Dear Friends,

This year, our programs and partnerships have continued to flourish, with amazing results.

Just one example is the mobile health, or mHealth, smart phone application that we developed to enable midwives to detect problems during pregnancy and connect mothers with medical care when they need it. In the three years since we piloted this app, we have seen deaths from childbirth in our service area drop from 8 to 4 to 0! We intend to expand this work, and impact, to other regions.

We marked 10 years with our diabetes program. Through this program, we’ve transformed the lives of hundreds of patients who otherwise would not have access to care and helped to tackle Guatemala’s exploding diabetes epidemic. We plan to continue to expand the program, particularly among poor and rural people, enabling them to better control their disease and live longer and more active lives.

Your support has propelled all of these remarkable achievements and more. I am filled with enormous appreciation and excitement about what we can do together in 2019!

With deep gratitude,

Anne E. Kraemer Diaz, Executive Director

Leadership

WALESKA LÓPEZ CANÚ, Medical Director

ANNE KRAEMER DIAZ, Executive Director

“Permiso, permiso,” yelled men in white scrubs pushing a patient prepped for surgery through the sea of people.

As the director for complex cases, Mérida acts as a bureaucratic navigator for patients requiring treatment and care in Guatemala City’s hospitals—everything from cataract surgery to ongoing cancer treatment.

“If a patient does not understand what the doctor said, I explain it to them again. Some of the doctors are understanding, but some will only explain once. Or if a patient needs paperwork done, I run to do that,” Mérida said.

After dropping off the first patient for blood work, Mérida and I made our way along the forested path from Roosevelt to INCAN, a semi-private cancer hospital, to meet with another patient awaiting her colposcopy results. In her weekly visits to these hospitals, Mérida has become an expert at navigating the labyrinth of cars, people, and vendors that extend between Roosevelt and INCAN.

“Most of the guards don’t give me trouble anymore,” she commented. “However, they haven’t let me accompany patients before when I was wearing a corte. There is still discrimination against indigenous people and indigenous dress here at hospitals in Guatemala.”

There is still discrimination against indigenous people and indigenous dress here at hospitals in Guatemala.

Like Roosevelt, INCAN was swarming with people - patients, family members, security, and medical staff. Lines extended outside the facility, where waiting patients and family members were curled up, sleeping on the steps.

Scanning the crowd, Mérida spotted her patient. The three of us weaved our way through the masses and dashed down winding hallways, barely making the appointment. The doctor shared the good news that the test results were negative and provided follow up instructions.

Hardly out the door, Mérida broke out into a smile and mini celebratory dance.

“This is great news. Did you understand all of the doctor’s instructions?,” she asked, embracing her patient.

“I live for these cases,” she said. “They make me so happy. It is always good news when a patient no longer needs me.”

It is always good news when a patient no longer needs me.

Unfortunately, not all cases are that simple or end happily. They are, after all, complex cases.

Back at Roosevelt, we met up again with the patient, who had finished her blood work. We waited with her to see the doctor. As a terminal breast cancer patient with metastasis to the lungs, she was waiting for another round of chemotherapy.

“Chemo has not been helping. It is very sad. She comes from very far and came to our organization already like this,” Mérida explained. We waited in line while her patient rested on a nearby bench.

The doctor confirmed that chemo was doing little to stop the growth and recommended a transfer to INCAN to begin radiation therapy. On a bureaucratic level, this is not an easy feat. The process requires filing another set of paperwork and making a series of photocopies to transfer everything appropriately. Only then can treatment commence.

The hospital’s bureaucracy makes it impossible for patients to receive the care they deserve, Mérida lamented. “There is so much paperwork required, and for what?”

The paperwork is hard enough for anyone dealing with a complex health condition. The challenge becomes even greater for patients who don’t speak Spanish, can’t afford the long trips to the hospital for treatment, or lack the emotional support to move forward in the face of persistent discrimination.

Although I’ve only been in Guatemala for a few weeks, I know that complex care navigators like Mérida and many others at Maya Health are the hidden heroes working to break down the inequality that still exists when it comes to accessing health care. They’re the superheroes battling against bureaucracy and discrimination to ensure that their patients receive the care they need, but more importantly, deserve.

This problem is particularly acute among Mayan women in rural Guatemala, who typically lack access to medical care during pregnancy, and who experience discrimination when they do visit health care facilities. As a result, up to 75% of women in Guatemala’s rural communities give birth at home, typically with the assistance of midwives.

Given these realities, we have equipped midwives with a smartphone application that helps identify potential concerns to increase the likelihood that mothers and their babies will get the care they need to remain healthy throughout pregnancy and birth. Our mCare app provides checklists of maternal and newborn warning signs, and enables midwives to check vitals like blood pressure and pulse. It securely transmits the information to clinical staff and flags serious complications for follow-up. An emergency on-call team is available to provide support during the referral process. When mothers need to access hospital care, we help navigate the system.

This early detection and support enables more women to get timely care when complications arise, leading to fewer deaths of mothers and infants at childbirth.

We are heartened to report stunning results. In our small service area, the number of women who died in childbirth has dropped from 8 to in 2016 to 4 in 2017 to 0 in 2018.

We are continuing to grow this project and to scale this lifesaving model to other regions in Guatemala and beyond.

Diabetes Program: Marking 10 Years

With Guatemala’s growing and aging population, the number of people with diabetes is expected to double in the next 20 years, from 700,000 to 1,400,000. Despite the quickly expanding number of diabetes cases, the public health sector, chronically underfunded, has not invested in diabetes care.

So one of the first services we provided when Maya Health began was home visits to elderly indigenous patients with Type 2 diabetes in Santiago, Sacatepequez. Over the last decade, we have cared for hundreds of indigenous people with diabetes who otherwise would not have been able to access health care.

Our blend of clinical expertise, deep local knowledge, and partnerships with local organizations enables us to deliver high-quality diabetes care to 150 patients a year at the relatively low annual cost of $200 per patient.

All patients are offered free, standard-of-care services, including regular medical check-ups, home education visits, laboratory testing, medications, and supplies (including insulin and syringes), and screening for diabetes complications. Diabetes nurses provide the bulk of direct patient care under close physician supervision. We also have invested in an electronic health record and medicine procurement system that dramatically reduces costs and increases efficiency.

Our approach integrates medical care with behavior change strategies that work for rural, indigenous people. We work with local partners in each community who can provide in-kind support such as access to local community leaders or space in existing facilities. This makes it possible for us to transfer nutrition knowledge to help build local capacity and reach more patients. We have published more than a dozen scientific papers and have become one of the country’s leading experts on treating Type 2 diabetes in rural Guatemala.

We have never wavered from our vision that Guatemalans, including indigenous Maya, should be able to access quality diabetes care in their native languages. It is heartening to see that some of the same patients we visited in 2006 are still thriving today.

For many Guatemalans, diabetes is an incredibly frightening diagnosis, one that suggests years of suffering, expense, and early death. When we meet a diabetes patient for the first time, we let them know that they can still live a long and happy life; that there is no reason that they cannot see their children, grandchildren, and great-grandchildren grow up.