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Stars: working with indigenous Guatemalan midwives to improve prenatal care for pregnant women

We are reducing maternal mortality for indigenous Guatemalan women through enhanced prenatal care and advocacy in the healthcare system.

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In no more than 3 sentences, please tell us who your idea is designed for and how it reimagines the new life experience.

Our idea is designed for underserved indigenous Mayan women in rural Guatemala. Giving birth at home with a local midwife is the traditional way for these women to give birth - if a complication arises during a woman's pregnancy, many would rather die in their homes than go to the hospital for fear. In working with local midwifes to enhance prenatal treatment to screen for complications and coordinating accompanied referrals to local healthcare centers, we are reducing maternal mortality.

We support a network of nearly 50 traditional midwives through education and facilitation of hospital referral for 70 patients a month. We are currently conducting an NIH-funded project using smartphones to improve community-based assessment of mother and baby. We provide prenatal services designed to fill in the many gaps in care left by the public health system, including management of medically complex pregnancies. For example, we have diagnosed and treated dozens of expecting mothers with preeclampsia and insulin-dependent diabetes, offering home-based care and long-term follow up for these disorders, which often require prolonged hospitalizations in the public sector. 

Moreover, we have recently started an obstetric care navigation program. Obstetric care navigation is an innovative model that combines aspects of accompaniment, patient advocacy, and care coordination to facilitate emergency referrals from home deliveries with traditional midwives to public hospitals.  

Care navigators provide a number of tangible benefits both to Maya women and hospital staff, including:

-Arranging emergency transportation via ambulance or community members

-Interpreting between Spanish-speaking providers and Maya speaking patients

-Advocating for informed consent and patient autonomy

-Offering emotional support including during labor

-Expediting care through knowledge of hospital workflows

-Facilitating necessary testing and treatments not available in public hospitals

The overall goal of this project is to improve maternal and neonatal outcomes by strengthening referrals between homebirths with traditional midwives and public-sector hospitals and promote respectful maternity care through the innovation of obstetric care navigators. The project is driven by rapid-cycle quality improvement, which empowers frontline health workers to efficiently identify implementation barriers, test potential solutions, and evaluate response using a rigorous data infrastructure.

A recent video featuring our program can be found here.

Wuqu' Kawoq | Maya Health Alliance is a non-governmental organization providing medical care in rural indigenous areas in Guatemala since 2007. In each of our programs we start by partnering with indigenous communities to identify health needs. Then, together we develop programs that are culturally and linguistically appropriate. For example, we use local Maya languages in all of our work, and we encourage local leadership by hiring and training young women and men to work as health staff in the communities where they live. We are unique among Guatemalan health organizations for our combination of high-quality health programs, our ability to evaluate our work with cutting-edge research methods like randomized controlled trials, and our understanding of local culture and language.

At what stage is your idea?

  • Full-scale roll-out: I have completed a pilot and analyzed the impact of that pilot on the users I am trying to reach with my idea. I am ready to expand the pilot significantly.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

We have fully tested and launched this project.

What skills, input or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

The diverse backgrounds and experiences of OpenIDEO community members can help us think of ways to continue improving our project, and how to build upon it in the future.

Tell us about your work experience:

I am a MD specializing in Women’s Health and Family Medicine. Along with working as the Women's Health Director for Wuqu' Kawoq | Maya Health Alliance I am currently a Global Women's Health fellow at Brigham and Women’s Hospital and Harvard School of Public Health.

This idea emerged from...

  • A group brainstorm
  • An organization or company

Are you a healthcare practitioner?

  • yes

Find this idea inspiring? Add your own!


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Hello @Bettina Fliegel and @Kate Rushton - thank you so much for your comments and questions!With regard to your questions, Bettina, to set the context a bit better, our organization is called Wuqu' Kawoq | Maya Health Alliance, and we are a global health NGO based out of Guatemala, serving more than 20,000 patients in the fields of primary care, chronic disease such as diabetes, women's health, nutrition, and complex care. Long term follow up care is provided principally through local midwives, however, if a patient's case is complicated our nurses provide additionalcare as needed. With regard to the smartphones, we developed an application that aids midwives during a pre and postnatal consultations - many of these midwives cannot read, so the app was developed to speak to them and guide them through each phase of the consult, all in their native language of Kaqchikel. Within the app, the midwives take photos of the patient's blood pressure and doppler readings, all of which get sent in real time to our staff. If a complication is found during consult, or if an emergency arises during birth, the midwives contact our on-call staff, who coordinate emergency transport to a local hospital accompanied by our care navigators. Thank you for the links to these other ideas, I will check them out!Kate, I hope to have answered your question about long term follow up above, but if there is more I can clarify, I am happy to add more! In the future we hope to expand this program to serve more women and work with more midwives, and we are always looking to build upon our existing infrastructure for quality improvement and future projects.
Many thanks again to you both for your comments!

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