Hello from Guatemala! What an exciting two months it has been for me as Saving Mothers' Research Fellow. Since the very beginning of medical school at Weill Cornell Medical College, I knew I would dedicate a year to expand my knowledge of global health and decided that a year of on the ground experience over an MPH was the right choice for me. And boy am I glad I made that decision!
In the last two months I have come to truly understand the depth of Saving Mothers' involvement in Guatemala. I have experience first hand how in a healthcare structure that is so fragmented and excludes its poorest residents, the School of POWHER supports and tries to re-integrate the comadronas (indigenous birth attendants) and their patients into the system in a very unique way. I have become part of the school both in teaching classes and precepting home visits. I am developing deep relationships with each of the 13 students in the current class, which has helped me understand the complexity of the different Mayan communities and how different cultural beliefs truly do affect healthcare.
Last week I went on home visits in a remote village with Dona Raymunda and I was a bit frustrated when during one of our prenatal visits a pregnant mom refused prenatal vitamins because she believed they would cause her baby to be too large and cause her to have a difficult home delivery. It was eye-opening for me to understand this coming from a place where prenatal care is a given. Dona Raymunda counseled her extensively in Ma'm, their native tongue, and the mother compromised and said she would rethink her position. Although these moments can be a bit defeating at first, it was a great teaching point that speaks about the beliefs of many indigenous communities and how they need to be acknowledged in order to provide adequate healthcare. Just one layer of the complexities here in Guatemala.
The last two months have also helped me understand how practicing medicine in a resource poor setting truly works, a skill that I would have not developed as quickly by sitting in a classroom. As a U.S .trained medical student I am always thinking about the gold standard of care, but have been challenged into thinking through clinical decisions when the gold standard isn't an option.
With the graduation of the third class of the School of POWHER on November 3rd, I am excited for what lies ahead! I will be helping with the opening of a casa materna (birthing house), and developing two research projects to be implemented in the Spring. One project will help assess the clinical skills acquired by our School of POWHER students through a standardized checklist. The second project, funded by a small grant from the New York County Psychiatry Society, will survey attitudes and beliefs regarding maternal pre and post partum depression within Mayan women as few studies on this topic have focused on indigenous women. I am most excited to help oversee the 4th School of POWHER in the Spring of 2017 where past comadronas will be the main educators.
Every day I am inspired by our work here. Saving Mothers is providing a wonderful service to the women of this region and I am honored to be a part of it all!
Sincerely, Sasha Hernandez