Mayan Medical Aid – Lake Atitilan – Santa Cruz, Guatemala

Posted by Harmony Schuttler, MD  (a second year OBGYN resident from Kaiser Permanente, San Francisco while on a global health elective in Santa Cruz, Guatemala with Mayan Medical Aid).

January 2013

The clinic I worked at in Santa Cruz, Guatemala, was the clinical center for several small pueblos in the mountains around Lake Atitilan whose population was comprised of indigenous Mayan people who, until the clinic opened 8 years ago, had no medical care. The clinic is at Santa Cruz three days a week and the other two days a week the providers of the clinic travel to smaller surrounding pueblos via small boats and/or by hiking into the mountains while carrying all their supplies in suitcases. The available diagnostic tests are very limited, with most tests needing to be sent to a larger city and taken by courier on a boat. The available antibiotics are purchased by the physician who started and runs the clinic every week in Antigua with his own funds and the money provided by rotating students and residents for their rotation.

More specific to my field, a large portion of the clinical volume of consists of prenatal care as most Mayan women in the area have their first baby before age 18 and most have >4-5 children in their lifetime. Contraception is available in variable forms, but there are multifactorial reasons that it is not often used including: cultural perception, extremely Catholic religious persuasion, misperceptions about contraception, lack of education, and lack of other roles/opportunities for women other than childbearing. The Mayan population has a different perception of time than most western countries, and patients often don’t present for care until well into their 2^nd or 3^rd trimester, and so dating is often inaccurate. Malnutrition is a very large issue for both adults and children. The area also used to be one of the highest in maternal and neonatal mortality given the majority of the births take place in the homes with the women either alone or with a midwife and there is little access to hospitals for complicated labor and or cesarean sections. Over the last few years the maternal morbidity has improved significantly, however neonatal mortality is still very high. The clinic providers are in the process of working with the midwives and the surrounding hospitals to help set up a system of triaging complicated pregnancies to hope to improve the neonatal morbidity.

Much of what I did was prenatal care and prenatal ultrasounds to help with dating. One of the most satisfying things I did during my rotation involved teaching providers at another clinic facility how to use their ultrasound and how to do basic prenatal ultrasound. The facility at the center of the county had a new, very modern ultrasound machine that was purchased by the Ministry of Health in 2010, however it was not being used when I arrived because none of the clinic staff, including doctors, nurses, and aides, knew how to work the machine. I put together a PowerPoint presentation on basic prenatal ultrasound including: establishing pregnancy, dating by crown rump length, estimating gestation in later pregnancy, fetal heart rate, and amniotic fluid index. With the help of the interpreter it was translated into Spanish. I then presented the PowerPoint to 20 healthcare providers at the clinic and spent over 6 hours doing “hands on” practice with the providers with pregnant women at the clinic that day. It was very gratifying to feel like I was providing something that might influence and help the patient population in the long term, beyond my limited time there.