"The project has helped us to reorganize and structure the service and to have a better coordination with the communities and to be able to carry out our work in the best way ... It has strengthened us." - Lady Cuyuch (LC)

Pologuá is a community in the department of Totonicapán that is very well organized. Most of its inhabitants highly respect local leaders. In health matters, patients place great trust in midwives; they are your benchmark regarding maternal and child health. For this reason, it is essential that the personnel who work in the Health Post have a close relationship with them, so that, together, they can provide a quality service to mothers and their babies.

"Most births take place in the community, with midwives, at home ..." (LC).

According to Lady Cuyuch, Head of Nursing at the Pologuá Health Post, coordination between community leaders and health personnel is a practice required and regulated by the Ministry of Public Health and Social Assistance (MSPAS), however, not the necessary conditions are always presented for said relationship to be strengthened. Reason why the support they have received from the MCSP Program, from Save the Children, has been very important. With their intervention, they have managed to get the community involved in health-related issues and strengthen ties between those who provide the service. from MSPAS and community leaders and healers.

"What they came to strengthen was that community organization, right? community involvement ”(LC).

When Save the Children started working with the Pologuá community, mothers, midwives, community leaders, etc. were interviewed to learn about their main health needs. As a result of these conversations, some problems that the community worried about and whose attention needed to be prioritized came to light. Among others, they mentioned that: in the community there are many cases of children with chronic and acute malnutrition; There are medical emergencies that occur during delivery and that midwives cannot attend due to lack of equipment; The community has an ambulance assigned, but they did not have the resources to put fuel or service it, so they had to charge the patients who needed to use it.

Knowing what the most urgent needs were, the staff of the Health Post, in coordination with community leaders, established different actions to improve the service offered. Some of them are listed below.

1. Work hand in hand with midwives

When midwives receive a patient, he takes her to the Health Post to have a medical file opened and to start the follow-up of her pregnancy, which includes clinical and laboratory tests, as well as the delivery of supplements. prenatal care you need.

“We have a monthly exchange of experiences with midwives. They refer each patient they have ”(LC).

At the time of delivery, the midwife immediately calls the health personnel, so that they can attend the postpartum period and verify that there are no complications. If there is any inconvenience in the delivery or postpartum, no matter how minor, the patient is taken to the Post, to be attended with the proper equipment, medications and materials.

"In general, most of the patients present some type of tear ... Then it is brought and sutured here ..." (LC).

2. Optimize the ambulance service

In order not to have to charge ambulance service to patients, the community started raising money and created a savings fund to cover gasoline and vehicle parts. For their part, the Health Post staff made sales with the aim of being able to cover the fuel of the trips that the ambulance made when they needed to transport medicines, vaccines and equipment.

After a while, the Post's staff, with the support of the community, managed to get the MSPAS to assign them a fund to cover fuel expenses and pilot fees, which are administered by the community health commission.

"If there were no such organization, perhaps we would not have paid attention to that, to the fact that they are charging patients ... Thanks to that organization, to that analysis that was done, with that community part, because we realized that We had to coordinate with the Ministry on various issues and now, because the Ministry already covers us ... "

"Seeing that we had to make sales ... Before they told us we can't give you, because you don't have it as a Ministry (the ambulance), the community has it, but in the end we were able to coordinate. We fill out the forms, we go for the vouchers; it is given to the community, the community fills the ambulance tank and the emergencies are already removed ”(LC).

3. Establish a community emergency plan

In order to avoid cases of maternal death and minimize mishaps in childbearing, a critical route for emergencies in childbirth was established.

"The first one who is there at the time of the complication is the midwife ... and they call us. For example, when a family does not want to remove the patient or take her to the hospital or a health care center, the midwife turns to the health commission. The health commission does everything possible to convince the family to remove her. If they don't remove the patient, then they already tell the community mayor, who is the highest authority in the community, and they also collaborate in removing the lady. ”

"It has served to save lives" (LC).

4. Offer training

Lady comments that health personnel are concerned that sometimes neither pregnant women nor families have enough information to make decisions in emergencies, and there are also beliefs that hinder the work of health providers.

“A main barrier for the ladies to come out and be cared for is the change in behavior that has not yet occurred. That they always have the idea that the woman has to resolve the birth at home, whether or not she has complications ”(LC).

That is the reason why the Post offers constant workshops to midwives, health commissions and pregnant women, on different topics, such as:

• preventive and nutritional health;

• the pregnant woman's right to make decisions about her delivery;

• making timely decisions.

"We can do a lot of actions from the Ministry, but if there are no behavioral changes, directly in the population, we cannot reduce those rates." (LC).

5. Change the category of the Pologuá Health Post in front of the MSPAS

The support that the Health Post has received from Save the Children has been provided by its staff to strengthen coordination with other instances of the Ministry.

“Notice that it was too helpful, because before we asked for such medicine and they did not give us because we were the first level of care, but the cases arose ... Now the area supplies us ...” (LC).

They are currently managing the category change of the Post, because they know that the care they provide corresponds to that of a Health Center. The change would help them to obtain more personnel, equipment and training.

6. Food counseling

With the aim of preventing maternal and infant malnutrition, the staff offers counseling during the lactation period and when complementary feeding begins.

“We have been trained (Save the Children) so that we can provide balanced counseling” (LC).

Lady is very pleased with what has been achieved as the Post began to coordinate actions with Save the Children. He mentions that, in addition to the support to link with the community, they received many refresher trainings for the nursing staff, among which are obstetric emergencies, postpartum care, neonatal resuscitation, delivery care, etc.

"As a professional, it has helped me a lot, because we have strengthened our skills, we have been able to update our knowledge and they have also given us tools to be able to attend emergencies ..." (LC).