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Working in Primary Care to Help Ensure Everyone Receives Healthcare Without Discrimination

Despite limited resources, Constanza Quilodrán Valle is committed to empowering the women in her care to become active participants in their own health.
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Constanza Quilodrán Valle

Constanza Quilodrán Valle, a midwife at the Vilcún Family and Community Hospital in Chile, believes working in a primary care setting allows her to make the greatest impact. 

“Throughout the nine years that I have worked as a midwife, my passion has always been primary care,” she says. “I have always believed that it is at this stage when we can make the greatest changes. Our goal is for clients to actively participate in making decisions about their health, rather than passively receive instructions from health workers.” 

Quilodrán Valle always had her heart set on healthcare. After leaving school she received a state scholarship to study Obstetrics and Childcare at the University of La Frontera. Quilodrán Valle went on to receive diplomas in Infertility, Family and Community Health and Associated Infections, all with the goal of delivering the best quality care to the communities she serves. 

Quilodrán Valle’s passion for her profession carries her through its challenges. Her first role was in the Municipal Health Department in Curacautín, located in the Andean sector of the La Araucanía region. Each day Quilodrán Valle and her colleagues would carry their equipment through the rain, wind and snow to reach rural communities and deliver vital health services. The Vilcún Family and Community Hospital, where she has been working for the last five years, is located 46 kilometers from the city of Temuco.

As the area’s only emergency care facility, it receives referrals from across the Vilcún community and beyond. The majority of the local population is highly vulnerable with low socioeconomic income and high psychosocial risk factors. Many of them have to travel to Temuco to find work. Quilodrán Valle is one of only two midwives in the hospital responsible for the obstetric care (including emergency care) for the entire Vilcún community and her days are packed—from prenatal and fertility checkups, HIV counseling and breastfeeding consultation to home visits to vulnerable pregnant women and obstetric emergency care.

“One of the great challenges we have is to provide high quality care with limited resources,” she says. “Almost a year ago a fire occurred in our hospital which completely burned down our delivery room and to this day it has not been replaced. In the event that a pregnant woman in the active phase of labor arrives at the emergency room, we can’t provide the level of care that any woman and her newborn deserves.”

These difficulties were compounded by the COVID-19 pandemic and consequent lockdowns, during which Quilodrán Valle and her colleagues spent their days visiting the homes of pregnant women and new mothers and their babies, putting their own health at risk to ensure the safety and well-being of people in the community. “As a health team, we always used to say that we wanted to participate in some big global event,” recalls Quilodrán Valle. “We never thought that our dreams would come true in the worst way, with a pandemic that hit the whole world, so many deaths and so much social and economic havoc from which we have still not recovered.”

Despite these challenges, Quilodrán Valle is motivated by achieving positive results and alleviating doubts for the women in her care. “The first childbirth, the first HIV+ pregnant woman, the first stillbirth… there are always moments that change your life as a midwife,” she says. “One of the most gratifying things for me is helping couples to get pregnant and then later when the postpartum woman with her newborn is discharged. As a midwife you feel like you’ve done your job well—especially when you later see those same children playing in the waiting room.”

Now, Quilodrán Valle is working through a Diploma in Sexual and Reproductive Health from Desafío Levantemos Chile, supported by a bursary from the Johnson & Johnson Foundation. Founded in 2010 in response to a devastating earthquake and tsunami that occurred off the coast of Central Chile, Desafío Levantemos Chile’s mission is to reach people in need and provide support in the form of capital, training and contacts. The organization serves as a bridge between people who need help and those who can provide it, providing sustainable solutions to public problems and empowering communities to build based on their specific needs. The Diploma in Sexual and Reproductive Health aims to strengthen and deepen health workers’ skills by providing updated knowledge through a gender, human rights and public health lens, enabling a comprehensive and transdisciplinary approach to the field.

Quilodrán Valle is hoping to learn new skills and tools to further improve her ways of working and help her better serve her community. “Sexuality is a continuous process of discovery and, as professionals, we need to have the necessary knowledge to respond empathetically to the concerns of our users, leaving prejudices and taboos aside,” she says. What’s more, Quilodrán Valle works in a region where the Indigenous Mapuche population are strongly represented but health workers have not had robust training around understanding and working with these members of the community. “The Diploma course will allow us to have a more integrated and respectful view of our community.”

In Chile, midwives are a significant asset to the health system, not only accompanying women and their families through each stage of their lives but also leading and setting the standard for quality care within health institutions and helping to improve the country’s maternal and perinatal mortality statistics.

Quilodrán Valle is motivated by her family and particularly her daughter, who wants to be a midwife when she grows up. “I did not choose this profession to give up in the face of obstacles that may arise along the way,” she says. “We stay resilient by being part of a team fighting for the same goals. I decided to give myself to others and strive for everyone to receive decent, quality care without socioeconomic or gender discrimination.”