CAMATI “women building from below,” is an organization born out of necessity currently working in two municipalities of incidence: Trinidad and the Comalapa border in the state of Chiapas. These two municipalities have a particularity. They are border municipalities with Guatemala and are mainly a migratory passage. The traditional midwifery of years ago had been in decline; it was being lost. That’s where CAMATI came in. The organization activated midwifery through traditional birth attendants and workshops on knowledge sharing.
In addition to its presence in these two municipalities, CAMATI is also working in the highlands of Chiapas in conjunction with other civil organizations. The headquarters are located in San Cristóbal de las Casas, Chiapas. From their base, CAMATI makes alliances and links with new organizations that are working on a national agenda for the recognition and rights of midwifery and traditional medicine.
All these organizations work in the highlands of Chiapas, mainly in the indigenous areas of Tzotziles and Tzeltales where midwifery has a great impact in the lives of local women.
Latina Republic met with Lucía Silva Martínez, leader of the organization, to learn about its roots and the vital role they play in the community. CAMATI‘s main objective is to prioritize and support free access to maternal and neonatal health and sexual and reproductive health for all those women who need it.
These services are delivered with warmth and quality of care to reduce maternal and neonatal mortality. “Chiapas, currently holds the first place in maternal deaths. In face of these statistics, we see the urgent need to have free, safe access to services for all the women who need it,” declared Silva Martinez.
Lucía Silva Martínez
I am a professional midwife and my mother is a traditional midwife. I started, from a young age, accompanying her in consultations and some deliveries. I really saw the needs that women faced in order to have access to quality care and warmth that is very important during this process of giving birth. It was then that I began to train in a very traditional way, and I was also given the opportunity to study at the school in San Miguel Allende de Guanajuato and finish a professional midwifery career.
Then, I went to work for approximately five years in the state of Guerrero, which is a place with many needs and with a predominantly indigenous population. Once finished in Guerrero, I returned to the state of Chiapas. I and other companions, Olga, Ofelia, Maria Luz, Eugenia, who are traditional and professional midwives, came together and built this organization.
I am the person legally responsible for the organization and right now I am serving as General Coordinator, supporting the workshops, having direct contact with the heads and health authorities, as well as the municipal authorities of each municipality and communities with the midwives.
My job is primarily to organize, make links, design strategies and also to apply for projects and resources so that we can continue moving forward and doing the work that we do as an organization.
LR: When was the organization formed and what is CAMATI’s goal?
The organization has been around for seven years. We started with the illusion of working with midwives in the communities that most needed us. Since 2016, we have been formally established for about 5-6 years.
In the communities, we have been around a bit longer because we started supporting other organizations for approximately 10 years. All of this was formalized on June 16, 2016. We have been working alongside other organizations in their own trenches. Afterwards we got together and formed this organization.
LR: Can you describe the evolution of CAMATI and the leadership within the organization?
CAMATI’s evolution has taken place step by step. It has been difficult to start, mainly because of economic resources. It has been difficult to get some donations, support, and to be able to work. So we started with our own money, and by going to different spaces to work. With the passing of time, we obtained some donations, some economic resources to go to the communities and it has been a very significant evolution. To this day, we cannot say that we are 100 percent financially well. We are evolving step by step and achieving certain skills within the group to be able to request more funds, prepare projects, and also work on the social media we need such as Facebook and the website to present and promote our work that we do as CAMATI.
I would say that the evolution has been good. We have made gains in various places of importance and of advocacy. In terms of our leadership, we all have unique capacities that enrich the organization. In the case of our group, we have the colleague Ofelia who speaks Tzotzil, and she is a great help for us when we need translation. We have a colleague who speaks Tzeltal, which are the two main languages with which we work here in the highlands of Chiapas.
These are great advantages that contribute to our leadership. In the case of other colleagues, they have various other skills that help strengthen the organization as well. So I think the leadership is very even, very democratic. All the decision-making we do is carried out in a very democratic way.
The difference in languages between midwives and indigenous communities
In the state of Guerrero, there is diversity, as in the state of Chiapas. There are Mixtec, Tlapaneco, and Nahuatl speakers, so most of the women in the communities speak one of these languages and, when I arrived in the community, I had to adapt to the needs of the women to work and I also had to learn some keywords to be able to communicate with them. Since I stayed, it was very important to have this contact because, if not, they would not even have the confidence to come closer and be able to provide them with the care they needed.
LR: In Chiapas, how important is the service of midwives and why is there a preference for traditional medicine?
In the highlands of Chiapas the midwife represents someone of great hierarchy, a very respectable person who is very wise. Midwifery is part of local life because it is very difficult for them to go to the hospitals or clinics, since the personnel there does not speak the same language. So when trying to communicate, it is very difficult for them, however, the midwife knows where they live, speaks the same language, understands them and treats them in a familiar way; that is what they have expressed. For them, midwifery is part of their community and of the utmost importance and vitality to their health.
As I mentioned, midwifery is a very fundamental part of families in great part because of the treatment they receive, which is different. They prefer to be with the midwife, since the midwife understands them, speaks the same language, and are also women. However, if they go to the hospital they won’t not know if the provider will be a woman or a man. This is also something that plays an important role and is connected to an issue we have tried to address and solve: domestic violence.
In these communities, domestic violence is very high, so women often prefer to stay at home attended by a midwife who is a woman, who is a person or a woman they have known for a long time and not a man because that is where the issue begins. Men can misinterpret that the woman has come to seek care with a doctor who is a man.
So many of the women prefer to stay at home to be cared for by a midwife than to go to a hospital and return to suffer the consequences of that. And what are the consequences? Blows, assaults, which have sometimes even led to death. We have had cases about that, that the husband did not want to take her down to the hospital because she had a complication and decided to leave her and died of a postpartum hemorrhage. All these characteristics are what we consider that for the family the role of midwifery and traditional medicine in the communities is very important.
LR: How is a woman chosen for midwifery? Is there a certain transition and instruction that you have to follow?
Well, here we talk in different ways about the transmission of midwifery. We call the main one, “The gift.” It is a gift that a woman brings to give care to another woman. And how is this revealed? Through a dream. We have heard that often from community midwives when we asked them how they were chosen for midwifery or how they chose midwifery.
And what they tell us is that they have dreamed of it and that it is a gift that their god, (each one has their own ideology), gave them. For this reason, they have to do it and through the dream they are told how they are going to take care of the woman, how they are going to rub her, how they are going to cut the baby’s cord, and how they are going to fix the woman after the childbirth, what herbs to use and what massages to use; it is a form of transmission.
The other way is hereditary. The grandmother or the mother is a midwife and transmits the knowledge to the daughter by necessity of the same community because many times these midwives are old, they are old, and they can no longer do many things due to their age. So they have to start teaching someone younger so they can do the job when she’s gone.
In Chiapas, mainly in Mexico, there are professional midwifery schools, where young people, with a certain level of study, can come and prepare. In these schools they study fifty percent traditional medicine, but they also learn allopathic medicine.
It is a joining of knowledge that, in the end, forms a midwife. Probably with other capabilities, but ultimately doing the same job. Through these ways, we could say that some of the women choose to be midwives.
LR: Do these schools focus on the traditional or the modern?
The first school where I studied was the first in the entire country, which is in San Miguel de Allende Guanajuato. The founder was a traditional midwife, Doña Antonia, along with another foreign person who supported her to be able to form the school. So there we did have a fifty percent training in traditional medicine, traditional midwifery, and also allopathic medicine. In a way they conjugate it and it conjugates very well.
The next school that was opened was in the state of Guerrero. I understand that the first three generations had eighty percent of traditional medicine; their curriculum is similar to the school in San Miguel de Allende. So I understand that this school is not one hundred percent traditional midwifery. It is a great shame and the truth is it worrisome because midwifery and traditional medicine are being lost in that school that is like the basis for midwifery.
LR: Who are the midwives’ patients and what are the services midwives offer?
Patients are children and adults, including men. The midwife is not only the midwife for the woman. A midwife for the community is practically a medic for the whole family. Midwives heal children. The beliefs in Mexico, in Chiapas, about the evil eye, empacho, healing the umbilical cord, these are some of the cases that they treat. In the case of women, they treat reproduction, and also sexually transmitted diseases, infertility, and other diseases that are gynecological.
When it comes to men, midwives are also healers. They are bonesetters, they are rezanderas. The men can also seek their services and prayers or ask them to take away “mal aire.” The work of the midwife is very complete, it is not only based on the care of the woman, but here we consider that the midwife is dedicated to the care of the whole family, from the smallest baby to the largest person within the nucleus family. So this would be the job that the midwife generally does.
LR: In the work environment of parterism, do men work in this field?
The number is rarely seen, but there are male midwives. They are very good midwives too. Just as there are women, which is the largest number, but there are also men within this group who are midwives.
LR: What type of payment do midwives receive? Are there certain payment plans?
In the case of the companions who are midwives within the communities, they don’t have a fixed payment. Sometimes they get paid, sometimes they don’t. They may get two hundred pesos, three hundred pesos, which is about ten dollars, five dollars, speaking of the Mexican peso. Many of the times they simply give them a meal or a chicken or a pig, and that is their payment for them. So there is no fixed payment for the fellow midwives.
In the case of the younger professional midwives, who have been trained in school, spaces are being opened or have been opening within the same health system for them to work. When working there, they already receive a fixed monthly or biweekly salary, but there are also a lot of problems because the institutions do not accept the midwife. So they may say they do not accept the traditional midwife, much less a professional midwife who is a girl who is considered too young to practice that profession.
They believe us somehow incapable of doing the job. So they tell us that we don’t deserve those contracts to be in those institutions. Many of the midwives do not have a fixed price because we are going to find families that can pay ten thousand pesos for a delivery, even families that can tell us that they can only pay us five hundred pesos for the delivery. So there is no salary that determines the midwife’s work, there is no fixed salary for them.
LR: Before caring for a woman, how do the midwife and the patient prepare?
There are different ways to prepare. There are different situations that come our way. Well, in the case of some women, they come with us from the beginning when they already know they are pregnant or some have doubts that they are pregnant from the first twelve weeks of pregnancy.
And from there, well, we already start to have contact with prenatal consultations. The previous studies of blood are made of the consultancy studies, ultrasounds to assess the growth of the baby, and also the positions to determine if in the end this baby will be for a normal delivery or if a different medical attention is required.
The women who come here are also preparing, in the aspect of their studies, to be taking care of their health throughout their pregnancy, taking their prenatal vitamins, those who have access. This is also another of the things that in Mexico, specifically in Chiapas, we are having a lot of problems with the health system, and right now it has become much more harsh due to the pandemic.
Many health centers or health houses, which we call them here, in remote communities, closed completely. So there are no prenatal vitamins for women and, for them to go down to town to buy them, it is a lot of money, it is far, and they have such little money to buy it. Many of these women do not consume the vitamins and so there are certain risks that they may have.
LR: How does the midwife prepare the pregnant woman?
We’ll talk to her about nutrition, her food, she has to eat properly, consume certain vegetables, certain fruits, in order to in a certain way supplement the vitamins that her body is needing during pregnancy. For her part, the midwife prepares herself with her materials, her tweezers, her gauze, if she needs alcohol. Many of the midwives do not have a sterilizing machine so they have to boil their forceps, wash their hands well to put on their gloves.
If the delivery is going to be at the midwife’s house, then the midwife already has a small space of her own where she gives care and if not, then she has to go to the woman’s house to do the care and carry all her materials to be able to provide the care that women need.
That is the preparation that the midwife takes, apart from being aware, and not falling asleep, which is another thing because, if she already knows that she is a woman who is about to give birth, then this midwife is continuously pending so that, if she calls, she can go and it’s not an early birth. Many times it happens that when one arrives, the baby is born, so they always fear that. They are always very alert.
LR: Can you describe a traditional birth assisted by a midwife. What is the difference in care that pregnant women receive from midwives compared to general hospitals?
Births, attended by midwives, start with trust. The trust that one transmits to the woman, the way in which we treat her, from the beginning always respecting her moments, her spaces, and the accompaniment is something very important for us as midwives. That the woman at the time of delivery is accompanied by whoever she decides. Whether it is the husband, the mother, a friend, or there are women who simply decide to be alone and want to be alone with the midwife. We always respect very much what they want. We always say that women are the protagonists of this whole process. The midwife, mainly, respects all the moments of the woman; we allow the woman to move as she likes.
We do not put an infusion or an intravenous serum. We do not use medications to speed up labor, which is another thing that we are not allowed to do. We do not do maneuvers that are not allowed that are done very regularly in hospitals, such as the vaginal cut, which is the episiotomy, which is very normal in hospitals.
The Kristeller, which is a maneuver made by pushing the baby from the mother’s womb, turning the mother’s tummy. We don’t do that as midwives either. The space that we suggest for care is the one that the woman and her partner always decide. If it is at home, they tell us where they want their delivery and how they want it; if they want to sit, kneel, or lie down. We use a birthing bench, we use a shawl, the maca, so that they can accommodate the births.
The difference between the care with a midwife to a hospital is that we allow all the movements of the woman. We accompany them in a respectful way and we give them massages, we use alternative therapies for pain, breathing, natural medicine, homeopathic medicine that we also use. However, in a hospital, you arrive, they admit you, they do not allow anyone else in labor, only the woman is there. They are left in one position, rather than lying on a stretcher, alone. They are desperate, restless, tearful, sad, because they are alone with great fear; that’s in labor. At the time of the expulsion, they are put on a bed, their legs are raised in a gynecological position, and for them it is very difficult. The fact of not being able to move is very uncomfortable.
I believe that also because most of the midwives, in the case of us, we have already given birth, we already had a baby, and we know what it really feels like. A male doctor just does his job. As we have always said, we are not at odds with allopathic medicine because it is very important and fundamental when there is an obstetric emergency,
Who will help us? They will. But there are actions that they do that are no longer allowed because, even in the official norm, and the WHO (World Health Organization) are declaring that these practices are no longer allowed and, however, they do it very routinely in hospitals. That is a big difference, there is a very big gulf between care with a midwife and care within a hospital institution.
LR: Describe a day in the life of a midwife (An everyday day).
Sometimes a midwife gets up at five in the morning; their daily life is like this. They live in the country. Every morning they get up at five or six in the morning to prepare a fire in the stove, not all of them have a stove, it is a stove with wood. They prepare breakfast, a coffee, some eggs, some tortillas, beans, they get the family together, have breakfast, and each one takes on their different tasks.
The husband may go to the fields to work the corn, beans, and, if the midwife is a middle-aged midwife, she may have children which go to school. Then she stays at home doing the chores, cleaning the house, doing the laundry, preparing the food for the children, being in her home and, if a pregnant woman arrives, she takes care of her.
She receives her, gives her her massage, her rub, orients her about her pregnancy, her health, and that would be like her routine; a very common day for a midwife. Probably she can go to a meeting of a school in the same community, if she is in contact with other midwives as well, another midwife arrives with her, or that she goes to talk with a midwife about a situation that they are experiencing among them, such as midwives, with their work that is going on. They are from communities, so their life is always a routine. They get up early, have food, make omelets, breakfast, what to do, cleaning and all that.
LR: CAMATI’s vision is that the practice of midwifery is recognized in health institutions and also in society. Why are midwives not recognized by government health organizations?
Our vision, one of most important goals that we have as an organization is that midwifery be recognized, given the value and the importance that these women and men midwives have in the communities, since they do a job that is very important for the health of the family and, mainly, for the health of women. We do consider this recognition very important and that is why we are organizing, making alliances, linking, advocating with these authorities for their recognition.
But this is also the case for the sexual and reproductive health of all women, that health access for them be free of choice, in a respectful way, without any type of threats, and of the best quality possible, as it should be for each of the women.
LR: Why don’t institutions accept midwives?
Here in Mexico, I was very young when I heard about this, because my mother was one of the main midwives in my community, but I saw that my mother attended births and she had no problem. But after various government projects entered, the attention of the midwives began to wane.
Since they demand that women go to health centers, simply to comply with a number, not because they needed to give them the attention they deserved, but to be able to send a number of care that doctors do in health centers in all these communities. Also, more or less, between 1995 and 2000, here in Chiapas, the number of maternal deaths increased considerably and these maternal deaths were blamed on midwives. It was then that they made a drastic decision to completely shut down first-level delivery care, which equaled the care with the midwives and the health centers, and sent these women to the hospital. What happened there? Hospitals began to saturate. Hospitals no longer provided enough care, and what was their surprise? Even in hospitals, maternal deaths still continued to rise, but they did not finish accepting that the midwives are not to blame for that. So they say that the midwives do not even have the knowledge, they are not even academically prepared, to give care to a woman. We consider that this is racism, we consider that this is violence to the right of the midwife to exercise her practice, which for years has been known as midwifery.
And also because of the public policies that have come out at the federal level throughout the country, there has been a reduction of budgets for hospitals and birthing houses. We believe that the institutions prefer that women be in hospitals in an unhealthy way, in a way where their rights are violated, and where many women have suffered different abuses and also medical negligence.
The reason being that it is much easier to cover up that a doctor did something, rather than a midwife, who does not have a basic study and could not do anything. It is easier to say, the doctor did everything but the midwife did nothing, and it is easier to put a midwife in jail than a doctor. So we consider that it is very important to continue influencing so that recognition is done now, as soon as possible, because the work of midwifery, we are sure, that it will not end, it will continue.
LR: How have health centers and the government limited the practice of midwifery?
Midwives have been threatened. In the communities, the fellow midwives have told us that, due to the different health programs that have come out, such as Popular insurance and Oportunidades, which is now called Bienestar, these programs greatly diminished the attention of midwives. They demanded that women go to health centers, and if a woman went with a midwife, they would go to that midwife and threaten to tell her that they were going to take away financial support received; not only to the midwife, but also to the woman.
So this made the woman intimidated, scared, and ultimately decided to go to a hospital because that way they did not take away the financial support they received. And in the case of the midwife, because she preferred to say “I do not attend, I prefer to send you to the hospital because if I treat you, the threat was: we take the money you receive, you do not receive anything this month, or if something happens to the woman, if she dies or the baby dies, you go to jail. ” So, of course, the midwives preferred to give in, in a certain way, and sent the women to hospitals or clinics and they no longer continue to attend. Yes, it has been, we consider, as direct threats towards the midwives, their integrity mainly.
LR: Can you talk about the division between modern medicine and traditional medicine. What is the history behind this division of tradition and modernism of midwifery practice?
I believe that this division was made by the human being himself. The professional ego, I consider, has been one of the very big factors for the division between the natural, traditional medicine, and modern medicine that, nevertheless, in the end, they are one. If we compare them, both are of vital importance in the life of the human being, but I consider that the professional ego has been like a watershed for this division. The fact that, “I am a doctor, I have a degree, a professional license, I know much more than you do, that you are a simple midwife who does not even have basic knowledge of a book, you do not even know how to read or write.” I consider, in a professional way, that this has been what has divided medicine, both of these medicines.
LR: How is CAMATI protecting the rights of midwives and the practice of traditional medicine?
It has been a lot of work. From the beginning, most of us members of CAMATI, are daughters of midwives. At certain moments in our lives, we experienced that abuse against our mothers in some capacity. It was from there that we decided to continue and make this movement, and how are we doing to protect it? We tell the comrades in the communities that they are not alone. There are many of us who are midwives. The more we are united and work together, the stronger we will become.
CAMATI is helping to promote the cause in conjunction with other organizations. The Nich Ixim’s midwifery movement, which is a movement that was born approximately five years ago was initially promoted by an organization from here, in San Cristóbal, called Formación y Capacitación AC (FOCA AC) and, it was through them that many alliances and promotions of midwifery took place. CAMATI is working together with them for the recognition of traditional midwifery and traditional medicine.
LR: We are living through a moment in time where medical attention in health centers is limited. What impact has the pandemic had on midwifery?
The number of attentions increased, visibly. In reality, the number of medical attentions we had throughout this year has been shocking. The fellow midwives have been of vital importance throughout this period of the pandemic in the communities, since health centers and hospitals, have been saturated. The health centers completely closed their doors, since many of the doctors, who were in charge, were high risk. They were disabled, left, and abruptly closed these health centers. Second-tier hospitals were filled due to the number of cases here in the state. The fear of women arriving at a hospital and having to worry about the probability of infecting herself and her baby, and infecting the rest of her family, made many women seriously consider what to do. They made the decision to see a midwife, either in their own home or in the home of the midwife. So the community considered the participation of midwives as very important throughout this pandemic.
We did have an increase in the provision of care and we also had cases of midwives who were infected; after all, we are in the front line of care as midwives, which the institutions did not see us that way. We did not receive any kind of help or support regarding basic health care materials, such as gauze, swabs, gloves, mouth covers, and protection for ourselves to provide care. So far no help has been received from the institutions, and midwives have had to face all of this on their own, so to speak, and with their own resources.
That’s when the work of these organizations came in. Now we did get financial resources, we got donations to buy alcohol, gauze, gloves, mouth covers, we made gowns to send to our colleagues and, in this way, they could protect themselves. It was very local with all these companions, with many municipalities in the state, but it was because of the organizations that were mobilized throughout this part. Because we didn’t really receive much help from the institutions, or almost nothing so to speak.
LR: Have midwives used traditional remedies to care for COVID-19 patients? What results did they have?
So far, no case of a woman with COVID has been reported to us. All the women who have received care have been COVID-free. The midwives who became infected with COVID got it from a relative. Here in the state, there are very strong migratory flows. People migrate to the United States but return at a certain time. So the fellow midwives who were infected with COVID got it through a relative returning from a country or another state of the republic. But none has been infected through a woman with COVID. So far we have no report of that.
LR: In the future, is it possible to see a collaboration between modern medicine and traditional indigenous medicine?
In the future, I think so. The truth is that we are very excited, very happy, and we hope to achieve this collaboration hand in hand with modern medicine. That midwives and doctors can work without any kind of self-centeredness, so to speak. We work with a common goal, to provide maternal and neonatal healthcare, which in our country is deplorable. The number of maternal deaths that we are experiencing is high.
LR: Is there something you want people to recognize about midwifery
More than anything to let people know that they have this option, which is a very good option. We are prepared women. We are women who have knowledge that has been acquired not in days, not in months, but in years. We immediately recognize whether or not a pregnant woman is with or without complications. Let them know that we are here for them, that we can provide them with care. We are also part of an entire health system.
LR: What would be lost if the practice of midwifery came to an end?
I think a lot would be lost. Mainly, we would lose the value of our ancestors because all our work is very ancestral and it would hurt us a lot if midwifery were to be lost. For these ladies to leave, now grown up, wise, with so much knowledge to share here in our country, and throughout the world, so much would be lost. And who would be mainly affected? Well, the women. All these women who are in the most vulnerable areas, who do not have the necessary resources to go to a health institution to receive care when they need it. I believe that they would be the most affected if midwifery were to disappear.
My name is Nancy Ortega and I am a current undergraduate student at UC Davis majoring in Animal Science and Spanish, but began my studies at Rio Hondo College. I am the proud daughter of two immigrants and the sister of a Dreamer. My interest in Latin America emerged due to the passion from my high school Spanish teacher. I became interested in the variety of cultures, the unique people, and the history still to be uncovered from underrepresented countries. In Latina Republic, I want to expand the beauty and complexity of Latin America and enrich my mind, as well as that of the readers, throughout this new experience. I look forward to meeting interesting individuals, hearing new stories, and coming out with a fresh mind set.