Safe Motherhood Project Guatemala

Safe Motherhood Project Guatemala

Educating and empowering Mayan midwives to help save the lives of mothers and babies.

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The Next Generation(s) of Comadronas

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Class of Week Two

Class of Week Two

We’ve come to the end of our time in San Pedro Sacatepequez-two successful courses teaching comadronas how to manage obstetrical emergencies. These comadronas have an important role in the care of women giving birth.  Many of the practicing comadronas are in their advanced middle age. Who will succeed them?  This year we had 2 sets of mother/daughter pairs and 2 sets of grandmother/granddaughter pairs in our classes.  We believe this reflects the importance of passing on knowledge and skills to younger generations in a culture that still values home births.  Indigenous women living in rural areas with poor access to hospitals and clinics are the most vulnerable in their pregnancies.  Having a skilled attendant can make the difference between life and death for both mother and baby.  The young women aspiring to become comadronas were thrilled with our course and the skills that they learned.

Feliz Dia Internacional de la Mujer

Managing stuck shoulders

Managing stuck shoulders

 

Resuscitating newborns

Resuscitating newborns

 

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Final Talking Circle

 

Class Photo

Class Photo

Happy International Women’s Day!  Yesterday we completed the first course of our visit this year. Imagine 22 women with smiles and increased self-esteem, pleased with what they had learned. In our final talking circle they all were very grateful to have received such a practical and useful course.  The 2 bomberos who participated were fine men who were very kind and considerate.  These are the men the comadronas must call for ambulance services in the case of an emergency. Having bomberos participate is an excellent team building exercise.  Comadronas and bomberos gain a better understanding of each other’s role in caring for mothers and babies. We have had nurses participate in the past who also gained a better understanding of the comadrona’s work.  It is our hope that doctors, too, will participate and change their attitude. A new law in Guatemala for safe motherhood includes comadronas as an official part of the system of care.

 

Our Class Begins!

Patulul statue- to Mothers everywhere

Patulul statue- to Mothers everywhere

Hand washing demo

Hand washing demo

Hands- clean and dry

Hands- clean and dry

After a wonderful reunion with our Guatemalan teammates, Cenaida and Gloria, our driver Conrado brought us to San Pedro Sacatepequez. Today, our first class began. We have 17 Comadronas in our class. We were received with much gratitude by the Doctor at the Health Unit, the staff at the Municipality and the students. We started our class with a talking circle as per usual, to get to know one another and to hear the concerns and needs for specific content for this course. Hand washing was the first activity.  There was much enthusiasm in learning the new technique in washing and drying one’s hands to help prevent infection, the third highest cause of maternal death and the first cause of newborn death in Guatemala.

Our 12th year-we have arrived!

Meeting with the Ministry of Health

Meeting with the Ministry of Health

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Ruth and I, Annette, arrived in Guatemala City on Feb. 26 and have spent the past 2 days making important connections with officials within the Ministry of Health and with the Pan American Health Organization. We met with the Director of the Program for National Reproductive Health, who was excited to hear about our project, our method of teaching, the longevity of our project, the areas in which we have taught through the years,  and spoke about the potential coordination of our project with the Ministry to bring this style of course throughout rural Guatemala. Very exciting! Tomorrow, we get together with our Guatemalan teammates! Can’t wait!

 

2014 trip preparations

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Once again, we are in the midst of getting ready to head off to the highlands of Guatemala for our 12th annual “Safe Motherhood” program. From February 26 to March 15, Dr. Ruth Brighouse and Annette Borkent, RN will be in Guatemala, joining Guatemalan teammates and collaborators Cenaida Juarez and Gloria Cutuj. Both Cenaida and Gloria have been instrumental in logistical support and ensuring good translation between Mayan dialects and Spanish and have helped us train over 600 comadronas in the past 11 years. For the past two years we have included volunteer paramedics in our courses, teaching them the assessment and birthing skills they need when called upon a birthing crisis. This allows the comadronas and paramedics to work together locally. We have seen a very positive change in relationships as the two groups learn how to work as a team and what their differing roles should be.

This year we will be training two further groups in rural Guatemala. Last year a proposed meeting with the Minister of Health fell through at the last minute and our hope is it will happen during this visit. We have always worked closely with the Public Health Unit of each area in which we have been teaching and the success of the program has drawn the attention of the government (in a very positive manner). We also plan to meet with the Pan American Health Organization in Guatemala City to discuss our project and possibilities of coordination and mutual support with PAHO as well as other groups. A course Cenaida and Gloria taught this past fall was in collaboration with “Amigas”, one such organization.

Hiring Cenaida and encouraging the growth of the project with local leaders is a natural and progressive step in our continuing work with Guatemalan midwives. We envision a strong expansion over the next few years, using our teaching model to reach many more communities, with independent and local leaders. This has always been our goal. Although it will, for a time, make the project more costly to maintain, it will pave the way for much greater Guatemalan involvement and support. Our expenses will now be about $25,000, as we not only need to cover the costs of implementing the program (materials and medicines, instructional booklets, etc.) throughout the year, including Cenaida’s wages and travel costs of the team but also to acquire more realistic birthing models.

We welcome donations to offset the costs. See our donations page to donate.

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Second update from El Rodeo

Hand washing practice.

Hand washing practice.


We spent our 2nd week training another 27 eager students from communities surrounding El Rodeo. Once again, the majority of students were comadronas who have been actively working, and the remainder were equal numbers of aspiring comadronas and volunteer ambulance attendants.

It was remarkable to see the students so intrigued by what they were learning. Their desire to learn was palpable! One of the important aspects of our training is for each student to do a real life interview and examination of a pregnant woman, to use their new knowledge that they have learned by using models and role playing.  One of our comadrona students asked each of her patients to come to our course so that everyone in the course would have the opportunity to do a hands-on interview and exam of a pregnant woman.  This was a huge gift for those who did not have a pregnant friend, sister, cousin or neighbour to join them for the private clinic which we set up as part of our course. During our second week, a pregnant student offered to have everyone watch as Ruth did a live interview and exam on her as an example for the whole class. Awesome participation!

The course was very well received and we had a wonderful graduation ceremony to celebrate all the students completing the 5 day courses. The mayor of El Rodeo supplied a wonderful meal for everyone present. We heard many times how much each student appreciated the course. We have already heard of many other rural communities requesting our course.

See more photos of our time in El Rodeo on our Flickr page. 

An interview with one of our students

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This is an interview with one of our students, Victoria Isabel Lopéz Lopéz, from La Agradía de la Esperanza. 

When I began I didn’t know anything. I wanted to serve but I was scared. I had dreams and everyone told me I should become a comadrona but I was afraid. I got sick and I suffered a lot as the years passed. I suffered and suffered with a lot of bleeding. I went to doctors and to comadronas but they couldn’t find any reason for it. They said everything was fine. I visited another person and they told me that I was suffering because I was supposed to become a comadrona. I was still afraid. I didn’t want to. My husband was jealous and didn’t want me to work either but in the end he accepted it.

When my sister became pregnant with her sixth child, my brother-in-law suggested that I should start with my sister. I had looked after her other babies after they were born and he had always told me I should become a comadrona.

The first time I touched her stomach, it seemed really big, not normal. I didn‘t know much but I knew it wasn’t normal so I sent her for a check-up with a doctor. The doctor told her she had lots of liquid but that everything was normal and it was fine for her to give birth at home.

I felt more assured. But then she began her labour early. It was only seven months.

In the beginning, for a short time, everything was fine, normal. She had pains and then came time for the birth. My sister was guiding me as she had had other children and knew what to do. The baby was born without problems and we waited for the placenta. I touched her stomach and felt something move!

“There’s another child!” I told her.

I don’t know if it was the shock of it or for some other kind of weakness but she fainted.

My brother-in-law went to find a doctor. When the doctor entered she looked at me and asked, “Why haven’t you cut the cord?”

I didn’t say anything. I had thought of it, but my brother-in-law had told me to wait for the placenta. Since I didn’t know much I listened.

The doctor told me I should have, that the baby doesn‘t need the placenta after it is born. Now I know and if the placenta doesn’t come quickly, I cut the cord. I learned this that day. I cut it while the doctor examined my poor sister and confirmed that there was another baby and that it was still alive.

The doctor gave my sister an injection and began to stimulate her so the pains began again. My sister woke up and gave birth to another baby. The doctor gave her some pills for an infection she had and then left us.

Word got out that I had delivered my sister’s twins and since that day, 25 years ago when I started to work, to serve as a comadrona, it hasn’t stopped. I’ve delivered more babies then I can recall. There are months when it’s only two but four or five is more common. As I gained experience, more and more people asked me to assist. All because my sister and her husband gave me the opportunity.

First update from El Rodeo!

Sunset over El Rodeo

Stepping off the airplane in Guatemala City, we were welcomed by a warm breeze, heavy with the perfume of tropical flowers. Over the next days, we made our way first to San Lucas Tolimán to meet up with our Guatemalan team-mates and then on to El Rodeo, the town we are teaching in this year. We had the opportunity to see a small portion of the incrediblebeauty and diversity of the country. Our route took us up through the highlands of cool pine forests, patchwork fields of vegetables and corn, and small towns clustered on ridges. Then we began to descend along a tortuous highway, through forests and across rivers. The air warmed and the vegetation became tropical. We passed through fields of food-bearing trees – bananas, coffee, cashew, and citrus – and clusters of houses almost hidden by crotons, bougainvillea, hibiscus, and datura trees.

El Rodeo, in the department of San Marcos, is in the foothills, halfway between the mountains and ocean. Tomorrow is the final day of training for the 28 participants in this week’s course. Our students are comadronas, the traditional birth attendants of the Maya people, and bomberos, the volunteer firefighters who also provide the local ambulance service. These students are bright and highly motivated. They learned surgical hand-washing as a way of preventing infection; prenatal care; how to identify the pregnant woman with risks who should not deliver at home; and the care of women during labor and delivery. We discussed, and practiced in great detail, the management of various complications during labor, including hemorrhage, convulsions, and shoulder dystocia (where the baby becomes stuck in the birth canal after its head is delivered). This is “hands-on” learning at its best.

Tomorrow we discuss emergency planning; we have already had great discussions between the comadronas and bomberos about improving communications and timing around emergency transport (there are two hospitals that people use here; one is one hour away, and the other is 1.5 hours away).  Our final themes relate to contraception and breastfeeding.

We expect to have a similar number of students next week from other nearby villages. Stay tuned.

We’ve added some photos of our time in El Rodeo to Flickr–check them out!

2013 Update

Once again, we are in the midst of getting ready to head off to the highlands of Guatemala. We are so excited to be planning our 11th “Safe Motherhood” program in the training of Traditional Birth Attendants, or “Comadronas”, as they are called in Guatemala, the needed skills of safe birthing and neonatal care.

This year from Feb. 16 – March 8, Ruth Brighouse (MD), Annette Borkent, and Kristine Zylstra-Moore will be in Guatemala, joining with Cenaida Juarez, our project coordinator, (whom you may remember, we employed in October) as well as Gloria Cutuj, and Gloria Mejia, both of whom have been part of our team for the past number of years. It is particularly exciting this year as we will be implementing the next step of our program to expand its reaches into other remote areas of Guatemala. Cenaida has sought out leaders in a variety of communities in rural Guatemala and has invited them to come to a “Train the Trainers” course. We will have a week of training and then facilitate these new instructors to teach the course to comadronas, who have not had previous training, the following week. Once the new instructors have returned to their villages, Cenaida will go to their towns at some point in the coming year, along with either one or both Glorias, to assist them in teaching the course to other comadronas in their own area. It is very evident that this is a very important step in promoting the independence and self sufficiency of this project.

Our third week will be spent in meeting with various officials from the government of Guatemala. Cenaida told us of the very real possibility of seeking an audience with important members of government and the Ministry of Health (she already has some strong connections). She sees this as a golden opportunity as there are members at varying levels of government who are interested in women’s health. She is in the midst of setting up these meetings. We also plan to meet with members of other NGOs involved in women’s health issues to see if we can work to enhance expansion of our training and coordinate some activities. We also hope to start some local fundraising efforts with a Guatemalan Rotary club.

Hiring Cenaida and encouraging the growth of the project with further leaders feels like a natural and progressive step in our continuing work with Guatemalan midwives. We envision over the next few years a strong expansion of our project, using our teaching model and format to expand to many more communities with independent and local leaders. This has always been our goal. Although this will, for a time, make the project more costly to maintain, it will pave the way for much greater Guatemalan involvement and support.

Would be willing to make a donation towards this year’s effort? Our expenses will now be about $15,000, as we not only need to cover the costs of implementing the program (materials and medicines, instructional booklets, etc.) throughout the year, including Cenaida’s wages and travel costs of the team but also need to acquire more equipment. We are part of Rose Charities which is a registered charitable organization and provides tax receipts. Please make out your cheque to “Rose Charities”, indicate on the memo line that it is to support ‘Safe Motherhood Project’, add your email address (to make tax receipts easy to send back to you) and send to:

Rose Charities Canada

1870 Ogden Ave, Vancouver, BC

V6J 1A1, Canada

It is also possible to donate online.  To do so click on “Donate Now through Canadahelps.org” on the left sidebar.  Within the Canada Helps site, the donation details under “Fund designation” please select “Safe Motherhood” from the dropdown menu.  Other details should be clear.

Of course, if you can’t contribute financially, please do not feel any obligation! And, in all of this, We appreciate your prayers and good wishes!  It is a real blessing to be looking forward to working in Guatemala again and to continue with our vision of bringing our Safe Motherhood Project to a variety of communities!

The very best to you in the New Year!

Safe Motherhood Project (Guatemala) Expands Outreach

Annette Borkent and Ruth Brighouse, directors of the Safe Motherhood Project in Guatemala, have recently returned from a week in Guatemala from Oct. 13-18th. It was very exciting to be in Guatemala, and officially employ a trained Guatemalan midwife, Cenaida Juarez, as the Coordinator of the Safe Motherhood Project. We have been training Traditional Birth Attendants in Guatemala annually since 2003 and Cenaida has been with the project since its inception. Cenaida is ready to take on a much larger role in the implementation of the training of the Traditional Birth Attendants in remote areas of Guatemala. It is very evident that this is a very important step in promoting the independence and self sufficiency of this project.

Although this will, for a time, make the project more costly to maintain, it will pave the way for much greater Guatemalan involvement and support. Cenaida’s primary task will be to train others who can teach the birthing course and who, in turn, provide support for local traditional birth attendants.

She will seek out leaders in a variety of communities in rural Guatemala and invite them to come to a “Train the Trainers” course next February. We will have a week of training and then facilitate these new instructors to teach the course the following week. Once they have returned to their villages, Cenaida will go to their towns at some point in the coming year, along with another one or two of our Guatemalan instructors, to assist them in teaching the course to traditional birth attendants in their own area. In short, she will develop a new and growing network of groups who will be teaching traditional midwives the needed skills of safe birthing and neonatal care. It will be great to have Cenaida use her great communication skills to help the project blossom in other areas of Guatemala.

Cenaida told us of the very real possibility of seeking an audience with important members of government and the Ministry of Health (she already has some strong connections). As this will be Cenaida’s employment, she will now be able to use her skills full time to seek support and obtain official recognition of this important course. She sees this as a golden opportunity as there are members at varying levels of government who have an interest in women’s health. These people were voted in last November and have a 4 year term. Cenaida will also link with other small NGOs involved in women’s health issues to see if we can work to enhance expansion of our training and coordinate some activities.

Our trip to Guatemala was an exciting watershed for us. Hiring Cenaida and encouraging the growth of the project with further leaders feels like a natural and progressive step in our continuing work with Guatemalan midwives. We are very fortunate indeed to have such a skilled and dedicated person like Cenaida in this official role and we look forward to exciting further developments.

Update prepared by Annette Borkent and Ruth Brighouse

Annette Borkent (Canada), Cenaida Juarez (Guatemala) and Ruth Brighouse (Canada) of the Safe Motherhood Project.

Cenaida Juarez, the Guatemalan Project Coordinator, from San Lucas Tolimán.

Working out the details of the future of the project and a contract for Cenaida.

Gloria Cutuj and her granddaughter Melanie. Gloria will be assisting Cenaida on all teaching workshops.

View of Lago Atitlán in the highlands of Guatemala.

About Us

The Safe Motherhood Project is a group of Canadian and Guatemalan nurses, doctors, midwives, traditional birth attendants, and volunteers. We provide education and training to rural Mayan midwives and traditional birth attendants throughout Guatemala.
Learn more.

Rose Charities



The Safe Motherhood Project is a member-project of Rose Charities Canada.

Donate Now

Donate online here at the Rose Charities website. Select "Safe Motherhood" from the "Fund" drop-down menu.

Visit our Donations page for information on how to donate via cheque.

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