Communication and understanding: The pillars supporting culturally sensitive maternal health care in Panama

CIUDAD DE DAVID, Panama – At hospitals around the world, the attire of health-care staff sends important messages to patients. White coats often signal professionalism; surgical scrubs suggest cleanliness and sterility.

Although the bright blue-and-pink clothing that intercultural interpreter Eira Carerra wears to the José Domingo De Obaldía Maternal and Infant Hospital in David, Panama, might be less typical for hospital settings, it communicates no less of an important message.

“I come dressed as a Ngäbe,” Ms. Carerra told UNFPA, the United Nations sexual and reproductive health agency. “It sets me apart from hospital staff.” 

Ms. Carrera is a member of Panama’s indigenous Ngäbe community. Her job at the maternal and infant health centre in David is to liaise between Ngäbe patients and the hospital’s predominantly Spanish-speaking providers.

The work is critical to closing gaps in access to health care for Panama’s Ngäbe population, who – like other indigenous communities around the globe – have long faced displacement,  oppression and rights violations as a legacy of colonialism.

Today, the Ngäbe people are among Panama’s most marginalized, forced to contend with high rates of poverty, discrimination and a lack of access to health care.

As a result, pregnant Ngäbe women often arrive at Ms. Carrera’s hospital experiencing dangerous complications, and the risk to their lives only escalates against the backdrop of a health system unfamiliar with their language, culture and values.

“Previously, the pregnant women visiting the health centre said there was no communication, no understanding, no sensitivity,” Ms. Carerra said. “But that has totally changed.”

Building a culture of consent

Between 2000 and 2020, Panama’s maternal mortality rate reduced by nearly 25 per cent. Yet this broad progress obscures dangerous disparities affecting the country’s ethnic minorities. For instance, research shows Panama’s indigenous women are approximately six times more likely to die in childbirth than their non-indigenous counterparts.

“Women were dying in their homes giving birth,” said Gertrudis Sire, president of the Ngäbe Women's Association. “We began meeting to identify our problems, to look for solutions and to seek support from institutions and allies.”

Research reveals Ngäbe women struggle to satisfy their need for family planning and to access quality maternal health services due to factors like cost and distance. Mistreatment by health providers also creates problems.

“Ngäbe women told me, ‘They don't understand me at the health centre,’” Ms. Carrera said. “On many occasions, they were told there was no space for them, or were addressed in a tone of voice that left them feeling scolded. And if a woman refused treatment, she sometimes received it in a forced, obligatory manner.”

To address challenges like these, Ms. Sire’s association worked with the maternal and infant hospital in David to set up an intercultural programme that aimed to lower communication barriers between indigenous patients and non-indigenous care providers, and to educate health workers on providing culturally sensitive care.

According to Ms. Carrera, following the launch of her hospital’s intercultural interpretation programme, its staff’s approach to Ngäbe women has changed dramatically for the better, with patient consent for procedures playing a crucial role.

“If she does not accept, that is respected”, Ms. Carrera said.

Integration and inclusion

Today, the José Domingo De Obaldía hospital’s evolving approach to inclusion is evident in everything from staff uniforms – many health-care providers have taken to incorporating traditional Ngäbe designs, patterns and colours – to the information posted on the walls in both Spanish and in Ngäbere.

It is also clear in providers’ changing attitudes. Ms. Carrera noted that before, Ngäbe women were sometimes turned away from the hospital even after walking for days.

In 2020, by contrast, one researcher quoted the hospital’s director for gynaecology and obstetrics as saying: “When a pregnant Ngäbe woman arrives at the hospital after walking nine hours through mountainous terrain and flooded rivers, and does not speak any Spanish, the least we can do is show some empathy and make her feel welcome”.

Together, these small gestures of solidarity and support amount to something bigger: An effort to tackle major social ills and save maternal lives.