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Guatemala Peter Rohloff and Anne Kraemer díaz Diverse in language, culture, and landscape, Guatemala is an authentic blend of the modern and the ancient. Traditional and modern ways of life are constantly negotiated in crowded markets, on busy streets, and among small farm plots that dot the countryside. Guatemala is a common vacation destination and also a travel hub for Spanish learners, lovers of archaeological ruins, and volunteers. At the same time, for the indigenous Maya who constitute the majority of Guatemala’s population, day-to-day life is often a struggle to put food on the table, to find access to healthcare, and to provide a steady income for the family. In this chapter, we describe the difficult and complex historical and sociological features that determine the healthcare landscape in Guatemala, with a special focus on the needs of the country’s Maya population. In particular, we use cases studies in chronic child malnutrition and adult type 2 diabetes to explore how effective healthcare programming can address the needs of indigenous people in Guatemala today. Geography and Population Guatemala is defined geographically by mountainous terrain in the central and western highlands. To the east and north, the landscape transitions to a lowland limestone plateau. Bordering Mexico to the north, the Pacific Ocean to the west and south, El Salvador to the southeast, and Honduras, Belize, and the Gulf of Honduras to the east, Guatemala is slightly smaller than the state of Tennessee at 108,890 square kilometers.1 The lowlands to the east and both coasts have a tropical climate. The highlands , on the other hand, range from warm to cool during the day and can be quite cold at night. There are two seasons: rainy from May to October, and dry from November to May. Four active and more than twenty dormant volcanoes span the Sierra Madre Mountains running north-south through the country. Rich biodiversity in flora and fauna is found throughout more than twenty different ecological zones. Because of such great ecological diversity, a wide range of cash crops and subsistence crops are grown in Guatemala. The main cash crops are coffee, sugar, bananas, cotton, cardamom, and cacao; 42 | 2 Guatemala | 43 the main subsistence crops are corn, beans, fruits, and vegetables. As of this writing, broccoli, asparagus, spices, snow peas, and cauliflower are increasing as export crops. Coffee and sugar account for almost 50 percent of the labor demand in Guatemala, and coffee alone generates almost one-third of Guatemala ’s foreign exchange.2 Tourism is also a large and growing industry, and is probably the most important segment of the economy in the highlands and core archeological region. Additionally, remittances sent from immigrants in the United States home to their families in Guatemala made up 10 percent of gdp in 2008, although these numbers may currently be waning because of recent, more aggressive US immigration and deportation policies.3 Guatemala is one of the most populous countries in Central America, with over 14 million people. However, the gdp per capita is only about one-half of the regional average for Latin America and the Caribbean.4 More than half of Guatemala’s population lives below the national poverty line, and extreme poverty disproportionately affects the country’s indigenous population.5 The major population centers are found in the highlands. Guatemala City, the capital, is the largest city, with over 2.5 million inhabitants in the metropolitan area. Quetzaltenango is the second-largest city, with about 200,000 inhabitants .6 Guatemala is divided into 22 departments, 331 municipalities, and 20,485 towns and villages.7 Some 48 percent of the population lives in urban centers, with the remainder living in rural communities.8 Internal migration hovers around 10 percent, and migration out of Guatemala is high. Overall, the country’s population is rapidly growing at a rate of about 2 percent per year.9 Guatemala is rich in cultural, ethnic, and linguistic diversity. The population is divided primarily into indigenous, mestizo (mixed indigenous-European), and European-descendant sectors. Guatemala has one of the highest proportions of indigenous people in the hemisphere, who consist primarily of the Maya, but also the Xinka and Garifuna peoples. According to recent figures, about 40 percent of the population is indigenous, but this is highly contested as a low number.10 The mestizo population is locally known by the term Ladino . Most of the indigenous Maya population live in rural areas, where almost 44 percent are monolingual in one...

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