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Research Proposal
Jennifer Wilburn
Towards a Balanced Understanding of Health Practices of the Maya in the United States
Jennifer Wilburn
UNC-Chapel Hill School of Social Work
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I pledge that I have neither given nor received any unauthorized aid on this paper. Jennifer Wilburn
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Research Proposal
Jennifer Wilburn
The Maya are descendants of a civilization indigenous to the Yucatan peninsula and
present-day Guatemala that dominated the region from around the first century (AD) until the
arrival of the Spanish conquistadors. The term “indigenous” has several definitions, including
self-identification, historical continuity within a certain group, strong link to territories, distinct
language and/or culture, resolve to maintain community, or distinct political or social systems.
However, the UN (2007) states that the most important aspect of an indigenous group is retaining
distinct characteristics that are clearly different from those of other segments of national
populations. The Maya demonstrate all of these, and this distinctive character is what makes
them a vulnerable population in need of interventions specifically tailored toward their specific
practices, beliefs and customs.
The ancient Mayan culture developed around 2500 BC and peaked during the Classic
Period in 250 AD. The Mayan civilization continued for the next 700 years as a collection of
interconnected city-states, even after the arrival of the Spanish. However, they eventually began
abandoning their cities for unknown reasons. Yet while many people believe the Maya are
extinct, they exist to this day. Having been exploited by the Spanish for both labor and land, the
Maya now live in poverty in rural villages. The usually live in huts, and men work mainly as
sustenance farmers while the women take care of their home and often are artisan craftspeople.
The Maya speak 29 officially recognized languages in Guatemala and Mexico that date back to
the Proto-Mayan language over 5000 years ago.
Mayan immigration to the United States has been in two waves. The first occurred during
the Guatemalan Civil War, which lasted from 1960-1996. Indigenous Mayans were particularly
impacted by the war, as they were believed to be supporting the guerilla movement against the
government. Over 400 Mayan villages were destroyed in the war and thousands of Mayans left
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Jennifer Wilburn
their homes as refugees, fleeing to Guatemala and the United States. This first wave of migrants
from war-torn Guatemala initially settled in Los Angeles, Houston, and southern Florida, areas
with long-standing Latin American populations.
The second wave of immigration began in the 1980s and 1990s as a result of the
challenges that indigenous Mexicans face in Mexico presently. The Mexican government
continues to oppress indigenous people through privatization of land, social exclusion,
indifference to poor health conditions, restricted political activity through civil rights abuses and
military presence in Mayan regions, and language discrimination. About 25% of indigenous
Maya who leave their villages choose to go to the United States (the other 75% migrate to the
city, often working along the Riviera Maya) and have settled in new communities such as the
Bay Area (Brown & Odem, 2007). They often work in construction and agriculture and form
tight-knit communities. It is estimated that between 500,000 and one million Maya from
Guatemala and Mexico live in the United States (Smithsonian Institute).
Mayan spirituality is a fundamental component of daily life for the Maya and it
influences their health practices and wellness. The Maya worldview is constructed on the
concept of balance, in which everything is connected, including nature, the body, the mind, and
other people. Their personal orientation is centered on the community rather than the individual,
and that community constructs values and meaning for each individual. The Maya look to each
other for advice, knowledge and wellbeing, as they strive for harmony within the community and
the greater world. Illnesses of humankind such as hatred, envy, materialism, and disrespect cause
imbalance in our lives, while Mayan spirituality seeks to restore harmony to our lives. Concepts
such as health and disease are understood as the search to restore balance to the relationship
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between the self and the whole, and physical and emotional health conditions are directly related
to social behaviors.
Present-day Mayan health practices reflect ancient Mayan practices of diagnosing and
curing illness. While the Maya have been influenced by European practices, the isolation of the
rural villages enabled the Maya to maintain their traditions and cultural knowledge throughout
the colonial period and into the modern day. The Mayan conception of health and disease is
based on a balance of temperatures. Health is maintained by avoiding exposure to extreme
temperatures and by consuming appropriate foods and beverages to maintain a balance of
temperature. They often rely on traditional healers as providers (such as a curandero or
partera/midwife) and often prefer herbal remedies to Western medicine.
The distinct cultural beliefs and language can create several barriers to care. Providers or
receptionists are often unable to distinguish between Maya and Latinos and this misidentification
can lead to many problems. Some, but not all, Maya speak Spanish, and avoiding
miscommunication about health care is critical. There is a desperate need for medical interpreters
who speak indigenous languages; the lack of interpreters often means that children act as
interpreters, a situation which puts the child in a difficult place of relaying sensitive and
sometimes frightening information. Many Maya are illiterate or have low literacy and therefore
have difficulty understanding materials and completing lengthy, complicated paperwork. Also,
the preference for traditional healers means that many Maya will wait too long to get treatment,
especially in the case of expectant mothers who rely on midwives. Moreover, there often may be
conflicting recommendations between the provider and the indigenous healer.
Besides differences between cultures, the Maya face many barriers to care that other
Latinos face. There is often confusion between multiple last names, which can lead to confusion
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of hospital staff, which can lead to names being entered into the computer incorrectly, files lost
or difficult to locate, babies misnamed, and an overall feeling of disrespect. Likewise, due to the
Guatemalan Civil War, many Mayan refugees in the United States do not know their birthdate or
family medical history, as those records may have been lost. The high cost of care is also a
barrier as traditional healers are usually much less expensive than Western medical care. Many
patients do not return for follow-up appointments due to the cost of appointments, their
preference for alternative care, transportation issues, a history of bad experiences, or
miscommunication about appointments. Finally, due to a history of oppression, many Maya do
not admit to being indigenous out of fear of discrimination.
Due to the Mayan language, distinctive cultural character, religious beliefs, views about
health, and history of oppression, it is crucial that health providers understand their patients'
unique history and background since it is relevant to their overall health and wellness. For this
reason, my proposed intervention is development of The Maya Health Resource Manual, a
resource for health providers and outreach workers that provides a balanced approach for
understanding health care practices as related to the Maya in the United States. There are 3
overall goals for the manual, which are:
1. Minimize barriers between patients and medical professionals in order to enhance the
health of the Maya community;
2. Identify the major healthcare barriers both from the provider’s and the patient’s
perspective;
3. Create a variety of tools to help providers and patients communicate better.
The manual will include a cultural profile, key medical terms and phrases in several of the main
Mayan languages, Key Medical Terms and Key Phrases in Translation (in main Mayan
languages), a body chart, an herbal medicine chart, a mental health assessment tool, and a list of
interpreters. The goal is to respectfully build on cultural knowledge and to reinforce the value of
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Maya cultural traditions while also incorporating sound health practices. This will increase the
likelihood that the Maya's beneficial practices remain a part of their transnational culture, while
also helping them to understand valuable biomedical knowledge and incorporate it into their
cultural framework.
While there are other similar manuals already available, my hope is to focus on
enhancing cultural and linguistic communication between Mayan immigrants to the United
States and their health care providers. This requires studying Mayan history and learning about
their cultural practices and beliefs. It also requires learning about Mayan health in the United
States, of which there are very few studies. There have been six studies published particularly
related to Mayan health in the United States in the past twenty-five years, three of which
specifically looked at barriers to care. The first with Maria Miralles in the 1980s was a study in
Florida. In 2002, Cecile Menjivar studied the use of social networks to access healthcare
information as a response to confronting barriers to care. Finally, Colleen Supanich analyzed
barriers to care for Guatemalan Mayan women seeking prenatal care in 2009. All of these studies
demonstrate that the Maya face many barriers to receiving health care and information and that
they are a population that are misunderstood and understudied.
The concept of cultural competency is the core of this manual. Through knowledge of
diverse cultural customs that might affect health care beliefs and practices, medical providers can
offer the best care to patients. Therefore, a review of the literature on cultural competency will
also be helpful. Studies show that when working with indigenous populations and refugee
communities, providers can provide better care to their patients when they understand the
cultural perspective of their patients (Brach & Fraser, 2007). Understanding a patient’s cultural
traditions and history can help ease tension, identify potential problems, and improve the patient-
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provider relationship. Therefore, a review of best practices models for working in indigenous
communities will be useful in the development of the manual.
Ideally this manual would be more relevant for areas with dense Mayan populations, such
as California and Georgia. However, within North Carolina most of the indigenous peoples work
in agriculture; therefore, my intervention will be aimed at partnering with organizations working
with farmworkers. While farmworkers are generally an invisible population whose work is often
forgotten and undercompensated, indigenous farmworkers are a group that is even more
marginalized. Farmworkers from indigenous communities are more likely to be exploited due to
language barriers and the difficulties of finding interpreters.
For example, there is a community of Maya in Morganton, located west of Raleigh.
When several hundred Guatemalan-born workers arrived in Morganton over 20 years ago, they
began working in poultry plants. Concerns about safety and fair pay led the workers to strike and
eventually organize a campaign against Case Farms. While the labor disputes have been settled,
a small diaspora of Mayans are still trying to retain their sense of community amidst a changing
global marketplace. This community demonstrates why it is necessary for advocates and service
providers to be respectful of indigenous beliefs and be able to communicate openly with
indigenous communities, who may be in our backyard. Too often we are unable to identify them
based on our naive cultural constructions.
I plan to partner with two farmworker groups here in the Triangle: The Farmworker
Advocacy Network, a statewide network of organizations that work to improve living and
working conditions of farmworkers and poultry workers in North Carolina, and the North
Carolina Farmworker Health Program, a statewide migrant health voucher program that works
with local agencies to provide care throughout the state to meet the needs of farmworkers. The
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Jennifer Wilburn
Farmworker Advocacy Network, now in its 10th year of advocating for farmworkers in North
Carolina, has a variety of research, handouts, and factsheets on its website, and I believe that the
Maya Health Resource Manual would be a good addition to their resources. Likewise, the
outreach workers at the NCFHP would benefit from training in how to use the Maya Health
Resource Manual in case they encounter Mayan farmworkers. The NCFHP works to provide
culturally and linguistically appropriate care for farmworker families, therefore, this manual
would serve as a general tool to help them distinguish the needs of indigenous farmworkers from
those of other Latino farmworkers.
Finally, I realize that learning about the needs of a group as diverse as the Maya in one
semester will be difficult. I hope to use the Maya Heritage Project at Kennesaw State University
as a resource for learning about contemporary Mayan communities. The Maya Heritage
Community Project is an interdisciplinary program that works in partnership with Maya
organizations and people of Maya heritage throughout the United States. The Maya Heritage
Community Project works with Maya leaders to promote knowledge about United States’ law,
health, and customs and to educate others in the community about the ancient and modern
culture of the Maya. They have already done much research around health practices of the Maya
and attempts to create a national network of Mayan translators, research which I think will be
helpful for the project of developing a new manual.
The Maya Heritage Community Project uses the method of community-based
participatory research (CBPR) in that they partner with Mayan immigrant groups in order to
better understand the contemporary Maya. CBPR is “ an orientation to research that focuses on
relationships between academics and community partners, with principles of colearning, mutual
benefit, and long-term commitment and incorporates community theories, participation, and
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Jennifer Wilburn
practice into the research efforts. (Wallerstein & Duran, 2006, p.#). This type of research is
particularly applicable to this manual because it uses principles of self-determination in order to
incorporate the ideas and the experience of the Maya in the final project. The new manual will
only be successful in minimizing communication barriers if it, like CBPR, is based on realizing
what is mutually beneficial to health care providers and the Mayan community they serve.
My next step in completing this project will be research. While I have a basic
understanding of Mayan beliefs and health practices, in order to write this manual I will need to
do much more. I plan to contact the Maya Heritage Community Project to see what research
around health practices they have done. I also plan on contacting the NCFHP to try and talk with
outreach workers who have experience working with the Maya. Finally, I plan to contact my
Mayan teachers who live in the Yucatan to see if they can put me into contact with Mayan
immigrants or traditional healers. I also plan to look at other toolkits available online to use as a
model for my own (for an example: http://www.k4health.org/toolkits/communitybasedfp).
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Jennifer Wilburn
References
Brach, C. & Fraser, I. (2000). Can Cultural Competency Reduce Racial and Ethnic Health
Disparities? A Review and Conceptual Model. Medical Care Research and Review, vol.
57, 181-217.
Brown, W. and Odem, M. (2011). Living Across Borders: Guatemala Maya Immigrants in the
U.S. South. Southern Spaces, Special Series.
Fink, L. (2003). The Maya of Morganton: Work and Community in the Nuevo New South.
Chapel Hill, NC: The University of North Carolina Press.
Menjivar, C. (2002). The Ties that Heal: Guatemalan Immigrant Women’s Networks and
Medical Treatment. International Migration Review, vol. 36, no. 2, 437-466.
Miralles, M.A. (1989). A Matter of Life and Death: Health-seeking Behavior of Guatemalan
Refugees in South Florida. New York: AMS Press.
Smithsonian Institute, Department of Anthropology. Unmasking the Maya. Retrieved from
http://anthropology.si.edu/maya/mayaprint.html.
Supanich, C. (2009). ‘You’re Too Late!’: Prenatal Health Seeking Behaviors of Guatemalan
Mayan Women in Palm Beach County. Master’s thesis, Florida Atlantic University.
UN General Assembly, United Nations Declaration on the Rights of Indigenous Peoples:
resolution / adopted by the General Assembly, 2 October 2007, A/RES/61/295, available
at: http://www.refworld.org/docid/471355a82.html.
Wallerstein, N.B. & Duran, B. (2006). Using Community-Based Participatory Research to
Address Health Disparities. Health Promotion Practice, vol. 7, 312.
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Annotated Bibliography
Adams, W.R. Randolph & Hawkins, J.P. (2007). Ed. Health Care in Maya Guatemala:
Confronting Medical Pluralism in a Developing Country. Norman: University of
Oklahoma Press, 2007.
This collection of essays addresses a variety of health care concerns that are currently facing the
Maya living in Guatemala. Examining the Guatemalan health care system and the way that it
interacts with traditional Mayan medical practices is important for understanding how Mayan
traditions interact with biomedical practices in the United States.
Anckermann, S., Dominguez, M., Soto, N., Kjaerulf, F., Berliner, P., & Mikkelsen, E.N. (2005).
Psycho-Social Support to Large Numbers of Traumatized People in Post-Conflict
Societies: An Approach to Community Development in Guatemala. Journal of
Community & Applied Social Psychology, Vol. 15, Issue 2, 136-152.
I am considering creating a section in the Maya Health Resource Manual devoted to mental
health as many Mayan immigrants have come to the United States as a result of the Guatemalan
Civil War. Due to the fact that the majority were either tortured or witnessed torture, murder or
disappearances, mental health screening is very important. This paper describes a community
development approach in Guatemala to support people affected by organized violence and
torture. It could be useful in terms of helping me to develop a mental health section that is
culturally appropriate.
Haffner, L. (1992). Cross-cultural Medicine: A Decade Later. Translation Is Not Enough,
Interpreting in a Medical Setting. The Western Journal of Medicine, 157 (3). 255-259
Linda Haffner, a professional medical interpreter and Spanish translator, offers unique insights
into the complexities of bilingual and bicultural communication in a hospital setting. While she
does not particularly address indigenous languages, her work with Hispanic patients can be
extended to other foreign language patients. Her work around miscommunication, differences in
attitudes about health care, and other misunderstandings due to translation is important for my
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Maya Health Resource Manual in terms of promoting good communication and interpretation
practices.
Loustaunau, M.O. & Sobo, E.J. (1997). The Cultural Context of Health, Illness, and Medicine.
Westport, Conn: Bergin and Garvey.
Written by a medical sociologist and a medical anthropologist, this book examines how culture
(including institutions, social class, and gender) affects our perceptions of health and illness. The
goal of the book is, "to examine the role of cultural differences in defining and dealing with
health and illness and to investigate the health-related factors that link humanity cross-culturally
through common needs." This will be useful for the cross-cultural ideas about wellness and the
ways that the Maya define health and wellness differently than Western cultures.
Odem, M. & Gonzalez, B. (2005) Health and Welfare of Maya Immigrant Families: Perspectives
of Maya Parents and County Agencies. In Maya Pastoral: National Conferences and
Essays on the Maya Immigrants, ed. Alan LeBaron. Kennesaw: Kennesaw State
University Press.
This paper, presented at the 2005 national Maya Pastoral conference, is a broad overview of the
barriers to care faced by many Maya. The authors identify many of the problems the Maya face
in the United States, including problems related to accessing health care. It outlines all of the
major gaps in services, which is essential for understanding the unique situation of the Maya in
the United States. Odem and Gonzalez’s work will be important for me in terms of analyzing
what the Maya Health Resource Manual needs to address.