Pain as art or painful art?

Bob Flanagan's pain journal
How can pain heal?
How can suffering push the boundaries of compassion?
Was this guy just complaining or was he on to something?

He died drowning in the fluid of his own lungs. He used his lifelong terminal illness as a medium for voice and art. Some might call it masturbatory, but I think it lives on the in the trenches between total self indulgence (I mean, what/who doesn't?) and total humanitarian effort. That makes it edgier somehow. The conditions of his emergence make possible this kind of art. Only a nicely privileged white guy would have the balls to spend years of his life exhibiting and flaunting his pain- and because of that, we learn something. About him. About ourselves. Thanks Bob.

Systems and Cycles

Bodies into the earth, earth into soil, soil into food, food into bodies.
Somebody once described death this way to me.
I am interested in the documenting of the cycle.
The medical history.
The documents that narrativize and archive the biomedical story of our bodies. The human body is performed. According to Diana Taylor our personal histories are embodied through a repertoire of learned and responsive gesture. The residue of trauma or physical pain is embodied and so is pleasure. Medical histories however, seem to only be an account of that which is diagnosed or ‘wrong’. Most of us then, have a missing narrative of our actual health. I believe there is power in the narrative. The story we tell about our body actually affects the way we care for it. In every moment there are infinite possibilities for interpreting meaning, thereby making ‘truth’ a relative term.

So I am thinking today about how that narrative is formed.
Articulated.
Brought into light.
Processing about engagement style.
Strategy.
Effectively communicating so that a point can be heard.
Cultivating space for voice.
Opening channels of and for communication.
Medical histories miss the point.
Are we asking the right questions?

How can what a woman says be so different from how she feels?
Or rather, what she feels, be so impossible to say?
Where is that gap?
What lives in the space between? I sense that this space is fertile.

I think and write a lot about cultural metaphors of the body affecting healthcare and therefore, embodiment. As Carolyn Merchant demonstrates in the Death of Nature, this model originally developed in the 1600’s by Descartes, Bacon and Hobbes assumes that the universe is mechanistic, following predictable laws, which those enlightened enough to free themselves from the limitations of medieval superstition could discover through science and manipulate through technology, in order to decrease dependence on nature. In this model, the metaphor for the human body is a machine. As it was developed in the 17th century, the practical function of the metaphor of the body as machine lay in its conceptual divorce of body from soul, and in the subsequent removal of the body from the purview of religion so it could be opened up to scientific investigation. Consequently, the men who established the idea of the body as machine also firmly established the male prototype of this machine. Insofar as it deviated from the male standard, the female body was regarded as abnormal, inherently defective, and in need of constant manipulation by man. Conceptions of the body are bound to this notion that the body is controllable and predictable… something like childbirth is a radical rupture of this model.

So it makes sense that we can't narrate our bodies.
How can we push boundaries in a system thats structure denies its own validity? Is any sort of questioning a crack in a system that has no floor to begin with?
In a medical space that is built on the model of the male body, the narration of womens bodies becomes either an act of violence to the system, or to the narrated woman, depending on how it gets used. Depending on who is listening (more on audience later).

I understand that a gentle entry is always the better way.
To become culturally competent. To work within to shape the borders. To have an understanding of or empathy for the person's experience in the world before attempting to understand the way she embodies; culturally contextualizing the symptoms manifest in her body.
I still question how we question without becoming a tool for the same mold we are trying to break.

Bodies into the earth, earth into soil, soil into food, food into bodies. Have you ever seen life leave a body? Without breath the body takes on a different shape, a different meaning. The experiences of that person are no longer connected to the body but to the memory of the body in life. The stories. The narrative. What that body passes on, will remain in the medical narratives of its children, re-invoking its own story through its constant telling. I believe that disease is truly just the body in dis-ease. If medical practitioners can engage and align with not just the measurable symptoms but the actual events and feelings surrounding the body in dis-ease, we may be faced with new questions- and with new questions come new answers, new ways to heal.

I don't feel well today.
I woke with this unquenchable thirst. Guzzled water, took a shower, hydrated my skin, guzzled water, made tea.
Felt better. Running late to lead a workshop on prepared childbirth for young pregnant mamas in the Bronx.
Got on the subway. Morning commute style. Bodies mashed into bodies, ten sets of hands on a pole, sweat mixed with perfume mixed with drycleaned suits mixed with coffee/garlic bagel breathe mixed with hormones mixed with sweat.
I am reading a book about women's health issues in Islam.
The author was describing the experience of having her genitals mutilated.
Suddenly I felt nauseous. I put the book down but it did not pass. I felt that thirst again, then hot, then cold, my knees wobbled like I couldn't stand any more. My vision was blurred. I held on tight to the pole with both hands and actually put my head on the shoulder of the man standing next to me. There was nowhere else for it to go. He looked a little concerned but didn't say anything.
I must have looked bad because the next thing I knew someone was leading me through the bodies to a seat. Phew. I thought I was going down.
I put my head between my knees and felt my breath return to normal. My pulse slow down.
As I came back into my senses I had the clarity to realize how this experience is moving through my body, literally, like a turbulent wave.
The body is this amazing, resilient, renewing cellular structure. Shedding old and taking in new all the time. And yet there is something about the way that trauma meets the cell structure... it gets stuck. It manifests in posture, in illness, rash, fear. How do we move trauma through the body to promote health?

On another note, I made it to and through the workshop.
I love teenagers. I really love New York teenagers. They are a special breed.
Some highlights:

Rachel: What do you think are some of the advantages of being able to walk in labor?
Girl dressed all in black: your boyfriend can check your ass out.

girl#1: Can I keep my underwear on when I am in labor?
Rachel: You can keep them on as long as you are comfortable... eventually they will have to come off.
girl #2: ... girl why you stressing about panties? You know white girls don't wear no panties!
girl #3: I don't wear panties either... I mean, I do when I go out, but when I'm in labor my labias be swingin'.

Girl asking question: As my pregnancy progesses, more and more people smile at me. Why?
Girl dressed all in black: Because you're fatter than they are.

Thoughts:
Maybe humor is an obvious answer to moving pain and trauma through the body. Its certainly an entry point for talking about it.

Fake it til we make it

You know, this work doesn't stop.
It spirals. Unlinear and intimately evolving.
Reflection is the ultimate power.
To see ones actions without the emotional charge, to be able to be objective with 'self' pushes boundaries and gently slaughters older versions of self, kissing her on the forhead and moving forward.
I think a lot about context. To speak of violence against women one must have context, compassion. To tell a story, to locate oneself, context is everything.
But context is relative to the teller.
One cannot speak of women without speaking of where they are.
That hospital which is running 735% over its capacity. That entire hospital is running on an annual budget of $500,000 including the salaries of everyone that works there (maternity ward, antenatal clinic, surgery ward, TB ward, isolation ward, etc ), is only marginally more disorganized than some of the New York City hospitals where one administrators salary alone might come close to 500k.
Everything is relative and context is everything.

I have fallen right back into my midwifery here. Seeing clients, attending births, answering the phone in the middle of the night to assuade discharge fears. And there is violence here. A friend of a friends baby died at an NYC hospital the other day. Her water broke at 22 weeks. Instead of hooking her up to fluids and trying to wait a couple of weeks for a viable fetus, the hospital induced. Telling here there was no other option. She did not question authority. Does the hospital truly have respect for a single black woman on medicaid? What is the value of her babies life? If this had been some rich white senator would the outcome have been the same?
Without becoming cynical, the questions must be asked. Contextualized. Brought into voice.

No matter where we are, birth is managed from a technocratic model. The story of the cells over the story of the woman. A white mans model. The two overlap and intermix, the story of the woman informing the management of the molecular tale. It is these moments of joining that fascinate me, inspire me to move forward with this work, to remain hopeful that the stories can evolve, if we give them voice.

In a world that promotes and seems to thrive on scandal, fear and violence, how do we keep hope alive and continue to walk with faith?

I always talk about 'faking it until you make it'- that positive affirmations, even if you are feeling down, can lead to actual manifestations. We believe our own bullshit, why not believe our own positives?

I have always been involved in women's work. Gatherings, ceremonies, ritual, comfort, laughter- the bonding that takes place to heal 'wounds' that just being a woman in this world invokes. It seems I was born into a generation and community of women who are given the space to do this.

Medicalized birth is managed from a mans perspective. The war that men create affects the way that women give birth, the care they receive. The research methods developed by men carve paths that women jump into, but rarely have voice enough to change. Men plant seeds, literally. Women negotiate that garden.

So where is the space for mens work? For positive evolution? Who is doing this work?

Women's work can only go so far without the men.

In all of the madness in the world right now, it seems particularly necessary for men to have a space to process and communicate with honesty, creativity and even vulnerability.

I want to invite the men in my life to question their own roles as partners, fathers, healers, teachers, leaders, and participants in the world.

You may not all jump to join into groups and bond with eachother, but keep the questions alive and active.

I also want to invite the women in my life to get behind every man you know who is open to the idea of activating this process.

Let's fake it will we make it people.

What are you fighting for?

How to write about Africa

Binyavanga Wainaina

some tips: sunsets and starvation are good

Always use the word 'Africa' or 'Darkness' or 'Safari' in your title. Subtitles may include the words 'Zanzibar', 'Masai', 'Zulu', 'Zambezi', 'Congo', 'Nile', 'Big', 'Sky', 'Shadow', 'Drum', 'Sun' or 'Bygone'. Also useful are words such as 'Guerrillas', 'Timeless', 'Primordial' and 'Tribal'. Note that 'People' means Africans who are not black, while 'The People' means black Africans.

Never have a picture of a well-adjusted African on the cover of your book, or in it, unless that African has won the Nobel Prize. An AK-47, prominent ribs, naked breasts: use these. If you must include an African, make sure you get one in Masai or Zulu or Dogon dress.

In your text, treat Africa as if it were one country. It is hot and dusty with rolling grasslands and huge herds of animals and tall, thin people who are starving. Or it is hot and steamy with very short people who eat primates. Don't get bogged down with precise descriptions. Africa is big: fifty-four countries, 900 million people who are too busy starving and dying and warring and emigrating to read your book. The continent is full of deserts, jungles, highlands, savannahs and many other things, but your reader doesn't care about all that, so keep your descriptions romantic and evocative and unparticular.

Make sure you show how Africans have music and rhythm deep in their souls, and eat things no other humans eat. Do not mention rice and beef and wheat; monkey-brain is an African's cuisine of choice, along with goat, snake, worms and grubs and all manner of game meat. Make sure you show that you are able to eat such food without flinching, and describe how you learn to enjoy it—because you care.

Taboo subjects: ordinary domestic scenes, love between Africans (unless a death is involved), references to African writers or intellectuals, mention of school-going children who are not suffering from yaws or Ebola fever or female genital mutilation.

Throughout the book, adopt a sotto voice, in conspiracy with the reader, and a sad I-expected-so-much tone. Establish early on that your liberalism is impeccable, and mention near the beginning how much you love Africa, how you fell in love with the place and can't live without her. Africa is the only continent you can love—take advantage of this. If you are a man, thrust yourself into her warm virgin forests. If you are a woman, treat Africa as a man who wears a bush jacket and disappears off into the sunset. Africa is to be pitied, worshipped or dominated. Whichever angle you take, be sure to leave the strong impression that without your intervention and your important book, Africa is doomed.

Your African characters may include naked warriors, loyal servants, diviners and seers, ancient wise men living in hermitic splendour. Or corrupt politicians, inept polygamous travel-guides, and prostitutes you have slept with. The Loyal Servant always behaves like a seven-year-old and needs a firm hand; he is scared of snakes, good with children, and always involving you in his complex domestic dramas. The Ancient Wise Man always comes from a noble tribe (not the money-grubbing tribes like the Gikuyu, the Igbo or the Shona). He has rheumy eyes and is close to the Earth. The Modern African is a fat man who steals and works in the visa office, refusing to give work permits to qualified Westerners who really care about Africa. He is an enemy of development, always using his government job to make it difficult for pragmatic and good-hearted expats to set up NGOs or Legal Conservation Areas. Or he is an Oxford-educated intellectual turned serial-killing politician in a Savile Row suit. He is a cannibal who likes Cristal champagne, and his mother is a rich witch-doctor who really runs the country.

Among your characters you must always include The Starving African, who wanders the refugee camp nearly naked, and waits for the benevolence of the West. Her children have flies on their eyelids and pot bellies, and her breasts are flat and empty. She must look utterly helpless. She can have no past, no history; such diversions ruin the dramatic moment. Moans are good. She must never say anything about herself in the dialogue except to speak of her (unspeakable) suffering. Also be sure to include a warm and motherly woman who has a rolling laugh and who is concerned for your well-being. Just call her Mama. Her children are all delinquent. These characters should buzz around your main hero, making him look good. Your hero can teach them, bathe them, feed them; he carries lots of babies and has seen Death. Your hero is you (if reportage), or a beautiful, tragic international celebrity/aristocrat who now cares for animals (if fiction).

Bad Western characters may include children of Tory cabinet ministers, Afrikaners, employees of the World Bank. When talking about exploitation by foreigners mention the Chinese and Indian traders. Blame the West for Africa's situation. But do not be too specific.

Broad brushstrokes throughout are good. Avoid having the African characters laugh, or struggle to educate their kids, or just make do in mundane circumstances. Have them illuminate something about Europe or America in Africa. African characters should be colourful, exotic, larger than life—but empty inside, with no dialogue, no conflicts or resolutions in their stories, no depth or quirks to confuse the cause.

Describe, in detail, naked breasts (young, old, conservative, recently raped, big, small) or mutilated genitals, or enhanced genitals. Or any kind of genitals. And dead bodies. Or, better, naked dead bodies. And especially rotting naked dead bodies. Remember, any work you submit in which people look filthy and miserable will be referred to as the 'real Africa', and you want that on your dust jacket. Do not feel queasy about this: you are trying to help them to get aid from the West. The biggest taboo in writing about Africa is to describe or show dead or suffering white people.

Animals, on the other hand, must be treated as well rounded, complex characters. They speak (or grunt while tossing their manes proudly) and have names, ambitions and desires. They also have family values: see how lions teach their children? Elephants are caring, and are good feminists or dignified patriarchs. So are gorillas. Never, ever say anything negative about an elephant or a gorilla. Elephants may attack people's property, destroy their crops, and even kill them. Always take the side of the elephant. Big cats have public-school accents. Hyenas are fair game and have vaguely Middle Eastern accents. Any short Africans who live in the jungle or desert may be portrayed with good humour (unless they are in conflict with an elephant or chimpanzee or gorilla, in which case they are pure evil).

After celebrity activists and aid workers, conservationists are Africa's most important people. Do not offend them. You need them to invite you to their 30,000-acre game ranch or 'conservation area', and this is the only way you will get to interview the celebrity activist. Often a book cover with a heroic-looking conservationist on it works magic for sales. Anybody white, tanned and wearing khaki who once had a pet antelope or a farm is a conservationist, one who is preserving Africa's rich heritage. When interviewing him or her, do not ask how much funding they have; do not ask how much money they make off their game. Never ask how much they pay their employees.

Readers will be put off if you don't mention the light in Africa. And sunsets, the African sunset is a must. It is always big and red. There is always a big sky. Wide empty spaces and game are critical—Africa is the Land of Wide Empty Spaces. When writing about the plight of flora and fauna, make sure you mention that Africa is overpopulated. When your main character is in a desert or jungle living with indigenous peoples (anybody short) it is okay to mention that Africa has been severely depopulated by Aids and War (use caps).

You'll also need a nightclub called Tropicana, where mercenaries, evil nouveau riche Africans and prostitutes and guerrillas and expats hang out.

Always end your book with Nelson Mandela saying something about rainbows or renaissances. Because you care.

The deepest love

Becky comes to us for breakfast two days after her baby died. She has been released from the hospital where she stayed for two weeks before giving birth. She is wearing a piece of cloth wrapped around her waste and a thin red shirt with no bra. She wears a piece of blue cloth around her head. A symbol of mourning. Her breasts are noticeably swollen and heavy beneath the fabric. She has taken the braids out of her hair and it stands about one inch tall in a halo around her head.
She sits at the table as we pass eggs and fresh bread, sim sim paste mixed with honey and mango marmelade. She does not eat. I pour her some tea and she stirs it with vague interest.
How is your boyfriend, I ask. She replies that she has not seen him since he came to take the babies body from the hospital.
I missed the burial, she says looking down into the milky tea.
Then she begins to cry. A tear at first and then deep sobs. Ash se cries her breasts begin to leak milk. The fluid seeps through the thin fabric of her shirt and spreads across her front. When she finishes, she gulps her tea down like she hasn’t taken liquid in days.
Then she takes bread as well and eats it with such speed I am tempted to offer her the whole loaf. I leave her at the table.
I go to my bedroom and return with a bra. Black and lacy, it is stretched out, I can’t remember when I bought it, but know that it has been around almost as long as I have had breasts. Perhaps I got it when I was seventeen like Becky. Aimee helps her put it on and she flashes a little contented look.
We ask her to tell her story to out camera. We filmed her for two weeks in labor. Our camera needs to know what happened, but only if she feels strong enough. She lifts her eyebrows up and down quickly, a Ugandan gesture for ;’yes’ and begins to speak slowly into the camera, giggling every so often. She speaks the facts, the doctor asked her to pay 40,000 shillings for the cytotec, about $22 but more than two months salary for her family. She borrowed it from her aunt, who borrowed it from her husbands first wife. The family paid for the drug that killed the baby.
I don’t think she knows this irony but I feel chills as she speaks into the camera. I cannot ask her anything else.
We part with a long embrace, both aware that it may be a liong time before we see one another. She places her head on my shoulder and I tell her I am proud of her. I give her a bunch of clothes I am leaving in Uganda and am going to pay her school fees so she can finish high school and live in the safety of a boarding school. She will start next week.

I am leaving Gulu. It is hard to part from my sisters at St. Monicas. We have grown close. It has been what Aimee calls our African Sound of Music fantasy. Each of these sisters is so special and have provided a depth of connection and support that has been crucial in this work. I have never in my life understood the drive to become a nun, except for here. In a place where most of the relationships and sex are based on either forced family obligation or just violent force, the call to have a relationship with God instead is attractive. And these women have fun. Their community is rich with laughter and music and the sustenance of giving. Sister Pauline says don’t go Rachel, you have become a true sister. What would I do here? I ask. It would take a lot of work to make me a nun. It is ok she says, you will be our first ever Jewish sister. The offer is mildly tempting, I realize it is because the comfort of such sustained faith and generous love is something I have never experienced with such dedication and seriousness.
I have been overwhelmed by the urge to run away so much in the last month, to just be free, far away from the trauma and the pain. The comfort of community life is tempting. Alas, I am afraid I would make a very bad nun.... for more reasons than one.

My backpack is heavy but I have successfully shed enough stuff to only carry the one bag. I am so tired I feel I have lost every drop of my personality. Just breathing and moving from one place to another takes all that I have. Almost like when I had mono in high school. Aimee and Sister Grace accompany me to the bus park where I will ride the six hours into Kampala. I embrace them both and we all cry. Aimee and Kevin are headed to Rwanda tomorrow. My bus is called ‘The White Cock’, which it announces in bold letters across the front. On the back it says “Try The Cock!”. Somehow I feel safe. (Another sign that I should not become a nun.) Irony of ironies, the person in the seat next to me has two live white cocks stored at our feet. I look around for another seat but this is it. I take a deep breath, let the fear of having my toes pecked by chickens go, and relish in my window seat. We wait for two hours before the bus is full enough to leave. We make about four false starts, rolling forward, then back as one final person squishes in, and then we are off. After ten feet we stop for gas and to change a tire. And then we are off. After ten minutes we stop as the bus is bum rushed by merchants selling goat on a stick, roasted corn, cassava, water, porridge, roasted banana, mango and boiled eggs, and live chickens. Hands fly out of the bus and deals are negotiated as the merchants throw goods up into the windows and money is placed hastily into hands as the bus takes off again. This repeats itself about every twenty minutes along the journey. After a series of potholes that make me wish I still had my bra, I settle into some sort of sleep. It feels feverish and I wake because something is funny. My feet are overly hot and sweaty. One of the cocks has nested on them. Startled, I kick him off. He skwawks and pushes back under the seat. My neighbor laughs at me. The chicken has shit on my toes. I wipe them with the paper my cassava snack was wrapped in and then squirt purrell all over them. The ‘White Cock’ pulls into the Kampalla bus yard four hours later.
I hop on another bus to Entebbe and arrive at the airport just in time for my flight to Nairobi.
I feel off center as we take off into the air.
Zawadi is waiting for me when I arrive. She is family and I am instantly calmed by her presence. We drive to a restaurant and indulge in a beautiful meal before crawling back to her house where I take the longest hot shower and climb into her soft bed for a sleep that feels like angels. Her is house is eerily like mine. A bold red wall, pillows stacked in corners, tapestries on the walls. I wake and Zawadi has left for work but she has left a note.
Don’t leave. I have a surprise for you at 11:00.
I shower again relishing the hot water and all of her salt scrubs and lotions. The doorbell rings. A woman with a massage table is standing outside. The next two hours are peppermint and lavender oil bliss. I melt into being held and spend the rest of the visit in and out of bed and eating and going out to listen to music at night.

The plane ride home is hard. I feel anxious. I wrap my scarf around my head and cry. Something new is stirring. I am not sure what but it pushes me beyond where I am comfortable. This will take a long time to process. To really be able to speak about.

I arrive home to the deepest love imaginable. The women just carry me. I am so held. So blessed. Massage and a clean home stocked with food and light and blessings. Healthy kittens and fresh sheets and a hot meal. I could not be more held. What a perfect gift to have this family so profoundly, present. Thank you. I could not do this without you.

I feel a lack of poetry.
Like words cannot begin.
Like every day starts and finishes in the same breath.
Like my heart, which is now so full, is aching something awful.
Is that pleasure or pain?
My hands smell of latex and even after I have scrubbed them, the rubber scent from glove after glove after glove lingers.
Like an animal I miss my old scent.
The one that was salty sweet and mine.
Will I be able to find my way home without it?
I wash again, this time my whole body.
The shower is cold and I feel my teeth chattering on their own.
I slather in salt scrub, rub dry with coconut oil.
That’s better.
I notice my feet are still a darkish red/brown color, like burnt clay.
It’s all I can do to describe the moment.
This body.
I feel such gratitude. Such love.
Mixed with such anger. Such sadness.
The combination is saltysour and it burns my lips.
And so I feel anxious, something small on the edge
I want to sleep it off
or run it off
peel it off in layers
watch the center drop between my legs
trickle to the floor in
silent droplets
of dissolusion
processed like sugar into something digestable
sweet
place it moist to my lips
The most beautiful poetry is what is not said.
What’s between the lines…

… I enter a dimly lit room in the back of the hospital. There are no windows so the only light comes from the hall. Becky (my friend with epilepsy who spent a week in early labor) is laying on a straw mat in the corner. She is sleeping. I know that something is wrong by the shape of her stomach. She has delivered in the night. But where is the baby?

This is the center of the story. The middle. I begin here because this is where every good story starts. In your gut. In the moment where you know it is a story and not just another moment passing. It only becomes a story in the moment when it is told. It doesn’t matter much where you start, because to trace its origin would be to go all the way back to the conception of all of those involved, the conception of their parents, grandparents, and friends. Start in the middle. The moment. Just start.

…Becky’s baby died.
Aimee calls me on the phone to tell me.
I vomit.

The doctor grew impatient with her slow labor and gave her cytotec to speed things along. Cytotec, while used in the USA is extremely controversial and is not FDA approved for use during labor. It is not FDA approved because it kills people. It also has a different name. The abortion pill. The doctor gave her two pills, four times the amount used in USA to induce a labor. The placenta detached from the uterine wall and the baby died. She gave birth twelve hours later to a dead baby. A girl.
I want to scream. Not again. Not this one. Will it ever stop?

Aimee and I write up a report and document many of the cases that were mishandled since we have been here. We highlight three cases that ended with either maternal or fetal death (or both) as a result of negligence and misuse of druggs. I state concerns and create a long list of simple suggestions. We share it with the head midwife. She is receptive. She says thank you and gives us gifts of sim sim paste. She shares it with the doctor and he becomes angry. He confronts me on the labor ward. I am gloved up and ready to catch a baby. He paces the room until I finish and come to him.
He wants to talk about Becky’s baby since she was in the report. He says the drug is safe. Otherwise why would the ministry of health give it to them to use? Especially since abortion is illegal here. I show him the passage in a midwifery book that talks about its dangers. He looks surprised. Says he will have to read more literature. I suggest he read the literature before he administers any drug. He says then he will become very tired. He is right and he is wrong. He is right. He has not been trained properly. He needs to read more. To be supervised by senior doctors. He is overworked. The issue is larger than him. He is wrong. His ignorance, forgetfulness and apathy are killing women and babies. Every day.

…I go to Becky in the evening and she is still sleeping.
She has not woken since she gave birth.
I sit with her.
Rub her feet with arnica.
She wakes after some time and smiles at me.
Rachel, she says
Yes
Can you buy for me some ice cream?
I feel the urge to cry.
Yes, I can buy you some ice cream.
I return with a frozen bar melting in my hands.
It is growing dark.
Power is out and the room has no windows.
I know I need to go home. Dinner is waiting. My body aches. I need to cry.
But not here.
Wait, she says, don’t go. I feel scared of the dark tonight.
Ok. I sit a bit more. I tell her to close her eyes and lead her on a visualization.
Down safe tunnels of light that carry her and the spirit of her baby.
She begins to weep.
I ask her if she has named the baby.
She laughs and says Rachel, the baby is dead.
Right. The baby is dead.
But it may help you. Even if it is just in your head.
She shakes her head a little and falls asleep. Her breathing is deep.
I leave and feel my hands shaking.
They smell of rubber. I wash them but the scent lingers.

The baby I was up with the other night died this morning.
Her mother was down in the cesarean recovery room and she had remained in the maternity ward on oxygen, an extra soul in the room.
This week has been hard.
Simple.
The relationship between living and dying so intrinsic and real. Raw.
As a midwife, one who ushers in life, I am exploring what it feels like to hold death as well.
It is hard and hard is good.
As a midwife, one who is with women, I am exploring what it feels like to have to set boundaries... and not always be there.

This week needs to be about working with the administration of the hospital to help implement some better practices... some standards of care and accountability amidst the chaos and trauma of working in this environment.

I am working the evening shift tonight and will spend the morning preparing a report and creating some worksheets that can be used on the labor ward to create accountability.
Simple.
Charts to document the fetal heart every hour... that must be turned in at the end of a shift.
Checklists for post partum care.
Cleaning each bed with bleach after every birth.
Infant CPR training.
Breastfeeding and HIV/AIDS transmission training.

I could go on and on. But some simple changes in practice might determing where women and babies stand in the line between life and the line between death

Red dirt

The woman with sepsis whose baby died, also died yesterday.
She was 17.
I didn't sleep again last night after I heard news of her death. I tried to wrap myself in a protective energy robe. My eyes were twitching. There was a loud thunder storm and rain beat down like a drum on the metal roof. I felt haunted and restless. A spider bit my foot at some point and I spent the rest of the dark night examining my foot and transferring my middle of the night paranoia onto the bite (if this is a poisonous bite how will I know? Will I die? Or maybe have my leg amputated..... one should never over think in the night) , as flashes of lightning allowed me glimpses into light.
Somehow morning came and once again a cold shower and a hot cup of coffee were my best friends.

We attended the burial at 1:00. Walked 4k deep into the bush, hiking up our skirts to avoid puddles, rocks and red ants as her brother led and a man hacked a path with a machete in front of us. The sun beat down and the red dirt stuck to my beading sweat in a patterned film on my skin, the natural lines mirroring the intricate work of a henna tattoo.
I imagined walking this path in labor to get to the hospital. How long it must feel. How the earth stretching out for miles in every direction could induce deep comfort or fear.
We passed corn fields and millet fields and fields and fields of grass until we came to a circle of 75 people. Our girl was wrapped in a cloth in the center. They unwrapped her face so we could see it. She was beautiful. Her eyes shut she looked like she was out of the anguish we have seen her in for the last week. We bent down, said silent prayers, and they lifted her body and placed her into the earth. Four men went down into the hole with her and began to pull the red dirt in with them. As the grave filled, they climbed higher and higher until they were standing on level ground.
Our girl's five mothers sat on a straw mat and watched silently. Her birth mother lay down unable to watch. As soon as the last shovel of dirt was placed on the grave the silence broke. A loud wail went up and suddenly all fifty women were screaming and crying and beating their chests, a communal wail that must have reached reverberated off the empty plains and fields, almost like a clap of thunder. It was impossible not to weep as well the communal permission to grieve felt much larger then just a sadness over this death, it felt like we were weeping together for all of the moments of suffering that led to this one.
Our girls mother got up first and placed her flip flops on the grave and led the procession back out of the bush into the IDP camp.
We followed behind, trembling but also feeling a sense of closure, this story, like so many others, does not end as the dirt covers the body. It lives on, in our living bodies- in the hearts that feel so much, the cheeks that support the tears, the eyes that take it all in, the lips that share the tale, and the ears that listen with compassion... and advocacy.

I have so much to write.