About the Guest Blogger: Majo Aldana is a Guatemalan anthropologist, passionate about people and health. Currently, she is working as an independent consultant for TulaSalud, systematizing seven years of lessons learned from an mHealth project that has helped reduce maternal mortality in Alta Verapaz, Guatemala.
Chamuchuj, Alta Verapaz. One of the communities where TulaSalud currently works. It is 2.5 hours away from the regional hospital, using a 4x4 car. Photo credit: Majo Aldana
Title: What about individual people, individual lives and quality of life of those who survive the country’s statistics?
I just finished a short consultancy in Alta Verapaz, Guatemala, working with a local NGO called TulaSalud and the Ministry of Health (MoH). It was huge learning experience, but also a shocking one. There are always things that consultancies involving fieldwork make me feel and think about, but sometimes there’s not enough spaces to share them. So, this is an attempt to share some of these thoughts and feelings, I ask that you bear with me.
I want to talk about racism, but mostly structural violence against indigenous women in Guatemala, and how it negatively affects maternal and child health. If we really want to strengthen health systems in a sustainable manner, we must address structural violence as well.
Guatemala is beautiful and diverse, with at least 60% of its population being Mayan; in the case of Alta Verapaz, Maya Q’eqchi’. It is also a country dealing with post-war trauma, and issues related to drugs, migration, environmental degradation, and extreme poverty. It’s a full package. This translates into many barriers to basic human rights, including health.
In this mix of realities, the Telemedicina project is contributing to reduce maternal mortality rates through mHealth. Using information and communication technologies (ICT), the time for women to receive attention for some complication related to pregnancy is reduced. The project is based on a partnership model where NGO, local MoH, community and private sector work together to strengthen the local health system. The central figure, the community health worker (CHW), coordinates better and timely health attention to pregnant and post-partum women using a Smartphone, among other ICTs. The uses of the phone go from sending photos of difficult cases via WhatsApp, to coordinating a referral for a difficult pregnancy. With decades of experience, the CHW knows the risk factors for pregnancy, and now has the training to use the Smartphone to keep track of pregnant women in their community, using Kawok, software based on the CommCare platform.
This sounds great, right? The system works. The CHW identifies risky pregnancies, keeps track of them, coordinates a referral using the current health system, and the woman gets to the health center faster.
However, there are still some barriers to tackle. This is an extract from one of the interviews I conducted. A Q’eqchi’ woman that lived at least two hours away from the hospital was near to giving birth, and since she had a C-section before, she needed to go there again. She refused to go. Her husband refused to let her go. For a few hours, there were negotiations, conversations on the Smartphone, explanations. She refused to leave her bedroom. She died. So did her baby.
There was rationality behind this couple’s decision. With the first C-section performed, she was transported from her community in the middle of a rainy night on the back of a pick-up truck. When she finally arrived at the hospital, with her traditional clothes wet and muddy, one of the nurses said, “You can’t go in all dirty”. The nurses proceeded to clean her, using a hose, outside of the hospital. The C-section was performed with little explanation in her language, and after such an infringement on her basic rights.
They would never go back to that hospital.
This made me wonder... would that happen to a white presenting woman like me, a non-indigenous woman that dresses differently and speaks Spanish (the language that these monolingual nurses speak)? No. They would not have treated me that way because I am not indigenous, I am not Q’eqchi’. We are both Guatemalan. This is racism. And it is one of many expressions of structural violence against indigenous women. Having less access to education, health and economic mobility, they also have to deal with discrimination.
Yes, we can strengthen local health systems using ICTs and contribute to reduce maternal mortality rates. But what about individual people, individual lives and quality of life of those who survive the country’s statistics? To walk the talk about health systems’ strengthening further we have to start addressing complex issues like racism. That sounds like a lot. But we can do it. We have to. Let’s start by calling out systems and structures. Call them for what they are: racist. Then, work so that systems and people slowly stop discriminating.
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About 7 Dresses 4 Health (7D4H): 7D4H is a year-long arts and health education campaign lead by visual artist, Marian Brown, in conjunction with Arts Connect International. The objective of the campaign is to promote inclusive community practices through adDRESSing health artistically and collaboratively. To learn more about the genesis of the project, read Marian’s New Year Blog.
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