During Pre-Service Training (PST), or the 9 or so weeks that Peace Corps Trainees in the Maternal and Child program spend improving their Spanish, and in “technical” sessions when we learned, in broad strokes, about public health and the healthcare system in Guatemala, we also attempted to understand and master the MCH Framework before being sworn-in as volunteers and heading to our sites. Paul, a former MCH volunteer who has since headed to law school, implored all of us to read our MCH framework each night and know it by heart!

The framework is used to classify, and guide, the activities that we as MCH PCVs (Peace Corps Volunteers) complete and then report on our semi-annual VRFs, or Volunteer Reporting Forms. Even more so, the framework was developed in conjunction with the Guatemalan Ministry of Health in order to define the objectives which we use to achieve our program’s goals.

In this blog post I was very fortunate to get a copy of a final presentation done by Jess, now a RPCV (Returned Peace Corps Volunteer) and former MCH’er for whom the stars aligned and she was able to hit all of the objectives of the framework during her service. So a big thanks to Jess! It is often said that each site (town or city where a given volunteer lives) is different, and hence not all MCH PCVs will have the same opportunities to do the same activities, or even be able to “hit all of the objectives on the framework.” Actually, our PSN (Peer Support Network), offers free, and confidential, telephone counseling for volunteers in site who may, through no fault of their own, not feel successful in site if they haven’t been able to hit all of the objectives in the MCH framework.

Notwithstanding this caveat, it was very helpful to be able to read about what Jess has done, and it has given me ideas and motivation for what I might like to accomplish in my town in the second year!

So, let’s get started!

At the top of our MCH Framework is the formal purpose of our MCH project in Guatemala: “Rural mothers and children of the highlands of Guatemala will lead healthier lives.” Even broader than reducing the high level of infant and maternal mortality in the western highland of Guatemala, under this rubric falls most of what MCH volunteers do here.

Next, we have our MCH Project Goals, of which there are two:

Goal 1: Improved Maternal, Newborn and Child Health Outcomes through local Institutional Strengthening.

So what is exactly is “institutional strengthening”? Well, one objective under this goal, Objective 1.1, describes capacity building of health center personnel. Under this objective Jess did the following activities: She planned monthly meetings of TSRs (Tecnicos de Salud Rural), or rural health technicians, here in in Guatemala which she then used to teach them strategies for educating adults, and she also did two HIV/AIDS workshops in addition to two behavior change workshops in 3 different health posts! In the U.S. this would be similar to providing continuing medical education (CME) for physicians and nurses in clinical practice, as well as continuing education for nutritionists and other specialists. Here are some pictures of Jess at her last TSR meeting.

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Next there is Objective 1.2 which also falls under Goal 1 which relates to developing and strengthening of maternal, neonatal and child health (MNCH) Training Programs and Resources. Under this activity, Jess worked with people in her health posts to create 39 lesson plans using the Peace Corps approach to adult education, or ERCA (please see my prior posts on this topic if interested). Also, under this objective would be work done in conjunction with health center or health post staff to develop training modules and lessons plans to teach health center personnel about maternal and child health related issues. So, in many instances the planning for a given training falls under this objective, and actually doing the training falls under previously mentioned Objective 1.1. Many PCVs work on manuals with pre-made health talks, we already have two for doing pregnant women’s groups.

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The final objective under this goal, Objective 1.3, has to do with the hoped for end results of the capacity building, such that people in our communities are adopting behaviors which will improve maternal and child health. For example, if I co-facilitate a health talk on the health warning signs in pregnancy with a nurse at a pregnant women’s group, and if using our M&E (Monitoring and Evaluation) tools I can say that x number of women learned these warning signs, then I am on my way to fulfilling this objective. This last Friday, when doing house visits with two nurses from my health post, I did a mini-health talk with one on the health warning signs in young infants, and at the end of the talk she was able to name four warning signs, and with two women, both of whom are pregnant, we reviewed the health warning signs in pregnancy with a song and a mini-health talk, and then asked these women to tell us four warning signs in pregnancy that means she should seek medical attention (photo of one Rueda house visit below).

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Some of Jess’s activities that she did that fall under this objective include: radio announcements, pregnant women’s groups, trainings given to food vendors, and doing house visits such as I have done in my site.

Now, we’ll take a look at the Maternal and Child Health Project’s big Second Goal:

Goal 2: Community Organizational Strengthening. Community leaders, health center staff, and municipal leaders will foster improved collaboration and effective implementation of activities that lead to healthier mothers, newborns and children in their communities.

After end of the Civil War in Guatemala and the signing of the Peace Accords, there was an emphasis placed on giving authority back to local communities, and encouraging the empowerment of locally functioning groups which could then act in concert with the health centers and health posts to improve people’s lives here. Many such groups exists outside of the formal hierarchy of the health posts and health centers, such as midwives (comadronas), local health commissions made-up of lay members of community, and health promoters, all of whom have a great degree of interaction with the general public at the local community level. So, it makes sense that MCH PCV are involved in fostering the development of these links between health care personnel and local community groups. (Photo of comadrona meeting below).

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Objective 2.1, which falls under this goal, deals with improving and focusing community based health groups to better address MNCH needs in their communities. In my town, I’ve been fortunate to work on this activity, in conjunction with PIES de Occidente workers, and we’ve been able to firstly, better define what the function of community health commission should be, we’ve done health assemblies to raise awareness among our community members of what our health commission can do for them, and we’ve done raffles to raise money for our fund. If, for example, a pregnant woman has one of the health warning signs of life-threatening blood loss during pregnant, and her family has trouble getting her to the hospital, she could call a member of the local health commission who could quite possibly secure the funds and means of transport, which could well be life saving.

Under this objective, Jess did a workshop with a community group on the design, management and implementation of small community projects, she also did a community latrine project, a march promoting exclusive breastfeeding during the first six months of the life of a child (pictured below), promotion of the Day of the Woman in her site, as well as monthly trainings for health promoters in her community! So beyond just training for health care personnel in her site, Jess was able to engage people in her community in multiple venues during her time as a volunteer.

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Objective 2.2 also falls under this goal, and it involves working with health commissions at the municipal level, or the municipal government, to complete a MNCH related campaign, activity or project. So, although Peace Corps volunteers often work in rural settings, and get to know community members very well in towns that may have populations between 7,000 and 20,000 people, there is also the opportunity to work with government leaders at the municipal level in order to advocate for maternal and child health and to even engage in a number of activities at this level.

Some volunteers live towns, or cities, that have a COMUSAN (Comisión Municipal de Seguridad Alimentaria y Nutricional), or basically a health commission at the municipal level. My town isn’t quite big enough to have a formal COMUSAN, though my town’s center has a health commission which functions as a COMUSAN in all but name, though many volunteers do have COMUSANs in their sites, or a nearby town. Jess participated in monthly COMUSAN meetings in her site, and in conjunction with her COMUSAN did a garden project that benefited mothers with malnourished children, and also a marathon against malnutrition in with her COMUSAN.

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