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