Friday, September 11, 2009

Leveraging indigenous culture to better serve a rural population

Denise Grady reports in the health page of a recent edition of the New York Times about a clinic in rural Peru that has adapted its practices to better serve women. The dateline is Ayacucho, Peru, which in 1999 had a very high rate of death in childbirth, in part because very few women (only about 6%) chose to give birth in clinics. Most chose home births, apparently in order to avoid the Western norms practiced in clinics, where staff did not speak their language. Here's an excerpt that explains what has turned things around:
Working with local people, members of a nongovernmental group, Health Unlimited, changed delivery services at a clinic in the Santillana district. They made sure Quechua was spoken, let relatives stay and help, set up delivery rooms so that women could squat and made other changes based on local traditions.
As of 2007, about 83% of women are giving birth in the clinic.

For another good-news story about health care delivery in the mostly-rural developing world, click here.

1 comment:

camp said...

Even MacDonalds adjusts the menu when they go to new markets, this is a lesson that medicine needs to adapt to local cultures if it wants to maximize positive impacts.
Reading the article I had this vision of caregivers creating formal protocols that are standardized and strictly followed in the US and then exporting them without realizing that much of protocol is culturally derived and not tied to improving medical outcomes. Their initial efforts bring to mind paternalism & colonialism; a very one sided interaction.
Fortunately the practitioners sought some input and changed their ways. perhaps it's a lesson that a new model that expects adaption and even openness to learning new (and perhaps better) ways of doing things should be more universally adopted.

A quick note on home births - mainly because my wife is doing one and because we've run in to so many biases against them over the last 38 weeks - a few reliable recent studies have shown that home birth is at least as safe as hospital birth when the birth is categorized as "low-risk" (See &

Of course, many people fall outside the low risk category, in which case we're lucky when we have access to a clinical setting with full service care, but when the mother and baby are low risk, a home birth can be healthier (same % of healthy babies w/ lower rates of intervention).

For any of you interested in an entertaining introduction to the subject I recommend Ricki Lake's documentary The Business of Being Born (