by Danielle Dittrich
Vanderbilt School of Nursing
Quetzaltenango, Guatemala
The past two weeks have been an absolute whirlwind. After overnighting in Antigua I took a small bus for five hours up the winding mountains into the western highlands, finally arriving in Quetzaltenango. Quetzaltenango was and still is a principle center of Maya Ki'che and is often referred to by its Ki'che name Xelaju and abbreviated to Xela. Xela is a large city seemingly disconnected from the surrounding cities but by small winding dirt roads which the revamped and repainted yellow school buses ride along. Most women in the city still dress in traditional Mayan clothing, which becomes even more prevalent as you head out into the country side. Every morning we take the unmarked school bus from the bus stop at the Calvario Church into the mountains of Tierra Colorada Baja. Outside the church, venders sell flowers freshly cut from the mountains and beans and eggs out of street charts.
Now is the perfect time for me to be at the Primeros Pasos clinic, as many exciting changes are going on around me. Originally a pediatric clinic, the Healthy Schools Program is one of Primeros Pasos largest components. Health educators go out into the local community schools and teach about prevention of infection and communicable disease. By participating in this program, the children receive free healthcare at the clinic. For the schools that are too far from the clinic, Primeros Pasos has a mobile clinic which runs at the end of the school year. The end of the Guatemalan school year is now approaching so we have been hiking into the mountains with backpacks full of medications and medical equipment. As we are about to hit a lull in pediatric consults, all focus is on the new women's clinic.The women's clinic will run in conjunction with the women's groups that have recently started up in the community. Similarly to the Healthy Schools program, women that participate in the women's group will receive free care. The objective is for patient to invest in their healthcare through commitment to health education. In the afternoons we have been hiking into the mountains to teach the women's groups and to talk about the new women's clinic. The women's education group has three phases: The first phase focuses on nutrition, hygiene and traditional medicine. The second phase focuses specifically on women's healthcare topics such as cervical, endometrial, and breast cancer, pap smears and self breast exams, pregnancy and prenatal care, menstruation and menopause. The last phase focuses on self esteem and leadership. In this phase, the women have a choice to start a community wellness project or to become a health educator. We are hoping to find the next group of women's health educators from this group. Each day of the week is a different women's group meeting in a different community, all in different phases of the program. The women at the women's group range in age from teens to grandmothers. Most women bring along their children, tied onto their back and over their shoulder with a traditional woven clothe. The first groups are entering the third phase; it will be very exciting to see these women become leaders. You can easily tell the difference between the timid participants of groups in phase one as compared to the outspoken individuals starting phase three, who eagerly ask me inquisitive health questions and willingly discuss women's issues.
On the first day of my clinic orientation I already had a patient. I had been told that many mothers had been asking for help when they brought in their children, but I had not anticipated for things to happen so quickly. Unfortunately, all the clinic supplies were still in the apartment, so I did the best I could with what I had. I guess you can say the women's clinic unofficially opened the first day and officially opened two days later and I have had at least one patient every day since. A new group of medical students have just started their rotation at the clinic. Two of the six medical students are females and I will be training them in the basics of obstetrics and gynecology in the primary care setting. It will be exciting to see them grow into the role of provider over the course of their eight week rotation. I can already tell that everyday will be a new adventure.
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