My charge this summer was to learn about local health care capacity with regard to pregnancy and delivery—pretty broad goals, but Dr. Nardos and I decided to try to administer two surveys: one for formal health care providers working at clinics, and one for midwives and other lay providers I happen to meet in the community. The surveys basically ask what these people do on a regular basis, how they handle certain prenatal and obstetric complications, the nature of their training, and what they perceive as successes, challenges, and needs in the realm of maternal health.
One of the most important lessons from my undergraduate studies in medical anthropology and global health is, forgive the cliché, to expect the unexpected. This type of research is clearly nothing like the sterile, controllable bench research I’m familiar with, and especially in developing countries one has to make allowances for language, culture, safety, geography, and general disorganization.
I was lucky to find a good translator within the first week of my stay, so my main challenge was undoubtedly logistics. I was unable to find any sort of detailed map, and the bus situation is far from reliable, so I spent a good deal of time wandering around and hoping I didn’t get stranded in the dark in the middle of nowhere (which, thankfully, never happened—we ended up being pretty good at hailing buses and hitching rides). Additionally, finding lay-level providers and traditional birth attendants proved to be harder than I thought: perhaps I didn’t get far enough into the countryside and away from formalized health care, perhaps home births are falling out of favor as the Ministry of Health invests more in maternal health outreach, perhaps I just didn’t ask the right people in the communities I visited, I’ll never know. Despite these hiccups, I think was able to visit enough health centers and speak with enough stakeholders to get a gestalt of how health care is organized and what gaps need to be filled to improve women’s access to quality obstetric care. I was touched by women’s stories, inspired by some of the providers I met, and I know I learned so much these past five weeks.
Hopefully the information I gathered this summer will lead to OHSU’s developing a future program with Gimbie Adventist Hospital to improve maternal health, and hopefully we’ll be able to give back to these people who taught me so much these past five weeks.