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Guatemala is a small country that is located in Central America. The climate there is warmer in the low lands and cooler in the high lands. There are three distinct terrains the mountainous highlands, the Pacific coast south of the mountains, and the vast northern Peten low lands. Guatemala has one of the youngest populations in Latin America and has roughly 11 million people. The country is rich in its history with influences from the Mayan Empire that are still relevant today. While Spanish is the official language that is spoken there, there are several other languages that are spoken as well. Most of the population follows the Roman Catholic Church; however, other religions are represented throughout the country. When working with Guatemalan people it is important to remember that health care is not always easily accessed, and it is a family affair with the women being the most influential when medical decisions need to be made. Therefore, it is important as medical professionals to respect their culture when providing care.
Guatemala is a country located in Central America. It borders the Caribbean between Belize and Honduras and is also located on the Pacific Ocean between Mexico and El Salvador. The country itself is a little smaller than the state of Tennessee at about 42,000 square miles (Guatemala). Guatemala offers many beautiful natural tourist spots as well as some of the best Mayan ruins in Latin America (Guatemala). The climate is warm throughout the year averaging around 75 degrees Fahrenheit (Guatemala). The typical climate in Guatemala is tropical, hot and humid in the low lands and cooler in the high lands (The World Factbook 2018). The terrain for Guatemala consists of two east-west trending mountain chains that divide the country into three regions the mountainous highlands, the Pacific coast south of the mountains, and the vast northern Peten low lands (The World Factbook 2018). Some of the natural hazards that Guatemala experiences are numerous volcanoes in the mountains, occasional violent earthquake, and the Caribbean coast is extremely susceptible to hurricanes (The World Factbook 2018). Guatemala has had some significant volcanic activity. This includes activity in the Sierra Madre range, which has been deemed a decade volcano by the International Association of Volcanology and Chemistry of the Earth’s interior and is worthy of study due to its explosive history and close proximity to human populations (The World Factbook 2018). Another active volcano is named Pacava, which erupted in May 2010 causing ashfall on Guatemala City and prompting evacuations and is one of the country’s most active volcanoes with frequent eruptions since 1965 (The World Factbook 2018).
Guatemala is one of the countries that is located along the Ring of Fire which is a belt of active volcanoes and earthquake epicenters bordering the Pacific Ocean (The World Factbook 2018). Around 90% of the world’s earthquakes occur along the ring of fire and is also dotted with 75% of all active volcanoes (National 2012). There are two different type of boundaries when talking about the Ring of Fire which is the divergent boundaries and transform boundaries (National 2012). The divergent boundaries are created by tectonic plates pulling apart from each other (National 2012). What happens at this boundary is the sea floor spreads and rifts begin to form which causes the magma to well up (National 2012). The sea water will cool the magma and create a new crust (National 2012). This type of boundary is what makes up the portion of the Ring of Fire the occupies Guatemala. The transform boundaries are created as tectonic plates slide horizontally past each other (National 2012). The parts where the plates touch and get stuck create a stress buildup (National 2012). This stress causes the rock to break or slip thus making the plates move causing earthquakes (National 2012). The Ring of Fire is the cause for Guatemala’s active volcanoes.
Guatemala is a poor country that struggles in areas of health and development, malnutrition, literacy, and contraceptive awareness and use (The World Factbook 2018). Guatemala has the highest population growth rate in Latin America and is ranked as number 59 in the world, while the United States is ranked at 130 (The World Factbook 2018). This large growth rate is most likely due to the large reproductive age population and high birth rates. Almost half of the population is under the age of 19, which makes it the youngest population in Latin America (The World Factbook 2018). Guatemala’s median age is 22 years for male and 23.1 years for females with a combined average of 22 years when compared with the world they come in at 179 while the United States comes in at 61 with a median age of 38.2 years (The World Factbook 2018). The average life expectancy for the people of Guatemala is 71.8 years which is number 149 in the world, where the United States comes in at 45 with an average of 80.10 years (The World Factbook 2018). When looking at the literacy rate, which is defined as people over the age of 15 who can read and write, it is broken down as follows an average of 81.5% of the population can read and write with males being 87.4% and females being 76.3% (The World Factbook 2018).
Guatemala’s population is roughly 11 million people with most people being Amerindian or mixed Amerindian-Spanish, also known as Mestizo (The Language). Mestizo roughly makes up 41.5% of the country population, which represents European and mixed indigenous heritage (The Language). Another 41% represents Guatemalans that are of full American ancestry. However, most of the Guatemalan people are of Mayan descent. This includes 11% of whom are K’iche’ the 8.3% of the Q’eqchi 8.3%, Kaqchikel 7.8%, Mam 5.2%, and other Maya tribes who make up 7.6% of the population (The Language). There are also White Guatemalans of European heritage that account for 18.5% of the population (The Language). They are mostly descendants of Spanish and German settlers, and other Europeans such as the French, British, Danish, Italians, Russians, Swiss, Dutch, and Belgians (The Language). The vast majority of the population resides in the southern half of the country, particularly the mountainous region, and more than half of the population living in rural areas (The World Factbook 2018). When comparing Guatemala to the United States of America and the world, Guatemala comes in at number 67 in the world and the United States comes in at number 3 (The World Factbook 2018).
Guatemalans have a history for emigrating both legally and illegally to Mexico, the United States, and Canada due to lack of economic opportunity, political instability, and natural disasters (The World Factbook 2018). These migrations, mostly to the United States, escalated during the 1960 to 1996 civil war and accelerated after the peace agreement was signed (The World Factbook 2018). Thousands that had migrated to Mexico returned after the War but the migration to southern Mexico continues (The World Factbook 2018). There is still migration to this day. Most recently Guatemalans have been migrating to Mexico to escape violence and poverty (Martin 2018). In addition to these reasons, the recent spike in Guatemalan migration is due to a hunger crisis (Miroff 2018). The hunger crisis has risen due to meager harvests, drought, and the effects of the “coffee rust” fungus on an industry that employs a large number of people (Miroff 2018). Therefore, the majority of people that are attempting to migrate are not just males but families with children ranging from newborns and up. They want to build a better future for their family and for them that starts with the ability to find work and feed their families.
The “coffee rust” fungus is causing what is known as the coffee crisis. Coffee is a huge part of the Guatemalan people’s income in the highlands (Leutert 2018). Most of the local residents have been growing and caring for their own coffee plants for several generations (Leutert 2018). This region has typically been either you grow coffee, or you migrate and while for many generations they have chosen the first option, which grew Guatemala’s position in the global coffee market (Leutert 2018). However, many are now forced to choose the second option due to the crisis caused by low global coffee prices, booming production in Honduras and Vietnam and the recurring coffee plagues (Leutert 2018). As a result of a struggle to stabilize in the industry the people who once relied on coffee production as a steady income can no longer rely on it as a steady and secure income, thus causing a spike in migration to the United States (Leutert 2018).
The Guatemalan culture has a rich history of Mayan culture. There was a firm divide between the Mayan society. While they shared the similar ideas and traditions they would never unite as one empire. They could not agree on nobles, commoners, and slaves (E (n.d.) ). Despite this, the civilization was very powerful and they achieved remarkable breakthroughs that are still influential in the development of society. The Maya civilization thrived in Guatemala and surrounding regions during the first millennium A.D. (The World Factbook 2018). After almost three centuries as a Spanish colony, Guatemala won its independence in 1821 (The World Factbook 2018). In 1839 Guatemala becomes fully independent (Guatemala Profile 2018). During the second half of the 20th century, Guatemala experienced a variety of military and civilian governments (The World Factbook 2018). During this time a 36-year guerrilla war was also ongoing (The World Factbook 2018). Most recently, in 1996, the government signed a peace agreement formally ending the internal conflict, which resulted in more than 200,000 people dying and an estimated 1 million refugees (The World Factbook 2018).
Guatemala culture is based greatly off of Mayan culture. The Mayan Empire was centered in the tropical lowlands of what is now Guatemala (H. (Ed. 2009). The Mayans excelled in agriculture, pottery, hieroglyph writing, calendar-making, and mathematics, as well as leaving behind the impressive architecture and artwork (H. (Ed. 2009). The earliest Mayan settlements date back to around 1800 B.C. during what was called the Preclassic or formative periods and where known to be agricultural in that they grew crops such as corn, beans and squash (H. (Ed. 2009). During the middle Preclassic period, the Mayan farmers began to expand into both the highland and lowland regions (H. (Ed. 2009). During this time period one of the first major civilizations started, the Olmecs (H. (Ed. 2009). It was during this time that the Mayans derived many religious and cultural traits in addition to their number system and calendar that still influence Guatemala today (H. (Ed. 2009). The Classic period came next at around A.D. 250 which was the golden age of the Mayan empire (H. (Ed. 2009). This is when the population grew and at its peak, there were an estimated 2 million Mayan people. As excavation of Mayan sites have been unearthed, it has been revealed just how advanced their society was in that there were plazas, palaces, temples, pyramids, and courts for playing ball games that were significant to the Mayan culture (H. (Ed. 2009). The Mayan cities were supported by a large population of farmers that practiced “slash-and-burn” agriculture, but also more advanced farming such as irrigation and terracing (H. (Ed. 2009).
The Mayans were a very religious culture and the worshiped various gods related to nature, including gods for the sun, moon, rain and corn (H. (Ed. 2009). At the top of the Mayan society were the kings or “kuhul ajaw” (holy lords) and they claimed to be related to the gods and followed a hereditary succession (H. (Ed. 2009). These kings were thought to serve as mediators between the gods and the Mayan people and would perform elaborate religious ceremonies and rituals that are important to the Mayan culture (H. (Ed. 2009). Most of what historians know about the Mayan culture comes from what remains of their architecture and art (H. (Ed. 2009). Guatemala is known to be the Heart of the Mayan World because of the traditions their people still carry from their ancestors (Welcome 2018).
The Mayans were spread across a large area and had over 30 different languages and dialects. These languages and dialects are known to originate from the mother language called Protomaya (E (n.d.) ). This mother language was spoken around 5,000 years ago. Today roughly 40% of Guatemalans are descendants of this outstanding civilization. Today, Guatemala treasures a total of 22 of the longstanding languages. The official and most spoken language for Guatemala is Spanish although, several other languages are spoken there (Nag 2017). Most of the population speaks Spanish. The Spanish language was introduced by the Spanish colonists and they taught it to the indigenous inhabitants by missionaries and the earliest schools (Nag 2017). Spanish is the primary language that is used for instruction in school throughout the country. Despite the fact that Spanish is the formal language, not all the locals speak it, in fact, some use it as a second language (Nag 2017). However, about 21 different Mayan languages are used throughout the rural area, as well as two other non-Mayan languages known as Xinca and Garifuna. (The Language). Some of the other languages that can be heard throughout the country include English, French, Chinese and German (The Language).
There are several different religions that are practiced in Guatemala today. However, Christianity remains as the main religion in the country today. Roman Catholicism was introduced by the Spanish and modified by Mayan interpretations, was almost universal in Guatemala until the early twentieth century when Protestantism began to make headway (Kimutai 2017). Today roughly 40% adhere to a Protestant church (Kimutai 2017). Many Mayans combine memberships in a Christian fellowship with a continued set of beliefs and/or practices that were inherited from their ancient ancestors (Kimutai 2017). They still participate in rituals for agricultural success, easy childbirth, recovery from illness, protection from the elements and to honor the dead (Kimutai 2017). A great deal of the indigenous people still believe in spirits of nature, especially caves, mountains, and bodies of water, and their religious leaders will perform ceremonies that are connected with these sites (Kimutai 2017). The Catholic church has been more lenient than the Protestants in allowing or ignoring dual allegiances, where the Protestants insist on strict adherence to doctrine and abandonment of all “non-Christian” beliefs (Kimutai 2017). As a result of the increasing number of Protestant in the country, a movement by the Catholics was launched to increases the number of Catholic converts (Kimutai 2017). Therefore, currently, the Roman Catholics form roughly 50% of the population and is the dominant religion (Kimutai 2017).
Protestant Christianity is the second largest religion in the country, representing around 37% of the population (Kimutai 2017). The first Protestant missionary was Frederick Crowe in 1843 but was pushed out by the Roman Catholicism president Rafael Carrera in 1845 (Kimutai 2017). In 1882 president Rufino Barrios asked several Presbyterian Methodist, and Baptist missionaries to the country to challenge the Roman Catholic church (Kimutai 2017). The amount of Protestant Christians stayed low until the Pentecostal Protestants came from the United States (Kimutai 2017). The Protestants in the country mainly reside in the northern highlands and are mainly the Mayan population (Kimutai 2017).
Atheism, Agnosticism or Irreligion is defined as the belief in the non-existence of a supreme creator or time and is referred to as non-religious in Guatemala (Kimutai 2017). In a recent survey that was conducted in 2010, it is reported that roughly 11% of the population has no particular religious affiliation and it is among the countries with the highest number of atheists in Latin America (Kimutai 2017). The other religions that make up roughly 2% of Guatemala’s population are Mormon, Jehovah’s Witness, Traditional Mayan Religion, Judaism, Islam, and Buddhism (Kimutai 2017).
In regard to religious freedoms and religious tolerance in Guatemala, there is no official state religion, however, the country’s constitution recognizes the legitimacy of the Roman Catholic church (Kimutai 2017). The other religions must first be approved by the government regulators to be recognized by the constitution (Kimutai 2017). The constitution does recognize the freedom of religion to all citizens which are honored and protected by law (Kimutai 2017). Since the civil war has ended the missionary activities have heightened and Protestant denominations have grown significantly (Kimutai 2017). These denominations have lived in coexistence with little to no friction between them (Kimutai 2017).
Approach to Medicine
When comparing Guatemala to the United States and other high-income nations the physician density is low (C. 2017). According to recent data, the physician density is roughly 0.93 physicians per 1,000 population (C. 2017). The World Health Organization estimates that with fewer than 23 healthcare workers per 10,000 population will most likely fail to achieve proper coverage rates for primary healthcare, as defined by Millennium Development Goals (C. 2017). This means that Guatemala is likely insufficient to achieve appropriate coverage for primary healthcare needs (C. 2017).
Having access to basic healthcare in Guatemala is dependent upon socioeconomic status and whether you live in urban or rural areas (C. 2017). In recent years there have been some improvements to the access and quality of care, however, despite the improvements that have been made to health services and systems rural populations still have difficulty accessing basic health services (C. 2017). It is estimated that basic health and nutrition services meet roughly 54% of the rural populations’ needs (C. 2017). This can be attributed to the fact that a majority of health services are located in the most developed cities, which are not easily accessible for the rural and indigenous populations (C. 2017). In rural and underserved areas people may also seek care from a traditional healer such as a curanderos or folk healer (C. 2017). These healers exist throughout Latin America and treat a range of ailments including illnesses modern medicine recognizes as well as “fold illness” that are specific to the locals (C. 2017).
Despite having a challenging time accessing basic primary care services Guatemala reports a high immunization coverage among children (C. 2017). Guatemala has roughly 88% vaccination coverage and administers vaccines in accordance with the World Health Organization’s (WHO) Expanded Program on immunization (C. 2017).
Due to tension, fear and uncertainty that may be triggered by chronic violence have lasting effects on both physical and psychological health (Refugee Health Profiles 2017). Exposure to prolonged violence can cause chronic distress, mental health conditions, hypertension and depressed immune systems (Refugee Health Profiles 2017). The fear and concerns regarding the crime deter people from utilizing healthcare and other services (Refugee Health Profiles 2017). Some of the infectious and communicable diseases that refugees are screened for when entering the United States are Dengue, chikungunya, and Zika, which are all mosquito-borne infections (Refugee Health Profiles 2017). Hepatitis B and Tuberculosis are also screened for, but most have received the newborn doe of the Hepatitis B vaccine and the tuberculosis prevalence was 106 per 100,000 population in Guatemala (Refugee Health Profiles 2017).
In addition to Guatemala improving their basic care for rural areas, many different organizations come to help. Some of these organizations include Entheos, Starkey, as well as several universities. These companies offer services ranging from basic medical care, dental work, women’s health, hearing services, and much more. This is one way that their population receives medical coverage to the people who normally do not see a medical professional for various reasons. These services are important for the people of Guatemala to have access to care that we have access to every day.
When working with a patient that is not the same culture as you, it is important to take into consideration what they might find offensive. Among women greetings and farewells call for handshakes, arm or shoulder patting, embraces and even cheek kissing, while men embrace and cheek kiss women and friends of the family but do not kiss each other (Guatemala n.d.). The children are taught to kiss all adult relatives and close acquaintances of their parents hello and goodbye (Guatemala n.d.). In the smaller towns and until very recently if eye contact is made with strangers on the street a verbal acknowledgment is custom (Guatemala n.d.). When working with this population it is important to remember that they may be hesitant to take advantage of medical services in part due to fears about immigration status or lack of insurance or other sources of payment (Harrah S. 2017)
When working with the Guatemalan population it is important to know that knowledge about general and mental health is not common (Harrah S. 2017). There are strong family ties within the Guatemalan community and they tend to stay together and care for each other in old age, and it is typically the women who make the healthcare decisions for the family (Harrah S. 2017). Therefore, as an audiologist working with this population, it is important to include the family and let the females weigh in on any decisions that need to be made. We should be respectful of their wishes and how they handle the decision of care based on their culture. We need to also explain what we are doing and what the results are in terms that they can understand. In addition to all of these points, we need to keep in mind that while yes using a translator is a great way to communicate, they might not open up as much to the interpreter as they would to a doctor that speaks fluent Spanish.
Guatemala is a country that is located in Central America. They speak several different languages depending on where you are in the country, however, Spanish is the official language. Guatemala has an extensive history that is rich in Mayan influences that are still practiced today. As a medical professional we need to keep in mind that they do not always have access to care or the knowledge of basic healthcare needs. Therefore, it is our job to explain it to our patient in terms that they can understand. It is also important to be respectful of the patients need for family input to make decisions based on their care because that is how they make medical decisions in Guatemala. It is important to be respectful of their culture and their beliefs so that we may provide the best patient care possible.
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- Martin, M. (2018, July 22). ‘There Is Nothing For Us Here’: Why People Keep Leaving Guatemala. Retrieved from https://www.npr.org/2018/07/22/631255034/there-is-nothing-for-us-here-why-people-keep-leaving-guatemala
- H. (Ed.). (2009, October 29). Maya. Retrieved from https://www.history.com/topics/ancient-americas/maya
- Miroff, N., & Sieff, K. (2018, September 22). Hunger, not violence, fuels Guatemalan migration surge, U.S. says. Retrieved from https://www.washingtonpost.com/world/national-security/hunger-not-violence-fuels-guatemalan-migration-surge-us-says/2018/09/21/65c6a546-bdb3-11e8-be70-52bd11fe18af_story.html?noredirect=on&utm_term=.2eb2b8209c4c
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