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
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