Friday, October 16, 2009

Fifteen Births

Today was a pretty amazing day. First at lunch, I ran into the father of a baby I watched being born on Monday night. I'd gotten to know his wife during our weekly Pregnant Mother's Group and she'd really wanted to come to the Casa Materna, but it was her first child and the labor was prolonged so the gynocologist decided it was too risky for her to leave the main hospital. She was disappointed though, and definitely frightened, so I'd stayed with her to help her breath through the contractions and rubbed her back to ease the pain. When her husband arrived and I tried to excuse myself to let them be together, they both said "Don't go!" So that was how I saw my first birth (ever) (yes, I know it's crazy considering I'm doing this project that I had never witnessed a birth before). All I can say is, Women are frickin amazing. I felt kinda bad that I got to enter the OR and the father wasn't even allowed to. After it was all over, and the OR staff had left her lying on the operating table to recover (she'd had a small episio, but no caesarean) I congratulated her and she told me she didn't know what she'd have done without me. I thought of the hundreds of moms who give birth alone in Bolivian hospitals, at times even before the nurse or doctor arrives. It was a powerful bit of participant observation, to say the least.
Anyway, so it was pretty cool to run into the proud father today, who greeted me and proceeded to buy my friend and I a HUGE bottle of Sprite in thanks. It was really sweet feeling.
Then, in the afternoon, one of the nurses came excitedly running to tell me that she had recruited a patient to come to the Casa Materna, that her husband was enthusiastic at the prospect of being able to see his new infant arrive (although they were a local Punata family, not rural indigenous Quechuas). Finally, I thought, I get to witness how the whole Parto Intercultural really works. Somehow up til now (despite the fact that we've had 15 births since August, woo!!) I've always been absent in the moment it happens. While I felt a little silly hanging out without a specific role, I occupied myself with boiling water and offering the mom anise tea during the dilation.
Of course it would happen that while they'd predicted a 10pm delivery, when I returned at 9 oclock after running to my house for a bite to eat, the baby was already crying on the weighing scale. Aw, man.
But then, another woman arrived from a little farther out of town and wearing the traditional "pollera" skirt. I talked with her sister in law and learned it was the first time either of them had given birth in a hospital, all of their previous children had been born in their home, attended by their husbands. However, the husband was out of town so they'd decided to come to the hospital, and found out once they got there about the Casa Materna (proof that we still have a lot of work to do spreading the word about it). Why did she want to come to the Casa Materna, I asked her and she replied that she wanted to have her baby "sentadita" (sitting down).
Of course once again, I left the room for just a minute after bringing in a cup of mate, and suddenly heard the cry of the second baby. I guess I'm just not meant to see it happen... :) But regardless it was quite a thrill to be so close to the process and get to comfort the moms and hold the newborn infants.
After it was all over and I'd said goodnight to the mom's and the doctor, I called a taxi to return to my house. "How's the Casa Materna?" asked the taxi driver as I climbed in. "What? Oh my gosh, how are you?" He was the father of another child born in the Casa Materna, back in September. Wow, what a day. :) Orientation with Dr. Vallejos in the Casa Materna Demonstration of one possible birthing position . Beautiful Sunrise on our way to an early morning community meeting. Promoting the Casa Materna in Lacanasuyu. The promotoras explain the Casa Materna in a community meeting in Laguna Sulty.

Friday, October 9, 2009

Señor de Milagros

As promised, here are some ridiculous photos and videos from the fiesta Señor de Milagros en Punata. Dancing with the capaorales was an incredible experience... exhausting, hilarious and unforgettable. I cant say too much more than enjoy the videos and hope you laugh as hard as I did when I first saw them. :)

Introducing "El Bloque Internacional" made up of myself and two friends who are Japanese peace-corp-type volunteers. We even made it onto the local news... haha. video
This is Paso (Step) 7 one of the trickiest we learned...This is my friend Ronald who is a college student and professional dancer. He does a lot of the choreography for the fraternity and taught us all the steps.
We got asked to take our picture with about 3 people per city block, but the younger members of the fraternity were especially excited to pose...

So the videos are giving me some technical difficulties, but I will upload more asap. Hasta pronto! Here are more fotos as well: http://picasaweb.google.com/kirsten.hansenday/SenorDeMilagrosPunata#

Saturday, September 19, 2009

Bolivian Moments and Bailando Caporales!

Every once in a while I get these “oh my god I’m in Bolivia” moments. Today I had a particularly beautiful one: I walked into an aisle of the Cancha (the largest open air market in Latin America, or so I’ve heard) thinking I would find a small refrigerator for my new apartment and instead stumbled upon stacks of dried llama fetuses, supplies for K’oas (burnt offerings to the Pachamama) and a row of yatiris reading people’s suerte (luck) in coca leaves and tarot cards... pucha, que maravilla.
The thing about the Cancha is that there’s really no way to find what you’re looking for without asking at least 4 people and/or getting hopelessly lost for half an hour or so. On the one hand totally inconvenient. On the other hand, shopping in the Cancha inspires way more social interaction than it takes to drive to Fred Meyer, park in the parking lot, and buy everything you need in 15 minutes. You have to talk to the 4 people who give you directions, the aproned women that you inevitable bump into in the crowded stalls, the casera that bargains with you over the coveted item once you finally find it, (and maybe even throws in a “yapita” or couple of extra fruits or vegetables as a kind of thank you and insurance of future business.) You trade convenience for human contact. Yep, I’m definitely in Bolivia.
Tomorrow is my caporales dancing debut in Punata. Its the Convite, kind of like a dress rehearsal, where we’ll parade all over town with our fraternity of dancers, but in matching t’shirts rather than the whole caporales outfit. Oh, yes, except we do get to wear the huge, jingle-bell covered boots. Which have no padding so you have to stuff them with cotton to survive the 2 hours tour of leaping and twirling across the paved streets. Hopefully we’ll have the kinks worked out for the Fiesta Senior de Milagros next weekend, where well dance in full costume for people from all across the Valle.
Learning the steps has been SO much fun though. My block of dancers includes myself and 2 friends who are Japanese (peace-corps-type) volunteers and we rehearse for an hour and a half every night. The scary thing is I’m technically “comanding” the block, or calling out the steps before we do them and yelling the signals to start and stop them… and with just the 3 of us pale white foreigners, I’ve a feeling we’ll be watched by pretty much everybody. Ack.
I will post pictures and hopefully videos of this ridiculousness after the fiesta, but for now, here’s a few videos to give you an idea of what the caporales dance is like. Enjoy!


Note: i will be dressed like the guys, not like the ladies in short skirts... thank goodness!

Saturday, September 12, 2009

Casa Materna in the News!

Some exciting news this week: A Cochabamba newspaper came to report on the Casa Materna in Punata! I have some issues with the reporting, for example we're trying to get people to stop using the term "humanized" (as if the other way of attending births was inhuman). I also don't think any of the women gave their consent to have their names printed in the paper. But "informed consent" doesn't seem to be a priority for everyone here. All the same it's great that people will be reading about the Casa Materna! Here is my (rough) translation of the article, the title just doesn't translate well though... (let me know if you have suggestions!). Here is a link to the original. Also check out this cool video with one of my colleagues describing the Casa and one of the health promotors as well!!

In the Punata Hospital, women of quechua origin can give birth in a squatting position, with the presence of their family members and traditional midwife, just as they would in their homes.

Four babies born with "humanized birth"

By Alcócer Caero Gisela - Los Tiempos - 9/09/2009


Atención a una gestante en la Casa Materna, de Puata, ayer. - Goitia Rodolfo  Los Tiempos

Attending to an expecting mother in the Casa Materna de Punata yesterday. -Goitia Rodolfo Los Tiempos

The "humanized birth" model, a project which was first presented six months ago in the Punata Hospital has now brought into this world four children. Three were born without a single problem, while the fourth with complications, but the life of the baby was saved thanks to a cesaerean section that prevented him from being strangled by the umbilical cord.

The Casa Materna of the Punata Hospital began attending its first patients that seek respect for their cultural traditions (such as giving birth in a squatting position) while ensuring a healthy birth.

According to the doctor responsible for the center, David Antezana, although it was inaugurated in March of this year, it began to function in June, since it lacked staffing to care for the women and now the Mayor's office, Hospital, and an organization from the United States (i.e. Compton Mentor Fellowship!!) obtained the resources to get the project going.

The center was installed to fulfill Law 496 that establishes that every woman has the right to be attended in accordance with her customs and understanding of her pregnancy and birth.

The first woman to give give birth with the "humanized birth" model, in the squatting position and with a midwife and the supervision of a doctor (note: this is not actually true, her husband supported her but there was no midwife present) was Valeriana Mamani Chura, aged 41, who learned of the center from her neighbors in Vacas and decided to come. The birth was a success, although the child weighed 4.100 grams. She left the hospital the next day with her son in her arms.

The second was Arminda Panozo Zurita, from Punata and 24 years old. She didn't want to renounce her family's traditions and opted for the special ream where she could have her baby in a squatting position and with the presence of her mother and a midwife. Her baby weighed 3.400 grams.

The last woman to use the Casa Materna was Aida Jiménez Saavedra, who learned of it in Toco. Her last birth was in her home and with the help of a midwife, she suffered a lot and almost lost the child. For this reason, she decided to come to the hospital for the security, but she didn't want to use the gynocological table and opted for the mattress to give birth in the squatting position. Her daughter weighed 2.600 grams and she left the hospital 2 days later.

Respect for traditions

The first humanized intercultural birth room in Cochabamba was inaugurated March 3rd of this year in the Hospital Manuel Ascencio Villarroel de Punata, with the economic support of Japonese Cooperation, which invested 65,000 dollares to make the space function.

It is hoped that this initiative will reduce the deaths in childbirth in all of the country, that are at least 190 cases for every 100,000 women of reproductive age and 61 of every 1,000 children born alive. These rates are so high in Bolivia because the women in the rural areas culturally give birth in their homes, acompanied by their husbands and other family members, in vertical positions and without the possibility to survive potential complications because there aren't specialiests or equipment for cesaerean sections and can bleed to death.

This new birthing center is designed so that indigenous women that come to the hospital don't feel traumatized by a health system opposite to their traditions, whichh, until now, obligated them to wear light colored gowns, impeded their family members from entering the room and made them lie down to give birth in a horizontal position.

Sunday, August 30, 2009

Poco a poco...

Well, time is flying by and I am learning tons and tons everyday, about Punata, about Bolivia, about international cooperation, and about myself. Here's a few examples:

1. Punateños really like meetings. And there are many rules that accompany said meetings. Like you must add at least half an hour to the set meeting time in order to predict when the participants will arrive. Introductions are formal, and there is a lot of summarizing and repeating what other people have said. They also have this very useful practice of writing by hand the main conclusions of the meeting in a "Libro de Actas" which everyone then signs at the end if they're in agreement. Although ususally I can't read the handwriting, so I'm not totally sure what I'm agreeing to...

2. Formalities are really important here. You can't just invite someone to a workshop by phone or email. You have to deliver them a letter. The more official seals and signatures the better. If not, they may get angry.

3. I think that the language of community diplomacy is probably the most complex level of communication in a second language that one could reach... and I am NOT there yet. Body language, tone of voice, word choice... yeesh. Needless to say, I feel like a bumbling idiot a lot of the time. Luckily, most people here seem to expect nothing less of me...

4. It's really strange to play the role of "financiadora." It makes it hard to tell when people are being sincere sometimes, and when they're being strategic. And being the only one here identifiable with the Compton folks, I'm the point person for "Couldn't your project also buy this equipment? Or hire one more nurse?". This is when # 3 becomes really important.

5. One of the hardest questions to answer is when people ask me what my profession is. Technically, I guess I should say "Biológa." But that doesn't really clarify too much. And after 17 years of perfecting the art of being a student, its hard to feel like I know how to do anything else.

6. A nice thing about being a student is that most of the time you have control over who you spend your time with. If you don't like a prof, often you can switch courses. If you don't like a fellow student, the most you have to work with them is for a group project or presentation of a few weeks. In the workplace, however, if you don't like someone, or, say, they treat you like you're a 12 year old girl, you still have to work with them, possibly every day. I've realized that learning to deal with people that rub you the wrong way is just something that you don't learn in college. But I'm working on it!

7. I have a hard time concealing my emotions in any context. This makes number 6 a little more difficult.
The view from my room in Punata.

Things are going really well in Punata though. We've hired our three promotoras and two doctors who are all very committed and excited about the project. What's more, we've signed an agreement with the hospital that they will hire on the two doctors at the end of January, so that they can continue to share their skills and knowledge with the rest of the staff for the future sustainability of the Casa Materna.

This week we had two days of training and planning sessions for the entire Casa Materna team. It was a challenging and really exciting experience, despite some logistical kinks (see number 5 above). My favorite part was just reveling in the depth and diversity of knowledge in the room as we sat around a table planning out every aspect of the care we're going to offer in the Casa Materna; the gynocologists, the traditional midwife, the nurses, and promotoras all had something to offer.

Then, that night, one of our projects doctors attended her FIRST intercultural birth in the Casa!!! I had the awesome experience of interviewing the mother and father after the fact, who were SO positive about the care they'd recieved, so grateful for the chance to give birth like they had 10 times before in their home with the husband kneeling and supporting his wife from behind, rubbing her back to ease the pain. They wanted to thank the "Doctorita" for being so patient and for not immediately ordering a C-section as others sometimes do. Their main suggestion was for more medicinal plants that we could stock up on, for matés that ease the birthing process. Hopefully there will soon be many more happy families like theirs!

So I have yet to take pictures of the Casa Materna, but to keep this from being one long block of text, I will share a few shots from the incredible festival of the Virgin of Urkupiña two weeks ago. It's like Carnaval, but minus the water balloons...

Dancing with my friend Julia and the Tinkus

Julia and I with the Caporales of San Simon (who inspired me to join a fraternity to dance Caporales in Punata in September.... more on that soon!)

My friend Aida with el Supay (Diablo) of the Diablada.

On Saturday night there is a 16km pilgrimage from Cochabamba to Quillacollo (where the Virgin of Urkupiña appeared to a little girl back in the day). My friend Julia and I decided we couldn't miss out. So at about 2am we left the bar where'd been dancing and joined the thousands of Bolivians all walking down Av. Blanco Galindo to pay respects to the Virgin. Like a giant moving party basically, until we arrived at 8:30 in the morning at the Calvario. Which was a little anticlimatic, but probably because of the exhaustion and our lack of personal commitment to the Virgincita.
Arriving at the Calvario: so many people!

You can see more pictures of Urkupiña here: http://picasaweb.google.com/kirsten.hansenday/FiestaDelUrkupina#

Friday, August 7, 2009

¡Back in Bolivia!

Dear Family, Friends, Professors, and Interested Strangers,

Welcome back to my blog! As many of you know, I have returned to Bolivia for a year to work on a maternal health care project with the support of a Compton Mentor Fellowship. I hope to keep you all updated on the progress of our project throughout the year, as well as my other adventures and musings on life in Bolivia. I hope you enjoy it and don't forget to leave comments! :)

So what exactly am I doing here? At its core, the goal of my project is to increase indigenous Quechua women's access to and satisfaction with maternal health care services in the Valle Alto of Cochabamba. We plan to do this by promoting an Intercultural model of hospital care that increases women's autonomy in the birthing process, valorizes traditional Quechua practices, and minimizes medical intervention in low-risk births.

Note: For those of you who want all the background info, read on. For those of you who've heard me talk about this a million times, feel free to skip to "Casa Materna Punata"

Background Info: Maternal Mortality and Sociocultural Barriers to Care:
So why is this necessary? Bolivia suffers from the highest rate of maternal mortality in Latin America: in the year 2000, an estimated 290 women died in childbirth for every 100,000 live births. There are a lot of reasons for this. For Bolivia's rural, indigenous majority, financial, geographic and sociocultural barriers restrict access to public health services. The health ministry has made many efforts to remedy this by building physical infrastructure to serve remote areas and providing free health insurance for pregnant women and children under age five. However, use of these services remains low. For example, in 2003, only 30% of births in the country’s rural areas took place in health care centers or hospitals.
While the geographic and financial barriers to maternal care have been addressed to an extent, cultural and social barriers remain a serious obstacle. Birth is a sacred event for the Quechua people of the Andean highlands, as evidenced by the wealth of rituals, beliefs, and customs that surround it. But for many Quechua women, giving birth in a hospital setting can be a traumatic and humiliating experience. Traditionally, women give birth in the home, surrounded by their family members. They often undergo labor fully clothed and in a squatting or kneeling position, which with gravity and the woman’s natural body movements, proves to be physiologically beneficial for both the mother and the infant. The husband may rub his wife's back, support her, and give her herbal teas to speed the labor. Dark colored blankets cover the floor and the room is dimly lit because strong light is believed to damage the baby's eyes. After the birth, the placenta is buried in the family’s patio with small gifts and food to ensure the future prosperity of the child. Family members perform a symbolic ritual burnt offering called the Q'oa, to give thanks for the new life, and prepare special foods so that the new mother can regain strength.
The contrast between these customs and the standard procedures of a modern hospital birth could not be starker. Many women are scared or ashamed to be attended by an unfamiliar male doctor. In addition, husbands are known to become jealous as a result of perceptions of the doctor’s central role. Women have also experienced discrimination or mistreatment by biomedical doctors who are often simply serving their obligatory six months of rural service before returning to a more lucrative practice in the cities. Regardless of their upbringing, university training tends to encourage doctors to exclude themselves from Quechua culture and to value Western knowledge over all others.
Bathing, shaving, and touching the woman's genital area is traumatic to many Quechua women, for whom modesty and privacy are very important and the chilly, sterile hospital environment can provoke anxiety over catching a cold, a common fear in the harsh Andean environment. Women may fear staining the white sheets with blood, bodily fluids, or dirt, as bathing is not always possible in their rural lifestyle. And the requirement that a woman undergo labor on her back on a gynecological table with her genitalia exposed is humiliating, as well as physiologically disadvantageous. Thus, it is not surprising that so few women are inclined to seek medical attention when they go into labor.
Many women believe that only complicated births require hospital delivery, but often problems aren’t apparent until labor has begun, so medical assistance does not arrive in time. Thus the cultural inaccessibility of hospital birth attention has serious and significant implications for women’s survival when problems arise during labor

An Intercultural Model of Care
For many years, Bolivian organizations like Acción en Salud Integral (ASI) and Causananchispaj have been working to address this issue and develop new models of care that better respond to the cultural practices of indigenous populations. ASI has helped various clinics in the rural provinces of Cochabamba and Northern Potosi implement a new model called "El Parto Intercultural." The model emphasizes communication and collaboration between the family, healthcare staff, and traditional birth attendants. Modern medical techniques are available should the need arise, but primarily the woman is allowed to give birth naturally with the support of her partner and family members. Intercultural birth rooms are designed to feel more similar to the homes where women would traditionally give birth. The sheets and bedding are dark-colored and the room is kept at a warm temperature by boiling water on a gas stove. Family members may feed the mother familiar foods or teas and the mother is supplied with a hospital gown that is similar to her usual dress. Unnecessary procedures such as shaving the mother's pubic hair, enemas, and routine episiotomies are eliminated.
Most importantly, the mother is allowed to labor in the position she prefers, whether walking, standing, sitting, kneeling or squatting on a specially designed mattress, while supporting her weight on a shoulder-height bar. This practice not only is more culturally acceptable, but also healthier, as it dilates the blood vessels, improving oxygenation to the mother and child, and decreases pressure on the uterus, reducing the effort and duration of labor.

The need to adapt birthing protocols to indigenous cultural practices has been recognized in other Andean countries as well. In Peru, after the implementation of such changes, health ministry studies found that in the rural areas, the proportion of births that took place in public health centers increased from 22% in 2000 to 40% in 2004. A similar project in Chile found that the Intercultural attention and vertical birthing position actually diminished the risk of cesarean section.
Various hospitals that have implemented the new model have already demonstrated the potential to greatly increase use of maternal health services and thus reduce maternal mortality. For example, in Torotoro, Potosí, in the year after the Intercultural Model’s implementation, deaths due to complications of childbirth were reduced from twelve in 2005 to only one in 2006.
Yet, there is still much resistance to these changes on the part of biomedical practitioners. The supine gynecological position is more convenient for the delivering nurse or physician to be able to medically intervene, especially if complications arise in during labor. The herbal medicines, vertical birthing position, and other traditional practices are often misunderstood and viewed as evidence of rural peoples’ “backwardness” rather than appreciated for their cultural and physiological merits.

Casa Materna Punata
So back to the original question: What am I doing here? Well the truth is a lot of that I am figuring out day by day. My project revolves around a Casa Materna, or intercultural birthing center, that was recently built by Japanese foreign aid in Punata, a mid-sized town 45 minutes from Cochabamba. It is the first center of its kind in the area, and the first in the country to be built next to a higher level hospital, where medical specialties like gyneco-obstetrics are available. While the physical infrastructure is there, the Casa Materna has yet to begin functioning, primarily for lack of human resources and resistance on the part of those specialist doctors, who dont see the necessity or importance of the intercultural model.
So our project is filling in that niche. We're hiring two doctors who will be trained to attend births in the center, in collaboration with the husband, midwife, and/or family members that the mother chooses to accompany her. The part I'm the most excited about will be working with a promotion/ investigation of team of 3 women from the community to spread the word about the new model through workshops, sociodrama skits in the marketplace, and home visits with families in the rural communities surrounding Punata, as well as interviewing women about their experiences. Once things are really working well, the plan is for the doctors to train each of their colleagues, one by one, in the new model. Because honestly, it seems that most of their resistance stems from an inability to imagine how one might attend birth in a vertical position and what it would be like to actually collaborate with family members and midwives, and that witnessing a colleague attending in this way might reassure them. I guess we'll see!
The second half of the year will be devoted to diffusing the results of the investigation and spreading the intercultural model throughout the region.... but I’ll have to tell you more about that when we get to it!
So thats the scoop for now, things have been going really well, the local government approved the project, I’ve been making friends in Punata, and we’re hiring doctors next week! Hope you all are well, take care, and I hope to write more soon!



New Friends on a Weekend Trip to Chapare!

Thursday, June 19, 2008

Pictures!!

Hi Everyone-
So I finally figured out how to upload my pictures to Picasa so you guys can see more of them than I've put on the blog. They aren´t very organized but hopefully you´ll enjoy them! The address is www.picasaweb.google.com/kirsten.hansenday

I just got back from touring the Salar de Uyuni with my dear friends Katherine and Katherine from Oberlin and Seattle. We´re headed to Tiwanaku for the Aymara New Year celebration tomorrow night and then on to Lake Titicaca and the Isla del Sol and then Peru!!! I´m super excited to be traveling with them, but it was definitely sad to leave Cochabamba.

Chau for now!
Kirsten