Helps International

Santa Avelina, Guatemala, January 9-15, 2010--
We returned to Santa Avelina for our second in-service

to find out how effective our training had been the previous year. After hugs and greetings, the comadronas were asked if they had been able to use any of the teaching from last year. Beautiful Marta, our most elderly comadrona, spoke up immediately, telling us about having a baby who wouldn't cry. She tried the stimulation techniques she had been taught, and then did mouth to mouth breathing. It worked! The baby breathed. Two others told similar stories. I could have danced on the ceiling! The teaching had helped those babies! To understand this, you should know that there is literature advocating that there is little value in training non-literate birth attendants since they cannot replicate the care that literate birth attendants can give. We agree with that in theory and would love to see that happen, but it is a fact that in the mountains of Guatemala the vast majority of births will be aided by non-literate comadronas. To receive feedback that the training had been helpful was incredibly reassuring!

This year, the first day was spent reviewing infant resuscitation techniques, with time included for every comadrona to practice the steps, especially mouth to mouth resuscitation. Other days we worked on cleaning and sterilizing instruments, maternal hemorrhage (prevention and

treatment), signs for transferring mother or baby to a hospital, breech births, and warming babies. Backpacks were given with tarps, ponchos, instrument pans with lids, bulb syringes, scissors, measuring cups for bleach, floss for tying the cord, and baby hats.

Ernie Didot, HELPS videographer, spent the week with us, videotaping techniques, even including comadronas teaching comadronas. Since non-literate societies use repeated story telling to learn, we hope this will be an effective teaching technique Our hope is to have several videos:

1. One in Ixil for the comadronas of Santa Avelina to review what had been taught. The video could be watched in the HELPS school with the aide of the librarian.

2. One in Spanish that could be used in other communities with translation into the local language.

3. One as a tool for health care workers interested in working with comadronas.

Interesting notes:

1. When asked what they would have done for the non-breathing babies before the in-service, we were told they would use a cut clove of garlic or pepper near the nose. One comadrona would put a hot machete on the (already delivered) placenta.

2. Only one of the comadronas would cover the pot of boiling water holding instruments. It is believed that to cover a pot would cause a woman's womb to close.

3. The comadronas were very intent on delivering the placenta, even when we were role playing a non breathing baby. Last year Dr. Matom mentioned that he was concerned about this and would prefer that they cut the cord and work on the baby unless the mother was hemorrhaging. This is an area we need to reinforce.

4. All of the homes we visited had dirt floors with sinks out in the yard. While we would love for the comadronas to use all of the cleaning techniques we taught, we realize that it will be difficult. One comadrona objected to using bleach because of the cost. (Q1 = $.12)

5. Eight of the nine comadronas signed with a thumbprint. One signed with a scratchy line.

We are so grateful to the comadronas for working with us so enthusiastically. We would also like to thank the Guatemala staff of HELPS International, especially Ana Nohemy Rodriguez de Sajil for her tireless efforts to work with our constantly changing ideas, and for translating faithfully into Ixil. Thank you to Holly Smith for creatively teaching the comadronas, Ernie Didot for making the videos and making us smile.

With amazing joy,

Lois Weeks