Foto publicatie in Kyiv Post

http://www.kyivpost.ua/ukraine/article/issledovanie-globalnyj-ekonomicheskij-krizis-ne-ubil-optimizm-ukraincev-24426.html

WJ in the media

MO* world magazine



http://www.mo.be/artikel/arabisch-ruil-voor-nederlands



Veto kuleuven Students Newspaper



http://www.veto.be/veto/veto3724/COUCH.html

EL ZOTZ DIARIES

Day - 2 El zotz diaries
by Willemjan Vandenplas on Sunday, June 5, 2011 at 6:38pm

When I think of Guatemala, the first thing I think about is the Jacobo Arbenz, who was a social democrat president from 51-54, but he was ousted by a CIA led coup, because his policies were a thread to the American Hegemony over Central America. The coup was followed by 30 years of military dictatorship and a long lasting Civil War. Since 2008 there is an other Social Democrat in power Alvaro Colom, I am interested in what his position is towards Venezuela, Mexico, Brasil and the United States and what the local people think about him. Is he really changing something for the people far away from Guatemala City.

Day - 1 El Zotz diaries
by Willemjan Vandenplas on Monday, June 6, 2011 at 1:01pm

I am about to leave Leuven, great moments I had here and some of my friends won't be here next year, but life goes on. And as I said in Argentina, nos vamos a encontrar en alguna parte del mundo...

A few hours before I leave for Guate, I think I reached the Nirvanna, I am totally relaxed and my spirit is ready for the undertaking. What I am planning to do, I will fly to Mexico City, stopping in Madrid. I would like to stay a day or 2 in Mexico City and visit the camp of the indignados there and then I will make my way to Comitan, but I am not planning to stay there for long because I will take a pick up to Yalanhuitz, just crossing the border with Guatemala.

The desire to sacrifice an entire lifetime to the noblest of ideals serves no purpose if one works alone.

Day 1 El Zotz diaries
by Willemjan Vandenplas on Tuesday, June 7, 2011 at 6:21pm.

I just arrived in Ciudad de Mexico, a city I like, but I won’t be staying here for a long time, because I want to go south.

I am staying at Hostel La Moneda, like 3 years ago, for 10 euros, you get also breakfast, dinner, a free internet connection and it’s in the center of the city close to the Zocalo and the presidential palace, where I saw the president Felipe Calderon 3 years ago at the día de la independencia, I would have preferred the socialist Lopez Obrador, but the Mexicans have decided otherwise. Calderon is already in power since 6 years and Obrador lost most popular support and his leftish party splited in two. Maybe Obrador should follow the example of Ollanta Humalla in Peru and be a little bit more pragmatic.

But here I am, in the backyard of the United States. Even here is the Palestian-Israel conflict is not far away, because the first people I met where Israeli-Argentinian and some Israeli soldiers that just finished their obligatory military duty and now want to travel a bit. I don’t have personal problems with Israeli’s, but because they knew I spoke Arabic and they immediately started talking me about politics and that they didn’t like Arabs. Did I really had to come to Mexico to meet these close minded, brainwashed Israeli soldiers. Hopefully Mexico will do the trick and make these people come in to contact with reality again because the Indians here, are the Palestinians in Israel. Like always I take sides of the “Have-not’s”, although I am maybe a “have” because of all the possibilities I have got in my life, but I try to use them to advocate the position of the “have not’s” in this world. But I don’t see myself as a modern Ernesto “Che” Guevara, although my life as some parallels with his. He mostly blamed the economical structure of this world as the cause of the division between the “have-not’s” and the “have’s”, for me this is too simplistic, because you can’t watch the world only true a materialistic lens, because a lot of the “have’s” are actually the poor socially speaking! A good example are the favela’s in São Paolo, who is the happiest? The Businessman that has the take the helicopter to work because otherwise he will get robed or the people of the favela who run around freely in the city!

Today I will try to enjoy the city a bit and relax, because tomorrow I have long bus ride to Yalanhuitz Guatemala. It’s nice to be with fellow travellers, but not for too long, because most of them are here to hit on girls, party and see some ruins. I am here to immerge myself into to the culture of the poor, not the culture of the international travellers.

Day 2 El zotz Diaries
by Willemjan Vandenplas on Wednesday, June 8, 2011 at 5:02pm.

While the social movements of Mexico where occupying El zocalo, I was sitting in the bar el cathedral, watching the spectacle in front of me. They kept serving me coffee, what was nice, I like the free refills. After a while I went back to the Hostel, where I realized that it full of Argentinians. It felt good, because I actually wanted to go back to Argentina for the summer, but the tickets are too expensive in the high season. I met this nice couple from Rosario, the city I used to live in. The subject of the evening was Argentinian writers, I got few good suggestions for books, because Ramiro studied Literature in Rosario. He actually told me that LOST is based on my favorite novel, La invención de Morel of Adolfo Bioy Casares, Wikipedia confirmed it. I actually got that book from one of my best friends in Argentina Sebastian Arrabal, Ramiro, the Rosarino, told me that he used to go also the Seba’s bookshop El Aleph. I spend a large part of my time in Argentina there!

Ramiro and Cecilia the Rosarinos, told me it was confirmed today that Cecilia was pregnant, I was one of the first to know. We shared our liter of beer together, like the Argentinians do, Victoria is actually a fine beer, and because they travelled threw Latin-American and finish there Mexico trip now we toasted to Pacha Mama and then he showed me the red star that was tattooed on his back, with the signature of El Che Guevara. At the end they gave me the rest of their mate and gave me there Bombilla (straw to drink mate) that had travelled all over Latin-America and I will give it a second life in Guate and in Europe, we called it La Bombilla Viajera. I ended the night speaking over the problems in Belgium with a Mexican girl, who studies Political sciences, but the fact that we don’t have a government for one year didn’t reach Mexico, but yeah I think Mexico has a lot of problems of itself, a so called emerging country, with the richest person in the world Carlos Slim, but you can’t walk the street without always being confronted with the terrible poverty, mostly old people. Maybe that why Mexicans live so much in the present, because they don’t believe life will always get better then it is. Yesterday night is was also very difficult for me the realize that life would get better than this. Maybe after 3 years of studying Arabic, and losing touch with Latin America I am back and maybe now I will fully grasp what Latin-America is, I think it’s all because of my Argentinian friend Tulio Cerolini, el me dio la chispa de Nuevo. Now I realize what I have been doing the last 9 years, some people goal in life is to Compare Religions, like Nabil Fayyad :), for my its more comparing the culture, politics, History … of Latin America, Africa and the Middle East. But the problem is that one gets so immerged into one of them it so difficult to keep the 3 in balance…

Day 3 El Zotz diaries
by Willemjan Vandenplas on Friday, June 10, 2011 at 2:28am.

Yesterday I left some beautifull people behind, but I suppose this is what life on the road is like... Wednesday I spend the day in the Park with the Argentinians drinking mate we talk about life and just relaxed… before I took the bus we had a lovely meal together melted cheese and alhambre with Tortilla…

At 17h I took the bus to Comitan, I had to take 1ste class but I didn’t dislike it, at 6 I arrived in Comitan and took a combi to Carmen Khan. I really would have crossed the border without noticing it, everybody was passing by, I had to search for the immigration office and there I got my Guatemalan stamp, one to cherish…

The border town at Guatemala was called Gracias a dios, and it was full of combi with on the trunk written: Si dios esta conmigo, quien es contra mi? Really religious people here, mostly catholic but the evangelicals are on the rise. The trip went smooth until they the drop me of at Yalanbojotch, there I had to wait for 5 hours, because there were no combi’s driving to Yalanhuitz, but luckily I was not the only one going to Yalanhuitz, there were other people waiting. There I met Pedro born and raised in this village, 19 years old, married and father of 10 months old girl. Told me life was very difficult in his town, all self-sustaining farmers, he told me they go to bed at 20H to wake up at 4 in the morning, normal in a village where there is no electricity.

The other people from Yalanhuitz fixed me transportation so after 5H the trip continued, where before I was still in the civilized world, this time I really entered into different territory, grind road going up and down, so we quickly ended up taking a pick up. There I was in the middle of nowhere in the trunk of a pick up and climbing a very bad roads to 1500m and then going down to Yalanhuitz at 900m, on top I had a very beautiful view of the town. I got off at the clinic, which is build around a football field, in front the town hall at one side an evangelical church and at the other side the catholic church, the difference between the two is that (they told me later) is that the drunk people go to the catholic church and the others to the evangelical church!

The clinic looked closed, but after knocking on the door, Nick opened the door, he was wearing pants of River Plate, one of the two football teams of Buenos Aires, and he told me he leaved for 4 months in BA, a real Porteño. He really likes football he even plays in the local team, I am more culture guy, but we are both open-minded enough so I met another great person and we really chilled together all day long, he told me a little bit about his experiences in the village and introduced me to Maria the midwife of the clinic. She seems to be a very busy women, if she is no working with her singer, sewing machine, she is working in the Clinic.

I am not so poverty struck in the village because everybody has a house, people seem happy and live in the most beautiful surrounding. But this my first impression, Nick already told me a bit what happens in the village, so I have 2 months the realize what it is to live in a small village far from everything, but I think I am a little bit too late, because the road that connected the village 2 years with the rest of the world, changed the life in the village, people have cellphones now from the big village and the young people already start looking as Mara Salva Truchas or Mara 18, the gangs of Guatemala and El Salvador.

Day 4 part one El Zotz Diaries
by Willemjan Vandenplas on Friday, June 10, 2011 at 8:12pm.

I arrived in Yalanhuitz and started immediately with the consultations, Nick was so kind to introduce me to people of the village and we went shopping, because we don’t have a fridge we have to buy everything just before eating, the big problem will be to put some variety in the food I eat, but I will have to be creative. At night we had an emergency a 6 months old baby with Pertussis (tos ferina), the parents didn’t want to take a risk, so they went to the hospital.

I went to bed early to get some sleep, because the last 3 days I didn’t sleep, I woke up with the singing of the birds, nice. After a coffee I was ready to start again at 9 and we had a 14 years old girl that we think that she was pregnant and a 21 year old girl with an infected wisdom teeth (muela de juicio, dente de siso) and migraine, she was already taking diclofenac so we gave her some paracetamol too to kill the pain.

Here in Guatemala, people have there wonderdrugs, you can just buy a big injection of Gentamicin (antibiotic for eye diseases) in the local shop and people use it for everything, something wrong, injection of gentamicine, even for little baby’s they give an adult dose. Gentamicine is very toxic and has a lot of secondary effect, so a lot of health education has to be done, but if the state permits these drugs can be sold without a problem, the life of a health promoter is very difficult…

day 4 part 2 El zotz Diaries
by Willemjan Vandenplas on Saturday, June 11, 2011 at 4:06pm.

We always have a break between 12 and 14h, it nice the chat about the patience we have seen and to read a little about the diseases we have seen, the work is really nice, we have really a Latin American attitude, we tend to see 10 people a day so we have a lot of free time to talk and walk around the village. I am really happy and lucky to be able to do this, maybe I am Lucky because of the traveller stone Truus and Sarah gave me, maybe it really works.

In the afternoon we had a women who came for a birth control program, she already had 6 kids, I think it’s the average people have here, an investment for the future they say. The problem was that the women was 4 month late with her intramuscular injection of depo-provera (every 3 months, normally) so we tested if she was not pregnant, and luckily not, for sake of the almost 7 billion people on this world.

An hours later there was a man who came for his child because he needed surgery because of Poliposis Nasi, we organized the surgery for him. Later we had a man with an irritation on the face, a lot of people seem to have it here, the dermatologist recommends a cortisone crème, the disease doesn’t really have a name so it may be an interesting research topic!

The rest of the afternoon we spend chilling, walking to the village and looking to the people playing football.

The village doesn’t seem to notice there is another stranger, it’s business as usual, everybody working, playing football in the afternoon. The village is really small and the people are very friendly, I think it’s because they are used to Belgians!

El zotz diaries on Neoliberalism in small rural villages
by Willemjan Vandenplas on Saturday, June 11, 2011 at 4:52pm.

Neoliberalism and small rural villages, what is there to learn, the small villages are characterized the fact that they are very autonomous from the central government. So everything that happens is based on private initiative, where I work the private initiative is based on charity, but the hard-capitalism is also working here. Multinationals are becoming rich here and take over the responsibilities of the government. Pepsi is building a waterwell and Tigo the mobile phone company that is becoming rich with all the calls to America, because a lot of people have family in America, are building schools.

In addition to this there are the remesas, money send by the Guatemalans living abroad (America) to their family, but this money is used to build a house out of stone, install solar panels, to buy a car and a cellphone to call the people abroad.

As long as the stones, the solar panels, the cars and the cellphones are produced abroad and by multinationals like Tigo, all the money that is accumulated by the poor people, all the money from the remesas is going back abroad, so this neoliberalistic system is not developing countries like guate. I think it’s time the state takes it over, although initiatives like where I am working will disappear too, maybe this is a cost to bear…

Day 5 El zotz diaries
by Willemjan Vandenplas on Saturday, June 11, 2011 at 8:43pm.

Last night Nick, the volunteer who is staying here for two years, opened his bottle of Mescal Illegal, a type of tequila, because I was so much on the computer writing the accu of our solar panel was empty, so we passed the whole night in the dark, but we had a really pleasant night talking about relationships, life abroad, the situation of Yalanhuitz and of course the final of the copa de libertadores,. Next Wednesday, peñarol of Uruguay will be playing against Santos of Brasil, we will watch it live.

I like the mescal a lot, it’s better than the vodka I drank in Ukraine…

Last night I didn’t sleep a lot, is it because of the Jet leg or the mescal I don’t know or the mosquitos, because it’s almost raining season.

We had 3 consultations in the morning, a 2 year old girl with Guardia, so we gave her some metronidazole, vitamins and started a rehydration therapy. Then we had a 6 year old boy with a cough, he had the syndrome of down, didn’t suspect this in a small Indian community. The 3 patient was a women that was 5 months pregnant, she was anemic so we gave her 300mg of iron daily, until 3 months you can give folium acid. In Belgium a doctor would just take blood and analyze it, but here we check the capillary refill and the eye lids, skin color etc.

During the break I discovered the village a bit, I think the average age must be 13 or something, the town is full of little kids and people are so friendly…

Day 5 part 2 El zotz diaries
by Willemjan Vandenplas on Sunday, June 12, 2011 at 7:33pm.

The afternoon was quiet, beautiful warm weather, until it suddenly started to rain, on iron roof the rain is 140 decibel loud. At the moment I was in the evangelical church praying, bad joke, I was actually installing a the printer of the church. A guy from the village bought it in the States while he was working there, don’t know why they need this equipment in village where most of the people are deprived from most things, but when it comes to god, the people here are “on their horse”. it’s incredible to see how big the power is of religion is for the villagers. For a person like me who isn’t interested in Religion, it’s not understandable…

In the afternoon we only saw one patient and it was not the nicest consultation, because we coughed the patient on fraud, we had paid him 200 euros to go to the clinic and see a specialist, but the actual price was 75 euros and he changed the doctor’s prescription to 205 euro’s, but we had the original one so we knew and he actually wanted the 5 euros we supposedly owned him! Shame be upon him! Note in 10 years this project runs it’s the first time this happens.

At 18H Nick left with his motorbike to pick up his girlfriend Lauranne at the border, she was travelling with her sister a bid, so I didn’t get to see her yet…

This type of work is really interesting, it gives me a lot of energy, while I can I try to read the book, where there is no doctor, it’s a guide book for peasants, really interesting, it’s actually world famous, and translated into different languages and also adapted to the different cultures, for example the pictures are with Indians, really funny.

As days pass by I realize I am living on an island of peace and tranquility, is it because I am surrounded by churches… The good thing is that we are not the gringos of the village. The villagers tend to pass by our house to come and say hello, it’s really nice, it’s like we are really part of the villages. My goal for the next days will be to connect more with the villagers, the first impression I gave was a little bit clumsy, because I don’t know what motivates the people here, but I try to smoothen things out the next days. I have sometimes the impression my Spanish is too difficult for them, people don’t tend to use complex sentences here, although my Argentinian way of speaking is understandable, it’s strange for them. Now the big question is should I adapt to their style of speaking or should I keep my Argentinian-Belgian way of speaking, it’s actually where it all started… but yeah maybe I shouldn’t focus on language this internship because it’s not at all a problem, maybe I should better focus on having a good time and learning medical and cultural related stuff…

Day 6 El zotz Diaries
by Willemjan Vandenplas on Monday, June 13, 2011 at 2:14am.

Last night I was all alone in the Clinic, all of a sudden I a big car arriving with loud music. I toughed it would become messy suddenly Nick jumps out and starts dancing in front of the car, a break dance type of thing, really funny and in the car everybody was clapping and dancing, the notorious Jimenez Clan. The problem was that Nicks Motorbike broke down on his way to Mexican Border. So he and his girlfriend Lauranne, were pick up by the Jimenez Clan, they run the transportation in this region, there father and brother were killed with a headshot a few months ago and last Sunday there other brother was killed in the same way at the river. That’s why my arrival the first day was a little bit delayed. The rumors go they also run a drug cartel and that this is the reason it’s dangerous for them here. There is no police in this region, so most of them are going back to the USA. Although they seem very nice people, I don’t think I will join them for parties : ). In the car was also Lauranne, a very nice girl, she is the midwife of the hospital, she also loves photography, so I found a buddy.

I went early to bed and slept good for the first time in one week, we woke up during the night because there was an emergency a women that was giving.

In the morning we went to the market in Isquisis, the neighboring village. I had the chance to take some pictures and we eat some tortillas. We were a late for the market, so the best things were already gone. At the market we met Juan Pablo and Hernando, they work for the social service of PEPSI and help the villagers to buy thing in the city and are investigation if they can produce electricity for the villagers.

On our why back from the market, the women who is giving birth had serious contractions and the head of the child was too big so Nick and Lauranne took her to the clinic in Huehue a 5 hour drive. So I was alone in the clinic. There was although an emergency, a 1 year old girl had put her arm a week ago in boiling water, she was checked a week ago and now they came back, because they had put tooth paste on the wound, so we started cleaning the wound, used a lot flammazine and gave her some painkillers for children. Tomorrow she is coming back, if the wound isn’t better and I don’t want to take risk so I will send her if needed to the hospital because if a girl has to start her life with a big scar on her hand it’s not nice so we should do everything to avoid a scar, but maybe this type of thinking is usefull in the place where every Quetzal (local currency) counts. People hardly have money to go to the Hospital! A dilemma!

After the consultation I talked with Maria the midwife of the clinic, she works here since 3 years and she speaks 4 languages and has really a lot of experience. She is from the village and didn’t even finish primary school. Now she is going to give it a second try… if somebody with not even primary education is able to reach this, then the only thing I can say is that the south got talent…

day 7 El zotz Diaries
by Willemjan Vandenplas on Tuesday, June 14, 2011 at 6:11pm.

Last night was the first night I was alone in the clinic, it was not a nice experience, but the idea that had 800 bodyguards comfort’s me. I think if there happened something, all the people of the village would come to help. It’s not like in Belgium, where everybody would look away, but I had a good night.

Maria and I started the day at 9 and worked until 7, we say 19 people. The girl with burned hand was back, here aesthetics are not so important so they preferred not to spend the money, but either ways I ordered cicatrisin to reduce scars, that the least we can do for that girl. I think probably the curandeiro, had put the tooth paste on there. After that we had an old women with diabetes, we gave her dose of atenolol and metformine. The problem was her husband suffers from Parkinson, but we could get any more medication for him, because the pharmacist’s in Huehue could sell us noting! Then we had a few cases of gastritis and one of the campesinos came because he had cut his hand with a machete. Then we had a girl we toughed she had gastritis, but she was actually pregnant, probably another Fidel!

We had a case of candidiasis, a fungus, and some women came for the depo-provera, so they won’t become pregnant. Probably this is for them the cheapest and the safest way not to get pregnant, safe because they avoid the curse of the catholic church.

The frustration of the day was that I didn’t speak that Indian language they always talk, they all can talk a Spanish with some mistakes, but prefer their original language. I am only staying here for two months, but if I would stay longer I would learn the languages, I think I better focus on others things, but I am sad my Spanish is as useful here as I toughed It would be… so be it, I think by myself.

After 9.30 I was really tired, my very first day of medical practice went quiet smooth, although I didn’t finish my studies yet I think I manage to do the basic things, I am actually capable of so much more then I toughed, but probably this is because my parents are doctors and they talk about it all the time, something I am happy of…

This day really gave me a lot of energy and fulfillment, because I was able to help some people. Sometimes it also difficult, because we can’t even do a blood analysis, for example we have a women that is already since a few years complaining of her liver, it’s inflated and touching it you feel there are abnormalities, but bringing her to Hueheu out of the question for the people. I Belgium a 65 years old women would be taken care of at best but here It’s more complicated…

We have system to do the registration of the patience, but a lot don’t even have autographs, so we take their fingerprint and a some don’t even know there birthday and age… is it due to ignorance or is it a cultural thing, maybe these thing are not so important for them, although that normally one of the first things you ask if you meet somebody new, but here they are not meeting so many new people…

Day 8 El zotz diaries
by Willemjan Vandenplas on Wednesday, June 15, 2011 at 6:23pm.

Last night Nick and Lauranne came back, they brought Rum, broccoli, potato ships, wine and Cheese from Huehue, perfect. Like always we had no more electricity at 19h, so we passed the evening drinking and eating, while it was raining again.

After a good night sleep we started early, but in the morning we had only two patients and a pregnancy. The women had already contractions for 3 days. Now she is in the Clinic, with her family waiting for the baby to get born. Lauranne who is a midwife can really do useful work here, it’s like every week we have 3 women giving birth. I think the family most be really important here, lots of children and at an early age. But it’s normal because there are very few things to do here, so why not take care of children. For them it’s also a good investment into the future. They send a few to the States and others to other cities in Guate, I think it’s there way of having the future safed!

I was running around in the village and there was a car passing by with music, I heard pescado, pescado (fish) I couldn’t resist and bought two fish and at noon we ate fresh fish, for me it’s luxury, because I have been eating like the extremely poor.

In the afternoon we went to a birthday party, it was in small wooden house. They started the party with praying, in Spanish and in their language, then we ate a chicken caldo, caldo de pollo, we all got a fine piece of chicken meat what is really is out of the ordinary, was able to take some pictures at the party.

We had only six patients that day, but there was a lot practical stuff to be done in the clinic. At night the light went off as always at 19H, so we eat an eggs in the dark, drank some fine rum and talked about some stuff, I am in really good company here, I try to give Lauranne some photography classes and Maria I help with English, so when there is nobody there is always something to do!

El zotz on development
by Willemjan Vandenplas on Wednesday, June 15, 2011 at 7:15pm.

There is a lot of inbreed in this regions, mostly you see this because the high rate of epilepsy. the community is not connecting with the rest of the country. You have some people from Guatemala city, but these are mostly Spanish descendants and they come here for work. Due to religious factors and poverty people get a lot of children on an early age and get married early age there are some cases of adultery but they are few, people tend to stay loyal to their partners. So diseases like aids do not touch ground here. But things are changing, more people are leaving for the States (mostly males) so we think it will take only time before we have a first case of Aids here. Other sexual transmittable diseases are more frequent here syphilis, gonorrhea,… But I think this is more due to bad hygiene.

The problem is if we develop the infrastructures, these people live standards will be growing, but certain disease will come and others will go. I don’t want to sound to conservative, but these people seem happy the way they live, the have nothing, but they have a nice family and quality of life. I think this is way I study medicine, because bringing healthcare to the villagers is essential, but other things can wait, because I think with medicine you only create a win-win situation. So I think we should preserve the way of living of these people here, because for them development is moving to big cities and here they survive by working their private land (there is big landowner here) in big cities they would maybe be beggars.

People seem free here, people I see that there are always people who try to take advantage of the villagers, the big companies, the religious institutions and the small private enterprises mostly narcos( a lot of travels to Colombia are done here). These people shoud be free to choose whether they want this foreign intervention, but they should have basic infrastructure, with the clinic we can do a lot but not everything, the school is also there. From what I saw there should come a strong man in Guatemala, somebody like in the ’60-‘93 with Félix Houphouët-Boigny, who brought basic infrastructure to the whole country and leaves everybody alone. Albenz would have been great to do this, but he was ousted by the CIA. The only problem with this country is that it’s so close to the USA.

Day 9 update El zotz diaries
by Willemjan Vandenplas on Thursday, June 16, 2011 at 1:33am.

I had a very calm day today, because we were 4 to run the clinic, so I took some to read donde no hay doctor, make some pictures and write a little.

At 14H I went to Maria’s House because she gives sewing classes, it wanted to take some picture of her old singer, because my grandmother used to have one like that, but her children were too shy to take pictures off. On my camera I still had the photos from last year in Morocco, so I should them the camels of Marzouga and the monkies, they never saw a camel in their life, the kids where really amazed.

It was nice to see how Maria was teaching her children how to sew, full of patience, she has really a warm heart. I hope she can finish primary school, because It would only be good for her self-respect and she would even be a better midwife. Maybe one day she can become like Rigoberta Menchu, the Guatemalan Nobel prize winner…

After the sewing club I was chilling at the Hospital, we only had 8 patients. Nick always, plays football with the villagers so I was alone with Lauranne, she told me she also did a year abroad like me in Peru and we talked about life. I am really happy I some interesting people around me, in 10 days they will leave and in 5 days Natasha a psychiatric nurse and in 4 weeks 2 doctors will come. So it’s going to be very interesting the next week.

Tonight the villagers were catching Beatles, so everybody was running around and jumping, they do it because the can make some good money with it. They sell them in Huehue for big money. The villagers say they are full of proteins…

In the evening Lauranne made soup, really good and we watched a episode of the killing.

Day 10 and Part "Doom" Day 11 el zotz diaries
by Willemjan Vandenplas on Saturday, June 18, 2011 at 12:33am.

I woke up today and Nick and Lauranne were still sleeping, so I took so I read a few pages in El Don Quichote De La Mancha. Nick woke a with a parasite infection, but luckily we had only one patient in the morning. Life is sometimes too beautiful here, that it becomes boring, but luckily I can do so many things here, take pictures, cook, read, relax. It’s strange that on Monday we had 19 people and the days after only a few. I came here to work, not to chill like I was doing the months before I was in Belgium. It already seems it’s a long time since I have left home, it’s now 10 days that I am here and I still have 48 to go, I think my personality will change, even when I was chilling in Belgium, I was always on the move, here my life has become really static, same people and sleeping, eating, working and relaxing at the clinic. I think I should go out more, but the problem is that if there is an emergency, we need to be in the clinic.

Almost all the men in the village work in the fields around the village, in the afternoon you see them coming back from work with their machete in their hand and a banana leave to eat on. Kids start from a young age with working, so I think they are kind of used to it. The core of their life still was Belgium a century ago, with the difference that most of them have cellular phones, although they don’t have electricity. Even most of the houses don’t have water, but the houses a built around wells, so you don’t see people like in Africa walking 2 kilometers just to get water.

In the afternoon it was a little more busy, I diagnosed a case of chronic gonorrhea we gave azitromice and ciproxine and a sick child of 1 year old, we gave a palet of everything we could get. In the book, donde no hay doctor, I read about dry malnutrition (marasmus) and wet malnutrition (kwashiorkor), the first is more common here, because a lot children get deprived from food. A few weeks ago a child died of malnutrition.

In the evening nothing special happened.

In the morning I woke up and there was bad news, a women with a molar pregnancy died in the hospital, the problem was that her husband didn’t wanted her to go to the hospital in Huehue, Nick and Lauranne had convinced him several times, but It didn’t work, after a week her husband decided to get her to the Hospital, but it was too late, she leaves 10 children behind, was only 44 years old and had a terrible husband. This is really a disaster for the clinic, because we only send the extreme cases to the hospital and the people always die there so nobody wants to go to the hospital in Huehue, for me when it take over, it will be difficult to convince people to go…

It was really a morning with very extreme cases also a girl (2,5 years) came with a facial open wound, it was very difficult to sew it, because it was right around her mounth, but Lauranne did a good job, hopefully in a few years a plastic surgeon can take the wild flesh away that you don’t see the scar too much. Then we had a boy with extreme malnutrition and dehydration, his situation is critique, we don’t think he will survive, the thing is he has my name, William Juan, so I feel there is a special bond with him!

In the morning I was giving an injection of depo-provera and the jeringa was hard that I used a little bit more force, but too much and the depo-provera exploded in my face, everybody was laughing…

day 12-13 el zotz diaries
by Willemjan Vandenplas on Tuesday, June 21, 2011 at 2:02am.

Had a calm day today, when I went to the village a drunk guy started talking to me, I noticed the difference between a drunk Belgian and a Guatemalan is very small, Alcohol does universal things with people, interesting…

When I got back we had a child with Guardia, you can recognize by yellow diarrhea and no fever, so we gave 3 ml of metronidazole 3 time a day for 7 days.

At noon I made some eggs with onion and tomatoes for Nick and Lauranne, and used our free time to listen to reggeaton and cumbia classics. I think in a few days I will be ready to take over the clinic for one month, it will be nice there will be one more nurse and 2 doctors, only girls by the way so I think I will miss my buddy Nick, but I think I will survive it!

In the afternoon we bought some beers and ice, so tonight will have ice cold beer, tomorrow we have our free day so we can enjoy the evening more!

At night we had really cold beer, very nice to finish the working week!

Next day I slept until 9.30 a record here and then we went walking to a Laguna. First time I could really appreciate the beauty of the nature here, although it was rainy and the sloops where I really slippery, I fell once Half a meter, but on the steepest part, we had to take a sloop going 50 meter down and it was full of ants, but the Laguna was just beautiful, surrounded by jungle. It wasn’t full yet because the rain season just started. On our way back we followed the river, nature is really fresh now because of the rain. It was beautiful!

day 14,15 el zotz diaries
by Willemjan Vandenplas on Thursday, June 23, 2011 at 5:44pm.

Tuesday morning we had a patient who had a pesticide in his eye, he was working in the field. We gave him some corticoid crème against the inflammation. We didn’t have a lot of work so I had time to dream, maybe after my studies I will start I similar project, but I would like to do it in the middle east, but the problem is the language, morocco would be the easiest place to do it, but in the occupied territories or the Syria it would be more amazing. I still have a long way to concretize, but the middle east is a little bit more difficult I think. Also as long as you don’t get recognized by Belgian government for this type of work it is quite impossible to do it, because if you don’t get a pension in Belgium, you are screwed as hell. There are something that demotivates people to do these types of things, maybe I should just find a nice project to work for a few years, instead of starting something myself. I don’t see myself working here for longer than a few months, because although I am doing interesting medical work, I am losing for languages, my level of Spanish is not getting better, because I don’t get stimulated by the people here, it’s quite understandable because Spanish is there second or third language and they make really a lot of mistakes.

At night we saw 3 episodes of the Killing, it’s going to its end, but it nice to watch, a great distraction from the clinic, because we live there 24/7.

Wednesday morning , Lauranne and I went to Huehue, to get some practical things done. I witnessed how she drove up the hill to go out of the village, incredible. Maybe she will have a second life as a rally pilot. Then we made our way to yalanbojotch, Nenton, la demacracia and afther 4h30 minutes on bumpy roads we finally arrived in Huehue, not a beautiful city, but still one where AFS drops his students, wouldn’t want to live in this place for a year, but yeah maybe it’s only my first impression!

In huehue, we went to the national hospital to get ride of our old medication, but they just told us to burn it. It’s incredible the closest hospital is at a 4h.30 drive from the clinic, people are so lucky that there is this clinic. The national hospital is really small, there are some private hospitals closers, but they are a lot more expensive. In Huehue we drove around and went to the supermarket, there I tasted the old rich world again, I had a cold cappuccino and an Ice cream, great taste after two weeks of black beans and tortilla. I bought the essentials, powder milk, cereals and a 1.75L bottle of 5 year old rum, enough to get me threw the next 40 days, everyday a glass. I couldn’t resist the olives so I bought two canes, olives are really my childhood addiction, that why I like Mediterranean countries so much. After the shopping we went to the farmacia and bought medication for 100 euros and got some free metformine against diabetes. The regular hotel was full so we had to find another one! A little bit along the way we found hotel la sexta, nice place. At night we eat something with the volunteers from Pojom Wouter and Miet. Wouter had just bought some chickens, but apparently they didn’t come back tonight, so there was a bit of panic. He told me the popular belief is that if you want chicks, you can’t hug to much your wife because the chicks watch from there shell and move to much so they can’t hatch…

At the restaurant we talk a little about 4 pillar initiatives and international aid, interesting. After a few beers we went to bed.


Day 16-17 el zotz diaries
by Willemjan Vandenplas on Friday, June 24, 2011 at 11:37pm.

Couldn’t sleep in huehue, my neighbor was snoring and I was just sleeping besides cages with toucans and they were making noise all night long, the morning came to early. We eat breakfast at a really fancy place, if people like English breakfast, they should try the Guatemalan breakfast, a big piece of meat, platanos, frijoles, cheese and eggs. I immediately felt the torpedo in stomach, but it was good. We had a 5h drive back. It’s a really dangerous road from time to time, and with all the speed bumps, it was really exhausting. When we got to lambogotch we had some hitchhikers, first the guy put a one cubic meters of cloths from the united states in our trunk and then he wanted to pick up his backpack, what hell he brought two more cases his wife and child. So fully packet we drove up the mountain to yalanhuitz, finally home after 5h.

When I arrived to the clinic, the new volunteer was there, it’s her first time alone abroad and not used to this type of environment and she doesn’t speak Spanish, but she is taking it easy, I can’t expect everybody to be a world citizen, but for a person like me who is preparing for this type of work since 9 years it’s a bid disappointing if people just come here out of the blue, with no preparation what so ever. Working in a place like this takes years to be able to do this, I am afraid most of the responsibilities will be on my shoulders, because Lauranne and Nick leave tomorrow. People should think more when they want to be an aid worker and it starts with learning the language!

In the afternoon, we did some practical stuff and Nick bought some beers in Isquisis. We saw another episode of the killing and went to bed.

Next day we had only 1 patient a boy with bronchitis, time to read, now I am reading a book about Guatemala, I read there is also an Indigena party here, it’s called Winaq and is headed by Rigoberta Menchu, she is running for the presidential elections in October, I will try to follow it! Especially the region where I am was hard hit by the civil war, it was actually a Marxist guerilla against the government and private militias. Maria she told me that during the war, when she was 5 she used to sleep in the forest, because it was safer there and she had to flee to Mexico like 100.000 other Guatemalans. The gruesome president Rios Mont killed whole villages in this region, himself was only 17 months in power, but he wrote the bloodiest chapter of Guatemalan History. In 2003 he was almost reelected for president, a symptom of the ignorance of the people here!

Due to my situation I have no time to discover more of Guatemala, but I am learning so much more here than a tourist could dream of …


day 18-19 El zotz diaries
by Willemjan Vandenplas on Monday, June 27, 2011 at 2:14am.

In the afternoon we had a whole family with Varicella, even a pregnant women had it, so we are a afraid of a perinatal infection. The wound where really big on the girl because it itched so much she started to scratch it open.

In the evening it was the last night of Nick and Lauranne, so our neighbour came and we drank some rum and talked about Guatemalan politics, He told me the wife of Colom, the actual president divorced from him especially to run for president this elections, Kirchner Style! We listened to some music and It was a pretty nice evening.

In the morning Nick and Lauranne left with the pickup and my first day as responsible for the clinic started. In the morning Maria is always there so she can help a lot, but in the afternoon I am alone with Natasha, a psychiatric nurse. We had a boy who was eating dirt and was really peal, that typical for anemia(it immediately ringed a bell) , so I gave him iron and after that he also had diarrhea with blood and fever so I opted for Trimethoprim and Sulfa antibiotics, because I think he had diphtheria. He had no sign of malnutrition, but we still asked him to come back in a few days. We also had a hernia umbilical with a 2 month old boy, a pediatric reference book said us to do nothing until he is 5 years old, if it’s not better do surgery, but we were afraid of an interruption because you could feel the intestines inside. But either ways the family didn’t wanted to go to the hospital!

In the evening Natasha made a good soup and we went to bed early.

Next day we woke up and talk to Alberto, Mateo, Balthazar and Antonio and they wanted to go to the river so we took them with us. First we went to the market in Isquisis, but it was already 11 so it was finished. At the Rio negro, we parked the car in the middle of field of cows and we went swimming the 4 guys started to catch snails, crabs and lobster. Suddenly they started making a fire and opened some bottles of aguardiente. They made an incredible caldo, they had everything with them, what a surprise. I tried to break the ice with a few jokes and we really laughed a lot. All of a sudden they gave me a pepper, and its a tradition after eating to pass it, but I didn’t notice it because they gave me first, so I got the chili pepper and eat it all in once, spicy that’s the least I could say, burning is more appropriate! Everybody had a good laugh. After that they went swimming and washed them self in the river, a terrible encounter with circumcision! After that we went back to the clinic and we finished my big bottle of Rum, talking about politics, the clinic and my chili pepper. Antonio showed me his Che Guevara necklace, I was proud! They talked about the civil war and how they fled to Mexico and lived there for a few years, because they were afraid of both the army and the guerilla. The reason is that a town called San Francisco close to yalanbojotch was totally destroyed by the army including the villagers, now it is a ghost town.

The guys really stayed until the end ( it was hard to get them out) and we made plans for the next weeks, we decided that every Sunday we will go out. Next Sunday we are going to the second Laguna, and fish there and if we don’t catch fish, we are going to eat chicken. These guys really live in nature, it’s nice to take part in this.

Day 20-21 El zotz diaries
by Willemjan Vandenplas on Wednesday, June 29, 2011 at 9:09pm.

On Monday we had a lot of people with urinary infections, so we gave them ciprofloxacin antibiotic. There was also a girl who was complaining from bad sleep, always thinking and sweaty hands, the actual problem was that she wanted to get pregnant, we could tell her the news that she was pregnant, so hopefully her problems will stop. I realized that Ladinos always come with more psychological problems and that the Mayan’s always come with biological problems, also because they don’t speak the language really well. But then you see there are really two different currents in this country. For Flemish Nationalist this is a reason to split a country, here it is used to exploit the Mayan’s and to deprive them from all basic needs. I really start seeing the Guatemalan society as a deeply divided and racist society, because the majority the Mayans have nothing to say and are good to work on their fields.

On Tuesday we had the women giving birth with varicella, she was 38 weeks, so because of the varicella the birth came early. Everybody said it was no problem, but I didn’t trust it, because there is very few literature about this topic. So I called a pediatric doctor, he told us to isolate the new born for 15 days, the time of the incubation, so we kept him at the clinic for the night, searching for other solutions, so we gave him a bath, gave him milk and make a comfy bed for him. In the bodega we found some baby cloths and at night we woke up to feed him and change his diaper. Next day the father who we had invited for food and he listened to Natasha’s mp3 player, proposed to bring it to another family, because in his family 6 out of 8 children had a severe case of varicella, they were full of blisters. Hopefully they will keep him there for 15 days, and I warned first sign of varicella he has to go to the hospital. I hoped we saved the child life doing this, because varicella under one year is deadly for a child! So hopefully Balthazar will live!

day 22 El zotz diaries
by Willemjan Vandenplas on Thursday, June 30, 2011 at 10:54pm.

After the waking up and letting Balthazar go to his grandmothers place, I was really tired. Luckily we had only 3 patients that day. One Maria Lucas Silvestre came like always for het milk, she is the a very pretty girl 6 months old, I have a picture of her with her mother in front of the clinic, where she points at me. She is always waving and laughing, it’s also Lauranne her favorite baby. Every time she comes I really want to make a picture of her!

Then the boy, Awner, came back with dysentheria, with the antibiotics he was really the old one again, he was playing and laughing, but he still had some diarrhea, so I gave him some suero and also metronidazole because I expect he also has amoebiasis, but the little bit of diarrhea could also become because of the antibiotics, but I didn’t wanted to take any risk. When I was doing the consultation his sister 4 years old, was sitting there and had de same symptoms, eating dirt, pale, swollen belly and varicella zoster or zona. The zona is painful, but not dangerous, so I just gave some acetaminophen. She didn’t have fever so I gave her some metronidazol against amoebisis, the usual iron and vitamines and I asked her to come back in two days. She lives in town so for them it’s not difficult to come back. In the afternoon I finished an English book about dermatology, because but I realized I had seen most of it in my courses during the first years. Because dermatology and gynecology are me weak points here, so next step will be reading the next book of no hay doctor, parteras it’s called or midwifes. In the evening I was reading the oxford handbook of tropical health, when all of sudden Mateo, our neighbor came whit the good news that he had a new son. He told me they were searching for a name and they wanted a European name, so he told me that he would take mine, Willemjan they can’t pronounce and my nickname here is Willy, like everywhere in Latin America, so there is now a boy in Yalanhuitz with the best name in the world Willy.

Day 22-23 El zotz diaries
by Willemjan Vandenplas on Friday, July 1, 2011 at 10:01pm.

Woke up early today, it was nice outside, everything was calm and the village started to get busy. We eat breakfast and there came the nicest old man, Balthazar he was feeling weak, he came in the consultation with a permisito when I asked him his birthday he didn’t know, he was only 35 kilos and 1m40 tall. He was the nicest old man I have met, we gave him a full body check, but he was in perfect health, we just gave him some iron and some vitamins. Later we had a women with mastitis we gave her amoxicillin and clavulaan acid, she had really a carbuncle the size of a lemon. The we had two women who fought, but I was really too lazy to attend them, if people want to fight, fight, but don’t think I will treat them like my other patients.

We had quiet afternoon, I had some time to plan my next adventure, maybe I’ll will be going to a refugee camp in the south of Algeria to help the Sahrawi, who had to escape western Sahara, will see, I don’t count on it I can do it, but I don’t think there are a lot of people in Belgium speaking good Spanish and decent Arabic, French and English.

Around 3.30 we had a 9 year old girl with muscular pain, it thought this would be a quicky, but she had 39 degree fever, polyarthritis and a streptococcal throat infection, bad news, we think she had rheumatoid fever, I hope not, because otherwise she will have to take maybe for the rest of her life antibiotics. I called the clinic in Pojom and there they were really proud I diagnosed it. Didn’t expect this type of diseases here.

At night Antonio passed by, he brought some pineapple and we talked a lot about healthcare. He is studying to become a health promoter. He told me the narco’s are heavily active in Yalanhuitz, every night at 1, there is a truck passing by full of drug and that in Isquisis there is a compound. He told me they are cultivating cocaine in San Marcos, Copan and Petén. Yalanhuitz is a turning point for the get drugs over the border, here they bring is to Yalanbojotch and from there over the river to Mexico and then to the United States.

Next morning I woke up late, we had some women who came for birth control and a man who had an epilepsy. Later we had a women with blood loss for 3 days in the second half of her pregnancy, after checking we decided she had a placenta previa, she has to go to the hospital, but her husband was working in the field and will come back in one day, so we had to wait.

Suddenly I saw Natasha crying at the computer, she received a mail that her uncle is dying, we decided quick that she had to go home. So tonight she will leave for Belgium. Luckily a English medical student is coming tomorrow so I won’t be alone in the clinic.

Every day there is something happening in the clinic, we yesterday the rheumatoid fever and today the placenta previa.

day 24-25 El zotz diaries
by Willemjan Vandenplas on Monday, July 4, 2011 at 11:28pm.

Natasha left Saturday morning at 3 with Leonardo to Yalambojotch. Next day I had really a bad time getting up, but there was only one patient, the father of the girl with Rheumatic fever, he told me that after she got the injection she got little blisters on her body. Later that day we visited her, first I toughed it was a penicillin allergy, but it was luckily varicella. What a coincidence she got it so quick after she left.

During the day Christina arrived a Chinese/Spanish volunteer who lived her whole life in Singapore and now she studies in Cambridge. She speaks good Spanish and is already in her 6th year of medicine, so perfect, then we can share the responsibility a bit. She arrived and we went straight to the girl with rheumatic fever. The lived far away, there wasn’t really a road to their house and the last 500m we had to walk. Their house had a beautiful scenery and they invited us for frijoles and eggs when we were there because I made spaghetti at midday the father. He had talked me about his membership of the sabbatical church and that he would vote “mano dura” the local Fascist party. But even then I liked him, because he was down to earth.

In the evening I had some time to read in the oxford handbook for tropical medicine and went to bed early because Christina was very tired too.

At 6 Antonio, Balthazar and Alberto woke us up because the wanted to go to the laguna, but it was bad weather. So we made them some pancakes and left for the market of Isquisis, where I met Wouter, Miet, Celine and Sarah the other Belgian volunteers at Pojom. We had a good talk, they had only heard people from here speak Spanish, so the looked up when I spoke with my Argentinian accent. After that we went to the house of Balthazar to watch football and eat chicken we bought in Yalanhuitz, finally after a week and a half some meat. I got really tired in the afternoon so I rested a bit and then we went walking and the rest of the day I spend reading my book!

day 26-27-28-29-30 el zotz diaries
by Willemjan Vandenplas on Saturday, July 9, 2011 at 9:57pm.

This week we had a girl with cataract and, we diagnosed a women with diabetes and gave her metformine and ace-inhibitor. It was a very calm week, only 6 patients every day, so I had plenty of time to read, I read donde no hay doctor once again and read the oxford handbook for tropical medicine. I also read the course book for tropical diseases of the tropical institute of Antwerp. All very interesting, but I want to see some action right now, except of giardia, ascaris and amoebisis, we are not doing a lot of tropical medicine. Thursday night I found donde no hay doctor in Arabic, I was really happy, I think it’s the best way to get better in medical Arabic.

Friday I got really tired, because already lost 10 kilo’s and the food here is really basic.

Friday night Christina left, although she ate all my food, it was a nice experience with her, she learned me a lot of things.

day 31-32-33-34 el zotz diaries
by Willemjan Vandenplas on Wednesday, July 13, 2011 at 9:37pm.

Saturday morning, I was alone with Maria in the clinic, we had a man who cut himself in his mouth and a boy with a Larva Migrans. The afternoon was quite, I didn’t like the fact of being alone in the clinic, so a few days earlier I decided to go to Pojom. At Six I left after I had locked myself out from the clinic; oeps! Alberto brought me to Isquisis and from there I took a Jeep to Pojom, the road to Pojom, If you can call it road, is about the steepest unpaved hill I did in my life. After an 1.30 min I arrived in Pojom, was welcomed by the volunteers there. And it was relaxing to be with a group of people there. They really live on an island in the city and have a lot more luxury then we have. Yalanhuitz is really in nature.

Next day we woke up early to go to the laguna, after an hour walk we arrived in Isquisis and from there we left for Yalanhuitz by car and then to the Laguna. It was almost full, and I swam like 200m into the Laguna, it was beautiful, Fidel, the dog, swam all the way too. We went back to isquisis and walked by Rincon a 2 hours walk to Pojom. To have finally arrived in Pojom after a very long walk. At night we ate brochetta and I went to sleep early.

Monday I chilled, read a little and talked to my friends on facebook and skype. Finally a good internet connection. On Saturday morning, the sister of Balthazar asked for milk, we had isolated him from his family, but the family lied to us. He was full of blisters, we immediately asked them to go the Hospital, but they didn’t want. Sometimes I think we should be more paternalistic with these people, give them no other option than going to the Hospital. Maybe it’s because they are so exploited, that they become so passive to life. A life doesn’t have so much importance in Guatemala. A sad fact, maybe we should invest more into health education, but if the Guatemalan government only gives 1% of BNP to healthcare, there is no point in even considering it. People need a revolution here like in the middle east, it should be massive enough, people should get conscious of how better their life could be if things are shared with more equity. That’s the idea of el Zotz, the mayans need a strong lider like el Zotz was before the conquista started. I really hope for a non-violent Mayan Spring, but it will take years to get to it and it’s something that has to grow bottom-up, winaq, mais, urng have a long way to go…

day 35-6-7-8 El zotz Diaries
by Willemjan Vandenplas on Tuesday, July 19, 2011 at 10:09pm.

On Wednesday I woke up early to go to Yalanhuitz, we walked for 1.30h up and down the mountain, where the river crossed the road, Andres was waiting for us with the car. At Yalanhuitz there was a capacitacion of midwifes, while I was there I got the news I would be there 4 more days alone, so I decided to go back to Pojom. After the capacitacion we had dinner, chicken, amazing! In the afternoon I walked back to Pojom, the live in the clinic, the other volunteers in Pojom are such nice people, so I really had a good time. Until Sunday I took the time to listen to some music, read a book for midwifes, but conclusion was that I had the time to plan next year in Belgium. The food is also really good here, the girls cook like queens.

Saterday night I had a hear cut, I had to go to the Pinchazo, there they were watching Argentina-Uruguay, fine game, I was watching the football while getting my hear cut, when I was looking in the mirror, it was like oeps, but I only paid 1 euro!

After that we eat some pancakes at Wouter and Miet’s place, the two responsibles of the project! Then of to bed!

day 39-40-41-42-43-44-45 El zotz diaries
by Willemjan Vandenplas on Sunday, July 24, 2011 at 11:43pm.

On Sunday I left again for Yalanhuitz, I could hop on the car of Wouter who was going to Huehue. I would be alone there for a day because Maria wasn’t working on Monday and the two tropical doctors Britta and Mandana would only come in the late afternoon. I took my time to watch some series, I watched the killing until 23h and then I went to bed. Next day I woke up and saw the last episode of this more than interesting series. I had a few patients in the morning one of the was Willy, he had an eye infection and his nose was blocked. At 17H the two new volunteers came, they immediately started cleaning the whole clinic, they were really afraid of becoming sick the 5 days they were here. It would become a strange week, because working with doctors who just finished their studies is not easy. Next day Willy came back and his breathing was very bad, he had recessions, so we gave him antibiotics amoxicillin and eye drops. Their also came a difficult family, they wanted milk because the mother of the kid had died a week after birth, but their story was really strange and it wouldn’t be the first time people lie to us to get milk, so I didn’t believe him and there was also no milk for them. Some people see the clinic as a supermarket for milk, vitamins and other stuff. On Wednesday there was this women who came with a priest and after the consultation she went to the back of the clinic and was in our room, at night I realized 40 euros was gone, a big amount of money for this place. But I couldn’t do anything because she was not living in Yalanuhuitz. On Wednesday I also did my first suration, 3 stitches, I was really happy of the result. On Saturday we had a man with a detached retina, he didn’t have money to go to the hospital so we had to wait. In the mean time we didn’t have news from Balthazar, the boy with varicella, we think he died…

Saterday night I left for Pojom again, on my way I got news from the new volunteers who are coming that they will be there on Monday. So on Monday I will go back to Yalanhuitz, to receive the sixth volunteer and to try to adapt to the new situation again and then I go home…

On Friday, I was a little bit worried about a mosquito bite that started to become a dirty wound and the two tropical doctors diagnosed it as Leismania, It’s a potentially fatal skin disease if not treated, but when I go back I will go to the institute of tropical medicine in Antwerp, to get checked!

Conclusion:
After a month being back I can only look back at it from a medical point of view, I can tell I learned a lot, but to make a shift from strictly biological medicine to more social medicine there is a need for more exploring the tools languages give in Medicine. It’s not only good to have full knowledge of a language, but also of communicative skills, saving a life was more a question of convincing people to go to the hospital, also one should consider the economical point of view.

De agrarische crisis in Argentinië: La historia de una crisis anunciada?

Is de agrarische crisis in Argentinië de voorbode van een internationale voedselcrisis die vooral de ontwikkelingslanden zal treffen? Het staat vast dat de crisis het gevolg is van de voedselprijzen op de internationale markt en dat deze crisis niet zomaar een staking is, maar mogelijks een conflict tussen de modellen voor de ontwikkeling van een land, staan we aan de vooravond van een paradigmaverandering of blijft het machtsbastion van Christina en Hectór Kirchner overeind?

De oorzaak van de crisis is de beslissing van de overheid om de belastingen te verhogen op de export van agrarische producten. De exportbelasting op soja steeg van 27% naar 40% met als gevolg dat in totaal 44%(+ de inkomstenbelasting) van de opbrengst naar de staatskas gaat. De productiekost is 50% van de opbrengst zodat slechts 6% winst overblijft voor de sojaproducenten.

De sojaproducenten pikten dit niet, de twintigdaagse crisis begon op 13 maart toen de werkgevers van la Sociedad Rural Argentina (SRA), la Federación Agraria Argentina (FAA), las Confederaciones Rurales Argentinas (CRA) y CONINAGRO, een lock out (een staking van de werkgevers, zij sluiten hun bedrijf en doen de werknemer stoppen met werken, dit is verboden in België) aankondigden. De stakers blokkeerden de wegen en manifesteerden met als gevolg dat heel het land werd lam gelegd, de grootste crisis sinds 2001 was een feit. 25 maart was het diepte punt, omdat de werkgeversorganisaties beslisten om de staking voor onbepaalde duur voort te zetten tot de overheid de beslissing ongedaan zou maken. Het resultaat was dat er grote tekorten aan voedingsmiddelen ontstonden in de winkels.

De gevolgen van de crisis polariseerde de Argentijnse samenleving. Er werden manifestaties gehouden zowel voor als tegen de beslissing van de overheid, ze eindigden op 28 Maart, maar de wegen bleven geblokkeerd. De strijdende partijen gingen aan tafel, maar de voorstellen van de overheid werden niet geaccepteerd met als gevolg dat de manisfestaties hervat werden. Op 1 April werd er een massale manifestatie gehouden door de vakbonden, politiekte partijen o.a. de partij van Kirchner en mensenrechtenorganisaties om de overheid te steunen. Hierop riep de belangrijkste organisatie van de Confederaciones Rurales Argentina, de belangrijkste organisator van de lock out op tot onderbreking van de acties. Op 2 April, de 21ste dag van de crisis, werd een bestand van een maand afgekondigd om te overleggen met de overheid.

Soja is booming business;

Argentinië is internationaal de derde grootste producent van Soja: 80% van het landbouwareaal bestaat uit Soja, waarvan 60% in handen is van grootgrondbezitters (vnl. van 4 grote transnationale agrobusiness bedrijven, waarvan 2 Argentijnse). De laatste oogst bedroeg 48 miljoen ton, ter waarde van 151 dollar per ton. De hoge wereldprijzen zorgen er voor dat soja veel winstgevender is dan andere commodities zoals graan. Het stijgende aandeel van de soja in het landbouwareaal zorgt ervoor dat graanproductie voor de binnenlandse markt daalt, maar de binnenlandse vraag naar graan stijgt door de stijgende welvaart, wegens de hoogconjunctuur van de grondstofprijzen, met als gevolg dat de prijzen stijgen.

De secundaire gevolgen van stijgende graanprijzen zijn ten eerste dat het brood en van graan afgeleide voedingswaren duurder worden. Ten tweede wordt het vlees ook duurder, omdat graan een belangrijk veevoeder is. Argentinië, dat één van de belangrijkste vlees exporterende landen is, heeft de hoogste vleesconsumptie per capita, dus een duurdere “Argentijnse Steak” bezorgt de doorsnee Gaucho heel wat kopzorgen.

Niet alleen de duurdere voedselprijzen, maar de monocultuur zorgt op sociaal en ecologisch vlak voor een ramp; duizenden kleine boeren verliezen hun land aan de grote sojaconcerns. Het zorgt voor een verarmingen vervuiling van de bodem en de ontbossing versnelt de verwoestijning van de Argentijns Pampa.

De strijd tussen Argentijnse ontwikkelingsmodellen;

Kenmerkend voor Argentinië is de hoge graad van urbanisatie, een beperkte industrialisatie en een economie die vnl. gebaseerd is op de export van landbouwgoederen en grondstoffen naar het buitenland.

Het politieke landschap van de laatste decennia werd in essentie bepaald door de belangenstrijd enerzijds tussen de grootgrondbezitters die van Argentinië eerst “de graanschuur van wereld” en nu “de bakermat van de soja” willen maken en anderzijds de industriële elite die Argentinië willen industrialiseren. De inzet van de belangenstrijd was welke de geprivilegieerde sector zou worden.

President Kirchner, die na de economische crisis van 2001 aan de macht kwam, droeg enkele maanden geleden de macht over aan zijn vrouw Cristina Fernández Kirchner. De partij van K’s noemt, el Frente para la victoria, dit is de linkse vleugel van de Peronistische partij. De Peronistische partij is de ruggengraat van de Argentijnse politiek en bestaat uit verschillende stromingen, waarvan de partij van Kirchner nu de belangrijkste is.

De regering van Kirchner koos na de crisis van 2001 voor industrialisatie, aan de hand van een neokeynesiaans beleid door de binnenlandse productie en importsubstitutie te stimuleren, als de weg voor de ontwikkeling van Argentinië. De partij trekt de kaart van de industriële elites door hun hoge winsten te garanderen, de lonen relatief laag te houden, een dure dollar zodat exportproducten goedkoop zijn en door import af te remmen.

La Sociedad Rural Argentina (SRA) bestaat uit een duizendtal grootgrondbezitters die samen meer dan 36 miljoen hectaren land bezitten. Zij strijden voor de invoering van hun agrarisch model van ontwikkeling en worden gesteund door de oppositie. Het is namelijk zo dat het onderscheid tussen de industriële elite en de grootgrondbezitters op economisch vlak vrij arbitrair is: hun belangen op economisch vlak zijn verweven, nl. ook de grootgrondbezitters investeren in de bouw en industrie en ook het monetaire beleid is gunstig voor hen om te exporteren.

Polarisatie bij de pequeños campesinos;

De lock out werd gesteund door La Federación Agraria Argentina (FAA), dit is een boerenorganisatie van enkele tienduizenden kleine producenten die niet produceren voor interne markt, maar speculeren op de internationale markt. De FAA verdedigt de eis van de grootgrondbezitters, terwijl het andere deel van de kleine producenten (el Movimiento Campesino de Córdoba (MCC) en el Movimiento Campesino de Santiago del Estero) die voor de interne markt produceren, de overheid steunen. Zij worden weggeconcurreerd door de grote transnationale agrobusiness, waardoor het voedselaanbod op de interne markt verkleint en de boeren verplicht worden om in de steden naar werk te zoeken of verplicht zijn hun arbeid te verkopen aan de grootgrondbezitters.

De alliantie tussen een deel van de kleine boeren en de grootgrondbezitters bestaat doordat de exportbelasting algemeen geldend is. de FAA zijn de stoottroepen tijdens de manifestaties en veroorzaakten de wegversperringen. De FAA bestempelt de overheid als arrogant en autoritair en meent dat de machtsconcentratie in de hoofdstad de ontwikkeling op het platteland afremt. Deze polarisatie recentelijk gebeurde, enkele jaren geleden manifesteerden de FAA, MCC en MCSE nog samen tegen het monopolie van de SRA (de grootgrondbezitters).

De Gaucho’s;

Op 1 april, de 20^ste dag van de crisis, waren er tekorten van vlees, melk en groeten over heel het land. In 70% van de scholen en enkele hospitalen kon zelf geen middagmaal worden voorzien. De FAA en grootgrondbezitters zagen dit als een overwinning omdat ze in staat zijn een voedseltekort te creëren. Confederaciones Rurales Argentina riep hierop een bestand uit van een maand om te onderhandelen met de overheid.

Het deel van de civil society dat de overheid steunt mobiliseerde zich massaal op 1 april: de vakbonden, de politieke partijen(el Frente para la Victoria, el Partido Justicialista, el Frente Grande, el Partido Comunista en el Partido Socialista de la Provincia de Buenos Aires) en verschillende mensenrechtenorganisaties (Madres de Plaza de Mayo, madres de Plaza de Mayo Línea Fundadora, HIJOS, Agrupación de Familiares de Detenidos Desaparecidos, y Abuelas de Plaza de Mayo). Hebe de Bonafini, de voorzitster van de Madres de la Plaza de Mayo, bestempelde de grootgrondbezitters als vijanden en bracht in herinnering dat het de grootgrondbezitters waren die de militaire dictatuur steunden en van het neoliberale model van de jaren ’80 en ’90 profiteerden.

2 Mei;

Zal het machtbastion Kirchner van koers wijzigen door de druk van de grootgrondbezitters en de FAA? Het staat vast dat de grootgrondbezitters in staat zijn voedseltekorten uit te lokken, hetgeen de krachtverhouding tussen overheid en de grootgrondbezitters verandert.

Het bestand dat Confederaciones Rurales Argentina heeft ingesteld loopt af op 2 mei.

De auteur van dit artikel is Willemjan Vandenplas, studeert geneeskunde en politieke wetenschappen aan de KULeuven. Hij studeerde 9 maanden in Argentinië.

De gezondheidszorg op Cuba;

Dit maal niet door Michael Moore's ogen , maar door die van een student geneeskunde.

februari 2007,

Na stapels theorie te hebben verwerkt, tijd voor praktijkervaring.
Dankzij Intal en Lena Van Der Bruggen kon ik in contact komen met de Cubaanse Dr. Mayda Guerra Chang, zij is verantwoordelijk voor gezondheidsprojecten van geneeskunde voor de derde wereld(G3W) en studeerde Public health aan het ITG in Antwerpen.
Plaats van afspraak: 'centro Habana', 14 februari om 9u 's morgens.

14 Februari,

De dag begint met een helse rit in een 'camello', zo noemen de cubanen de twee bultige 'guaguas', bussen, die een prominente plaats in het straatbeeld van Havanna innemen. Plaats van afspraak ligt midden in de meest dichtbevolkte, 170.000 mensen op 3km², en meest vervallen deel van Havannna, 'centro de habana'. Op straat is het een drukte van jewelste, spelende kinderen, Cubanos op weg naar hun werk, de gepensioneerden die domino spelen of gezeten, met een blik op oneindig, voor zich uit staren. Velen kijken op, omdat buitenlanders zelden deze wijk betreden, misschien ook omdat we met twee kartonnendozen vol medicamenten uit België rondlopen.

Eens aangekomen worden we hartelijk verwelkomd door Dr. Mayda, zij geeft ons uitleg over het Cubaans gezondheidszorgsysteem en de rol van G3W binnen dit systeem met als 'case study', het project van G3W in 'centro Habana'.

De resultaten die het Cubaanssysteem voorlegt;

Cuba spendeert jaarlijks 6,3%(bron: UNDP report 2006) van haar BNP aan gezondheidszorg, evenveel als België. In Latijns-Amerika enkel overtroffen door Colombia(6,4%), na Cuba komt Costa Rica met 5,8%. Het percent BNP is een belangrijke referentie, maar natuurlijk is kwaliteit, belangrijker dan kwantiteit.
Enkele cijfers uit 'The Human Development Report (2006)', van de WHO(2007) en 'The State of the World's Children(2007)' rapport van UNICEF; in 2005 was de prevalentie van TBC 9 gevallen per 100.000inw, tegen 2015 willen de Cubanen TBC uitroeien; prevalentie van HIV bedraagt 0,1% van de bevolking; er zijn 591 dokters per 100000inw.; 98% van de bevolking heeft toegang tot sanitaire voorzieningen; 4% van de kinderen onder 5 jaar lijdt aan ondergewicht; maternele mortaliteit bedraagt 33 per 100.000 inwoners, kindersterfte onder de 5 jaar bedraagt 7 per 1000 levende geboortes; gemiddelde levensverwachting bedraagt 77,6 jaar.
('the human development report office is primeraly a user and not a producer of statistics', deze cijfers worden doorgegeven door de nationale overheden en worden niet onderworpen aan Internationale controle)

De voedings- en gezondheidsstatus van de Cubaan

Het voedingsprofiel;
De lipidenintake is te groot, overdreven gebruik van vetstoffen bij de bereiding; de overconsumptie van proteïne(vlees), voornamelijk varkensvlees; en een te klein dagelijkse intake van fruit en groenten. Een belangrijke toelichting; op Cuba is de voeding gerantsoeneerd, maar het rantsoen garandeert geen voldoende evenwichtige en gevarieerde voedingsmiddelenintake.

Lichaamsgewicht;

31,5% van de mannen tussen 20 en 59 jaar heeft een BMI >25 en wordt geclassificeerd als obees, voor de vrouwen is dit 39,4%. (cijfers cuba: http://www.unu.edu/Unupress/food2/UID10E/uid10e19.htm)

Alcohol consumptie;

De prevalentie van alcoholisme bedraagt 5%, met een genderverhouding 3man:1vrouw, dit is een ernstig probleem op Cuba, 1 op de 3 verkeersongevallen zijn te wijten aan een overdreven alcohol consumptie.

Rookgedrag;

Op cuba is roken op de openbare plaatsen verboden en je mag onder de 16 jaar geen

sigaretten kopen, maar roken op Cuba is een traditie, zo zijn sigaren en sigaretten opgenomen in het rantsoen, samen met basismiddelen als bonen en rijst. Ook is de sigaar één van de symbolen van de revolutie. Op een bevolking van 11,2miljoen inwoners roken er meer dan 2miljoen mensen, waarvan 76% begon vóór hun 20 jaar. Longkanker is één van de belangrijkste doodsoorzaken.

Lichaamsactiviteit;

Cubanen doen ook te weinig aan sport, ze leven te sedentair, bv. het geval ven 'centro habana', daar zijn weinig sportfaciliteiten, hierbij zou ik willen vermelden dat er een project van G3W loopt om straten in te richten als een sportveld, 'los callesparques'.

Ziekteprevalentie;
De hoge dagelijkse intake van lipiden, de hoge prevalentie van obesitas, het rookgedrag, de alcoholconsumptie en de sedentaire levensstijl dragen bij tot de hoge prevalentie van hart en vaatziekten, diabetes, hypertensie op Cuba. Deze ziektes worden aanzien als 'beschavingsziektes'.
Opmerkelijk is de lage incidentie van infectieziekten, omwille van de preventie, nationale campagnes bv tegen Dengue, de hoge vaccinatiegraad van de bevolking, dit is opmerkelijk in de 'aula van de ontwikkelingslanden'.

Het Cubaanse systeem toegelicht, rol van G3W hierin;

De eerstelijnsgezondheidszorg is volledig gratis, bij de andere echelons moet de patiënt een kleine bijdrage leveren.
Iedere 'médico de familia', zoals de huisarts wordt genoemd, wordt bijgestaan door een verpleegkundige, dit is de centrale spil in het systeem. Zij zijn verantwoordelijk voor 800 tot 15000 mensen. Hun werkterrein strekt zich uit tot de wijken, daar ligt de nadruk op gezondheidsopvoeding en preventie. 10 tot 12 huisartsen werken samen in een basisgroep, die ondersteund wordt door een geneesheer specialist, een socioloog, een psycholoog, kinesist, tandarts,...
Als de huisarts beslist dat een patiënt niet binnen de eerstelijn geholpen kan worden, wordt hij doorgestuurd naar een polikliniek, er is er één per 30.000, mensen en bakent een gezondheidszone af, waarbinnen de polikliniek een belangrijke coördinerende functie heeft. Hier verzorgen specialisten de doorgestuurde patiënten, bij eventuele nood aan opname zijn er de nationale ziekenhuizen. De huisarts speelt ook een prominente rol bij revalidatie van de patiënt.
Opmerkelijk is het wijd verspreide gebruik van homeopathische geneesmiddelen.

Preventieve geneeskunde en gezondheidsopvoeding zijn pijlers in het systeem, de Cubanen redeneren: 'voorkomen is beter dan genezen', en ook goedkoper. Participatie van de bevolking is het sleutelwoord in het Cubaanse systeem.

Mayda vertelde dat binnen dit systeem in 1998 het G3W-Project in 'Barrio Dragones', een deel van 'Centro Habana', startte onder de vorm van een pilootproject, het liep zodanig goed dat het bestaande project over heel 'Centro Habana' werd uitgebreid en sinds 2003 zijn er gelijkaardige projecten in Cienfuegos en Yaguajay. Het project kaderde in het gezondheidsmodel: 'juntos por el bien estar de todos'; Het doel was en is de medische dienstverlening te verbeteren door het opknappen en moderniseren van de dokterspraktijken en poliklinieken, ook om de activiteiten van gezondheidsvoorlichting en -opvoeding op te voeren.
Dit hielt in: bijscholingen voor artsen en verpleegkundigen rond communicatie met de buurtbewoners om op deze manier plaatselijke gezondheidsproblemen beter te kunnen analyseren en aanpakken, het opleiden van gezondheidspromotoren, acties rond gezondheid, op scholen en op straat bv. de Bulevars de Salud, marathons, teken- en literatuurwedstrijden, sportactiviteiten, ... allemaal met het accent rond gezondheidsvoorlichting.

Op het terrein;
Dr. Mayda nam ons mee naar een 'médico de familia', opmerkelijk was hier de aanwezigheid van de verpleegkundige, die de klacht in kaart brengt en parameters(lengte, gewicht, bloeddruk,...) nam van iedere patiënt, de gegevens vormden de basis voor de verdere onderzoeken van de huisarts.We bezochten ook een 'centro promotor de salud', waar preventie en gezondheidsopvoeding centraal staat, hier worden groepsgesprekken georganiseerd rond bepaalde thema's: alcolisme, drugs, tabaksverslaving, hypertensie, cholesterol, soa's,...

'centro promotor de Salud' is voornamelijk voor volwassenen, de jeugd wordt bereikt via de school. Zo volgden we een preventieles mee over infectieziektes, het was opmerkelijk hoeveel de leerlingen wisten en hoe vlot ter taal ze waren, 'chicos espabilados'!
We kregen ook een rondleiding in een 'polyclinico' aan de Malecon, de bekende dijk van Havanna. Volgden een les gegeven door een gezondheidspromotor, waarin hij, op verhelderende wijze de hiv- en aids-problematiek uitlegde voor huismoeders uit 'centro Habana'.

's Avonds gingen we uit met een paar jonge artsen die terugkwamen van Venezuela, waar zij werkten binnen de Cubaanse missie die kadert in de ALBA, Cuba levert artsen in ruil voor Venezolaanse olie: Oil for Healthcare.

Mijn ervaring;

Opvallend is de dispariteit enerzijds tussen het aantal artsen, 9% BNP gaat naar onderwijs, en anderzijds de precaire toestand van de infrastructuur en het tekort aan medisch materiaal, medicamenten, medische apparatuur.

Cuba wijst hiervoor de VS met de vinger, de VS-blokkade is calamiteus voor Cuba. Het VS-vetorecht in de veiligheidsraad van de VN, blokkeert iedere resolutie hieromtrent.

Opmerkelijk is het feit dat met de weinig materiele middelen, zeer goede resultaten voorlegt.

Ook de andere visie op de arts-patiënt relatie, die niet alleen zijn oorsprong vindt bij de patiënt, maar ook bij de arts die de verantwoordelijkheid krijgt om zijn patiënt actief op te zoeken in zijn leefomgeving, met als gevolg dat de huisarts zich; ten eerste actief kan toeleggen op preventie en gezondheidsopvoeding, ten tweede sneller kan anticiperen op mogelijke gezondheids -en sociale problemen, ten derde kent hij beter de maatschappelijk -en familialecontext van zijn patiënt, ten vierde kan hij beter de therapietrouwheid controleren.

Het was goed om zien dat de Internationale Solidariteit zoveel aandacht geniet in de opleiding geneeskunde, dat studenten actief gestimuleerd worden om naar het buitenland te vertrekken. Ook dat er zoveel buitenlandsestudenten een studiebeurs krijgen op Cuba, ze komen uit alle hoeken van de wereld, een grote groep komt uit Venezuela in het kader van de ALBA, andere landen zijn bv Angola, Nigeria, Uruguay, Vietnam,... en paradoxaal genoeg de VS)
Een jaar geleden was ik in Gabon, dé oliestaat van Afrika, op doortocht in Omboué, bezocht ik een veldhospitaal, wat ik aantrof tart ieders verbeelding, zeker het UZ Gasthuisberg kennende; kapotte couveuses, sterilisatie machines,... diagnose: geen personeel die herstellingen kan uitvoeren, een lege farmacie, een operatiezaal met schimmel aan de muur. Geen VN of NGO's aanwezig, enkel de bilaterale coöperatie van de Cubaanse overheid, een Cubaanse dokter verzorgt patiënten die anders verstoken zouden blijven van gezondheidszorg.

het Cubaanse gezondheidszorgsysteem; de problematiek

Los van problemen die het handelsembargo veroorzaken, zie ik nog veel andere problematieken en tegenstellingen in Cuba; enkele nuanceringen en bedenkingen hieromtrent;

Cijfers van cuba interpreteren;

Men moet enige voorzorg indacht nemen als men de cubaanse bevolkingsindicatoren interpreteert en vergelijkt met de rest van de Latijns-Amerika of de rest van de wereld.
Ten eerste, geografische factor Cuba is een eiland, dit is een belangrijke bedenking bij het interpreteren van de cijfers die Cuba voorlegt. Dit verklaart bv. de lage prevalentie van Hiv, dit komt omdat de Cubanen in isolement leefden voor de ontwikkeling van de toeristische sector, opmerkelijk is de explosieve toename van incidentie van Hiv en andere soa's sindsdien.
Ten tweede, een demografische, moet men ook weten dat de levensverwachting op Cuba in 1955, dus voor de revolutie, al 63 jaar was, dit staat in contrast met het Latijnsamerikaanse gemiddelde van 52 jaar. Ten derde van de 70,594 Cubaanse artsen(UNDP 2006), 29000 in het buitenland werken in verband met de 'internationale solidariteit van Cuba'.

Opmerkelijk is dat de Cubaanse staat massaal het medische toerisme promoot, dit is één van de redenen voor de enorme wachttijden voor bij behandelingen. Geduld dat is een nuttige deugd op cuba, uiteindelijk wordt toch iedereen geattendeerd.


De rol van de staat is zeer ambigu;

Ik schrok van de controle van de staat op de verschillende aspecten van het gezondheidszorgsysteem, de mate waarin het systeem gepolitiseerd is.
De staat beïnvloedt en controleert alles tot de arts-patiënt relatie; de Cubanen zijn niet vrij om te kiezen naar welke dokter ze gaan, ze krijgen er één toegewezen. Enkel op expliciete vraag van de patiënt, kan er na een admistratieve procedure van arts worden veranderd, wat de drempel gevoelig verhoogt.
Een ander opmerkelijk fenomeen is ook het feit dat voor kostelijke behandelingen, een cubaan de toestemming nodig heeft van de staat.
Mayda vertelde mij hoe moeilijk het is om op Cuba iets te realiseren, de administratieve rompslomp, hoe moeilijk het is om budjetten los te weken van de overheid. De bureaucratie verlamt innovatieve projecten, die cuba nochtans broodnodig heeft.

Ook de opleiding geneeskunde blijft niet gespaard, zo kan je niet kiezen om geneeskunde studeren. Studenten geven een lijstje van studierichtingen door die hun voorkeur draagt, de staat beslist dan over je toekomst rekening houdende met het curriculum en de nood aan geschoold personeel in een bepaalde sector.
Ook zijn er meer politiek georiënteerde vakken in het curriculum opgenomen, zoals de geschiedenis van de revolutie.


De keerzijde van de medaille van de internationale solidariteit;

Veel dokters die in het buitenland blijven, vluchten, zo was er enkele jaren terug een exodus van duizenden artsen, vaak mensen met onmisbare medische kennis en ervaring. Met als gevolg ten eerste dat er een enorme druk heerst op de universiteiten geneeskunde om nieuwe studenten op te leiden en de calamiteit is dat vaak de beste proffen zijn vertrokken naar het buitenland, wat de kwaliteit van de opleiding zeker niet ten goede komt. Ten tweede dat de wachtlijsten weer aandikken.
Het medisch personeel dunt niet enkel uit, maar ook het medisch materiaal, Dr. Mayda vertelde dat er op Cuba 4 CT-scanners zijn, in het kader van de ALBA, staan er nu 3 in Venezuela.

Slotbeschouwing

Cuba is zeker een van de primussen tussen de ontwikkelingslanden qua gezondheidszorg, de resultaten zijn vergelijkbaar met ontwikkelde landen. Toch kan ik niet genoeg benadrukken dat er met die cijfers op een kritische manier moet omgesprongen worden. De sociale en fysische factoren op zijn verschillen van de andere ontwikklingslanden.

De Cubaanse gezondheidszorgsysteem is zeker revolutionair te noemen, omwille van zijn simpele structuur en effectiviteit. Ook de nadruk op preventie en gezondheidseducatie is revolutionair, de projecten van G3W zijn essentieel in het tot stand brengen van dit beleid.
Maar door toedoen van enerzijds interne factoren zoals bureaucratie en staatscontrole resulteert het in een té rigide structuur. Anderzijds door externe factoren, zoals de exodus van medisch personeel en het VS-handelsembargo, staat er een enorme druk op dit systeem, zodat zowel intern als extern veranderingen nodig zijn omdat systeem van een implosie te vrijwaren. Het opheffen van het handelsembargo zou voor zuurstof kunnen zorgen, maar dit zal zonder effect blijven als 'vadertje staat' niet de touwtjes viert zodat het systeem kan openbloeien.


Willemjan Vandenplas,
3 bachelor geneeskunde aan de kuleuven