On a global scale, NGOs have played an important role in development and addressing healthcare inequities over the last several decades. Yet in recent years, the work of NGOs is continuously impacted by processes of socio-cultural, political, and economic change in increasingly post-neoliberal contexts. NGOs working within a social justice framework for health are a unique area to examine this shift as they continue to operate in the ebb and flow of changing fields of social power. The Guatemalan context has provided a salient example of this process, as changes in NGO-state relationships, health policy, and an increasingly pro-impunity state that protects perpetuators of corruption, have steadily impacted the subjectivities, resources, and practices of those working for NGOs. This dissertation explores the changing socio-political healthcare climate in Guatemala and its effects on the abilities of NGO workers to continue serving the needs of marginalized Indigenous Maya communities in the intersecting fields of health and social justice. Subjectivity is a useful theoretical framework for understanding how this larger shift in socio-political context impacts the actions, perceptions, and experiences of NGO workers involved in health intervention. This dissertation is guided by the notion that subjectivity is the site in which larger socio-cultural, economic, and political forces shaping social policy can likewise be seen to shape actors immersed in the ramifications of policy change. I propose that subjectivity is an amalgamation of individually, institutionally, and politically formed subjectivities. NGO worker’s subjective realities are individually formed through their unique personal experiences and identities; institutionally formed through the structure, history, and agenda of their organizations and funding institutions; and politically formed through their intrinsic and fluctuating relationship with the state and government institutions. This dissertation presents findings from a research project conducted over several summers between 2014 and 2019 exploring NGO workers’ experiences in health intervention from multiple NGOs in Guatemala. Utilizing semi-structured interviews, participant observation, textual and discourse analysis, this dissertation examines how NGO workers continue to serve Indigenous Maya communities despite dramatic shifts in state supports for NGOs. This work discusses how factors such as identity, indigeneity, and institutional legacy can impact the health interventions and community activism implemented in Indigenous communities. NGO workers navigate both their personal subjectivity as Indigenous individuals with unique connections to the Maya community, and an institutional subjectivity as actors immersed in NGO rhetorics of development. These competing subjectivities yielded profoundly gendered understandings of empowerment and feminist solidarity within approaches for health intervention. NGO workers also possess institutional and political subjectivities that are defined by a complex relationship with the state. Health activism in the context of NGOs can be transmuted over time through contractual relationships with the state whereby bureaucratic policies that place value on managerialism over social justice, thoroughly shift the nature and content of health intervention. Ultimately, I argue there is a fundamental link between non-governmental and government institutions, as NGO workers’ political subjectivities are continuously shaped by politically driven policy change, authoritative discourse, and popular belief. It is through this fundamental link with the state where regimes of truth manifest that can ultimately manipulate the actions of NGOs, refracting their perceptions of “doing good” for the most marginalized.
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