A Lesson in Healthcare from Rural Guatemala

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“Can you hear that? That’s your baby’s heart beating! Everything sounds good,” Sandy, one of the women’s health nurses here at Wuqu Kawoq, explains in Kaqchikel to a young, soon-to-be mother as she holds the Doppler on the woman’s pregnant belly. Her patient, Sylvia, smiles and nods in relief and recognition of that familiar sound. While this interaction in isolation may seem straightforward, the number of steps that have gone into making it happen are impressive:

Sandy is a bilingual (Spanish and Kaqchikel) nurse who travels over two hours each way to visit this particular community where she has a cohort of prenatal patients. She often carries prenatal vitamins, urine dipsticks, and ultrasound gel in her backpack with her as she travels, because restocking her supplies in this rural community is no easy feat. She carries her computer with her to enter her notes in the electronic medical record. She works with a local community coordinator to find and recruit pregnant patients in the area.

Sylvia is grateful that Sandy can come to her community. Even the local Health Center is farther than she would be able to go on a regular basis, because she has many responsibilities at home in addition to preparing and selling tamales to help supplement her husband’s income as an agricultural worker. Here with Sandy, Sylvia is able to have consistent monthly prenatal visits.

I watch as Sandy draws Sylvia’s blood to run prenatal labs (which she has come prepared for – she has rapid test kits with her to give Sylvia her results on the spot). She weighs Sylvia and measures her blood glucose levels to test for gestational diabetes, and she checks her urine for any signs of infection. She measures the height of Sylvia’s abdomen and checks to make sure it matches how many weeks along she is.

After all these steps are complete, Sandy sits down face to face with Sylvia. She counsels her on everything from how to deal with common problems in pregnancy (nausea, back pain, acid reflux), to what warning signs to look out for (bleeding, severe abdominal pain, lack of fetal movement), to family planning options for after she gives birth. Sylvia takes all this information in, and she says she would like to have a contraceptive implant placed after she gives birth. She is excited to have a new baby in the house, and she wants to wait a few years before having another kid. These conversations are just as important, if not more, than the tests Sandy just finished running. Sandy’s counseling allows her patients to be informed agents of their own health, and she makes their pregnancies safer by ensuring they know which signs mean they need to go straight to the hospital.

As a medical student, I can’t help but compare this prenatal visit between Sandy and Sylvia to the prenatal visits I have seen in New York City, where I study. An equivalent visit in the US would include a doctor, a nurse, a medical assistant, a phlebotomist, and a lab, at a minimum. Here in rural Guatemala, all these roles are filled by Sandy. And yet, I find it deeply impressive that Sylvia is still receiving high-quality, comprehensive prenatal care, albeit without all the fancy equipment and personnel. What’s more, she is receiving this care in her own language and in her own community.

For me, this is what I will take with me next year when I return to the US to finish my medical education. More than any fancy labs or pristine clinics with abundant medical staff, patients want to be listened to, they want to be engaged in their care, and they want to be understood. That is what the nurses of Wuqu Kawoq are providing.