Fun times with PIES

(warning: this is long post where I try to summarize some of my thoughts on what I did at PIES. I'm not sure who is still reading this blog, but this might be long and boring if you are not someone like my parents... but it does include pics, so you can just look at those.)

Yesterday was my last day volunteering with PIES. I really enjoyed my time there and feel so lucky to have found them. In coming to Guatemala, my intentions were pretty vague: gain more international public health experience, hopefully in maternal and child health. I didn't really know that would take me, or if I would even like where it did, but PIES turned out to be a perfect organization. In my short time with them, I learned a lot about the health of the women and children of Guatemala, primarily indigenous women, and how organizations are working to combat the major health problems.

Midwife trainings: The work that PIES does is vital to health of mothers and children. When I was able to go to the midwife trainings, I was more of an observer than a helper. I would, when needed, help write names and register women. Over 60% of Guatemalan women are illiterate, the second worse in the world, so I would help write names when women couldn't and take their fingerprints. And at least this made me feel useful. But it was through these where I felt like I was learning the most. A midwife is considered a Mayan doctor - she uses herbs, conducts post birth massages and ceremonies. But given how important a fundamental "medical" understanding in giving a healthy birth, the emphasis on formalizing training and enforcing it is much stronger, then say for the bone healer and spiritual guide. During these trainings, it was clear how important they were. I appeared that many of the women weren't confident in their roles and didn't know the answer to basic questions. Limited economic resources and mistrust in chemical medicine, require families to hire a midwife, as opposed to going to a health center or hospital. Given that there are fewer and fewer midwives, some who don't have a lot of experience are called upon to attend a birth, and this is where problems usually arise.



(juanita with the fake baby and placenta)
On the other hand, a small number of the women at the training had a deep understanding of how to properly attend a birth and all the possible complications. These were also the ones who spoke to the group about the importance of learning this information and unifying. Midwives are often blamed for anything that goes wrong during pregnancy. In order to prevent this, they need to educate communities that things do go wrong during birth, so if the midwife says it's better to go to the hospital, the community needs to respect that and see that it's for the health of the mother - not accuse the midwife of not doing her job.



(Doña Esperanza hard at work)

Traditional Mayan Medicine: I spent most of my time in the office working on this program. PIES has a mission to increase the awareness, acceptance and respect for traditional mayan medicine. After bringing together a network of Mayan doctors, they have been working with medical schools with the hopes of implementing a mandatory traditional mayan medicine course in the medical curriculum. I spent one day at a workshop for 6th year medical students on Mayan medicine. While one day was not enough, the students were extremely interested. Many stayed after to ask questions about patients they had seen who had described medicines they had used that the students didn't understand. I'm really lucky to have been able to work on this topic, because it's clear that for the guatemalan health system to improve western medicine needs to understand and incorporate mayan medicine. If not, it will continue to alienate a large number of people who will not seek the services they need.
While it seems that the mayan doctors are older and not being replaced by the younger generation, many Guatemalans - even the ones who live in the city - do adhere to some traditional practices. If doctors don't understand what these practices are and why they are done, there could be serious health complications.

In transcribing 11 interviews by different mayan doctors and mayan medical experts, I saw some basic themes: 1) Guatemalans use mayan medicine primarily because they don't have the resources for "chemical" medicine. 2) Mayan doctors (bone healers, midwives, etc...) have a gift. At some point in their lives they realize they have this gift and it becomes known that they are now a practicing mayan doctor. Usually they realize they have a gift through a sign or a dream, or someone else telling them that they do. They then become an apprentice to learn all about it. 3) They all said that Mayan medicine is important because it is of the ancestors and has cured people for thousands of years, and therefore must be taught and preserved. 4) Mayan doctors are important because they are available at all times of the day and are in people's communities. If someone is sick, they can only go to the hospital when the office is open, but there is always a mayan doctor who can help heal.



(Doña Angela, who wanted her picture taken)

I also worked on other various projects such as making materials for the Women's groups. As part of a government program where women receive formula for their under 6th month old, they must be present at a workshop that PIES gives. Marta asked me to put together some materials. I first thought the theme was anemia and that they wanted a powerpoint (Dona Esperanza, the old midwife, and Marta told me this). I then still thought the theme was Anemia, but understood that they wanted a large poster - printed I thought. The next week, Dona Esperanza told me the theme was actually Healthy Prenatal Care. I somehow realized that they didn't want a poster printed, they wanted it painted - on cloth. So, I whipped out my 8th grade art skills and painted 5 posters on cloth representing hygiene, healthy eating habits, midwife checks, etc... While it was very bizarre, it was a nice blast from the past and putting together science projects.

All in all, my time at PIES was never boring. A lot of self initiation was involved, but it was a wonderful group of women who I hope to work with again someday. I also gained the experience I was looking for, understood some of the PIES and Guatemala faces in improving health and health care, and feel better prepared for the three years of study ahead of me.

La Senora de la Refra

I don't think it would be right to leave Guatemala without having mentioned refracción, or snack time. I didn't really get a good idea of the significance of refracción until I started working at PIES. Primeros Pasos, which is primarily American, doesn't really have the same culture around refracción. But, in working with PIES both in the office and in the communities, I soon learned. Most countries outside the US take more time for food and it plays a larger symbolic role in daily life. But, I think what strikes me the most about refracción, is not that they pause and eat around mid morning, but the quantity and quality of the food - as well as how much care goes into it and how important it's place is in the culture.

I'm not sure how many Guatemalan's eat breakfast, or what the culture is around breakfast. The younger people I worked with in the office skip breakfast in order to be able to sleep longer before going into the office (sound familiar?). I think if you have someone to make you breakfast - eggs, tortillas, refried beans, etc... - then you eat it, if not, you don't. Just a guess though. Anyway, by the time 10:30 rolls around, people are hungry and ready for their 30min food and coffee break.

PIES' office is on a side street in a residential area of Xela. It's about a 10min walk away from my house. Sellers seem to know that there is an office there, and I think there might be others on the street, because many walk down the street daily selling all sorts of things. There is the fruit truck with a large megaphone on the top that announces what fruit it has that day and how much it costs; the tortilla man on a moped that comes everyday at noon, honking his horn; the ice cream cart with its bell around 10. I've also seen/heard bookcases (a man walking down the street with one small bookcase), pizza, and a banana lady.

So, it's no surprise that everyday between 10 and 10:30 comes the "Refra lady" or "La Senora de la refra." With all her food in a basket on her head, a stool and usually 1-3 kids, she enters in the office, sits in the lobby and waits for PIES employees to buy something. She usually has a pretty good selection: empanadas de pollo, or cheese, tostadas, some other fried dough shaped like a log with meat or beans. Other days she has chicken sandwiches, tortilla with sausages, or ham sandwiches. She also has an Atol, or Arroz con Leche - hot rice or corn based drinks. Whenever she arrives, Emilia the Admin Assistant, calls everyone in the office to let them know that she has arrived, and 90% of the people in the office buy something. They then all sit down to eat it in the office kitchen.

On special occasions, birthdays and good-bye parties, the staff makes refracción. My most memorable refracción in the office was on the Director's birthday. I was sent out in the morning to buy the food for it. We were making ham and cheese sandwiches, on white wonder bread, with tomato and onion, mayo, ketchup, ham and processed sliced cheese (yum!) with chips on side. I was taken with how much care went into making these sandwiches and how crucial they were to the celebration. They almost seemed like the center of the party. It doesn't seem like you can take a morning break from work without eating a big, hearty "snack." For my despidida - goodbye party - Emilia's mom made chicken tostadas with an awesome, not too spicy, chili sauce. It's always amazing to me that after all this food, people are still ready to eat a giant (also homemade, in the office kitchen) lunch around 1:30.


Refra is equally as important when we are in the communities. During the trainings with the midwives, there is always a midmorning break. While the food is not as elaborate, mainly cookies or bread with highly sugared "coffee," it would never not happen. Even if the workshop is running way behind schedule, you have a long break.

Even though refra isn't elaborate during the workshops, lunch is. They all end with lunch for the participants, and the lunch is not a boxed sandwich with an apple and bag of chips. Just like the Refra lady, a woman arrives with lunch for all. She comes armed with a giant pot of whatever she's made - soup, chicken or beef is sauce, etc... - rice, tortillas, tamales, spicy sauce and coffee. She brings real plates and silver wear and everyone gets served one by one. I think this meal is part of what gets the women to come each month, this is probably one of the few times a month they eat meat. I wasn’t able to figure out exactly how much these cost, but PIES is accountable for all the meals provided. The main reason we register people is so that we have a name for each meal provided. As most of us probably do, while these lunches and refra are really time consuming, expensive and a often a long distraction from work, I wish that the US cared just a little bit more about meal time.

Nebaj to Todos Santos

My friend Meghan from Boston came down for a visit last week to do the 6-day, 40 mile, trek from the town of Nebaj to Todos Santos. Since I arrived in Xela I´d been wanting to do this trek and I was thrilled to be able to share it with the good friend and rock-star hiker that Meghan is. The trek was pretty incredible, my writing and the pics won´t do it justice, but hopefully you´ll get a good enough sense of it to make you jealous. There were only 3 of us on the trek, (Me, Meghan and Kathryn) plus two guides (Jon and Brandon).

To give you a rough idea of what area we walked through, here is a map: http://www.gmap-pedometer.com/?r=2859271

One of the most interesting and difficult things about this hike was enjoying it for all of its beauty, uniqueness and coming upon small towns, all while knowing that these the people of this area have recently suffered so much. The Cuchumatanes mountain range, where Nebaj, Todos Santos, and the area in between is located was one of the areas most affected by the civil war. The mountains made is easy for the guerillas and the army to hide. The people in the small towns, with little communication to the large towns or outside world often provided food ans shelter for guerillas, but were also the largest victims and pawns of the war. During 1981 and 1982, the most gruesome phase of the civil war, numbers of entire villages were burned and destroyed. The army and the guerillas used civilians however they pleased to prove whatever point they were trying to make. Civilians rarely knew what the fighting was about, who was a guerilla and who was the army (the army tried to confuse people), and suffered the most casualties. Today, they suffer the highest rates of poverty and illiteracy.

Walking through small remote towns, it was hard not to wonder what these families had lived through, how they were coping today or how things had changed, and how life would have been without 30 years of war. The majority of those in the 10-20 family towns that we walked through did not speak Spanish. Nebaj is in the K'iche' speaking area and Todos Santos is in Mam speaking area. I wish I could have learned more about the history and people of the area over the course of the trek. It was hard not to feel guilty or fake enjoying the beauty of the mountains, knowing that it was just that that had caused these people so much pain. So, with that in mind, here is a run down of this wonderful trek.

Days 1 and 6 of the trek were spent traveling. It took about 6 hours to get to Nebaj from Xela. We got there mid-afternoon, settled into the hostel we were staying in for the night and then explored the town. Kathryn, Meghan and I then explored the town. The appeal of Nebaj is really the mountains and trails that surround it. So, after wandering through the cemetery and the market we felt like we had seen most of the town. The cemetery was pretty typical except for the large number of identical looking crosses for tombstones and large white rooms full of crosses and candles. Given the my limited knowledge of Nebaj, I wondered if the rows of identical unmarked crosses were victims of mass killings and the rooms with crosses for those who disappeared. Similarly to Santa Anita, there was a mural that represented the history of the village.

For the rest of the 4 days, we walked about 10 miles a day. The terrain changed everyday, even drastically over the course of the day making for some incredible landscape. The days weren't too long, 6-8 hours of walking a day, with long lunch breaks and arriving to our sleeping place between 3 and 4 each day.


Day 1: Beginning around 8am, we set off on our trek. It was uphill pretty much from the start. We first passed the town of Acul, an example of a "model" village. In the mid 80's, the Guatemalan Government built model villages for the international community to see. Journalists and others were coming to Guatemala and the government would take them to these villages to say "See, nothing's wrong! Guatemala's in great shape." Most of the international community knew that these were just a front. Just outside of Acul, is a cheese farm owned and run by 3rd generation Italians. Apparently, they refused to leave during the war until they were repeatedly threatened and warned by the army that they would not be protected. They then returned when it was safe and continue to have their farm and hotel that is paradise in Guatemala. We then walked through the town of Xexucap to Xexocom, where we slept in a community building/school. We ate dinner with a family in Xexocom and had a Tamascal - a steam bath (the same that midwives use to do their massages, the clay structure that most families have outside their houses). I learned that Tamascals are used by people instead of bathing, so we were given buckets of water and soap. It was a really nice way to end our first day of hiking.


Day 2: We began the morning at 3:30am so that we could be at the top of 85 switchbacks to have breakfast and see the sunrise. I had been anticipating this early morning since I learned about it. So as soon as we had the 3:15 wake-up call, I sprang up as if it were 9am. This was the longest uphill of the trek, and doing it that early is actually quite nice. You get it over with and have a great satisfying breakfast, where you look straight down and can just see what you've come up. Amazingly, when we were on our way up, at around 4:30, 2 guatemalan women and one man, who must have been in their 60's were heading down with their flashlights, headed who knows where. Maybe to one of the farther towns to work, or buy food for the week, who knows. All I know, is that I was thankful this was the only time I was going to go up this hill, all the while it was just part of their routine.

After a nice long breakfast, we went up the rest of the switchbacks (a total of 109 - Meghan counted) and the rest of the day was fairly flat. At this point, we spent the next two days hiking through towns where there are no roads. (but they did have road signs...) Towns appeared out of nowhere, like the towns of Chortiz and Canton Primera, where we spent the night. Canton Primera, was a little strange of a town. I'm not really sure why, but we all go the weirdest vibe from it. I think it had something to do with it being built on a hill, so it didn't have a central area where the people could congregate, hang out and give it a friendly vibe. It was also the dirtiest place I'd seen in a while, with trash strewn everywhere. The school that we stayed across from looked like it hadn't been used in a long time. From the school, we had a great view of the valley we would be descending and ascending the next day. Regardless of the weird/sketchy vibe of Canton Primera, we were all so tired from the long day that we ate our pasta dinner and slept like logs.



(Meghan at Canton Primera with a view of where we headed on day 3 and the road sign, through the towns with no roads.)

Day 3: A 5:30 start took us down the valley to El Pericon River for a breakfast and water filtering session. Day 3 had been described to us as the day with 2 hills: "the bitch" (yes, its politically incorrect but fitting for the short, but extremely steep hill) and the Hill of Terror. One hill was soon after we left for lunch, and the other towards the end of the day. Guatemala doesn't really have wildlife. It used to, apparently, but I was told that the army and the guerillas killed it all. So, we didn't see many animals on our trek, except for sheep. There was a remarkably large number of sheep herders - mostly women and children who would walk with the sheep and sticks. I wasn't able to figure out what they used them for as the towns where the sheep were were so far removed from large cities where they could sell meat or wool.




(right before the first nasty hill, and at the top of the second)

After heading through San Nicolas, where we bought food for lunch and fresh bread (a random woman baker, don't know how they discovered her) and headed towards the Hill of Terror. It reminded me of the Incline, by Pikes Peak - steep, a little too long, and has a false summit. But the view from the top makes it worth it. And lunch at the top was a great reward. From there we headed down to the road and a small town where we took a truck to the town of La Ventosa. While there are Microbuses, Chicken Buses and Pick-ups that go to La Ventosa, the first thing that happened to dive by was a large truck. While they were headed in our direction, I wish we had realized that we would be sitting on organic fertilizer the entire way, before we got in. I had never smelled it before, but soon realized that it's rather disgusting. At first, it smells like a mixture of chocolate and coffee, but in a bad way. Let's say I couldn't get rid of that smell, that made me feel naseous, all night - even after a Tamascal. I get sick even just thinking about it.

Guillermo and his family live in La Ventosa. Guillermo's son was a student at the school that Quetzaltrekkers (the group we treked with) supports. His son then became a guide for 8 months and is now studying to be a teacher. So, Guillermo and his family are family of the Quetzaltrekkers and he received us that way. After a tamascal and a nice dinner, we all headed to bed ready to climb La Torre the next day and head into Todos Santos.

Day 4: La Torre is the highest non volcanic point in Central America at 3870 meters. Geronimo was our guide for the day and so I got some good time to ask him all my questions, and probably drive him a little crazy. Geronimo was a member of the Guatemala Civil Patrol, this was an aspect of the war that I knew little about. Many men were forced to join the Army and be part of the Civil Patrol. The Civil Patrol was used to do some of the hardest work during the war. They were put on the front line, sent into villages where the army would most likely be attacked and forced to guard posts with little or no food. Geronimo is one of the two people (voluntarily) responsible for guarding the Torre. It's a natural reserve, but one of the two of them head up to the top everyday to keep it clean and safe. He said that everyone knows that the two of them guard it, keeping robberies and other unpleasant activity to a minimum. When we got to the top of the Torre, I realized that this spot was more to him then a place he guarded. During the war, the army forced him to guard it. So, he spent months up at the top, in the cold suffering of cold and hunger. "How much suffering" he kept saying. The people in his town, and the neighboring ones suffered so much, he said. The house where the army general used to stay is still there, along with a UN tower.




(Geronimo and the group at the top of the Torre)

I learned other fun facts from Geronimo. Things like, 1) the price of sheep has gone down and there is no market for wool, so he just holds on to his heard. 2 of his 11 children take them up the hill towards La Torre to eat grass during the day. 2) His town was thrilled that Tigo, Moviestar, and Claro - the three Guatemalan Cell Phone networks - built towers right up this hill from his house. (I had asked if the people disliked the towers, since the were on someone's land). He said no, they were great - people could communicate now and they were paying the owner of the land a lot of money to rent it. 3) He also showed me caves where Mayan priests come to do their ceremonies (complete with a bottle of Quezetalteca- cheap Guatemalan rum).

Geronimo lead us down the mountain, a good 2 hours of steep downhill. He had brought lunch for us to - rice, beans, tortillas and hardboiled eggs to eat halfway down. This was some of the steepist downhill I've ever done, and the only thing I was sore from on the entire trip. Once we got down the hardest part, Geronimo and his four dogs that had come with us (and eaten tortillas) left to take a pick-up back home. The last time the dogs did this trek, Geronimo didn't leave quickly enough and one of the dogs followed the trek all the way to Todos Santos. It took two days, but the dog eventually found its way back home. Impressive, huh?

It was then - finally - just another two hours to our final destination: Todos Santos. Todos Santos is characterized by the continued use of traditional dress, especially for the men. It's rare to find men in traditional dress in Guatemala, except for Todos Santos. It honestly gives the town a totally different vibe, you feel a little out of place, and especially a lot more like a tourist. In the same vain, the town has been able to implement laws, or social codes, that other guatemalan towns wouldn't be able to. For example, they drove out and then outlawed all western clothing stores (unfortunately, I can't remember why). Todos Santos also had a big problem with drinking. Therefore, they recently outlawed the selling of liquor and this has really helped. The only place you can buy liquor in Todos Santos, is at the language school. However, the language school will only sell it to foreigners, not Guatemalans.

The town is fairly wealthy, as it was hit hard by the war (even though this wasn't a good hiding area for the army and guerillas) and there are a lot of people from this area in the US. Houses are large and brightly painted, and American Flags painted into the sides of the houses are easy to spot. Throughout a number of the small towns, you saw many women weaving on their porches - something that I hadn't seen on any of my other travels in Guatemala.

We spent our last night of the trek in Spanish School, eating a nice meal and looking back on how much we had walked and what we had seen the past 5 days. It was an incredible trip that I'm so lucky to have been able to do in my final weeks in Guatemala. I also need to make sure to say that we didn't get rained on. Given that this was Guatemala, in the rainy season, this was pretty incredible. It rained every night, once we were settled in, but never (except for one short drizzle the final day) while we were walking.




(a group of Todos Santos boys watching a soccer match, and Meghan sporting the TS´s hat!)

Walking for fun

It is a luxury to be able to hike. We willingly put a 15 pound bag on our back and climb up physically challenging mountains, for fun. We have nice backpacks that distribute the weight so that we don't hurt our upper or lower backs, shoes so that we don't hurt our ankles, etc - you get the point. On our 3:15 morning, as we are hiking up in the dark we passed 2 60ish year old women and a man coming down the mountain with their flashlights. I could guess that they were walking to town to work, buy food or supplies, or something along those lines. Either way, they were going to have to walk back up these 109 switchbacks. Unlike us, who ate breakfast two-thirds of the way up to watch the sunrise, this much walking is a part of their lives, not something they tell their friends and families that they accomplished.

In Canton Primera, a family that had just been deported from Kentucky could not understand what we were doing. Kathryn had told them she was doing this trip as her vacation. "You are walking on your vacation?" They asked multiple towns. If you look at it that way, it is a little bizarre.

When I got back to PIES and told them what I had done, Marta made a joke saying it was like the immigrants walking to the US. We then had a short conversation about how truly difficult and dangerous it is for people who do walk to the US. I was lucky to have food, water, shelter, etc... They walk for days and days, worried about getting caught, bearing through whatever weather might come, with children or pregnant.

So, I'm really lucky, blessed, privileged to be able to do treks like this, and continue to do treks like this.

PIES de Occidente

As I've mentioned, I've been volunteering with PIES de Occidente. PIES stands for Promotion, Research, Education and Health (in Spanish, obviously) and has a number of women's health programs that have been really interesting to learn about, and pertinent to what I'll be studying just soon enough.

PIES isn't really used to having volunteers, which has worked out well for me. This means that I pretty much get to dictate my own schedule and decide where I want to go and what I want to do. This also means though that if I don't talk to the right person on the right day, I'll miss the boat and spend the whole week in the office. So, I've learned where the schedules are kept and am comfortable enough with the staff to ask if I can tag along. I'm usually most "helpful" when I'm in the office, so I try to balance those days with going to the communities.

PIES has a small staff: Cristina, who I spend a lot of time with, is the director of Communications; Marta, my initial contact, is the director of programs; Dona Esperanza, Dona Angela, Dona Angelita and Juanita, are the midwives and facilitators for the majority of the programs; Pattie, Dtra. Aurey, Emily, Raul and few other miscellaneous people that I'm not really sure quite yet what they do. I know some work in a small back office on their computers a lot. Since PIES also operates 2 clinics, I think one or two of the women are also doctors. I feel really welcome amongst all these people by now. It's a nice atmosphere in the office, they eat together, snack together, chit chat and when every one is in the office (maybe once a week) it has a nice homey feel. I'm the only foreigner, so I get to practice my spanish much more then when I was at Primeros Pasos and actually feel like it's improving - which is a great feeling.

PIES has a few programs that it appears are dictated by what funding comes around, although I'm not really sure how it works exactly. One of USAID's main focus in Guatemala is Maternal and Child Health, but I haven't quite figured out how large of a role they play in guiding organizations, like PIES's, work. In 2000, due to the high rate of maternal death, Guatemala instituted a law that all midwives had to have a certification card. Each month they have to attend a training, and they have to attend a full year of training before they can receive the card. To keep their card, they have to continue attending each month and take a test as long as they work. When a family registers their child after it's born, the government requests the name and number of the midwife, and the family can get in trouble if the midwife isn't registered. This incentivizes the family to only work with a certified the midwife. I've gone to a few of these trainings (including the one with the "interesting" games) which has been informative - I knew little to nothing about the complications of giving birth - and culturally insightful. These have also given me the opportunity to go to small towns, see small health centers and understand how things get done.

PIES also has a domestic violence program, including two radio shows every Friday that touch on a different topic related to domestic violence. Marta estimates that 70% of all Guatemalan women have suffered some form of domestic violence. These groups bring together groups of women to begin raising awareness around domestic violence and teaching communities that it is not part of a normal relationship and should not be tolerated. I was able to go with Marta one day to Concepcion, a town where they want to start a group. We went to the Justice of Peace and Police Station to see how many women had reported cases (a relatively new thing in Guatemala) and what their status was. Not suprisingly, the majority of the reports (11) were done at the Justice of Peace then at the Police Station (3). It was unclear what action had been taken other than a report filed.

The two other main program are the Comites and Mayan Medicine. Pattie, works with the Comites. The idea behind this program is that each town have an Emergency Committee that is trained and knows what to do in case of an emergency in the town. PIES works with them to find the women to form the group, help them understand their roles and what to do in case of an emergency. I only attended one of these training sessions and am not sure how they are working. I've heard that they are hard, primarily because the women themselves don't really understand why it's needed if they've never had one before. But that's another topic for another time.

I've learned a lot about Mayan Medicine since working with PIES. This is mainly because Cristy has needed the most help, transcribing the interviews I helped her with 2 months ago. She is making a documentary on Mayan Medicine (an a brochure) for Guatemalan medical students. The idea is that they need to understand it, and acknowledge it, even if they don't practice it or believe it. Their patients are going to come in having tried it first, and it will scare people who already hate hospitals even more if they don't try to work with it. PIES has already started by giving talks to the doctors at the main Medical Schools, with hopes that they will make one class part of the curriculum and increase acceptance and awareness. The 15 min documentary will be distributed in a few schools to help begin this process.

I haven't written much about PIES because it doesn't really feel like I've "done" much. As I reach the end of my time in Guatemala, it's starting to process. I'll write more about it, and these different groups that I've visited over the next week.

Killing time, the Guatemalan way

I've been meaning to write a new post for some time. Not a whole lot of exciting things have happened this past week and half. Since, I've done most of the day trips around here I don't feel the need to travel every weekend. Not wanting to miss a day at PIES to take a day or two for travel, I've stuck around Xela. There was a housemate's 30th birthday party, I've gone back to Los Vahos, the natural steam baths, played Ultimate Frisbee, and done a fair about of cooking with housemates. I was going to write a bit about the various things I've been doing with PIES. However, my day yesterday was so bizarre (another "cultural experience") that I had to share.

I went to San Martin for a midwife training. My understanding was that it was supposed to be all day. I was interested to learn what the midwives were learning and to see how PIES run it's training sessions. Also, I was excited that this one was going be in Spanish. The past 2 that I had gone to had been in K'iche, so I had some difficulty following along. I was going to go to San Martin with Marta, the woman who I have mainly been working through. However, a death in the family meant that Dona Angela would be doing the training instead. For those of who you might remember reading about the birth I saw, Dona Angela was the midwife.

The topic of the day was "Post-birth hemorrhaging." This is number one cause of maternal death for at-home births. So, the topic was extremely important. The doctor at the San Martin health center gave a presentation for about an hour. I'm not really sure how much the midwives actually learned from the presentation, but that's a blog topic for another day. There was also a brief presentation on the Swine Flu, or H1N1. I'm not sure how much the midwives got out of that talk either. During the doctor's presentation, the Health Center staff asked me if I was doing a presentation or if I had something prepared. A few minutes later, I realized that this was because Dona Angela didn't have anything prepared either. I'm not sure if Marta didn't tell Dona Angela what to do when she asked her to fill in, or if Dona Angela forgot. Either way, this hour presentation was all the material they had for the day and they had 3 hours to kill before morning snack and lunch. Letting the women out before lunch was not a possibility. They did have a special mother's day lunch planned after all.

What they did to fill the time was what I found most bizarre and interesting. They decide to play games. I was asked a few times if I knew of any "dinamicas" that I wanted to lead. While I didn't want to lead any, I did give a few suggestions that they didn't really like. Milton, one of the health promoters from the clinic has some balloons that he really wanted to use. So they played a form of hot potato with the four, deflated, balloons that he had. The four people who "won" the hot potato then had to go to the front of the room. The goal was now to be the first person to blow up your balloon and then sit on it. So, the four midwifes got in front of their chairs and prepared to race. The woman who won seemed very excited and the prize was a plastic rose.

The second game consisted of 4 pieces of yarn, about 3 feet each, each with a small piece of candy tied to the end of the yarn. Again, they played hot potato to choose which two women would go to the front of the room. One the two women were chosen, they went to the front of the room and were given a piece of yarn. They had to put the candy-less end of the yarn in their mouths and their hands behind their backs. One the count of three, using only their mouths they had to essentially "eat" the yarn. (Imagine having to suck up spaghetti with your mouth, but it's wool yarn instead) The first person to reach the candy, again, "won." However, they both got to keep the candy. This game was played twice. I couldn't tell what the midwives thought of these games, but the health center staff seemed pleased with themselves and that they had successfully killed about 45 min. I left wondering what had just happened.

A birth

I actually got to attend a live birth this week! It was a pretty incredible experience, I’d have to say.

I was in Concepción, a town about 30min outside of Xela where PIES has a clinic. The clinic has a doctor who is there 2 days a week and a nurse full time, but the midwife, Dona Angela, is the primary attender of the pregnant women who come in. Women come into the clinic for their prenatal checks and to give birth. I was in Concepción with the director of the Domestic Violence program Marta, and 2 other women from the office. They were gathering information at the justice office and police station on how many cases of domestic violence had been reported, what the follow-up had been, etc… At around mid-morning break time (refraccion) we stopped in at the clinic to have our bread and coffee. When we got there, we found out that there was a woman in labor in the 2-room clinic. Wanting to see a birth, and thinking that this might be my only chance I asked if I could stay, and I did. For the sake of this blog, I will call the woman giving birth Maria and the father of the child Jose. I don´t actually know their names.

Maria was 31 and having her 5th child. She had started to go into labor at around 9am, and her water had still not completely broken when I got there around noon. She was walking around the room trying to get her water to completely break. I learned from Dona Angela that this is normal for women who have had many children. Apparently, the water can fully break hours into labor - for women with many children the child often comes soon after the water breaks. At about 2 (2 hours after thinking that the baby would be arriving soon), Dona Angela was getting impatient. Therefore, it was not unusual that Dona Angela, fully broke Maria´s water herself by sticking her index finger up the birth canal.

The staff at the clinic was very laid back about the whole thing. At noon, Dona Esperanza went into the room to see how Maria was doing. The staff was trying to figure out when to eat lunch. If Dona Angela thought that the baby would come soon, we would eat lunch afterwards. If not, we would eat now. Dona Angela decided that we should go ahead and it as she said - a phrase I hear a lot that day - "Falta un poquito" (a little more time).

I entered the room with Maria, her mother and a friend at around 1pm. We spent the time in between contractions talking and chit-chatting. Dona Angela and Maria´s family would speak in Mam and I would listen, not understanding a word, but enjoy watching their grand hand motions and animated speech. I gathered that they weren´t talking about much. At one point they started looking at Maria´s mother´s shoes and I think were talking about prices and where she bought them. I would speak with the nurse who was in the room too - only to provide back up. She would explain things to me and help me get a sense of what was going on.

Maria was almost totally silent through out the other births. While I heard that many women scream from the pain, yell "no, no, i don´t want it" and other things of the sort, Maria did not say a word. You could tell she was in pain, because as each contraction came, she would tap on the bed post, calling over her mother or husband and then have an extremely pained looked on her face.

Around 2:30, Dona Angela and the nurse started to express their concern about the birth. Maria´s contractions weren´t getting closer together, at times it even seemed like they were getting farther apart. For a while Dona Angela had been thinking that the baby was close, but was now starting to get worried. Her stomach was soft, while during the end of labor, it should be hard to show it´s contracting. You could see the black of the baby´s head, but for some reason it didn´t want to come out. Dona Angela and the nurse knew that taking her to the hospital would be a bigger risk then keeping her at the clinic, given how close she was. They decided that she needed to be in a better position to push. Her mother and husband who came to her side during her contractions were pushing her down, rather than keeping her in a position where she could use all her force to push. Maria had refused to lay on the bed with stir-ups, which didn´t help. To help give Maria sustenance and to get rid of all the bad blood before the baby is born, Maria drank a fruit nectar and raw egg concoction. Yum!

Dona Angela sent the family of the room and took matters into her own hands. We moved the bed, propped Maria up, and the nurse stood behind her. The entire time I am standing right at the end of the bed, so that I can get a good view of the birth, they tell me. This helped and soon after progress was being made and a 3:20 a baby girl was born. She weighed 9lbs 12oz, which is why they think Maria had so much trouble.

There were a lot of things I didn´t realize about birth. One, once most of the head comes out, the entire body follows in what feels like one second. Secondly, it´s not really over for the mom who now has to push the placenta out too (which takes anywhere from 10-30 min). The umbilical cord is really long and Dona Angela spent some good time looking at it. She said that you could see all the children Maria had in it. I´m still not really sure what she meant by that. It was really incredible to be a few inches away from Dona Angela as she cut the cord, cleaned the baby and handled the placenta.

The placenta - by the way - is given to the family who then buries it. Dona Angela put it in a plastic bag and the family threw it into the sacks they had brought. As if it were a t-shirt. I found that a little disturbing.

After the placenta came out, the baby girl was cleaned and placed in crib while Dona Angela dressed Maria. Then, Dona Angela blessed the baby with a candle, followed by the grandmother, and the baby was dressed. I have never seen a newborn in so many clothes! She looked like a little sausage when Dona Angela was done with her. 3 sweaters and a fleece blanket as a diaper, plus being wrapped in another fleece blanket. The baby was then handed to the mother for the first time, about 40 min after birth. It was interesting to me that she wasn´t handed over sooner to the mother. Other people in the room (at this point, other relatives had arrived too) and they had had a chance to hold the baby before the mother. Even when Maria left, she went in a separate car then the child.

The family asked me where I was from and told me what an honor it was to have me there. Dona Angela had been telling them that I was going to be a woman´s doctor (not really sure where she got that from, but she is a bit old). I told them it was for me as well and thanked them for the opportunity. They then asked me my name, and said how much they liked it. Maybe they would name their daughter Laura Estefanie. In Guatemala, you don´t have to name your child for a month. So, who knows, maybe Concepcion will have a new Laura.