Between November 2011 and May 2012, Diana Shane, a nurse-midwife from Colorado, volunteered at INMED's maternity waiting home in the Amazon community of Atalaya, in Peru's Ucayali region. She shared her experiences and perspectives through a monthly journal. This is her first installment.
How I Ended Up Here
Ever since nursing school I have considered volunteering in another part of the world where my knowledge and skills might be of some help to the people there. Then, after finishing midwifery school, I decided that it was the most opportune time to take on such an adventure. I was even more encouraged when I heard what a great experience my friend Beth Tucker had when she volunteered in Peru. I talked to Beth and she introduced me to the wonderful NGO INMED Partnerships for Children. I contacted INMED and learned about the opportunity to volunteer in the casa de espera in Atalaya, Peru, where my knowledge and skills as a nurse midwife would be useful in promoting vertical birth and in improving maternal/fetal outcomes.
The casa de espera, a project of the Municipality of Atalaya, serves as a maternity center/temporary home for pregnant women who live in hard-to-reach, outlying communities around Atalaya. These women come to stay in the casa for the last few weeks of their pregnancies and then for a short time postpartum. Bringing these women to the casa de espera ensures them better access to healthcare services in the weeks before, during, and after giving birth, as their communities are often many hours away by boat or truck and difficult to access. Without a place to stay close to the hospital while waiting for the birth of their babies, many of these women end up giving birth in their native communities. These births are too often attended with dirty materials and by persons with little or no training, leading to increased risk for significant complications up to and including the death of the mom and/or baby.
Vertical birth is when a pregnant woman gives birth to her baby in a vertical position such as standing or sitting. Women from the native communities that the casa de espera serves are accustomed to and prefer to give birth in such positions. However, the personnel in the local hospital are not well versed in attending vertical births, and therefore require women to lay on their backs with their legs in stirrups for the delivery. The ability to attend native women in the positions they prefer to give birth will assist in encouraging women to come to the hospital to delivertheir babies instead of remaining in their far-away communities. There are many benefits to a vertical birth, including less pain, less risk for laceration, better fetal oxygenation and a faster, easier delivery.
Understanding the benefits I might bring to Atalaya and the opportunity to know another culture in a different part of the world, my decision was easy. A few months later and there I was, sitting on a plane heading for Peru.
I arrived in Lima on a late night flight from Miami on November 20, 2011. To ensure my safe arrival, Ursula Barrientos, from the INMED Andes office in Lima, and her husband kindly picked me up from the airport even though I didn’t get in until after midnight. I stayed the rest of that night and the next in a nice little hotel, Hostal El Patio, in Miraflores, which is a tourist beach town right outside Lima on the coast. I didn’t have a lot of time but I was able to walk down to the beach and check out a local restaurant with great fish, Al Fresco. It was a really beautiful start to my South American adventure!
From Lima to My New Temporary Home
From Lima I traveled to Pucallpa on November 21, where I met my now good friend Zarela Bravo from the INMED Andes office in Pucallpa. I stayed the night in Pucallpa then left with Zarela on an early flight to my new temporary home, Atalaya. Upon arriving I was welcomed by a wonderful woman and very hard worker Nelly Medina Leyva, who is the director of the division under which the casa de espera project exists. After that, they took me around to meet all the different people I would be working with, including the mayor of Atalaya. Then I got to check out the casa de espera where I would be living and working for the next six months.
My first few months in Atalaya were full of ups and downs. The people here are very kind and helpful to the point that my friend Nelly insisted I come stay at her house while I was sick. Getting used to the change in diet was a challenge. With that and the lack of immunity I had to the normal flora on food here, it took a while for my stomach to get back to normal. The food consists mostly of rice with sides of meat, potatoes, and yucca (a potato-like root), but vegetables are lacking. Fruits, however, are in abundance. They make a great jugo (juice) with whole chunks of fresh fruit blended with water and a bit of sugar. It is definitely something I will miss when I leave.
My living quarters are pretty comfortable. It is private and they have made sure I have all the necessities. It also has taken some getting used to, though, as I am accustomed to the excess of comforts we have in the United States. For example, I shower with only cold water here, there is no air conditioning, and the water and electricity often fail for hours at a time (sometimes more). However, there are people here who have no running water and have to wash their clothes and bathe in the river, so I consider myself lucky.
The weather here is either hot and sticky or raining. At first I preferred the rain because it was cooler, but I am getting used to the heat now so it bothers me less. My time here happens to coincide with the rainy season so I get lots of breaks from the heat. When it rains here it usually falls like a waterfall, very heavy and with vengeance…. 30 seconds out in the rain and you are completely soaked—but I guess that’s why that call it a rainforest.
It is really interesting to observe the many layers of culture here that I still don’t fully understand. People are identified as either mestizo (mixed European and native blood) or nativo (native). There are three main regions in Peru: la costa (the coast), la sierra (the mountains), and la selva (the rainforest), and there are various individual communities within each region. Each layer has both unique and shared cultural practices. It seems, at least in the area where I am, that those who are mestizo tend to be of a higher socioeconomic status and better educated whereas native people, though many are educated and fairly well off, tend to be more impoverished. In many communities they live under very basic conditions—for example, no electricity, homes without walls, and no access to clean water. The local hospital/heath post, the Centro de Salud, mostly tends to serve those with few resources, as the families that are wealthier pay a private care provider for their care or they travel to Pucallpa or Lima to receive their care.
Work the first month and a half was slow going as the casa de espera did not have many patients or activities going on. I spent the mornings in the local hospital/health center, the Centro de Salud, in order to get to know the personnel there and familiarize myself with how they attend labor and birth. They do a fair job with the resources they have here, but it was still a bit of a shock to observe my first birth there. Pain medications and epidurals do not exist for patients here… they just have to endure the pain. Then, when the patient is ready to give birth, they make her lay flat on her back on a tall skinny birthing table with her legs in stirrups and routinely utilize practices that I learned to avoid, such as fundal pressure to deliver the baby, manual rotation of the baby after delivery of the head, and episiotomy on all first-time moms. The births I witnessed of this manner struck me as traumatizing rather than the empowering and beautiful experience I strive to achieve in every birth. Understanding the challenge ahead of me, I felt even more motivated to do what I could to implement a safer, gentler way of attending birth that serves to support and empower women. And so my campaign to promote the casa de espera and vertical birth began.