By Joanna Ross
I am majoring in psychology and minoring in gender studies at the University of California in Santa Barbara, and will be entering my second year this fall. I haven’t yet decided what I’d like to do after I graduate, but I am considering a career in public health. I am specifically interested in medical systems in developing countries, and I feel that sustainability and women’s empowerment are both key to establishing a long-term, structured system. I have been in Guatemala for the past two months, interning at PCI’s Casa Materna initiative in Huehuetenango. I have been working on a variety of projects here, gaining experience in working with poor, underserved areas and delivering quality medical care to these vulnerable communities. My work has included writing a business plan for alternative dining for patients and family at the clinic which will provide sustainable income, revising and implementing new training methods for the comadronas (traditional midwives) in the surrounding indigenous communities, constructing a reference model for internal clinic quality maintenance, and working with Bal Maria Gutierrez, the Regional Director of PCI Huehuetenango, to improve marketing for Casa Materna’s services.
Perhaps one of the most crucial things I have learned is the importance of working with communities to gain trust and respect. Unless we communicate on an equal level with the people, they will never accept our assistance or trust the information we provide. I have loved going to the indigenous communities to speak with the women for whom we provide pre and post-natal care, as well as assist in comadrona trainings. I am learning first-hand about the various barriers (both physical and social) women here face in accessing reproductive healthcare and education.
I witnessed one such example of the issues these women face on a trip to a pregnancy checkup in Todos Santos, a municipality of Huehuetenango. One of the women was 36 years old and pregnant with her 10th child. All of her children were living and healthy but she is having complications with this pregnancy. The woman’s comadrona told us that the baby was transverse, meaning that it was lying sideways instead of its head facing down as usual. Rocio, Casa Materna’s external nurse, conducted a physical examination and concluded that the baby was actually breach, meaning that it is facing fully up instead of down. What the comadrona thought was the head was actually the baby’s bottom (this is a typical example of the lack of general medical knowledge in the indigenous communities). Because this is a high-risk pregnancy, Rocio advised the husband and wife that the woman needed to give birth in a hospital, and should go a few weeks early to ensure that she has a safe birth. The family speaks Mam, one of the eight Mayan languages used in the mountain communities. This made it a bit difficult to communicate the importance of the situation to the family, even though we had a translator with us. The husband thought his wife would be fine as she had already given birth nine times without complications. We finally persuaded him to allow her to go to the hospital when she goes into labor.
Unfortunately, this is a huge cause of maternal and infant mortality and this family is a good example. With nine children to care for, it is difficult for the mother to leave weeks in advance because of one child that isn’t even born. On top of this, the cost of staying a week at Casa Materna, while only the equivalent to four dollars, is a large amount of money to spend for such a big family. It is understandable for the family to want to delay, but traveling on unpaved, uneven roads for three hours while in labor with a high-risk pregnancy is how many women die. I brought this topic up with Bal, and she told me that in some cases, the husband decides that the wife is not allowed to go to the hospital when she goes in to labor because he does not believe that she will live to make it to the healthcare facilities and does not want to spend the money on a useless trip.
It is vital that we educate these communities to cultivate a culture supportive of healthy reproductive practices and a respect for the complications that can occur. I am so humbled to have had the opportunity to learn more about factors that determine how women even get to Casa Materna, and am excited to continue learning more about social determinants of healthcare access in developing countries. Thank you PCI for such an educative, amazing summer!