Guatemala

Indigenous and Garífunas fight discrimination in health care system

Louisa Reynolds

23/11/2011

Opinión

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María Natalia Soc is exhausted. It’s 10 p.m. and she still has a night’s work ahead of her. She is by the bedside of a young woman who has just begun to go into labor.

For the past 24 years, Soc has worked as a midwife in the village of El Durazno in the central department of Guatemala, where most of the population is part of the Mayan Poqomchí community.

According to official figures, between 40 and 50 percent of all babies in Guatemala are delivered by indigenous midwives like Soc.

“Last year, I assisted a woman whose fetus was in the wrong position and with the methods that a midwife knows, I tied a rope around her and helped the baby to turn around,” says Soc.

Hugo Icú Perén, director of the Association of Community Health Services, or ASECSA, and author of the study “Rescuing Mayan Medicine and Achieving Social and Political Recognition: A Case Study of Guatemala,” explains that Mayan medicine is closely tied to spirituality. Illness is regarded as an imbalance and health is understood as a balance between different energies and between the human being and nature as well as the rest of the cosmos.

Thus, from a Mayan perspective, the healing process is about more than just achieving physical wellbeing; it involves restoring harmony between the sick individual and the rest of the community as well as his or her natural surroundings.

Indigenous therapists — midwives like Soc, healers or shamans, bone specialists known as “hueseros” and masseurs known as “sobadores” — usually discover their “gift” or “mission” as medical practitioners through dreams, and ancestral knowledge is passed on from one generation to the next.

The methods used by Mayan healers include observation to diagnose symptoms, asking the patient what he or she feels and palpation and the interpretation of dreams. Symptoms do not just concern the sick individual but also his or her family and surroundings.

A variety of resources such as medicinal plants, minerals, vegetable oils, animal fat, prayers, Mayan thermal baths or “temascales” and massages to cure dislocated bones or joints, are used by indigenous healers to treat a patient.

As Icú’s study explains, the peace accords that ended a three-decade civil war in 1996 establish that “traditional indigenous medicine must be valued, its study must be promoted and its practices and concepts must be rescued”.

According to Rafael Haeussler, director of the Ministry of Health’s Department for the Regulation of Attention to Patients, some progress has been made in terms of respecting indigenous customs with regards to medicine and healthcare.

Racism’s deep roots

Under the administration of President Álvaro Colom, the Health Ministry created a special unit dedicated to health care of indigenous people and for interculturality to address the rights of the Mayan, Xinca and Garífuna, or Afro-Caribbean, communities.

Before the end of this year, he adds, it will be compulsory for all public hospitals and health centers to allow women to choose whether they wish to have a vertical or horizontal birth. Vertical births are the most commonly used position among indigenous communities and Western doctors have been increasingly willing to accept that this is more natural and has a lesser impact on the woman’s bone structure.

However, Haeussler admits that Guatemala is still “a racist, discriminatory and ethnocentric country” and this is reflected in all public institutions, including the national health service.

He points out, for example, that very few non-indigenous doctors speak an indigenous language and rarely are the doctors themselves indigenous which means that the service provided is often culturally inappropriate.

Soc adds that indigenous midwives often suffer discrimination by non-indigenous doctors and nurses. When a birth becomes difficult and the patient needs to be taken to hospital, midwives are told to leave, even though their presence is emotionally beneficial for the patient.

She says that nine years ago, the Health Ministry provided a basic midwifery course for indigenous practitioners, at the end of which she was given a diploma and an ID card. Every month she goes to the local health center to receive refresher courses. However, the nurse in charge of the training sessions often cancels them with no prior warning.

“We’re made to feel that we’re a burden and that [the nurses and doctors at the local health center] don’t have time for us,” says Soc.

Indigenous organizations speak out

Last year, the Health Ministry began a “Dialog for the Universalization of Healthcare” with the participation of over 150 government bodies, academics, nongovernmental organizations, international organizations and civil society associations, to reach a consensus on what type of public health care model Guatemala needs and how it should be funded.

The initiative aimed to respond to the deep crisis currently faced by the national healthcare system, which is desperately underfunded, with hospitals often facing a shortage of medicines and basic supplies and medical professionals forced to go on strike in response to long delays in the payment of wages.

An increasing number of indigenous voices began to participate in these debates, including the Guatemalan Confederation of Spiritual Leaders, the Indigenous Women’s Network for Sexual and Reproductive Health and Nutrition, and ASECSA.

“We cannot think about a universal healthcare system without taking into account the different systems and practices on how to treat illness,” said Haeussler.

Although many indigenous organizations attended the sessions, it soon became clear that for these talks to be truly inclusive and representative of the country’s ethnic diversity, a de-centralization process would be needed.

On Sept. 5-6 this year, ASECSA decided to hold a plebiscite or consultation in the department of Chimaltenango with over 40 indigenous organizations from a wide range of linguistic communities, in order to discuss the agreements that had been reached so far in the talks.

During the event, participants asserted indigenous people’s right to use traditional medicine and the right to a culturally appropriate healthcare service with medical professionals that speak indigenous languages. Their main demands focused on respect for indigenous midwives and healers and a rejection of privatization initiatives in the healthcare system.

A list of indigenous demands was added to the proposal for the transformation of the national healthcare system that was put forward during the talks. During the final session, Health Minister Ludwig Ovalle pledged to use the document as a blueprint for an overhaul of the current system.

However, it is uncertain whether the new government of Otto Pérez Molina, which takes office early next year, will make universal healthcare coverage for all Guatemalan citizens, regardless of ethnicity, a priority. —Latinamerica Press.

https://www.alainet.org/en/active/51087