Maria Bernarda, apprentices and other news

There is a lot going on and I hardly have time to write - on the 25th Maria Bernarda had her Baby with us in Manos Abiertas, - because of being chronically undernourished she did not have much strength and the birth was hard but we could keep her bleeding under control - and she sked me to tell the sponsors that she "would like to thank the people who m ade it possible for her to have her baby at Manos Abiertas. We were so nice and patient with her and really good people."

Anyway, when she brought her baby to our (free) pediatric consult three days later, the baby had a fever and was hospitalized by advice of our pediatrician - by now baby is back home and doing fine. but he probably had an infection that his mother had prenatally and we had no chance to diagnose since she did not have regular prenatal visits with us.

Other exciting things are happening: since last week Wednesday, our interns from Momostenango are with us and learning avidly. On their very first day I took them to a workshop on "Interculturalidad" - put on by several big NGOs and by ( surprise!) the Ministry of Health. There were quite a few Mayan midwives present and I believe Olga and Paty enjoyed the event.
Since Friday they have been following Carmen and Sandra around and are learning a lot. On Thursday they will come to the city with me to another event, this time for the international day of the midwife. I hope between learning and ging to events they will not get bored with us!

The 26th of this month we will do a VIA/cryo and Pap day clinic at lake Atitlan. by then Olga and Paty will have learned to fill out basic clinical histories and will accompany Gabi, Carmen and Sandra. The clinic will also give them their first exposure to the VIA procedure, so they get an idea what they are looking at.

On the other hand , we are working with several dedicated individuals on finding grants we could apply for. Josie, who works for WINGS is sacrificing her spare time for us, Rina is doing long distance collaboration with us, and José Roberto, who now works for UNFPA has pointed me in the right direction regarding visibility and grant applications. Let's hope for the best and I'll keep you posted...

Our newest idea is bearing fruit: the sponsor-a-birth program!
Two nights ago we attended the first of many sponsored births to come! The first sponsor was my mother, thank you so much!
Silvia and her husband are a young couple that was having their second baby. She had had the first baby at the national hospital and did NOT want to go back there.
She labored quickly and easily and gave birth without a tear to a beautiful 7.8 lbs baby girl named Elisabeth. Emily Kate, one of our interns was present, as well as Natasha who is taking pictures for our website. They arrived Just on time.
They were very happy with their experience and the husband donated the 400Q he had been able to save up for their birth to the clinic. Here a picture of Silvia and Elisabeth:

After a busy year...

Better late than never - here we are again! Manos Abiertas is going strong though we have had a difficult year with lots of obstacles - in terms of employees, money and the aftermath of Agatha - and now we have elections coming up in Guatemala which is about as bad as another hurricane.
The main changes in the last year have been staff modifications - and all for the better! Amarilis is helping us with accounting and we have Carmen, Sandra's mom who used to work at WINGS as a second care provider in Ciudad Vieja.
Our team feels good, very solid, eager to learn and in good spirits.
The very high expectations of our donors though we were not able to meet this year - considering all the obstacles we faced we are doing pretty good though, all things considered. we have given almost all the services projected - we have just not been able to charge what we hoped. The people have no money, especially the women! So we charge less, or we do not charge at all... we have recently started to implement on a very small scale the "sponsor a birth" program - a woman came to us, 47 years old, 6 kids, pregnant again and her husband had broken his leg and was not able to work. She had had one prenatal visit with us but could not afford to come in regularly. So the next time she came in she was already eight and a half months pregnant, severely anemic and undernourished.
She was also afraid to have her baby at the hospital because she had not been treated well in the past.
Knowing that the hospital would not pay attention to her low iron etc. we decided to start a mini-campaign to fund her birth with us. By contacting twenty people, in a matter of 24 hours I had enough money for three sponsored births! Thanks again to everybody who contributed for Maria Bernarda to have a good and safe birth experience. We will keep you posted !

Our intern program is also humming - seven paying people have signed up so far for this year! they are from Germany and from the US, some recent graduates from Midwifery school, some students and some people wanting to study midwifery.
Right now we have two lovely interns with us , Laura and Emily Kate - no midwives yet but oh, so useful! And motivated and smart and lovely... ok, I stop right here. They are redoing our website, perhaps incorporating this blog, did a little study on anemia in our clients, will make an herb garden, found us a grant writer (temporary)... the kind of people we need! Besides, Lauras mom will bring books...!

On the networking front, we have also had some success - looks like a German NGO will want us to train two future midwives and health workers from the highlands, from Chocruz, Momostenango. These young women will get some practical training with us, both administrative and medical, so they are able to run a primary care health post in their village.

And I am seriously looking into building our own midwifery education program! So many things have come together that I actually believe it is possible - we have the right place, the right time ( MG4 and 5...) and the right connections. but again - I will keep you posted as things develop.

In zone 11 we are facing the problem that people do not have a concept of a natural birth anymore - we have lost four clients so far because they lost patience!! People are so used to getting their babies cut out of them or pulled out of them or being hooked up to an IV that they do not believe in letting birth progressing normally. The urban clientele on one hand is used to getting things fixed "now" and on the other hand has no education to reason for themselves. that does affect our spirits in the clinic in the city!

Ciudad Vieja has had quite a few births and some of them very close together - last month we had three births in 12 hours! I believe the "sponsor a birth" program will bring a lot of births to Ciudad Vieja - there are so many women who would like to have their babies with us and can not afford to. Here some more birth pictures...

Now it's July already!

Just a quick update -
I was gone all of May and part of June. Foprtunately we had Carolin, a wonderful german intern midwife whop magaed my waterbirth center in Guate City together with my daughter Elena - two transports , one birth, that's how it happens sometimes... and Carolin did a lot of care in Manos Abiertas 1 in Ciudad VIeja as well.
Ciudad Vieja was hit hard by hurricane Agatha, but both the clinic and my house are still standing. For a week Sandra, Caro, Norma and Evy helped shovel mud in San Miguel Escobar, where there are styill about 50 families without a home. Then the clinic started collecting clothes and basic food for the victims of the desaster. And the whole time Sandra and Norma did a lot of trauma counseling during the appointments.

Now things are slowly getting back to normal - it is still raining a lot and there are more hurricanes to come though.

Caro has finished her internship and is travelling and Clara has arrived - a sweet young californian intern, it's her first tiome in a third world country and she just started her spanish classes... it must be a lot at once for her!

At least the first birth she was at was not complicated - actually, we all almost missed it ... It was Claudias third baby and she went very fast after a long latent phase, no time to fill the tub even!
Clara got to take a few picturews and the baby was out...


The new clinic in zone 11 is becoming "ours" more and more. Gabi opened the doors three weeks ago and we are having clientele already almost every day, several ultrasounds a week and a few procedures as well.
Ciudad Vieja is humming as it was before the hurricane, though we still do not have as many births as we would like ... we are thinking of a little educational video about good birth practices... anybody out there who would like to fund this? ; )

The next project to put into practice will be the implementation of the VIA/cryo system for cervical cancer prevention. In a first jornada I will start training Gabi and Sandra and we will educate people about the advantages of getting treatment the same day they come for their test.

Internally, we are still struggling with our sudden growth - especially since administration seems to grow potentially in comparison to the linear growth of the clinics. I particularly am having a hard timeto keep track of everything I need to do in my new position as deçirector rather than care provider, and I believe the other team members suffer from similar difficulties.

This Saturday there will be a meeting of the board and hopefully we will be able to delegate some of our tasks to some sympathetic board member with the right qualifications!
Sopon I'll post a picture of the location of Manos Abiertas 2!

I can not believe that I lost my text twice now!! I hate the computer! How about me just writing all of you a nice , long letter...

oh, not twice - three times... this time the internet died... should I give up??

well, without any inspiration, the plain facts:

the new funding year with PPFA starts tomorrow, this time negotiations were pretty tough - we are taking on another clinic, in the city. The clinic formerly was called Apoyame, and for whatever reasons never made it off the ground - for five years. Now we shall try.

Gabi is going to be the coordinator there, Sandra in Ciudad Vieja, both will do routine care as well, Sandra will have another nurse here to help her (we are desperately looking for an appropriate person). I will be directing more (brr) and do less clinical work, but will still do everything out od the ordinary, births, ultrasounds, cryotherapy - yes, I did the VIA / Cryo course, passed the exam and now we will get a cryo gun for Manos Abiertas 1 in Ciudad Vieja. that can make all the difference for clients who have a hard time to come back for results or treatment.

All the work we have done in Ciudad Vieja would not have been possible without our interns, especially Kathleen, who was just wonderful! And now she sent us her friend Nita, who is also great and a big help - and it looks as if there are more to come this year!

We had a nice visit a week ago, by Jenna from San Francisco University and some of her students who were down here for an internship in Lake Atitlan. They asked a lot of questions and it looks as if at least some of them are seriously considering coming back to visit. They also brought some baby rolls, just as we were running out! (Baby rolls are a blanket and a n outfit for a new baby which is given to the mother at birth)

And the last news is that I got a scholarship to go to the Women Dekliver Conference in washington DC - I am very excited , especially about the opportunity to meet prospective funders!

And now to Kathleens piece, thanks, lady!

Manos Abiertas

In December and January of this year, I had the opportunity to intern at Manos Abiertas, and it was an incredible experience. The clinic offers full-scope women’s health care… everything from well-woman annual exams, to fertility counseling, to problem-solving, to counseling, to caring for sick women, pregnant women, attending labor and delivery, and everything in between. I was able to observe almost every type of visit and procedure imaginable, and I was also able to observe that the waiting room got more crowded and crowded every day as satisfied women passed along the referral to their friends and family. It is unfortunate that respectful, empowering, and patient-based care is not the norm, but it is clear that when women find it they will not settle for anything less. Patients came to Manos Abiertas from across the country, taking 3 and 4 hour bus trips to seek care. Patients told stories of other clinics they had visited, where they never received results, where procedures and medications were not explained, where their birth control was unreliable and suddenly unavailable, and where they were c-sectioned unnecessarily. Manos Abiertas offers something different, and it is clear that it is needed.

One of the most extraordinary things about Manos Abiertas is the home-birth atmosphere that they are able to offer to their clients. Women labor and birth in a quiet, comfortable, homey environment, surrounded by their family and friends (and sometimes half of the village ...). They are able to deliver naturally, and usually go home to their family the next day. The new baby is celebrated and fussed over by the clinic staff, and the mom is at the center of all of the action. Below are the stories of the births I was lucky enough to attend at Manos Abiertas.

Number 1: Pati

The first birth I attended (EVER) was a little 17 year old named Pati, and she came in with her mother, her husband, and her sister. Hannah could tell from the beginning that the baby had some other part than its head coming first, but couldn't figure out what part (and the baby had been head down at its last prenatal visit a week before). Pati labored quickly, in about 3 hours she was ready to push, and she barely made a sound. She was just focused, breathing, working SO hard, and towards the end napping between contractions. The next time Hannah checked her, she felt a foot... and indeed, Juan David came foot first, (actually, one foot and his balls) with both arms over his head. It is an extremely rare presentation, and an extraordinary birth to witness, both for the technical skill that Hannah showed and for the bravery of the mom. Pati's mom was really cool, and so proud of her, and Pati's sister was scheduled to have her baby with Hannah the next month.

Number 2: Emilie
The second birth was at the water birth center that Hannah owns, and it was a woman (Emilie) who came late in her second pregnancy for care. Emilie had had a cesarean with her first birth (they induced her, and after 4 hours of labor said that she wasn't progressing fast enough and cut her open) and the doctors were threatening another cesarean due to "lack of fluid." Hannah thought it was B.S. and agreed to care for her. Emilie came to have her baby with her husband and sister, and it was a really FUN labor... they laughed and told stories and giggled the whole time, and Emilie labored much of the time on the toilet (and she recommends it!). The labor and birth were fairly straightforward, and they had a beautiful baby boy, Andre. The two things I will never forget are: 1) I messed up draining the birth tub and it overflowed, leaving me crawling around and mopping up fluid for what felt like hours!! and 2) Emilie and her husband came back to talk to the childbirth class that they were part of before the baby came (that Hannah teaches). Emilie had been transformed by the birth, and by her own power... her husband (almost 20 years older than her) told the group that he looks at her totally differently now, and is amazed by her strength, and Emilie said that she felt like she could move mountains.

Number 3 & 4: Nancy and Ana
The third and fourth babies came on the same night!! The fourth showed up early, a young girl of 15 (Nancy), because her water had broken but she was not having many contractions. Officially, her baby was premature, but there were some conflicting ultrasound dates, she wasn't sure of her last period, and the baby felt (to Hannah) to be about 8 months along and safe to deliver. She looked like she was going to labor all night, so we all went to bed to rest up. Pretty soon after, Sandra, another assistant at the clinic, woke me up because another woman had come in (Ana). This was Ana's sixth child, and she was as calm and focused as Pati had been a few weeks before. Ana was at the clinic for less than an hour before she delivered her daughter (5th daughter... they were a little disappointed!). Ana also was anxious to leave the next morning… because it was her day to wash clothes, and she needed to get back home. By this time Nancy's labor was heating up and she was quickly spinning out of control, as she had no idea what to expect and was just freaking out, and screaming her head off! She also brought half of her village with her, and because the night was freezing cold, they were all in the room. When she finally started to push, she would jump off the bed, squat, jump back up on the bed, jump to the other side of the bed... just back and forth like a frightened animal. She finally delivered a beautiful baby boy.

Number 5: Maria
The last birth was with a woman named Maria. She had had two babies, both delivered by cesearean. This was an interesting one because the babies heart rate was really low and not changing at all (it can be low, as long as it is fluctuating). We gave her oxygen, we had her squat, lie on her side, stand up, any number of things to try and get the baby's heart rate up. Nothing, and things were getting tense, to the point where it was almost time to talk about transporting her to the hospital. Finally, we had her roll over to her hands and knees and VOILA... heart rate back up and healthy. The cord must have been compressed in all other positions. One more baby born wailing and healthy.

One of the biggest things that I took away from all of this is that four of those five women would have had a cesarean if they had been in a hospital, particularly a public hospital. The c-section rate in Guatemala is shocking, and seems to largely come from doctors being in a hurry (lots of patients!) and having inadequate training in obstetric techniques. They also get more money for performing a c-section than a vaginal delivery (as is the case in the US as well), so that might have something to do with it too. But these babies were gorgeous and healthy, and got to snuggle with mom a milli-second after coming out. Moms also didn't leave the clinic until they were feeding okay, and I watched Hannah spend an hour with a new mom helping her coax her baby to take her breast. It was really amazing, and I learned SO MUCH.

I am so grateful for the time that I spent watching this little clinic thrive. I would recommend the experience to anyone, and also urge funders and donors to consider supporting MORE clinics that are able to capable and compassionately serve women through their lifespan.

How time flies!

It's been over half a year since I last wrote...meaning we have been extremely busy.

Here the highlights:

Presentation of movie "Gasolina" in the park of ciudad Vieja.

Dental Jornada in Manos Abiertas.

The arrival, Jornada, break down and repair of our ultrasound machine... now we are using it and the clients are happy to get everything done here and at once. 

For the same reason we have implemented simple lab tests: Type and Factor, Hemoglobin, UA. 

Since Sandra, our  addition since May, is studying to be a lab tecnician, we are seriously thinking about adding still more lab services.

Both Gabi and Sandra have been very busy with administrative issues. they are inventing (!) a  database, with help of Sandra's friend Melvin, a computer wizz.

We are surpassing out set goals for this year already! Many more clients, many more users of contraceptive methods and several more births, with relatives signing up after they hear about the first women's experience.

Below a picture of a recent birth...

Right now Jessica is here , reviewing financial issues. Tomorrow there will be a board meeting, with hopefully more people singning up for the association. There will be pictures of that event as well!

Oh yes, I almost forgot!

We had a visit from Christy Turlington and her film team for the documentary on maternal and child health she is directing!

Besides learning lots of new info on recent development in strategies concerning maternal and child health, we also hadd a good time, visited Doña Marcela in San Antonio who was interviewed and we shared our birth experiences with Christy...

I am very much ashamed for not having written in about half a year... but one could see it as a good sign, too: we are busy!

While I was talking about not one sole client in the last blog, that has definitely changed. Now some days we see as many as 12 people! 

Several births have taken place and every day there is at least one  new woman for prenatals. Not all of them stay with us for the birth , actually just very few do. that has to do both with lack of money and with lack of faith... people have been very much brainwashed against midwifery care.

But the few who keep their faith and have their baby with us are usually vey happy afterwards...like Blanca, who left 200 Quetzales more than we asked from her, because she enjoyed her experience. 

We have done so much!

Between interns ( Canadian Karine was just an angel!), visitors, trainings, donations.... 

  The fact that actually some people can not pay for their care, even though we are charging hardly anyhting  also brought about the idea of an emergency fund, which I am talking about now in several organizations, starting with my old Rotary club in Guatemala City. they spontaneously handed over a little check, even before I had finished my presentation!

But there is so much missing... one of our fetal dopplers is abot to die, we need basic lab equipment...no end to it!

Since it will be my job for the next funding period with PPFA to go out and look for additional local funding ( since PPFA funding is scarce... I guess we just learned the hard way one of the lessons in the NGO world: if you are doing well, your funds will be cut, so you won't fly tooo high...).

The good new is that we are getting a new coworker, starting in April!

Sandra used to work at Behrhorst clinic in Chimaltenango, and she is going to help Gabi with administrative stuff, but she is also trained to do rutine clinical work, since she is an auxiliary nurse. She fits right in and I am sure that we are going to have a lot of fun together...besides being extremely productive, of course!

We are having an article published in the Antigua magazine La Cuadra ( thanks, Jessica A. and Mike), which I hope might bring us some local fnding as well.

For this next period I have planned , among other things, to teach a CPR course for staff and traditional midwives, to start a basic lab, get me trained to do ultrasound....oh yes, the machine is supposed to be coming! Whatever that means, since it is in Costa Rica, of all places...

we need to repaint the clinic, with some stuff that will keep the humidity out.

Talking aout our space: this place is a good plce for starters, but in the long run we would like to build our own cllinid. gabi will write grants for that and for the school for midwives we hope to be able to have in the long run. So much for now!