Fieldwork in Guatemala sheds light on global health work

Mia Giordano spent most of last summer traveling from Antigua, Guatemala to reproductive health clinics within a day’s travel of the city.

“Some days were very long. We would leave at 5:00 a.m. and didn’t return until 5:00, 6:00 or even 7:00 p.m.!” said the UCLA graduate student of her work as a monitoring and evaluation intern for WINGS Guatemala. A nonprofit organization headquartered in Antigua, WINGS provides free reproductive health services to mostly rural, underserved populations in the country.

Giordano is a student in a joint M.P.H./ M.A. program at UCLA, where she is pursuing an M.P.H. at the Fielding School of Public Health and a master’s degree in Latin American Studies at the International Institute. Prior to her studies at UCLA, she earned a B.S. in public health at Temple University and worked for a hospital system in Pennsylvania. Giordano, a community health sciences student, also serves as a student ambassador for the UC Global Health Institute's Center for Gender & Health Justice. The UCLA Fielding School's Department of Community Health Sciences is led by Dr. Gilbert Gee, professor and chair.

“I’ve always been broadly interested in global health. One of my main goals coming to graduate school was to get more international experience by combining my two areas of interest: public health and my Spanish language skills,” said Giordano, a second-year M.P.H. student.

Giordano is fluent in Spanish, having begun her study of the language in a primary school immersion program and continued her studies in college, completing a second major in Spanish.

Her job at WINGS was to administer an annual satisfaction survey to its clients, then analyze the findings. She spent one day a week at the organization’s standing clinic in Antigua and the other four traveling with the two mobile units to interview clients at mobile clinics.

The internship, which was made possible by support from the Fielding School and a Monica Salinas Summer Research Scholarship awarded by UCLA Latin American Institute, fulfilled a 400-hour fieldwork requirement for her M.P.H. and gave Giordano direct experience in global health.

“It was a really great first-hand experience to see how a public health program is implemented in a country with limited resources and hard-to-reach communities.

“I traveled with two mobile units that had to bring every material that they would need to provide services. For surgery clinics, that meant packing up the truck with everything from the table that patients would lay on to the tools the nurses would use — everything.

“It shifted my perspective, as I saw the thought and time that goes into being able to deliver services to communities that have low access and other barriers to health care.”

Altogether, the young graduate student conducted 188 in-person interviews, complemented by phone interviews with clients of the few clinics that she was unable to reach physically. All her work, both oral and written, was conducted in Spanish.

“It was a really robust experience; I definitely learned a lot,” she said.

Giordano points out that a 2022 Guttmacher Institute research reported showed that less than two-fifths of sexually active women between the ages of 15 and 19 years old use contraception in Guatemala, yet the majority of the same age group does not seek to become pregnant in the near future.

“The surveys largely focused on understanding how the clients perceive family planning and contraceptive methods,” she said. “Many questions focused on understanding their perceptions of short-term versus long-term methods, because WINGS has found that in some areas, clients prefer short-term methods.”

Her interviews showed, for example, that many young women had at one time thought of using a long-term method of contraception (such as an arm implant or a copper IUD), but decided in the end to use a short-term method  (such as a three-month injection, birth control pills or condoms) because they felt more secure with the latter.

“We did find a kind of disconnect in people’s perceptions, where some believed there were major side effects with long-term methods. There is also a lot of stigma associated with these methods. From what I understood from my coworkers, myths about the copper IUD (such as a future pregnancy ending with a baby born with a copper coil on its forehead) are pretty pervasive.

“The survey will help WINGS understand the unique needs in each community and ensure clients have accurate information,” she explains.

Reflecting on her internship, the community health student shared, “Prior to this experience, I hadn’t really explored the area of reproductive health much outside of courses. But it is definitely an area of interest now, as it combines areas that I’m interested in, such as health equity and access to care.

“There are so many barriers that definitely apply to rural communities in the U.S., (which have) much lower rates of health care utilization and access to care. So definitely I’ve gained a transferable understanding of reproductive health.”