Since 2007, Maya Health Alliance has been a leader in developing practical solutions to improve the quality of medical care in rural and indigenous communities in Guatemala. The Center for Indigenous Health Research (Centro de Investigación en La Salud Indígena) was founded by a multidisciplinary group of researchers at Maya Health Alliance, with the goals of advancing scientific investigations into the health needs of these communities.

Researchers at CISI come from diverse backgrounds, but we share an interest in core themes (noncommunicable diseases, like cancer and diabetes; chronic malnutrition and food security; civil society and the study of “development”; and gender and health). We also share an interest in certain methodological approaches, especially in mixed methods, applied anthropology, and implementation science.

Research leadership

Peter Rohloff, MD PhD. Chief Medical Officer. Interests: noncommunicable chronic diseases, pediatric growth and development, chronic malnutrition, implementation science
Anita Chary, MD PhD. Research Director. Interests: cervical cancer, medical anthropology
Kirsten Austad, MD MPH. Director of Women’s Health. Interests: family planning, cervical cancer, implementation science

Core researchers

Meghan Farley Webb, PhD. Research Scientist. Interests: food security, migration, medical anthropology
David Flood, MD. Affiliating Researcher. Interests: chronic kidney disease, diabetes, child nutrition
Pablo Garcia, MD. Affiliating Researcher. Interests: chronic kidney disease
Nora King, MD. Affiliating Researcher. Interests: women’s health
Stephen Alajajian, RDN. Research Fellow. Interests: malnutrition, food security
Marcela Colom, MD. Research Fellow. Interests: women’s health
Ana Cordón, MD. Research Fellow. Interests: pediatric nutrition, civil society, social entrepreneurship
Andrea Guzman, RDN. Staff Nutritionist. Interests: malnutrition, food security
Michel Juarez, MD. Research Fellow. Interests: obstetrical continuum of care, neonatal care
Boris Martinez, MD. Research Fellow. Interests: pediatric nutrition, early child development

Research coordinators and assistants

Enma Coyote. Research Coordinator. Interests: midwifery, obstetrical emergency
Eloin Dhaenens. Junior Research Scientist. Interests: chronic kidney disease
Yolanda Juarez. Senior Research Coordinator. Interests: midwifery, obstetrical emergency
Lilian Ajú. Research Assistant.
Damaris Cabrera. Research Assistant.
Ingrid Chicol. Research Assistant.
Marta Quina. Research Assistant.

Scaling-up self-management interventions for type 2 diabetes (2018-)

Using an implementation science framework to evaluate the impact of a home-based self management intervention for adults with type 2 diabetes in two health districts in central Guatemala.

Funding: World Diabetes Foundation

• Flood, Hawkins J, Rohloff P. Evaluation of a Home-Based Type 2 Diabetes Self-Management Intervention in Rural Guatemala, 2014–2016. Preventing Chronic Disease 2017; doi: 10.5888/pcd14.170052.
• Flood D, Douglas K, Goldberg V, Martinez B, Garcia P, Arbour M, Rohloff P. A quality improvement project using statistical process control methods for type 2 diabetes control in a resource-limited setting. Int J Qual Health Care 2017; doi: 10.1093/intqhc/mzx051.
• Baird C, Rohloff P. Educación Para El Autocuidado de Diabetes Tipo Dos en Guatemala: Una Revision de la Literatura. Wuqu’ Kawoq | Alianza Maya para la Salud: Tecpan, Guatemala; 2019.

Population-based survey of chronic kidney disease (2018-)

Representative, population-based study surveying prevalence and risk factors for traditional and nontraditional chronic kidney disease in adults in rural Guatemala.

Funding: NIH/FIC

• Flood D, Garcia P, Douglas K, Hawkins J, Rohloff P. Screening for chronic kidney disease in a community-based diabetes cohort in rural Guatemala: a cross-sectional study. BMJ Open 2018 Jan 21:8(1):e019778.

Care navigation to improve obstetrical care (2017-)

Using a quality improvement framework and care navigation to improve patient satisfaction and emergency obstetrical referral outcomes.

Funding: Grand Challenges Canada

• Austad K, Chary A, Martinez B, Juarez M, Martin YJ, Ixen EC, Rohloff P. Obstetric care navigation: a new approach to promote respectful maternity care and overcome barriers to safe motherhood. Reprod Health. 2017 Nov 13; 14(1):148.
• Juarez M, Austad K, Rohloff P. Lay Midwives: On the Front Lines of the Fight Against Maternal Mortality in Rural Guatemala. Am J Trop Med Hyg. 2019 Feb;100(2):237-238.

mHealth technology to support obstetrical care (2015-)

Using smartphones and decision support mHealth applications to support identification and referral of high-risk pregnancies by lay midwives.

Funding: NIH/NICHD (PI Gari Clifford, Emory University)

Trial Registration: NCT02348849

• Valderrama CE, Stroux L, Katebi N, Paljug E, Hall-Clifford R, Rohloff P, Marzbanrad F, Clifford GD. An open source autocorrelation-based method for fetal heart rate estimation from one-dimensional Doppler ultrasound. Physiol Meas. 2019 Feb 26;40(2):025005.
• Martinez B, Ixen EC, Hall-Clifford R, Juarez M, Miller AC, Francis A, Valderrama CE, Stroux L, Clifford GD, Rohloff P. mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial. Reproductive Health 2018;15:120.
• Martinez B, Hall-Clifford R, Coyote E, Stroux L, Valderrama CE, Aaron C, Francis A, Hendren C, Rohloff P, Clifford GD. Agile Development of a Smartphone App for Perinatal Monitoring in a Resource-Constrained Setting. J Health Informatics in Dev Countries. 2017; 11:158.
• Stroux L, Martinez B, Ixen EC, King N, Hall-Clifford R, Rohloff P, Clifford GD. (2016). An mHealth monitoring system for traditional birth attendant-led antenatal risk assessment in rural Guatemala, Journal of Medical Engineering & Technology.

Individualized home-based interventions to improve diet quality and developmental outcomes in stunted children (2015-2017)

Investigating optimal strategies for empowering caregivers and improving nurturing care for infants at risk.

Funding: Grand Challenges Canada

Trial Registration: NCT02509936

• Martinez B, Cardona S, Rodas P, Lubina M, Gonzalez A, Webb MF, Grazioso MdP, Rohloff P. Developmental outcomes of an individualised complementary feeding intervention for stunted children: a substudy from a larger randomised controlled trial in Guatemala.BMJ Paediatrics Open 2018;2:e000314. doi:10.1136/bmjpo-2018-000314
• Martinez B, Webb MF, Gonzalez A, Douglas K, Grazioso MdP, Rohloff P. Complementary feeding intervention on stunted Guatemalan children: a randomised controlled trial. BMJ Paediatrics Open 2018;2.
• Martinez B, Webb MF, Rodas P, Gonzalez A, del Pilar Grazioso M, Rohloff P. (2016). Field report: Early child development in rural Guatemala. Perspectives in Infant Mental Health. 24(1-2):6-8.
• Brown K, Henretty N, Chary A, Webb MF, Wehr H, Moore J, Baird C, Díaz AK, Rohloff P. Mixed-methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala. Matern Child Nutr. DOI: 10.1111/mcn.12141

Evaluating a Family-based Nutrition and Garden Intervention in Rural Guatemala (2019-)

Investigating integration of home gardening into nutrition interventions to improve growth and diet quality for stunted children.

Funding: American Academy of Dietetics and Nutrition

Trial Registration: NCT03689504

• Roquel E, Wilson K, Alajajian S, Guzmán A. La Realización de un Diagnóstico Agrícola en una Comunidad Rural de Guatemala. Wuqu Kawoq | Alianza Maya para la Salud, 2019.

Dr. Joaquin Barnoya, Unidad Cardiovascular de Guatemala

Dr. Gari Clifford, Department of Biomedical Informatics, Emory University

Dr. Alejandra Colom, Department of Anthropology, Universidad del Valle de Guatemala

Dr. Meredith Fort, Department of Family Medicine, University of Colorado

Dr. Rachel Hall-Clifford, Department of Anthropology, Agnes Scott College

Dr. Maria del Pilar Grazioso, Department of Psychology, Universidad del Valle de Guatemala

Dr. Carlos Mendoza, Instituto de Nutrición de Centro América y Panamá

Dr. Ann Miller, Department of Global Health and Social Medicine, Harvard Medical School

Public Data Repository

Please contact us if you wish to access any of our publications.

2019

• Valderrama CE, Stroux L, Katebi N, Paljug E, Hall-Clifford R, Rohloff P, Marzbanrad F, Clifford GD.An open source autocorrelation-based method for fetal heart rate estimation from one-dimensional Doppler ultrasound. Physiol Meas. 2019 Feb 26;40(2):025005.
• Juarez M, Austad K, Rohloff P. Lay Midwives: On the Front Lines of the Fight Against Maternal Mortality in Rural Guatemala. Am J Trop Med Hyg. 2019 Feb;100(2):237-238.
• Smith BA, Hall ML, Greenspan B, Rohloff P, Prosser LA, Lobo MA.Wearables for Pediatric Rehabilitation: How to Optimally Design and Utilize Products to Meet the Needs of Users. Phys Ther. 2019 Feb 27. pii: pzz024. doi: 10.1093/ptj/pzz024.
• Baird C, Rohloff P. Educación Para El Autocuidado de Diabetes Tipo Dos en Guatemala: Una Revision de la Literatura. Wuqu’ Kawoq | Alianza Maya para la Salud: Tecpan, Guatemala; 2019.

2018

• Martinez B, Cardona S, Rodas P, et al. Developmental outcomes of an individualised complementary feeding intervention for stunted children: a substudy from a larger randomised controlled trial in Guatemala. BMJ Paediatr Open 2018;2(1):e000314.
• Colom M, Austad K, Sacuj N, et al. Expanding access to primary healthcare for women through a microfinance institution: A case study from rural Guatemala. Healthc (Amst) 2018;6(4):223-30.
• Flood D. Poverty, Genocide, and Superbugs: A Carbapenem-Resistant Wound Infection in Rural Guatemala. Am J Trop Med Hyg 2018;99(3):561-62.
• Colom M, Rohloff P. Cultural considerations for informed consent in paediatric research in low/middle-income countries: a scoping review. BMJ Paediatr Open 2018;2(1):e000298.
• Austad K, Shah P, Rohloff P. Correlates of long-acting reversible contraception uptake among rural women in Guatemala. PLOS One 2018; doi.org/10.1371/journal.pone.0199536
• Martinez B, Ixen EC, Hall-Clifford R, Juarez M, Miller AC, Francis A, Valderrama CE, Stroux L, Clifford GD, Rohloff P. mHealth intervention to improve the continuum of maternal and perinatal care in rural Guatemala: a pragmatic, randomized controlled feasibility trial. Reproductive Health 2018;15:120.
• Austad K, Chary A, Xocop SM, Messmer S, King N, Carlson L. Rohloff P. Barriers to Cervical Cancer Screening and the Cervical Cancer Care Continuum in Rural Guatemala: A Mixed-Method Analysis. J Glob Oncol 2018 July:(4)1-10. doi: 10.1200/JGO.17.00228.
• Martinez B, Webb MF, Gonzalez A, Douglas K, Grazioso MdP, Rohloff P. Complementary feeding intervention on stunted Guatemalan children: a randomised controlled trial. BMJ Paediatrics Open 2018;2.
• Flood D, Chary A, Austad K, Coj M, Lopez W, Rohloff P. Patient Navigation and Access to Cancer Care in Guatemala. J Glob Oncol 2018:1-3.
• Flood D, Chary A, Colom A, Rohloff P. Adolescent rights and the “first 1,000 days” global nutrition movement: A view from Guatemala. Health and Human Rights Journal 2018 Jun;20(1):295-301.
• Webb MF. Transnational Migration’s Psychosocial Impacts for Kaqchikel Maya Migrants’ Wives. Human Organization 2018;77:32-41.
• Moore J, Garcia P, Rohloff P, Flood D. Treatment of end-stage renal disease with continuous ambulatory peritoneal dialysis in rural Guatemala. BMJ Case Reports 2018: online first.
• Flood D, Rohloff P. Indigenous language and global health. Lancet Glob Health 2018 Feb;6(2):e134-135.
• Flood D, Garcia P, Douglas K, Hawkins J, Rohloff P. Screening for chronic kidney disease in a community-based diabetes cohort in rural Guatemala: a cross-sectional study. BMJ Open 2018 Jan 21:8(1):e019778.
• Colom M, Austad K, Sacuj N, Larson K, Rohloff P. Expanding access to primary healthcare for women through a microfinance institution: A case study from rural Guatemala. Healthc (Amst). 2018 Feb 7.

2017

• Austad K, Chary A, Martinez B, Juarez M, Martin YJ, Ixen EC, Rohloff P. Obstetric care navigation: a new approach to promote respectful maternity care and overcome barriers to safe motherhood. Reprod Health. 2017 Nov 13; 14(1):148.
• Flood DC, Chary AN, Austad K, Garcia P, Rohloff PJ. A patient navigation system to minimize barriers for peritoneal dialysis in rural, low-resource settings: case study from Guatemala. Kidney Int Reports 2017.
• Chary A, Flood D, Austad K, Colom M, Hawkins J, Cnop K, Martinez B, Lopez W, Rohloff P. Accompanying indigenous Maya patients with complex medical needs: A patient navigation system in rural Guatemala. Healthc (Amst). 2017 Sep 14. pii: S2213-0764(17)30177-X.
• Flood, Hawkins J, Rohloff P. Evaluation of a Home-Based Type 2 Diabetes Self-Management Intervention in Rural Guatemala, 2014–2016. Preventing Chronic Disease 2017.
• Hall-Clifford R, Roche S, Fathima S, Palmius N, Hollingworth K, Kennedy J, Merida J, Stephens M, Lavalley R, Rohloff P, Garcia P, Patrick S, Clifford G. Sustainable Technology for Surgical Referrals: Pilot Implementation of an Electronic Referral System for Short-Term Surgical Missions. J Health Informatics in Dev Countries. 2017; 11(2).
• Martinez B, Hall-Clifford R, Coyote E, Stroux L, Valderrama CE, Aaron C, Francis A, Hendren C, Rohloff P, Clifford GD. Agile Development of a Smartphone App for Perinatal Monitoring in a Resource-Constrained Setting. J Health Informatics in Dev Countries. 2017; 11:158.
• Martinez B, Flood D, Knop K, Guzman A, Rohloff P. Improving infant and young child nutrition in a highly stunted rural community: A practical case study from Guatemala. In: Preedy VR, Patel VB, eds. Famine, starvation and nutrient deprivation: from cells to policy. Cham, Switzerland: Springer International Publishing; 2017.
• Flood D, Douglas K, Goldberg V, Martinez B, Garcia P, Arbour M, Rohloff P. A quality improvement project using statistical process control methods for type 2 diabetes control in a resource-limited setting. Int J Qual Health Care 2017.
• Moore J, Webb MF, Chary A, Kraemer Díaz A, Rohloff P. Aid and gendered subjectivity in rural Guatemala. Journal of Development Studies. 2017;53:2164
• Flood D, Mathieu I, Chary A, Garcia P, Rohloff P. Perceptions and utilization of generic medications in Guatemala: A mixed-methods study with physicians and pharmacy staff. BMC Health Services Research 2017; 17:27.

2016

• Stroux L, Martinez B, Ixen EC, King N, Hall-Clifford R, Rohloff P, Clifford GD. (2016). An mHealth monitoring system for traditional birth attendant-led antenatal risk assessment in rural Guatemala, Journal of Medical Engineering & Technology.
• Martinez B, Webb MF, Rodas P, Gonzalez A, del Pilar Grazioso M, Rohloff P. (2016). Field report: Early child development in rural Guatemala. Perspectives in Infant Mental Health. 24(1-2):6-8.
• Chary A, Flood D, Austad A, Moore J, King N, Martinez B, Garcia P, Lopez W, Dasgupta-Tsikinas S, Rohloff P. (2016). Navigating Bureaucracy: Accompanying Indigenous Maya Patients with Complex Healthcare Needs in Guatemala. Human Organization. 75:305-14.
• Flood F, Chary A, Austad K, Kraemer Díaz A, Garcia P, Martinez B, Lopez Canu W, Rohloff P. (2016). Insights into global health practice from the agile software design movement. Global Health Action. 9:29836.
• Austad K, Chary A, Colom A, Barillas R, Luna D, Menjivar C, Metz B, Petrocy A, Ruch A, Rohloff P. Fertility awareness methods are not modern contraceptives: defining contraception to reflect our priorities. Glob Health Sci Pract. 2016;4:342-5.
• Flood D, Mux S, Martinez B, García P, Douglas K, Goldberg V, Lopez W, Rohloff P. Implementation and outcomes of a comprehensive type 2 Diabetes program in rural Guatemala. PLoS One. 2016; 11:e0161152.
• Webb MF, Chary AN, De Vries TT, Davis S, Dykstra M, Flood D, Rhodes MH, Rohloff P. Exploring mechanisms of food insecurity in indigenous agricultural communities in Guatemala: a mixed methods study. BMC Nutrition. 2016; 2:55.

2015

• Chary A and Rohloff P (Eds). (2015). Privatization and the New Medical Pluralism: Shifting Healthcare Landscapes in Maya Guatemala. Lanham: Lexington Books.
• King N, Chary A, Rohloff P. (2015). “Leveraging Resources in contemporary Maya midwifery.” In Privatization and the New Medical Pluralism: Shifting Healthcare Landscapes in Maya Guatemala. Chary A and Rohloff P (Eds). Lanham: Lexington Books. Pp 123-140.
• Flood D and Rohloff P. (2015). “This Disease is for Those Who Can Afford It”: Diabetes in Indigenous Maya Communities. In Privatization and the New Medical Pluralism: Shifting Healthcare Landscapes in Maya Guatemala. Chary A and Rohloff P (Eds). Lanham: Lexington Books. Pp 51-68.
• Rohloff P and Henderson B. (2015). Development, Language Revitalization, and Culture: The case of the Mayan Languages of Guatemala, and Their Relevance for African Languages. In Language Documentation and Endangerment in Africa (Eds Essegbey J, Henderson B, and McLaughlin F). Amsterdam: John Benjamins Publishing company. Pp 177-194.

2014

• Stroux L, King NE, Fathima SN, Hall-Clifford R, Rohloff P, Clifford GD (2014). A low-cost perinatal monitoring system for use in rural Guatemala. Appropriate Healthcare Technologies for Low Resource Settings.
• Fathima SN, Palmius N, Clifton D, Rohloff P, Clifford GD, Hall-Clifford R.(2014). Sanitation-related disease surveillance using community health promoters and mobile phone technology. Appropriate Healthcare Technologies for Low Resource Settings.
• Wehr H, Chary A, Webb MF, Rohloff P. (2014). Implications of gender and household roles in Indigenous Maya communities in Guatemal for child nutrition interventions. International J of Indigenous Health 10:99-112.
• Chary AN, Rohloff PJ. (2014). Major challenges to scale up of visual inspection-based cervical cancer prevention programs: the experience of Guatemalan NGOs. Glob Health Sci Pract. 2:307-17.
• Brown K, Henretty N, Chary A, Webb MF, Wehr H, Moore J, Baird C, Díaz AK, Rohloff P. Mixed-methods study identifies key strategies for improving infant and young child feeding practices in a highly stunted rural indigenous population in Guatemala. Matern Child Nutr.
• Henderson B, Rohloff P, Henderson R. (2014). More than words: towards a development-based approach to language revitalization. Language Documentation and Conservation Journal 8:75-91.

2013 and earlier

• Chary A, Messmer S, Sorenson E, Henretty N, Dasgupta S, Rohloff P. (2013). The normalization of childhood disease: An ethnographic study of child malnutrition in rural Guatemala. Human Organization 72:88-97.
• Chary A, Kraemer Díaz A, Henderson B, Rohloff P. (2013). The changing role of indigenous lay midwives in Guatemala: New frameworks for analysis. Midwifery 29:852-858.
• Kraemer A and Rohloff P. (2013). Guatemala. In Building Partnerships in the Americas: A Guide for Global Health Workers. (M Krasnoff, Ed). Dartmouth: University Press of New England.
• Tummons E, Henderson R and Rohloff P. (2012). Language Revitalization and the Problem of Development in Guatemala: Case Studies from Health Care. Symposium on Teachng and Learning Languages of Latin America. University of Notre Dame.
• Chary A, Greiner M, Bowers C, Rohloff P. (2012). Determining adult type 2 diabetes related health care needs in an indigenous population from rural Guatemala: A mixed methods preliminary study. BMC Health Services Research 12:476.
• Rohloff P, Kraemer Diaz A, Ajsivinac Sian J. (eds). (2011). Nïm chuwäch k’iyirisanem: Tajin runuk’ik’ ruk’aslem ri chwa’q kab’ij pan Iximulew. Bethel, VT: Wuqu’ Kawoq.
• Tummons E, Henderson R and Rohloff P. (2011). “So that we don’t lose words:” Reconstructing a Kaqchikel medical lexicon. First Biennial Symposium on Teaching Indigenous Languages in Latin America. Indiana University.
• Chary A, Messmer S, Rohloff P. (2011). Male Influence on Infant Feeding in Rural Guatemala and Implications for Child Nutrition Interventions. Breastfeeding Medicine 6:227-31.
• Rohloff P, Kraemer Diaz A, Dasgupta S.(2011). “Beyond development “– A critical appraisal of the emergence of small health care non-governmental organizations in rural Guatemala. Human Organization 70:427-437.
• Chary, A., Dasgupta, S., & Rohloff, P. (2011). Breastfeeding, subjugation, and empowement in rural Guatemala. In An Anthropology of Mothering (M Walks & N McPherson, Eds.). Toronto: Demeter Press.
• Rohloff P and Sotz Mux M (2008). Tiqaq’omaj qi’. Bethel, VT: Wuqu’ Kawoq.

See our philosophy on indigenous languages and additional resources on this topic at another section of our website.

Publications on Mayan languages and health care

• Flood D, Rohloff P. Indigenous language and global health. Lancet Glob Health 2018 Feb;6(2):e134-135
• Henderson B, Rohloff P, Henderson R. More than words: towards a development-based approach to language revitalization. Language Documentation and Conservation Journal 2014;8:75-91.
• Tummons E, Henderson R and Rohloff P. (2012). Language Revitalization and the Problem of Development in Guatemala: Case Studies from Health Care. In: Proceedings of the Second Biennial Symposium on Teaching and Learning Languages of Latin America; 2011 Oct 30-Nov 2; Notre Dame, IN. Notre Dame: University of Notre Dame; 2012. p. 1-17
• Kaqchikel Cholchi’ et al. (2012). Kaqchikel Choltzij: kolon chuqa’ k’ak’a taq tzij. Medical and technical neologisms in Kaqchikel Maya. Guatemala: Kaqchikel Cholchi;2012.
• Tummons E, Henderson R, Rohloff P. (2011). So that we don’t lose words: Reconstructing a Kaqchikel medical lexicon. In: Coronel-Molina SM, McDowell JH, editors. Proceedings of the First Biennial Symposium on Teaching Indigenous Languages in Latin America; 2008 Aug 14-16; Bloomington, IN. Bloomington: Indiana University; 2011. p. 127-135.