Genç hekimin Soner Yalçın'a mektubu üzerine

medikritik Çar, 27/11/2019 - 10:31

Eren Öztürk’ün “Kara Kutu” ile ilgili Soner Yalçın eleştirisini okuyunca insanın zayıflamış umutları depreşiyor. Bilimsel ve sosyal konularda pek çok akademisyenin ilgi ve bilgi düzeyini gördükçe, bir tıp öğrencisinden böyle nitelikli bir yazı okumak sevindirici bir şey. Yalnızca ilgi, bilgi ve duyarlılık yok, aynı zamanda dili ve kurgusuyla da iyi bir makale. 

Aşılar konusundan başlarsak: Önce son 100-120 yıldır insanın yaşam süresi neden bu kadar devrimsel oranda uzadı sorusunu sormak gerekir. Bunu birçok başka kitap dışında özellikle Dr. Akif Akalın’ın çevirdiği ve yazdığı “toplumcu tıp” kitaplarından öğreniyoruz. İnsan yaşamının uzamasında ilk büyük sıçramayı yaratan şey, tıpla doğrudan bağlı görülmeyecek, ama göbekten bağlı bir gelişmedir. İngiltere ve Batı Avrupa’da geniş yoksul kesimlerin yaşadığı semtlere temiz su ve kanalizasyon götürülmesi! O mahallerin ve o evlerin en temel düzeyde sağlıklı hale getirilmesi… 

İnsanın ortalama yaşamında devrimsel oranda sıçrama yaratan öteki iki şey ise 1- Antibiyotikler, 2- Aşılardır. İşte Soner Yalçın’ın bilerek ya da bilmeden saldırdığı iki şey sosyal tıbbın ya da halk sağlığının en büyük iki silahıdır. 

Soner Yalçın’ın antibiyotikler hakkında söylediği birçok şey gerçi doğru. Son elli yıldır leblebi çekirdek gibi tüketilmesi, gerek vatandaşın, gerekse doktor ve eczacıların aşırı ve kötüye kullanımları ciddi sorunlar yaratmakta. Ancak zaten o konuda, beğenmediğimiz devlet bile ciddi önlemler alıyor. Sayın Soner Yalçın her konuda olduğu gibi bu konuda da bazı temel doğrularla birtakım kulaktan dolma yanlış bilgileri ve şehir efsanelerini harmanlayarak ilgi uyandırmayı seçiyor. Ne var ki bu taktik o bahsettiği doğruları itibarsızlaştırıyor.  Birtakım ilaçların yan etkilerinden dolayı sonradan yasaklanması, ilaç şirketlerinin aşırı kâr hırsıyla insan sağlığını riske atması, yaşanan gerçekler. Fakat tüm bunlar uyanıklığı, sorguyu, sosyalist bir tıp anlayışını doğurmalı. İlaçlara karşı genel bir güvensizliğe, tüm antibiyotiklerin “tu-kaka” ilan edilmesine yol açmamalı. Bilimin sorunları o bilim ne kadar yolundan sapsa da bilim içinde çözülmeli. 

Eren Öztürk’ün “modern tıbbın sorunlarının” “modern tıp dışı yöntemlerle” nasıl çözüldüğüne, daha doğrusu çözülemediğine dair yaklaşımı ve örnekleri gayet yerinde. 

Aşı muhalifliği ise bu çözümsüzlüğün en uç, en sorumsuz noktası. Fakat elbette aşılar da bilimsel anlamda tartışılmalı, onun da aşırı ve kötüye kullanımları önlenmeli. Ne var ki özellikle bizim gibi ülkelerde bu konu kişisel inisiyatiflere asla bırakılmamalı. Çünkü salgın hastalıklar kişisel ve özel karar alanları değildir. Öztürk’ün belirttiği gibi aşıları daha önce yapabildiğimiz gibi kendimiz üretmeliyiz. Sadece aşıları değil mevcut ilaçları ve yeni bulacağımız ilaçları da ülke olarak kendimiz üretebilmeliyiz. Soner Yalçın’ın da uyarısı doğrultusunda ilaç kalitelerini sürekli denetleyebilmeliyiz. Tüm bunlar hem doğrudan ölüm-kalım meselesidir, hem maliyet hesapları, ilaca ulaşılabilirlik ve ülke bağımsızlığı ile ilgili temel sorunlardır. 

İKİ İTİRAZIM VAR

Fakat değerli Öztürk’e iki noktada itirazım var. Biri gebelerde şeker yükleme testi ile ilgili. Epey bir süredir bu konuyu tartışıyoruz, “şeker yüklemeci” doktor arkadaşlar henüz beni ikna edebilmiş, sorularıma tatmin edici bir cevap vermiş değiller. Bilimsel iddiadaki argümanları şu: Gebelerde diyabet ortaya çıkacaksa kritik bir 5-6 haftalık dönemde çıkma olasılığı yüksekmiş. İşte o dönemde yapılan şeker yükleme testi ile erken tanı sağlanabiliyormuş. Gebenin ve ceninin sağlığı bu şekilde korunuyormuş. Peki bu kritik 5-6 haftalık dönemin son gününü nasıl saptayıp o günde test yapıyorlar? Hiç de öyle bir şey yapmıyor, herhangi bir günde yapıyorlar. O halde test yapıldıktan sonraki günlerde, haftalarda diyabet ortaya çıkarsa ne olacak? Üstelik diyabet illa o en yüksek olasılıklı dönemde çıkmayabilir, sonraki haftalarda da çıkabilir. Şeker yüklemesi negatif çıkan gebe bu yöntemle demek ki kendini sağlıklı sayacak ve aylarca diyabetle birlikte yaşayacak. Oysa bunun yerine önerdiğimiz şey son derece ucuz bir seçenek olarak açlık kan şekeri düzeyi ölçümünün gebelik boyunca birkaç haftada bir yinelenmesi. Ayda bir de hemoglobin A-1c ölçümü yapılırsa iş taçlanır. Ancak sadece şeker ölçümü bile yeterli. Uygulanırsa çok daha iyi sonuçlar alınabilir. 

Testte verilen ve o “az” denen şeker miktarı hiç de az değil ve kadın doğum uzmanlarının vermeyi pek sevdiği “bir dilim pasta” örneği yanıltıcı. Miktar hem fazla ve hem de bir dilim pastadan çok farklı bir içerik söz konusu. Üstelik bu test sıkça gördüğümüz gibi bir kez değil, birçok kez de yapılabiliyor. Yüklemeyle diyabeti gösteren miktar neden kendi başına diyabeti tetiklemesin? Modern tıbbın başta radyolojik tetkikler olmak üzere sıklıkla kötüye kullandığı tüm agresif tetkik yöntemleri sorgulanmalı. 

Bazı ülkeler bu yöntemi uygulamıyor. Örneğin toplum sağlığında örnek ülke Küba’da sadece riskli gebelere uygulanıyor ve o bile tartışılıyor. 

İkinci itiraz noktam ise değerli Öztürk’ün şu sözüne: “Emin olun, ilaç endüstrisi en çok sağlık camiasında eleştiriliyor.” Keşke öyle olsaydı. Bizler “Tıp Bu Değil” kitaplarının yazarları olarak bu konuları yıllardır gündeme getirmeye çalıştığımız halde üstünü en çok örten, en çok görmezden gelen, gargaraya getirmeye çalışan doktorlar ve sağlıkçılar oldu. Doğrudur, birtakım siyasi bildirilerde, TTB’nin kimi söylemlerinde yoğun bir anti-kapitalizm var gibi… Ama sadece “gibi”. Biz on yıllardır mücadele ediyoruz, hekimler hem de “muhalif” hekimler arasında ne aşırı tetkike, ne aşırı teşhise, ne aşırı tedaviye hevesi önleyebildik ne de koruyucu hekimliğe, sosyal tıbba bir eğilim yaratabildik. 

Çok ağır ve neredeyse hakarete varan eleştirilerimize karşın hala medikal şirketler sponsorluğunda kongreler dışında “bilimsel kongre” yok gibi… Ve hekimler bireysel olarak ve de örgütsel anlamda uzmanlık dernekleri ve onlardan aidat alan TTB vasıtasıyla bundan nemalanmaya devam ediyorlar. Böyle bir ortamda bilim ve bilimsel tartışma ne derece güçlenebilir? 

Hüsnüniyetin (iyiye yorma ve yorumlamanın) karşılığını gerçekte bulmasını elbette tüm kalbimizle dileriz. Konuya bu yaşta Eren Öztürk gibi nitelikli bakanların sayısı arttıkça belki o günleri göreceğiz. O konuda genç sağlıkçılara, doktorlara büyük iş düşüyor. 

Yine de tıp ve sağlık işleri sadece doktorların konuşacağı bir tabu değildir. Öztürk belirtmiş: Toplum da bilinçlenmeli ve bilinçli hastalar istiyoruz. Akalın’ın sık yinelediği gibi: “Sağlık sadece doktorlara bırakılamayacak kadar ciddi bir konudur.” Toplum, halk bilinçlenmeli, örgütlenmeli, kendi sağlığı için baskı gücü oluşturmalı. Devlete karşı, politikacılara karşı ve tabii doktorlara karşı da bir baskı gücü oluşturmalı. Örneğin güçlü biçimde şu sesi yükseltebilmeli: “Sigaraya karşı büyük kampanyalar ve devamlı bir karşı propaganda yapıyorsunuz. Güzel ve doğru. Ama o konuda gerçekten samimiyseniz fabrikaların baca filtresiz çalışmasına nasıl izin veriyorsunuz?” 

Bunu diyecek kitle Soner Yalçın kitaplarıyla oluşmaz. Aksine oluşacağı varsa da oluşmaz. 

Kaan Arslanoğlu

http://www.medikritik.com/haberler/tip-fakultesi-ogrencisinden-soner-ya…

Yorumlar

DonaldNum (doğrulanmamış) Cu, 09/05/2025 - 23:32

Water and life
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Lightning is a dramatic display of electrical power, but it is also sporadic and unpredictable. Even on a volatile Earth billions of years ago, lightning may have been too infrequent to produce amino acids in quantities sufficient for life — a fact that has cast doubt on such theories in the past, Zare said.

Water spray, however, would have been more common than lightning. A more likely scenario is that mist-generated microlightning constantly zapped amino acids into existence from pools and puddles, where the molecules could accumulate and form more complex molecules, eventually leading to the evolution of life.

“Microdischarges between obviously charged water microdroplets make all the organic molecules observed previously in the Miller-Urey experiment,” Zare said. “We propose that this is a new mechanism for the prebiotic synthesis of molecules that constitute the building blocks of life.”

However, even with the new findings about microlightning, questions remain about life’s origins, he added. While some scientists support the notion of electrically charged beginnings for life’s earliest building blocks, an alternative abiogenesis hypothesis proposes that Earth’s first amino acids were cooked up around hydrothermal vents on the seafloor, produced by a combination of seawater, hydrogen-rich fluids and extreme pressure.
Yet another hypothesis suggests that organic molecules didn’t originate on Earth at all. Rather, they formed in space and were carried here by comets or fragments of asteroids, a process known as panspermia.

“We still don’t know the answer to this question,” Zare said. “But I think we’re closer to understanding something more about what could have happened.”

Though the details of life’s origins on Earth may never be fully explained, “this study provides another avenue for the formation of molecules crucial to the origin of life,” Williams said. “Water is a ubiquitous aspect of our world, giving rise to the moniker ‘Blue Marble’ to describe the Earth from space. Perhaps the falling of water, the most crucial element that sustains us, also played a greater role in the origin of life on Earth than we previously recognized.”

MorrisCasse (doğrulanmamış) Ct, 10/05/2025 - 00:40

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Andrewgroks (doğrulanmamış) Ct, 10/05/2025 - 03:37

Water and life
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Lightning is a dramatic display of electrical power, but it is also sporadic and unpredictable. Even on a volatile Earth billions of years ago, lightning may have been too infrequent to produce amino acids in quantities sufficient for life — a fact that has cast doubt on such theories in the past, Zare said.

Water spray, however, would have been more common than lightning. A more likely scenario is that mist-generated microlightning constantly zapped amino acids into existence from pools and puddles, where the molecules could accumulate and form more complex molecules, eventually leading to the evolution of life.

“Microdischarges between obviously charged water microdroplets make all the organic molecules observed previously in the Miller-Urey experiment,” Zare said. “We propose that this is a new mechanism for the prebiotic synthesis of molecules that constitute the building blocks of life.”

However, even with the new findings about microlightning, questions remain about life’s origins, he added. While some scientists support the notion of electrically charged beginnings for life’s earliest building blocks, an alternative abiogenesis hypothesis proposes that Earth’s first amino acids were cooked up around hydrothermal vents on the seafloor, produced by a combination of seawater, hydrogen-rich fluids and extreme pressure.
Yet another hypothesis suggests that organic molecules didn’t originate on Earth at all. Rather, they formed in space and were carried here by comets or fragments of asteroids, a process known as panspermia.

“We still don’t know the answer to this question,” Zare said. “But I think we’re closer to understanding something more about what could have happened.”

Though the details of life’s origins on Earth may never be fully explained, “this study provides another avenue for the formation of molecules crucial to the origin of life,” Williams said. “Water is a ubiquitous aspect of our world, giving rise to the moniker ‘Blue Marble’ to describe the Earth from space. Perhaps the falling of water, the most crucial element that sustains us, also played a greater role in the origin of life on Earth than we previously recognized.”

Russellgriew (doğrulanmamış) Ct, 10/05/2025 - 06:20

An ancient ‘terror crocodile’ became a dinosaur-eating giant. Scientists say they now know why
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A massive, extinct reptile that once snacked on dinosaurs had a broad snout like an alligator’s, but it owed its success to a trait that modern alligators lack: tolerance for salt water.

Deinosuchus was one of the largest crocodilians that ever lived, with a body nearly as long as a bus and teeth the size of bananas. From about 82 million to 75 million years ago, the top predator swam in rivers and estuaries of North America. The skull was wide and long, tipped with a bulbous lump that was unlike any skull structure seen in other crocodilians. Toothmarks on Cretaceous bones hint that Deinosuchus hunted or scavenged dinosaurs.
Despite its scientific name, which translates as “terror crocodile,” Deinosuchus has commonly been called a “greater alligator,” and prior assessments of its evolutionary relationships grouped it with alligators and their ancient relatives. However, a new analysis of fossils, along with DNA from living crocodilians such as alligators and crocodiles, suggests Deinosuchus belongs on a different part of the crocodilian family tree.

Unlike alligatoroids, Deinosuchus retained the salt glands of ancestral crocodilians, enabling it to tolerate salt water, scientists reported Wednesday in the journal Communications Biology. Modern crocodiles have these glands, which collect and release excess sodium chloride.

Salt tolerance would have helped Deinosuchus navigate the Western Interior Seaway that once divided North America, during a greenhouse phase marked by global sea level rise. Deinosuchus could then have spread across the continent to inhabit coastal marshes on both sides of the ancient inland sea, and along North America’s Atlantic coast.

The new study’s revised family tree for crocodilians offers fresh insights into climate resilience in the group, and hints at how some species adapted to environmental cooling while others went extinct.

With salt glands allowing Deinosuchus to travel where its alligatoroid cousins couldn’t, the terror crocodile settled in habitats teeming with large prey. Deinosuchus evolved to become an enormous and widespread predator that dominated marshy ecosystems, where it fed on pretty much whatever it wanted.

“No one was safe in these wetlands when Deinosuchus was around,” said senior study author Dr. Marton Rabi, a lecturer in the Institute of Geosciences at the University of Tubingen in Germany. “We are talking about an absolutely monstrous animal,” Rabi told CNN. “Definitely around 8 meters (26 feet) or more total body length.”

ThomasBrops (doğrulanmamış) Ct, 10/05/2025 - 07:51

Water and life
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Lightning is a dramatic display of electrical power, but it is also sporadic and unpredictable. Even on a volatile Earth billions of years ago, lightning may have been too infrequent to produce amino acids in quantities sufficient for life — a fact that has cast doubt on such theories in the past, Zare said.

Water spray, however, would have been more common than lightning. A more likely scenario is that mist-generated microlightning constantly zapped amino acids into existence from pools and puddles, where the molecules could accumulate and form more complex molecules, eventually leading to the evolution of life.

“Microdischarges between obviously charged water microdroplets make all the organic molecules observed previously in the Miller-Urey experiment,” Zare said. “We propose that this is a new mechanism for the prebiotic synthesis of molecules that constitute the building blocks of life.”

However, even with the new findings about microlightning, questions remain about life’s origins, he added. While some scientists support the notion of electrically charged beginnings for life’s earliest building blocks, an alternative abiogenesis hypothesis proposes that Earth’s first amino acids were cooked up around hydrothermal vents on the seafloor, produced by a combination of seawater, hydrogen-rich fluids and extreme pressure.
Yet another hypothesis suggests that organic molecules didn’t originate on Earth at all. Rather, they formed in space and were carried here by comets or fragments of asteroids, a process known as panspermia.

“We still don’t know the answer to this question,” Zare said. “But I think we’re closer to understanding something more about what could have happened.”

Though the details of life’s origins on Earth may never be fully explained, “this study provides another avenue for the formation of molecules crucial to the origin of life,” Williams said. “Water is a ubiquitous aspect of our world, giving rise to the moniker ‘Blue Marble’ to describe the Earth from space. Perhaps the falling of water, the most crucial element that sustains us, also played a greater role in the origin of life on Earth than we previously recognized.”

MorrisCasse (doğrulanmamış) Pt, 12/05/2025 - 06:19

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DerekAlate (doğrulanmamış) Pt, 12/05/2025 - 15:19

A? ship that US and Philippine forces planned to sink beat them to it.
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A former US World War II-era warship, which survived two of the Pacific War’s most important battles, was supposed to go down in a blaze of glory in a live-fire exercise off the western coast of the Philippines as part of annually held joint military drills.
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Instead, before the bombs and missiles could fly, it slipped slowly beneath the South China Sea Monday morning, age and the ocean catching up to it before modern weaponry could decimate it.

The ex-USS Brattleboro was to be the main target for the maritime strike (MARSTRIKE) portion of the annual US-Philippine “Balikatan” exercise, which began April 21 and runs to May 9.
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“The vessel was selected because it exceeded its service life and was no longer suitable for normal operations,” according to a statement from the Armed Forces of the Philippines.

Chinese coast guard offices display their national flag on a tiny sandbar in the disputed Sandy Cay in April, 2025.
Related article
China and Philippines unfurl competing flags on disputed South China Sea sandbars, reviving tensions

A US Navy spokesperson told USNI News last month that the? 81-year-old ship was to be the target for US Marine Corps F/A-18 fighter jets during the exercise. A report from the official Philippine News Agency (PNA) said it was to be hit by US and Philippine forces with a combination of anti-ship missiles, bombs and automatic cannon fire.

But as the 184-foot-long vessel was being towed to its station for the exercise, 35 miles west of Zambales province on the northern Philippine island of Luzon, it took on water, the Philippine military statement said.
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“Due to rough sea conditions that we are currently experiencing in the exercise box and with its long service life, as is expected, she took on a significant amount of water and eventually sank,” Philippine Navy spokesperson Capt. John Percie Alcos said, according to PNA. He said the vessel was not damaged while being towed.

The ship sank quietly at 7:20 a.m. local time near the spot where it was to be obliterated later in the day, according to the Philippine military.

Other elements of the MARSTRKE exercise would go on, the military statement said.

The Philippine and US joint task forces “will rehearse virtual and constructive fire missions,” the statement said, without detailing what elements were still scheduled as part of the drill. “The combined force will still achieve its training objectives,” it added.
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The Philippine military said there was no environmental danger from the sinking as the vessel had been cleaned before being towed out for the exercise.

EugeneTut (doğrulanmamış) Pt, 12/05/2025 - 18:22

It wasn’t the most contentious meeting the Oval Office has ever seen. Nor was it the warmest.
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Instead, the highly anticipated meeting Tuesday between President Donald Trump and his new Canadian counterpart Mark Carney fell somewhere in the middle: neither openly hostile nor outwardly chummy, evincing very little neighborliness, at least the type used on neighbors one likes.
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The midday talks illustrated neatly the new dynamic between the once-friendly nations, whose 5,525-mile border — the world’s longest — once guaranteed a degree of cooperation but which, to Trump, represents something very different.
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“Somebody drew that line many years ago with, like, a ruler, just a straight line right across the top of the country,” Trump said in the Oval Office as his meeting was getting underway. “When you look at that beautiful formation when it’s together – I’m a very artistic person, but when I looked at that, I said: ‘That’s the way it was meant to be.’”

That is not how Carney believes it was meant to be.

“I’m glad that you couldn’t tell what was going through my mind,” Carney told reporters later that day about the moment Trump made that remark.
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Still, Carney didn’t entirely hold his tongue.

In a meeting dominated by Trump’s comments — he spoke 95% of the time on all manner of topics, from the Middle East to Barack Obama’s presidential library to the state of high-speed rail in California — it was the new prime minister’s pushback on the president’s ambition to make Canada the 51st US state that stood out.

“As you know from real estate, there are some places that are never for sale,” he said, drawing a begrudging “that’s true” from Trump before Carney carried on.
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MorrisCasse (doğrulanmamış) Sa, 13/05/2025 - 11:39

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Michaelbal (doğrulanmamış) Sa, 13/05/2025 - 20:42

Guatemala has pledged a 40% increase in deportation flights carrying Guatemalans and migrants of other nationalities from the United States, President Bernardo Arevalo announced Wednesday during a press conference with US Secretary of State Marco Rubio.
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Guatemala has also agreed to create a task force for border control and protection along the country’s eastern borders. The force, composed of members of the National Police and army, will be tasked with fighting “all forms of transnational crime,” Arevalo said.
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Foreign nationals who arrive in Guatemala through deportation flights will be repatriated to their home countries, Arevalo said, adding that the US and Guatemala would continue to have talks on how the process would work and how the US would cooperate.
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Arevalo also said that Rubio has voiced his support for developing infrastructure projects in the Central American nation. He added that his government would send a delegation to Washington in the coming weeks to negotiate deals for economic investments in Guatemala – which he said would incentivize Guatemalans to stay in their home country and not migrate to the US.

Arevalo said Guatemala has not had any discussions about receiving criminals from the US as El Salvador’s president has offered. He also insisted his country has not reached a “safe third country” agreement with the United States, which would require migrants who pass through Guatemala to apply for asylum there rather than continuing to the US.
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Michaelbal (doğrulanmamış) Per, 15/05/2025 - 10:19

Guatemala has pledged a 40% increase in deportation flights carrying Guatemalans and migrants of other nationalities from the United States, President Bernardo Arevalo announced Wednesday during a press conference with US Secretary of State Marco Rubio.
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Guatemala has also agreed to create a task force for border control and protection along the country’s eastern borders. The force, composed of members of the National Police and army, will be tasked with fighting “all forms of transnational crime,” Arevalo said.
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Foreign nationals who arrive in Guatemala through deportation flights will be repatriated to their home countries, Arevalo said, adding that the US and Guatemala would continue to have talks on how the process would work and how the US would cooperate.
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Arevalo also said that Rubio has voiced his support for developing infrastructure projects in the Central American nation. He added that his government would send a delegation to Washington in the coming weeks to negotiate deals for economic investments in Guatemala – which he said would incentivize Guatemalans to stay in their home country and not migrate to the US.

Arevalo said Guatemala has not had any discussions about receiving criminals from the US as El Salvador’s president has offered. He also insisted his country has not reached a “safe third country” agreement with the United States, which would require migrants who pass through Guatemala to apply for asylum there rather than continuing to the US.
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