A couple of years ago, I spent several days in San Cristobal de Las Casas, the capitol city of Chiapas, Mexico. It's a gorgeous place. The most traditional and the most modern of Mexican culture mix in a city that is both remote and pivotal. It's a city nestled among the mountains, where there are hundreds of small villages. Many of these villages lack good transporation; most people don't have cars; poverty is common. It's a place where multiple languages are spoken, and people are fierce about their traditional lands and culture -- as well as their future.
An important part of that culture is the tradition of parteras, or community-based midwives that tend to at least half of births in the region. These midwives, often with little or no "formal" training, are highly respected in communities for their warmth, wisdom, expertise, and skilled hands.
However, Chiapas also has some of Mexico's highest rates of death in childbirth. These deaths are preventable, for the most part. As the New York Times reports, "These midwives handle normal births with ease, but most lack the training, medicines and equipment needed to deal with obstetric emergencies like hemorrhage, high blood pressure and infection." Many women are resistant to using hospitals, due to expense and a perceived lack of respect for their values.
So, many new programs are coming about to bridge the gap that is causing these deaths. There are government clinics that aim to mimic home birth conditions in villages; and others that intend to give parteras training that would help them in case of emergencies.
For me, the situation with childbirth in Chiapas is important in and of itself, but it also highlights dynamics that exist anywhere in the world.
Here are 3 healthcare collaboration lessons I see in Chiapas's midwives, doctors, and mothers:
- Good medical care is about more than just good interventions.
It doesn't matter if hospitals have equipment to deal with medical emergencies. If women perceive that their values, families, babies, and health won't be cared for in the way they wish, they won't access or benefit from hospitals -- period. It's up to every medical team to provide excellent care to the patient, and that involves more than just good medical interventions.
- There has to be collaboration and communication across the continuum of care.
We've seen similar dynamics in communities across the US. The parteras have expertise that doctors and "professional" midwives don't have; and vice versa. So if there is not communication and collaboration across those "siloes" then the patients are the ones that lose. Caregivers, aides, patients, doctors, specialists, and nurses all have key parts of the knowledge and experience that make up good care: each of those people needs to be able to collaborate with the others.
- If hospitals are doctors aren't proactive, patients in more remote areas won't get care.
It's everyone's responsibility to ensure that all patients have access to excellent healthcare. That said, hospitals and doctors in more central or "skilled" centers need to be active about engaging caregivers and patients in more remote areas. Tools like iClickCare can make that easier; but it's still takes curiosity and humility.
We've found hybrid store-and-forward telemedicine to be the best tool for healthcare collaboration across the continuum of care. Click here for a simple summary of what it is:
Photo used under Creative Commons rights from elpichas on Flickr