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I'll let the photos paint the picture of what this small, bright blue, low, crowded and busy hospital is like. Our first meeting was with Dr. Maximo Vega (director of the hospital) and Bacilia Vivanco Garfias, an "obstetrica," which translates to "midwife" in an American job description. Dr. Vega explained his hospital delivers approximately 300 babies per month for women who live in or anywhere near Ayacucho. "Anywhere near" often means hours of walking or rough road travel. The yard outside was teeming with families awaiting care or just hanging out while other family members were treated. There were chickens and dogs, taxis and trucks and everything was so colorful. It was a kid in a candy store visual experience.
Dr. Vega talked about the reasons women refused to come to the hospital for delivery prior to initiating the FEMME project in 2000. They were terrified of episiotomies and of being treated poorly. The lack of privacy and disrespect for their culture along with complete ignorance of their need to seek medical care kept huge numbers of women delivering at home. They died from easily-treated complications like hemorrhage, infection and pre-eclampsia.
Another problem Dr. Vega described was the inconsistency of practices from one hospital to the next. They really had to start from the ground up improving care for patients, educating staff on standard procedures and getting the word out that they meant business about treating their citizens well; about saving their mothers' lives. Dr. Vega described the 15-day training programs that educate nurses, doctors, midwives and students on cultural sensitivity, proper technique and procedure for managing and avoiding obstetric emergencies.
Later, we toured the emergency admission/triage room where two frightened and painful teenagers had just been driven in by taxi. I was told that adolescent pregnancy was a huge problem due to rape and incest and whenever a teenager came in, they provided extra personnel (a psychologist and extra nurse) to support her.
Two midwives demonstrated vertical birthing techniques since the only patients in labor during my tour were teenagers. These poor girls had enough trouble and there was no way I was infringing on their privacy. I'd been introduced as a "journalist from North America." They were in labor, in pain, really young and had a look on their face that could only be translated as, "what the heck is she doing behind my curtain?" Though providing privacy is an important piece in convincing women to deliver in the hospital, a curtain doesn't hide much.
We toured their childbirth preparation class. Nobody gets epidurals or narcotics for pain management unless they have a cesarean section. It's all breathing and relaxation. Husbands usually participate and if someone doesn't have time to take the class, they give them an emergency, slam-dunk session during labor. I asked Dr. Vega about the no-pain-medicine thing and he said, "we don't have the staff for that and women know this is just going to be their time to suffer." OK, then. I noticed the girls in labor spent all their time on their feet, walking and rocking, despite being close to delivery. They weren't being monitored with fetal heart monitors (though the hospital has one and uses it "when necessary" and there were only two labor beds that I could see. Labor is a vertical experience.
Next we visited a post partum room where six full beds of newly delivered women were packed into a mighty small space. There were also grandmothers, husbands and other family members resting on the floor between beds. The sheets were flowered and clean but the one, shared bathroom had blood on the floor.
We were at the hospital for many hours before we took a break for lunch. Then we were off for an official visit with the Vice President of Ayacucho, Senor Alcides, and Dr. Marco Cabrero, responsible for social health care. Dr Cabrero told me that Ayacucho translates to "Corner of the Dead," but as part of improving public relations, they were re-translating it and marketing it as "Resting Place for the Soul." That does sound better, right?
We talked about why a North American journalist was interested in health care in Peru. I told them how impressed I was by the quality of care they were providing and the work CARE was doing. He read me an official speech about how proud his government was of the FEMME project and, (for I think the fourth time that day) was told it was so successful, the model was being studied and replicated in other countries like Bolivia. We took pictures by the flag, shook hands and departed. Later in the week, I found out that visit had actually been rather important.
We returned to our hotel, visited the plaza in Ayacucho, found some pizza and enjoyed some girl talk. Then we went back to our hotel and I, for one, collapsed.
Everything I've written so far about days one and two are in retrospect (written from home) because believe me, there wasn't a speck of time for articulate, introspective blogging with the pace we were keeping and the less than reliable Internet. Day Three—The trip to Vilcashuaman will be titled "My Biggest Day Ever." Read why.
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