Today when I arrived at the health center, I began my day as I usually do by helping pull files for the patients that need to be seen. After working through a few lengthy lists of "historias" (histories or files) the head office lady asked me if I would be interested in shadowing the obstetricians today. Of course I happily replied yes and followed her to the obstetricians' room.
I sat down and waited for a bit while the doctors/nurses (like I have mentioned before, I rarely know if the people I'm working with are doctors or nurses or something else) sorted through a bit of paperwork. One lady, Carmen, was searching through a database on the computer to find addresses of the "gestantes" (pregnant women) who had not been coming in to their regular checkups and control appointments. When the list was completed with a total of about 8 names and addresses, another lady named Milana and I took off to track down the missing pregnant ladies.
While we were walking in the direction of the first address, Milana told me that the Centro de Salud Santa Rosa is the health care clinic for the region within Cusco called Santa Rosa. Only residents of this region are allowed to come to the clinic and receive the insurance called SIS that is offered there. As far as I have understood, SIS, which stands for Seguro Integral de Salud (Integral Health Insurance), is free or close to free for people who make less than a certain amount of money. I don't fully understand how the whole process works but I know it must be a good deal because Milana told me that some people make up addresses in the Santa Rosa region in order to get the free insurance.
Milana also talked to me about how many of the pregnant women don't come in for their regular checkups, which is a big problem especially if something goes wrong with the pregnancy. Currently there are 510 pregnant women in the Santa Rosa region and under the care and supervision of the Centro de Salud Santa Rosa. If any of these women experience complications during their pregnancy and do not receive treatment, the Centro de Salud Santa Rosa is responsible. For this reason, the nurses and doctors are very adamant about making sure that the women come in for regular checkups. Often the ladies don't know exactly how to take care of themselves during pregnancy, which can be detrimental for the mother and the child.
The first lady we met with told us that she had been going to her controls regularly and proved it to us by showing us her control card completed with up to date information. Milana took note and mentioned that the computer system may not have been updated correctly. She gave the lady some advice about different warning signs and various things to watch out for during her pregnancy. She said that if she experiences things like headaches, swelling of the arms or legs, or blood or other fluids coming out of the body that she should go to the hospital for care right away. It was also interesting because at various times while we were walking, we encountered pregnant ladies walking in the street and Milana would always stop to talk to them and ask where they were living, which health center they were going to, and if they were regularly going to their controls.
While we were actually able to contact a few of the women, others were never found. Milana talked to a couple of ladies on the phone and left a note with the family of another. Every time we talked to someone (whether a family member or the pregnant ladies themselves) Milana filled out a form about the contact that was made. I believe the purpose of this form was to report that the health center made an effort to track down and contact the various pregnant ladies and relieve their responsibility if something were to go wrong during the pregnancy.
While we only had visit about 8 addresses, this proved to be quite the challenge for various reasons. First of all, the address system in Cusco is far from organized and many of the doors and homes are unmarked. The various sector and blocks are organized by letters and then each of the homes has a number, C-10 for example. There was no clear way to know which direction to walk in to find a certain house number so often we just picked randomly and hoped we were headed in the right direction. More often than not, we walked many circles and up and down incredibly steep hills searching for elusive addresses. The lack of organization was exacerbated by the fact that some of the addresses we were searching for DID NOT EXIST. They were phony addresses that seemed real but were made up by the patients, like I mentioned before. Other times, the address did in fact exist, but the people living in the house did not even know the person who claimed to live there. It proved to be quite an adventure searching for all the missing pregnant women.
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