Maya Health Alliance

Delivering high quality, community-based healthcare to a rural population is never easy. Doing so in multiple indigenous languages, within communities still recovering from decades of violence, genocide and oppression during Guatemala’s long civil war, is about as challenging a situation as you can get. Wuqu’ Kawoq, also known as Maya Health Alliance, has been working to accomplish that since 2007.

There are more than 6 million Maya in Guatemala, 43% of the population, speaking 22 Mayan languages. Health care has traditionally been offered in Spanish and primarily at city-based hospitals and clinics. Wuqu’ Kawoq’s goal is to work with the existing health system to improve its delivery to the most underserved populations. To do this, they bring comprehensive care to 11,000 patients in their homes and communities, in their languages, across child health and nutrition, chronic disease, women’s and maternal health, and primary care.

At the centre of this effort are Maya Community Health Care workers who understand their patients’ cultures and languages. Trained by Wuqu’ Kawoq and equipped with medicines and technology, these are the primary care providers as well as navigators of the larger system when their patients require advanced care. They are employed and paid by the organization, furthering gender equality as 80% of the team are women. Says Anne Kraemer, CEO of Wuqu’ Kawoq, “It’s a highlight for me to see the staff grow and rise and become more skilled, leading issues, becoming scientists themselves. Most of them are women and they get purchasing power in their own communities through what they do with us.”

Women’s health is a key focus area, including maternal health, but these services are interconnected with others. As Anne explains, “Women’s health is our largest activity in terms of people served, but it’s inextricably linked with the nutrition and health of children. Treat one and you see the effects on the other.” Malnutrition in children, and its impact on their development, is one of the most pressing health issues in Guatemala where, in some rural Maya communities, up to 70% are malnourished. Last year, Wuqu’ Kawoq’s CHWs made 6,700 nutrition care visits.

“One of the key challenges,” says Anne, “is navigating the difference between hunger and malnutrition.” Wuqu’ Kawoq provides personalized care for 800 children a year, including counseling, monitoring, and food supplements. Even children who might appear to already be getting enough to eat can be seriously short on the nutrients needed for healthy development of their bodies and brains.

Anne recalls speaking with a mother in a particular community who, initially, felt that her undersized child was getting adequately fed. When every child in a village is small for their age, they appear normal. After a few years of applying what she’d learned through nutrition counseling, the same mother was shocked to realize her 3-year old was almost the same size as her then 6-year old. “I’ll never forget hearing that woman say to me that now she understands what malnutrition is,” says Anne.

The initiators of Wuqu’ Kawoq came from research backgrounds, making multidisciplinary, rigorous research a core part of their programs from the beginning. Chronic disease and maternal and infant health take a lot of time and good data to understand. Their Center for Indigenous Health Research is a global resource for investigating indigenous health needs and advancing treatment models. “This is implementation research,” says Anne. “What works in maternal health, in child development. How can it be brought into a system.”

Her own background as a medical anthropologist informs their multidisciplinary approach. “We go beyond a bio-medical perspective to include anthropological aspects. How do populations define health and sickness, how does their culture view care? What are the upstream causes of ill health and malnutrition?”

Because health and wellness are rooted in systemic issues, Wuqu’ Kawoq actively partners with the Ministry of Health and other organizations to address the multifaceted causes and to share learnings. Endemic poverty, inequality, food shortages, climate disasters, and economic opportunity all play a part. Some of the most important partnerships for the organization are those within the Guatemalan health system itself.  As Anne puts it, “It’s exciting to see the whole system working, for example in maternal health when a patient and midwife trust to go to the hospital because they’ll have a Maya care guide there. And the hospital staff see how that’s working for all of them. The people involved are seeing the system working and are believing in it.”

As they build on their successes, Wuqu’ Kawoq is expanding its geographies with the significant depth and breadth of medical care it offers. “Who says you can’t treat diabetes or cancer in rural communities,” says Anne. “We’re here to say we can, in fact. Let’s use data, plus the power of the human story, to see what we can do together.”

The Patchwork Collective is pleased to be funding Wuqu’ Kawoq’s impressive work.

‍