Around 28,000 peasants, returnees and people internally displaced for economic reasons live in Champerico district, southwest Guatemala. Ladinos and Mayas from the high plateau share a depressed rural area where a subsistence economy prevails.

Housing conditions as well as basic healthcare and water and sanitation services are inadequate."Médecins Sans Frontières (MSF) decided to intervene to improve the district's preventive and curative healthcare services taking into account factors such as exclusion and vulnerability," explains Jordi Passola, the project's general co-ordinator.

From a medical point of view, Champerico's outlook is not encouraging. Three out of the six healthcare posts have been closed due to a staff shortage. Around 80 per cent of births are home-assisted, with traditional birth attendants, and there are high maternal and child mortality rates. There is a high chronic malnutrition rate, over 40 per cent among children under five years old. Moreover, this is a cholera-endemic area. It is also affected by natural disasters and other epidemics.

Improving management

Aiming at reducing mother and child mortality rates, the MSF team has developed a project to improve the quality of healthcare services. Since the project started in October 1999, the number of curative consultations has increased by more than 60 per cent over the first quarter of last year. "The main problem is the mismanagement of resources, which overloads healthcare structures," says Dr Anna Cavalli.

The MSF team has a support role in the district, working in one healthcare centre and six healthcare posts. Activities include vaccination programmes, pre-natal checking, mother and child healthcare, training of birth attendants, medical consultations, improvement of medical data collection, support of pharmacy management and basic sanitation work.

Significant achievements have been obtained in the short term, such as the introduction of a basic drugs list for healthcare centres and healthcare posts being used at a regional level. These activities allow for standard treatment protocols to help control drugs expenditure and its rational use.

Small emergencies

Complex emergencies rarely happen in Guatemala. However, the team's regular work is sometimes disrupted by small emergencies that take place throughout the year.

"Generally speaking, emergencies will affect groups of under 5,000 people," explains Jordi Passola. "The advantage of developing medium-term projects in Guatemala is that it allows us to be there just when the emergency is taking place and to assist populations in precarious situation using the human and material resources we have in the area."

New settlements

A 100-family community has been settled in the outskirts of Champerico since mid-May. The families live in plastic and wooden huts next to the farmland they have just sown, and they lack any medical-sanitation services. "We came from the high plateau, from Quetzaltenango, because we had no land or subsistence means," one man explains.

"When they arrived from the highlands, they suffered from fever and diarrhoea due to the change of climate as well as poor hygiene and shelter conditions," explains Valentin Calvente, MSF field co-ordinator. An emergency intervention was carried out to provide them with plastic sheeting, blankets and water tanks. MSF is also supporting them with the construction of latrines and water-wells. "The most important thing for them was to sow, even when they had no shelter to protect them from the rain."

In the meantime, selling some cattle they keep in the highlands allows them to get by until next harvest. "Since peace accords were signed, population displacements are taking place," explains Valentin. "People are in search of farmland, and these displacements provoke small medical emergencies due to the bad living conditions."

Cholera outbreak

Nueva Cajola, in Champerico municipality, is a small village of Mayan people from the city of Cajola, in neighbouring Quetzaltenango region. Nueva Cajola is a cholera-endemic area. The population is 30 per cent temporary migrant farmer. As the farmers move, they bring cholera with them.

The first suspected cholera case was registered in late April. "Laboratory analysis at Quetzaltenango's Regional Hospital have confirmed two cholera cases coming from Nueva Cajola and another two from Cajola," explains Esther Goni, the programme's medical co-ordinator. "Champerico's health authorities declared an epidemic outbreak and a contingency plan supported by MSF was put into place."

The MSF team is also supporting activities such as hygiene education, distribution of oral rehydration salts and chlorine, medical management of diarrhoea cases and epidemiological data.