This past summer, Voces y Manos partnered with the USF School of Nursing and ASECSA (Asociación de Servicios Comunitarios de Salud) in Guatemala to organize community health members in Rabinal, Guatemala, illuminating the health needs of the community. The result was a framework for transforming findings into action.
Citizens of Rabinal are in a more dire need of health care than ever before. Over the last few years, a non-governmental organization called Funcafé provided health care on a rotating basis to the various communities in the surrounding area. With this service, people in Rabinal got a medical visit once a month. Unfortunately, this program was recently eliminated due to lack of funding.
Additionally, Centro de Salud, the community clinic in the center of town, is largely unaffordable for most patients and medical supplies are very low. Given that these services have been affected so greatly by a lack of funding, Voces y Manos team wanted to see how our team could have the biggest positive impact on health for those living in Rabinal.
Recognizing this pressing need for health care, we combined forces with Linda V. Walsh, a professor from the University of San Francisco School of Nursing, to hold community-wide health assemblies in Rabinal. The purpose of these assemblies was to identify critical gaps in the health system and to determine how Voces y Manos can partner with local organizations to fill these gaps.
“The goal that Michael, Josh, Jessica, Amy and I had was to really listen to what the community members identified as health needs that Voces y Manos could possibly address in a partnership with them,” said Professor Walsh.
Furthermore, Voces y Manos wanted to ensure that a health partnership with the people of Rabinal would be culturally relevant and appropriate, benefiting all those involved.
“All too often, well-meaning people go into the developing world and do their own assessments, then tell the communities what interventions the visitors think are needed,” Walsh said. “ Who knows better about perceived needs than those who live and work in a community?”
With this in mind, Voces y Manos welcomed a wide variety of perspectives, including both lay health workers as well as public health professionals. To this end, Voces y Manos enlisted the help of ASECSA to recruit health promoters, traditional midwives, doctors, nurses, and nutrition specialists from throughout the region. While perspectives differed in many regards, a common theme identified was the dramatic impact of budget cuts on community health. Given the severity of these cuts, all assembly participants recognized the increased the need for traditional medicine.
“What came across very strongly in both the community members’ group and the agency participants’ group was that the current economical forces prevent individuals from having access to even the most commonly used pharmaceutical agents,” Walsh said. “A return to traditional Mayan medicine reflects respect for the non-Western medicine approach to health and healing, and also provides a cost effective way to prevent and treat disease.”
Now that the assembly findings have been compiled, Voces y Manos turns its attention to developing projects that will address the identified needs. In December, the Voces y Manos team will return to Rabinal to resume dialogue with assembly participants. First, the assembly participants will reconvene to review key findings from the assemblies. Next, they will brainstorm viable solutions. Finally, a small subgroup of the participants will form a local community advisory board that will chart a 4-year plan for creating long-term community health care solutions that will be culturally relevant to Rabinal.
“I am a believer that community members are the experts in identifying needs and potential interventions that would be in concert with the beliefs and rituals of the culture,” Walsh said.
Voces y Manos also hopes that by involving the community in creating this new program, we have created a sustainable option for health care in Rabinal.
“Another factor in including the community from the beginning is that the community response is essential for sustainability of initiatives,” Walsh said. “There is a history of numerous initiatives that end up being short-terms fixes without any follow through due to lack of acceptability in the community and/or lack of economic sustainability. This approach is also necessary in the developed world. Particularly in communities representing vulnerable populations, community involvement is essential for bringing about necessary change.”
Although the eventual outcome of these meetings is yet to be determined, Voces y Manos is confident that by involving the community at each step of the way, the end result will truly meet the needs of the local community and set the foundation for sustainability.
-Allison Van Vooren
