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The death of a woman during pregnancy or childbirth transcends the tragedy of a single loss, unraveling into deeper societal consequences. It precipitates a domino effect of increased financial instability, higher rates of school dropouts, premature marriages among girls, and escalated child mortality. Furthermore, women who endure pregnancy but face maternal morbidity-adverse outcomes due to pregnancy complications-experience devastating impacts that linger far beyond the postpartum period. In Panama's Ngäbe Bugle comarca, maternal mortality, already a dire and preventable issue, was severely exacerbated by the COVID-19 pandemic, which doubled the distressingly high rates. Prior to the pandemic, the region's maternal mortality rates soared above the national average, a situation that strained healthcare resources to their limits and highlighted the indispensable role of traditional Ngäbe midwives. Despite their lack of formal training and recognition, these midwives emerged as vital healthcare providers amidst the crisis.
In response to this crisis, in 2020, a Maternal and Child Health called the Manchichi was implemented in Panama modeled after a program implemented successfully in Guatemala by rotary and Phalarope members with the primary objective of strengthening women's healthcare in rural areas, specifically for indigenous communities . The approach involves training traditional midwives, fostering collaboration between traditional and modern healthcare practices, and establishing a sustainable care model. This community-led approach combines cultural practices with modern knowledge to create lasting improvements in healthcare. These efforts are dedicated to enhancing maternal and child health outcomes and promoting healthier pregnancies in these regions. The program is an intense 12-month program where traditional midwives and traditional healers are taught to identify risk factors and conditions related to a woman's reproductive cycle. This enables the prevention or prompt management of certain conditions during pregnancy, labor, delivery, and the postpartum period. Through conducting thorough health histories, comprehensive physical examinations, and the use of basic medical equipment, midwives are taught how to assess fetal growth and position, as well as proper labor and delivery practices, which includes instrument disinfection. Finally, midwives learn to identify signs of infection or conditions in both the infant and mother during the postpartum period. After this one-on-one training, these concepts are reinforced every 15 days by our field staff, who accompany the traditional midwives on their visits to all their pregnant and postpartum patients.
A key feature of the program is its culturally sensitive approach, which is adapted to the local language and culture. Members of the target communities are hired and trained to implement the program with the Rotary Vocational Team members and Phalarope, increasing patient adherence to treatment and the overall acceptance of the program. During the implementation of the first global grant, MANCHICHI-1, the enhanced training provided by the Manchichi program had yielded several positive outcomes. Firstly, it led to improved clinical management by equipping midwives with the knowledge and skills to better handle pregnancies, labor, delivery, and postpartum care. This included early detection of potential complications and timely referrals, which significantly enhanced maternal and neonatal health outcomes. Secondly, the program had fostered enhanced health-seeking behaviors among pregnant women by encouraging them to recognize potential health issues and seek professional medical care when necessary. Lastly, midwives, with their advanced training, could provide continued monitoring and ensure patient adherence to treatment plans when referrals to healthcare facilities were required, leading to better patient compliance and improved treatment outcomes. Twenty-seven midwives and five traditional healers had graduated from the program, serving in the six target communities as the primary providers of health. They often bore the responsibility for an entire community's healthcare due to the absence or limited availability of health centers.
Ninety-eight pregnant women received a total of 249 prenatal care visits, resulting in 84 births. Among these births, 59 women were referred due to risk factors, such as multiparity, prior diabetes, or hypertension, and teenage pregnancy. Additionally, ten women were referred for alert signs before labor. Health education classes were provided to all pregnant women, totaling 162 prenatal care education classes.
An exemplary situation that had illustrated the effectiveness and success of the program was a referral of a high-risk pregnant woman with signs of preeclampsia. The midwife had been able to showcase the new knowledge and skills acquired in the program as she correctly identified and referred the patient. She had accompanied the patient to the emergency room, had presented her to the ER medical staff, and had assisted in the diagnosis and treatment of preeclampsia. It had been confirmed by the emergency doctor, and the pregnant woman had been induced.
Another component of the program had emphasized health education provided by midwives to their patients and health education by the Manchichi team to members of the community. Midwives and the Manchichi team had provided targeted health education messages, focusing on lifestyle behaviors that may lead to co-morbidities during pregnancy and chronic diseases. All 98 pregnant women and 35 members from the community had received a total of 372 health education classes.
This grant aims to expand the reach of the MANCHICHI-1 program to 7 additional communities in Panama, including areas on the islands, ensuring broader coverage of maternal and child health services.
Phalarope the original collaborative organization will be partnering for this expansion with Floating Doctors, a reputable nonprofit organization operating in the Bocas del Toro region, to leverage their expertise in deploying medical interns and enhancing healthcare access.
ESRI Panama will continue to be an important partner in streamlining field data collection and reporting using a geospatial platform. This platform enables us to map the locations of households and collect information from program beneficiaries. Our system can send data from the field in two formats: as a dashboard summarizing the information and as individual reports for high-risk pregnancies, post-partum women, and neonates who are referred to the clinic or emergency room.
With the Rotary Vocational Team members, Phalarope, NGO partners, and seven exceptional indigenous women from the Chiriqui and Bocas del Toro region, who will be hired as trainer-mentors for midwives, pregnant women in the selected communities, we aim to create a more comprehensive and impactful program that addresses the continuum of care from pregnancy to early childhood. Through the collaboration of various stakeholders and the dedication of indigenous trainer-mentors, we envision a brighter future for the health and well-being of mothers and children in these underserved regions.
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