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Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

Horizons is thrilled to invite the next group of Canadian maternal and child health practitioners, experts and advocates to participate in its second Canada-to-Guatemala knowledge-exchange, planned for February 17-26, 2018.

These exchanges form part of an ambitious, four-year Maternal, Newborn and Child Health (MNCH) project, with support from Global Affairs Canada and led by our local partner PIES (the Association for Health Promotion, Research and Education), that is improving the delivery and use of MNCH services for thousands of Indigenous Maya K’iche’ women, children and families in the province of Totonicapán, Guatemala.

Knowledge and experiences will be shared between Canadians vocationally concerned with MNCH and Guatemalan MNCH providers and leaders, including traditional Indigenous midwives. Canadian participants will therefore learn first-hand of the challenging MNCH realities Indigenous Maya K’iche’ communities and health providers face in Totonicapán, a predominantly Indigenous province with one of the highest maternal mortality rates in the country, and how the project is helping overcome them – training over 1,000 traditional Indigenous Maya K’iche’ midwives in culturally-pertinent MNCH best practices, providing essential medicines and equipment to dozens of severely undersupplied health centres, executing a wide-ranging health promotion campaign and more.

The exchange is not designed to be service-based, as is common in medical brigades. Rather, it will provide an opportunity for participants to approach MNCH through a social justice lens and go beyond a ‘technical’ medical intervention. 

One of the health centers visited by the team

A nurse talks to the Canadian exchange participants

Not only will the exchange team shadow traditional Indigenous midwives and PIES health educators as they perform home visits in rural villages, and observe the care provided in formal health institutions. The team will also learn about the historic and systemic inequalities that have marginalized Indigenous peoples in Guatemala and contributed to alarming MNCH gaps, while understanding the crucial need for culturally-pertinent care given a virtually all-Maya K’iche’ population. 

Knowledge-sharing under the exchange is thus a fundamentally reciprocal process that will take place between equals – be they traditional Indigenous midwives, doctors, nurses, public health experts, community health educators or even Maya priests. Horizons firmly believes in the importance of Indigenous approaches to health, and is convinced that by rescuing and respectfully promoting them, spaces for traditional and Western medicine to coexist and learn from one another can be created.

After an incredibly successful first exchange, 10 Canadian participants became committed to fostering long-term solidarity with their Maya K’iche’ and Guatemalan counterparts thanks to this experience. These are some of their testimonies:

Canadian team with Guatemalan health providers

6 midwives, 3 nurses and one family doctor formed the first exchange team

“I now have a much better understanding of the limitations health providers, including traditional Indigenous Maya K’iche’ midwives, face in Totonicapán. Due to this situation there is a need for various health groups to work together, trusting and respecting each other. Horizons and PIES’s MNCH project is contributing to this trust and respect by providing culturally-pertinent training to traditional midwives and by sensitizing formal health staff to the Maya worldview, making the initiative an excellent example of sustainable, culturally-sensitive aid.”

  • Dr. Paul Caldwell – Family doctor who has provided family practice obstetrics at the Northumberland Hills Hospital in Cobourg, Ontario.

“There were several personal moments that highlighted the challenges experienced by Indigenous Maya K’iche’ communities in Guatemala – especially during our visits to rural health clinics and the home visits with traditional Indigenous midwives. Both provided a better understanding of the day-to-day issues, and left a strong desire to help address such blatant within-country inequalities. Horizons and PIES’s project is a wonderful example of what a positive partnership with mutual respect and a common goal (MNCH) can look like. I have spoken of this partnership and initiative often as an example for others to follow.”

  • Dr. Patti Tracey – Registered Nurse and Professor with the Trent/Fleming School of Nursing at Trent University in Peterobourgh, Ontario.

“I have had the opportunity to witness or be involved in many NGO projects in several countries over the past 20 years. I can honestly say that the MNCH project with Horizons of Friendship is the most impressive, people-centred development initiative I have encountered to date. Horizons’ partnership with PIES, the ethics behind implementation and the scope of its outcomes – including our exchange – makes this a project, and organization, I can wholeheartedly endorse!”

  • Joanne Gillies – Registered midwife working in Victoria, British Columbia, and former locum midwife in a primarily-Inuit community in Nunavut.  

All Canadian professionals that work in an MNCH-related field or are prominent advocates that support MNCH can apply to the second exchange. This includes, but is not limited to: family doctors, OBGYN professionals, pediatricians, midwives, nurses, community health workers, public health personnel, researchers, community leaders or gender equality experts. 

Horizons will release a call for participants in early August, with full details and a link to an online application. If you would like to learn more about the exchange, and join the applicant distribution list, please contact Raúl Scorza at rscorza@horizons.ca / 905-372-5483 / 188-729-9928 [ext. 24 for both].

Thank you to our individual and organizational donors, whose support makes this important project possible.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

Patricia María Oxlaj is a young, Indigenous Maya K’iche’ woman living in Totonicapán, Guatemala. 

Lives like those of Patricia Maria Oxlaj and her son are being transformed

Left to Right: Silvia, PIES Health Educator; Patricia Oxlaj and son; Horizons ED Patricia Rebolledo

Winding dirt paths weave between the small houses that dot her village’s landscape, with imposing mountains towering over ravines that are near impossible to navigate with a vehicle. At the age of 24, Patricia became pregnant with her first son. She resides in one of the departments with the highest maternal and infant mortality rates in the country, where Indigenous women are twice as likely to die during pregnancy or childbirth as non-Indigenous women. As her pregnancy continued, Patricia noticed that breathing became increasingly difficult for her. 

In the fall of 2016, a Health Educator under Horizons and the Association for Health Promotion, Research and Education’s (PIES) Maternal, Newborn and Child Health (MNCH)project conducted a household visit with Patricia after walking numerous hours on the dirt paths leading up to her home. 

The nearest health posts and clinics are usually a 2-3 hour trek away

The village of Xesaná

Household visits by PIES Health Educators include warning signs of high-risk pregnancies as a focus

Telma Cuc, PIES Health Educator, providing counselling to Roxana Castro

The Health Educator helped Patricia recognize her shortness of breath as a warning sign of a high risk-pregnancy. Patricia was promptly referred to the department hospital - a journey taking approximately 3 hours given the village's terrain and its remoteness. At the hospital, doctors let Patricia know that had she not sought out medical attention, her own life and the life of her baby would have been in grave danger. 

Patricia’s son, who was due in January 2017, was born in November 2016 – three months premature – but both mother and child are alive and healthy.

Thousands of lives, like those of Patricia and her son, are being transformed thanks to the MNCH project, which counts on your support and the support in part of Global Affairs Canada. Having recently concluded the first official year of the project (with year two already underway), we would like to share some key highlights that have directly benefited more than 40,000 Indigenous Maya K’iche’ women, children and families in the first year of this four-year initiative.

• Health educators, fluent in the Maya K’iche’ language, have conducted more than 6,000 household visits and facilitated more than 90 women’s discussion groups, promoting MNCH best practices among 16,000 women and helping prevent maternal and child deaths.

40 traditional Indigenous midwives, all Maya K’iche’ women, have completed a year-long training on culturally-pertinent MNCH best practices, including a focus on gender equality. Each of these midwives will now share their updated knowledge by replicating their training with 25 other midwives, enhancing practices for a total 1,040 midwives - essentially all midwives in Totonicapán. 

Training is conducted by our local partner, PIES

Midwives trained in Year 1 were recruited from 6 out of the 8 municipalities of Totonicapán

 Equipment to assist the trained traditional Indigenous midwives in safe, clean deliveries has been procured.
300 medical and nursing students started training on the foundations of health and illness in the Maya worldview, sensitizing future health workers caring for a virtually all-Maya K’iche population.
• First major purchase of medications, medical equipment and culturally-accepted nutritional supplements (Incaparina).

Chronic malnutrition levels in children under five in Guatemala are among the highest in the world

Incaparina is a culturally-accepted supplement due to its resemblance to "atol", a traditional drink

 Agreements reached with Totonicapán health authorities to formalize controls for distributing medicine and supplies.
Mass media campaign rolled out, with radio and TV spots promoting MNCH best practices (exclusive breastfeeding, immunization , warning signs of high-risk pregnancies and more) in Maya K’iche’ and Spanish among tens of thousands of people.
Knowledge-exchanges from Canada to Guatemala and from Guatemala to Canada held, with the involvement of one Canadian family doctor, 3 Canadian nurses and 6 Canadian midwives, and 3 traditional Indigenous midwives and 2 physicians from Guatemala, respectively.
• A series of public engagement activities, including outreach during the exchange to Canada, carried out to raise awareness among more than 1,300 Canadians and over 230 Canadian health practitioners – including a partnership with an elementary teacher’s local that has helped educate more than 250 youth on MNCH challenges.

The team shared knowledge and experiences with their Guatemalan counterparts

10 Canadian health practitioners visited health posts and clinics, as well as shadowed traditional midwives in home visits

The above is only an overview of the tremendous efforts that Horizons, PIES, Totonicapán’s health authorities and all other collaborating organizations have pooled together to transform Indigenous lives.

These efforts would not have been possible without your support and solidarity, and we invite you to continue to be part of this transformation. You can keep attending our engaging events, like a free public presentation we will hold on Tuesday June 27 at 7:00pm in the Cobourg Public Library, or reach out to Raúl Scorza at rscorza@horizons.ca to talk about all of the ways in which you can contribute to this important initiative.


Daniel Quesada, Community Outreach Officer

In February, we led a 10-day delegation of Canadian healthcare professionals to Guatemala to visit Guatemalan midwives, doctors, and health-promoters. This month, the traditional Indigenous Guatemalan midwives and doctors will come to Canada and meet us! This North-South exchange is thanks to our Maternal, Newborn, and Child Health (MNCH) project with support from Global Affairs Canada. Throughout the month of March, we'll be travelling across Ontario with this delegation of traditional, Indigenous Guatemalan midwives and doctors, visiting hospitals, clinics, and venues. 

 There are several public events, we invite you to join us at: 

TORONTO, ONTARIO — Sally Horsfall Eaton Centre for Studies in Community Health (SHE) room 653 @ 4:30PM-6:00PM — 99 Gerard Street.

Join us for a panel discussion with traditional, Indigenous Guatemalan midwives and doctors. There will be a Q&A and light refreshments provided.

For more information or to RSVP, please see our Facebook Event Page: http://bit.ly/2lXNzsk


COBOURG, ONTARIO — Horizons of Friendship, 2nd floor — March 23 @ 6:00PM-7:30PM — 50 Covert Street.

Join us for an Open House and Roundtable Discussion with traditional, Indigenous Guatemalan midwives and doctors. This will be an excellent opportunity for you to meet the front-line workers in Guatemala's healthcare system. Light refreshments will be provided.

For more information or to RSVP, please see our Facebook Event Page: http://bit.ly/2nkFEWw


PETERBOROUGH, ONTARIO — TrentU, First Peoples House of Learning, March 24 @ 7:00PM-8:30PM.

Calling all Trent & Fleming students and Peterborough residents: come out and meet the front-line workers of Guatemala's healthcare system. At this event you'll have the opportunity to engage with traditional, Indigenous Guatemalan midwives and doctors who are working to save the lives of women and children in Guatemala.

For more information or to RSVP, please see our Facebook Event Page: http://bit.ly/2n71fkG


KINGSTON, ONTARIO — Haynes Hall, March 25 @ 3:30PM-5:00PM — 115 Clarence Street. 

Join us for an afternoon presentation and Q&A from traditional, Indigenous midwives and doctors from Guatemala. Come and meet the front-line workers of Guatemala's healthcare system and learn more about Horizons' MNCH project.

For more information or to RSVP, please see our Facebook Event Page: http://bit.ly/2n6ViUW


We hope to see you at one of our events. If you have any questions or concerns please contact Raúl Scorza at rscorza@horizons or give us a call at 905-372-5483 ext. 24.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

After a brief hiatus, Horizon’s maternal, newborn and child health (MNCH) blog is back! This time, it will follow the travels, experiences and stories of ten Canadian health professionals who will head to Guatemala this Sunday and participate in Horizons’ ten-day MNCH knowledge-exchange.

The team of Canadians, consisting of midwives, nurses and an obstetrician, represents cities and towns from across Ontario and British Columbia. Residents of Ottawa, Toronto, Peterborough, Cobourg, Waterloo, Brockville, Kingston and Victoria, British Columbia, these Canadian healthcare providers will learn first-hand about the challenging maternal and child health realities in Totonicapán, Guatemala – and how Horizons’ project alongside its Guatemalan partner, the Association for Health Promotion, Research and Education (PIES), is improving MNCH in this predominantly Indigenous Maya K’iche’ province and transforming the lives of Indigenous women, children and families.

Participants in the Canadian knowledge-exchange team include:

Betty-Anne Daviss – Registered midwife in Ontario and Quebec residing in Ottawa, with extensive experience in national and international midwifery settings.
Dr. Paul Caldwell – Family physician who has provided family practice obstetrics at the Northumberland Hills Hospital in Cobourg for 40 years.
Heather Mason – Registered midwife, co-owner of a midwifery practice in Brockville and Head Midwife at the Brockville General Hospital.
Janis Herold – Registered midwife working in Waterloo, with additional experience as a childbirth educator, infant massage instructor and breastfeeding advocate.
 Joanne Gillies – Registered midwife working in Victoria, B.C., who recently worked as a locum midwife in a primarily-Inuit community in Nunavut.
Taryn Woolsey – Registered midwife in Northumberland County and the Durham Region with experience providing care to incarcerated women and domestic/sexual abuse survivors.
Tia Sarkar – Registered midwife in Toronto who has served on the College of Midwives and various committees on the Canadian Association of Midwives, as well as worked with internationally educated midwives at Ryerson University.
Michelle Verbeem – Registered and primary care nurse with the Northumberland Family Health Team in Cobourg.
Patti Tracey – Registered nurse and professor with the Trent/Fleming School of Nursing at Trent University in Peterborough, with experience as a clinician, educator and researcher.
Wendy Kelen – Registered nurse with the Kingston Community Health Centres and lecturer at Queen’s University, with experience in maternal-newborn health education.

PIES health educators walk towards a rural village

The Canadian exchange team will visit rural communities alongside traditional midwives and health educators

Accompanying Guatemalan traditional Indigenous Maya K'iche' midwives in the delivery of their day-to-day care. Observing the medical attention provided to Indigenous Maya K’iche’ families in maternal-child care health centers. Following health educators as they carry out their health home visits in rural communities. These are just some of the activities in which the Canadian team will participate, learning from and exchanging knowledge with key actors that are helping strengthen MNCH in Totonicapán through this project, which is funded in large part by Global Affairs Canada.

Being the first of five knowledge-exchanges that will take place as part of the MNCH project – and preceding the first of five visits to Canadian cities and towns, including Toronto, the Clarington region, Cobourg, Peterborough, Kingston and Ottawa, by a group of Guatemalan traditional Indigenous Maya K’iche’ midwives and other health providers in late March – this exchange will help pave the way for advocacy that calls for greater international cooperation to improve MNCH, addressing global health from a social justice perspective, and respect and recognition of Indigenous approaches to health.

Follow our live blog by visiting our website, our Facebook page and our Twitter often - we'll be posting on Instagram, too! - and share the experiences and stories we will bring back to you. See you soon!

For more information or to become involved, please contact Raúl Scorza at rscorza@horizons.ca.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

In the Spring of 2016, Horizons embarked on the largest initiative it has undertaken to date: a four year, multimillion dollar project alongside its long-time Guatemalan partner, the Association for Health Promotion, Research, and Education (PIES), aimed at reducing the gaps in maternal, newborn and child health (MNCH) for Indigenous Maya K’iche’ peoples in Totonicapán, Guatemala. With the year’s end offering an opportunity to reflect on how this project has started to transform the lives of Indigenous women, children and families during its first six months, we invite you to read our latest blog post and learn how this transformation is taking place.

An essential component of the project rests on increasing MNCH service coverage to remote, predominantly Indigenous areas of Totonicapán. Given that approximately 70% of births in Totonicapán are attended by traditional Indigenous Maya K’iche’ midwives at the home, training and equipping these community-based care providers is an important step towards improving MNCH. PIES reports it has successfully recruited 40 traditional Indigenous midwives, all Maya K’iche’ women from six of the eight municipalities in Totonicapán, and has begun training them in updated, culturally-relevant MNCH best practices that include a focus on gender equality. This training will result in fewer maternal deaths as well as the early referral of high-risk pregnancies to formal health care services. After one year of training, these 40 traditional Indigenous midwives will then train another 1,000 traditional Indigenous midwives, upgrading the skills of virtually all traditional Indigenous midwives in Totonicapán.

Doña Esperanza

Doña Esperanza, one of the midwives recruited and being trained by PIES

137 community health promoters, all of whom are Maya K’iche, were also recruited by PIES. These promoters, key to family planning counselling and the early detection of high-risk pregnancy warning signs and prevalent diseases among children under five years old in Totonicapán’s rural Indigenous communities, were all exclusively recruited from municipalities with few to no health promoters. They, too, have begun to receive training in updated MNCH best practices with a gender equality focus during the first semester.

This initiative will not only train community-based care providers. It will also ensure current and future formal health sector staff possess knowledge of culturally-pertinent MNCH care, helping erode the discrimination Indigenous peoples often face at conventional health institutions. 220 medical and nursing students have started an educational module on traditional Mayan medicine and the Mayan view of health and illness, a module based on a training program developed by PIES and being delivered in collaboration with Guatemala’s University of San Carlos in Quetzaltenango. The module will be adapted for health care providers employed by the Ministry of Health and Social Assistance (MSPAS), which will culminate in an accredited Diploma on Culturally Pertinent MNCH care.

Further, more than 5,000 Indigenous women have participated during the first six months in over 70 women’s discussion groups revolving around MNCH best practices, including family planning, high-risk pregnancy warnings, exclusive breastfeeding, immunization and improved nutrition. Pregnant women, new mothers, mothers of children under five years old, and even in-laws (of important notice, as relatives like female in-laws may act as decision-makers in health-related choices such as seeking care in an obstetric emergency) have been part of these discussion groups. The fact that these figures have already surpassed the project’s first year target clearly shows the desire shared by Totonicapán’s Indigenous women for safe spaces to talk about the health and wellness of their children, their families and their own selves.

PIES health educator and Maya K'iche' woman with her family

The PIES health educator shows a Maya K'iche' family the "wheel of MNCH best practices"

The MNCH best practices described above are also being promoted by means beyond the discussion groups. A mass-media health communications campaign led by PIES has kicked off, with seven radio spots being released on Totonicapán’s airwaves to share information about topics including family planning, high-risk pregnancy warning signs and exclusive breastfeeding – both in the Spanish and K’iche’ languages.

Additionally, more than 1,000 household visits were carried out by PIES health educators in remote rural communities with some of the worst MNCH indicators in Totonicapán. Health educators continue to promote behaviours linked to better MNCH outcomes. When Horizons visited Guatemala to monitor and evaluate the progress of the project, Horizons staff accompanied one of these health educators on her household visits. An Indigenous Maya K’iche’ mother of four children, who was six months pregnant with her fifth child, narrated how she had gone for her first ever prenatal visit to a health centre after having been visited by a health educator. The woman, who was consulted exclusively in K’iche’ and said she had experienced complications in her previous pregnancy, would remain “on alert” for the high-risk pregnancy warning signs she learned about. This example, one of thousands, shows how responding to the MNCH realities in rural, Indigenous Totonicapán will directly lead to lives saved. 

First Canada-to-Guatemala Knowledge Exchange Team

Horizons staff and the first Canadian participants of the project's MNCH knowledge-exchanges

Work to share stories like that of the PIES health educator among Canadians, engaging with them in ways in which the importance of MNCH is made clear and cooperation between Canada and Guatemala to strengthen MNCH is facilitated, has been carried out during the project’s first six months. More than 40 Canadian MNCH-concerned professionals were reached through awareness-raising activities at community venues and MNCH institutions, where over 250 Canadians from the general public were also informed about the project. Horizons, seeking to provide an opportunity for Ontario’s youth to learn about global issues like MNCH, partnered with the Kawartha Pine Ridge Elementary Teacher’s Federation of Ontario (KPR-ETFO) to carry out a youth engagement program that will start up in the Clarington region in the coming months. Finally, dates for reciprocal knowledge-sharing exchanges between Canadian MNCH providers and leaders and their Guatemalan counterparts, including traditional Indigenous midwives, were chosen for February and March 2017. After conducting its selection process during the first semester, Horizons confirmed the participation of the Canadian and Guatemalan individuals in the first exchanges.
We hope this post has given you chance to look back at what has been accomplished in the MNCH project’s first six months. Know that the Horizons and PIES teams are prepared to look ahead, and continue to transform the lives of Indigenous women, children and families in Guatemala. This project, which is enabled in part with the support of Global Affairs Canada, would not be possible without the solidarity of our individual and institutional supporters. To discuss ways in which you can be part of this transformation, please contact Raúl Scorza at rscorza@horizons.ca.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

Welcome back to our bi-weekly blog on the maternal, newborn and child health (MNCH) project in Totonicapán, Guatemala.

For this post, we will touch on traditional Mayan medicine in Guatemala and the role traditional Indigenous midwives play in it. Working with formal health sector staff to increase their understanding of traditional Mayan medicine is a vital way through which the project aims to strengthen culturally-pertinent care, a key to improving MNCH outcomes in Mayan communities. For over twenty years, our Guatemalan partner for the MNCH project, the Association for Health Promotion, Research and Education (PIES), has practiced and promoted culturally-pertinent health care that respects and honours traditional Mayan medicine. We draw on this expertise to share with you some very general principles of traditional Mayan medicine and the worldview that underpins it.

The Maya constitute nearly half the population in Guatemala, divided into 21 linguistic groups. Despite this rich diversity among the Maya, they share a distinct traditional worldview. An important part of that worldview revolves around understanding and addressing health and sickness. To begin to understand traditional Mayan medicine, it is necessary to first understand central principles of the Mayan worldview.

The Mayan worldview rests on the relationship between three elements: the universe, nature and the human being. This relationship is both indivisible and non-hierarchical. The universe encompasses matter, in both visible and non-visible forms, that comes together to create life and nature. Nature encompasses rivers, mountains, volcanoes, the wind, animals, plants and the human being. The human being is therefore a part of nature, entailing a sense of belonging and stewardship to ensure the continuation of life and recognition of the existence of the visible and non-visible forms of universal matter.

Traditional Indigenous Maya midwives

Traditional Indigenous Maya midwives - "Iyom" in Maya K'iche'

This worldview has important implications. First, if nature consists of tangible and intangible matter, then developments that occur within it can have both material (visible) and spiritual (non-visible) causes and dimensions. Second, because the relationship among the three elements in the Mayan worldview is indivisible and is not hierarchical, human beings must maintain proper relationships with each element for the well-being of all: performing rituals to thank the universe for creation, ensuring the continuation of nature, and following established norms and values when interacting with other human beings.

Considering these implications, an imbalance or disruption in the way of life that affects any of the three relationships can lead to sickness, product of the alteration of the proper order, or well-being described above. Thus, this understanding of sickness identifies not only strictly physical causes, but also social and value-related ones. Addressing sickness in the Mayan worldview, including the selection of the people that will do so, happens within that same model.

Traditional Indigenous Maya midwives do not personally choose to become an “Iyom”, (direct translation from Maya K’iche’ means ‘grandmother’) or “comadrona” (Spanish). Rather, their “gift”, or ability to deliver maternal, newborn, and child health care is derived from their “nawal” – the ‘energy’ specific to the day in the Mayan sacred calendar on which they were born.

Traditional Indigenous Maya midwives address two shortcomings of the formal health sector in Guatemala: they offer care in Mayan languages, which is seldom offered in health centres, and are available in remote rural areas. Yet the relationship between traditional Indigenous midwives and the communities they care for goes beyond pragmatism. As the grandmothers that see the children they helped bring into this world grow, traditional Indigenous midwives are viewed as an important part of the Mayan medicine model, and therefore, respected within the Mayan worldview.

While some members of the formal health staff in Guatemala strive to respect and understand the Mayan worldview and medicine model in order to provide culturally-pertinent care, traditional Indigenous midwives are commonly discriminated against or outright barred from accompanying their patients into health centres – despite the fact that almost 70 percent of births in Totonicapán are attended by traditional Indigenous midwives, with less than 30 percent taking place in the formal health sector.

Formal Guatemalan Ministry of Health Staff

PIES has for years been an advocate of culturally-pertinent MNCH care among formal health staff

The MNCH project will see PIES train this essential body of community care providers, with more than 1,000 traditional Indigenous midwives being trained in updated – and culturally appropriate - MNCH practices, as well as provide clean delivery kits. This will not only help achieve safer births but also strengthen traditional Indigenous midwives’ abilities to identify early danger signs of higher-risk pregnancies and make the necessary patient referral to the formal health sector.

For years, our partner PIES has advocated that increased acceptance of traditional midwives by the formal health sector leads to increased use of formal health care services. Indeed, our project baseline study noted that women in Totonicapán were more likely to use formal MNCH services if their traditional Indigenous midwives were more accepted in health centres. To overcome the barriers between traditional Indigenous midwives and formal health staff, the MNCH project will train 250 formal health staff and more than 600 nursing and medicine students, the future public health personnel, in culturally pertinent MNCH care which includes an overview of the Mayan worldview and medicine model.

We hope this post was a useful introduction to the Mayan worldview and its medicine model, which plays a part in transforming the lives of Indigenous women, children and families in Guatemala through this important project. The project, which counts on a generous contribution from Global Affairs Canada, would not be possible without the support of our individual and institutional donors.

To learn more and talk about ways to support us, please contact Raúl Scorza at rscorza@horizons.ca.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

Recently, part of the Horizons team traveled to Guatemala to evaluate and officially inaugurate our maternal, newborn and child health (MNCH) project in Guatemala alongside our local partner, the Association for Health Promotion, Research and Education (PIES de Occidente). We’d like to share an account of our trip to bring you closer to this important project.

After flying over the northern tip of Central America and driving on roads that snaked up the steep mountainsides of Guatemala’s western highlands, we arrived to the city of Quetzaltenango, or Xelaju (Xela for short) in Maya K’iche’. It is here that we first met with the Observatory on Reproductive Health (OSAR).


Quetzaltenango, or Xelaju (Xela)

OSAR was established in Quetzaltenango in 2009 as an entity consisting of more than 20 civil society organizations - including PIES. The Observatory was designed to monitor the Guatemalan state’s commitments to reproductive health, especially for Indigenous women. We sat down with OSAR Director Telma Suchi and her colleague Juan Alberto Cutz to catch up on their work and discuss the state of maternal-child health in Guatemala.

Suchi and Cutz talked about child and adolescent pregnancies in Guatemala, a troubling phenomenon that has been on the rise. In 2009, 41,000 girls from the age of 10-14 became pregnant. By the end of 2016, it is estimated that this number will reach 67,000. Pregnancies at a young age have a direct impact on maternal-child health. Girls under the age of 15 are five times more likely to die during pregnancy than women above the age of 20, and children born to mothers who are under the age of 18 are sixty percent more likely to die before they turn one year old. Worryingly, OSAR found that some of these child and adolescent pregnancies were the result of sexual violence perpetrated by a person close to the victim.

OSAR works to address this issue by advocating for reproductive education among youth, an effort to chip away at the cultural taboo surrounding sexuality, and lobbying officials to create legal mechanisms through which young girls can be protected. We are glad to confirm that OSAR will give a presentation on the impacts of gender violence on maternal-child health to the first delegation of Canadian MNCH providers participating in the project's planned knowledge exchanges

Horizons and PIES teams

Horizons and PIES teams at a work meeting

Next, we met with PIES to review the progress to date on the MNCH initiative. Largely funded by Global Affairs Canada, this project aims to contribute to the reduction of maternal and child mortality and improve maternal-child health by strengthening the delivery and use of MNCH services. As a baseline study conducted for the project demonstrated, these efforts will take place in the midst of a critical situation for the Ministry of Health in Guatemala.

The Ministry of Health was not insulated from the corruption and fraud that gripped Guatemala’s last administration, found to be orchestrated by people in the highest levels of government. Diverting funds earmarked for medicine purchases to the hiring of cronies and creating “duplicate” managerial positions that led to a bloated administration, coupled with a fall in state resources, have put the already precarious Guatemalan health care system in a direr situation. In Totonicapán, the province where the project will be implemented, crumbling infrastructure and a chronic lack of medical equipment and supplies is commonplace in health posts, clinics and centres.

Momostenango CAIMI

The Momostenango CAIMI (Centre for Maternal Child Care)

Dr. Ariel Diaz

Dr. Ariel Diaz explains the power cuts at the CAIMI

A short visit to Momostenango, a municipality in Totonicapán, and its Centro de Atención Materno Infantil (CAIMI – Centre for Maternal Child Care) demonstrate this reality. CAIMI Director, Dr. Jorge Ariel Díaz, showed us the challenging conditions in which his staff provides maternal-child care: An irregular and usually non-existent supply of oxygen, the complete absence of a blood bank and even a frustrating problem with electrical power, which forced one of the Centro obstetricians to perform a C-section under the light of his cell phone.

Dr. Díaz noted that while these issues affect patients equally, Indigenous people have to deal with the added challenge of a navigating a formal health system that virtually marginalizes them. Dr. Díaz’s CAIMI is one of few that offers culturally-sensitive care (signs in both Spanish and Maya K’iche’, an inpatient ward with traditional Mayan bedding), a tragic paradox in a province where 93 to 97 percent of the population self-identifies as Indigenous Maya K’iche’. More often, Indigenous peoples cannot receive care in their first language, are ridiculed when reporting ailments that are dismissed as “superstitious” and have difficulty arriving to the health posts and centres due to the rural settings in which they live.

Inpatient Ward Momostenango CAIMI

Momostenango CAIMI's Inpatient Ward, with culturally-sensitive bedding

It is in this context that the MNCH project will seek to improve the maternal-child health situation for Indigenous peoples in Totonicapán, providing some ‘breathing room’ for the pressed Ministry and transforming the lives of women, children and families.

As part of the initiative, 170 community health posts like Dr. Diaz’s will be fully stocked with medications and medical equipment essential to quality MNCH care. Additionally, current and future formal health providers will receive a module, in association with one of Quetzaltenango’s most prominent universities, in culturally-pertinent MNCH care. Fortified nutritional supplements will also be distributed to thousands of women and children, helping improve nutrition –key to better MNCH outcomes. Further, more than 1,000 Indigenous traditional midwives and 250 community health promoters will be trained in culturally-relevant, updated MNCH practices and receive proper MNCH equipment. This cadre of community health providers is vital in closing the Ministry’s gaps in providing care to Indigenous rural populations.

Health Promoters

Project health promoters hold up the "best-practices" wheel used in their visits

PIES has let us know that the core team of Indigenous traditional midwives who will be intensively trained in quality MNCH practices, and will proceed to train other traditional midwives in the province using a “train-the-trainer” approach, have been selected – and even received the first couple capacity-building workshops. Additionally, the bulk of health promoters who will visit rural communities in municipalities throughout the province to focus on family planning and the early detection of warning signs in pregnancy have also been selected and are currently undergoing training.

San Andres Xecul

Panorama of San Andres Xecul, with its renowned, central church

One of those municipalities, San Andres Xecul, was chosen as the place to formally inaugurate the MNCH project. Hundreds of families and individuals joined members of PIES and Horizons’ teams, representatives from the Canadian Embassy in Guatemala and officials with the Totonicapán branch of the Ministry of Health for the inauguration.

After words from PIES’s legal representative and the mayor of San Andres Xecul, PIES Project Coordinator Dr. Iris Champet, Canadian Ambassador Deborah Chatsis, Horizons Executive Director Patricia Rebolledo and Ministry of Health official Dr. Higinio Flores shared their perspectives on this crucial project. Horizons also presented the 2016 Founders Award, with accompanying certificates from Cobourg Mayor Gil Brocanier and Northumberland-Quinte West MPP Lou Rinaldi, to the Midwives of Quetzaltenango for their selflessness and conviction in ensuring women and newborns are cared for.

MNCH Midwives Founders Award 2016

Horizons ED Patricia Rebolledo presents the 2016 Founders Award to the Midwives of Quetzaltenango

Rebolledo, Dr. Champet, Ambassador Chatsis and Dr. Flores then placed their names on a symbolic, inaugural certificate to mark the official launch of the project. After this, a portion of the team of health educators and promoters were presented in their traditional Maya attire and performed a traditional Maya dance.

Symbolic Certificate Inaugurating MNCH Project

Signing of the symbolic certificate formally inaugurating the MNCH project

Once the inauguration concluded, Horizons’ team toured the Centro de Salud Permanente (CAP – Permanent Health Care Center) of San Andrés Xecul. This CAP is another exception to the lack of cultural sensitivity in maternal child care in Totonicapán. Evidence of this is its strong promotion of the benefits of breastfeeding – both in Spanish and Maya K’iche’, and even in pictorial form. However, the CAP is not exempt from the widespread undersupply of medical equipment. Head Nurse of the CAP, Jenny Ramírez, said that medical instruments as basic as stethoscopes are in urgent need of replacement – a telling sign of the critical state Guatemala’s formal health care sector is in.

Canadian NGOs for MNCH in Guatemala

Canadian NGOs for MNCH in Guatemala meet, along with Guatemalan Ministry and Department officials / Photo Credit: Canadian Embassy in Guatemala

CAP San Andres Xecul

Head Nurse Ramirez of the San Andres Xecul CAP

Finally, Horizons had the opportunity to make new connections and share information on the MNCH situation in Guatemala. Horizons was invited to a session organized by the Canadian Embassy in Guatemala, where Canadian NGOs carrying out initiatives to strengthen maternal, newborn and child health could meet with each other and introduce the projects being carried out in the country. Representatives of the Guatemalan Ministry of Health and the Guatemalan Department of Food Security, along with officers of the United Nations World Food Programme in Guatemala, were also in attendance, and fruitful conversations on improving MNCH took place.

As this account hopefully showed, this project will transform the lives of Indigenous women, children and families, responding to on-the-ground needs identified by a local partner. Your support will help enable that transformation, so if you would like to reach out, please contact Raúl Scorza at rscorza@horizons.ca - and make sure to view all the visit photos on our Facebook page!

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

Thank you for visiting Horizons' maternal, newborn and child health (MNCH) project blog. We've posted a bit earlier than our usual bi-weekly schedule to share exciting news: the application form for the first of five knowledge-exchange visits between Canada and Guatemala is now available online!

Horizons has embarked on a four-year project alongside its Guatemalan partner, the Association for Health Promotion, Research and Education (Pies de Occidente), to contribute to the reduction of maternal and child deaths and improve MNCH in Totonicapán, Guatemala. As part of the project, which is largely funded by Global Affairs Canada, Horizons has organized a series of international knowledge-sharing visits between Canadians and Guatemalans, with the following end-goals:

  • Deepening Canadians' understanding of the importance of MNCH in Guatemala, Canada and globally 
  • Sharing knowledge between equals, helping enable cooperation between Canada and Guatemala to improve MNCH
  • Raising awareness of how the project aims to improve MNCH in Totonicapán

Each exchange visit will last 10 days, with the first Canada to Guatemala trip taking place from February 19-28, 2017 and the first Guatemala to Canada trip occurring from March 19-28, 2017.The cohort of 10 Canadians that will learn about the challenging MNCH realities Totonicapán, as well as share experiences and knowledge with their Guatemalan counterparts, will have an opportunity to participate in some of the tentative activities outlined below.

Canada to Guatemala
Proposed Activities
Overview of Guatemala, Canada relation; Guatemalan Public Health expert explains health care system crisis
PIES introduces Project; Mayan Priest presents Mayan worldview; Participants accompany Traditional Indigenous Maya midwives; Explore Quetzaltenango market
Workshop on Culturally Pertinent MNCH care at Guatemalan university; Participants accompany personnel in health centres; Visit glassblowing co-op 
Participants attend community health session for pregnant women and families; Participants accompany Traditional Indigenous Maya midwives; Visit Museum of Mayan Garb
Participants deliver basic workshop on neonatal resuscitation/ALARM programs to medicine, nursing students; Participants attend session in support of MNCH with Indigenous leaders; Participants interviewed by media involved in pro-MNCH campaign
Participants learn how gender discrimination and violence impact MNCH; Participants present workshop on basic, pertinent MNCH practices or Aboriginal Health practices and issues to traditional midwives; Participants attend health home visits or present basic NRP/ALARM workshop to health personnel 
Traditional Mayan ceremony; Feedback on exchanges; Visit to Chichicastenango market; Participants explore Quetzaltenango
Depart for and explore Antigua; Return to Guatemala City; Feedback on exchanges and dinner at Hotel Conquistador

Horizons will ask participants to meet the following expectations prior, during and after the exchanges.

  • Before departure, read preparatory literature distributed by Horizons and attend mandatory briefing sessions.
  • During the visit, provide feedback on the exchanges in order to assist Horizons in creating a document detailing best practices in engaging the public in MNCH. The document will be published in English, Spanish and Maya K'iche.
  • Upon return, raise awareness in Canada of the importance of MNCH and how the project aims to improve the same in Totonicapán. 
Participants are strongly encouraged to welcome the visiting cohort of 5 Guatemalans (including traditional Indigenous Maya midwives and other health providers) for public events to help meet the awareness expectation, but this is only one of many ways through which participants can profile MNCH and the project in their communities.   

There is only one necessary criterion to participate: being professionally involved in an MNCH-related field or being a prominent community advocate in support of MNCH.

This includes, but is not limited to: 

Potential Participants
Midwives Public health personnel
Nurses Early childhood development specialists
Physicians Community leaders
Community health or social workers Gender violence experts

However, when reviewing applications, Horizons will consider the below experience and qualities as assets.

  • Experience providing care to, or working with, underserved populations or Aboriginal Peoples
  • Eager to learn about MNCH from a social justice perspective
  • Open to learn about, and share, Indigenous approaches to health
  • Knowledgeable in ALARM International, Neonatal Resuscitation or Emergency Skills Workshop Programs
  • Committed to raising awareness for the entire duration of the project
  • Able to demonstrate record of supporting gender equality
  • Moderately fluent in Spanish

The application form, which you can find here, will be available until midnight, October 13th

Horizons' Info Session on Knowledge-Exchanges

Keep track of Horizons' events to attend a session on the exchanges!

After the deadline, Horizons' Selection Committee (consisting of the Executive Director, Program Manager, and Community Outreach Coordinator) will work to select a diverse, multi-disciplinary cohort of participants. All applications are welcome, including those from underrepresented or Aboriginal peoples, and all applicants will be notified of results on October 19th.

A fee of $1500 CAD is required for the exchange. This fee will cover the match for participants' own expenses - which include accommodation (hotel), transportation (ground transport), meals (breakfast, lunch, dinner), and workshops - and help partially cover the same expenses for Guatemalan visitors. Horizons will clarify which expenses are not covered by the fee.

Remember: You may learn more about the knowledge-sharing visits at our upcoming information session at Peterborough Public Health on Tuesday, Sept. 20th. Click here to get more details and RSVP.

If you have any questions about the project, the knowledge-sharing visits, or your application, please contact Raúl Scorza at rscorza@horizons.ca.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

We welcome you once again to Horizons’ bi-weekly blog series on its maternal, newborn and child health (MNCH) project, which will transform Indigenous lives in Totonicapán, Guatemala thanks to funding from Global Affairs Canada. Our previous post highlighted the opportunity to participate in international knowledge-exchange visits between Canadian and Guatemalan MNCH providers and leaders being organized under this initiative. It’s not too late to attend one of our information sessions covering the exchanges on September 13th in Cobourg and September 20th in Peterborough – RSVP here and here, respectively.

Be mindful that you don’t need to be a specialist to support work that will better the lives of Indigenous women, children and families in Guatemala. In fact, you don’t even have to be out of elementary school to advocate for greater social justice like improved MNCH outcomes for Totonicapán’s Indigenous people. As this post will show, Horizons is striving to engage Ontario’s youth in this important project, and is thrilled to announce an exciting partnership to do so.

Youth are the future leaders of our society, and as such, play an essential role in addressing global issues. The possibility for youth to become catalysts for positive social change comes in no small part from their being subject to the world’s most pressing challenges. This is clear in the case of maternal and child health issues in Guatemala. Half of the country’s women are already married by the age of 20 and 44 percent give birth by the same age. These statistics rise to 54 and 68 percent for Indigenous women and women without formal education, respectively. And in a shocking and recent report (in Spanish), the United Nations Population Fund revealed that one in five Guatemalan adolescents has become a mother before they even turn 17 years old.

MNCH - Guatemalan mother with her baby

Ontario youth will be engaged in a project that will transform Indigenous lives in Guatemala

As if these figures were not alarming enough by their own, they become more so when considering Indigenous women are twice as likely to die during pregnancy and childbirth as non-Indigenous women in Guatemala. In Totonicapán, where approximately 94 percent of the population is Indigenous, this translates into almost twice the number of average maternal deaths in the country.

Horizons and its Guatemalan partner, the Association for Health Promotion, Research and Education (PIES de Occidente), will take concrete steps to contribute to the reduction of maternal and child deaths and the improvement of MNCH for Indigenous women, children and families.

But Horizons has also had more than 40 years of experience coordinating public engagement activities in Canada related to international development projects, and has learned that youth in Ontario are highly motivated to help address global issues, such as Totonicapán’s critical MNCH situation. However, youth have pointed to multiple barriers preventing them from becoming agents of social change.

Women Deliver, an international institution advocating for women’s health and women’s rights, found that youth from across the world identify the following as factors that prevent youth from being meaningfully involved in global issues, such as maternal and newborn health:

• A lack of accessible information
• Decision-makers placing low trust in the opinions youth express
• Shortage of spaces and opportunities for international engagement

Horizons is proud to announce that it has partnered with the Elementary Teachers’ Federation of Ontario Kawartha Pine Ridge Local (KPR ETFO) to help Ontario youth overcome these barriers and be meaningfully engaged in a global issue as important as MNCH in Totonicapán.


Horizons is thrilled to have partnered with KPR ETFO to engage Ontario youth

Every year of the project’s duration, Horizons and KPR ETFO will invite three Grade 8 classes, each in a different school in the Kawartha Pine Ridge District, to participate during a school term in a roster of five activities that will raise awareness of MNCH issues in Totonicapán. The roster is designed to build upon an accessible introduction to MNCH and culminate in a review of methods for peer-based youth action on global issues like MNCH. Starting in the Spring of 2017, activities will include presentations, workshops, role-play, and critical reflection exercises, as well as visits by Guatemalan delegations of traditional Mayan midwives and health providers that will grant participants a unique opportunity to meet and learn from project beneficiaries.

Participating students will develop qualities facilitated by social justice education, like empathy for different individuals and groups, the ability to recognize bias and discrimination and critical thinking. This in turn will contribute to the creation of strong and diverse communities – inside and outside the classroom.

Teachers that commit to the roster will have the opportunity to attend a preparatory professional development workshop with Horizons on teaching social justice themes to youth. This will provide a chance to impact the design, selection and integration of roster activities into lesson plans. Further, educators will notice direct links to the Ontario Grade 8 Geography Curriculum. Building on Citizenship Education Framework themes, roster activities will help fulfill Global Inequalities: Economic Development and Quality of Life expectations, like: addressing factors contributing to global inequalities and quality of life, investigating quality of life issues through a geographic perspective and identifying patterns and trends affecting quality of life and economic development.

Finally, to ensure the voice of Ontario youth is heard, participating students will be continuously asked to evaluate Horizons and KPR ETFO’s program. Their input will not just shape and update activities, but will also be featured in a publication detailing best practices in engaging the public in MNCH issues to be distributed to health providers in Canada and Guatemala.

“This project will provide students and teachers rich learning experiences about issues of justice relevant to all citizens across the globe”, says David Berger, First Vice-President of KPR ETFO. “Partnering with Horizons for this program, an organization ETFO has supported for many years through its Provincial Humanity Fund, will help our youth bridge the gap between the international and the local”.

Horizons reminds non-school youth groups interested in raising awareness of MNCH challenges in Totonicapán that they too can support this project. For more information about this possibility, or to learn more about the youth engagement program, contact Raúl Scorza at rscorza@horizons.ca.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

Welcome (back) to our bi-weekly blog series on our maternal, newborn and child health (MNCH) project. Thank you for visiting us every second Monday to learn how this initiative, with funding from Global Affairs Canada and alongside our local partner PIES de Occidente, will transform Indigenous lives in Totonicapán, Guatemala. In our previous post, we interviewed our Program Manager, René Guerra Salazar, to go over how the project aims to improve MNHC, how these strategies fit into the current situation in Guatemala and how Canadians can support these efforts.

Today, we will talk more about one particular way in which Canadians can contribute to this project: participating in knowledge-exchange visits between Canada and Guatemala.

To help Canadians become more engaged in advocating for improvements in MNCH, Horizons is organizing international exchanges where knowledge and experiences will be shared between members of vocational groups concerned with MNCH in Canada (ranging from physicians, midwives, nurses, and community health workers to specialists in public health and early childhood development) and MNCH providers and leaders in Guatemala – including traditional Indigenous Maya K'iche midwives.

Over the four-year duration of the project, five exchange visits from Canada to Guatemala, each involving ten Canadian participants, will take place. Similarly, five exchange visits from Guatemala to Canada, each involving five Guatemalans, will be carried out during the project’s lifespan. Horizons will strive to involve, in particular, Canadians that work with underserved populations like marginalized urban communities or Aboriginal peoples.

The exchanges from Canada to Guatemala will allow Canadians that are professionally involved in MNCH to witness first-hand the challenging realities faced by women, children, families and care providers in Totonicapán, a province with one of the highest maternal mortality rates in Guatemala. This in turn will enable exchange participants to be credible ambassadors in supporting the project and international cooperation, with Horizons providing guidance on reaching out to health and community networks here in Canada, both pre- and post-departure.

MNCH Knowledge Exchange Info Session September 13

Visit our Facebook page for more details

It is important to note that these exchanges are not designed to be service-based missions, as is common with medical brigades.

There is a need for traditional Indigenous midwives, the main primary care providers who attend approximately 70% of live births in Totonicapán, to strengthen their MNCH practices – a need that will be met by the rigorous and culturally-relevant training PIES will provide for 1,040 traditional midwives as part of the project. But why, in the first place, are births in institutional settings in Totonicapán below 30%? Why has Totonicapán, a province that is predominantly Indigenous, experiences strenuous levels of poverty and lacks infrastructure and a significant state presence, continuously reported one of the highest maternal mortality rates for over 15 years? And why do traditional midwives use the words “discrimination” and “dismissal” when describing how they are treated by the formal health sector?

These are questions that hint at persistent, systemic inequalities, a legacy of Guatemala’s turbulent political past. With a social justice lens on MNCH, the exchanges will provide opportunities for participants to go beyond a solely ‘technical’ medical intervention. For example, Canadians visiting Guatemala will learn about the social and economic structures that create gaps for Indigenous peoples in the country’s already unstable health care system from a Guatemalan public health expert. They will also listen to how gender discrimination and violence affect MNCH from the Guatemalan Observatory on Reproductive Health.

In addition, the exchanges will stress the fact that knowledge-sharing is a fundamentally reciprocal process that occurs between equals.

Horizons is convinced of the importance of Indigenous approaches to health, and firmly believes that recovering and respectfully promoting them can create spaces for traditional and Western medicine to not only coexist, but learn from one another. This is why the exchanges are designed to be two-way avenues of learning. An example: Canadian visitors to Guatemala highly trained in the ALARM International or Neonatal Resuscitation Programs will introduce basic concepts to appropriate Guatemalan counterparts, but will also learn of traditional medicine and midwifery from traditional midwives and will have a chance to accompany them in their day-to-day.

The knowledge-exchanges will therefore invite participants to address global health from a social justice perspective, to open the door for a critical introspection of their practice and experiences, to foster long-term solidarity that could lead to further international cooperation and to raise awareness of the need to improve MNCH in Totonicapán.

Horizons will release a call for participants for the first Canada to Guatemala exchange visit, planned for February 2017, in early September. A number of information sessions that will cover full details (dates, selection criteria, expectations, activities, itinerary) of the exchanges will be held in the coming weeks. The latest are scheduled for:

  • Tuesday, September 13th at 7pm in Horizons of Friendship’s Offices

  • Tuesday, September 20th at 5:30pm at Peterborough Public Health

The first of these sessions specifically invites Canadian midwives and nurses to attend, as they will have the opportunity to contribute to designing the activities planned for the Guatemala to Canada exchanges.

Please visit our events page on Facebook for more information and to RSVP for both.

Thank you for your generous and continued support, which makes this project possible.

If you want to know more about the exchange visits, the information sessions or the project, please contact Raúl Scorza at rscorza@horizons.ca.