Women Making a Difference

Mayan Auxiliary Nurse-Midwives, Guatemala

"I am in love with the work I do," Pabla Moreno Milian beams in Cobán, Guatemala. Source: URC-CHS

Pabla Moreno Milian is an energetic, passionate, and skilled birth attendant who has been working for the past two years to save lives in her home community of Chisec, Alta Verapaz, Guatemala. A mature 22-year-old, Pabla is the only daughter in her family to have received the opportunity to obtain a school education. In return, she has dedicated her life to giving back to her community. In the 20 villages where Pabla works, there was not a single maternal death in 2006 and 2007.

In Guatemala, Pabla and many other young women are truly making a difference to reduce maternal mortality in their communities. These exceptional leaders, known as Mayan auxiliary nurse-midwives, form part of a training program developed by the Ministry of Health (MOH) with the support of the USAID/Calidad en Salud program, which is placing skilled birth attendants in remote Mayan communities of Guatemala. In these communities, a common language is spoken, yet lack of acceptance of modern obstetric techniques remains a real threat. Amidst these and many other obstacles faced in rural communities, these dedicated young women are contributing to lives saved.

Since 2005, the Mayan auxiliary nurse-midwives have received training to address the root causes of high maternal mortality rates in Guatemala's remote rural areas. Under an eight-month scholarship program, which combines clinical training with aspects of Mayan culture, the nurse-midwives have been trained to instruct and supervise traditional birth attendants, provide quality pre and postnatal care, and more effectively attend births. Perhaps most importantly, the nurse-midwives are trained to quickly detect signs of complications and to refer patients in time to receive the critical medical care they need. In addition, the nurse-midwives are working with families and traditional caregivers to train them in recognizing warning signs and with communities to establish emergency plans to transport patients to health centers and hospitals.

Group of 21 Mayan auxiliary nurse-midwives graduates from the National School of Nursing. Source: URC-CHS

Amalia Lem Coy, another Mayan auxiliary nurse-midwife, describes one of her first complications and successful referral, which took place in the village of Paquix. "One of the first things I did as I began work in my community was form a health commission within the community so that in a time of emergency, help is available. A month after forming this committee, I received a call from one of the health [workers], Don Santiago, who came looking for me early in the morning as I was preparing to start my daily visits. Don Santiago reported that the local midwife was with a woman, Ana, who was experiencing prolonged labor; they had been working on her birth for more than 24 hours and needed assistance. Upon arrival, I checked her vital signs, which were normal. Nevertheless, Ana was experiencing irregular contractions and had more than 12 hours of broken membranes. Quickly, I thought, we need to activate the community emergency plan. Ana was carried in seat to the health center by the commission for 45 minutes. The health center took her in, hydrated her, and monitored her birth. Three hours later she was mother of a healthy new boy."

Initial data from the program show that the 88 nurse-midwives who have been placed so far have referred more than 400 women to clinical services. The auxiliary nurses have worked with community emergency committees to facilitate timely transfer of women with complications, thereby addressing another significant obstacle to appropriate medical care.

Integral to their success is the trust and confidence built with the traditional midwives. According to Pabla, "I work closely with the local midwives to monitor all pregnant women in the community to schedule visits and plan for delivery. We keep a list that tracks all of the women in need of maternal care. I have been working in my community for over two years now and the traditional midwife will not do anything without consulting me. We are a real team. In some of the more isolated communities where I work, I may stay the whole week to make sure the woman receives the support she needs, as transport is a real concern."

The communities in which the Mayan auxiliary nurse-midwives work have also taken note. According to Oscar Ixquiac, "The community is incredibly grateful for the work of the Mayan auxiliary nurse-midwives. The work that they carry out is of equal satisfaction to us and to them. The fact that most originate from the communities where they work, speak the local language, and share the same customs supports their performance and has been critical to their success in reducing maternal mortality. Previously, many women and infants died here when they experienced complications at birth. However, with the help of the Mayan auxiliary nurse-midwives, this has changed."

Pablo Castillo, a driver who has worked with MOH for more than 27 years, describes this program as "the program of miracles." He says, "Never in my 27 years of working with the Ministry have I seen a program that truly reaches the people. The families and communities are so grateful for this influence of these young women and their support and offer what they have in return – tortillas, beans – anything to show their gratitude."

The program continues to gain in credibility as MOH incorporates the position of Mayan auxiliary nurse-midwife into its salaried structure and has committed to training more auxiliary nurse-midwives. The Gynecological and Obstetric Association of Guatemala recently recognized them as honorary members of the Association.

Pabla dreams one day that all Guatemalans will have equal opportunities. Her contribution, as well as that of her peers, is a very important start.

Story provided by the USAID/Calidad en Salud project, managed by University Research Co., LLC

>>> Read more stories from the Women Making a Difference in Global Health Series