Thoughts on Guatemala, Part 1

Let’s talk about our time in Guatemala, shall we?

This trip had so many facets– my work, Sam’s work, building bridges for future work, the kids’ experience, and our experience as a family– that I haven’t really known where to start the conversation.  But I think I’ll break it up just like this, and then we’ll see how the threads come together.

My job was to teach the postpartum exam and warning signs to two tecnicas (health outreach workers) and their supervisor.  It’s work I do myself all the time, so the material was intimately familiar.  Even in Spanish.  But I was preparing to teach an unknown audience, and that was hard.  I didn’t have a sense of their knowledge level or experience, and I found myself over thinking it.  The OB resident who was finishing her time there was reassuring, “You know this.  They’re nice. Don’t stress.” But I did anyway.

So after a weekend stressing, I taught for a morning. Of course the tecnicas wanted to learn, and I wanted to teach, so we had a lot of good will in the room.  It went well.  Then we moved on to home visits, which was the best part of my work.

Each home visit takes about an hour, with transport time in between.  The project serves about 3000 families so far (with an eventual goal of 25,000 families), with almost 200 women enrolled in the prenatal piece.  Almost 100 of those have delivered since the beginning, and we visited fourteen of them (and their babies) in three days.

Home visiting is so different from working in the clinic.  Granted, my being in one place means I can see three to four people per hour at the clinic.  It is efficient.  But visiting someone means you also see their neighbors, and their home.  Homes in this part of Guatemala are concrete block, with open concrete work (often in the geometric shapes like leaves) above the windows. The windows had metal shutters and sometimes screens, but I didn’t really see the point when the eaves and decorative concrete works let bugs in anyway.  The houses had metal doors to the outside, but most of the rooms inside the houses were without doors.  Some homes had beds; a few had hammocks instead so that one room could serve as living-, dining-, and bedroom all at the same time.  Because most of the cooking seemed to be  done over wood fires, the kitchen was always a separate area, even if it was only a space outside the back door.  Soot stained many walls.  In the more affluent houses, pigs, chickens, and turkeys wandered in and out.  Dogs with exposed ribs were present whether the house had a source of protein to eat or not.

The moms were very hesitant to let the babies get cold, so the shutters were often closed, and the babies were all wearing multiple layers and hats.  It was above ninety and very humid; all the adults were sweating freely.  Everyone looked so tired.  The schools are on vacation in Nov-Dec, so that the older children can help with the coffee harvest, so there were lots of younger children underfoot. 

So we’d come in, Ada would introduce us to the family (usually mom, baby, mother-in-law or mom’s mom, and a sister or two with her children) and Ada would explain why we were there.  We examined mom and baby, and then the real work began: helping to correct cultural norms which are dangerous.

Cross-cultural work is hard.  The goal is to slearn what we can, share our commonalities, appreciate our differences, and only change habits or customs that are dangerous.  I do the same thing in my office all the time (and in fact, many of the custom I see are the same).  So we didn’t point out that no one needs to be wrapped in a fleece blanket when it’s 90 degrees out.  Instead, we focused on the custom of giving babies water-with-honey instead of breast milk.  Feeding babies water (with or without honey) in the first months contributes greatly to rural Guatemala’s childhood malnourishment and is a frequent cause of diarrheal illness, which is a top killer of children under 5 in the developing world.  But it is firmly ingrained (in fact, all but one of the families we visited was practicing this custom) and hard to change.

The need was overwhelming.  One mother’s experience in the hospital was so bad that when she went home and her Cesarean section wound reopened, she didn’t go back to the hospital.  Instead, it healed on its own with a large hernia, which was incarcerated when I saw her.  As we traveled, Hilda collected a mental list of kids for Sam to see when we brought him down.  Hilda, the tecnicas’ supervisor, seemed to know everyone around and certainly knew how to help them access care, which she did with skill and sensitivity, but it was often too late to prevent serious complications.   I felt comfortable signing off, as it were, on Ada’s and Hilda’s skills with their patients, and the work they were doing.

I think that’s enough for today.  Next time: Sam’s work.  Thanks for supporting us.