Students and global health experts share their experiences working with communities.

Category: Emily

Highlights from the Highlands in Guatemala

It’s hard to believe another month has gone by and that I am wrapping up my practicum very soon!  During the second half of my time with Curamericas in Calhuitz, Guatemala, I continued collecting and analyzing data on neonatal outcomes, modifying my interview guide, and then conducting and analyzing these group interviews with the nursing staff to collect their perspectives on managing and improving neonatal outcomes.

I am lucky to have shared most of my time in Calhuitz with another Gillings practicum student, Kay, and for both of our projects we needed to visit the neighboring Casas Maternas of Santo Domingo and Tuzlaj.  This was a great opportunity to learn first-hand about the different catchment areas covered by the organizations’ projects, meet more staff, and switch up the scenery.

We were told the Casa Materna in Tuzlaj had a different feel, that the area was more remote and unaccustomed to seeing foreign volunteers, and that it would be close quarters due to the Casa’s small size.  After a jostling two hours up and down rocky mountain roads, it’s true we found a cozy atmosphere, but with welcoming vibes.  We walked into what felt like a data-organizing party serenaded by Romeo Santos and reggaeton.  There was hot chocolate for breakfast and Philly cream cheese.  Dogs sprawled lazily on the grass rather than lurking fearfully for scraps.  A 13-year old was admitted to the Casa, and rather than experiencing a prolonged and difficult labor, delivered a healthy baby within a couple of hours.  Tuzlaj was full of surprises.

Entrance to the Calhuitz Casa Materna.

One of the main objectives for visiting Tuzlaj, and one of the most engaging parts of my practicum, was to conduct these group interviews with staff about their perspectives on neonatal complications and deaths.  I continue to admire these nurses and mujeres de apoyo for their hard work with limited resources.  These conversations convey a strong initiative and sense of responsibility to prepare and educate oneself due to their isolation and limited access to cell signal.  They share a holistic view of health and social determinants that’s at the heart of nursing, but which we hospital-based nurses can lose during hectic days.  As with many public health issues, it was clear these neonatal and maternal health challenges we were discussing had deep roots in longstanding gender and socioeconomic inequities, discrimination, and language barriers.  The staff knew the solutions still lie in preventive measures such as continuing to strengthen their health education outreach, community engagement, and garnering more support from civic and government partners.

View of Calhuitz and the Casa (tall green building) at dusk.

At the end of my time in Calhuitz, we were pleased to step fully back into tourists’ shoes for a couple days and visit Lake Atitlán on my way back to fly out of Guatemala City.  It’s one of those places that pictures don’t do justice and distance perception must be altered due to the enormity of the volcanoes and the beauty of the water.  We walked to a popular lookout and cliff-jumping site and after Kay confidently took a birthday jump, I of course had to follow. Only afterwards we learned that it was almost 40 feet—twice what it had looked to me.

Numbers that balance at Lake Atitlán, unlike in spreadsheets.

Back in NC I am continuing to work with both the quantitative and qualitative data in order to report back findings to staff and discuss next steps.  It is interesting to see how the data complement each other and also the amount of information available from a data set that was a bit confusing to piece together.  It’s been very meaningful having a practicum that places a foot both in global health and nursing, and hopefully this research work will offer the organization some insight into their outcomes and assist in determining next steps for reducing neonatal mortality.

– Emily

Saludos desde Guatemala!

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