The impetus for the Belize midwifery project grew out of our experience working with Kek'chi and Mopan Maya people in the Toledo District. Spread out over approximately 48 rural villages, the Maya in this district have the poorest health indicators of any population in Belize. Mayan infants have a 45-55% mortality rate, meaning 45-55 babies out of a thousand live births die before the age of 3 months, a rate about 5 times higher than that of the US. A high percentage of Mayan women are anemic, which puts them and their unborn babies at risk during pregnancy and childbirth, and a high number of Mayan children suffer growth retardation due to malnutrition.

The majority of Mayan women birth their babies at home. Since many of Toledo's rural villages are several hours drive from the local hospital, and transportation and communication systems are generally poor, the focus of the midwifery training project is to train rural village women to assist their neighbors during pregnancy and childbirth and to provide back up support to them in times of emergencies.

The first training began in April 2000, under the direction of Plenty trainer Deborah Flowers, with 14 women from 11 villages. These women were chosen through a community meeting process, and represented a cross section of the Toledo population in rural villages: 7 Mopan Maya, 6 Kek'chi Maya and 1 Mestizo. The midwifery training course focused on essential skills that would have the most impact in saving the lives of women and newborns such as prenatal care, identifying high-risk pregnancies; when to refer a pregnant women to the medical system; how to minimize infection using sterile techniques; and newborn care.

A second midwife training course began in May 2001, targeting an additional number of underserved villages. This second phase was organized by Plenty midwife Christina Kahlou and assisted in large part by the Ministry of Health staff of the Punta Gorda Hospital, who conducted the majority of the classroom training and facilitated the midwive’s hands-on practical work in the hospital. In February 2002, 10 new midwives completed their theoretical and practical training, and successfully graduated. Participants from both groups received a basic supply kit for deliveries as well as a copy of the training manual.

Mary Kroeger has been our project manager/trainer since June 2002. Mary is a Certified Nurse Midwife (CNM) with extensive international work experience, including two years prior work in Belize managing a USAID Child Survival project. She has maintained follow up support for the 22 midwives trained in both phases, including regular Continuing Education classes on various reproductive and child health issues. Project staff have also visited each midwife in their home village to do more personalized assessments of their skills and to identify and help address any community or personal issues that may be limiting their service. An additional ongoing capacity-building activity begun in December 2002 under the guidance of Plenty volunteer Reva Kidd is literacy and ESL training for midwives that are in need of such help. With this support we aim to increase the level and quality of communications that the midwives are able to maintain with Ministry of Health personnel, their ability to contribute to record keeping and health monitoring, as well as their self-esteem and broader ability to participate actively in the affairs of their community and district. Some midwives are also beginning to serve as contact/reference points for the Belize Family Planning Association, and are sources of basic family planning information for their communities.

All program activities encourage sharing of information and experiences, and create an atmosphere of greater trust and friendship among the women. Through these activities we emphasize the importance of the midwife in her community as an advocate for women and children, and the importance of respect for women. The project touches on other key issues as well such HIV/AIDS, spacing of children, and domestic abuse. Through the course we encourage midwives to become more active in their communities in these areas.

As of January 2003 the midwives have successfully handled over 120 deliveries in their villages and referrals for high-risk situations have numbered at least 20.

We continue to be excited about the program’s successes and the opportunities presented. Via this endeavor we are enhancing women's equal access to quality health care, and also empowering the Village Midwives to become respected service providers in their communities and income earners in their families. There is still much work to do, and as previous program funders support is ending, we need to identify other funding sources in order to continue this program. We gratefully acknowledge UNICEF Belize and the Ministry of Health for their support and guidance, our midwife trainers Deborah Flowers, Christian Kahlou, and Mary Kroeger, as well as the Atkinson Foundation, Daniele Agostino Foundation, International Foundation, and Plenty donors for their financial support.

In early 2002, Plenty Belize collaborated with the Toledo School Feeding Program Committee (SFP) on a short-term hurricane relief project that included establishing organic gardens at four targeted rural primary schools. The intent of the project was to begin to establish more sustainable food sources for the schools involved in the SFP, which were providing a hot lunch for their students. Further discussion with the SFP and the PTAs of these schools led Plenty Belize to develop the scope of the project further, and the GATE project became an integrated educational tool to address the multiple threats of environmental degradation, unsustainable agriculture, and poor nutrition. Plenty Belize has a successful history of community-based work in all three of these interconnected areas. In the 2004-04 school year the GATE program grew to incorporate thirteen primary schools and the regional high school.

While the school garden is the centerpiece for this project, this school gardening project includes several components that make a productive and sustainable program. These include: Extension work/ technical assistance; tools, seeds, and other supplies; training of village volunteers to assist with the gardens; classroom training; educational support to teachers in integrating the gardens into their curriculum; encouragement to start home gardens; and nutrition and food preparation education. Plenty Belize staff, local partners and volunteers provide this support at each school on an ongoing basis.

The GATE project is a collaborative effort of many people and organizations - The District Education Department, the administrations of the Methodist and Catholic schools, PTA members, villagers, teachers, principals, Sustainable Harvest International, Belize Minerals, Belize Marketing Board, Trees for Belize, Pan American Health Organization, Atkinson Foundation, UNICEF Belize, NOPCA, Peace Corps, and many individuals, as well as Plenty International’s donors. The efforts and resources of these varied people and organizations are coordinated and managed by Plenty Belize and Plenty International. Funding is needed to continue providing support to the GATE project in the coming school year. Read more about GATE from previous Plenty Bulletins.

The Toledo District School Feeding Program is part of a national effort to help undernourished primary school children do better in school by providing them a hot lunch. Eleven schools in the district participate in this program. Each school has to raise funds to buy food or secure food donations, as well as provide volunteers to cook, and the success of these efforts varies with each school. Through the designated donations of several Plenty supporters, in the spring of 2003 we have been able to provide cash donations for two schools in the School Feeding program that needed a little extra help to feed their students a hot lunch. Donations are still needed to continue this support. Contact Plenty for more information at plenty@plenty.org.
Additional information: See School Feeding Program from previous Plenty Bulletins.