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.