love and business from a rural midwife...
I was hanging out with a midwife in Guatemala, Doña Ana. She herself has had a tough life. She started working before she was 10 trying to feed her younger brothers, and some days she would go without food so they could eat, but often they would cry because of the hunger. She got married at 15 to get away from the poverty of her mother´s house. She had her first child at 17. She trained to be both a nurse and a midwife and works profoundly hard to provide for her family and her community and give as many children as she can a better shot at life, a better childhood than she had. It was an amazing blessing to stand beside her as she welcomed a child into life. I was there and awkwardly wrapped him up in his baby clothes and held him in my arms. It was an incredible joy to be there with this child, fresh to the world, held warmly against my chest. I brought him over to the father and said he was very beautiful. The parents were both happy. Then Doña Ana scooped up the baby and prayed over him before placing him in his mother´s arms.
A few days later one of the other girls in my program came with me to interview Doña Ana. In the context of the interview we could ask questions I might have found difficult to bring up otherwise. She talked about the discrimination that her patients have faced when they go to the hospital, because they´re poor and many speak Mam, a Mayan language, instead of Spanish. About five years ago she had two patients within two weeks of each other that she brought to the hospital with complications that seriously endangered the life of the babies. For both of them they were made to wait hours and she had to hunt down a doctor or resident to get them the attention they needed. When the second baby came out black and blue from lack of oxygen, the doctors begged her not to report what had happened so that they could keep their jobs. She agreed not to pursue the issue provided that they would listen to her and her patients could be seen promptly and respectfully. Now she´s treated well at the hospitals but the other midwives still have a hard time getting their patients the attention they need and there are no translators and very few bilingual nurses at the hospital.
Because so many of her patients fear going to the hospital, she would love to expand the services she offers out of her clinic, which is also her home. She has no laboratory tests or sonogram to offer her patients in their prenatal visits. A student who was with her at one point saw a premature baby born and not survive for lack of an incubator. The student called around and solicited Donations and eventually found and sent an incubator that Doña Ana now uses for premature babies. Doña Ana and the other midwives receive no help or training from the government. Her patients have to pay for the medicine they get so that she can make ends meet, but she does it on a sliding scale and makes sure they get what they need whether or not they can pay. She provides her consults and prenatal checks for only 5Q, about 70 cents, or, if even that´s a burden she´ll waive it. Between her and her husband she has found a way to provide for her family though, and provides a great service to her community.
I went back one more time after that and she was talking with the vendors of pharmaceutical products that she gives to her patients. They were true marketing types, congenial, chatting her up, handing over stacks of free samples, and eventually working around to the bill for last month. She actually moves a tremendous amount of medication and the 5Q visit is often accompanied by a 60Q ($7) injection or something like 150Q ($16) worth of pills and herbals. Her mark-up goes up to 25% depending on the economic situation of the patient and their family. It is still quite inexpensive, but it was interesting to see that from an income perspective she's really a pharmacist who offers midwifery services though her time is spent the other way around.
She's also been successful enough as a business person to build a new house and shop which was under construction while I was there. She'll be moving from her old consult room with it's jumbled shelf of pills and medications to a bright blue extension with glass cabinets and better lighting. The cinderblock construction is two floors and will expand both her house and office spaces. This is interesting because it means she has sufficient capital to make major investments that she feels will be worthwhile.
A friend of mine brought up the idea of leap-frogging in technology, like getting cell phones in rural villages before landlines. When she talked about ways she would like to expand her practice she mentioned blood tests for pregnancy, which are more accurate than urine tests, a women's support group, and an ultrasound. It turns out the girl who was interviewing her has a mother who's an ultrasound technician. For now Doña Ana palpates the fetus in the womb and can tell the general orientation of the baby. She listens to the heart through a stethoscope and can tell if it's beating or not. Part of me deeply respects these physical diagnostic skills that she can get so much information through such low tech and direct observation practices. On the other hand with an ultrasound she could get more detailed information about the development of the fetus earlier in the pregnancy, check the gender, and screen for birth defects. Many of these women come only to Doña Ana for their prenatal care. What if she were able to improve her standard of care by offering ultrasounds? Is this something we could get a foundation to help invest in? How complicated is it to do accurate scans and maintain the equipment? Do we have a way to learn and teach this?
I'd love to find a way to partner with her, to share in what she's doing--recognizing that she's managing really well in her community, but maybe our lives could be enriched through connecting more. What could that look like?
A few days later one of the other girls in my program came with me to interview Doña Ana. In the context of the interview we could ask questions I might have found difficult to bring up otherwise. She talked about the discrimination that her patients have faced when they go to the hospital, because they´re poor and many speak Mam, a Mayan language, instead of Spanish. About five years ago she had two patients within two weeks of each other that she brought to the hospital with complications that seriously endangered the life of the babies. For both of them they were made to wait hours and she had to hunt down a doctor or resident to get them the attention they needed. When the second baby came out black and blue from lack of oxygen, the doctors begged her not to report what had happened so that they could keep their jobs. She agreed not to pursue the issue provided that they would listen to her and her patients could be seen promptly and respectfully. Now she´s treated well at the hospitals but the other midwives still have a hard time getting their patients the attention they need and there are no translators and very few bilingual nurses at the hospital.
Because so many of her patients fear going to the hospital, she would love to expand the services she offers out of her clinic, which is also her home. She has no laboratory tests or sonogram to offer her patients in their prenatal visits. A student who was with her at one point saw a premature baby born and not survive for lack of an incubator. The student called around and solicited Donations and eventually found and sent an incubator that Doña Ana now uses for premature babies. Doña Ana and the other midwives receive no help or training from the government. Her patients have to pay for the medicine they get so that she can make ends meet, but she does it on a sliding scale and makes sure they get what they need whether or not they can pay. She provides her consults and prenatal checks for only 5Q, about 70 cents, or, if even that´s a burden she´ll waive it. Between her and her husband she has found a way to provide for her family though, and provides a great service to her community.
I went back one more time after that and she was talking with the vendors of pharmaceutical products that she gives to her patients. They were true marketing types, congenial, chatting her up, handing over stacks of free samples, and eventually working around to the bill for last month. She actually moves a tremendous amount of medication and the 5Q visit is often accompanied by a 60Q ($7) injection or something like 150Q ($16) worth of pills and herbals. Her mark-up goes up to 25% depending on the economic situation of the patient and their family. It is still quite inexpensive, but it was interesting to see that from an income perspective she's really a pharmacist who offers midwifery services though her time is spent the other way around.
She's also been successful enough as a business person to build a new house and shop which was under construction while I was there. She'll be moving from her old consult room with it's jumbled shelf of pills and medications to a bright blue extension with glass cabinets and better lighting. The cinderblock construction is two floors and will expand both her house and office spaces. This is interesting because it means she has sufficient capital to make major investments that she feels will be worthwhile.
A friend of mine brought up the idea of leap-frogging in technology, like getting cell phones in rural villages before landlines. When she talked about ways she would like to expand her practice she mentioned blood tests for pregnancy, which are more accurate than urine tests, a women's support group, and an ultrasound. It turns out the girl who was interviewing her has a mother who's an ultrasound technician. For now Doña Ana palpates the fetus in the womb and can tell the general orientation of the baby. She listens to the heart through a stethoscope and can tell if it's beating or not. Part of me deeply respects these physical diagnostic skills that she can get so much information through such low tech and direct observation practices. On the other hand with an ultrasound she could get more detailed information about the development of the fetus earlier in the pregnancy, check the gender, and screen for birth defects. Many of these women come only to Doña Ana for their prenatal care. What if she were able to improve her standard of care by offering ultrasounds? Is this something we could get a foundation to help invest in? How complicated is it to do accurate scans and maintain the equipment? Do we have a way to learn and teach this?
I'd love to find a way to partner with her, to share in what she's doing--recognizing that she's managing really well in her community, but maybe our lives could be enriched through connecting more. What could that look like?