Story Publication logo November 9, 2021

Clinic Day in Xela

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landscape in Guatemala
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It is the third week of my being in Guatemala to film a documentary about migration, and I am tired. I stayed the night at the headquarters of 32 Volcanes in hopes that the morning would be clear enough to film a dramatic sunrise over the murals inside the courtyard that doubles as a parking lot. 32 Volcanes is an NGO focused on sustainable health, education, and social development programs in the Western Highlands of Guatemala. 

The Guatemalan dawn can be breathtaking with the "niebla" [mist] coming off the mountains. It’s haunting. I woke up just after 5:00am and filmed, but it wasn’t the sunrise I wanted. Today is going to be a long day. I hurry to get ready to leave with Carmen Rosa Benitez and a handful of other clinic staff. 

Carmen Rosa is one of the daughters of the wife and husband founders of 32 Volcanes. She is a doctor and runs much of the day-to-day operations. We are going to a puebla, still within the municipality of Quetzaltenango, called San Juan Ostuncalco, where they will operate a day clinic in the neighborhood of Aldea Buena Vista for the clients who are "tercera nivel" [elderly], and mostly from the Mam community.

Woman consults patient from behind face shield
Carmen Rosa Benitez (right) of 32 Volcanes holds a health consultation with a patient (left), a Mam Indigenous woman, at the day clinic in San Juan Ostuncalco, Guatemala. Image by Amelia Tyson. Guatemala, 2021.

I will take a moment to give a quick history of Quetzaltenango. It is a name given by the Spanish after the invasion and subsequent conquest of the area in 1524. In day-to-day conversation, you will hear people refer to the city as "Xela." The word "Xela" comes from the Mam language and is short for "Xelajú," derived from the words "xe laju’ noj," which have been translated to mean "under 10 mountains," although "no’j" can also be translated to mean wisdom.

This mix of Mayan and Spanish culture is everywhere, from the crumbling historic Catholic Churches and old Spanish-style buildings around the Parque Centro América in Xela to the informal mercados filled with vendors of fruits and vegetables, clothes, and other goods. Most vendors wear traditional Indigenous dress either from the K’iche or Mam communities.

The previous evening, on July 30, there had been city-wide protests against the central government and president set off in part because five days earlier the lead governmental anti-corruption prosecutor Juan Francisco Sandoval fled Guatemala for his safety, in the middle of the night, after being removed from his position by the country’s attorney general. People were already a bit on edge because weeks before that, on July 10, three days before I arrived in Guatemala, a prominent activist and independent journalist, Frank Stalyn Ramazzini, was killed in Guatemala City. You can feel the tension and frustration, hope and, somehow, simultaneously, the apathy that is brewing.

The building that houses 32 Volcanes is a two-story structure located in Zone 1 of Quetzaltenango, just a couple streets south of the Parque Centro América where the office of "el alcalde" [the mayor] of Quetzaltenango is located. There’s a large black matte metal front door with the organization’s logo at the top of the door. As you enter into the courtyard there are buckets, pots, and wooden crates with plants and two murals. The first mural you see as you enter is the logo of 32 Volcanes, and the second one is a beautiful mural painted by one of the women beneficiaries of 32 Volcanes named Doña Faviola. She is also the caretaker of the building, along with her daughter Jocelyn.

A colonnade wraps around the inside of the building in an L-shape. There’s a clinic, library, bookstore, and kitchen. The organization is trying to tackle a multitude of underlying problems that exacerbate migration, including the health of the community through regenerative and comprehensive health clinics. That is what they are doing today.

Carmen Rosa, Iris Romero, Veronica Istazuy, Escarleth Perez, Omar Cordova, Gabriela Istazuy, and Yolanda Lopez pack the van, and we head out at 9:00 am for San Juan Ostuncalco. The feeling in the van is exhaustion. For the two weeks that I have been here, the team has been working nonstop. It isn’t just the clinic; others are preparing to restart a variety of education classes, and still others are preparing for two reforestation projects. For a small operation, they cover a lot of ground. But for Carmen Rosa, the holistic approach is the only approach possible.

Leaving Xela, the elevation rises and the community setting gives way to dispersed, long tracks of land dotted with clusters of houses and a business or two along the road, while the mountains rise up behind. Two scenes become quickly noticeable. The first is partially constructed houses. They are gray and either one story with rebar and concrete form rising out of the top or two-story, with the same bare bones structures coming out of the top level of the house. These houses, though incomplete, are a sign of the wealth a family accumulates mostly through remittances from relatives who have migrated to the United States. Not every house or family is so lucky. Sometimes the money dries up, and the house is abandoned—leaving a mosaic of gray and green dotting the landscape between towns.

We pull into a two-spot parking space in front of a small clinic attached to a one-room meeting hall. Patients are already seated in a semi-circle inside the hall. Although it is only 10:00am, the sun feels directly overhead. It’s hot, dry and dusty. Outside the meeting hall stands a woman waiting with her son. This is Doña Luisa. She is Mam Indigenous and a scholarship beneficiary of 32 Volcanes. She translates between Spanish and Mam for the clinic. Doña Luisa is younger than all the patients present at the clinic today, yet she is known and respected in the community.

A woman receives guidance during nutrition workshop
Doña Luisa (left) translates from Spanish to Mam language for Omar Cordova (right) during a nutrition workshop at the day clinic in San Juan Ostuncalco, Guatemala. Image by Amelia Tyson. Guatemala, 2021.

Doña Luisa’s eldest daughter migrated to the U.S. about two weeks ago. All involved understand very deeply the draw and the desperation that even a 16-year-old can feel living in financially and socially uncertain conditions. I greet her and she smiles warmly back. She has an intensity in her eyes, an intensity created through trials, hardship, and the building up of resilience that is hers and hard-won. She is one, among many mothers, who have seen their young ones become so overcome with desperation at the disparity of wealth and poverty, exacerbated by the view of life in the United States and the reality of daily living in Guatemala, that they make the treacherous journey North.

As I film the set-up of the clinic and stand at the back of the room next to the entrance, I wait to be introduced to the room by Carmen Rosa. The clinic staff wastes no time. Like clockwork, four stations are set up and the patients move through the line. 

During a lull in the line, I ask Carmen to explain what’s happening. She says that they have “had some problems with the Ministry of Health allowing us to do all of our activities.” More rules were put in place and, in order for them to host the clinic, they had to meet all the requirements.

The health center that is next to the town hall where 32 Volcanes holds the clinic has created a situation where Carmen Rosa and her staff “are very controlled.” Whether it is good or bad, it presents logistical barriers that the already spread thin and underfunded 32 Volcanes has to overcome to provide holistic care for the chronically ill patients of this "vecindario" [neighborhood]. They don’t just provide medicine or medicinal care for these elderly patients with chronic illnesses. 

“The chronic patient program is based, also, in food sovereignty,” Carmen says. “We didn’t have the funding to keep doing workshops, to keep doing medical care, nutrition, in a holistic way. And as we couldn’t follow all the terms and requirements of the ministry then we needed to stop for at least one year. This is the first time we are coming back after a year.” She continues to explain that they are not only monitoring their vitals, they are also concerned about their emotional and psychological status as well, especially during this past year as a consequence of the pandemic.

As part of the holistic care that 32 Volcanes provides, the chronic patient program also teaches gardening classes connected to nutrition and qigong meditation, and it provides a collective group therapy for the psychological health of the elderly patients.

The clinic starts to wrap up by the late afternoon. And as swiftly as Carmen Rosa and team set up the clinic, it is taken down and loaded back into the van.

There is a strength born of resilience among Guatemala’s Indigenous community, but the people are not alone. Guatemalans of all backgrounds band together to work against the rising tide of forces pulling at their hopes and dreams for a just future, where corruption is not the first thing that comes to mind when thinking about the trust of the government, and where companies from outside the country no longer have a stronghold in extracting the resources of both land and people.

Where is the freedom for them to fulfill their hopes and dreams? Carmen Rosa and 32 Volcanes are here for the long fight. They and every beneficiary of the organization embody the idea that even a few can have an effect on the transformation of society. 

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