Midwifery in the Mayan culture of Guatamala is an honoured vocation, despite the lack of equipment, funding and training. Morag Prunty reports
When Hurricane Stan swept across the southwest coast of Guatemala, it caused flooding and mayhem that its limited shabby infrastructure could not take. Roughly the same size as Ireland, with a population of 13 million, Guatemala has an 80 per cent illiteracy rate and the greatest gap between rich and poor of all the Central American countries.
A few days before the Pakistan earthquake took the world's attention, one village around Guatemala's Lake Atilan region was buried entirely under a massive landslide. With a death toll estimated at 1,000 inhabitants, the area was simply declared a mass grave by the government and virtually ignored by the world's press.
One of the victims of this tragedy was Maria Gavina Catu, a 60-year-old rural midwife whose essential midwife's kit got washed away in the floods. Ten years ago, she had delivered an astonishing 2,500 babies when she decided to stop counting. Maria is one of 17,000 Mayan midwives who work voluntarily in their rural communities.
Midwifery in the Mayan culture is an honoured vocation; you are called to it either by a dream, by your date of birth if you are born on the day of the midwives, or by being struck down by a mystery illness for failing to follow your pre-destined path.
Maria is one of a lucky 5,000 midwives who have been trained by ACECSA, a non-governmental organisation that promotes rural health and is funded by foreign aid. ACECSA works among the five million or so indigenous Mayan people, most of whom live in conditions of appalling rural poverty among the lush landscape of Guatemala's mountainous jungle regions. With its policy of training key people from within local communities rather than recruiting foreign help, ACECSA runs modestly funded health centres around the country. These are staffed entirely by voluntary health promoters, most of them Mayan women whom ACECSA has trained in basic medical and nursing skills.
The average life-expectancy of a Mayan woman is only 48, among the lowest in the world. A contributing factor to this is that 25 per cent of all births in Guatemala result in the death of the mother. Most of these deaths occur in hospitals and result from a lack of pre-natal care or are emergency cases that arrive in hospital too late.
It is common practice for a man to refuse to send his wife to hospital when things become complicated during pregnancy or birth, believing that it would be cheaper for her to die at home.
With an average of between five and nine children born into each family, ACECSA sees the training of midwives and provision of basic equipment such as scissors and latex gloves as crucial work. Because she no longer has her ACECSA-donated midwife's kit, Maria must now return to improvising with whatever comes to hand - cutting the umbilical cord with a machete or Gillette razor is common practice among untrained midwives.
Because she has been trained in hygiene, Maria will know to use boiled water or heat a blade before cutting, but facing the prospect of going backwards is nonetheless painful.
To receive their ACECSA training, some women must travel for up to six hours on a bus twice a month for four years. Once trained, all midwives remain unpaid, their only reward being the education they have received making their vocations easier to fulfil.
These trained midwives then go back into their communities and train other women.
One of the keys to ACECSA's success in gaining the trust of these Mayan women - most of them illiterate and few of whom speak the "official" language of Guatemala, Spanish - is the respect they have for the traditional birth methods they practice, many of which the West could learn from.
In the Tikal region, the Q'eqchi communities hang a rope from the ceiling. The squatting woman grabs it and her husband supports her from behind as she pushes the baby out. Often, mothers and fathers will attend the birth offering encouragement and support, and for 40 days after the first child is born, all of the laundry and household chores fall to the man of the house.
Midwives attend pregnant women every 15 to 30 days throughout the pregnancy, and for six weeks afterwards. Some offer a service called Temascal - a basic Mayan sauna used during pregnancy, and sometimes labour, as pain relief.
The Mayan culture favours large families and it is not unusual for a girl to get pregnant shortly after puberty. One health promoter told of a woman who came to her bleeding and frightened at the age of 30. This was her first period, as she had become pregnant before menstruation and, nine children later, had been pregnant ever since.
The midwives encourage natural birth control. Not because the size of their families upsets Mayan women, but because they worry about how they will care for their children in the future; how they will survive in a country whose government seems impervious to the plight of a large section of its population.
ACECSA is doing the job of a government agency in terms of providing almost all of the healthcare facilities for up to 40 per cent of the Guatemalan population, funded entirely by foreign aid money - a substantial chunk of which comes from the Irish agency, Trócaire.
Trócaire's Global Gift Plan offers people the chance to buy a midwife's kit for a woman in Guatemala that will offer her the basic tools of her trade and a place in a four-year training programme that will equip her with the necessary knowledge to protect mothers and babies.
• To buy a gift: call 1850 408 408 from the Republic of Ireland or 0800 912 1200 from the North or log on to www.trocaire.org/globalgift2005/globalgift2005.html or e-mail: globalgift@trocaire.ie
• The author Morag Prunty travelled to Guatemala with Trócaire in November 2005. Her new book, Recipes for A Perfect Marriage, is in shops now under the name Kate Kerrigan.