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!

Rolling!

Some news...
we are getting used to working the center, getting more visits everyday and connecting with important people in the community. We are also making the place our home, putting up pictures, hanging flowerpots. Gabi found her own workspace and now reigns over her own desk.
Jessica came to visit and cleared a lot of our doubts regarding paperwork, stats etc.

The TV is up and the new DVD bought, now we just need to convert and copy our VHS movies.

The first prenatal class is running with three participants at first, but one of the babies was already born (see photo!).
One of the other two will also be born at Manos Abiertas. Many other people are inquiring about our services, most of them because they saw the ad on Televolcanes.

We also have our first "user" ( ...of a family planning method by PPFA), but so far most people come for prenatal care or for their pap smears.

Just two days ago I was very happy to see that one of the traditional midwives I used to work with at IXMUCANE years ago, found us and inquired about bringing in her clients both for prenatal care and for her birth. Here the TBAs are forbidden from attending first time moms, and we want to help our traditional colleages and their clients to be able to gave a "humanized" ( that is what they call it here!) birth, which by (our) definition means to keep them out of the National Hospital and allow for a natural, gentle birth experience for both mother and baby.

Jill ended up not staying with us, I understand that it is hard to keep faith when you are sitting for days without seeing one sole client... but that is what you call starting a clinic!

Next week our next intern will arrive, Karine from Quebec. I have high hopes since she sounds so motivated and organized...good for her and us, we need a bit of rest and she needs exposure!
We have had to ask Margaret a lot more to help us than planned and we do not want her to get tired.

Last but not least some news from Centro de Parto Natural in the city: we had our twins! Violeta and Ivan had their planned twin homebirth and Alexis and Marcos, 6 and a half lbs each slipped easily into this world on Sunday night.

Long time no write...

I guess it is a good sign if there is no time to write...
we have been very busy fixing the birth center, getting equipment, moving forward with the paperwork and actually starting to hold clinic hours...
YES!
The clinic is open and little by little, actually some people are coming in.
Last week Clara inaugurated the birth center by having her little son...

the official opening will be this Saturday, with Champagne and Orange juice, and hopefully with all our sponsors and board members.
before the opening we will hold our first assembly, a very scary and formal event.

The week after Jessica from PPFA is coming to help us with the worst of all challenges, the report...
I wish we had more to show her, but our beginnings have been slower than at least expected, I'm trying not to loose optimism!

two months of silence

...do not mean that nothing has happened!
WE OPENED YESTERDAY!
The last months we did paperwork , means we have managed to become a legal association, and are in the process to get legal as a clinic as well. The municipality has authorized us to open the doors, and yesterday already a young girl stepped in and inquired about a birth!
Sandra, our pediatrician already has an appointment for today and other people have inquired about gyn services.
Now we have to learn to stick to opening hours, against all odds...I think all of us are having a hard time with that. Gabi has moved to San Antonio and is trying to get her act together and Jill is growing into her position as a volunteer with hopes for a future job.
Dr Menendez has been a great help and we are happy to have him as our director and advisor. I personally am learning a lot of new things, the hardest being how to actually coordinate and not inhibit, demotivate etc.
Just for everybody to see that we are not just talking but getting a women´s health center started, some photos:

Donations coming in!

After a long birth a few days ago, see picture, we are now concentrating on getting the MANOS ABIERTAS clinic going. We have so much support, I can´t actually believe it. Karin Reichensperger from the Message Program has been particularly helpful, see the picture from her warehouse at Familias de Esperanza!
We have about half of our medical equipment already at the clinic, not even talking about disposables...
and I just got an email from Dianne Thompson , from Antigua, who wants to donate our file cabinet! Thanks Dianne! (And thanks Terry, from the Revue magazine, who is publishing our ad for free which was how Dianne found out about us!!)
Yet another donor is Raul Minondo, somebody who has actually nothing whatsoever to do with our work, but who happens to have been a friend for years. Raul is giving us our beds and the fridge.

And , of course, thanks to the best friend of all, to John Mann. Are you ever done helping people?