The Marjorie Kovler Center
December, 2001

The Momostenango Project:
a Guatemala Story

 By: Marianne Joyce and Lauren Heidbrink

Momostenango Project, Guatemala: (from left to right)
Mayan Priest Don Abraham Vicente, Social Worker Lilian
Lopez, Dr. Karla Santizo, and Psychologist Sonia Merida.

In November, Marianne Joyce and Lauren Heidbrink of the Kovler Center traveled to Guatemala to work with Momostenango Community Hospital during the start-up phase of their new torture treatment program. The project started when Don Abraham Vicente, a community organizer and Mayan priest, approached Dr. Leonel Lopez of Momostenango Community Hospital to discuss the mental health needs of communities affected by the war. Dr. Lopez contacted Kovler Center, with whom he has a long-standing relationship, to collaborate on fund raising and training in the hopes of establishing a torture treatment program at the hospital. This project is now entering its third month. Funding has been provided by the United Nations Voluntary Fund for Victims of Torture, two anonymous donors, and through the assistance of Margaret Knapke, who held a special benefit for this project last year. The project will help torture survivors in Momostenango and neighboring regions rebuild their lives, five years after the PeaceAccords were signed.

The 30-year civil war in Guatemala predominantly targeted indigenous Mayan communities. The government systematically employed intimidation, persecution and torture against Mayans under the guise of a counter­insurgency campaign. This United Nations-defined genocide has left a legacy of damaged lives and eroded attempts at democracy. The social and psychological effects of torture and politically motivated violence constitute a major public health problem in Guatemala, affecting individuals, families and communities. Because of the unique nature of torture and the severity of its effects, torture survivors generally require longer, more intensive treatment than other participants in traditional mental health programs.

According to a report of the Commission for Historical Clarification, the departments of Quiche, Peten, Alta and Baja Verapaz were most affected by the violence and repression during the armed conflict in Guatemala from 1962 to 1996. This recognition has resulted in political and economic attention in these regions of Guatemala that suffered the greatest conflict, with minimal attention in the remaining areas. On a recent trip to Momostenango in the department of Totonicapan in November, we were able to get a sense of how the team at the community hospital was coalescing with its work in the early stages. We also found that many people remained affected by the war, although the battles between the guerrilla and military, the government's scorched earth campaign, and most of the massacres occurred in other regions of Guatemala.

The hospital serves approximately 120,000 residents of the area of Momostenango and is a main referral center for the primary health care providers throughout the Department. A rough survey of the population residing in the department of Totonicapan revealed over 325 self-identified torture survivors. However, a culture of silence surrounding torture and disappearances is more common than disclosure. Momostenango Community Hospital provides medical services in the Momostenango region. It is the only accessible hospital in the region and is 1­2 hours away from government hospitals in Totonicapan and Quetzaltenango. Governmental health services are inadequate and poorly supplied; there are only two government health centers staffed by physicians and six basic primary health care posts staffed by auxiliary medical practionners.

Dr. Lopez, however, catalyzed an exciting change when he requested that the Cuban government expand their medical mission in Guatemala to Momostenango. There are now nine Cuban doctors working in these health centers and posts in Momostenango and outlying areas. Dr. Lopez and the Cuban physicians have been working together on initiatives to improve coordination of prenatal care with the traditional midwives in the area.

The torture treatment team of the Community Hospital includes psychologist Sonia Perez Merida, social worker Lilian Sac Pac de Lopez, Mayan priest Don Abraham, and physicians Leonel Lopez and Karla Rivera Santizo who hope to develop relationships of trust with community members and begin to deconstruct a pervasive culture of silence in the region. This is a tall order for many communities where the military and civil patrol commanders from the years of conflict now hold positions of power. The treatment team is currently engaged in a community outreach program in surrounding, rural areas. This outreach entails Don Abraham visiting with other community leaders (often accompanied by Bill Wagner, a former Kovler staff member now doing dissertation research in Momostenango) and laying the foundation of trust for the team to provide medical services to a community. Prior to our visit, the team conducted its first health campaign in Santa Lucia La Reforma, a region bordering the Quiche and suffering from the armed conflict more intensely than most of Totonicapan. That day, rumors spread that the man hosting the health campaign in his house was organizing the guerrillas again. This demonstrated the fragility of trust within communities as well as with an outside project in the wake of other failed and deceptive government programs. Don Abraham's skill and stature in the community makes his participation in the team essential.

We were the first to meet with the torture treatment team, health professionals, and community leaders, though many already know Dr. Lopez from his previous visits to Chicago. We spent one week meeting with individual team members about their understanding of their roles and training needs, in addition to meeting with the group to brainstorm and prioritize their training needs. This needs assessment will be used to plan more trainings for the team in the coming year. Advice for any visitors to Momos: pack your woolens and ask for Los Riskos, where Bill Wagner and Dr. Lopez live with their respective families.