Supporting Safe Birth

Last night I actually slept well…..let’s hear it for Benadryl, earplugs, and Nancy’s little travel fan that she graciously loaned me.  Day two of training begins with Helping Babies Survive: Helping Babies Breathe and ends with the ceremonial handing out of certificates of completion.  Teaching neonatal resuscitation in a low-resource country as a NICU nurse is emotionally difficult.  At home, there is so much by way of medicines and technologies and procedures that we rely on that simply are not available here.  So many of the babies that are lost here could be saved if….if it wasn’t so hard to get to a hospital…..if those hospitals had enough trained medical personnel……if birth attendants in remote areas were better trained. For me personally, it was incredibly difficult to butt up against limitations that I’m not used to hitting in my everyday practice and then having to be ok with that.

On a happier note, Training Day 2 is also graduation day and its exciting for everyone, trainers and midwives alike.  It was really wonderful to see the expressions of pride and accomplishment on the faces of the comadronas as they come up and receive their certificates from us. There is lots of laughter, lots of selfies and lots of fun!  We went out for pizza to celebrate another successful training in the books and it was delicious!

We head back to Guatemala City tomorrow so Nancy and Karen can attend a Rotary International meeting, leaving me in the company of the menfolk.  Menfolk who wanted McDonald’s for lunch. Tune in tomorrow to see how that went down.

Yes. The answer to yesterday’s question is Yes, there are roosters in Xela and they will wake you up early. Today was our first day teaching the indigenous Mayan midwives, comadronas, from the Xela region. The comadronas are similar to lay midwives here in the US in that they do not have any formal midwifery education, but rather their mothers and/or grandmothers were comadronas and they learned by working alongside them. Many of these women are quite elderly and unable to read. We travel with two interpreters who help us communicate with the midwives in their own language.  But even beyond that, it’s remarkable what a shared love of women, babies, and birth can do to dissolve a language barrier.

The first day of training is always Helping Mothers Survive: Bleeding After Birth which focuses on recognizing and managing a post-partum hemorrhage. Post-partum hemorrhage is the leading cause of maternal mortality worldwide, the US included. The maternal mortality rate in Guatemala is approximately 120 women per 100,000 live births.  Among indigenous Mayan women, the maternal mortality rate is three times higher. Since the comadronas are the primary birth attendants for women in their communities, this is life-saving training.

Our classroom for the day was pretty small and we “borrowed” several wooden tables that we found randomly hanging about in the walkways. There were 12 comadronas, 3 trainers and 2 interpreters crammed in that tiny space, but we made it work. The comadronas were bright, incredibly motivated to learn, and regularly expressed their gratitude for the opportunity to attend this training.  They shared with us their lively senses of humor and their many experiences in attending birthing women…..some experiences were funny, some were sad, some were straight-up tragic, and we learned from them just as surely as they learned from us.

Training days are long and tiring. At the end of the day, all I wanted to do was snuggle a dog and Guatemala has lots and lots of stray dogs everywhere.  My natural inclination upon seeing a dog on the street is to exclaim loudly, “Puppy!” and go in for a snuggle. However, I was told in no uncertain terms that I can’t do that here because the dogs all have fleas and/or rabies. It dang near killed me.  Today though, we stopped by our driver, Eric’s house and lo and behold he had a 3-month-old puppy named Bumper that I could love on as much as I wanted!  Happy day!  Speaking of animals, when we got back to our hotel, I looked out my window and saw a couple cows and goats grazing on the open lot next door.  In the second-largest city in Guatemala.  Next up: Training Day 2.

Well, “they” were right.  In the middle of Guatemala City, population: ~1 million, rooster racket will wake you up. Followed quickly by planes, dogs, and honking horns. Guatemala is a noisy place. I’m glad I followed the advice of seasoned Guatemalan travelers and tossed in some earplugs at the last minute. Before we get to the Market, I’d like to take a minute to rave about the tipico breakfast in Guatemala. Scrambled eggs, fresh fruit, plantains if you’re lucky, a little piece of fresh queso and black beans that are so delicious I miss them to this day.  French pastries have nothing on this ultra-fresh, bursting-with-flavor start to the day. Farm to table is a way of life here, not a fancy millennial “clean-eating movement”.

Today we planned to go to the big public market in Guatemala City before heading into the western highlands to Quetzaltenango which is also known by its Mayan name Xela. If you’re consulting a map, Xela looks to be maybe 2 hours or so from Guatemala City. Except just kidding, it’s more like 4-5 hours because of road conditions, that (in)famous Guatemalan traffic and mountainous terrain. But first, the market.

The Mercado Central is an underground market that has at least three levels with the uppermost level full of all the beautiful handcrafts and the lower two levels being all the meats, produce and other foodstuffs.  By and large, tourists don’t venture down below the artisan level. As with any crowded space in a big city, using some common-sense precautions will make sure you have fun and stay safe.  We had pretty limited time at the Market, so we focused on the level with all beautiful handcrafts.  Everywhere you looked were gorgeous, brightly colored textiles piled high, beautiful tote bags, leather goods, scarves, clothing, shoes, paintings and jewelry…..and all of it is handmade (well, not the “Guat’s Up t-shirts, but you know what I mean).  Now, the cultural expectation is that you haggle over prices, but given that we can afford the list price and the sellers could really use the money, it feels ethically challenging.  Our rule of thumb is to never, ever low-ball a seller and just don’t be a jerk.  Another cardinal rule of market shopping is that if you like it, buy it because you will not see it again at another stall.  Every single stall has something different and I am so glad I heeded this advice!  I had a blast picking out just the right little treasures for family and friends.

It was hard to leave, but we piled back into the van and headed UP…..Xela is located at an elevation of nearly 8,000’.  We arrived at our hotel in the early evening, but because Guatemala is located 4 degrees north of the Equator, days and nights are equal and last 12 hours each, so it is nearly dark by 6pm.  Our driving days were always way more fun than you’d think. I spent the hours flying from one side of the van to the other hanging out the windows with my camera completely agog at the passing scenery: volcanos, cows in the back of pick-up trucks, and farm fields that go straight up the sides of the mountains, I mean, volcanos.  No doubt I annoyed the crap out of my seatmate, Karen, as I launched myself across her lap for the 100^th time that day because “OMG that’s an even better view of those volcanos out your window now that the road curved left”. But she was nothing but kind to me for which I am eternally grateful.

Tomorrow is our first day of teaching, so there was a fair bit of prep work to do after dinner. Will there be rooster alarm clocks in Xela?  Stay tuned!

About the Blogger:

My name is Bridget and I’m a NICU nurse and midwifery graduate student. I’ve known Nancy for several years and on serve on the Advisory Board for Supporting Safe Birth. I have done a lot of international travel, but this was my first trip to Guatemala and my first medical mission trip, both of which I had been looking forward to for a very long time.

Day One: Arrival

We landed in Guatemala City at dusk. It was a very easy flight and everyone’s luggage appeared in record time. Surprisingly (to me), it was only about 5.5 hours of flight time from Chicago to Guatemala City and Guatemala is only one time zone behind our CST. In spite of that, upon exiting the airport to wait for our driver, the overwhelming impression was “Toto, we are not in Kansas anymore”. “Overwhelming” was a word I would find myself using again and again as the trip went on.

Our driver, Eric, is someone Nancy and Dave have known for years and consider their Guatemalan son. He has a quiet, reassuring presence and I would quickly come to trust him and his judgement. Tonight though, he texted to say he was stuck in traffic. Meh, I thought, it’s a big city, of course there is traffic.  Well there is traffic, there is big city traffic, and then there is Guatemalan traffic.  I don’t remember how long we waited, but eventually Eric appeared and we loaded up the van and were on our way to dinner.

Driving through the city at night was a little bit shocking, intimidating and overwhelming. I was not prepared for the security measures that Guatemalan’s employ almost universally: walls topped with razor wire and heavy metal doors as the only passage through the wall.  I learned that this is the physical manifestation of widespread corruption and the subsequent lack of trust in the entities that are charged with protecting the populace.

We arrived at the restaurant the veteran Guatemalan travelers had chosen: Kacao. Like many places in Guatemala it was sort of indoors and outdoors at the same time, which I thought was very cool. It had a thatched roof that soared above us, billowy, white panels of fabric, hanging lanterns, string lights and lots of beautiful Guatemalan textiles. And the food was amazing!  Before dinner I was finally able to call home and speak with my husband and son and, admittedly, I got a little weepy.

After dinner we headed to our hotel which was located in a gated community. Gated communities in Guatemala are similar to gated communities here in principle. It looks a little different though. Here, there is a gatehouse with an armed guard letting people through (in our case) or not (as in the case of the car in front of us). But before we knew it we were safely ensconced in our hotel and ready to crash. The roosters, I was told, would wake us up early.

Check back tomorrow for the adventures of Day 2: Mercado Central.

February 2018

A small team of two of us (Kathy, you’re the best!) spent 18 days in Guatemala (in conjunction with Hope2Others) revisiting some of the midwives and teaching Helping Mothers Survive-Bleeding after Birth (HMS-BAB) and Helping Babies Breathe programs in Chiquimullilia. We also completed a 2-day training with midwives in San Marcos La Laguna and at Manos Abiertos in Cuidad Vieja and also met with a doula group to talk about birth options. Statistics to come!

A short presentation to a Rotary group in Guatemala City was a surprise opportunity to discuss future training. We had such great connections with everyone we met! Thanks to the doula group for a great time of sharing and to all the midwives we met. Thanks to so many of our friends for help with lodging, transportation, and interpreting. As always, we were sad to leave.

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A group of 10 volunteers from the Madison, Wisconsin area (together with Hope2Others) spent 3 weeks in August 2016, in four areas of Guatemala: Chiquimulillia, Sumpango, El Tejar, and Totonicapan implementing the first combined Helping Mothers Survive-Bleeding After Birth & Helping Babies Breathe seminars outside of facilities. We had some difficulty collecting data on all 100 participants but of the 89 learner data we have, there were 68 midwives who identified as registered midwives with the local health clinic, four student midwives, eight nurses, and three nursing assistants. Other learners were also trained, such as a local firefighter, two physicians, a lactation consultant, and two community workers. Age ranged from 18-86.

Results of this training demonstrated statistically significant improvements in both confidence and knowledge for the management of bleeding after birth and neonatal resuscitation, along with high scores for the skills testing. In addition, because of donations and added assistance from Hope2Others, each midwife received a bag with an ambu bag, an infant stethoscope, a suction device, and several baby hats.

Our team also enjoyed many experiences together appreciating Guatemalan culture. We attended a small church service, a dinner hosted by a friend in her home (thanks Nely), a coffee farm tour, a visit to a domestic violence shelter, Lake Atitlan, and trips to the markets. Can’t wait to return!

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