Guatemala, Part 3

Part 1

Part 2

In the early morning hours of August 14, our fifteen year old patient was in the throes of labor. Her contractions were pretty regular and her comadrona said the pregnancy had been fairly healthy, nothing out of the ordinary. We felt ready to deliver.

A few hours into the labor, however, it became clear that things were not okay. As we lacked medical equipment, we had no way of knowing that the baby had breeched– gotten flip-flopped in his mother’s womb and was coming out feet first. Under normal circumstances this would require a skilled obstetrician to decide whether to continue or perform a cesarian section. Recognizing this, I began to plead with the mother and her family that they go to a hospital, we simply did not have the skills to do this. The family spoke little Spanish, however, and tension was starting to run high as the baby’s heartbeat was getting more and more faint. In addition, due to the cultural complications of Guatemala, the woman feared that going the four hours to a hospital would only result in her being turned away as an indigenous woman.

For her, that risk outweighed the risk of trying to deliver there. She insisted on staying and continuing.

A couple more hours in, an even more harrowing realization occurred when we noticed that the umbilical cord was exiting with its feet ahead of the child’s head, which put pressure on the cord and stopped oxygen flow to the baby. This is called an umbilical prolapse and even in developed countries in hospital settings, this type of birth is extremely dangerous and always calls for an emergency C-section. Even then, the risk of damage to the infant or the mother is extremely high and the mortality rate for the fetus is around 17%. Despite more pleading that they get to a hospital– we were untrained student volunteers, not doctors– the family insisted on staying, reiterating the fear that they would not receive attention in the city because of their language and culture.

Taking in the distress of everyone in the room and feeling that we could no longer be of any help, I made a decision to call my volunteers out of the situation. Having five strangers look on helplessly, speaking a foreign language and not knowing what to do just did not seem like a good way to be of assistance. The only other important thing I knew was that the mother needed to stay on her left side so that the baby’s umbilical cord would not be crushed, but unfortunately the birthing assistant would not translate that from Spanish into Chu’j (or perhaps she did not understand my Spanish), and the mother continued in labor with her comadrona coaching her.

After about four hours of labor, only half of the baby was out. His lower half hung from the mother and as we coached it out the rest of the way, it was evident that the child was not breathing and had not been for a while– it’s body was discolored and not warm. The pressure on the umbilical cord had stopped oxygen flow and he exited silently and lifeless in my hands– fully formed, full-term, but stillborn from the physical trauma of the last few hours.

It is hard to describe that moment in time. My volunteers were visibly upset and quiet. The mother and her family looked on as I started to perform CPR, though it was evident that it was too late. After a few minutes, the mother’s family took the baby into the kitchen near the stove, hoping that warming it back up and continuing CPR might resuscitate his tiny body. They continued to try for another hour. I felt broken. I felt responsible. I had just lost this young woman’s child, which only hours prior had had a healthy heartbeat and was ready to enter the world. My journal entry reads:

August 14

I just watched

helped

5 hours

a woman

who couldn’t go to the hospital

–4 hours away—

because she would be discriminated against

knowing the risk

knowing the child in her belly was transverse

try to give birth

in a wooden room

cord, followed by feet first

GO TO A HOSPITAL”

but there are no nurses

no doctors

no ambulance

for 4 hours

she pushed

LAY ON YOUR SIDE”

WAIT”

while her comadrona is telling her different

we stepped away for a while. We prayed

an hour later

they called us in

everything but the head was out

but in the back of my mind I knew the cord had been crushed for hours

it wasn’t breathing

but for another hour

they pumped

and pushed

and warmed

and breathed

and tried

daddy crying

blood on my hands

baby boy

I held him

and tried to make him breathe

he wouldn’t breathe

It was one of only two or three stillborn deliveries in the history of the village. Ever. We were entrusted to take care of these people and we had failed in the worst way imaginable. We left the family to mourn. Needless to say, everyone was extremely shaken and emotional and the rest of the night into the next morning was somber. I felt an instinct to put my own anguish aside temporarily and be sure that my crew and the family were alright. Seeing death first-hand– being a part of it– is not an easy thing to deal with. My volunteers came together privately to mourn and express our complicated emotions. It wasn’t until several hours later that I knelt by myself outside the dorms to acknowledge my own feelings and pain and allowed myself to grieve.

In what seemed like a surreal series of events, we awoke the next morning to two sounds: the nailing shut of a tiny coffin, and the first cries of a healthy baby girl who had been delivered easily and successfully while we slept. The cycle of life had never been more tangible than right then.

When the nurses returned the next day we were still all fairly upset. Although we knew it wasn’t our fault– the baby was at very high risk from the beginning– it weighed heavily on us. I took a chance to speak to the young woman, her husband and her family, noting that although it was hard to understand, they were actually lucky– the mother could have lost her own life in that process and her living through it was a testament that life would go on and they could try again. In a gesture that left me unable to speak, the father thanked me for saving his wife’s life and for trying to save his son. He thanked me even though I had failed him.

With the help of the nurses, we went on to assist in several more births during the rest of our time in Calhuitz. It is true, delivering a baby is not the most difficult thing in the world, as long as there aren’t complications. I have faith that we would have been able to successfully deliver the baby boy if it had not been for the prolapse. I also feel that if it weren’t for the complex cultural and societal prejudices of Guatemala with regards to indigenous people, that child would have had a better shot at surviving. His mother should not have felt afraid to go to a hospital. His family should not fear being denied basic care because of their ancestry. Much of the whole situation was out of our hands in the far larger scheme of things.

Even so, it was difficult to not feel at fault for losing the baby. That trip cemented my own decision to step away from public health for a long time. I went on to write my master’s thesis largely about that experience, motivated by anger that we were unprepared and many parts of the whole trip felt unnecessarily dangerous and inappropriate for untrained volunteers. My thesis focused on volunteer training and preparation in developing world settings, including writing a handbook for future volunteers with Global HEED. After presenting my thesis, I decided to take time away from the field, and I continue to struggle with the complexity of how I feel about global public health in a larger scale. Sometimes the problems around the world seem insurmountable and too complex to even begin to fix. That leaves me feeling kind of useless, hopeless. But ever the optimist, I do hope to find some way of impacting people positively. One giant shining beacon in this story is that two of my volunteers have gone on to earn Master’s in Public Health and begin their own noble paths trying to make the world a more just place through health and education. I will always be incredibly grateful for the strength of my volunteers, the graciousness of the people of Calhuitz, and opportunities that allow me the privilege of working face to face with the most basic and universal parts of humanity; life, death, and human connection to one another.

If you are interested, I wrote two spoken word poetry pieces after this experience. They can be found here:

YouTube: This Is Public Health, pt. 1

Blood on my Hands

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