Archive for Guatemala

Carchá

This past Friday, Monday, and Tuesday we spent time with the midwives of Carchá teaching them the same three topics that we taught the midwives in Chisec. That’s where the similarities end though. This group of midwives was vastly different from our first. There was a wider range of education to begin with, some couldn’t write or read and others who could read and write in multiple languages. There were women who were activists trying to fight for more rights for midwives. There was a mother of 19 who had delivered all of her babies herself – two of her daughters were there as midwives with her. There was a woman who had been a nurse for the government and changed to become a midwife.

I like to think that the six days we spent teaching these midwives has changed us all. We complain about salaries and hours and working conditions in the States, but it’s nothing compared to these women. They don’t get paid for anything that they do. They are on call 24/7. They don’t get vacations or sick leave. They walk at night for miles without lights to show them the way and then deliver babies on dirt floors by candlelight. I know they don’t have the same risk of malpractice – but they have a greater risk of maternal/fetal morbidity and mortality.

While I would like to say that all midwives in the States do what they do because they love it, I’d also like to think I’m not naive enough to believe that. The midwives here do this because they view it as a calling from a higher power. They do it for the love of their community and the love of their women. They do it in spite of constantly being put down by the government, of constantly being scorned, of constantly being waved off like they are unimportant – like they’re something less than others. I’m just in awe of them.

Teaching here was harder for all those who did it. We’re tired and languages are harder when your brain isn’t firing as sharply as it normally does. We all struggled to understand and to communicate. We struggled to accommodate the variety of educational levels. We struggled with illnesses taking out two of our more proficient speakers on the last two days. We struggled with patience for each other. It’s definitely been a harder go this time around on all fronts.

 

Guatemala Day Three-Five

Part of the fun of international travel is always finding reliable internet connectivity. Since my last post I have been fighting quite aggressively with the internet and my computer, but finally I overcame (which is impressive if you knew how little I understand about computers). Anyway here is what I had typed up for day three and then some extra added to it to include days four and five (so it’s crazy long):

Afternoon storms are becoming a normal part of our routine – I think that they’re the only thing that actually runs on schedule here. Those of us who need internet, for homework or more leisurely activities like Netflix viewing, are watching the clouds and lightening roll in from the open, covered area where we get internet at this hotel. It’s making things significantly cooler here, which is such a blessing. The rainy season has begun in Guatemala, which means that the entire night was filled with rain falling on the tin roof of our room and that the entire day felt sticky and hot.

This morning, as the midwives started walking into the courtyard this bubble of excitement overwhelmed the table that where we were all sitting. We wanted so badly to go and greet them, and know them, and express our appreciation for them being there. Two issues with that desire: we didn’t want to overwhelm them and none of us speak their native language. Instead we settled for the traditional “Buenas días” and a pat on the arm/kiss on the cheek as they headed to our conference area.

Rebecca Gloss and Hannah Lake-Rayburn did the teaching today. The spent the entire morning dialoguing with the midwives about high blood pressure during pregnancy, preeclampsia, symptoms of these conditions, and when women were traditionally referred out. We then broke off into small groups and taught these midwives how to take blood pressures using the BP cuffs and stethoscopes we brought down for them. It was so exciting to realize how veracious these people are to learn new skills and about new equipment that they knew would help the women that they love so much.

Not that this teaching didn’t come without challenges: the majority of our group speaks some Spanish, but that becomes completely moot when trying to communicate with the majority of the midwives because they speak a traditional Mayan language that sounds and tastes nothing like Spanish. It’s harsher sounds, stronger syllables, thicker tongues. Luckily, we had a translator there, Maria, and quite a few of the midwives also spoke both, so in the end it all worked out from that standpoint. We were also educating a couple of illiterate individuals, which made taking blood pressures difficult for them because while they could hear the sounds and understand where on the monitor they needed to note numbers, they couldn’t dictate what the number actually was – which almost defeats the purpose. Our solution? Mark on the cuff monitor which pressures indicated an emergent situation and necessitated a referral. This job requires nothing if not adaptability.

After eating lunch with the midwives, they began there journeys back home – some of which would be more than two hours – and we returned back to our rooms for a quick siesta. At 1530, we met back up with one another and took the bus into the town of Chisec. We could hear and see the storm rolling in, but we were determined to get in a little bit of walking in spite of the obvious incoming weather. We paid for our stubbornness and got caught in a small shoe shop during a torrential downpour. All of the people who were in town took cover under something and we just watched the streets quickly fill with water. Luckily, the shop keepers were extremely pleasant and allowed us to stay under cover until Oswaldo came and picked us up in the bus.

The rest of the evening was spent putting together small packages for the midwives – consisting of gloves, umbilical ties (they don’t do clamps down here), new scissors to cut the umbilical cords with, sterile blue towels, and a couple of pairs of sterile gloves. All of these new goodies will provide the midwives with a very limited supply of some of the resources that they need – but we’re trying. These packages coincide beautifully with the educational session about sepsis and neonatal infections that will be conducted tomorrow by myself and Tamara Noy.

Our teaching went well. We got to have lengthy conversations about infections and how the midwives traditionally care for their women. I think at this point we were all quickly coming to the realization that these midwives are so so so knowledgable and so passionate. It becomes much more of a dialogue and much less teaching – an exchange of treatments and options and ideas. It’s so inspiring to learn from them and to hear what they go through on a daily basis.

We got to do a home visit with one of the comadrones, which was very eye-opening. The woman we saw five months pregnant with her fifth child. Her husband, her four daughters, and she lived in a building that is roughly the size of typical dorm room with dirt floors and a large curtain splitting off some of the sleeping areas from everything else. There were three chickens living in the house with them and a large (I mean large) bin of corn in one corner. Even though it was small, and the family was obviously impoverished, everything was clean and well-cared for – and the woman had pride showing us where she lived and introducing us to her daughters (all through the interpreter mind). We also got to see the return OB visit, the midwife did Leopold’s (basically felt the belly to determine the size and position of the fetus) and then did a mini rubdown of the woman’s legs and belly and arms – kind of like a massage. It was wonderful to see a midwife in another country utilize similar tools that we do in the States.

Finally, on Thursday, Chelsea and Michelle did their teaching on postpartum hemorrhage. They used chucks and poured different amounts of fake blood on to them to have the midwives determine which needed a referral and which was okay. We also supplied the midwives with headlamps and showed them how to use them so that they could see when they were walking in the middle of the night and check for tears in poorly lit buildings. Chelsea and Michelle mimed a birth with a postpartum hemorrhage and asked the midwives what they would do throughout. It was a very successful learning day.

We then went a stood in a circle with all of the comadrones and began throwing a ball of yarn from person to person. The person with the yarn would share what they had learned or what they enjoyed most about the past three days, would keep a hold of the string, and pass the ball along. At the end, we were all connected by this string which physically exemplified the way in which we were connected by our profession and our passion for the women that we get to care for on a regular basis. I think it’s safe to say that these three days in Chisec were inspiring and uplifting on both ends and just made me so much more excited to enter this profession.

BP practice with the midwives.

Erika, Hannah, and Becky teaching the midwives.

Jenny, Becky, and Tamara teaching more about BP

Guatemala Days One & Two

In all seriousness, our first day was wholly a travel day. The travel adventure began at 0400 for some of us and others at the slightly more reasonable time of 0700. The day did not end until 1900, Guatemala time, which is 2100 for those of you reading on the East Coast – which roughly equates to 14-17 hours of travel, depending on who you’re talking to from our trip. We flew into Guatemala City and were ushered onto a bus by Sofia (She’ll make lots of appearance on this blog, I’m sure. She’s our fearless leader and organizer from CEDEPCA – the organization we came with) and Oswaldo (He’ll also make lots of cameos – he’s our bus driver and we all love him. PS you say his name OsValdo). We quickly learned that things didn’t really run on a schedule as what was supposed to be a four hour drive to Cobán became a six hour long trek down a well-loved road. Our hotel was lovely (see picture below), dinner was delightful (think well-seasoned eggs with onions and tomatoes with some plantains and beans), and then we all crashed.

This morning we met with the ministry of health and the nurse who’s in charge of all the midwives here, Erica (she’s also in charge of TB, but that’s a different story for a different group). We talked all about our role here, educating, and how the midwives have historically been viewed in this country. As a future midwife, it was fascinating, but I won’t bore you with all the details. I do think that it’s significant to let you know that the midwives deliver 45% of the babies born out in the community, which is an impressive percent when compared to the out-of-hospital births in the United States (according to one source, it’s roughly 1-1.5% of births). These midwives do this with limited resources and the closest hospital/back-up provider about two hours away (if they can find a car).

After our meeting we got back into the van and drove two hours to the city of Chisec. Parts of Guatemala seem so untouched, like humans have never stepped foot on the majority of its land. I keep mentally comparing it to Jurassic Park because it has the same level of lushness and similarly impressive mountains. It’s crazy to think about the Mayan people walking these mountains that felt so uncomfortable to drive along. The cities and neighborhoods themselves are obviously impoverished, but a few of us have noted that in spite of the poverty, they feel exceptionally clean and friendly in comparison to other countries we’ve visited. As we drove along the roads we could see two of the major commodities in the country – corn and coffee. The corn is essentially grown over every square inch of available land and comes right to the edge of the road with the occasional rectangular house breaking up the jungle. On the other hand, the coffee is grown in beautiful lines or concentric circles up and down the mountains. It looked like my version of heaven – caffeine and order. Chisec itself is much lower than where we stayed last night (and when we return to Cobán on Thursday, I’ll give you the scoop), and it’s hot and muggy. Imagine Florida during the dead of summer and you’ve got the weather we’re staying.

Tomorrow is the first day where we actually get to meet the midwives and all of us expressed excitement at the thought tonight during our reflection time. Don’t worry, we do this every night so I’m sure you’ll get to hear all about them at some point. Anyway, it’s almost 2100 my time (2300 Eastern), so it’s time to go tuck in bed, watch an episode of Arrow (no, I’m not kidding), and set my 0630 alarm.

Jenny Foster and Marissa Storms [me!] enjoying all the fruit and yogurt for breakfast.

The courtyard at our hotel in Cobán

Our hotel in Chisec – it’s rained like this on and off since we got here.