Browsing by Subject "Guatemala"
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Item Open Access Assessing Community Based Water Organization Performance in Central America(2017-06-26) Browning, NeilWhat are the effects of household, community, technical, and environmental variables on the performance and resilience of CWOs in dry regions? Since 2014, drought has severely affected Central American economic and health outcomes, necessitating international intervention. 2.5 million people were at risk of food insecurity across the region in 2014, and 65% of homes had no stock of food during the 2015 harvest season. Low-income families living in Central America’s “dry corridor” are affected the most by droughts; the UN’s long-term plan is to build climate resilience in these communities as climate change increases the magnitude and frequency of droughts. Local community-based drinking water organizations (CWOs) are key actors in Central American water provision. In rural and urban peripheral areas, CWOs provide the populace with up to 60% of its drinkable water. As climate change strains water accessibility, these local institutions will require effective management strategies so they have the capacity to handle the resource declines they will experience. I assessed how different independent variables are associated with the adaptive capacity of CWOs and identified attributes that lead to success by conducting regression analyses on a data set from three Central American countries: Costa Rica, Guatemala, and Nicaragua. I also compared the statistically significant outcomes across the three countries. The regressions are based on survey data that has been gathered at the household and CWO level, technical data that was collected by engineers, as well as environmental and census data on the subnational regions in question. First, I examined household reports of water access – defined as number of hours per day. I analyzed how this definition of water access related to household, engineering, community-level, and environmental variables. I found that volumetric pricing and elevation are the key variables to consider when designing an effective governance structure for a Central American CWO. I also determined that it is possible that national norms in CWO procedures may overstate the effect of volumetric pricing. Second, I used three different engineering variables as dependent and analyzed how they were affected by household, community-level and environmental variables. Unlike the hours of service variable, the engineering variables were collected at the community level by engineers, rather than self-reported at the household level. I conclude that elevation and volumetric pricing are the most relevant variables to consider in effective rural water provision. Elevation increases the start-up and maintenance costs of obtaining water. Volumetric pricing should be promoted as well, as it encourages the regulation of scarce water resources in the simplest way. I also conclude that higher elevation communities require more maintenance from community members, and require more expensive and powerful pumping technology.Item Open Access Coffee and Civil War: The Cash Crop That Built the Foundations for the Mass Slaughter of Mayans during the Guatemalan Civil War(2017-05-08) Calvo, MarianaThis thesis explores the connections between coffee production and genocide in Guatemala. This thesis centers its analysis in the 19th and 20th centuries when coffee was Guatemala’s main cash crop. Coffee became Guatemala’s main export after the Liberal Revolution of 1871. Prior to 1871, the ruling oligarchy in Guatemala had been of pure European descent, but the Liberal Revolution of 1871 gave power to the ladinos, people of mixed Mayan and European descent. With the rise of coffee as an export crop and with the rise of ladinos to power, indigenous Guatemalans from the western highlands were displaced from their lands and forced to labor on coffee plantations in the adjacent piedmont. Ladino elites used racism to justify the displacement and enslavement of the indigenous population, and these beliefs, along with the resentment created by the continued exploitation of indigenous land and labor culminated in the Guatemalan Civil War (1960-1996). This conflict resulted in the genocide of Maya communities. Historians have traced the war to the 1954 CIA backed coup that deposed democratically elected president, Jacobo Arbenz over fears that he was a Communist. This thesis will take a different approach and argue that the origins of the war can be traced to the introduction of coffee in the late 19th century. This thesis is important to understanding the mechanisms of genocide because it argues that dependence on commodities leads to the commodification of entire groups of people.Item Open Access Economic Analysis of Pediatric Surgical Financing and Universal Health Coverage in Guatemala(2020) Landrum, Kelsey RaeBackground: Financing of surgical care in low- and middle-income countries remains challenging and poses challenges for implementation of Universal Health Coverage (UHC). This study is an exploration of financing of surgical care for children and alignment of surgical financing within UHC schemes in Guatemala. Our hypothesis is that current financing mechanisms do not address key barriers to provision of surgical care for children within current UHC schemes. Methods: We performed a qualitative analysis of the financing of surgical care for children in the public health system in Guatemala. We surveyed key informants (n=20) in medical, financial, and political sectors to assess mechanisms and operations of financing for pediatric surgical coverage. Qualitative results were triangulated with national financing data and health system reports, with a set of recommendations generated to improve financing of surgical care for children. Results: We found several macro-level challenges to financing for surgical care in Guatemala, including complex political contexts, health finance system fragmentation, and lack of earmarked funding for surgical care. Dominant micro-level challenges include lack of provider agency in financing and patients functioning as financing agents and beneficiaries. Although formal user fees are not used in Guatemala, informal fees for surgical services are common barriers to care. Conclusions: Pediatric surgical financing in Guatemala remains challenging, with little inclusion of surgical care within existing UHC schemes. Recommendations to improve surgical financing include evidence-based financing with provider technical input, strengthening organizational structure for surgical financing, and quantification and reduction of informal user fees through resource pooling between health system actors.
Item Open Access Family and Provider Perceptions of Barriers to NGO-Based Pediatric Surgical Care in Guatemala(2014) Silverberg, Benjamin AndrewBackground: Globally, there is often a gap between medical need and access to care, and this is particularly true for surgical care for children. In Guatemala, for instance, families frequently pursue care outside of the government health system. Using a structured anthropologic approach, we sought to explore the barriers to surgical care for children in Guatemala, suspecting both financial and cultural barriers were the primary obstacles families had to face.
Study design: Twenty-nine parents/guardians of children receiving surgical care at two non-governmental organizations (NGOs) in Guatemala and 7 health care providers participated in semi-structured interviews to explore what they believed to be the impediments to care. Transcripts were analyzed using a grounded theory approach. Current models for barriers to care were critiqued and a novel Framework for Barriers to Pediatric Surgery in Guatemala (FBPSG) was developed, which highlights both the existence, and centrality, of fear and mistrust in families' experience.
Results: Families and providers identified financial costs, geography, and systems limitations as the primary barriers to care. Mistrust and fear were also voiced. In addition, health literacy and cultural issues were also thought to be relevant by providers.
Conclusions: Due to biases inherent in this sample, parents/guardians did not necessarily report the same perceived barriers as healthcare providers - e.g., education/health literacy and language - and may have represented a "best case" scenario compared to more disadvantaged populations in this specific Central American context. Nonetheless, financial concerns were some of the most salient barriers for families seeking pediatric surgical care in Guatemala, with systems limitations (waiting time) and geographic factors (distance/transit) also being highlighted. Fear and mistrust were found to be deeper barriers to care and warrant reevaluation of organizational heuristics to date. NGOs can address these worries by working with individuals and organizations already known by and trusted in target communities and by providing good quality medical treatment and interpersonal care.
Item Open Access Rings of Fire: Assessing the Use of Efficient Cook Stoves in Rural Guatemala(2010-12) von Ritter Figueres, NaimaMore than half of the world’s population still depends on open-fires for cooking, causing an alarming array of health and environmental concerns. Over the past few decades, many efforts have been made around the world to substitute open fires with improved cook stoves (ICSs), which reduce both smoke and wood consumption. However, these efforts have turned out mixed results. In Guatemala, an NGO called HELPS International has been distributing a specific type of improved cook stove, the ONIL Stove, for more than 11 years. The objectives of my study are threefold: 1) to measure the level of ONIL stove utilization, 2) to explain the differences in usage levels across regions by examining potential reasons why people do not use ONIL stoves, and 3) to recommend practicable interventions that HELPS could undertake in order to enhance the effectiveness of the ONIL stove program. The key methods employed in this study were a structured oral survey, focus group discussions, in-depth interviews, and participant observation. Analysis finds a great deal of variance across the selected communities. This study concludes that in order to maximize the health and environment benefits of the ICSs, it is not enough to ensure that households regularly use the ICS. Instead, HELPS needs to strive toward “intact adoption,” which this study defines as the combination of 1) the daily use of the ICS; 2) no parallel use of less efficient cooking methods; and 3) no efficiency-reducing alterations of the ICS design on the part of recipients.Item Open Access Through the Lenses of Q’eqchi Maya: (Re)Framing the Story of Development in a Guatemalan Indigenous Community Through Participant-Created Photographs(2016-08-24) Funk, LaraThe question of evaluations of development projects has been widely debated within the field of international development, with scholars and development practitioners calling for increased community-driven evaluations. However, there has been a paucity of research in community-led project evaluations, and a largely absent investigation utilizing visual anthropology/sociology methodologies. This paper seeks to shift this power by giving voice to the intended beneficiaries of an eco-tourism project in a rural indigenous Guatemala village. Through photographs taken by community members and corresponding interviews, this paper shows the way in which community members have and continue to reframe the idea of development in their village. Specifically, my analysis reveals how residents see changing forms of access, how they reframe ideas of beauty and modernization, and how they reframe their relationship to the land through Western conservation and private property ideals. This research thus provides an alternative narrative to the Western NGO’s evaluations and knowledge production, especially in respect to development and indigenous knowledge. By showing how community members are reframing the story of development, this paper demonstrates the usefulness of using participatory documentary photography in community-led evaluations, and helps balance the playing field by providing a much-needed alternative narrative of project evaluation.Item Open Access Whole genome sequencing identifies circulating Beijing-lineage Mycobacterium tuberculosis strains in Guatemala and an associated urban outbreak.(Tuberculosis (Edinb), 2015-12) Saelens, Joseph W; Lau-Bonilla, Dalia; Moller, Anneliese; Medina, Narda; Guzmán, Brenda; Calderón, Maylena; Herrera, Raúl; Sisk, Dana M; Xet-Mull, Ana M; Stout, Jason E; Arathoon, Eduardo; Samayoa, Blanca; Tobin, David MLimited data are available regarding the molecular epidemiology of Mycobacterium tuberculosis (Mtb) strains circulating in Guatemala. Beijing-lineage Mtb strains have gained prevalence worldwide and are associated with increased virulence and drug resistance, but there have been only a few cases reported in Central America. Here we report the first whole genome sequencing of Central American Beijing-lineage strains of Mtb. We find that multiple Beijing-lineage strains, derived from independent founding events, are currently circulating in Guatemala, but overall still represent a relatively small proportion of disease burden. Finally, we identify a specific Beijing-lineage outbreak centered on a poor neighborhood in Guatemala City.