When we left the hospital three days ago we left a seventeen year old in active labor. She was 9cm, fetal heart was great, and we had spent the day laboring with her. She was open to walking the halls, singing, massage, and we spent moments between active pushing as her doulas. She had a group of women with her, her mama and her father’s five other wives- also her mamas. We assumed we would arrive in the morning and get to meet her baby. Instead we were told she had needed a cesarean and the baby had died. The story from the Doctor was that he had been called in the morning because her labor was obstructed. The story from the women on the hall was that she had become fully dilated around 10 at night but was having trouble pushing properly. The midwives told her they would hit her if she cried and to call them only if the head was coming out. Then they went to sleep. At 4am, her mother woke a midwife in a panic. Her daughter was asking them to bring a hoe, which in Acholi culture is a sign of death. Sure enough, the midwives checked and the baby’s heart rate was dangerously low. The head had been in the vaginal canal for 6–8 hours. The doctor was called but he did not pick up his phone. Another was called but he said he would not come until morning. A 9 in the morning a cesarean was done, and the baby was dead.
We spent the day trying to find out the real story. In the report book it stated that the mother was ‘found’ in second stage of labor and that the baby was already dead. I know this is not true. Aimee and I (but mostly Aimee) labored with this woman and her live baby all day.
When we visited her, they had not yet told her that the baby was dead. Instead, the doctor told her the baby was very sick. His explanation was that he needed to prepare her, the shock of finding out her baby had died would be too much, so this lie was to ease her into the loss. She lay on the bed with a puss filled incision, her eyes darting back and forth, her breathing shallow, her pulse quick. We sat with her and cried with her and when she asked us to please make sure her baby was ok, we didn’t know what to say.
But I did know the hospital, the current system, was responsible for this babies death. Neglect and lack of action. I felt an anger that was deep. A sense of right and wrong violated like a line drawn in the dirt, blurring and more and more people step on it.
Day two. We return after a sleepless night to find this mother in septic shock. She learned her baby had died, shit herself and cried until she passed out. Now she is completely unconscious, has a raging fever, her stomach is distended, her breathing is shallow, lungs filled with fluid and her eyes are rolled back in her head. She will die unless she is transferred to another care facility. She too, is being neglected. The lack of management in this hospital mixed with apathy and trauma of staff makes for a standard of care, a culture of care, that is dangerous. The midwives are as traumatized and sick as the patients.
We spend the day arranging an ambulance to another hospital. Aimee pays for the gas. The family stands vigil around this young mama, they lay a bible on her head and pray and pray and pray. I begin to cry and have to step out of the room. She is only seventeen. We get her in the ambulance. All six mamas, her brothers, her husband, Aimee and I crawl in with her. She is on a straw mat on the floor of an old ambulance that has to be roll started. We have to straddle her to hold her still as we crawl through the unpaved and bumpy streets. A stop for gas and a half hour later we arrive at another care facility where she is immediately attended to with IV antibiotics, clean equipment, two doctors and three nurses. She is transferred to intensive care with a fighting chance for life. For the first time in two days I feel like I can breathe. This hospital has no more supplies, but strong management and a culture of caring.
Returning to the hospital much has happened. A woman has died of hemorrhage. Another woman who we worked with earlier in the week has had a cesarean and her baby is dying on a table. I feel the trauma of the day in my body. My neck begins to spasm and I am tired. I place a shaky hand on the baby’s forhead, she has a raging fever. The nurses seem indifferent. Please I beg of them, call the doctor, this baby needs help. They stare at me blankly, it is night time. They will get in trouble if they call the doctor unless it is an ‘emergency’. A dying baby girl is not an emergency. I hold this baby and with a broken bulb syringe spend time suctioning bloody mucus that has already become infected. I drip clean water into her mouth and place cold washcloths on her forhead.
I felt the urge to lick this baby, like a cat, take her, inflamed, in my mouth , soften and clean, until it doesn't hurt anymore.
The baby gasps, I think she has died, and then she breaths again. Softer.
Here I am, miles from home, in Uganda, where the dirt and the heat
blend my sweat with my tears
my hands
her skin
desire to lick
take her in my mouth
that urge
to draw closer
saliva
and moist cheeks
dried by the sun
and I wonder
if it will ever be right
or if it ever was
and how I come to know myself
enough to
figure out
the difference
between the spaces
the difference
between a lick
that heals
a lick that cleans
and a lick that draws lines in the dirt
I send out a text for those closest to me to pray for her. The response is enormous. My father is holding the torah for her. Clare and James are sending Reiki. My girlfriends are praying. My community is so rich.
When I get into bed though, sleep cannot find me. I feel panicky. My back hurts and the foam mattress feels absorbs my shape, my tears, my sweat. I finally sleep and wake to a cold shower and strong coffee. Human resiliance is truly amazing.
The line between right and wrong is a relative line depending on which side you stand. I feel the pull to understand and the pull to trust my instincts because it is the only way that I know how to function.
Saturday, June 30, 2007
Thursday, June 28, 2007
We had a lovely workshop with the child mothers at St. Monica’s yesterday. Thirty child- mothers, thirty babies, a story circle and some ‘working’ sessions on defining supportive roles for each other. We sang a lot and danced a lot and the overall feeling was full.
It is this relationship of extremes that is so challenging, Dynamic.
One moment a traumatic experience watching death and life converge with the premature cutting of a cord or the neglect of an obstructed labor; the next moment is pure hope as we put on ‘plays’ about how to support one another as mothers and young mamas sculpt one another into images of love.
The work evolves. So do we.
It is this relationship of extremes that is so challenging, Dynamic.
One moment a traumatic experience watching death and life converge with the premature cutting of a cord or the neglect of an obstructed labor; the next moment is pure hope as we put on ‘plays’ about how to support one another as mothers and young mamas sculpt one another into images of love.
The work evolves. So do we.
Freud said that depression is anger turned inward. I think this is astute. I also think that when anger and depression become so internalized that they define a practice, violence is born. It is hard for me to just say that there is some serious neglect and malpractice happening in this hospital. I have spent the last month kind of dabbling around the issue, intervening at moments and keeping quiet at others. It is hard for me, as a westerner who is concerned with issues of hegemony and cultural representation to say that the care is truly sub-par, and lack of funds and supplies are not the main issue. I have to check myself and the academic bullshit. It is wrong for women to be left bleeding on cold metal tables for hours on end while their babies die and the midwives sleep. It is wrong for women to be hit and screamed at while pushing a baby out. It is wrong for the bulb syringe and the fetuscope to be taken off the busy labor ward and not returned for days while babies suffer with ingested mucus and low heart rates. It is wrong to discharge young mothers with no resources who are clearly showing signs of depression and whose babies are not yet breastfeeding. It is wrong to leave women laying for hours in puddles of their own blood and feces. It is wrong to drink alcohol while on shift. It is wrong. It is bad medicine and it is violence against women. Only the poorest women come to this hospital because it is free. This is a human rights issue. This is so deeply layered there is nowhere to point a finger. Apathy is easier.
The issues are multi- layered, as most issues are. They may start with the administration or maybe with the war, or perhaps poor training, exhaustion, anger or maybe it is tribal hatred as one young mother suggested to me. As an outsider I may never know but I also feel that these issues need to be exposed so that they can evolve, take new form.
I am too tired to describe the events of yesterday, but they were traumatic. I have not yet processed for myself. Dead babies due to neglect, administrative lies to cover up malpractice, and very sick women still left unattended and laying in their own urine. For a moment I considered just walking away. Not my problem. But I slept last night and awoke this morning feeling like that is exactly the issue. It is too easy to walk away and allow practices to continue. It is too easy to say this is not my problem. But it is. It is all of our problem. As women. As mothers. As sisters. As men. As humans in the world.
I am not sure of the next step, only that I have been here as witness, and now I need to share.
The issues are multi- layered, as most issues are. They may start with the administration or maybe with the war, or perhaps poor training, exhaustion, anger or maybe it is tribal hatred as one young mother suggested to me. As an outsider I may never know but I also feel that these issues need to be exposed so that they can evolve, take new form.
I am too tired to describe the events of yesterday, but they were traumatic. I have not yet processed for myself. Dead babies due to neglect, administrative lies to cover up malpractice, and very sick women still left unattended and laying in their own urine. For a moment I considered just walking away. Not my problem. But I slept last night and awoke this morning feeling like that is exactly the issue. It is too easy to walk away and allow practices to continue. It is too easy to say this is not my problem. But it is. It is all of our problem. As women. As mothers. As sisters. As men. As humans in the world.
I am not sure of the next step, only that I have been here as witness, and now I need to share.
Wednesday, June 27, 2007
A book can be a mother
Waking before as the sun rises and sleeping as it sets, the day takes on a new rhythm. It is fuller somehow, as if a person’s sense of time is actually connected to the circling of the sun. We forget that with electricity. I worked the evening shift last night. There was no power so we caught babies by candlelight. The halls of the hospital were quiet and laboring women moaned and cast long shadows across the room. I had to pee and my torch burnt out along the way. I walked slowly, sliding along the walls and using an internal sense of direction to guide me to the pit latrine. I had a moment of panic as I feared a mouse running across my feet while I squatted down, but it passed in a wave and I returned to the ward relieved.
What is medicine without intuition?
Can one be a true healer without also being intuitive?
I don’t mean psychic. I mean awake. Finding one’s way in the dark. Perceiving that which bubbles under the surface. Listening for that which is not spoken, that which cannot be put into words. Remaining open enough to take in another’s energy and feed it back, transformed.
Is the doctor or midwife or psychiatrist or natropath or nutritionist or massage therapist or witch, who heals you best, intuitive to your needs? Do you feel heard? Special? Understood? I read a study once that determined that 97% of people who sue their doctors in malpractice suits did not feel heard.
Healers who know how to listen are more effective. Healers who can listen both to what is spoken and what is unspoken are magical.
Here medicine is by the book. It’s an old book, but it’s a book. The book is like missionary position sex under a fluorescent lamp, totally dry and no room for improvisation… or intuition. I find myself constantly pushing up against the book, trying to turn the lights off, to listen and to move beyond the edges, to expose each woman as her own story, her own body, her own unique set of needs. It’s a dance to maintain balance; to keep relationships healthy and the narrative ribbon of dialogue moving back and forth. I turn the light switch off, my colleague flips it back on. I say the book can change, she says it’s a book, the print is permanent. I say try, she says why. We laugh and share a meal, chalk it up to cultural difference and connect over a mutual distaste for Miranda grape soda.
My young friend Becky is still in labor. Intuitively, I believe it’s because she has nowhere to go once she delivers. I think she is holding on as long as she can. The walls of the hospital offer shelter and some small amount of attention. She cried hysterically again today and called out for her mommy. Aimee and I sat with her, massaging feet with essential oils and satiating tears with small offerings of chocolate and tea. I imagined the comfort of having a mother while you make the transition into motherhood, and the utter feeling of loss if she were not there as witness, protector, and most of all, knowledge. The midwives feel my friend should go for a cesarean, because the book says she has labored for too long. I shudder at the thought unless the fetus or mother is in extreme distress. While the fetal heart rate is strong and the membranes still intact, I continue to advocate for rest, food and love to move things along at a snails pace.
Aimee witnessed a C section yesterday. I stayed on the ward while she went down with an obstructed labor to the ‘Theater’. She filmed it and showed it to me afterwards. The doctors ended up ‘extracting’ (their words) two ‘undetected’ (their words) twins. In order to do this they performed a three hour long surgery with a gas mask, and came close to killing the mother, slicing her open vertically from pubic bone to breast, shredding the womb and performing a tubal ligation without her permission. In Uganda, if a woman has more than five babies a doctor is allowed to perform a tubal ligation during cesarean. She bled so much she is still not conscious. This ‘by the book’ performance is supposed to save lives.
I do not mean to spend so much time in critique. Nor do I mean to privilege my instincts over those of others. I cannot imagine what it takes to have survived this conflict and still maintain a daily sense of togetherness. Perhaps surviving in the bush, living by gut and instinct, moving through the darkness of not knowing who to trust, where to sleep, how to protect your body, makes the comfort of a ‘book’ a necessary coping mechanism. It is comforting to have something that ‘knows’, something you don’t have to question because it is right. Like a mother. A book can be a mother.
There is so much strength here, so much determination, so much willingness, so much so much.
This afternoon I lay on a blanket in the grass and held baby Peace who is now three weeks old. She sucked on her fingers and I read a story by Isabel Allende. The sun felt comforting and consistent, an old friend. Something I know, trust, and can refer back to. A mother.
What is medicine without intuition?
Can one be a true healer without also being intuitive?
I don’t mean psychic. I mean awake. Finding one’s way in the dark. Perceiving that which bubbles under the surface. Listening for that which is not spoken, that which cannot be put into words. Remaining open enough to take in another’s energy and feed it back, transformed.
Is the doctor or midwife or psychiatrist or natropath or nutritionist or massage therapist or witch, who heals you best, intuitive to your needs? Do you feel heard? Special? Understood? I read a study once that determined that 97% of people who sue their doctors in malpractice suits did not feel heard.
Healers who know how to listen are more effective. Healers who can listen both to what is spoken and what is unspoken are magical.
Here medicine is by the book. It’s an old book, but it’s a book. The book is like missionary position sex under a fluorescent lamp, totally dry and no room for improvisation… or intuition. I find myself constantly pushing up against the book, trying to turn the lights off, to listen and to move beyond the edges, to expose each woman as her own story, her own body, her own unique set of needs. It’s a dance to maintain balance; to keep relationships healthy and the narrative ribbon of dialogue moving back and forth. I turn the light switch off, my colleague flips it back on. I say the book can change, she says it’s a book, the print is permanent. I say try, she says why. We laugh and share a meal, chalk it up to cultural difference and connect over a mutual distaste for Miranda grape soda.
My young friend Becky is still in labor. Intuitively, I believe it’s because she has nowhere to go once she delivers. I think she is holding on as long as she can. The walls of the hospital offer shelter and some small amount of attention. She cried hysterically again today and called out for her mommy. Aimee and I sat with her, massaging feet with essential oils and satiating tears with small offerings of chocolate and tea. I imagined the comfort of having a mother while you make the transition into motherhood, and the utter feeling of loss if she were not there as witness, protector, and most of all, knowledge. The midwives feel my friend should go for a cesarean, because the book says she has labored for too long. I shudder at the thought unless the fetus or mother is in extreme distress. While the fetal heart rate is strong and the membranes still intact, I continue to advocate for rest, food and love to move things along at a snails pace.
Aimee witnessed a C section yesterday. I stayed on the ward while she went down with an obstructed labor to the ‘Theater’. She filmed it and showed it to me afterwards. The doctors ended up ‘extracting’ (their words) two ‘undetected’ (their words) twins. In order to do this they performed a three hour long surgery with a gas mask, and came close to killing the mother, slicing her open vertically from pubic bone to breast, shredding the womb and performing a tubal ligation without her permission. In Uganda, if a woman has more than five babies a doctor is allowed to perform a tubal ligation during cesarean. She bled so much she is still not conscious. This ‘by the book’ performance is supposed to save lives.
I do not mean to spend so much time in critique. Nor do I mean to privilege my instincts over those of others. I cannot imagine what it takes to have survived this conflict and still maintain a daily sense of togetherness. Perhaps surviving in the bush, living by gut and instinct, moving through the darkness of not knowing who to trust, where to sleep, how to protect your body, makes the comfort of a ‘book’ a necessary coping mechanism. It is comforting to have something that ‘knows’, something you don’t have to question because it is right. Like a mother. A book can be a mother.
There is so much strength here, so much determination, so much willingness, so much so much.
This afternoon I lay on a blanket in the grass and held baby Peace who is now three weeks old. She sucked on her fingers and I read a story by Isabel Allende. The sun felt comforting and consistent, an old friend. Something I know, trust, and can refer back to. A mother.
Monday, June 25, 2007
Heart
At the end of the day sometimes I realize that I have been running on emotional autopilot. That in order to work effectively amidst trauma after trauma, I tuck my heart safely into my back pocket and only bring her out for fresh air when I get home. (Clare says I am queen of compartmentalizing). It scares me to work with a woman and then forget her name and her story two days later because I have worked with so many others between that time. I am trying to write it all down, but at the end of the day, I am tired.
On Friday a girl came to the clinic in early labor. She immediately struck me as different. Something about her energy, nothing concrete. Amidst five other laboring girls I did not have much time to speak with her, just a quick exam and instructions to walk the halls and drink a lot of tea.
After two women delivered and hemorrhaged, I sat down needing some water. I must have been sitting for ten minutes when I realized that this girl was sitting right next to me, quiet and almost ghost like.
Her English was good and we began to speak. Softly at first, and just formal exchanges, but soon her story started to spill out. Her name is Becky. She came alone. Her parents both died in the conflict and she has been on her own since she was eleven. She lived in the bush, surviving mostly on termites and crickets, until a year ago, when she met a man. She married him and got pregnant immediately. His parents disapproved the union and threatened to disown him if she kept the baby, so she was once again, out on her own. She had not eaten in three days when she arrived in early labor.
I was moved by the story, but I am not sure why I was more moved by her story then any of the other fifty stories I have heard that parallel hers. I went home that night thinking of her and returned on my day off to check on her. She still had not delivered and was sitting outside looking very despondent. We chatted for a bit but she was so disengaged that she didn't acknowledge the food or baby blanket Aimee and I had brought for her. She appeared in my dream last night.
Today, Monday, I did not see her when I arrived, but she was not in the delivery registry. I was elbow deep in a woman who had a prolapsed uterus when she was carried into the maternity ward on a stretcher. She was having a seizure. She was still pregnant. I immediately felt my heart jump from my back pocket into its proper feeling place. I sat with her and stroked her hair and massaged her feet until she came back into consciousness. When she awoke she began to sob. It was the first time since I have been here that I have seen raw and unapologetic human emotion.
I stayed with her most of the day. Feeling pulled in a way that I have not felt since I arrived.
When I left the hospital she still had not delivered and I will not be surprised if she is still in labor when I arrive tomorrow. I think she is psychologically holding herself back because she does not know where she will go when she delivers the baby. Tomorrow is her 18th birthday.
I feel joyfully aware that my heart is guiding me. I surrender and trust.
On Friday a girl came to the clinic in early labor. She immediately struck me as different. Something about her energy, nothing concrete. Amidst five other laboring girls I did not have much time to speak with her, just a quick exam and instructions to walk the halls and drink a lot of tea.
After two women delivered and hemorrhaged, I sat down needing some water. I must have been sitting for ten minutes when I realized that this girl was sitting right next to me, quiet and almost ghost like.
Her English was good and we began to speak. Softly at first, and just formal exchanges, but soon her story started to spill out. Her name is Becky. She came alone. Her parents both died in the conflict and she has been on her own since she was eleven. She lived in the bush, surviving mostly on termites and crickets, until a year ago, when she met a man. She married him and got pregnant immediately. His parents disapproved the union and threatened to disown him if she kept the baby, so she was once again, out on her own. She had not eaten in three days when she arrived in early labor.
I was moved by the story, but I am not sure why I was more moved by her story then any of the other fifty stories I have heard that parallel hers. I went home that night thinking of her and returned on my day off to check on her. She still had not delivered and was sitting outside looking very despondent. We chatted for a bit but she was so disengaged that she didn't acknowledge the food or baby blanket Aimee and I had brought for her. She appeared in my dream last night.
Today, Monday, I did not see her when I arrived, but she was not in the delivery registry. I was elbow deep in a woman who had a prolapsed uterus when she was carried into the maternity ward on a stretcher. She was having a seizure. She was still pregnant. I immediately felt my heart jump from my back pocket into its proper feeling place. I sat with her and stroked her hair and massaged her feet until she came back into consciousness. When she awoke she began to sob. It was the first time since I have been here that I have seen raw and unapologetic human emotion.
I stayed with her most of the day. Feeling pulled in a way that I have not felt since I arrived.
When I left the hospital she still had not delivered and I will not be surprised if she is still in labor when I arrive tomorrow. I think she is psychologically holding herself back because she does not know where she will go when she delivers the baby. Tomorrow is her 18th birthday.
I feel joyfully aware that my heart is guiding me. I surrender and trust.
Saturday, June 23, 2007
Questioning
This is hard. I feel quiet again. Like I cannot process enough to turn these experiences into words that are condensed enough to put forward as an offering.
E.M Forster believed narrative could be ‘truer than history because it goes beyond evidence, and “each of us knows from his own experience that there is something beyond evidence”.
There are not words to speak the body. Language is inadequate, lacking the depth of perception and affect to describe textured sensations such as sight, sound, smell, touch and taste. To narrate the body through words is in some ways is to miss it entirely.
Humans frame understanding of experience in terms of narrative account. When we try to understand why things happen, we put events in temporal order, making decisions about beginnings, middles and ends or causes and effects by virtue of imposing plots on otherwise chaotic events. Yet, the stories of the bodies that birth are separate from the accounts that the women give of themselves. I believe this to be a global truth.
It is not surprising that the dominant metaphors describing birth in the late twentieth century are characterized by mechanical images in which a woman’s body is fragmented into working parts over which she has little control. As Emily Martin in The Woman in the Body: A Cultural Analysis of Reproduction, phrases it “medically, birth is seen as the control of laborers (women) and their machines (their uteruses) by managers (doctors) often using other machines to help”. The canonical obstetrics text-book Williams Obstetrics encapsulates the mechanicity of the dominant medical view; it defines birth as “the complete expulsion or extraction from the mother of a fetus”. In every act of childbearing two stories are simultaneously produced, a story of what the ‘body’ does and a story of what the ‘woman’ does; the ‘body’ might dilate slowly while the ‘woman’ screams out for help. The body and the woman intersect and influence one another while still managing to maintain independent realities.
A traumatic day (for me) at the hospital- the necessary equipment just isn’t there. There is no suction. No suture kits. No sterile gauze. And I don’t think it’s that the midwives don’t care, but there is some sort of passive acceptance of the situation, so in an emergency it feels like everybody just walks away. Attempts to save babies or hemorrhaging women are half hearted and then the blame is placed on poverty and a lack of supplies. In truth, some of the supplies could be here. Sterile cotton wool and suture kits are in the hospital, there is just no consistent method of getting them from the supply room into the maternity ward. The suction device simply needs a new plastic tube in order to work…but nobody is advocating to get it fixed, even though a baby dies here once a month for lack of it working. I feel stuck in an impossible situation. Acceptance of poor conditions means nothing will change and my outsider perspective is received as hope for a handout. I can buy some cotton wool for the hospital, but it will be gone in a week. Sustainability comes with accountability. Where is the anger? I wonder. Perhaps to anger is also a privilege.
Sister Rosemary's sister was describing to me a bridge she has to cross occasionally. It has no railings and she feels close to death every time she crosses it. She is upset about it. She feels the government should put up rails to fix it. Her daughter jumped into the conversation and said yes but mommy, they cross it every day so for them it is normal. You are an outsider so the conditions anger you, but for them, it is just the way things are. Is this what is happening in the hospital? Acceptance of sub par conditions because it is just ‘the way things are’? Is this what keeps a slave a slave? A victim a victim?
The women I have engaged with in the labor ward remain stoic with their emotions. Almost apathetic. The midwives work quietly and without showing a trace of feeling, except for anger. If a woman is not pushing effectively, the midwives will begin to yell and slap her into pushing. After the birth, she will return to her normal static state. Almost like New Yorkers in a traffic jam. The anger bubbles to the surface but then disappears after the incident.
Pregnant women walk quietly, kneel down on the floor as a sign of respect for the midwives when they enter the labor ward, and then often remain stoic throughout early labor. If asked how they are they will without exception answer ‘fine’. Some look a bit sad or scared, but of course this is my interpretation and may have no reflection of the actual truth. The hall is full of women who remain calm and collected, almost detached, until they are in second stage of labor and are allowed entry into the maternity ward. The moment a woman places her plastic sheet on the metal bed, it is as if permission is given to set the apathy aside. Many women instantly and almost inevitably begin to scream and wail and fling their limbs about wildly. They roll on the bed and ask for Jesus to save them. Eyes glaze over and women pee and shit all over themselves without seeming to notice or care. It is a dramatic performance of extremes and is staged by almost every woman I have witnessed give birth at Gulu Hospital. The moment the baby is born, the melodrama ends. Women become stoic again, show no interest in seeing their babies and at most may flash a smile or a quiet thank you to the midwives. The moment of possession is over. The scene of childbirth offers permission to emote, but it is a package deal when it is over, it is over.
I want to explore apathy. It doesn’t seem like an authentic human emotion. Children aren’t born apathetic. It is learned. Is learned the right word? Perhaps it comes into existence through traumatic experience and suppression of emotion. Maybe it is passed down and transmitted from mother to child, brother to sister. What purpose does it serve?
How can childbirth be a vehicle for processing emotion and raising voices?
I do not have answers. Only more questions. Which I love. I am grateful for the opportunity to see and to emote freely and to question, question question. What a gift.
E.M Forster believed narrative could be ‘truer than history because it goes beyond evidence, and “each of us knows from his own experience that there is something beyond evidence”.
There are not words to speak the body. Language is inadequate, lacking the depth of perception and affect to describe textured sensations such as sight, sound, smell, touch and taste. To narrate the body through words is in some ways is to miss it entirely.
Humans frame understanding of experience in terms of narrative account. When we try to understand why things happen, we put events in temporal order, making decisions about beginnings, middles and ends or causes and effects by virtue of imposing plots on otherwise chaotic events. Yet, the stories of the bodies that birth are separate from the accounts that the women give of themselves. I believe this to be a global truth.
It is not surprising that the dominant metaphors describing birth in the late twentieth century are characterized by mechanical images in which a woman’s body is fragmented into working parts over which she has little control. As Emily Martin in The Woman in the Body: A Cultural Analysis of Reproduction, phrases it “medically, birth is seen as the control of laborers (women) and their machines (their uteruses) by managers (doctors) often using other machines to help”. The canonical obstetrics text-book Williams Obstetrics encapsulates the mechanicity of the dominant medical view; it defines birth as “the complete expulsion or extraction from the mother of a fetus”. In every act of childbearing two stories are simultaneously produced, a story of what the ‘body’ does and a story of what the ‘woman’ does; the ‘body’ might dilate slowly while the ‘woman’ screams out for help. The body and the woman intersect and influence one another while still managing to maintain independent realities.
A traumatic day (for me) at the hospital- the necessary equipment just isn’t there. There is no suction. No suture kits. No sterile gauze. And I don’t think it’s that the midwives don’t care, but there is some sort of passive acceptance of the situation, so in an emergency it feels like everybody just walks away. Attempts to save babies or hemorrhaging women are half hearted and then the blame is placed on poverty and a lack of supplies. In truth, some of the supplies could be here. Sterile cotton wool and suture kits are in the hospital, there is just no consistent method of getting them from the supply room into the maternity ward. The suction device simply needs a new plastic tube in order to work…but nobody is advocating to get it fixed, even though a baby dies here once a month for lack of it working. I feel stuck in an impossible situation. Acceptance of poor conditions means nothing will change and my outsider perspective is received as hope for a handout. I can buy some cotton wool for the hospital, but it will be gone in a week. Sustainability comes with accountability. Where is the anger? I wonder. Perhaps to anger is also a privilege.
Sister Rosemary's sister was describing to me a bridge she has to cross occasionally. It has no railings and she feels close to death every time she crosses it. She is upset about it. She feels the government should put up rails to fix it. Her daughter jumped into the conversation and said yes but mommy, they cross it every day so for them it is normal. You are an outsider so the conditions anger you, but for them, it is just the way things are. Is this what is happening in the hospital? Acceptance of sub par conditions because it is just ‘the way things are’? Is this what keeps a slave a slave? A victim a victim?
The women I have engaged with in the labor ward remain stoic with their emotions. Almost apathetic. The midwives work quietly and without showing a trace of feeling, except for anger. If a woman is not pushing effectively, the midwives will begin to yell and slap her into pushing. After the birth, she will return to her normal static state. Almost like New Yorkers in a traffic jam. The anger bubbles to the surface but then disappears after the incident.
Pregnant women walk quietly, kneel down on the floor as a sign of respect for the midwives when they enter the labor ward, and then often remain stoic throughout early labor. If asked how they are they will without exception answer ‘fine’. Some look a bit sad or scared, but of course this is my interpretation and may have no reflection of the actual truth. The hall is full of women who remain calm and collected, almost detached, until they are in second stage of labor and are allowed entry into the maternity ward. The moment a woman places her plastic sheet on the metal bed, it is as if permission is given to set the apathy aside. Many women instantly and almost inevitably begin to scream and wail and fling their limbs about wildly. They roll on the bed and ask for Jesus to save them. Eyes glaze over and women pee and shit all over themselves without seeming to notice or care. It is a dramatic performance of extremes and is staged by almost every woman I have witnessed give birth at Gulu Hospital. The moment the baby is born, the melodrama ends. Women become stoic again, show no interest in seeing their babies and at most may flash a smile or a quiet thank you to the midwives. The moment of possession is over. The scene of childbirth offers permission to emote, but it is a package deal when it is over, it is over.
I want to explore apathy. It doesn’t seem like an authentic human emotion. Children aren’t born apathetic. It is learned. Is learned the right word? Perhaps it comes into existence through traumatic experience and suppression of emotion. Maybe it is passed down and transmitted from mother to child, brother to sister. What purpose does it serve?
How can childbirth be a vehicle for processing emotion and raising voices?
I do not have answers. Only more questions. Which I love. I am grateful for the opportunity to see and to emote freely and to question, question question. What a gift.
Tuesday, June 19, 2007
The better it is, the worse it is!
Beans Beans Beans
The more you eat the more you poop
The more you poop the better it is!
This ‘rhyme’ sung to me by Sister Beatrice while I cooked dinner for the nuns is a perfect metaphor for much of post-colonization post-war Ugandan culture. The original song, brought in from an outside source, has been orally transmitted so many times that it has lost all but the shell of its former self, and yet it is still being sung with utter conviction and without questioning. The fact that it makes no sense is irrelevant. Is it about proper nutrition or diarrhea?
Aimee and I sang Sister Beatrice the version we know.
Beans Beans good for your heart
The more you eat the more you fart
The more you fart the better you feel
So eat your beans with every meal.
She liked it, but I liked her version better and we spent the afternoon shelling beans and making up new ditties, all ending with either ‘the better it is’ or ‘the worse it is’ depending on the circumstances of our improv.
The metaphor translates perfectly to the hospital. Western medicine, brought in by colonizers fifty to one hundred years ago, has not been 'updated' because nobody wanted to come to a war torn country to train doctors. What remains is the shell of 1950's medical practice. The med school at Gulu regional teaches student doctors to make vertical incisions on cesarean sections; women rest afterwards on dirty foam mattresses, go home when they can walk and there is no follow up care for infections. Women come in with stitches that are oozing puss and are told to purchase antibiotics. Hardly anyone can afford antibiotics. Are these practices really saving lives if the risk of dying of a post- op infection is almost as high as death from an obstructed labor? Were there as many obstructed labors when women used local herbs to speed labor along and before women were forced to lay on their backs on metal gurneys in a hospital with no running water?
And yet the practice is not questioned. It is Western. It is right.
What a privilege it is to be able to tell a story!
We interview women for this film and ask them to tell us their birth stories and we get the facts. She was born on this day, I felt the labor pains at 3:00 and she was born at 8. She weighed 4 Kilos. How did you feel? We ask. Fine. The women answer. I felt fine.
Or maybe it is a privilege to think that your birth experience is special and worth talking about. The concept of a doula does not translate. People spend thousands of dollars to have someone massage them and advocate to make their experience meaningful and positive?
This weekend we went to two IDP camps to meet with TBA’s from all around the North. Over one hundred TBA's showed up in all. They had prepared skits and songs for us to show us how they work. Our intention was to host some Red Tent like events where women shared birth stories, either their own or ones they had attended. The first group turned into a story group about abnormal births- one woman attended a birth where the woman began to push and one thousand black fly’s flew out of her vagina in a thick cloud. They took her to the hospital and there was no sign of a pregnancy. Another woman attended a birth where all that came out was some mucus and a set of human eyeballs. At the end of this story the translator looked at me and said ‘What was that? She would like to know specifically.”
Aimee said she was tempted to say ‘An alien’. Instead we used the question as another moment to exemplify that we do not know, and try to dialogue around what the TBA’s thought could have been the cause of such abnormalities. The two most feasible answers were malnutrition and the devil.
At the end of our session we were fed a large meal. Potatoes and cassava and boiled greens and beans and rice and goat meat and chicken meat and coke. The meat here is really not stored well and so we have used the Jewish religion as an excuse to not take meat at a meal and offend our hosts. It has worked well. However at this camp they understood it too well. "If the issue is the way that the meat is killed, then you can kill it on your own!" They came to us with a bag of eggs, a pot of homemade peanut butter, and a live duck in a bag.
“You can take this and kill it the Jewish way. Please, it is our offering to you!”
We were remiss to say no, and walked out of the camp with our duckie and plans to set him free. We sent Aimee's husband Kevin a text on the ride home 'Travelling with live duck. Help!"
Duckie met is fate however, because we re-gifted him to the midwife who was translating for us so that she could feed her family.
And then there is the hospital. Some days it is insane and other days it is quieter. Yesterday there were only two births on my shift, but there were six women laboring in the hall. One got so frightened watching another woman push that she took off in a sprint out of the hospital. She returned a few minutes later realizing she could not escape the intensity. Aimee massaged her with lavender oil and she calmed down, even came to assist the next birth.
I have noticed that we have to resuscitate an alarming number of babies. I am pretty sure there are two contributing factors. One is that women lye on their sides throughout their labors and are not encouraged to walk around. When a woman is fully dilated she is told to lye on her back or side until the head is crowning. One of the midwives says this is to save gloves. Another says it is because women get too tired if they push. Often there will be meconium and the fetal heart will be scarily low or high, but there is no active pushing. Because of this babies spend a very long time squished in the vaginal canal and come out in distress. Aimee and I have encouraged pushing in cases like this and are promptly shut down by the other midwives who say that the women will get tired. The question becomes- is it more important that she is full of energy or that her baby comes out alive?
The second contributing factor is the clamping and cutting of the cord. The UN has issued a health statement that in order to prevent mother to child transmission of HIV cords should be clamped and cut immediately after birth. Broad spectrum this is the best way to prevent transmission. However, the cord is connected to the placenta, which provides the baby with oxygen. If a baby is not breathing they are still getting oxygen for a few moments from the cord. We have no suction devices at the hospital. The one bulb syringe is too large to fit in a babies nose and is often not sterile. When cords are cut immediately a baby gasps for air and sucks in all sorts of mucus and meconium before there is time to massage or wipe it out. Since there is no suction, babies end up with enormous amounts of fluid in their lungs. One died a few days ago from ingesting too much fluid. I don’t know if she could have been saved, but to me it would make sense that women who have been tested and tested negative would get to keep their babies on the cords at least until the baby is breathing properly on her own.
Realizing that in a country that has no economy there is almost nothing that can be done that is sustainable is scary. And yet, the little things give birth to enormous satisfaction. Placing lavender oil on the third eyes of one hundred new born infants. Watching a Ugandan midwife try for the first time to massage a womans’ perineum with almond oil so that she doesn’t tear. Dancing and drinking homemade pineapple wine with the nuns.
And so it goes. On and on.
I question my role every day.
I straddle worlds and ideas and stories.
Last night at dinner Joy, a two year old came and ate a mango on my lap. I call her the little opportunist. She is one of those toddlers who knows how to love you when she wants something and completely ignores you the rest of the time. And then you hear her story. Her mother is a child mother who was abducted when she was ten years old and escaped the rebels, (her captors, her rapists and the father of her child), when Joy was two days old. She strapped Joy to her back, stole a gun, and set off into the bush with the baby and the gun. She came to a road, saw some American soldiers who waved her down. She pointed her gun at them and said she wouldn’t come over to them until they put their guns down first. They did and she got rescued. She was brought to St. Monica’s and has been here for the last two years. The image of a fifteen-year old mother with a child on her back and a gun in her hand haunts me. I watch Joy slurp her mango and hug her a little tighter. Another woman, Nancy had her jaw hacked off with a machete. She had it sewn on again and the result looks like a beginning seamstress attempting to sew the face onto a Raggedy Anne doll. She delivered her baby (nobody knows who the father is) last week and she named her Peace.
The simple facts of a human life create these stories that weave in and out of one another, creating this enormous web of human suffering, perseverance and dignity.
Babies Babies Babies
The more you see the more helpless you feel
The more helpless you feel the worse it is!
Babies Babies Babies
The more you catch the more you see
The more you see the better it is!
The more you eat the more you poop
The more you poop the better it is!
This ‘rhyme’ sung to me by Sister Beatrice while I cooked dinner for the nuns is a perfect metaphor for much of post-colonization post-war Ugandan culture. The original song, brought in from an outside source, has been orally transmitted so many times that it has lost all but the shell of its former self, and yet it is still being sung with utter conviction and without questioning. The fact that it makes no sense is irrelevant. Is it about proper nutrition or diarrhea?
Aimee and I sang Sister Beatrice the version we know.
Beans Beans good for your heart
The more you eat the more you fart
The more you fart the better you feel
So eat your beans with every meal.
She liked it, but I liked her version better and we spent the afternoon shelling beans and making up new ditties, all ending with either ‘the better it is’ or ‘the worse it is’ depending on the circumstances of our improv.
The metaphor translates perfectly to the hospital. Western medicine, brought in by colonizers fifty to one hundred years ago, has not been 'updated' because nobody wanted to come to a war torn country to train doctors. What remains is the shell of 1950's medical practice. The med school at Gulu regional teaches student doctors to make vertical incisions on cesarean sections; women rest afterwards on dirty foam mattresses, go home when they can walk and there is no follow up care for infections. Women come in with stitches that are oozing puss and are told to purchase antibiotics. Hardly anyone can afford antibiotics. Are these practices really saving lives if the risk of dying of a post- op infection is almost as high as death from an obstructed labor? Were there as many obstructed labors when women used local herbs to speed labor along and before women were forced to lay on their backs on metal gurneys in a hospital with no running water?
And yet the practice is not questioned. It is Western. It is right.
What a privilege it is to be able to tell a story!
We interview women for this film and ask them to tell us their birth stories and we get the facts. She was born on this day, I felt the labor pains at 3:00 and she was born at 8. She weighed 4 Kilos. How did you feel? We ask. Fine. The women answer. I felt fine.
Or maybe it is a privilege to think that your birth experience is special and worth talking about. The concept of a doula does not translate. People spend thousands of dollars to have someone massage them and advocate to make their experience meaningful and positive?
This weekend we went to two IDP camps to meet with TBA’s from all around the North. Over one hundred TBA's showed up in all. They had prepared skits and songs for us to show us how they work. Our intention was to host some Red Tent like events where women shared birth stories, either their own or ones they had attended. The first group turned into a story group about abnormal births- one woman attended a birth where the woman began to push and one thousand black fly’s flew out of her vagina in a thick cloud. They took her to the hospital and there was no sign of a pregnancy. Another woman attended a birth where all that came out was some mucus and a set of human eyeballs. At the end of this story the translator looked at me and said ‘What was that? She would like to know specifically.”
Aimee said she was tempted to say ‘An alien’. Instead we used the question as another moment to exemplify that we do not know, and try to dialogue around what the TBA’s thought could have been the cause of such abnormalities. The two most feasible answers were malnutrition and the devil.
At the end of our session we were fed a large meal. Potatoes and cassava and boiled greens and beans and rice and goat meat and chicken meat and coke. The meat here is really not stored well and so we have used the Jewish religion as an excuse to not take meat at a meal and offend our hosts. It has worked well. However at this camp they understood it too well. "If the issue is the way that the meat is killed, then you can kill it on your own!" They came to us with a bag of eggs, a pot of homemade peanut butter, and a live duck in a bag.
“You can take this and kill it the Jewish way. Please, it is our offering to you!”
We were remiss to say no, and walked out of the camp with our duckie and plans to set him free. We sent Aimee's husband Kevin a text on the ride home 'Travelling with live duck. Help!"
Duckie met is fate however, because we re-gifted him to the midwife who was translating for us so that she could feed her family.
And then there is the hospital. Some days it is insane and other days it is quieter. Yesterday there were only two births on my shift, but there were six women laboring in the hall. One got so frightened watching another woman push that she took off in a sprint out of the hospital. She returned a few minutes later realizing she could not escape the intensity. Aimee massaged her with lavender oil and she calmed down, even came to assist the next birth.
I have noticed that we have to resuscitate an alarming number of babies. I am pretty sure there are two contributing factors. One is that women lye on their sides throughout their labors and are not encouraged to walk around. When a woman is fully dilated she is told to lye on her back or side until the head is crowning. One of the midwives says this is to save gloves. Another says it is because women get too tired if they push. Often there will be meconium and the fetal heart will be scarily low or high, but there is no active pushing. Because of this babies spend a very long time squished in the vaginal canal and come out in distress. Aimee and I have encouraged pushing in cases like this and are promptly shut down by the other midwives who say that the women will get tired. The question becomes- is it more important that she is full of energy or that her baby comes out alive?
The second contributing factor is the clamping and cutting of the cord. The UN has issued a health statement that in order to prevent mother to child transmission of HIV cords should be clamped and cut immediately after birth. Broad spectrum this is the best way to prevent transmission. However, the cord is connected to the placenta, which provides the baby with oxygen. If a baby is not breathing they are still getting oxygen for a few moments from the cord. We have no suction devices at the hospital. The one bulb syringe is too large to fit in a babies nose and is often not sterile. When cords are cut immediately a baby gasps for air and sucks in all sorts of mucus and meconium before there is time to massage or wipe it out. Since there is no suction, babies end up with enormous amounts of fluid in their lungs. One died a few days ago from ingesting too much fluid. I don’t know if she could have been saved, but to me it would make sense that women who have been tested and tested negative would get to keep their babies on the cords at least until the baby is breathing properly on her own.
Realizing that in a country that has no economy there is almost nothing that can be done that is sustainable is scary. And yet, the little things give birth to enormous satisfaction. Placing lavender oil on the third eyes of one hundred new born infants. Watching a Ugandan midwife try for the first time to massage a womans’ perineum with almond oil so that she doesn’t tear. Dancing and drinking homemade pineapple wine with the nuns.
And so it goes. On and on.
I question my role every day.
I straddle worlds and ideas and stories.
Last night at dinner Joy, a two year old came and ate a mango on my lap. I call her the little opportunist. She is one of those toddlers who knows how to love you when she wants something and completely ignores you the rest of the time. And then you hear her story. Her mother is a child mother who was abducted when she was ten years old and escaped the rebels, (her captors, her rapists and the father of her child), when Joy was two days old. She strapped Joy to her back, stole a gun, and set off into the bush with the baby and the gun. She came to a road, saw some American soldiers who waved her down. She pointed her gun at them and said she wouldn’t come over to them until they put their guns down first. They did and she got rescued. She was brought to St. Monica’s and has been here for the last two years. The image of a fifteen-year old mother with a child on her back and a gun in her hand haunts me. I watch Joy slurp her mango and hug her a little tighter. Another woman, Nancy had her jaw hacked off with a machete. She had it sewn on again and the result looks like a beginning seamstress attempting to sew the face onto a Raggedy Anne doll. She delivered her baby (nobody knows who the father is) last week and she named her Peace.
The simple facts of a human life create these stories that weave in and out of one another, creating this enormous web of human suffering, perseverance and dignity.
Babies Babies Babies
The more you see the more helpless you feel
The more helpless you feel the worse it is!
Babies Babies Babies
The more you catch the more you see
The more you see the better it is!
Saturday, June 16, 2007
silence
It is quieter now.
Or perhaps I have settled a little.
The same work feels more joyful and the connections more concrete.
Still straddling the line between observing and engaging- learning more and more every day.
I have been thinking a lot about silence.
What does it mean to be silent? To be silenced?
How is silence an integral and essential part of having a voice?
There was an earthquake last night. Nothing big, just a little trembling of the earth. Everyone was outside drumming and dancing and as the ground began to shake the singing turned into yells, and then, silence. For one moment, even the crickets were silent. And then laughter. The croak of a frog. The hum of the generator. Business as usual.
Today is Saturday, a day of rest for this Jewish girl.
I have offered to cook dinner for the nuns (mostly because I am sick of potatoes and goat every night) so I am headed to the market.
Love.
Or perhaps I have settled a little.
The same work feels more joyful and the connections more concrete.
Still straddling the line between observing and engaging- learning more and more every day.
I have been thinking a lot about silence.
What does it mean to be silent? To be silenced?
How is silence an integral and essential part of having a voice?
There was an earthquake last night. Nothing big, just a little trembling of the earth. Everyone was outside drumming and dancing and as the ground began to shake the singing turned into yells, and then, silence. For one moment, even the crickets were silent. And then laughter. The croak of a frog. The hum of the generator. Business as usual.
Today is Saturday, a day of rest for this Jewish girl.
I have offered to cook dinner for the nuns (mostly because I am sick of potatoes and goat every night) so I am headed to the market.
Love.
Wednesday, June 13, 2007
I have been at a loss for words. The days pass by like months and then with a spark they are over. Last year this hospital was refuge for the girls who were night commuters; they sought safety in the sweat soaked walls from the terrorists from whom they escaped. Now these girls come back to this place to deliver their babies. They return with mothers, aunties, sisters, or alone. They bring with them a piece of plastic, which they lay on the seventy year old metal gurney to birth on, and a blanket to wrap the baby in. If they have a little more money, they may bring two blankets. There are five metal birthing beds. Soon after one woman delivers, the plastic is removed and another woman comes to take her place.
Often there is only one midwife on the floor. Or maybe just the woman who does the cleaning. She has become a lay midwife by virtue of spending time in that space. Women labor in the halls and come onto the beds to be examined and when they are close to pushing. The first baby of the day is strong and comes out with a cry. As we deliver the placenta a woman who has delivered at home comes in because she is hemorrhaging. She has a displaced uterus and is HIV positive. I triple glove, push it back up inside of her and massage it into place. She must lay on the floor because all of the labor beds are in use. I send her auntie to make her tea. Another woman pushes for three hours while two more deliver. We have one set of clamps and a pair of dull scissors. If the power is out they cannot be sterilized so we use string and a razor blade to clamp and cut the cord. Even if the power is on, there is not enough time between each birth to sterilize. The child mothers seem to take the longest because they are young and they are scared. One girl refuses to push for two hours while her baby waits just below the pubic bone with a very low heart rate. She is scared she will poop on the bed and no amount of coaxing will convince her that this is an ok thing to do. Another woman lays in fetal position and cries out for Jesus to save her. She has been in labor for two days. We have packed a small lunch of sim sim paste and mango marmalade on stale white bread. We take five minutes and while we are gone another woman has been admitted. Late in the day a woman comes in from the Congo. She has a group of seven Congolese women with her. They wear charcoal on their eyes and bright red blush. They stand around her and rub her and speak to her softly, holding her hands and feet as she labors. As she pushes they begin to wail, flailing their arms around, beating their chest and then they begin to slap her and strangle her (there is no way to contextualize this properly, but from what I can gather this practice is used to stop a woman from blowing out her nose when she pushes) this baby has the cord around his neck very tightly. The sisters are still wailing and strangling this mother and I have to scream at them to stop. They stare at me strangely, but pull their hands away from the birthing mother. The clamp and scissors are in use so I hold the head while Aimee uses the string and razor to cut him free. When he comes out he is lifeless and blue. I flash to the first baby of the day and feel the tears well up in my chest. I push them down. This time the bulb syringe is clean so I am able to suction him and massage him into breathing. While I am working on him his mother gets off the metal bed, cleans up the fluid (they all clean up after themselves) from her birth and walks out. One of the seven women comes to take the baby and I explain that she must keep him very close to her body for warmth. His skin is still blue, clammy and cold, but he is breathing and his heart rate is good. With each mother I make a connection and then forget her name. When one returns because she is bleeding too much I cannot remember if she has delivered today even though she is the one who spent three hours pushing. The placenta bucket is overflowing and one of the orphans who lives in the hospital brings it out to empty it in the placenta pit. There is a moment of silence and while one young mother pushes (it will be a while) and another tries to sleep I step outside to see the sun setting.
We leave the hospital at 6:30. Two hours after we were supposed to leave, but this is when the night shift midwife shows up. I feel I have no personality left. The nuns invite us to tea and it is all I can do to sit for ten minutes as the milky warm liquid swishes in my mug. When I return home I step into the cold shower, immerse myself and cry. The water beads up and trickles slowly into the drain. The cold feels shocking and real. The dinner bell rings but I cannot imagine eating. My head is swimming with images of placentas and tears, spurting blood, amniotic fluid and feces. This was today. I cannot remember the ten women whose babies I caught yesterday.
I feel numb but also terribly alive. The aches in my back and feet, the pulse in my chest, the chapped skin on my hands from all of the gloves, the washing, the purell, converge together as both witness and testimony to my day.
Aimee and I stay up late talking. She re-enacts parts of the Congolese drama that I missed because I was so focused on the baby and the cord, I laugh hard for the first time today. We question ourselves. What are we doing here? What can we do that will really impact this situation?The medical information being used is dated. There is no one here to update it. One of the midwives was talking about how the TBA’s are contributing to maternal death rates because they only refer women to the hospital when labor is obstructed. I wonder though, if there is anything in that hospital that could help an obstructed labor. All we have are razor blades and string. Perhaps the herbs and gentle coaxing of a TBA would better move a labor along. Of course it sounds ‘better’, it sounds like progress from a western governmental perspective to send women to a hospital, but when the circumstances are dire, I am not convinced.
The individual stories are pieces of one larger story. We will hold our first story circle on Saturday, and then a mini ‘conference’ for the hospital midwives where we will exchange best practices. Ideas flow in and then out. At the end of the day I fall into a deep sleep and I dream of working in a clinic where legs are falling off and women carry double headed babies on their backs. This is a lot to process. I have been at a loss for words.
Often there is only one midwife on the floor. Or maybe just the woman who does the cleaning. She has become a lay midwife by virtue of spending time in that space. Women labor in the halls and come onto the beds to be examined and when they are close to pushing. The first baby of the day is strong and comes out with a cry. As we deliver the placenta a woman who has delivered at home comes in because she is hemorrhaging. She has a displaced uterus and is HIV positive. I triple glove, push it back up inside of her and massage it into place. She must lay on the floor because all of the labor beds are in use. I send her auntie to make her tea. Another woman pushes for three hours while two more deliver. We have one set of clamps and a pair of dull scissors. If the power is out they cannot be sterilized so we use string and a razor blade to clamp and cut the cord. Even if the power is on, there is not enough time between each birth to sterilize. The child mothers seem to take the longest because they are young and they are scared. One girl refuses to push for two hours while her baby waits just below the pubic bone with a very low heart rate. She is scared she will poop on the bed and no amount of coaxing will convince her that this is an ok thing to do. Another woman lays in fetal position and cries out for Jesus to save her. She has been in labor for two days. We have packed a small lunch of sim sim paste and mango marmalade on stale white bread. We take five minutes and while we are gone another woman has been admitted. Late in the day a woman comes in from the Congo. She has a group of seven Congolese women with her. They wear charcoal on their eyes and bright red blush. They stand around her and rub her and speak to her softly, holding her hands and feet as she labors. As she pushes they begin to wail, flailing their arms around, beating their chest and then they begin to slap her and strangle her (there is no way to contextualize this properly, but from what I can gather this practice is used to stop a woman from blowing out her nose when she pushes) this baby has the cord around his neck very tightly. The sisters are still wailing and strangling this mother and I have to scream at them to stop. They stare at me strangely, but pull their hands away from the birthing mother. The clamp and scissors are in use so I hold the head while Aimee uses the string and razor to cut him free. When he comes out he is lifeless and blue. I flash to the first baby of the day and feel the tears well up in my chest. I push them down. This time the bulb syringe is clean so I am able to suction him and massage him into breathing. While I am working on him his mother gets off the metal bed, cleans up the fluid (they all clean up after themselves) from her birth and walks out. One of the seven women comes to take the baby and I explain that she must keep him very close to her body for warmth. His skin is still blue, clammy and cold, but he is breathing and his heart rate is good. With each mother I make a connection and then forget her name. When one returns because she is bleeding too much I cannot remember if she has delivered today even though she is the one who spent three hours pushing. The placenta bucket is overflowing and one of the orphans who lives in the hospital brings it out to empty it in the placenta pit. There is a moment of silence and while one young mother pushes (it will be a while) and another tries to sleep I step outside to see the sun setting.
We leave the hospital at 6:30. Two hours after we were supposed to leave, but this is when the night shift midwife shows up. I feel I have no personality left. The nuns invite us to tea and it is all I can do to sit for ten minutes as the milky warm liquid swishes in my mug. When I return home I step into the cold shower, immerse myself and cry. The water beads up and trickles slowly into the drain. The cold feels shocking and real. The dinner bell rings but I cannot imagine eating. My head is swimming with images of placentas and tears, spurting blood, amniotic fluid and feces. This was today. I cannot remember the ten women whose babies I caught yesterday.
I feel numb but also terribly alive. The aches in my back and feet, the pulse in my chest, the chapped skin on my hands from all of the gloves, the washing, the purell, converge together as both witness and testimony to my day.
Aimee and I stay up late talking. She re-enacts parts of the Congolese drama that I missed because I was so focused on the baby and the cord, I laugh hard for the first time today. We question ourselves. What are we doing here? What can we do that will really impact this situation?The medical information being used is dated. There is no one here to update it. One of the midwives was talking about how the TBA’s are contributing to maternal death rates because they only refer women to the hospital when labor is obstructed. I wonder though, if there is anything in that hospital that could help an obstructed labor. All we have are razor blades and string. Perhaps the herbs and gentle coaxing of a TBA would better move a labor along. Of course it sounds ‘better’, it sounds like progress from a western governmental perspective to send women to a hospital, but when the circumstances are dire, I am not convinced.
The individual stories are pieces of one larger story. We will hold our first story circle on Saturday, and then a mini ‘conference’ for the hospital midwives where we will exchange best practices. Ideas flow in and then out. At the end of the day I fall into a deep sleep and I dream of working in a clinic where legs are falling off and women carry double headed babies on their backs. This is a lot to process. I have been at a loss for words.
Sunday, June 10, 2007
The last three days have been rich.
So rich I am not sure where to start. How does one tell a story and bring it to life?
Of course, any point that I start will never be the beginning, so I will just start with this moment.
I am sitting in an internet cafe called 'Long Tick'it is across the street from the side of the market where they sell flipflops and second hand clothing. Up the road from me is the hospital and in the other direction is St. Monica's, where I am staying.
This is an interesting time to be entering into the birth dialogue.
Aimee and I were invited by one of the nurse midwives, Sister Florence, to attend a workshop she was leading for Traditional Birth Attendants. These are women who have not been formally trained, but attend to most of the births happening in villages. The purpose of the workshop, she explained to us, was to train them in recognizing the signs of early labor so that they can refer women to hospitals. Because of HIV/AIDS the Ugandan government has now made it illegal for TBA's to conduct a delivery unless it is 'by accident'.
Aimee and I attended the workshop and we filmed.
Thanks to IMovie we were able to edit together 3 minutes of our footage last night which I will try to be internet savvy enough to post. (the quality will be shitty since I have reduced the pixel size for the blog, but you will get a sense).
The hope is that we can continue filming in the villages and the hospital to really get to the heart of how women hope they will birth, talk about birth and actually birth.
So rich I am not sure where to start. How does one tell a story and bring it to life?
Of course, any point that I start will never be the beginning, so I will just start with this moment.
I am sitting in an internet cafe called 'Long Tick'it is across the street from the side of the market where they sell flipflops and second hand clothing. Up the road from me is the hospital and in the other direction is St. Monica's, where I am staying.
This is an interesting time to be entering into the birth dialogue.
Aimee and I were invited by one of the nurse midwives, Sister Florence, to attend a workshop she was leading for Traditional Birth Attendants. These are women who have not been formally trained, but attend to most of the births happening in villages. The purpose of the workshop, she explained to us, was to train them in recognizing the signs of early labor so that they can refer women to hospitals. Because of HIV/AIDS the Ugandan government has now made it illegal for TBA's to conduct a delivery unless it is 'by accident'.
Aimee and I attended the workshop and we filmed.
Thanks to IMovie we were able to edit together 3 minutes of our footage last night which I will try to be internet savvy enough to post. (the quality will be shitty since I have reduced the pixel size for the blog, but you will get a sense).
The hope is that we can continue filming in the villages and the hospital to really get to the heart of how women hope they will birth, talk about birth and actually birth.
Thursday, June 7, 2007
shit in a hole
For the first time in my life I can shit in hole with almost perfect aim.
I am oddly very proud.
I am oddly very proud.
The night belongs to the animals.
Monkeys wrestle, termites swarm around light posts buzzing in harmony with the humming mosquitoes. Dogs howl, a rooster crows every hour like a grandfather clock, frogs croak, and a hyena laughs in the distance, or is it a woman?
I lay on my foam mattress, cocooned in hot pink mosquito netting, and I sweat.
When I sleep it is deep and fast, like falling into a black hole, and I startle awake as the nuns clang pots together because it is time for Mass.
The day belongs to the people. Motorcycles compete with cars who compete with trucks to pass down the one lane dirt road. Dust flies through the air and sticks to sweaty skin. Now animals hang from poles, dead, ready to be sold in the market. Chickens, fish, goat, and cow. Lots for sale, produce, cloth, plastic, cell phones.
People. This is a community that has never not known conflict and war. The trauma is palpable. Physically, there are scars and missing limbs, eyeballs, faces. There is HIV and the yellow eyes of hep b, malaria and parasite.
But beyond the skin, beyond the blood and the viruses that bubble through veins, there is a sense of unrest, something I can feel but cannot know.
It is easy to want to romanticize a place that is different from where one came. Even easier here, where amidst fear and struggle, daily life remains simple and sweet. Rising with the sun, praying together, living together.
I ate a live termite last night. One of the girls caught it, pulled off the wings and offered it to me. They were all feasting and made them look pretty good. I will try anything once. This was definitely a one time thing. The taste of chlorine and bile still makes me want to gag. Some things are an acquired taste.
The hospital is bare. Women labor in the hall and then come into a room where they give birth in rows on beds. I can help, lend a pair of hands to catch some babies, but I see the work as layered. The way that trauma manifests in the body is so clear in laboring women. Sexual abuse, physical violence, and fear of bringing new life into conflict position women into hunched over, physically closed bodies as they birth. Labors become unnecessarily complicated with no supplies to aid those complications.
I have spent the last year studying narrative. I am interested in the way that speaking a story and being heard or conversely, not being heard, affect the physical body. I think this is the place to start. As a listener and a vessel for stories and voices. The alchemical dance can journey through my body, through this keyboard, and into you. Can you feel it? Where does it live? What does it feel like? Keep these questions in mind as I return with stories.
Monkeys wrestle, termites swarm around light posts buzzing in harmony with the humming mosquitoes. Dogs howl, a rooster crows every hour like a grandfather clock, frogs croak, and a hyena laughs in the distance, or is it a woman?
I lay on my foam mattress, cocooned in hot pink mosquito netting, and I sweat.
When I sleep it is deep and fast, like falling into a black hole, and I startle awake as the nuns clang pots together because it is time for Mass.
The day belongs to the people. Motorcycles compete with cars who compete with trucks to pass down the one lane dirt road. Dust flies through the air and sticks to sweaty skin. Now animals hang from poles, dead, ready to be sold in the market. Chickens, fish, goat, and cow. Lots for sale, produce, cloth, plastic, cell phones.
People. This is a community that has never not known conflict and war. The trauma is palpable. Physically, there are scars and missing limbs, eyeballs, faces. There is HIV and the yellow eyes of hep b, malaria and parasite.
But beyond the skin, beyond the blood and the viruses that bubble through veins, there is a sense of unrest, something I can feel but cannot know.
It is easy to want to romanticize a place that is different from where one came. Even easier here, where amidst fear and struggle, daily life remains simple and sweet. Rising with the sun, praying together, living together.
I ate a live termite last night. One of the girls caught it, pulled off the wings and offered it to me. They were all feasting and made them look pretty good. I will try anything once. This was definitely a one time thing. The taste of chlorine and bile still makes me want to gag. Some things are an acquired taste.
The hospital is bare. Women labor in the hall and then come into a room where they give birth in rows on beds. I can help, lend a pair of hands to catch some babies, but I see the work as layered. The way that trauma manifests in the body is so clear in laboring women. Sexual abuse, physical violence, and fear of bringing new life into conflict position women into hunched over, physically closed bodies as they birth. Labors become unnecessarily complicated with no supplies to aid those complications.
I have spent the last year studying narrative. I am interested in the way that speaking a story and being heard or conversely, not being heard, affect the physical body. I think this is the place to start. As a listener and a vessel for stories and voices. The alchemical dance can journey through my body, through this keyboard, and into you. Can you feel it? Where does it live? What does it feel like? Keep these questions in mind as I return with stories.
Tuesday, June 5, 2007
A dialogue with self
Having a ‘toe in the door’ of academia has made it hard to just write,
Every response to a lived situation becomes a problem of representation and contextualization. I thought maybe my inner academic and my authentic response child should have a dialogue, so I called them both here today for an interview.
My inner academic (herein known as IA) was a little bit wary, she wanted to know who the audience was and if the article would be peer reviewed. My authentic response child, (herein known as ARC) was also wary, she was scared of speaking publicly and therefore being vulnerable to attack. With a little creative thinking I was able to sidestep most concerns and bring them both here with the promise of a latte.
IA: I see your trip to Uganda as quite problematic. I mean, how do you, a western woman with white privilege expect to come into a country with a long history of colonization and missionary work and just ‘volunteer’ as a midwife without playing that role? I see your position as inextricable from the history of western influence.
Me: Good question IA. I don’t really know how to answer you except that I think you are right. However, context and intention cannot be discounted. My work is not to show up and ‘teach’ anybody anything- I am here to exchange practices with other midwives and women. I understand that I am coming in with a position of privilege, but I only see that as inherently bad if it is not questioned properly.
ARC: Can I interrupt here?
IA: What about sustainability? If you come in and catch a bunch of babies what is going to happen when you leave and your pair of hands isn’t here anymore?
Me: I don’t plan on just catching babies. I truly hope to learn how these women are doing what they do, and if it seems right, offer some of what I have learned as practices that may be helpful and sustainable. I think the key is being accountable to both giving and receiving.
ARC: Can I say something?
IA: In a minute. That’s fine I guess, but you also say you are here to collect stories. Just the word ‘collect’ makes my skin crawl, like you think you can just take somebody else’s story and make it your own, or bring it somewhere else. Are you really so naïve to think that by listening to and telling their story, you can just give somebody else a voice?
Me: Isn’t that what it’s all about? I think story exchange is a delicate alchemy. When a story moves from one woman’s lips to another woman’s ears and then out another woman’s lips it becomes an alchemical dance, changing form and meaning along the way. Impoverished communities are usually under-heard communities. Regardless of who you are, or what your privilege, it feels good to be listened to and it feels good to be able to share a story that gives a glimpse into a woman’s situation or understanding of her life. This is what indigineous communities have known all along, and feminism sort of revived in the western sphere. I think your questions are valid, but not valid enough to stop me.
ARC: Yes! Story groups! We need to hold story groups! Where women can have a space to share and dialogue with each other, to tell their birth stories in a space that honors that as important. Yes! Because then you take away the issue of ‘Rachel’ as collector and it just becomes women in a community sharing with each other.
IA: First off, ARC, you are a hippy. Second, that still doesn’t take away the issue of a western facilitator creating the space. Do you really not think that these women create their own spaces and tell their own stories? To be safe you should really just record exactly what you hear and not influence it in any way. You did bring an audio recorder?
ARC: Let’ not forget that the context here is war. These women have grown up in violence, storytelling and women’s ability to speak changes form in this way. Rachel is a really good facilitator. That is one of the tools she brings with her, the ability to gather people in a room and ask questions that push them to deeper places within their story- perhaps places that can be healing. Would you really have her not do that because you are scared of how things get represented?
Me: Thank you ARC. What a nice compliment. IA, are you saying that every time I toot my own horn I take away the ability for a Ugandan woman to authentically have her own horn tooted?
IA: Well, not exactly. It’s more complicated then that. Its wrapped up in a system of colonization and hegemony and…. Could we stop using the word ‘authentic’? It’s starting to offend me.
ARC: Just say what you need to say Rachel and worry about it later. Nobody ever made change in a system without offending most people, especially the academics. Academia can be an excuse to just stand back and observe instead of ‘doing’. You are a doer.
IA: But that’s exactly the problem! What kind of ‘change’ do you really think you are going to make? I mean seriously, can we at least stay away from the ‘go to Africa save the world discourse’?
Me: Absolutely. But change is inherent. Probably more for me than for anyone else….
ARC: Yes, and its ok to write a little poetry and respond from your gut once in a while. Then when you are done you can locate all that writing within the context of your white privilege, your problematic representation, the hegemony of the academic institution, yada yada yada. I mean, whatever comes out of you first is REAL and that is more interesting and probably more useful in the long run.
IA: I actually see your point ARC. If Rachel responds authentically, but locates her responses first as problematic, what comes up could be very useful to her project- because it will reflect the exact issues that we are so concerned with.
ARC: If they are inherent, why not wear them on your sleeve?
Me: You guys are scaring me.
ARC: Forge on sister. Don’t let the institution stop you!
IA: Just be careful. Tread lightly. Cross-reference. Footnote.
Me: I’ll do my best. Thanks guys.
IA: What about that latte?
Me: I could have sworn that Uganda produced some of the worlds best coffee…. How come I haven’t seen a cup of joe anywhere?
IA: Well, you know the export business is completely….
ARC: Don’t start. Please don’t start.
Every response to a lived situation becomes a problem of representation and contextualization. I thought maybe my inner academic and my authentic response child should have a dialogue, so I called them both here today for an interview.
My inner academic (herein known as IA) was a little bit wary, she wanted to know who the audience was and if the article would be peer reviewed. My authentic response child, (herein known as ARC) was also wary, she was scared of speaking publicly and therefore being vulnerable to attack. With a little creative thinking I was able to sidestep most concerns and bring them both here with the promise of a latte.
IA: I see your trip to Uganda as quite problematic. I mean, how do you, a western woman with white privilege expect to come into a country with a long history of colonization and missionary work and just ‘volunteer’ as a midwife without playing that role? I see your position as inextricable from the history of western influence.
Me: Good question IA. I don’t really know how to answer you except that I think you are right. However, context and intention cannot be discounted. My work is not to show up and ‘teach’ anybody anything- I am here to exchange practices with other midwives and women. I understand that I am coming in with a position of privilege, but I only see that as inherently bad if it is not questioned properly.
ARC: Can I interrupt here?
IA: What about sustainability? If you come in and catch a bunch of babies what is going to happen when you leave and your pair of hands isn’t here anymore?
Me: I don’t plan on just catching babies. I truly hope to learn how these women are doing what they do, and if it seems right, offer some of what I have learned as practices that may be helpful and sustainable. I think the key is being accountable to both giving and receiving.
ARC: Can I say something?
IA: In a minute. That’s fine I guess, but you also say you are here to collect stories. Just the word ‘collect’ makes my skin crawl, like you think you can just take somebody else’s story and make it your own, or bring it somewhere else. Are you really so naïve to think that by listening to and telling their story, you can just give somebody else a voice?
Me: Isn’t that what it’s all about? I think story exchange is a delicate alchemy. When a story moves from one woman’s lips to another woman’s ears and then out another woman’s lips it becomes an alchemical dance, changing form and meaning along the way. Impoverished communities are usually under-heard communities. Regardless of who you are, or what your privilege, it feels good to be listened to and it feels good to be able to share a story that gives a glimpse into a woman’s situation or understanding of her life. This is what indigineous communities have known all along, and feminism sort of revived in the western sphere. I think your questions are valid, but not valid enough to stop me.
ARC: Yes! Story groups! We need to hold story groups! Where women can have a space to share and dialogue with each other, to tell their birth stories in a space that honors that as important. Yes! Because then you take away the issue of ‘Rachel’ as collector and it just becomes women in a community sharing with each other.
IA: First off, ARC, you are a hippy. Second, that still doesn’t take away the issue of a western facilitator creating the space. Do you really not think that these women create their own spaces and tell their own stories? To be safe you should really just record exactly what you hear and not influence it in any way. You did bring an audio recorder?
ARC: Let’ not forget that the context here is war. These women have grown up in violence, storytelling and women’s ability to speak changes form in this way. Rachel is a really good facilitator. That is one of the tools she brings with her, the ability to gather people in a room and ask questions that push them to deeper places within their story- perhaps places that can be healing. Would you really have her not do that because you are scared of how things get represented?
Me: Thank you ARC. What a nice compliment. IA, are you saying that every time I toot my own horn I take away the ability for a Ugandan woman to authentically have her own horn tooted?
IA: Well, not exactly. It’s more complicated then that. Its wrapped up in a system of colonization and hegemony and…. Could we stop using the word ‘authentic’? It’s starting to offend me.
ARC: Just say what you need to say Rachel and worry about it later. Nobody ever made change in a system without offending most people, especially the academics. Academia can be an excuse to just stand back and observe instead of ‘doing’. You are a doer.
IA: But that’s exactly the problem! What kind of ‘change’ do you really think you are going to make? I mean seriously, can we at least stay away from the ‘go to Africa save the world discourse’?
Me: Absolutely. But change is inherent. Probably more for me than for anyone else….
ARC: Yes, and its ok to write a little poetry and respond from your gut once in a while. Then when you are done you can locate all that writing within the context of your white privilege, your problematic representation, the hegemony of the academic institution, yada yada yada. I mean, whatever comes out of you first is REAL and that is more interesting and probably more useful in the long run.
IA: I actually see your point ARC. If Rachel responds authentically, but locates her responses first as problematic, what comes up could be very useful to her project- because it will reflect the exact issues that we are so concerned with.
ARC: If they are inherent, why not wear them on your sleeve?
Me: You guys are scaring me.
ARC: Forge on sister. Don’t let the institution stop you!
IA: Just be careful. Tread lightly. Cross-reference. Footnote.
Me: I’ll do my best. Thanks guys.
IA: What about that latte?
Me: I could have sworn that Uganda produced some of the worlds best coffee…. How come I haven’t seen a cup of joe anywhere?
IA: Well, you know the export business is completely….
ARC: Don’t start. Please don’t start.
Monday, June 4, 2007
Brussels
Brussels Airport.
Screaming baby on flight from NY and they didn't even show a movie.
Need Coffee. My retnas hurt.
Screaming baby on flight from NY and they didn't even show a movie.
Need Coffee. My retnas hurt.
Saturday, June 2, 2007
I am headed to Uganda tomorrow and I have been weepy all day.
Not really sure why except for the feeling of being overwhelmed by all that I need to get done in the moment mixed with a distinct lack of control over future moments makes for a potent combination.
I can't decide if I will take the anti-malarial pills or not.
They are about fifty percent effective- so I am not sure if that fifty percent is worth the nausea and hallucinations they induce. I know that garlic and citronella are also a powerful combo. The travel doctor who prescribed the Malerone called me a hippy when I refused the Typhoid shot and told him I might not take the anti- malarials. I say I am just a conscious consumer.
My hope is to approach this journey as open and naive as possible.
To catch a few babies, learn a few things, offer a few things, exchange.
I am acutely aware of my western privilege and its implications for both sustainable change and destruction within a community. This is a delicate balance- one that takes a constant 'locating' of self and willingness to admit that I will be taking more then I will be giving.
It's midnight. I need to pack.
Bring a bunch of extra underwear since they tend to get moldy in the humid air.
That's it for now.
More from Gulu.
Not really sure why except for the feeling of being overwhelmed by all that I need to get done in the moment mixed with a distinct lack of control over future moments makes for a potent combination.
I can't decide if I will take the anti-malarial pills or not.
They are about fifty percent effective- so I am not sure if that fifty percent is worth the nausea and hallucinations they induce. I know that garlic and citronella are also a powerful combo. The travel doctor who prescribed the Malerone called me a hippy when I refused the Typhoid shot and told him I might not take the anti- malarials. I say I am just a conscious consumer.
My hope is to approach this journey as open and naive as possible.
To catch a few babies, learn a few things, offer a few things, exchange.
I am acutely aware of my western privilege and its implications for both sustainable change and destruction within a community. This is a delicate balance- one that takes a constant 'locating' of self and willingness to admit that I will be taking more then I will be giving.
It's midnight. I need to pack.
Bring a bunch of extra underwear since they tend to get moldy in the humid air.
That's it for now.
More from Gulu.
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