About a year ago, amidst the trials of being a third year medical student at Northwestern’s Feinberg School of Medicine, I decided to take a year off from school to volunteer abroad. I had always believed that international work would be an important part of my medical career but felt that I needed more first-hand experience to really understand what international medical work entailed. As someone who followed a straight path most her life – from high school to college and then directly to medical school - I figured that I had time to take a detour.
Ethan Molitch-Hou, a fellow medical student at Feinberg, pointed me in the direction of his father, Dr. Mark Molitch, a Professor of Medicine at Feinberg. Dr. Molitch helps manage Centro Médico Humberto Parra (CMHP.) After learning more about CMHP, I not only decided to volunteer at Centro Médico for a few months, but also decided to do the research project required for completing my masters in public health (MPH) degree at the clinic.
For my MPH final requirement I wanted to conduct a research project that would ultimately benefit the clinic and incorporate my special interest in women's health, specifically in maternal and perinatal morbidity and mortality.
While planning my project, I learned that short intervals, less than two years, between pregnancies had been associated with increased maternal and perinatal morbidity and mortality. I also learned that women in rural areas in Bolivia only want 2 to 3 children in their lifetime but in reality have 5 to 6 children over a relatively short period of time.
I developed a survey that explores rural women's attitudes toward birth spacing and contraceptive use. My study investigates whether limited access to contraception, lack of sex education and cultural factors can explain why rural women commonly have more children than they desire.
I just passed my three-month mark at CMHP and have administered 100 surveys. Just as the existing research indicates, the women in my study have more children than they desire or have children spaced too closely together. The women see this as a normal part of life. They would have waited longer in between pregnancies but got pregnant, so what could they have done?
Often the women in my study did not use birth control. Their reasons for not using birth control included lack of education on birth control methods and their side effects, inconsistent access to contraceptives and being part of a culture that is accepting of having many children over a short period of time.
The Bolivian government provides birth control, but it is not as easy as it sounds. Frequently government programs at local health posts only give a one-month supply at each visit. Inclement weather and bad road conditions often make it difficult to return to the post every month. In addition, the selection is usually limited to birth control pills or Depo-Provera injections. Sometimes the supplies even run out, causing poor patients to pay out-of-pocket at the local pharmacy or simply go without birth control.
It has been enlightening to talk to the women at the clinic. In general, the women seem comfortable and happy to speak with me and do not shy away from answering questions that probe feelings about their pregnancies or their attitudes toward contraceptives.
Volunteering at the clinic has been rewarding, tiring, fun and a great experience that has affirmed my desire to do more international work in the future. I am more confident in my Spanish-speaking abilities, diagnosing skills and general repertoire with patients. This has been a valuable few months away from medical school and worth deferment into the graduating class of 2008.
After the study is complete, I hope to come up with conclusions and recommendations that will strengthen contraception education in the women's health program at CMHP. Because the women respect and listen to CMHP volunteers, I believe that we can continue to educate women in order to help them take care of themselves and their families.