ACAM (Association of Mam Speaking Midwives) is a cooperative of Maya midwives who banded together in 1997 after the Guatemalan Civil War to seek their own solutions to the many health issues facing their communities. Based in the town of Concepción Chiquirichapa, Quetzaltenango, the communities served by ACAM consist of about 50,000 people, 80% of whom are indigenous Maya. The surrounding communities struggle with poor health and nutrition, low levels of education, and poverty. Maternal and infant mortality rates are among the highest in Guatemala, and there are significant problems with child and spousal abuse, and mistreatment of indigenous people in the health system, especially women. However, these communities have worked hard to preserve the rich traditions and customs which have sustained them through 500 years of hardships spanning from Spanish conquest to the 36-year Guatemalan civil war, which ended in 1996. They are incredibly proud of their heritage, and the strength of their communities.
In Guatemala, midwives have been practicing and supporting women, families and communities for thousands of years. In Maya communities, midwives are highly respected health care providers and integral members of the community. The ACAM midwives blend ancient traditional care with modern medical approaches as they provide high quality, low cost prenatal care and counseling, attend normal births, and provide postnatal care to mothers and their newborns. For high risk pregnancies or complications, they will refer to the nearest hospital in Quetzaltenango, though many women refuse to go due to cost, poor quality care, or lack of female and/or culturally competent providers. The ACAM midwives speak the language of their clients (Mam) and share the same heritage. They have a very personal stake in the welfare of their home communities and are likely to continue serving these isolated populations.
ACAM services are provided at a nominal fee and fees are waived for clients who cannot afford to pay. The midwives are constantly seeking creative ways to generate revenue in a society where traditional midwives do 80% of births in the Maya towns, but receive no salary, material support or recognition from the health care system. ACAM midwives receive a living wage, a rarity in Guatemala.
ACAM midwives envision a model where skilled, traditional midwives, who speak the language of the community (Mam), provide services in a well-equipped, mid-level facility, with reliable means to transport women to the hospital when indicated; and mobile or satellite midwifery outposts staffed by local skilled midwives, with emergency equipment, medicines, and strong transport and referral capacity.
Today, the ACAM midwives provide much of the care for their clients in their birth center in Concepción Chiquirichapa, built in 2003 (donated to ACAM by US-based midwives and supporters). It is the only medical facility in Guatemala owned and operated by indigenous midwives. It has 4 birth rooms, 2 exam rooms, space for training and meetings, pharmacy, and a medicinal garden. They attend over 200 births per year at the birth center; additional births take place in the homes of women in the surrounding communities attended by midwives who are part of the ACAM cooperative. Every woman who delivers at the birth center receives a postpartum visit in her home. Each year, thousands of prenatal and postpartum visits, family planning visits, cervical cancer screenings with cryotherapy services, and other consultations take place at the birth center.
However, many women in remote communities cannot utilize the birth center for regular care because of lack of access to and/or costs of transportation, and other demands of work and family life. Since 2016, with grant funding, ACAM is providing mobile clinic services to four isolated communities where they have seen over a thousand women. All this in addition to the almost 4000 women seen at the ACAM center during that same period!
ACAM is a unique model. Its many accomplishments are the fruit of a 20-year partnership, with its sister organization, Maya Midwifery International. North American midwives, physicians, and other volunteers act as allies, advisors, and mentors, bringing requested educational and financial resources to support their ACAM colleagues, in an ongoing relationship based on mutual respect and local control.
ACAM (Association of Mam Speaking Midwives) is a cooperative of Maya midwives who banded together in 1997 after the Guatemalan Civil War to seek their own solutions to the many health issues facing their communities. Based in the town of…