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New book examines shifting health-care landscapes in Maya Guatemala

Written by Anita Chary, MD/PhD, student at Washington University School of Medicine

Privatization and the New Medical Pluralism: Shifting Healthcare Landscapes in Maya Guatemala is based on experiences in health care delivery in rural Guatemala over the last decade. I worked with Peter Rohloff, an internist and pediatrician at Brigham and Women’s Hospital and faculty at Harvard’s Department of Global Health Equity, on this portrait Guatemala, a Central American country with high levels of poverty, poor maternal and infant health outcomes, and a double burden of infectious and chronic diseases, through the lens of rural healthcare.

The title of our book derives from important features of Guatemala’s health care system. First, approximately half of Guatemala’s population is indigenous Maya and endures significant health disparities due to long histories of colonialism and genocide during the recent civil war (1960–1996). Local and traditional indigenous modes of healing—midwifery, shamanism, and herbalism, for example—have long been important avenues of health care for Maya people, particularly as biomedical care is often inaccessible. Scholars use the term “medical pluralism” to describe such settings where local and biomedical systems co-exist and present people with different avenues for care in times of illness.

Privatization and the New Medical Pluralism highlights an additional aspect of “medical pluralism” that shapes Maya people’s health care encounters: privatization. Over the past few decades, global health policy has encouraged privatization of basic health services in low- and middle-income countries. Additionally, the field of global health has exploded, encouraging medical missions and non-governmental organizations to provide health care in the Global South. Guatemala is a perfect example of both of these phenomena. The public health system has long been underfunded and deteriorating, and in recent years numerous private for-profit clinics and pharmaceuticals have emerged to fill the gaps. Government health services have largely been contracted out to non-governmental organizations. And Guatemala is an extremely popular destination for medical volunteering: there are now thousands of nongovernmental organizations and foreign medical missions providing health care in the country, whose NGO per capita ratio approaches that of Haiti.

Against this backdrop, our book provides an anthropological account of how marginalized indigenous Maya people access healthcare in a fragmented and increasingly privatized environment of care. We seek to capture the lived experiences of indigenous Guatemalans and front-line health care workers and offers practical insights into health care delivery and policy.

Chapters cover many important topics, including child malnutrition, adolescent pregnancy, mental health, midwifery, and the growing burden of diabetes and cancer in the global south. Overall, the book demonstrates how healthcare privatization can limit access to health care for some and offer novel opportunities for care to others, on the one hand creating new forms of inequality and health care disparities, and on the other unlocking possibilities for social justice.

This book is recommended reading for any students interested in visiting Guatemala as well as scholars and health care professionals working in global health or health systems research.

We appreciate the support from several scholars at Washington University in St. Louis contributed to this book as authors or reviewers, and this book was published with the generous support of the Global Health Center of the Institute for Public Health as well as the Medical Scientist Training Program.

All profits from book sales will be donated to Maya Health Alliance, a non-governmental organization that offers free healthcare to rural indigenous Maya communities in Guatemala.

Click here to find Privatization and the New Medical Pluralism on Amazon.