Lessons from a Guatemalan Midwife

I was born in Russia, but my strongest international involvement has actually been in Guatemala. I took an educational trip there for several weeks in college, and later returned for several months to learn Spanish and volunteer. Although my time there was short, the experience had a deep impact on me. Working with a comadrona, or traditional midwife, exposed me to the way many women live in other parts of the world, and made me marvel at their resilience in the face of great hardship. I want to share with you the story of the Guatemalan comadrona.

I worked with Doña Ana, who works in the outskirts of a town called San Juan Chamelco, near Xela. With 27 years of experience as a comadrona, natural healer, and nurse, she is a charismatic leader in her community. She sees patients all morning for pregnancy pain and every other problem imaginable, at times over 20 patients a day. One patient told me proudly that she has been coming to Doña Ana for 12 years. Speaking both Spanish and Mam, she prescribes a mix of western and herbal drugs to her primarily female indigenous patients,charging each depending on their ability to pay. In the afternoon, she purchases medicine for her pharmacy. At night, she delivers babies. Some say she never rests. I was impressed by her ability to blend elements of different cultures into her healing, and to effortlessly befriend both members of her indigenous community and outsiders likeme. In my eyes, she is a role model and a truly international woman; although she has never traveled outside her country, she has bridged the cultural divide.

Yet Doña Ana’s level of training is the exception, not the rule. Many comadronas in Guatemala do not have simple equipment such as gloves, scissors, and clean towels, let alone a pharmacy from which to dispense medicine or the training necessary to provide appropriate medical care. If all comadronas were trained as extensively as Doña Ana, Guatemala’s infant and maternal mortality rate – one of the highest in Central America – would surely fall.Although comadronas oversee most births in indigenous communities, the majority receive no formal medical training, and are not prepared to manipulate fetuses nor recognize situations in which a woman requires emergency hospitalization.

While indigenous women come to Doña Ana instead of to doctors for cultural, economic, and logistical reasons, she sometimes refers patients to the nearest public hospital in Xela, about 45 minutes away. Despite her experience and training, Doña Ana shares the feeling of discrimination most indigenous Guatemalans say they encounter in public hospitals. According to her, many hospital employees show no compassion, patience, or respect toward her orher patients, nor are translators provided to her non-Spanish-speaking patients. She shared the following examples. When she brought in her patient with an umbilical cord complication, she was told by the receptionist that “she didn’t know anything.” Then she and her patient sat for hours until she found a resident who would see her patient.By the time the woman was finally evaluated, the baby had nearly asphyxiated. In the case of another pregnant patient, the hospital resident would not trust her evaluation, and sent the patient home. The woman’s child was born in the street.

The discrimination described by Doña Ana can no longer be tolerated, as it needlessly endangers lives. Moreover, many non-indigenous Guatemalans are of the opinion thatcomadronas are the cause of high maternal and infant mortality in indigenous communities.Instead of placing the blame on comadronas, however, it is far more worthwhile to equip and prepare these women, who are often the only source of care available to women in remote indigenous villages. Comadronas also have the potential to be important sources of information about family planning and STDs in their communities.While President Colom has proposed new training programs for comadronas, the Guatemalan Ministry of Health (MOH) has collaborated with USAID to train auxiliary nurse-midwives, and various NGOs (such as the Safe Motherhood Project and PIES de Occidente) have worked to train comadronas, the programs have not reached the majority.

So what did I take away from all this? That we should follow Doña Ana’s lead, if these problems or any others are to get solved. Like her, we must be resourceful, open to new ideas, and willing to communicate and work with others who may be very different from ourselves.Like her, we can begin by improving our own communities.

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