The integration of modern medicine into traditional systems can be challenging. One Heart World-Wide (OHW) works with the Tarahumara populations of the Canyon in Northern Mexico. The Tarahumara are among the indigenous groups farthest removed from mainstream society, and as a result suffer from many barriers to care. Discrimination against indigenous groups in Mexico creates one such barrier. Many Tarahumara people fear that medical providers will disrespect them, violate their right to make informed medical/family planning choices, or otherwise mistreat them. Language barriers further exacerbate these issues, as many Tarahumara do not speak Spanish and many providers do not take the time to make sure indigenous patients have understood them.
Many Tarahumara women feel that providers make little effort to understand their practices or beliefs, and often act with an air of superiority by telling women that there is no place for their use of traditional parteras (midwives). They often leave the clinics feeling patronized and without an understanding of the care or advice they have received. This is due to the complicated medical language that the providers use, which even a well-educated, native Spanish speaker might have trouble with.
These circumstances, coupled with the difficult travel and long distances that many women face in order to reach a clinic, lead to almost 90% of Tarahumara women delivering without a skilled birth attendant. This in turn results in dismal maternal and neonatal survival outcomes.
OHW is seeking to improve this situation through our Network of Safety model. The Network of Safety is an intervention aimed simultaneously at several levels, from the mothers to the referral hospital. Providers are trained, health facilities are upgraded and outreach programs on safe motherhood target community members.
In order to encourage facility-based deliveries, we have found it necessary not only to inform women of services available and advise them on their use, but also to work with clinical staff to ensure they provide culturally appropriate, quality care to indigenous patients. We want the Tarahumara women to feel comfortable in the clinics so that they will be willing to return.
We recently began including a new cultural sensitivity training module in all of our trainings for providers. Our trainers focus on raising awareness on the effects of communication on patient relations by discussing intercultural communication theories and dynamics and by practicing techniques to increase clarity and understanding by both parties. Through the exploration of different viewpoints, we invite trainees to recognize beliefs held by the Tarahumara, even if they are not aligned with their own, so long as they do not cause harm to the mother or newborn.
It is our hope that behavioral changes among health care providers that lead to more respectful provision of care will allow for greater changes among the Tarahumara as well, ultimately resulting in increased numbers of facility-based/attended births and therefore healthier birth outcomes for Tarahumara women.
For more in the respectful maternity care blog series, click here.