The First 2 Work Weeks

The CASA building, in all its glory

I spent my second night in a hostel, and was fortunate to find an apartment by the third night. Its a 10 minute walk from CASA, up and down a hill on Avenida de Los Ninos Heroes. The street names - when the streets actually have names - are rooted in history or religion: "28 de abril", "Avenida Independencia", "Calle San Rafael". I know this because I have embraced my status as extranjera, and rely on my trusty map. I feel like Dora the Explorer con su mapa. People who actually live here just direct me "Luego, luego" and recognize landmarks, instead. They also look at me as if I were from another world, and, I guess, I am.

The work at CASA is very interesting. The organization divided into several groups of promotores: PESANE, who provide workshops about sexual health to teenagers; ECOSS, who work with mothers; TEATRO, who put on works about ecology and family violence in primary schools; and REDESS, a radio program who broadcast throughout northern Guanajuato. The programs are run by young people in their late teen and early 20s, and coordinated very well by former promotores in their early-mid 20s. They take their jobs very seriously - there is none of the childish attitude you find in a lot of their peers in the US. There is also a day care, a library, a computer lab. Sliding scale fees are charged for all the services. I am sure this is out of necessity, to pay staff salaries, but I expected the "free and confidential" I am accustomed to, working at The Door AHC.

I have been going out with promotores to observe their work, in order to decide which group I will stick with for the summer. The program is very much self-starter, so if you're bored or unsatisfied, its basically your fault. Nadine, the founder, was soliciting a grant in order to create a new play with TEATRO and broadcast an on-air segment with REDESS, dealing with nutrition. The local people here eat so poorly! Chips, Coke, and fast food are ubiquitous. Mexico, apparently, is the world's biggest consumer of soft drinks, and the second fattest country in the world (after the US, naturally). The most popular chain in the city is Pollo Feliz, and the only advertisements more prominent than those of Coca Cola are those of Pepsi. Even the bottled water are Coke and Pepsi products. This is a direct clash with the healthy, traditional Mexican diet of fruits, vegetables, and legumes. It is also very ironic, because there is also much malnutrition, so having fat children is not considered unhealthy by many mothers. So, I decided to work on the up and coming nutrition program, which Lourdes, the administrator and a licensed gym teacher, will head. I decided to conduct a census, in order to gather data about the nutritional practices and beliefs of the residents of San Miguel and the surrounding communities. No such statistics exist. I will work on the census with ECOSS. Also, I will help write the play about nutrition, targetted at the children.



In addition, on Friday, Kelsey and Tim (the other interns) and I observed the work of CASA's hospital. It is a private hospital, and patients pay on a sliding scale. CASA developed a UN-recognized model of midwifery, so we were there primarily to observe their work. (The 3 year program, followed by a year of residency, is so popular, that women from other states travel to study with CASA. There is even a Guatelmateca.) However, the midwives cannot work in San Miguel's public hospital, due to political reasons. The government does not accept the midwife training curriculum. Rather, the parteras are contracted by CASA and paid by birth.

Our guide, a young midwife of 25, allowed us into the room of a woman who had given birth the night before. The 27-year old mother was attended by female members of the family, as well as her 3 other children. Afterwards, Kelsey, Tim and I took turns observing visits: Kelsey and Tim sat in on pregnancy check-ups, while I observed a GYN exam. This was especially cool for Kelsey, who was actually considering parteria as a career. It seems so womanly, and such a proper existence - to bring life into the world, and be so close to death at the sametime; it reminds me of the Red Tent. I was just about to sit in on a pregnancy check-up when my landlady called, alarming me of a strong smell of gas coming from my home. I ran home, remembering with bitterness that I left the oven on after an attempt to heat up breakfast tortillas. Thankfully, all the house needed to prevent me from Sylvia Plath's fate was a day of airing out.

The GYN exam I observed prior to my emergency was an experience. The patient entered, a woman of 37 who needed an HPV exam. She claimed to have her last exam 2 years ago, to use condoms for birth contol, and to obstain from drinking and smoking. Condoms, pills, and IUDs are provided free of charge by the state. She then went to the bathroom to change and then took her place on the same sheets used by the previous patient. (The sheets are changed twice a day. Luxuries such as disposable sheets are not available in a country of limited resources). I was baffled that the midwife did not ask the woman's permission to allow my presence, and that the woman did not inquire about it. The last thing I would want when my cervix is in someone's face is to have another stranger gaping at me. Embarassed, I asked if it would be okay for me to stay. She shrugged, as if she had no choice. I am extremely spoiled by The Door, where everything is not only free but extremely private.

Then, the exam began. The midwife snapped on the rubber gloves. She took out one of those horrible metal speculums (again, no disposable luxuries here), and talked the patient through the discomfort. After inserting it, she waved me over - to look at the woman's cervix! My curiosity overcame my modesty. Here it was! How many GYN exams have I had, and now I had the opportunity to actually see what the provider sees. Beneath the bushiness of her mons pubis, the canal was wide open, and there, at the end, was the pink entrance to her uterus. My eyes lit up. It looked so ... right. Better than the drawings. (Though this particular one seemed a bit inflamed). The midwife drew samples of discharge, using the same tools I have presented and explained to scores of AHC patients in the waiting room. Then, it was over. I thanked the woman as she walked out. Then, the midwife took down our phone numbers to alert us if there would be a birth and we wanted to observe it. I can't wait.