K’allam’p: “Sustaining Life throughout the Land” with Improved Indigenous Maternal Healthcare Access

According to the WHO, 95% of maternal and neonatal deaths occurred in low and middle-income countries in 2020. For the last 9 years, Ecuador’s maternal deaths per live birth has stagnated at 66/100,000: 20 times the rate seen in European countries. These statistics highlight disparities in quality healthcare access and the impact of economic gaps on maternal and infant mortality and life expectancy. Most maternal deaths are preventable when timely managed by a skilled medical professional working in a supportive environment. Our project seeks to address this crisis by delivering globally successful educational programs and training to healthcare providers in the rural regions of northern Ecuador. 

Children also are affected by inequalities in healthcare. Overall, 2.3 million children around the world died within the first 20 days of life in 2020. Approximately 6,500 newborns die daily; that tragic sum constitutes nearly half of all child deaths under the age of 5 years. WHO estimates that 75% of all neonatal deaths occur during the first week of life. Furthermore, about 1 million newborns die worldwide within the first 24 hours. Birth asphyxia is a leading cause of these deaths and in under-resourced areas, this remains a prevalent concern. In Ecuador, more than 6 of every 1,000 newborns die in the first 28 days of life, according to UNICEF. The number in remote Indigenous areas is likely higher. By comparison, the neonatal mortality rate in developed nations is much lower — nearly five times lower in Sweden, for example. Infant mortality is not the only outcome of birth asphyxia. Even mild cases can result in lifelong problems such as developmental delays and learning disabilities. Access to and availability of quality healthcare therefore continues to be a matter of life and death for mothers and newborns globally. 

Within the Imbabura Province of Ecuador, public hospitals and community midwives are both utilized in childbirth. These rural hospitals are extremely underfunded: there is little financial capacity for up-to-date equipment or completely hands-on, skills-based training for medical providers. Comparatively, no such resources exist for Indigenous midwives servicing their communities. Although these two groups face similar economic strain, a larger cultural rift exists between these healthcare providers. Local hospital staff often discredit Indigenous midwifery practices, which in turn breeds skepticism from local community members reliant on midwife services. Even in the event of postpartum complications, Indigenous mothers do not seek out hospital care due to this distrust and the impression that their health needs will not be met or believed by medical professionals. Ultimately, Indigenous mothers and babies seeking quality, culturally-aware healthcare services pay the price for this mutual lack of respect. With our initiative, Kinray Hub seeks to bridge this gap, which only continues to drive the region’s high maternal and natal mortality rates, by creating solutions that are not only medically sound but also culturally inclusive and accessible to Indigenous communities.

With its K’allam’p initiative, Kinray Hub plans to deliver the Helping Mothers and Babies Survive (HMBS) curriculum to rural hospital staff and Indigenous midwives. HMBS is a series of skills-based programs developed by the World Health Organization (WHO) and the American Academy of Pediatrics (AAP). We will train practitioners in the following programs: Essential Newborn Care 1(ENC1) and Bleeding After Birth Complete (BABC). We will also train the 63 medical providers who have already successfully completed our Helping Babies Breathe program to become trainers for their peers in this course, thereby expanding the reach of the program into more rural communities.

HMBS courses allow students to learn and maintain skills using realistic simulators.  Content is delivered in short simulation-based activities. Continued practice sessions in the hospitals, referred to as low-dose, high-frequency (LDHF) practice, is encouraged to help cement and maintain learning. By having trainers on the ground, we will ensure LDHF practice is occurring when our North American Master Trainers return home. Unlike the commonly available didactic approach to learning offered in underfunded public hospitals, these courses combine instruction and hands-on practice to improve skills and competencies needed before, during and after birth. 

We have already experienced success in facilitating the HMBS curriculum. In 2022, along with two volunteer trainers from the US, we offered free training to a small group of Indigenous midwives in ENC1, in effort to supplement their pre-existing Indigenous medical knowledge. In 2023, we upscaled the initiative with a team of 5 U.S.-based “Master Trainers,” who taught the course to 55 doctors, nurses and Indigenous midwives at two public hospitals in Otavalo and Cotacachi. The technology required for this coursework includes: evidence based flip charts and wall posters, which visually present the steps to take during training and clinical practice; provider guides to support continued practice of skills learned; inflatable, portable, realistic newborn manikins; reusable hand-operated ventilators (known as upright newborn bags); and masks and suction devices used to remove obstructing fluids from a newborn’s nose and mouth.

For 2025, Kinray’s goals are 3-fold in order to help trainees retain their skills, promote local capacity building and expand course offerings:

           · Provide refresher courses to graduates of the 2023 ENC1 workshops and “train the trainers.” Graduates of the 2023 HBB course will be selected and taught to be Master Trainers of the HBB courses. They in turn will be mentored as they train 25 providers in a public hospital in Atuntaqui. Promoting local training-of-trainers will have a cascade effect and aid in future scalability and replicability of the activities and resilience of our initiative, possibly to the national level.

 · Teach 30 providers the “Bleeding After Birth Complete” (BABC) course. BABC provides course participants with the knowledge, skills and competency to prevent and manage postpartum hemorrhage — one of the leading causes of maternal death. This course utilizes a maternal wearable birthing simulator, designed specifically for the third stage of labor by simulating realistic bleeding.

Kinray Hub is a non-profit dedicated to making positive and sustainable impacts for the Indigenous peoples of Ecuador while uplifting and preserving their cultural knowledge and heritage. As members of the Kutakachi Nation, our team leaders strive to improve the lives of their fellow community members. Kinray Hub has interviewed and collaborated with Indigenous midwives from 44 Andean communities to identify the struggles they faced working with public hospitals, the factors limiting their ability to provide proper medical care and the complications they regularly experienced in the birthing process. Through our program, we are raising up women leaders in the Indigenous community—Kichwa midwives—by building on their ancestral medical knowledge and training them in neonatal care for infants at high risk of birth asphyxia. Moving forward, we will expand that training to help birth attendants save the lives of mothers who suffer postpartum hemorrhage—one of the most common direct causes of maternal injury and death. We regard every pregnancy and birth as unique. Addressing inequalities that affect health outcomes, especially reproductive health, is fundamental to ensuring all women have access to respectful and high-quality maternity care.  In this way, Kinray Hub opts to respect and uplift community knowledge, rather than disregard it in a manner traditionally seen in hospital settings, thereby earning the trust of midwives and medical practitioners alike. By marrying ancestral knowledge with science-based approaches, we improve health outcomes for Indigenous mothers and babies. Indigenous women of the Andean highlands steward the household economy, focusing on agricultural production. By encouraging local women’s education, we empower them as providers for their families and major contributors to the local economy, thereby strengthening  community resilience. Our program strives to improve the healthcare system of local public hospitals. We aim to model respectful healthcare, offering scientific-based, hands-on education to maternal and infant care providers, in addition to supplying public hospitals with updated medical equipment. With these actions, we are bridging the healthcare gap between Indigenous communities and the quality treatment they deserve to receive.

Kinray Hub is uniquely positioned to facilitate these courses to both Western-trained medical providers and Indigenous midwives because we are led by an Indigenous Medical Doctor, Dr. Kayakanti Alta. Native to the region and trained by The Pontificia Universidad Católica del Ecuador, she serves as both a portal and provider to the members of her community in the Kutakachi Nation. As an Indigenous-led initiative we have received positive feedback from other Indigenous communities in the Imbabura province and beyond, who express their willingness to apply the HMBS curriculum to their own communities. With support from MIT, we will be able to train more Indigenous medical providers to become “Master Trainers” of the HMBS curriculum and to pass on educational resources and technology (both coursework and supplemental medical equipment) to even more rural communities in the country.

While we are facilitating a course that is pre-designed, through Dr. Alta’s knowledge of Indigenous Medicine (IM) we have also made adjustments to include and acknowledge any IM practices that mothers may have taken before or after birth. With this knowledge, we have updated the globally-aimed curricula to the specific practices of our community, making it more accessible and valuable for medical providers across rural Andean Ecuador.

So far, Kinray Hub has interviewed and collaborated with Indigenous midwives from 44 Andean communities to identify the struggles they face working with public hospitals. Women in these communities consistently lack access to proper medical care and regularly experience complications due to the birthing process. With this knowledge, we launched a small pilot program in 2022 called “Helping Babies Breathe in the Andes.” Dr. Kayakanti Alta, along with two volunteer trainers from the U.S., offered free training to a small group of Indigenous midwives in ENC1. By combining Dr. Alta’s professional expertise with the Indigenous midwives’ pre-existing  knowledge, we were able to create a training program that was both medically informed and culturally comprehensive. In 2023, we brought a team of 5 U.S.-based “Master Trainers” to teach the course to 55 doctors, nurses and Indigenous midwives at two public, under-resourced hospitals in Otavalo and Cotacachi. We are on track to train at least another 50 medical providers this year and have contacted two additional rural hospitals to join our initiative. Our next step involves securing funding so we can expand our program and purchase more medical equipment to supplement our trainings.

Kinray Hub began its K’allam’p initiative with maternal and natal care because we believe that, although amongst the most vulnerable, Indigenous women are critical to the wellbeing and resilience of their communities. That said, gender and ethnic bias remains a global issue that has the potential to impede our progress in the healthcare space, both locally and abroad. These biases are further intensified by the fact that we are working closely with Indigenous women whose expertise draws from knowledge systems outside of formal medical education. Indigenous knowledge has continued to be devalued and regarded with immense skepticism, especially within the scientific and medical communities. 

We anticipate that the systemic mistrust of Indigenous healthcare practices will occur on a larger scale, especially as we expand outside of the Cotacachi region and Ecuador. We designed our programming to be integrative of multiple educational and social perspectives and our hope is that Solve will help us navigate market barriers rooted in cultural misunderstanding, especially as we continue to introduce our work to broader audiences. 

In that regard, while we are ready to start documenting and publishing the long-term impacts of our earliest pilot program, we highly value data sovereignty and must ensure this collection is done ethically and with the informed consent of our community partners. We therefore look to Solve and its ability to provide technical and legal guidance for this process and counsel on how our findings may best be shared with the Solve community and beyond.  

Our solution is innovative in our marriage of Western and Indigenous medical knowledge systems. Taking the HMBS curriculum and adapting it to include awareness of local practices both trains hospital staff to better treat Indigenous mothers (by expanding their cultural competencies) and includes Indigenous midwifery methods in the trainings.

Our project will reduce the maternal and neonatal mortality rate in the rural Andean and Amazonian regions of Ecuador by educating health practitioners in life saving techniques, and ensuring skills are retained through follow-up refresher courses.

In addition to the evidence-based, lifesaving curriculum we will disseminate, we will also be providing important, modern training equipment to under-resourced rural hospitals. These pieces of equipment, accessible to North American medical students and hospitals, are critical aides in ensuring that healthcare providers know how to act in a crisis situation. These pieces of technology will be purchased and disseminated to participating hospitals and groups: maternal wearable birthing simulators designed specifically for the third stage of labor which simulate realistic bleeding; inflatable, portable, realistic newborn manikins; reusable hand-operated ventilators (known as upright newborn bags); and masks and suction devices used to remove obstructing fluids from a newborn’s nose and mouth.

Our staff includes 10 volunteers working on a part-time basis.

We have been conducting trainings for 2 years and working with Indigenous midwives and rural medical providers since 2019.