In Bolivia - Miriam Rouleau Perez
An Aguayo for Risk-Free Childbirth: Action for Mothers and Newborns
By Miriam Rouleau-Perez,
Organizational and community health consultant in the municipality of Curahuara de Carangas, Bolivia
Photo: Doña Gregoria Calle, sage-femme et guérisseuse et Miriam Rouleau Perez
I arrived in Bolivia on July 3, 2006 to work with the rural municipality of Curahuara de Carangas, located high in the Andean plateaus, nearly 4,000 metres in altitude. My mission was to support preventive health-care actions in the municipality, which has a population of about 5,000, in order to improve the community’s health and quality of life. One of the major issues in health care is access to water and clean drinking water. Diarrhoea is the leading cause of infant mortality here in Bolivia; and, after Haiti, the country has the second-highest infant mortality in the Americas.
Since August 2006, I’ve worked on a project to prevent infant and maternal mortality, “Un Aguayo para un parto sin riesgo: Acción para madres y recién nacidos” (literally, an Aguayo (an Andean garment worn by women to carry their babies and, for all intents and purposes, a symbol) for risk-free childbirth: Action for mothers and newborns), which we launched with players from the health centre and a midwife and healer from Curahuara de Carangas.
From the project’s inception, we created a network of players in the health-care industry who meet once a month (decision-makers and politicians, the mayor, municipal councillors, traditional health-care practitioners, midwives, professional health-care workers, native authorities, and also organizations which support health-care measures, such as schools, the water management committee, and various other concerned players…). Like all consultative processes, it needs ongoing support and I am still actively involved in the appropriation and consolidation of this structure.
We also initiated a communications campaign; created a mural with the children and young people on the theme of Aguayo and childhood; created an intercultural or “humanized” birthing room (referring to humanized childbirth, parto humanizado, a term used in Bolivia) adapted to native cultures; handed out food to women who agree to four prenatal checkups at the health centre; given an Aguayo (Andean garment) and baby accessories to women who’ve established a relation with the health centre, allowing a follow-up to be done with newborns and their mothers. Lastly, a rapprochement was effected between health-care volunteers (promotores de la salud), midwives, and traditional physicians living in remote regions and the health centre itself.
The 
Wawa Yuriñ Uta (Childbirthing home in Aymara)
As part of this project, we created a culturally adapted birthing room (with 2 rooms, a low bed, a stepladder which women use to squat and hold onto), a small kitchen, earthenware dishes and pots, a bed for the family… the room is painted in earth tones, recalling the adobes (terracotta bricks) of the women’s own homes and embellished with aguayos on the walls and floor) to encourage midwives to accompany expectant mothers and conduct the birth in a safer place in the event of complications at the health centre itself. According to statistics from the health-care sector in 2006, the great majority of women (more than 90%) were not going to the health centre to give birth; they are often accompanied at home by a midwife, family members or a spouse. The problem is that if complications were to arise, the risks to mother and child are very high (geographically, because of travel times, and culturally, because it can be difficult to convince them to see health-care professionals).
Concerted action in tandem with the Bolivian government
Conclusive results
In the next months, we expect to publish a brochure to inform and educate families; organize training sessions on attention to health in modern and traditional medicine; work with one of the communities on the creation of a botanical garden of medicinal plants; hold cooking classes with mother s to prevent the kinds of malnutrition problems that are very common in children (33% in Curahuara) and in their mothers, too. This is another cause of death among newborns; three weeks ago, a baby barely 4 months old died of malnutrition. It mu st be said that sometimes diarrhoea is also at fault, being the leading cause of infant mortality – since after each bout of diarrhoea, newborns tend to lose a lot of weight. As the project moves forward, we will adjust our actions and we hope to organize activities that will help us battle infant mortality.
Concerted action in tandem with the Bolivian government
Throughout the entire process, we strive to ensure that Aguayo project actions are also in keeping with the country’s national policies. Bolivia is one of the rare countries to have a deputy ministry specifically assigned to Traditional Medicine and Intercultural Affairs. This is one of the new achievements of the government of Evo Morales. With the midwife and healer, Doña Gregoria, we contacted this deputy ministry, which was created in March 2006, and were received with open arms. Since then, we are gradually making progress with the recognition of traditional physicians (yatiris, as they are commonly called here). And, big news! Since mid-April 2007, Curahuara de Carangas has had a traditional medicine practitioner at the health centre… paid for by the State! This is a very big deal; we are the very first rural municipality to employ a traditional health-care provider!
What we do is such a challenge because there is no established model to follow. We are creating it! In that sense, I work with Doña Gregoria, supporting her integration into the public medicine system – a world unto itself, and so different from hers! The deputy ministry is our real support because there is still a great deal of work to be done to convince modern health-care players of the importance of working with and respecting traditional medicine for the greater good of the Bolivian people. According to recent statistics (source: Plan Nacional de Desarrollo, 3.4.2. SALUD, Bolivia, 2006, p.37), “77% of the Bolivian population is excluded from health-care services,” often for geographical, economic but primarily cultural reasons. We’ve been observed in action and the deputy ministry supports us in that sense, as a Municipality that could inspire others.
Conclusive results
Since the project began, we have doubled the number of care services in prenatal tests and institutional childbirth or in cooperation with midwives and health centre staff. We have established the “intercultural o humanizada” birthing room which, last April 13, 2007, was the scene of the birth of a boy, assisted by the midwife, and I saw his parents beaming with joy, as at ease at the Wawa Yuriñ Uta as if they were in their own home. Finally, we have just recently welcomed a traditional medicine practitioner to our ranks and hope that the integration, still a challenge in the present context, proceeds smoothly.
We are working on the development of various actions within the framework of this project, but we are also consolidating all actions undertaken since the beginning; since my arrival, the physician and nurse at the health centre have changed, which involves a new period of appropriation and adaptation for the new arrivals.
Children’s and mothers’ health
In the next months, we expect to publish a brochure to inform and educate families; organize training sessions on attention to health in modern and traditional medicine; work with one of the communities on the creation of a botanical garden of medicinal plants; hold cooking classes with mother s to prevent the kinds of malnutrition problems that are very common in children (33% in Curahuara) and in their mothers, too. This is another cause of death among newborns; three weeks ago, a baby barely 4 months old died of malnutrition. It mu st be said that sometimes diarrhoea is also at fault, being the leading cause of infant mortality – since after each bout of diarrhoea, newborns tend to lose a lot of weight. As the project moves forward, we will adjust our actions and we hope to organize activities that will help us battle infant mortality.
With this project, we have truly helped raise recognition of the importance of health. The mayor and municipal councillors of Curahuara de Carangas have supported the project with municipal funding. For 2007, the municipality has included budgets for further project development in its program. Furthermore, other nearby member-municipalities of an association of rural municipalities, Aymaras sans frontiers (Mancomunidad de Municipios Aymaras sin Fronteras), are interested in repeating this project in their own areas. Gradually, local players are learning the essence of the project, but also the importance of working together to better solve health issues in their populations. I could talk about this for hours… it’s a project with a global vision that consists in several coordinated, complementary actions taken by a group of people in the health-care sector (both traditional and modern medicine) and other people concerned by these issues.