Menstruation and Goats and TV; Aka, random post

Internet has been down, power has been in and out, and we have all had the flu. I am sitting in an internet cafe where they are blasting Annie Lennox and the computer keeps turning on and off.
Ahh, what a week.
We have launched 'The Moon Project'. The issue of menstruation across developing nations is becoming bigger and bigger. Women want to use sanitary napkins because they are modern and yet they are often purchased in place of food in communities of extreme poverty. Secondly, there is no sanitation department coming around to collect trash- pads are filling/clogging up pit latrines. Last week at St. Monicas they pulled out TWO WHEELBARROWS full of used pads that were clogging the pit latrine. So pads are a burdensome cost, and there is no way to properly dispose of them. Women don't want to burn them because of a belief that if one burns menstrual blood one will become infertile.
Third issue is chlorine bleaching of pads- that chlorine when warmed against skin can emit dioxin gas which studies are showing leads to increased risk of cervical cancer, heavy bleeding and cramping and infertility.
So the moon project is a sewing collective of Child Mothers who are making re-usable cloth pads. They are AWESOME. Made with sofr terry cloth with inserts for lighter or heavier days. They have 'wings' that button under the underwear and are cute- sewn with bright aftican prints and are able to be folded into a little square for storage. We are making 'kits'- each kit includes a bucket for washing pads, five pads (three small and two large), a bar of soap and an information booklet.
The kits sell for the same cost as 3 month supply of disposable pads, but will last for 2 years. We completed our first order yesterday, which was sold to a dance troupe called 'Undugu Family'. The child mothers are taking home 2/3 profit after supplies, and the cost of the kits are still affordable to the community. We now have orders from boarding schools all over region. It is an exciting venture into a truly 'holistic vision' for Earth Birth and for women's health in general. We will post pictures on the website soon.

What else....Trainings have been amazing. Figuring out how to get creative when we hit information blocks because of language or cultural understanding. We have been trying to work on counting fetal heartrate, but are finding multiplication is a challenge (you have to listen for 15 seconds and multiply the number by 4 in order to get a full minute count)- so we have created a colored bead system. Strings of bead that you count off on your fingers as you listen. If you are in the white zone the heart rate is too slow, in the green zone it's good, in the purple, it's too high. When we were making them last night a priest asked if we were making molyo beads- which he explained are what women traditionally used to count the days of their cycle and know when they were most fertile.
Tomorrow is our workshop on labor management. We have made a large vulva puppet (out of bright african prints) that women can reach into and check cervical dilation and the position of the babies head, which we fashioned out of paper mache. It works really well and gets a laugh every time we whip her out.

In non midwifery related news, Chioke slaughtered a goat. They asked him to do it and without any apparant fear he took the dull knife he was handed and slit its throat. It was so dull he had to saw for a while until the goat stopped moving. I watched. It was both repulsive and impressive. The goat was then skinned and BBQed for a large feast. I made ground nut stew and stuffed peppers which were a big hit. The next morning, Sister Rosemary placed the roasted testicles of the goat on a plate and presented them to Chioke. For virility. He didn't say a word, just ate the rest of his meal around the jiggling balls. Finally when nothing remained but the testicles, everyone looked to him and he said 'no thanks sister rosemary' and everyone burst out laughing.

There are a number of American funders staying with us for the opening of a new counseling center. One of them is the host of a Cathlolic television show in the US called 'Focus'. She interviewed Olivia and I about the project. It was a difficult interview- I ended up having to sidestep a lot of questions like "tell me Rachel, are these the worst conditions you have ever seen for women giving birth'?
Which is a difficult question because yes, they are, but at the same time I feel a deep commitment to avoiding the Western Gaze onto poverty and the struggle of 'the other'. I know that evoking emotion in others creates commitment to change, but it's playing into a difficult and complicated discourse of 'west saving Africa' that I feel we need to more actively address in any kind of activism/outreach work.
Anyway, this is a national TV show and will probably bring lots of good attention/funding to the project- I suppose I will need to live with and write about my complicated feelings as it airs.


That's it for now. I am off to make broth for Chioke and Olivia who were both sick in bed this AM.

great north roads

It is still dark out but the alarm is blaring from Olivia's room and I can hear it through the tin walls as if it is were in the bed with me. I roll over in hopes of blocking out the noise but soon there is a knock at the door. It's 6:00. Get up.
We are driving to Atiak this morning for our first workshop with the Traditional Birth Attendants who will staff the clinic.

Breakfast is dry white bread with peanut butter and hot water with lemon.
Chioke has volunteered to drive the old white truck that Sister Rosemary has given us (now that she has a fancy Safari vehicle). Better him than me. It is a stick shift, but the gear shifter is up by the wheel, and there only appear to be two gears. We cannot find reverse, so our first moment involves Olivia and I jumping out and pushing the car out of the driveway.

'The Great North Road' stretches from Cape Town to Cairo. The stretch from Uganda to the Sudan is a thin strip of unpacked red dirt that has more pot holes and puddles than actual road. It is the kind of road that would make a chiropractor rich and makes a girl wish she had a better bra. There is never a moment of relief in which one can shift into a higher gear and just drive, it is a constant navigation of holes, bumps, puddles, mud and of course, people, chicken, cows, goats, motorcycles and huge trucks and busses carrying dry goods, soldiers and villagers alike, into the Sudan.
After about ten minutes on this road, Chioke turned to me and said 'Why are we doing this alone?'- to which I had no good answer.

One hour into our two hour journey we were flagged over by soldiers with guns. I realized as soon as Chioke slowed the truck what they wanted, but it was too late.
"Please, help these refugees get to the next town". We looked over to see about fifty people, babies, luggage, animals by the side of the road.
"How can we take all of them?"
"Please, just take the women and children"- and who can say no to that?
If in doubt, always play the women and children card to passing Americans.
So suddenly there was a rush of bags, pots of water, babies, women (and a few sneaky men), chickens loaded up into the cab of the car, piled on top of one other and spilling upward so that the final passengers rode on top of the truck.
Chioke, who now had the grave responsibility of driving smoothly enough to not knock any of these people onto the road, placed his face in his hands and took a deep breath. I felt bad, but not that bad as I was also hysterically laughing at the madness of it all.

The IDP camps of Atiak are located along the Great North Road (only great because of its length). Because of its proximity to this road and its proximity to the border of Sudan it is what most people call the 'pathway for the rebels'. It was the first village in Northern Uganda to be devastated by the war and the last to receive aid. The World Food Program only came in six months ago. There was a major massacre in this village on April 20th, 1995. Someone pointed out this was also the day of the Columbine Shootings which the entire world heard about, but very few have heard that on this day 250 people were lined up and shot while the rest of the village watched. In fact, this tiny Wikepedia article was all I could find on it.

We arrived 20 minutes late, to a group of thirty five traditional birth attendants (34 women and one man). More than we expected. They sang and danced to greet us and we soon settled into a comfortable circle under a large tree.
The training went amazingly well. It was a true sharing of practices, knowledge, ideas and stories. We began by having everyone speak about their first experience at a birth. Many of them had attended the births of their 'co-wives' as young girls who were first married. In all of the stories, history was reflected- they all got 'trained' in 1989 by World Vision and this was when they considered themselves official TBAs, and also the time they were taught to keep women lying on their backs throughout labor, to restrict them from food and water and to refer, refer, refer to the health unit (at that time the closest one was 7 miles away).

We then invoked an image of a large pot and asked for everyone's collective knowledge. Olivia and I enacted a 'normal' birth one of us in labor, the other the midwife, and we asked them to tell us what to do in order to manage it. We then acted out complications and asked for the same feedback. It was really fun for everyone (most who cannot read or write) and tt was an incredible tool for gathering what they do know and also seeing where the gaps in knowledge are (ie, when Olivia fake fainted from a hemorrhage they said, give her tea and wipe the blood).

We spent a lot of the day focusing on labor positions and comfort, which was also really fun. Massage, comfort and one on one support are arts that have been lost in the flurry of technocratic trainings and trauma of war- and yet were able to pull out some of their 'old knowledge' and also add a few of our tricks to the bag- and lastly, on our little laptop screen in the middle of a refugee camp, we showed a video of a home birth in America, which really caused some tong clicking and oohs and ahhs as the woman in the video squatted down and leaned on her husband for support as her baby was born.

I once again question the line between offering 'too much' information and allowing what they know to be trusted as well. I think we were as successful as we could be- allowing for a group knowledge that grows and builds on itself and where best practices are valued as those that are safest and most culturally relevant.

The drive back was pure misery. We got stuck in the mud and once again, Olivia and I hopped out to push the truck which slid and skidded all over the place, blowing black smoke and red clay like mud all over us. Eventually a truck stopped and with the help of a few more men we were soon bouncing down the road to Gulu. I can't quite imagine how we will do this every Monday.

A long update today. I suppose the great north road is a good metaphor for this project- it is something you can navigate, but it twists and turns in the most unexpected places, it is longer, it is deeper, it is more expansive than any one person, one project, could ever know.

ways of knowing

Sunday mornings are slow. I baked some eggs with fresh garlic and tomato and brewed fresh Ugandan coffee.
I have a moment to reflect and yet I can't shake this feeling of wanting to escape the process somehow. I have been thinking a lot about communication and its culturally embedded nature. Sometimes you think you are on the same page with someone but it turns out you are not. I had such an encounter yesterday with Lam, our connection in Atiak.
He was a generous host. He housed us, fed us, connected us to the chief of the village so that we could get his blessing, and helped us to coordinate the first meeting of the TBAs. We set up our first training for monday (tomorrow).
Yesterday I ran into Lam on my way to a workshop with the child mothers at St. Monicas. He was insistant that we meet that moment, even though I was rushing to begin the workshop. What came out was that he thought we should wait a week to begin the trainings because he wanted to be there for it and he had other obligations. I explained that I understood his frustration, however, since we are here such a short time, it is important to begin sooner and that he should rest assured there would be a place for him when he came. He then became very upset that I did not concede to him, stating a few times that my project won't be sustainable without him and 'This is Africa, you need to listen to the men". I explained that this sounded like it required a real meeting and I was running to a workshop so could we please meet later? He stormed off.

I left the room feeling shaky and uncomfortable. I spoke to Sister Rosemary who said he simply likes control and it is not a big deal, and ultimately, it is not- but it speaks to an overall issue of communication. We all have these different cultural narratives and ways of knowing that shape and shift the way we understand events- so the same conversation can be interpreted in a multitude of ways. I wonder how we enter into international dialogue in a way that nurtures some of these gaps and allows for perspective and listening. I wonder how women can navigate male spaces, and vice versa, I wonder what it will take to make it safe to allow men into womens spaces.

I saw Becky for the first time on Friday. For those of you who remember, she is the girl who lost her baby to an unmonitored cytotec induction last year. She came to the compound and we had a nice meeting, she is back in school and doing well. Then yesterday she showed up again. She said had been beaten by her landlords son, and kicked in the uterus and had been bleeding all night, soaking through pads. In reality she was bleeding very little and it came out later that this may have been her period, since she was expecting it. Not to discount her pain because I know it is valid and I believe she is indeed being beaten ( a cyclce I wish with all of my heart I knew how to stop), but I am interested in the need for women to present themselves as victims in order to get attention- even from other women. So many questions are coming up for me around how to advocate, how to heal, how to empower and how to represent in a way that speak to my earlier questions of communication and cultural difference. Robbie Davis Floyd has a great article on Ways of Knowing and thinking in midwery systems. She says that even cultural relativist thinkers (those of us who value each cultural belief as equal, not prioritizing our own), must move beyond to what she calls Global Humanism, a way of knowing that says yes your way is good and my way is good, but there are certain things, like the beating of women, which we ALL must move beyond, even if it is 'cultural'. I like this, yet the way into action is thickly layered and complicated.

We have just returned from Atiak.
It is a community of IDP camps 20 miles from the Sudanese border.
Literally the pathway for the rebel army and as such nearly untouched by resources.
We slept in huts in the camp and met with the elders of the community as well as the TBAs to do a needs assesment. It seems the largest issue is that Doctors Without Borders came in about 5 years ago in the height of the conflict. They provided tons of care but in the meantime, replaced the doctors and healers of the community. They left last month to go to Somalia and the community is without any formal healthcare system. The TBA's have jumped back in to catch babies but do so for no money and with no backup support should an issue arise.
Sister Rosemary is setting up her second school in this area and so we are beginning the TBA work here. The TBAs will work hand in hand with child mothers to create a model for safe birth that is realistic for their community.

Internet is in and out so I will have to be short again, but I promise some full throttle blog entries soon. They are collecting on my computer, just can't plug it in yet.

Arrival

It has been a journey.
Start with the getting here. It took us three days, four planes, one night in a tent and a six hour drive through the night to land us in Gulu. On the plane from London to Nairobi, Chioke fainted. I was fast asleep and felt a strong tapping on my shoulder. I looked at my seat mate to the left and he pointed to the floor where I saw Chioke's legs. At first I thought he had just fallen into a deep sleep and perhaps fallen out of the aisle seat, but it soon became clear that he was unresponsive. A few minutes later with some oxygen and some loud and unnecessary freaking out of the missionaries sitting around us (was he drunk? was he acting weird? do you think it's a seizure?), he was back into consciousness and had no memory of even feeling sick before he went down. We chalked it up to altitude, and I kept my hand on his pulse and plowed him with tea and power bars to bring his blood sugar and body temperature up.It was an intense experience for both of us, and for very different reasons. For me, it brought up feelings of impermanence and transition- moving from one space to another. Perhaps there is a necessary moment when we all must check out in order to make room the next space. I don't think this moment is one we often acknowledge or think about, but I think it is intrinsic to moving through time and space. Chioke provided me with a dramatic enactment of this. He made me take a picture of him with the oxygen tank on his mouth (that was when I knew he was feeling better) so perhaps I will post it and others soon with internet is more reliable.

The first night in Nairobi, sleeping in a tent, feeling the stars and the cool air around my body and in the words of Sister Pauline, deep in the belly of my blanket, I took a deep breath and allowed my arrival on the continent to sink into my body. The weight of travel, of moving through, and finally arriving somewhere is a process that inspires reflection and perhaps even eloquence. And yet what I found was that I had no words. The sound of the monkeys outside, the coyotes in the distance, a crickets at my feet provided a sweet lullaby and I fell into deep sleep.

I am going to invoke a 'fainting spell' into this narrative now, a necessary checking out and skip to our arrival in Gulu. It is beautiful. Perhaps even more than I remembered. The amazing warmth of the nuns and the hospitality they provide. Lush green grass layered over brick red dirt and trees that house animals large and small. The sweetest pineapples, the juiciest mangoes, the ripest avocados, stacks of fried dough and mushrooms that grow in abundance from termite mounds and melt the moment they meet your tongue. Perhaps the eating of meals offers a way of knowing a place that is as layered and diffuse as the hands that harvest, buy, prepare and eat the food itself. The contrast of course, is that most people are hungry here and that hunger or shall we say great need, pervades moments of intimacy, connection, genuine opportunities to achieve success. I find it hard to have anything to say. I'll call it an adjustment and processing period and hope that in a few days I will be able to describe the actual events that have unfolded. For now I will give a bit of a list.

1. Olivia has done a lot of prep work. She has selected 12 Traditional Birth Attendants to begin training immediately. The vision shifts a little every day as reality and needs come up and we work to create a project that is truly community centered.
2. The clinics walls are up and the construction is in full swing. It should be finished within two weeks.
3. Sister Rosemary has identified a group of women between Gulu and the Sudanese border who have been untouched by resources. She has purchased land in this area called 'Atiak' and will build another St. Monicas there. We are headed there this evening to meet with the TBA's and think about how all of our sites can connect to resource these child mothers. We will stay over night and conduct narrative interviews in the morning.
4. I am tired.
5. I am excited.