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MNCH: Traditional Mayan Medicine, Traditional Indigenous Midwives and Formal Health Staff - Towards Culturally-Pertinent Care

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.

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