BUILDING DESIGN ALEXANDER AGUILAR, LUIS KOHÖN – ARCHITECTS, FACULTY OF ARCHITECTURE UNIVERSITY OF SAN CARLOS


Merging Mayan culture into primary healthcare


This article presents a methodological approach to the architectural integration of the Mayan medical world view into primary healthcare in Guatemala.


In Guatemala, a Central American country with 16.5 million inhabitants, Mayan and Spanish cultures have co-existed for almost 500 years. In terms of medicine, each world view has maintained and developed its own approaches to disease prevention and healing. With regard to healthcare buildings, Guatemala has served most of the Mayan population from a western viewpoint, putting aside their ancestral heritage, which has constituted a medical and cultural barrier to improving the health conditions of this population. However, the Guatemalan Ministry of Public Health and Social Assistance (Ministerio de Salud Pública y Asistencia Social; MSPAS) recently implemented the Health Inclusive Model (Modelo Incluyente en Salud; MIS) at primary care level, which focuses on ‘interculturally appropriate humanisation’. Guatemala is a country where Mayan


and western world views merge to create a syncretic and heterogeneous mix of customs and traditions. In Guatemala, social exclusion and inequality are key to the high rates of poverty, morbidity and mortality, which are mainly seen in the Mayan population. In 2016, Guatemala had about 16,500,000 inhabitants, 40-50 per cent of whom identified themselves as Maya’s descendants. According to the World Bank: “Guatemala, the biggest economy in Central America, has one of the highest inequality rates in Latin America, with some of the worst poverty, malnutrition and maternal-child mortality rates in the region, especially in rural and indigenous areas.” For almost 500 years, Guatemala’s


western health model has neither recognised nor understood Mayan cultural heritage. Western medicine has a biomedical paradigm that is evidence- based and considers the health-disease binomial as a chemical and biological imbalance. Mayan medicine considers the “physical, mental, spiritual and emotional elements of the individual… as well as economic, political, social and cultural dimensions;”2


thus the Mayan healthcare


paradigm is based on an holistic approach, balance and spirituality.3


IFHE DIGEST 2018


Guatemala is a country where Mayan and western world views merge. research4


This paper is part of a bigger body of carried out within the Faculty


of Architecture at the University of San Carlos. The first phase was completed in February 2017 and was developed within a thesis written by Gabriela Diaz.2


The


thesis is an architectural proposal for a primary care maternity centre in a Mayan village in Sololá, Guatemala,6


which is a


result of research arising from a review of medical and anthropological literature and memos written during discussions on the topic, enriched and contrasted


with the professional experience of the authors. At this stage, the methodology of anthropological architectural analysis proposed by Fernando Martín Juez6


a great help. The next step will be to interview


Mayan health leaders, including midwives and witch doctors, in order to gain an understanding of their view of disease and healing and then identify archetypes from which to propose architectural healthcare design categories. Medical staff at the western hospital will be interviewed in the


Alexander Aguilar


Alexander Aguilar is an architect at the Faculty of Architecture University of San Carlos (FARUSAC), has a Master’s degree in architecture for health from La Sapienza University, Rome and undertook doctoral studies in Guatemalan hospitals. He has been a full time associate professor at FARUSAC in


architectural design and structural systems since 2004, was guest speaker at the XXII AADAIH Congress, Buenos Aires,


Argentina in 2011 and visiting professor for diverse international workshops at La Sapienza University, Rome in 2015 and 2016.


Luis Kohön


Luis Kohön is an architect at the Faculty of Architecture University of San Carlos (FARUSAC) and has a Master’s degree in architectural design from FARUSAC and in


Architecture for Health from La Sapienza University, Rome. He has been associate professor in architectural design at


FARUSAC since 2002 and specialist in hospital design and management at the Ministry of Public Health and Social Assistance, Guatemala since 2000.


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