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Teaching and Learning Moments

Full House

Draper, Phoebe Frances

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doi: 10.1097/ACM.0000000000003584
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A bowl of dragon fruit and a bouquet of Bougainvillea sit between me and Señora G, the directora of a traditional midwifery school in Oaxaca, Mexico. Emphatically motioning to the plastic newborn on my lap, I offer to teach an 8-hour neonatal resuscitation course for the midwives—known as parteras.

Initially hesitant, Señora G describes a previous training involving nurses from Mexico City who “treated us like children.” Perhaps my clumsy Spanish puts her at ease, because she ultimately decides that the parteras may benefit from my proposed course. I procure grant money, buy 21 inflatable mannequins, and recruit my Spanish-speaking neonatologist mentor, Dr. S, to the project.

Several months later, a wide-eyed medical student, an orange-haired neonatologist, and several suitcases overflowing with plastic newborns and bag valve masks return to the school. Señora G leads us past 16 excitedly chattering parteras before she turns and says, “Remember, we don’t cut the cord until it’s stopped pulsing. We use our bodies, not devices.” Her obvious skepticism mirrors my own—I am unsure if the American-trained Dr. S will be willing to support someone whose practices so contradict her own training. Worse, I don’t know if the parteras will trust us enough to even give the bag masks a try.

The morning portion of the course focuses on techniques familiar to the parteras: rubbing a baby’s back and sucking mucus from its mouth. In turn, they share stories of herbal remedies, long rides with laboring women in truck beds, and devastating fetal losses. By afternoon, it’s time to discuss advanced interventions for asphyxiated newborns. For the parteras, who primarily use their lips, hands, and 5 senses to deliver babies, the introduction of a medical tool like the bag valve mask feels like a leap.

“We all share the same goal when a baby is blue—to get the baby breathing,” I start. Dr. S introduces a mask and demonstrates its use on a plastic mannequin. An hour later, I watch as the parteras, deeply committed to home births and herbal medicine, practice with masks produced by one of the world’s largest medical device companies. Surprised by their willingness to engage with the unfamiliar, I am equally struck watching my neonatologist mentor learn from the parteras while teaching them a new skill.

Dr. S and the parteras taught me what it means to be a learner. They showed me that no matter how expert we are or how time-tested our techniques, we can always seek to mesh our way of understanding the world with new information. As a future physician who will be challenged to apply science in a setting fraught with human variables, my interactions with Dr. S and the parteras will remind me to maintain a sense of openness as I explore problems with patients. I commit to consistently observing the subtleties of patient behavior, asking thoughtful questions, and practicing medicine with the spirit of curiosity Dr. S and the parteras brought to life.

As I box up the mannequins we are leaving at the school, I remember a conversation I had with an Oaxacan friend. He described how his indigenous Zapotec ancestors greeted each other daily. Instead of a mere, “How are you?” they asked, “Is your heart a full house?” As I thank Dr. S, Señora G, and the parteras and step out into the brilliant Oaxacan sunshine, my heart is the fullest of houses.

Acknowledgments:

The author would like to acknowledge Dr. José E. Rodríguez, interim vice president for health equity and inclusion at the University of Utah Health Sciences, whose office funded this project and whose personal assistance and support made this essay possible.

An Academic Medicine Podcast episode featuring this article is available wherever you get your podcasts.

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