By Bernadette Bernon
August 17, 2001
At the fork of Río Tatin and Río Dulce, Guatemala
15 46.695 N 88 48.200 W
"Here, people really do rise from the dead, kill for love, and get struck down by mystery diseases that might very well be curses," said Kelly McBroom, who lives aboard her Jeanneau 30 Betty Boop, anchored near Ithaka, just off the Ak'Tenamit Clinic. Kelly's been the midwife at the clinic for more than a year now, and in addition to standing call and attending to general patients at Ak'Tenamit, her job's been to train women in 40 Q'eqchi villages in the skills of "catching babies." Douglas and I have become friends with Kelly while we've been at Ak'Tenamit for the last couple of weeks, and she's let us trail after her a bit, watch her work, and learn more about the people of the hills here.
When women come into the clinic, or when Kelly or someone else has to take a Q'eqchi to the main hospital in Barios for emergency surgery — "Pray you never have to go there" — it's often the woman's first trip outside her village and off the river, Kelly said. "She's petrified. We try to calm her by telling her that there are other women of her 'corte' there — women of her skirt." Q'eqchi women traditionally wear gathered skirts made of many yards of colorful woven fabrics that differentiate the villages.
In a normal week, Kelly hikes through muddy rivers waist high, attends to the pregnant village women, trains midwife apprentices, gives babies checkups, and sees sick and malnourished infants. In one village, she examined a 3-year-old who weighed only 17 pounds and couldn't walk. "So many babies die in their first three months," she said, "that for many days the family doesn't tell people they've had a baby.
"Q'eqche people were from the highlands before the war," Kelly said. "They were driven down to the lowlands around the Río Dulce. This uprooting has made them an untrusting people. When they lived in the highlands, in each village, there was a midwife who held a high status. But most of the midwives were murdered during the war, and so there's been no one from whom to inherit the skills. Today, women giving birth sometimes are attended by their husbands, or maybe their mothers. But most often they give birth alone, in secret, so that no one outside the immediate family even knows about the baby."
Q'eqchi tradition holds many superstitions about babies, and a great deal of distrust. As a holdover from the terrors of the genocide during the war, village people are still afraid to let anyone know how many children they have, believing if their family is selected to be killed, the assassins will know how many children to look for. "If no one knows how many children you have, well, it's possible some will escape," said Kelly. "That's how people still think here." So, to respect this secrecy, after a birth, no one asks how the mother and child are doing. No one says a word, until the mother brings the baby "out."
Since the tradition of midwifery died out, the mortality rate of mothers and newborns has soared; now, Kelly said, the Q'eqchi have the highest rate of deaths at birth in Guatemala. She told us that most women marry at around 14, give birth to six to 10 children — they're discouraged from practicing birth control — and most watch at least two or three of their children die before the age of three months.
Superstitions surrounding pregnant women are taken very seriously here, and Kelly gave Douglas and me a crash course. While we've been working at Ak'Tenamit we've met lots of newborns and expectant moms (many who look barely old enough to date, let alone give birth). A pregnant Q'eqchi woman believes she never should see people or animals die, because her baby will remember and get sick from the scare. She believes that if she sees someone breathing raggedly or taking their last breath, then her baby will be born with hiccups that will affect its whole life. She believes that if she comes upon a howling dog that's dying, then her baby will howl. When a woman gives birth, she stuffs her ears with cotton to keep out evil spirits, wraps up warmly, and rests near a burning fire to keep her "hot/cold" in balance — and it's already 100 degrees here! "Plus, don't look directly at the infant," warned Kelly. "Q'eqchi are afraid that you'll inadvertently give the baby the evil eye, it'll get sick and die. So ask special permission to look at a newborn. After you do, lick your fingers, and then make the sign of three crosses on the baby's forehead, then touch it all over with your hands. This exorcises the evil spirits."
Kelly did her Stateside midwife training and her masters in cultural anthropology at Case Western Reserve University in Cleveland, Ohio. She's been working with women in Central America for the past 10 years: in the refugee camps of Chiapas, during the civil war in Nicaragua, and now in Guatemala. Her training has been practical, courageous, intense, and eclectic. In addition to her duties at AK'Tenamit, two weekends a month she's also catching babies with a 70-year-old Garifuna midwife named Doña Catato, "an old, truly granny midwife, with nappy white hair under a checked scarf, whiskers that poke irregularly out of her chin, and three teeth, yellowed and twisty, left in her mouth. The skin on her face is stretched tight over her cheekbones, and she has a mass of greasy wrinkles when she smiles. She's beautiful. Cata's grandmother was a midwife and told her that she'd one day be a midwife, an idea she resisted at 12. She caught her first baby at 15, after she had a dream about birth. She explained that while all her neighbors relied on men to bring them food and clothing in exchange for coupling, she was independent and would never rely on men in that way. She had her pigs and chickens and her hands and her trade, and all her 114 grandchildren are welcome in her home. They come and stay and eat fish when they want, and she's always there to receive them and the women who come to her for help.
"Garifunas, Q'eqchi and Latinas come to Doña Catato's tin-roof, dirt-floor house for pregnancy massages, foul-smelling herbal brews, and cures of all kinds," said Kelly. "She helps them in giving birth, and I wanted to see what it was like with a traditional midwife here. Cata's birthing room has three wood-pallet beds covered with grass mats, and an altar always alight with novena candles. Whenever she had a more challenging patient, she'd disappear into her bedroom, light more candles, and summon help from the saints.
"One rainy day a woman named Candida arrived, a Latina, nearly toothless after 12 pregnancies, and grieving the five that she'd lost. She was worn, haggard, and used up, and was probably only in her early 40s. Women's lives are very hard here. Candida was splayed out, moaning, and pushing on the hard bed when I walked into the birthing room that night, and she said she'd been pushing since morning. Cata gave Candida a bottle of fuerza-grain alcohol and told her to drink it. It took an hour or so, but Candida finished the entire bottle and became quite drunk. Cata told me to get ready, whatever that meant. There was no way to wash my hands, no instruments, no forceps. By my training, the woman was still a long way off. I knelt between Candida's legs, Cata greased up her hands, straddled Candida's abdomen, and began pushing at it with all her force. Little by little as I watched, a round black orb of a head appeared, Candida bared her gums and writhed in pain, the baby crowned, and was born with a gush of green fluid into my nest of rags. I rubbed it up, and it squalled. As the scrawny creature gained color, Cata whooped, 'It's your first boy child! Girl, you owe me a chicken!'
"Cata got Candida some hibiscus tea to sip while nursing — it's high in iron — and put a spoonful of anise seeds in a swatch of cotton fabric dipped in honey for the child to suck on as a pacifier. Anise is a digestive and stimulates bowel motility. Well, the baby was soon shitting like crazy all over the mom's belly. While everything calmed down, I gathered up all the bloody sheets and walked down to the river to wash them and think on everything I'd just seen. I love to wash birth sheets by hand. As I splash the stains with water, and the crimson fades, order returns to the world. It's a contemplative time for me.
"I know that alcohol stops uterine contractions, makes them weaker and less effective. I know that fundal pressure, as Cada had used, carries the risk of rupturing the uterus and killing the mother. I'd cringed, yet had to stand by and watch. Part of me wanted to nudge Cata to change her practices, but then again, she'd been a midwife since 20 years before I was born. I was the visitor."
Ak'Tenamit's primary school (escuela), volunteers' and workers' dorm, and the clinic.
Kelly's life as a midwife in Guatemala is full of contradictions. One day, she's learning from a revered village elder about natural remedies and catching babies. The next she's conducting a two-day Health Fair for 150 Q'eqchi women on the menstrual cycle, fertility, breast exams, and natural family planning. "Here, we call it 'child spacing,'" she said. "I was a walking uterus, my arms outstretched, and plump red balloons for ovaries. I talked about the labia, the clitoris, the 'little frijol of women's pleasure,' and all the girls covered their mouths with their hands and giggled. By candlelight, I slung my hammock with the women, wrecked, but happy."
In the time she's been at Ak'Tenamit, Kelly's delivered 35 successful breach births, where the baby's head isn't aiming down, a serious situation for women in labor that in the United States would mean the woman would need special medical attention. Here, without help, it can mean death for the mother or the baby or both. But this is all in a normal day's work for Kelly. "I love it here," she said. "I get to do so much I'd never be able to do in the States. And at night, I get to row back to the boat, and let Betty rock me to sleep."
For More Information
Ak' Tenamit sustains itself by recruiting full-time volunteers, by tax-deductible private donations, and by seeking international sponsors to help cover each student's basic costs (about $1/day/student). Many cruisers who visit the Rio Dulce anchor off the facility (a safe, well-trafficked spot) and stop by to offer a hand for a week or more. A hearty hot lunch and a list of chores needing to be done are always available. Ak'Tenamit is also a great resource for cruisers seeking medical attention, as it's staffed by highly-trained physicians.
For info on Ak'Tenamit, log on to www.aktenamit.org.
The to contact Ak'Tenamit's American Office:
The Guatemalan Tomorrow Fund (a 501-C3 corporation): P.O. Box 3636, Tequesta, FL 33469. Phone: (561) 747-9790, or e-mail: email@example.com.
To contact the Guatemala City Office:
Asociación Ak' Tenamit, Apartado Postal #2675, Zona 1, Ciudad de Guatemala, Guatemala, Centro América. Phone: (502) 254-1560 (ask for Guillermo, who speaks English)