When Peter Rohloff, MD, PhD, of the Divisions of Global Health Equity & General Internal Medicine & Primary Care, first traveled to Guatemala in 2003, they aimed to learn Spanish — a skill they desired to better serve Spanish-speaking patients at their medical school at the University of Illinois. Rohloff soon learned that more than half of Guatemala’s population is Indigenous Maya and doesn’t speak Spanish. It was the first of many realizations that led them to explore inequities in Guatemalan health care.
“In Guatemala, the racism and inequity indigenous people face affects the quality of medical care they receive,” Rohloff said. Because of both social and geographic barriers to health care, many opt to receive medical treatment at home rather than trek across mountainous terrain to hospitals. This lack of adequate care has led to one of the region’s highest maternal mortality rates and one of the world’s highest levels of stunted growth among young children. Rohloff knew they could help.
“It was really just a matter of being in the right personal space, spiritually and emotionally, and in the right place where it was clear I could make a difference,” they said.
After their initial stint in Guatemala, Rohloff returned the following year to learn Indigenous languages. They now speak two — Kaqchikel and K’iche’. In 2007, they co-founded Wuqu’ Kawoq | Maya Health Alliance, a nonprofit healthcare system serving rural Guatemalans. Rohloff also began their residency at the Brigham during this time, extending the residency’s duration to spend 12 to 15 weeks per year in Guatemala.
“Not many institutions in the U.S. value and support global health work,” they said. “The Brigham is one of the few places helping clinician scientists build careers around global health, and it remains one of the few places where you have the freedom to do that kind of work.”
Now, Rohloff spends about half their time working and living in Boston, where they are a practicing internist, a pediatrician and a researcher with clinical affiliations at the Brigham. They spend the other half in Guatemala, researching and providing solutions to the country’s health inequities.
“What I do isn’t just research; it’s research with advocacy,” said Rohloff. “It’s research with a point.”
Solving Inequities in Pregnancy and Child Nutrition
Much of Rohloff’s work in Guatemala involves improving outcomes for pregnant individuals. Many Indigenous people rely on local midwives for childbirth, as hospitals often disrespect or even abuse Maya seeking care. In addition, hospital workers often don’t speak Indigenous languages and routinely blame midwives for complications in pregnancy.
Beginning in 2015, the team at Maya Health Alliance, including Rohloff and others, partnered with 41 Mayan midwives and provided them with a smartphone application to guide them through emergency checklists and connect them to an on-call medical team. Later, the team also collaborated with hospitals to deploy care navigators, Indigenous women trained on emergency situations and hospital culture. These care navigators improve relationships between pregnant individuals and hospitals, heightening the chance they will seek medical care in case of difficult labor. Thanks in part to these efforts, rates of hospital births where the programs operate have increased from 20 to around 60 percent.
To combat stunted growth among young children, Rohloff’s team has addressed misconceptions about the condition. Many Guatemalan health professionals and policy makers previously considered stunted growth to be a genetic condition rather than an effect of poverty and poor access to nutritious food. By reversing this notion, Rohloff and others have helped move child nutrition to the front-and-center of policy agenda. However, barriers still stand in the way of systemic change; many interventions have focused on short-term fixes, such as providing children with micronutrients and food supplements, rather than focusing on broad social initiatives meant to empower rural, Indigenous populations and reverse economic inequity and discrimination.
Empowering Indigenous People
The Maya Health Alliance doesn’t just provide temporary help in Guatemala; it trains and employs Indigenous people to provide sustainable medical care and conduct advocacy-focused research in their communities. Rohloff noted that limitations in rural areas have provided substantial obstacles. They mentioned a lack of research infrastructure and training in Guatemala as a barrier, as well as the difficulty of training individuals to work across multiple languages, including Spanish, English, and Mayan languages.
“There’s a lot of early-stage mentorship we do, because folks don’t come into these jobs with the same training as they might in a higher-resource country,” said Rohloff. “I’m in the trenches more than I think I should be, doing some front-line things like primary data analysis.” They also mentioned obtaining funding stands in the way of providing robust care, as most global research grants stem from a small group of high-income countries. Right now, they receive most of their funding through the Eunice Kennedy Shriver National Institute of Child Health and Human Development, one of the National Institutes of Health committed to providing positive outcomes for children and those giving birth.
Despite formidable challenges, Rohloff noted they have seen the sustainable effects of their work. Throughout the COVID-19 pandemic, when health care has been disrupted in even the most established systems, access to obstetrical care for women and nutritional services for children held steady in their programs.
“Even among unforeseen global challenges, our outcomes didn’t worsen at all,” said Rohloff. “It’s just so rewarding and exciting to see how remarkably strong and resilient this system is.”
The Future of Global Health Work
“We have a good sense of what kinds of interventions can work in rural Guatemala, which means we know a lot about what it means to be rural,” said Rohloff. “So now let’s see how these lessons translate in other settings.” Right now, their team is collaborating with researchers from India and Guatemala to conduct a clinical trial of the International Guide for Monitoring Child Development in both countries. The Guide is a problem-solving tool that helps community health workers provide support for parents. It has been widely endorsed by the World Health Organization and the United Nations Children’s Fund, but clinical evidence of its impact on child development has been missing — a shortcoming that Rohloff’s trial hopes to overcome. “I’m also involved in the International Developmental Pediatrics Association, which is pulling me into many directions around the world,” they added.
Rohloff mentioned they are at a mid-career transition point, and their focus has turned to supporting those just beginning in the field of global health.
“When I started out, I wondered if this sort of career is possible, and I want to support younger folks having the same thoughts,” they said. “I’ve learned that it is possible, and it’s an exciting field to work in. There’s a lot of resources at the Brigham and at Harvard to support this work, but they’re mostly unknown, and it can be hard to make connections when just starting out.”
Rohloff stressed that nascent global health workers must quickly find mentors. “You need help navigating the decisions that need to be made,” they said. “Having engaged people at your side helps you think through those decisions.” They also pinpointed peer support as critical in a field with such an unusual composition and trajectory. “It’s important to reflect on your experiences with others going through similar challenges,” they added.
“A career in global health is possible,” they concluded. “And once you make connections and get going, good things happen.”