Berkley Center

Background: Dee Smith has spent the past 25 years in Guatemala, working with people living with HIV/AIDS and other vulnerable groups. She lives close to the border with Mexico and thus is a witness to caravans of migrants from the Northern Triangle countries moving northwards, towards the United States. She and Katherine Marshall spoke in Annecy, France, on the margins of a Forum on faith and health. Their discussion explored Dee’s work in Central America and Africa and returns repeatedly to her caring for the most vulnerable and how that translates into both approach and action.

How did you come to where you are now? What is your story?

My journey is quite unexpected in various ways. I was born in the North of England to a working-class family. My mother was of Irish descent. She was one of 11 children. We were brought up in poverty. My mother had to start working at 15 and my father left school at 12. They were typical northern English parents who wanted to work all the hours God gave them, so that their children could have an education.

Thus I was brought up from the very beginning with an understanding, as an uncontestable fact, that to get anything in life, you have to work, but you also must be appreciative of everything you have in life, because some people didn't have anything. I grew up, also, with a social conscience, coming especially from my father. He was what we call a work steward, in charge of an area of the union, and I grew up with the whole labor understanding and imbibed the labor philosophy of equality, just wages, and social justice for everybody. So I suppose, in a way, that's how it all started.

Were both of your parents Catholic?

No. My father was from a Methodist family. At that time, as elsewhere, the rule was that even if one of a couple is not Catholic, you have your children brought up in the Catholic faith. My mom came from an Irish background, and that's where the Catholicism came into our family. That was the case for many people in the north of England. So, my Dad converted.

Right from an early age, 11 years old, I was mixed in with people of other faiths. I went to a public grammar school. There were three schools in my area: the Holy Cross Convent, the De La Salle boys’ school, and the mixed, non-denominational school. You took an exam and wherever you came on the 11+ that's the school you were offered. Or if you didn't pass your exam, you went to what we call secondary modern schools. At the Derby grammar school, my friends were Jewish and Mormon, Seventh-day Adventists, and Jehovah's Witnesses. There were three Catholics in the whole school and we would have extra lessons in the evening to prepare for confirmation.
When we were 15, a series of people came to give us talks at the school. A priest came and talked about volunteering in Africa. That sounds so exciting, I thought. Oh, to go to Africa! My father used to tell us stories about when he was in the Navy, and he would go off to the South China Seas. He was a signalman on a ship responsible for taking prisoners of war back to their own countries from Japan, thus the Japan to Australia run. In the evenings, we didn't watch TV and we would sit round the fire and he'd say, "So we were on the ship for three days and the wind was howling…” And he'd start his storytelling. I was fascinated by this idea of travel. 

So the idea was planted when I was 15 of going to Africa and teaching. When I was 17 I went to a career convention in London. Edwina Gateley had a stall there, for the Volunteer Missionary Movement. She does absolutely marvelous writing, and gives retreats, based in the US. I wrote to her and said, “I want to be a volunteer missionary in Africa.” And she wrote back and said, “Well that's wonderful, you're only 17, you need a career. And then come back to me.” So off I went to St. Mary's University, Strawberry Hill at 18 to become a teacher. 

At 21 I wrote back to her and said, “I'm a teacher now; can I come to Africa?” She invited me to an interview, then the induction, and preparation course to go to Africa. I was assigned to Uganda, but it was the time of Idi Amin, and he'd just thrown out all the Ugandan Asians and the situation was quite volatile. Edwina said, “It seems highly unlikely that anybody's going to get a visa to go to Uganda any time soon. We've just received a request for Kenya. Would you be willing to go?" I said, "Sure, just get me out there. What I want to do is teach in Africa." These were two-year commitments, and after two years, I renewed. After four years, I decided I really wanted to stay longer. At that time there was no financial stability or anything in VMM. So I signed on to the Kenya Teaching Board as a locally employed teacher. And I stayed 13 years.

Were you committed to the Maryknoll Sisters yet?

Not yet. That began around 1981. Within the Catholic sphere, as a teacher, it was common to stay with different people and I was staying with some priests. They had a stack of old Time magazines. I was flipping through them and I saw, I think in a February issue, a piece about the four church women murdered in El Salvador. It said they were Maryknoll sisters, and I remember thinking then, back in 1981, when vocation was the furthest thought from my mind, “Gosh if ever I wanted to become a sister, that's the group I would join, because they're willing to die for the cause.” At that time, though, I had a Kenyan boyfriend and I was fine. 

But in 1987, the seeds of a vocation started. A vocation to mission, not a vocation to religious life, a vocation to permanent mission. So I got in touch with the Maryknoll sisters, and began the process, and I joined them in 1990.

How did you get involved with HIV/AIDS?

In my later years in Kenya I was exposed to the growing challenge of HIV/AIDS. I was living and working at the time near the Uganda border, and seeing friends die of HIV. We had no idea what it was at the time: they called it “Slim Disease.” At that time, many of the women sex workers living at the border, would accept to have anal sex so they didn't get pregnant with the truck drivers. Now we can see how the transmission was going, but at the time we had no idea. This is obviously hindsight.

In Ossining, New York, where I started off as a Maryknoll sister, we had to do voluntary work as part of our formation. I was in Newburgh, New York, a crossroads of two communities: Hispanic and African American. There were lots of drugs. They had just started an HIV clinic. Ila Gallegos, a Mexican-American woman, was in charge of this new unit and she knew our Maryknoll sisters from the local church. A colleague said that I was interested in HIV so I was sent to Cicatelli and Associates in New York City to train for HIV prevention, care, and counseling. So off I went.

During that time a sister, Mary Annel (a retired who's now back at the Maryknoll Sisters’ home in Ossining), was doing promotion work in Chicago and she simultaneously started to work in an HIV unit in a hospital as a volunteer. We got together and agreed that Maryknoll needed to start looking at this problem. In 1990 we started, with Scott Harris, a Maryknoll physician, the Maryknoll AIDS Task Force. We realized that many of us were likely to get involved overseas with HIV work, so we needed to educate ourselves and educate our community. While I was there in my orientation and until 1993 I was involved in this clinic and also involved in moving the Maryknoll AIDS task force. We did courses for the sisters, priests, and the brothers around HIV.

At that time a couple of the sisters in Guatemala, who were physicians, were seeing people die of TB. They suspected that it could be HIV related, co-infection. They applied for funds from Misereor to start low cost testing and follow up, though they had little real knowledge about HIV. They asked Maryknoll if I was interested in coming down to Central America; would I consider working with another sister whom I'd known in Kenya? She didn't know very much about HIV, but she was a lab technician and could do the testing. That's how we started off.

When was this program started?

We started in 1994, in Quetzaltenango. I had had six months of Spanish language training in Cochabamba, in Bolivia.

Janet Ikeda, who's back in San Francisco now, had come down to do research on TB co-infection as a Fulbright scholar. She was based at the local TB clinic. She asked me whether I could help with low cost counseling in the TB clinic and hospital. I started to do that in 1994, simultaneously trying to move the parishes on HIV. That was really hard, because many of the priests weren't interested at all, and even the catechists wouldn't help. They said, “Oh we can't be talking about that in the church. Go somewhere else.”

What I noticed was that the majority of the people who were testing positive at our clinic in the highlands, were actually from the coastal region. I felt there was no point in me living there when the problem was at the coast. So I moved there in 1997 with another Maryknoll sister who was a nurse and had just finished her work at the Maryknoll Central Governing Board.

We focused on doing testing. Marlene had worked for many years in Chile, almost as a physician, and she started to attend to the people, but with no antiretrovirals, nothing. But there was almost a profile to the people we were finding who were HIV positive. At that time we didn't identify the issue much with MSM (Men having sex with men), rather, it was the sex workers. I started to go to the bars and talk to the women and offer them testing, and then to link them up with the local health centers. The women needed what they called their health cards every week (a terrible process). But through these routes we started to do a lot of prevention work.

People focused then on the “poor men” who were getting infected by these awful women who are not protecting themselves, and so forth. I was less bothered about the poor men than about the awful women. At the least they should protect themselves. I've never had the severe complex that they shouldn't be in this work, especially because I could never offer them any kind of alternatives that could pay them as much. Listening to their stories, I knew how many of them had children and families to support. Many of them came from El Salvador and Honduras, some from Nicaragua. Because they were ashamed of doing sex work in their own countries, they moved to Guatemala. Moving between the Northern Triangle countries is very easy because there are conventions that allow it. I started working with the women.

That's one of the success stories that I'm proud of. When we began to do testing in 1997, I'd say to 2002, there were always two or three positives, every time, often in the same bar, and we covered a number of bars. Now, it's rare to find a woman who is positive. They look after themselves. And the older ones now bring the younger ones to testing and to be taught how to protect themselves. God bless the women, they take it on board.

But the situation and thus the challenges changed. With antiretrovirals, people were living longer. We started to move more into home visiting and touching more people, apart from the sex workers.

To digress a little. I have seen how the rural men, the campesinos, work so very, very hard on the banana and coffee plantations. The women do as well. They have no self-esteem and they are not recognized. So for a man to feel he's something, he gets his salary, has a couple of beers, and goes with a sex worker. And for the moment he can forget all his problems. Now, I'm not justifying it, but that's what was happening. But these men, in some ways were innocent, innocent in that they had no idea about HIV. They just wanted to forget about all their troubles. They wanted a release. And of course their poor wives were at home looking after the children.

Even now, the majority of people who come to our clinic are campesinos. Men and women, most of them (not all but many) have had only a primary school education and their income isn't very much. They have no idea about HIV until they're positive and that's when their education begins. Especially in our hospice facility, we have received over the years many young people that have gone to the States illegally and have either been deported or got sick and come back. They're too ashamed to go home or they've lost contact with their families, so they come to us. A number have died in our hospice facility and we’ve had to work with the consuls of Honduras and El Salvador to repatriate the bodies of people who have died in our hospice.

My fear now with the migrations is that there are tremendous health implications involved. We have no way of screening these people as they're going up to the States. Many of the young women have already started to take contraceptives because they know they're going to be sexually abused and they don't want to get pregnant. There's no way that they can negotiate, when they're being violated, the use of a condom. The sexual vulnerability of women migrating is something we really have to look at. Those are the kind of people that we focus on.

How long have you worked in Guatemala and where do you see the future there?

I've been there 25 years. I am not of that school that we go in, we do, we set up, and we leave. Because that's not who I am. It takes years to build relationships with confidence and to really look at, and understand another culture. Many Guatemalans are so busy trying to make it themselves that there is little left to allow them to become passionate about another person who's suffering. There are so many other problems and there's still a lot of stigma, discrimination, and abuse. We are coming out of 36 years of civil war, so there are lots and lots of unresolved issues between families. Sometimes the person at the receiving end of the discrimination or violence in the family is the person with HIV, because that's the easiest thing you can insult them with. Even if it's not that, it may be because their grandfather was a Patrullo and was working with the army. But how do you get to those people? You can discriminate against someone with HIV in the family.

I live near San Marcos on the coast. We are very few Maryknolls now from overseas, so we live in ones and twos. I lived with Marlene for 20 years, but she was a lot older than me (she's 88) and needs care, so she's back in Maryknoll now. I received a young sister last December from Tanzania, but because of immigration problems she's had to go back to Tanzania. Tanzania has wonderful relations with China, and Guatemala recognizes Taiwan, so that is a problem. To get a visa, she has to go to Egypt because that's the closest Guatemalan consulate, but to get to Egypt as a Tanzanian, she needs a specific letter of invitation from some organization in Egypt. We in Maryknoll don't know anybody there. The result is that at the moment, I'm alone.

We built a hospice facility and the house for the administrator. At the moment I'm the administrator so I get to live in the house. But it's not my house and it's not a Maryknoll house. We still have an office and an outreach center in Coatepeque, which is where the closest HIV clinic is. That's where we started off. 

You are near the border with Mexico?

By car, we are five minutes from the border, 20 minutes walking. So everything comes past us: all the migration, the commerce, the trail, everything. Though we're off the main road on a hacienda and it is quite rural. We have an organic farm next door to the hospice that we started. We get funding from Misereor. They have been very kind to us over all these years, even as our projects have changed. At first, it was very much about educating the parishes. Then we started the sub commission of HIV out of the Bishops’ Conference. Other people are now able to do education with the parishes throughout the country, so we do less. We focus on empowering people with HIV, especially women, to do their own advocacy for services. And we also monitor the quality of care and attention at the three HIV clinics and government treatment clinics.

Do the government clinics function well?

They do function but local health centers and health posts in Guatemala are desperately underfunded. They call them integrated, and in theory they have doctors, psychologists, and social workers. But the reality is that they all have very few resources. So they refer people to us when they need help. They don’t have organized outreach programs or home visits. The problem we have in Guatemala, as it is in many countries, is that so many resources go into the tertiary level. But HIV can and should be managed well at primary level. People should be able to go to their local health center, if they've just got headaches and diarrhea. But they don't, so they go to the clinic in Coatepeque for diarrhea. And because they've got HIV they have to be seen and treated by the doctor. That puts great pressure on the services. But you can't tell people to go to your local health center when there isn't anything there. There have been a couple of attempts to transform the situation but they did not work, because there isn't government will. Also it's very hard to get funding for primary health care. Donors want to see big results immediately, so they'd much rather do research and investigations in the hospitals whereas really, there is a tremendous amount of work to do at the primary level.

My own understanding of HIV has evolved over the years and the needs and the people have also changed. People live a lot longer, but now we have to look at ways to generate income for them, especially for the poor because there are very few opportunities. And HIV is going off the boil, and so resources are more and more difficult to secure. Guatemala has been receiving very good global funding in public health for 12 years now. Has it been used wisely? Some reservations. But worse, the government does not seem to be putting a sustainability plan in place, for when global funding is phased out, which will happen within the next couple of years. 

Sometimes money is misallocated, which is another cause of frustration. We started what's called the Red Sur Occidente, the south west multi sector network. It has gone on for years and years. We exchange resources and it's probably the only network in the country that's working successfully. We don't need funds for us to meet every month; everybody pays their dollar for their meal. We've achieved a lot with it. But about 10 years ago there was a huge injection of money from USAID and various organizations, to set up networking for people with HIV and providers. That lasted maybe two years and then the funding stopped and the networks stopped.

You are a witness to the migration northwards that is happening today. What can you and others, churches included, do in the face of the tragedies unfolding in that region? 

Two things are driving the tragedy. One is the indifference of the governments and their failure to look at the real needs of the youth of their countries, which are above all, job creation and security. And so people in all three Northern Triangle countries (Honduras, El Salvador, Guatemala), migrate into the big cities: Tegucigalpa, San Pedro Sula, Guatemala City, San Salvador. That puts huge pressure on those infrastructures. Many youths have the vision, or the dream that they're going to get jobs. But there are no jobs available. So the young people are very vulnerable to being inducted into gangs. The whole phenomena of gangs started with deported youth from Los Angeles. Many families and parents now are frightened that their children will be inducted into these gangs, and the life expectancy of a gang member isn't more than 25 years old. So parents are taking their children north, to take them away from all this.

Secondly, fractured families are trying to reunite in the States. Often mothers and children are going up now, because their husbands are in the States working illegally. They’ve been sending money down, back to their homes, and the local extortionists know this. They wait for the money every month. So even from the States the families are suffering extortion. They want to move. There are women who've been victims of terrible domestic violence who are basically running away from their husbands.

What prompted the large caravans of migrants moving north?

For people traveling to the States, the route has been very dangerous. Moving through Mexico has been extremely dangerous because of the Zetas and the other narco groups and because of the abuse of the authorities. When they get to the border, they have to cross the desert and people die. So they're moving together in caravans for safety. But it's also a witness to their own governments, that we are driven to do this now, to leave our country because there's nothing here for us.

The governments essentially do nothing. There is very inadequate investment, economic and infrastructure, in the three countries. The will to prevent young people from going, or to keep families together, is simply lacking.

The immediate need is to look to the well being of these migrants, but in the long term it is to challenge governments and say, “This should not be. People should have enough opportunities in their own countries.” Our role traditionally as church has been to give refuge. That is really important and that's what we're doing. We giving people comfort as they're passing through, providing food and basic hygiene equipment and attending to their medical needs, thus preparing them to carry on. That's not a solution; it’s just a gesture. So we should be questioning, as church, why people are migrating.

As churches we have to advocate more. We have to say, this is a humanitarian crisis. It’s really important that we speak up more. And are more proactive in challenging governments. Pope Francis is good on the topic.

Another witness that we can give is not telling our own stories but theirs. In Guatemala it's hard to find a family that doesn't have somebody in the States. I ask myself, what is the real benefit of living longer as we do today. What's the quality of life? A person who migrates from Central America is not a person who is going to the U.S. to begin a new life. No, they're going to work so they can send money back. They are not interested in becoming Americans. That’s not why they're going. It's not that they admire the U.S.; they see the U.S. as a job opportunity and they're willing to work at any job, any work, for any length of time. Because they have four or five, or even 10 people back in Honduras waiting for that money. That's the nature of the migration. A migrant is a very kind person. Because they're not going just to make their own lives better, far from it. They're going to earn enough to improve the lives of the people.

You said earlier that the first time the caravans moved north people were sympathetic and supportive but as time passes they are less supportive. Why?

The first caravan that formed in October last year, was huge. Some 3,000 people left Honduras and crossed over the Guatemala border. Right from the moment they crossed over there was solidarity. People across Guatemala were aware that their brothers and sisters were having to make this terrible trek. There was a lot of international coverage. The border personnel on the Mexican border had absolutely no idea what to do and as a result people were trapped at the border between Guatemala and Mexico for a number of days. Everybody was out helping them. In February there was another wave and the people didn't respond as much this time. The churches continued to respond, and Pastoral Movilidad Humana, which is the Catholic pastoral for human mobility, was active. When the most recent caravan came, the process at the border had been sped up; people didn't want to stop at the border, they just wanted to keep going. So the opportunities to help people, the window of time to help them, was greatly reduced because they weren't hanging around Guatemala. They are moving, moving, moving. And because they're moving, there isn't the visual impact of 3,000 people stuck on the bridge.

During Holy Week we attended to 1,200 people in three days. But these were people who were scattered around the towns waiting for the border to open. So they passed by for about five or six hours each day on the way up. One of the difficulties for these people, is that there is absolutely no preparation when they leave their own countries. They have no idea what they're going to encounter when they start the journey.

How do you experience the Catholic Church? How divided or united is the response in the face of this crisis?

The parishes at the coast and at the border are very united and our humanitarian response is outstanding. The local parishes are poor: it’s not a rich place where we live. There is solidarity between the poor who offer refuge, places to stay. Many of us, when the caravans were coming through, are out on the road giving rides to people to the border. We fill our pickup truck. Many people were doing that. I would describe it as a tremendous outpouring.

The organized response is through the Pastoral de Movilidad Humana, and it offers counseling services at the border. There is a migrant house, with a lawyer. The parishes constantly take goods to the Casa Migrante for the people. There is another large house Guatemala City. Thus there is an openness and a connection. Pastoral de Movilidad Humana is the organ that's doing the negotiating with the government and it has tremendous backing of the Bishop's Conference.

I have not heard many pronouncements from the Salvadorian or Honduran Bishop's Conferences but the Guatemalan Bishop's Conference is very outspoken. I would say the migrant agenda is very much at the forefront.

How are the evangelical churches responding?

We don't see much direct response of evangelical churches. Some small churches and parishes are involved and the Mormon church has been very good, very kind, doing what they can to get medicines and supplies for the people. There are many Mormon missionaries in the area and they seem to be quite involved in social action. The local evangelical churches, including the big evangelical churches in Guatemala have a reputation for being money spinners.

What about some of the Mayan organizations?

The indigenous movements tend to focus most on work opportunities and labor protection. They stress that people are migrating because we're still a feudal system, where the wealth is in the hands of the few. If we could change that balance, more opportunities would open up for the poor and they wouldn't need to migrate.

What about the gangs, the maras?

I look at all those kids with tattoos in prison and I think what they need most is a little love. They need a big hug and to be told they're worth something. Yes, they've killed and everything and that's not right. I don't believe in the evil of people; I think we're all good underneath it all. But circumstances change things. Many of them are from abandoned families or madres solteras (single mothers). They’ve been unwanted, left on their own. So they join these gangs for a little identity and community. The Catholic Church has some initiatives to work with these youth groups. In my local parish a number of local youth go to Mass on a Sunday and are involved in Pastoral Jovenil. So there is a hope.

You mentioned a story that moved you deeply. What happened?

This happened recently on the bridge that links Guatemala and Mexico. I was talking to a woman from Honduras. She looked tired, so tired. So I put my arm around her and asked, "Are you okay?" And she burst out crying. So I asked her to sit down and brought her a bottle of water. I said, "What's happened? Is it just walking?" And she answered as so many do, making me feel so very humble, "God bless you" and "thank you.” Yet I am doing only a little bit and she’s the one carrying the burden. Anyway, she told me, "I've just left my son under the tree. He's in a wheelchair. He’s 19 and he was born with only half a brain." (I think she meant that he was hydrocephalic or something like that). Then she pointed to two children with her. "This young girl, here, she's 15. Her mother threw her out of the house because she was accusing the stepfather of sexually abusing her and mother didn't believe her. So I've adopted her from the streets. And this little one here, [about six years old, and I'd given him an ice cream] that's my grandson. His mother and father are in the States and I'm trying to reunite them."

And I said, "You mean you're pushing your son?" And she said “Yes. The medicine is so expensive to keep my son alive and I can't afford it. So I'm pushing him to the States so I can get a job and I can look after this young girl and my son can have his medicine.”

I heard that story about three weeks ago, and it never leaves me. I just keep thinking of that woman and wonder, could I push another person from Honduras to the States in a wheelchair? Amazing and tragic. And there are so many other stories. A couple of the women cried with us because our team all volunteered their time in Holy Week. We didn't ask for any money. We really needed a debriefing moment ourselves, to talk about our feelings. It was very healing for us to cry.

If somebody in Trump's administration could just spend a weekend in those camps, they would change their minds. If it doesn't touch you personally, it doesn't affect you too much.

The bridge that connects Guatemala to Mexico put me in mind of Jesus, the way of the Cross and Jesus walking to his Calvary. It’s a resurrection moment. When the women were crying for Jesus and Jesus says, "Weep for yourselves," and for me, I thought, "Yes, we should be weeping for ourselves because how far have we come to let this migration happen? How far have we as humans failed?" The women wept because Jesus was going to the Cross. We are weeping because we are sending the migrants to the Cross. Terrible, terrible, terrible.

Jesus's death did not transform Jesus. Jesus's death and resurrection transformed us. So for me attending the migrants in the greater scheme of things doesn’t really change the migrants, but it transformed me. When you think that handing out toothpaste and toilet paper is received with such gratitude, it brings home the shame and horror of th