Tag Archives: Mexico

Partera Influence on Health and Culture in Mexico | A Personal Story

This piece was written and contributed by CFHI participant Carmen Simmons, who was a Medical Student at Meharry Medical College when she participated in the Women’s Reproductive Health program in Puerto Escondido, Mexico in 2018.

When first arriving at the Centro de Salud, I have to admit I was proud of myself. I had managed to find the right colectivo in a mountainous countryside in the quaint town of Río Grande. After exchanging various “Buenos Dias”, I made my way over to partera, traditional midwife, Señora Lucia Zaguilan Mayoral.

At our first meeting, Sra. Lucia patiently listened to my never-ending questions in – let’s be honest – broken Spanish. When she spoke I struggled with the speed of her words. After some compromise on both of our parts, we found a tempo that worked for us to communicate.

Sra. Lucia calls Colonial Villa De Tututepec home and is a Rio Grande native. She has been attending births since she was 13 years old (today she is 63). Coming from a long line of parteras, she started learning as her grandmother’s apprentice. To this day, her family is filled with an impressive variety of healthcare workers.

She has attended conservatively well over 5,000 births. INCLUDING HER OWN CHILD’S! Yes, that’s right, she delivered her own son. She recounted the story to me while laughing at its ridiculousness. In her last days of pregnancy, she was in the kitchen cooking when her contractions started getting too close for comfort. She can’t exactly remember why no one was home, but nonetheless she had her abundant knowledge of births to comfort her. As calm as anyone could be while delivering her own child, Sra. Lucia guided her son toward the light of life. She even cut the cord herself! By the time her family came back home, they were greeted by a nursing newborn.

During the partera training I was able to witness, Lucia reflected on the immense amount of knowledge her grandmother bestowed onto her. This particular partera training is an annual training co-facilitated by Child Family Health International, local staff and a group of Northwestern students in partnership with the Oaxacan Ministry of Health. As a young girl, Lucia learned many techniques from her grandmother including monitoring her patient’s hair, skin, and eye color and the various methods of moving a baby into the correct position for delivery.

At the partera training, I immediately noticed that all of the women were 60 years or older. I asked her what she thought had changed in the last 20-30 years since she began practicing as a partera to account for this . She comments that she, and others, have noticed a change in attitude with the younger generation. She states that “most young women (under 35) are scared of anything to do with childbirth. Many want cesareans now. And the others are too afraid to learn to be a partera.” The sociopolitical context on the increasing cesarean rate in Mexico is interesting in itself. Approximately 39% of all hospital births in the state of Oaxaca were cesarean births. The World Health Organization states when the cesarean rate goes above 10%, there is no evidence that mortality rates improve.

During my time with Lucia and other parteras, I learned of the integral role that Parteras play in women’s health in Mexico although it seems to be an aging profession. I also learned about the scarcity of resources (financial, equipment, etc.) that the parteras face and overcome daily in their work. I fear that communities will not truly understand the immense importance of their role until there are very few left. My hope is we don’t wait until then, and find a way to revitalize younger generations to strengthen the tradition and empower the existing parteras.  

CFHI & Northwestern University Students Impact Women’s Health in Mexico

A Global Team

Global Health Initiative (GHI) at Chicago Lake Shore Medical Associates is a nonprofit organization leading through philanthropic advocacy.  Funding from GHI provided medical students at Northwestern’s Feinberg School of Medicine (FSM) the opportunity to engage in a month-long global health experience in Oaxaca, Mexico with a lasting impact.  Beginning in 2011, Continue reading

CFHI’s Model for Global Health Electives Included in Oxford University Press Publication

Oxford Handbook on Neuroethics

Oxford Handbook on Neuroethics

“Global Health Ethics is once again in the forefront of discussion with the recently published Oxford Handbook of Neuroethics chapter emphasizing the relevance of biomedical, clinical and public health ethics within the global medical and academic community.  Child Family Health International’s (CFHI) Evaleen Jones M.D., Jessica Evert M.D., Scott Loeliger M.D., and Steven Schmidbauer co-authored the chapter on the importance of establishing and sustaining an ethical framework for educational global health programs.

With growing interest in Global Health Electives among the medical and academic community, there are genuine concerns regarding equity, justice, and sustainability within underserved communities.  CFHI’s chapter discusses global citizenship via a socially responsible framework to create positive global health educational experiences for students and host communities, connecting students with local health professionals and through direct investments in local community based projects.  ”

So reads the beginning of the Press Release for CFHI issued today.  Needless to say, we are all very proud and very happy to have this recognition especially from such a noted publisher as Oxford University Press.  The portion that CFHI contributed to this chapter on Global Health Ethics is an attempt to describe our model of working in underserved communities by identifying local experts and building on the inherent strengths of the communities.  We have seen over and over again low-resource settings where amazing things are being accomplished every day in patient care due to extremely dedicated local professionals.  We see their deep commitment to serving the people and we join together with the local health professionals to design Global Heath Education Programs that are open to international students and trainees.  You can read our submission here but I want to take this opportunity to thank all our international partners who have chosen to work with us to develop this model and make it successful for the last 20 years.  No partnership is one-sided and we are deeply indebted to all the local doctors and nurses, hospital and clinic staff, local coordinators, host families, language teachers, drivers and many others who make our international programs function so well, even in some very challenging circumstances.  Our hats are off to all members of the CFHI global family –you all share in this recognition!

Read the full CFHI Press Relase and Chapter.

World Food Day

United Nations World Food Day

World Food Day

Today is World Food Day.  The United Nations Food and Agriculture Organization has issued a report that should be on the ‘must read’ list of anyone interested in global health.  There is some good news but also some disturbing news that should act as a wakeup call for the world community.  Staple food prices are at or near all time highs.  One of the most alarming facts in the report entitled Food Prices From Crisis to Stability is that just since last year the increases in the cost of basic food has, “pushed nearly 70 million people into extreme poverty.” 

 

Past Successes Have Not Kept Pace

The report points out that while the world’s population doubled between 1960 and 2000, there were significant advances in agriculture that allowed food production to “meet and even exceed demand in many countries.”  Unfortunately, the investments in research that were made, by both rich and poor countries, to produce the much needed innovations have not been maintained in recent decades.  There has been a 43% decrease in government spending on research and development in the area of agriculture in the last 30 years.  Therefore while the population of the world continues to increase, food production has not kept pace.

The last time food prices were this high was in 2008, when the price of various staple foods shot up very quickly and there was rioting in over 20 countries as a result.  Certainly the global

FAO Food Price Index October 2011

FAO Food Price Index October 2011

economic situation is in even less shape to deal with record high food prices today.  What’s worse is that due to the inability of food production to keep pace, “The global market is tight, with supply struggling to keep pace with demand and stocks are at or near historical lows.”

 

Promising New Successes

While the report warns that food price volatility may become an unsettling fact of life for the foreseeable future, it also gives some success stories that offer great hope.  If we can prioritize research and development and scaling of existing successes, we may be able to prevent some of the volatility that now seems inevitable.  Some scientific advances in Africa and Asia are resulting in higher yields but much more needs to be done in this area.  Some countries have made increasing their food production a priority by encouraging agricultural land use and supporting research.  Other countries like Mexico have been proactive in targeting assistance to some of the 70 million globally who are the new poor.  Through carefully monitored programs tied to the education system, the Mexican government has been able to provide assistance to one in four families who have been hardest hit by rising food process.  Even in these difficult times, this effort has, “…been credited with improving the health of children and adults, and raising nutrition and school enrollment levels.”

As we advocate for improved basic healthcare, we must also advocate for smart basic development that learns from the past and is doing the necessary research to keep up with our current and future needs.  For the cornerstones of global public health continue to be water, food, sanitation, and education.

New US Census Data Shows Diversity of US Population Increasing

We are approaching a new highpoint in the prevalence of US residents who were born outside the country.”  This is part of a message on the Director’s Blog of the US Census Bureau website that is aimed at the marketing industry, at advertisers of goods and services, but we at CFHI believe it is also important information for current and future health professionals.

While the Census Bureau is providing this new data, none of the basic trends of an increasingly diverse population for the United States should be a surprise to us.  Forward thinking health professionals and medical educators have seen the indications of these trends for many years.  Health science students (including medical students, nursing students, and public health students) have not waited for courses to be developed by the data that is now beginning to be analyzed, but have taken the initiative to seek out medical electives and rotations that would give them first-hand experience of different cultures and the different ways people view health around the world.

Source: US Census Bureau -Director's Blog

With some 6,000 alumni of CFHI Global Health Immersion Programs to date, we hear over and over again from them how their CFHI experience gave them insight into the role that culture plays in health and healthcare.  Tenny Lee, a 2010 CFHI Mexico alum, reports: “My experience in Mexico has given my medical career a foundation to help underserved communities and break though language and cultural barriers.”  You can read more about her CFHI experience  in her review posted on the website Great Nonprofits.  The ability to competently serve a more widely diverse patient population will clearly become the expectation for health professionals, as we can see from the wealth of information that the US Census Bureau is releasing.

One of the most important data points released so far is that the Hispanic population of the US now exceeds 50 Million, a 43% increase since the last census as reported by CNN.  And it is not just in border states in the south.  The CNN article quotes demographer Jeffrey Passel at the Pew Hispanic Center as saying, “Previously, the Hispanic population was concentrated in eight or nine states; it is now spread throughout the country.”

Medical schools, organizations, and institutions of higher learning have also recognized these trends, and CFHI has been happy to work with many of them to design specific programs.  The Patient Advocacy Program at the Stanford Medical School began a program abroad with CFHI in 2007.  The University of California at Davis has partnered with CHFI for over five years now to offer a Bi-National Health Quarter Abroad program for undergraduates in special arrangement with the Chicana/o Studies Department at UCD.  Both of these programs also make use of CFHI’s built-in Spanish Language and Medical Spanish Instruction.  Students are also living with host families so they are immersed into the culture during the program.  Guided journaling and weekly meetings help students reflect and integrate what they are learning from their daily interactions.  CFHI is also working with others, including Northwestern University, The Student National Medical Association (SNMA), -which you can read more about in an earlier posting–  and the Public Health Institute in association with the Global Health Fellows Program.  CFHI has been able to partner with each group and use our 20 years of experience working at the grassroots level in underserved communities abroad to design programs that meet specific learning objectives that are achieved in real life settings with the help of local health professionals who have the unique expertise of the local healthcare system and the best understanding of the local culture.

Jessica Brown, a 2010 CFHI Ecuador alum, pulls it all together in her reflection about her CFHI experience:

“… [I] learned a wealth of information about health that extended beyond the Reproductive realm.”  Jessica goes on to say, “I learned a lot about Ecuador’s healthcare system by discussing health care access, education, socioeconomic class and ethnic background with my mentors and preceptors. I learned about how religion, education and customary social/cultural schools of thought (i.e. machismo) weigh heavily on Ecuador’s society, and individual minds; I saw how the cultural “way” dictated the population’s attitude towards healthcare, especially in Women’s Reproductive Health.

The moments that caused me to question belief systems in place within myself really stretched me beyond limits I never knew possible.  And it is these reflections upon the state of health care in Quito that can broaden my understanding of client needs, beliefs and culture here in the states.”

CFHI Teams Up with SNMA for Special Global Health Experience

CFHI Logo CFHI and SNMA have teamed up to present this new and specialized program that offers participants the opportunity to participate in a 2-week global health program in the city of Oaxaca Mexico!

The Student National Medical Association (SNMA) is the oldest and largest, student-run organization focused on the needs SNMA Logoand concerns of medical students of color.  For over 40 years SNMA has been dedicated to ensuring culturally sensitive medical education and services.  For 20 years, CFHI has been offering Global Health Immersion programs designed to help students appreciate the role that culture plays in health and healthcare.  By teaming up, CFHI and SNMA hope to make a Global Health experience accessible to more students.  This special 2-week program, previously open only to SNMA members, is now open to all health science students.  Space is limited so apply early.

The SNMA-CFHI 2-week Urban Primary Care in Oaxaca program aims to introduce students to the cultural competencies that are crucial for effective health care professionals. This program is tailored for those who wish to increase their cultural and linguistic competency as well as their understanding of the health factors affecting Latinos.

Oaxaca is an excellent setting for studying the healthcare system of Mexico and the healthcare practices of the population.  Students often hold the false assumption that the healthcare is available to all, but find in Oaxaca that poor and rural populations are increasingly unable to compete for scarce health resources.

CFHI programs offer participants the opportunity to learn more about health issues that transcend national borders, class, ethnicity, and cultural divisions.  By participating in CFHI’s global health education you will gain a unique insight into healthcare systems of developing countries and increase your cultural competency. Increasing one’s awareness of other cultures (cultural competency) is becoming increasingly relevant for healthcare professionals as industrialized countries become more ethnically, culturally and linguistically diverse. Click here to read an article and learn more about why cultural competency is important for today’s healthcare workforce.

The program dates are June 3rd to June 18th. Please visit the CFHI website to learn more.

We look forward to having you join our grassroots work to build a global community in support of better healthcare for underserved communities and more globally aware health professionals!

CFHI Alum: “It Made Me Want To Be A Doctor A Lot More…”

It made me want to be a doctor a lot more, for sure,” she said. “Seeing doctors in action, they were really fantastic role models. It’s hard to get exposure shadowing doctors here (in the Bay Area). I’ve had a few opportunities at Stanford. The  more time I got… the more inspired I am to become a doctor.”  These are the words of Christina O’Neal, as reported in the Contra Costa Times by Correspondent Doug Mead.  Christina, a Stanford University premedical student,  spent part of her summer in the Cultural Crossroads in Health Program in Mexico MapOaxaca, Mexico.

Christina told the Contra Costa Times in the article that her month on the CFHI program in Oaxaca, “was pretty life-changing.  Everybody gets pretty much free health care there,” she said. “It’s interesting to see how things are run. There’s a lot of poverty, and the government, in terms of health care, has a lot of problems. But the infrastructure was good. I was impressed with how smooth it ran and how dedicated the doctors were. It was an awesome experience.”

The experience really improved Christina’s Spanish and Medical Spanish skills.  “I’d say, before I got there, I was conversational (in Spanish),” she said. “Now, I’m borderline fluent. My comprehension, especially, skyrocketed. I’ve always had a pretty standard ability to speak. Now, I understand everything that’s happening. Even though my vocabulary didn’t grow as much, I can express myself better. Once you understand people better, it helps you to speak more correctly. We went over grammar and medical vocabulary every day (in class).”

We are very glad for Christina that her experience was so impactful and we greatly appreciate her kind words about the CFHI program as she ended her interview with the newspaper saying, “Everything was fantastic. It surpassed all my expectations. It was a phenomenal experience.”

CFHI Medical Director Receives Special Award -Final Report From Curenavaca

Dr. Jessica Evert, the Medical Director of Child Family Health International, received the Christopher Krogh Award at the GHEC – INSP Conference today.

Dr Jessica Evert Receiving Special Award at Global Health Conference in Mexico

Dr Jessica Evert Receiving Special Award from Dr Anvar Velji GHEC Co-Founder and Dr Richard Deckelbaum GHEC President at Global Health Conference in Mexico

The award, honoring the memory of Dr. Krogh, a founding member of GHEC, who died in 1994 in a plane crash while traveling as a physician for the Indian Heath Service, is given to an individual who shows dedication to serving the undersered both domestically and internationally.

Dr. Evert has worked in various places around the world, and also works on a daily basis treating patients in several underserved communities in the San Francisco Bay Area.  Prior to becoming the organization’s global  Medical Director, she volunteered with CFHI for several years so we are well aware of her talents and her dedication.  CFHI extends a hearty congratulations to our new Medical Director as she receives this distinguished honor!

South-South Collaboration -Second Report From Cuernavaca

This is my second report from the Global Health Conference happening in Cuernavaca, Mexico.  The conference is the joint effort of the Global Health Education Consortium (GHEC), based in San Francisco, California,  and the Instituto Nacional de Salud Publica (INSP), here in Curenavaca.  I spoke with Lisa DeMaria, Investigadora en Ciencias Medicas of INSP and she told me about a perhaps lesser known part of the Global Health field. “There is a sophisticated network in Latin America of middle income countries with similar health issues that are working closely together to address common challenges.” “The face of Global Health is changing,” she told me as we discussed that there is much more happening today in Global Health than just the very wealthy countries attempting to help the very poor countries.

The conference this weekend is a good manifestation of this with at least 22 countries represented.  It is also the First Latin American Caribbean Conference on Global Health and so the extensive regional network of health professionals is strongly represented.  INSP and GHEC have championed the effort to establish this first of a kind conference without knowing for sure if there would be a second conference but the momentum that has been created here seems to be sufficient to ensure continuation with countries like Brazil, Chile, and others stepping up to carry on the tradition.

South-South Collaboration

The 19th Annual GHEC Conference and the 1st Latin American and Caribbean Conference on Global Helath

GHEC - INSP Conference 2010 Cuerenavaca, Mexico

GHEC - INSP Conference 2010 Cuerenavaca, Mexico

Of course, the planning for a conference like this  happens more than a year in advance so as we are gathered comfortably here in Curenavaca, Mexico, having important discussions and sharing of ideas, it is important to look back and see all that has happened along the way on the journey to Cuernavaca.  Not long after the decision to have the conference, came the outbreak of H1N1 in 2009 and many questioned the wisdom of continuing with the conference plan especially with the fear that a repeat flu outbreak could happen in early 2010.

More fundamentally, the intention of this conference –different, I think, from other South-South conferences– is to have the South participants truly take the lead.  “The idea from the beginning was that the North participants are the guests and are primarily coming to learn” said Karen Lam, the Global Health Education Consortium (GHEC) Program Manager.  With its almost 20 year history and strong following,  GHEC has been able to bring the numbers that frankly support the undertaking of a major conference like this and make it financially feasible.  The back story is all the effort to truly make it a success.  GHEC has partnered with the Instutio Nacional de Salud Publica (INSP) here in Cuernavaca.  INSP is the conference venue and has been a great host for this event.  Both INSP and GHEC are to be highly commended for all the hard work to bring this event to a reality and in such a successful way!

“The vast majority of the presentations  are by and from the perspective of the South participants,” Lam pointed out.   Sessions are covering everything from Ethics and Equity Issues, to Global Health Diplomacy, to Public Policy, and Social Determinants of Health.

It is encouraging to see so many Mexican, Caribbean, and South American students able to be a part of this conference and to see the work of the collaborations of  their fellow students and teachers so prominently featured.  So far the sharing and exchange of ideas is stimulating and leaves one hopeful for all the collaborations that will now have their beginnings here in Cuernavaca.

Global Health South/South Collaboration Conference in Mexico

2010 GHEC Conference png

The 2010 Global Health Education Consortium’s  (GHEC) Conference will be held in conjunction with the Instituto Nacional de Salud Publica (INSP) in Cuernavaca, Mexico.  This promises to be an engaging conference.  The theme of the conference is Alliances for Global Health Education: Learning from South/South Collaboration.  More information on the conference can be found on the GHEC website here.

Those who have worked in Global Health for any period of time, will find the idea of a major conference with the focus on South/South Collaboration to be refreshing.  Many conferences have had sessions featuring purely South/South partners but we believe this is the first major conference to have this as its main focus.  In addition, it is being identified as the First Latin American and Caribbean Conference on Global Health.

We of course all remember that it was almost one year ago that many of the first reported cases of the A(H1N1) Virus were identified as occurring in Mexico.  Clearly Mexican health workers and scientists performed heroic work in the face of a mysterious epidemic. Their work helped the world avert a public health problem that could have been significantly worse that we have experienced so far.  The location of the conference, at the premiere Mexican public health institute in Cuernavaca, will provide a great opportunity to hear first-hand the story of the crisis and to share the lessons learned.

New Technology Brings Efficiency and Increases Capacity for Department of Hospital Civil in Oaxaca, Mexico

Computer being received at Hospital Civil in Oaxaca, Mexico

Computer being received at Hospital Civil in Oaxaca, Mexico

CFHI is proud to announce the donation of a Macbook computer to one of our partner sites in Oaxaca, Mexico– the teaching department of Hospital Civil. The donation to the subdireccion de ensenanza department came after the hospital requested this equipment from CFHI as a useful tool in improving operations there. The replacement for the manual typewriter, also in the picture, is a welcome addition to this very busy facility.

The computer will serve in many capacities including logging various activities occurring within the department and in managing the coordination of medical residents working at Hospital Civil.  In the photo above from left to right: CFHI Oaxaca Medical Director Dr. Tenorio, Dr. Gabriel Augustin Velasco, the head of Hospital Civil’s teaching department, and CFHI Program Manager Nick Penco, alongside the new computer.  CFHI would like to thank the participants of our Global health Education programs as well as support from our donors in making such contributions possible.

Hospital Civil is an outstanding facility with a dedicated staff.  CFHI has enjoyed a long relationship with this excellent teaching hospital.  This municipal facility is an anchor of the community and has seen everything from the increase of chronic diseases, to the fallout of civil unrest.  And  Oaxaca was one of the initial detection points of the Novel H1N1 Virus this past year.  We commend them on their quick and professional response to what was an unknown crisis.  The quality of their work has helped to blaze the trail for everyone working to treat and stop this pandemic.