Impatient Optimists: A Field Visit to the Kuna Territory in Mesoamerica
Jeff Raikes (left) and Wolfgang Munar (red shirt) greet
partners during a recent visit to the Kuna Territory. (©Photo Inter-American
Development Bank)
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Jeff Raikes, Wolfgang Munar
On a recent trip to Panama to look at innovative health
investments, we visited the communities of Carti and Wichub-Huala, in the San
Blas Islands archipelago, an autonomous territory of the Kuna Peoples.
The Kuna participate in the Salud
Mesoamerica 2015 initiative (SM2015) that the Gates Foundation is jointly
funding with the Carlos Slim Health
Institute, the Inter-American
Development Bank (IADB), the Governments of eight Mesoamerican countries,
and the Spanish Bilateral Aid Agency. SM2015 is a catalytic initiative that
uses an outcomes-based funding approach to support Mesoamerican governments in
implementing pro-poor policies and programs that improve the health of women
and young children in rural areas.
At the first community we visited, we were greeted by Mr.
Gardi Sugdub, First Sahila (Chief) of the tiny islet of Carti, who was chosen
by the community to lead their public affairs because of his proven wisdom and
ability to articulate the People’s rich oral tradition as “keeper of metaphor.”
Shaila Sugdub highlighted the high value the Kuna people place on protecting
the health of their women and children. However, he also underlined the need
for respecting Kuna traditions because, as he put it, “people who lose their
tradition, lose their soul.”
We also met Ernesto Harris, Secretary of Carti’s Kuna
Council. Ernesto went to college in the United States and, upon returning to
the Kuna Territory, became part of the community’s leadership. Having “seen the
world,” he felt his responsibility was to serve as a connector between his
people’s needs and the external sources of knowledge that can benefit them. He
reminded us that, in order to have lasting impact, investments in Carti’s local
health system should not only consider valuable elements like a functioning
infrastructure, available supplies, and well-trained personnel but, also, clean
water and education.
Our conversations with these two local actors highlighted
some of the challenges and opportunities faced by the SM2015 initiative in all
eight participating countries and territories. We know, for instance, that
traditions can be at odds with population health. The consequences of this
conflict can be exemplified by delays in the management of complicated
pregnancies which often contribute to the high number of maternal deaths among
the poorest populations in Mesoamerica. To respond to these types of cultural challenges,
SM2015 is taking into account existing social norms and behaviors of the local
communities when implementing its health programs.
Ernesto also reminded us that health is determined by many
factors in addition to behavior – including the supply of health products and
services. Like him, we believe that for the Gates Foundation’s work to truly
act as a catalyst for change and have a lasting impact, we need to do a better
job at putting together investments that integrate multiple sectors like water,
hygiene, and health. The SM2015
partnership is a great example of how to do this, as different sponsors have
the complementary resources and knowledge to oversee a comprehensive program
for maternal and child health.
At the end of our visit we spent time with Ernestina Scott,
Carti’s local nurse who moved from Panama City to the Kuna Territory 20 years
ago and never left. Ernestina has a true passion for her work, and this passion
motivates her to stay despite obviously difficult conditions. Through our interactions
with Ernestina and other local health care providers we got a glimpse into
Carti’s primary health care system.
As we reflected on the interactions we had with local
residents, community leaders, and health care providers, we were left with a strong
sense of optimism as the local health system in Carti –and across the other
seven countries involved in the SM2015 Initiative – start implementation of
this unique program.
We believe that this program’s innovative outcomes-funding
approach can create powerful incentives for improving the policy and financial
environment across Mesoamerican health systems. However, its ability to drive
lasting impact at scale will ultimately depend on the ability to effectively
encourage local health care providers and households to improve their practices
and behaviors.
We were genuinely impressed by the positive energy and the
degree of commitment to improving population health that was evident among the
people that we met in Carti. We were also humbled by the wisdom of this ancient
community and their capacity to survive under conditions of extreme hardship.
Jeff Raikes is the CEO
of the Bill and Melinda Gates Foundation, which first published this blog on April 30. Wolfgang Munar is
Senior Program Officer in the Family Health Division comprising the Maternal,
Neonatal and Child Health, Nutrition and Family Planning programs.
Labels: bill and melinda gates foundation, Carti, health care, jeff raikes, Kuna, public health, Wolfgang Munar
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