Escalera a Una Buena Salud

The women we serve at Primeros Pasos

Prevention, prevention, prevention.  It's what nurses try to teach their patients, when doctors overlook the opportunity or are just too swamped to do so.  While working with school children has been wonderful, for me, going out into the communities of Bella Vista and Llano del Pinal to talk about Pap smears and cervical cancer was more in line with what I wanted out of my volunteer experience.  Miriam y Marloes, the only 2 staff members of Escalera a Una Buena Salud (EBS)--the women's health education program at Primeros Pasos, graciously invited me.

My talks in the community became an important component of the women's health education program.  A few years ago, Danielle Dittrich, an American Women's Health Nurse Practitioner, began a Women's Health Clinic at Primeros Pasos.  With a gynecological exam table in tow as well as other supplies, she came to Xela to jumpstart Primeros Pasos' cervical cancer prevention initiative.  These scheduled talks preceded Danielle Dittrich's return to perform a week of Papanicolaus.  The goal was to inform EBS participants of the importance of a yearly well-woman exam and Pap smear and to strongly encourage their attendance.

A few summers ago, my old roommate Veronica worked in Antigua, Guatemala with a reproductive healthcare clinic called Wings.  They provide medical care to women, train men about reproductive health and family planning, train youth peer educators, and provide pap smears and treatment to those who need it.  Since the program, which has been in existence for a while now, is a perfect model of what Primeros Pasos could be for the highland communities, Vero kindly guided me to their website as a resource.  (Interested in learning more go to: http://wingsguate.org/)

Vero at Wings, Antigua, Guatemala

Why are reproductive health services important for our patient population in the Palajunoj Valley?  Here are some facts that are important to know in this context: 

"Cervical cancer is the number one cause of cancer-related deaths among women of reproductive age in Guatemala. Worldwide, 470,000 new cases of cervical cancer are detected each year and more than 200,000 women die annually of this preventable illness. The vast majority of deaths occur in developing countries, where comprehensive screening programs, which have been shown to reduce mortality by up to 90%, simply do not exist.

Many Guatemalan women have increased risk for cervical cancer due to factors such as limited and irregular screening, multiple pregnancies, early initiation of sexual relationships, poor nutrition, and unfaithful partners who are more likely to transmit HPV."         

                    ~ Wings, non-profit organization, Antigua, Guatemala

EBS participants in Tierra Colorada, where the clinic is located

The women we serve in the Palajunoj Valley are sexually active teens interested in family planning, teen moms, veteran mothers with extensive pregnancy histories, and older women in their menopausal years.

One mother, a 32 year-old woman, has been pregnant 11 times with only 5 children living.  Four were miscarriages; 2 died soon after birth.  Another woman, 23 years-old, was married a little over a year ago and has been trying to get pregnant since.  She thought she was infertile until she discovered that she was pregnant.  Four months later, she had a miscarriage, and immediately after, when she chose to get contraceptives to give her some time to heal both physically and mentally, her husband's family insisted that she stop taking them so they could try again.  Another mother of a 3 month-old newborn, is 16 years old.  She is planning to have another child soon.  She has a low level of education and has difficulty maintain her own good health, that of her newborn, and potentially that of her future child.

While this is not representative of all the women in the Palajunoj Valley, it is illustrative of some of the reasons why many Guatemalans are at higher risk for poor reproductive health outcomes including cervical cancer.  A lack of education about HPV and pap smears, inaccessibility to cervical cancer prevention services, multiple pregnancies in a short period of time, and a lack of control over health decisions concerning their own bodies, compromise the reproductive health of these women.

Miriam, Director of the EBS program, with her sweet son Tony demonstrating good dental hygiene

The morning of my talk in Bella Vista, I met Miriam at the main bus terminal in Xela: Terminal Minerva, where the bustling market is located and where pick-pocketers prey on shoppers.  We in turn, met up with Marloes on the way.  On a dusty road past Tierra Colorada (where the clinic is located) we traveled to Llano del Pinal by chickenbus.  From there no chickenbuses travel further to Bella Vista so we began our climb by foot.  With some luck, we were offered a ride on the back of a pic-up, though the type not outfitted for public transport.

I sat in the back as we navigated through some rough terrain -- the rocky, dusty road up the mountain.  I felt each and every rock, as I was jostled around; once catapulted in the air nearly 2 feet until my sacrum met the truck bed with a loud thump.  My bony butt did not see the humor in this.  Unprotected in the back from the elements, our vision was also obscured with waves of dustclouds.  If I protected my face and lungs, this meant not having hands or arms free to brace the sides of the truck.   It was a relief to finally arrive at our destination.

EBS group with former staff assistant, Elizabeth

Bella Vista is one of the smallest communities we serve and the second furthest from the clinic.  Nervous about doing a talk in Spanish in front of a group of adults, I had come prepared with a Power Point presentation (on paper), images of cervixes (cervices?), specula, and the female's reproductive organs.  I imagined myself speaking to a group of about 20 or so.

After being confronted in the street by one of the women, who stated that she was unable to attend because she had some last minute business in the big city, then minutes later meeting another woman who stated that she and her sister (who had just given birth the previous day) would also not be attending, the group of "20 or so" was quickly dwindling.  I realized quickly that the group of 20 or so that I anticipated was actually a group of 8 women in total.  Three of whom were already not attending.  We sat patiently for several more minutes, when one EBS participant, Ofelia arrived.  After several more minutes 3 more women arrived.  My audience of 20 was now an audience of four.

Marloes, current EBS staff assistant from Holland

I had been informed by Marloes of the difficulty in building rapport with these women in such a short time.  With this in mind, Miriam introduced me as a nurse who specialized in women's health, there to educate them about Pap smears, to address their questions and to invite them to our upcoming week of Papanicolau exams.  Minutes into my presentation, I realized the irony in the words on my sheets of paper.  Less than 5% of Guatemalan women have more than a 6th grade education, and only a slightly higher percentage of them are literate.  It was silly really.  The sheets of paper served me more than they did the women.  They were my crutch.  My presentation was received with some yawning, a few melodic cellphone ringtones, and some street noise.  Sadly, my talk had been more glamorous in my imagination.

My talk at Llano del Pinal two days later was better received.  Seven women from the group attended the talk.  They were genuinely interested in who I am, my work, my family, my age, and my life.  The environment was significantly warmer and by presentation's end, the women were offering hugs and cheek kisses to send us on our way.  Excited to hear that I would be assisting the "doctora" (aka Women's health nurse practitioner Danielle) coming the following week, the women stated that they looked forward to seeing a familiar face at the clinic.  The response was reassuring and validating and the following week I greeted them with a warm smile and an earnest desire to educate them about their health -- to offer an opportunity for them to regain their power over their health decisions.

Sweet little niñita