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Guatemala: Atención de Mujer a Mujer
By Holly Carpenter
As a full spectrum doula and nursing student in the US, I have had ample opportunities to witness the ways in which the culture of hospitals can harm, rather than heal. Hospital caused infections, medication administration errors, and overly managed birth all have negative consequences for patients who enter the hospital environment in search of help and good health. As an intern at a women's health clinic and birth center in Guatemala, I have seen these consequences reach a pervasive and profound extreme I didn't realize was possible, especially for women seeking care during pregnancy and childbirth.
I arrived at Asociacion Manos Abiertas (AMA) on a Friday and by Saturday morning I was two hours away in a tiny village setting up a field clinic for cervical cancer screenings with Carmen and Sandra, two of the Guatemalan clinic staff members. We spent the next two days doing over 125 screenings in a makeshift clinic, battling moscas (flies) with electric fans and the faulty health care system with plastic speculums and vinegar. The real challenge, however, was hearing the stories, and not just because my Spanish leaves something to be desired. I’ve worked in many women’s health settings, from a double wide trailer in rural Sonoma county to the inner city San Francisco General Hospital, but nowhere have I heard stories like these. Women who went to the national hospital for their six month prenatal visit and were told that the position of the fetus at that time was enough to warrant a planned c-section. Rampant domestic violence. Women who requested hysterectomies but were never able to find out whether they were actually performed after their c-sections. Babies half delivered and then manually forced back into the uterus because of shoulder dystocia and delivered through the most grotesque and barbaric cesarean incisions one could imagine.
The theme that really stayed with me though, was the total disempowerment and lack of respect these women faced in the hospital setting. Let me qualify by saying that I haven’t yet been to these hospitals, nor interacted with the health care providers employed there. I don’t know what the pressures were that caused the providers to treat these women so poorly - if I could hazard a guess, I would say it’s probably an extreme lack of resources, minimial funding, low quality education, and a political system that impedes most progressive and idealistic individuals. The doctors I have met are generous, intelligent, and extremely respectful of their patients. But the truth was in these women’s downcast eyes, quiet voices, and complete lack of confidence in their ability to take control of their health. It took nothing more than a sympathetic word to start the stories flowing. The questions about bleeding and birth control. The embarrassment over a grade three prolapsed uterus and the relief from one widow that her husband was dead - setting her free from future pregnancies... she felt 11 was more than enough. These are not typical stories that you hear in the US, with all its health care problems. Occasionally, to be sure. But these stories came from many voices, and echoed the same theme over and over. They had no power.
Fortunately, las mujeres de Guatemala have at least one possible alternative: Asociacion Manos Abiertas. Manos Abiertas is the opposite of the impersonal, disempowering hospital system here. When women walk in the door of our brightly painted clinic, often accompanied by children and partners, they are greeted as peers. They are shown respect, interviewed about their wishes and desires regarding their health and family planning, and provided with a comprehensive set of services including psychology consults, pediatric care for their little ones, and complete gynecological care. Women leave empowered and eager to continue their care with AMA. Best of all, this is not a typical non-profit staffed by gringos with mediocre Spanish (with the exception of me!). The care is largely provided by Sandra and Carmen, women from this community who embody the concept of atencion de mujer a mujer.
If Manos Abiertas didn’t exist, these women would have no alternative to the national hospital. I only wish it could exist in every community here, and indeed, throughout the developing world. It is a simple and beautiful solution to a problem that most international leaders acknowledge as being among the greatest facing our generation - poor maternal and child health care.