1. Waste Management in the village of Patanatic
Heather Miller
Patanatic, Guatemala

2. Objectives
Use evidence-based practices, health care technology, and effective communication strategies to guide the essential public health interventions across the lifespan.
Use data from population assessments to identify the influences of the determinants of health (environmental, social, political, legal- ethical, economic, behavioral, and cultural) on delivery of care to diverse populations.
Assess the health status, health care access, and emergency preparedness needs of the defined population.
Participate with healthcare providers and community leaders in the planning, implementation, and evaluation of health interventions.
Collaborate with healthcare providers and community partners to promote clinical prevention and population-focused health. Apply knowledge from nursing and related arts and sciences to the care of selected community based aggregates.

3. Background
The focus of our populations health trip was on the community members of Patanatic. It is a village that is divided up into 4 sectors. The clinic delivers free health care to each family in the sectors.
Upon arriving to this country we learned that this community lived in poverty and did not have access to many of the services that we have in the U.S
They lacked proper health care, dental care, vision care, and also contained very poor environmental health.
There was a major issue with waste management. Many people were burning their trash due to not having a garbage service for the community.

4. Background
When speaking with community leaders the COODE one of the major issues was not having a plan in place to address the waste management issue.
The leaders needed help developing and implementing a plan that would help get the trash off the streets.
This specific objective addresses how we can aide in the development of this program.

5. Clinic
Our main location was the Centro De Salud in the village of Patanatic.
The clinic offers free health care to all the families In sectors 1 through 4.
The clinic does not have a physician, it is ran by two women who have taken basic level nursing courses. Similar to CNA or LPN.
The clinic relies heavily on volunteers who travel from the U.S. With our help they are able to perform more well-checks for the families.
The clinic lacks many resources such as medications. Donations and volunteers are vital for keeping the clinic up and running.

7. Learning objective
“Participate with healthcare providers and community leaders in the planning, implementation, and evaluation of health interventions.” While in Guatemala we met with the urban and rural community development committee. We asked many questions about current community issues, and how they planned on addressing them. One major topic was on waste management issues. It is clear that they do not have a standardized process for trash clean up. As you walk through the villages, you can see that garbage is left in the streets. The mayor’s assistant Carlos Garcia mentioned that this was a great concern, and there is not a process in place now, but hopes there will be one in the near future. With this information it was clear that community members need help with the planning and implementation of a waste management process. This objective describes this need.

8. Sanitation information
There are many areas in Guatemala where trash is dumped and just left there. The sewage system is untreated, and backs up into the water system. Lake Atitlan is full of toxic bacteria due to this issue.
One reason why there is a poor waste management structure is due to poor infrastructure. There are no designated area to dump the trash. There are also no dump trucks to collect the garbage. Most garbage is either burned or dumped into the river, that in turn pollutes Lake Atitlan and the drinking water.
Another primary issue is due to financial resources. It is expensive to implement a waste management crew, and that is why there is major push back.

9. Effects on health
In looking at data for morbidity and mortality, we found diarrheal diseases were among the top three causes of premature death in Guatemala as listed by Institute for Health Metrics and Evaluation (2017), accounting for nearly 57.6% of premature deaths in the country.
These health effects could be do to poor sanitation. Garbage and sewage getting dumped into Lake Atitlan, and in result hurting our drinking water.

10. Conclusions and suggestions
While in the community meeting, the mayors assistant recognized the waste management issue that resides in the community of Patanatic. He went on to mention that there are currently no processes in place for the problem, and one of his goals is to develop a plan to address this matter. I have made the following suggestions to begin working on the waste management crisis:
Develop a coalition that only addresses waste management crisis. This will allow this specific coalition to solely focus on sanitation issue and not various issues at once.
Education is key. Teach children in the schools and families in the clinic how to properly manage wastes. Providing them with information on why it is important will lead to more compliance.
Hold the community accountable. Schedule a day that will encourage everyone to go out to clean up their community. Since there is a huge value on community keeping everyone responsible could be a great option.

11. Our implementation
While in Guatemala we attended a school assembly to deliver information on clean water, clean hands, and clean streets.
We educated the children on keeping their environment, school, and homes trash free.
We educated them on using trash cans instead of throwing garbage in the streets, and if they see trash laying around to pick it up.
We encouraged them to bring this information home to further relay the education

13. Most profound clinical experience
Throughout my time in Guatemala what stuck out to me the most is the appreciation and trust the community members put into us as student nurses. They constantly thanked us for our work and not once complained about the long waiting times. They trusted us enough to talk about personal was issues, and was eager to soak in education that we could provide them. The mothers encouraged their children to not leave without a giving us hug and a kiss on the cheek. It was amazing to see the appreciation and the love that they have for their health care workers. At time many nurses in the U.S can feel burnt out and very frustrated. Working in this clinic was a great reminder of why we do what we do.

14. Most profound cultural experience
What has impacted me the most culturally was the focus on community. While in Guatemala it was clear that the people did not see themselves as independent individuals that only looked out for themselves. There was a significant value in family and togetherness. The community was constantly looking out for each other, and was always willing to give a helping hand. Even those who did not have much continued to give to those less fortunate than them. Going into this trip I expected to give as much as I can to these families. Little did I know that I returned from the trip with them teaching me more than I could have ever imagined. This was truly a life changing experience that has left an everlasting impact on my life.

15. References
Institute for Health Metrics and Evaluation. (2017). Guatemala. Retrieved from:
Lesniewski, C. (2017) Patanatic clinic data [Microsoft Excel spreadsheet].
Pan American Health Organization, & World Health Organization. (2002). Health in the Americas (Vol. 1). Pan American Health Org.