For indigenous women and children in Panama, the disparities in health access and health outcomes translate into alarmingly high mortality and injury. In fact, 3 X higher than average for indigenous women in Latin America. The “Ngäbe Buglé, with 156,747 inhabitants (2010 census), are among the most impoverished and least medically served in the country (multidimensional poverty index score of 0.469); highest of all the regions in the country. Lack of access to prenatal care has been identified as a main cause of injury and mortality; >90% preventable. Approximately 40% of pregnant women receive no prenatal care and 60% of births occur at home.
Care is generally provided by traditional midwives (Comadronas); most lacking formal training and diagnostic tools.
THE MANCHICHI PROGRAM
The Manchichi program is based on Phalarope’s Ixchel Midwife Program successfully implemented in 8 rural Mayan communities in Guatemala. Attesting to the encouraging results, this Rotary supported project has now expanded to 13 additional communities. The program is unique in that it focuses attention on the traditional midwives in these communities who become equipped and trained in the use of basic diagnostics and care. They learn how to identify signs, symptoms, and underlying causes that put the pregnant women and their babies at risk. These communities then have a corps of highly effective, community-based sentinels in constant vigilance for the health of mothers and infants.
The integration of traditional midwives into the health system has resulted in an effective mechanism to identify, support, and track high risk patients such that referrals to physicians can be made to allow for critical and timely intervention.
The program also includes a Cultural Competency training for clinical, administrative and students working at the Minister of Health hospitals and health centers to vastly improve interaction both with patients and midwives within the Indigenous culture.
Finally, the program has a Women and Child Health Education module to raise awareness on a plethora of health topics of importance to the community.
The program is written at an appropriate comprehension level to allow training in both Spanish and in the native indigenous language. Topics include breast and cervical cancer, sexually transmitted diseases, colon cancer, nutrition, HIV, osteoporosis, diabetes, cardiovascular disease. All women who are pregnant through post-partum receive information about proper weight gain during pregnancy, premature labor, hemorrhage during pregnancy and postpartum.
Building on the success of the Guatemala Midwife program, the Manchichi program will be implemented in 6 communities in the Ngäbe Buglé Comarca. All midwives in this communities will be trained, and all members of the community will be invited to participate in the health education program.
PARTNERS, so far…
Rotary Club of Boquete
Skidaway Isle., GA, Rotary Club
Lake Oswego Oregon, Rotary Club
Panama Health Ministry
Instituto Nacional de la Mujer (INAMU)
Congreso Regional Indígena de la Comarca Ngäbe Buglé
ASASTRAN (Asociación de Agentes de Salud Tradicional)
Fundación Nuestra Señora del Camino
Tommy Guardia Geographic Institute
Del Mar Rotary Club
Playa Coronado Rotary Club
Rotary Club of Boquete
Jeff Flynn, Project Director,
firstname.lastname@example.org WhatsApp – Panama +(507) 6447-2547
U.S. +1(225) 806-7393 U.S.
Jeff Flynn, proud grandfather, a semi-retired sugarcane agronomist who worked in the US, Latin America, Asia and the Middle East, and a member, Jeff Flynn will manage a major Club Rotario de Boquete initiative, the Maternal and Infant Mortality Prevention (MIMP) project. He and his wife purchased a home in Boquete in 2011 and, while working with a nearby sugar business in Alanje, developed a keen interest in working with and helping the Indigenous people living in Ngabe-Buglé, the largest and most populous of Panama’s five Indigenous Comarcas.
When the opportunity arose in Rotario de Boquete to develop a program addressing the high rate of maternal and infant mortality in Panama’s Comarcas, Jeff took on the task of finding possible approaches. The MIMP project started to take form once Jeff identified the need to support the midwives serving rustic and remote areas in the Comarcas.
Jeff has always had a respect for midwives and all legitimate health providers struggling for recognition; his children and grandchildren were all delivered by nurse midwives.
Jeff saw his father, a Chiropractic Doctor, experience the frustration of fighting for recognition and legitimacy by the American Medical Association. The same kind of struggle persists in this country. “In Panama, the time has come to shine a light on the work and needs of midwives in the remote Comarcas currently providing maternal and infant health-care services,” Jeff said.
When Jeff learned of Phalarope, a US-based NGO headed by Dr. Mariam Rittmeyer, and of midwife support and empowerment training in Guatemala, he knew he had found a model of a possible approach for Panama. Phalarope created a self-sustaining program that developes skilled trainers from within a community. With the implementation of a similar program in the Comarcas in Panama, trained Ngobe tribal women could become “health promoters,” increasing the medical knowledge and capability of midwives, making them more effective in caring for pregnant women in remote areas. As a result, “These midwives, the familiar, trusted face of community health care, steeped in deep generational and traditional knowledge regarding health,” will be more effective in maternal and infant care and will have the ability to recognize high-risk conditions that require referral for early intervention.
Ngabe-Buglé: Largest of the Comarcas in Panamá
“It is time to recognize and unleash the incredible human resources residing within the Ngobe communities,” Jeff said. Club Rotario de Boquete, with Phalarope’s assistance, will partner with groups in Panama including ASASTRAN, a group of midwives and traditional healers. Dr. Rittmeyer met via video-link with Sra. Rosa Moreno, the maternal health mission director of Padre Adonai’s Fundacion Nuestra Senora del Camino. After Dr. Rittmeyer described Phalarope’s methods used to develop their midwifery program in Guatemala, Sra. Moreno responded enthusiastically. Dr Rittmeyer will come to Panama to meet with Sra Moreno and members of Club Rotario de Boquete in November. We will introduce our MIMP project plans to the recently installed regional ministry of health (MINSA) director, Dr Enilso Miranda.
With the assistance of Phalarope and partners in Panama, Club Rotario de Boquete’s MIMP project hopes to bring significant and sustainble improvement to maternal and infant health in Panama’s Comarcas.
Miriam Rittmeyer MD, PHD, MPH, Phalarope Chair, Dr Miriam Rittmeyer is Chair of Phalarope and director of its Maternal and Child Program. She is a native of Guatemala, where she
received her MD from Francisco Marroquin University Medical School. She received her Master in Public Health (MPH) in International Health from Johns
Hopkins University, and her PhD in Nutritional Epidemiology from the University of north Carolina School of Public Health.. Dr Ritttmeyer received a post-doctoral award from the National Institute of Health (NIH) and another post-doctoral Fellowship from the Organization of American States. Dr Rittmeyer is currently Assistant Clinical Professor in the Community Medicine Program, School of Medicine, Mercer University, in Macon, Georgia.
EOL Tablet-Lending Program Update
Two of the many families who have borrowed Rotary Tablets
Club Rotario de Boquete’s Tablet-Lending program continues to grow in answer to the needs of our families living in remote areas. During our pilot phase of lending just 18 Rotary Tablets, more than 72 students in grades pre-K through 12 and university have been able to continue their education during the current closure of schools. We have ordered an additional one hundred tablets to arrive mid-November to be part of the Tablet-Lending program of our Equal Opportunity for Learning (EOL) project. Our objective is to make internet-connected devices available to families in remote areas during school closure so their children can connect to their lessons and assignments currently available online.
Because school vacation starts in December, the Education Committee of Rotario de Boquete decided to work with the Director of the Boquete Library, Elsa Castillo, to develop a program to continue online learning by teachers and students during the vacation months from December through February. We are concentrating our efforts on four schools: Alto Auel, Jaramillo Abajo, Palmira Abajo and Volcancito. Ms. Catillo will assist in communicating with the directors of the schools and their teachers. We hope to increase their interest in learning how online academies can be used to support teaching and learning, and how students can continue their learning during their school vacation by coming to the library and using Rotary Tablets to access learning programs online.
After school vacation, schools may open for students to attend in person for part of the day or for alternative days with students completing their lessons and assignments at home. If so, many students will continue to need Rotary Tablets to continue their learning online.
On October 22, two EOL committee members visited Jaramillo Abajo, one of the first schools to borrow Rotary Tablets for their families. The EOL committee was warmly welcomed by the Director, Jorge Castero, three teachers, and parents from six families. Everyone in the school showed their gratitude for Rotary’s concern for their children’s education.
Rotario de Boquete’s EOL Tablet-Lending Program is grateful for the opportunity to call the Boquete Library home during the school break.
The Boquete Library is unusual as it is the first book-lending library in Panama from which books are borrowed and then returned for others to borrow. In addition to its collection of books, videos, and music CDs, the library offers world-class music concerts throughout the year. Works of local artists are featured in the gallery which often includes receptions with food and beverages. Boquete Library even includes the delightful Andrea’s Café, located on the ground floor, where visitors can relax with a cup of coffee and a light meal. Within than a year of its inauguration in February of 2012, its collection grew to more than 10,000 books with an average of 80 books being checked out daily and more than 1,000 library cards issued. From that time on, the Library has continued to grow. The building and ongoing support of the library have been generously provided by the Patricia Price Peterson Foundation.
Ron always has a smile when he is working
People of Action
Last year Club Rotario de Boquete received support from Rotary International to build trash receptors for the town of Boquete. We met with the Mayor of Boquete and he was pleased to receive these trash receptors for the town’s first trash-separating efforts. These cans will enable the city to start recycling. As with many of our projects, the pandemic lengthened our original time-line for completion. With the dedication and stick-to-it-ness of a core of people headed by Ron, the end seems to be in sight.
Thanks to Hector, Ralph, Joe, Ginny, Gisela, Bruce and many others, we are now proud of the completion of yet another community-service project. With social distancing and limited days to gather for work, this is a testimony to Rotarians’ dedication to selfless work.
Newton G. Osborne, Chiricano Making a Difference in the World
We Salute, Newton G. Osborne, one of Club Rotario de Boquete’s founding members, for his contributions to the community. Doctor Osbone was born in Puerto Armuelles and grew up in La Concepción, Chiriqui. After he graduated from the Univ. Hospital of Panama, he studied at Yale where he received a master’s degree in molecular biology and biophysics. He received his first PhD in bacteriology from the Univ. Connecticut and his MD from the Univ of Michigan. He completed his residency in obstetrics and gynecology at the Univ. of California Hospital, San Francisco. He has co-authored five books and published over 370 articles in medical journals. He has been a consultant to numerous international health organizations such as WHO, CDC, PAHO and FIGO. With the limited amount of space in this feature, we will end this shortened list of accomplishments by mentioning that he received the First Educational Leadership Award in 2014, Master Ramón Guerra in the City of David.
Newton Osborne faces life and death everyday in the hospital, but he cannot accept the tragic and needless death of girls and women from childbirth. The majority of maternal and infant mortalities in Panama occur in the Comarca (indigenous reservation) population. The statistical rate of maternal death in Panama’s Comarca is equal to the most impoverished countries in the world. Osborne also knows tha,t in addition to issues with prenatal care, medical support and education, there are cultural issues; and these may be the most challenging of all to overcome. Osborne feels that if the indigenous population were educated in managing child birth through awareness and birth control, the mortality rate would reduce dramatically.
Two years ago, Osborne approached Club Rotario de Boquete with a proposal to work on the issue of maternal and infant mortality in the Comarca. Club Rotario de Boquete developed the Maternal & Infant Mortality Prevention (MIMP) project . Initially, the Club proposed a mobile health clinic that would service remote areas of the Comarca. After visiting the Comarca, it was clear that a mobile clinic would have had a difficult time traversing some of the undeveloped, steep dirt roads during the rainy season. As well, the cost of what would be required for such a venture might have been out of our Club’s reach. Members of the Club decided to revisit our initial ideas and to research what was being done in other Latin countries faced with similar issues. The Club members were determined to find a way to help address this important health issue.
Maternal & Infant Mortality Prevention (MIMP) Meets with Phalarope
Club Rotario de Boquete learned about Phalarope, a non-profit NGO based in Savannah Georgia, that has been working with Guatemalan indigenous people with health and cultural issues similar to the Comarcas in Panama. Phalarope is also steeped in Rotarian culture. Dr Miriam Rittmeyer, Phalarope’s Director of the Maternal and Child Program, is a Rotarian in Skidaway Rotary Club in
The Phalarope model of effective community assistance in Guatemala focuses on a system of training and education of local indigenous health providers and midwives. For its initial step, Phalarope made an assessment of the knowledge base and current level of care given by midwives including their level of literacy, training, and use of traditional methods. From this information, training modules were developed specific to the needs of the target population. Recognizing the limited formal education of many of the midwives, Phalarope developed practical and effective instructional methods to convey important medical concepts.
Phalarope identified the best candidates from the community to attend their training to become “Health Promoters.” They play the key role of delivering the training programs to the local midwives. Certificates were given to trained midwives and, though not considered officially, they empowered midwives to network with other area midwives to lend advice and support. The Guatemala Health Ministry actively supports Phalarope’s program.
Following the success of the initial program, plans have been approved to expand to an additional twelve communities pending the ending of pandemic restrictions.
Health Promoters are trained and tasked with providing educational and training classes for the community and for midwives in the Comarca. The target audiences are: 1) community members who are invited to receive information on general health and wellness; and 2) midwives who are intensively trained in health and wellness with specific emphasis on pregnancy and delivery and infant care. Training in the understanding and use of basic diagnostic equipment such as blood pressure monitors, gluco-meters, stethoscopes and doppler imaging is emphasized, since these are the tools that allow midwives to detect potential preexisting conditions and problem pregnancies so that physician referral, intervention and hospitalizations can be arranged in advance.
Nutritional guidance is another critical component of health training. A host of other complicating health factors including parasites, diarrhea, HIV, flu, a n d C O V I D – 1 9 w i l l l i k e l y b e encountered by these health providers.
Dr. Rittmeyer uses survey tools for assessments. Follow-up data are constantly collected on pregnancies and births. The most significant barometers of success are the improvement in early intervention and recommendations in cases of complications.
The Phalarope organization designed its program to encourage self-propagation with moderate additional investments as midwives and local health promoters share their training. These programs, established within Guatemala indigenous communities, have proven to be effective in improving health outcomes.
Club Rotario de Boquete has a unique opportunity to participate in a project that could significantly improve the health of communities in the Comarca for generations to come.
Currently, our Club is identifying the communities to target for our project initiative based on needs, infrastructure and accessibility. We are also gathering information on potential collaborators such as US Rotary Clubs, local organizations such as Floating Doctors,Peace Corps, ASASTRAN and other organizations currently working in the Comarca.
The Bag that Keeps on Giving
Update on EOL’s Tablet-Lending Program
Club Rotario de Boquete’s Equal Opportunity for Learning (EOL), Ta b l e t – l e n d i n g p r o j e c t continues to navigate the twisty COVID-19 road. We have met many challenges with prolonged school closures. In last month’s Newsletter we spoke of how EOL was inspired to start a math program in private households who had struggling math students. At the same time, a struggling math student with one of our tablets could share the tablet with siblings who could
use it for their schoolwork.
These were all great concepts until we realized that the cost of keeping the Tablets loaded with unlimited data enabling internet access on an ongoing basis was unsustainable. Just when we were about to abandon the idea of financing unlimited data, MADUCA, the Panamanian Ministry of Education, and the major cellular providers established a national program offering unlimited data SIM cards to all students if they applied for it online. When we heard this news, the EOL committee was ecstatic; now all we need to do is to provide Tablets to students!
With the new online school curriculum, the immediate need of students in rural Panama for Tablets became obvious. EOL decided to postpone the math-learning requisite of the Tablet-lending program. We decided to lend Tablets to families who do not presently have internet access for their students during the day.
Currently, we plan to purchase an additional one hundred Tablets to lend out. We will wait for a couple of weeks to see how our Tablets fare in private homes since our initial plan was to use them in a controlled school setting.
Mr Candelario Pineda, principal of Valcancito Primary School and Ms. Juanita Espinoza, teacher at Jaramillo Abajo Primary School are the first recipients of EOL’s Tablet-lending program. Candelario said, “I have a family with ten children, and all of them go to school, but the father is the only one with a cell phone. Often the father does not get home until 10 pm at night. Therefore, the children are not participating in school at all because they do not have access to their classes during the day.”
Ultimately, once schools reopen, we will recall all tablets on loan and resume our initial pilot project plan of introducing KhanAcademy.org in primary schools.
Our Club Rotario de Boquete bags were used to provide food for people in quarantine. This time, Club Rotario de Boquete bags contain the vital tool students need to participate in school learning. It is truly a bag that keeps on giving.
Our website update has not yet complete, but check back in a couple of weeks. The website will include a fund-raising section so that you can support the project of your choice with your VISA card.