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Women Making a Difference

Mayan Auxiliary Nurse-Midwives, Guatemala

By Erin McCarthy

“I am in love with the work I do,” Pabla Moreno Milian beams, Cobán, Guatemala.

Pabla Moreno Milian is an energetic, passionate and skilled birth attendant who has been working for the last two years to save lives in her home community of Chisec, Alta Verapaz, Guatemala. A mature 22 year old, Pabla is the only daughter in her family to have had the opportunity to get an education.  In return, she has dedicated her life to give back to her community. In the 20 villages where Pabla now works, there was not a single maternal death in either 2006 or 2007.

In Guatemala, Pabla and many other young women are making a difference by reducing maternal mortality in their communities. These exceptional leaders were trained as auxiliary nurse-midwives, by a program developed by the Ministry of Health with support from URC through the USAID-funded Calidad en Salud program. The program  is training and placing skilled birth attendants in remote Mayan communities of Guatemala, where modern obstetric techniques are still viewed as a threat. Amidst these and many other obstacles faced in rural communities, these dedicated young women, are helping to save lives.

Since 2005, the eight-month training program has been preparing Mayan auxiliary nurse-midwives to address root causes of high maternal mortality rates in Guatemala’s remote rural areas. Under the program, which combines clinical training with aspects of Mayan culture, the nurse-midwives  are learning to instruct and supervise traditional birth attendants, provide quality pre- and post-natal care, and more effectively attend births. Perhaps, most importantly, the nurse-midwives are learning to quickly detect signs of complications and to refer patients in time to receive the critical medical care they need. In addition, the nurse-midwives are working with families and traditional caregivers to train them in recognizing warning signs and with communities to establish emergency plans to transport patients to health centers and hospitals.

Amalia Lem Coy, another Mayan auxiliary nurse-midwife, describes a delivery which took place in the village of Paquix. One her first experiences with birth complications, she made a successful referral: “One of the first things I did as I began work in my community was form a health commission within the community so that in a time of emergency, help is available.  A month after forming this committee I received a call from one of the health vigilantes, Don Santiago, who came looking for me early in the morning as I was preparing to start my daily visits. Don Santiago reported that the local midwife was with a woman, Ana, who was experiencing prolonged labor—they had been working on her birth for more than 24 hours and needed assistance. Upon arrival, I checked her vital signs, which were normal.  Nevertheless, Ana was experiencing irregular contractions and had more than 12 hours of broken membranes. Quickly, I thought, we need to activate the community emergency plan. Ana was carried in seat to the health center by the commission for 45 minutes. The health center took her in, hydrated her and monitored her birth. Three hours later she was mother of a healthy new boy.”     

Initial data from the program show that the 88 nurse-midwives who have been placed so far have referred over 400 women to clinical services. The auxiliary-nurses have worked with community emergency committees to facilitate timely transfer of women with complications, thereby addressing another significant obstacle to appropriate medical care.

Integral to their success has been the trust and confidence these nurse-midwives have established with traditional midwives. According to Pabla, “I work closely with the local midwives to monitor all pregnant women in the community to schedule visits and plan for delivery. We keep a list which tracks all of the women in need of maternal care.  I have been working in my community for over two years now and the traditional midwife will not do anything without consulting me. We are a real team. In some of the more isolated communities where I work, I may stay the whole week to make sure the woman receives the support she needs as transport is a real concern.”

The communities in which the Mayan auxiliary nurse-midwives have also taken note: 

According to community resident Oscar Ixquiac, “The community is incredibly grateful for the work of the Mayan auxiliary nurses. The work that they carry out is of equal satisfaction to us and to them. The fact that most originate from the communities where they work, speak the local language and share the same customs supports their performance and has been critical to their success in reducing maternal mortality. Previously many women and infants died here when they experienced complications at birth. However, with the help of the Mayan auxiliary nurse-midwives, this has changed.”

Pablo Castillo, a driver who has worked with the Ministry of Health for decades, describes the program as “the program of miracles. Never in my 27 years of working with the Ministry have I seen a program that reaches the people so much. The families and communities are so grateful for this influence of these young women and their support and offer what they have in return—tortillas, beans—anything to show their gratitude.”

The program continues to gain visibility and credibility as the Ministry of Health incorporates the position of Mayan auxiliary nurse-midwife into its salaried structure and has committed to training more auxiliary nurse-midwives.  The Gynecology and Obstetrics Association of Guatemala recently recognized them as honorary members.

Pabla dreams that one day all Guatemalans will have equal opportunities.  Her contribution, as well as those of her peers, is a significant start.

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