Not Everything Can Be Controlled

FOLLOWING UP ON ANA AND HER TWINS IN TOJ RINCÓN

We piled back into the Land Cruiser with high hopes for the day, heading to Toj Rincón for our third mobile clinic in the village. We arrived early, just before 8:00 AM, as the day began to heat up in the April sun.

During this trip to Toj Rincón, we were hoping to see Ana, the mother with the twin pregnancy, who was now 32 weeks pregnant. We learned that she lived nearby, so Carmen, the local midwife, left the clinic to see if she could find her at home and encourage her to visit us at the clinic.

Ana seemed a bit quieter than usual as we ushered her in to see Dr. Valeria and Fabiola, our midwife in the mobile clinic. The clinic’s makeshift ‘exam room’ was only a bedroom in Carmen’s house, divided down the middle for privacy with a cotton bedspread. I waited outside during the appointment, keeping myself busy with the other patients.

After an unusually long time, Dr. Valeria called me into the exam room. “I can only find one heartbeat,” she said in a serious voice. We both looked at the ultrasound image on the screen and I had to agree with her: Only one of the twins was alive. We called in Carmen to help Fabiola break the news to Ana in Mam, the Maya language of the area. Dr. Valeria made an urgent phone call to the doctor in charge of the nearest government health center, approximately 30 minutes away, in San Martin. Ana murmured that she would have to consult with her husband, her parents and her in-laws before making a decision, so Carmen and Dr. Valeria accompanied Ana back to her house to speak with the family.

 Dr. Valeria in the exam room with Ana at the mobile clinic in Toj Rincón.

Dr. Valeria in the exam room with Ana at the mobile clinic in Toj Rincón.

Although her house was a five minute walk from Carmen’s house, an hour passed before they returned to the mobile clinic. Upon arrival, Ana told us that she had permission to go to San Martin, but under no circumstances would she be able to go to the hospital.  We finished the clinic, packed up the Land Cruiser, and went with Ana to the health center, arriving just before they would close for the day. 

Dr. Barrios was expecting our arrival and whisked us into her office, which doubled as an exam room.  Her small ultrasound machine confirmed what we had found at the mobile clinic. Dr. Barrios was even more concerned because it looked like the twin had been dead for several weeks in the womb, which could mean infection and/or other potentially deadly complications for the mother and the surviving twin.  We all agreed that it would be urgent for Ana to go to Xela for hospitalization, but Ana’s husband and sister, who came separately, disagreed. Unfortunately, despite our midwives’ attempts to explain the severity of the situation in Mam, the family was adamant about taking Ana back with them to Toj Rincón. There they would “talk with a prophet” who would tell them what to do.

Fundamentalism is a powerful force in the many churches of Toj Rincón.  There are many denominations that have undercurrents of belief in prophets who hold great power in the community. In addition to prophets, women are also under the control of their husbands as well as older family members.

I was bewildered and, in vain, tried to hold back tears. We had done everything possible to get Ana the care she needed, providing her with prenatal care and transportation to the nearest referral center. Now, we were facing obstacles that are beyond our control and had nothing to do with access: machismo and fundamentalism.  I was horrified to think that Ana could die, leaving behind her one year old at home without a mother.  All for reasons that could have been avoided.

When we returned to ACAM center that evening, I received a call from Dr. Valeria and she told me Dr. Barrios informed her that Ana had been admitted to the hospital in Xela after all.  I assumed her family had a change of heart. I felt a great sense of relief and hope.

 Mary Ellen Galante of Maya Midwifery International with Ana and her daughter in Toj Rincón.

Mary Ellen Galante of Maya Midwifery International with Ana and her daughter in Toj Rincón.

Later on, Ana told us that no one explained anything to her during her five days in the hospital.  She did not even know if the surviving twin was still alive or not. With the exception of a quarter of an IV bag, Ana stated that she did not receive any care from the hospital staff. Her family was so angry that they decided to take her home to Toj Rincón to see what the prophet would say instead.

The prophet had Ana’s family bring flowers to the mountain and pray at the house each day.  Finally, on April 24, Ana’s labor began. Carmen attended her and a three pound little girl was liveborn. The second twin came soon afterward, lifeless as expected, followed by a single placenta. Miraculously, there were no complications and the three pound little girl is growing strong and breastfeeding well.

On May 19, our midwives and I visited Ana and the baby in her home in Toj Rincón.  Initially, she was a bit reserved, but eventually invited us in to tell her story, carrying her tiny newborn in a bundle on her back. Despite her delicate appearance, Ana assured us with some pride that this tiny girl has a really strong grip. She certainly must have a really strong grip on life as well.  I pray for Ana and this little fighter who, so far, has made it against all odds.

 Ana and her daughter at home in Toj Rincón.

Ana and her daughter at home in Toj Rincón.

Despite Maya Midwifery’s best intentions, there are some things that are beyond our control.  The care we give through our midwives and our doctor is extraordinary in many respects, but our mobile clinics can only address some of the problems facing women in these communities. For example, the care in the public hospital was so poor that Ana felt no choice but to leave.

When I arrived at the house after our initial visit with Ana, Imelda, one of our midwives, told me: “Now you know what we go through. We can try to convince our patients to go the hospital when there are complications, but many times they won’t go and then if something happens we get blamed.”

We will keep going to Toj Rincón, and hopefully, over time build the relationships needed to gain trust and affect change. The government’s hospital system is another challenge, one that I am less optimistic we can change. Thankfully, Ana’s case gave us the opportunity to gain the respect and trust of Dr. Barrios in San Martin. Now, we can hope that these links will improve the care at the secondary level and, one day, perhaps in Xela.

 

Author: Mary Ellen Galante