One of the unique things about Impact Global Health Alliance Global is our commitment to finding sustainable solutions to the health needs in the communities we work with. At each of our sites, this means finding solutions that are culturally appropriate. In Guatemala, it is a tradition for Mayan women to give birth at home, typically on a dirt floor with the assistance of a traditional midwife, or comadrona as they’re called in Spanish.
The comadronas play an important role throughout the pregnancy, delivery, and post-partum, providing emotional and spiritual support to the women in their communities. Midwives are highly respected healers in their communities and possess knowledge that has been passed down from generation to generation. Although they have an immense amount of expertise and experience, most midwives lack formal medical training. As a result, they often lack the conventional medical skills and equipment needed to manage many complications during labor and delivery.
One solution is to refer complicated pregnancies to the hospital. Unfortunately, we’ve found that the majority of women in our communities are resistant to the idea of going to the hospital. Here’s why: when a Mayan woman gives birth at a hospital, her cultural customs are not welcome. She is not allowed to choose what clothing she wears or what position she would like to deliver in, both of which are essential to their culture. Additionally, most Mayan women do not speak Spanish and are unable to communicate with the hospital staff.
Rosa is a midwife. She is a valuable member of the community and an ambassador of the Casa Materna Program.
Perhaps, and worst of all, her midwife is not allowed to enter the room with her or participate in any way during labor and delivery. This leaves the woman alone in a foreign environment, without any allies to support her. In addition to these and other cultural barriers, there are many other barriers (including geographic and financial) that contribute to a general feeling of fear regarding government health facilities. It’s no wonder that people in the communities where we work try to avoid the hospitals at all costs.
With this in mind, we worked with local communities to create a local health care system that is not only welcoming of the local culture, but that actually celebrates it. Admittedly, this didn’t happen overnight. When we first started our project, we were not immediately embraced by the comadronas, who understandably were wary of our intentions. But, after many months and years of working together, soliciting the opinions of the midwives to help design aspects of the project as well as providing valuable, evidence-based trainings to the midwives, we’ve established an incredible relationship with these community leaders.
Nowadays, at our Casa Maternas, the comadronas are an essential part of the success of our projects.
They are the first person to learn of new pregnancies in the communities and are the person most trusted by their patients. As such, they play a crucial role in encouraging women to seek prenatal care and deliver in health facilities (like our Casa Maternas), which are some of the primary interventions that have helped us reduce maternal mortality rates in the communities where we work.
Ensuring that interventions are culturally appropriate is one of the most important ways to secure the sustainability of a grassroots community healthcare project. Our work in Guatemala would never have been as successful as it has been without the incorporation of the comadronas and other cultural traditions.
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