Return to Casa Materna October 2014

October is fast approaching, and a new team of doctors from the Providence Oregon Family Medicine Residency Program is returning to Project Concern International's Casa Materna in Huehuetenango, Guatemala, for more work that needs to be done. The trip is able to happen thanks in large part to the support of Providence Health International, which has identified Guatemala as a region of focus for improvements in health care and has carefully developed strategic partnerships to support this goal. They continue to provide grants for teams who work with many other organizations as well, which is what has helped our trip to be possible. This time our team consists of::

• Dr. Tom Schwartz, Medical Director of the Providence Medical Group's Family Medicine Southeast Clinic, faculty preceptor
• Dr. Brenda Brischetto from PMG Gateway Family Medicine, faculty preceptor
• Dr. Alexis Hansen from the Milwaukie Clinic, second year resident
• Dr. Peter Benziger from the new Hood River Rural Training Track Residency, second year resident
• Suzy Happ, Home Visiting RN with Providence Beginnings, maternity case management program, trip leader.

We have some exciting proposals from Bal Maria, the director of Project Concern International's Huehuetenango Division and head honcho at Casa Materna. The Casa is a halfway house for impoverished women with high-risk pregnancies who come from villages scattered throughout the department of Huehuetenango in order to increase their chances of a safe delivery.  The local health department has asked PCI to roll out a misoprostol-carrying program for the comadronas, or village midwives, in Huehue. This is a life-saving medication that can be quite effective in controlling postpartum hemorrhage, which is a leading cause of maternal mortality in the department of Huehue. PCI has asked our team to develop a protocol to teach to the midwives who will be piloting this program. Along with the misoprostol program and the teaching we will be doing in the villages, we have been asked to provide ongoing ob ultrasound and obstetric care training for Casa Materna staff, as well as rural health consults, and an invitation to work for a couple of days alongside local doctors in the "CAP" or small rural hospital in Jacaltenango. All this work is sure to keep us busy for the 2 weeks we will be there.

We are doing some preliminary fundraising as well, to support ongoing night staff salaries at Casa Materna. Unfortunately, due to funding shortages, Casa Materna can't serve all the women who show up asking for help.  Last year we provided beautiful new beds to the women at the clinic.  This year with your generous donations we can make sure that more women have access to care. Casa Materna has always made due with less and has even weathered financial crises. It is only with the support of foundations and individuals who are committed to the cause of globally equitable access to perinatal care that they can meet the needs of this rural community. If you wish to make a donation, email me at Susan.Happ@Providence.org and I will let you know how to do so. We will keep you updated as our trip approaches and throughout the time we will be there, October 11-25th. Thank you for your ongoing support of our mission to Casa Materna!

Wrapping Up

Suzy presenting some baby gifts for expectant moms

Suzy here. We are currently riding the bus back from Huehue to the capital. Not a chicken bus this time, it's a nicer Pullman type bus but less than $10 for the 5 hour ride. No borrachos bothering us, we got seats right up front behind the driver. There is time to talk and look back on the last couple of days to create what might be our last blog entry.

Bob and Ana playing tug of war

Yesterday was the second day of the "Feria de salud". It was decidedly much better than the first, since we had learned some important lessons of chaos control, plus it was only a half day. Beto and I ran the ultrasound room again, this time we put a sign of the door "No Entre, Examens Privados", as well as locking it to prevent Cristóbol from barging in. I question the grammar of the ultrasound reports I wrote on the computer, but am not too worried, because Robert Gobbo's name is at the bottom of each of them, not mine. Flaminga the cervix queen did 15 paps in one morning which sent her into throes of ecstasy, and Gallo saw general consultas. 

After finishing up at the Casa Materna, we were treated to a special lunch in the garden with PCI staff and the nursing students who had worked by our side during the Feria de Salud.  There were of course the usual nice speeches--Guatemalans have such a nice way of formally thanking people and have the rare ability to use beautiful flowery language that is imbued with a humble sincerity that is really touching. El loro presented one of the models "Estela" to Doctora Ana, for them to use for educational purposes in their work that will continue on. We are kinda jealous that she gets to stay behind……

Meeting with Dr. Palacios

After lunch we had a nice meeting with the director of the National Hospital next door, Dr. Omar Palacios, where we discovered that there was a degree of openness to do a resident exchange in the future and where we also found out about a group called "Arco Iris" that is coming to Huehue in the spring to do some orthopedic surgeries on children.  This was very exciting news for some of the children of Santa Eulalia we saw earlier in the week.  Little Vicente has some hope to get his foot fixed if we can help facilitate that happening : ).  We then got a brief tour of the hospital, including labor and delivery, the pediatric unit and the mens and women medical and surgery units.

Nursing Students who helped us in clinic

Back at Casa Materna for the final goodbye, we gathered all the patients together in the back room to distribute the gifts our Portland friends had sent. Since there were all those ultrasounds this week, most of them knew the gender of their babies, so we could give them each a package of little baby girl or boy booties, t-shirts, blankets, hats, etc. They were probably a bit surprised to hear that people back in the US cared enough to pick out the clothes for them and send them down with us.  One of the women who was a bit more outgoing than the average shy Casa Materna patient suggested getting up and dancing on the tables much to our delight.  

Dinner at Manuel's house

Since we had already had our formal goodbye at Abesaida's house, we were free to accept an invitation to the "cool urban bachelor pad" of another friend of mine from a decade ago, Manuel Saenz.  Manuel and his former wife Lucky as well as their 3 grown children had the opportunity to study in the US as youngsters so he has a bit more of a worldly perspective and it was nice to be able to lapse into English at times.  He is of a well-known family who operated the town grocery store "Casa Saenz" for 70 plus years until the Walmart affiliated Paiz showed up in Huehue in 2001. They were forced to close the family business, and he has branched out to other business ventures over the years, but has also discovered his artistic side.  It showed through in many different ways: starting with the liquor cabinet which contained everything from fine Guatemalan rum to the more homespun moonshine of the region, Cushe, in different flavors. It was a great tour to take on our last night in Huehue.  Dinner was a tapas-style meal served from the restaurant below on large communal earthenware plates, and was just as beautiful to look at as it was delicious. To top it off, we got a tour of Manuel's artwork which included several local artists and his own creations. Melissa and I were both thrilled with our purchases of his original paintings to bring back with us, yet another recuerdo of our awesome trip to Guatemala. 

We will arrive to Guatemala City in a few hours and are staying at the same nice hotel where we met the other Providence team at the beginning of the trip which seems so long ago now. Melissa found a nice restaurant in her guide book for us to go to, where we will enjoy a last meal together before the flight home the next day. We have realized that the synergy of personalities during our trip has melded together to create a real team spirit (even though Chris Anderson will always be my bike rival) and we will miss being together. We have bonded!  But hey, maybe there will be future trips, with future adventures, learning and bonding in different configurations. Maybe one of you, who speaks Spanish or wants to learn, loves adventure, can be flexible, has an open heart and a desire to serve the most poor and vulnerable (and can handle assuming a bird nickname) might be writing the next blog…. 

Bal Maria offers her thanks and best wishes to us the the moms at Casa Materna

Parting Shot

We hope you have enjoyed reading about our adventures and seeing the photos that convey the amazing spirit of life in Guatemala. thanks for tuning in. it has been nice to have your company on the journey. Paz to all on behalf of the team, Suzy, Melissa, Bob and Chris.

P.S. We will post some of our best "dichos" (sayings)...words and pics later this week. Stay tuned.

Feria de Salud

Would you come to see this doctor?

Our days are rapidly winding down in Guatemala. Wednesday and Thursday were prescheduled at Casa Materna as a "Feria de Salud" (Health Fair). For the last several weeks, Casa Materna had a billboard with a seductive female doctor announcing the feria. We really weren't sure what to expect when we arrived but we quickly found out.

one more ultrasound?

There were about forty! women who wanted ultrasounds, both nonpregnant women with pelvic discomfort, and pregnant women wanting to have an ultrasound. Bob and Suzy managed to do 28 ultrasounds at a patient cost of $6 each (that's a net $170 for the day). Melissa was once again the queen of pap smears, and did about 20 paps. Chris did "consultas generales" and worked with a couple of nursing students from the University Rafael Landivar, which has a nursing school here in HueHue and a med school in Guatemala City. We are going to meet with the director of the school tomorrow. 

Rosio and Suzy

Back to the "Feria" which did not include any corn dogs, coin tosses or thrill rides, In fact we are not sure why it was called a "Feria", it was more of a "Clinic Cluster" and an opportunity for the poorest of HueHue to get some care they otherwise could not afford. We did get pretty tired and even a wee bit grumpy, as the lights dimmed in our exam rooms, the air became heavy and more patients kept showing up. The "Fair" was broadcast all day on the radio and tales of the Dra. Caliente (we know as La Flaminga Negra) spread. Still, we did not have to deal with EPIC, so we realized it could have been much worse!  It was worthwhile to be of service and we were again touched by so many!

our mark at the shop

We met with Bal Maria, the director of PCI in Huehuetenango, her husband Ariel, and daughter Elisa after "office hours" in an amazing coffee bar in HueHue that had the most amazing cup of the bean we had ever savored. After leaving our mark at this fine place, we did manage to aquire some of this gold as well as some Sal Negra (black salt) that will be coming back with us if La Aduana (customs) allows. Finally we dined with la familia Lopez (Abesida's family) and were treated with the most delicious Chile Relleno Guatemateca ever: Abecida's son Manuel confided to us that she had labored all day to prepare this delicacy by hand for us as a special gift. It does not get any better!

La Familia Lopez
Edward, Evelyn, Abesaida, Pati, Noeli
Arnoldo, David, Samuel, Manuel

Tomorrow will be a bittersweet day as it is our last full one in Huehuetenango. We will start with "La Feria day 2" and then after some meetings with the directors of the national hospital, will be celebrating with the staff and patients at Casa Materna.

Hasta Pronto: El Loro y El Gallo

Todos Santos, Todos Fuertes, Todos Amables October 22, 2013

After a stormy and cool night with no heat in the Hotel Fran Pab in Santa Eulalia high in the Guatemalan mountains, our team packed up the PCI pickup trucks and headed to Todos Santos about 3 hours away to meet with 60 midwives who serve that community. Our trip there was made memorable by clear skies, incredible scenery through mountains and the Altiplano, a breakfast of eggs, corazon de trigo (cream of wheat) and coffee in a small restaurant in Soloma and our first live broadcast in Guatemala.

We were interviewed by La DJ “Dominga” on Radio 88.5 FM by cell phone, which was translated into Q’anjob’al. Dominga helped us the day previous with translations during the evaluations of the children with disabilities, yet also is a disc jockey and radio personality in Santa Eulalia. She had actually invited us to her radio station, but because of our long journey and desire to not be late for the midwives or “co-madrones” waiting for us, the cell phone interview was the next best option. Although we could not of course hear the interview, since we were speaking to her on the cellular.

Chris is looking for a YouTube version to post on the web. I wonder if she including our “Motes” or nicknames in the broadcast. For your information, El Gall Blanco (Chris – the white rooster) translates as “Saj Mam Kaxlan” in Q’anjob’al, but he prefers the Mam translation of “Sec Se”, for obvious phonetic reasons. There is no equivalent my nickname “El Loro” in Q’anjobal since there are no parrots that high up in Guatemala! Que Lastima!

Once we arrived at Todos Santos through most incredible mountain passes, our truck and “piloto” Josue negotiated the mud roads as we sang Beatles songs and entered the village.

Todos Santos has a remarkable association of midwives, who meet monthly, train their apprentices and even do case reviews of poorer outcomes.

Their community has had no maternal deaths for the past two years and much of this is directly linked to Casa Materna’s support of the midwives for the past 10 years in helping them deliver infants safely in their villages and identify higher risk pregnancies for delivery in the National Maternity Hospital in Huehue 2-3 hours a away.

Lider of the Midwife Association Francisca and Susan

Once we arrived at the education center in Todos Santos, the 60 colorful Co-madrones welcomed us with a communal prayer, chants and singing that was mesmerizing and incredible, we even started quietly chanting along with them. It was truly beautiful that reflected the spiritual devotion of these amazing women.

Bob with midwives in the Postpartum Hemorrhage Workshop

Suzy facilitating the discussion on Eclampsia in pregnancy

We presented the same program as the day previous and the women were organized by the PCI staff into 4 small groups of about 15-20.  Chris, Melissa, Bob and Susan used the Mannequins (named Simone, Estela and Pascal) for workshops in post-partum hemorrhage, medical conditions such as pre-eclampsia/eclampsia, bleeding in pregnancy and birth dystocia. Each group participated actively and the experiences and knowledge of these women were quite exceptional. Many had attended several hundreds to thousands of births. Melissa learned that many “co-madronas” have large families themselves, but when they receive the call (usually on a cell phone!) in the middle of the night to attend a birth, despite rain, cold and wind they walk up mud paths and narrow streets in the pitch dark to assist a woman in labor. We were struck by their skills, their wisdom of thousands of years their traditions and yet still they maintain a desire to learn and improve their abilities.   

Chris foolishing acting out the "Tonto"manuever, to be schooled by "Comadrona Suzy" on the correct way to safely care for a woman with a shoulder dystocia in labor.

McRoberts and a Comadrona to the rescue. Now that is better!

We finished with a medical drama of shoulder dystocia with the “Not Ready for Acting in Mam or Spanish” players and received several cheers and laughs. The session ended after 2 hours with salutations and gifts. We presented the community with one of the Mannequins (we think it was Pascal) so they could use this teaching tool to help train each other and future midwives. We shared lunch with this community of strong and committed women, who clearly demonstrated a passion and professionalism for their chosen vocation.

Presentation of beautiful woven sacthels and our mannequin

We did get a little shopping done in Todos Santos, and then were safely “piloted” back to Huehuetenango by Josue. Bal Maria, the director of Casa Materna invited us to dine with her family and we learned much of the troubles and hardships of Guatemala, and recanted our experiences of the past day. We shared our vision for the future hopes of the friendship between ourselves, Casa Materna and the people of Guatemala…..but more to come on that as it is getting late and the steady rain is lulling us to sleep. Peace.

Shepherding in the Altiplano of Guatemala

Comadronas and Discapacitados (Midwives and Disabled Kids)

El Mirador with clouds and volcano

Monday began with another trip up north over El Mirador and onto the altiplano. This time we headed through San Juan Ixcoy and Soloma to the community of Santa Eulalia (ay-oo-la-lee-ah). The drive took 3 hours over a very windy road over the Cachumatanes mountain range. Santa Eulalia is a community of 50,000 people in the western region of Guatemala in the departament of Huehuetenango named after Saint Eulalia a 13 year girl from Barcelona who was killed by the Romans for refusing to recant her faith. The predominant language in the area is Q'anjob'al (kahn-ho-bal), then Castellano (Spanish).

Santa Eulalia from a distance

Due to various delays, we arrived for our meeting with the comadronas (midwives) about an hour late. As  we awkwardly entered a small room, we received a round of applause from a group of about 60 comadronas quietly waiting for us. After a speech by a leader of the comadronas in Spanish, Suzy and Doctora Ana made gracious comments from us in Spanish which were interpreted to the comadronas in Q'anjob'al. 

Comadrona leader interpreting in Q'anjob'al

We broke into four groups to have small group workshops on specific topics: bleeding in pregnancy, preeclampsia, postpartum hemorrhage, and prolonged labor, with about 15 women in each group. Each group had its own Q'anjob'al interpreter. They told us they were doing a lot of deliveries, with some women delivering 2-12 women per month and one older woman having done 2,000 deliveries. Many followed their mother or aunt into the role of comadrona. After the small group workshops, we did a small drama about shoulder dystocia, demonstrating the McRoberts and Gaskin maneuvers, the latter maneuver having originated with comadronas in Guatemala. The comadronas expressed their thanks profusely, saying "Yuj wal dios" (thank you in Q'anjob'al) many times. They also asked about getting some resources such as backpack kits to include scissors (to cut the cord), thread (to tie it off), suction bulb, clamps, and gloves.

Bob and Dominga, who had a missing arm from birth

After our session with the comadronas, we met with an organization called "Pixan Konob" (Heart of the People). Pixan Konob (see link) was founded one year ago by community leaders to advocate for disabled children and adults. What we found is that although all Guatemalans have access to free emergent care in the municipal health center or the departmental hospital (in Huehue), children with special needs often receive no special care or therapy and instead are mostly kept out of sight. As a result, their development is often stunted. During the afternoon, we saw thirty children and created a database with their diagnoses and recommended treatment. Their were several children with limb deformities (club foot, missing legs/arms) as well as many children with severe developmental delay and cerebral palsy. There was one 15 yo girl with obvious features of Down Syndrome that the mother had never sought or received any medical care and was unaware of her diagnosis. This was by far the most emotionally challenging times during our trip, seeing the disabilities and lack of access to appropriate care. We are hoping to do some resource connecting for some of the patients as well.

Pixan Konob leaders with our team

We ended the day sharing dinner with the directors of Pixan Konob, one of which who won the national "Mayan Princess" award for 2011. This was a recognition of her outfit, native language speech, and comportment. We spent the night at Fran Pab, a small but comfortable hotel in Santa Eulalia which ran a whopping $10 (80 Quetzales) per person for a shared room.

Vicente, who had a foot deformity and a penchant for charming Suzy