Day 269: Rock Bottom

“When this ultimate crisis comes… when there is no way out – that is the very moment when we explode from within and the totally other emerges: the sudden surfacing of a strength, a security of unknown origin, welling up from beyond reason, rational expectation, and hope.”*                                       - Émile Durkheim

As I discussed in my last post, I try very hard to keep a positive outlook in Guatemala.  This is largely for my own sanity and for the wellbeing of those around me, but it’s also for you, my readers, who probably don’t want to read a bunch of online whining.  However, there are times, like now, when being a Peace Corps Volunteer in Guatemala just…well, just sucks.  And I feel like I would be doing a disservice to you, and to me, if I lied about that, and only told you about the more positive aspects of service.  So I’m warning you now that this post is not a happy one.  Take comfort from the fact that, as I am a couple weeks behind in blogging, I can promise you a much much happier post next time.

I know it’s melodramatic to say I’ve hit rock bottom.  It’s entirely possible that I will feel worse at some point in my service.  But this is the most hopeless and unhappy I’ve felt so far during my time here, and in this environment of fluctuating and extreme emotions, that’s saying something.

So what went wrong?  I can think of five things that kind of snowballed to bring me down.  First, in a casual conversation with my two health center bosses, I learned that they thought my role as a Peace Corps Volunteer was basically to bring them money (this is in fact pretty much the opposite of what Peace Corps is about).  My health center staff thought I would be paying for foreign doctor visits, surgeries, vaccines, medications, you name it.  They were disappointed that I hadn’t brought them any of these things.  I explained to them that Peace Corps does not provide direct funding to the communities with which it works, and that my job is more about capacity-building.  They then asked me if I could find them organizations that would bring them money.

I fully understand that money is lacking in my community, and that without appropriate funding it’s really hard to practice good medicine.  It’s absurd that when someone comes in to the CAP with a head laceration, we send them back out to the local pharmacy to buy thread for suturing.  It’s crazy that we can’t use our ambulance because we can’t afford gas.  But I also know that we can improve community health using the resources—largely personnel—that we already have.  And it’s becoming clearer and clearer to me that the work of many charity organizations in Guatemala, while producing good short-term results, has lead to a crippling culture of dependency.  The fact that my health center bosses want me to spend my time here searching for foreign aid, rather than working on local capacity-building, makes me wonder why they requested a Peace Corps Volunteer in the first place.  It also makes me worry that I don’t have their full support for my project.

After this illuminating chat, I had to draft and submit my semiannual Volunteer Report Form, or VRF.  The VRF is basically a summary of what you’ve accomplished in site, what you’re still working on, and how you feel your community integration is going.  I had heard from other volunteers and Peace Corps staff that your first VRF can feel a bit lacking; the slowness of community integration and project development here means that you generally achieve very little in your first six months.  But I had a few solid activities to list, and I felt good about my VRF.  I knew that some of my comments on community integration (read: frustrations with my host family and health center staff) were somewhat negative, but I also felt that they were honest.

Shortly after submitting my VRF, my Peace Corps boss emailed me with edits and comments.  She thanked me for my honesty, and told me that the best course of action over the next few weeks would be to adjust my expectations.  As the first Maternal and Child Health Volunteer in my site, she said, it’s very possible I won’t really achieve any positive health outcomes.  Instead, I should focus on integrating as best as I can, so that integration and project work will be easier for the next MCH volunteer.

I know that my boss was trying to be helpful—to give me something positive and attainable to work toward.  But her words left me reeling.  Making the next volunteer’s job easier is a fine goal, but it doesn’t seem to me like it’s worth two years of my life.

I thought a lot about her words over the next few days at work, especially when my Pregnancy Club (which, let’s be honest, didn’t have that promising of a start) completely derailed.  I had planned the next session with the CAP health educators, and I arrived the morning of the meeting ready to make posters and buy snacks.  When I asked the health educators if they were ready for Pregnancy Club (just trying to make light conversation, really), they shocked me by replying that they had forgotten about it, that they hadn’t invited any pregnant women, and that we would have to reschedule.

I tried to be casual and upbeat about this little snafu.  It would, after all, give me extra time to make posters and practice my presentation.  We rescheduled for the following week, and left it at that.

But when I reminded them about the Pregnancy Club the next week, the educators told me that they had once again forgotten about it and had a conflicting event that day anyway.  This time—and I know this sounds really over-the-top but it’s true—I felt too frustrated to even bother rescheduling.  That’s not to say we’ll never have another pregnancy club; I just didn’t have the moxie to try again that day.

My fourth frustration took the form of a Peace Corps training on Behavior Change.  The training, intended for Peace Corps Volunteers and their Guatemalan coworkers, took place at a delightfully zany hotel in the department of Chimaltenango.  I was excited to get out of site/not have to cook my own food/spend time with other volunteers/learn about how to encourage and measure local behavior change.

Some photos of said zany hotel:

The bathrooms

The bottle-construction exercise room

The exercise room proper

"Daniel and Gabriel's Forest" (I love you, bro!)

The other Peace Corps Volunteers and I quickly learned that the three-day workshop would not actually involve much new information; instead, we would sit through about twelve presentations we had already seen.  We were supposed to use our prior knowledge to encourage and help teach the Guatemalans.  Unfortunately, Guatemalans can be a difficult bunch to teach.  This is partly due to widespread childhood malnutrition (which causes decreased brain capacity), partly due to the poor education system (Guatemalan teachers encourage rote learning, and frequently take random days off), and partly due to impenetrable culture clashes.

Some examples:

When I asked my two coworkers for examples of how to do a community health diagnostic (hoping for an answer like “interview patients” or “compile diarrhea statistics”), they stared at me for over thirty seconds before suggesting, “We could ask the Municipality for money.”

My friend Paul and his coworkers, while planning a lesson on “Warning Signs in Newborns,” got in a fight about who they would give this lesson to.  Paul thought the lesson should be given to mothers and fathers.  His coworkers argued that the lesson should be given to the newborns.

My fifth and final frustration was a small run-in with my host dad.  I’ve been having a lot of trouble sleeping recently, because of the frequent Muñeca barking sessions at 2:00 and 3:00 am.  I’ve been trying to think of a way to bring this up to my host family, and I seized the opportunity when my host dad started telling me about a special flower that treats insomnia.  I pulled a, “Oh, maybe I should try that.”  When he asked me if I suffered from insomnia, I explained that the dog’s barking has been keeping me awake.  He then said, “Well, that’s not what’s keeping you awake.  There are a lot of barking dogs in the neighborhood, and it’s not ours.  Besides, there are a lot of drunks who walk the streets at night, and if it weren’t for our dog, they would break in to the house.  That dog is keeping you safe.”

So.  All of these things have me feeling pretty down about my work in Guatemala.  I keep asking myself the same questions: Why am I in Guatemala?  Can I achieve anything here?  How?  How can I work with people who only seem to want money that I don’t have?  How can I motivate educators who rarely get paid, and who will all lose their jobs when a new president is elected (that’s how socialized medicine works here)?  Why am I in Guatemala, when I could be at home, with people I love and who love me back?

*Here’s hoping.

Day 251: Semana Santa and Semuc Champey

“Two thousand years ago Jesus is crucified, three days later he walks out of a cave and they celebrate with chocolate bunnies and marshmallow Peeps and beautifully decorated eggs. I guess these were things Jesus loved as a child.”     - Billy Crystal

I was recently informed by several confidantes that my last blog post was a bit negative; for that I apologize.  I do try to stay positive here, but, as I know better than anyone, I have a tendency to slide into self-pity and just stay there.  It’s all too easy to focus on homesickness, and what isn’t working in my community, and how I have it so hard.  When I stop to reflect, though, I actually have it pretty good.  I have all the basic stuff—my health, a sturdy house, a loving family, etc. etc. etc.  But I also have a lot of tiny comforts that many Peace Corps Volunteers (and Guatemalans, and people around the world, for that matter) go without.  I have a working hot shower.  I’m close to a hippie gringo town, where I can buy quinoa and sometimes even Pop-Tarts.  I can exercise safely and happily on my stationary bike.  I can afford to take vacations—and this brings us to the main topic of this post.

It’s Holy Week in Guatemala, and it’s a big deal.  There are no measly Easter egg hunts or pagan bunny costumes; it’s all about the resurrection of Christ.  Seemingly half the western hemisphere gathers in Antigua for celebratory parades (each parade participant shouldering about 90 lbs of a heavy wooden “float” showcasing various saint statues or Jesus’s tomb).  The streets are lined with alfombras, intricate pavement designs made with brightly dyed sawdust.

Pretty rad, even in hazy weather.

Said alfombras are destroyed as the parades (or rainstorms) pass over them, and then recrafted for the next day—because the Holy Week celebration lasts for at least four days, from Thursday through Sunday.  Interestingly (to me, at least), the biggest parades and Masses take place on Good Friday, the day of Jesus’s crucifixion, while Easter Sunday is more a day of rest and recovery.  When I passed through Antigua on Easter Sunday, the streets felt exhausted and abandoned, with only a few stragglers constructing half-hearted flower alfombras.

Most Guatemalan Peace Corps Volunteers take vacation during Holy Week (Semana Santa), because there’s so much to see around the country and no one’s working anyway.  My friend Naomi and I decided to take a trip to Semuc Champey, widely regarded to be the most beautiful place in Guatemala and one of the most beautiful places in the world.  The best way I can describe Semuc Champey is as a series of turquoise pools cascading down a limestone land bridge, which in turn stretches across a rushing river.  You kind of have to see it.  And so, starting from far away and gradually zooming in, I give you the following photographic masterpieces:

Perhaps the single downside of Semuc Champey is how difficult it is to get to.  It’s only 190 miles (by road) from my site, but it took Naomi and me 14 hours to get there.  First, our shuttle from Sololá to Antigua was an hour late.  I actually didn’t mind this so much, because it gave us the opportunity to observe a street vendor making and selling some sort of…health drink?  After juicing a few oranges, the vendor would add a mysterious powder to turn the OJ green (the box holding the powder promised sexual endurance and clearer sinuses and all sorts of things).  Then, just before handing the glass to a customer, the vendor added one or two (unrefrigerated) raw eggs.  Naomi and I watched in awe as customer after customer chugged the fluorescent eggy concoction.  When they finished, the vendor scrubbed out the glass, gave it a quick rinse, and set to work creating more sexual endurance juice.  I like to think I’m fairly adventurous in trying new foods, but you would have to pay me many many quetzales to try this one.

Once on board our shuttle, we had a quiet but hot ride to Antigua, where we had to wait for a second, also late, shuttle.  This second shuttle, in the course of its nine-hour trek to the town of Lanquin, took only two bathroom breaks.  I amused myself with podcasts, crosswords, and eavesdropping on the flirtations between a really desperate American dude and some giggly Australians (an excellent moment from their game of 20 Questions: Is it smaller than a plane?  Yes.  Is it a country?).  We rolled into Lanquin at about 11:30 pm, then boarded our final, rough-terrain shuttle.  Given that Lanquin is only about nine miles from Semuc Champey, I thought we were minutes from the hostel.  But it was a rough-terrain shuttle for a reason.  It took us over a half hour to traverse the rutted path, by which time I was desperate for sleep.

We spent the next day exploring the Semuc Champey nature park.  We hiked up a steep hill overlooking the land bridge, then headed back down (significantly sweatier) for a swim.  We feasted on pineapple, hot corn tortillas, mashed avocadoes, and these weird chocolate patties, which I’m pretty sure were comprised solely of cocoa powder, sugar, oil, and cardamom.

During the hot hot hot afternoon, we hiked the nine miles uphill to Lanquin, in search of provisions.  Naomi wanted ice cream, I wanted yogurt, and we both wanted to prove to our hostel owner that we could walk there (when we told him our hiking plan in the morning, he told us it was not possible to walk so far).  Sadly, he was less than impressed when we returned to brag about our success.  No matter; the views alone were worth the sweat:

For a bit of a more cultural experience, Naomi and I bussed over to Coban, a veritable city two hours from Lanquin.  We saw Holy Week floats,

This man is kind of my hero.  Guatemalans usually don't smile, let alone thumbs-up, in photographs.

and solved the mystery of alfombra construction.

Answer: STENCILS!

We even got to help make one.

Our last day of vacation was spent hanging out with our Argentinian hostel roommates and attempting to go tubing in the river.  I say attempting because, while the rest of the tubing group floated happily past, Naomi and I sat motionless in the middle of the current.  A Guatemalan eventually took pity on us, and jumped into the river to push us.  It was surreal and kind of magical.

The tubing river

As most vacations do, ours ended too soon.  I don’t think I’ll ever return to Semuc Champey—it’s just too hard to get to—but I’m so glad I went.  I leave you with two last photos.  The first is a snapshot from a crowded pickup truck ride from Semuc Champey to Lanquin, during which all 30 pickup bed occupants were airborne at one time or another.  The second is a shout-out to a family friend and his faithful chihuahua Rosita.

"Parking/TV Cable/Hot Water/24 Hours"

Day 236: Rollercoastering

“I wanted a perfect ending.  Now I’ve learned, the hard way, that some poems don’t rhyme, and some stories don’t have a clear beginning, middle, and end.  Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next.  Delicious ambiguity.”  - Gilda Radner

During my initial Peace Corps training, in August and September, I was repeatedly reminded that my entire Peace Corps experience would be studded with sharp emotional ups and downs.  I thought I understood what I was being told, given that, despite my desire to be in Guatemala, I was liable to break down crying at the slightest reminder of home.  But the past few weeks have shown me what emotional ups and downs really are.  Completely unremarkable events can push me over the edge, into anger or sadness or shock; at the same time, many of the things that would have shocked me in the United States barely register.

Some examples:

Barking dogs: Barking dogs are totally passé, both in the U.S. and here in Guatemala.  But my host family’s dog, which splits its time between the roof and the landing outside my door, yips with a vengeance, at all hours of the day and night.  I can no longer count on my hands the number of nights I have spent lying awake in bed, listening to Muñeca’s barking wars with the dogs next door.  As my friend Hannah put it, “If I could kill that dog with no one knowing it was me, I would do it.”  Ok, I probably wouldn’t kill Muñeca.  I think that would probably go against my whole personal-philosophy-of-pacifism thing.  But I wouldn’t be too upset if she got struck by lightning, or wandered off, or in some other way disappeared from my life.  In any case, the sound of dogs barking, which I hardly noticed before leaving the U.S., has now become a sort of psychological trigger, sending me into an immediate panic and/or rage.

Homicidal dogs: As you may have guessed from the fact that my host family keeps a creature as annoying as Muñeca, my host dad has a soft spot for dogs.  I honestly don’t understand why anyone in Guatemala keeps dogs as pets, because a) all the dogs are flea-ridden and quite likely to infest one’s house with the parasites, b) dogs therefore generally aren’t allowed to come inside, c) they bark constantly, and d) they cost money, and most of the Guatemalans I know spend a lot of time bemoaning their meager finances.  So it’s a bit of a mystery to me why my host dad keeps picking up new dogs.  Allow me to explain.  When I first came to Guatemala, there was only Muñeca.  But my host dad soon adopted “Bobby,” a giant black mutt he found in the road, nursing two broken legs (my host dad did not seek medical treatment for Bobby, but gave him some pills in the hope that they would “make him better”).  Shortly after Bobby arrived, my host dad bought my host brother a puppy.  This puppy, dubbed Osita or “little bear,” was positively crawling with fleas, and frequently bore signs of recent fighting—torn ears, bleeding paws, etc.  Then, a couple weeks ago, my host dad adopted another street dog, bringing our total tally to four.  After the adoption of this most recent “chucho” or street dog, Osita disappeared.  I finally asked my host dad what happened to her.  His response: “Se fue.”  “Se fue” literally translates as “she left,” but Guatemalans also use it to express that someone has died (this is very confusing).  I foolishly concluded that Osita had run away, until my host dad continued, “Yeah, that new street dog and Muñeca killed her.”  I fully recognize that this is absurd and terrifying, but I barely batted an eyelash, even when I found Osita’s severed paws hanging out on the kitchen windowsill a few days later.

Constant questions and stares: I totally understand that I’m an anomaly here.  I don’t look like the locals, I don’t dress like them, and I don’t act like them.  So it’s completely natural for Guatemalans to stare at me, or ask me questions about my behavior.  But, after so many months of constant curious attention, I hate it.  I’m sick of Guatemalans walking up to me in the park, introducing themselves, and enthusiastically shaking my hand while assuring me, “It’s such a pleasure.  An absolute pleasure.  Such a pleasure to know you.”  I’m tired of seven-year-old Guatemalan boys staring at me for five to ten minutes at a time on public transportation (smiles, winks, and waves have no effect on their deadpan expressions; it’s creepy).  And I’m over the constant stream of questions every day: How old are you?  How much do you weigh?  Why don’t you have a boyfriend?  Why don’t you wear skirts?  When are you going to have kids?  Your hair is dyed, right?  Are you walking (always asked while I am walking)?  You made it home (always asked when I walk in the door)?  What did you do to your eyelashes/are they real?  When I examine all these questions rationally, after the fact, I know that they should just make me chuckle, and appreciate Guatemalans’ curiosity.  But in the moment, the questioning frustrates me to no end.

The curious incident of the pregnant woman in the daytime: My fellow volunteer Paul, also known as Twinnesota, recently told me the following bizarre story: A woman in his town, who had planned a home birth, decided, in the middle of labor, that she would prefer to deliver at the health post.  She set off, alone and with a baby IN HER BIRTH CANAL.  She did not make it to the health post, but instead squatted in the town’s central park and proceeded with the whole giving birth thing.  The health post staff, on learning of the active labor on their town’s green, told Paul to try to get their single stretcher, which they keep in a locked room with no key.  The only way to open it is for a tall person to reach in, grope around for a tiny string tied to the lock, and pull on said string with all his or her might.  Paul, at over six feet, had found his true calling.  Sadly, by the time the stretcher was retrieved and brought to the park, it was no longer needed.  The woman and her (thankfully healthy) newborn were chilling on the grass.  Again, there’s a part of me that knows that everything about this story is crazy.  But there’s also a part that just feels, Eh.  Guatemala.

It’s not only my emotions that are rollercoastering these days; it’s also my projects at work.  I’m really happy to say I have a lot going on these days (finally), but I must admit my success with said goings-on really varies.

To elaborate, over the past two weeks I have started four big new work activities:

1. An Espacio Amigable, or “Safe Space,” for local youth.  The gender-segregated Espacio Amigable meets every other week in the municipal library, and is intended as a place/time for high school kids to learn about sexual and reproductive health, seek advice from trusted adults (read: me), and get help on homework.  By the way, I’m joking about that whole me-as-the-trusted-adult thing.  While I am active in the Espacio Amigable, and definitely consider myself a resource for the young men and women attending, the meetings are held as a joint effort by the health educators, my site mate Laura, and me.

At our very first meeting, I was shocked and incredibly pleased to find several teenage girls waiting outside the locked library, eager for the session to start.  They loved the video we showed them about the importance of self esteem, and we were even able to facilitate a little bit of discussion with the notoriously shy ladyfolk.

Our second meeting, for the chicos, was less successful.  Maybe they had a harder time relating to the video, given that the main character is a girl and machismo is not portrayed in a positive light.  Maybe they were afraid of coming off as overly sensitive in front of their peers.  Or maybe they’re just not that interested in the Espacio Amigable.  Whatever the cause, getting them to participate in a discussion after the video was worse than pulling teeth.  I tried to start them off with easy questions, and to address specific boys to get them to talk.  Their response was to stare at me in silence for minutes at a time.  So, not the most comfortable or productive meeting.  I’m hoping that as they get more comfortable with each other, and with the weird gringas in their midst, they’ll open up.

Desperately trying to get local high school boys to speak

2. A Club de Embarazadas, or pregnancy club, for—you guessed it—local pregnant women.  The idea here is a sort of support group that meets once a month at the CAP to share advice, learn about health during and after pregnancy, and eat healthy snacks.  This initiative takes a bit more planning than the Espacio Amigable, because the health center staff and I have to look for outside funding.  In addition to the healthy snacks, we want to provide each woman with a small gift basket when she gives birth—nothing fancy, just some diapers and a toy and an outfit, or some such.  The health post can’t afford these things (given that we can’t even afford thread for sutures), and we can’t ask the municipal government, because they already cover a lot of our needs (i.e. gas for the ambulance, medications for patients who cannot pay, etc.).  We therefore wrote a letter to a separate governmental organization, located in Sololá and dedicated to nutrition, soliciting financial aid.  I went to deliver the letter in person and plead our case (twice), but was told the organization has absolutely no money.  We’re now working on similar solicitations to the local bank, the grocery story (run by Walmart), and the Sololá governor.  I thought about applying for a special type of Peace Corps grant allowing Americans (largely friends and family) to donate to the cause, but I really want this club to be entirely sustainable within Guatemala.

The point of this long-winded financial rambling is to relate that, by the time our first meeting rolled around, we still had no money.  The educators and I agreed to foot the bill for the first healthy snack (a giant fruit salad), and to explain to the pregnant women that we are doing all we can to find funding for the gift baskets.  The day before the meeting, I learned that the educators had forgotten to spread the news of the club on their house visits to pregnant women, meaning that none of the pregnant women in our community knew about the club.  The educators frantically went door-to-door that day, and I rested easy.

The morning of our first meeting, I learned that there was educator confusion about who would be running the club with me, and that three of the four educators in charge of the club did not know they were involved.  This made me feel very stupid indeed.  But, we worked through the morning to orient ourselves and to prepare lesson materials, and by the afternoon I was again feeling hopeful.

My hope quickly died when only one pregnant woman showed up (she got a very large serving of fruit salad).  We decided to continue with the lesson plan, but that too ran amok: the attendee was Kaqchikel Mayan, and spoke only baseline Spanish.  One of the educators stepped in to translate, which would have been great except for the fact that she got quite overenthusiastic with her teaching.  I would say one sentence, like, “One warning sign during pregnancy is vaginal bleeding,” and this educator would expound upon the point for 3-5 minutes.  I know this doesn’t sound like a problem; it sounds like she’s just being super educational.  But due to childhood malnutrition, the vast majority of Guatemalans don’t process information like you or I do.  They learn best in small doses, and basically can’t handle too much information at one time.  So, as the lesson went on, this poor pregnant woman just got more and more confused.

When my lesson had finally ended (the ten-minute plan extending into a 30-minute execution), a visiting lecturer on nutrition stepped up and told me she would now be giving her own lesson to this single pregnant woman (who had already told us she was in a hurry to leave).  I was kind of mortified, but also felt completely powerless to stop the visitor from giving her lecture.

The pregnant woman finally left (read: fled), and the visiting lecturer sat down with my educators and I to talk.  She asked me if I often gave lessons to locals or to the educators, and I explained to her that my project was really just starting to take off, today being the first meeting of the Club de Embarazadas.  I’m also starting to plan lessons for my educators, at the request of my boss at the CAP, but haven’t given any lectures to them yet.  This visitor then turned to my educators and said, “Well, if you ever want me to come and give you lessons, since Ann can’t, let me know.”  What?!  The educators then rubbed salt in the wound by telling her how great that would be.  I felt like I had been kicked in the stomach.  I literally ask the health post staff every day what I can do to help them, and they always tell me, “Nothing,” or, “Just be.”  I was embarrassed that this visiting nutrition expert thought that I was so useless, and ashamed that I hadn’t done more at the CAP to make myself useful.

In summary, the first Pregnancy Club really sucked.

3. A year-long “diplomado,” or workshop, dedicated to training health educators on better education methods (I mentioned this in my Christmas post, I believe).  Two other volunteers and I have spent the past month preparing lessons on teamwork and respect in the workplace, printing and organizing follow-along worksheets and homework, and generally slaving over logistics (lists of attendees, venue preparation, lunch arrangements, etc.).  I’m happy to say that the result was…pretty good.  There were a few snags in the day-long presentation (the Guatemalan in charge of the entire project had invited a guest speaker without telling us), but overall things went well.  We made it through all the necessary talking points in the time allotted, and in a fun/interactive way.  All the food was delivered on time.  The Guatemalans scored, on average, 22% higher on the post-test than on the pre-test.  I felt proud of what we had accomplished, and am looking forward to next month’s session.

A quick aside: the one thing the Guatemalans really didn’t like about the training event was the food (I think it’s a good sign that the food was the worst part, don’t you?  It’s probably the easiest thing to fix).  We had ordered them a pizza party lunch, thinking that this would be great fun for all involved.  But we had made a great cultural misstep.  In Guatemala, pizza is a snack food, not a meal.  The comment cards the Guatemalans turned in at the end of the day featured such suggestions as, “No pizza.  Only tortillas,” and, “Next time we would appreciate an actual lunch.”  (Just FYI, Guatemalans insist on eating pizza with ketchup, mayonnaise, and spicy green sauce.  Must make all food as unhealthy as possible.)

4. Assisting the social worker at the Sololá Hospital.  The head of the diplomado committee (see #3 above) is married to the social worker at the Sololá Hospital, and my boss at Peace Corps suggested I take advantage of my proximity to Sololá and try working with her.  I’m not entirely sure what I’ll be doing with her (she mentioned doing education on exclusive breastfeeding), but on my first day she threw me into social work headfirst.  She showed me to the neonatal care ward, where tiny stick-figure babies breathed tiny ragged breaths in tiny beeping incubators.  This was another moment when I felt like I had been punched; I was overwhelmed by the sadness and desperation of the scene, and by the fact that there were no nurses around.  Shouldn’t these babies, most of which seemed to be barely clinging to life, be receiving round-the-clock attention?

The social worker led me to one baby in particular, which happened to be from San José Chacayá.  She had been born extremely premature two months previously, and her parents had basically abandoned her immediately postpartum.  She now needed to undergo cardiac testing in Guatemala City, an ambulance journey that required the presence of at least one parent.  Despite multiple calls and even appointments set up by the social worker, the parents had failed to return to the hospital.  The social worker wanted me to seek out the parents back in my community and find out what exactly they were playing at.

So, the next day, back in San José Chacayá, I corralled a few educators to accompany me, and trekked the two and a half miles to this woman’s house.  It turned out that the educators were a necessity, because the woman spoke Kaqchikel.  We spent about an hour at her house, explaining the situation/scolding her/pleading with her to go care for her baby.  She finally agreed to go to the hospital that afternoon.  I followed up with the social worker a few days later, and I’m happy to say that both parents went to the hospital to accompany the baby to Guatemala City.

I know that getting a single pair of parents to reclaim their abandoned baby isn’t the sustainable or widespread work that Peace Corps is looking for, but I can’t help feeling like it’s the most important thing I’ve done so far in country.  It makes me feel like even with my failed Pregnancy Club attempt, I’m doing good here.  With all these rollercoastering emotions and day-to-day activities, it’s things like this that keep me sane.

Day 199: It's A Girl!

“Birth is not only about making babies.  Birth is about making mothers—strong, competent, capable mothers who trust themselves and know their inner strength.”                                                                                                – Barbara Katz Rothman

First things first: no, I didn’t have a baby; my host mom did!  The baby doesn’t have a name yet, so throughout this post I’ll be referring to her as the Guatemalans do: la nena.  “Nena,” as far as I can tell, is basically a cutesy word for baby girl (the male version is nene).

My host mom has been visibly pregnant my entire time in site.  She’s actually been a little too visibly pregnant; both her family and the local doctors grew concerned about her insanely large belly, leading her to get an ultrasound at a nearby hospital.  It might come as a shock to you, as it did to me, that ultrasounds during pregnancy are not the norm here.  Most women pass through their five-ish pregnancies without once seeking medical imaging.  Only if a woman develops one of the six pregnancy “warning signs”* does she usually seek medical advice, and even then there’s no guarantee that she’ll get an ultrasound.  This is partly due to lack of ultrasound machines and health staff training (there is a $60,000 ultrasound machine in the next town over, gifted to the health center by the Japanese aid organization JICA; the machine sits unused, because no one in the health center, including the doctor, knows how to operate it).  But the lack of ultrasounds is also a matter of tradition: women aren’t used to getting ultrasounds, and health centers aren’t used to promoting them.  Pregnancies simply aren’t as carefully monitored here as they are in the U.S.  Oh, and each ultrasound costs about $25, which is a big chunk of Guatemalan change.

In any case, in November, my host mom went to Sololá, a fifteen-minute car ride away, to get an ultrasound.  The imaging unfortunately revealed that the fetus was breached, which in turn meant that my host mom would probably require a Cesarean section.  In the U.S., Cesareans have become fairly passé: no one really wants one, but if it’s necessary, it’s no big deal.  Here, it’s a big deal.  The procedure is dangerous, and the recovery period is really dangerous, mainly due to lack of personal hygiene.  I recently met a 19-year-old with an infected Cesarean wound (she had been cleaning it once daily with hand soap, and didn’t seem to know how to apply clean dressing).  My fellow volunteer Hannah had an even more dramatic encounter, with a 17-year-old permanently paralyzed from the waist down following a botched Cesarean (I know I’ve mentioned this story before, but I still feel horrified every time I think of it).

So my host mom came home from her ultrasound, understandably upset about the idea of a Cesarean.  In an attempt to cheer her up, I asked her if she had learned the sex of the baby.  With a smile, she said no, that the ultrasound technician had told her husband, but that her husband had forbidden the tech from telling her.  He wanted to be the only one to know.  This was another shock for me.  In what kind of world can a man prevent his wife’s doctor from telling her the sex of the baby?  It just goes to show, to me at least, how deep the machismo runs here.

The plan after the ultrasound was follow-up: Maria, my host mom, would return to the hospital in one month for a second ultrasound, to see if the fetus had flipped.  But she never went in for the follow-up.  When I asked her about it, she said, “I don’t really need to know.  Better to keep it a surprise.”  In other words, better to see what happens when I give birth.  Her blasé attitude toward her health (and the health of her fetus) was alarming, and pretty much the norm here.  I was comforted by the fact that she at least planned to give birth in the hospital (not the norm here).  If anything went wrong, she would be in a place with somewhat adequate staff, equipment, and capabilities.

Yesterday morning, at about 2:00, I was woken by the sound of movement in my house: my host dad practically yelling in his loud voice, my host mom responding in hushed murmurs, and, inexplicably, someone taking a shower.  This isn’t the first time my host family has woken me up at strange hours with their strange goings-on (a couple weeks ago, my host dad got up at three in the morning to drive to Mexico in search of a pick-up truck), so I didn’t think much of it.  I rolled over groggily, pressed my head harder into the pillow to muffle the sound, and went back to sleep.

At around 7:30, as I walked out of the house to go to work, I ran into my host dad—disheveled, bleary-eyed, and clutching a roll of toilet paper.  We exchanged our usual morning pleasantries, and then he said, “Oh, by the way, Maria is in the hospital giving birth right now.”  SAY WHAT?!  He told me that she had woken at 1:00 am with contractions, and that they had driven to the hospital at about 3:00 am, when her labor pains were coming five minutes apart.  She had showered before leaving, because “the hospital is such a dirty place.”  The nurses in the hospital, finding her to be about 5 cm dilated, predicted that she would give birth at about 7:30 or 8:00—in other words, at exactly the time Juan and I were talking.

And here we come to another shocking fact about Guatemala: in public hospitals, family members are not permitted to be present during births.  Pregnant women are attended by doctors and nurses, and no one else.  None of the Guatemalans I’ve talked to have been able to explain this rule, and none of them seem to like it.  And I have to agree: wouldn’t it be better to allow mothers, sisters, husbands into the room, to hold hands, verbally encourage, and just generally provide support?

Not only was my host dad barred from attending his daughter’s birth; he couldn’t even visit until the afternoon.  The hospital allows visitations only between 2:00 and 3:00 pm.  At all other times, the hospital entrances are guarded by men with guns, and anyone trying to gain entrance is questioned.  This is silly for a lot of reasons, not least of which is that emergency patients have to waste time explaining to hospital guards why they’re seeking medical care.

This weird (read: stupid) visitation policy explained why my host dad was working a half day in San José Chacayá, and why when he came home for lunch he ate at a leisurely pace.  I had scarfed down my meal, raring to go to the hospital, but he knew there was no sense in leaving early.  We would just be turned away at the hospital gate.

Before going to the hospital, we had to stop at the grocery store for supplies.  See, another crazy thing about the maternity wards in Guatemala is that they don’t provide diapers or clothing for the babies, or any personal hygiene items for the mothers.  My host dad had packed clothes and towels from home, but he needed to buy soap, toothpaste, diapers, etc.  He also bought bananas for my host mom, a detail that will become relevant in several paragraphs.

We finally made it to the hospital, and started pushing our way through the crowded waiting room.  There was no one to greet us, ask us who we were, direct us to the correct ward, or anything like that.  Instead, there was a single woman charged with corralling children.  The hospital has a rule that no one under 12 can visit any patients, presumably for hygienic reasons.  As my host brother is only seven, he was quickly picked out as underage and targeted.  The hospital worker swooped down on us, and basically detained my host brother in the waiting room.

We continued down a long hallway, searching for the maternity ward.  But, before we found it, my host dad spotted a woman and her clearly-less-than-12-year-old son walking the hallway, most likely visiting an ailing relative.  My host dad insisted on storming back to the waiting room, grabbing my host brother, and basically dragging him through the halls to the maternity ward.  This did not sit well with the hospital authorities.  We were soon surrounded by a group of security guards with large guns (I wish I was talking about biceps here, but I’m talking rifles).

Jon Isaias, my host brother, was soon returned to the waiting room, and my host dad, host grandmother, and I walked on to the ward.  Each “room” (really more a cavernous space with an opening to the hallway in place of a door) held six to eight new mothers, each lying on a twin bed, and about three bedside tables.  I guess only the lucky patients got a place to store their things, besides the floor.  We had no idea which room my host mom was in, so we had to look in each room, scan the tired faces, and move on.  We finally found her tucked snugly against a wall, cradling a nondescript, and allegedly sleeping, baby bundle.

Here we come to some comforting good news: the delivery went very well.  The nena had spontaneously flipped to the correct position, and Maria didn’t require a Cesarean section.  Both mother and baby were healthy and happy.

Apologies for the poor image quality; I didn't feel like I should use my flash around all the tired new moms!

My host dad quickly picked up la nena, and I eagerly began my duties as family photographer.  But, within about twenty seconds, my host dad had turned to me and asked if I wanted to hold the baby.  I was shocked—if I had just had a baby, I think I would want to hold it forever.  He had held her for twenty seconds, and was now offering her up to this weird gringa who happens to live in his house!  I was so blown away that I almost said no.  But I took the baby and nuzzled her fuzzy little head for a few seconds, before my host dad took her back.  He redeposited her at Maria’s breast, then LEFT to go continue waging his war with the security department.  Seriously.  He went to go fight with the men with guns.

His mother stayed, and promptly busied herself pouring out sugary flour atole for Maria (atole is the hot beverage of choice here, and comes in many different varieties: plantain atole, chocolate atole, rice atole, corn atole, you get the idea.  It’s almost always loaded with sugar).  As Maria sipped away, her mother-in-law started sorting out all the stuff we had brought her.  When she got to the bananas, she and Maria turned to me: Would it be safe for Maria to eat some bananas?  Are they healthy enough to eat after giving birth?

Something you have to understand about Guatemala is that university degrees are very rare here.  Anyone who has a university degree is regarded with the same respect afforded to a PhD in the United States.  Seriously, most Guatemalans think I’m basically a doctor.  The whole respect thing is nice, but I’m often asked questions that I’m not really qualified to answer.  For instance, earlier in her pregnancy, my host mom had asked me if I could tell her how to flip her breached baby.  Now, I was being asked for dietary advice.  Back in the United States, while working as a medical scribe, I would never have considered it safe or okay to tell any patient what he or she could or could not eat.  But here, after glancing at the hot sugar water my host mother was happily sipping, I felt quite comfortable telling her that yes, bananas are okay.  I did make her promise not to give any to the baby, though.  After all, one of my primary Peace Corps jobs is to promote exclusive breastfeeding.

All too soon, visiting hour was at an end.  We had to leave the maternity ward, but we hung around outside the hospital for another half hour, because my host dad wasn’t finished hashing it out with the guards.  I get where my host dad was coming from—it’s ridiculous that a healthy seven-year-old can’t meet his healthy new baby sister.  It’s even more ridiculous that the hospital has no limit on the number of visitors.  Two beds over from my host mom, one new mother had about twenty friends and family members clustered around her bed.  I’m pretty sure those twenty people were carrying more germs than my single host brother.  But, I didn’t understand why my host dad was making such a big deal out of this silly hospital rule, when he only had an hour to visit his new daughter.

The germ-ridden (presumably) crowd

I’ve thought a lot about whether his behavior has anything to do with the fact that la nena is a daughter, and not a son.  The sad truth in this country is that men are literally valued much more than women.  I say literally because midwives actually charge more to deliver a male baby than a female one.  With a male baby comes the promise of an educated child, an asset to the labor force, and income to support the parents in their old age.  With a female baby comes early marriage and housework.  Slightly less appealing.

The new nena also has the disadvantage of being Guatemalan, whereas my host brother is an American citizen (he was born in the United States while his parents were living there illegally).  My host dad even brought this up while fighting with the security guards.  He told them that his son was an American, cleaner than Guatemalan children and with more right to visit the hospital.

So, all of that, combined with the ruthless machismo of Guatemala, has me a little worried for la nena’s future.  But for now, she’s at home, safe and healthy.  And for now, that’s all I can ask for.

*The pregnancy warning signs, as my health center teaches them, are: fever, headache, shortness of breath, epigastric abdominal pain, vaginal bleeding, and swollen feet.