Appropriate Health Programming: Why Clinical Solutions are Not Enough

Imagine briefly that heart-stopping moment: Your child suffers a medical emergency and you rush them to the nearest hospital, eager for quick and efficient treatment. This time, as you wait helplessly at the door of the emergency room, you are turned away because there are not enough supplies or doctors on staff due to a national debt crisis. What can you do if you or a loved one is sick and hurt and there is nowhere for you to go? How can it be fair that your government isn’t protecting taxpayer money that you’ve given them for even the most basic services? Where can you find hope when the doctors are on strike because they too, have given up?

This is what the people of Guatemala are currently facing when in need of health services, and it’s difficult to imagine being in their place. As of November 2015 and continuing on into the new year, there has been a major medical crisis going on in Guatemala. The country is suffering due to a lack of funding for public services, including hospitals, as a result of a major import and customs tax scandal called “La Linea.” This customs fraud ring involved officials receiving bribes in exchange for discounted tariffs, “a scheme that effectively stole millions from the treasury.”1These politically corrupt actions and mismanagement of public funds by now incarcerated government officials is tearing apart the already weak medical infrastructure in Guatemala, making it impossible for hospitals to treat people, and leading to major strikes by doctors and health officials that keep them from doing their jobs and serving the people.

Additionally, Guatemala’s health system consistently fails to allocate resources to indigenous and rural populations outside of cities. A 2015 USAID study of the state of Guatemala’s health system, presented to the Ministry of Health in February 2016, pointed out some very troubling and historic inequalities. Due to geographic and ethnic inequalities in provision of health services, the study found that the maternal death rate is 4 times higher in indigenous regions outside of the capital, resulting in rates of 159 indigenous maternal deaths per 100,000 births, as opposed to 79 per 100,000 non-indigenous births. Another finding was the unequal allocation of health workers in rural areas, with 3 workers for every 10,000 rural indigenous inhabitants compared to 26 workers for every 10,000 inhabitants in urban sectors. Worsening this inequality is the fact that Guatemala’s spending on health care is the lowest in Latin America, tragically spending no more than 1.2 percent of its GDP, where the average public investment in this region is between 4 and 6 percent.2

Members of the legislature of the health commission for San Juan de Dios hospital in Guatemala city, one of the largest and most important hospitals in the country, requested in February that the president declare a state of emergency after visiting the hospital to see first hand the deplorable state.  In spite of witnessing such disgraceful situations as patients purchasing their own medication for operative procedures only to be told that the wait for entry into the operating room is often seven months long, government officials continue to rule out the option of declaring a state of emergency, and hospitals continue to attempt to operate without enough funding, millions of quetzales in debt, and with doctors regularly on strike.3

All these terrible statistics paint a very bleak picture for Guatemalans, especially those indigenous populations living in rural areas. Though we cannot, as a small grassroots organizing entity, solve the health crisis in Guatemala, we can- and do- work to change commonly held perceptions about what proper healthcare means to rural Guatemalan families, and assist them in a process that will sustain their health and livelihood using principles and practices of traditional Mayan medicine. We strive to integrate the ancient cultural knowledge of Mayan medicine and healers with the newer, western model that has only recently been brought to Guatemala. Within HSP and AMA, this integrative and culturally relevant health model is what we call Appropriate Health Programming.

When certain foreign aid groups come to rural, underserved, and struggling communities in Guatemala with medicine, temporary clinics, or even constructed clinics, they come with good intentions, but a very different model of health that clashes with the culturally relevant model of health currently practiced in those Maya communities. Unfortunately, when western medicine is implemented without a true understanding of rural Guatemala and its history, the results are short-term, providing only temporary relief to illness while instilling a worldview of dependency and an inability to achieve sustainable, local healthcare.

AMA and HSP’s Appropriate Health Programming helps those rural Guatemalan families gain access to adequate healthcare in their communities before having to travel long distances to hospitals and clinics, focusing on health education and empowerment as preventative medicine. These principles are derived from the practice of Mayan medicine, which sees the world of the human body, health, and healers in a very different way than we do in the West. The integration of western health practices and modern medications with education on how to stay healthy, including a focus on community-identified needs like diabetes education, anatomy and reproductive system workshops, and eradication of upper respiratory infections through the use of smokeless stoves, all steeped in relevant cultural context, are key aspects of the locally developed appropriate health curriculum aimed at sustainably improving health care in rural Guatemala.

A great example of the Program at work is the holistic nutrition class given to health promoters, midwives, and interested community leaders. Rural Guatemala has a 70% malnutrition rate, with stunted growth and brain development issues being the most tragically prevalent result.  Due to lack of access and popular marketing, communities are eating nutritionally vapid, processed and imported foods that are cheap and easy to prepare. Without proper nutrition, children struggle to focus in class, a common issue raised by teachers involved in AMA’s Mayan Arts Program.  Without a nutrient rich diet, unfocused students are performing poorly in school, and are often held back due to their inability to stay awake, let alone thrive, in the classroom. AMA has collaborated with local health promoters, PTAs, school officials, and  women’s circle members to give workshops about nutrition and cooking that help parents understand the importance of nutritious foods and their effects on the body, as well as how to take advantage of locally-produced ingredients and vegetables, equipping them with new recipes and cooking techniques to ensure the health of their children and families.4

In addition to the nutrition workshops, community members identified the need to address the increased number of maternal deaths in rural communities. Without access to healthcare, less than 5% of indigenous mothers end up giving birth in a health facility, resulting in a greater need for access to local birthing resources and tools, including trained midwives, that can assist a mother in her home.5  With this in mind, AMA and HSP formed an alliance with the midwifery training program, CODECOT, that trains rural Maya women in the traditional practice of a midwife, an invaluable and absolutely necessary part of Maya society.  30 of AMA’s women circle members are enrolled in the program, learning the importance of midwifery in their culture, the use Mayan medicinal plants, basic health checks during pregnancy, breastfeeding techniques, signs of complications during pregnancy and birth, and when to refer a woman to a hospital. The goal is to help these women be as educated as possible about infant, maternal, and child health, empowering them and their communities so that everyone has the best chance of good health and survival.

As always, it is through the empowerment of the communities themselves, and local educational efforts with our partners near and far, that a sustainable health system is developed, allowing indigenous families to break free of the system of dependence that has ultimately failed them.  With the community leaders as a guiding force and experts in Maya history and culture as consultants, AMA and HSP are working toward a day when, in spite of government corruption and misuse of resources, the rural Maya communities of the highlands can achieve community health and prosperity.

Karen Mayorga