Paola is in her mid-thirties and has six children. She is deathly afraid to become pregnant again, but her husband wants more children. She is reluctant to have sex with her husband, and he is looking around for other women. He has threatened to leave Paola and their children if she does not submit, and Paola does not know what to do or where to turn.
Fortunately for Paola, Manos Abiertas offers a solution. Manos Abiertas, or “Open Hands,” is an integrated women’s health center providing family planning and maternal health services. The clinic is located in the small town of Ciudad Vieja, five kilometers from Antigua, at the base of Volcan Agua. The clinic is run by its founder and director, Hannah Freiwald.
Ms. Freiwald, originally from Germany, is a trained midwife who has managed birthing centers in Guatemala City since 1997. Several years ago, a representative from Planned Parenthood Federation of America, Inc. (“PPFA”) contacted Ms. Freiwald about funding a Guatemalan project focusing on maternal health issues. With PPFA funding, Ms. Freiwald decided to open Manos Abiertas in Ciudad Vieja.
Before Manos Abiertas opened, there were no comparable services in Ciudad Vieja. Women lacked education about family planning choices. Ciudad Vieja had (and still has) no hospital. The public emergency health center was attended by a general auxiliary nurse with no emergency services outside of office hours. Generally, women delivered babies at the National Hospital in Antigua. Yet, the hospital had a high rate of infant mortality and performing C-sections, which are inherently dangerous to the mother. Women who chose not to deliver at the hospital gave birth at home with the assistance of a traditional midwife. Ms. Freiwald explained that although traditional midwives are good, they are not trained to handle emergency situations.
Manos Abiertas now offers a full range of women’s health care services – from family planning options to post natal care. The clinic offers full gynecological care, including pelvic exams and pap smears, which test for cervical cancer and other abnormalities, and receives lab results in about a week. In addition, Manos Abiertas tests for most sexual transmitted diseases, including herpes, syphilis, gonorrhea, hepatitis B and C, and HIV. If other or more expensive tests are necessary, Manos Abiertas will refer the patient to other doctors, usually in Guatemala City.
Manos Abiertas supplies several family planning options. The clinic offers oral contraceptives, birth control shots (one or three month injections), birth control implants, condoms, intrauterine devices, emergency contraceptives, and other services. Most importantly, the clinic provides education and counseling about all of these family planning methods so that women can make informed decisions.
If a patient is pregnant, the clinic provides prenatal and postnatal services. Manos Abiertas supplies pregnant women with nutrition and health counseling, nutrition supplements, lab work, routine check ups, and prenatal classes. After delivery, the clinic offers check ups for the mother and baby for up to six weeks.
Manos Abiertas is also a birthing clinic, following a professional midwifery model. This means that the mother decides her position for delivery and who she wants present during delivery. She also delivers naturally without chemicals. There are two individual rooms for birthing at the clinic, and the mother may remain at the clinic for up to 24 hours after delivery. Only in an emergency situation will the clinic staff attend a delivery at the home of the mother.
The three staff members of Manos Abiertas, Ms. Freiwald, her assistant Gabriela, and the head of clinical maintenance, are all women. Ms. Freiwald is a certified professional midwife and has personally trained Gabriela. Both women are qualified to provide clinical care for women. The clinic also hosts interns studying midwifery for several months. Other volunteers are welcomed. The clinic is open every day during the week, with a staff member on call for emergencies.
On average, a woman will pay Q25 for each prenatal appointment until she delivers her baby. However, Manos Abiertas offers these services on a sliding scale, meaning that the amount a woman will pay for clinical care is based on her ability to afford treatment. Approximately one or two women a month are unable to cover the Q25 fee. According to Ms. Freiwald, “No one is ever turned away.” The clinic will work out a payment plan for those who cannot afford to pay at the time services are rendered.
For example, recently a mother of five children in her mid-thirties sought the clinic’s help. The mother had miscarried twins at four months and had developed an infection and anemia. She had been to a doctor who had prescribed her antibiotics to prevent her from becoming more septic. The woman was too ashamed to tell the doctor that she could not afford to pay for the medicine. She refused to see the doctor again despite needing more care.
A family member then brought her to Manos Abiertas. The clinic realized that she desperately needed help. The clinic purchased and administered the expensive medication and allowed the woman to rest at the clinic. If the woman had gone without treatment for another twenty-four hours, she would likely have died. The clinic then worked out a payment plan with the family to pay off the debt from the medications. Manos Abiertas’ determination to turn no one away is an enormous drain on the clinic’s operating budget, and the clinic needs donations to cover these kinds of emergencies.
As for other funding, Planned Parenthood Federation of America, Inc. has supplied Manos Abiertas with a renewable grant for up to four years to cover general operating costs. PPFA also provides technical support, training, and all of the tests and contraceptives the clinic offers. Manos Abiertas hopes to be self sustainable in the next few years.
Manos Abiertas is the only clinic in Central America funded by PPFA that offers midwifery services. PPFA requires that the clinic use PPFA funds for maternal health care but has not placed any other restrictions on the clinic. Private donors have also helped by supplying the clinic with medical equipment and furniture.
MAKING A DIFFERENCE
On average, the clinic sees eight to ten women a day, with most women being around the age of sixteen. The counseling and education the clinic provides is working. According to Ms. Freiwald, the clinic’s success is due in large part “because there are no men here.” Manos Abiertas offers “Atención de mujer a mujer;” care from women to women. By creating an environment free from the influence of men, the women – and only the women – make decisions concerning their reproductive health.
Traditional midwives have also been supportive of Manos Abiertas. For example, a young woman named Maria was expecting her first child. She had been attended by a traditional midwife throughout her pregnancy, but her midwife was not allowed to deliver her baby because regulations from the Guatemalan Ministry of Health prohibit traditional midwives from delivering the baby of a first time mother. Instead of going to the hospital, the traditional midwife recommended that Manos Abiertas deliver the baby. Maria was able to deliver a healthy baby at Manos Abiertas with her family present.
Despite its success, Manos Abiertas still faces many challenges. The “machismo” culture in Guatemala oftentimes dictates that the husband will make all reproductive health choices for the wife, including when she has children and how delivery will occur. Additionally, some Guatemalan men believe that a woman who does not get pregnant is unfaithful. Accordingly, men often forbid women from using contraceptives.
As a result, women are seeking counseling secretly. For example, Paola, as noted above, has six children and does not want to get pregnant again. So, Paola comes to Manos Abiertas, without her husband’s knowledge, to receive monthly birth control injections. She plans to undergo sterilization surgery soon, and she must not become pregnant for the surgery to be successful.
Some religions also prevent women from receiving care because they advocate against contraceptives, emergency contraception, and abortion. (Abortion is illegal in Guatemala except in cases to save the mother’s life). Additionally, some patients are mono-lingual in a Mayan language, making counseling difficult.
Despite these challenges, the future for Manos Abiertas is promising. Backed by PPFA support, the clinic intends to reach more women and eventually offer more services. For now, Manos Abiertas is glad to be able to offer women an alternative to the maternal health choices – or lack of choices – that they have had in the past. With hands open, Manos Abiertas invites women to receive integrated family care given from one woman to another.
HOW TO HELP:
Manos Abiertas accepts donations and volunteers. The clinic desperately needs an ultrasound machine and donations to its emergency fund. If you are interested in helping, please contact the clinic via telephone at (502) 7888-7740 or (502) 5000-4810; via email at firstname.lastname@example.org; or in person at Manos Abiertas, 2 Calle 2-59 zona 3, Ciudad Vieja, Sacatepequez. Manos Abiertas’ website is available at http://centrodepartonatural.org/index_archivos/Page487.htm.