The concept of a Safe Motherhood Project in Guatemala began in Feb. 2001. While in Guatemala with an NGO, Poco a Poco, I (Annette, a maternity RN) had the opportunity as part of a medical-surgical team to spend one day with a few midwives and a group of traditional birth attendants (TBAs) . The latter have no training other than their personal experiences but are the main women involved in assisting at births. They asked if I would please come back and provide some education to help decrease the death rate of their moms and babies. The statistics concerning childbirth in this area of Guatemala are truly shocking, with a 4% maternal death rate and 10% infant mortality!
On return to Canada, a group of health care workers, including the above RN, an Obstetrical GP and an international Red Cross RN. put together a course based on a UNICEF program that had been used in some African and Asian impoverished countries. The course we put together was 20 hours in length with sessions focusing on basic anatomy and nutrition, hygiene, prenatal risk assessment, normal delivery care and management of complications in childbirth. Many of the TBAs were functionally illiterate so we focused our teaching with the use of hands on experiences with many demonstrations and role-playing to assess whether the concepts were understood. We adapted the curriculum from the UNICEF TBA training guide, providing some additional sketches and translating all the information into Spanish. We also used plastic pelvic and birthing models and resuscitation baby models.
In 2003, we held 2 classes of 1 week each for a total of 37 students. These women were either already involved in helping other women deliver their babies or wanted to make this their vocation. Only 2 had any previous training. We began each of our weeks with a “talking circle” and everyone told something about themselves and what they were hoping to learn, or hoping to give, in the coming week. We had come prepared with a basic course and were very happy to discover that this matched what the women said they wanted to learn. We worked together with Cenaida Juarez, a trained midwife in San Lucas Tolimán, who was excited by our idea of teaching this course. She helped us out by recruiting women to attend the course, providing a lot of logistical support and helping us to teach as well. The course was very well received and we had 37 enthusiastic graduates!
The following year we went back to the same town. During our first week, we taught a more advanced course to some of our graduates from 2003 so they could become teachers themselves. We had 5 who became instructors along with 6 others who became teaching assistants. The 2nd week we facilitated the new teachers and teaching assistants as they taught 15 new students. We continue to work together with our Guatemalan instructors every year.
In Dec. 2004 we returned to assess the effectiveness of our courses. We were very happy to discover that some major progress had been made since our last visit in February, 2004. The government of Guatemala, in cooperation with some NGOs, had started a hospital based program in which local midwives could deliver their babies in a hospital annex. Midwives assisting deliveries must pass this government course. Of the women we had previously taught, 14/14 were accepted, while women from other areas had a very low percentage of acceptance. We had the opportunity to go with the 14 students to their course in Solola. In being part of the class of 42 women, we felt very strongly the vital importance of continuing our project. Our course has a very hands on approach and our women were very comfortable with the subject matter and were not as preoccupied with the struggle of comprehension through reading and writing. We also visited some of the surrounding towns and enthusiasm is high for us to teach our hands on course again in these towns.
In Feb 2006, our 1st week was spent in San Andres and was a great success with 17 graduates who were an enthusiastic and able group of students. It was delightful to see how much they learned. The second week was spent in Nahuala, a poverty-stricken city of 100,000 with very little infrastructure and no hospital. The mayor had invited over 100 women to the course and we were prepared for a maximum of 50. We were only able to reduce the group to 62, with the promise that we would return to offer the course again. Logistically, it was quite a challenge to teach this many TBAs as our course is so geared to hands-on experiences and only four of the students could speak Spanish!! Thankfully one of our Mayan instructors was able to speak their Mayan dialect and we were able to teach the basics of our course.
In 2007 we were able to teach 58 Mayan TBAs in the 2 weeks of training in a very remote agricultural area, Pajoca. We had incredibly eager students! Both weeks the women arrived early and were ready to start the course by 8:00am. Many of these women walked 21/2 – 3 hours each way to come to the course. This meant getting up at around 4am as they wanted to make sure they arrived on time. Once again, we relied heavily on our Guatemalan team mates to translate and teach in Quiche (the Mayan dialect). Once again it was delightful to see how much they learned.
In Feb 2008 we returned to Nahuala, and were able to teach 57 Mayan TBAs in our 2 weeks of training. Our students were eager to learn as many concepts as they could. Each day brought many women anxiously waiting to see what they would be learning that day. The day before we arrived, a young woman had died in childbirth from hemorrhaging, so the importance of what we were teaching was very tangible. As per usual, we had only a couple of students who could understand Spanish, so we relied heavily on our Mayan teammates to translate and teach in Quiche. It was wonderful to see the smiling faces as the women grasped a new idea and the accompanying skills.
While in Nahuala, we received a formal written request from the Public Health Center asking us to return next year to teach the doctors and nursing staff in Nahuala. We feel very excited about this and have responded with an emphatic “Yes, we’d love to!”. There will be a group of about 20 and we will present a course with a lot more depth tailor made for them. We have also been asked to come to the next town about a ½hr. drive from Nahuala to give the course to the traditional midwives of that area. This made up our 2 wks. for Feb., 2009. We have since taught 2-week courses in 2010 and 2011 and plan to teach again in 2012.