On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
Liz Quinn, SOM ’12, traveled to Guatemala, where she conducted research on the history of midwifery there for a book she is planning to write about Guatemalan midwives. Her memo captures what a truly small world we live in with such easy global transportation and communication. It also captures the power of a medical student's ability to reflect about patients who are immigrants to this country.—Hugh Silk, MD
Que mundo pequeño
This is my fifth trip to Guatemala, and after nearly two months, it is coming to an end. Always at this point in my travels, I start to feel homesick, as if knowing I’ll be back in Worcester next week makes being here in Guatemala City more difficult. Last Thursday, I planned to visit the National Library to review newspapers from 1956 (a pretty typical day for me, as I am here researching medical history), but at the last possible minute, while eating my breakfast, I decided instead to accompany my friend Maria to work. She is a lactation consultant at one of Guatemala’s biggest public hospitals.
The neonatal unit has struggled with recent fatal outbreaks of a multi-drug-resistant acinetobacteria and necrotizing enterocolitis. Soap and alcohol-based hand scrubs make only occasional appearances on the very crowded wards, so the infection problems are not surprising. In such an environment, Maria’s work helping these indigent mothers to breastfeed feels like a matter of life and death (where one cannot trust bottle sterilization in the hospital, if it is done at all). On Thursday morning, she and the nurse on her team worked with more than 50 new mothers, including the mother of a newborn with a cleft lip and palate who was still too small for a safe surgery. I was happy for this intensive review of breastfeeding guidance and by the end of the morning was eagerly helping moms and babies on my own.
In the last room we entered, I met a young, exhausted mother whose second daughter had been born earlier that morning. As I asked her about her desire to breastfeed, she told me this child had "almost been" a U.S. citizen. I asked her where she’d been living in the United States, and as it turns out she’d lived in Clinton, worked in Worcester, and was a Queen Street patient during this pregnancy. I sat down on the bed facing her and smiled, a little dumbfounded by the connection. Que mundo pequeño. What a small world, we both agreed.
At Queen Street, she'd been cared for by two different female doctors who both spoke Spanish, but she didn't remember their names. She assured me that they’d been very kind, and that she missed the United States. Her older daughter had been born in the U.S. some years before and is a U.S. citizen, so she really regrets that this new infant had not been born in Worcester. But her husband had been deported a few months ago, and she and their U.S.-citizen daughter had had to leave with him. She was excited that I would let her Queen Street doctors know she was okay (she’d had a C-section, like approximately 70 percent of the hospital's patients).
Sitting there in the hospital's sunny, crumbling wards, I was so moved by the unexpected connection that I almost started to cry. We hugged and said goodbye, but I haven’t stopped thinking about this woman or her family. Meeting her made me worry for my undocumented patients back in Worcester, and I’ll think of her sadly when I board my flight to Boston in a few days.
Happily, her baby girl latched beautifully.