Okay, I found a few minutes and needed a break from being part of le collective, so Ill write *another* final blog. A final, final blog (before the reunion tour when I get to New York and need to post photos and decompress).
And I think, in this final episode, I want to talk about my butt. So lets be frank: I have an ass. For a white girl, anyway, I have some junk in the trunk. I cannot be accused of having a back with a crack, or be teased and offered a quarter to go to the corner store and buy myself a booty. I am peasant stock, and my ass reflects that. I will never be Kate Moss and though I do not consider myself fat, I have some meat on my bones. I read an article last year that said researchers have determined that men are especially drawn to the triangle created in the ratio of the waist to the hips on a woman --the wider the hips and the thinner the waist the better. Specifically, researchers said, this is ratio is an accurate determination of fertility. So something in men is hardwired to know that the bigger the booty and the smaller the waist, the better the chances of procreation.
It has been my experience that many American men do appreciate those of us from peasant stock, but it has equally been my experience that lots of American men prefer the waifs, and I chafe against that sometimes. Here in Senegal, the women are thin for sure, but lots of them --dare I say, most-- have healthy booties, and I LOVE it. Discussion of body size here is not taboo like it is at home and several times Senegalese men or women have commented on our bodies in frank terms that would normally make me feel uncomfortable. Madeline, one of the people we are staying with, has slapped my ass several times to proclaim it is "good". The other night, she introduced me to one of her friends on the street and then speaking loudly in Wolof, unwrapped me from my shawl and turned me around to show her friend my "good" butt. I struggle with body image as much as any other American woman I know. Its has been nice spending the last month without access to a mirror (seriously, I havent seen my reflection more than twice since being here) and thereby getting a break from the stream of habitual (dare I say, ritual) commentary and criticism I give myself in front of mirrors at home, and it has been equally nice to discover that my figure is appreciated by the majority in at least this part of the world. I have, at least to Senegalese standards, a good butt.
We are geared up for our last day. Yesterday, we finally got to go to all the clinics and distribute the truly mind boggling amount of supplies we brought for them. I didnt understand, when we first got here, why we didnt distribute them right away, until I started attending births and saw how much we use at every birth. I dont know how we could make birth a less wasteful event and still keep it safe and sterile for the women we serve and for ourselves, but goddamn, I never confronted how much plastic goes into it. Anyway, we decided to use what we needed for our stay and then divided everything remaining betweent he clinics. It was incredibly rewarding to see the amount of donations we left at each one andI was very proud and grateful for all those who gave me things to bring here. Now, devested of our donations and our gifts, we are going to the beach to sunbathe, collect shells, swim, and play drums with our Senegalese friends. Well return for dinner tonight, and then pack... and then... we go.
I was driving in the ambulance today and I realized I can honestly say I love it here. Im so glad I came and I hope this feeling lasts, and continues to inspire me to travel and to help people who need it, like they do here. It fills me in a way and satisfies me in a way that no other pleasure in my life has to date.
Okay. Off to lunch and the beach!
xoxo L
Sunday, December 7, 2008
Saturday, December 6, 2008
exit music
So I know whats happening, which always makes it feel more real. We leave at dawn on Monday for a long drive into Dakar, where we will be dropped off at a posh hotel to spend the day lounging, eating lunch and dinner, and waiting to get a cab to the airport for our 11pm flight. So tomorrow is our last day! Crazy! Fully realizing its not over, and also fully acknowledging that a car crash would be the most likely thing to kill me here so Im not yet out of the woods there, I am amused and horrified that I was so convinced that I wouldnt make it through this trip. Like I said, theres still 40 hours to go, but I really REALLY figured I was just going to keel over and die here. Im so glad I didnt!
The end is anticlimactic. Ive been expecting to realize a huge shift has occurred, or have some kind of brutal kick me in my teeth experience, but it hasnt been like that. I dont doubt there have been changes in me though, its just got to be much more subtle. I will be curious as to anything people notice about me that seems different when Im back. Im sad that I wont get home until Thursday. As glad as I am that I will have a couple days to wash the grime off of me, do laundry, and look in a mirror before I see Chris and my family and friends I also just want to go home and get on with my life there.
I have been realizing how much anticipation has gone into this trip for the last year. Its been this boulder of worry sitting behind my sternum, to be carried with the already considerable amout of stress I already carry. And now, with only a couple days before I touch back down on American soil, I realize there is a crease running down the center of my life, with Before Africa on one side and After Africa on the other. Relieved of all the worry and anticipation of this trip, I am free to fill that space with lighter thoughts and activities, to plan my life without that burden. Im so excited to do After Africa! There is so much possibility ahead of me. I had NO IDEA that I had sort of put all my thoughts beyond this trip on hold until I got here and allowed myself to consider what came next and realized it is WIDE open. That feels amazing. And is very instructive to me in how I stress myself out, and a valuable lesson about avoiding that behavior in the future.
This may be my last entry until I get back to New York. Wish me Godspeed!
xoxox L
The end is anticlimactic. Ive been expecting to realize a huge shift has occurred, or have some kind of brutal kick me in my teeth experience, but it hasnt been like that. I dont doubt there have been changes in me though, its just got to be much more subtle. I will be curious as to anything people notice about me that seems different when Im back. Im sad that I wont get home until Thursday. As glad as I am that I will have a couple days to wash the grime off of me, do laundry, and look in a mirror before I see Chris and my family and friends I also just want to go home and get on with my life there.
I have been realizing how much anticipation has gone into this trip for the last year. Its been this boulder of worry sitting behind my sternum, to be carried with the already considerable amout of stress I already carry. And now, with only a couple days before I touch back down on American soil, I realize there is a crease running down the center of my life, with Before Africa on one side and After Africa on the other. Relieved of all the worry and anticipation of this trip, I am free to fill that space with lighter thoughts and activities, to plan my life without that burden. Im so excited to do After Africa! There is so much possibility ahead of me. I had NO IDEA that I had sort of put all my thoughts beyond this trip on hold until I got here and allowed myself to consider what came next and realized it is WIDE open. That feels amazing. And is very instructive to me in how I stress myself out, and a valuable lesson about avoiding that behavior in the future.
This may be my last entry until I get back to New York. Wish me Godspeed!
xoxox L
Friday, December 5, 2008
creature comforts
I can say confidently that I think it takes about a month to settle in someplace. This was true for me in Europe both times I travelled there, and in London when I studied there. It was time to go when I had finally figured out how to Do It there. This is how Im feeling as my time here winds down --that I have just started to figure it out, and now its nearly time to go.
We havent had consistent electricity much this week, which eats into my ability to keep you, gentle reader, apprised of my (mis)adventures here and for this I apologize. I had also run out of money and, with the nearest ATM a 45 minute cab ride away (that I was told would cost me the equivalent of 80 dollars US), I feared my blogging days in Africa were over. However, electricty has returned (for now) and my mother was able to wire me money via Western Union which I managed to pick up through a series of comedic errors and blind panic and now I am flush with more CFA than I could possibly spend in the remaining 4 days here. So Im going to spend an hour on the internet, which costs about 15 cents in US dollar, and try to make a dent in the wad of smelly cash I have (seriously, i feel dirty touching the bills here. They are positively grimy) burning a hole in my long Senegalese skirt.
To get you up to date, I have now caught 9 babies on this trip and assisted on 11, which is shy of the number I had hoped to participate in but is also a totally reasonable and respectable nuumber if regarded on its own and from underneath the shadow of my expectations. I dont know if Ill be able to attend any more births before we leave as our preceptor (the midwife in charge) has to leave at dawn tomorrow, leaving us on our own until Monday when we leave. Without her, I dont know what our clinic schedule will be like, which is disappointing. Nevertheless, looking back over the past weeks, I feel like Ive learned a lot and while I would have loved to spend more time and get more experience, Ive also been grateful to have the quiet time Ive had here, since I have very little of it at home. In our off hours, Ive torn through 3 books and would have devoured more if Id thought to bring any, slept more than I have probably slept in the last year in total, and have probably lost some weight. If nothing else, this was a good enforced vacation and Ill return home recharged for the crazy life I have made for myself.
I have so much to share and the little things dont always fit into the larger entries I feel like writing when I sit down to write, so Im going to do the equivalent of a sitcom writers lazy trick and give you an episode of flash backs. So here are some vignettes of experiences Ive had here to entertain and astound you!
One of our first days here, it became clear that our names were really hard for the Senegalese to pronounce, especially Heathers. The Senegalese tend to name their babies the same traditional names here so we have met many Fatous and Haddies and Bintous. The matrones decided we needed Wolof names and named each of us after one of themselves. A month earlier, when Chris and I had gone to the public health office for my travel vaccines, he had been reading through an introduction to Wolof culture and told me he wanted to give me a Wolof name. He chose one that I couldnt pronounce and, looking over his shoulder, I told him I wanted to be called "Penda". So fast forward to my first week in Senegal and the Matrones are naming us and laughing and Haddie points and me and exclaims "PENDA!" And, strangely, more than anyone elses it has stuck and is what Ive been called the entire time Ive been here. It amuses the people we meet to no end when I tell them "Penda la todo" which is Wolof for "my name is Penda" and they point to me and say "youre Wolof!" I answer readily to Penda, and really like it, especially since its exactly what I would have named myself.
Serguy, our driver/ambulance driver claims to be in love with me. He speaks very little French so our communication with him is often ridiculous and totally ineffective. He seems to love English words though and often says "OKAY! NICE!" in response to things we say, even if it makes little sense. He pronounces "nice" with an "sh" so its "ni-sh" which I find particularly amusing and we have adopted it as a joke that gets us all laughing around the compound. One morning, Serguy was in a particularly festive mood and we taught him the word "extreme" which he then tacked on to the end of "okay! nice!" and had me and Tara in stitches with his pronounciation and enthusiasm. In fairness, the Senegalese equally amuse themselves with our attempts at their language. For the past two nights, I have entertained our hosts with my attempts at the Wolof words for knife, fork, and spoon, and especially the word for "small spoon." They think its hilarious. Anyway, driving us around, Serguy will often declare "Penda! I LOVE you!" which elicits giggles from everyone in the car except me, and when I say "no, get over it! I am married!" (the only safe response in Senegal) he clucks and shakes his head and wags his forefinger at me in the Wolof way of telling me in no uncertain terms that I am incorrect.
I played some Heavy Metal music for our Senegalese hosts. They are really into our MP3 players and take every opportunity to have us play music for them. I was in a grumpy mood the other afternoon, working on some schoolwork, when Fodey picked up my MP3 player and asked to hear something. Mischeviously, I decided to play High On Fire, one of my favorite metal bands from Oakland, aware that it was probably exactly opposite of the kind of music he would appreciate. He put the headphones in his ears and waited expectantly and I hit play. I started laughing as I watched his face go from curiosity to confusion and them attempt to recompose himself politely. "Reggae?" he asked hopefully. "No reggae!" I cried, "HEAVY METAL!!!" he shook his his head and I laughed so hard I doubled over. Madeline, seeing the commotion came over and asked to listen too. She put the earbuds into hear ears and made a face of disgust. "He no sing?" she asked, "No, he GROWLS!" I corrected. She listened for a moment longer, her face betraying total incomprehension. "It just noise." she concluded, and I laughed so hard I was choking. Feeling bad, I changed the song to one by Justin Timberlake (a not so secret love of mine) knowing hes popular here in Senegal. Madeline and Fodey shared the earbuds and danced happily and I suppressed giggles thinking of how I wished my friends at home could have seen this introduction of Metal to our foreign friends.
We were leaving one of the clinics the day before yesterday when Jake, our preceptor, pointed out something in the road. It was a large animal, totally flattened and covered in dust, just the outline showing like the chalk marks at a murder scene. I thought it was a dead iguana and I made the appropriate sad noise for the critter and kept walking. However, returning to the clinic an hour later, I saw the animal again and realized it had not been an iguana but a rat. An iguana sized rat.
I caught a baby the other night of a first time mother who refused to labor on her back, unlike many of her more submssive Senegalese sisters, and I was really into working with her as she contorted into various positions that felt better to her, including hands and knees with her ass high in the air so that all I could see in front of me was her belly, vagina and (it must be said, quite spectacular, like the nicest Ive seen) ass. She was young and feisty and I really liked her. She gave birth beautifully to a big headed little boy who squawked right away and looked for the breast not long after. However, she tore and needed to be sutured, which I didnt feel like I could do myself and asked Nicole if she would be willing. Nicole did the best she could but got to a point with the tear where she didnt know how to finish reparing it and so we asked the Matrone on duty, Penda (my namesake) how she could finish the repair. Penda was busy wiping down the counters with The Sponge, which is the only cleaning implement Ive seen in this clinic, in the total absence of paper products here, and they soak it in bleach and soap and wipe down everything with it. Just this evening, I had already seen the beds wiped down with it, seen it used to clean out a shit filled bed pan, wipe up vomit and blood from the floor and a puddle of amniotic fluid. So anyway, Penda is wiping down the counters when we ask her about the repair and she sets down the sponge and comes over, with her gloves still dripping with sponge water and sticks her hands into the sterile field and the womans gaping vagina. I shreiked a little and then made the face youd made if youd just taken a bite of a rancid lemon and couldnt move. This is Africa. Penda happily finished the repair with her filthy gloves as I stood shocked. SHOCKED. Thank god they give everyone antibiotics is all I can say.
Lastly, I have discovered my Senegalese vice. Cafe Touba. We have shared our coffee with our hosts and they all hate it. All they drink here is dark, bitter, heavily sweetened tea and Nescafe, which us coffee snobs abhor. However, at the clinic on Tuesday morning, Haddie made me Cafe Touba which is a kind of spiced coffee with lots of sugar and powdered milk. I dont know if its base is Nescafe or not, but its got so much sugar in it and is so caffeinated, I dont care. Its AWESOME and I have had to restrain myself from walking to the little stand near our house multiple times a day to get some. It really speeds me up and leaves me with an awful headache but I love it.
The Wolof word for a white person is "Tobab" (I may be misspelling it) pronounced "Two-Bob" and we have all gotten the sense that it can be a benign term or an offensive one, depending on who says it and how. The children here are fascinated by us and stare at us and often run to shake our hands with cries of "Bonjour Tobab!" or yell it after us as we pass. We have a group of maybe 6 neighborhood kids who are often waiting for us outside our gate when we leave or come home that Ive started calling the Lollipop Guild because they are so small and so insistent on shaking our hands when we come and go that they remind me of the Munchkins from the Wizard of OZ. I mostly think its very funny when we get called "tobab" and have started calling "Bonjour Tobab!" back at them when they say it, which leaves them with a confused look on their faces. Last night Soleman taught me the Wolof word for black person, but Ive forgotten it, but am eager to try it out in response to the next sea of 2 foot tall greeters calling "Bonjour tobab!" at me. I have also taken to calling the Cafe Touba I so adore, "Cafe Tobab," which either frustrates or amuses our Senegalese hosts when I say it to them.
Sigh. So much more to tell but Im out of time. STILL no apostrophe! I cannot WAIT to come home!
xoxox L
We havent had consistent electricity much this week, which eats into my ability to keep you, gentle reader, apprised of my (mis)adventures here and for this I apologize. I had also run out of money and, with the nearest ATM a 45 minute cab ride away (that I was told would cost me the equivalent of 80 dollars US), I feared my blogging days in Africa were over. However, electricty has returned (for now) and my mother was able to wire me money via Western Union which I managed to pick up through a series of comedic errors and blind panic and now I am flush with more CFA than I could possibly spend in the remaining 4 days here. So Im going to spend an hour on the internet, which costs about 15 cents in US dollar, and try to make a dent in the wad of smelly cash I have (seriously, i feel dirty touching the bills here. They are positively grimy) burning a hole in my long Senegalese skirt.
To get you up to date, I have now caught 9 babies on this trip and assisted on 11, which is shy of the number I had hoped to participate in but is also a totally reasonable and respectable nuumber if regarded on its own and from underneath the shadow of my expectations. I dont know if Ill be able to attend any more births before we leave as our preceptor (the midwife in charge) has to leave at dawn tomorrow, leaving us on our own until Monday when we leave. Without her, I dont know what our clinic schedule will be like, which is disappointing. Nevertheless, looking back over the past weeks, I feel like Ive learned a lot and while I would have loved to spend more time and get more experience, Ive also been grateful to have the quiet time Ive had here, since I have very little of it at home. In our off hours, Ive torn through 3 books and would have devoured more if Id thought to bring any, slept more than I have probably slept in the last year in total, and have probably lost some weight. If nothing else, this was a good enforced vacation and Ill return home recharged for the crazy life I have made for myself.
I have so much to share and the little things dont always fit into the larger entries I feel like writing when I sit down to write, so Im going to do the equivalent of a sitcom writers lazy trick and give you an episode of flash backs. So here are some vignettes of experiences Ive had here to entertain and astound you!
One of our first days here, it became clear that our names were really hard for the Senegalese to pronounce, especially Heathers. The Senegalese tend to name their babies the same traditional names here so we have met many Fatous and Haddies and Bintous. The matrones decided we needed Wolof names and named each of us after one of themselves. A month earlier, when Chris and I had gone to the public health office for my travel vaccines, he had been reading through an introduction to Wolof culture and told me he wanted to give me a Wolof name. He chose one that I couldnt pronounce and, looking over his shoulder, I told him I wanted to be called "Penda". So fast forward to my first week in Senegal and the Matrones are naming us and laughing and Haddie points and me and exclaims "PENDA!" And, strangely, more than anyone elses it has stuck and is what Ive been called the entire time Ive been here. It amuses the people we meet to no end when I tell them "Penda la todo" which is Wolof for "my name is Penda" and they point to me and say "youre Wolof!" I answer readily to Penda, and really like it, especially since its exactly what I would have named myself.
Serguy, our driver/ambulance driver claims to be in love with me. He speaks very little French so our communication with him is often ridiculous and totally ineffective. He seems to love English words though and often says "OKAY! NICE!" in response to things we say, even if it makes little sense. He pronounces "nice" with an "sh" so its "ni-sh" which I find particularly amusing and we have adopted it as a joke that gets us all laughing around the compound. One morning, Serguy was in a particularly festive mood and we taught him the word "extreme" which he then tacked on to the end of "okay! nice!" and had me and Tara in stitches with his pronounciation and enthusiasm. In fairness, the Senegalese equally amuse themselves with our attempts at their language. For the past two nights, I have entertained our hosts with my attempts at the Wolof words for knife, fork, and spoon, and especially the word for "small spoon." They think its hilarious. Anyway, driving us around, Serguy will often declare "Penda! I LOVE you!" which elicits giggles from everyone in the car except me, and when I say "no, get over it! I am married!" (the only safe response in Senegal) he clucks and shakes his head and wags his forefinger at me in the Wolof way of telling me in no uncertain terms that I am incorrect.
I played some Heavy Metal music for our Senegalese hosts. They are really into our MP3 players and take every opportunity to have us play music for them. I was in a grumpy mood the other afternoon, working on some schoolwork, when Fodey picked up my MP3 player and asked to hear something. Mischeviously, I decided to play High On Fire, one of my favorite metal bands from Oakland, aware that it was probably exactly opposite of the kind of music he would appreciate. He put the headphones in his ears and waited expectantly and I hit play. I started laughing as I watched his face go from curiosity to confusion and them attempt to recompose himself politely. "Reggae?" he asked hopefully. "No reggae!" I cried, "HEAVY METAL!!!" he shook his his head and I laughed so hard I doubled over. Madeline, seeing the commotion came over and asked to listen too. She put the earbuds into hear ears and made a face of disgust. "He no sing?" she asked, "No, he GROWLS!" I corrected. She listened for a moment longer, her face betraying total incomprehension. "It just noise." she concluded, and I laughed so hard I was choking. Feeling bad, I changed the song to one by Justin Timberlake (a not so secret love of mine) knowing hes popular here in Senegal. Madeline and Fodey shared the earbuds and danced happily and I suppressed giggles thinking of how I wished my friends at home could have seen this introduction of Metal to our foreign friends.
We were leaving one of the clinics the day before yesterday when Jake, our preceptor, pointed out something in the road. It was a large animal, totally flattened and covered in dust, just the outline showing like the chalk marks at a murder scene. I thought it was a dead iguana and I made the appropriate sad noise for the critter and kept walking. However, returning to the clinic an hour later, I saw the animal again and realized it had not been an iguana but a rat. An iguana sized rat.
I caught a baby the other night of a first time mother who refused to labor on her back, unlike many of her more submssive Senegalese sisters, and I was really into working with her as she contorted into various positions that felt better to her, including hands and knees with her ass high in the air so that all I could see in front of me was her belly, vagina and (it must be said, quite spectacular, like the nicest Ive seen) ass. She was young and feisty and I really liked her. She gave birth beautifully to a big headed little boy who squawked right away and looked for the breast not long after. However, she tore and needed to be sutured, which I didnt feel like I could do myself and asked Nicole if she would be willing. Nicole did the best she could but got to a point with the tear where she didnt know how to finish reparing it and so we asked the Matrone on duty, Penda (my namesake) how she could finish the repair. Penda was busy wiping down the counters with The Sponge, which is the only cleaning implement Ive seen in this clinic, in the total absence of paper products here, and they soak it in bleach and soap and wipe down everything with it. Just this evening, I had already seen the beds wiped down with it, seen it used to clean out a shit filled bed pan, wipe up vomit and blood from the floor and a puddle of amniotic fluid. So anyway, Penda is wiping down the counters when we ask her about the repair and she sets down the sponge and comes over, with her gloves still dripping with sponge water and sticks her hands into the sterile field and the womans gaping vagina. I shreiked a little and then made the face youd made if youd just taken a bite of a rancid lemon and couldnt move. This is Africa. Penda happily finished the repair with her filthy gloves as I stood shocked. SHOCKED. Thank god they give everyone antibiotics is all I can say.
Lastly, I have discovered my Senegalese vice. Cafe Touba. We have shared our coffee with our hosts and they all hate it. All they drink here is dark, bitter, heavily sweetened tea and Nescafe, which us coffee snobs abhor. However, at the clinic on Tuesday morning, Haddie made me Cafe Touba which is a kind of spiced coffee with lots of sugar and powdered milk. I dont know if its base is Nescafe or not, but its got so much sugar in it and is so caffeinated, I dont care. Its AWESOME and I have had to restrain myself from walking to the little stand near our house multiple times a day to get some. It really speeds me up and leaves me with an awful headache but I love it.
The Wolof word for a white person is "Tobab" (I may be misspelling it) pronounced "Two-Bob" and we have all gotten the sense that it can be a benign term or an offensive one, depending on who says it and how. The children here are fascinated by us and stare at us and often run to shake our hands with cries of "Bonjour Tobab!" or yell it after us as we pass. We have a group of maybe 6 neighborhood kids who are often waiting for us outside our gate when we leave or come home that Ive started calling the Lollipop Guild because they are so small and so insistent on shaking our hands when we come and go that they remind me of the Munchkins from the Wizard of OZ. I mostly think its very funny when we get called "tobab" and have started calling "Bonjour Tobab!" back at them when they say it, which leaves them with a confused look on their faces. Last night Soleman taught me the Wolof word for black person, but Ive forgotten it, but am eager to try it out in response to the next sea of 2 foot tall greeters calling "Bonjour tobab!" at me. I have also taken to calling the Cafe Touba I so adore, "Cafe Tobab," which either frustrates or amuses our Senegalese hosts when I say it to them.
Sigh. So much more to tell but Im out of time. STILL no apostrophe! I cannot WAIT to come home!
xoxox L
Monday, December 1, 2008
Slowly, slowly, the monkey comes out of the bush
As of today, we have a little more than a week left before we head back to Dakar and the airport to get on our way home. I really feel like Ive been here for months, and even though it also feels like its ending very soon, I am ready to come home. Glorified camping and rogue midwifery are exhausting and losing a little bit of their charm. Im also ready to get back to MY routines, MY space, MY things, hot showers when I want them and (bless it) familiar food. Im ready. So hello last week in Africa: bring it on.
I spent Friday night and all of Saturday in one of the clinics waiting on a second timer to have her baby. I was expecting it to be relatively straight forward, and it was anything but. We had first seen this mama on Friday morning while observing prenatals at the clinic. She was about 3 centimeters dilated, having basically no contractions, her cervix was maybe 60 percent effaced and felt a little sleevelike, like the babys head wasnt well applied. (Some baby-having 101: to have a baby, your cervix needs to thin out AND open up. When youre not in labor, a womans cervix is long, firm and closed. As her labor progresses, with the help of a well applied head to the cervix, it shortens and thins which is called effacement, and it opens up which is called dilation). I had a hard time locating the heart tones, which is often indicative of a "malpresentation" and she felt very full of baby --especially large for the women weve seen here. The clinics dont assign due dates here unless a woman has had an early ultrasound, because often the women dont know when they got pregnant or when their last period was, so without an ultrasound, they only date a pregnancy by how she measures at her prenatal visits. More baby-having 101: the midwifes rule of thumb is that, from the time when the pregnancy rises out of the pelvis, the pregnancy is going to grow about a centimeter a week on average, measured from the top of the pubic bone to the top of the uterus. At 20 weeks gestation, the pregnancy should be at the belly button, or about 20 centimeters on a measuring tape. At term, the top of the fundus should measure about 40 cm, for 40 weeks gestation (this is a big oversimplification) give or take a couple centimeters. Anything within 2-3 centimeters is considered within the range of normal, but if a woman is measuring consistenly ahead of or behind where youd expect her to be for her "dates" (based on her date of conception or last period), thats something to look at. So, here in Africa, it is probably usually fine for the clinics to "date" the women and pregnancies they see by how the woman is measuring because the majority of pregnancies are healthy and straightforward even without the HOLY and SANCTIFIED monitoring of a midwife or doctor, but its misleading and problematic. First, its hard because they dont see these women often. Maybe 2 or 3 times on average through the entire pregnancy, so its hard to monitor growth with such a small sample siz of measurements. And also because they can say "she is measuring 26 centimeters" and that *probably* means shes about 26 weeks pregnant, but what if shes only 20 weeks pregnant? Or what if shes really 31 weeks pregnant? So shes 26 centimeters against *WHAT*? Like I said, even without prenatal care, most pregnancies are going to go off without a hitch, but the ones that are having issues arent going to be caught without good dates. So...
Anyway, this mama felt big and her kid seemeed like he was in there kinda funny, so I made a note of it on the chart and thought to myself that she felt like maybe just had a lot of fluid or maybe it really was a pretty big kid in there. The mama was just resting and waiting for labor to kick in. I figured it was daytime and her baby was probably not in an ideal position so maybe shed take the day to rest, the baby would turn and labor would start boiling when things got quiet after dark --we are mammals after all. (I also sort of thought, just send her home! But thats not how it works here.)
After dinner, Tara and I went back to the clinic to spend the night and wait for her baby. Before we went to bed, she was still not contracting much and had only dilated to 4cm and while I was a little surprised so little was happening, I also accepted that maybe this was just how she does it. The next morning, having lost half my body weight in fluid loss to the mosquitos over night, we checked on her, saw no change and went home to breakfast and wait for a call. An hour later, the matrone called us back. We fairly raced back the clinic but hadnt missed anything. The mama was now 7 centimeters dilated, with a slightly bulging bag and a more regular labor pattern. Sweet! So about an hour later, she was mostly complete with a bit of a cervical lip to the right and behind the babys head, but the head was definitely lower. Not long after, she got a little pushy and so she did that for a while. And then she rested. And then she pushed and then she rested. The lip seemed stretchy and like the babys head could come right past it, but I couldnt seem to work with the mama to get her to push the head past the lip. For 6 hours, she pushed and slept on and off. This is A VERY LONG TIME. I would not have stayed at home with this situation. But this is Africa. The baby sounded GREAT the whole time, and I figured the mom was exhausted from having been in the clinic for so long. She walked, she lay on her side, she pushed, she slept. We gave her an IV of dextrose to give her some energy and make sure she was hydrated. Nothing helped. The kid didnt budge. Around 2pm, after shed been donig this for almost 4 hours, I did a more vigorous exam to try to see if I could find anything to explain what was happening. Palpation was really hard on this woman for some reason, so I couldnt get great information on the babys position that way, though the location of heart tones gave me some good info and I knew the baby was head down. However, this time, the bag was a little more forgiving and I could clearly feel the babys sutures (newborns skull bones are not yet fused in order to accomodate the molding that needs to happen to navigate the bones of the pelvis. The spaces between the skull bones are called sutures and can be felt with our fingers and give a lot of valuable information regarding the babys position) and sure enought I could feel the kid was coming into the pelvis super cock-eyed! Dammnit! I told this to the matrone who felt it too and then made the mama drink "Gris Gris" which the matrone mimed to me would help the baby turn.
In the meantime, a woman arrived at the clinic at 8 centimeters, particulate meconium in the bag of waters when it was ruptured (indicating possible fetal distress), and a prolapsed urethra (weve been seeing a LOT of this and are having a hard time explaining it). When she finally gave birth, she dumped a bunch of blood and I ran around helping Tara stop the hemorrhage. We actually ran out of supplies due to these two births. It was crazy and exhausting.
So after all that chaos, two hours had passed with my monitoring my mamas fetal heart tones and her vital signs between gushes of blood on the other side of the curtain, but leaving her mostly alone to rest and hope the Gris Gris worked. However, with everything settled, nothing had changed and the poor mama was wiped out. I agreed when the matrones suggested the mama needed to be transported and 30 minutes later, through a sea of gathered family and much shouting (I can never decide if theyre just excited or talking passionately about something or if theyre actually ANGRY), off she went to the hospital. I havent heard anything for sure but...here goes:
The rumor going around is that she got to the hospital and gave birth to TWINS. I very possibly, in fact probably, missed TWINS. Ive been beating myself up over it, but I really am not sure how I was supposed to know, even though now in retrospect there are a few things that could have tipped me off, if Id been looking for it. Argh. Another learning experience and Im very curious to know if the rumor has any foundation. Ill update you as I know more.
In the meantime, a new week has begun which means a new partnership with another group member and we are on call tonight. Pregnant, in other words, for more stories waiting to be born. Stay tuned.
xoxox L
I spent Friday night and all of Saturday in one of the clinics waiting on a second timer to have her baby. I was expecting it to be relatively straight forward, and it was anything but. We had first seen this mama on Friday morning while observing prenatals at the clinic. She was about 3 centimeters dilated, having basically no contractions, her cervix was maybe 60 percent effaced and felt a little sleevelike, like the babys head wasnt well applied. (Some baby-having 101: to have a baby, your cervix needs to thin out AND open up. When youre not in labor, a womans cervix is long, firm and closed. As her labor progresses, with the help of a well applied head to the cervix, it shortens and thins which is called effacement, and it opens up which is called dilation). I had a hard time locating the heart tones, which is often indicative of a "malpresentation" and she felt very full of baby --especially large for the women weve seen here. The clinics dont assign due dates here unless a woman has had an early ultrasound, because often the women dont know when they got pregnant or when their last period was, so without an ultrasound, they only date a pregnancy by how she measures at her prenatal visits. More baby-having 101: the midwifes rule of thumb is that, from the time when the pregnancy rises out of the pelvis, the pregnancy is going to grow about a centimeter a week on average, measured from the top of the pubic bone to the top of the uterus. At 20 weeks gestation, the pregnancy should be at the belly button, or about 20 centimeters on a measuring tape. At term, the top of the fundus should measure about 40 cm, for 40 weeks gestation (this is a big oversimplification) give or take a couple centimeters. Anything within 2-3 centimeters is considered within the range of normal, but if a woman is measuring consistenly ahead of or behind where youd expect her to be for her "dates" (based on her date of conception or last period), thats something to look at. So, here in Africa, it is probably usually fine for the clinics to "date" the women and pregnancies they see by how the woman is measuring because the majority of pregnancies are healthy and straightforward even without the HOLY and SANCTIFIED monitoring of a midwife or doctor, but its misleading and problematic. First, its hard because they dont see these women often. Maybe 2 or 3 times on average through the entire pregnancy, so its hard to monitor growth with such a small sample siz of measurements. And also because they can say "she is measuring 26 centimeters" and that *probably* means shes about 26 weeks pregnant, but what if shes only 20 weeks pregnant? Or what if shes really 31 weeks pregnant? So shes 26 centimeters against *WHAT*? Like I said, even without prenatal care, most pregnancies are going to go off without a hitch, but the ones that are having issues arent going to be caught without good dates. So...
Anyway, this mama felt big and her kid seemeed like he was in there kinda funny, so I made a note of it on the chart and thought to myself that she felt like maybe just had a lot of fluid or maybe it really was a pretty big kid in there. The mama was just resting and waiting for labor to kick in. I figured it was daytime and her baby was probably not in an ideal position so maybe shed take the day to rest, the baby would turn and labor would start boiling when things got quiet after dark --we are mammals after all. (I also sort of thought, just send her home! But thats not how it works here.)
After dinner, Tara and I went back to the clinic to spend the night and wait for her baby. Before we went to bed, she was still not contracting much and had only dilated to 4cm and while I was a little surprised so little was happening, I also accepted that maybe this was just how she does it. The next morning, having lost half my body weight in fluid loss to the mosquitos over night, we checked on her, saw no change and went home to breakfast and wait for a call. An hour later, the matrone called us back. We fairly raced back the clinic but hadnt missed anything. The mama was now 7 centimeters dilated, with a slightly bulging bag and a more regular labor pattern. Sweet! So about an hour later, she was mostly complete with a bit of a cervical lip to the right and behind the babys head, but the head was definitely lower. Not long after, she got a little pushy and so she did that for a while. And then she rested. And then she pushed and then she rested. The lip seemed stretchy and like the babys head could come right past it, but I couldnt seem to work with the mama to get her to push the head past the lip. For 6 hours, she pushed and slept on and off. This is A VERY LONG TIME. I would not have stayed at home with this situation. But this is Africa. The baby sounded GREAT the whole time, and I figured the mom was exhausted from having been in the clinic for so long. She walked, she lay on her side, she pushed, she slept. We gave her an IV of dextrose to give her some energy and make sure she was hydrated. Nothing helped. The kid didnt budge. Around 2pm, after shed been donig this for almost 4 hours, I did a more vigorous exam to try to see if I could find anything to explain what was happening. Palpation was really hard on this woman for some reason, so I couldnt get great information on the babys position that way, though the location of heart tones gave me some good info and I knew the baby was head down. However, this time, the bag was a little more forgiving and I could clearly feel the babys sutures (newborns skull bones are not yet fused in order to accomodate the molding that needs to happen to navigate the bones of the pelvis. The spaces between the skull bones are called sutures and can be felt with our fingers and give a lot of valuable information regarding the babys position) and sure enought I could feel the kid was coming into the pelvis super cock-eyed! Dammnit! I told this to the matrone who felt it too and then made the mama drink "Gris Gris" which the matrone mimed to me would help the baby turn.
In the meantime, a woman arrived at the clinic at 8 centimeters, particulate meconium in the bag of waters when it was ruptured (indicating possible fetal distress), and a prolapsed urethra (weve been seeing a LOT of this and are having a hard time explaining it). When she finally gave birth, she dumped a bunch of blood and I ran around helping Tara stop the hemorrhage. We actually ran out of supplies due to these two births. It was crazy and exhausting.
So after all that chaos, two hours had passed with my monitoring my mamas fetal heart tones and her vital signs between gushes of blood on the other side of the curtain, but leaving her mostly alone to rest and hope the Gris Gris worked. However, with everything settled, nothing had changed and the poor mama was wiped out. I agreed when the matrones suggested the mama needed to be transported and 30 minutes later, through a sea of gathered family and much shouting (I can never decide if theyre just excited or talking passionately about something or if theyre actually ANGRY), off she went to the hospital. I havent heard anything for sure but...here goes:
The rumor going around is that she got to the hospital and gave birth to TWINS. I very possibly, in fact probably, missed TWINS. Ive been beating myself up over it, but I really am not sure how I was supposed to know, even though now in retrospect there are a few things that could have tipped me off, if Id been looking for it. Argh. Another learning experience and Im very curious to know if the rumor has any foundation. Ill update you as I know more.
In the meantime, a new week has begun which means a new partnership with another group member and we are on call tonight. Pregnant, in other words, for more stories waiting to be born. Stay tuned.
xoxox L
Wednesday, November 26, 2008
Cutting the mustard (or the flesh)
The last 24 hours have been busy ones. I caught baby number 4 here yesterday (Tuesday) morning and then Tara and I went and spent the night at the clinic last night where we each caught two apiece more and missed a fifth because she was so quiet behind a curtain. The first baby was a special and difficult one, almost like the universe decided to dish out some of those hard knocks I was waiting for.
Before coming to Africa, I had heard that the clinics used some pretty harsh and outdated (arguably abusive) practices here. These include "fundal pressure" which means putting a large amount of your body weight onto the top of a womans uterus to literally force her baby down into the vagina, routine episiotmy --which is when scissors are used to cut a slice in the vaginal opening to widen it in order to birth the babys head, routine use of pitocin after birth which is a drug that causes uterine contractions to help control uterine bleeding postpartum, and that all women give birth on their backs here with a bedpan underneath them. Some of these things turn out to be not in practice or rarely in practice anymore, which is nice. What is or isnt done routinely also seems to vary between the three clinics we are working in. The harshest clinic Ive seen is the one Ive spent the most time in and where I caught 5 of the 6 babies Ive caught here so far. Some of these practices make some sense culturally. In America, most of the women I attend get to take weeks off work, can lie in bed for days post partum and heal their bodies. In Senegal, the day you give birth is a day off. The next day you care for the rest of your children, you wash, you cook, you clean, you carry 25 lbs of water on your head. You cannot afford to not suture small tears here, to allow them to bleed here, because their bodies dont get time to heal slowly like our mothers at home do. So maybe Pit routinely post partum isnt the worst thing in the world. Maybe suturing a lot, while traumatic to the tissues in our view, makes sense here because it means her vagina will withstand the weight the woman has to bear every day. I havent seen routine episiotmies, which was a relief, but the fundal pressure is common and is very VERY hard to watch, and is incredibly violent and traumatic to both mother and baby, in my humble opinion: there is no clinical reason for such a practice under normal circumstances, and potentially puts the baby in very grave danger due to placental separation and trauma to the baby. We are noticing a new thing (compared to trips past, according to our leader) which is that the clinics are also giving an anti-spasmotic medication via IV to most women "for the pain" which, as far as we can tell, only results in women still being in a great deal of pain but disoriented, with lethargic gacked-out babies who are slow to breathe, and high blood pressure readings post partum. This is not good public health medicine.
So my first baby last night was with a beauty queen of a mother. She was tall and lithe with delicate bone structure and an elegance in labor I couldnt help but marvel at. She responded to me immediately, letting me rub her back and rock her hips during contractions, taking my hand and jamming it into the places that hurt her and grabbing my wrist to keep me close whenever I needed to go assist Tara with something. She dilated quickly and was soon ready to push. On the table, I checked her dilation and the babys station (how low he was in her pelvis) and I noticed her vagina was particuarly small. Like three quarters or half the length of most vaginas Ive seen. Every womans body is different, but the sight made me nervous because the matrones at the clinic are notorious for being impatient with pushing; with a small openining, depending on her tissues, I was worried I may have a fight on my hands to give her the time she needed to stretch and open. After about 30 minutes of pushing, I noted some decellerations of the babys heart rate with her contractions and pushes which is characteristic of head compression. At home, these decels get my attention but doesnt make me worry necessarily. In the clinic, its a different story because I know there is rough treatment around the corner. At an hour of pushing, she was making slow but steady progress but the matrones were getting impatient. They kept wanting to put their fingers into her vagina to vigorously massage her tissues, so I would plunge my fingers in to her vagina to keep the matrones out whenever I could. But I noticed that, every time I did this, the mother reflexively reared back and kept her baby from coming down. A reasonable response to someone mucking about with your coo, if you ask me. I didnt know what to do -- it was them or me, but it was impeding her progress either way. Finally, I figured out that if I gave her counter pressure by placing my hand and a square of gauze outside of and just below her vagina, she was able to push effectively and I could cover the vaginal opening partially with the gauze to deter the matrones bossy fingers. However, this time buyer only lasted a short while. A bit after midnight, one of the matrones stood up on a stool next to the bed and began to plunge all her body weight into the top of the uterus. Pop, pop, pop the babys head appeared and diappeared from the opening of the perineum with each violent shove, like a whack-a-mole game. The mother cried out in pain and her eyes bulged. She grabbed at the matrones wrists to get her away. Tara got the doppler to listen to the baby after getting the matrone away momentarily. She listened and listened, and there was no heart beat. My own heart skipped. I impatiently grabbed the doppler away from her (sorry, Tara) and tried to listen myself. Nothing. My mind raced. The matrones had already pulled out scissors and were getting ready for more fundle pressure. The mothers tissues were nowhere close to stretching enough to allow the heads birth yet and I was afraid the trauma of the last big push by the matrone had hurt this kid. He needed to be born, NOW. I looked at the scissors. Again, it was either going to be them or it was going to be me. I picked up the scissors and looked at Tara. I was debating whether it was a waste of time to get Lidocaine to numb her first. Just do it Tara said. I inserted the scissors to the mothers right, under the tight band of her perineum and bit down into the flesh. The scissors were dull and the sickening feeling of having to saw down into her skin as she wailed in pain made my throat catch. I made as small an incision as I could, as cleanly as I could and pulled the scissors out. The matrones dug their fists into the mothers belly again and the head blossomed around fresh red blood. His head was born, but it didnt begin to turn with the next push. I wiped at his face and mouth and felt around for cord around his neck, but found a little hand up near his chin. I cant be sure, but I think his fingers closed around mine. He didnt budge. A minute passed, then another 30 seconds and I was getting antsy. Its normal for babies to take a contraction or two to restitute, so their shoulders can navigate the pelvis, but he wasnt turning. The mother was pushing hard and he wasnt moving at all. I couldnt reach his armpit from above, so I reached in for the hand underneath him but it slipped away in the blood and fluid. I tried again and it slipped again and then I saw the piece of gauze Id been covering her vagina with on the table. I grabbed it, wrapped it around his hand for traction and pulled and his arm came free. I hooked my fingers under his armpits and gave some traction and his little body spun out, looking grey and floppy. I passed him up to his mother and began to rub him up. Tara said she had the bag and mask ready. I dont think I was breathing either. For what seemed like an hour I talked to him, welcomed him, told him i knew that had been a hard trip getting here but I was so glad to see him and that things were nicer out here. When he finally cried and I did too. His heart rate was good, his color improved, his tone was great, he was a strong baby. I said, thats it; Thats what I came here for. I looked down at the mother and smiled at her through my tears. Her son was wailing on her belly. Her eyes filled with tears too. I held that baby for the next two hours, blessing him and thanking him for being so strong. The matrones teased me that he was my husband and asked my boyfriends name. I said my boyfriends name is Chris. They pointed to the baby "thats mister Chris" they laughed. Okay, whatever you say.
The rest of the night was a blur. Three more babies before we stumbled out of the clinic at 7 am begging for breakfast and a bed. I slept most of today, feeling full and victorious, having succeeded in scaring the shit out of myself in Africa, and rising to the occasion.
Its easy, in retrospect --knowing that the baby was okay, to doubt my choice to cut the episiotomy. Its not something I should expect to do in home practice, but I should be prepaed to do in an emergency. However, I think I made the right choice. I was afraid he was in danger and I did it to get him out as quickly as I could with the least trauma possible. So I stand by it. I feel haunted by it and a little guilty about it, but I know I did the best I could do in the situation I was given. And thats okay, I think. Thats all I can do.
xoxo L
Before coming to Africa, I had heard that the clinics used some pretty harsh and outdated (arguably abusive) practices here. These include "fundal pressure" which means putting a large amount of your body weight onto the top of a womans uterus to literally force her baby down into the vagina, routine episiotmy --which is when scissors are used to cut a slice in the vaginal opening to widen it in order to birth the babys head, routine use of pitocin after birth which is a drug that causes uterine contractions to help control uterine bleeding postpartum, and that all women give birth on their backs here with a bedpan underneath them. Some of these things turn out to be not in practice or rarely in practice anymore, which is nice. What is or isnt done routinely also seems to vary between the three clinics we are working in. The harshest clinic Ive seen is the one Ive spent the most time in and where I caught 5 of the 6 babies Ive caught here so far. Some of these practices make some sense culturally. In America, most of the women I attend get to take weeks off work, can lie in bed for days post partum and heal their bodies. In Senegal, the day you give birth is a day off. The next day you care for the rest of your children, you wash, you cook, you clean, you carry 25 lbs of water on your head. You cannot afford to not suture small tears here, to allow them to bleed here, because their bodies dont get time to heal slowly like our mothers at home do. So maybe Pit routinely post partum isnt the worst thing in the world. Maybe suturing a lot, while traumatic to the tissues in our view, makes sense here because it means her vagina will withstand the weight the woman has to bear every day. I havent seen routine episiotmies, which was a relief, but the fundal pressure is common and is very VERY hard to watch, and is incredibly violent and traumatic to both mother and baby, in my humble opinion: there is no clinical reason for such a practice under normal circumstances, and potentially puts the baby in very grave danger due to placental separation and trauma to the baby. We are noticing a new thing (compared to trips past, according to our leader) which is that the clinics are also giving an anti-spasmotic medication via IV to most women "for the pain" which, as far as we can tell, only results in women still being in a great deal of pain but disoriented, with lethargic gacked-out babies who are slow to breathe, and high blood pressure readings post partum. This is not good public health medicine.
So my first baby last night was with a beauty queen of a mother. She was tall and lithe with delicate bone structure and an elegance in labor I couldnt help but marvel at. She responded to me immediately, letting me rub her back and rock her hips during contractions, taking my hand and jamming it into the places that hurt her and grabbing my wrist to keep me close whenever I needed to go assist Tara with something. She dilated quickly and was soon ready to push. On the table, I checked her dilation and the babys station (how low he was in her pelvis) and I noticed her vagina was particuarly small. Like three quarters or half the length of most vaginas Ive seen. Every womans body is different, but the sight made me nervous because the matrones at the clinic are notorious for being impatient with pushing; with a small openining, depending on her tissues, I was worried I may have a fight on my hands to give her the time she needed to stretch and open. After about 30 minutes of pushing, I noted some decellerations of the babys heart rate with her contractions and pushes which is characteristic of head compression. At home, these decels get my attention but doesnt make me worry necessarily. In the clinic, its a different story because I know there is rough treatment around the corner. At an hour of pushing, she was making slow but steady progress but the matrones were getting impatient. They kept wanting to put their fingers into her vagina to vigorously massage her tissues, so I would plunge my fingers in to her vagina to keep the matrones out whenever I could. But I noticed that, every time I did this, the mother reflexively reared back and kept her baby from coming down. A reasonable response to someone mucking about with your coo, if you ask me. I didnt know what to do -- it was them or me, but it was impeding her progress either way. Finally, I figured out that if I gave her counter pressure by placing my hand and a square of gauze outside of and just below her vagina, she was able to push effectively and I could cover the vaginal opening partially with the gauze to deter the matrones bossy fingers. However, this time buyer only lasted a short while. A bit after midnight, one of the matrones stood up on a stool next to the bed and began to plunge all her body weight into the top of the uterus. Pop, pop, pop the babys head appeared and diappeared from the opening of the perineum with each violent shove, like a whack-a-mole game. The mother cried out in pain and her eyes bulged. She grabbed at the matrones wrists to get her away. Tara got the doppler to listen to the baby after getting the matrone away momentarily. She listened and listened, and there was no heart beat. My own heart skipped. I impatiently grabbed the doppler away from her (sorry, Tara) and tried to listen myself. Nothing. My mind raced. The matrones had already pulled out scissors and were getting ready for more fundle pressure. The mothers tissues were nowhere close to stretching enough to allow the heads birth yet and I was afraid the trauma of the last big push by the matrone had hurt this kid. He needed to be born, NOW. I looked at the scissors. Again, it was either going to be them or it was going to be me. I picked up the scissors and looked at Tara. I was debating whether it was a waste of time to get Lidocaine to numb her first. Just do it Tara said. I inserted the scissors to the mothers right, under the tight band of her perineum and bit down into the flesh. The scissors were dull and the sickening feeling of having to saw down into her skin as she wailed in pain made my throat catch. I made as small an incision as I could, as cleanly as I could and pulled the scissors out. The matrones dug their fists into the mothers belly again and the head blossomed around fresh red blood. His head was born, but it didnt begin to turn with the next push. I wiped at his face and mouth and felt around for cord around his neck, but found a little hand up near his chin. I cant be sure, but I think his fingers closed around mine. He didnt budge. A minute passed, then another 30 seconds and I was getting antsy. Its normal for babies to take a contraction or two to restitute, so their shoulders can navigate the pelvis, but he wasnt turning. The mother was pushing hard and he wasnt moving at all. I couldnt reach his armpit from above, so I reached in for the hand underneath him but it slipped away in the blood and fluid. I tried again and it slipped again and then I saw the piece of gauze Id been covering her vagina with on the table. I grabbed it, wrapped it around his hand for traction and pulled and his arm came free. I hooked my fingers under his armpits and gave some traction and his little body spun out, looking grey and floppy. I passed him up to his mother and began to rub him up. Tara said she had the bag and mask ready. I dont think I was breathing either. For what seemed like an hour I talked to him, welcomed him, told him i knew that had been a hard trip getting here but I was so glad to see him and that things were nicer out here. When he finally cried and I did too. His heart rate was good, his color improved, his tone was great, he was a strong baby. I said, thats it; Thats what I came here for. I looked down at the mother and smiled at her through my tears. Her son was wailing on her belly. Her eyes filled with tears too. I held that baby for the next two hours, blessing him and thanking him for being so strong. The matrones teased me that he was my husband and asked my boyfriends name. I said my boyfriends name is Chris. They pointed to the baby "thats mister Chris" they laughed. Okay, whatever you say.
The rest of the night was a blur. Three more babies before we stumbled out of the clinic at 7 am begging for breakfast and a bed. I slept most of today, feeling full and victorious, having succeeded in scaring the shit out of myself in Africa, and rising to the occasion.
Its easy, in retrospect --knowing that the baby was okay, to doubt my choice to cut the episiotomy. Its not something I should expect to do in home practice, but I should be prepaed to do in an emergency. However, I think I made the right choice. I was afraid he was in danger and I did it to get him out as quickly as I could with the least trauma possible. So I stand by it. I feel haunted by it and a little guilty about it, but I know I did the best I could do in the situation I was given. And thats okay, I think. Thats all I can do.
xoxo L
Monday, November 24, 2008
boddichitta
So, AFRICA. One week down. Some thoughts about it so far, before my connection runs out. First, Im glad Ive come and thats a relief. People have thanked me for doing this trip and that has made me uncomfortable for a few reasons, the prime one being that I didnt come here for strictly selfless reasons and to do good and help. It is awesome that the work I am doing here might help a little and make an ipact in a small way, but I have to be honest with myself that I am getting more from this than I could possibly give. So I cannot pretend Im a true philanthropist: I wish, and maybe someday I will be, but for now, that isnt true. What is true is that I came here to use this time and my experiences here as a mirror of sorts. I am here, WAY outside my comfort zone, away from the protective wing of my preceptor at home, and away from the safety net of Alta Bates Hospital a quick ride away in the event that something goes horribly wrong. "Horribly wrong" here means that, maybe, in the morning, you will be taken to the hospital, if you have the money to pay the ambulance driver. So Im here to take advantage of and learn from "horribly wrong" when it does happen, and to see if theres anything I can do to make sure that when "horribly wrong" happens here, they have the tools they need to deal with it. *
Perhaps more specifically, Im here to find out for sure what I know and what I dont know. On the first day of one of my first introductory midwifery classes, my teacher asked me point blank in front of the class "What do you know?" She didnt ask it in a snide or condescending way, but seriously just asking me, as a wanna-be what I knew. What she demonstrated to me when I couldnt formulate an answer was that I knew so little, I didnt even know what I knew. So now I know a little more, but I want to take careful stock of what I have gotten down and what I still need to work on. And admittedly, the last few years have not been kind to my self confidence and it has started to show. Perhaps being a little more timid and cautious isnt a bad thing, but I can only imagine that is gets exhausting for my preceptor to constantly have to urge me out of the nest to discover I can actually fly. So here I am. Firmy, unequivocally, OUT OF THE NEST.
What have I figured out so far? Well, first, this trip is not just about discovery of myself as a midwife, although it is certainly that. Im figured out that this is also about discovery of myself as a person, a human in a large and diverse world, and as a spiritual being (as much as the bile automatically rises is my throat to even type that phrase). I havent been homesick. Homesickness, maybe even more that serious sickness, was what I was most afraid of about this trip. I was terrified that I would get here and be so wracked with longing to go home that Id do nothing but mope around and cry myself to sleep and have a terrible time and not any of the important things I came here to do. The trip is hard, undoubtedly, and I do want to be home with my family and my friends and with Chris, but I dont cry about it and it doesnt dominate my thoughts. And honestly, every time Im in the birth room, I feel like I could stay here forever. For me, NOT being homesick is sort of proof to myself that Im not as weak as I thought I might be. Dude, I can go to AFRICA --BY MYSELF-- to do the biggest work Ive ever done, and I feel FINE? Yeah, Id fuck me.
Also, Im living with four other women (and three Senegalese people) and Im getting along with them. For somoeone who has a pathological resistance to communal situations of any sort, Im pretty impressed with myself that there have been no sharp words, no hair pulling, no exchanges at all reiminiscent of "Heathers." And Im making friends with our Senegalese hosts. I feel that Ive formed a special connection with nearly every one of our regular players, including those we live with. The other night, after the water came on, I was alone in the yard washing our cups and silverware next to the spigot, refilling our water jugs, and getting ready for bed while our Senegalese roommates were around the corner listening to music, burning incense over coals and talking and they made me stop what I was doing to come dance with them. Just me, dancing in a yard in Africa with my Senegalese friends. Even in the moment, I was aware of how special and rare this fact of my life was. Its not just them. Im noticing my capactiy to connect with people in general, even if the language/cultural barrier seems prohibitive. The other day, we were in the market shopping for fabric to have skirts made and a few of us stopped at a stall where another woman was already shopping. The womans young daughter, who was maybe all of three years old, was sitting on the stoop outside the stall. The little girl smiled up at my as I approached so I bent over and offered her my hand and a smile in greeting, which she shyly took. Another woman in my group bent over and high fived with her, so I did too (you know how I love high-fivin) and the girl beamed. The stall was getting croweded so we took a few steps back into the street and the little girl sort of followed us. I danced toward her and fluttered my shawl over her face which seemed to delight her and I giggled with her. Her mother finished her shopping and called to her daughter. The little girl took maybe two steps toward her mom before turning and RUNNING full force back to me and burying her hands and face in my skirt for just a moment before running to join her mother. It was SUCH a magical moment of unadulterated love and connection, totally absent of cultural or language barriers. SO awesome and possibly one of the purest most magical moments Ive ever experienced with another human. I cant imagine the story translates well to the page, but it fills me with joy to remember it.
I dont get to form the kind of relationships with the women I serve here that I do back home. Generally, I meet the women here in an advanced state of labor and they really arent into attempting small talk with the young white girl who butchers the few words of their language I can mutter. But at my first overnight clinic shift, there was an 18 year old having her first baby who clung to me for dear life and used eye contact and body language and sign language to indicate to me what she was needing. It didnt seem to matter to her that we shared not a common word between us --she understood that I was her midwife and that I came from a place of love and I guess that made her feel safe to labor with me, to collapse in a heap in my lap and sleep between contractions as her labor progressed, to tell me to check her immediately after the Senegalese midwife already had, etc. It was extremely gratifying.
My hardest day here so far was last Wednesday. I did postpartum visits at one of the clinics all morning and saw many women and their darling, healthy new babies. But then we saw a woman whose baby had died inside her at aboud 25 weeks gestation and then another woman, also at about 25 weeks, whose baby was still alive but was experiencing heavy cramping and bleeding. The woman whose baby was alive got an IV to hydrate her and give her a drug to help stop the contractions and hopefully avoid miscarriage. She was obviously fearful and in pain and all I could do was sit with her while she got her IV and gently rub her back and shoulders. She never acknowledged that I was there. The mother whose baby had died also got an IV, but with drugs to put her into labor so she would pass the fetus. I sat with her as well and as she lay on the table, she lifted her blouse and took my hand and placed it on her breast and grimaced and gasped in pain. Her breasts were rock hard and hot, engorged with milk. I asked the matron if we could use hot compresses to help her express the milk and make her more comfortable, but the matron said no, not until after the baby was out. Discouaged, I went home for lunch and resolved to return and see if I could attend the stillbirth. When we arrived back, I passed a labor room and saw the mother whose contractions they were trying to stop. From 200 yards away, she saw me, smiled, and waved. I was stunned; she hadnt even looked at me when Id sat with her earlier. We went and sat with her and it seemed very clear to me that she was going to lose her baby. The drugs were not helping and she was in a great deal of pain. The Sage Femme at the clinic said that maybe she could be transported to the hospital the next morning if things didnt improve. In the meantime, there was nothing to do but sit with her and bear witness. A short while later, we examined the mother of the baby who had already died. Shed been on pitocin all day to get her labor started and had dilated only 1 cm. It was very discouaging news.Again, she raised her blouse and demonstrated how painful her breasts were and I asked again if there was anything we could do. This time, the Sage Femme said hot compresses would be okay so Heather and I set about expressing the milk. It obviously hurt the mother greatly but the compresses seemed to help considerably. For over an hour, we worked in near silence, holding hot bandages on her breasts and gently pushing out milk. The stimulation of her breasts caused her contractions to get stronger and more painful and when one would come, we would stop our work and breathe with her before resuming again. The mother started taking my hand during contractions and placing it on her belly during the contraction. I dont know if the heat of my hand felt good, or if it was comforting in another way but she was very insistent about it. Several times she took my hand and laid it over the bump of her baby and Heather asked me if something was hurting her. Probably, I said, but I think what she really is wanting is for us to witness that her baby is dead. In Wolof, they seem to speak in gestures as well as in words. Earlier that day, I had learned the gesture for "dead." I first saw it used after we examined the stillbirth mother for the first time, and then again when I asked the matron about her own children. "Dead" she had said and made the downward grabbing of the air in front of her nose. Now, sitting with this mother, another contraction hit and she lifted my hand away from her breast again and placed it over the the bump of her babys back. "Dead" she signed to me, as if needing me to know that all this work we were doing was for the mother of a dead baby. I placed ly other hand on her belly and held her baby in both my hands and looked her in the eyes. "I know" I said, in English, I nodded. Her eyes filled with tears and, as if in a movie, the call to prayer began to drift in through the open window. I turned away to blink away tears of my own and noticed that, for the first time, that I understood the call to prayer. It no longer seemed werid or alien to me and I was glad for its presence in the room with us. After a while more of hot compresses, the mother looked up at me and down at her breast and said "Cest bon" --It is good. "Merci" --Thank you. I smiled and nodded, glad to have made her moderately more comfortable as she slowly opened to birth her dead son or daughter. I went home that night with a heaviness in my heart. Both women were transported to the hospital the next morning, but I do not know what happened to either of them. It is very hard to follow up on people here. Despite the sadness, I am proud of these interactions, proof I can connect against great odds.
As a midwife, Im thrilled to find how relatively comfortable I am in the birth room, even without my "mama" midwife. Ive been at 7 births since arriving here, and caught 3 of those babies. Of the 4 that I didnt catch, I was busy catching another one when one of them was born, and we arrived too late to catch the other three, but I witnessed them all and did whatever I could do support those ones too. Of my three catches, two were with first time moms under the age of 19 and one was with a woman having her 9th baby. The first timers had VERY tight perineums, one so tight that my fingers ached afterwards, and her baby was born sunny side up with a gigantic head, but I stayed present the whole time and unafraid, only stressed by the astonishing violence of the matrones who stood on stools over the birth bed to put their body weight into the tops of these womens uteruses to force the babies out. NOT, I repeat, NOT something you will see me do at home unless it was a very crazy emergency and we were very very far from a hospital. It was not an emergency here, just something that they do. Blech. The last baby I caught I may as well not have been there. Her ninth baby basically fell out, then came the placenta, intact perineum, and so little blood loss that I didnt even know how to estimate it.
Ive seen a hemorrhage and a resuscitation since being here and felt really comfortable with both. The resuscitation was on the younger of twins (they came for real this time!) we saw born the day before yesterday. I keep waiting for the other shoe to drop: I came here for the reason that big scary things happen at births here and have to be resolved because there is no transport to the hospital really. So far, everything Ive seen, I felt like I could handle. I know Im not ready for everything, so its sort of a false sense of security or confidence that, of the difficulties/complications Ive seen so far here, I knew what to do. I guess I had steeled myself to arrive and get kicked in the teeth by stuff Im not prepared for and that hasnt happened. Im still waiting for the opportunity to learn hard lessons, to recieve my hard knocks. I dont know what that will look like, but Im waiting. On the other hand, totally acknowledging the canyon-siwed gap of knowledge I have to fill, I feel like Ive really stepped firmly and confidently into my midwifes shoes, or clogs, or birkenstocks maybe. I feel totally in my element in the birth room, though I want to stress that Im remaining vigilant, and I feel ready for It, for What Is Coming, to serve however I can. Like I said before, when Im at a birth here, I feel like I could stay here forever and thats encouraging. I wondered if from this trip Id gain confidence like Mason has been trying to instill in me and I think I have. Probably, this is a dangerous time for me as a student and I need to be careful to not get cocky and be careful of my judgement. But I also feel like Ill be able to return home and step into the role of primary midwife with much more confidence and that will be a nice step forward for me.
Spiritually, I feel especially fed and uplifted. It was the conviction that I want my life to reflect the way of the Boddhisattva (a warrior of love in the Buddhist tradition whose Mission Impossible is to go into difficult situations and try to alleviate suffering, even that of those they dont know or those they loathe) that I finally gathered the nerve to come here. I do want my life to be dedicated to service. And while I fully acknowledge thqt I am here for selfish reasons as well, I do want to help and I do want to alleviate suffering. I cannot be healed unless we are all healed. Seeing that I have been able to connect so well here, even through cultural barriers, seeing that I am stronger that I realized, and seeing that I am capable of at least SOME comptence in my chosen profession is all very encouraging to me -- as if maybe this is just the beginning for me, and maybe my life path is going to look different from the babies and house in Oakland I have envisioned for myself. Maybe Ill have those things too, but Im starting to see the possibility of much broader horizons for myself, and thats exciting.
Still no apostrophe. Two more weeks left to find it.
xoxoxoxo L
Perhaps more specifically, Im here to find out for sure what I know and what I dont know. On the first day of one of my first introductory midwifery classes, my teacher asked me point blank in front of the class "What do you know?" She didnt ask it in a snide or condescending way, but seriously just asking me, as a wanna-be what I knew. What she demonstrated to me when I couldnt formulate an answer was that I knew so little, I didnt even know what I knew. So now I know a little more, but I want to take careful stock of what I have gotten down and what I still need to work on. And admittedly, the last few years have not been kind to my self confidence and it has started to show. Perhaps being a little more timid and cautious isnt a bad thing, but I can only imagine that is gets exhausting for my preceptor to constantly have to urge me out of the nest to discover I can actually fly. So here I am. Firmy, unequivocally, OUT OF THE NEST.
What have I figured out so far? Well, first, this trip is not just about discovery of myself as a midwife, although it is certainly that. Im figured out that this is also about discovery of myself as a person, a human in a large and diverse world, and as a spiritual being (as much as the bile automatically rises is my throat to even type that phrase). I havent been homesick. Homesickness, maybe even more that serious sickness, was what I was most afraid of about this trip. I was terrified that I would get here and be so wracked with longing to go home that Id do nothing but mope around and cry myself to sleep and have a terrible time and not any of the important things I came here to do. The trip is hard, undoubtedly, and I do want to be home with my family and my friends and with Chris, but I dont cry about it and it doesnt dominate my thoughts. And honestly, every time Im in the birth room, I feel like I could stay here forever. For me, NOT being homesick is sort of proof to myself that Im not as weak as I thought I might be. Dude, I can go to AFRICA --BY MYSELF-- to do the biggest work Ive ever done, and I feel FINE? Yeah, Id fuck me.
Also, Im living with four other women (and three Senegalese people) and Im getting along with them. For somoeone who has a pathological resistance to communal situations of any sort, Im pretty impressed with myself that there have been no sharp words, no hair pulling, no exchanges at all reiminiscent of "Heathers." And Im making friends with our Senegalese hosts. I feel that Ive formed a special connection with nearly every one of our regular players, including those we live with. The other night, after the water came on, I was alone in the yard washing our cups and silverware next to the spigot, refilling our water jugs, and getting ready for bed while our Senegalese roommates were around the corner listening to music, burning incense over coals and talking and they made me stop what I was doing to come dance with them. Just me, dancing in a yard in Africa with my Senegalese friends. Even in the moment, I was aware of how special and rare this fact of my life was. Its not just them. Im noticing my capactiy to connect with people in general, even if the language/cultural barrier seems prohibitive. The other day, we were in the market shopping for fabric to have skirts made and a few of us stopped at a stall where another woman was already shopping. The womans young daughter, who was maybe all of three years old, was sitting on the stoop outside the stall. The little girl smiled up at my as I approached so I bent over and offered her my hand and a smile in greeting, which she shyly took. Another woman in my group bent over and high fived with her, so I did too (you know how I love high-fivin) and the girl beamed. The stall was getting croweded so we took a few steps back into the street and the little girl sort of followed us. I danced toward her and fluttered my shawl over her face which seemed to delight her and I giggled with her. Her mother finished her shopping and called to her daughter. The little girl took maybe two steps toward her mom before turning and RUNNING full force back to me and burying her hands and face in my skirt for just a moment before running to join her mother. It was SUCH a magical moment of unadulterated love and connection, totally absent of cultural or language barriers. SO awesome and possibly one of the purest most magical moments Ive ever experienced with another human. I cant imagine the story translates well to the page, but it fills me with joy to remember it.
I dont get to form the kind of relationships with the women I serve here that I do back home. Generally, I meet the women here in an advanced state of labor and they really arent into attempting small talk with the young white girl who butchers the few words of their language I can mutter. But at my first overnight clinic shift, there was an 18 year old having her first baby who clung to me for dear life and used eye contact and body language and sign language to indicate to me what she was needing. It didnt seem to matter to her that we shared not a common word between us --she understood that I was her midwife and that I came from a place of love and I guess that made her feel safe to labor with me, to collapse in a heap in my lap and sleep between contractions as her labor progressed, to tell me to check her immediately after the Senegalese midwife already had, etc. It was extremely gratifying.
My hardest day here so far was last Wednesday. I did postpartum visits at one of the clinics all morning and saw many women and their darling, healthy new babies. But then we saw a woman whose baby had died inside her at aboud 25 weeks gestation and then another woman, also at about 25 weeks, whose baby was still alive but was experiencing heavy cramping and bleeding. The woman whose baby was alive got an IV to hydrate her and give her a drug to help stop the contractions and hopefully avoid miscarriage. She was obviously fearful and in pain and all I could do was sit with her while she got her IV and gently rub her back and shoulders. She never acknowledged that I was there. The mother whose baby had died also got an IV, but with drugs to put her into labor so she would pass the fetus. I sat with her as well and as she lay on the table, she lifted her blouse and took my hand and placed it on her breast and grimaced and gasped in pain. Her breasts were rock hard and hot, engorged with milk. I asked the matron if we could use hot compresses to help her express the milk and make her more comfortable, but the matron said no, not until after the baby was out. Discouaged, I went home for lunch and resolved to return and see if I could attend the stillbirth. When we arrived back, I passed a labor room and saw the mother whose contractions they were trying to stop. From 200 yards away, she saw me, smiled, and waved. I was stunned; she hadnt even looked at me when Id sat with her earlier. We went and sat with her and it seemed very clear to me that she was going to lose her baby. The drugs were not helping and she was in a great deal of pain. The Sage Femme at the clinic said that maybe she could be transported to the hospital the next morning if things didnt improve. In the meantime, there was nothing to do but sit with her and bear witness. A short while later, we examined the mother of the baby who had already died. Shed been on pitocin all day to get her labor started and had dilated only 1 cm. It was very discouaging news.Again, she raised her blouse and demonstrated how painful her breasts were and I asked again if there was anything we could do. This time, the Sage Femme said hot compresses would be okay so Heather and I set about expressing the milk. It obviously hurt the mother greatly but the compresses seemed to help considerably. For over an hour, we worked in near silence, holding hot bandages on her breasts and gently pushing out milk. The stimulation of her breasts caused her contractions to get stronger and more painful and when one would come, we would stop our work and breathe with her before resuming again. The mother started taking my hand during contractions and placing it on her belly during the contraction. I dont know if the heat of my hand felt good, or if it was comforting in another way but she was very insistent about it. Several times she took my hand and laid it over the bump of her baby and Heather asked me if something was hurting her. Probably, I said, but I think what she really is wanting is for us to witness that her baby is dead. In Wolof, they seem to speak in gestures as well as in words. Earlier that day, I had learned the gesture for "dead." I first saw it used after we examined the stillbirth mother for the first time, and then again when I asked the matron about her own children. "Dead" she had said and made the downward grabbing of the air in front of her nose. Now, sitting with this mother, another contraction hit and she lifted my hand away from her breast again and placed it over the the bump of her babys back. "Dead" she signed to me, as if needing me to know that all this work we were doing was for the mother of a dead baby. I placed ly other hand on her belly and held her baby in both my hands and looked her in the eyes. "I know" I said, in English, I nodded. Her eyes filled with tears and, as if in a movie, the call to prayer began to drift in through the open window. I turned away to blink away tears of my own and noticed that, for the first time, that I understood the call to prayer. It no longer seemed werid or alien to me and I was glad for its presence in the room with us. After a while more of hot compresses, the mother looked up at me and down at her breast and said "Cest bon" --It is good. "Merci" --Thank you. I smiled and nodded, glad to have made her moderately more comfortable as she slowly opened to birth her dead son or daughter. I went home that night with a heaviness in my heart. Both women were transported to the hospital the next morning, but I do not know what happened to either of them. It is very hard to follow up on people here. Despite the sadness, I am proud of these interactions, proof I can connect against great odds.
As a midwife, Im thrilled to find how relatively comfortable I am in the birth room, even without my "mama" midwife. Ive been at 7 births since arriving here, and caught 3 of those babies. Of the 4 that I didnt catch, I was busy catching another one when one of them was born, and we arrived too late to catch the other three, but I witnessed them all and did whatever I could do support those ones too. Of my three catches, two were with first time moms under the age of 19 and one was with a woman having her 9th baby. The first timers had VERY tight perineums, one so tight that my fingers ached afterwards, and her baby was born sunny side up with a gigantic head, but I stayed present the whole time and unafraid, only stressed by the astonishing violence of the matrones who stood on stools over the birth bed to put their body weight into the tops of these womens uteruses to force the babies out. NOT, I repeat, NOT something you will see me do at home unless it was a very crazy emergency and we were very very far from a hospital. It was not an emergency here, just something that they do. Blech. The last baby I caught I may as well not have been there. Her ninth baby basically fell out, then came the placenta, intact perineum, and so little blood loss that I didnt even know how to estimate it.
Ive seen a hemorrhage and a resuscitation since being here and felt really comfortable with both. The resuscitation was on the younger of twins (they came for real this time!) we saw born the day before yesterday. I keep waiting for the other shoe to drop: I came here for the reason that big scary things happen at births here and have to be resolved because there is no transport to the hospital really. So far, everything Ive seen, I felt like I could handle. I know Im not ready for everything, so its sort of a false sense of security or confidence that, of the difficulties/complications Ive seen so far here, I knew what to do. I guess I had steeled myself to arrive and get kicked in the teeth by stuff Im not prepared for and that hasnt happened. Im still waiting for the opportunity to learn hard lessons, to recieve my hard knocks. I dont know what that will look like, but Im waiting. On the other hand, totally acknowledging the canyon-siwed gap of knowledge I have to fill, I feel like Ive really stepped firmly and confidently into my midwifes shoes, or clogs, or birkenstocks maybe. I feel totally in my element in the birth room, though I want to stress that Im remaining vigilant, and I feel ready for It, for What Is Coming, to serve however I can. Like I said before, when Im at a birth here, I feel like I could stay here forever and thats encouraging. I wondered if from this trip Id gain confidence like Mason has been trying to instill in me and I think I have. Probably, this is a dangerous time for me as a student and I need to be careful to not get cocky and be careful of my judgement. But I also feel like Ill be able to return home and step into the role of primary midwife with much more confidence and that will be a nice step forward for me.
Spiritually, I feel especially fed and uplifted. It was the conviction that I want my life to reflect the way of the Boddhisattva (a warrior of love in the Buddhist tradition whose Mission Impossible is to go into difficult situations and try to alleviate suffering, even that of those they dont know or those they loathe) that I finally gathered the nerve to come here. I do want my life to be dedicated to service. And while I fully acknowledge thqt I am here for selfish reasons as well, I do want to help and I do want to alleviate suffering. I cannot be healed unless we are all healed. Seeing that I have been able to connect so well here, even through cultural barriers, seeing that I am stronger that I realized, and seeing that I am capable of at least SOME comptence in my chosen profession is all very encouraging to me -- as if maybe this is just the beginning for me, and maybe my life path is going to look different from the babies and house in Oakland I have envisioned for myself. Maybe Ill have those things too, but Im starting to see the possibility of much broader horizons for myself, and thats exciting.
Still no apostrophe. Two more weeks left to find it.
xoxoxoxo L
Friday, November 21, 2008
51 minutes
is how long I have left to type another blog entry on this funky French keyboard. I just got home from catching baby number three, which was such an easy birth that I actually felt ripped off afterward. A nice change of pace, however, from the bigger things Ive seen and done since being here.
Im feeling a lot better than I was yesterday. After dinner last night I couldnt be upright any longer. I felt like I was never going to feel better and so, even though I couldnt breathe lying down, I finally just surrendered to the sickness and lay helpless in bed until sleep took over. When I fell asleep, the ranch was bustling with activity but when I awoke at dawn with the call to prayer, everything was dark and silent around me. Its always disconcerting when that happens --when you never realize you are falling asleep and wake to a changed world. I was still too immobile by sickness to do anything but feebly rub crusted snot from around my nose and mouth and fall back to sleep for another couple hours before being woken up by the phone ringing and Heather talking to a midwife at one of the clinics that twins were being born! TWINS!! We hustled out of bed and I realized my sore throat was gone and the cold has moved to my chest: fine, I can deal with that. We called the other ladies who had spent the night at a nearby clinic and they picked us up and off we went, arriving just in time to see a single baby be placed under the lights the clinics use as a warmer. Never shy at a birth in Africa, I went over to the baby and looked back at the woman on the table. Only one cord --the other baby must not be born yet. She looked awful small for twins... turns out there was only one baby being born. Maybe Heather was half asleep when she answered the phone, but no twins were coming at this moment. The post partum wasnt uncomplicated however: the baby on the table sounded gurgley and the midwife who brought him to the table walked away, as often happens here when we attend a birth. I have mixed feelings about it --on one hand, great I can run the show. On the other hand, I dont expect to be handed the keys to the castle and it makes me slightly uncomfortable that theyre SO accommodating about it. Anyway, this baby needed a little help and this midwife clearly was expecting me to give it to him so I got a glove on quickly and turned him on his side to help him spit up the fluid he was choking on. Nicole saw me struggling to care for baby with a single gloved hand and helped me get another one on and then she went to attend to the placenta. An hour later, the placenta still hadnt come. Tara left the room to look for our preceptor to check in with her about a dose of pitocin wed decided to try to help the placenta detach when suddenly, there was the placenta with about a cup and a half of blood behind it. Fuck, I said. Pitocin. Now! No one had it, so I put down the baby and ran for supplies, drew up the shot and gave it to the mom and the bleeding stopped. Exciting 60 seconds!
After Tara and Nicole shared duties repairing a nice second degree tear, we were on our way with Serguy playing Take It Easy by the Eagles on his cassette player in the ambulance. So awesome... That song is so appropriate for this trip: take it easy, take it easy, dont let the sound of your own wheels make you craaazzzzzyyyyy. We stopped by the market for the usual Senegalese adventure of trying to find eggs, cheese, bread and yogurt. Money here is SUPER confusing. After a 30 minute trip (which, I kid you not, included a quick stop by the car junk yard as we searched for bread) that should have taken 5 minutes, we went home for breakfast of scrambled eggs and fresh baguette with cheese and black coffee. SO GOOD after an exciting few hours. After breakfast Heather and I headed off to Mboro 2 to see what was going on there and I showed her how to do a vaginal exam to assess dilation, we labor sat for a while, went home for lunch, and returned in time for me to catch this womans NINTH baby. This is very, very common in Senegal -- 35 year old women who have already had 10 babies. Crazy.
Im feeling really good about my skills, though a little disappointed I havent seen anything that really challenges me yet, just because Im here to get a real sense of what Im good at and what Im bad at and I KNOW I cant be good at everything yet. The easy births (someone here calls them "butter births") are nice, for sure, but I really want to learn some hard skills. Give me bleeding uteruses, babies not breathing, give me deep tears in need of suture. Maybe Ill eat my words later but I did not leave the comforts of my own home to squat over holes in the ground, to miss COLD drinking water so much I want to cry, to miss my family and friends and Chris so much it feels like drowning sometimes, to just have babies fall out. And they havent all fallen out, in truth. This week began with two hard births and two very sad experiences and Ill try to get into that next time, but for now Ill just say that Im good, kicking ass, getting along with everyone, feeling like Im on the mend, and ready for what comes next.
Write me love notes because I miss you like a fat kid misses seeing his pecker. Or like I miss an apostrophe on a keyboard.
xoxoxox L
Im feeling a lot better than I was yesterday. After dinner last night I couldnt be upright any longer. I felt like I was never going to feel better and so, even though I couldnt breathe lying down, I finally just surrendered to the sickness and lay helpless in bed until sleep took over. When I fell asleep, the ranch was bustling with activity but when I awoke at dawn with the call to prayer, everything was dark and silent around me. Its always disconcerting when that happens --when you never realize you are falling asleep and wake to a changed world. I was still too immobile by sickness to do anything but feebly rub crusted snot from around my nose and mouth and fall back to sleep for another couple hours before being woken up by the phone ringing and Heather talking to a midwife at one of the clinics that twins were being born! TWINS!! We hustled out of bed and I realized my sore throat was gone and the cold has moved to my chest: fine, I can deal with that. We called the other ladies who had spent the night at a nearby clinic and they picked us up and off we went, arriving just in time to see a single baby be placed under the lights the clinics use as a warmer. Never shy at a birth in Africa, I went over to the baby and looked back at the woman on the table. Only one cord --the other baby must not be born yet. She looked awful small for twins... turns out there was only one baby being born. Maybe Heather was half asleep when she answered the phone, but no twins were coming at this moment. The post partum wasnt uncomplicated however: the baby on the table sounded gurgley and the midwife who brought him to the table walked away, as often happens here when we attend a birth. I have mixed feelings about it --on one hand, great I can run the show. On the other hand, I dont expect to be handed the keys to the castle and it makes me slightly uncomfortable that theyre SO accommodating about it. Anyway, this baby needed a little help and this midwife clearly was expecting me to give it to him so I got a glove on quickly and turned him on his side to help him spit up the fluid he was choking on. Nicole saw me struggling to care for baby with a single gloved hand and helped me get another one on and then she went to attend to the placenta. An hour later, the placenta still hadnt come. Tara left the room to look for our preceptor to check in with her about a dose of pitocin wed decided to try to help the placenta detach when suddenly, there was the placenta with about a cup and a half of blood behind it. Fuck, I said. Pitocin. Now! No one had it, so I put down the baby and ran for supplies, drew up the shot and gave it to the mom and the bleeding stopped. Exciting 60 seconds!
After Tara and Nicole shared duties repairing a nice second degree tear, we were on our way with Serguy playing Take It Easy by the Eagles on his cassette player in the ambulance. So awesome... That song is so appropriate for this trip: take it easy, take it easy, dont let the sound of your own wheels make you craaazzzzzyyyyy. We stopped by the market for the usual Senegalese adventure of trying to find eggs, cheese, bread and yogurt. Money here is SUPER confusing. After a 30 minute trip (which, I kid you not, included a quick stop by the car junk yard as we searched for bread) that should have taken 5 minutes, we went home for breakfast of scrambled eggs and fresh baguette with cheese and black coffee. SO GOOD after an exciting few hours. After breakfast Heather and I headed off to Mboro 2 to see what was going on there and I showed her how to do a vaginal exam to assess dilation, we labor sat for a while, went home for lunch, and returned in time for me to catch this womans NINTH baby. This is very, very common in Senegal -- 35 year old women who have already had 10 babies. Crazy.
Im feeling really good about my skills, though a little disappointed I havent seen anything that really challenges me yet, just because Im here to get a real sense of what Im good at and what Im bad at and I KNOW I cant be good at everything yet. The easy births (someone here calls them "butter births") are nice, for sure, but I really want to learn some hard skills. Give me bleeding uteruses, babies not breathing, give me deep tears in need of suture. Maybe Ill eat my words later but I did not leave the comforts of my own home to squat over holes in the ground, to miss COLD drinking water so much I want to cry, to miss my family and friends and Chris so much it feels like drowning sometimes, to just have babies fall out. And they havent all fallen out, in truth. This week began with two hard births and two very sad experiences and Ill try to get into that next time, but for now Ill just say that Im good, kicking ass, getting along with everyone, feeling like Im on the mend, and ready for what comes next.
Write me love notes because I miss you like a fat kid misses seeing his pecker. Or like I miss an apostrophe on a keyboard.
xoxoxox L
Thursday, November 20, 2008
sick day
It shouldnt be a surprise that Im sick, and yet, it is. Im sick! With a nasty sore throat and now sinus and chest congestion. Blech. So I stayed home from clinic last night and this morning to rest. However, i hardly slept because I was COLD last night and so congested. Blech.
On the other hand, it affords me some time to sit and type and reflect on my first week here.
I live with four other American midwives and midwives-in-training and three(?*) Senegalese people in a four room cinderblock house in Mboro, two and a half hours from Dakar. Our little house has foam mats for sleeping on and windows with shutters and torn linoleum floors. There is even a television that gets some fuzzy reception when there is electricty (which there usually is). We have an outhouse with a squat toilet and an "American style" toilet --except theres no seat and it doesnt flush, and a shower head which gets unheated running water from about midnight until 6am.
*more on this shortly
Every morning we are brought breakfast of a baguette and margarine or their version of nutella, and we supplement this with our own tea, coffee, cheese, and as of yesterday, eggs hardboiled in our tea kettle over the little propane stove we were provided. Its fancy camping, basically. I brush my teeth next to a spigot which is surrounded by beat up plastic jugs of water that are filled when the water runs and wash my hands with a bar of soap and a plastic tea kettle. To do my "business" I generally opt for the seatless toilet as I still tend to pee all over myself in the squat and I rinse myself with a plastic squeeze bottle I brought from home for the occasion. I havent used toilet paper once because there is none. Every now and again, I feel grungy enough to take a bucket shower which, it turns out, is exactly what is sounds like: I dump a bucket of cold water over my head, soap and shampoo, and dump another bucket over my head. It takes the breath out of me with the cold, but its surprisingly functional. I am also surprised at how quickly Ive adapted to feeling gross. I havent seen myself in a mirror since Spain.
In the mornings, we split up into two groups to do prenatals at one of the three clinics we are helping here. We reconvene for lunch, take the afternoon to ourselves and then one group goes to spend the night at a clinic and do prenatals there the next morning. Or, at least, thats the idea. It hasnt been quite as smooth so far.
We are quickly amassing a cast of characters:
Jake, midwife from Hollywood and our fearless leader
Tara, newly minted midwife from Boston
Nicole, student from Oregon and about to take her license exam
Heather, a student from outside Boston who is just starting her studies
Dr and Madame Sarr own our house, and Dr Sarr runs a respected medical clinic a few blocks away. Madame is a nurse and runs the Mboro 2 clinic which is one of the clinics where we are working.
Madeline and Soloman live with us at "the ranch." Madeline is the Sage-Femme (a higher trained midwife who completed several years of schooling) at Dr. Sarrs clinic, and Soloman is an architecture student and the great nephew (we think) of Dr. Sarr.
The goats also live with us at the ranch.
A mystery boy who I *think* lives with us, whose name I do not know because every time I try to talk to him, he laughs shyly and doesnt respond. He feeds the goats and I think sleeps in the room with Soloman.
Etienne 1 picked us up from the airport and is charge of all our financial matters like paying for a taxi to take us to and from the clinics, and the cleaning woman who comes occasionally to help us with things like laundry.
Sergey the funny ambulance driver for Mboro 2 (a beat up Subaru station wagon with "Ambulance" painted on the side) who often shows up at odd times and teases me mercilessly and continually asks Tara to marry him.
Etienne 2, a young man who was apparently hired to guard us during the day and sits in our front yard and doesnt say much.
The Sage-Femmes are the midwives in charge at the various clinics.
The Matrons are the midwives who work for the Sage-Femmes, and have only a few months training before beginning their work.
Its a lot!
Every morning, at dawn, the first call to prayer is sung by the Muezzin. Prayers are observed 5 times a day here: at dawn, noon, midday, sunset, and an hour after sunset. The call is made by people walking the streets or from loudspeakers on the corner or in cars and is sung out. It was very creepy to me the first time I heard -this loud disembodied Islamic singing, especially the first time it woke me at dawn. Im used to it now, but it is definitely a strange thing for me... everything closes during prayers, which means basically everything stops 5 times a day here.
Most people here speak Wolof, a native language, but there are other native dialects spoken here so even knowing Wolof is not a guarantee of communication. Many people also speak French, but not as many as speak Wolof. I am muddling by with my limited French and what I am picking up of Wolof. People here are VERY friendly and seem genuinely pleased when we respond to their Wolof greetings in Wolof. Im getting less shy about trying it, and almost always get amused laughs when I say "Jerijeff" which means thank you.
Lunch time is around 2pm and Soloman, who takes his lunch at Mboro 2 clinic, brings us back a serving bowl of whatever the cook has prepared. Usually it is rice, root vegetables, and some fish. Occassionally, instead of rice we are given french fries. Dinner is served around 9:30 or 10pm and is more of the same. I am adept from this trip to holding my nose most of the time --in the clinics, in the toilets, and while I eat. Surprisingly, my spirits are good even with a sort of bleak food situation. Its temporary, and probably better for me than what I eat at home.
My first night here I discovered that I am the bug beacon and I shared my bed with at least one terrifying monster. I spent most of the night cold and awake in abject terror with my legs curled under me into a tight ball, afraid to stretch back onto the lower half of my mat, or touch the sheet I had been sleeping under. In the morning, I found three dead bugs next to my bed: a FAT spider that looked like a minature tarantula, a gigantic cockroach (maybe?) and a critter that looked like a cross between a wasp and a banana. Since then, Ive slept in the net tent someone was kind enough to lend me for the trip. Everyone else has been well served by the mosquito nets that hang over our beds, but I draw the line at bugs that look like bananas. Im also the only one getting eaten alive by mosquitos. DEET does nothing to deter those beasts. Grasshoppers, flies, and GIANT beetles are all very fond of flinging themselves DIRECTLY at my head at night (why? why does it have to be my FACE?!!) but Ive gotten pretty desensitized to it. Terrifying monsters or no, this is the hand Ive been dealt and I had better suck it up and make the best of it for the next three weeks. The Sage-Femmes and Matrones tell laboring women here "Masa3 meaning basically, buck up. So Masa, girl. Masa.
Still havent found the apostrophe.
Love and miss you all,
L
On the other hand, it affords me some time to sit and type and reflect on my first week here.
I live with four other American midwives and midwives-in-training and three(?*) Senegalese people in a four room cinderblock house in Mboro, two and a half hours from Dakar. Our little house has foam mats for sleeping on and windows with shutters and torn linoleum floors. There is even a television that gets some fuzzy reception when there is electricty (which there usually is). We have an outhouse with a squat toilet and an "American style" toilet --except theres no seat and it doesnt flush, and a shower head which gets unheated running water from about midnight until 6am.
Every morning we are brought breakfast of a baguette and margarine or their version of nutella, and we supplement this with our own tea, coffee, cheese, and as of yesterday, eggs hardboiled in our tea kettle over the little propane stove we were provided. Its fancy camping, basically. I brush my teeth next to a spigot which is surrounded by beat up plastic jugs of water that are filled when the water runs and wash my hands with a bar of soap and a plastic tea kettle. To do my "business" I generally opt for the seatless toilet as I still tend to pee all over myself in the squat and I rinse myself with a plastic squeeze bottle I brought from home for the occasion. I havent used toilet paper once because there is none. Every now and again, I feel grungy enough to take a bucket shower which, it turns out, is exactly what is sounds like: I dump a bucket of cold water over my head, soap and shampoo, and dump another bucket over my head. It takes the breath out of me with the cold, but its surprisingly functional. I am also surprised at how quickly Ive adapted to feeling gross. I havent seen myself in a mirror since Spain.
In the mornings, we split up into two groups to do prenatals at one of the three clinics we are helping here. We reconvene for lunch, take the afternoon to ourselves and then one group goes to spend the night at a clinic and do prenatals there the next morning. Or, at least, thats the idea. It hasnt been quite as smooth so far.
We are quickly amassing a cast of characters:
Jake, midwife from Hollywood and our fearless leader
Tara, newly minted midwife from Boston
Nicole, student from Oregon and about to take her license exam
Heather, a student from outside Boston who is just starting her studies
Dr and Madame Sarr own our house, and Dr Sarr runs a respected medical clinic a few blocks away. Madame is a nurse and runs the Mboro 2 clinic which is one of the clinics where we are working.
Madeline and Soloman live with us at "the ranch." Madeline is the Sage-Femme (a higher trained midwife who completed several years of schooling) at Dr. Sarrs clinic, and Soloman is an architecture student and the great nephew (we think) of Dr. Sarr.
The goats also live with us at the ranch.
A mystery boy who I *think* lives with us, whose name I do not know because every time I try to talk to him, he laughs shyly and doesnt respond. He feeds the goats and I think sleeps in the room with Soloman.
Etienne 1 picked us up from the airport and is charge of all our financial matters like paying for a taxi to take us to and from the clinics, and the cleaning woman who comes occasionally to help us with things like laundry.
Sergey the funny ambulance driver for Mboro 2 (a beat up Subaru station wagon with "Ambulance" painted on the side) who often shows up at odd times and teases me mercilessly and continually asks Tara to marry him.
Etienne 2, a young man who was apparently hired to guard us during the day and sits in our front yard and doesnt say much.
The Sage-Femmes are the midwives in charge at the various clinics.
The Matrons are the midwives who work for the Sage-Femmes, and have only a few months training before beginning their work.
Its a lot!
Every morning, at dawn, the first call to prayer is sung by the Muezzin. Prayers are observed 5 times a day here: at dawn, noon, midday, sunset, and an hour after sunset. The call is made by people walking the streets or from loudspeakers on the corner or in cars and is sung out. It was very creepy to me the first time I heard -this loud disembodied Islamic singing, especially the first time it woke me at dawn. Im used to it now, but it is definitely a strange thing for me... everything closes during prayers, which means basically everything stops 5 times a day here.
Most people here speak Wolof, a native language, but there are other native dialects spoken here so even knowing Wolof is not a guarantee of communication. Many people also speak French, but not as many as speak Wolof. I am muddling by with my limited French and what I am picking up of Wolof. People here are VERY friendly and seem genuinely pleased when we respond to their Wolof greetings in Wolof. Im getting less shy about trying it, and almost always get amused laughs when I say "Jerijeff" which means thank you.
Lunch time is around 2pm and Soloman, who takes his lunch at Mboro 2 clinic, brings us back a serving bowl of whatever the cook has prepared. Usually it is rice, root vegetables, and some fish. Occassionally, instead of rice we are given french fries. Dinner is served around 9:30 or 10pm and is more of the same. I am adept from this trip to holding my nose most of the time --in the clinics, in the toilets, and while I eat. Surprisingly, my spirits are good even with a sort of bleak food situation. Its temporary, and probably better for me than what I eat at home.
My first night here I discovered that I am the bug beacon and I shared my bed with at least one terrifying monster. I spent most of the night cold and awake in abject terror with my legs curled under me into a tight ball, afraid to stretch back onto the lower half of my mat, or touch the sheet I had been sleeping under. In the morning, I found three dead bugs next to my bed: a FAT spider that looked like a minature tarantula, a gigantic cockroach (maybe?) and a critter that looked like a cross between a wasp and a banana. Since then, Ive slept in the net tent someone was kind enough to lend me for the trip. Everyone else has been well served by the mosquito nets that hang over our beds, but I draw the line at bugs that look like bananas. Im also the only one getting eaten alive by mosquitos. DEET does nothing to deter those beasts. Grasshoppers, flies, and GIANT beetles are all very fond of flinging themselves DIRECTLY at my head at night (why? why does it have to be my FACE?!!) but Ive gotten pretty desensitized to it. Terrifying monsters or no, this is the hand Ive been dealt and I had better suck it up and make the best of it for the next three weeks. The Sage-Femmes and Matrones tell laboring women here "Masa3 meaning basically, buck up. So Masa, girl. Masa.
Still havent found the apostrophe.
Love and miss you all,
L
Wednesday, November 19, 2008
Jamm rekk (only peace)
I am here. Its been four days and Im not sure now how Ill be able to convey this journey once I get home. I cant find the apostrophe on the keyboard, so maybe I cant convey it here either. All I know is that two days ago I helped two women bring their babies into the world, and today I am helping two women let go as their babies die. That seems like a lot to try to hold in for a month before I can let it all spill out when Im home. So here it is: an attempt to chronicle, with a foreign keyboard and an unreliable internet connection, the intensity of the work I am doing here now. Over the next few days I hope to lay it out for you so you can get a picture of what it is like here, and I can create a narrative about what I witness... and maybe Ill find the apostrophe on the way.
Malekum salaam (unto you peace),
L
Malekum salaam (unto you peace),
L
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