A Thousand Indigenous Nurses Head into the Field

Over 1,000 Indigenous students in Guatemala received their Auxiliary Nurse Training Program (ANTP) diplomas on December 6, 2023. Their graduation from the yearlong program is a milestone for them, and for the entire country—allowing them to become frontline health workers in the underserved rural communities of the northern Guatemalan highlands.

A partnership between TulaSalud and the Guatemalan Ministry of Health, the ANTP was funded under the World Bank’s Crecer Sano (Grow Healthy) initiative. These new auxiliary nurses, 1,170 of them in all, will take healthcare the last mile into their communities, where they have the linguistic and cultural understanding to make the most impact.

The goal is to improve health outcomes, particularly for mothers and children under three, by delivering primary care, prenatal and postnatal care, nutrition education, and vaccines, among other things.

“This graduation is a significant event, because these students are going to go on to be really important wherever they end up working,” says program director Christy Gombay. “With the skills they’ve learned, and their roots in these areas, they are uniquely able to make a real difference to the health and well-being of people who have been historically marginalized for centuries.”

The students, most of whom are in their twenties, were able to take courses in their own communities, or nearby, thanks to a hybrid educational approach that blended remote learning with hands-on practicum work.

“What was really innovative about the teaching approach was the fact that these were young people learning in their own communities,” says program coordinator Stuart Davidson. “Technology gave them an opportunity they would otherwise never have, allowing them to do auxiliary nurse training without having to move to a distant city.” 

Lectures by nursing experts in the city of Cobán were delivered to students at 43 health centers across four different regions, known as departments. The practicum work was performed across two dozen regional hospitals and health centers. 

Graduating from the ANTP promises to be life-changing for all the students, 70 percent of whom are women. Most of the participants come from communities and cultures where, historically, women have not been considered equal to men, says Gombay.

“Now they have a chance to have a job with a salary, where they can pay for food for their kids, where they can pay for schooling for them, and where they can help the rest of their families overcome challenges most people in the global north can’t even imagine.”

TulaSalud began educating health practitioners in rural Guatemala in 2004. By 2014 the program had graduated more than 1,300 auxiliary nurses—men and women—to help improve health outcomes in Indigenous communities in 10 departments. “The main indicators we tracked in our early years were maternal and infant mortality,” says Eric Peterson, cofounder of Tula and the TulaSalud program. “For us, success was not measured by how many nurses we had in the field but whether the health indicators actually improved as a consequence.”

These efforts helped create positive shifts in Guatemala. In the aftermath of a long and troubled history of intervention by US corporations, a CIA-orchestrated coup, and a protracted civil war, some improvements began in the mid-1990s. One indicator was malnutrition, which dropped almost 10 percent between 1995 and 2015.

But there’s still a great need, and these 1,170 students represent a new wave of Indigenous healthcare leaders, who can bridge the gap between the formal healthcare system and their own, often remote, communities.

“How I feel right now is hard to put into words,” says Gombay. “I’m thrilled and honored, and just so impressed with everyone who has worked to make this happen, to get us to this moment of graduation. It’s really a miracle, a watershed moment.”