A Glimpse into the Mysterious World of Mayan and Ladino Traditional Birth Attendants´ in Guatemala.
Introduction:
This first article presents the Mayan and Ladino Traditional Birth Attendants´ in the Macro context of Guatemala. We describe the current situation of the Traditional Birth Attendants´ within the frame of the Public Health problems in Guatemala.
Further on we will publish articles with more specific contents related do the complex world of the Guatemalan Mayan and Ladino Traditional Birth Attendants´. Their mysteries, mission, vision, their heritage of the Maya culture, Maya traditional medicine and practices, as healers, as leaders and as a link to the modern world. We will describe the problems of the Guatemalan Mayan and Ladino Traditional Birth Attendants´ and their ability to survive the complex political situations of the 35 year civil war in Guatemala. We will tell their stories and experiences with their patients, life and death situations, how they save lives under the most adverse situations and their immense capacity for human compassion and thirst to learn more to help the mothers and baby's that they have under their care.
As a physician I have worked with Guatemala's Mayan and Ladino Traditional Birth Attendants for over 20 years. They are the most extraordinary women I have had the privilege to meet. Their courage and their singular role in Mayan and Ladino rural indigenous population are little known and mostly misunderstood. The myths, bias and fallacies surrounding their work are innumerable and are strongly entrenched in the official health personal (medics and nurses) and the many people that never meet them.
We hope to shed some light on this important issue using rigorous scientific information generated and accumulated during 20 years of research and hands-on experiences with Guatemala's Mayan and Ladino Traditional Birth Attendants. The challenge is to present it in a language that scientists and the rest of the world will understand.
A macro perspective of the situation of Guatemalan Mayan and Ladino Traditional Birth Attendants.
One of the special situations of Guatemala's Public Health system is that it has the capacity of attending only 20 - 30% of all births in the public hospitals. This statistics vary according to rural and urban population and Ladino and Maya communities. Guatemala City is an exception with many more hospital births compared to Peten or Huehuetenango, Quiche and other highland departments. The population growth is faster than the capability of the Guatemalan Government to provide sufficient basic health services and hospital beds.
Guatemalan Mayan and Ladino Traditional Birth Attendants attend approximately 50% of all births in the country, again this trend is much more seen in the rural than the urban areas. They attend at least once 75% of all pregnancies that happen in Guatemala. That makes the Mayan and Ladino Traditional Birth Attendants one of the key elements to improve maternal and neonatal health and above all, to reduce maternal and neonatal mortality in the country.
Disregarding this important key role in Maternal and neonatal health of the Mayan and Ladino Traditional Birth Attendants, the public health policies and recourses are not addressing their needs. They are mistreated, disrespected, scolded, interrogated and sometimes put in jail because they are seen as the cause of the problem and not the solution.
This is a phenomenon that can be observed all over the world in countries that have Traditional Birth Attendants.
The Ministries of Health all want to be modern and politically correct in the ambiance of international public health, what works in Geneva and is promoted in Geneva is the gold standard. And all Ministers of Health want to look good at the International Health Conferences. It looks bad to the international community if women do not give birth in hospitals, even if they die there unattended as it is often the case in Africa, Guatemala and many other countries with similar problems as ours. Ministers of Health want the latest technologies, they want to be "modern" have the latest western technological advances, even if it is not usable in their respective environments.
The technology, the "know how" to train the Traditional Birth Attendants and all levels involved in maternal and neonatal care exist. They have been proven successful and can be done. Successful models have proven that the link between Traditional Birth Attendants, their patients, the rural Mayan and ladino communities and the public health system can be made efficiently and at low cost. Emergency transport using a communal fund for gasoline to be repaid by the families who need to use it, do work.
Changes in attitude of health personnel are possible, it all has been done and documented.
The only thing lacking is political will.
Within this complex ongoing situation, the Traditional Birth Attendants just keep doing the best they can. Regardless if they are recognized, rewarded, ignored or misunderstood, with and without resources they are delivering babies every day, doing prenatal care, look after the women after the birth and walk miles and miles on foot at day and at night, rain or shine, to do their job. Sometimes they get paid, sometimes they get a chicken, sometimes they go to jail.
Traditional Birth Attendants in Guatemala and around the world are working on.
Photos: Mayan woman. Ignacio de Wit | Puppets. Barbara Schieber
