In the Chocó region of Colombia, pregnant women rely heavily on traditional midwives due to inadequate medical facilities. This article explores the interaction between traditional and modern medicine and the need to improve healthcare infrastructure.
In the remote municipality of Iró, located in the Chocó department of Colombia, pregnant women face significant challenges in accessing adequate medical care. The journey from their homes to the Santa Rita health center involves only fifty steps, but conditions at the center often lead them to rely more on traditional midwives, known locally as midwives. Despite their dedication, these midwives work in difficult conditions, highlighting the urgent need to improve healthcare infrastructure and support.
Rely on traditional midwives
Jennifer Palacio, head nurse at the Santa Rita health center, reveals that many women prefer to give birth at home with the assistance of midwives like María Crucelina Sánchez, affectionately known as ‘Chilina’. The health center, which lacks essential equipment such as an ultrasound machine and the ability to perform cesarean sections, struggles to provide the necessary care. “In May we did not attend a single birth, everyone is attended to at home,” Palacio admits.
Chilina’s house has become a sanctuary for pregnant women in the community. Despite the challenges, she uses a Doppler device to detect fetal heartbeats. The lack of adequate medical facilities forces women to rely on their expertise, which often involves navigating through dense forests and rivers to reach healthcare services.
Leidy Quinto, an apprentice midwife, echoes the challenges facing the community. In areas like Todositico, where there is no health center, a midwife is crucial. “If there is no midwife, there is no one who can care for the babies,” explains Quinto. The dire situation in these remote areas highlights government negligence, as evidenced by the lack of basic health infrastructure and support.
Government negligence and maternal mortality
The health crisis in Chocó is exacerbated by the lack of medical professionals willing to work in these difficult conditions. Manuela Mosquera, president of the Association of Midwives of Chocó (Asoredipar), describes the reluctance of doctors to enter health centers with doors riddled with bullets. The region is plagued by violence from criminal groups such as the Clan del Golfo and guerrilla factions such as the National Liberation Army (ELN), creating an environment of fear and abandonment.
This lack of medical care has dire consequences. Chocó’s birth rate is almost three times the national average and preventable maternal deaths are significantly higher than in other parts of Colombia. Mosquera notes that he often unfairly blames midwives for these deaths despite their efforts to work closely with medical professionals. “The envy and lack of respect towards the culture of the surrogate mother who goes to the midwife is evident,” she asserts.
For midwives like Chilina, modern medicine is not an adversary but an ally. Insists on having an ultrasound report before treating any pregnant woman. “If the doctor says the risk is high and something happens, they will blame the midwife,” he explains. This collaboration is crucial, however, the systemic issues of gun violence, domestic violence, and poverty create significant barriers to achieving comprehensive maternal care.
Integrating traditional and modern medicine
Integrating traditional and modern medicine is essential to improve maternal care in regions like Chocó. Mosquera advocates for a better relationship between medical professionals and midwives. “If doctors and nurses listened to the midwives who bring pregnant women to them, there would be a perfect link because the midwives are in the territories wanting to minimize maternal deaths,” she argues.
Colombia’s Constitutional Court has ordered the government to integrate midwives into the health system and compensate them for their invaluable work, especially during the pandemic. However, midwives like Manuela emphasize that more than recognition is needed; They need respect and acceptance of their role in the community. “We don’t need recognition, we need respect and acceptance,” she says firmly.
This call for integration and mutual respect is crucial for the sustainable development of health in Chocó. Providing midwives with the necessary training and resources while ensuring that medical facilities are equipped to handle emergencies can significantly reduce maternal mortality rates. Additionally, fostering a culture of collaboration between traditional and modern healthcare providers can improve the overall effectiveness of maternal care.
Latin American context
The challenges faced by midwives in Chocó are not exclusive to Colombia. Throughout Latin America, indigenous and rural communities often rely on traditional midwives due to a lack of accessible health services. In countries such as Mexico, Peru and Guatemala, midwives play a critical role in maternal health, especially in remote areas where health infrastructure is inadequate.
These regions share similar challenges, including high maternal mortality rates, limited access to medical facilities, and cultural barriers to healthcare. In many Latin American countries, the integration of traditional midwifery practices with modern healthcare is an ongoing effort. Successful programs often involve training for midwives, government support, and community involvement to ensure that maternal care is culturally sensitive and medically sound.
In this broader context, the experiences of midwives in Chocó reflect Latin America’s broader struggle for equitable health care. Addressing these issues requires a comprehensive approach that includes policy changes, investment in healthcare infrastructure, and recognition of the valuable role that traditional healthcare providers play in their communities.
The journey of pregnant women in Chocó, from the guidance of midwives like Chilina to inadequate facilities at the Santa Rita health center, underscores the urgent need to improve health care infrastructure and support. Colombia can create a more inclusive and effective maternal care system by fostering collaboration between traditional and modern healthcare providers.
Also read: Colombia’s health system faces critical challenges and inconsistencies
Lessons from Chocó highlight the importance of integrating cultural practices into health care, ensuring that investments in health care infrastructure respond to community needs, and recognizing the critical role of midwives in improving maternal health outcomes . As Latin America continues to address these challenges, the stories of midwives and the communities they serve provide valuable information to build a more equitable and effective health system for all.
