The Manchichi Program

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The Manchichi Program


For indigenous women and children in Panama, the disparities in health access and health outcomes translate into alarmingly high mortality and injury. In fact, 3 X higher than average for indigenous women in Latin America. The “Ngäbe Buglé, with 156,747 inhabitants (2010 census), are among the most impoverished and least medically served in the country (multidimensional poverty index score of 0.469); highest of all the regions in the country. Lack of access to prenatal care has been identified as a main cause of injury and mortality; >90% preventable. Approximately 40% of pregnant women receive no prenatal care and 60% of births occur at home.

Care is generally provided by traditional midwives (Comadronas); most lacking formal training and diagnostic tools.


The Manchichi program is based on Phalarope’s Ixchel Midwife Program successfully implemented in 8 rural Mayan communities in Guatemala. Attesting to the encouraging results, this Rotary supported project has now expanded to 13 additional communities. The program is unique in that it focuses attention on the traditional midwives in these communities who become equipped and trained in the use of basic diagnostics and care. They learn how to identify signs, symptoms, and underlying causes that put the pregnant women and their babies at risk. These communities then have a corps of highly effective, community-based sentinels in constant vigilance for the health of mothers and infants.

The integration of traditional midwives into the health system has resulted in an effective mechanism to identify, support, and track high risk patients such that referrals to physicians can be made to allow for critical and timely intervention.

The program also includes a Cultural Competency training for clinical, administrative and students working at the Minister of Health hospitals and health centers to vastly improve interaction both with patients and midwives within the Indigenous culture.

Finally, the program has a Women and Child Health Education module to raise awareness on a plethora of health topics of importance to the community.

The program is written at an appropriate comprehension level to allow training in both Spanish and in the native indigenous language. Topics include breast and cervical cancer, sexually transmitted diseases, colon cancer, nutrition, HIV, osteoporosis, diabetes, cardiovascular disease. All women who are pregnant through post-partum receive information about proper weight gain during pregnancy, premature labor, hemorrhage during pregnancy and postpartum.

Building on the success of the Guatemala Midwife program, the Manchichi program will be implemented in 6 communities in the Ngäbe Buglé Comarca. All midwives in this communities will be trained, and all members of the community will be invited to participate in the health education program.


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