Preventing maternal and neonatal mortalities is a public health priority in Perú and around the world. In many places in Peru the situation has improved dramatically in the last 10 years. However, in the highlands of Huancavelica it is still a daily struggle to save the lives of mothers and their newborn babies. The rest of this entry shares some hard to digest accounts of the lives of women here. While I may present them as stark events they are emotional bundles of pain, held inside the depths of individual women, often swept aside in the communal memory.
In my first few months in Quisuarpampa there were several maternal health tragedies. A woman from Rumichaca (1 ½ hr hike) delayed coming to the health post when she had labor pains and gave birth in an irrigation ditch on the side of the path. Her baby died in the freezing water. Then there was a 15 year old girl in 6th grade, likely the victim of rape by a family member, who gave birth by herself in the corner of an adobe hut. A neighbor called the health post via a community phone when it was already too late. The obstetrician found the baby dead and covered in blood in one corner and the girl shivering in another corner with a retained placenta. The other day she shared with me that she suspects that the girl’s older brother killed the baby. Another woman who lives a 6 hr hike from the health post refused to come for a prenatal screening and sonogram until the nurse forced her to come. She was 8 months pregnant and arrived with a raging infection and dead fetus inside her. Another day and she could have lost her life as well as her baby’s life. Then there was a woman who lived in the highlands with her alpaca, far from other neighbors, and hid her pregnancy until she gave birth in a field. Her mother brought the baby to the health post when it was already 5 days old. It is a testament to the strength of life that the baby lived… she weighed barely 4 lbs and today, 16 months later, continues to be severely malnourished.
Teaching about the risks during a pregnancy
The experiences of these women weigh on me and more than a year ago, as these events unfolded and I was attempting to make sense of my role here, they blighted my idealism. Women in town went about their daily lives and the obstetrician told me matter-of-factly that cases like these were normal here. But little by little I came to see that the way women internalize these tragedies is a coping mechanism and that not all health staff are apathetic. They are working within a system that does see a lot of these cases—but underneath a hard, supposedly more professional, shell is also compassion and solidarity. Health professionals in Peru are underpaid yet answer the call to service on a daily basis. They are helping their country advance, one mother and one child at a time. Women have a low level of education, low self-esteem, and are often victims of domestic violence. They have a hard time standing up for themselves when it comes to sex, birth control, and their health.
What a place to give birth
One of the most interesting aspects of my time in Quisuarpampa has been to accompany the obstetrician as she carries out the Ministry of Health’s Maternal Health Goals. We hike to the outlying villages in the early morning hours to meet pregnant women in their houses and review the symptoms of obstetric emergencies, create birth plans, and talk to them about the risks of giving birth in isolated villages without trained help, sterile materials, transportation, or communication. We do prenatal exams, distribute folic acid tablets, send them for sonograms and analysis, and go running at any hour of the night to attend a patient. We fight myths, stop rumors, and do everything we can to educate and convince pregnant women and their families to seek care in the health post. Despite the horrific tragedies that I have seen here, maternal health is an area full of inspiration. While visiting pregnant women in their houses and convincing them of the benefits of a safe birthing experience I can’t help but feel like woman by woman the health staff is reducing mortalities. And there is nothing better than watching a woman show up with labor pains and decide to have a safe birth. After all, there is hope and there is progress.
Visiting a 16 yr old who was pregnant