BUILDING DESIGN


same way. The aim of the authors will be to be able to discuss cultural integration in such a way that new design categories will come to light and they can propose a multicultural Guatemalan theory of architectural health design.


The Health Inclusive Model In 2015, Guatemala failed to meet the United Nations Millennium Development Goals. Therefore, the focus was shifted towards sustainable development goals in a national plan called K’atun 2032.8 In 2016, the MSPAS introduced the MIS9 to promote the redistribution and re- organisation of national health services, mainly in primary care, using a multi- ethnic, pluricultural and multilingual public and social approach. In a pyramidal health system such as that found in Guatemala, MIS would strengthen the referrals and counter referrals model so that it would work in a more co-ordinated way, gaining the confidence of the population and improving national coverage. Primary care, which has wide coverage


but low medical capacity, should be significantly reinforced to promote disease prevention and the health education of the population. Hugo Icú stated that the “official healthcare system in Guatemala is rooted in western medicine, biology and welfare based, and has a low healing potential. It also tends to exclude other alternative systems such as the medicine of the Mayan people.”10 Health services should be accessible to everyone territorially and culturally, promoting social participation. Lucrecia Hernández stated that it is a


question of transforming the MSPAS in several areas. For example, from a focus on the poor maternal child population to one that serves people of all ages; from a restricted focus on some infectious diseases and deficiencies to one that addresses all current epidemiological complexity and its social determinants; from a fragmented organisation with health programmes for individuals to one that also gives attention to families and communities; from a public system that has generated relationships with Mayan medical systems based on subordination to one that seeks to build relationships and learn from them; from an MSPAS that has seen the population as an object of interventions from the perspective of public charity to one that recognises social participation and is seen as guarantor of the right to health.11 The western biomedical health model


has failed to overcome the problem of social exclusion and the inability of the state to provide universal coverage to all Guatemalans. This model represents a structural failure in the organisation of health services, and given the constant crises that make it unsustainable, the authors consider MIS as an effective state


52


From an architectural point of view, it is easy to see the imbalance between Mayan people and the western medical infrastructure, such as community health centres and hospitals


policy to generate confidence in the Mayan population towards the health system. The Guatemalan state model is not capable of overcoming social and economic exclusion due to an inequitable redistribution of wealth.


The culture of pregnancy What is really important now is that western and Mayan medicine are opening a dialogue. From an architectural point of view, it is easy to see the imbalance between Mayan people and the western medical infrastructure, such as community health centres and hospitals. A building conceived in a different health-disease paradigm is not a good fit for Mayan people. For example, they don’t understand why a male gynaecologist has to treat women. For them, midwives (known as comadronas) are the only people who can assist a pregnant woman. They also believe that during pregnancy women need to purify and heal themselves by carrying out a bath ritual (known as a temazcal).12,13


Usually the


temazcal is located close to their homes. However, in public health architectural terms, the woman must leave the house and her husband and children to be treated in an unfamiliar environment, mainly by male doctors who use western medicine and speak in Spanish.


As health architects, it is necessary to identify this kind of medical relationship as a critical and creative challenge that must be overcome. According to Alfonso Aparicio: “The temazcal constitutes the most genuine and important element of the traditional Mesoamerican health culture, in my opinion. It is also the most closely related to traditional old content. Healing as a renewal involves death and rebirth. Real fire and symbolic fire eliminate the old, the worn, the dirty, the no longer worthy of/the person (understood as a unit formed by gross elements, body and subtle, soul or souls). In the universal flask that represents the microcosmic uterus of the temazcal is reborn a new person. This image is one of the oldest preserved in Mesoamerican cultures (...) Earth, fire and water, as elements of nature are present in an environment in which the movement of steam, the inner circulation of air and the release of aromas complete the basic microcosm next to the vegetal element represented in the used plants that act as intermediaries between human beings and nature. All these connotations are still taken into account today.”14 Therefore, the authors propose using


an architectural concept that they call the ‘temazcal – pregnant woman space code’.


Mayan altar


Surgical block/ Sterilisation centre


Western medical axis Emergency


Female inpatient area


Temazcal area


Support services


Reception area


External consultation


Figure 1: Western and Mayan medical axes proposal. IFHE DIGEST 2018


Mayan medical axis


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