Panajachel, Guatemala

Katie spent six weeks throughout the Western highlands of Guatemala intensively learning Kaqchikel, which is one of the predominant Mayan dialects. Immersed in Mayan linguistics, culture and cosmology, Katie worked to identify the leading health issues among the indigenous people of Guatemala. Katie later worked with Dr. David Lindstrom at Brown University on a study conducted in Guatemala regarding contraceptive usage in relation to internal migration patterns.

Guatemala is a predominantly rural country with 61% of the population living in undeveloped areas and 75% of that population lives below the poverty line. Resulting from decades of civil war and mass genocide, the Mayans live in primarily rural areas and remain a relatively isolated group. Such isolation and skepticism towards Spanish speaking 'Ladinos' has resulted in numerous barriers regarding access and utilization of health services. Guatemala is the most populated country in Central America and has the highest annual population growth rate in the western hemisphere of 2.9% per year, and according to UN statistics only in Haiti is contraceptive use less prevalent.

Guatemala also has the highest fertility rate in all of Latin America with a total fertility rate of 5.1 children per woman (6.2 in rural areas and 3.8 in the urban population); noting the large difference between rural and urban areas. Studies from APROFAM and the Population Council found that community residents appeared willing to accept the concept of birth spacing when there is an emphasis on improving health and the quality of life. The studies found that the indigenous populations were open to discussing issues of sexual health, reproduction and family planning but lacked accurate and concrete information. Men knew far less than women and focus groups demonstrated that men knew very little about the fertile period of the woman. They did express a willingness to learn more about reproductive issues, if the information was presented in a culturally acceptable manner.

In many of these societies, families lack the capital to afford health care from the formal sector, often preferring traditional health services. However, the traditional model lacks formal regulation, offering a large spectrum with respect to the quality of health services provided. Only one in four rural births is delivered in a hospital or clinic, compared to well over two-thirds of births in urban areas. Guatemala has the highest rates of infant and maternal mortality in Central America. The infant mortality rate is 46 deaths per 1,000 live births, while the maternal mortality rate is 270 per 100,000 live births. Such alarming figures can be attributed to the extremely low levels of formal prenatal and delivery care, especially in rural areas.

Lindstrom's study also reveals that women with more than six years of schooling are close to four times (3.7) as likely to use formal prenatal care as women with no schooling. As one might expect, the indigenous Mayan population is less likely to seek such services due to overall lower levels of education. The Guatemalan Institute for National Statistics found that over two-thirds (67.6 percent) of Ladinas use formal prenatal services compared to slightly less than one-half (45.6 percent) of indigenous women. As well 55 percent of Ladinas use formal delivery services compared to only 17 percent of indigenous women.

Given the numerous barriers impeding access and utilization of health services in Guatemala, the overall health status of indigenous women in rural areas is extremely compromised. Given the skepticism of outside or foreign medical services, community based programs need to engage local health promoters in the process of health information disbursement. Lindstrom's studies have found that when new information is presented by a member of the community it is more widely accepted than when it comes from a foreign source. To ameliorate such health disparities, current and future initiatives should heavily emphasize culturally appropriate health education programs to narrow the gap in health information between 'Ladinos' and Mayans. The disbursement of accurate information will serve to empower women, dispel previous 'misinformation' and hopefully promote the utilization of health services.

Secondly, medical care and existing health care facilities should be staffed by culturally similar personnel to appease the fear of a 'Ladino' run health care system. In effect, programs to train local health promoters and medical staff should be strengthened and solidified to empower the local community and create a sustainable healthcare model that does not rely on outside professionals. Thirdly, health care services need to be more accessible for Mayan communities. Subsidized health care initiatives can address the monetary issues; however outreach programs along with health promoters are needed to reach rural populations. Numerous initiatives are currently in place to address the needs of the indigenous people of Guatemala, however the most successful and sustainable programs have engaged the community and grown from the ground up.

 

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