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.