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When birthing goes bad - really bad - disaster turns into
tragedy. Is the lack of health care the fault in this matter?
Or does the culture become its own worst enemy? If an
epiphany is what you are looking for, this story will fill
that bill. - CAS
Marta died, but she should not have. Her family was ecomonically prosperous by the village's standards. And she was different because she had graduated from high school and wanted to become a professional - a first for a woman in Santa Cruz.
People saw her as smart, sensitive, good-humored, lively, and optimistic. She had learned Excel, and she was running the lab of a medical anthropologist, who was processing hundreds of saliva and urine samples each week. For a women in her early 20s and living in Santa Cruz, she was an inspiration to all.
Marta had an on-again-off-again relationship with a young man. Julio also was from a relatively properous and educated family. Julio drank sometimes, and when he did, Maria would break up with him. But then, he would swear off alcohol, and that would rekindle the relationship.
Finally, Marta and Julio formed a union. Julio built a house for them. And Marta became pregnant. Her pregnancy was relatively uneventful. She had no major issues. For prenatal care, she went to a local midwife.
A characteristic of midwives in Santa Cruz is that they are not trained to become midwives in the sense that we think about midwives in the US. Mostly, they self-declare their desire to act as a midwife, but receive no formal training beforehand. And they need no formal licensure from the Guatemalan government.
Moreover, they view themselves as facilitating the good vibes of pregnancy and birth. They do not particularly see themselves in the role we think of a midwife taking: to identify problems and get them treated.
When bad results occur during pregnancy or birth, the midwives generally chalk it up to God's will or to being the result of witchcraft. In either case, whatever bad that happens is not their fault or doing. It was the latter type of thinking, plus what is considered the normal decision-making process in Santa Cruz, that led to Marta's plight.
Marta gave birth one day, but she would not stop bleeding. And she was unconscious before the midwife and family members sought help.
The ways in which people in Santa Cruz make decisons are nothing like our own. We are individualistic. We have license to make decisions for ourselves or for our immediate, loved ones, if they cannot. Except with end-of-life decisions, we generally do not need agreement among close and extended family members to decide.
Marta and her partner did not live in that world. Decisions about most aspects of life in Santa Cruz, particularly those relating to health, are made by the family as a unit. Little or no no action is taken until there is some consensus between the family members. In Marta's case, that meant finding consensus not just within her own family, but also consensus between her family and Julio's.
The family debate was whether Marta needed an IV or whether she needed to go to the hospital. A big problem was that there was no IV solution in the village and no one to start an IV even had the solution existed. But those family members lobbying for the IV solution felt strongly that going to the National Hospital would result in Marta's death.
Many people in Santa Cruz do not trust the National Hospital. They have questions, partially due to Guatemala's long civil war, about whether the Hospital personnel want to make them sick or even kill them.
They also feel that the Hospital is a bad place: where there are long waits, where there is a lack of personal respect for them, and where people die frequently. In addition, if people do die in the Hospital, the surviving family members have to pay approximately 10-15 days in wages to get the body released. In this context, one can understand the reason for the debate.
Finally, after much time, much discussion, and more bleeding, the Hospital faction won out over the IV faction. But the IV faction still was not convinced that going to the Hospital would save Marta's life.
Getting to the Hospital from Santa Cruz is no easy task. The village is located on a ridge top, which is a 20-minute walk up a very steep hill from the North shore of Lake Atitlán. In addition, there is no outside road to Santa Cruz. The only access is by foot or by boat.
So to get Marta to the Hospital, the family first needed to contract the pick-up truck, which normally transports freight from the shore to the village. They then had to arrange for private boat transportation to Panajachel, a 15-minute ride away. From there, they had to reload Marta into another pick-up truck and go to Sololá, located 20-minutes to the North and the site of the Hospital.
Marta did not survive her last pick-up truck ride. She was dead on arrival.
The tragedies of Marta's life and post-partum course are many and varied. No oxytocin. No IV. Too much debate. Too much time wasted.
And to top it off, the IV faction was correct. They said that Marta would die if she went to the Hospital. And she did die.
To be continued . . .
Based in part on a doctoral thesis by Nicole S. Berry: Emergency Obstetric Care Choice among Kaqchikel in Guatemala, 2005
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