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When he was little, he wrote in a poem, he noticed that October was far away. It was his birthday month, and he had a “feeling that my birthday would never come.” When he got older, “it seemed as if they were waiting, one after another, on street corners. I ran so that October wouldn’t catch up with me.” That day, the ambulance picked up its pace, trying to reach another October. It didn’t arrive.
He did not do so because his emergency transport took four hours from the capital to reach Totonicapán and then repeat the same journey to San Juan de Dios General Hospital; he did not arrive because the departmental hospital did not have the medical equipment to treat him; he did not arrive because the health center did not enter him into its system.
After several hours of driving, the ambulance stopped. The final destination was a place that, despite the bright lights of the large sign with its name, had a rather gloomy atmosphere. It was nearly midnight when the stretcher entered San Juan de Dios. The patient was in critical condition, and his last rays of hope were fading…
This is the story of the early hours of January 29, 2019, when the poet Humberto Ak’abal died. But it is also the story of a disconnected public health system.
From birdsong to sunset
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With the exception of high school, Humberto lived in Momostenango, Totonicapán. He grew up in his grandparents’ house, although his parents gradually built their house on the same plot of land. There was a calm there, and nature welcomed anyone who came here. Throughout his life, he pondered everything around him, which was reflected in his admiration for the birds that he captured in his poems. The birds’ songs were truly resonant, as if they were at dawn all day long.
His mother, Doña Esteban de Ak’abal, a 92-year-old woman, found it difficult to say what she wanted to say, but she did not hesitate to share this memory with him. He said that due to his health difficulties as a child, they became very close. That is why Humberto and his wife, Mayuli, decided to build their home next to her.
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Amid the flowers and fountains of the central courtyard, you can see Humberto’s studio on the second floor. “It’s his sanctuary,” his wife comments. Although there’s no room for one more book, the air you breathe is invigorating. The table is almost invisible among so many wooden shelves. Most of the rooms are filled with books, but the one behind his chair houses more than 200 CDs. “He listens to everything,” his wife says, smiling.
The walls are almost invisible, covered with paintings. Some were painted by his wife, some were given to him, and the rest were purchased. Although the wood will darken, the bookcases are no longer obscure because there is a window in front of his desk that overlooks the sacred mountain of Momostenango, Paklom.
Humberto stopped sitting there a few years ago, but everything is intact and it seems that he still spends hours writing on the computer.
He fought off life’s hardships, such as polio as a child, though through his own efforts and those of his mother, he learned to walk, his wife said.
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So, his partner estimated that in his last days, he did feel terrible because he didn’t let the disease take away his daily life, but for this last time, he did decide to do something.
With abdominal pain, she went to see a doctor, but could not find one. Without much choice, he went to a pharmacist friend who prescribed him some medicine. He took the medicine and, as usual, went to his study to prepare a speech to his students.
“He went there despite the pain he was feeling,” he explained.
The discomfort continued and he had to ask his sister Blanca Estela to accompany him to the Momostenango Health Center.
“The system does not input you”
Humberto knocked in vain on the door of a system that had never entered him. At the health center, he could not be treated due to the lack of resources to find out what was causing his severe discomfort.
Gustavo Estrada, an expert from the Institute of Natural Sciences and Technology (Iarna), explains the network system: “It has three levels that should be connected and provide services according to their complexity. The first is the basic level, which they call communities. It is the one that provides the most services, with about 1,200 health posts and the presence of nursing assistants.
Because it is a portal, assistants only need to study for ten months to graduate. Its capabilities are very elementary, like giving vaccines. The service is based on standards that are published regularly. They provide care for pregnant women, newborns, infants, adolescents, adults and the elderly, but if there is no procedure or no prescribed solution, they must refer it to the next level: the health center.
Estrada said this level has medical staff and professional nurses. According to the classification, these centers have laboratories, midwifery resources, 24-hour bed rest, nutrition, psychology and social work services. According to the health department, there are 359 institutions divided into: 186 health centers, 162 permanent care centers (CAP) and 11 integrated maternal and child care centers (CAIMI).
Health Center A or B is open Monday to Friday, 8am to 5pm. They deal with outpatient issues, some emergencies and do digital work. There are no appointments, but they give you a phone number when you arrive. CAP is open 24 hours a day, deals with obstetric emergencies, mainly childbirth, and has the ability to keep someone in bed 24 hours a day; if that can’t be solved, they should be sent to the hospital.
Humberto arrived at the Momostenango Health Center. They examined him, but due to a lack of supplies, they told him it would be better to go to the Totonicapán Provincial Hospital.
The Iarna researcher explains that at the first contact of a patient with any service, data and description of symptoms are entered manually. If they cannot be treated there, a referral note is written and given to the patient, and they must be transferred to the next level of care. “An ancient mechanism is used for transfers: the reference note,” he adds.
They also gave Humberto a referral so he could get to a local hospital on his own.
Hospitals are the tertiary level of care. The ministry has registered 46 of them. They are divided into regions, departments, regions and countries and provide both specialized and sub-specialized services. The people in the departments take care of the most basic things. Then, the regional institutions provide sub-specialized services.
Humberto had problems with his intestines and doctors had to operate on him at the hospital, but they needed to check beforehand and the hospital didn’t have the equipment.
Mayuli found a lack of agility and resources. “My sister-in-law has to walk to the other side of town for the test so they can do a blood test,” he decried. Once again, the artist had to do what he could to find a solution.
Medical staff also experience the consequences of a disconnected system. Napoleón Méndez, director of adult emergency surgery at San Juan de Dios, recognizes that this makes treatment difficult.
«It is necessary to have electronic records that are traceable and thus avoid duplication of work. Investments must be made in technology, but we are still struggling for basic medicines. ” exclaims Mendes, who remembers that thanks to all the efforts made, many lives have been saved.
Surgery will only prolong his suffering.
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Hoping to find a solution, Humberto walked through the hospital gates amid a crowd of more than a hundred people waiting to see their loved ones. After the surgery, he was taken to recover in a small hallway where three other patients were staying. His wife reported that he was not observed for the next few hours due to lack of staff. “Only the practitioner felt his pulse,” he continued.
She barely spent the night in the care of her friends because they took her sister out because the areas were divided by gender. It all started with a fever. Mayuli added that her husband is very spiritual and believes in omens. Humberto shared that that night he seemed to see many people dressed in black in his dreams. The friend asked if it was a dream and he responded, “No, I’m not dreaming, it’s something I saw.”
“It was like he felt his own mortality,” Mayuli said.
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In the morning, the doctor came and he was worried. Her patient needed antibiotics because she had an infection and the hospital didn’t have them, so her sister had to go get them. They were out of work and the doctor had no other options and asked to be transferred to the capital.
Find an ambulance
Humberto needed an ambulance, and the hospital only had cars, not enough equipment. They suggested her sister go to the town’s social worker, but she couldn’t find her. In desperation, Humberto’s sisters who lived in the capital took the unit on their own.
An ambulance from the capital to Totonicapán waited four hours, and so began their four-hour journey back to the city.
Estrada, who is from Ilna, explained that the country has no emergency transportation system. Each hospital has its own ambulance, but it is not integrated into the system. Even the Roosevelt and San Juan de Dios lack them.
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Mayuli shared the details, but he was working in Switzerland at the time. Accompanying him at every moment was his sister Blanca Estela, who did not want to relive those difficult moments.
So, on the way to the hospital, Mayulí and her son Nakil tried to communicate with Humberto, but the doctors were reluctant. “Maybe there was a lack of psychological preparation, but the argument is that this could cause great emotions and he could die. “He no longer hears his son’s voice, we can’t talk to him, it’s not very human,” lamented the poet’s partner.
So they chose to write him a short message and read it to him in the ambulance. As always, the words my son wrote moved him and made him shed a few tears. I almost lost consciousness.
“The letter was full of love and gratitude, like he realized his father might not be alive anymore,” his wife recalled.
Humberto reached his final destination, his final destination.
The stretcher entered the emergency room through long, narrow hallways. Those hallways held stretchers for other patients waiting to be examined. Those hallways that were meant to hold Humberto so that he would get better. Those hallways that had seen him walk into them alive, walk through them as his breathing faded. Those hallways that were used to people dying.
“When he entered San Juan de Dios, he stopped breathing,” his wife lamented.
Aware of the tragedy, authorities at the capital’s other main hospital, Roosevelt Hospital, and members of a human rights law firm made a proposal to the Ministry of Health this year to establish a medical emergency system called “Humberto Ak’abal.”
Another victim of the system
Akabar loved his country and his people so much that he dedicated his life to writing poetry about them. He experienced what it was like to be a child, a Quiche Maya, a father, a husband, a Momostec, proud, sad, happy, far and near from his home.
People felt represented by what he wrote and he felt identified with the people, which is why he wrote:
When I was born
I shed two tears
In the eyes
So I can see
How much my people have suffered.
Despite his recognition in several countries, he died like so many of his compatriots: a victim of a system that stole his time because… everything was far away from him.
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