Type of project- Humanitarian and Vocational Training
Description: Maternal and infant mortality in Panama's indigenous territories is much higher than the rest of the country and indigenous women are three times more likely to die than indigenous women in Latin America.
"For indigenous women and children in Panama, one of Latin America's highest per-capita income countries, the disparities in health access and health outcomes are equally stark."
"Ngäbe Buglé, with 156,747 inhabitants according to the 2010 Census, is the largest of Panama's three indigenous territories and has the highest multidimensional poverty index score of all the regions in the country (0.469). Geographically, it is very remote and comprised mostly of small and dispersed communities. Its mountainous terrain, numerous rivers and remote coastal geography make travel between communities and outside the region very difficult."
In 2019 , Phalarope, as a collaborative organization, with Rotary International, district 6920, the Rotary Club
of Skidaway Island and the Vista Hermosa, developed and implemented a training program for comadronas in 8 communities of the department of Chimaltenango. The program was unique as the comadronas were trained as traditional medical teams; they learned how to detect hypertension using sphygmomanometers, high blood sugar using glucometers, and conduct fetal monitoring using medical equipment such as a portable fetal Doppler. They also learned how to identify signs, symptoms, and underlying causes that put the pregnant women and their babies at risk. Some of these causes needed immediate referral, while others needed a closer follow-up and referral to a physician when the due date for the delivery was approaching. During this first phase, the program provided health education training to 367 members, with the provision of 180 educational sessions, and the certification of 26 traditional midwives after 1 year of training. The program showed improvement in knowledge about diseases, use of preventative services like pap-smear, self-breast examination, and nutrition. In one-on-one interviews midwives of the Ixchel-1 expressed that they felt better prepared, as they were able to detect high-risk patients before labor and better present their patients to the firemen when a referral was needed. The program increased their credibility and respect by the firemen who are instrumental in getting patients to hospitals. The midwives were acknowledged in public for their achievement by the COCODES (Mayan local government). Because of the success of the program the Mayor and the Mayan goverment of 2 municipalities (Tecpan and San Jose Poaquil) requested in writing to expand the program to their municipalities . Because of the success of the program, the qualtiy of work from Phalarope as cooperative organization, a second Roary Global grant has been awarded and it will be expanded in 13 rural communities. Due to the Covid Pandemic the startin date for the expansion has been delayed. It is expected to start during the first trimester of 2021 if regulations allows it.
Given the success this intervention, the Boquete Club contacted Phalarope to explore the posibility of expanding the program into Panama given that the similarities in the underlying causes of maternal mortality that Panama experience.
Goals of this area of focus will your project suppor
1. Reducing the maternal mortality and morbidity rate
2. Improving access to essential medical services, trained community health workers, and health care providers
How will you measure your project's impact?
- Number of mothers receiving prenatal care- Direct observation-Every 2 weeks-100-499
Number of communities that report decreased mortality rates of mothers Surveys/questionnaires Every month 1-19
Number of pregnant women identified with gestational hypertension (preclamsia) Direct observation Every two weeks 100-499
Number of pregnant women who are identified with high blood sugar levels using finger stick blood sugar Direct observation Every month 100-499
Number of pregnant women who were diagnosed with gestational diabetes Direct observation Every month 100-499
Number of women who are identify as a high risk pregnancy due to age (teenage pregnancy or older , more than 45 years of age) Surveys/questionnaires Every three months 100-499
Number of pregnant women identify as a high risk pregnancy due to short stature Direct observation Every three months 100-499
Number of traditional midwives trained by the vocational team in th egarget communities Direct observation Every three months 20-49
Number of women who attended a health education program Direct observation Every two weeks 100-499
Number of health educationa classes provided to the community Direct observation Every two weeks 100-499
Number of pregnant women identified with an acute emergency condition and refer to the hospital Direct observation Every two weeks 100-499
Number of pregnant women identifed with a pregnancy risk factor (e.g. baby in transverse) that needs close follow-up by physician and commadrona Direct observation Every two weeks 100-499
Number of staff members (medical and administrative) from the minister health hospital, and health center that participated in the Cultural Competency Program Surveys/questionnaires Every three months 50-99
Organization that will collect the monitoring and evaluation information?
Phalarope, Inc. is a non-profit 503(c) NGO with operations in USA and Guatemala since 2016. Phalarope's
mission is to improve children's lives by empowering women through education, community outreach and opportunity, enabling families and communities to reach their full potential. The organization has no religious or political affiliations. Phalarope has six priority areas: maternal and child health, women's economic empowerment, education, food access-agricultural, professional training, and technical support of other nonprofits.
Phalarope's members have more than 25 years of experience working in the medical field, with expertise in public health, epidemiology, medical anthropology, program development, implementation and evaluation in the USA and Guatemala. Currently, Phalarope is part of the task force formed by Rotary district 6920 for a GA state wide project called Savings Lives with Medicine for Georgia. The project is an initiative of MAP International to bring free medications to the uninsured and undeserved in Georgia. Phalarope has been instrumental in the implementation and success of the program.
In addition, Phalarope has pioneered in Guatemala the integration of traditional indigenous midwives into the health system. The program focused in creating a continuum of care between rural communities and the health system by training traditional Mayan midwives (Comadronas). The objective of the program is to improve prenatal care management, identify, refer and provide follow-up to high risk patients in rural indigenous communities, educate member of the community in key health problems, and improve the cultural sensitivity of healthcare providers when they interact with the indigenous population. The program started in 2019 in 8 communities, and it was funded by a global grant. Phalarope has absorved the program as part o their operations ensuring its sustainability Because of the success of the program, the Mayan goverment of two municipalities requested the expandion of the program. A second global grant has been approved to expand the program to 13 communities with Phalarope as he collaborative partner in the grant. For more information about the Ixchel program in Guatemala see the following video: Phalarope Guatemalan Project
The project will be conducted in 6 indigenous communities(Cerro Banco, Cerro Otoe, Jad Aberi, Hato Pilon, Chichica, Lajero) in the Ngäbe-Buglé Comarca, Panama. The project is schedule to start 07/07/2021 to 26/07/2022.
The Cooperative organization is Phalarope an NGO who has its headquarters in the USA registered in USA and GUATEMALA with offices in Savannah GA and San Jose Poaquil, Chimaltenango Guatemala. Phalarope was selected as the collaborative partner as they were the organization that helped the vocational team implement the Ixchel -1 program in the initial 8 communities and will expand it to another 13 communities in 2021. Phalarope is a truly benevolent organization. Their board members obtain no personal financial gain. Phalarope received in 2019 a Platinum Seal of Transparency, the highest level of recognition by GuideStar. Their experience in working in the medical field as well as in the areas of public health, program evaluation
makes them a strong partner. Phalarope's 26 midwives trained during Ixchel-1, and the approval of a second Global grant to expand the program into 13 more communities make them the perfect organization to expand the program into the Ngäbe-Buglé Comarca of Panama. In addition one of Phalarope's traditional midwives from Guatemala will be participating in training the midwives in Panama as part of the vocational team. This will allow us to have a cultural exchange of wisdom from two different indigenous groups.
Other partners in the Project include
1. Congreso Nacional de la Comarca Ngäbe-Buglé (Indigenous Government)
2. ASASTRAN - (Asociación de Agentes de Salud Tradicional y Natural Ngäbe-Bulge) an organization of mostly indigenous midwifes servicing women in the Panamanian comarcas.
3. MINSA - (Minister of Health is the Government Panama Health
4. FNSC - Fundación Nuestra Senora del Camino and Casa de la Comarca (CAJU) are non-profit organizations that focuses on the Ngäbe-Bugle Comarca in Panama. CAJU focuses on the social development related to high-risk pregnant women and youth through workshops and seminars.
The Community needs that this project will address include 3:
Cultural Competency - This is a new program for members of the hospital and Heath Centers of the Panama Minister of Health (MINSA) . None of their members are trained. All areas of training will include how to prepare the infrastructure and staff of the Hospital and emergency response entities in order to provide culturally competent care according to traditional birthing and respecting the patient's modesty and beliefs. The need for interpreter services in all areas will be evaluated since many of the patients do not speak Spanish and are illiterate. The Vocational team for the Manchichi program is the same that developed the training modules for the Ixchel-1. This training module will be provided to the staff of the Panamanian Minister of Health hospital and health centers serving the 6 communities in the Ngäbe Bugle Comarca. The curriculum will address issues on :
•patient-physician/emergency agent situations during provision of medical care
•perception of these interactions under the Western and the Ngäbe culture.
•Attitudes values, communication, gestures differences for description of illness during medical examination.
2. Women's Health and Child Health Education - Pregnant women and midwives in the target communities do not have a structured educational program from the health post/center. This training is done when the woman assists to her prenatal care, which is rare as most women do not use the western health services. Most of the women who live in remote areas do not use the health center/health post as they are frequently considered sometimes not cultural appropriate, and it is a place where people dies. Therefore they rely on the midwives. Also transportation is a barrier. The Manchichi Program program will provide, as it is done with the Ixchel program in Guatemala, onsite education where pregnant women and midwives live. This education will be provided during the prenatal care. Follow-up will be conducted by the midwives and Phalarope's health promoter ensuring continuity.
3. Prenatal Care, Labor and Postpartum Clinical Skills- Traditional midwives lack proper training in the identification of high risk patients and no program provides them with basic medical equipment to screen and detect these high risk pregnancies. The 1-year training will ensure that midwives understand the concepts behind the use of this medical equipment, feel comfortable in its use. Finally the program will address the problem of proper patient referral, the lack of close working relationship between midwives and and the MINSA hospital and Health Center's staff.
The Manchichi program is a replication of the Ixchel program implemented in Guatemala. and its training and education components are:
Cultural Competency - will be provided to medical students, faculty, clinical and administrative staff of the Panamanian Minister of Health hospital and health centers serving the Ngäbe Bugle Comarca . This is a new program for them. The training was developed by the vocational team and Phalarope during the Ixchel-1 program. The training include patient-student, patient-physician, patient-administrative staff situations during provision of medical care and how this is perceived within the Ngäbe culture.
2. Women and Child Health Education -This is an educational program The program takes into consideration the cultural match between community health workers, traditional midwives and the target communities. The program will be written at the 4th grade level in Spanish and Ngäbe. The curriculum includes topics on breast and cervical cancer, sexually transmitted diseases colon cancer, nutrition, osteoporosis, diabetes, cardiovascular disease and HIV. For women who are pregnant or post- partum, they will receive information about proper weight gain during pregnancy, premature labor, hemorrhage during pregnancy and post-partum, gestational diabetes and hypertension. This education model will include the use of screening tests to detect breast, cervical and colon cancer : pap-smears, self- examination and mammograms, and occult blood in stools. Finally, the education program uses 3D visual aids. The classes specifically dealing with infant's health will include breastfeeding, weaning foods, immunizations, infectious diseases, and growth.
3. Prenatal care, Labor and Postpartum Clinical skills: This program is meant to train the Traditional Medical teams in the following areas:
• Prenatal care (nutrition, identification of high risk pregnancies).
• Delivery and postpartum techniques
• Fetal monitoring using portable fetal Doppler,
• Identification of fetal position
• Post-partum care, placenta and cord management cord, postpartum hemorrhage, placenta retention.
• Development of a referral system of high risk patients to the hospital
• Birthing simulator is used for the training.
• All midwives received medical equipment that included portable fetal Doppler