“You just missed it, she gave birth while you were in the bathroom.” This is what one of the Casa Materna managers, Michelle, shared with me during one of my barrier analysis survey trainings in Tuzlaj, Guatemala. She assured me that I hadn’t actually been in the bathroom that long (which was a relief) and that the birth had happened a lot faster than anyone had expected. I was extremely lucky to share half of my experience in Guatemala this summer with fellow Gillings Student Emily Berns, who joined me moments later. Before we entered the room to visit the mother and newborn, Michelle told us that the girl who had given birth was thirteen years old. Having never seen a birth before, I began to feel fortunate for my poorly-timed bathroom break. This was one of many surprises that this summer held, including playing multiple games of dreidel with the staff and finding Philadelphia cream cheese in the rural highlands!

It rained most days in Calhuitz, but one day we were rewarded with a rainbow!

After completing a barrier analysis training at three different Casa Materna locations, I had some down time. I was able to observe the nurses at the Casa Materna as they did some routine prenatal consultations. Despite a slight miscommunication at first (the word for ultrasound in Spanish “ultrasonido” sounds a lot like the word for United States “estados uniods” when said quickly and made for some strange context clues), I was able to observe my first ultrasound. The nurse, Anne, told me to feel the woman’s stomach to see if I could tell what position the baby was in. I’m not a nurse, so touching this woman’s stomach felt strange and like I might offend her in some way, but she smiled at me and told me it was alright. I felt around blindly until I found a hard area, which Anne told me was the baby’s head. She then drew a small picture of the position of the baby on a form which she used for the rest of the consultation. Anne took out a small tablet-like laptop to begin the ultrasound and determined that the woman was 8 months pregnant.

In the United States, medicine is a very private matter. But in Guatemala, it’s a family affair. The exam room was only separated from the entrance to the Casa Materna by a curtain. In the sectioned off area for the exam room was the woman, the nurse, me, the woman’s three children, and her mother. “Look, that’s the baby’s leg” Anne said to the woman’s daughter who was watching the ultrasound intently, trying to decipher what was darkness and what was her future sibling. I was impressed how Anne had effortless made this a teachable moment and included this child in the experience. It was extremely powerful to see and I felt very lucky to have been there to experience this moment with this family.

Flore a “mujer de apoya” (helper woman, who is similar to a doula) at the Casa Materna getting a woman’s signature before beginning the barrier analysis questionnaire.

In addition to observing nurses in the clinic, I was able to go into the field with some of the community health educators to watch them survey women in the communities. Using records kept at the Casa Materna, the educators were able to identify women who reported using a method of family planning, so that’s where we started. This was an effective way to identify potential participants, but meant that women who may be using a modern method of family planning but did not already have children would probably be excluded from our sample size. As frustrating as this was, I understood that due to staff capacity, this was just a limitation that I would have to accept. Sometimes we would get to a house and a woman wouldn’t be home or it would turn out her child was too young to participate. Since exclusive breastfeeding for the first six months of life is a form a contraception, we decided to only include women who had children older than 6 months to ensure that she was she was using a modern method of family planning. Due to the size and close-knit nature of the community, we were also able to ask women if they knew of any other women who might be able to participate and use snowball sampling to find other participants. This allowed me to get a glimpse into the lives of the women who we were surveying and better understand what everyday life in Calhuitz was like. I also got to see a lot of kids chasing around chickens, pigs, and pigeons, which is always fun.

A goodbye photo with a few comadronas (midwives) from the surrounding communities and some of the Curamericas Guatemala staff who lent me a gorgeous huipil and corte for the picture. Can you spot me?

I am still in awe of the efforts by the staff to complete these surveys. It was a close call, but on my second to last day in Calhuitz, I received the last of the 96 surveys that we needed for the barrier analysis. Although the analysis and recommendations were supposed to be finished in Guatemala, as with most field work, we had a few setbacks that changed our timeline. Instead, I will be completing my analysis back in the US and will make a presentation to staff on the findings in order for us collaborate on recommendations in mid-August. I am deeply appreciative to the Curamericas Guatemala staff for their patience with this new type of study, their willingness to include me into their daily activities, and their politeness when eating my first attempt and making tortillas by hand.

¡Gracias y hasta pronto!

– Kay