Our Program


  • To explore efforts to achieve social and occupational justice in Guatemala, a country with a history of ethnic and class violence
  • To explore the concept of “occupational justice” as an emerging practice area in occupational therapy and applied anthropology, focusing on occupational capacities
  • To examine health disparities in Guatemala through applied medical anthropology theory and human rights discourse
  • To understand the determinants of health and basic epidemiology in developing nations
  • To provide a transdisciplinary fieldwork opportunity to students of occupational therapy, anthropology, and related subjects
  • To promote social justice through partnerships in and around Antigua, Guatemala with NGOs, community groups, health care workers, and other social change agents


Our program balances academic engagement with critical scholarship on key topics relating to social and occupational justice with applied research and practice and the study of Spanish. 

Students study Spanish one-on-one with individual instructors at their own level and pace for a minimum of 9 hours per week.  In the case of students who are assessed as fluent Spanish speakers, alternate programming in Mayan languages will be made available.  Living in a home stay increases language fluency and understanding of Guatemalan culture.  Both the student home stays and Spanish instruction are organized through our partner Tecun Uman Spanish School (http://www.tecunuman.centramerica.com/main.htm).

Students participate in weekly seminars on topics that will provide important contextual information and theoretical perspectives through which we can query the current status and potential for advancement of social and occupational justice in Guatemala.  These seminars will include lectures presented by field school faculty, discussion of academic literature, and first-hand engagement with Guatemalan films and case studies.  Students will be asked to read one or more academic articles prior to seminar sessions.  Field school students will also have the opportunity for weekly interactions with Guatemalan scholars and policy advocates through guest speakers, who will be drawn from Guatemalan universities, human rights organizations, and international NGOs and governmental agencies.

Through the Project Groups, students will engage first-hand with research and practice in the promotion of social and occupational justice through working with the field school's partner NGOs and other collaborators.  Each Project Group combines students from both anthropology and occupational therapy backgrounds and will be supervised by field school faculty, providing students the opportunity for individualized mentorship in field methods.  For the 2016 season, the field school will be offering Project Groups in:  1) Health Systems Accountability:  Citizen Participation and the Right to Health
, 2) Midwifery:  Cultural Complexities and Health Care Accessibility
, and 3) Pediatric Practice:  Interrelationships of Play, Nutrition, and Early Child Development (see project descriptions below). 

Sample Topics for Lecture & Discussion Seminars

Seminars include lecture and discussion emphasizing our focus on social and occupational justice:

  1. Orientation:  What is Occupational Science and Occupational Therapy? What is Applied Medical Anthropology?
  2. Overview of Guatemalan History and Culture; The Guatemalan Health System
  3. Globalization, Ethnomedical Systems, and Treatment Evaluation
  4. Political Economy of Infectious Disease and Undernutrition
  5. Occupational Capacity and Ethnic Inequality
  6. Development, Gender, and The Politics of Reproduction
  7. Justice and Governance
  8. Health as a Human Right

Typical Weekly Schedule








1-hr. Check-in


Group Projects  

Group Projects


Field visits and Group Projects


Spanish (3-4 hrs.)

Spanish (3-4 hrs.)

Guest lecture

Spanish (3-4 hrs.)


Project Group Descriptions 

Health system accountability: Citizen Participation and the right to health in rural Guatemala

Faculty: Alison Hernandez, PhD, MPH, BSN

Project Objectives

  • To understand the role of citizen participation and social accountability in promoting the right to health in rural Guatemala
  • To investigate the role of NGOs in health system accountability and health policy advocacy
  • To examine evidence of health system failures generated by citizen vigilance teams and accountability mechanisms employed to advance social change
  • To explore the life stories of community leaders and their actions to promote the right to health through ethnographic interviews
  • To examine local understandings of citizen participation and identify key perspectives and experiences underpinning leadership for the right to health
  • To develop short films capturing the life stories of community leaders employing analyzed data from interview recordings and photographs from their communities
  • To position health service delivery within human rights and social and occupational justice frameworks

In Guatemala, as in many low and middle income countries, the full enjoyment of the right to health is inhibited by deficiencies in the health system, including inadequate infrastructure, human resources shortages, and lack of medicines and equipment.  Strengthening citizen-driven accountability processes is a critical strategy for making states respond to their obligations and addressing democratic deficits in contexts of deep-rooted inequality and marginalization. Since 2006, Center for the Study of Equity and Governance in Health Systems (CEGSS, http://cegss.org.gt/index.php/en) has been working with rural indigenous communities to operationalize the country’s legal framework for participation as a mechanism for making the health system respond to their needs. CEGSS has supported communities in over 30 municipalities to implement a system of citizen vigilance of health services through capacity building in human rights, the country’s legal framework and health advocacy, as well as data collection techniques that would allow them to present reports to local health and municipal authorities regarding the state of the healthcare they received.  Community leaders involved in the citizen vigilance teams have managed to influence the improvement of public health services at local level and the allocation of resources.  However, the most important achievement has been the political empowerment of community leaders from highly marginalized communities to mobilize change through democratic participation. 

The Health System Accountability group will partner with CEGSS to explore the life stories of community leaders who have been active in the mobilizing their communities for the right to health.   Employing ethnographic interview techniques, students will engage with the community leaders to explore the stories they tell about their lives in order to understand who they are as individuals and as members of communities.  Students will analyze the recorded data by identifying and coding meaning units and developing a framework of themes.  These themes will guide the development of story lines capturing central and defining elements of the community leaders’ lives.  Students will present their findings to the CEGSS field team and will work collaboratively to develop short films relating the community leaders’ life stories drawing from interview clips and visual media from their communities. 

Key competencies to be developed include: an in-depth understanding of social accountability as a strategy for promoting the right to health and democratic participation in health system governance, ethnographic interviewing skills, qualitative data analysis, story line construction, and integration of audio and visual media to create a research product. 

NOTE: Students’ willingness to contribute to the report in the 2-4 weeks following the field school end date of June 24 is requested, in order to complete the writing, editing, and/or posting of the report.

Midwifery:  Cultural Complexities and Health Care Accessibility

Faculty:  Martha Rees, PhD

Project Objectives

  • To respond to local community or organizations’ information needs with respect to midwifery or health
  • To describe and compare the different kinds of training and practice of midwives in Guatemala.
  • To explore the practices of different kinds of midwives.
  • To compare women’s experiences with different kinds of birthing practices (midwives, obstetricians, etc.)
  • To explore different cultural practices and perspectives about birth from women of different generations and origins.
  • To learn about the institutional structures and constraints that midwives and women experience in the birthing process.
  • To describe NGOs and governmental agencies in the birthing institutions, regulation and practice.
  • To explore access to perinatal care within human rights and social justice frameworks

 Project Activities

What are the differences in practices and outcomes of different kinds of midwives? What do women say about their beliefs and experiences giving birth? Studies of birthing show that women who give birth with midwives often report and experience (in terms of quality measures) better health and social outcomes than do those who give birth in hospitals with obstetricians. Aside from the cost and unnecessary practices (such as caesarians), women may report less pain, more autonomy and control. This project takes a rights-based approach to birthing.

The percentage of women giving birth in health facilities has increased over the period from 1998-2009, as well as the percentage of births by C-section, although the rate of home births remains at almost half of all births, however this varies widely by region and social class [http://www.who.int/maternal_child_adolescent/epidemiology/profiles/maternal/gtm.pdf]. Kinds of midwives vary, from those trained by older women, to those who study two-year programs, to university and post-graduate trained nurses. This project compares different kinds of midwives in terms of their actual activities (using a task analysis methodology), interviews with them about their training and practice, interviews with the institutional structure they are inserted in, and interviews with patients. Interview data will be analyzed. Products include a description of the cultural, social and work environments of midwives.

This project will be developed in collaboration with local Guatemalan NGOs and health services, and it builds on evaluation of midwife training and practice in Mexico.

Students will develop and implement semi-structured in-depth interviews with midwives, women and institutional representatives, in order to map the variety of practices and beliefs with respect to birthing and midwifery, taking into account the cultural and socio-economic diversity of Guatemala.  Students will gain experience in analyzing interview data, as well as in compiling and analyzing official data. The research findings will be shared with participating NGOs and other stakeholders.

Key competencies gained will include: mapping of midwifery beliefs and practices in Guatemala; understanding of the roles of different stakeholders, NGOs, medical institutions, and women in the context of the social, economic, legal and political systems operating in Guatemala today; qualitative and quantitative methods, data coding and analysis, including visual anthropology methods; report writing; and community collaboration.

NOTE: Students’ willingness to contribute to the report in the 2-4 weeks following the field school end date of June 24 is requested, in order to complete the writing, editing, and/or posting of the report.

Pediatric Practice: PLAY as a Therapeutic Practice for Undernutrition, Feeding, and Development

Faculty:  Juliana Gutiérrez, MA, OTR/L

Project Objectives

  • To understand the effects of play within the context of an inpatient infant nutrition unit in Guatemala
  • To identify the therapeutic characteristics and practices of play in relationship to feeding, health, and early childhood development.
  • To understand the relationship between nutrition and early childhood developmental trajectories and occupational capacity.
  • To recognize the importance of play as part of children’s occupation and its impact on health and development

·         To explore play activities within the context of Guatemala’s culture and within the Hospital Obras Sociales

  • To gain insight into issues of nutritional deficits as determinants of health and early child development in Guatemala
  • To engage with Guatemalan community members and professionals to extend the student’s understanding of attitudes and practices regarding  feeding, nutrition and developmental milestones 
  • To explore the relationship between occupational capacity and social and occupational justice

Project Activities

Approximately 45% of all children in Guatemala experience chronic undernutrition, which is one of the highest rates in the Western Hemisphere. Undernutrition has a profound impact on early childhood developmental trajectories. Through direct hands-on experience on an in-patient infant nutrition unit, the Pediatric Practice group will focus on the social, political, and economic determinants of child development in Guatemala and the impacts of chronic undernutrition on childhood occupational capacities. The group will specifically consider the clinical outcomes and social implications of local infant and child feeding practices and norms of development, including expectations for play.  

The Pediatric Nutrition group will gain hands-on experience on an infant nutrition unit at Obras Sociales Hermano Pedro, a Catholic charity hospital located in Antigua, Guatemala, serving low-income families throughout the country. The infant nutrition unit is a restricted-entry in-patient medical unit with 25-30 beds, served by a specialized team of nurses, nutritionists, and volunteers. The unit is populated by infants with cleft palate awaiting surgical reconstruction; severely malnourished infants presenting with failure to thrive; and infants and children with neurodevelopmental disabilities requiring special feeding.

Students will be introduced to occupational therapy pediatric practice using developmentally-based and sensory-motor approaches in order to understand the developmental trajectories of children experiencing severe undernutrition.  Observational methods and chart reviews will be used for assessing nutritional and occupational status, and students will experience a variety of feeding techniques and therapeutic approaches based on play and sensory motor intervention strategies. Students will be guided in how to observe and understand the cultural dimensions of early childhood development and explore them in light of the social determinants of health.  The group will develop case study analyses of developmental trajectories of children on the clinical unit, describing in detail the feeding and handling techniques implemented by clinical staff and students.  These techniques will be further analyzed in comparison to the infant feeding and play practices and beliefs found within the local community, which will be elicited through informal engagement with the community and qualitative research methods.

Key competencies gained will include:  in-depth understanding of the physiological outcomes of poor infant and child nutrition and impacts on occupation and neurodevelopment; knowledge of feeding and swallowing techniques, sensory-motor and play strategies; ability to use growth parameters/measurements to understand the impact of nutrition on physical development and to compare nutritional status across populations; and qualitative research methods and analysis, including case study methodology.