What are the unspoken and spoken norms in your area? Have you ever thought of why such norms exist and the value in keeping or not keeping them? How do these norms affect our interactions with one another? 

Midwives from the communities in Guatemala, generally speaking, receive no formal training. They feel called to the work by God because of an illness or struggles of their own. In recent years the local health department has started offering training to the midwives in attempts to help mothers who might need more care get the help they need. The training points out issues that may require a pregnant woman to come to the health department for urgent medical care. Once the mother gives birth, the midwife brings her to the health department for a new baby check and birth certificate. 

Once a month a group of midwives meet with the nurses from the local health department. Last year, Dr. Utsey as part of the UTMB team, taught them how to do some basic exercises for women postpartum. Dr Utsey is a the chair of the PT program at UTMB and a  pelvic health physical therapist. So when the team returned this year, we asked if she’d hold another training.

The nurse overseeing the group thanked Shes for taking the time to create a relationship and offer this opportunity for continued training.  Not knowing how the midwives work, Dr. Utsey wanted to learn from them so she could better teach them. Generally, midwives do not share with other midwives what they do and how. I think there is a fear if they share their “secrets,” others may take their jobs or patients from them.Well, something happened this year and the midwives shared what they knew not only with Dr. Utsey, but also with the other midwives in the course. This created a great atmosphere for mutual learning and further development of relationships established last year. The midwives were so thankful for the course and the things they learned. Even our translator, a man, learned many things that helped him understand some of the experiences of his wife. He left with more empathy and compassion for his wife. 

As we go into communities, we are looking at how these norms, spoken and unspoken, affect what we would like to do. We have concerns that the people we train may not want to share the information with others, but we hope and trust we can establish relationships of trust and confidence to break these barriers down. Just like the midwives, we’re trusting barriers, our own and those of others, be broken down and relationships of mutual trust and learning be established. Who knows what will happen as we work together.