impact on the health of a region," Khuu said.
Ties that bind Providence Health & Services has found the medical mission trips form and strengthen bonds among its employees. Most of those who participated in the latrine building trip from Feb. 21 to March 1 work in the system's marketing and communications departments. They work in various locations, and the service work brought them together as a team. They spent four days helping villagers build latrines in El Soch.
The latrine project is an on-going project. The target total is to build 84 latrines in El Soch, with a goal of installing 1,080 latrines in the eight villages, Khuu said.
Before every trip, volunteers raise money for supplies needed for their project. The group that went to El Soch raised about $11,500 for the latrine-building, Khuu said.
Employees use personal or vacation time for the trip and pay $800 out of pocket to cover a portion of their travel. Providence Health & Services pays for organizational costs of the work and $1,000 toward each volunteer's travel costs, explained Khuu.
Before the volunteers arrived from the United States in February, Medical Teams International staff in Guatemala purchased materials to install fiberglass latrines and dug large holes to hold waste.
The Providence Health & Services volunteers were based out of Chicaman city, and they drove about an hour and a half on one-lane dirt roads to the mountainous village of El Soch, which has fewer than a thousand residents. There, at the site of each latrine, they built a wooden frame and mixed and poured concrete to create a base for the latrine, which fit snuggly on its foundation over the deep hole in the ground, to create a composting toilet. Volunteers said the families that received the latrines had outdoor toilets, but they weren't tightly sealed, and bugs or rodents were a problem.
By each latrine, community members built a "tippy tap," a basic system that uses a foot pedal rigged to tip an elevated container filled with clean water, so that people can wash their hands after every latrine use.
Khuu said new latrines are constructed for a family on a family's property, with an estimated six family members per latrine. Individual families refill and maintain their own tippy tap.
Time for reflection
Karina Jennings is Providence Health & Services senior director for product and digital marketing. She went on a trip in February of 2014 and returned as a co-leader for the February 2015 trip. The Guatemala trips include co-leaders who were volunteers during previous visits. They lead reflections for the group each morning and night in Guatemala.
Jennings said she and her co-leader Robert "R.J." Tripicchio asked questions of volunteers that were intended to bring context and focus to the work. In the morning, they might ask: "What do we want to accomplish today? What's the difference between serving, helping and fixing?" Or at the end of the day: "What have we learned from the experience?"
The volunteers used interpreters to communicate with villagers. The villages served by Providence Health International primarily speak three Mayan indigenous languages, Q'eqchi, Pokomchi and Quiche, Khuu explained. Many of the children and some of the volunteers knew Spanish, too, so they could communicate with each other.
Volunteers said they don't think they'll ever forget the comments they received from villagers. One father told them: "In all of my time in the village, I've never seen a project like this. God bless you all."
One of the mothers, who works with Medical Teams International to educate other mothers about health issues, said, "Even when you are no longer here with us, you'll be here in our hearts."