"Spotlight on Dr. Saúl Madrid & Eduardo Cabrera, directors of Mexico's public healthcare program in Chiapas

Dr. Saúl Madrid and Eduardo Cabrera seated to the right talk to representatives of the Nich Ixim Midwife Movement of Chiapas at GPA's office in Chiapas, Mexico

With 642 health units and nearly 2 million people enrolled—almost 40% of the state’s population—IMSS-Bienestar in Chiapas serves more people than any other public state health program in Mexico. Most of these individuals live in rural areas and face significant poverty and marginalization.

Over the past two years, GPA collaborated with IMSS Bienestar to launch two joint initiatives to improve health services for women. The first initiative involved Respectful Maternal Care training to more than 500 health professionals, while the second established regional working groups with traditional midwives and health officials, to build collaborative and respectful relationships, and resolve issues women face, especially Indigenous women, in their efforts to access quality care

We hope you enjoy the interview with Dr. Madrid and Eduardo Cabrera.

Q: What are the biggest challenges you face in providing quality maternal care in Chiapas?

One of the main challenges is communication. Most of our staff do not speak the local languages, which makes it difficult to connect with patients. Another challenge is cultural understanding. Our team’s academic training doesn’t usually include an intercultural approach, so when they arrive in these communities, they often experience culture shock. Our health services aren’t always adapted to the worldview of a predominantly Indigenous and rural population. For example, women can’t choose their birthing position, midwives don’t have space in the hospital, and hospital diets don’t reflect local foods. Because of this, many women don’t feel comfortable or confident coming to the hospital for pregnancy or childbirth care. Building trust is a real challenge—we have to adapt to the communities, not the other way around. Strengthening our relationship with traditional midwives and recognizing traditional medicine is also essential. We need to work with them respectfully.

Q: Why is it important to raise awareness among health personnel?

First and foremost, we are public servants. We are bound by ethical codes, and our primary responsibility is to treat patients with respect and avoid any form of mistreatment or violence. Chiapas unfortunately ranks among the highest in maternal mortality and obstetric violence in Mexico, so it’s crucial that we work with our staff to address these issues. We must provide quality service to everyone, earn the community’s trust, and meet their needs—especially since we serve the poorest and most marginalized people, who have the least opportunities. That’s why we need to strengthen our team and our approach.

Q: What results have you seen from the recent training and initiatives?

It’s difficult to measure precisely, but we’ve noticed positive changes. There’s a greater willingness among staff to provide better service. Hospital directors have observed improvements in staff attitudes and performance. We’ve also seen fewer complaints about mistreatment in the suggestion and complaint boxes where we’ve intervened. That’s encouraging and tells us these efforts are making a difference. Another positive sign is that hospital directors and supervisors are now requesting more training sessions.

Q: Can you share more about your work with traditional midwives this year?

Recognizing traditional medicine is crucial, especially since women often seek out midwives first. Our program works with 2,750 midwives. We’re working to raise awareness among our staff that collaboration with midwives should be horizontal—based on dialogue and the exchange of experiences. The regional meetings we’ve held have really opened our eyes. We thought we were doing a good job, but we realized we weren’t fully recognizing or valuing the midwives’ knowledge. We’ve even had to address cases of mistreatment toward midwives. It’s vital that our medical staff understand how to build these relationships respectfully and act when norms aren’t being followed.

Q: Why is collaboration between institutions, organizations, and communities so important?

At the end of the day, our goal is to improve the well-being of our population. We’re grateful for initiatives that help us move forward. The communication and teamwork we’ve experienced have helped us reflect on our progress and challenges. Having an external perspective is incredibly valuable, and it helps us ensure our staff are doing their jobs well. Ongoing monitoring and collaboration are essential to ensure we provide the best possible care.