March 2016 Peru Maternal-Fetal Health

The work of Reach Out And Learn volunteers benefits thousands and saves lives!

Preparations for our efforts to train Peruvian Maternal-Fetal health professionals and to help those in need, began years in advance, as this is a “fifth annual” event, not including our neonatal resuscitation training that was held October 25-30, 2014.

We had a “Trainers” meeting for our professionals at the Esplin home in Salt Lake on January 22nd, attended by Chad Fugate, Ty Erickson, Mark Dowdle, Sean Esplin, and Michael Huntsman. At this meeting we discussed and made plans regarding the training itinerary and topics. The training areas have been decided through the years as we have formed relationships of trust with our Peruvian counterparts/colleagues, discovering the issues that are important to those in need that they work with.

Newborn and delivery kits were given to each midwife, nurse, and doctor who attended the Reach Out And Learn Maternal-Fetal training meetings.

We had an orientation meeting on Saturday, February 20th in Pocatello, at the Wheatley home, where we, as directed by Patty, packed 22 large duffle bags with newborn and delivery kits, lovingly prepared in advance by Patty and others. These kits were distributed to nurse midwives at our Maternal-Fetal health training meetings in Cusco, Quillabamba, and Puno, Peru.

There were 34 in our group, from the U.S.. We left the United States on Thursday, March 24th, 2016. Most of our group traveled from Idaho, others from Utah, Arkansas, and Maryland. During our education workshops, we trained more than 100 nurse midwives, nurses, and doctors in Cusco, Quillabamba, and Puno, Peru. Our training workshops included, postpartum hemorrhage, newborn resuscitation, vacuum delivery assist, hypertension (preeclampsia), difficult deliveries, and leadership principles. We expect our native “trainees” to help thousands in need as they work in maternal-fetal health facilities in Peruvian cities and in rural areas.

Reach Out And Learn Volunteers, with Casa Ccunca in the background, to the right. (Our bus driver, Exaltación, took the photo)

We arrived in Lima just after midnight, around 1:30 AM or so. As we made our way through immigration and customs, then to the exit and found our driver holding up a paper with the Reach Out And Learn logo on it.

We loaded our bags and found our seats on the bus for the short drive to our hotel. The hotel was a nice one, though we only were there a few hours, long enough for a little sleep and a quick shower. A humorous comment from one in our group was, “my room doesn’t have a bathroom!” After further investigation, we found that the bathroom entrance was behind the room door, and that the bathroom entrance was “hidden” when they entered their room. I think one other person said, “Neither does mine!”

At 6:30 AM we loaded the bus and back to the airport for our "domestic" flight from Lima to Cusco. Our first significant miracle occurred when we got through the check-in process, with more than 75 luggage pieces, and were charged no extra fees!!

We were given the choice to have our bags go before us on an earlier flight to Cusco, which we chose to do. The flight we were on, which was suppose to leave around 10 AM, was delayed a couple hours. We called ahead and asked Cesar to pick up our luggage at the airport in Cusco and take them to our hotel. Amazingly, and our second significant miracle, all our bags were in our hotel rooms when we checked in!!

This time of the year, in Cusco, is fall, coming into winter, the dry season. When we exited the airport in Cusco, it was sprinkling a bit, but we had at least one day of significant rain, on Wednesday evening, though we were all eating at a buffet during the deluge.

We settled in at our hotel, and while some rested, others ventured out to explore the city.

Notice the Inca walls, located lower on the wall, with newer construction above.

The Catholic Cathedral in the Plaza De Armas (Central Square) in Cusco.

Early Saturday morning, most of our group loaded a bus and travelled to Casa Cunca, a remote village located at an altitude of nearly 13,000 feet above sea level.

A family in the yard next to their home in Casa Ccunca

Since it is Saturday, few families are at home, as most of the villagers are working in their fields, which are spread across the vast mountainsides. Some families walk an hour or so to get to their fields.

While many of us went to Casa Cunca, others, Mark Dowdle, Ty Erickson, Chad Fugate, Jeff McClellan, and Terry Richmond, went to hospitals in Cusco (Antonio Lorena, Belen Pampa) for training meetings.

Barbara, with the villager’s fields in the background

In this village, we were given the task to explore, observe and discover, as we walked among the houses, throughout the village. Some of the questions that prompted our discovery were,

Group 1: What is the source of water for the village? Where does the water originate? If there’s a community water tank, where is it located? How is water brought into the tank? Does the village have pipes that bring the water from the tank to specific areas or homes (faucets)? How pure do you think the tap water is? Do you think the community’s potable water may be vulnerable to contamination, from humans, animals, or the environment? What can you recommend to improve the community’s water system?

Group 2: What types of food do villagers consume? Are there gardens? If so, what types of fruits and vegetables are grown? What is their source of protein? What animals are found in the village? Which animals are raised for food? Do villagers eat eggs and milk? Can you think of any other foods that the villagers may be able to add to their diet?

Group 3: How do villagers stay warm and dry? Do the homes have a source of heat inside, such as a furnace? How are those (the very young) protected from cold temperatures? Do the home have windows? Do the walls of the homes provide insulation? What types of roofs are on the homes? Do the roofs provide the inhabitants protection from rain? What possible sources of heat can you think of?

Group 4: What schools or opportunities for learning are available to villagers? What subjects are taught? How many teachers are there in the schools and what are the teacher’s credentials? At what age do children begin their formal education? At what age do students in the village complete their secondary education? What opportunities are available to villagers who further their education? What technologies are available in the schools? What educational resources/technology may be added to student learning?

Group 5: What methods of transportation are available to villagers? Do they have workout rooms in their homes or exercise gyms nearby? What physical challenges do you think villagers may encounter? What health problems exist here? What sources of medical attention are available to villagers? What is the life expectancy of villagers? What things contribute to cause health problems to villagers? What natural disasters are possible here? In the event of such a disaster, how prepared to handle, survive, and recover from the disaster, do you think, are the villagers?

Group 6: What is the native dress of the villagers? Choose a male from our group and a female to dress up in the villager’s native clothing. Have a villager help build a fire that will be used to cook food for our group. Prepare and cook the food we brought with us. Collect information about the history of this village. How long has this community lived here? Collect a personal history from one of senior villagers. When did their ancestors come here? Where did they live before here? How many villagers live here? How many families are there in this village?

Group 7: Interview two or three adults about their individual, family, and village history. Here are some questions. Did you grow up in this village? How long has this village been here? Where are your grandparents from? How many families live here? How many people live here? What is a common family size here? What is the predominant religion? What are your hobbies? Singing, play an instrument, weaving. How do people here measure success? Children, harvest, livestock, clothing, transportation, health, faith. What is the life expectancy of villagers?

Carolyn with a village niño. We gave “burrito babies” to the niñas

On Monday, we returned to Casa Ccunca. We were met by school children. They draped streamers around our necks and we did activities, sang songs, had a relay race holding balloons between each pair of two, painted fingernails, sang songs, handed out fruit and so forth. This village has a water tank located above the village. There are water spigots outside of some of the homes. Villagers wash their clothes in one of the streams that flow through the village, on areas of cement. They don’t use laundry detergent though.

Aunie Bell raised money which went toward a number of purposes, including, purchasing school supplies for schools in small villages, the water project, and fruit she handed out to school children in Casa Cunca.

Working on the water project: Darrell, Brent and Sam Funk, and Bob Trevino

As part of his Eagle Scout project, Seth Esplin collected donations (jackets and coats) to provide to children who live in high mountain villages where the temperatures are below freezing at times during the winter months.

Jeff McClellan, PhD provided leadership training to medical professionals at the Colegio de Obstetras, and to “Bomberos” (First Responders), at the City of San Sebastian

On Monday, March 28th we went to the village of Pampahuaylla where we had activities with the school children.

Including soccer, a fish pond, singing, and hop scotch.

Carolyn

On Friday, our group was split, with some going to Quillabamba, to train midwives, nurses, and doctors at the Quillabamba hospital.

While others in our group went to Puno to do similar training.

Patty and her team, gathered and assembled kits (purple bag) containing items for delivery professionals to use while assisting during childbirth.

Jacqueline is a Peruvian midwife. Over the past few years, she has participated in our train-the-trainer meetings and provides “team-teaches” with us.

Dr. Sean Esplin leads a maternal-fetal training meeting in Quillabamba, Peru

Chad Fugate, a Certified Nurse Anesthetist, leads a discussion during a maternal-fetal training meeting in Quillabamba, Peru

Dr. Ty Erickson, explains procedures to properly respond during difficult (childbirth) deliveries

Chad Fugate, CRNA, provides instruction during a “breakout” workshop session. This “station” focused on newborn resuscitation.

Susan Binegar, MSN, CNM, prepares to train Peruvian “Obstetras” on how to treat postpartum hemorrhage

Chad Fugate and Janet King, FNP, train maternal-fetal professionals on neonatal resuscitation

Getting hands on experience with neonatal resuscitation

Our work is most effective when we train “native trainers” who conduct the training

Barbara West, RN checks that a midwife uses an ambu bag correctly

Dr. Mark Dowdle has a fun moment showing some of the props used to help those in need by training foreign medical professionals

Terry Richman, RN, helps midwives in a workshop focusing on “breech” deliveries

Dr. Erickson demonstrates, in a workshop session, what to do when a baby is delivering breech (feet or buttocks will come out first during childbirth)

Doctor Esplin, with many “engaged” learners in a workshop session

We have found that learning in workshop-type sessions provides better opportunities for information exchange and questions to be asked and answered

Susan Neibaur, RN, looks on as Lori Ellsworth, RN, CNOR and Carolyn Ranten, OMS III, conduct a maternal-fetal training workshop, for midwives at the Colegio De Obstetras in Cusco, Peru.