Notes from the Field: Guatemala Edition

Karen Nassi, Every Mother Counts Program Director

I recently returned from a visit to Guatemala where I was able to experience the amazing work that our grantee partners are doing firsthand. Guatemala was one of the featured countries in “No Woman, No Cry”, the documentary film that led our founder, Christy Turlington Burns, to start Every Mother Counts seven years ago.

My first visit was with ACAM (Asociacion de las Comadronas del Area Mam) in Concepción Chiquirichapa, which is a collective of Indigenuous midwives who educate and provide maternal healthcare for women in the region. When I reached the ACAM house I met Imelda and Nancy (the comadronas- traditional midwives- on call that night — two comadronas are on shift at all times to receive patients in labor at the ACAM house), as well as Mallory, a volunteer CNM (Certified Nurse Midwife) from the United States who is there to provide clinical skills mentorship to the group. At 5:30am the next morning, the whole team loaded the Land Cruiser with supplies to bring to the mobile clinic site, which included a bed, portable ultrasound, medications, blood and urine testing equipment, and more.

The clinic site on this day was in Las Barrancas, a village approximately two hours outside of Concepcion Chiquirichapa, up and down a very treacherous road. About an hour or so into our drive in the mountains, we pulled over to a pretty overlook and everyone spilled out to share the breakfast (tortillas, eggs, beans, fruit, tamales, and tea) that the comadronas on duty at the house had prepared and packed for the mobile clinic group. It is a sweet ritual they’ve built into their work day.

When we arrived there were more than ten people already waiting at the small three room building, donated for ACAM to use once a month. The comadronas made quick work of setting up the facility for the day — one area was set up for initial intake, blood pressure, and weight readings, another area set up as a pharmacy where medications could be dispensed, and one room was outfitted with the bed and ultra-sound machine for private consultations. The electricity had been out for days, but it luckily started working about two hours into our day. Thankfully the ultrasound was equipped with a small battery that lasted until the electricity kicked in.

Comadronas Ofelia and Azucena set up the pharmacy at ACAM’s mobile clinic site in Las Barrancas while a patient waits outside.

Throughout the day, the comadronas and the doctor took turns seeing patients: from intake, to consult, to pharmacy. The CNMs were on hand to help the comadronas with blood and urine tests, consulting when certain test results were particularly hard to discern. Many of the women seen that day had urinary tract infections, which is likely caused by chronic dehydration. They would receive doses of amoxicillin as well as prescriptions to drink more water, if they could come by it.

A drop-in visit to the nearby government health clinic came with news that they had recently received a shipment of flu vaccine, and that our patients should be directed there if they had not yet been vaccinated. Such collaboration is commonplace in the mobile clinic sites — when the public health clinics have enough staff, they will sometime send one of their nurses to perform vaccinations at the ACAM mobile clinic.

Azucena prescribes medications to a patient, explaining what each is for and how to use it.

The day’s twelve patients included two post-partum follow ups, about which the comadronas were very pleased. Getting people to make postpartum visits has been a struggle for them — this is a challenge everywhere and further complicated by the cultural practice that has new mothers sequestered within their homes for a period of about six weeks after childbirth. They are working to develop ideas to incentivize these visits — currently, they’re handing out cute baby clothes. All in all, the midwives called the day a great success!

The comadronas on the roof of their ACAM birth center, making one another laugh.

Next, I joined other EMC staff members and a group of EMC supporters to visit Asociacion Corazon del Agua, another one of our grantees. This year’s cohort of students had just returned from two months in “practicum” doing field-based learning with doctors, nurses, comadronas, and other healthcare workers in their home communities. Corazon del Agua’s students are recruited from Indigenous communities all over the country. More than one of them shared about her experience of being back home since having started midwifery school, being identified by neighbors as a resource for reproductive health information or being approached by a neighbors seeking prenatal care; so urgent is the need.

One of this year’s cohort of students is the daughter of a comadrona who is a longtime, well-known advocate for women’s health in their community; she is proudly continuing in the family business, extending her family’s legacy into professional midwifery. It was my first time meeting these students that I had read so much about, and I was so inspired by how forcefully each of them spoke about why the training they are doing is not just important to them personally, but to their communities back home.

I had the opportunity to discuss with both organizations the importance of the policy landscape on the work they are doing day in and day out, and each relayed to me the importance of representation at a time when Guatemala is working out a national level strategy for reproductive and maternal health. Each is clear on the importance of traditional and professional midwives, comadronas and parterasalike, having a seat at the table — at Every Mother Counts we are committed to using our platform to help foster networking between groups to help strengthen local connections and advocacy efforts. For me, this is the most exciting part of the work — using our role to bring people together and then watching them do their thing, their way. If these ladies get to have their say, Guatemala is in good hands.

We will be following up this blog post with posts from two of our supporters who will share their own thoughts on these experiences. Stay tuned for more.