March was a busy month and therefore went by really fast. I attended two vertical births, one of which continued on as a postpartum patient with her newborn baby in the casa de espera. The first vertical birth I attended was the patient of another midwife who is a friend of mine. This midwife has her own little birthing center here in Atalaya and sometimes has to deliver babies by herself when the nurse who works with her is off duty. On this particular day she was concerned about her patient because the baby’s heartbeat was a little fast, so she called me to see if I could also be present for the delivery. I ended up attending the delivery, so that in case the baby needed extra attention after delivery, she could take care of the baby. The patient had a beautiful delivery in a sitting position, but not only did the baby need some extra help transitioning after birth, the mom also needed extra attention as she was bleeding a little too much. Thanks to some simple interventions performed by myself and my midwife friend, both mom and baby ended up doing well.
The second patient was a native woman from a community many hours away who was only visiting Atalaya when she went into labor. She wanted to deliver in a sitting position, so the hospital called me to help attend her birth. The midwife on duty preferred to watch me attend a vertical birth at least once before attempting to do so herself. Therefore, I attended the birth and she observed. The patient quickly delivered a baby boy with no complications and was grateful to be able to give birth in the position of her choice. They next day, lab analyses revealed that the patient had syphilis, so she and the baby needed to stay in Atalaya to receive treatment for the next couple of weeks. Therefore, after being discharged from the hospital, they came to stay at the casa de espera, where we were able to ensure her health and that of her baby. Without the casa de espera, they would have had no place to go while finishing their treatment and may have left without receiving the treatment they both needed.
I also kept busy in March with educational sessions, preparing materials for the promotion of vertical birth, and other events related to the International Day of the Woman (March 8). The educational sessions included three via the radio, one in a neighborhood in the city of Atalaya, one with lay midwives from the native communities along the Tambo River, and three in native communities along the Ucayali River (San Pedro Lagarto, Chicosillo and Tahuante). In these sessions, we continued to promote vertical birth as well as maternal and newborn health with topics such as caring for the newborn, hand washing, danger signs in pregnancy and postpartum, danger signs in the newborn, and family planning.
The need to educate the community about such topics is really important here because there is a lot of misinformation going around. For example, many women here are afraid to use birth control due to the myth that it will cause hemorrhage or pain. Many of these same women end up with eight or nine children and have no means to properly care for them. Therefore, dispelling such myths and encouraging women to take control of their fertility is important for their health and the health of their entire family. Hand washing is another good example. Many, especially in native communities, rarely wash their hands even after performing some very dirty tasks including changing dirty diapers or working all day in the dirt. This leads to some pretty bad infections that can sometimes end up being deadly. For instance, a breastfeeding mother may not wash her hands after changing a dirty diaper, then touches her breast as she offers it to her baby. The baby can become infected, resulting vomiting and diarrhea. Worsening the situation, parents often wait far too long to seek medical attention when they or their children become ill. Then when they do finally bring their sick baby to the hospital, the baby is very ill and it is sometimes too late to save them. Therefore, we are going out into the community to educate women and men on how to prevent, identify and care for such conditions.
In every one of these educational sessions, I have continued to promote vertical birth, but found that the materials I have been using are not really culturally appropriate. Therefore, I decided that I needed to put together some materials designed with the women from this region of Peru in mind so that they would be better able to identify with the materials. I found two local pregnant women who consented to being models demonstrating the positions of vertical birth, and made the materials more colorful and using local terminology.
For the International Day of the Woman, we decided to celebrate women by offering an entire week’s worth of events including a Pap smear campaign, a march to promote women’s rights, educational sessions on the radio, and a soccer championship. The topics of the educational sessions covered a variety of women’s health issues, including breast cancer, cervical cancer, and pregnancy-related issues.
During the two-day Pap smear campaign, we performed more than 60 Pap smears and breast exams completely free of charge. We also did a lot of teaching via the radio and with the patients of our campaign on cervical cancer and the importance of receiving Pap smears regularly. I found out that cervical cancer is a significant problem among women in Peru, as many do not get their Pap smears done regularly or have never even had one done. I performed Pap smears on several women for the very first time, including one woman in her 50s. Thankfully, none ended up with cervical cancer, but we did find several at risk and therefore counseled them on their risk and that, for them, an annual Pap smear is even more important.
With all the work activities in March, I really didn’t have a lot of time to do too much else, although I did get to go dancing with some friends a few times. Dancing is very popular here with both men and women. They mostly like the cumbia, salsa, and huayno (a dance from the Sierra). My favorite is the salsa! I may have even less time in the coming month, which is the last full month I will be here in Peru. I cannot complain, though, because working hard is how I will make the most difference.