A Rebirth in Guatemala : As War Subsides, U.S. Doctor’s Unique Rural Health Program Finds New Life

The story of Dr. Carroll Behrhorst in Guatemala, an uncommon tale of altruism and dedication, could have come to an end four years ago.

A war between Marxist-led guerrillas and the Guatemalan army was raging through the country’s picturesque and impoverished highlands in 1981. The killing had disrupted the health and development program that Behrhorst had labored two decades to build.

“When there was death and destruction all around--it was really terrible--we had to make a decision whether to continue,” Behrhorst recalled. “We decided that the work should continue.”

Behrhorst, a pudgy physician from Kansas with a ruddy face and bright blue eyes, stayed in Chimaltenango. He did what he could to keep his program alive, but most of it was paralyzed by the war.

“We lost four years,” he said.

But now, the army has dominated the guerrillas and the war has subsided in most areas. And Behrhorst, 63, is helping to organize a new network of community improvement projects aimed at overcoming widespread sickness and misery among rural Indians.

“It will really be a rebirth,” he said on a recent afternoon at his Chimaltenango clinic, where he was treating Indian patients.

Behrhorst, however, will take a much less active role in the “rebirth,” shifting most responsibilities to Guatemalans he has groomed to carry on the work.

So the story of Dr. Carroll Behrhorst has come to a major turning point.

“It’s time for me to to be moving on to other activities, like teaching,” he said.

Soon after he was interviewed here, Behrhorst moved to New Orleans, where he will teach public health at Tulane University. He said he will come back to Guatemala for three or four days a month and during summers, but “the majority of my time in the future will be spent in teaching.”

Behrhorst taught a course at Tulane last fall, and most of his students were from developing countries. Through such students, he said, his work will have far wider impact than if he stayed in Guatemala.

It already has had considerable international impact.

“The Chimaltenango development program has become world-famous for its innovative approach to rural health care,” said a 1984 issue of World Health Forum, a journal published by the United Nations’ World Health Organization.

Behrhorst believes that in poor, backward areas such as the Guatemalan highlands, sickness can best be conquered by attacking its main causes: the malnutrition, poor sanitation and ignorance of extreme poverty.

Thus his program has included not only a clinic and hospital in this provincial capital, but a network of village-based “health promoters,” nutrition and hygiene classes, potable water and latrine-building projects, agricultural extension work and revolving loan funds to help peasants buy fertilizer, seed and even land.

Behrhorst came to Guatemala in 1959, leaving behind a medical practice in Winfield, Kan.

“I came for Albert Schweitzerian reasons,” he said. “I wanted to use my skills where there was a high need. I felt that here I would have more sense of fulfillment, more sense of achievement than I would have in the United States. And that has been a fact.”

But Behrhorst bridles at any other comparison between himself and Schweitzer, the medical missionary of African fame. Schweitzer “didn’t accept the Africans as equals,” Behrhorst said. “He was very condescending and he created a tremendous dependency of the Africans on him, when you should do the opposite.”

Accumulation of money is a low priority for Behrhorst, but he does not believe it necessary to be missionary-poor. The privately endowed Behrhorst Clinic Foundation in New York City provides him with a salary of $30,000 a year.

He, his Kakchiquel Indian wife and their four children live in a comfortable house outside the town of Chimaltenango.

Middle-Class Life Style

“Our life-style is the average middle-class life style here in Guatemala,” he said. “I mean, we don’t live in a hut and bake tortillas on a floor stove.”

Behrhorst started his work in Guatemala as a Lutheran medical missionary. In 1962, the Lutheran missionary service stationed him in this market town and administrative center about 35 miles west of Guatemala City.

He soon resigned from his mission because of policy differences with the church, he said, but he stayed in the town and established a small, nonprofit clinic.

The clinic expanded, and a hospital was built. Then Behrhorst began training residents of outlying villages as “health promoters,” teaching them how to diagnose the most common illnesses and prescribe simple medicines.

Promoters charged their patients small fees--usually 25 cents or 50 cents--and sold medicines at cut-rate prices. They received no pay from the parent organization in Chimaltenango.

But treating illness was only part of their work.

‘Community Catalysts’

“Our promoters are community catalysts,” wrote Behrhorst in a description of his program. “They work in many spheres other than curative medicine. Vaccinations, tuberculosis control and treatment, water projects, literacy programs, family planning, agricultural extension, the introduction of fertilizers, new crops and better seeds, chicken-raising projects, improving animal husbandry--all are part of the promoters’ work and responsibility.”

The health promoter system became a model for rural development programs in many underdeveloped countries.

But then came the war.

Behrhorst said most of the 75 promoters who were working in Chimaltenango and neighboring Quiche provinces in 1980 were killed. The system has been inactive since the end of that year.

“We have been reluctant to reactivate this sector because the mortality rate was so high that we don’t want to be training people to be killed,” he said. When health promoters were working in the field in 1980, he said, “security forces would arrive and they would see that you had medicine, and they would feel absolutely sure that you were supporting the guerrillas.”

Behrhorst’s organization--a foundation financed by international contributions--continued to operate its clinic and hospital and to help villages with water projects.

21 Projects Completed

Twenty-one such projects were built from 1976 through 1983, providing clean drinking water for more than 11,000 villagers.

In the Guatemalan highlands, the main cause of child death is dehydration from diarrhea, and “that comes from dirty water,” Behrhorst said. In some areas lacking clean water, he said, more than half of all children die before they are 5 years old.

The reactivation of Behrhorst’s program in Guatemala will begin with 21 new water projects. He said $609,000 for the projects will come from the U.S.-sponsored Inter-American Development Foundation and $180,000 from the Inter-American Development Bank.

The villagers will provide all the labor and many of the materials used in the projects. The water projects will serve as a vehicle for starting other projects in the same communities, Behrhorst said.

“Once you have the people’s confidence and they are well organized, through the introduction of water, you can meet all sorts of other needs,” he said. New community health promoters will be trained to help meet those needs.

“I think there is a general sense of security, and since the guerrilla movement was crushed, we can go ahead with planning and get back to work,” he said.