Victor Alfonso Gómez flashes a quick smile, and his eyes brighten as he recalls the kick-off of his health career, which grew out of necessity and camaraderie after a 1983 clash with Government forces left four of his five guerrilla companions wounded in the Guatemalan highlands.

"All I knew then was to wash the wounds. That's what I did. And slowly they got better," Gómez said in an interview only eight months after the Guatemalan Government and the rebels from the Guatemalan National Revolutionary Unity signed an agreement on 29 December 1996 to end their 36-year war. "Maybe it was just God's will. I never, ever thought about being a health worker."

Opportunity, good fortune, and a strong social commitment led Gómez, 40, to formalize the medical tactics he learned on the battlefield, enabling him to be working with--rather than fighting against--the Government. He recently completed a program that gave him certification as a physician's assistant. His training was a direct result of the health agreements included in the final peace treaty, and recently he was working at a Government-run shelter in rural Quiché providing health care.

The treaty, called the Firm and Lasting Peace Agreement, put an end to Central America's longest war, which claimed 140,000 lives, mostly among the indigenous Mayans of Guatemala. The signing ceremony came just two days before the 1997 new year, and tens of thousands of Guatemalans, dignitaries from the Americas, Europe, and many other parts of the world gathered in Guatemala City to mark the historic event. The event blended men and women wearing traditional brightly embroidered and woven fabrics, dark suits, and uniforms, and military music and marimba bands. The message was clear: we can't forget the past, but we celebrate the future.

A Decade Of Discussions

Peace came after 10 years of sporadic negotiations, which gained momentum when Álvaro Arzú took office as Guatemala's president in January 1996. Pledging to make peace one of his first priorities, he announced on inauguration day: "From now on we will live in the culture of life, of hope for a new resurrection, where we will no longer look to the past. The streams of tears caused by the injustices of those who despised the poor and the weak should now move us to forgive because vengeance does not bring the dead back." Two months later, the Government and the rebels, known as the URNG, which is the Spanish acronym for the Unidad Revolucionaria Nacional Guatemalteca, agreed to a cease-fire. "From that moment on, there were no more dead, wounded, orphans or widows," a URNG document proclaims.

During 1996, agreements were reached on social, economic, and land issues; ways to strengthen civilian power; the role of the army in a democratic society; and constitutional and electoral reforms. Negotiators worked on details, general operating procedures, and technical aspects to end the armed conflict.

On 4 December 1996, the agreement called the Definitive End of War was signed in Oslo, Norway. It set out the strategy for incorporating the URNG combatants into civilian life, beginning with the plans for demobilization. The United Nations Verification Mission for Guatemala, known as MINUGUA, designed and carried out the demobilization strategy. A commission for the demobilization program was set up and included the Guatemalan Government, the URNG, and the international community, including the Pan American Health Organization (PAHO),the United Nations Development Program, the United Nations High Commissioner for Refugees, the United States Agency for International Development (USAID), the Organization of American States, and the European Union.

Health: A Bridge for Peace

PAHO had broad experience with the concept of health as bridge for peace, having successfully worked with the Governments of El Salvador and Nicaragua to use the common values of health to open talks between warring factions and to insure health care delivery during the wars in those countries. PAHO, working with the countries, even arranged truce days to vaccinate children in remote villages of war-torn areas.

In Guatemala, at the Government's request in 1994, PAHO opened a satellite office in the high-conflict western highland area of Huehuetenango and helped coordinate maternal and child health programs and sanitary projects. That same year, another office opened in Santa Cruz del Quiché. In 1995, PAHO opened its satellite office in the north-central city of Cobán. The PAHO staff in Guatemala works closely with the Ministry of Public Health and Social Assistance to put into place the Government's program for primary care, which seeks to provide 100% coverage to all Guatemalans.

Guatemala is a poor country, with some 75% of the population of 11 million living in poverty. The level of illiteracy among the poor is close to 80%. In the rural highlands and coastal areas, where the majority of the indigenous live or migrate to work, basic sanitation and water reaches only about half the population.

The PAHO/WHO Representative in Guatemala, Dr. Jacobo Finkelman, was part of a 1995 United Nations working group that detailed the health specifics of the peace accords. The final 60-page document set out a detailed framework and timetable for the reincorporation of the rebels into civilian life, security, recognition of indigenous rights, protection of human rights, reduction of the army, and reforms in agriculture, election laws, and the economy. The peace agreement also calls for increased spending in public health, a reduction in infant and maternal mortality, the elimination of measles by the year 2000, and decentralized services to ensure that all Guatemalans have access to adequate care.

D Day, the code name for the planned start of demobilization, began on 3 March 1997 and lasted 60 days, giving the 3,000 guerrilla fighters, supporters, and their families time to move into eight U.N.-operated camps constructed in various parts of the country. Many others came home from refugee camps near the border in Mexico. The time in the camps was used to provide job training, distribute identity papers, and tend to education and health care.

While in the camps, former URNG fighters, some of them women wearing traditional Mayan dress, lined up to turn in their arms--some of them home-made, others Russian-designed AK47s, and still others U.S.-manufactured M-16s--to the blue-bereted U.N. forces. For many in the URNG, the identity papers they received marked the first time in their lives they had documents with their given names, rather than the noms de guerre to which so many had become accustomed.

PAHO handled all the technical direction of health activities and supervised the health care aspects of the demobilization, which included physical exams for each of the returnees, an assessment of their overall health condition, including mental as well as oral care, epidemiological surveillance, and environmental sanitation. The work at the camps was done in collaboration with other international organizations, the Government, the URNG, the University of San Carlos, and nongovernmental organizations. Funding came from the European Union and USAID.

The work was laudable: almost 3,000 UNRG members received physical evaluations, which included lab tests, vitamin supplements, and vaccinations. Special attention was given to health promotion with emphasis on personal hygiene and food preparation. Measures were taken to avoid malaria and dengue fever. Dry latrines were set up, and water was chlorinated in small tanks.

"Perhaps the greatest achievement, for which everyone deserves credit, is that there were no outbreaks of disease in the camps," says Finkelman.

The results of the exams showed that the combatants were in better physical condition than the irregular forces, who had lived among the general population. During the war, the guerrillas in their clandestine camps had permanent medical assistance from physicians' assistants, known as health promoters, and doctors who lived and traveled among them. The major health problems facing the UNRG were skin fungi, gastritis, and acute respiratory infections.

Mental health workshops highlighted the new transition, affording time for a look at the past and gaining a perspective on the then uncertain future. "It was quite good; at times it was quite dramatic," notes PAHO's Juan José Escalante, a public health officer based at the Quiché satellite office. "People broke down in tears."

On 3 May, the demobilization phase ended, and the majority of former guerrillas headed back to their homes, with the largest number settling in the highlands of Quiché. About 600 who had had no place to resettle were moved into Government-run shelters in Quiché, Quetzaltenango, Retalhuleu, and Alta Verapaz.

New Opportunities, New Life

Former guerrilla medic Gómez was at the Quiché shelter when he spoke about his newly received Government certification as a health promoter, a word used to describe those who work to provide basic health care and diagnoses in the rural areas. He and three of his coworkers operated a makeshift clinic at the shelter, which housed about 120 people. While still in a demobilization camp in early 1997, Gómez and the three others were among a group of 40 who attended a month-long course set up by the Ministry of Public Health and Social Assistance with technical input and oversight by PAHO, to provide formal health training for the former guerrilla lay medics and health promoters.

"It was political recognition," says María Luisa Rosal, a doctor working with the ex-combatants, in describing the course and certificate. "These people had operated in the field for years. The idea is for them to return to their communities to work. We never dreamed of working together. Now it's a necessity."

The vice minister of health, Dr. Carlos Andrade, praises the caliber of health expertise among the URNG. "We have a promise with the URNG to offer opportunities to their medical personnel. We found very good promoters with good skills. With the lack of funds and lack of human resources that we have, we know that within the URNG there are good people."

PAHO, earlier this year, signed an agreement with the Ministry of Health and Social Assistance outlining the Organization's technical cooperation work in Guatemala. As part of that agreement, a satellite office opened in remote Ixcán in 1997, and others are under consideration. Andrade speaks enthusiastically about the Government's health model, the Integrated System of Health Care and PAHO's work and support.

The model is designed to reach all Guatemalans, using outside support from nongovernmental agencies when needed. It requires cooperation at all levels, including input from the communities.

Guatemala is healing the wounds of war. People who fled from their homelands are coming back from Canada, Cuba, El Salvador, and Mexico. The Guatemalan winter in August showed a better than normal corn crop. The bougainvillea seemed a bit brighter than last year. And many shared a guarded sense of optimism about the nation's peace.

In the capital of Guatemala City, Alfredo Zarazua, head of social communication at the Guillermo Toriello Foundation, set up by a group of former URNG rebels to ease the return to civil society, said in August 1997 that Guatemala was "in a period of transition." He added: "Now it is up to us. They laid down their arms and reality sets in. They have no jobs, they have to use their real names. It is really difficult. We will do it. But it will take time."