Christina has been working to improve the health of indigenous communities in Guatemala for 12 years. During that time she has built up an impressive reputation, often going above and beyond for her patients.
Nurses in the UK are so often praised for taking this approach that I didn’t realise how unusual Christina was until I met other hospital staff there. Then I saw for myself the discrimination people from indigenous communities face every time they try to access the healthcare that is their human right.
On a visit to the region’s primary birthing centre, a doctor took us to see an indigenous mother and told us to interview her while she was in the late stages of labour. We declined, but the doctor’s indifference during a potentially dangerous, and deeply private, time in this lady’s life shocked me.
For indigenous mothers and their children, this blatant discrimination combines with extreme poverty and other cultural barriers to make them some of the most disadvantaged in the world.
Indigenous women are three times more likely to die in childbirth than others in the same country.
The lack of well-stocked health clinics and hospitals means women must travel hours for treatment and check-ups during pregnancy – and finding the money for transport is often impossible. When they do make it to hospital, the Spanish-speaking staff there usually cannot speak their indigenous languages, Mam and K’iche.
In addition, the enduring culture of ‘machismo’ means decisions about women’s health are often made by their father or husband. “While men are away working (which happens a lot) they will often forbid their wife to seek treatment if she’s pregnant, or to go to a health centre to give birth, in case she is seen by a male doctor,” Christina tells me.
Seeking healthcare, if it has been forbidden by their husband, can be very dangerous for women in communities with such traditional beliefs. A recent study of eight Mam communities found that 80% of women had been physically or psychologically abused by their partner, and 24% had been raped.
Due to these cultural barriers, as well as the distance between communities, Christina therefore spends a lot of time travelling to communities where women cannot come to her. She is also working to create change on a wider level, by holding training sessions at local health posts, supported by Health Poverty Action. This means that women can access healthcare and education easily, within their own communities.
“We’re training Traditional Birth Attendants (TBAs), who are trusted women in these communities, working with trainers who speak their language.”
“Now TBAs know how to recognise women with high-risk births and get them to hospital, and what should happen when they get there. And they have the birthing kits to conduct safe deliveries at home where possible.”
Funded by the Big Lottery Fund and European Commission, this project aims to increase the number of mothers accessing antenatal care, currently as low as 5% in some areas, to 66%.
To do this, Christina co-ordinates her records with the TBAs, creating an informative network reaching even the most vulnerable mothers. Christina conducts health visits and TBAs work with each mother to develop emergency birth plans so they know how to get the treatment they need.
And because the barriers to health are not necessarily overcome at the hospital doors, we’re working with hospital staff to ensure that TBAs can accompany mothers, so that they feel safe and their beliefs are respected during more complex deliveries.
During my visit, Christina held a training session with some local TBAs where she handed out some of the safe birthing kits supported by Health Poverty Action. These kits are full of potentially life-saving tools; gauze, sterilizing equipment, even a wind-up torch for conducting night-time deliveries in areas with no electricity.
These kits are such simple solutions to a more complex problem, but Christina told me that even these have been delayed by the Ministry of Health, which tried to prevent these kits being given to the TBAs before the Ministry have ‘inventoried’ them.
I asked why that was a problem. “We knew that would mean extra work for the Ministry staff; if we handed them in, we would simply never see them again.”
As I left Christina to complete her training session, I understood just how crucial all of these incredible women are in the fight for health justice.
Indigenous women must battle harder than anyone for their right to healthcare. With the support of amazing nurses like Christina, they are fighting – and they will win.
Thank you for supporting Health Poverty Action and standing in solidarity with those at the sharp end of global injustice.