Andrea Isabel Aguilar Ferro

Neonatal mortality remains a significant equity issue in rural Indigenous communities of Guatemala, where structural barriers and systemic discrimination impede access to quality newborn care. This field report describes a novel community-based initiative implemented by Maya Health Alliance, an Indigenous-lead NGO, to address high neonatal mortality in Maya Kaqchikel communities through a quality improvement (QI) framework. The intervention centers on home-based neonatal care delivered by trained Neonatal Technicians (NTs), supported by a co-designed smartphone application enabling early identification of neonatal danger signs, clinical decision-making, and data collection. The initiative also leverages a culturally responsive referral and patient navigation system to overcome humanistic barriers to care. Designed using QI methodology, the project applies iterative cycles to track key performance indicators such as perinatal and neonatal mortality rates, referral success rates, and the proportion of newborns receiving timely home evaluations. Since launching in 2024, the program has reached 85% of reported newborns, increased referral rates, and engaged local midwives and health staff through ongoing training and co-design efforts. However, challenges have emerged, including high prevalence of low birth weight, limitations in local hospital capacity, and discriminatory care at facilities that discourage families from accepting referrals. The intervention centers Indigenous practices by positioning TMMs at the frontline and adapting protocols to the communities' lived realities. This initiative demonstrates the potential for culturally embedded, digitally supported, and equity-focused QI interventions to improve neonatal outcomes in resource-limited Indigenous settings. Future efforts will focus on expanding staff capacity, deepening community trust, and strengthening health system partnerships.

Introduction SARS-CoV-2 has impacted globally the care of chronic diseases. However, direct evidence from certain vulnerable communities, such as Indigenous communities in Latin America, is missing. We use observational data from a health district that primarily serves people of Maya K’iche’ ethnicity to examine the care of type 2 diabetes in Guatemala during the pandemic. Methods We used a parallel convergent mixed methods design. Quantitative data (n=142 individuals with diabetes) included glycated haemoglobin (HbA1c), blood pressure, body mass index and questionnaires on diabetes knowledge, self-care and diabetes distress. Quantitative data was collected at two points, at baseline and after COVID restrictions were lifted. For quantitative outcomes, we constructed multilevel mixed effects models with multiple imputation for missing data. Qualitative data included interviews with providers, supervisors and individuals living with diabetes (n=20). We conducted thematic framework analysis using an inductive approach. Results Quantitative data was collected between June 2019 and February 2021, with a median of 487 days between data collection points. HbA1c worsened +0.54% (95% CI, 0.14 to 0.94) and knowledge about diabetes decreased −3.54 points (95% CI, −4.56 to –2.51). Qualitatively, the most important impact of the pandemic was interruption of the regular timing of home visits and peer group meetings which were the standard of care. Conclusions The deterioration of diabetes care was primarily attributed to the loss of regular contact with healthcare workers. The results emphasize the vulnerability of rural and Indigenous populations in Latin America to the suspension of chronic disease care.

In recent years, in academic contexts, both anthropological and feminist, we have sustained reflections on the need to carry out committed, situated and, in possible horizons, collaborative research. These reflections invite us to adopt pertinent and relevant ethical considerations with whom we do research. In this article I write from my experience as a feminist researcher and I present some examples with research that have led me to recognize the agency of the contexts in which we research and of the research itself, insofar as it produces experience in us, situates us and affects us in multiple dimensions, including our emotions. Especially derived from my experiences in collaborative research, I reflect on the mutability of the positions that we adopt as researchers but also as research subjects. I am talking about mutability of positions insofar as the experience that is produced from research is never and will never be static, neither for those who lead the processes, nor for those who collaborate in them. Our positions become more complex as they intertwine with our emotions and mutual affections that can come to mediate our experience with the research itself. In this sense, I also address the relevance of doing research with our circles, with our colleagues, friends, and peers, not only in academic contexts but also in activism. Finally, I reflect on the implications of positioning and situating ourselves in investigative experiences (collaborative or not), on the power dynamics that go through these experiences, and on the need to build self-care practices for researchers, starting from recognizing ourselves as sensitive beings. En los últimos años, en los contextos académicos, tanto antropológicos como feministas, hemos sostenido reflexiones sobre la necesidad de hacer investigación comprometida, situada y, en horizontes posibles, colaborativa. Estas reflexiones nos invitan a adoptar consideraciones éticas pertinentes y relevantes con quienes hacemos investigación. En este artículo escribo desde mi experiencia como investigadora feminista y presento algunos ejemplos con investigaciones que me han llevado a reconocer la agencia de los contextos en los que investigamos y de las investigaciones mismas, en tanto producen experiencia en nosotras, nos sitúan y nos afectan en múltiples dimensiones, incluyendo nuestras emociones. Especialmente derivado de mis experiencias en investigaciones colaborativas, reflexiono sobre la mutabilidad de los posicionamientos que adoptamos como investigadoras pero también como sujetas de investigación. Hablo de mutabilidad de posicionamientos en tanto la experiencia que se produce desde la investigación jamás es ni será estática, ni para quien lidera las investigaciones, ni para quienes colaboran en ellas. Nuestros posicionamientos se complejizan al entretejerse con nuestros afectos y afectaciones mutuas que pueden llegar a mediar nuestra experiencia con la investigación en sí. En ese sentido también indago en la relevancia de hacer investigación con nuestros círculos, con nuestras compañeras, amigas y pares no solo en contextos académicos sino también de activismo. Finalmente, reflexiono sobre las implicaciones de posicionarnos y situarnos en experiencias investigativas (colaborativas o no), sobre las dinámicas de poder que atraviesan estas experiencias y sobre la necesidad de construir prácticas de autocuidado para las investigadoras, partiendo de reconocernos como seres sensibles. Nos últimos anos, em contextos acadêmicos, tanto antropológicos quanto feministas, temos sustentado reflexões sobre a necessidade de realizar pesquisas comprometidas, situadas e, em horizontes possíveis, colaborativas. Essas reflexões nos convidam a adotar considerações éticas pertinentes e relevantes com quem fazemos pesquisas. Neste artigo escrevo a partir de minha experiência como pesquisadora feminista e apresento alguns exemplos com pesquisas que me levaram a reconhecer a agência dos contextos em que pesquisamos e da própria pesquisa, na medida em que produzem experiência em nós, nos situam e nos afetam em múltiplas dimensões, incluindo nossas emoções. Especialmente derivado de minhas experiências em pesquisa colaborativa, reflito sobre a mutabilidade das posições que adotamos como pesquisadores, mas também como sujeitos de pesquisa. Estou falando de mutabilidade de posições na medida em que a experiência que se produz a partir da investigação nunca é e nunca será estática, nem para quem conduz as investigações, nem para quem nelas colabora. Nossas posições tornam-se mais complexas à medida que se entrelaçam com nossos afetos e afetos mútuos que podem vir a mediar nossa experiência com a própria pesquisa. Nesse sentido, também investigo a relevância de fazer pesquisas com nossos círculos, com nossos colegas, amigos e pares, não apenas em contextos acadêmicos, mas também de ativismo. Por fim, reflito sobre as implicações de nos posicionarmos e nos situarmos em experiências investigativas (colaborativas ou não), sobre as dinâmicas de poder que passam por essas experiências e sobre a necessidade de construir práticas de autocuidado para pesquisadores, a partir de nos reconhecermos como sensíveis seres. Nos últimos anos, em contextos acadêmicos, tanto antropológicos quanto feministas, temos sustentado reflexões sobre a necessidade de realizar pesquisas comprometidas, situadas e, em horizontes...