Matt In Guatemala

This blog represents the personal experience of one MCH (Maternal and Child Health) Peace Corps Volunteer who served in Guatemala from 2015 to 2017. The opinions expressed here are neither those of the Peace Corps nor of the U.S. or Guatemalan Governments.

Motivational Interviewing and House Visits: Empowering People to Change Their Lives

This last Friday I, and nurses from a local health post, completed house visits in the outlying community served by this health post for several hours in the morning. The purpose of these visits was to give women in this community a shiny plastic “Rueda de Practicas” (Wheel of Practices), and ask them a question about each “practica” (practice) which impacts their family’s health, such as if they use soap and water to wash their hands, and when they wash their hands. One third of questions probe general health practices, (such as hand-washing), others are for parents with kids less than two years of age, (such as if they know health warning signs in their young children that indicate they should take them to the health post or health center), and others are for pregnant women (such as are you eating better, and taking prenatal vitamins, now that you know you’re pregnant.)

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Depending on their answer, I fill in a happy face, a neutral face or sad face. As I don’t want to be seen as the Rueda Brute Squad in my community, i.e. going door to door and giving pop-quizes on people’s personal daily lives, so I tell the adults in the household to, “no tenga penas”, don’t worry, this Rueda is just a tool to help us figure out how to help people in the community live healthier lives. If I put down a sad face all it means is that we get to give a health talk to you today, nothing more. I think that when using this tactic, I am more likely to get genuine answers from people, including from mothers who admit to giving their infants younger than six months “atol”, instead of exclusively human breast milk (lactancia materna exclusiva), which is strongly encouraged during the first six months as most atols are carb-heavy and lack the more complete nutrients, and antibodies, present in human breast milk.

When I, and the nurses at the health post, were going house to house to do the census, some families, perhaps some who had difficult experiences during the Civil War in Guatemala, declined to participate in the census. So, doubtlessly some people are a little bit wary when it comes to the Rueda, (especially the part about leaving the Rueda up on a wall for our planned return visits), so I think it is good to explain upfront what the information they provide us will be used for.

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Also part of my effort to avoid being the Rueda Brute Squad, I am practicing using techniques of Motivational Interviewing, which were developed by doctors in the U.S. to help patients with alcoholism change their drinking habits by eliciting their own reasons for behavior change, rather than repeating the same dry health warnings that such patients had doubtlessly heard before. Techniques used in motivational interviewing can be applied to other health impacting lifestyle choices and behaviors, such as diet in the cases of diabetes and smoking, to name a few, and as Motivational Interviewing has been verified by dozens of randomized controlled trials over the past decades, I am using a tool that is evidence-based.

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This Friday, one woman had a child less than 6 months whom she never takes to the health center for the recommended monthly visits, and I asked her if this was something we could work on with her, and she said yes. And then, instead of telling her that now is a good time to take her child to the health center every month in order to get vaccinated, I asked her what she thought the benefits of monthly visits for her child would be and she gave me her own reason! She said that she would be able to know how her child was growing by having her weighed and measured. I let it slip that she could get her child vaccinated, and one of the nurses from the health post informed me that the child was, in fact, up to date with vaccinations, possibly because the nurses will travel house to house to vaccinate kids who are behind.

I really enjoy doing Rueda visits, especially when using Motivational Interviewing as the technique makes it easy to start a conversation with people, and as it recognizes that people are their own best experts on how to improve their own daily habits. I don’t need to be talking to a passive audience (which can be tiring), plus I get to learn what makes people tick and learn their own perception of how a variety of behaviors can help them and their families. Also, when asking people in my community what they think about a given health practice, or how they could incorporate a given practice in their lives to improve their family’s health, I often get laughter then a moment while they think about applying this health information, as perhaps they were just expecting to be “lectured at”, instead of being included in the discussion. In this fashion, I am learning to be a good listener and empowering people to make positive changes as opposed to just directing people on how they should live their lives.

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