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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!