faculty focus Saving Lives in Guatemala
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Rachel Hall-Clifford, assistant professor of anthropology and public health at Agnes Scott College, went to Guatemala through what she calls a set of “happy coincidences” to do her dissertation work and fell in love with the mountainous highland region. As a result, she has spent the past 15 years trying to improve the health of indigenous Guatemalans through her research and applied projects. “Guatemala is an incredible place with a huge abundance of natural and human resources, yet inequality and lack of access to good health care are persistent problems,” says Hall-Clifford, who has been teaching at Agnes Scott since 2013. “It’s important to me to be a small part of the solution to these problems.” She is currently focusing on reducing maternal morbidity rates in the Chimaltenango region of Guatemala, which are among the highest in Latin America. Due to financial, language and cultural barriers, most indigenous women give birth at home with the help of midwives. Hall-Clifford believes it is important to support the cultural preference for home birth when it can be done safely, but also wants to maximize health system resources to make sure complicated cases are cared for in hospitals. Hall-Clifford, along with her husband, Gari Clifford, chair of the Department of Biomedical Informatics at Emory University, and Peter Rohloff, assistant professor at Harvard University Medical School, created safe + natal, a program that utilizes smartphone technology to help the midwives monitor pregnancies, identify risk factors and communicate with the local hospital if the mother shows signs of complications. Originally funded by a grant from the National Institutes of Health, safe + natal provides midwives with a kit containing a smartphone, blood pressure monitor, pulse oximeter and Doppler ultrasound—all tools to measure maternal health and fetal growth during pregnancy. A smartphone app records and transmits data for review by medical staff at a local health provision nongovernmental organization, which then facilitates necessary care. Because most of the midwives cannot read, the app uses pictures and sound to guide them through taking measurements and identifying risk factors, and it helps them communicate with medical staff. The device will even call an ambulance if needed. “We worked with about six of the midwives to get the right user interface,” says Hall-Clifford, who had a role in developing and implementing the training. “It was a long process. We tested what the symbols would be, learned how they liked the design and listened to their feedback.”
Assistant Professor of Anthropology and Public Health Rachel Hall-Clifford
Hall-Clifford worked closely with a Guatemalan nurse, who delivered the training in the Kaqchikel Maya language. The device took about three years to develop, and the app with the user interface took another year. The team has seen positive results. “When our device was used, there was an increased rate of completed referrals to the hospital and increased detection of pregnancy complications,” says Hall-Clifford. She says Agnes Scott students have been involved with analysis of data from this project, primarily coding qualitative data from interviews with the midwives. Hall-Clifford, who lived in Guatemala while completing her Ph.D. work, says on average she visits the country for about two months out of the year. She conducts research and also directs the National Association for the Practice of Anthropology-Occupational Therapy Field School in Antigua, Guatemala, sometimes taking Scotties to help with community-based research. She also co-teaches Affordable and Sustainable Healthcare Technology with her husband, and, although the class is taught on Agnes Scott’s campus, it includes students from Emory University and the Georgia Institute of Technology. “We’re teaching the process of developing a health innovation for resource-constrained contexts,” she says. “We’re engaging our students to identify and solve a real problem—not just by coming up with technology, but also by its thoughtful application in a real-world situation.” Plans for the future of safe + natal call for expanding the program within Guatemala as well as in other parts of the world. Still, she says, the Guatemalan people will always have a place in her heart. “After working in Guatemala for so long, I have made lifelong friendships and connections to the people and place,” she says, “so I feel committed to staying and helping do my part.” For information about the safe + natal project, visit safenatal.org.
