Lester Figueroa

Ever since he was young, Lester Figueroa knew that he wanted to be the “guy who delivers babies”. In the social services component of his OBGYN residency, Lester worked in a remote area in Northern Guatemala. This was Lester’s first experience witnessing the lengths women in his country had to go to access maternal healthcare. He once delivered a baby for a woman who had walked 2 hours to the hospital with the hand of the baby outside of her body. He rushed this woman into a C-Section and was heroically able to save both mother and baby. Lester knew from his time working in rural Guatemala that he wanted to save the lives of mothers and babies in these hard-to-reach parts of his country.

Global Network Coordinator was Lester’s first job out of residency. His residency thesis was about preterm delivery and used this experience to obtain the job as the ACT coordinator, a trial focused on improving identification of women at risk of preterm delivery.

Placenta Tissue
Hemoglobin Participant

Working with the Global Network provided Lester the opportunity to see how health systems work around the world. While all GN sites follow the same protocol, each site develops individual strategies for implementation in their existing infrastructures which are commonly shared across the Network. He sees huge value in comparing the GN results obtained across various countries as it emphasizes that there is not always a universal solution to many issues, but a need to adapt solutions to a specific country and context for it to work. Lester believes that the feasibility of implementing the interventions the Global Network is studying in Guatemala and other LMIC both gives value to the studies and encourages their staff to strive to provide higher quality healthcare.

The GN06 Guatemala team was one of the founding sites of the Global Network. They were the lead site in the Women First study and were the first site to pilot the intervention in-country. Their team led the development of the study documentation including educational placental sample and cord blood collection videos. Having ultrasound as a part of the Women First protocol encouraged women to come to the hospital for ANC care and deliver at the hospital and resulted in a significant increase in hospital delivery rates.

Guatemala is a country rich in culture, which strengthens their community but can also pose significant barriers to healthcare. Local community TBAs often facilitate home deliveries, but many of them have not received official birth training and their practices can be outdated. For example, they may make a small steam room for a woman to encourage labor progression but do not check if a woman has other symptoms (i.e. is actively hemorrhaging) which can lead to maternal death or negative outcomes. Global Network initiatives have helped increase hospital delivery rates, reducing such types of birth outcomes during home births.

TBA Meeting

The Guatemalan Ministry of Health has insufficient resources to provide adequate coverage in rural Guatemalan areas. For example, the Chimaltenango region of 1 million inhabitants only has 2 hospitals, which are the only health facilities able to accommodate deliveries. Guatemalans get free access to healthcare but when they are discharged, do not receive any out of hospital support with medications. This is like putting a bandage on a hemorrhaging wound – people leave the hospital healthy but when they cannot afford to refill prescriptions, underlying health issues return. Additional contributing factors to health issues are that many people who are in extreme poverty only have access to fast food. There are high rates of obese women delivering malnourished infants, and food support programs are needed to encourage mothers to develop healthy eating habits for their and their baby’s health.

The Guatemalan Ministry of Health has been very impressed with the effort and capabilities of the GN06 site. Through the MNHR, the site has shown that by going into the community to identify pregnant women rather than waiting for women to come to the health center is a more accurate way to conduct pregnancy surveillance. The GN06 staff has even capacity built MoH members – during the First Look study, medical personnel were trained to use the ultrasound machines provided by the study. To this day, the 5 ultrasound machines from the study remain in health centers in the Chimaltenango region and staff will still contact Lester through a WhatsApp group with maintenance or diagnostic use questions. Staff who have been a part of Global Network studies have even reported having an easier time finding jobs within the MoH after study completion, as the MoH knows that these folks are well-trained and diligent workers.

Lester and team have done a wonderful job leading the Global Network in Guatemala and their success has truly permeated into the health system at so many different levels.