by Lucinda Grande
Many of us in the medical profession can recall a single moment of passionate clarity during a patient interaction that became a turning point in our lives. For many the moment occurred long before applying to medical school, in some cases during childhood. Mine occurred a year ago at age 53, during the final year of my late-blooming and absurdly prolonged medical training.
I was on the outskirts of Quetzaltenango, Guatemala, in the modest but flamboyantly turquoise-painted clinic of Dona Ana, an ebullient and experienced comadrona (midwife) who serves the indigenous Mayan community of San Juan Ostuncalco. I was nearing the end of my third year at the St. Peter Family Medicine residency program in Olympia, Washington. I had elected to spend a month at Asociacion Pop Wuj in Quetzaltenango, locally known as Xela. The program included intensive Spanish-language tutoring and participation in their urban and mobile rural clinics. I also opted to visit Dona Ana’s clinic – primarily as a novelty, because obstetrics was distinctly not in my future plans.
I had the delightfully good luck that two pregnant women arrived in active labor during my observation period. The first childbirth was smooth and dreamlike. Dona Ana radiated calmness. After the newborn girl was delivered, she was wrapped in colorful handwoven blankets, passed around between beaming extended family members who crowded into the delivery room, and at last returned to her mother to begin breastfeeding.
The second delivery was troubled from the start. The mother’s frequent prolonged contractions would almost certainly have ended in a cesarean section back home. Both Dona Ana and I expected a poor outcome. As we feared, the baby was born blue and limp, and was not breathing. Dona Ana briskly set to work suctioning his mouth with a worn-out device that infuriatingly malfunctioned. She held him upside down and slapped his back. She rubbed chopped onion in his eyes – presumably a traditional stimulation technique. His limbs moved a little but he didn’t breathe. I watched, paralyzed helplessly for 2-3 minutes, at a loss without the familiar breathing bag devices ubiquitous in the obstetric ward.
I somehow eventually overcome my fear and natural reserve. I stepped in and began performing hands-on chest compressions, a standard technique in family medicine training for newborn emergencies which I had never seen until that day. We worked frenetically together for 30 seconds or so. The baby then began to take some tentative gasping breaths. In the ensuing 3-5 minutes as we worked on him, his breathing became stronger. He began making some weak cries. He grew pale, then pink.Â Eventually Dona Ana felt his condition was stable enough to invite the family in to admire their new member. The exhausted mother was smiling. I was in tears and it was not because of the chopped onion.
The use of medical training to help a baby take his first breaths, in a remote “third world” setting: I had had a vague fantasy of doing something like this when applying to medical school, tempered by the near certainty it would never actually happen. Then there I was in Dona Ana’s clinic in Guatemala, where infant mortality is as high as in much of Africa due to weak government health services, mountainous rural terrain with poor roads, widespread poverty, and cultural obstacles.
Timmy Global Health has been providing support to the Pop Wuj medical clinic since 2009. After returning home, I approached Matt MacGregor, Timmy’s Executive Director, to propose a grant to Pop Wuj through Timmy to undertake training of Xela-area midwives in newborn resuscitation. We ended up broadening the grant’s scope to address pediatric malnutrition and to train community health workers. But clearly my heart was with the midwife project.
This week my concept came to magnificent fruition, following months of meticulous planning by Anna Pollock, Timmy’s project coordinator, in cooperation with the Pop Wuj directors and clinic staff, and with assistance from the Xela Ministry of Health. The Pop Wuj Guatemala team – Dr. Hugo, Dr. Wilder, and nurse Luby – trained 80 Xela-area midwives in Helping Babies Breathe, an evidence-based curriculum from the American Academy of Pediatrics intended for resource-poor settings exactly like this. We provided each of the midwives with a sturdy little penguin-shaped suction bulb and a newborn breathing bag. We were assisted by student volunteers, and Pop Wuj and Timmy staff. These experienced midwives clearly recognized the need and were thrilled to get the training and equipment.
I amazingly managed to lure Dr. Marilyn Berko, an Olympia pediatrician with a background in global health and Helping Babies Breathe, into joining me on this trip. She and I are both excited to continue working with the Pop Wuj-Timmy team toward our next goal of training and equipping the rest of the 1000 Xela-area midwives. I am extremely thankful to Timmy and Pop Wuj for providing this extraordinary opportunity to make a dent in infant mortality in Guatemala.
This week in a moment of poignant intensity nearly matching that of the baby’s birth a year ago, I received from Dona Ana the gift of a multicolored handwoven blanket embroidered with the following: “DR LUCINDA THANK SO MUCH FOR THE TRAINING. YOUR SUPPORT MADE OUR GROUP STRONGER. GOD BLESS WITH LOVE, THE COMADRONAS OF SAN JUAN OSTUNCALCO.”
More Photos from the Midwife Training (Click on the image to enlarge)