In the Peten Department, the patient population is served in rural clinics. Patients include former refugee communities of Guatemalans resettled in Guatemala by 2002, as well as long-term residents, specifically Ke'kchi indigenous communities. Each return community has a different history and ethnic mix, but generally, approximately 70% are indigenous Maya and 30% are Ladino or Mestizo. Both males and females of all ages are seen. Adult, youth and children visit the clinics and are cared for by "health promoters" community health workers. Medical doctors visit some clinics on a rotating basis, as assigned but rarely once a month. Hospital visits are a rarity due to expense and lack of transportation. Most adult males work in physically demanding farm labor, and adult women child bearing age often suffer from anemia. The lack of balanced nutritional diets is a familiar pattern. Many patients bare the long term effects of trauma brought on by the 36 year war ending in 1995 after the worst genocide in the history of the Americas.