LIFE BY LIFE Story by Drew Gaines Photographs by Greta Diaz
Dar a luz,” to give light, is the term Doña Sofia Malvaez Gonzalez uses to describe her work. The single, white fluorescent bulb hanging in her one-room clinic is the first light her newborn patients see, her experienced and smooth hands the first they feel. The 72-year-old midwife, or “partera” as they call it in Mexico, is a comforting fixture in the rural community of Santa Maria Pipioltepec, a farming village that lies two hours west of Mexico City. She delivered her first baby here in the 1970s and has since maintained a zero percent infant mortality rate, a statistic almost unheard of in a country with lackluster public healthcare.
Midwifery remains a tradition here in Mexico where women have trusted the practice since before the arrival of Europeans. Today, the practice thrives in rural areas where access to hospitals and trained doctors proves difficult. As of 2012, nearly 16 percent of registered pregnant mothers gave birth at the hands of a midwife, though this number is most likely higher in rural areas.
“ Her greatest talent,
what she insists is her calling, is to deliver babies, more than 3,000 of them in her 40-plus years as a Mexican midwife. ”
Women put their trust in practitioners like Sofia, despite the fact that many of these medical practitioners receive little formal training or education beyond high school. Midwives are seen as an alternative to long waits and unsanitary conditions at public hospitals. Stories of women giving birth on the street as they wait to see doctors, and negligence by hospital staff are not uncommon. The
long lines of people waiting hours at the closed gates to Valle de Bravo´s public clinic is a testament to the problem.
“Sometimes, in the hospitals, doctors lose the sensitivity that pregnant women need,” says Doctor Rubio, a middle-aged woman with wavy brown hair and braces on her teeth. She serves as Sofia’s supervisor from her small office at Valle de Bravo´s center for Health Jurisdiction. “Doña Sofia doesn´t reject them. On the contrary, she gives a more humane treatment than in the hospitals. That is why women go to her,” she says. A 20-minute taxi ride from the closest hospital through the mountainous landscape of central Mexico takes Sofia back to her clinic and her home in Pipioltepec. She makes the trip to and from the tourist town of Valle de Bravo to deliver stacks of fresh birth certificates to Doctor Rubio. She is the only accredited midwife in the areas surrounding Pipioltepec and Valle de Bravo. Sofia could always count on one hand the number of midwives she knew locally – five. But one has since died and another is ill, she says. The other three operate under the radar and lack the experience that makes Sofia sought after by the local health institutions and the Red Cross.
There is one family doctor practicing in the public sector for every 2,000 Mexicans, according to Mexico´s National Institute of Statistics and Geography (INEGI). In many rural communities, midwives like Sofia fill the void for those who get ill. Parents bring their sick children to her at all hours. A stomach virus that circulates around the community of Santa Maria Pipioltepec brings an influx of hunched-over patients that keeps her busy. She is always on-call, often looking out the single window of her small clinic to spot patients before they arrive. About 10 p.m. on a recent evening, a plump woman in her early 30s shows up, a victim of the stomach bug. Sofia gives her a shot, and another one early the next morning when the woman returns still nauseated. Sofia seems to enjoy giving injections. A quick prick of the needle and a push of the syringe into her patients´ bottoms is employed for a wide range of ailments, including the common cold, diabetes and stomach viruses from local taco stands. “Injections make you better quicker,” says Sofia, her hair pulled back into a single ponytail so as not to get in the way of her work. But her greatest talent, what she insists is her calling, is to deliver babies, more than 3,000 of them in her 40-plus years as a Mexican midwife.
Sundays are for family time in Santa Maria Pipioltepec. Fathers take a break from working in the cornfields and fruit orchards that grow rapidly during the summer rainy season. They play soccer with their children in unfenced yards in front of their humble concrete-block homes. Mothers hang the week´s laundry over drooping clotheslines before cooking the family dinner. Everyone in this tight-knit community knows the name Sofia Gonzalez or has visited her on at least one occasion. Many of the children who run about giggling, with soccer balls at their feet were brought into the world by Sofia´s hands. She has their names, heights and weights recorded in a simple spiral notebook that documents every birth since 1989. “Confianza,” the Spanish word for trust, is repeated by mother after mother when they describe Sofia. Maria Lopez, a 35-year-old mother of two, says it from her post behind the counter at the neighborhood butcher shop, as does Elfega Sanchez, a local cook who serves plates of chiliquiles and tortilla soup out of her home kitchen. Another Maria holds her 16-month-old son at the family´s dining room table. She says Sofia inspired trust when she labored through the birth of her only child. “My baby was born healthy thanks to her and thanks to God too,” says Yeserith Guadarrama, 29, who adds that she would never have another baby should Sofia quit her work. Trust doesn´t come easy in Mexico. People carry deep-rooted suspicion of their government institutions. Longstanding traditions of corruption, bribery and failed reforms taint people´s views of authority, especially among the poor land workers who rarely feel the trickle down effects of government assistance. Doctors with lengthy titles and college degrees are often seen as outsiders who can´t connect with the men and women who spend their lives toiling in the fields. But Sofia is a part of the community. Like many people here, she never received an education beyond the 6th grade. She attends quinceñeras, weddings and birthday parties with the same people she treats.
“ She spent a total of two weeks taking healthcare classes in Valle de Bravo. Two months later, she delivered her first baby. ” Sofia´s daughter runs a one-room pharmacy just a few feet from the clinic. This is where she resupplies her operation with new syringes, cotton swabs and medicine, keeping the money in the family. Word spreads that Sofia may hand down the reigns to her daughter, but Sofia doesn´t see that happening. “It scares her,” she says. “There are beautiful moments but bad ones too,” like the teenage mother who they rushed to the Red Cross after she became incoherent and bled profusely after birth. The
young mother bled for two days in the local hospital before recuperating. She and her baby are both fine now. Days later, the call to mass sounds from the bells of the old church that rises above the main street of Pipioltepec. Its blue-tiled steeples shine brightly in the midmorning sun. Sofia makes the familiar walk up the hill to join the local faithful who sit and kneel at the worn wooden pews. Her black loafers shuffle on the sidewalk. Her grey checkered dress and knit scarf blow subtly in the wind. Catholicism runs deep in this part of Mexico. Shrines to saints sit behind glass at major intersections. A portrait of former Pope John Paul hangs over the bed in Sofia´s sparse clinic. Mother Mary of Guadalupe stands next to the tabletop scale she uses to weigh babies. Faith binds Sofia to her patients. It establishes another level of trust between her and the women she treats. “Thanks be to God,” she says, “the day is going well.” An 18-year-old expecting mother lays belly up on the bed in her clinic. She is nine months in, and dark stretch marks show as she pulls her solid pink shirt above her bloated belly. Sofia leans in with an old-fashioned horn-shaped stethoscope to her ear. She places the cold metal listening device above the young mother´s belly button and listens for the baby´s heartbeat. “You may need a Caesarean section,” she informs her in a calm, patient tone. The baby´s fate will be up to the doctors at the public hospital down in Valle de Bravo. Latin American women are 27 times more likely to have complications during pregnancy than their female counterparts in the United States. Sofia rarely commits herself to high-risk births. She doesn´t have the necessary equipment. At one time, the government supplied her with the bed sheets, syringes and medical supplies. She now buys them herself or receives them in small allotments from Doctor Rubio. But five years have passed since she last received free supplies. Much of the initial support ended in the late 1970s along with the government program that made her a midwife. Now, the government pays her nothing.
In 1972, María Esther Zuno, the wife of then President Luis Echeverría Álvarez, began a national campaign aimed at providing the jobless and uneducated with technical skills. The program produced cooks, carpenters, masons and midwives who would return to their communities with the proficiency to better their towns and the economy. Sofia, then in her mid-thirties, spent a total of two weeks taking healthcare classes in Valle de Bravo. Two months later, she delivered her first baby. Like so many helpful programs in Mexico, the one that made Sofia a midwife ended with the inauguration of a new president. When Echeverría´s six-year term came to a close, so did the funding and flow of medical supplies to midwives like Sofia. She was left to care for the people of Pipioltepec on her own with the periodic help of Doctor Rubio. But she stays dedicated nearly 40 years later. “It´s for the people of the countryside,” she says. “They ask for God to help but sometimes they need more… I do what I can to prevent suffering and help the people.” As Sofia approaches the last years of her service and there is no one to replace her, fear has begun to stir in Santa Maria Pipioltepec. Women like Yeserith Guadarrama, who gave birth to two of her three children in Sofia´s clinic, worry over the possibility of taking their children to the local hospital, a last resort for her, she says.
“ It´s for the people of the countryside… They ask for God to help but sometimes they need more… ” Though women receive free care at public hospitals during pregnancy, many fear the unhygienic conditions. Doctor Rubio blames the problem on a lack of human resources, politics and inadequate funding from the state health department. Doctors come and go from Valle de Bravo´s public clinic. The stress from an overabundance of patients and the lure of higher paying jobs leaves the hospital with a constant doctor shortage. Many times, pregnant women arrive for treatment only to find that there is not a doctor at the hospital that day. “What we have to do, we as a health institution, is focus on these women who are not going to have the care of Doña Sofia anymore,” Doctor Rubio says. “This is a grave problem because Doña Sofia attends to many births.” Rain falls during the night and continues pouring steadily through the early morning. People with umbrellas and rain jackets pass on the potholed streets. But the midwife sees very few patients this morning. ´´It´s a sad day,´´ she says. Her neck is swaddled by a brown scarf to ward off the day´s chill. She sits down on one of the two twin beds, her hands smoothing out the pleats of her long dress, and she looks out the window, waiting for the next patient.