Saludos desde Santiago Atitlán, Guatemala! I am writing this post following my experience as a Saving Mothers volunteer on site in Guatemala. Not a single day has gone by since my return that I haven’t missed everything about being on ground- waking up to the sound of birds chirping, having beans for breakfast, the delicious coffee- and of course the splendid beauty of the lake that never ceases to amaze me. I know that these memories will be help get me through the year that lies ahead as a first year OB/GYN resident.
As a Saving Mothers volunteer, I was able to spend time in several settings that gave me broad exposure to Guatemalan healthcare, culture, and of course, how they interact. I strongly believe that the latter is crucial in global health, and in my time on site, I came to understand how Saving Mothers works with cultural understandings of medicine and childbirth in order to create safer conditions for women to give birth. The first of SM efforts in Guatemala in which I was able to participte is the School of POWHER. The School of POWHER has been set up by SM and recruits comadronas, traditional birth attendants, to enroll these women in a 4 month course that covers topics from the physiology of conception through postnatal care. The population of Sololá is 96.5% indigenous; as such, the curriculum is designed to reflect the traditional practices of various Mayan cultures. I had the opportunity both to observe class as well as teach various topics. The syllabus is designed to reflect these cultural practices and to make them safer instead of replacing them. Most comadronas, for example, are accustomed to clamping the umbilical cord with string as opposed to with a clamp. Although we instructed them how to use the clamp, we also practiced how to use the string in an appropriate sterile fashion.
The curriculum also includes weekly home visits in which an SM lead educator and a volunteer accompany one of the comadrona students on prenatal home visits to see their patients. Getting to see patients in their homes was incredibly enlightening and helped me understand childbirth and medicine overall from a new perspective.
The fourth School of POWHER is currently in session, and is run primarily by SM lead educators. The lead educators are local comadronas from Santiago Atitlán that work with Saving Mothers to run the school, and to oversee everything from class to the home visits. Additionally, SM partners with the ministry of health in order to ally foreign and local efforts. To me, one of the greatest aspects of the SM mission is the aim of creating a sustainable system that is not entirely dependent on foreign sources. Seeing our lead educators be so familiar with and take charge of the SM curriculum was beautiful to see. The School of POWHER recruits a diverse group of comadronas from throughout the department of Sololá; some of these women travel from villages up to four hours away to attend class every week. They have had an elementary level education, if any, so their attitude towards learning is one of incredible enthusiasm and humility. I went a home visit with one of our current students, doña Pascuala, along with Josefa, one of our educators in Pascuala’s village of Nahualá. Josefa guided Pascuala through her first time using the doppler on a patient, and the elation on Pascuala’s face when she found the fetal heartbeat really showed how education has empowered these women (she was so humble that she bought us refreshments and didn’t even allow us to pay for our tuk-tuk, the local 4 wheel scooter) It is incredibly reassuring to see that the hard work the SM team has done is beginning to come full-circle: Guatemalan women teaching their peers in a movement both to create safer conditions for mothers to give birth as well as bridge the very distinct divide that exists between healthcare professionals and traditional medicine in Guatemala.
Another site I spent time at was the local centro de salud de Santiago, or CAIMI. The CAIMI is a healthcare facility, staffed with nurses and a doctor, that acts as an acute and primary care center. Patients come with any and all ailments, and pregnant women also come for prenatal visits and to give birth. Many times, laboring women would come in with their comadronas, some of which worked with SM. I remember when I was working at CAIMI and one of our comadronas brought in her patient in labor. She confidently reported that she had done a vaginal exam and that the patient was 3 cm dilated. Seeing the comadronas have the education necessary to integrate themselves into the Guatemalan healthcare system was very rewarding.
I am so incredibly thankful for my experience with SM. I met some truly amazing women, from Sasha, our SM research fellow, to the comadronas, students, and patients, who are all true heroes. I am grateful to all those that have worked so tirelessly to make the work SM is doing in Guatemala possible! I feel that I have learned just as much, if not more, from these women in my time in Guatemala than they from me. I look forward to continuing to work with Saving Mothers and, por supuesto, returning to Guatemala!