Hannah, the midwife

                                                                     Hannah, die Hebamme; Deutsche Fassung

In the Iguana Perdida, a backpacker hostel on Lake Atitlan, I came to talk to Hannah from Belgium at the dinner table. She had an interesting tale to tell, I would like to share with my readers. When I met her she was on a weeklong holiday at the shores of Lake Atitlan before venturing out to her new workplace in Rio Dulce where she will work in an outpatient clinic as a midwife. At dinner she told me about her experiences at a former workplace in the north of the department Huehuetenango, near the Mexican border. She had lived and worked there together with her husband from September 2012 to July 2014 in the Mayan village Yalanhuitz with 1500 inhabitants (ethnicity: Q’anjob’al). She was the town’s midwife, her husband the ambulance driver of basic medical aid station, founded by a Belgian aid organization.

It all began twelve years ago: in 2003 Hannah visited Guatemala for the first time with a colleague for a two months’ vacation. Already on the second day they climbed the volcano Pacaya. At that time she was just 16 years old and her mother was reluctant to let her go, she consented only because she knew her slightly older companion well. On this trip started her love for Guatemala.

After studying history of art, she decided to train as a midwife, because she wanted to work in a helping profession and was eager to travel. And travel she did: first as a backpacker in Asia, then she worked as a nurse in a health centre and later as a midwife in Uganda. There she met her future husband and together they decided on a longer stay in Guatemala.

Far out in the countryside
Her new workplace was in a small village in the north of the department of Huehuetenango near the Mexican border. The village in the mountains at 1200 meters above sea level had no electricity, the road to get there was not paved and only 2 people in the village had a license in the village. The two moved into a house and established themselves, cultivated a small garden, raised chickens and bought a horse. The villagers were mostly returnees from Mexico, where they fled to after the Civil War. Most of them were Mayan Q’anjob’al and Chuj and couldn’t read or write and only few of them spoke Spanish.

In her job as a midwife, she was well received, but subliminally Hannah and her husband felt a reluctance and sometimes resistance of the patients to their work. Similar to the attitude the locals have towards doctors: they usually wait as long as possible until they ask for medical aid.

To be accepted and feel part of it
To overcome these difficulties and integrate socially, the two tried to learn the local language Q’anjob’al, and attended service at one of the eight Christian churches in the village. It took about a year until they felt socially accepted and cultivated outside of work social contacts with neighbours and a few families in the village. It was not only the language barrier, but also the kind of communication. The Q’anjob’al of the village talk among themselves very sparingly, more important is the non-verbal communication with gestures and touches. This “other language” also had to be learned.

A sign of Hannah’s professional integration was the first invitation to participate at an assembly of the elders, all of them men, to consider whether one of her patients is to be driven to the hospital. And in the neighbourhood, she felt fully accepted, when her neighbour was openly angry and yelling at when her cat had killed the neighbour’s duckling. Over time, friendships developed, they were invited by other families for dinner, but on the more intimate concerns of her indigenous friends, such as alcoholism, domestic violence, etc., they were not taken into confidence.

Difficult but ultimately fruitful encounter between two professional cultures
The professional network of the health centre includes 22 traditional midwives (comadronas) in the region, which meet every six weeks to exchange their experiences. Again, the integration was a long process. At the beginning her colleagues projected overly professional authority on her, although she was the youngest in the group and hadn’t borne any children yet. But just because she was white, and the only one with a formal training as a midwife her colleagues treated her differently.

 The ‘career’ of an indigenous comadrona
The indigenous comadronas start their ‘career’ when they feel a vocation to the task and they learn their craft from their elder colleagues. Often they use their dreams to find a good solution in complicated situations. For them, it is hard to imagine that their profession can be learned with the help of books. Hannah had to learn to hold back in discussions with her comments. Often she was tempted to tell the indigenous comadronas how it is done properly. Properly, of course, by the Belgian midwives manual. Gradually she learned to listen to the comadronas and to acknowledge their procedures as equally successful. Sometimes she could even find in a, for her initially incomprehensible action, a rational explanation. For example she had observed that the comadronas press with all her strength on both sides of the hip bone during difficult deliveries. Coincidentally she later discovered in an anatomy manual that by doing this the birth canal can be extended somewhat, because the symphysis is slightly flexible during pregnancy.

Mauerbild in San Pedro La Laguna

Mauerbild in San Pedro La Laguna                               (c) www.cultureatitlan.com             Dona Iyom Chona Rax                       For an interview with her follow this –>link

A example of the benefits of indigenous practices and the damage that European methods can sometimes cause: The comadronas traditionally cut the umbilical cord with a sharp-edged blade from a certain grass species. With the advent of modern medicine, more and more razor blades were used, but without the necessary hygiene. The multiple use of rusty razor blades have caused post-natal infections in certain villages in almost all birth during a couple of years.

 Birth is not a disease….
During pregnancy, the pregnant women receive frequent visits from their comadrona. They drink coffee with the expectant mother, observe her behaviour and posture and palpate the abdomen. From early on, they works with masages toward a convenient location of the child in the uterus, at a time when Hannah had the impression that the embryo is still so small that it had plenty of space in the womb and his location could easily change three times more.

 The comadronas and indigenous women handle the contraction pain quite differently than the European midwives and their patients: At the onset of labour, the women continue to work and repress the pain; they cook, make tortillas, wash and perform household chores. Only at the onset of the final contractions, they get active assistance from their comadrona. She walks around with them, leads them to the sauna (temascal) and shields them off from husband and children before the birth. Only the mother of the woman in labour and the comadrona stay in the room, the rest of the family has to wait nearby. While for Hannah controlling the heartbeat was routine during her visits to the pregnant, the comadronas work much more with observation of the pregnant woman and the palpation of the abdomen.

 Many Mayan rituals in connection with birth were lost through Christianisation. The generation of grandmothers still know about them, but they are no longer practised by the present generation of comadronas, with a few exceptions.(for example for a slight birth they sway a chicken above the belly of a pregnant woman or the belief that a pregnant woman should avoid to see a man on horseback). Every now and then the family lays out a Mayan altar. These are temporary, usually circular images (similar to a Mandala) laid with flowers, needles of conifers, leaves of medicinal plants and candles. The disappeared Mayan rituals are nowadays replaced by Christian prayers.

 In the case of unwanted pregnancies comadronas also secretly perform abortions. The girls and women in the village rely on a comadrona in such a situation. In most cases the abortion cannot be kept secret, but it is treated as a taboo and will not be spoken about. Through their activity, the comadronas gain much insight into the family situations of the whole village. Therefore, they have a special social status and are consulted by the Elders, when they discuss women’s issues, such as a rape.

 In many Mayan villages, the children have early intercourse and sexual violence against girls between 12 to 16 by older men is frequent. This is only regarded as an offence if the woman is physically damaged. If a girl gets pregnant, she must marry the child’s father, join his family and be subordinate to the parents in law.

 Sex education has only been introduced a few years ago. The comadronas are not involved. The teachers for this touchy subject come from outside the village. Sex education was opposed by many villagers with the argument that the children would thus be encouraged to have sex even earlier in their childhood.

 What did Hannah learn from indigenous midwifery?
Above all, she was able to experience how a natural birth looks like. It made her realize that it is not the midwife but the mother that brings the child into the world, and that the midwife is merely there to provide assistance. She also learned to trust nature. There is no standard for a good birth. Duration and intensity of contractions can vary widely and also the pain of women in labour is experienced differently by every individual mother.

 In these two years she has learned to observe more with all her senses rather than to intervene immediately. She has become experienced to palpate the child’s location and movements in the uterus and she can now read a pregnant woman in her movements, her expression and her posture.

 In this learning process she had been coached by Maria, her indigenous colleague, her closest co-worker in the clinic. But this also was a slow process to build up the necessary confidence so that the traditional comadrona without formal education was able to criticize the actions of her white colleague with a university degree, and that Hannah on the other hand could accept her criticism.

The first two years at the new place of work were a promising beginning, although the integration in the village was not quite as fast as Hannah and her husband had hoped for. But mutual understanding increased steadily and it seemed likely they would overcome the remaining reservations. It was all so promising …… if it were not for the conflict over the dam project that split the village.

–> to be continued in Part Two

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