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Field Report: Jessica Cowan shares her thoughts from her time in Mexico with PRONTO

Jessica Cowan is currently completing her residency in family medicine and obstetrics at Swedish Hospital, Cherry Hill; she sees prenatal patients in a Seattle community health center and cares for laboring women at Swedish Hospital and Group Health. She attended Harvard Medical School and earned her MPH from Johns Hopkins University. She is one of PRONTO’s newest volunteer Trainers, having completed PRONTO’s Train the Trainer course in December, 2012. Jessica shares some of her insights from her time spent in the field in Quintana Roo, Mexico, on the blog below the pictures from PRONTO’s Train the Trainer course; where Jessica volunteered to play the Patient Actress:


I returned from PRONTO trainings in Quintana Roo, Mexico a few weeks ago.  Along with three Mexican medical professionals (a doctor and two nurses) I spent time with teams at two public hospitals facilitating the second round of PRONTO training at each hospital.  Our days were long; we would start each morning before seven and finished our work long after dark….

The first hospital we visited is a referral center for the region and as a result, the nurses and doctors care for women who have been sent from other smaller clinics and hospitals for management of complex illnesses and complications.  Our curriculum for the day focused on teamwork, communication and the management of two types of emergencies that impact laboring women and their infants: preeclampsia and shoulder dystocia.  Over the course of time we spent with these nurses and doctors, we heard the stories of care for complex and very ill patients.  As we talked through management options in obstetric emergencies, these nurses and doctors had a chance to debrief difficult cases, some of which had ended badly, and bring a fresh look to management choices and teamwork.

After running our simulated emergencies and debriefing each team’s experience, we closed the day with a “spider web” exercise in which all members of the group created a web with yarn while speaking out loud their hopes for the future of their hospital.  One nurse wished for consistently humane and compassionate care.  One obstetrician wished that the hospital could become a model in safe childbirth.

After the training, when we’d cleaned up the mess and packed away the plastic infants used for resuscitation exercises, one of the nurses in the group sat with me and described a few of the maternal deaths she had seen in the past few years.   I was grateful for the chance to hear her stories as well as her thoughts about changes that could be made to serve patients better.  I hope that our few hours together helped this team take small steps that will protect lives in the years to come.  It was an honor to share the journey with them.


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