Clinicians Working Alongside the Traditional Ngäbe-Buglé Lay Midwives of Panama

Although strides have been made to decrease ethnic, social, and economic disparities in Latin America, inequality still persists among the most marginalized indigenous groups. In the small Central American country of Panama, the Ngäbe-Buglé are two distinct indigenous groups with similar cultural and linguistic characteristics combined into one general Comarca or indigenous reservation, making it the largest indigenous group in Panama (over 280,000 individuals). Although Panama presents a thriving economy, occupying second place in the region after Chile, indigenous groups face extreme poverty. Their poor living conditions, coupled with a treacherous mountainous terrain and limited healthcare infrastructures and service delivery, place them at high risk to develop numerous diseases. These include high rates of maternal and child mortality (48/100,000) as compared to urban areas of Panama (13/100,000). Allopathic clinicians working at the community level, with inclusion of lay midwives, can help to bring positive change to this forgotten population and alleviate the burden of unequal maternal, pregnancy, and reproductive health outcomes. Since the early 1990s, the Ministry of Health of Panama has provided training to lay midwives of the Ngäbe-Buglé Comarca to prevent further maternal and child deaths occurring during pregnancy, birthing, and postpartum. Also, additional training related to reproductive health is provided to the midwives.