Family Planning for Guatemalans Living in Poverty

One of WINGS’ longest-standing programs is our network of roughly 35 Volunteer Health Promoters: community leaders identified within underserved rural areas to be a local point of service. Through their intimate linguistic and cultural knowledge of the communities they serve, they are able to provide quality contraceptive counselling, low-cost short-acting methods, and referrals to WINGS medical clinics for additional services.

Our Volunteer Health Promoter, 40 year old Enma Rodas, started with WINGS 5 years ago after being referred by a friend that was in the program at that time. She has become one of our strongest supporters, advocating for reproductive health in Guatemala: “Family Planning means everything to me. It helps us in every single aspect of life and thanks to it, I have a better life. My siblings have a better life. My community has a better life. Everyone is better.”

Enma serves the community of San Pedro Yepocapa in Chimaltenango. She used to sell cosmetic lotions in her community and started promoting contraceptive methods to her clients. Now she has around 40 patients. “I bring everything I learn from WINGS to my village. Now, after all this time, I see meaningful changes in the women that are using a contraceptive method. They are happier because they can enjoy their lives without being afraid of getting pregnant.”

San Pedro Yepocapa is a poor community and most of Enma’s patients are unemployed or work as farmers. She explains that promoting reproductive health to village elders is extremely difficult, since they believe many myths and are closed minded regarding contraceptives. “They say, for example, that anyone who uses the birth control injection will accumulate filth in her stomach and it will make her fat. It is hard to stop the rumors,” she explains.

Enma’s mother had 10 children but 3 of them died as children. Enma wanted to have 2 children, but she ended up having 3. “When my last daughter was 6 months old, I got a tubal ligation and it was the best decision of my life. I feel that I still have a lot of energy and I can fully enjoy my children, who are already teenagers!” She has two sons, 20 and 17 and a daughter who is 16 - she is proud that she talks about reproductive health with all of them. They, as well as her husband, are totally supportive of her.

She recognizes that working with WINGS means facing some hard moments. “Every patient reacts differently to each contraceptive method and sometimes they are scared, but I always try to calm them.” She loves to be part of this journey and she sees the rewards. “One of my patients is a 30 year-old woman with 8 children. I tried to convince her for long to use a contraceptive method. Now she is truly thankful to me and WINGS for helping her. Before she had no time for herself and her body was going through many changes. Now she is gets a monthly injection and she is happy because she feels self-confident and young again.”

Links:

• WINGS 2016 Annual Report

My name is Blanca and I’d like to tell you about a moving experience I had when I was a nurse with one of WINGS’ Mobile Units.

WINGS is always looking for ways to "reach the unreachable" - it's part of our mission and all of our service provision activities are set up to be delivered to rural areas of Guatemala. The Ixil Region is one of the most remote areas of our country. It is in the province of Quiché and is one of the parts of Guatemala most affected by poverty.

As WINGS started to take our services to Ixil, particularly the villages of Nebaj, Cotzal and Chajul, there were definitely moments of uncertainty on the part of our Mobile Unit team, since the known routes are difficult and the communities are incredibly hard to access. During our first clinic in Ixil, we especially appreciated the participation of Ministry of Health staff as they accompanied us to the remote communities where we were pleased to attend to 42 patients, among them 38 cervical cancer screenings (through visual inspection with acetic acid - VIA), 6 cryotherapy treatments, 4 subdermal hormonal implants, and 7 IUDs. We considered these results to be a great achievement, given language barriers and the culture of the area.

Among all the cases, one was special. Marisol was a 24 year old mom from Santa Avelina Cotzal, who had 4 children and weighed 99 pounds. She approached our nurses very fearfully, indicating that she was there only for a cervical cancer screening. But then, in a very low voice, she told us that she wanted to receive a contraceptive method because she no longer wanted to have more children. However, her husband refused to let her use a method and she was very afraid because her mother-in-law was standing just outside the clinic room.

She was counselled about the IUD as a discreet option where no one in her family would know about her chosen method. When her VIA results showed a positive result, the situation became a bit more complex since being treated with cryotherapy would mean that she should not have sex for at least a month.

The case was presented to the district nurse to address it jointly. Guidance counseling was given, and a commitment was made to hold a meeting with the husband, family, and health personnel to safeguard the client's integrity if she so chose in the future.

At last, after nearly an hour, she decided to place the IUD and receive treatment with cryotherapy, saying that she felt comfortable and protected.

As a nursing team we were happy and satisfied to have contributed to preventing cervical cancer and to support the wishes of this young mother by limiting her risk of pregnancy with an IUD. I am reminded with these cases of the important work that WINGS accomplishes by travelling to the most hard-to-reach areas and centering our care on doing what is best for each patient. I will never forget Marisol.