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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.

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

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
Arrival
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
Departure

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.

KPR ETFO

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.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

Thanks for checking back on Horizons' bi-weekly blog series on our maternal, newborn and child health (MNCH) project in Totonicapán, Guatemala - out every second Monday of the month! In the last blog entry, we delved into the meaning of MNCH, its global importance, and Canadian efforts to help strengthen it abroad. For this post, we sat down for a conversation with René Guerra Salazar, our Program Manager for the MNCH project. We hope you enjoy the interview as René speaks to project details, the Guatemalan context in which it will take place and how Canadians can help. Shout out to Candace Ellison for helping us with this post!

Horizons: How would you briefly summarize Horizons of Friendship's new MNCH project? 

MNCH René Blog Interview

Program Manager René Guerra Salazar, wearing a traditional Mayan tzute as a baby carrier

René: It’s an ambitious initiative that aims to directly benefit more than 200,000 Indigenous Maya K’iche women, children and their families by improving the delivery and use of culturally-relevant MNCH services.  The project spans the entire Guatemalan province of Totonicapán, which has some of the poorest health indicators in the country.  It’s a social justice intervention as well, as it targets the significant health gaps faced by Indigenous Guatemalans – product of the structural racism Indigenous Guatemalans suffer daily. The project also aims to engage Canadians on the importance of MNCH locally and globally.

H: So what is the current Guatemalan context in which the MNCH project will take place? 

R: In one word: crisis. The Minister of Health resigned only a few weeks ago given the dire state of the public health care system. Multi-million dollar corruption scandals, including in the health sector, have rocked the country over the last couple of years. In the meantime, Guatemalans continue to suffer from a lack of quality health services. Community health centres are severely understocked and patients often have to take their own medicines when seeking care, even under emergency situations. This is worse if one happens to be Indigenous.

That said, there is hope. The newly appointed Health Minister, Dr. Lucrecia Hernández Mack, was Guatemalan civil society’s preferred choice. She’s known for her public health expertise and also happens to carry the social justice legacy of her martyred mother, Myrna Mack Chang – a respected Guatemalan anthropologist murdered by government security forces for her defence of Indigenous peoples’ human rights.

H: Given that crisis, what are some of the ways in which the project plans to contribute to the reduction of maternal and child mortality and improve MNCH in Guatemala? 

R: We can start with the impressive goal of training more than 1,000 Indigenous traditional midwives and 250 community health promoters in updated MNCH practices. This is essentially the entire body of community-based primary care providers in Totonicapán. Despite their importance to the health of women and children, traditional midwives and health promoters aren’t properly recognized by Guatemala’s formal public health care system. They’re discriminated against, undervalued and under-resourced. This project aims to help change that. With proper training and better equipment, they’ll help save lives – plain and simple. We’ll also work with Ministry of Health personnel and medical/nursing students to increase their knowledge of, and respect for, traditional Indigenous health practices – the very same practices that the overwhelming Maya K’iche population of Totonicapán is familiar with. 

MNCH Comadronas

Traditional midwives will be trained using a "train-the-trainer" approach

We’ll also be fully stocking 170 community health posts with essential MNCH medications and medical equipment – again, clear cut measures that will save lives. Because improved nutrition is also key in improved MNCH outcomes, we’re providing protein-rich, fortified nutritional supplements and micronutrients to tens of thousands of women and children, all of this over four years.

In addition, we will seek to work with male partners and extended relatives. One of the major barriers to proper MNCH care for women and their children is that they ultimately do not have the final say over their care. We’ll be working with communities in terms that are culturally appropriate to help women gain greater sovereignty over their bodies.

One final measure I’ll mention is a mass-media, province-wide MNCH promotion campaign focusing on some standard best practices: exclusive breastfeeding, full vaccination, family planning, improved nutrition and early detection of high-risk pregnancy warning signs. The campaign will be culturally appropriate, with communications in K’iche and other Indigenous languages in addition to Spanish.

H: What makes this project unique compared to Horizons' previous initiatives and other projects in general?

R: Mostly its scale and scope. Horizons has been working in Guatemala and with PIES de Occidente, our local partner, on community health projects for years. It is that successful collaboration that has prepared both organizations to take on this challenging and much-needed initiative. The project is the biggest for both organizations, and it demands some serious commitment. I’m glad to say that we have the right people on board to guide it through to success.

More generally, the initiative is interesting because of its focus on MNCH that is culturally appropriate. In that sense it’s not a simple “technical” health care intervention. While that component is robustly present, the project is one that strives for greater social justice: greater respect for life-saving Indigenous knowledge and practices, greater sovereignty for women over their bodies and health care, and reducing health gaps for Indigenous peoples that have been historically marginalized.

H: Why is MNCH important to you, and why should it matter to Canadians?

R: Health outcomes, and thus MNCH outcomes, tend to be direct indicators of broader social injustice. Why is it that in general terms, poorer populations have worse health outcomes? Why are Indigenous peoples the world over (including in Canada) disproportionately afflicted by health threats? And why do women tend to bear the brunt of most of this? Unless you subscribe to the rather dangerous idea that poorer, more marginalized people are somehow inherently responsible for their poorer health outcomes, the reasons must lie elsewhere. And they often lie in social inequality and discrimination, whether it’s socioeconomic, race, class, and/or gender based.

MNCH Indigenous women

Photo Credit: Paul Caldwell

We see it in comparative MNCH outcomes in Guatemala. Indigenous women and children almost without exception suffer significantly worse MNCH outcomes than non-Indigenous Guatemalans. You’ll find the same gaps in other socioeconomic indicators including education and access to basics such as potable water.

Despite the gloomy picture, it’s well-documented that strategic investments in MNCH improvements can lead to positive lifelong impacts for women and children. Improving the chances of women and children to lead healthy lives strengthens communities and ultimately societies as a whole. So, while MNCH can be a marker of social inequity, it’s also a vehicle for positive change – should we decide to support it.

Fortunately, the health of women and children is a key part of Canada’s official international cooperation program. It’s something we should be proud of – even if there’s still much more work to do as Canadians to contribute to global social justice

H: What then, can Canadians do to support the project and raise awareness of MNCH in Guatemala?

R: Donate! Seriously, we need it! It’s a $13.2 million project for which we’re very grateful to count on Global Affairs Canada’s support. Our government contributes 85% of that budget, and Horizons has to raise the remaining 15%. That’s about $450,000 per year. The good news is that our government’s significant contribution means that for every dollar you donate, it matches it six times.

Further, we want to help Canadians become more engaged in MNCH and other social justice issues. We’ll work hard to talk to folks about MNCH’s importance locally and globally, and would love to connect with interested audiences. For example, we have partnered with a local elementary teachers’ federation to involve youth in raising awareness on MNCH, are reaching out to champions of Canadian-based Indigenous MNCH initiatives and are also organizing knowledge exchanges between Canadians and Guatemalans to help build longer-lasting solidarity. So please, stay in the loop and share this information with your communities. All this work is impossible without the generous support of fellow Canadians.

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

This second post, part of our blog series on Horizons’ maternal, newborn and child health (MNCH) project, talks about the meaning and importance of MNCH globally, highlights Canada’s efforts to improve MNCH around the world, and situates Horizons’ project in that context. Thanks to our volunteer Candace Ellison for helping write this!

MNCH Young Mother and Child

Photo Credit: Charlene Cowling Zeljkovic

MNCH encompasses the health of women throughout pregnancy, childbirth and postpartum; the health of newborns up to 28 days old; and the health and healthy growth of children. These demographics are vulnerable to death due to preventable complications during and following pregnancy. Complications include profuse bleeding, infections and high blood pressure disorders, which can be detected and prevented by the timely intervention of a health provider. The World Health Organization lists maternal and children-under-five mortality ratios as two of the most common MNCH indicators, and though global rates for these indicators have dropped dramatically since the 1990s, work remains to be done in Majority World (i.e. low- and lower-middle income) countries, where 99% of preventable MNCH-related deaths still take place.

Canada has contributed to improving MNCH in these countries, and its leadership in the launch of the Muskoka Initiative at the 2010 G8 Summit brought the country’s role as an advocate for global MNCH to the fore. 

The Muskoka Initiative focused on “improving nutrition, reducing the burden of disease, and strengthening health systems to deliver integrated and comprehensive health services for mothers and children”. Canada provided $2.85 billion in funding over five years in support of the Initiative, and after the Initiative’s end, pledged an additional $3.5 billion over five more years to “improve the health of mothers and children for the period of 2015-2020”. Canada’s contributions have helped strengthen MNCH in over 155 countries worldwide by enabling the training of upwards of 113,000 health workers, the vaccination of 5.8 million children to prevent leading diseases, the distribution of iron and folic acid supplements to pregnant women and more. 

MNCH Dr. Caldwell Talk at Horizons

Dr. Paul Caldwell talks about the benefits of Horizons' new MNCH project in Totonicápan.

Horizons’ “Reducing Gaps for Indigenous People in Totonicapán, Guatemala” project, thanks to funding from Global Affairs Canada, forms a part of Canada’s efforts to improve MNCH abroad. Two weeks ago, Horizons Board President Dr. Paul Caldwell presented a detailed breakdown of how improvements on MNCH in Totonicapán would be achieved to a diverse audience of Northumberland and surrounding area residents. Midwives from throughout the region were in attendance and have begun supporting the project. Horizons is working to partner not only with the midwifery community but also nurses, physicians and health promoters in hospitals and health centers – and even a local teachers’ federation – to facilitate knowledge-sharing between Canada and Guatemala and raise awareness of MNCH issues.

Improving the health of women and children is an essential step in ensuring that vulnerable populations are given equal opportunity to become active members of their communities. An important part of the Canadian identity has and continues to rest on solidarity with those beyond Canada’s borders. 

This makes all Canadians noteworthy advocates of initiatives like Horizons’ project to improve MNCH. Visit our blog again in two weeks to read a brief interview with our Program Manager, who will provide insight into the project’s activities and the situation of MNCH in Guatemala.  

Raul Scorza blog

Raúl Scorza
Community Outreach and Communications Coordinator

Horizons of Friendship, with funding from Global Affairs Canada, is undertaking a new four-year project alongside its partner organization PIES de Occidente (Association for Health Promotion, Research and Education) to improve maternal, newborn and child health (MNCH) in Totonicapán, Guatemala.

The project will improve the delivery and utilization of MNCH services by providing training and equipment to traditional indigenous midwives, health promoters and community health centers in Totonicapán, a region where the population is almost exclusively indigenous Maya K’iche.

Charlene Cowling mother and child MNCH

Photo Credit: Charlene Cowling Zeljkovic

Additionally, this project seeks to deepen Canadians’ understanding of MNCH issues, and strengthen the cooperation between Canada and Guatemala on MNCH, by carrying out a number of public engagement initiatives.

These initiatives include international knowledge-exchange visits to Guatemala and Canada by Canadian and Guatemalan MNCH leaders and professionals, enlisting educational institutions and youth groups in Canada to participate in MNCH awareness raising activities, and presenting opportunities for the general Canadian public to encounter and interact with visiting Guatemalan MNCH providers and traditional indigenous midwives.

In an effort to keep you in the know, Horizons is launching a new series of biweekly blog posts dedicated to the project’s milestones and public engagement initiatives.

Every second Monday starting from today, a new blog post will be published to cover:

• The latest information about key project developments
• Accounts of previous public events and announcements for upcoming ones
• Entries detailing the broader themes underlying the project – the importance of MNCH, gender equality and the coexistence of indigenous and Western medicine, to name a few.

Keep an eye out for special posts written by project supporters and partners, too!

Remember: you can become involved in the project’s public engagement initiatives in more than one way. Let us know if you are a practitioner interested in the exchange visits or represent an institution or group wanting to enlist in awareness raising activities. Follow us on Facebook and Twitter and attend one of our public events near you, or champion the project in your own community and networks.

Your involvement is essential in helping save the lives of women and children in the Western Highlands of Guatemala.