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The Association of Communitarian Health Services (ASECSA) is a transnational, religiously influenced health program in Central America created during the Cold War. ASECSA was founded in 1978 by a small group of international health professionals with ties to programs started by Catholic and Protestant clergy and laity in Guatemala’s western highlands in the 1960s. It introduced a model of healthcare in which Maya health promoters and midwives became partners in healing rather than objects to be cured. Support for the health programs and ASECSA came from secular and religious international agencies, including the United States Agency for International Development (USAID), German Misereor, Catholic Relief Services, and the World Council of Churches. ASECSA was founded to disseminate knowledge of popular health education strategies used by health promoters and midwives to provide preventive and curative medical services to their communities. The education methods grew from Paulo Freire’s Pedagogy of the Oppressed and its use by religious agents influenced by liberation theology. Although it was founded in Guatemala, ASECSA’s publications and meetings attracted participation by health professionals and paraprofessionals from Mexico, Central America, and even the Caribbean. Ecumenical religious centers affiliated with liberation theology in the 1960s and 1970s facilitated the development of popular health programs that played a defining role in the region.

Article

Heather Vrana

In Guatemala, experiences, meanings, and impacts of disability differed depending on one’s race, ethnicity, gender, social class, education, and location, among other factors. They also changed over time. Pre-Hispanic Mayan art indicates physical disability did not exclude people from the elite. In the colonial period (1521–1821), an important charity hospital system emerged. Some Guatemalans who might be identified as disabled today lived with widows and orphans in charity hospices and asylums. Disabled Guatemalans underwent cutting-edge treatments, for better or worse, owing to avid medical research by the protomedicato and faculty at the University of San Carlos. After independence in the early 19th century, Catholic charity endured and worked in tandem with state-building projects, even as disputes between the Conservative and Liberal parties churned. Guatemala’s growing hospital system relied upon this cooperation. The new century brought explosive growth in infrastructure and an expanded role of the state in everyday life. Reforms in policing, public health, and education transformed the lives of some disabled Guatemalans, often expanding confinement and surveillance alongside medical resources. The period of democratic florescence, known as the “Ten Years Spring” (1944–1954), brought reforms, including the creation of the Guatemalan Social Security Institute (IGSS) in 1946 and work-injury, illness, and maternity-benefits laws. Between 1946 and 1948, the Guatemalan and US governments conducted syphilis experiments on disabled residents of the Insane Asylum (Asilo de Alienados), as well as on soldiers, incarcerated people, orphans, and commercial sex workers. By the mid-20th century, decades—or even centuries—of inequality debilitated poor Guatemalans. Chronic illness, workplace injury, malnutrition, and other endemic conditions created temporary and permanent disabilities. Civil war (1960–1996) erupted and revolutionary groups argued that they fought to end the inequality that caused debilitating conditions. The war itself created new disabled people. Combat, torture, and trauma transformed Guatemalans. Yet the Historical Clarification Commission report neglected this topic and the experiences of disabled people in the war. Unlike their peers in El Salvador, Guatemalan veterans did not form influential advocacy organizations after the war. Since the 1990s, disability has been a serious cause and effect of widespread migration to the United States. Migrants have fled Guatemala because of inadequate access to disability-related healthcare and education. Some people have been disabled by dangerous conditions en route to the United States.

Article

Sterilization is an increasingly familiar phenomenon to women worldwide, and it is the most prevalent contraceptive practice in the world. Costa Rica, where the use of contraceptives is generalized, is among those countries in the world with the highest prevalence of female sterilization. In Costa Rica, female sterilization is homogeneously distributed, common among women living in rural and urban zones, as well as among those of diverse educational levels. In contrast to what one may expect given the legacy of abusive birth control practices in Latin America, the “problem” of sterilization in Costa Rica has been framed by women and doctors alike not as the “need” for curbing its use but rather as a “struggle” for broadening access as much as possible. Interestingly, current rates of sterilization have been attained in the absence of a formal program offering sterilization for contraceptive purposes and in the context of a very restrictive legal framework for its provision. It was not until July 1999 that sterilization for contraceptive purposes was explicitly regulated and permitted. Before that year, it was only so-called therapeutic sterilization that was legally allowed. Sterilization was supposed to be offered only for health reasons. Notably, successive moves intended precisely to broaden access to this surgery within the state hospital system have been realized through regulation formally restricting its provision. This sometimes counterintuitive history of the provision and regulation of sterilization in Costa Rica is analyzed.

Article

With its diverse ecological zones and varied public health threats that ranged from lowland epidemic to highland endemic diseases, Central America is a challenging place to practice healthcare. In addition to topography and geography, social relations have also influenced the dynamic, contested, and negotiated process of healthcare in developing countries. Adversarial relations among indigenous people, African immigrants and slaves, and the state marked the region’s pasts. After the Spanish conquest established racist structures that favored Hispanic citizens by instituting forced labor mechanisms and limiting access to political, economic, and social power, colonists extracted land and labor from indigenous communities. Although most countries assumed that adopting Hispanic customs would improve the lives of indigenous and Afro-Central Americans, many elites felt such workers’ health was important only insofar as it did not impede their ability to labor. Characterized by holistic approaches to health that took into account psychological, emotional, and physical well-being, indigenous and other traditional healing practices flourished even after states embraced the fields of bacteriology and parasitology in the late 19th and early 20th centuries. Primarily served by curanderos, midwives, bonesetters, and other traditional healers for generations, some remote rural communities were isolated from schooled medicine and its practitioners. In other rural communities and cities, hybrid healthcare offered patients palatable and efficacious healing options. As doctors became politicians and states embraced science to modernize their nations, politics and public health became inextricably linked. Often with the assistance of multinational companies and nongovernmental organizations, governments deployed scientific medicine and public health campaigns to undergird assimilationist projects. Based on assumptions that traditional medicine was impotent and indigenous people and African descendants were vectors of disease, public health campaigns often discounted, rejected, or persecuted the healing practices of such peoples. When authorities embraced rather than problematized the confluences of race and health, they enjoyed some success. Yet neither authoritarian nor democratic governments could establish a medical monopoly.