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!