Julcan, Attempt #2

2/16/09

So, I came back to Julcan today to give it a second chance. I took the bus back and the road was amazingly smooth…what a difference no rain makes. I got back and for a while could not find Rolando, the midwife who was going to help me make my schedule for the next few weeks. I roamed the center for a while and had a nice talk with the psychologist. She’s been in Julcan for about 4 months now and she says she’s focusing on domestic violence. She says there is a high prevalence of both emotional and physical abuse. I then went and hung out with two of the midwives for a while and they explained to me the whole system of care for a pregnant women.

Decreasing maternal mortality is a priority in the region of La Libertad (La Libertad has the highest maternal mortality in all of Peru), therefore the care of the pregnant woman has been a big focus of the health center. Julcan is divided into sectors and each sector has a team that is responsible for that sector. The team consists of (in theory): a doctor, a midwife, a nurse, and a medical assistant. The sectors don’t affect prenatal care all that much, but at least there is one midwife assigned to each sector, although it seems like they all cover for each other. Pregnant women are supposed to get seen as soon as possible in the center…they don’t want them to have to wait, b/c they say that otherwise they’ll leave. The care is not dissimilar to what we do in the states and at PCC. Each pregnant woman has to see the doctor, the midwife, the nutritionist, the psychologist, and the dentist. She gets a prenatal panel done twice and she gets two ultrasounds (I’d say this is truly different than in most MINSA health centers). They also get home visits on a weekly basis from 36 – 40 weeks. Lastly they also are encouraging family planning in all girls 15 – 49. The methods available are the pill, the IUD, Depo, or condoms.

I did finally get to meet with Rolando and we made a plan. I’m going to try and visit all the pregnant women in Julcan city proper…which is about 40. And we made a very extensive list of things for me to cover…from prenatal care issues, to post partum, newborn care, diarrhea, URIs, and nutrition. It’s a pretty ambitious goal to cover all that stuff, but we’re gonna give it a go and see what happens. Tomorrow I need to really get the nutrition stuff down. It would be nice to see if what we were going to do made some kind of difference. We’ll have to keep really good track and maybe we can come up with something to follow.

Oh, and in other news…we are currently doctorless, well, besides me. Dr. Paola did finally leave, the new doc has a vacation day, and the other doc that was working here just never came back from his vacation. They have called a doc to come in from one of the other health posts, but that leaves that health post all by itself. It’s a no win situation…anyway, so I’m it for any emergencies…although I doubt they’ll call me...I still don’t think they fully trust me in that sense. OK that’s all.