Structural Violence and Mayan People in Guatemala (Schirmer, 2/5/2020)

Muchas gracias to Dr. Billy Schirmer who gave a compelling (and dense) Grand Rounds this week on Structural Violence and Mayan People in Guatemala—spanning from 1492 to the present. While some of us may be surprised to see such a topic at a hospital grand rounds, it was an excellent reminder that we are not caring for patients on an island in Santa Rosa—but rather in a complicated global, sociopolitical context. And that context matters.

Dr. Schirmer reminded us right up front that current immigration from Guatemala (and really all of Central America) are directly related to a long and sordid history of structural violence**—violence that has been perpetrated continuously by the United States toward indigenous people as long as there has been foreign policy. 


Dr. Schirmer challenged us to take the long view—Guatemalan people are not coming to the US simply because coffee prices have dropped or opium fields are being destroyed or gang violence is endemic. While all these individual things are true, the story is much more layered—full of centuries of war, classism, fear, racism and persecution.

**structural violence: the imposition of unequal risk for disease, injury, and death by social, political, institutional and economic configurations and policies on identifiable population groups . This violence is structural because it results from durable systemic inequality produced by large scale social forces, including racism, gender inequality, poverty and harmful public policies rather than from isolated individual actions or serendipity (-definition from Dr. Paul Farmer, physician and medical anthropologist)



Some stats:

• There are 21 unique Mayan languages in Guatemala
• 41% of Guatemalans identify as Mayan/indigenous
• 79% of indigenous Guatemalans live in poverty
• 40% live on less than $1.90/day
• 90% of poor kids never graduate from high school

• 33% of indigenous Guatemalans cannot read or write
• Average educational attainment for indigenous women is 2 years
• The number of Guatemalan people seeking asylum at the US-Mexico border continues to rise—surpassing Mexican nationals

• 33% of those that apply for asylum without medical evaluation are granted asylum; 88% are granted asylum with a medical evaluation

And some history (I cannot possibly cover it all here, check out the recording of his GR here if you want to hear in its entirety)

• 1500s Pedro de Alvarado leads the Mayan conquest
• After the Spanish conquest all of the land in Guatemala is divided amongst ruling class “encomienda system”--legal slavery of the indigenous people by the ruling class.
• 1821 Guatemalan independence from Spain (not for the indigenous, who continue to be oppressed)
• 1877 remaining land on which indigenous people are living is stolen and sold to private coffee growers, leaving most Mayans without land
• Early 1900s, the United Fruit Company (a US company) establishes the banana industry. United Fruit owns (and controls) much of Guatemalan infrastructure (roads, trains, ports, radio, land) in the name of the banana industry. All supported by dictatorships who were supported by the US.
• 1940s: Guatemalan spring: attempt at unionization of the United Fruit workers
• Early 1950s, democratically elected President Arbenz implements Agrarian reform to reacquire land for the people of Guatemala
• Soon thereafter (1954), President Eisenhower and other high level US officials (the Dulles brothers) create an uprising against Arbenz and force the democratically elected president out of office in the name of “anti-communism”
• Over the next 40 years—during the Cold War—fear of communism drives horrible human rights abuses. Land is burned and taken from indigenous people, people in power abused people without power, and thousands of indigenous people were systematically murdered
• The US supplied training and weapons to corrupt Guatemalan governments in the name of democracy. This training and weaponry has left footprints everywhere
• 1970s and 80s: era of La Violencia under President Rios Montt: “scorched earth campaign”, 70-90% of indigenous communities are burnt to the ground by the Guatemalan government. President Reagan continues to send money and weapons to support Pres. Rios Montt
• Rigoberta Menchu, Nobel Peace Prize 1992
• 1999 Historical clarification commission: investigation of human rights abuses, “Memoria de Silencio”, highlights endemic racism contributing to violence and war in Guatemala

And now fast forward to current reality:

• International commission against Impunity under former President Jimmy Morales: In 2013, Guatemalan president Rios Montt was convicted in Guatemala of genocide, a week later that ruling was overturned on a technicality. He was never retried, and ultimately died in 2018 without punishment.
• Ongoing rampant sexual violence in Guatemala: 50-80% have experienced intimate partner violence, a culture of silence
• President Trump’s 2019 “Safe Third Party Agreement” with Guatemala, Honduras and El Salvador requires that any asylum seekers passing through Guatemala on the way to the US (from Honduras, El Salvador, etc) MUST apply for asylum in Guatemala before applying in the US. Though international experts agree that Guatemala has neither the infrastructure nor the resources to support such people, Trump threatened tariffs if Guatemala didn’t cooperate

And SO what can we do as health care providers?

• Create safe spaces in clinics and hospitals (be aware of chronic institutional distrust)
• Know that trauma is ongoing; it doesn’t end when people arrive in the US. It has negative effects on people’s health and should be addressed sensitively
• Don’t make assumptions about patients’ history or language of choice. Ask, humbly.
• Don’t blame the victims.
• And last, but not least, get trained to do asylum evaluations