A Midwife in Dialogue with Medicine

Midwives Everywhere

2008-09-28T12:47:00.001-07:00

Online Shopping? Support Earth Birth!

2008-09-08T18:25:00.000-07:00

Click Here to link to our cause on Igive.com

In the spirit of getting our birth clinic fully built in Uganda, I am happy to say we have linked up with a cool site: http://www.igive.com/

Basically, you sign up as a member (it's free) and choose us as your cause.
Whenever you shop online at one of the stores they are connected to, a donation comes directly to us (between 12%and 2%)

There are 700 stores. Examples are: itunes, barnes&noble, homedepot, expedia, officedepot, staples, sony, radioshack, bestbuy, ebay, overstock, bose, sears, orbitz, macys, nordstrom, urban outfitters, bloomingales, steve madden, at&t, etc.

So please sign up- and if you have any online shopping to do, you will instantly get good karma points! Free money for women's health care!

Thanks for all your support and love!

Questioning, Witnessing, Teaching

2008-09-05T13:04:00.000-07:00

I wonder what it means to be called into action.
To turn an apathetic understanding of an issue and move it into an activation of energy and resources.
I read once that 'people are not moved to action by information alone'. We can hear of devastating things, but the fact alone will not produce change. We have to be 'moved' emotionally or physically. This is why 'Save the Children' campaigns show pictures of a lonely and sad looking child in the dirt- the point is to move us into feeling into action. It works. Affect is effective.

We do things because they feel good, or because they prick us, it hurts, and we think our action will make it feel better. I believe it is hard not be apathetic about issues that are 'larger' than us our outside of our immediate control. I have spent most of the time our country has been at war 'not really thinking or feeling' about it. It doesn't effect me personally, so I tend to ignore it except for the occasional "this has to stop" statement to no one in particular.... and of course, I plan to vote for Obama who also wants to stop the war, but ultimately this remains outside of my control and outside of my feeling place.

I have been pricked. Not by our war but by another countries war. Maybe the objectivity of the other makes it an easier entry into compassionate engagement than my feelings about the Iraq war, which quite frankly just brings up feelings of disgust and shame.
I have been an active witness to the effects of the war in Northern Uganda. Working with, breathing with, struggling with women giving birth. It was not romantic or pretty. Women were traumatized, terrorized. The pain and pressure of pushing a child out is often mirror like to that of being raped.
The hospital has no resources (no running water, watered down and re-used bleach, limited glove supply) and a staff of midwives who are victims of war themselves, traumatized and often apathetic since it is the only way to get through the day. At the time, my partner and I thought this was the way in. To work within the hospital system in an exchange of ideas and practice. The result was that we were traumatized and exhausted at the end of each day and the failing system did not shift. We were outsiders coming in and we would leave. This was the very thing I tried to avoid, instead of accepting its inevitability.

Upon my return I struggled with a number of questions.
Was my presence as an outsider an act of violence unto itself?
Had we really 'exchanged' anything at all?
My fear was that with the power dynamics such that they are, we really hadn't.

With Earth Birth trip the entry is different. I the point to facilitate spaces of safety in which culturally appropriate linkages and exchanges of information/best practices naturally occur. We all become simultaneously outsiders and insiders to the process of building as women, sisters, mothers, daughters, etc.
I guess the larger question is how does one stand active witness to WAR itself. I am now teaching an undergraduate class at Rutgers University on women's health issues in areas of war and terror.
The first question I asked the students was:

How does war effect women?

The answers were insightful and sparked a great discussion.

When women's bodies become political weapons.
When rape becomes a tool for political gain.
When children are bred to be turned into soldiers- women still must carry, birth and nurture.
When there is no food, women still have milk.
When shame and stigma are attached to forced sexual acts and reproduction is the evidence.
When resources are so low and poverty and malnutrition is so high that giving birth is truly risking life.
When trauma becomes set into the body and is ignored, sedimented.

The war in Northern Uganda has been a reproductive war.
It is literally about creating a new generation to fit the rebel armies vision and plan.
That creation takes place at women's reproductive cores and therefore the physical and emotional toll of giving birth and raising babies cannot be overlooked.

I think the next question is one for the women who are victims of war : What would radical intervention look like?
Feel like?

I don't think it's a question I can answer- but it's certainly been done before- the madres in Argentinas Dirty War, or the Women in Black in Israel/Serbia. Sustainable interventions created and led by women- I think the first step is to create a space in which it is safe enough to even begin the conversation. Apathy and silence are symptoms of trauma, violence and oppression.

Witnessing

2008-09-04T22:16:00.001-07:00

I used to feel like it was enough to hold space and witness another as they transform through something.
I attended a birth the other day where a woman really worked through some deep psychic pain.
It was all I could do to stand present, hold space, witness, and ultimately make sure she was medically okay. In the end I wonder what it is that the presence of an 'other' does in the room. I can see how it can be both productive and destructive-perhaps at the same time.

In order to witness, one has to make arbitrary decisions about what is important to notice. Significance is produced through the gaze of one onto another. In order to notice one thing, there are other things that will get blind spotted. This is a characteristic downfall of critical theory-when light is shed on one thing, shadows fall elsewhere. I wonder what knowing this does to the role of the witness as a productive member in a room and how it can both make and unmake an experience of the one who is experiencing/embodying the event.

Labor dance

2008-09-01T20:38:00.000-07:00

The question of how narrative is transmitted is to my understanding one of the biggest concerns of folklorists. For me, how narrative is interpreted and understood is perhaps a more fertile space for inquiry; However, I have not spent much time thinking about how one performs understanding. I was brought into this way of knowing when the TBA's spontaneously began to embody labor support techniques.
After a workshop where we spent a lot of time unlearning the World Vision model of women laboring lying on their backs with hands and knees flat, the midwives thanked us by improvising a labor support dance. I had chills when it was happening and I get chills every time I watch it.

On performing illness, part 1.

2008-08-28T12:07:00.000-07:00

We break for lunch. The meal is a small piece of overcooked goat slathered in a salty brown sauce (quite literally salt, onion, water and brown coloring) and millet bread (actually kind of a dough) served on multi colored plastic plates. I get pulled out of the room by the chairman who complains that we have not purchased soda for everyone. I explain why I think buying sugary soda instead of clean water (in a camp that has no running water or sustainable food supply) is not something I want to do. Instead, we have brought raspberry leaf tea. The chairman is annoyed. He wants soda. I return back to the lunch area and Olivia explains the benefits of this herb for women and gives everyone some seeds along with their cup of tea, for their own harvest. We do a ‘raw foods’ demo- talk about the nutrient and medicinal value in eating raw veggies that grow in their area- like garlic and avocado- we make guacamole and it’s a hit. Women scramble on top of each other and argue about who had a bigger sample. Is this as good as the bliss of a cool, bright orange Fanta sipped from a glass bottle? It's all in how you look at it.

Upon return to the workshop space there is a commotion. Everyone is huddled around a woman and speaking rapidly. It seems this woman’s money has been stolen. She brought her entire months earnings with her (20,000 shillings, or about $13), and it is gone. She is inconsolable. There is a group discussion about who and how. Someone suggests that we all give 500 shillings (30 cents) so that she can recover the $.
Everyone agrees but the woman refuses to accept it. She says it is gods will that the money was taken. Upon her refusal everyone turns to us to begin the workshop. There is nothing more to be done.

We begin with stories. The playback theater was so succesful we do it again. The first woman stands and delivers her tale in rich detail. As she comes to the climax of the story the woman whose money was stolen falls to the floor. She is unconscious. Everyone gathers around her and begins fanning her and a group prayer invoking jesus into the room is instantly organized. Olivia and I check her pulse- it is strangely normal for someone who has just passed out. The decision is made to move her to the middle of the room and out of the seating area. As we lift her, she becomes rigid. Not the body of someone who is unconscious. She is performing. And her audience is responding. Women are wailing and praying, others have run to get medicine from the nearest health unit, some sit and silently witness. Olivia runs some cold water through her hair and she opens her eyes. She moans loudly and everyone who was sitting to the side rushes to her again. A woman returns from the health unit with some sort of pill which she places in her mouth, washes it down with water.
What is that pill? I ask.
It’s for high blood pressure, the woman responds.
There seems to be no logic to the giving of the pill or its intended function in the body- instead it seems that the notion of medicine, any medicine, as instant healer, will work.
And it does. The placebo effect of the high blood pressure medicine takes immediate effect in this performance and the woman sits up and returns to her seat. Everyone is greatly relieved and we return to our regulary scheduled programming. By the end of the day she is smiling and laughing with everyone else and eventually announces she will in fact accept the offer of everyone antying up 500 shillings.

On the ride home I think about illness and how it works in the body. We know that most illness is indeed psychological and so is there ever really anything that goes on in the body that isn’t in some way performed through the will of the mind?I know this to be particularly true in childbirth. Once women are able to overcome any fears that are psychologically blocking labor and accept the support and love of those around her, labor tends to happen much more quickly and with fewer complications. And to what end do we need to perform our illness or pain (especially if it is ‘real’) in order to engage the necessary response of help and care from our community? As illness is an extremely isolating experience, it is also one that directly calls on the community to witness and to be present. An interesting juxtaposition.

How to do interventions with words

2008-08-28T10:34:00.000-07:00

Return. Re-focus. Re-shape. Re-shift. Reflect.
Those 'Re' words all have to do with turning something around. The 'Re' is an intervention on the word itself.

People ask how the trainings went and I realize I am uncomfortable with the word because it sets up a necessary information hierarchy.
So, I have been using the word workshop, because I think it is more descriptive of the dynamic of Olivia and I as ‘facilitators’, not information providers.

It seems to me that issues of power are largely issues of voice and inherently, listening- who feels empowered to speak, who is listening when one speaks and how that voice shifts or effects change.

The last few workshops were magical. We were talking about how the war effected birth, and used playback theater techniques of having women share their stories and then other members from the group ‘playback’ and act out the story they heard. What happened was that as the stories came to life, more and more women wanted to share and the details in their narratives began to grow more and more vivid. Stories of pushing babies out while hidden in barns and gunshots are being fired down below, stories of running in labor to escape abduction, stories of giving birth alone in the bush while villages burned to the ground in the background, I could go on and on but you will all hear the audio soon. These stories were enacted with such talent and love and enthusiasm I was brought to tears many times.
Women in general and especially women of color and especially women of color in third world countries and especially women of color in third world countries that have been ravaged by war, have historically been and still are, an underheard population. In order to create a holistic health space where each midwife is an equal part of the team, I cannot think of anything more important than cultivating voice. Cultivating voice inherently cultivates listening, cultivating listening cultivates questioning, cultivating questioning cultivates best practices.

As the workshop continued I asked the questions: How can our stories act as a political intervention? How can what we do as midwives help to shape and shift this countries next generation?
Women broke off into groups and we discussed the questions and tried to come up with answers that led to direct action steps.
As I have written here before, apathy is a very real coping mechanism after severe trauma. Those who study poverty cycles note that ‘the sense that one does not have any personal power or ability to make change leads in their own lives is the key to the continuation of poverty’. Apathy, or a sort of numb waiting for others to hand you information creates the necessary conditions in which a community can accept with little resistence, gross violations of human rights.
So how can midwives create an active space? One in which there is a sense of individual investment in the work and therefore, community change.

I want to ask the same questions of anyone who might be reading this blog as well. How can we use our agency as women with voices/stories as both political intervention and as medical intervention? How can apathy be addressed and redressed, reshaped, redone?

Title reference:

Menstruation and Goats and TV; Aka, random post

2008-07-20T02:27:00.000-07:00

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

2008-07-08T03:31:00.000-07:00

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

2008-07-06T01:44:00.000-07:00

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.

2008-07-04T00:29:00.000-07:00

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

2008-07-01T02:03:00.001-07:00

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.

Preparing and Breathing

2008-06-24T06:13:00.001-07:00

I am readying myself for another journey.
A year later and somehow no less complicated.
Last year in Uganda the goal was to work on a maternity ward at a government hospital serving mostly refugees of the war.
The trauma was deep (go back to the June 07 archives of this blog to read about the experience) and it manifested not only in the care that women received, but in the culture surrounding birth and intrinsically, death.

My partner and I worked in a hospital with no running water and unreliable electricity, and perhaps it was that our goals were not clear enough or that there really is a fine line between helping and hurting, or that we put ourselves in a traumatizing situation from which we had the privilege to walk away from, but ultimately we never managed to escape the dynamic of insider/outsider. I believe that both of us had radically different experiences of our time and of the ward itself.

I returned from that trip with post traumatic stress disorder. I began to have panic attacks and had to slowly peel back the layers of hurt and anger that I had pushed through in order to survive, in order to work, in order to be a healer to the best of my ability in that environment. Many things have come up in this process of reflection that have brought me to an innate trust that both personally and globally, change begins within. So how does a person, a group, an organization effect sustainable change in a space that so desperately needs help?

The Earth-Birth project has been a long time collaborative vision between myself and my co-midwife Olivia. Over the last year much has happened to turn vision into reality and without going into a long list, I will say that the turning point for me was when I realized I needed to stop pushing up against a system that isn't working. The question of why 'western' medicine is problematic in under-resourced areas is a subject of much fascination to me- and is the heartbeat of my work in academia, narrative medicine and midwifery. Right now it's all questions- but the main goal is to create sustainable birthing centers that allow women access to important maternal and child care while at the same time offering opportunities for emotional health, healing and empowerment.

So how do I enter into this?
Midwives say its all in how you breath.
Find the center of it, go deeper, allow it to fill all the little spaces and then release. Expansion and contraction.

I am feeling the contraction after expansion. Perhaps it is the necessary tightening before opening wider. I wonder how a person stays open despite the past.

Turning Vision Into Reality

2008-06-11T20:51:00.000-07:00

I am happy to announce the initial launch of the home site for The Earth Birth Global Women's Health Collective: http://www.earth-birth.com/
We are officially virtual.

Thank you to everyone who has supported our project. If I have not been able to send you a personal thank you it is because things have been blossoming quickly.
If you have not had the time to see how you can get involved and support this enormous effort, check out the website!

The site is a work in progress. Please check back for updates, podcasts, interviews and more.

Midwives reach out

2008-05-27T19:08:00.000-07:00

This is a great little PSA for a better trained international community of midwives.
The problem, as I see it, is that we tend to train from one model (a western model) of care which fails to take into account the cultural needs and resources of a community. I think hand in hand with the medical training of midwives, we must do training's in critical risk assessment based on a community of cultural competent midwives. We have to start thinking about how culture effects medicine and inversely, how western medicine effects culture, if we want to have truly integrated approaches to treating women.

Abnormal agency

2008-05-26T09:22:00.000-07:00

Twenty-four women sit cross-legged on straw mats that are laid out strategically to cover the dirt between two huts in Unyama, a camp for internally displaced persons in Northern Uganda. A plate of boiled yams is passed around and water is poured from a large gourd into tin cups. One of the women towards the back raises her hand and begins to speak. I cannot tell if she is young or old. Her voice is soft and we all lean in to hear her. She pauses between sentences so that the translator can speak into the recorder.
A woman came to me in the night. She was feeling strong labor pains. I stayed with her into the morning. Finally, she began to push. I leaned in close to her, placed my hands to catch, but instead of a baby… she pauses and glances around the circle, we are all silent in anticipation, imagining what could have come out in place of a baby…instead of a baby, a swarm of one thousand black flies flew out of her vagina into the hut in a thick cloud. Almost like smoke from a fire. After this there was no sign of a pregnancy. Nothing at all. Her belly became small and tight very quickly. We took her to a hospital and the ultrasound revealed nothing. It was as if it never happened. An American doctor for World Vision suggested we were crazy but I know what I saw. Tell me sisters. Tell me. Was this the Devil? Most women begin to nod their heads in agreement and one woman calls out “yes, yes, this is the work of the devil, I have seen something similar…”
Suddenly there is a rush to speak. Women begin rapidly telling tales of abnormal or ‘devil influenced’ births they have attended: a woman who gave birth to a large hairy eyeball, a child born with her foot attached to her head, and a baby born with a full set of teeth. Sitting in this circle I find myself wondering how narratives about the body and birth work to both create and heal the traumatized female body.

This particular incident was transcribed during a meeting of Traditional Birth Attendants, women trained by their mothers, sisters and aunties in the art of catching babies. None had been formally trained by Western standards, but all had attended hundreds of births and most were mothers as well. Supported by a grant from Mama Cash, an organization that allocates funds to bolster the position of women’s rights, I was one of two Americans, a midwife and a doula, working alongside Ugandan midwives with the intent to exchange practices, share techniques and understanding of the birthing body. I hold a Masters degree in Performance Studies, which framed my understanding of this circle of tales as a performance of it.

The ‘devil’ is one of multiple answers to the question of ‘what’ came out of this woman instead of a baby. The biomedical rationale for a swarm of flies disguised as a pregnancy could be that the laboring mother had a parasite. According to the American Journal of Infectious Disease ‘Gasterophilidae’ or ‘Stomach Botflies’ can produce a pregnancy like distension of the pelvis. Another biomedical explanation may be that, as the World Vision doctor suggested, the birth attendant was delusional and imagined the entire incident. The institution of medicine produces a certain story of the body, one that is skeptical of personal experience narratives. From the biocultural perspective however, the rationale will be as diffuse as the experiences of the women sitting in the circle. Religious belief systems, myths and ritual may be used to make sense of the world in ways that move beyond scientific explanation and offer points of entry into understandings of health. dimension of narrative and voice as intrinsic to women’s health care in particular.

In war torn Northern Uganda, the biomedical conditions of women’s reproductive health are mediated and created by the circumstances of cultural warfare. For twenty-years a group of rebel soldiers attempted to tear down the Ugandan government to replace it with one, it claimed, based on the Ten Commandments. In the name of those religious principles the ‘Lords Resistance Army’ kidnapped more than 20,000 children, who made up the bulk of their fighting army. Some academic attention has been paid to the stories of boy soldiers but fewer accounts have been published of what happened to the girls, although we know that rape and servitude - as well as murder - are part of the tale. Most of the women in Unyama are refugees who have escaped abduction by rebel soldiers and are now giving birth to their rapists babies.

Even in rural Uganda, birth is managed from a technocratic model. “Traditional” birth attendants are trained in practices that date back only as far as British colonization. The story of the cell is privileged over the story of the woman. In spaces such as Unyama, I posit that the biomedical explanation of an ailment is not always the most helpful. Knowing that the flies were a parasite might be useful in America where one has access to clean drinking water and hand sanitizer in order to change future outcomes. In Unyama, knowing the conditions of emergence does little to change the circumstances of transmission. It is not surprising that it is the abnormal birth stories that create the necessary conditions for narrative sharing among the group of women who are both refugees and birth attendants. The tales are bound to overarching themes of religious morals, sin and punishment; themes that are not unlike the conditions that produced the pregnancies themselves. These tales of the devil mirror cultural circumstances and can be useful biomedical tools towards understanding what women think about their own bodies, the babies that pass through them and how they care for one another. The vocalizing of the tales demonstrates a certain level of ownership and rationalization of the circumstances, making possible the potential for personal decisions and choices about bodies and babies, which may be inclusive of safer biomedical practice. The two models overlap and intermix, the story of the woman informs the management of the molecular tale.

In a medical context, interpretation of narrative is critical; the successful transmission of information becomes intrinsic to the care that a patient receives. A scientific explanation may have its place in the treatment of physical ailments- yet it does not address the integral nature of women’s understanding of her own experience and therefore her ability to heal or prevent future instances.

I am interested in intersection of these two tales of the body– the spaces between what a woman speaks and a doctor understands, what a human experiences and science explains. I am interested in exploring the multiple narratives or means of framing one story, and locating the cultural influences between these narratives that can lend agency to both medical practice and patient care. While science may offer some explanations for the social conditions, to privilege the biomedical tale of the body misses opportunities for understanding and thus changes of practice that might be accessed through cultural narrative. The spaces and gaps between the story that is narrated by a patient and the story that is actually heard and interpreted by a health care practitioner should be explored to determine impact on women’s bodies and agency.

Personal Narrative as Medical History?

2008-05-08T11:59:00.000-07:00

I am the daughter of a storyteller.
Personal narrative has been alive in my cell memory since I was born.
My research as of late has been on the medical history- this charting of abnormality we all fill out at the doctor, which helps them to pathologize and diagnose, yet misses most of our actual history of 'health'.

About two years ago I had Cellulitus (a bacterial skin infection) on my face.
I recently switched doctors and so I had my medical records shipped to me. In the ‘notes section’ of this chart, my Doctor had written:
Patient presents with swelling and rash on ears (and face). Bumpy and hot to the touch. Skin is swollen to capacity and has burst… oozing a sticky yellow fluid, between water and puss. Left ear grotesque. Diagnoses: Cellulitus. Treatment: Penicillin and Benadryl.

Aside from feeling slightly woozy from the description, I was intrigued. Here was a history of my body that somebody else had narrated, and I had never seen. Not only that, I remembered the experience completely differently. In my memory it was not my ears that mattered so much, but my eyes, mouth and cheeks: a parenthesis in the Doctors description, but the most painful for me. I remember that all I wanted to do was cry, but could not because my eyes were swollen shut. I remember my cheeks stung and dirt kept collecting on the moist (pussy) skin so I had to lay with a wet washcloth spread across my face to keep from further infection

As Foucault points out in ‘The Birth of the Clinic”, “I cannot be present to a temporality that exceeds my own capacity for self-reflection, and whatever story about myself I might have to give has to take this into consideration. It constitutes the way in which my story arrives belatedly, missing some of the beginnings and preconditions of the life it seeks to narrate”.

Interestingly, a year before I received these charts, I had a flare up of the exact same symptoms that landed me in a Brooklyn emergency room. When my medical history was taken, nobody asked if I had ever had the same thing happen before. I was diagnosed this time with an allergy to Penicillin, the very drug that was used to treat the initial condition. It is hard for me to narrate the significance of these events on my physical body, in part because it is impossible for me to understand them apart from the context in which they emerged. Swollen to the point of having no facial features, my body became unrecognizable to my ‘self’. In order to give an account of myself in a way that was meaningful to the Brooklyn ER Doctors, I needed to remove myself from the actual experience; citing exact moments of swelling and symptoms, and leaving out the rest of the story. Reflecting on this experience and flipping through the charts that documented my medical history I cannot understand them as ‘mine’ without attaching experience to them. In my present embodiment I carry a mark of those stories. I still have a scar on my left ear from the broken skin that the doctor described as the biggest he had ever seen. Yet if asked for proof, ultimately, it is the charts that become the ‘official’ history of my body and not the scar. The scar, however, carries a story, one that is more ‘mine’ than the chart.

In a medical history form there are a prescribed set of questions that are meant to engage and evoke answers that fit into a prescribed way of understanding the body and its past or present malfunctions. The chronological history of the ‘event’ of malfunctions as well as a number of vague lifestyle questions such as overall diet and exercise lead the practitioner to a fuzzy framework of understanding the body they are treating.

The Health Care Financing Administration (those who decide what medical procedures will or won’t be reimbursed) and American Medical Association require the history component of the examination to the following elements (commentary in italics is written in a guide for medical students by chairwoman Donna McCune ).
• Chief complaint (CC)
“The CC states why the patient is in your office. It is a brief description of the reason for today's visit including symptoms, conditions, problems, diagnoses, physician-recommended return, or other explanation. It is usually stated in the patient's own words. This entry is an essential part of every chart note. There must be a reason the patient is sitting in the examination chair.”

• History of present illness (HPI)
The CC and the HPI have a similar connotation. The HPI is a chronological description of the present illness from the first sign or symptom or from the previous encounter to the present. It contains subjective symptoms not observable by another (e.g., pain and nausea) and objective symptoms that are observable (e.g., redness, swelling).

• Review of systems (ROS)
An ROS is a listing of any signs or symptoms the patient may be experiencing or has experienced organized by body system. The ROS is not a history. It is a review of systems directly related to the problem(s) identified in the HPI as well as any pertinent current medical problem(s). There are 14 possible systems: constitution (general health), integumentary, eyes, musculoskeletal, ears nose throat, neurological, cardiovascular, hematologic lymphatic, respiratory, allergic/immunologic, gastrointestinal, psychiatric, genitourinary, and endocrine

• Past personal, family, and/or social history (PFSH)
The PFSH has three parts:
Past personal (current medications, allergies, prior illnesses/injuries, operations/admissions) Family (members living, health status, hereditary conditions related to the present complaint or illness) and Social (marital status, employment, tobacco, alcohol, drug use).

The author of this guide may provide insight into why health histories of the last one hundred years are only concerned with moments of rupture. Unless there is scientific capital to be gained, liability says that it cannot be done.
This locks Doctors into a system from which they must obtain very specific information and ignore the information that doesn’t fit into the box of what insurance says is important. In relation to what she is suffering from, the patient becomes an external fact; the medical reading takes her into account only to place her in parentheses. This enables classificatory medicine to presuppose a certain configuration of disease. The above framework for taking a medical history is used by all Doctors who are members of the American Medical Association. It takes into account a certain history of the body and completely ignores or bypasses another, assuming that illness happens in a prescribed and methodological way. Arthur Kleinmen, in his preface to Patients and Healers in the Context of Culture (1980) offers, “Clinicians tend to be simplistic about clinical practice. Their tendency toward positivistic scientism and atheoretical pragmatism discourages attempts to understand illness and care as embedded in the social and cultural world. Their reliance on ‘common sense’ often masks ignorance of relevant behavioral and social science concepts that should be part of the foundation of clinical science and practice”. (7)

Just a whole slew of thoughts today....

Byllye Avery

2008-04-11T05:33:00.000-07:00

I attended this talk last week, given by Byllye Avery:

Breathing Life into Ourselves: Personal Stories as Research

For the past 25 years Black women have been engaged in telling the stories of their lives, their struggles and triumphs as part of the Black women's health movement. These stories are liberating for the women who tell them as well as the women who listen. The process of sharing personal stories, some obviously related to women's health, some less so, allows women to become active proponents of their own health. Active listening to such stories develops awareness of shared experiences and helps to suggest answers for addressing health and social issues. It also provides information for conducting research and understanding the power of acceptance and self esteem in self care and self healing.

Byllye Avery is a busy woman. Founder of the Avery Institute for Social Change and the National Black Women's Health Imperative and The Birth Place

It was so overwhelmingly inspiring to hear not only about the incredible projects she has effected, but also to think about framing and creating solutions to women's health issues from a narrative as evidence perspective. Listen to a podcast of her speaking here.

A quick shout out to the conference Byllye is organizing in Boston next week. Details are below. I so wish I could be there but I will be helping my good friend Ame at the Umami Festival that night. Also something worth checking out for all you NY foodies!

» Women Must Lead Health Care Reform: National Health Care Conference April 17-18

BOSTON (April 10, 2008) Some of the nation's leading women's health advocates, including former U.S. Surgeon General Joycelyn Elders, will convene at a national conference April 17 and 18 at Simmons College in Boston, to help mobilize a grassroots movement for creating a progressive U.S. health care system that meets the needs of women and their families.

More than 300 national, state and local women's health care advocates will attend the conference, "Hear Us Now! Raising Women's Voices for the Health Care We Need," to engage in an array of panel discussions and training sessions on topics ranging from health care insurance obstacles facing women and girls, to the vision of health care for all from a policy perspective.

This event is open to the public, but R.S.V.P. is required. To register, visit www.raisingwomensvoices.net.

The national conference is organized by the Avery Institute for Social Change, National Women's Health Network, and MergerWatch Project of Community Catalyst, to launch a campaign of actively involved women's health advocates in health care reform. The "Raising Women's Voices for the Health Care We Need" strategy focuses on identifying policy issues related to women's health and healthcare reform; engaging a national network of key women's health stakeholders; developing a women's vision of quality health care for all; and engaging women to become actively involved in the national health care reform debate.

Joycelyn Elders, M.D., former U.S. surgeon general for health and human services, will deliver the keynote address April 17 at 9:45 a.m., "The Crisis in Our Health Care System: Why Don't We Have Quality, Affordable Health Care for All?" in the Linda K. Pareksy Conference Center, 300 The Fenway, Simmons College.

Other featured speakers include Judy Ann Bigby, M.D., Massachusetts secretary of health and human services; Claudia Morrissey, M.D., MPH, president of the American Medical Women's Association; Byllye Avery, founder and president of the Avery Institute for Social Change and founder of the Black Women's Health Imperative; Miriam Yeung, executive director of the National Asian Pacific American Women's Forum; Judy Norsigian, director of the Boston-based Our Bodies, Ourselves; Jessica Rojas-Gonzalez, policy director of the National Latina Institute for Reproductive Health; Judy Waxman, vice president of the National Women's Law Center; and Maureen Corry, executive director of Childbirth Connection.

Conference topic titles include:
• "Uninsured or Under-Insured: Who is Left Out of the System Now?"
• "Making Our Health Care Culturally Competent"
• "Why Isn't Health Care Considered a Human Right?"
• "A Call to Action"

Women's health care advocates say that women's input in the debate on health is crucial, considering their frequent role as the decision-maker for their family's health care. Additionally, with 47 million Americans without health insurance, certain groups of women, such as Latinas, are often disproportionately affected. Those women who do not have insurance, or whose insurance coverage is inadequate or too costly to use, often postpone care or do not get prescriptions filled for themselves or their children. The Institute for Medicine reports that more than 18,000 women die from lack of medical care each year. Women face special concerns such as the loss of dependent health insurance when they become divorced or widowed, and the refusal by insurers in some states to insure women who are pregnant.

To determine specific health care needs and problems of women and their families, organizers have been conducting small group meetings with targeted women's health audiences, particularly underserved groups that are often excluded from health care reform discussions.

Blurring edges

2008-04-06T13:38:00.000-07:00

This is one of the best things I have seen in a long time.
It directly addresses questions of the body, its boundaries and our relationship to those edges.
I am always in awe of how very very beautiful a scientific or mathematic understanding of this world can be.

Poo-phoria

2008-03-12T15:30:00.001-07:00

Thanks for the link, Grace!

I always say that poop is a 'fringe benefit' of working in the birth field.

Avatar Birth

2008-01-28T11:30:00.000-08:00

This is an avatar in Sims 2 giving birth .

Interesting to pay attention to what the programmers choose to 'keep' of the birth process. The woman appears to be in pain, however, the actual giving birth process involves spinning around and catching the baby and an outfit change all in one.

Historical Ruptures

2008-01-28T08:59:00.000-08:00

“The knowledge of a disease is a doctors compass; the success of the cure depends on an exact knowledge of the disease; the doctors gaze is directed initially not towards that concrete body, the visible whole, that positive plentitude that faces him- the patient- but towards intervals in nature- like negatives- the signs which differentiate one disease from another, the true from the false, the legitimate from the bastard, the malign from the benign.” Michele Foucault, The Birth of the Clinic.

In the medical tradition of the eighteenth century, illness was defined in terms of ‘symptoms’ and ‘signs’. These were determined from one another by their semantic value. The symptom is the form in which the illness presents, all are that is visible- a cough, fever, a rash, they allow the invisibility of illness to ‘show through’. The sign on the other hand ‘announces’. The sign performs the illness: The prognostic sign: what will happen, and the diagnostic sign: what is happening now. Between it and the disease is the doctor’s interpretation of a patient’s narrative and symptoms. Medicine produces historical knowledge of the body. Medical ‘gaze’ as Foucault names it is like a magnifying glass, which when amplified to one part, has the potential to call into question that which one might not otherwise perceive and simultaneously has the power to only magnify what it deems important. During a medical interview, we are conditioned to respond to only the questions that the Doctor asks us, nothing more. So conditioned, that the answers becomes the story that we tell. The patient becomes the portrait of whatever the doctor diagnoses. We frame the history of our illness in clinical terms, the chronology of events in or on the body, rarely delving into physical feelings or emotional connection to and awareness of the body.

What happens to the history of the body that does not go into the charts? Does the person who has never seen a doctor not have a health history? In the framing of the body in medicine, the paper of a chart is more of an archive than the body itself. There may well be agency then in the un-narrated history of the body. The history that does not show up in charts, but is narrated through a repertoire of physical embodiment and the performance of ‘self’, as either a healthy or sick person.
Think about it. Is your health 'history' a portrait of your health or a portrait if your body in dis-ease? Is viewing the body through a series of rupture the best approach for comprehensive medicine?
More on the inadequacy of language to express of pain later....

Slippery Narratives

2008-01-27T19:41:00.000-08:00

Sit with a group of new moms together and you will inevitably hear a story or two about birth. From the moment that a women reveals that she is pregnant she is surrounded by women telling their birth tales: in line, in the bathroom, in the park, over lunch; women participate in the ritual process of recounting birth experiences, forming those experiences out of the threads of memory and pieces of stories left after the ritual performance of birth itself. Pregnant women (and anyone around them who will listen) become members of a narrative ring; bound by a conspiracy of the body, contracted by maternity to hear, to tell and retell what others insidiously, joyously, even anxiously- tell and retell. 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 pain medication. The body and the woman intersect and influence one another while still managing to maintain independent realities.

Human’s 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, creating what Rita Charon calls narrative knowledge. If narratives are stories that have a teller, a listener, a time course, a plot and a point, then narrative knowledge is what we naturally use to make sense of them. The narrating and sharing of birth stories play an important role in creating and recreating the performance of giving birth. A classic story of the marriage of childbirth and narrative, cited by Claude Levi-Strauss, is one of a woman who had difficulty giving birth. After a long night and eventually a stalled labor a shaman told the woman in labor the story of valiant warriors freeing a prisoner trapped by strangers, and on hearing the plot resolution, she gave birth to her child. After an imagined break-through, she had a physical break-through. Nature imitated narrative. In this instance narrative served as mental and emotional tool for the production of a woman in labor, and in the course of her giving birth, a new story was created. One that will be recounted time and time again, to her sisters, her friends, anthropologist’s and in a few years, the child herself.

Telling a narrative in any setting is a bridging performance. Most obviously it connects the teller and the listener. A pregnant woman becomes both the subject of and subject to birth stories. Depending on the community she is in, she could hear childbirth described as anything from a horrific and severely painful event to a cosmically orgasmic body quake – there is rarely any narrative in between. This discrepancy of experience, leads one to believe that what one hears about childbirth might influence and shape physical enactment of childbirth. When faced with the often frightening and confusing language of clinical medicine, it is the stories of other women’s experiences that serve as navigational guidance. Asked why she was opting for an elective Cesarean section, a woman recently said to me "my friend’s baby had a really big head and got stuck in her vagina. My Doctor says I have a small pelvis and I just don’t want to be stuck like my friend. She said it was the worst”. Whether a claim like this is ‘bio-medically’ true or not, it certainly is bioculturally interesting. This woman, backed by her doctor, is making a physical choice based on the medical fact of her small pelvis (small compared to what?) and the story of another woman’s birth experience. Another woman stated that she was scared to have babies because all of the women in her family have reported excruciating births. What gets passed on from generation to generation through the body is transmitted and constituted through oral narrative. Oral texts are slippery entities, the way that they are performed and made meaning of shift from person to person. Here I will explore how the sharing of birth stories shapes and reshapes the performance of childbirth within three women’s lives.

A woman walks into a birthing clinic to deliver her first baby. The midwives check her dilation, determine that she is only two centimeters dilated and send her home telling her to come back when her contractions are three minutes apart and lasting one full minute. The woman leaves, gets in a taxicab, and delivers her baby in the cab on the way home.

The dramatic story of a taxicab birth is not a new one; although nobody has formally written about it, this tale is one of the most commonly produced and reproduced birth stories (at least in places like NY where most people travel while in labor by taxi to the hospital or birthing center). I heard this story, and almost identical versions of it three times by three separate tellers in March of 2007. Each teller was pregnant with her first child. Presumably the events of this particular story happened in Brooklyn, NY but as is characteristic of folk and oral narratives its original source cannot be traced. Its interpretation is as diffuse as the tellers who make meaning of it.

The first teller is a forty five year old singer who is married to the drummer in her band. They are having their first child ‘late in life’ because they spent years on the road touring. They plan to deliver their child at home. In her version of the story the taxicab birth happened to her ‘friends cousin’. She told me the story in the context of a hospital versus home birth discussion that she and her husband had been having. Upon hearing this story she was swayed towards homebirth.

“I really see how very natural childbirth is. I mean, in a hospital they try to control everything, but like this woman her body just had its own thing going on. And the baby was fine. Like totally fine. In a taxicab. I mean she could have been squatting in the bush like most women do. I mean who cares if I am older, my body wouldn’t have let me get pregnant if it couldn’t have the baby. So anyway, it (the story) just made me less scared, and more like… no matter where you are babies come out and well if I am at home at least I won’t have anywhere I need to get except the bed.”

The second teller is a nineteen-year-old West Indian immigrant. She is having her baby without the support of her parents or the baby’s father. She plans to deliver at the hospital closest to her house. In her version of the tale, the woman giving birth was her ‘sister’s friend’. Upon hearing this story she felt fearful of her own circumstances and expressed desire for medical intervention and constant supervision.

“ I mean it’s totally crazy how fast it could happen. I just want them to like take it out of me. Not really, but I would hate for something like that to happen to me, to be all alone on my way to the hospital and have nobody to catch the baby, except you know, a dirty cab driver. So scary. So I just want them to umm, induce me when its time, like start the whole thing there that way I wont have to worry about being alone, the nurses will always be there."

The third teller is a corporate lawyer in her early thirties. Her husband is an entertainment lawyer. They plan to travel an hour to a hospital that has very high tech equipment and celebrity birthing suites. This woman did not admit to any personal connection to the woman who gave birth in a cab, but said she heard it from a coworker. In recounting this story to me, her intent was to confirm her decision to travel far to a hospital that was high tech and high intervention, which in her version intrinsically meant ‘better’.

“I wonder if there was a law suit against those midwives that sent that poor woman home. I mean clearly she knew that she needed care or else she wouldn’t have come in the first place, and those midwives that sent her away, well, it just makes me feel really good that we will be going to the hospital where all of the best doctors are and they understand that birth in this day and age is not something you treat lightly, we have the technology so why not use it! You know my sister had her baby at this hospital and she came in at 2cm and they just gave her a nice epidural, some pitocin to speed things up, and voila, she had a baby. That’s what I expect. To be treated like a human being. None of this animal stuff. “

The same story produces three radically different meanings and performative outcomes for each woman’s birth experience. It is not possible to view these oral narratives apart from issues of race, class, power and gender. In ‘Absent Gender, Silent Encounter’; Debora Kodish identifies one purpose of feminist scholarship as the deconstruction of ‘male paradigms’ and another as the reconstruction of models attentive to women’s experiences. Childbirth is certainly a woman’s experience, and yet is embedded in a medical narrative of the body that is historically male centered. As each woman wades through the creative, shifting, interstitial process of negotiating the meaning and value of birth, the taxi story dramatizes the convergence of multiple performativities on the birth experience. In telling the tale, she reclaims an identity for herself as a birthing woman within the context of an always constructed feminine performance. This identity is inextricable from the birth narratives that she has been told by others and chooses to align herself with. Each of these women is telling the taxicab story with the hopes of a better outcome for herself, and yet ‘what’ a better outcome is varies from woman to woman, community to community and ultimately story to story.

In many ways birth stories imply a radical inversion of established structures of meaning and action and so must be, it seems, counter-performed. Della Pollack writes about this counter performance of birth stories stating “They must be circumscribed, discredited, pushed to the margins of discursive practice, whether by identification with ‘gossip’ lore’ or anecdote, or to make a woman’s body and so her story conform to prescribed medical narratives”. This fundamental connection between tale and body has a narrative tracing to the Cartesian philosophical separation of mind and body inherent in the scientific medical view, which does not permit the interaction of individual consciousness with the molecules and atoms that comprise the ‘substance’ of scientific inquiry. Not surprisingly, 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 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 textbook 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”. Martin argues that “there is a compelling need for new key metaphors, core symbols of birth that capture what we do not want to loose about birth”. She argues that any attempt to conceive new languages for birth will be fraught with the contradictions arising from living within an andocentric society shaped by mechanical images of birth and bodies.

In the United States, pregnant women have two choices, to birth at a hospital with an obstetrician, or to birth at home with a midwife. Only one percent of the population chooses the latter . Choice is often rooted in privilege, and feeling free to choose where, how and with whom to birth is no different. Because western culture privileges medicalized, technological and interventionist birth over natural birth, it is ironically most often only the privileged who have access to ‘natural’ birthing options. Western women who choose to birth at home tend to have access to education that allows them to challenge the hegemony of the system, but to do so with the knowledge and confidence that hospitals and insurance companies are there for ‘backup’ should they need them; they therefore inhabit what theorist Donna Haraway calls post-biomedical bodies- bodies that do not entirely deny the usefulness of biomedicine, but are able to challenge its authority. Conversely, in areas of the world without large western influence, most new babies pass through the hands of midwives. In these areas, it is only the privileged who have access to ‘western’ style birth experiences in a hospital. These ironies provide ample room for questioning the intersections between cultural and medical practice as they are chosen, experienced, embodied and turned into tales.

A story like the taxicab tale, in its unpredictability, its high drama, and uncontrollable female body rupture, disrupts this ‘male tale’ of the body and perhaps is why women across race and class divisions feel so drawn to telling it. The middle-aged singer, who sees the ‘good’ in the tale, elaborates on the potential for a natural and un-interventionist homebirth; in doing so she disrupts the medical narrative that assumes the birthing body must be controlled. By invoking alternative systems of knowledge, this woman uses the story to challenge the hegemony of mainstream childbirth systems. The young woman, who reads into and interprets ‘fear’ as the dominant theme of the woman alone in a cab, aligns herself as a subject to medical practice and is comforted by the notion of her rupturing body under constant management. By virtue of her vulnerability as an ‘other’ this young, single, pregnant, woman of color trusts the institution of medicine to take care of her, exemplifying what Foucault called the clinical ‘gaze’. Finally the lawyer both expects and demands technology as an extension of her privilege. The body as machine is a removal from that which is primitive. For this woman, the ‘uncontrollable’ birth of the woman in the taxicab is a gross malpractice of a medical profession that should be better at monitoring and managing bodies.

One clear distinction is that none of these women wants the taxicab birth to happen to them, yet everybody wants to talk about it. The women told this story in the hopes of achieving for themselves and thus being licensed by what medical discourses describe as a ‘good outcome’, to elaborate and embellish dangers and conflict, with the intent of improving the climax, of ensuring relief in the final orderliness of all things. What Della Pollack calls the ‘almost but’ structure of birth stories, the expression of happiness depends on a ‘flirting’ with death: exposing the possibility of death only to deny it. Depending on her cultural circumstances, each woman sees a different path to denying it, yet is equally intrigued by the dramatic thread.

Perhaps unintentionally, the narrative ring of women telling these stories undermine the presumed neutrality of medical procedures and the apparent transparency of birth experiences with the pressure of their own reflexivity, effectively hot wiring a networked of rituals and resistances composed at least in part of medical techno-dramas, prenatal pedagogies, compulsive performance of the ‘good mother’, and the birth narratives that in various forms pervade, mock and sustain all of the above. Looping through multiple performativities, birth stories threaten not only the conventional isolation of birth from other episodes in the formation of cultural identity but also the concomitant isolation of birth from the broader body-politics, related issues that become silenced narratives such as miscarriage, abortion or even sexual orientation.

When women tell stories of the birthing body, the body becomes story; birth stories are always already performed. As performances they are unique constructions of bodies in time. As minor myths of origin, they loan history the authority of beginnings, through repetition and condensation, they become the founding facts of history. The convergences of performativity and maternity, in making history subject to the maternal body performing itself in ritual, spectacle and story.

Tell me what we gonna do

2008-01-24T17:40:00.000-08:00

Joss stone wants to become a midwife.
Just had to share.

Performative Medicine

2008-01-24T11:05:00.000-08:00

How do we change medicine? My thoughts are really questions and my questions spark further inquiry. How does one engage to change a system that doesn’t acknowledge its own malleability? Last year with the help of Anna Deveare Smith, I created a basic model for the collection of a medical history that was organic and comprehensive of a health narrative that moved beyond ‘ruptures’ of normal, and at times beyond words to describe events on and within the body. This model was based on practice as a midwife and my lifetime of observation of medical practitioners, performing on and around me. It is the beginning of an inquiry into better practices, better performance and better healing.

Modern medicine is based on the notion that what ‘science says’ is right. Even though what science says often changes, in the moment it is treated as the absolute and last authority. “Science Says” language positions the logic of science over the expression of human experience or knowledge of self. We are conditioned to believe and trust ‘science says’ over our own innate knowledge or feeling. Human voice, agency and desire are wrapped up in a system that is integral to their existence and yet does not acknowledge them as important. I believe that medicine must acknowledge human experience as intrinsic to what science says. The separation of the two is dangerous.

Science say is also related to ‘liability says’. Healing in this country is tied to money and to insurance coverage. Doctors and nurses are trained to heal from a liability perspective. Unless science says, liability says that it cannot be done. This severs the intuition present in genuine human interaction and also locks Doctors into a system from which there can be no creativity or out of the box thinking.

I realize that I can write a medical model for care but unless it is actually used, the model as a tool does not reach its full potential. It becomes like a script for a play that never gets produced; one that just sits in a file somewhere, or is performed for only an audience that likes and agrees with what it is saying. We need to challenge the audience who does not agree with us. Fortunately and unfortunately this is a very large audience. It constitutes most of the Doctors and the nurses who manage medicine and therefore what ‘science says’ is health in this country. Those of us working off the grid need to be a good enough engagers to work with other medical practitioners- to ask questions of the system we work in; to try new things; to trust the human voice and human emotion as intrinsic to the numbers, the cells, the blood and the skin.

As healers we are channelers. We take in another persons story, the account that they give about their embodied experience and channel what we have heard into some sort of action. I thought a lot about this in watching Anna perform her 'ADS' method, which is indeed a channeling; a taking in and a feeding back of words, gesture, expression so that you become a conduit for that person’s energy and story. As Richard Schechner would say, one becomes simultaneously ‘not and not not’ the person that one is performing. Intrinsic to this is a deeper understanding of a person’s role or position. I believe this to kind of transmission, of really listening and offering back, could transform medicine.

I want to think about and question the role of listening and the role of empathy in medicine. I once had a therapist who would cry every time that I cried. This made me terribly uncomfortable. In fact, it was inappropriate. He was taking on my emotion as opposed to staying removed from it. I expected him to be removed so I was unsettled when he was not. And yet, if ‘science says’ language told me that a therapist healed through empathy tears, I would most likely have expected and desired for him to cry with me. What is ‘normative’ we accept as healing. Truly, empathy does play a big role in healing. Healers take in an account of the body in dis-ease and the only way that we can relate to it is through our own embodied experience, or through the logic of science. Most people are informal healers all the time, suggesting that friends take a certain vitamin that we took that energized us, or offering soup to someone who is sick. Empathy is the reason that women often feel more comfortable with a woman gynecologist; aside from a scientific understanding, empathy (a not but not not situation) can make it easier to engage; easier to heal. So how do I engage with the medical institution so that the performance of healing is more holistic, more empathetic?

My personal primary care physician is a woman named Dr. Susan Massad. Six year ago, for fun she took a theater improvisation class and realized that all Drs should learn to improv, because it would make them better listeners, better reactors, better engagers, and thus, better healers. She partnered with an organization called ‘Performance of A Lifetime” and began teaching improvisation classes for medical residents in New York. You can check out an article about her at http://nymag.com/nymetro/health/bestdoctors/features/9259/ http://www.performanceofalifetime.com/press3.html

In my opinion, Dr. Massad has a proverbial ‘toe in the door’ into the way that medicine needs to be reframed and re-thought if we are going to truly improve health care in this country. I think the next step is to develop engagement workshops for healthcare practitioners. In order to do that we need to locate medicine in key moments where it both engages and disengages embodied experience. We need to understand where and why these practices both work and don’t work. I am concerned with what science says but also concerned with myth as lived experience and representation as product and practice.

How do we channel the story of the body into something that fits within science…. What would happen if we channeled science into the story of embodied experience? What if Doctors performed their patients? What if patients in return, performed their Doctors? What if Doctors were trained as extensively in listening as they are in anatomy? What if healing were to be approached from a ‘healthy’ perspective as opposed to only the moments when health ruptures? What if we learned from and shared healing practices with other countries…. we certainly share what ‘science says’ with other countries, why not performative healing as well? What would happen if we directly asked Doctors to imagine and think about their own position within the health dynamic?

We need to ask more questions to get more questions. Try things and fail at them, try things and succeed at them. Not every practice will work for every body. Be open to the futility of concrete answers, only a humble questioning. A celebratory loss of control. The story of medicine is as ancient as the human body itself. There is no point of origin. No beginning and no end. Only multiple points of entry. From this perspective, my engagement with medicine is a journey; one that starts in my body, in my inquiry, and lands itself in the resonance of questions and answers that follow. In my near future, I hope to make an offering to the medical communtiy, a series of workshops and performance practices whose boundaries will be also defined by the resonance of questions, thoughts, and action that are provoked through their telling.

Public/Private: Gloves/Bareskin

2008-01-15T12:17:00.001-08:00

There has been a lot of talk in the birth community about The Business of Being Born.
Natural birth advocates seem happy since it is a film that is clearly promoting women's education and informed choices towards safe and empowered childbirth experiences.
The medical community is raising a threatened fist, with a lot of comments about skewed statistics and woowoo medicine.
Now, my sense is that statistics in general are a crock of BS used mostly for propaganda. They can usually be dis-proven with a different focus group. The statistics in this film may be skewed, but certainly not any more skewed than those that the medical establishment uses to frighten women into what is often unnecessary intervention.

What this film has done is to bring something that is usually very private into the public sphere. Sure, 'A Baby Story' on TLC did it first, but they tend to highlight only hospital births with doctors screaming, women hooked to machines, flat on their backs and drugged to the point of delirium. I cannot watch 'A Baby Story' without wanting to throw something at my TV. Fortunately, I don't have cable, so I still have a TV.

I went to see the film with a group of girlfriends and one girlfriend's brave male partner. There were seven of us, all in the birth community, in a theater full of pregnant women, midwives, doulas and a smattering of men. A bit tragic since the film was truly preaching to the choir with that audience, but we have to start somewhere.

Here is what made me cringe:
Cara, the NYC homebirth midwife featured in the film, is not wearing gloves in three of the highlighted births she attends. Gloves, as I see it, are something everyone can agree on.
An abundance of latex gloves is a tremendous benefit and privilege of first world medicine. Even if you know a woman's health status, gloves are smart. Personally, I don't care if Cara wears gloves. This is her choice, and for whatever reason, she doesn't see them as necessary. My cringe though, was for the attack that I felt coming from the medical community. It seemed fuel for the argument that home birth midwives are untrained and unsafe. "Cara", I thought, "you knew you were being filmed. Why didn't you throw on some gloves?".

I went home with this thought. But the more I thought about it, the more my own thought bothered me. Why would I want Cara to put on gloves to give some sort of illusion to the medical community? Isn't that exactly the point? Home birth midwifery IS off the grid. We all practice differently and while the medical community attacks that, we embrace it. We see this diversity as the juice, the good stuff, in helping women choose the best possible route to having an amazing passage into motherhood.

I locate this thought in the binary between public and private, most things that occur in the body live in this space (hence, the body politic). Somehow, I want to prove to the medical community that homebirth midwifery is a smart, effective, cost efficient and SAFE way to have a baby, while at the same time remaining true to the nature and essence of midwifery which supports individual choice and interpersonal relationships. Clearly, Cara felt safe enough with these women to expose her bare hands to their bodily fluids. We should trust that. I may not make the same choice (even with my closest friends), but I support hers and her bravery in exposing that to the scrutiny of those who want to shut us down.

Perhaps more on this later. I would love to hear thoughts.

Dr. Grant's Gift to Women

2008-01-06T08:41:00.000-08:00

I ended up at NYU hospital a few months ago after we had to transport a mama (possible placenta separation which turned out to be fine once we got there... still, better safe than sorry).
She was totally committed to continuing laboring as home birth-like as possible, so we had sort of set up shop in the L&D room. We had our oils and birth ball out and my co-partera was doing some EFT. The nurses were surprisingly great and everything was moving along as smoothly as possible (of course mama was still hooked up to all sorts of machines), when this guy walks in.

He walks past everyone in the room and comes up to mama mid contraction and says with a huge grin on his face "Hi, I am Dr. Grant and I am the Director of Obstetric Anesthesia here. Tell me something, do you find labor painful?"

Mama breathes through her contraction and then looks up at him and nods.
Dr. Grant then begins to push the epidural like a high class drug dealer. I have never seen such a hard sell. "Look, you wouldn't have an appendectomy without anesthesia would you? Why would you suffer like this? My wife had an epidural from the first pain she felt and we have three wonderful children, all c- sections, all healthy!"

After his long winded pitch and still no candy takers, Dr. Grant pulls out the big guns.
"Look" he says "have you read my book? You never heard of it? It's called Enjoy Your Labor!"
He moves quickly out of the room and returns with two signed copies of a shiny book with the image of a pregnant belly with sunglasses balanced on the front; no doubt intended to conjure up feelings of lazing on the beach with a margarita.

The proselytizing did not stop.
It was as if Dr. Grant believed he had found Gods gift to women and it was his duty to spread the word. To share the gift. It had similar feeling to those moments when well intended born agains have tried to save my soul. After several unsuccessful attempts, Dr. Grant shook his head and stated that some women just feel they need to be a martyr and left the room.

At some point, I opened the book.
Here are a few choice excerpts found on his website:

A sure way for women to expericence painless childbirth

I did not read much more. Only to the point when he says that he believes the C-section rate should be higher than one in three because it is so safe.

I have read plenty of natural birth advocacy books, and believe me, I know many are every bit as slanted towards the positives of the midwifery model of care as this book is slanted towards complete interventionist and technocratic model- however, this book just infuriates me.
It is an abuse of power and obstetrics to be so medically one sided and opinionated. It is his job to inform the patient of the risks and benefits of the procedure, not sell it like a used car.

Dr Grant, who are you to decide what importance the labor process may or may not have on a woman's experience of transition into motherhood.
And honestly, comparing childbirth to an appendicitis? What? An appendicitis is an emergency surgery. Nobody is suggesting women go into c-sections without anesthesia. But the correlation between natural childbirth and men having an organ cut out of them is beyond ludicrous.
Stating that women will be able to push more effectively with an epidural because they will have better control? Excuse me, when is total numbness a better source of control than being able to move and feel your own legs? And Dr. Grant, the medical evidence on this one is not on your side. Most studies show that women with epidurals take significantly longer to push their babies out, often leading to increased fetal distress, forceps, episiotiomy and c-sections. There is no evidence that suggests epidurals help the pushing process in any way. You just can't find it.

And lastly, on his website under 'book reviews' you have a bunch of moms exclaiming the wonders of their epidurals:

"A must for all mothers-to-be! Enjoy Your Labor dispels the myths that are all too common. Finally, the straight scoop from the best source. Thanks to Enjoy Your Labor, I was able to make an educated decision regarding anesthesia and to finally rest easy knowing I could advocate for my own pain relief." - Katie Cullen, mom, San Diego, California

I have to question using phrases like 'able to advocate for my pain relief'. Since when did women have to advocate for the right to be made numb in a labor room? It seems we haven't come so far from the Twilight Sleep era after all.

Too Posh To Push

2008-01-02T22:00:00.000-08:00

Last week at a restaurant on the Upper East Side of Manhattan, a group of women gathered for lunch, martinis, and to discuss their Cesarean sections. There was one pregnant woman, sipping cranberry juice and seltzer, she was deciding whether or not to become a member of “Too Posh To Push”, a collective of women who have scheduled and advocate for other women to schedule cesarean sections so that they do not need to enact the ‘primitive’ and ‘uncivilized’ drama of childbirth. The existence of the “Too Posh To Push” movement makes the embodied experience of childbirth a performance necessary only for poor, the rural, or those who (gasp) chose it

Who ‘should’ be having babies, and the method in which they do, is clearly socially constituted.
By its very animal nature childbirth is a rupture of civility and femininity. It is also a physical rupture, a rupture of skin, of water, of fluid and blood, and of two bodies separating. The “Too Posh to Push” women are advocating to enact a prescribed discourse of motherhood which says that the blood, sweat, tears and moans; the fluids and sounds of childbirth are threatening to their identity and thus, the performance of entry into motherhood. Those who advocate for it promote staying ‘honeymoon fresh’, suggesting intrinsically that after being stretched out women become less desirable to their men. The childbirth ‘event’ is thus planned and carefully staged within notions of ‘good’ femininity (one can even wear makeup and not sweat it off), rather than the random, un-timable and ‘out of control’ event of natural childbirth. The women scheduling cesarean sections, separate their ‘self’, their notions of motherhood, from their bodies. The fact that the medical institution agrees to these planned Cesarean sections speaks volumes about where pregnant women are located in ‘the body politic’.

Christina Aguilera is the latest celebrity to join the club. Christina honey, labor lasts a day or two. A scar will mess up your bikini style forever.

lessons in normality

2007-12-31T08:56:00.000-08:00

It's the last day of 2007.
Yesterday a few of the November babies I caught came to brunch at my house (yes, the parents were also invited).
A few older babies came too and we munched and sipped mimosa (well, the parents did) and as is apt to happen among new moms, everyone traded birth stories.
These are all women I have worked with who entered into giving birth within the midwifery model of care. Each woman had varying levels of success with this, depending on where she chose to give birth (a few were home, one birthing center, one hospital).
So, after some swapping dramatic tales with happy endings, somebody asks 'does anyone ever have a 'normal' birth?'
I was shocked to hear this asked in my circle of mamas! We are so conditioned to think about birth from the biomedical model that even those who escape its boundaries and have positive, self fulfilled home births, compare their experiences to the parameters of 'normal' established by obstetrics! I exclaimed very quickly that yes! you ALL had normal births! It is not abnormal for a cervix to take a pause in its dilation (even a five hour pause). It is not abnormal to go two weeks over your 'due date'. It is not abnormal for pushing to take a couple of hours. These are things the body does to get a baby out! There is nothing more normal. It is trying to place the body in a box of time management that is abnormal!
Everyone laughed and agreed.
But I had to sigh a little inside. It truly is hard to escape something so deeply engrained. It's like unlearning how to breath.
Happy new year y'all. May you all remember how very, very normal and beautiful you are!

This is like watching a train wreck

2007-12-30T22:44:00.001-08:00

Childbirth Ecstasy

2007-12-28T23:29:00.001-08:00

I lifted these videos from the unassisted childbirth website.
First of all, the one up top almost looks fake.
Her hair, her makeup, her smile, it's all so 'I Love Lucy'.
Does this woman get off on pain or is she really feeling THAT good?
Either way, I'll take what she is taking, please.
Additionally, are these births taking place in France?
The vaginal birth of twins (in the video below), especially a breach twin, would never be done in an American hospital. I love how quiet all of the assistants are and how they allow the babies to just come out. The mom is so wide open and calm. Totally animal. Totally beautiful. Totally resistant to the technocratic model, and yet in a hospital. Who are these women? Who are these attendants? I want an interview!

Partera

2007-12-16T21:47:00.000-08:00

'Nuff Said

2007-10-25T20:26:00.000-07:00

US Maternal Mortality Rate Increasing
The maternal mortality rate in the US is the highest it has been in decades, according to statistics released in August by the National Center for Health Statistics. The US maternal mortality rate was 13 deaths per 100,000 live births in 2004, compared to 12 in 2003, which was the first year the maternal death rate was more than 10 since 1977. The major direct causes of US pregnancy-related deaths are blood clots, hemorrhage, complications of medical conditions, and eclampsia and pre-eclampsia.

The report says the increase in maternal deaths "largely reflects" more states' use of a separate item on the death certificate indicating pregnancy status of the woman. A rise in the number of caesarean sections could be a factor in the increased maternal mortality rate, some experts said. Race and quality of care also factor into the maternal mortality rate. The maternal mortality rate among black women is at least three times higher than among white women. Three studies have shown that at least 40% of maternal deaths could have been prevented with improved quality of care. The rise in obesity might also be a factor. Finally, more women are giving birth in their late 30s and 40s, when risks of pregnancy complications are higher.

The report is available online at www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf

Yes, Chinua, Things do fall apart

2007-10-07T17:41:00.000-07:00

Watch this on NY Times.com.
It is a short news blurb on the women of the Congo.
Some of the women I worked with in Uganda were refugees from the Congo. I feel anxious when I think about how big, how long, how devastating this war has been to so many thousands of people.

With the recent peace talks I wonder who will be the first to surrender. Surrender in Military definition is when soldiers or nations stop
fighting and become prisoners of war. Of course, nobody every mentions
that the white flag is usually conditional. There is always something
we just can't give up. Something we will still die to hold onto. And
what happens if there are multiple truths, perspectives, ideas we are
all clinging to the death for? Who surrenders what? So we negotiate
surrender. I'll give this up if you give that up, and then are we
even? Men sit around in suits and sign pieces of paper that are
contracts on other peoples lives. Surrender becomes the compromise,
and at once, the center of the story.

Its kind of like, Yes, Chinua, Things do fall apart: I can't talk my
way out of it. or into it. Just have to lay still and accept the
uneasiness as it washes over my broken body. a wave, pushing over
sand. And sometimes, when I wake, I am no longer who I thought I was
At ALL. I am only the pieces held together with blood and piss and
tears. Chaotic energy sparking into ash at your feet, blending into
the Earth as a molecule of something bursts into nothing and is gone.

Women of East Africa. Women all over who have been violated in the name of a battle being waged by men. Women who give birth and die for political violence.
I offer you my hands. My heart. My voice, which I am so privileged to have been taught how to use.
And yet I feel as powerless as you. When one woman is violated, we all are. Rape as a tool of war makes all of us prisoners. How do we shift what has already devastated? In the hearts of the men who rape. In the boys who are now growing and being raised by mothers who conceived and gave birth in violence. How do we shift the cycle?

These photos were taken by me in Uganda. Child Mothers to the left, and a TBA with a child she caught in an IDP camp to the right.

The 'Best'

2007-10-02T11:23:00.000-07:00

I want to dialogue with the idea of 'the best' doctor.
I hear that a lot. It seems everyone has found 'the best' doctor to fit their needs.
"They have to operate, but he has the best heart surgeon in the United States".
"My gynecologist is rated number one in cervical cancer treatment".

First of all, who is doing the rating?
Second of all, what are they basing the ratings on? Lowest number of patient deaths? Highest level of training? Best bedside manner? (highly doubtful), Sexiness? (more likely.)
A small amount of research has led me to believe they base it on statistics which show the most performance with the best outcomes for the least amount of money paid by insurance companies.

It certainly is a comforting thought. Having the best.
We all want the best, but clearly, by nature of the word itself, only one person can inhabit that position. You are either 'the best' or you are not.
Seems like a strange binary for a field that needs to heal an entire world of people.

Read Rafael Campo's book 'Desire To Heal'.
It is a poetic look into empathy and the twisted business of being 'the best' doctor.

2007-10-01T10:42:00.000-07:00

I love this belly. So often what is right beneath the skin seems so far away, so unimaginable, so un-real. And then you see the contours of a foot, skin pressing up against skin, and the distance is lessened, the body understood, everything just makes a little bit more sense.

Uter-"I"

2007-10-01T09:53:00.001-07:00

What is a uterus?

"Uterus: 1. In the primates; The organ in which the young are conceived, developed, and protected till birth; the female organ of gestation; the womb. b. In other animals: The matrix; the ovary 1753. 2. Bot. a. = PERICARP 1676. b. In fungi: The envelope of the sporophore 1829." -- Oxford English Dictionary.

Uterus, then, appears to be a medical or botanical term. My uterus is there to perform a reproductive function, as in other animals (and fungi), and in some ways it is not dissimilar to a nut shell (pericarp -- the pod, husk or shell of a fruit). This description does seem to lack depth and breadth, being purely about physical form and function, but then that's exactly why I recognize it as a scientific definition.

So aside from its nutshell function, the cultural relationship of uterus to 'woman' is an interesting one to explore. What happens when our uterus betrays us by not holding life? Or when we lost it to illness? Or what happens when a perfectly functional uterus turns fifty and stops serving its life purpose? I am interested in a discussion of uterus vs femininity or gender roles in particular. I am most interested in an international discussion because I am sure it varies - I mean, shit, it probably varies from brownstone to brownstone here in Brooklyn.

A laying on of hands

2007-09-30T09:43:00.000-07:00

Shamanism is in and underesourced Western medicine is... out?
I don't think so. However, this article seems to point to the idea that somewhere in the international consciousness indigenous practices may have a place. I think those spaces where what used to work, and new 'innovative' (I locate that problematically) ideas can mix, are the only potential we have for effective health care in rural communities.

Lack. Loss. Limbs. and Love.

2007-08-25T19:11:00.000-07:00

I have been reading 'Minding The Body' a collection of essays by women writers on the body.
I read it years ago, but it strikes something different this time around.
Perhaps it is the subtlety of shared experience that evokes a sense of closeness to my own fleshy body, or maybe it is just a point of entry for discussing something that is lived and very rarely articulated. Words are at once inadequate and yet simultaneously unveil truths that mimic the expansion and contraction of the lungs with every breath. Simple and so necessary.

It seems one of the overarching themes of the book is loss, or coping with a percieved loss.
Loss of youth, body shape, children, facial features, sexuality, wildness. Each writer finds a nugget of truth or wisdom in her loss, but nevertheless her discussion begins with a lack.
Must every discussion of women's bodies begin from lack?

I think about the body and loss, generally.
The body can experience physical loss, and does so every day. The shedding of cells, hair, skin.
The body can lose entire organs, limbs, and yet still compensate, heal and function.
Is the body ever really whole?
We lose partners and its as if our bodies have failed us somehow.
We lose hair, memory, muscle- the process of the bodies slow decline back into the earth is at once growth and loss.

Our bodies are always lacking and so how do we respond? We become obsessed with losing weight. Losing wrinkles. Losing spots. Losing any sign that we are alive and changing.
We expect to gain from that loss. Even as I write this, I have friends over getting ready to go out. I am quick, perhaps too quick in my application of product, so I find myself with a half hour at least to write while they apply makeup, tie straps, spray body splash and body shimmer. Each addition in compensation for a percieved lack.

However, I think in its own twisted way, we like it. We enjoy the process of compensation. We enjoy finding the edges of our lack and the process of defining those boundaries. We enjoy wearing strappy heels because we know the kind of power that extra leg boost creates.

So is lack the same as loss?
If you are born without a limb is it the same as losing it? Clearly we have a different emotional relationship to loss than to lack. Inherently, we spend so much time compensating for a lack, that we lose not only the potential for relationship with these bodies we live in, but also the potential for joy, for pleasure, for intimacy.

And since this is a blog in dialogue with medicine, I have to question women's relationship with their bodies in the context of our overall health.
I think its imperitive that we start examining our own relationships to our bodies and lack. Its ok to lose, but I don't think that loss must be defined in terms of lack. Prepare for a generation of women who define their bodies by what is, not what isn't. What we carry with us now, we pass on to our daughters. Historical memory is a very, very real. Thanks Grandma.

Pain as art or painful art?

2007-07-25T12:23:00.001-07:00

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

2007-07-25T10:21:00.000-07:00

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.

2007-07-19T08:36:00.000-07:00

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

2007-07-16T06:41:00.000-07:00

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?

2007-07-13T09:16:00.000-07:00

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

2007-07-10T18:59:00.000-07:00

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.

2007-07-05T01:43:00.000-07:00

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.

2007-07-02T00:27:00.000-07:00

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

2007-07-01T06:52:00.000-07:00

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.

Lines in the dirt

2007-06-30T01:26:00.001-07:00

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.

2007-06-28T06:27:00.000-07:00

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.

2007-06-28T06:23:00.000-07:00

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.

A book can be a mother

2007-06-27T01:40:00.000-07:00

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.

Heart

2007-06-25T06:06:00.000-07:00

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.

2007-06-23T02:40:00.000-07:00

Also, read Aimee's blog.
She is writing about the same experiences from a different perspective.

http://www.akuganda.blogspot.com/

Questioning

2007-06-23T02:29:00.000-07:00

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.

The better it is, the worse it is!

2007-06-19T23:39:00.000-07:00

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!

silence

2007-06-16T05:27:00.000-07:00

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.

2007-06-13T23:40:00.000-07:00

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.

Let's try this again

2007-06-10T01:05:00.000-07:00

excuse me if it shows up twice. I am a movie posting virgin.

here is the link

2007-06-10T00:58:00.001-07:00

http://www.worldpress.org/Africa/1933.cfm

2007-06-10T00:47:00.001-07:00

Below is some footage we took yesterday (see the blog below it for a little description).

Also, read about Child Mothers in Uganda.
These are many of the women we will be working with and delivering at the hospital as they have recently been released.

let's see how internet savvy Rachel really is....

2007-06-10T00:32:00.000-07:00

2007-06-10T00:07:00.000-07:00

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.

shit in a hole

2007-06-07T07:40:00.000-07:00

For the first time in my life I can shit in hole with almost perfect aim.
I am oddly very proud.

2007-06-07T07:12:00.000-07:00

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.

A dialogue with self

2007-06-05T09:17:00.000-07:00

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.

Brussels

2007-06-04T00:16:00.001-07:00

Brussels Airport.
Screaming baby on flight from NY and they didn't even show a movie.
Need Coffee. My retnas hurt.

2007-06-02T21:17:00.000-07:00

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.

Dr. Oz

2007-02-13T14:15:00.000-08:00

I like to schedule going to the gym around Oprah.
I plug my headphones into the eliptical machine and join thousands of other women in a daily ritual with the true queen of daytime television.
Has anyone ever seen Dr. Oz on Oprah?
I think I love him.
He has taught me so much.

Last month I learned that my poop should be in the shape of an S, or at least a C.
If it is not curved, does not float, or happen twice a day, I have a constipation problem or am eating too much fatty food.
Thank you Dr. Oz.
Or rather, my bowels thank you, Dr. Oz.

Oprah loves to bring people back again and again. This is one of the things I love about her. She likes you, she launches your career. Dr. Phil being a prime example.

So today, Dr. Oz was talking about acupuncture and reiki.
And he broke it down. Scientifically, a cell is characterized as 'alive' when it has a certain amount of energy radiating in and out of it. Each cell is a live wire of energy.
Healing work, aka, medicine, is about shifting energy cells that are in out of harmony.
This is not woowoo, this is scientific.
So, he says, the next wave of TRUE medicine is going to be energy medicine.
Prayer, Reki, acupuncture, laying on of hands.

I shit you not.
I almost fell off the treadmill.
I actually teared up at the gym.

Ten years ago a Dr. would never have said that on national TV.
The connection between the emotions, between energy that flows in and out of the body and what 'science says' has been ignored for so long, people like to deny it ever exhisted.
If the medical establishment acknowledges this as something integral and essential to healing (instead of on the outskirts where it now lives), if insurance companies payed for healing like this, if there were free energy healing clinics....

I am going to stop, but I feel optimistic today. We have nowhere to go but forward.