May-June updates

6/03/08, 9:45 am, posted by Peter Rohloff

I am sitting in La Aurora airport in Guatemala City writing this update. Flights have been cancelled due to a number of hurricane-related rains squalls, so I have some time to kill. I am just finishing up a short 5 day trip that we put together mostly for administrative purposes (meaning lots of meetings, all weekend long).

ACOTCHI. On Friday I went to Comalapa to meet with the ACOTCHI board of directors, as we are trying to put together our common plan for the coming year or two. A major focus of the next few months will be securing continued funding for the training classes in 2009, which we feel fairly confident that we will be able to do, as our data are compelling. Additionally, however, we are really interesting in getting the concept of a midwifery "school" off the ground, as we have a large cohort of brand-new midwives, many of whom have not yet attended deliveries independently. I will probably be shopping this idea around to some funders in the next few months as well. Also in collaboration with ACOTCHI, we have managed to secure an excellent source of low-cost, high-quality medications in Guatemala. This is a major step forward, because it will allow us to avoid the headache of hand-carrying drugs, as well as putting this aspect of our programs more squarely in the hands of our local staff, which is where it belongs.

It remains as always extraordinarily stimulating to be able to hang out with the ACOTCHI folks. It is quite common in anthropology and other circles in Guatemala to bemoan the demise of the traditional health provider. The evidence used to predict this sad fate is three-fold: (1) Midwives are all old and do not pass on their knowledge to the next generation; (2) Midwives have no mechanism for self-organization or self-regulation; (3) High rates of illiteracy keep midwives from moving forward on the national stage. On the contrary, in our work with ACOTCHI, more than 25% of our affiliates are young women just beginning to learn the trade, the organization itself is strongly self-regulated and making good first steps toward sustainability, and many of our illiterate midwives are enthusiastically attending literacy classes.

Pa K'in. On Saturday, we had a clinic in Santiago. This included a brief review of the diabetic patients, but most of our time was devoted to a number of interesting new cases and complicated old ones. A few of these cases illustrate the larger problems of lack of access to care that we continue to try to address in our work. For example, we have one young woman, about 20 years old, who has had one leg amputated. She has a genetic nerve disorder which led to the development of a foot ulcer. Because she had no money to pay for antibiotics, this ulcer got so large that she had to have the leg amputated when she was about 16 years old. She came to us just a few months ago, because she was starting to develop an infected ulcer on the other foot and was afraid she was going to lose it as well. We were able to successfully treat the infection, as well as make some wound care suggestions. The ulcer is nicely healed at this point.

Another case is a young man who suffers from incapacitating agoraphobia and panic attacks. As a result of this condition, he has been unable to work for almost 10 years and, in fact, never leaves his bedroom. The fact that he does not work places considerable financial strain on his family, and his wife also is at her wits' end. He has had no effective treatment, mostly because there is no access to psychiatrists nor to basic psychotropic medications in Guatemala. For those well-connected few who do manage to find a psychiatrist who will see them, they quickly find that the requisite medications are among the most expensive they have ever had to purchase. For example, a generic antidepressant in Guatemala can easily cost the equivalent of two weeks' salary every month. Our treatment goal for this unfortunate man will be to find a steady source of affordable medications in the United States and get him hooked up as quickly as possible.

In other exciting news, it looks like we are approaching an agreement with the owner of a property in Santiago that we are attempting to purchase. This property is quite large, and would allow us to expand our services in a number of importants ways, including stocking a larger pharmacy, setting up a diagnostic laboratory, and have community space for health training classes. We will keep you informed of developments.

On "Alternative Medicine." Recently a friend of ours from Santiago went to see a chiropractor in Guatemala City. This was apparently after seeing an ad for relief of back pain. She describes the strangeness of the experience, especially of having someone pull on her neck, which she feels probably made things worse. Also, she called me after this appointment to ask my advice; the chiropractor had told her that she had back pain because her back molars where compressing her jaw and neck and, therefore, she had to get them pulled. This concerned her greatly, and she did not understand why she had to get her perfectly good teeth pulled.

What this shows is the number of cultural barriers presented to her by such a foreign medical practice. In particular for me it highlights what I perceive as a big problem in the area of current talk about traditional indigenous medicinal practices. Namely, "complementary and alternative medicine" (CAM) has become quite fashionable on the international scene, and this is tending to get rolled up with talk about traditional indigenous medicine, as if they were the same thing. Just to give one example, right now there is a good bit of funding available to teach acupuncture to Maya. There is no discussion at all about whether or not this is a helpful or useful thing to do. Rather, it is assumed that because they are "into" their own traditional medical practices they will also be "into" acupuncture.

The point here is not whether or acupuncture is helpful or not, but rather that we want to resist the tendency to conflate indigenous medical wisdom with all the various things that go under the fashionable heading of "complementary and alternative medicine". Although there certainly are similarities between CAM and indigenous medical practices, to assume that they are natural blood relatives without any sort of questioning is irresponsible, and also another example of telling indigenous people who they are and what they should do. CAM springs out of the luxury of postindustrial society, where we have now in our time of long and healthy lives seen fit to question and deconstruct the assumptions of our dominant medical culture. But for Maya, who have life expectancies more than 20 years less than us and incomes a fraction of ours, traditional medicines are neither alternative nor complementary, they are just what there is available at hand, at relatively low cost. Nor do they engage in the use of traditional remedies out of a sort of critique of Occidental instrumentalism, as we do with CAM. As our own research and that of others also has shown, they will use any and all remedies, including the most invasive, chemicalized ones, if they can afford them, if they trust the referring provider, and if they think there is a chance it will keep them alive. This is a dynamic of need, and one of poverty, and that is why we cannot conflate it with CAM.

Advisory Board. On Sunday, we had our first reunion of the Wuqu' Kawoq advisory board, which has representatives from each of the various towns we work in. Many of the members of the board work directly for Wuqu' Kawoq, but others are from ACOTCHI, or are affiliated with other NGOs. The purpose of this board is to guide Wuqu' Kawoq's programs and also to serve as a forum for folks from across the region to get to know the resources available and problems confronted in the various places we work. This is a tremendously productive activity, and one which all the participants enjoy. The people we work with have many experiences and insights that they are anxious to share with others. Just to give one example, a large portion of the discussion on Sunday had to do with the possibility of expanding ACOTCHI's midwife organizing work into all the other represented towns. We plan to have meets of the board every few months, both to keep all members informed about projects that they are not involved with day-to-day and also to maintain a forum for problem-solving, critical thinking, and planning for the future.

Socorro. Finally, on Monday we were in Socorro for the usual clinic but also and more importantly for a brief community meeting to bring folks up to speed on the water project, as well as on the child health work that Anita and Sarah will be doing there starting in July. It has been raining nonstop for 5 days, and the sound of rain beating on sheet metal roofs makes it almost impossible to hold a meeting without shouting, but all in attendance were content to be there. What's more, we prefer the rain to the scorching heat.

Grant-writing season is upon us

5/16/08, 9:31 pm, posted by Peter Rohloff

We apologize for the lack of a regular update in some time, but we have been very busy arranging plans for summer projects and also submitting all of the grant applications, which seem to all come due in late June and early July.

We were in Guatemala at the end of April for the usual round of adminstrative visits and also medical consultations. We saw about 200 patients, a rather light load actually, in the usual venues, including subspecialty consultations in pediatrics and gynecology with ACOTCHI, house calls to diabetics and bed-ridden elderly in Pa K'in, and child malnutrition visits in Socorro.Medically-speaking, there have been several gratifying experiences lately. The first has been our increasing success at making referral connections up to tertiary centers in Guatemala City. It has taken a long time to begin to develop this network, but it is nice to see it working. In one case, we had a woman pregnant with twins who had severe preeclampsia; we were able to participate in arranging transfer to a competent center where she delivered by cesarean and, after a three week hospital stay due to prematurity, her and the two identical twin boys were discharged in good health. In a second case, we encountered an 11 year old girl with severe kidney failure who were able to transfer to a specialist; she is doing much better after a brief hospital stay and is getting good followup.

Due mostly to the hard work of Wicha, our Pa K'in coordinator, we have begun to implement insulin therapy with our most severe diabetics, and the results and general compliance and satisfaction are excellent. Insulin therapy has been up to now a very frustrating experience for us, as the networks for ensuring follow-up and monitoring have not been in place. However, our health promoters are now very well-trained, and they are doing an excellent job.

The Engineers without Borders group that is collaborating with us on the potable water project in Socorro has released their final report and project recommendations. We can now see our way clear to a water systems solution, probably by early 2009, as long as we can get all the funding to fall into place. This project is essential to the health and well-being of this extremely impoverished village, where nearly all the residents suffer from chronic diarrhea and other consequences of unsafe water and where more than 50% of the children have growth stunting.

Very soon, you will become acquainted with the two newest additions to our staff. Sarah Messmer and Anita Chary will be Wuqu' Kawoq interns starting in July 2008. They will be primarily responsible for administering child health programming on the coast, as well as more broadly interfacing with all aspects of our work in K'ichee' speaking towns (Socorro, Chocolá, and environs).

Magda in the United States!

4/22/08, 10:47 am, posted by Peter Rohloff

March-April were busy months for some of us, as we were hosting the visit of Magda Sotz Mux, our friend and collaborator from Chiq'a'l, on her first visit to the United States. Wuqu' Kawoq helped to arrange a visiting scholarship for her at the University of Illinois, where she had a chance to give multiple lectures on life in Guatemala, development work, and of course weaving. She also made a side trip to the University of Kansas to visit with textiles and anthropology faculty there, as well as make guest appearances in Kaqchikel language classes.

The academic highlights of the month-long trip included a very well-received panel about language revitalization on the American continent (see promotional materials here) and a textiles exhibit at the Spurlock Museum with associated weaving demonstrations and lectures (more info here and here). These events were made possible through the support and collaboration of our friends in the Spurlock Museum and the Center for Latin American and Caribbean Studies at the University of Illinois and the Department of Anthropology and Center for Latin American Studies at the University of Kansas.

In addition to Magda's academic activities during the month, she also had many opportunities to fundraise both formally and informally for Wuqu' Kawoq and, as a result, we have had a successful fundraising month!

I have including a few pictures from some of the weaving events at the University of Illinois, and videos of this and other elements of Magda's stay in the United States can be viewed on our YouTube site.

Magda weaving in the museum/credit S. Steiner


More weaving/credit S. Steiner


Setting up the loom/credit S. Steinger


Magda with Peter at a university function/credit A. Brandon

Midwife training

3/28/08, 9:46 am, posted by Peter Rohloff

Several of us had the opportunity to be together working in Guatemala in the weeks leading up to Semana Santa. This included the usual suspects such as myself and Anne Kraemer, but we also had a return visit from Pat O'Brien from the Sylvan Lake Rotary Club, who is helping us to pursue some infrastructure solutions in Pa K'in. Part of this has involved looking at properties and engaging in fierce price negotiations. This is not the most enjoyable part of our job, but it is very nice to see how excited community members are at the prospect of having "our own" space.

For my own part, I was in country for just over three weeks, and I had the opportunity not only run the usual clinics (two in Socorro, two in Tecpán, two in Chiq'al, two in Pa K'in), but also to just some business done - community meetings, strategizing with the ACOTCHI board of directors, meeting with physicians and other interested parties. The highlight was being able to spend one day hanging out in midwife training without any duties other than picture taking. Some of these are included here.

Erika teaching the class


Following along in the Libros para Parteras text


Lots of joking


Role-playing patients interviews

It is high summer in Guatemala right now, which means hot days and cold nights. In Chiq'al and other highland towns, the bean crop is in flower, as can be seen here in these pictures taken outside the front door of the home of our friend and colleague Magda.

March Newsletter

2/21/08, 9:37 pm, posted by Peter Rohloff

Our March 2008 newsletter can be downloaded here

Another trip to Guatemala, video work, and more

2/6/08, 4:34 pm, posted by Peter Rohloff

We had another very successful whirlwind trip Jan 27-Feb 2.

Arriving on Sunday was pleasant, as I had not actually scheduled any work for that day, so it was much more relaxing than last time. It was also very exciting to be able to follow up on the patients who we sent to the COTA jornada in Tiquisate Jan 19. COTA is a very impressive surgery NGO that makes one mammoth trip to Guatemala every year to do hundreds of surgeries. We have established a good relationship with them, and they were kind enough to see several of our referrals during their trip. Additionally they donated hundreds of dollars worth of insulin and pediatric formulation lasix and digoxin. These are desperately needed, as we have several children with diabetes and others with congenital heart conditions.

On Monday, we were in Santiago to see the usual array of diabetics and other long-standing patients. We also had extra time to see several new patients. The most tragic of these was a young woman, perhaps 35 years old, with a massive, ulcerated parotid gland tumor perhaps 25 cm in diameter. She has been lying in bed for months as the tumor grew and grew and now can no longer eat solid foods. Apparently she did have an evaluation at INCAN, the national cancer institute, and had a CT scan and MRI, both of which she showed to us. No further interventions were performed, however, and it is unclear whether this is because the physicians told her the tumor was inoperable or because the amount of money required was beyond her reach.

Tuesday Anne Kraemer and I were in Socorro, where we saw a very large number of patients, about 80 I think, as well as got some general business done regarding the water project. Wednesday we had a site visit from Heart to Heart International in Santiago to show off mostly some of our work with diabetics there. Thursday and Friday I was in Comalapa and Tecpán, respectively, working with the midwifes in part doing follow-up for some of the patients that we saw at the beginning of January and in part seeing new patients as well. We saw about 30 patients in each location, and we also got a good deal of business done, as Anne and I had a long meeting with the board of directors for ACOTCHI.

On Saturday, I flew to Austin, where I spent two days working on various media projects with Laura Welch, our trustworthy media expert. One of the results of this was the new video spot which you can see embedded on this webpage or by going here . We also developed some new ideas for website architecture, which you should see unfolding over the coming weeks, and also worked on some of the other video projects which we have in the works.

More photographs

1/22/08, 6:33 am, posted by Peter Rohloff

Some excellent photographs, courtesy of Catherine Szalkowski.

Photographs and feedback

1/21/08, 10:42 pm, posted by Peter Rohloff

We continue to receive positive feedback from our recent trip from both our on-site partners and our United States-based participants. Dr Malcolm Hill, our pediatrician, writes:

I am honored to have had the opportunity to work with Cat, Emily, Hannah , Melinda , Kevin , Olga,Pat and Peter. We functioned well together and were a very effiecient MASH unit. I also want to thank the ACOTCHI midwives for their wonderful hospitality ... especially the incredible meals that they provided. I look forward to working with everyone in the future.

He also sends along the following pictures:

Finally, Catherine Szalkowski, the photojournalist who accompanied us on the most recent trip, is working through her images. We expect many more later, but for now you can visit her blog here to see a few samples.

Trip updates!

1/15/08, 6:35 pm, posted by Peter Rohloff

On Saturday, January 5, numerous friends and partners converged on La Antigua, Guatemala, including members of the UIUC Engineers without Borders, physicians from the Carle Clinic Association, and members of the Sylvan Lake Rotary Club. The purposes for this meeting were numerous, but included exploration of partnership opportunities with the Rotary; kickoff of the engineering component of our water and sanitation project in Socorro, San Pablo Jocopilas; and running of a subspecialty clinic in collaboration with our midwifery partner ACOTCHI.

I cannot speak at this point to the specifics of how all of these various activities unfolded over the week, as we are yet to have time to regroup and debrief. Consequently, I will just write briefly about the medicine side of things, as that is the part that I was specifically in charge of. Other components of the trip were run by other board members, and we will await blog postings from them. Also forthcoming will be a number of pictures, as we had the good fortune of having on board a professional photojournalist for the trip.

On Saturday evening, we took a trip to Pa K'in for an inaugural ceremony with our friend who is an ajq'ij (Maya spiritual guide) Roberta. We are in the habit of having a large ceremony on January 1st of every year, which is usually highly anticipated by the community, but scheduling problems kept us out of the country until January 5.

On Sunday, January 6, the physicans took a field trip to see our projects in Pa K'in. The purpose of their visit was to provide critique and perspective, and to help us prioritize how to grow this project in the most efficient way possible. Their feedback on essential medications, patient management, and other logistical issues will be most valuable over the coming months.

After this short day, we took a bus to Chiq'a'l Sunday evening in preparation for the real heart of the week, which was subspecialty work (pediatrics and gynecology) in Tecpán and Chiq'a'l with ACOTCHI. We saw patients for three days in Chiq'a'l and two days in Tecpán, entirely in Kaqchikel, with myself and Emily Tummons translating for our pediatrican Mike Hill and our gynecologist Melinda Dabrowski. Although we have been working with ACOTCHI for some time, this has previously been mostly in the realm of training and capacity-building. This was our first of what will become ongoing attempts to provide regular specialist contact for their patients, and it went very well. The pace was slow and leisurely, with much laughing and fun, and we provided a wide range of free medications and diagnostic services in addition to consults.

Two half-days during the week, one in Tecpán and one in Chiq'a'l, were also dedicated to midwife training. As part of our grant from the Conservation, Food, and Health Foundation, we are trying to foster regular training connections between North American medical specialists and the midwifes. In part these connections are designed to show the healthy, collegial ways in which physicans can interact with midwives--something that is sorely lacking in Guatemala. Additionally, as these sessions are all conducted in Kaqchikel, they are designed to introduce midwives to some themes in maternal and child health in a way that is comprehensible to them--most training sessions in Guatemala are conducted in Spanish and, as a result, much is lost on the participants. The training themes for this week included neonatal resuscitation and postpartum hemorrhage.

The latter theme of hemorrhage also served as a kick-off for another of our midwifery collaborative projects, which is the introduction of misoprostol (kindly donated by US organizations) into home-based midwifery practices, as a way to reduce the in-home maternal mortality rates.

The week concluded on a high-note in Tecpán with a field-trip and formal exchange of thanks and gifts at Iximche', the ruins of the Kaqchikel empire.

Newsletter available

12/26/2007, 1:15 pm, posted by Peter Rohloff

Greetings in the new year! Our first newsletter has just been published and mail to all current donors and supporters. If you have not received your copy, just send us an email to let us know! Alternatively, it can be downloaded here. Stay tuned for other updates soon, as we have a number of engineering and medical trips scheduled for the first several weeks of January.

Wuqu' Kawoq receives notification of grant funding

12/08/2007, 10:17 am, posted by Peter Rohloff

Wuqu' Kawoq has just received word that its grant application entitled Training of indigenous Kaqchikel-speaking midwives in Guatemala has just been funded at a level of nearly $10,000 by the Conservation, Food, and Health Foundation. This grant will provides support for our training programs in San Juan Comalapa and Tecpán working with the Associación de Comadronas Tradicionales de Chimaltenango. This training program is unique in two ways: First, all training is conducted in the native language, Kaqchikel, of the participants themselves. Second, an integrated and sophisticated data collection and evaluative component is built into the program. We thank the CFH foundation for its support, which will go a long way toward developing culturally appropriate, community-based health education efforts in the region.

Thanksgiving Dash

12/02/2007, 02:01pm, posted by Peter Rohloff

I was in Guatemala for a lightning trip over Thanksgiving, November 22-25. There was a lot of work to be done.

I was picked up at 6 am as I arrived in the airport by Ernesto, whom Anne and I feel is perhaps Guatemala's best driver-for-hire. We went straight to the San Antonio Suchitepéquez-Chocolá region, where we spent the day seeing patients in our Socorro project. As we are now entering the summer, we were able to work all day without dashing around avoiding the rain. I took advantage of having a vehicle and driver to visit some friends and collaborators from some of San Antonio's eastern aldeas, which are Kaqchikel speaking. We were not able to do this without providing some medical care of course, but it was mostly just sitting around, talking about life and plans for future collaborations. I immensely enjoy San Antonio's Kaqchikel dialect, which has taken on something of the neighboring K'iche's crisp delivery while still remaining pure Kaqchikel.

Also in Socorro, we held a community meeting to finalize plans for the visit from the Engineer without Borders group (University of Illinois chapter), who will be down in January to make a preliminary site assessment for a drinking water system. After finishing up in Socorro, we ran up the hill to Chocolá, where Anne (our board member currently living in Chocolá) had arranged for us to see a few patients as well. We do not have a project in Chocolá strictly speaking, but we have been asked to provide advisement and oversight for a medical project being developed by one of our collaborating NGO partners, Semillas Para El Futuro. Consequently, I have been spending some time there when able, trying to get to know midwifes and other community leaders.

One of the most difficult cases we saw this day was a young boy with type I diabetes. This is an extraordinarily difficult thing to take care of in Guatemala, as access to blood-testing equipment, insulin, and the like is limited and these supplies, even if available, are very expensive. The mother is currently spending about 14,000 Q yearly on medicines, which is a huge amount. We will try to help her simplify and optimize his medication regimen and will arrange an appointment with our pediatrician in January.

We spent the night with Anne, and were up at 4:30 am Friday morning in order to make it over to Comalapa before 9 am. In Comalapa, we gave a half-day training session to the assembled midwives which was a continuation of the sessions we gave in October. In the afternoon we had a planning meeting with their Board of Directors, Magda (our Comalapa field manager), and myself to plan the clinic week in January. We also finalized arrangements for our maternal-child health survey, which Magda will begin working on this month. Friday night I was back to Antigua for a dinner meeting with Earl and Susanne, board members from Semillas Para El Futuro to discuss our collaborative efforts in the Chocolá region.

Saturday, the final working day of the trip, saw us in Santiago, where we saw mostly established patients and reviewed the diabetes management program with Wicha, our field manager who is running this project. Most of our diabetics are doing very well and feeling great. There are a few however, who have not been taking their medicine nor watching their diet very well. This is, in part, why we have brought Wicha on board, to keep an eye on them, and she is doing an excellent job. Already a few patients who were previously not very adherent to their regimens are showing marked improvements, because of the weekly visits she makes to check in on them.

Sunday I flew back to Chicago. When I landed, the immigration agent remarked, referring to my passport, "Looks like you've got a few miles on this thing!" Which is the truth.

Peter's trip October 2007

11/04/2007, 04:50pm, posted by Peter Rohloff

October was a busy month for me. I was in Guatemala the week of October 14th.

Part of this trip was spent in Pa K'in, where we were attempting to iron out the bugs in our diabetes program. Wicha is now in charge of this, and she is doing a great job. Every diabetic in the program is receiving weekly visits now, to reinforce the need to continue taking medicines regularly and to check blood sugars. One of the greatest challenges to diabetic programs anywhere in the world, not just Guatemala, is that people stopping taking medicines or adhering to their diet when they start feeling better. Wicha is in charge of making sure this does not happen.

We had an emotional encounter with one family. The matriarch of this family has advanced Parkinson's and she has been progressively declining. In the space between this and our last visit, she has taken to bed and is refusing food and drink and drifting in and out of consciousness. The family was tearful and effusively thankful for "all that we had done" for their mother. Actually, we have done nothing for her medically; we have simply tried to be a supportive presence.

Another part of the trip was spent in Chiq'a'l with Ixkamey's family. Part of this trip was personal, since I am very close to her family and enjoy spending time with them. Ixkamey and I talked a lot of business too, since she is heading up all of our census and survey work in Chiq'a'l and elsewhere. We are working through the bugs of two large survey projects we are planning for this winter.

I spent one day in the Socorro down on the Bocacosta. We have an exciting potable water project in the works there. The University of Illinois Engineers Without Borders will be doing the system design and implementation, and Wuqu' Kawoq will be providing the community connection and doing the fundraising. Most of the day was spent with friend and colleagues from the village laying the groundwork for this.

Finally, I spent two days teaching midwives about the safe and effective use of herbal medicines. One day was spent in Iximché (Tecpan) and the other in Chiq'a'l. Both groups of midwives were very engaged and very smart, and the sessions were so successful that we have a second round scheduled for November (Thanksgiving). I hope to have some pictures of these classes up soon. We also delivered 50 copies of the Hesperian Foundation manual to the midwives during these sessions.

September updates

9/07/2007, 02:30pm, posted by Peter Rohloff

Collaboration with midwives

Our relationship with the ACOTCHI cooperative in Comalapa continues to evolve. We have recently built a a new ACOTCHI website, which you can see in its nearly-completed form at the link above in our menu bar.

Recently we purchased 50 copies of the Hesperian Foundation's Book for Midwives, which will be given free of charge to the ACOTCHI members. This represents half of our goal of 100 copies this year. Feel free to donate specifically to this at the 'help' tab above if you would like to see us meet this goal this year!

Recently, we also purchased equipment for ACOTCHI for the measurement of blood glucose and urine analysis, two very important items in any high-quality program of prenatal care. Just this last week we donated a high-quality microscope, which will permit them to perform more essential blood, urine, and fecal tests, such as for parasites and other infections.

New focus in Santiago

At the August board meeting, the future and direction of the work in Santiago was discussed, and the decision was made to exert effort to expand primarily in the direction of diabetes-related care, with a strong focus on community education classes and the training of local health promoters. Currently, the roster of regular patients is 150, of whom 57 are handicapped or very elderly and therefore visited in the home. We have 16 diabetic patients who are all received regular home visits, nutritional education, glucose testing, and financial support for medication purchasing. We would like to expand this number to over 50 patients this year, but your help is needed to make this happen!

In other exciting news, this week we hired our first official local employee, who will be overseeing the diabetes program as it grows, performing all the glucose testing, education, and intake of new patients as this program grows.

Clean water

Peter Rohloff and Anne Kraemer have been working on developing a clean water solution for one of our small partner communities on the Boca Costa. Recent work has including preliminary water quality analysis of several potential natural spring sources, a community-wide census and survey of water source and usage needs, and, most excitingly, a developing partnership with the University of Illinois Engineers Without Borders chapter, which has agreed to take on the project.

Maternal-Child Health Census

Wuqu' Kawoq has just taken on a major new project in Comalapa and Tecpan. In partnership with ACOTCHI, we will be performing a large ethnographic study designed to assess current midwifery practices and diagnoses major deficiencies in practice. Interviews in dozens of aldeas in both town will be conducted by locally-based collaborators (in Kaqchikel, of course) with both practicing midwives and their patients. This project has a planned start date of November 2007.

Training sessions

Peter Rohloff, our executive director, will be giving a training session in Comalapa on Sept 18 on the identification of parasites in fecal samples. He has two more training sessions scheduled on the safe and effective use of medicinal plants, one in Comalapa on October 16th and the other in Tecpan on October 18th.