Our last week in Santiago Atitlan

As Leah and I prepare to leave Santiago tomorrow to work in villages south of Antigua, I’d like to share some of my favorite pics (next post) and some of the more touching moments.

The poverty and needs continue to be overwhelming and sobering.   What does one do with the sense that a step forward is a wonderful thing, but a “drop in the bucket” ?   There have been times when I have felt the most honest response would be to burst into tears, maybe even sob in response to the sadness of the lack of education, nourishment, basic resources, or access to the most basic healthcare. Right in front of us.  Everywhere.  Given this is not an appropriate response (especially not a culturally appropriate one!), I remind myself we are making a difference here, no matter the size.  There was the morning with the community health nurses where Leah and I helped the women understand the few but available contraceptive options in their community.  Visiting in the narrow, dusty alley that was the meeting place of two women’s homes, tattered clothes drying on the lines above our heads,  I watched one of their young boys, hair thin, head too large for his body with large tired eyes, and knew there were so many others like him. In truth, I have never seen a malnourished child. This mother was interested in contraception. Maybe our time with her that day will help her obtain it, use it successfully, and be able to best care for her family.

There was the 39 year old woman with her 8th pregnancy at the hospital at 38 weeks by a 24 week ultrasound with definitive signs and symptoms of intrahepatic cholestasis (ICP).  For us as providers, what a difficult situation — was she term? preterm?  Was she 35 weeks and an induction of labor would put her baby in jeapordy due to lack of resources here to support the needs of a baby if premature?  Or, if she did have ICP would continuing her pregnancy be potentially fatal to her baby, especially if she was 38+ wks?  As I spoke spanish to the translator, who relayed the inforamtion to her in her indigenous language, it was clear that with her level of education and the literally foreign concept of what I was offering, there was no way I could successfully transfer this information about abstract medical options, risks, benefits, and treatment.  She wanted nothing to do with interventions, so that provided our “answer”, but I was left with a sense of, “how do we do this”? and hoping and praying that her baby would be safe and born healthy.

There have been several opportunities to pass on education, information and demonstration on intermittent monitoring in labor (as opposed to continuous or not enough), the benefits of maternal position changes, and skin to skin after the baby is born.  There is a long way to go, but I am hopeful.  My greatest lesson in this area carries a familiar ring, that we must all work together — the midwives, docs, nurses, and staff — to make it work for the mothers and babies. I believe we can do this, and do this together.

There are many more stories, including the worst from today’s report from the night call MD — the one year old who died from acute diarrhea. Yet, I am once again inspired by the efforts made here by many both locally and from all over the world. Hospitalito is able to provide services from birth to emergency and surgery to this community – a rare and unique service in these more remote areas. Not to mention provide a site for medical missions such as Smile Network. Que Milagros! Then there are the Community Health nurses from El Centro de salud get right into the homes to help those that may not be able to make it to the health center for food, antidiarrheals for their children, or vaccines, or who might not be aware that contraception is available. And there are peace corps volunteers, Europeans, Americans and Canadians starting libraries and cooperatives, and many medical missions that local people have built and rebuilt after devastating mudslides.  Especially inspiring is the relationship between the local midwives (comadronas) and the medical community who seem to understand the need for collaboration.  Leah and I attended the monthly meeting this week where a local doctor from the community health center taught the midwives to recognize danger signs and when to transfer. The comadronas were interested, responsive and engaged and the doctor supportive, committed, and respectful. We were asked to give a presentation at the next meeting. Que suerte! While we will not be here, I hope to do so with the students during our November trip.

Needless to say, these are people who know how to move forward. So, what does one do with the sense that a step forward is a “drop in the bucket”  but to keep moving forward? I am reminded of our Dean’s famous sayings, “onward”.  And so here we go, onward, into this wide neighborhood full of beauty, need, sadness, miracles, desperation, and always, birth.

Favorite pics from Santiago Atitlan

Leah helps woman with difficulty breastfeeding. Success!

 

boy with cleft lip and palate scheduled 4 surgery today!

 

woman in annual procession to relocate Santiago saint

 

OR at Hospitalito, Smile Network's site for cleft lift & palate repairs

 

working with community nurses - what an honor!

 

Martin (Volunteer Spanish translator) with baby scheduled for surgery

 

Woman carrying firewood - load are often much heavier & larger than this

Traditional Midwives-Santiago Atitlán

An Educational Session for Traditional

 

Nicole and Vincenta

Leah Talking with Delores-the Lead Midwife at El Centro de Salud

 

This  morning after a fabulous training with the Smile Network International surgeons at Hospitalito (more on that later), the social worker, Vincenta, invited us to a “capitacion de las comadrones”, which was like an inservice for the traditional midwives. More than thirty midwives came in their traditional Mayan dress to learn from each other, and from doctors and nurses from El Centro de Salud (the health department). Dr. Maynor Toc gave a power point presentation, along with his nurses, describing danger signs during pregnancy, birth, and postpartum. It was so inspiring to see health professionals respecting the tradition of the midwives and acknowledging their experience, yet bringing forth important medical information in a very respectful way. Vincenta brought a list from Hospitalito Atitlán of high risk pregnant women who have not been at their prenatal appointments. The names were read aloud so that the community midwives could get in contact with the women to check on their health status and to reinforce the importance of their prenatal appointments. The midwives broke up into small groups to facilitate a learning activity about danger signs during the pregnancy & birth. Nicole was asked to give a presentation for the comadrones in the future. How exciting that Frontier has such open opportunites in Santiago Atitlán!  As most of  us in the states can attest to, the cohesiveness between community providers and hospital providers is so important for continuity of patient care. It was great to hear the comodrones The group was very welcoming of our presence and we were honored to be representing Hospitalito Atitlán with Vincente and FSMFN.

Smile Network International at Hospitalito Atitlàn

María After the Surgery

María Before the Surgery 

This morning I rounded with the Smile Network Nurses on post-surgical patients. María had just awakened with her “whiskers” (steri strips). She was a little disoriented, but her parents were thrilled with the surgery and happy to be taking her home today. Thanks to Smile Network International she will have a whole new face and a changed life. I plan to round on surgeries throughout the week and am glad to be here to help. For more on Smile Network International visit:  http://www.smilenetwork.org/Smile_Network/About_Us.html

Puertas Abiertas

The Students and Teacher Working on Projects at Community Library-Puertas Abiertas

Nicole & Martin talking with Amanda at Puertas Abiertas

Monday we had the opportunity to see some other community resources. Amanda Flayer, former Peace Corps volunteer, and her husband and two daughters reside here in Santiago Atitlan, Guatemala. Amanda has started a wonderful opportunity for children and parents alike, with the opening of her library, Puertas Abiertas. She assists students with after school homework as needed but also has interactive preschool and reading for chilren ages 3-5 years old. One of the great sessions that she has includes the mothers in the reading and activity time with the children. Amanda is working to create a love for reading and learning earlier in life for Guatemalan children. Amanda says that she has had nurses come to give talks for the students on basic hygiene and health, as well as cardiopulumonary resuscitation (CPR). This is another great opportunity for Frontier students to link the people to community resources and participate in health education-a very important need here! For more information visit: http://www.opendooratitlan.org/index.html

Community health & home visits in Santiago, Atitlan

Leah & the community health nurses in woman's home

This was one of our best days yet. Earier in the week Leah and I braved a surprise meeting to the public health center (El Centro De Salud). We were well received by the nurses and the comadrona (a local midwife) who invited us out to the home visits in the community first thing the next morning. Of course, we accepted and were thrilled!  The day brought many lessons and an undeniable “en face” perspective of the cultural health disparities here.  The good news first — these nurses are making progress, step by step, home by home, as they travel up and down the stone streets and pass through cement alleyways to assist women and families.  We checked on a new young mother, just days post-partum (thank goodness all was well) and a woman who agreed to be vaccinated for tetanus (many decline the vaccines for concern of the side effects). We also visited a young malnourished child (the nurses will help connect the mother with a supplemental food program) and helped diagnose a women’s gynecological issues for which we then discovered there was no medication available.  We will continue to foster this relationship with the health center — these are excellent opportunities to provide support, learn, and understand some of the true struggles these women and families face, which will then, hopefully, help us to be figure out how we can be of service.

Cleft Lip/Cleft Palate Surgeries

Waiting to be Interviewed for Cleft Lip/Cleft Palate Surgery

A Family Being Interviewed

A Happy Ten Month Old

A Little Girl Who Wants Surgery

Mom is Happy That her Son Will Have Surgery

This week the mission team, Smile Network International, will begin cleft lip/cleft palate surgeries. On Saturday I had the opportunity to participate in the interview process for 37 families who were hopeful that their child/family member would be able to have surgery. It was very moving, as some of them had traveled as far as 15 hours for the interview, and many of the infants and children were kept hidden from view,  masked by a cloth. What a bright new world this will open for these precious children! As of Saturday only one person didn’t qualify for the surgery and lab results were pending on some of the others. A team of surgeons, physiscians, nurses, and volunteers all came together to meet with families and bring joy to their lives. I am excited to see what will happen this week at Hospitalito Atitlàn, and I feel honored to be part of the process. For more information about Smile Network International visit:  http://www.smilenetwork.org/Smile_Network/Mission_Calendar.html

Presentation on Birth Positions

 

Upright Position with Support

Relaxation of Muscles & Letting Go of Tension

The Double Hip Squeeze for Relief of Back Pain

A Slight Incline Shifts the Pelvis & the Flow of Gravity

Last Friday Nicole and I had the opportunity to present information to a group of physicinas at Hospitalito Atitlàn on varying birth positions in labor and the effect on the labor, birth outcome, mother’s comfort, and infant position. Nicole presented studies from the Cochrane Review data base , and she and I were able to demonstrate variations of labor/birth positions. Dr. Jennifer, who is here from the States with her husband, Dr. Brent, was there with her children, (the kiddos in the background). This family practice couple have been at Hospitalito Atitlàn for one year and plan to be here for another two years. Dr. Jennifer s aid that when she is on call and a woman is laboring, that she encourages the mother to move and vary her positions. The group included a third year resident OB, Dawn, who is completing her residency in Portland, OR, another resident OB, Carolina, from Belgium, Dr. Jennifer, and physicians from Hospitalito Atitlàn, Dr. Susana and Dr. Otto. Isabella, a nurse from the States who is here for a year with her husband was also in attendance. We were thankful for the opportunity and placed a copy of the power point, in Spanish, on the hospital computer for future use.

Hospitalito Atitlàn Nurses

 

Presentation on Birth Positions

 

This morning I had the opportunity to accompany two public health nurses in the community. Nicole and I visited El Centro de Salud, which makes referrals to Hospitalito Atitlàn, so it was good to get the overall picture of how systems within a community interact together for patient care. After a GYN clinical visit at Hospitalito I gave a presentation to a group of seven nurses about different positions for labor and birth, while Nicole finished up with patients in the clinic. I started out by asking the nurses about customs for birth in their setting and asking for feedback on their customs or desires of laboring women. Since they seemed very hesitant to have a discussion I went ahead with the power point presentation and demonstrations. The group of nurses were very interested the idea of different positions but the idea of the nurse staying with the mother and assessing her desires and needs during birth, in addition to assessing the couplet’s safety, was a new concept. The charge nurse said that staying with the mother was usually the work of the midwives, not the nurses, and here in Guatemala the midwives (las comadrones) do not work in the hospitals. The charge nurse also said that she had only seen pictures of the birth positions in books. The presentation prompted some discussion, and I asked the nurses to let me know how the positions worked after trying them with patients! Nicole and I will be giving the same presentation to the physician group on Friday, per their request. Theyare a delightful group of nurses and it was an honor to be invited to their staff meeting. Overall it was a wonderfully productive day.

Maya Guatemala

Fountain of Life...

Buenos días a todos! I am so excited to be here in Guatemala for the first time and have dreamed of coming here with Frontier since before enrolling in the university. For those of you who don’t know me, my name is Leah Trombley and I am a Women’s Healthcare Nurse Practitioner student who has worked as a Doula and has a heart for midwifery. I am so blessed to have had the opportunity to meet with Kathryn Schrag and to be here with Nicole Lassiter; both CNMs and amazing women. The picture that I am posting appealed to me as a woman and as a lactation consultant, but more importantly as a person interested in learning the culture here. This beautiful fountain, decorated in colorful array, captures the essence of a core Mayan belief that may be unfamiliar to many of us; that corn is necessary for sustaining health and balance throughout life. So you maybe thinking, “I don’t see a corn field!”, but what is flowing from the woman’s breasts demonstrates to the Mayans the result of  balance and health. Corn is truly vital to Mayans and Guatemalans for life. Corn is believed to assist with the abundance of life-sustaining liquids in the body: blood, semen, sweat, and breast milk. This is why Guatemalans eat many corn tortillas and the women drink atol (a sweet corn gruel) after birth. This is a key concept as we begin working with the Guatemalans and seeking to assist women within their culture and healthcare system. To learn more about Mayan beliefs and healthcare, check out the book:  Healthcare in Maya Guatemala:  Confronting Medical Pluralism in a Developing Country, by Walter Randolph Adams and John P. Hawkins. More updates later…Leah