Communication and understanding: the pillars supporting culturally sensitive maternal health care in Panama

CITY OF DAVID, Panama In hospitals around the world, the attire of healthcare staff sends important messages to patients. White coats often indicate professionalism; surgical scrubs suggest cleanliness and sterility.

While the bright blue and pink clothing worn by cross-cultural interpreter Eira Carerra at the Jos Domingo De Obalda Children’s Hospital in David, Panama, may be less typical for hospital settings, it communicates a no less important message.

I come dressed as Ngbe, Ms Carerra told UNFPA, the United Nations sexual and reproductive health agency. It sets me apart from the hospital staff.

Ms. Carrera is a member of the indigenous Ngbe community of Panama. Her job at David’s Maternal and Child Health Center is to link Ngbe patients and hospitals, primarily Spanish-speaking providers.

The work is critical to closing gaps in access to health care for Panama’s Ngbe population, who like other indigenous communities around the world have long faced displacement, oppression and rights violations as a legacy of colonialism.

Today, the Ngbe people are among the most marginalized in Panama, forced to deal with high rates of poverty, discrimination and lack of access to health care.

As a result, pregnant Ngbe women often arrive at Ms. Carreras’ hospital with dangerous complications, and the risk to their lives only increases in the context of a health system unfamiliar with their language, culture and values.

Previously, pregnant women visiting the health center said there was no communication, no understanding, no sensitivity, Ms. career But that has totally changed.

Build a culture of consent

Between 2000 and 2020, Panama’s maternal mortality rate was reduced by almost 25%. However, this broad progress obscures the dangerous disparities affecting the country’s ethnic minorities. For example, research shows that indigenous women in Panama are approximately six times more likely to die in childbirth than their non-indigenous counterparts.

Women were dying in their homes giving birth, said Gertrudis Sire, president of the Ngbe Women’s Association. We started meeting to identify our problems, find solutions and seek support from institutions and allies.

Research reveals that Ngbe women struggle to meet their need for family planning and to access quality maternal health services due to factors such as cost and distance. Abuse by health care providers also creates problems.

Ngbe women told me, ‘They don’t understand me at the health center,'” Ms Carrera said. On many occasions they were told there was no room for them, or addressed in a tone of voice that made them feel scolded. And if a woman refused treatment, it was sometimes forced and compulsory.

To face challenges like these, the association of Ms. Sires worked with David’s Mother and Children’s Hospital to establish a cross-cultural program that aimed to reduce communication barriers between Indigenous patients and non-Indigenous care providers, and to educate healthcare workers about culturally sensitive delivery. cure

According to Ms. Carrera, following the launch of her hospitals intercultural interpretation program, her staff’s approach to Ngbe women has changed dramatically for the better, with patient consent for procedures playing a crucial role.

If he doesn’t agree, that’s respected, Ms. Carrera said.

Integration and inclusion

Today, the evolution of Jos Domingo De Obalda Hospitals’ approach to inclusion is evident in everything from the staff uniforms that many healthcare providers have adopted to the incorporation of traditional Ngbe designs, patterns and colors to the information posted on the walls in both Spanish and Ngbere.

It is also clear that suppliers are changing their attitudes. Ms. Carrera noted that before, Ngbe women were sometimes turned away from the hospital even after walking for days.

In 2020, however, a researcher quoted the director of gynecology and obstetrics at the hospital as saying: When a pregnant Ngbe woman arrives at the hospital after walking nine hours through mountainous terrain and flooded rivers, and no He speaks Spanish, as little as we can. to do is show some empathy and make her feel welcome.

Together, these small gestures of solidarity and support are something bigger: an effort to tackle major social ills and save maternal lives.

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