An essential part of our work empowering indigenous health workers, who understand our patients’ languages and cultures, is our partnership with Mayan midwives.
Most Mayan women choose to give birth at home with traditional midwives because of the discrimination, distance, cost, and other barriers they face accessing care at public hospitals. Our Maternal Mobile Health Program equips midwives with the tools and supports they need to identify and address problems and avoid maternal and neonatal deaths.
Doña Marina, mother of 12 and a midwife for 40 years, is one of the women who works with us in the Tecpán region. A year ago, she was devastated when a mother in her care died nine days after giving birth. When the mother began experiencing vomiting, diarrhea, and difficulty breathing, Doña Marina tried to convince her family to seek hospital care, but they insisted on working only with a healer in their home. The mother died, leaving two orphaned girls.
For months, Doña Marina mourned, wondering what she could have done to convince the family to allow the patient to go to the hospital. Over that time, members of our Maternal Health team visited with her regularly to provide support and talk about how to avoid similar tragedies.
“I was very afraid to use the equipment and the telephone that Wuqu’ Kawoq had given me, but little by little I began to recognize that this helped my work,” she recalled. “I can hear the baby's heart, I can see the blood pressure. I have more strength because I know that there is a team receiving the information and supporting my work with my patients that answers my calls regardless of the hour.”
Doña Marina now has more confidence to make the case to families when advanced medical care is required. “I have more courage to point out the dangers to the patients and their families,” she said.
The support also has improved her relationship with the nurses and doctors in the hospitals that receive her cases. “Hospitals say that midwives send patients too late, in very bad condition. Wuqu’ Kawoq gives us the support to make referrals on time. Thank you, thank you to all the people who make our work valued, dignified and recognizable. I am proud of the work I am doing. Everyone judges us, but Wuqu’ Kawoq does not.”
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The Covid pandemic has overwhelmed Guatemala's public health system and left many pregnant women feeling isolated, highlighting the need for our Maternal Health Program navigators, who accompany women on their journeys and provide a variety of supports along the way.
From July 2020-June 2021, midwives and navigators with our Maternal Health Program have monitored 769 births and saved 31 lives by identifying potential problems in pregnancy and connecting mothers with the care they need to avoid further complications.
Doña Ana's story is just one example.
At the time of her fourth pregnancy at age 31, Doña Ana, a field worker from a village outside Tecpán, was living in fear of her husband. He was controlling and verbally abusive, especially when he was drinking. Several years earlier, she had put her first child, whom she had with a former partner, under the care of a relative out of concern for the child’s safety.
Because Doña Ana had a Cesarean delivery with her last child just over a year earlier, workers at the local health post advised her to seek medical care during her pregnancy to address potential risks and to consider another Cesarean delivery. She was reluctant to do so, fearing that it would provoke her husband, who did not like her to leave home. Working with our care navigators, Doña Ana was able to get her husband’s agreement to see a doctor at the Tecpán Health Center and schedule a Cesarean delivery.
A month later, she developed pain in one of her legs and went for an evaluation at the Health Center. The doctor indicated that if the pain persisted, she should go to the hospital and seek emergency care. In a follow up call, our team noted the possibility of premature labor and advised a hospital visit. In calls over several hours, our team attempted to convince Doña Ana’s husband to allow his wife to seek care at a hospital, but he refused to allow her to leave the house before dawn.
Early the next morning, Doña Ana, who continued to experience pain, met our care navigator, who had been waiting for her at the hospital. With sadness, she revealed that she had left the house secretly. Communicating through the navigator, who translated from Spanish into Doña Ana’s language of Kaqchiquel, the gynecologist indicated that Doña Ana should be admitted for treatment to stop labor since she was just 27 weeks into pregnancy. Doña Ana broke down in tears, sharing her fears that her husband would not agree to the treatment. After repeated unsuccessful attempts to contact her husband, Doña Ana agreed to have the navigator reach out to her mother-in-law. The mother-in-law expressed surprise and concern, approved the hospitalization, and agreed to speak with her son. After being released, Doña Ana let the navigator know that things were ok with her husband upon her return home.
A couple months later, Doña Ana again began experiencing labor pains before her scheduled delivery. Thanks to her earlier experiences, she understood that it was important to get help regardless of how her husband might respond. But when a doctor suggested that she should be admitted for treatment of an infection, Doña Ana again began to worry about her husband and about care for her children who were at home. Fortunately, this time, when she spoke with her husband, he said he supported the treatment and agreed to care for the children at home. Crying tears of relief, she agreed to stay.
Three weeks later, after waiting at the hospital with several shifts of navigators for more than 24 hours, Doña Ana gave birth by Cesarean delivery to a 6-pound 4-ounce boy. Today, she is enormously grateful for her healthy new baby and for the support and care she now receives from her husband. She credits her work with our team for teaching her the value of her own life.
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Here in Guatemala, the pandemic continues to pose a serious threat to both individuals and the health care sector. Only about 3% of the population has received any vaccination and less than 1% is fully vaccinated. Thankfully, our Maternal Mobile Health Program continues to overcome barriers and provide life-saving care to mothers and infants.
Our midwives, who are trained local Mayans, meet patients where they are at, socially, culturally and importantly physically. They travel to expecting mothers to lead them through home births when possible, and when not, arrange for transport to local hospitals, where our navigators help guide them through the healthcare system.
This program serves several communities and many women. One recent patient was 23-year-old Doña Irma, who had had a bad experience in the hospital delivering her first child and was planning on delivering her second at home. A midwife attending her at her home noted that Doña Irma was not in labor although she was past 40 weeks pregnant and her water had already broken. The midwife communicated with our emergency team, who coordinated a plan to get Doña Irma to a local hospital for a safer delivery.
Despite severe rain, we were able to safely transport Doña Irma to the hospital along with one of our navigators. Doña Irma mostly speaks the Mayan language Kaqchikel, which complicates healthcare for her as most Guatemalan doctors only use Spanish. Luckily, navigators from the Maternal Mobile Health Program were there to translate and advocate.
Ultimately, Doña Irma avoided a C-section and other complications, and gave birth to a healthy baby. Doña's Irma’s two hospital birthing experiences stand in sharp contrast. With her first child, Doña Irma was in the hospital alone, struggled to communicate with doctors, and felt scared. The second time around, she felt supported, comforted, and was able to better advocate for herself with our navigators’ help.
Despite the many obstacles arising during the pandemic, the midwives and navigators in our maternal mobile health program have continued to make house visits to expectant mothers and help them access hospital services when necessary.
Mothers like Doña Rosa, 42, who late into her pregnancy experienced high blood pressure, blurred vision, and headaches. Her midwife had been monitoring her symptoms using our mobile health app and noted that her condition was worsening. She urged her to go to the hospital to check for preeclampsia, which can cause serious problems for both the mother and baby.
Concerned that she would be stopped at one of the COVID barricades in the journey across four communities, Doña Rosa was reluctant to leave home. She agreed to make the trip only after our care navigator offered to accompany her and help negotiate the many barriers.
After a long journey, Doña Rosa delivered her child at the hospital through a cesarean section due to complications from preeclampsia. Throughout, the navigator helped Doña Rosa, who speaks Kaqchikel, communicate in Spanish with the doctors.
When the doctors pressed Doña Rosa to undergo sterilization, the navigator advocated on behalf of her patient, who declined the procedure.
Doña Rosa is now home with her baby and doing well; her blood pressure is under control. From time to time, she calls the maternal mobile health program to express her gratitude. She tells them she saw death flash before her, but now she is ok.
In the Tecpán region where we have piloted our program, maternal deaths among the hundreds of mothers we serve have dropped from eight in 2016, to four in 2017, to zero in 2018, 2019, and 2020.
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