Post from the field: Carolina, Samantha and Joelle

The weekend is here and I hope everyone is enjoying some rest and relaxation (and don’t forget to call your mom tomorrow and wish her happy Mother’s Day!)

Today we have a blog post from Dr. Joelle Morrow, Dr. Carolina Bibbo, and Samantha Haspel RN who are down in Santiago Atitlan. I shared some photos of these lovely ladies last week and now you can read about what they’ve been up to in Guatemala these past few days.

Hope you enjoy!

It has been an exciting first week here in Santiago Atitlan! We have had the opportunity to meet lots of wonderful people, collaborate with different physicians, nurses, and traditional midwives (comadronas), and get a taste of what life is like here in small town Guatemala.

The week started off with an amazing demonstration of post partum hemorrhage care to the comadronas of San Pedro. Carolina and I, along with Saving Mothers Staff Members Jessica Olivera and Tara Shirazian, brought the women birth kits for their deliveries, demonstrated how to use the kits, and went over what action to take in the eventof a hemorrhage. With help from “Mama Natalie,” a pregnancy belly that delivers a baby, followed by the placenta (which can be intact or not), and finally hemorrhages blood, we were able to demonstrate and then have the women show us what they do in the event of a port partum bleed. It was illuminating session, where we learned a bit more about what knowledge these women possess, the holes in their education, and how we can better help to provide information to these women in an effort to improve birth outcomes in their community. I think we all left with a sense that we had accomplished our mission with these women, though there are still opportunities to do more.

We began working at Hospitalito Atitlan on Monday, and during this week we have seen a variety of patients needing everything from reassurance to major medical intervention. Most patients are seen through the clinic Monday-Friday, with the exception of those who are brought in through the ER. Treatment here can be tricky, as people are paying out of pocket and things can get pricey by Guatemalan standards. A consultation often involves deciding what is truly necessary vs. what things might be diagnostically helpful, but not essential. We have to focus on weighing out the safest, most cost effective options. A great example of this was a patient who came in 15 days post partum but still bleeding. After a physical exam and an ultrasound it was clear that there were retained products in the uterus…maybe placenta, maybe just clots, but either way the uterus was unable to contract down enough to stop bleeding. Often in the US treatment for this would be a D&C, but here that is a very costly procedure for people who make only a few hundred dollars a month if they are lucky. Although Joelle offered them the option of a D&C she explained that using misoprostol, a cheap and effective medication that would cause uterine contractions and dilation enough to expel the retained products was safer and easier. Where it gets interesting is that after the family heard the options they decided they needed to speak with the entire family to decide, and possibly with a spiritual advisor, after which they decided to refuse care. At this point, much like in the states, a representative of the hospital ethics committee got involved and managed to convince the patient´s family to allowtreatment. It was an interesting case because it involved navigating cost effectiveness and cultural influences that seem to be inherent in all care here. Even the decision to give a child a Tylenol can take a few hours because the family (which can be 20 people) needs to discuss and weigh the options.

A few of the other cases we have had this week included the induction and delivery of a pre-ecclamptic patient, the delivery of a 38 week stillborn, which was heartbreaking, and a number of prenatal visits and pap smears. The week ended with a visit to the Centro De Salud, which is the free clinic in town, where Carolina and Samantha did a medical postpartum hemorrhage (PPH) demonstration and delivered some much-needed misoprostol to the clinic pharmacy. The Centro subsist largely on donations and they reported that they are in desperate need of sutures, foley catheters and a few other materials that we hope we can fund raise or find through donations. They are doing much needed community work and education with very limited resources and it is impressive how far they are able to stretch what little supplies they have. They were very pleased with both the demonstration and with Carolina´s pre-made PPH kits.

After the morning at the Centro we all traveled out to San Lucas Tolliman to do prenatal visits and pap smears in the community. We were most taken aback by the two in-home prenatal visits we did there. The conditions in which these women were living was unimaginable by American standards. The women were living in concrete shacks with corrugated tin roofs. The houses were meager, dirty, filled with flies and other insects, and filled with smoke from the small wood chimney in the corner. COPD is a tremendous problem here due to all of the people that have non-ventilating chimneys’ in their houses. The conditions were sad and scary at best, especially for women trying to maintain healthy pregnancies. We all wished that there had been more we could have done to help.

Overall I think after the week we have a strong sense of how fortunate we are in the US to have access to the kind of care these women can only dream of. Though we all knew how important the work Saving Mothers does is, there is such a different perspective that comes from seeing it with your own two eyes. We realize how much need there is, and how much the little help we can give is truly appreciated in the community.

We will put out another post next week. For now regards to all our Saving Mothers friends and family!

Best from Guatemala,

Carolina, Samantha, and Joelle

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