Day 3: Under the Apple Tree

Today was our first day of official business. We reunited with our hero, Dr. Marta Julia Ruiz in the morning to discuss today's visit to The Institute of Basic Health in Chimaltenango. This is 1 of 54 training centers for community-based (or auxiliary) nurses in Guatemala. We met with the director, Doris J. Polanco Bran de Escobar to discuss her goal of implementing a genetics curriculum in her school. However, this was not the initial reason for our visit as we understood it. GenetAssist planned to speak to the nursing students about their experiences with folic acid and neural tube defects, and hand out our pamphlets. Lesson number 1 in genetic counseling: be flexible!

Doris shared her observations of increased rates of birth defects in rural Guatemalan communities. She suspects this is due to pregnant women being increasingly exposed to toxic fertilizers as they work in the fields to support their families (jobs traditionally done by men). Doris would like her students to be able to differentiate between birth defects due to teratogenic exposures and those that can be inherited. She asked us to create a pilot program for her school that can eventually be included in the national curriculum, which would be taught in all 54 schools. The goal of the genetics curriculum/pilot program is to teach nursing students to make appropriate referrals to genetic services, by identifying families at increased risk for genetic conditions.

At last we got to deliver the message about folic acid to 120 uniformed nursing students. This took the form of an impromptu lecture given by Zoe, assisted by Dr. Ruiz and Doris. Lesson number 2 in genetic counseling: be flexible! The GenetAssist team distributed the pamphlets, which Zoe used as a guide for her lecture. When the students were asked who in the room had taken folic acid, a group of young women raised their hands. They indicated that they had taken folic acid only during a previous pregnancy. So, our focus was on the importance of pre-conceptual folic acid. We also encouraged the students to use the pamphlets as an aid when instructing their future patients. Doris decided to make it a class project to create larger versions of the pamphlets in order to help them do so (in spite of the posters we had already given them).

Finally, we retired to Antigua where we ate pizza under an apple tree and debriefed about the events of the day with Dr. Ruiz.