Every week, midwives from the ACAM birth center and the ACAM doctor, Valeria, travel to a nearby community to deliver prenatal care in a mobile clinic. This week we went to Tuil Canabaj, a place that has proven to be the most complex of all our locations. For some reason, this place has a greater number of women with high risk pregnancies and it’s a place where people and families like to keep to themselves. The midwives know that the mobile clinic here helps to encounter women that might need more care and builds trust between them and the community.
Normally, the ACAM team connects with the local mayor a few days before in order to confirm the date and time. He shows up at the site before we do to open the building and to make an announcement in Mam over the loudspeaker (that actually travels quite a distance) that the ACAM midwives have arrived to give care that day. The midwives couldn’t reach him this time. We found out later that it was because he had a family member sick in the hospital and was preoccupied, but least to say, everyone was a little nervous about what we were going to do when we got there if we couldn’t get into the building and didn’t have access to the loudspeaker to make an announcement to the community to remind them it was ACAM’s mobile clinic day. “Are there going to be patients?” asked Emelda, one of the midwives. All of us in the van on the way to Tuil Canabaj gave a collective shrug and exchanged looks of maybe and hopefully.
Mobile clinic set up in Tuil Canabaj
As we suspected, on arrival the building was locked and we couldn’t get in. Brainstorming turned into action quickly. Our driver Don Andres moved the van closer to the building. Doctor Valeria started tying the twine that is usually used to secure storage boxes from the van to the window fixtures. We hung sheets from the twine and made a small exam room with our massage table set up inside of it. The midwives arranged tables for equipment to take vital signs, the mobile ultrasound machine, a station for lab work and one for the pharmacy and nutritional supplements. They were ready for patients. It happened so quickly that I wondered if they had discussed this earlier as a possible option. The midwives are excellent at taking action and I constantly admire the ingenuity they use to solve a problem. This can be the case in big or small situations, like how to see patients when there isn’t a space prepared to see them or how to conserve ultrasound gel when they won’t receive a new supply any time soon.
The midwives hung sheets with twine to make an exam room for patients.
Dr. Valeria and the midwives work to get their equipment set up.
Now, as Emelda voiced earlier, were patients going to come? We only worried for a moment. Sure enough, they started to trickle in for their prenatal and postpartum checks. In a community that had been so insular, it was clear through the loyalty of these returning patients that the ACAM midwives are making headway and becoming trusted as care providers. These women actually anticipated and looked forward to this clinic day and used the date previously written in their patient cards by the midwives to know when to arrive for the clinic. They didn’t mind the open air clinic setting and sat on the tailgate of the van waiting their turn for the next appointment, like neighbors visiting on their familiar street block.
Midwives work with a patient at the mobile clinic.
A woman we have been following through her pregnancy with serial ultrasounds due to a growing fibroid came for her regular scan. Doctor Valeria assured that the baby’s growth was normal and the fibroid was not constricting it, but it is still important to get consistent prenatal care to stay vigilant. Valeria outlined risk factors and what symptoms would look like if the woman would need to go to the hospital for any reason. She was appreciative and the midwives counseled again in Mam to make sure she had a full understanding of all the teaching and care that was being given.
The day felt like a success when it was finally ready to pack up. The warm sun felt nice on our faces as we took down the sheets and twine. An obstacle which in other settings might have postponed or even canceled the clinic was met with a fast and creative solution. “Well done. That was very impressive,” I applauded when we all got back in the van. My comment was met with polite smiles and looks of mild confusion. When something needs to get done, the midwives just do it. They thought nothing of having to find a work around or overcome a roadblock. The genuine altruism of wanting to care for these women made it hard to see that this was a challenge that needed to be bested. Instead it was only part of a day’s work and now they could continue to the next important task that would be completed without any hesitation. I smiled to myself at their bewilderment to my compliment. They aren’t even aware of the mountains they’re climbing and how many peaks they’ve already reached.
