Day 6: Café Tacaño y Pan Dulce

Genetic counseling lesson number 47: be flexible. While today was not what we planned, it turned out to be a great one. We headed into the mist of the mountains towards Santa María de Jesús, a small village on the outskirts of Antigua. On the schedule for the day were conversations with pregnant women, medical students, and comadronas (midwives, you know this by now).

After being turned away from a private Puesto de Salud, we arrived at a courtyard alive with the day's market activities. Buried at the back of the marketplace lay the public Puesto de Salud, where we were to hold our meetings. We walked into a waiting room full of pregnant women, who looked at us as if we were from another planet, to which we have become accustomed. After getting the go-ahead from Rosa Elma, we began a short conversation with these women about pregnancy and folic acid (shocking, we know). They all reported that they have been taking folic acid throughout their pregnancies, but few knew that they should take it prior to future pregnancies.

We spoke with Gabriela, a young woman who is the education director for pregnant women at the puesto. She has recently spearheaded a "pregnancy club," where women can come freely ask questions and receive support. The club, which began this year, is growing steadily. In January, no one attended. February saw six attendees, and March saw 13. Gabriela has high hopes for the club's future. We marveled that the concerns of pregnant women are universal, whether they be in Midtown Manhattan or rural Guatemala.

We then hoped to have a conversation with medical students, but we were informed that after their morning's exam, they were making house calls. Each student had to see about 10 families, then return to Guatemala city.

To end the day, we met with a small focus group of local comadronas. We asked if they knew why they had been gathered to speak with us, but they said simply, "es una sorpresa." After explaining the purpose of our visit, we opened the floor for them to share their experiences with folic acid and birth defects. The comadronas were universally supportive of the use of folic acid during pregnancy, and reported that they had not seen a baby born with a serious birth defect in many years. They attributed this drop to an increased uptake of folic acid. Further, they echoed feedback from yesterday's students surrounding our educational materials, and were grateful for this resource.

To show our appreciation, we shared Café Tacaño y Pan Dulce (Stingy Coffee and Sweet Bread) as the skies opened up and the rain poured down on the tin roof of the puesto.