In the lush Western highlands of Guatemala, the deep blue gem Lake Atitlán sits quietly, surrounded by volcanoes and colourful Maya villages with distinct customs and deep-seated beliefs. One of these beliefs is that a chronic disease like diabetes is inevitable.
Yet change is possible – and it comes from within.
This is what inspired Asociación K’aslimaal (Hospitalito Atitlán) – WDF’s local partner in the area – to roll out 'Healthy Habits for Prevention of Chronic Disease in Guatemala', a two-year project (and WDF’s fundraiser in 2021), in six villages of the Sololá department.
If in the past decade, the projects implemented by Hospitalito Atitlán (WDF 11-669, WDF 14-909, WDF 17-1527) have been the most consistent form of diabetes intervention helping marginalized populations, ‘Healthy Habits’ is the first systematic effort to provide primary prevention understanding and methods to Maya villagers, at the grassroots level.
But that was no easy task in a country affected by political instability, inequality, and poverty.
The healthcare system is significantly challenged by the burden of diabetes. According to the IDF Diabetes Atlas, the diabetes prevalence in Guatemala is 13.1%, which is the highest of all countries in Central and South America, accounting for 15% of all deaths in the country.
Unfortunately, the ones suffering the most are the Maya people. More than 70% have no formal education, and the monthly family income is around USD 130. Moreover, diabetes care and preventive information is lacking in most health and educational facilities, and the existing information is mostly in Spanish, not the Mayan language. The project also faced an unexpected barrier – the Covid-19 pandemic - which brought uncertainty, lockdowns, difficulties in reaching people, and an alarming mortality rate.
The indigenous communities in Sololá abound in diversity, with more than 22 different Maya languages
Based on years of local experience, Hospitalito Atitlán sought sustainable ways of making change possible. To promote healthy choices and reduce risk factors for diabetes and other NCDs among this marginalized population given these challenging circumstances, the project formed alliances and relied on the existing groups of diet and lifestyle decision-makers – the women.
“Focusing on primary prevention in these rural communities where health information is lacking is vital, and the involvement of women and existing women’s groups have been crucial to the success of this project”, explains Line Bechmann, Programme Manager at WDF. “The same goes for our partner’s ability to collaborate with local and national authorities and actors. This is an excellent example of how a multistakeholder approach can deliver great results”.
‘Healthy Habits’ has been the first WDF-supported project targeting a dynamic education of women leaders within the indigenous population of Sololá, as the ones able to effect sustainable change within their families and, to a larger extent, their communities.
This would ultimately help build a culture of primary prevention of chronic disease adapted to the Maya culture, by educating and encouraging them to adopt healthier behaviours that have been lost in time due to globalization.
Local and national authorities and women school leaders highlight the importance of nutritious school menu options
Back to healthier roots
Almost 200 traditional birth attendants (TBAs) – highly respected women, recognized as healthcare providers by the government – church leaders and school leaders accepted to become agents of change by participating in the training organised by the partner to improve their health and the health of their families and the people who need them – pregnant women, mothers, and children.
The Maya women have learned that a healthy lifestyle can be affordable, enjoyable, and convenient. And most importantly, rooted in their culture, behaviours that have been forgotten, such as growing gardens, walking to the market, eating locally grown food, and cooking healthier.
“Many pregnant women present complications without knowing that gestational diabetes exists because they do not attend their appointments at the health centre. There are things we ignore, but these workshops helped us learn about them.” – Vicenta González, TBA
The workshops have made a difference for more than 1000 people, who are now better informed about having a healthy pregnancy and baby, healthy food for diabetics, and hygiene essentials. They have trusted leaders who share their culture and language, to whom they can ask questions.
By focusing on the women leaders of the community, the project could have a powerful ripple effect. Maria Cortez, one of the trained TBAs, says that “the training was a gift of knowledge for the benefit of our families. The ones in charge (red. of family diet and lifestyle) are the women who attended these workshops, and to share this knowledge they must start with themselves, they are the example at home”.
Cultural barriers, however, have proven to be a tough challenge.
One of the obstacles to the accessibility of preventive measures, health promotion and health services is that they are offered in Spanish. Despite it being the national language of Guatemala, most indigenous people speak one of the Maya languages instead.
To address that, the project focused on speaking their language. All activities and educational materials have used the languages of three Maya ethnicities – Tz’utujil, Kaqchikel and Kiche’.
While it might take a generation to see lasting change in health patterns, persistence is key, and it starts with leading by example.
“I appreciate the information provided to all the midwives because they have patients who are stuck at home and do not have complete information on food”, says Dominga Cotiy, one of the TBAs participating in the programme. “They are the agents that must make a change because they pay home visits. This way, they can share the information gained in the workshops and hopefully prevent premature births.”
The trained Maya women explain how to cook using more accessible, locally grown food
Healthier mind and body in difficult times
More than 270 families received seeds, soil and other resources through the ‘Healthy Habits’ project, while the Ministry of Agriculture, Livestock and Food (MAGA) supported the establishment and sustainability of the family home gardens.
As a result of the programme, 85% of the families consumed the harvest and enjoyed vegetables such as spinach, beets, or chard (a new “family favourite”) for the first time. While eating healthier, they have also reduced their expenses.
But tending to the gardens has helped beyond expectations, helping them learn and achieve personal development, enhancing their psychological well-being and even becoming a source of happiness in the troubled times of the pandemic.
As always, sustainable change is possible with sustainable partnerships.
There have been many encouraging stories within the Maya communities of the Sololá department.
Ana, a 47-year-old single parent of two children living in San Lucas Tolimán, is one of the beneficiaries, who was unaware of her poor health before joining the programme. She had a weight classified within the obesity range and a glucose level of 180 mg/dL. After learning the meaning of these values and how to improve health by adopting healthier behaviours specific to the Maya culture, she decided to make a major change. As a result, she improved her health and reached a weight loss of 19 kg and a normal glucose level of 136 ml/dL.
This is just one example that more education on chronic disease prevention among marginalized communities is needed.
The data collected by the Hospitalito Atitlán staff before and after the programme tells the same story. At the end of the project, there has been a 13% increase in the number of people showing normal ranges of blood glucose and an 8% decrease in those within the diabetic values of glucose. Similarly, there has been a 6% decrease in the number of people with stage 1 hypertension values and a drop in percentage among those within the overweight/obesity categories.
The 'Healthy Habits' project has also advocated for safer public spaces for families and children to go for walks and enjoy exercise
The project was largely successful and created great perspectives for future interventions due to the broad range of stakeholders involved - from the Guatemalan Ministry of Health (MoE) and the Ministry of Agriculture to the national and municipal authorities and the local communities themselves.
The synergy of these partnerships contributed to the effective implementation of the guidelines. The project enforced the ban on unhealthy snacks in schools and the recommended healthy menus being served.
In Santa Lucía, Utatlán, the municipality coordinated with the Municipal Commissions for Food and Nutritional Security (COMUSAN) to plant more than 2,000 family gardens increasing access to and availability of healthier local food.
Finally, part of the project was to advocate for safer public spaces to promote exercise and recreational activities for the 6,000 people living in the villages surrounding Lake Atitlán. Four out of six villages allied to implement changes at a local level, such as traffic-free areas.
Even after completion (2023), ‘Healthy Habits’ continues to inspire change for the better health of the Guatemalan populations.
The projects selected by WDF as fundraisers give donors the chance to directly support diabetes prevention and care projects. The 2023 fundraiser project will benefit children and youth in Lebanon by increasing access to sports in urban areas and nurturing life skills.