Guatemala Handbook

GUATEMALA ORIENTATION HANDBOOK Version 9: April 2016 Birth Institute
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CURRICULUM OVERVIEW Midwives provide essential care to women across the lifespan. Experiential Learning Abroad participants in Guatemala will gain first-­‐hand perspective on traditional midwifery, women's health care and family planning as they examine models of midwifery care for women from diverse cultural, economic and political backgrounds. Duration: Participants should expect to spend 8-­‐weeks/ 300 hours engaged in various aspects of the course, including: • Online coursework, including lectures, case reviews, discussion, personal reflection exercises, quizzes, research, independent reading, and group assignments. Shared online classroom with participants at all locations. • Non-­‐clinical rotations at a local health clinic under supervision of midwives, doulas and/or community healthcare professionals. Activities Participants will rotate as observer to midwives in distinct settings, including: • Placement at Maya Midwife International, ACAM, a unique Birth Center and Cultural Project founded, owned and operated by traditional Maya Midwives in the Western Highlands of Guatemala with the support and collaboration of N. American midwives and other friends. • Placement at Manos Abiertas (AMA), a Planned Parenthood supported women’s health clinic in Ciudad Vieja. Birth Institute
Learning Objectives Working specifically in the context of Guatemala participants will gain introductory knowledge and understanding of… • The social determinants of women’s health and/or maternal and newborn health as they relate to international healthcare service delivery systems, community health and women’s empowerment. • The principles of community-­‐based primary care using health promotion and disease prevention and control strategies. • Indicators of quality health care services. • Principles of health education. • Health services and infrastructures supporting the continuum of care (organization and referral systems), and how this infrastructure encourages or prohibits access to needed resources for midwifery care. • Relevant national or local programs or initiatives; provisions of services or knowledge of how to assist community members to access services such as immunization and prevention or treatment of health conditions prevalent in the country or locality. • The concept of alarm (preparedness), the protocol for referral to higher health facility levels, and appropriate communication during transport (emergency care). • The legal and regulatory framework governing reproductive health for women of all ages, including laws, policies, protocols and professional guidelines. • Human rights and their effects on health of individuals, including but not limited to: health disparities, domestic partner violence and cultural practices. Based on educational competency recommendations for social, epidemiological and cultural context of maternal and newborn care by the International Confederation of Midwives (ICM). 2
VOLUNTEER PLACEMENT Maya Midwifery International (also known as ACAM) Concepcion, Chiquirichapa, Guatemala Maya Midwifery International is a 501c3 charity dedicated to assisting indigenous Guatemalan midwives and other local health providers in addressing the many obstacles to effective and sustainable health care in their communities. Our model is based on listening to local concerns and addressing issues beyond training sessions and provision of services. It is one of material, economic, and cultural support, educational development, and community empowerment. The ACAM Midwifery and Birth Center was built with donations of North American midwives and other private donors and completed in 2003. The midwives and other community members were directly involved in construction of the building. 1300 people attended the opening. It is the only medical facility in Guatemala owned and and operated by indigenous midwives. Over 1100 babies have been safely delivered there and many more at home by ACAM midwives. The two story building consists of four birth rooms, 2 exam rooms, waiting area, small pharmacy, midwife and apprentice call rooms, kitchen, laundry, traditional sweat lodge, medicinal plant garden, large teaching/community meeting room, learning lab with computers and medical models, office, and a 2 bedroom guest apartment. The center is staffed by two paid Maya midwives per 24 hour shift, a part time Mam speaking MD and volunteer midwives, physicians, and public health specialists who mainly offer workshops and do clinical teaching of the midwives and apprentices versus direct care. Prenatal, birth, postpartum, family planning, and primary care services are provided for token fees which are often waived entirely. The midwives presently bring in about a third of their operating costs and the remainder comes from donations. The small salaries received by the midwives have enabled them to send their daughters to school and now some of those daughters are becoming midwives committed to continuing the work of ACAM! Community midwives come to the center for monthly meetings and training sessions and can get or replenish birth supplies. The Center is also available to community groups for meetings and workshops. To learn more about Maya Midwifery International, visit http://www.mayamidwifery.org Birth Institute
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Asociación Manos Abiertas (AMA) Ciudad Vieja, Guatemala The mission of Manos Abiertas is to offer a safe and welcoming environment where health services are provided for women by women, in a respectful and confidential manner without discrimination. The clinic strives to treat the woman as a whole person, in an environment where she feels safe to express, think, and make decisions for herself. Services: By increasing access to health care services for women, the clinic seeks to educate and raise awareness of a woman’s right to control her body and her reproduction, and address the following: • Women’s health – By educating women about the importance of pre-­‐ and post-­‐natal care, family planning options and other reproductive health topics, we empower women to have safe pregnancies and space their births as they choose. By offering humanized and natural birthing options, with all services supervised by skilled midwives, women are provided with access to safer births. Additionally, we offer cervical and breast cancer screenings; information about and treatment for sexually-­‐
transmitted infections (STIs); family planning, contraceptive counseling and abortion services; a 24-­‐hour emergency hotline; and mobile cervical screening services in rural areas; all with the goal of increasing access to health care for women. • Children's health – AMA provides comprehensive pediatric health care services to newborns and young children. We educate mothers on the importance of breastfeeding and proper nutrition to help curb the alarmingly high rates of childhood malnutrition and deaths under 5 years of age in Guatemala. When parents are able to choose the number and timing of their children, they can plan their families so that they have sufficient resources to invest in the health and nutrition of each child. • Poverty – The health of women is critical to their families, communities, and the entire process of economic and social development. When a woman is ill, she is unable to adequately care for her children, maintain a job, and ultimately be a productive member of society. Younger girls oftentimes are forced to bear the brunt of sick mothers and are unable to attend school because of their household duties. This cycle contributes to vast inequalities in education and income between women and men and feeds the poverty trap felt in many countries like Guatemala. We work with primarily low income, rural, and indigenous women who have received little to no education about reproductive health and family planning. Furthermore, many of the women that we work with do not speak Spanish as a first language, and have difficulty communicating with health workers who do not speak their language. • Education – We place great importance on education and health literacy. All clinic interactions involve an educational component. We seek to not only treat our patients, but to empower them with information that they can apply to their lives, passing such knowledge onto members of their families and communities. In smaller families, children (especially girls) are more likely to attend school because parents can afford school costs and do not need older siblings to help care for younger siblings. • Women’s rights – We provide free legal services to women in need of legal counsel. The clientele that we serve at Manos Abiertas ordinarily cannot afford legal services. The consults mostly deal with problems of violence, and issues of alimony and child support. Also, access to health care services, whether family planning, cervical cancer screening or STI treatment, gives women more power over their bodies, their lives, their relationships, and their futures. Supervisor: Sandra Lopez: Sandra joined AMA as Coordinator in April of 2009. She first came to know of AMA through the birth of her child, Juan Sebastian, at Ixmucané where Hannah was previously the Director. Trained as an auxiliary nurse, Sandra gained extensive experience working with low-­‐income, indigenous women as the Coordinator for a women’s health program with the Behrhorst Foundation, a local community development NGO in Guatemala. At AMA , Sandra’s role ranges from attending births to helping families understand their reproductive rights and options. She is also in charge of maintaining the database of clients. Sandra is currently studying health care administration at university on the weekends. Her goal at AMA is “to improve the situation that many women (in Guatemala) live in.” Birth Institute
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PARTICIPATION PARTICIPANT ROLE AND RESPONSIBILTIES Your role during all rotations is to take a position of active observation and assistance as requested by the on-­‐site supervisor. You should therefore expect to watch and listen before you “do,” knowing that once you have gained the respect and trust of the local midwives, you may be asked to take a more active role. This also means that if there are cleaning, chores, or tasks to be done that you are capable of doing, you should offer to do them. Note for Midwifery Students: Experiential Learning Abroad courses are solely designed to deepen cross-­‐cultural understanding and to enhance participants' understanding of issues in global maternal and newborn health. ELA placements do NOT count toward clinical requirement for Holistic Midwifery students. ROTATIONS On-­‐call rotation will vary depending on how many students are on site. Typically call shifts rotate every 24 hours. Participants are expected to be onsite Monday – Saturday and be prepared to be engaged and working with the local staff. Birth work is unpredictable. At times, the days will be very busy and you may find yourself lacking sleep, other days may be very slow with little clinical work to be done. Please use down times to complete your course work. It is the responsibility of the participants to assert your self into the daily activity at the clinic. The Midwives enjoy having you work with them, but they can be shy and “don’t want to bother you” or “ask you for help” This is a cultural dynamic that you must learn to work around. It is encouraged that you spend as much time with the Midwives on-­‐site as you can. This means having coffee or tea together, cooking meals together, and staying involved in the daily rhythm out side of birth work, i.e helping with chores, preparing herbs & vitamins or cleaning floors. Please Note: Both clinics are open all day and night. Women and families will come in throughout the day. There are no scheduled appointments. You should be prepared to be flexible and to use the slow times of day for your course work. Staff midwives will go home at night and on the weekend at AMA unless a birth is taking place. *Note that daily/weekly rotations will change according to the needs of the clinic. Conduct Policy Participants shall respect fellow participants, faculty, and other community members and uphold the highest standards of ethical and professional behavior and academic honesty at all times. Misconduct, including unethical treatment of others, violation of confidentiality, academic dishonesty, illegal activities, consumption of non-­‐prescribed drugs or alcohol or possession of weapons during clinical rotations, sexual harassment and inappropriate personal or sexual behavior is not allowed. Conduct violations will be addressed through the Grievance Process and may result in permanent dismissal without refund. PLEASE REFER TO THE BIRTH INSTITUTE CATALOG FOR ADDITIONAL POLICIES AND PROCEDURES Birth Institute
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CLINIC SUPERVISOR ROLES/RESPONSIBILITIES Clinic supervisors are responsible for overseeing daily rotations and coordinating participant schedules with clinic staff, including workshops and field trips. All rotations, workshops and fieldtrips will be communicated with participants upon arrival. Supervisors will provide copies of charting and other intake tools and will allow participants to participate in ongoing observation at the clinic. Clinical partner reserves the right to make changes to volunteer rotations, workshops and field trips at any time and may communicate such changes verbally or in writing. Birth Institute is not responsible for day-­‐to-­‐day operations, staffing, policies or procedures related to delivery of health care services by clinical partner facilities. No representative of Birth Institute, including facilitators, participants and staff shall interfere with ongoing operations, policies, procedures or staffing of the clinical partner. Birth Institute will not be responsible for any issues arising from mismanagement or unforeseen issues related to operations, policies, procedures or staffing at clinical partner facilities. BIRTH INSTITUTE RESPONSIBILITIES Orientation Proper orientation is critical to participant transition and immersion and all orientation assignments are mandatory. Orientation will begin with receipt of the Site Orientation Handbook, followed by an online course requiring 6-­‐8 hours of participation prior to the start date of the course. Failure to participate in scheduled orientation meetings, readings and assignments may result in immediate dismissal from the program. Please note: You must complete a Cultural Competency Course before you arrive to your host site. In addition to orientation support from Birth Institute, participants are responsible for taking the following steps to become knowledgeable of behavioral expectations in the country where they are placed: Become familiar with country laws; Be aware of local conditions and customs that may present health or safety risks when making daily choices and decisions; and read U.S. Department of State Travel Advisories and other safety-­‐related communication relating to clinical assignments. Supervision Birth Institute is responsible for: ensuring that faculty and instructors are effectively trained to oversee, monitor, and maintain ongoing communication with participants; maintaining open channels of communication with all parties throughout the experience; evaluating clinical partners and instructors and recommending program modifications based on feedback from all parties; ensuring that there is a clear distinction between the learning role and the work role of participants, and anticipating/navigating conflicts that may arise between these goals; ensuring that the placement is safe and non-­‐threatening; providing participants clear learning goals, intended outcomes, and the connection between experiential and academic components of the program; and ensuring that the participant is being adequately supervised and offered feedback when it is helpful and appropriate. Birth Institute
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LIVING IN YOUR HOST COUNTRY Guatemala Full name: Republic of Guatemala Capital: Guatemala City Major languages: Spanish, more than 20 indigenous languages Major religion: Catholic, indigenous Mayan beliefs, others. Life expectancy: 68 years (men), 75 years (women) (UN) Monetary unit: 1 Quetzal = 100 centavos Main exports: Coffee, sugar, bananas, fruits and vegetables, meat, petroleum, cardamom. GNI per capita: US $2,740 (World Bank, 2010) Ciudad Vieja Ciudad Vieja is a municipality in the Guatemalan department of Sacatepéquez. Conception Is located about 20 minutes from Quezaltenango Population In July 2015 the estimated population is 14,918,999! History Guatemala, a Central American country south of Mexico, is distinguished by its steep volcanoes, vast rainforests and ancient Mayan sites. The capital, Guatemala City, is home to the stately National Palace of Culture, institutions such as the National Museum of Archaeology and Ethnology, and the lively Zona Viva nightlife area. Antigua, west of the capital, contains cobblestone streets and preserved Spanish colonial buildings. Birth Institute
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BIRTH IN GUATEMALA Guatemala suffers one of the highest mortality rates for both mothers and newborns in the Americas. Guatemala was listed by the World Health Organization (WHO) in 2009 as having the third highest maternal mortality rate, exceeded only by Haiti and Guyana. There is an urgent need for comprehensive women’s health care in Guatemala, including access to sexual and reproductive health services. Nationally, only 51.3% of births are attended by a skilled birth attendant, compared to 77% of births in the Central American region. Guatemala loses 290 mothers for every 100,000 live births to pregnancy and birth-­‐related causes (World Health Statistics, 2009). In the rural highlands of Guatemala (where the population is 95% indigenous), the rate is 446 per 100,000 (Bailey, 2002). As a matter of comparison, the rate in neighbouring Costa Rica is 30/100,000 and in the Netherlands, where midwife-­‐attended home birth is commonplace, the rate is 6/100,000 (World Health Statistics, 2009 Additionally, the disparity between births attended by a skilled attendant in rural, mostly indigenous areas and urban areas is growing. This leaves indigenous women of Guatemala with some of the most compromised maternal health outcomes in the Americas. Statistics • • • • • • • 42% of the Guatemalan population does not have access to regular health care Midwifery School Guatemala Women, even those in urban areas of Guatemala, generally must visit many different health agencies to obtain well woman care, contraception, STD/HIV prevention education, maternity care, and post-­‐natal care, if this range of services is available at all The majority of Guatemalan women give birth at home, with midwives attending 60-­‐70% of all births (90% in rural areas) Guatemalan health officials routinely exclude midwives from the formal health system in attempt to centralize medical services within hospitals Midwife training in Guatemala is largely centred around the identification of risk factors and transfer of patients into the hospital system, ignoring the reality that the majority of births are uncomplicated and can safely take place outside the hospital setting Maternal mortality in Guatemala measures 200 deaths per 100,000 live births. Among indigenous Mayan women this figure may be as high as 446 per 100,000. Infant mortality is 51 per 1,000 live births. 75% of Guatemala’s overall population lives in poverty; 93% of the indigenous population is poor Statistics Source: Midwives for Midwives Recommended Reading: Berry, N.S. (2010). Unsafe Motherhood: Mayan Maternal Mortality and Subjectivity in Post War Guatemala. Berghahn Books. Birth Institute
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CULTURAL NORMS In Guatemala, you will live and work among people who may have life experiences that are very different from your own. From food and language to spiritual beliefs and politics to class and gender norms, we each bring many assumptions based on our own socio-­‐cultural upbringing. As guests in Guatemala, participants are expected to have an open mind and a day-­‐to-­‐day willingness to examine core assumptions and beliefs that define interpersonal relationships and health care protocols. It is essential to be able to sit back and observe, discover what matters, see what is not important, and above all remember that the participant role is to observe and learn, not to judge or change. Be flexible and open to the specific challenges of the community in which you work. Remember that the staff has been working long and hard for many years and has gained the respect of the community, even if there are challenges to overcome. As a participant, you will find that you bring with you, ideals that may not be relevant in the Guatemalan context. In preparation for your trip, please consider the following: Informed Consent and Client-­‐Provider Trust: In Guatemala, informed consent is viewed as an interruption in the birth process and is assumed. Women generally trust the midwives they choose, as they travel long distances to see them. Women may be intimidated or upset by being asked to make a choice they consider the authority of their care provider. Building trust and foundations for informed consent are larger education and cultural issues that may not be easily addressed during a single exam or birth. Personal Space and Time: Guatemalan indigenous people are not accustomed to privacy. They have no word in their language for privacy. Being alone is unheard of, and wanting to be alone is even more rare. This will not affect your ability to have alone time while you are living at the clinic or in your own home, but please remember this during your time in Guatemala. Family: Guatemalans in general are very family-­‐oriented, and sometimes families can be quite hermetic. Friendships do not have the same value as in the US or Europe. Close-­‐
knit family can be a good thing, but sometimes they have impacts that Westerners look down upon. For example, given the closeness of the family, n o woman ever makes a decision alone – or hardly ever. Decisions tend to be made by older, male family members. Gender Roles: Machismo is the word used to describe the patriarchal gender structures in Latin American countries. This looks like men dominating and exercising their power over women on a regular basis. Guatemala is ladled with machismo in general, but especially rurally. Young city people are starting to live gender roles differently, but it is taking time. Although women in Guatemala generally occupy a somewhat “secondary” status in this traditionally male-­‐dominated society, many operate businesses and may have considerable personal freedom. Work Habits: Work is not related to the same way in Guatemala as it is in the United States or Europe. It is generally more relaxed, and deadlines are not always respected. Punctuality: Guatemalans also relate to time differently, and in general are not punctual. This is related to them being present where they are, and not rushing to get to the next place. Mañana (Spanish for “tomorrow”) means that something may get done at some point, and ahorita (Spanish for “right now”) can mean anything from right now to never. Communication Styles: In Guatemala, communication is generally non-­‐confrontational and indirect. People often avoid direct communication in an effort to avoid hurting one another. Guatemalans won't say "I Don't Know" when they don't have an answer to a question, and might actually invent an answer for you! Spirituality: Guatemala is primarily Catholic (50%), however, it’s estimated that approaching forty percent of the population now belong to one of several dozen US-­‐based Protestant churches. Many of Guatemala’s Catholics also continue to practice ancient Maya religious customs in the indigenous villages of the highlands. There has been a resurgence of interest in Maya spiritualism among young, educated Guatemalans since the end of the civil war, and attending “shamanic colleges” has become fashionable. Guatemala City also has tiny Jewish and Muslim communities. Birth Institute
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CULTURAL SENSITIVITY Please read the following information about respectful behavior in Guatemala, and do your best to follow these cultural norms while you are in the country. Remember that you are representing yourself, your country and the organizations that you are working with, and respect is held in a high regard in Guatemala. • • • • • • • Greeting People in Guatemala: o Introduce yourself with a polite greeting of “buenos días/tardes” (good morning/afternoon or evening). Up in the highlands, if you’re walking a trail or passing through a small village, it’s usual to say hello to everyone you meet. o If you’re introduced to someone, a gentle handshake and a “con mucho gusto” (“pleased to meet you”) is appropriate. o Women may pat each other's right forearm or shoulder instead of shaking hands. o Female friends may also hug and lightly kiss each other on the cheek. Dress: There’s no special dress code for women to consider when visiting Guatemala, though you might want to avoid seriously short skirts or tight tops to avert potential hassle. Generally in indigenous areas, most local women wear a calf-­‐length skirt, but it’s fine for foreigners to wear trousers or knee-­‐length short pants. Covering your shoulders is polite. Body language: o The "O.K." sign (thumb and forefinger forming a circle) is considered obscene. o Handshakes are generally quite limp. History and Politics: o Be mindful of Guatemala's tough past by not bringing up sensitive subjects such as war, violence, or genocide. o Avoid conversation about politics, business or war when at the table. Eating: o The main meal is eaten at lunchtime and an afternoon "snack" or "coffee break" is common around 4 p.m. Business dinners tend to be lighter fare and begin after 7 p.m. o Traditions are important at meals. Guests are expected to clean their plates and wait politely for their host to ask them if they would like more. Visitors with good manners first decline but then finally accept second helpings when their host insists. This is seen as a compliment to both the host and the cook. Tipping: o In some restaurants a ten percent tip is appropriate, but in most places, especially the cheaper ones, tipping is the exception rather than the rule. o Taxi drivers are not normally tipped. o Leave a small tip for the marimba (wooden xylophone) band. Respect: o Don’t give white flowers; they are reserved for funerals. o Speaking softly is considered the most polite. o The colorful dress of the indigenous Maya may tempt you to photograph them, but you should always ask first. Adults are especially sensitive to being photographed. o In Guatemala, as elsewhere, “please” and “thank you” (“por favor” and “gracias”) go a long way. A smile helps as well. Birth Institute
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HOUSING Participants will live on site at ACAM and Manos Abiertas. The facilities are safe, clean and convenient for full participation in clinic activities. The living area is equipped a community kitchen and a shared bathroom. *PLEASE NOTE: Manos Abiertas is not staffed after hours or weekends unless a birth is in progress. Students will have a key to the clinic. The on call midwife will come to the clinic when needed by clients. Rooms: Rooms will be shared by two participants and will be equipped with a bed, lamp and small shelving space for each participant. A single bed with sheets and pillows will be provided for you. A light weight sleeping bag is recommended, as temperatures drop during the night-­‐time hours. Kitchen: All clinics have small kitchens equipped with a refrigerator, stovetop, sink, table/chairs and dishes/utensils. Participants should plan to shop daily and be equipped with ample food when on call. All cooking and cleaning of kitchen facilities is the responsibility of the participant. Study Areas: The clinics are equipped with Internet (although slow and often unreliable), and tables/chairs for group meetings/studies. Bathrooms (Baños/Servicios): Participants will share a bathroom with flush toilet and hot water shower. Due to the poor plumbing, the toilets are not able to handle toilet paper. Please make sure that all toilet paper or sanitary products are disposed of in a nearby waste-­‐bin. Laundry: Washing facilities and clothesline will be available for student use. Participants may use the laundry facilities so long as use does not interfere with the needs of the clinic. Security: All clinics are located in safe neighborhoods and have key-­‐lock entry where appropriate. Electricity: The voltage in Guatemala in most places is V110, 60hz. The plug is two flat blades, such as found in North America. Three-­‐prong outlets are not generally available, however. If your device has a 3-­‐prong cord, you should bring a simple 3-­‐prong to 2-­‐prong adaptor. When using computers or iPods, make sure to use a voltage regulator between the electronic device and the socket. Additionally, due to the frequent outages, back-­‐up your work regularly. Trash: The clinic has a trash service that is picked up regularly. When it is picked up, it is taken to a landfill. Recyclables are separated out once the waste arrives to the landfill. As with everywhere you live, but especially when living in underdeveloped countries, please create as little trash as possible. Be conscious of the packaging that products come in, and re-­‐use whenever possible. Please bring your own water bottle to fill with filtered water, rather than purchasing bottled water to drink regularly. Birth Institute
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FOOD & DIETARY CONSIDERATIONS As a participant living among the people and culture of Guatemala, you can expect to eat plenty of tortillas! Tortillas of the Mayan Highlands are small, white or blue corn tortillas that are eaten at every meal. Vehicles for nearly anything, you can expect them to be paired with the mail dish at every meal. If you choose to eat like a local, at breakfast, you’ll eat tortillas with your beans, eggs and cheese or crema. At lunch, you’ll dip your tortillas in caldo (soup), and at dinner they’ll compliment your rice and meat (either chicken, fish or beef) in a delicious sauce. With each meal you might be lucky to be indulged with a small cabbage salad or some avocado – and of course fresh-­‐squeezed fruit juice to go with it! In the streets and markets you might find elote (roasted corn on the cob), tamales, tostadas or freshly sliced fruit with lime-­‐juice and salt. The colorful and lively markets in each town are a great place to find bountiful fresh fruit and vegetables each week! Simple, hearty and delicious, the food in Ciudad Vieja is enjoyable for all who visit. No need to worry if you a vegetarian – eggs can be substituted any time for meat, and there are plenty of other elements to every meal to ensure you are getting your fill of nutritious food. FRUIT & VEGETABLES The basic vegetables are typically easy to find. During summer months’ tomato, green pepper, onion, cabbage, plantain, potatoes, broccoli, and carrots are readily available. As just mentioned, some vegetables can be purchased at the tiendas during specific seasons. Sunday is official market day but every day people are selling their fresh vegetables and fruits on the main streets. FILTERED WATER Small bags of filtered water can be purchased at all the tiendas to aid a quick thirst. The clinics also have filtered water for filling water bottles. TIENDAS AND GROCERY STORES Tiendas sell different items primarily staples such as rice, beans, corn, flour, baking soda, salt, oil, candy, soda, and medicine for minor ailments. Additional house items can be purchased such as toilet paper, light bulbs, laundry soap, toiletries, hair bands, etc. Depending on the season, basic vegetables can also be bought at certain tiendas. Bread is available at local bakeries like Dona Luisa Bakery (Calle 4, between 2 and 3rd Ave). For groceries, try Bodegona (Calle 4, between Calzada and 7th), or Organica (Calle 5, between 5th and 6th Ave). Birth Institute
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TRANSPORTATION Taxis: As you will quickly learn there is not a shortage of cabs in Ciudad Vieja. Every taxi that passes will honk their horn at you to advertise their business. If you are in the market for a taxi, then stick your hand out and wave one down. If not, shake your head or finger “no” and they will stop honking at you. From Antigua to Ciudad vieja you can expect to pay Q30 for a taxi. Taxi’s in Guatemala City maximize their service by picking up multiple people along their route, so they will often have other passengers join your ride or already be in the car when you get in. When flagging down an already occupied taxi, it is best to tell them where you are going first to see if your destination is in the same direction that they are headed. Taxi service is not readily available at ACAM in Conception. Buses: To get to Antigua from AMA, catch any bus that passes by the clinic. They run from 4:00 in the morning until late at night. The bus fare: is Q3 (always carry small change). To return to clinic from Antigua: Catch the bus that says “Ciudad Vieja” leaving from in front of the white church that is down the street from Pollo Campero on La Calzada Sta. Lucia. To get from ACAM to San Juan walk down from the clinic to the main road. Catch any bus heading down the hill. They all go through San Juan. The bus fare: 2Q one way… Make sure you tell the driver you want to get off in San Juan. It’s only about a 5 minute ride. Tuctucs: A very common form of transportation, these are small, covered motorcycles. They are generally a less expensive option than taxis, and are available even when buses are not. Remember that there are very few road signs, street names and address numbers in Ciudad Vieja, therefore the majority of people use landmarks to give directions. Here is the phone number for a trustworthy taxi driver in Ciudad Vieja/Antigua named Selvin: 55073609 Julio Baeza is a highly recommended private driver. 5582-­‐1697 or 4846-­‐4167 [email protected] He is based in Antigua and will take you anywhere safely in the country. Early Arrival or Late Departure: If you arrive before the date you start working, or stay past your end date, you may need to secure other accommodations, as we must accommodate the flow of incoming and outgoing participants. Please know that ultimately it will be your responsibility to find a place to stay if you arrive early or stay later. WEATHER/TROPICAL LIVING The differentiation between summer and winter months is that summer is the dry season (October through May). Rainy months are typically November through February. Days will generally by warm, with the air-­‐cooling significantly at night. This region of Guatemala and Central America has been historically prone to natural disasters, especially Birth Institute
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hurricanes, tropical storms, and landslides. This continues to be a risk and more so with recent global climate changes. Storms are most common during late-­‐August through December, frequently bringing torrential downpours and strong winds. Due to these risks it is important that all Birth Institute Participants and staff are always alert and tuned into the national and international weather conditions so that proper precautions and planning can be taken when there are dangerous storms. Large insects, lizards and birds are everywhere and may sometimes end up in your home; most are harmless and would rather not be stuck in your room. Coax them out or have someone help you. Geckos and small lizards, which you will hear chirping inside your room, eat many smaller insects so they are your friends! LANGUAGE In Guatemala, the first language of most of the population is one of the 21 indigenous Mayan languages spoken throughout the country. Some people, especially the elderly, only speak their native dialect, which can vary from town to town. However, the most widely spoken shared language is Spanish. We ask that you learn the basics of Spanish at the very least, before you arrive on site. Even once you have the basics, one of the biggest challenges you will face while on site is the language barrier between you and the women you serve. While the difficulty of this is not to be underestimated, there are many opportunities for growth and breakthrough. You should feel comfortable with living in a context where you can not express your needs as easily as you might be used to, and you should be open to finding new ways to communicate with the people around you (i.e. body language, picture drawing, etc). Staff members at your host site will often act as interpreters, as professional interpreters are generally not available on a day-­‐to-­‐day basis. COMMUNICATION We recommend that you communicate with family and friends at home no more than twice per week. We find that doing so more often can make you more homesick, and takes you out of the reality that you are living. You will be much better adjusted and have an overall more powerful experience if you use your downtime to communicate with locals rather than those at home. Internet: For long-­‐distance communication, you can rely on the Internet. Both clinics have WiFi, although it can be slow compared with what you are used to. Internet cafés can be found on most main streets, and will cost you about Q8 (US$1) per hour. Or, if you’d prefer to have Internet available anytime, anywhere you can purchase a USB satellite Internet connection for Q145 (US$18) to Q350 (US$43.75), depending on how fast of a connection you are looking for. These small boxes that plug directly into your computer provide reliable Internet service through a pay-­‐by-­‐the-­‐minute service or a monthly subscription that will cost you about US$15. In country calls and text messages: For in-­‐country communication, bring an old cell phone (or buy one there) with a place for a Guatemalan SIM card. The cost for a simple phone with a SIM card and some minutes is about US$25. We recommend that you purchase a TIGO phone, as the other companies’ service can be spotty. The chip itself, which will give you your own Guatemalan phone number, can be purchased for around $10. Then, you’ll purchase rechargeable minutes through any local tienda. Keep watch for the promotional days when minutes are two – or sometimes three – for the price of one! Generally, they will cost you about Q1 (US.12 cents) per minute for local calls. Your minutes can also be used for local text messaging, which has become a common way of communicating among young people in the area. If you want to use your smart phone in Guatemala for a data plan it MUST be unlocked before you leave your home country. International Calling and Texting: Your smartphone or iPad will allow you to download several Apps for inexpensive or free international phone calls or texts. We recommend that you download and test the following Apps before leaving: • • WhatsApp allows you to make free text messages and calls anywhere in the world and will work whenever you have access to cellular data (whenever you can make a phone call). WhatsApp is recommended for all study abroad percipients to ensure that you can reach our program director at any time. Viber allows you to make free phone calls or text messages any time you have access to cellular data (whenever you can make a phone call). Viber is required for all Birth Institute
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preceptors to ensure that you can reach our program director at any time. Talkatone allows you to make free phone calls to the United States or Canada wherever you have access to the internet. Skype allows you to make free video calls anywhere in the world or to make phone calls for a fee (rates vary based on the call destination). Skype will work wherever you have access to the internet. Skype is required for all participants to ensure that you can reach our program director for weekly check-­‐ins. Guatemala Country Code: 502 US Country Code: 001 Mail: Sending or receiving mail in Guatemala from the United States takes approximately 15-­‐20 days. The Manos Abiertas address is as follows: Manos Abiertas 2 Calle 2-­‐59 Zone 3 Ciudad Vieja, Sacatepéquez Phone: (502) 7888 7740 Packages can be sent and received at Manos Abiertas, however it is not recommended that items of value be sent through the mail system. Occasionally the postal workers may open packages, and depending what they find may confiscate specific items or ask for payment to pick-­‐up the package. • • MEDICAL CARE Living in Guatemala, it is possible that you could experience the woes of unfamiliar bugs – stomach discomfort or fever is not uncommon for foreign visitors. Such ailments are nothing to fear, however, because services are readily available within the community to treat them. To avoid the chances of getting a parasite: 1) DO NOT DRINK TAP OR STREAM WATER in rural or urban areas 2) BOIL, FILTER, OR PURIFY WITH CLORINE DROP before consumption of water* 3) DO NOT INGEST THE WATER when brushing your teeth 4) WASH FRUITS AND VEGETABLES (including beans and rice) before consumption with treated water *Clay drip-­‐filters are a common way locals and foreigners alike ensure their own access to clean water. Bottled water is available in any tienda, although we do not encourage this to be your main source of drinking water, as there is no established means for disposing of the plastic waste this creates. As a first line of defence against unfamiliar bugs, The clinics you will be staying at have the capacity to provide knowledge on medicinal herbs and treatments. The clinic staff and community of knowledgeable healers welcome your inquiry to help you solve your health concerns. Beyond that, Guatemala City and Antigua offer the full range of health and medical services for serious health concerns. Small government-­‐run medical hospitals, staffed largely with doctors trained in Guatemala City and stocked with a plethora of modern medicines, are available in each community. Although we don’t recommend these as your first choice for care, services in these hospitals are available free of charge for locals and foreigners alike, while you may have to pay a nominal fee for take-­‐home medicines. Another option for care is local clinics and private doctors, where more reliable services may be offered at fees ranging from Q150 ($18.75) to Q300 ($37.50) for the consultation. The midwives can advise and refer you to a care provider in the event of a medical situation. Birth Institute
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It is important that you let Birth Institute know about your serious condition immediately, and that you work with ACAM and AMA staff if you become sick so that they can make sure you have access to the best health care. Please make sure that your international health insurance will cover this cost. While your local host clinic will coordinate it for you, neither Birth Institute nor the clinics have the funds to cover you in the event of an emergency or health issue. SAFETY You may have heard Guatemala described as one of the most dangerous countries in Latin America, and while this description should not be taken lightly, it is important to consider your location in Guatemala and the precautions that you take. The two most frequently reported types of incidents involving foreigners are highway robbery, when a vehicle is stopped and its occupants relieved of their belongings, and robberies on walking trails. Other potential dangers are pickpocketing, bag-­‐snatching, bag-­‐slitting and the like in crowded bus stations, buses, streets and markets, but also in empty, dark city streets. While the area around your site has become a relatively safe haven for tourists and participants, please keep this in mind throughout your time in the country. Guatemala City is a large metropolitan city and is known for its crime and gangs. While there are definitely many charming aspects, we advise foreigners who are unfamiliar with the city to be cautious and remember that you stand out. We recommend that you follow these common-­‐sense guidelines: 1) Dress appropriately. Make sure you are covered, as this will help you blend in with the local population and not be harassed. 2) Don't walk alone at night or in deserted areas, and do not walk on forested paths during the day or the nighttime. 3) Be aware of your surroundings, and follow your gut instinct. If you feel unsafe, swiftly remove yourself from the situation. 4) Travel around the city with at least one other companion. You are less of a target when in a group. 5) Always carry your cell phone with your local number, and important numbers on speed dial. 6) When moving around at night, make sure that you hire a private car. Do not rely on public transportation, especially buses or tuk tuks. 7) Do not wear valuables or carry large sums of money at any time. 8) Sleep with your windows and doors locked. 9) Be confident. Nervousness or skittishness makes you a more likely target, as potential predators see it as weakness. 10) DO NOT seek or accept intimate contact with anyone in the community. This is against the code of conduct in your contract. Animals Dogs and cats are often free-­‐range; do not get friendly with them, even if they seem healthy. Always wash your hands if you come in contact with any animal. Wear gloves! It is your responsibility to protect yourself from biohazard. The women at the clinic are not tested for communicable diseases, so it is your responsibility to take the proper precautions. You may spend many hours offering support without need for gloves, but birth may happen quickly and you need to be prepared. There should be non-­‐sterile gloves available in each room. If not, ask for some. Gloves are also mandatory for clean-­‐up tasks. Birth Institute
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ENTERTAINMENT Living in Ciudad Vieja you will have access to many options for entertainment, especially given its proximity to the tourist destination of Antigua. You will find a plethora of restaurants, nightlife (such as dance clubs called discotecas), and diverse ways to experience the region’s natural beauty, including visits to the nearby volcanoes. Some of our favorite places to hang out, eat and shop in Antigua: • • • • • • • • • • • • El Chaman (7a Avenida y la Calle 5). o Yoga classes available here. Earthlodge (www.earthlogdeguatemala.com) o A perfect getaway to a mountain lodge that is just outside of Antigua! Spanish CoOp: (6th Avenida and Calle 4). o Good exhibits and documentaries on Wednesday nights. Caoba Organic Farm o They can deliver, 78329201 Y tu Piña (1a Avenida y 6a Calle) Cafe No Sé (1st Ave or Ira Avenida Sure 11c) Market (behind la calzada) o Souvenirs, cheap movies, fruits and veggies Bagel Barn (5th Calle right by the park). o Kombucha lovers should come here! Epicure (3rd Ave, between 2nd and 3rd Calle) Naturista in Jocotenango. o Massage Therapist, open Sunday. Restaurante Rainbow o Great food, live music at 8 p.m. every night. La Fabrica -­‐ Gym (On Hermano Pedro, one block north of 1st Ave.) • • Cafe Sky (1a Avenida Sur no. 15) Valhalla (Macadamia Farm) o A wonderful place to sit, great macadamia pancakes, walking distance from the clinic. • • Horseback riding up the volcano: get in touch with Hannah, the clinic director Make sure to check out the ruins in Antigua. They are everywhere! Birth Institute
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NATIONAL HOLIDAYS Most business will be closed on the following days, and participants will take the day off as long as there are no births happening. January 1: New Year's Day March/April: Easter May 1: Labor Day June 30: Army Day September 15: Independence Day October 20: Revolution Day November 1: All Saints Day December 25: Christmas Day NATIONAL EVENTS We recommend that you do your best to participate in some of the following Guatemalan events! Guatemala is a largely Catholic country, and many of these events are religious in nature. We encourage you to participate and enjoy the cultural beauty of these events even if you are not religiously aligned. • January: On January 15, the day of the Black Christ is celebrated in Esquipulas. • February or March: Lent processions begin throughout Guatemala. • March or April: Lent and Easter week processions throughout Guatemala. The largest processions occur in Antigua Guatemala on Good Friday. • May: On May 2 and 3, the Day of the Cross is celebrated with colorful traditions at Lake Amatitlan near Guatemala City. • On May 9, Jueves de Ascencion is celebrated with traditional music, flowers and prayers at Lake Chicabal. Please be very respectful of this tradition and do not take photographs. • July: July 25 is the town fair in Antigua Guatemala, with parades, music and other festivities. • On July 27, the annual Rabin Ajau beauty pageant is held in Coban, with traditional dances and ancestral music. • August: On August 15, Guatemala City celebrates the day of our Lady of the Asuncion; also several other towns, like Sololá, where you can see the brotherhood of the Lady of Asuncion passing through the streets of the town with their icon on their way to the church. • September: September 15 is the national holiday to commemorate Guatemala's Independence from Spain in 1821; the largest holiday fair is in Quetzaltenango. • October: On October 20, Guatemala celebrates the overthrow of Dictator Jorge Ubico in 1944 and the beginning of 10 years of revolution government known as the "10 years of Spring". • November: All Saints Day, celebrated on November 1, is celebrated with unique traditions throughout Guatemala; giant kites are flown in the cemeteries of Santiago Sacatepequez and Sumpango near Antigua Guatemala. Many Guatemalans feast on a traditional food known as fiambre. An unusual horse race is held in Todos Santos Cuchumatan. • December: The town fair in Chichicastenango culminates on December 21 with traditional dances and music. Nativity scenes, hand-­‐made Christmas ornaments and small procession known as "posadas" create a joyful atmosphere during December. Birth Institute
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PREPARING FOR YOUR DEPARTURE Policy on Travel Prior to Courses Students are asked refrain from personal travel prior to the start of any Experiential Learning Abroad course. Given the extensive online orientation, mandatory virtual meetings and time-­‐sensitive travel documents (visas) to be arranged prior to the start date, it is important for students to remain in their home country to ensure that all necessary work and documents are in order, and so as not to jeopardize their experience. If students wish to explore the region beyond the program dates, they may do so at the end of the course. Birth Institute will not under and circumstances expedite visa letters or alter mandatory orientation dates to accommodate personal travel schedules. ENTRY/EXIT REQUIREMENTS The following are the requirements for United States citizens to enter and exit Guatemala: • A passport valid for six months beyond the date of entry • Evidence that you have sufficient funds and/or an exit ticket (flight). o A credit card is likely sufficient evidence. • An exit tax must be paid when departing Guatemala by air. The exit tax (currently $30) is generally included in an airline ticket price, but may be charged separately. • There is an additional airport security fee (currently 20 Quetzales, or approximately $2.60) that all travelers must pay at the airport. Visas Birth Institute’s recommendation is that you enter into Guatemala as a tourist, which does not require a visa. To enter Guatemala as a tourist, you must present the documents listed as entry/exit requirements (above). Your passport will be stamped with a departure date that is 90 days after your entry. Near the end of your 90 days you will need to exit Guatemala and the region (going to Honduras, El Salvador or Nicaragua will not count as exiting Guatemala), OR apply to extend your visa. Please note that overstaying your 90-­‐day permission will result in a small daily fee that you must pay upon exiting. Given that you will be entering Guatemala as a tourist at the time of your entry to the country, no action is required on your part at this time to obtain a visa. Document Authentication If possible, we recommend that you bring the following documents to your local Guatemalan consulate for authentication: • Birth Certificates (two copies) • Police Record (two copies) Birth Institute
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This is not absolutely necessary to enter Guatemala, but it is recommended by the Denver consulate and may save you some hassle upon your arrival or renewal. Having these documents is also likely necessary should you decide you want to apply for temporary residency. It costs ten dollars per document to authenticate. Upon arrival in Guatemala, we recommend taking a copy of your passport to the American embassy. MEDICAL CHECK-­‐IN AND IMMUNIZATIONS As you are preparing for your departure, please schedule a general check-­‐in with your doctor 4-­‐6 weeks prior to your departure to make sure you are healthy and to discuss immunization for Guatemala. During your visit, remember to request a 12-­‐month supply of all prescription medications for you to bring on your journey with you. There are currently no inoculation requirements for entering Guatemala. However, if you have traveled in areas of the world with rampant Yellow Fever, you are asked to travel with your inoculation documents. Birth Institute recommends the following immunizations for Guatemala, however they are not required. Immunization is your decision. • Hepatitis B & A– strongly recommended • Rabies – potential for dog bites • Tetanus • Typhoid • Measles, Mumps & Rubella (MMR) • Whooping cough OR DTaP (Combined Diphtheria, Tetanus & Whooping cough) Please visit the Center for Disease Control website to learn more about current and up-­‐to-­‐date health issues and immunizations need for Guatemala. • Center for Disease Control http://wwwn.cdc.gov/travel/destinationGuatemala.aspx • Travel Health Online www.tripprep.com • Lonely Planet Health www.lonelyplanet.com/health Malaria: You do not need to bring with you Malaria preventatives of medication because there is no Malaria where you will be living and working. INSECT BITES Insects carry some unpleasant illnesses, and their bites can be bothersome. One of the best protections is to prevent insect bites by: • Using insect repellent (bug spray) with 30%-­‐50% DEET. There is just no “natural” spray that prevents bites as well as DEET. Birth Institute
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• • • • • Using natural preventatives, which include: eating raw garlic and adding tea tree oil to your bug spray. Wearing long-­‐sleeved shirts, long pants, and a hat outdoors. Remaining indoors in a screened or air-­‐conditioned area (in the city) during the peak biting period for malaria (dusk and dawn). Dengue is a day-­‐time mosquito, so you need to apply repellent after each shower, and regularly during the day. Sleeping in beds covered by nets treated with pyrethrum, if not sleeping in an air-­‐conditioned or well-­‐screened room. You will be supplied with suitable mosquito net, as many of those brought from overseas are not fine enough to keep the mosquitoes in Guatemala out. Spraying rooms with products effective against flying insects. HEALTH INSURANCE Medical insurance is required for you to be a participant in any Birth Institute program. Many United States-­‐based medical insurance companies do not cover emergency expenses abroad, including treatment or medical evacuation, and Birth Institute nor Asociación Manos Abiertas or ACAM are able to support you in a medical emergency. Please make sure that you are able to cover the expenses, and in the event that you need medical care. The clinics will assist you in getting you to an appropriate hospital for treatment. When comparing insurance, please make sure it will cover you in case of evacuation to another country for emergency treatment, as Guatemalan hospitals offer limited care. Ideally, you will want coverage that will evacuate you to your own city. Also when making a decision regarding health insurance, you should consider that many foreign doctors and hospitals require payment in cash prior to providing service. Ascertain whether payment will be made to the overseas healthcare provider or whether you will be reimbursed later for expenses you incur. TRAVELERS INSURANCE We strongly recommend you also get travelers insurance before departing for your destination country, as this should cover anything from lost baggage to theft. Birth Institute is unable to cover expenses related to these unexpected mishaps, so please make sure you are able to cover yourself in these circumstances. For a list of traveler’s health insurance providers, visit the United States Government Department of State Travelers Website or Square Mouth Insurance Comparison. BANKING AND MONEY Before you Depart: It is extremely important that you let your bank know ahead of time that you are planning to leave the country, where you are going and for how long. If you do not, they may put a hold on your money when they see the first out-­‐of-­‐country transaction, and this could be difficult to lift from abroad! Check with your bank when leaving your home country to make sure that your debit card will work abroad. Currency & Exchange Rate The currency in Guatemala is called the Quetzal (Q). Although the exchange rate changes slightly from day to day, the average rate around Q8 for every dollar. • USD$1 = Q8 • USD$5 = Q40 • USD$10 = Q80 Birth Institute
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• USD$20 = Q160 There are many foreign and local banks available in Guatemala. When arriving at the airports, you will find numerous ATM machines at the airport where Quetzals or dollars can be withdrawn with a debit card. Although most places in the cities will accept U.S. dollars, you will receive a better price if you pay with Quetzals, therefore we advise people to exchange your money as quickly as possible. For exchanging only a few dollars, making a small purchase and requesting your change be in Quetzals, this is an easy way to get cash. We do not recommend carrying large sums of money while you are in transit or while traveling. Foreigners are frequent victims to robbery or theft and being unfamiliar with the surrounding with lots of belongings will make you an easy target. While some people prefer to travel with traveler’s checks, banks are very inefficient in Guatemala, and often you will have to wait in lines for hours, therefore, we recommend instead of travelers checks, bringing simply a bank debit card and withdrawing cash as needed. ATMs are in abundance and visa debit and credit cards can be used at most restaurants, stores and lodging accommodations in the cities. Although carrying a debit card and withdrawing money as needed may be the safest and most convenient option, keep in mind your bank may charge you a foreign transaction or withdrawal fee every time you make a purchase or take out money. The charge will be different with each banking establishment, so check with your home bank about foreign fees before leaving. Foreign/International Banks in Guatemala: We do not recommend transferring your money to an international bank or dealing with any bank directly in Guatemala. Rather, we recommend that you use your local bank and bring your debit card to take money out of the local ATMs. However, there are international banks in Guatemala in the event that you need to use one. PREPARING FOR YOUR ADVENTURE Completing the Readings: Please thoroughly complete all readings and assignments that are given to you before you depart. These are essential for your success during orientation and will impact your experience of the remainder of the program. Learning Spanish: Gaining a working knowledge of Spanish before coming to Guatemala will deepen your experience more than any other aspect of preparation. Birth Institute highly encourages participants to take at least a basic Spanish course before arriving in Guatemala. This will make connecting and getting comfortable with your site much, much easier. Learning about Guatemala: Guatemala is a beautiful and dynamic country. Learning as much as you can about Guatemala and its intense past before your arrival will tremendously enhance your experience. In addition, Guatemala also has had its fair share of foreign presence, much of which has contributed to its inability to progress, therefore, understanding the history, will allow for you to be more effective and responsible when volunteering and working with local communities. Birth Institute
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PACKING LIST • • • • • • • • • • • • • • • • • • • • • • • • • Guatemala is a country in which modest dress is the standard. It is imperative that you follow a respectable dress code while working in the communities and birth clinics • Long skirts or pants ONLY. • Shoulders and chest area should be covered. Revealing your breasts, cleavage or mid-­‐drift is never acceptable. • Clothes should be loose-­‐fitting but not baggy. Bring warm layers to cover up for cool days and chilly nights (it can get quite cold in the highlands of Guatemala!) Sleeping bag (optional) Towel Wrist watch with a second hand Ear plugs Plug adapter Very modest jewelry (if any at all) Shampoo/Conditioner Toothbrush/ Toothpaste Razors Deodorant Sunscreen Environmentally friendly soap Contact lenses and/or glasses Menstrual products Grapefruit seed extract is seen to be effective in preventing stomach bugs. Chinese herbs for stomach strength: Huang Lian Su tablets, and Po Chai pills (they work wonders for upset stomachs!) Immune-­‐boosters: Vitamin-­‐C tablets, Emergen-­‐C, Wellness Blend. We recommend that everyone take at least 500 mg of Vitamin C every day. Please bring enough vitamins and supplements to sustain you for the entire visit, as it may be difficult to find locally. Bring whatever other medicine or prescriptions you might need, or regularly take, as well. Cell phone Laptop Computer Solar reading light and/or headlamp for nighttime study (we recommend Nokero products http://store.nokero.com/) Items to Interact with local midwives and families • Pictures of family, friends, and your life in home. • Children’s books Birth Institute
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TRAVEL Airline Tickets • Your final destination should be Guatemala City. Words of Advice: • We strongly encourage you to purchase a flexible plane ticket, as your program dates or location may change up to 30 days before you are scheduled to be on site. • We recommend ensuring that you have at least 2 hours between connecting flights, as in our experience missed connections causes for major problems with luggage and coordinating ground transportation. • There are many websites to assist you in finding the cheapest and most direct flights, including Adioso, Orbitz or Kayak. Remember that while these sites may offer convenience, it might be more difficult to change your ticket in the event that your program changed or delayed. Orbtiz will charge you $330 PLUS the difference in airfare to change your ticket. For this reason, you may consider booking a flexible fare directly with an airline. • Take a look at this website which gives an overview of major airline additional fees: www.farecompare.com/about/airline-­‐fee-­‐chart/ Documentation: Please forward a copy of your passport, insurance & airline itinerary to Sierra so that Birth Institute can help you in case of a mishap. Please send your travel itinerary to bee@birth-­‐institute.com as soon as you have purchased your ticket. Luggage Please make sure you check with your airline to find out the weight limit, and weigh your bag before departing. Exceeding the weight limit can result in large fees (which differ according to the airline). Generally, the limit is 50 pounds. Whilst it is not common for baggage to be lost when traveling to Guatemala, pack all valuables such as money, cameras, iPods or computers in a carry-­‐on bag. In addition, include in your carry-­‐on a change of clothes, a toothbrush, or other basic toiletries in case your bags are not retrieved immediately. Make sure you keep your tracking number with you. Phone: Please make sure that your phone is able to make emergency calls in Guatemala. This means that you should either get an international calling plan, or ensure that your phone can make quick calls on roaming in case of emergency. We will help you get set up with a local phone upon arrival in Guatemala City, but it is important to make sure that you have a mode of communication in case of emergency. Register as a traveler with your government: Below are the traveler enrollment programs for the United States and Canada. It is important to enroll in your country’s program so that your government is able to help you in case of emergency, including everything from loss of passport to emergency evacuation. • United States: o Register with the Smart Traveler Enrollment Program: https://step.state.gov/step/. • Canada: o Register as a traveler with the Government of Canada: http://travel.gc.ca/travelling/registration. Birth Institute
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BUDGET Participants should budget and plan for the following expenses in addition to tuition and fees. All expenses are estimates and are subject to change without notice. Participants are responsible for covering these expenses out-­‐of-­‐pocket. Site-­‐Specific Expenses Entry Tax: US $33.00 Airfare (sample fare, based on Denver to Guat.City, 60-­‐day advanced purchase on Orbitz): US $800.00 Airport Shuttle: US $30.00 from the airport to Antigua. Private transport between AMA and ACAM is $120 Additional Transportation: US $5.00 -­‐$10.00 per week (public transportation) Food: US $20.00 -­‐ $50.00 per week (basic meals and snacks) Note: Eating at cafes and restaurants will be more expensive then buying food at local markets and cooking it your self. General Expenses (based on participant preferences) Cell Phone + Cellular Service Ipad or Laptop Valid Passport Travel & Health Insurance Entertainment/souvenirs Transportation Food INSTRUCTIONS FOR ARRIVAL Please read the following. Then ask Bee (bee@birth-­‐institute.com) if you are unclear about your ground transportation arrangements before you leave. Travel Arrangements & Instructions: • Immigration: When you de-­‐board your plane, you will be guided to the immigration area, where your passport will be stamped to signify when you entered the country (you are allowed to stay 90 days past this date). If you are asked to write a destination address in Guatemala on your entry card, you should put the address for clinic, which is: Manos Abiertas 2 Calle 2-­‐59 Zone 3 Ciudad Vieja, Sacatepéquez • When you exit the airport: If Birth Institute has arranged transportation for you, please look for our driver holding a sign that says "Birth Institute". The sign will not say your name. If there is nobody there, please wait at the airport for your ride to arrive. The driver will be there, however, in the past drivers have had breakdowns or gotten stuck in traffic. • Distance to Destination: The journey to Ciudad Vieja is 1-­‐2 hours, and 4-­‐5 hours to Conception depending on traffic. • Cost: We will ensure your safe delivery to your destination sites in Guatemala upon your arrival however the cost is at your own expense. Please plan to pay Birth Institute
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• approximately $30 for transport from the airport to Antigua. AMA to ACAM: Private transportation runs about $120 between sites. Although it may be less if you travel at the same time as other participants. Participants are advised to arrive on the recommended day so that they may share the cost with others. What to do if pick-­‐up does not go as planned: 1. If you do not see the sign that says "Birth Institute" please wait IN THE AIRPORT. 2. Then, please locate WiFi or another Internet connection and email Bee to let her know where you are and what the situation is. Please stay in the airport, and stay in the general vicinity of where you say you are in the email so that we can send someone to look for you. 3. Please TEXT or WHATS APP Bee in California, United States: o Bee-­‐ +1707.337.9865 o Skype brandi.lauher 4. Remember that it is best to stay in the airport if you do not find the Birth Institute representative, unless you have arranged your own transportation. . 5. Staying in Guatemala City Some groups will stay in Guatemala City for a night before moving to site. Please see email to confirm whether or not this applies to your group. Please be sure that this is agreed upon ahead of time. TIPS AND REMINDERS Pace & Consideration This is a final reminder to leave your Western expectations behind. While you are accustomed to high standards, strict guidelines, deadlines, schedules and markers of productivity and accomplishment, this may not be the case in Guatemala. It may take some time to adjust to the local pace and manner of getting things done. It is important to remember that life surrounding the clinic and work within the clinic are on “Guatemala-­‐time.” Please, be patient and have an open mind. Please commit to respect and learn from this pace as it is often at odds with Western concepts of schedules and deadlines. Self Care Given the intensity and the unfamiliarity of living abroad and spending time in the clinic, it is easy to get overly tired, dehydrated or sick. Therefore, in order to maintain your studies and have the clinic run as smoothly as possible, taking care of yourself is imperative. It is during times that people do not care for themselves, both physically and emotionally, that problems arise. Please rest, eat healthy food and drink plenty of purified water. Take your vitamin supplements and green powder regularly to add to your nutrition so that you stay strong and healthy. IMRPOVEMENTS Help us improve this handbook for future participants! • What do you wish you had known? • What do you wish you had brought with you? • Anything you would have left behind? Please send corrections and additions to this handbook to Bee at bee@birth-­‐institute.com Birth Institute
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