In Guatemala, mothers have a 7 to 10 times higher risk of death due to pregnancy-related conditions.
In the rural indigenous communities in which we work, women usually receive prenatal and delivery care from a traditional birth attendant (TBA), or midwife. Birth attendants are usually the only healthcare system available when life-threatening complications occur. That is why we at MHA|WK created a smartphone application program to collaborate with midwives to recognize maternal and neonatal complications and make sure indigenous women in rural areas can receive life-saving care, right when they need it.
Two months ago, a TBA – who is receiving training with our nurse Enma to detect pregnancy complications – brought Julia to our clinic. The midwife was worried about Julia’s pregnancy because she was diabetic. Julia was scared. She lost her last pregnancy due to diabetes-related complications four years ago. And this time, when she went to the government-run health center to get advice and treatment to prevent this from happening again, the nurses yelled at her, telling her, “You are so irresponsible: why did you get pregnant again if you know you are diabetic?” She left, not knowing what to do and worried that she or the new baby could die this time.
Due to diabetes, Julia had a high risk of developing pre-eclampsia and its complications. Pre-eclampsia, a syndrome that affects 3-5% of pregnancies, is usually diagnosed when a pregnant woman has dangerously high blood pressure. It is a main cause of death for both pregnant mothers and their babies, especially in low-resource settings like the rural indigenous communities in which we work, since hospitalization is necessary to make sure the mother and baby survive.
A trip to the hospital often takes 2-3 hours, and once they get there, indigenous women are likely to face discrimination, long wait times, and not receive care in their native Mayan language. To make sure indigenous women aren’t locked out of life-saving care, we give TBAs the tools to check their patient’s blood pressure, the fetal heart rate, and be able to contact us immediately with any questions and concerns—all within the comfort of the patient’s home. Julia’s midwife was able to check her blood pressure and condition, and we stayed involved.
When Julia started to feel ill, our midwife called us to describe the symptoms and arrange an emergency appointment. Enma and Sandy (our women’s health manager) found that Julia’s blood pressure was high: she had pre-eclampsia. They sat with Julia to explain the risks of preeclampsia in Kaqchikel, her native language. But she was scared to go to the hospital, back to the system that had treated her so poorly. But once we explained that we would check in on her, be in constant communication with her husband and the doctors, and be there for any need that may arise, she agreed to go.
We transferred her to the hospital, stayed in communication with her, and provided and paid for lab testing. She told us that at the beginning, she was shivering, scared of dying, but that with time she began to have more trust in our care, and started to feel like she was going to live…
And after a few days, her blood pressure was controlled, labor was induced, and she delivered a cute, healthy little girl weighing 6 pounds 6 ounces with no complications.
We all celebrated the success. These were just two lives saved, but two important lives. Not always does someone identify the signs of complications. Not every day do front-line health workers find a doctor or nurse to check on those complicated patients. Not all the time do patients feel that they can trust and communicate with their doctors and nurses in their own language. Not always are conditions detected early and lives saved. Not every day you find a team of dedicated people that are always there for their patients.
A few days after delivery, Julia came back to our clinic for a check up, accompanied by her husband and older son, and carrying a beautiful, healthy baby girl wrapped in blankets. Julia’s condition is improving. And, as a complete coincidence, the newborn’s name is Enma, the same name as our nurse that cared for her and allowed her and her mother to emerge from a scary pregnancy, happy and healthy.