Title

Gender, Maya identity, and the multi-level politics of forming community health promoters in highland Guatemala

Date of Completion

January 2004

Keywords

Anthropology, Cultural|Health Sciences, Public Health

Degree

Ph.D.

Abstract

This dissertation examines the process and politics of training community health promoters in three non-governmental organizations (NGOs) working in the Kaqchikel Maya-speaking region of Guatemala's central highlands in the mid-1990s. Although prior research on community health worker (CHW) programs has tended to focus on the role of either local-level culture or macro-level political economy in affecting CHW participation, this comparative NGO analysis highlights the critical role of local organizations in linking macro and micro-level influences and in shaping the patterns and meaning of CHW participation. In particular, I found that different training approaches had a significant impact on the characteristics of trainees, including their gender and life cycle stage. I argue that from their founding, Guatemalan health promoter programs have helped determine who took on this new health role. ^ I examine three major debates within these programs regarding health promotion, traditional Maya medicine, and women's involvement to elucidate how these NGOs helped form distinct images of health, gender, and ethnic identity through their training philosophies and procedures, thereby contributing to changes in individual promoter lives and to broader social identity movements. I suggest that conflicts over the debate issues arose from shifting and often contradictory ideas and material conditions at different levels regarding health work, Maya identity, and gender, which often left NGO trainers and promoters caught in the middle. In addition to revealing inconsistencies in macro-level policies, this study demonstrates variability in views and practices at the local community level, belying any simple conclusions about the impact of “local culture.” Furthermore, the NGO comparison highlights how organization traits including the health promotion philosophy, training scale, and staff composition influenced the ways organizations approached health, gender, and Maya identity. By showing the multi-level dynamics involved, this research calls into question common assumptions about the ability of local NGOs and CHWs to connect easily with local communities and represent community interests. I argue that the complex, multi-level politics of CHW participation has implications for theory, ethics, and practice in the fields of anthropology and international health. ^