The problem of infant mortality and maternal health has been a concern of ours ever since we were made aware that the Chirripó district has the highest infant mortality rate in Costa Rica, approximately 6 times the national rate.
One of the recognized problems for the Cabécar people in the reservation is timely access to the healthcare system and general education regarding the importance of preventative healthcare. Few Cabécar women have prenatal care, mainly because they don´t come to the appointments. Well-child visits are often sporadic, and women wait until their children are very sick before coming to the clinic – sometimes not until it’s too late.
Puentes de Vida (Bridges of Life in English) is a project where we train and employ Cabécar women as maternal-infant health promoters in their communities. Our goals include the detection and referral of women and children at risk, health surveillance, patient health education, and emergency intervention and evacuation. Our ultimate purpose for this project is to reduce maternal and infant morbidity and mortality on the reservation, as well as increase access to and utilization of the government healthcare system.
After 15 months of training, we began employing the first Cabécar women health promoters in August 2013. Each promoter visits the mothers’ homes at least once a month during pregnancy, and then at least once a month through the infant’s first year of life. In addition, the mothers are encouraged to go to the government clinic for regular prenatal and well-child care appointments.
The Mule is a four-wheel drive all-terrain utility vehicle purchased in 2015 in order to improve access to both preventative and urgent medical care for the women and infants who are a part of the Puentes de Vida. This mule is able to traverse the treacherous muddy roads in the Chirripo reservation, extending access to areas not easily reached by vehicle, thereby saving women many hours of strenuous hiking through the mountains. Drivers for the mule are local volunteers who have been trained in first aid and CPR.
The impact we have seen the health promoters make is noteworthy. They are on the front-lines in advocating for the health of women and infants in their Cabécar communities. In their full first year of work, the infant mortality rate for the entire reservation was reduced by more than half. Adequate prenatal care and intrahospital deliveries are on the rise among the Cabecar women.
Since the beginning, the promoters have faced and overcome many challenges. Lives have been saved through timely evacuation, as well as application of their knowledge in basic emergency interventions. Many, including early adolescents, have been touched by the promoters’ love and support throughout their pregnancy and the first year of their baby’s life. They have even exposed injustices that have contributed to the health disparity among the Cabécar people.
Funding for Puentes de Vida depends entirely upon contributions for the continued employment of these health promoters, and to cover the cost of necessary materials and equipment, continuing education activities, emergency evacuations, and maintenance for the mule. In 2016, 16 more health promoters graduated from the training program, and we are currently employing a total of 8 full-time health promoters. As funding allows, we hope to expand the program to reach additional communities within the reservation. Since January 2017, ICDI has been privileged to provide a full scholarship for one of the promoters to study in a four-year nursing program in the city of San Jose, with plans for her to return to work for Puentes de Vida in a leadership position for the betterment of her people.