In the western highlands of Guatemala, Arthur Demarest oversees archaeological sites where Vanderbilt PhD students are studying ancient Maya civilizations.

In Quetzaltenango, Guatemala, Vanderbilt University School of Nursing students help to implement a new healthcare model at the Primeros Pasos clinic.

On the third floor of Calhoun Hall at Vanderbilt, Mareike Sattler teaches graduate and undergraduate students the dialect of the Maya language K’iche’ that is spoken in Nahualá, Guatemala.

Vanderbilt University is inextricably tied to the country of Guatemala through dozens of programs, initiatives and academic networks. The Hustler explored many of these connections, which combine the study of Ancient Maya civilizations with programs that study and support the modern Maya population.

Center for Latin American Studies

Over 17 percent of faculty in the College of Arts and Science have a Latin American studies focus. Vanderbilt’s Center for Latin American Studies connects many of these professors and their work in the region. Specifically, it serves as a hub for many of the connections between Vanderbilt and Guatemala.

In 2006, the CLAS was designated as a National Resource Center on Latin America by the U.S. Department of Education. This status ensures funding for the CLAS to educate the community about Latin America. This grant lasts for 12 years, and Vanderbilt is currently in the process of re-applying for the status. The Vanderbilt CLAS is one of only eleven National Resource Centers on Latin America in the country. Other universities with National Resource Centers on Latin America include Stanford University and Tulane University.

Executive Director Avery Dickins de Girón and Director Ted Fischer work together to run the Center for Latin American Studies, as well as facilitate collaborations between different departments and schools at Vanderbilt who are doing work in Guatemala.

Vanderbilt is the premier program in studying the Maya of Guatemala and Guatemala as a country.

Dr. Brent Savoie works closely with de Girón and Fischer as a CLAS affiliated faculty member. He appreciates the role that the CLAS plays in sustaining interdepartmental relationships.

“There’s always been a lot of people who have some degree of involvement with Guatemala on Vanderbilt’s campus, but previously it was very hard to connect those dots,” Savoie said. “So the CLAS is really helpful in terms of helping create and maintain those relationships, because there’s a structure for it.”

De Girón’s connection to Guatemala began when she moved there to learn Spanish. She soon fell in love with the country.

“I was fascinated by the country and the people, and that’s actually what set me on my path to want to study anthropology.”

She received her PhD in Anthropology from Vanderbilt after doing her dissertation work studying inequality and the security guard industry in Guatemala. De Girón lived in the Alta Verapaz department, or state, of northern Guatemala while she conducted fieldwork to determine the benefit and impact of economic development programs supported by USAID and several other actors in the Chisec municipality and surrounding villages.

De Girón found that these programs actually resulted in increased inequality where they were implemented. Those who could speak English and had more education benefited most from the programs due to their language experience. Additionally, these were people who were already better off, and tended to be men and boys.

While studying the implementation of economic programs, De Girón recognized that many young men in these villages didn’t have job opportunities – even those who had completed an eighth or ninth grade education, which is considered successful there. Many of these men would take jobs as security guards in Guatemala City in order to support their families back in their rural villages.

De Girón found that these indigenous men were exploited for their work, but often took advantage of the system.

“They will jump from one security agency to another because the industry is quite exploitative of these indigenous men,” De Girón said. “But the men use it to their advantage. So if they want more time off that the agency is not going to give them, they’ll quit their job, go take a break for a month in their home community, and then go back when they’re ready and sign up at another agency to work.”

As the Executive Director of the CLAS, De Girón is in charge of operational oversight and strategic planning. This includes grant-writing and overseeing the staff, daily operations, and budget. She also connects faculty from the undergraduate and graduate schools whose work focuses on Latin America.

“One of the most exciting parts of my work currently as the Executive Director of the center is meeting people and working with people from across campus,” De Girón said. “That’s amazing – I really have an interdisciplinary work life.”

De Girón also enjoys being able to share her passion for Latin America with others through the center’s work, which has included working with Nashville institutions like the Frist Center for Visual Arts and Cheekwood Botanical Gardens.

“It’s really amazing thinking about how you can bring information on Latin America to people through the arts and through other public events and talks,” she said.

De Girón works closely with Ted Fischer, the Cornelius Vanderbilt Professor of Anthropology and Director of the Center for Latin American Studies. His work in various areas of anthropology has frequently intersected with Guatemalan and Maya studies.

“Vanderbilt is the premier program in studying the Maya of Guatemala and Guatemala as a country,” Fischer said.

Institute for Coffee Studies

Guatemala is known for its coffee growers and production, and the Vanderbilt Institute for Coffee Studies has been studying the various dimensions of coffee as a global product since 1999. It was initially founded under the School of Medicine to study the health benefits of coffee. Now Fischer directs the institute, which is currently housed under the CLAS.

According to the founder of the ICS, Dr. Peter Martin, the institute and anthropologist Arthur Demarest are the main reasons that multiple Vanderbilt organizations operate in Guatemala today. During Martin’s first trip to Guatemala, he spoke at a meeting of the Guatemalan Coffee Federation, which expressed interest in his work.

”In the early 1990s, I was contacted by a scientist in Brazil, since Vanderbilt had an extremely good pharmacology department, of which I am a member as well,” Martin said. “And the idea was to lead us to investigate about the health benefits of coffee. At that time it was very broadly accepted by a lot of people that coffee may be harmful and what they wanted to do is formally study that. And for a couple of years we were sort of going back and forth about setting up the Institute for Coffee Studies here at Vanderbilt, devoted to looking at the health benefits of coffee.”

Martin decided to start the institute at Vanderbilt. With the health benefits beginning to emerge from the research, the institute’s work soon began to gain recognition from coffee-producing countries.

Our idea was that coffee is this unique product about which you can sort of tell the whole story of the world.

“So it was in the late 1990s that we were awarded resources (like grants) from a number of foreign countries, including Guatemala, for whom coffee is extremely important in their economies,” Martin said. “At that point the cost of coffee was extremely low, so they were really suffering. They wanted to make people drink coffee and the market increase.”

With the advances in the coffee studies, experiments in the early 2000s began to remove lifestyle variables and the health benefits of coffee began to show. These studies increased the coffee consumption and fueled more studies into the benefits of coffee.

“Interestingly enough, in about 2014 a big paper came out in the New England Journal of Medicine which said that coffee consumption is associated with protection against all causes of mortality, which means that if you drink coffee, you are going to on average live longer, in proportion to the amount of coffee that you drink,” Martin said.

Besides discovering health benefits of coffee, Martin also made progress in discovering additional compounds present in coffee.

“We found components of coffee other than caffeine, so called chlorogenic acids, which seem to have opposite effects from caffeine,” Martin said. “It’s almost like within coffee we have a yin and yang effect on the adenosine system. What caffeine does is it antagonizes the adenosine system and causes us to wake up. But we uncovered these other compounds in coffee that work in the opposite direction from caffeine.”

These discoveries helped coffee gain popularity among consumers and helped increase the demand for and price of the product. This in turn benefited coffee-producing countries, including Guatemala, whose gross national product largely depends on coffee exports.

“Some people say that of all the commodities that are traded between nations, coffee is the second most important,” Martin said, “So economically and socially, there are an awful lot of people that benefit from it.”

Under the CLAS, the ICS studies coffee as a global product.

“Our idea was that coffee is this unique product about which you can sort of tell the whole story of the world,” Fischer said.

Along with Owen Graduate School of Management professor Dr. Bart Victor, Fischer has conducted research on the rise of third-wave or high-end coffee and the impacts that has had on smallholding coffee growers in Guatemala.

“Guatemala is ground zero for third-wave coffee,” Fischer said.

The history of coffee production in Guatemala includes exploitation of the labor of indigenous populations by foreign companies. These companies accumulated low-altitude land on which they could grow as much coffee as possible, forcing indigenous populations to live at higher altitudes.

Recently, the shift in the coffee industry towards third-wave coffee, which is grown in small batches at high altitudes, has flipped the historical narrative of coffee in Guatemala.

“Our first research that came out of this is kind of this story of this poetic justice,” Fischer said. “It’s like these people, who were displaced from their ancestral lands, but now it turns out where they were displaced to produce this great coffee that commands these high prices. So phase two of that, we started looking at ‘Well, how much are they benefiting?’”

Fischer and Victor found that Mayan smallholding coffee growers were getting paid significantly less than other growers for coffee of similar quality.

“Part of that is… they speak a Mayan language, they have much less land so they don’t have any sort of leverage because of that,” Fischer said. “(They have) more barriers to entry into the market… and a lot of non-economic barriers as well.”

Victor and students in the business school are working to develop a business model for these smallholding coffee growers so that they are fairly paid for the coffee that they produce.

“We see our sweet spot as… where we can actually discover something new about the coffee business, or discover something new about society through coffee,” Fischer said. “But combining that with actually helping these coffee farmers. This study was a perfect example: we had undergraduate students and business students going down there and looking at the coffee market, buying coffee from these smallholding producers, (and) we came up with this study that showed something interesting that people had not really realized about the coffee market. And now we’re having those students work on projects about how to come up with a market model that could benefit these producers. So it’s like research, teaching, and this service to humanity.

An ancient world: Mayan archeologists at Vanderbilt

Many of Vanderbilt’s connections to Guatemala tie back to Arthur Demarest, Director of the Vanderbilt Institute of Mesoamerican Archaeology and Development and Ingram Professor of Anthropology. Demarest’s archeological work in the Q’eqchi Maya region spans over three decades, and he is regarded as an authority on ancient Maya civilization.

At age four, Demarest told his parents that he wanted to become an archaeologist. He received his undergraduate degree from Tulane University and completed his PhD in archaeology and anthropology at Harvard University. After completing his PhD at Harvard, Demarest moved his career to Vanderbilt, which offered him the opportunity and resources to manage a large archaeological site in Guatemala.

The most important thing archeology can do is help the living people around you.

Today, Demarest has been referred to as a “Modern-Day Indiana Jones”. His work and contributions to Mesoamerican archaeology have won him various awards and honors.

Despite his evident success in his field, Demarest stresses the importance of supporting the communities that he works in. He values the opportunity to assist community development in Guatemala, but says that he can never do nearly enough.

“The most important thing archeology can do is help the living people around you,” Demarest said.

One of Demarest’s specialities is in exploratory archaeology – going into areas where no one has ever worked before. An example of this is the Maya palace that Demarest and a team that he led discovered in the remote jungles of northern Guatemala. Discoveries like this have marked Demarest’s career.

Demarest usually teaches classes during the fall semester at Vanderbilt, and spends the spring in Guatemala. This spring, he is spending much of his time travelling between various projects and archaeological sites in Guatemala to reinforce his previous work.

Demarest is also heavily involved in fundraising to support Vanderbilt’s initiatives and projects in Guatemala. He gives talks on his archaeological work and research into the collapse of ancient societies.

All of us here at Vanderbilt are really aware of this ethical responsibility that we’re not just researchers, but also human beings who try to work with locals and try to help better their lives.

Much of Vanderbilt’s involvement in Guatemala and the Maya region can be accredited to Demarest for his decades of work in the area. Demarest credits Chancellor Nicholas Zeppos for dedicating resources to building up the international presence and reputation of Vanderbilt.

Demarest also noted the integrated nature of Vanderbilt’s work in Guatemala. He works closely with Fischer, who he called a “matchmaker” for resources, opportunities and faculty related to Guatemala. Demarest has also worked with Dr. Brent Savoie, founder of the Primeros Pasos clinic in Quetzaltenango, Guatemala, and Dr. Peter Martin.

Demarest spoke to Vanderbilt’s involvement in Guatemala, noting that many leaders in the Guatemalan archaeology community and the larger public sector are Vanderbilt graduates.

“We’re really invested in this place,” Demarest said.

While Demarest works mainly in the Guatemalan highlands, Dr. Markus Eberl works in the tropical lowlands. Eberl is the director of the Tamarindito Archaeological Project in the Petén department in northern Guatemala and an associate professor of anthropology at Vanderbilt.

Eberl was initially fascinated by the visual aspects of the Mayan writing system and in the intricacies of this disappeared ancient culture. He is originally from Germany, but he began working at a Guatemalan archaeological site through a series of what he calls lucky connections.

“I talked at one point with my professor back in Germany, and he told me that one of his doctoral students just had happened to marry a Japanese archaeologist, who happened to work in the Maya area,” Eberl said.

Eberl has been working on archaeological sites in Guatemala for the past 20 years. His work has spanned much of Mexico and Guatemala, but his most current project at the Tamarindito site looks at the seat of a royal dynasty. Eberl works with his Guatemalan co-director and a local team of archaeologists to study inequality and the lives of commoners in this ancient city.

Inequality in the ancient Maya world is evident in what people wore and ate. While wealthy people wore jade earrings and ornaments and ate meat, commoners wore clothing made of coarse fiber or cotton and ate beans, tamales, tortillas and less meat. Eberl works with colleagues who can reconstruct diets of the ancient Maya through animal bones and remains.

“For me, it’s a fascination to reconstruct a lost world – to really try to understand people who are completely untouched by the modern world,” Eberl said. “To understand people who were living thousands of years ago in a land that was completely different. For me, it’s an intellectual challenge to understand them.”

Eberl likened studying ancient Maya cities from thousands of years ago to researchers studying an abandoned Vanderbilt in the future.

“You have to imagine how Vanderbilt would look in 1000 years, when there are no students, when scholars come back and try to understand how Vanderbilt functioned,” Eberl said. “If you would take away all the people, all the major equipment, you would just have the buildings, then you try to make sense of what happened there.”

Eberl is on sabbatical this semester, analyzing and writing about the data that he has collected over the past few years. He is also writing a book titled “Community and Difference: Change in Late Classic Maya Villages of the Petexbatun Region,” which explores the role of innovation in social change. The book details how innovations drove ancient Maya societies to develop.

When he is teaching anthropology classes at Vanderbilt, Eberl uses case studies from his archaeological work in Guatemala to give students an understanding of ancient Maya culture beyond a textbook and to show students the realities of research. He stresses the challenges that he confronts in the region.

“For example, I deal with a lot of drug-trafficking,” he said. “Most of the cocaine that is consumed in the United States comes exactly through the area where I am working. At night I get these small planes… flying without lights over my site, in the direction of Mexico. I want to give students a sense of what it means – both to work as an archaeologist, but also the challenges of doing research.”

As an archaeologist, Eberl is fascinated by studying ancient Maya societies, but he also stresses the importance of giving back to the communities that he works in.

“I, as an archaeologist, and all of us here at Vanderbilt are really aware of this ethical responsibility that we’re not just researchers, but also human beings who try to work with locals and try to help better their lives,” Eberl said. “We try to help as much as we can to improve conditions.”

Eberl has given back by helping to build a medical center in one of the communities that he worked in and by donating medicine to the center. He has also used his research at the Tamarindito site to help the local modern Maya population.

“For example, specifically, at the royal capital where I am working right now, the ancient Maya were very careful with the terrain,” Eberl said. “It’s rather hilly, so the ancient Maya built a lot of terraces to limit soil erosion and to allow intensive agriculture to grow on for centuries. It’s then interesting that the modern inhabitants of that area–they are all newcomers, so they don’t know the local environment very well––and then it’s fascinating if I can show them ways of sustainably living in an area where the ancient Maya were living almost two thousand years ago. For me it’s fascinating to be able to give back a little bit to the modern people.”

Mayan K’iche’

For over a decade, Vanderbilt has offered courses in the Mayan language of K’iche’. There are over a million native K’iche’ speakers in Guatemala. Vanderbilt teaches a dialect of the language that is spoken in the western highland city of Nahualá.

Vanderbilt entered the Vanderbilt – Duke – UVA Partnership for Less Commonly Taught Languages in 2015. This consortium allows Vanderbilt students to take courses in Haitian Creole taught at Duke University and Tibetan at the University of Virginia via a telepresence classroom. Likewise, students at Duke and UVA can take the K’iche’ courses that are offered at Vanderbilt.

Taking a course via a telepresence classroom is not the same as taking a course online; students who don’t attend the host university are present in the classroom on large televisions on one wall.

Vanderbilt doesn’t have a linguistics department, so anybody who’s interested in linguistics and other languages or how they work, if you’re interested in getting to know a different world, if you have interest in Latin America or Central America or Guatemala in particular, I would highly encourage that students check out the classes.

Undergraduate and graduate students can take the K’iche’ courses, which are offered in a four-semester sequence including elementary and intermediate levels. During the fourth semester, students study a sacred text, the Popol Wuj, which is written in K’iche’.

“I reserve the last semester to look at the more historical sources, so we go back and read documents from the sixteenth and seventeenth centuries,” said Mareike Sattler, who teaches the K’iche’ courses at Vanderbilt. “(The Popol Wuj) is sometimes described as the ‘Bible of K’iche’”. It’s a long document that has mythological stories and tells about the creation of the K’iche” maya world…students learn different skills sets to work with an old text, and they learn spanish paleography.”

Sattler has been teaching K’iche’ at Vanderbilt for almost a decade, but started learning the language when she was attending university in Germany. Like Eberl, she was originally interested in the Mayan writing system.

“I was really interested in the hieroglyphs, the Mayan glyphs, which is a writing system that the Maya independently developed.”

To learn to decipher hieroglyphs, it is helpful to learn the spoken language. Sattler took an intensive six-week summer language course in Guatemala to learn an indigenous Mayan language and was hooked.

“That turned my life around,” Sattler said. “Instead of working on ruins, I met living Maya people who were fighting for recognition of their own languages in the national context of Guatemala. And that impressed me so much, so I switched to modern languages. I learned Kaqchikel, a sister language, which is very close to K’iche’.”

Sattler learned K’iche’ at university in Germany, and this skill made her the perfect fit to take over teaching K’iche’ at Vanderbilt in 2009.

Besides teaching K’iche’ at Vanderbilt, Sattler also teaches a six-week intensive summer language course through Tulane University in Nahuala, similar to the one that she participated in as a student.

“Nahuala is one of those towns where life takes place in K’iche’,” Sattler said. “The younger generation is bilingual, but… anything that you might do in your daily life takes place in K’iche’. So it’s a very good environment for students to learn because there’s lots of opportunities to practice.”

Sattler recommends that students take courses in K’iche’ to learn how another language works and to gain a new perspective.

“Vanderbilt doesn’t have a linguistics department, so anybody who’s interested in linguistics and other languages or how they work, if you’re interested in getting to know a different world, if you have interest in Latin America or Central America or Guatemala in particular, I would highly encourage that students check out the classes.”

Innovation in Guatemala through the School of Engineering

Biomedical Engineering

Dr. Cynthia Paschal’s biomedical engineering service-learning course is a unique opportunity for students to actualize classroom learning and serve a community with limited resources. Students in Paschal’s course travel to Guatemala and apply skills learned throughout the semester, such as repairing medical equipment.

In the 2007-2008 academic year, Paschal decided to explore options for a biomedical engineering service-learning course, ultimately deciding Guatemala would be the destination for students during spring break.The course was first offered to students in spring of 2009, and then again in 2010. Since then, the course has been offered to a group of 12 students every other year.

Two organizations that influenced the creation and continuation of the course are Engineering World Health and Project C.U.R.E. EWH is a non-profit organization that works to improve healthcare delivery to low-income countries around the world. Project C.U.R.E. provides donated medical equipment to developing countries.

“Engineering World Health really helped make apparent to me the need for dealing with medical equipment, particularly in resource-limited settings,” Paschal said.

Project C.U.R.E. has a volunteer location in Nashville and loaned equipment to Paschal so that students could develop skills of testing and evaluating it. Students utilize this to prepare for their service in Guatemala, which involves identifying issues with medical equipment and seeking potential solutions.

While many aspects of the course have remained consistent since its creation, two major changes were implemented two years ago. Previously, students would visit Universidad del Valle de Guatemala and present projects to each other, learning what it was like to study engineering elsewhere. However, one of the changes to the course changed this interaction from a visit to a collaboration.

“We started having those students come and work with us, which was very generous of their professors because it’s not like our spring break is a break for them,” Paschal said. “They actually miss classes to come work with us.”

The second change to the course was the production of videos detailing different types of medical equipment and common failure modes. Students produced videos of anesthesia systems and noninvasive blood pressure monitors. With support from the Center for Latin American Studies, the same videos were also produced in Spanish.

Paschal hopes that through this course, students are able to apply skills learned in the classroom to help others and recognize the utility of their education.

“We learn a lot in the classroom and while we have of course laboratory exercises, it’s not the same as actually having to do something in the real world,” Paschal said. “So there’s that gut-level awareness that my education is really useful.”

Engineers Without Borders

Dr. Janey Camp is the Student Chapter Advisor for Engineers Without Borders (EWB) at Vanderbilt. On Jan. 1 of this year, Camp took three EWB students to Guatemala for a five-day assessment trip. Communities in need of engineering services can submit projects to EWB, and then chapters apply to take on the project. The group of Vanderbilt EWB students visited two schools in Txemuj and Paxoj, focusing on community needs and local impact projects. Camp said that depending on scheduling and fundraising, another trip could take place this upcoming summer.

I hoped that they would gain an appreciation for life in a third world country and the needs of the people there

“I think the biggest challenge was leaving and knowing how much work we have to do,” Camp said.

Camp emphasized the hospitality and gratitude the EWB group received from the community. The principal of one of the schools welcomed them into his home, introducing them to his family and insisting they stay there for the night. Ultimately, making human connections was an integral part of the trip, and one that Camp wanted her students to take with them.

“I hoped that they would gain an appreciation for life in a third world country and the needs of the people there,” Camp said.

At the end of last spring, there was a push to explore options for an international service trip, as EWB was not currently working on one. Hunter Conti, Noah Gertler, and Jared Rothstein are the three Vanderbilt undergraduate students who participated in the EWB assessment trip to Guatemala. Once in Guatemala, the students worked with community leaders and saw firsthand the challenges of implementing certain solutions.

“There are certain solutions that we’d like to implement that make the most sense, technically speaking on paper, but whether it’s money that we don’t have or it’s labor that we don’t have or it’s time that we don’t have to be there,” Gertler said.

While on the service trip,the students worked throughout the day and collected data, figuring out what the data meant for the area and how they could find solutions to the community’s problems. All three students said that getting to know the people in Guatemala was one of the most impactful aspects of the trip.

“Having that experience where you feel what it means to be a human there, it really just gives you this bigger, more loving, compassionate, holistic view of the world,” Gertler said.

EWB will continue to design solutions throughout the semester to address the priorities of the communities that they worked in. Conti said the projects at the forefront of their design are a septic system, a retaining wall and improvements to a school entrance. One of the unique aspects of the EWB trip is the improvements that can be continually utilized throughout the community.

“It’s not meant to just help them; it’s also meant to teach them and show them the right ways to do things and how to build certain things,” Rothstein said. “It’s kind of cool because you’re helping, and when you leave you know you’re still directly impacting them because they’re going to be able to further improve on the community.”

One of the challenges with future trips to follow up the assessment will be fundraising. Rothstein said that EWB will be holding fundraisers this semester in order to raise the necessary amount for designing solutions and taking implementation trips with more members.

“We have to raise a good amount of money for the construction, but we’re also trying to grow the club a lot and be as big as some other big international service clubs on campus,” Rothstein said.

Institute for Global Health

Another Vanderbilt organization that works in Guatemala is the Vanderbilt Institute of Global Health (VIGH), which performs cancer control research in what is classified as the CA-4 region. The CA-4 region consists of the countries of Guatemala, Nicaragua, El Salvador, and Honduras which are clustered together due to their similar geography, language, history and poverty, according to the VIGH website.

Dr. Douglas Morgan is one of the faculty members involved in the various cancer control and cancer registration initiatives that began operating in 2013 in Guatemala and the CA-4 region.

We have been able to provide equipment for clinical care and a variety of related programs that help the rural public patient populations on a daily basis.

Originally trained as an engineer, Morgan began his career in medicine after witnessing the health care needs in Honduras and after additional volunteering in the region. After the discovery of cancer-linked genes, he began his cancer research in Guatemala.

“We were impressed by the amount of cancer and specifically stomach cancer in the region and began to look into some the newly reported genes that were linked to stomach cancer and these were found to be highly prevalent in the region,” Morgan said. “And one thing lead to another in terms of a focus on what we call cancer control and cancer prevention in the CA-4 region with a focus Western Honduras, and also in Nicaragua and El Salvador, and then with colleagues in Guatemala.”

Cancer control refers to cancer prevention and identifying the major causes of cancer in the region.

“The basis for a lot of work in public health and also cancer prevention is really epidemiology, understanding where the cancer is most prevalent, and what kinds of cancers are important and then behind that understanding the risk factors, be they genes, be they infections, be they diet, or environmental factors that may be contributing to higher risk for cancer,” Morgan said. “And then those serve as attack points for prevention.”

The data collected by these research teams is given to the country’s Ministry of Health or to the Pan-American Health Organization (PAHO). This data allows the countries to make decisions about cancer or disease needs to be prioritized and how to best proceed in managing it.

Apart from data collection, the work performed by Dr. Morgan and other contributors helps to better improve the quality of care of patients living in Guatemala and the CA-4 region.

“What is exciting is that I’d say the research collaborations and working with colleagues on the ground on a daily basis does have a direct effect on the improval of the clinical care for each patient that served in that area each day,” Morgan said. “For instance, through the research and donation sector, we have been able to provide equipment for clinical care and a variety of related programs that help the rural public patient populations on a daily basis.”

In addition to Dr. Morgan and other faculty, Vanderbilt students also participate in contributing to the overall mission of the various projects occurring in the CA-4 region.

“We have quite a few students in medicine and public health and hopefully soon in the nursing school that do clinical rotations in the clinics and hospitals with local patient populations in Guatemala, Honduras and Nicaragua,” Morgan said. “We also have quite a few students who work on an individual basis both with faculty up here and also collaborators on the ground, either doing research projects, or in the case of M.D./PH.D. students, doing their practicums for three to four months on the ground.”

The Vanderbilt faculty and students that work in Guatemala also collaborate with various professionals in the region.

“The teams on the ground are from a variety of backgrounds in healthcare… most of the individuals are doctors and surgeons, pathologists, microbiologists, epidemiologists and nutritionists,” Morgan said. “So really a multidisciplinary group that have trained usually in the region, but very often with advanced training elsewhere, be it in the US or Europe or elsewhere in Latin America.”

Primeros Pasos Clinic

In the city of Quetzaltenango, within the department of Quetzaltenango where Fischer and Victor conducted their research, is the Primeros Pasos Clinic, founded by Vanderbilt alumnus Brent Savoie. The clinic began when Savoie was conducting research on pediatric parasites in the local school system. As he and his colleagues ran the study, they had to hire a doctor and fix the equipment in a clinic that had been closed during the civil war.

“Before we knew it, we had sort of re-opened the clinic just to run this study, and it was pretty cheap,” Savoie said, “And so there’s this one point, this was because I was young and naive, I wrote out a budget and I was like ‘We can totally do this. We can keep this going.’”

Savoie’s role in the connection between Vanderbilt and Guatemala began years before starting Primeros Pasos. He completed his undergraduate degree at Vanderbilt, majoring in English, before attending the School of Medicine. Savoie also conducted medical research in South Africa and Tanzania, and completed his law degree at the University of Virginia in between his pre-clinical and clinical years of medical school. His legal research focused on the impact of the Central America Free Trade Agreement on pharmaceutical pricing and availability of medicine in Central America.

That was the motivation for keeping it going – building a solution to the problem that we had quantified.

Savoie moved to Guatemala to learn Spanish and to study pediatric parasites. He became friends with a group of medical students who were supposed to complete a rotation at a medical clinic that had been closed during the civil war, which had heavily impacted much of the health infrastructure in rural Guatemala.

Savoie and his colleagues re-opened the clinic, but Savoie was motivated to keep it running beyond the course of his pediatric research.

“There are a lot of studies that are just quantifying degrees of badness without necessarily proposing or executing a solution,” Savoie said. “So that was the motivation for keeping it going – building a solution to the problem that we had quantified.”

Primeros Pasos initially offered pediatric wellness checks, which are uncommon in Guatemala, but has expanded to treat adult patients as well. The clinic is unique for its dual focus on health and education, whether that is in the clinic, in schools or in working with women’s groups.

“Whenever we have some structured program bringing patients in, there always has to be an educational component,” Savoie said.

Savoie is currently an Assistant Professor in Clinical Radiology and Radiological Sciences at the Vanderbilt University Medical Center and is less involved in the day-to-day operations of Primeros Pasos. He still visits the clinic several times per year and is involved in budget review and fundraising.

“I’ve always wanted the organization to be run locally,” Savoie said. “I can provide support when it’s helpful, but (running the clinic from the United States) is not a sustainable structure – it’s not really a great way of making sure what you’re doing is informed by the preferences of the people that live there. So there’s a local board of directors, a local director, physician and volunteer coordinator, all on the ground in Guatemala.”

I feel like I won the country lottery, because it’s a place that is endlessly interesting.

When he first moved to Guatemala, Savoie read an article that referenced Arthur Demarest and emailed him. He stopped by Demarest’s house in Guatemala relatively unexpectedly. This was Savoie’s introduction to the world of healthcare in Guatemala.

The more Savoie learns about Guatemala, the more he appreciates the country that he has come to specialize in.

“I feel like I won the country lottery, because it’s a place that is endlessly interesting,” Savoie said. “Just when you think that you’ve got it figured out, there’s always something new. There’s always one more layer to unwrap.”

Nursing School

This spring break, six students in the Vanderbilt School of Nursing will travel to Guatemala to work on a collaborative project with Primeros Pasos. These six students are enrolled in a course called Enhancing Community and Population Health (NURS 5205), taught by Natasha McClure, an Assistant Professor in the School of Nursing. McClure co-coordinates community health nursing within the pre-specialty program at Vanderbilt and focuses on project-based learning, partnering with local or global agencies to do work that organizations wouldn’t typically have the capacity to do. This year, her goal to engage students in projects in Central America has come to fruition.

“It’s a clinical course, so students have clinical hours. So they have 70 hours of time that they’re going to spend implementing the project,” McClure said.

Leading up to spring break, McClure, her students and other School of Nursing faculty are working to assess the needs of the clinic through conversations with Savoie, the clinic founder, and the staff in Guatemala. This needs assessment, according to McClure, drives the work they will do in March.

“Really it’s driven by the organization. We try to plug in projects that they want but don’t have people or resources to do.”

Through an initial assessment in the fall, McClure and her students were able to establish their goals for the project and began to prepare for the trip accordingly.

“They asked if we could help with their transition in their care model. Previously, they were a brick and mortar healthcare organization,” McClure said. “They had some mobile services, but now they’re shifting to a primarily mobile care delivery model, and so they’re going through a pretty significant transition. The nursing students are working with them to analyze and determine some health indicators they might want to measure to help reframe the model and also to incorporate quality improvement as part of their new model.”

In the months leading up to the trip, McClure’s students are gathering as much information as they can through workshops and Q&As with the Guatemalan clinic staff. Additionally, they are working with local experts who have experience in healthcare modelling.

“Fortunately under the School of Nursing we have a lot of expertise,” McClure said. “Our Senior Associate Dean for Clinic and Community Partnerships was formerly the Chief Nursing Officer at VUMC, and so she has been really helpful in helping us look at the finance pieces of the overall delivery model, and identifying some indicators that the clinic may want to consider.”

When they arrive in Guatemala, students will observe the clinic and make recommendations to help the staff implement the mobile care delivery model.

“We’ll work them through the process from beginning to end to help set up their new model and then help them figure out what the next steps are and what their needs are for implementation,” said McClure.

Latin American Public Opinion Project

An important part of Vanderbilt’s work in Latin America is the Latin American Public Opinion Project. LAPOP conducts survey research in the Americas, including the AmericasBarometer, a survey on political opinions with respect to democracy that is conducted in two-year cycles in over 30 countries.

LAPOP was founded in 2004, but its founder, Vanderbilt Centennial Professor Mitchell Seligson, has been collecting survey data in Guatemala and other Central American countries since the 1990s.

Data from the 2016/2017 AmericasBarometer reports published by LAPOP show a decrease in support of democracy in Guatemala, a commonality of the region, and higher perceptions of corruption in the country. LAPOP Associate Director and Associate Professor of Political Science Noam Lupu says that these trends are likely due to recent high-profile corruption cases in Guatemala.

Lupu described how LAPOP data is used in Guatemala.

“American major newspapers do their own polling and you can sort of believe most of what they produce, but newspapers in Guatemala don’t have the resources to do that.” Lupu said. “Our data set is pretty unique for them because it’s not… generated by some campaign or something like that. So the press picks up a lot on the hard findings.”

Lupu has researched the effects of violence, particularly Guatemala’s civil war, on political attitudes and opinions across generations. His research focused on the Ixil Maya of Guatemala, who were particularly targeted by genocidal violence. Lupu found that the children of people who experienced violence were affected by their parents’ experiences.

“In general, and this is just in Guatemala but in a couple of other cases I’ve done similar work in, Crimea and Cambodia… in general group identity becomes much more important to people, and people become much more attached to their group,” Lupu said. “In the Guatemalan case it’s a sort of ethnic identity. And (they become) much more hostile towards outgroups.”

Lupu’s research also revealed that those whose parents suffered violence are more accepting of violence.

As he completed this research, Lupu sent a graduate student to Guatemala to conduct research for him. LAPOP often sends graduate students to the countries that they collect survey data in to train and survey local interviewers.

“That’s one way that I think we see as our mission to sort of build local capacity in doing the kind of research that we do,” Lupu said. “We do that in Guatemala, and I think we’ve done that pretty successfully.”

Combating Malnutrition: Mani+

Another vestige of Guatemala’s civil war is a problem of severe malnutrition, particularly among children. To combat this problem, Ted Fischer and other Vanderbilt faculty started Nutriplus, a social enterprise that produces a supplement called Mani+.

Mani+ is a type of fortified peanut butter that contains many essential nutrients.

“Peanut butter turns out to be the perfect vehicle for micronutrients,” Fischer said. “It coats the micronutrients and protects them. It lasts a really long time.”

People from across Vanderbilt’s campus were involved in the development of Mani+, including undergraduates conducting initial research, faculty from Peabody College involved in the educational aspect of the company, and faculty from the nursing school assisting with the nutrient makeup of the supplement. Teams from the Vanderbilt Owen School of Management developed the business model for Mani+.

“I’m really proud of it because of how many people from different units on campus have been involved,” Fischer said. “It’s been really beautiful to see all these different corners of campus come together.”

Miguel Cuj is a Kaqchikel Maya who is completing his masters degree in Latin American Studies at Vanderbilt. He was involved in the initial development of Mani+.

I think Vanderbilt allowed me to learn more about my country in a socio-cultural context.

Cuj studied nutrition issues and food science as an undergraduate student. He was initially interested in food access in Guatemala because he saw firsthand how the Guatemalan civil war affected the rural Maya population’s access to food.

“A lot of people focus on the social and political issues after the armed conflict, but we don’t think about the food and nutrition issues,” Cuj said. “That had a lot of impact for these rural population in general, more than all the civil issues.”

Cuj and Fischer met in Guatemala seven years ago, and Cuj developed the formula for Mani+ as head nutritionist. He is currently less involved with the Mani+ project than he initially was as he pursues his masters degree, but Cuj is still interested in the topics that first motivated him to join the project.

“My thesis now is about the legacy of the war and nutrition issues in Guatemala,” Cuj said. “I think Vanderbilt allowed me to learn more about my country in a socio-cultural context. I really appreciate that Vanderbilt allowed me to focus on something that I am really interested in with food and nutrition issues.”

As an undergraduate at Vanderbilt, Ben Kessler studied economics and was interested in working with social enterprises. He met with Fischer and other professors to talk about his options, and was eventually hired onto the Mani+ program.

The Mani+ project has recently encountered problems with production, licensing, and getting the mix to create the supplement. The project ran out of funds and stopped production in 2017. Kessler and his partner are working as co-executive directors to re-start the project. They are currently doing intensive research on nutrition and other aspects of the company to revamp Mani+.

“We’re trying to make this version of Mani+ the best that it can be,” Kessler said.

Kessler has enjoyed the opportunity to live and work in Guatemala.

“I think it’s a really underrated company to both live in and visit,” Kessler said. “It’s a country with a ton of potential.”

Training the next generation

Many archaeologists and academics in Guatemala studied at Vanderbilt. Vanderbilt also works closely with Universidad del Valle de Guatemala, a university in Guatemala City that Demarest referred to as “the Vanderbilt of the South”.

“So many of the top leaders in Guatemala are Vanderbilt graduates,” Demarest said. “We’re really invested in this place.”

When you have a concentration of people like this––of people who are looking at all of these different angles in one country––this is going to change Guatemala.