Saludos desde Calhuitz, Guatemala!  It’s nearing the end of a second week in the rural highlands of Huehuetenango.  For my practicum I am working with Curamericas Global and Curamericas Guatemala, who partner with the Guatemalan Ministry of Health to provide community-based maternal and child healthcare services, as well as basic health education, to remote areas which historically experienced high maternal mortality.  Over the years the project has constructed Casas Maternas, or birthing homes, which serve as clean, safe settings where women can elect to deliver according to cultural traditions, but with nursing supervision and referral to higher level care if needed.  The project also includes post-partum home visits for mother and child health, and community-run Care Groups focusing on women’s and adolescent health topics.

View from the walk to San Juan market.

The first week here turned out to be a more collaborative learning environment than anticipated, with the staff from the project’s three territories all coming together in Calhuitz for meetings and trainings.  A Haitian doctor from a potential partner organization presented on refining ultrasound interpretation skills for assessing potential pregnancy complications such as hydrocephalus, placenta previa, and placental abruption.  It was exciting to learn so much from his expertise in a health area unfamiliar to me, and then to immediately see these skills demonstrated during prenatal visits at the Casa’s clinic.  Another day focused on the project’s data management systems and future changes in reporting required indicators.  This presentation turned into an important opportunity for staff to share their perspectives on current challenges in their monitoring and evaluation systems, and to discuss their preferred strategies to improve the organization’s data and M&E capacities.

The following weekend, when most staff leave the Casa for their own homes, turned out to be a busy one for the Calhuitz Casa Materna with three births occurring.  It was remarkable to be in a setting where multiple new lives were beginning while simultaneously feeling so far removed from the rest of the world, and to witness a tiny newborn’s first cries while helping to dry and swaddle them.  As a nurse myself, it was humbling to recognize the variety of responsibilities and breadth of knowledge the staff here have in order to successfully run the Casas and programs.  The nurses are the primary providers and decision-makers during deliveries, with a doctor available via phone if necessary.  Role-shifting is clearly also an important strength, as the data manager and community educators have been quick to assist nurses with births or consults for pregnancy complications in the Casa.

As I focus on practicum-specific tasks centered around analyzing neonatal outcome data and staff focus groups on managing neonatal complications, I’ve been reminded of key lessons applicable to public health work in general and perhaps particularly to global work.  Challenges in locating and accessing data needed—not to mention understanding the organization of a new data system as a whole—have made me check my own assumptions about how much time certain work “should” take and the ease with which information “should” be available.  Being so used to having information at my fingertips via the internet and digitalized charting systems, I forget that that is a luxury.

Got internet? For internet, the prime office space is the roof.

The importance of understanding the perspectives of local health workers and their work-loads has also been re-emphasized.  Gaining more background knowledge of prior project changes, expansions, and funding has allowed me to better comprehend the work and program goals through staff’s eyes.  These conversations lead to a greater understanding of the challenges and power dynamics in global health work and the importance of maintaining a decision-making process based upon beneficiary impact.

I look forward to further learning and collaboration as my practicum continues, and am grateful that the staff here have been patient, open, and welcoming.  In the next couple weeks we will be traveling to other Casas in the region for data collection, focus groups, and home visits.  I am sure to continue enjoying the simple pleasures of life here—such as the staff’s sense of humor, fire-fueled hot showers, and the best homemade salsa I’ve ever had—and will be curious to see how the terms “communication” and “planning” continue to take on new meanings in new contexts.

– Emily