Tula Salud
When we founded the Tula Foundation in 2002 our priority was health and equity because of our past experience in health systems. We were particularly interested in the problem of health and equity in developing countries. We wanted to focus on a specific region that was well matched to our capabilities, and because of a combination of factors we chose the department of Alta Verapaz in the central highlands of Guatemala. One of the main reasons for that choice was the presence in the main town of Coban of the national school of nursing--La Escuela Nacional de Enfermeria de Coban, or ENEC for short. ENEC impressed us then, as now, with their expertise and dedication to their service area, which includes remote, rural indigenous (Mayan) communities that have consistently shown poor health indicators.
We originally began work with two Canadian partners, the Canadian International Development Agency (CIDA) and the Centre for Nursing Studies (CNS) in Newfoundland. Since 2008 we have been the sole funder of the program.
Over the years we have focused on the following interconnected topics, all ultimately with the goal of improving health indicators in rural communities:
- We provide funds and technical expertise to help ENEC develop and extend programs to educate auxiliary nurses (similar to licensed practical nurses in Canada) in their home communities. This decentralization of education is supported by internet based distance education in combination with local tutors and local clinical experience in rural health centers. The education program has now extended beyond Alta Verapaz to many additional departments. Five hundred auxiliary nurses have graduated or are in courses now.
- With the leadership of ENEC the distance education program was extended to professional nurses in 2008. Two hundred professional nurses are in courses now.
- We were very concerned that nurses notonly be educated but also hired within the health system so they could apply their training for the good of their communities. We therefore work closely with the national Ministry of Health and the Department of Alta Verapaz to ensure that graduates are hired, deployed to target communities, and supporting on the job.
- We are determined to see health care go that 'last mile' to isolated communities. To that end we have worked with the health authorities to supplement their resources with a cadre of telesalud (telehealth) workers who are trained with support from ENEC, integrated into the formal system, equipped with a field kit and a cell phone, serving in the most remote and challenged communities.
- The improvement in health indicators in the communities served has been encouraging, particularly in the area of maternal and infant health, which is one of the Millenium Development Goals, and therefore a particular area of focus for Guatemala.
- Technology is merely a means to the end, the end being improvement in health indicators. Nonetheless, we do believe that appropriate technology can be of great benefit to health care professionals (including nurses of course) in rural Guatemala, who are spread so thinly across a complicated landscape.
By 2009 we recognized that the Guatemalan team was becoming more and more capable of running the programs themselves. Accordingly, we established a Guatemalan NGO, Tula Salud, staffed entirely by local professionals. The Tula Foundation continues to provide funding, advice and technical assistance where necessary, drawing upon our network of advisors and volunteers in Canada.
Tula Salud also benefits from a partnership with Pueblo Partisans, a network that includes volunteers in Canada and the USA, and field projects in Peten, which is the department to the north of Alta Verapaz. In turn, the Tula Foundation helps fund the work of Pueblo Partisans in Guatemala.
Update: November 2010
We have decided to extend and expand support for programs in Alta Verapaz for an additional five years. Based on the positive outcomes we have seen we will more than double the scope of the Telesalud initiative, working even more closely with the Ministry of Health and the Department of Alta Verapaz.