Brave Woman

Adventures of a future nurse-midwife


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A Reflection on Journaling

Posted by Lucille on June 1, 2011 at 10:05 PM Comments comments (0)

I've noticed that I've devoted a lot of writing to the things that shock me, even though those events don't give an accurate representation of day-to-day life here.

It's true that most of the women are unemployed and pregnant, but it seems that is by choice. Education for women is free in Gambia, and there are women who take full advantage of it. Contraception is readily available at the health clinic. People simply choose not to use it. Part of it is probably a passive peer pressure that comes just from education and contraception being so new here. When everyone around you has ten kids, it makes sense that that would be the future you'd picture for yourself. Part of it is that infant mortality is so high, many women feel they have to have many pregnancies in order to have enough children (most women seem to want between 6 and 10) make it to adulthood. Also, as part of the MDG goals of reducing maternal and infant mortality, Gambia increased the availability of health care to pregnant women. This backfired by offering women an incentive to be pregnant, but it was out of a desire to help them.

The most disturbing things I've seen have happened in the maternity ward. I won't try to justify them. Some may be necessary procedures, I don’t have the training to know, but I do know that at least some of them simply should not happen. They are a result of systemic poverty, post-colonialism, desensitization, and training that was imported from ‘Western’ countries years ago, when actively managed birth was our norm as well. The midwives here see an average of six births a day. Think about that. Six births a day, every day, for years. Some of the midwives have been working here for decades. With that kind of demand, of course there's no such thing as a patient-provider relationship, in any of the wards, not just maternity. As for the forceful procedures, like pumping a woman's uterus, most of the nurses and midwives (leaving the rough nurse out of it for now) do it out of a desire to help women. They are intelligent, caring women who are passionate about the work they do, and who have gone out of their way to welcome us. They see a woman in pain and want to get it over with as quickly as possible, like ripping off a bandaid or setting a bone. That is how they are trained. They don't have the time or resources to learn and implement alternatives. This is not to say that these things are okay--they're definitely not. I just want to recognize that the situation these people are working in is sufficiently different from the US that the line between right and wrong as we see it is blurred.

The nurses cannot take care of everyone. It would be better if the women's families came with them, and many do. Seriously, not every birth here is a horror story; in fact that's a small percentage. The maternity ward is also my sanctuary. It's not a hellhole, it's just the place where the spectrum is most broad and both extremes happen every day. Many women have family with them to take care of them, and many women give birth without complication. It's just that those aren't the women we work with, because that's not where we're needed. I wish that every woman had a supportive family to help take care of her, but that's not the case, in the U.S. or here.

I'm working in a hospital. (In fact it's not a hospital, it's a health clinic that tends to the same number of patients as the local hospitals with much fewer resources. We call it a hospital as a compliment to what they have accomplished.) This means I have a front row seat to the darkest aspects of life here. But this is not representative of the country, the people, or the culture. The most important pieces are the little details that I overlooked in the beginning, grew accustomed to, and am gradually rediscovering. I want to make an effort to write more about these things.

Men and Food

Posted by Lucille on June 1, 2011 at 10:00 PM Comments comments (0)

A man approached our group leader the other day to explain that the men in our group shouldn't do a cooking rotation because men in this culture do not cook. She explained very politely and diplomatically that our men are cooking no matter what. When she next spoke with the women who are cooking with us, she told them about the exchange. Both women were shocked and said that men here cook all the time. A male group member cooked the next day and said it wasn't uncomfortable at all and several of the men in the compound came out to help them. I think there is a tendency to want to describe other cultural norms as being ‘all one thing’, but just like in America, cultural expectations vary a lot family-to-family and person-to-person.


Posted by Lucille on June 1, 2011 at 10:00 PM Comments comments (0)

I saw a child being hit with a switch on my way to work today. OCA was very clear about our role here. We are observers. We are here to learn and to assist where we feel comfortable. We are not here to enforce our culture or our ideas of right and wrong. But there are certainly times when this is difficult.


Posted by Lucille on June 1, 2011 at 9:55 PM Comments comments (0)

We went to Sanyang today, a secluded beach that the people from the lodge showed us. A group member was sick, so another group member stayed with her and the rest of us piled into a rickety van that was started by crossing the wires. We were temporarily delayed by a herd of cows crossing the road, but eventually made it to Sanyang.

Remember when I said you'd have to be crazy to swim in Africa? Apparently I'm fully and completely insane. White sand and clear water that was probably 80 degrees. We ran in and floated on the waves for a while, and when that got boring we taught the guys how to do a fireman's hold and launch us into the air. When the tide went out, a group member and I walked out over the tide pools to watch the crabs eating the anemones and the fish that darted away when our shadows passed them. Another group member made friends with a dog affectionately named Nipples. Despite living 20 minutes from the beach, none of the people from the lodge knew how to swim and one of them had not been to a beach in 15 years. We gave them swim lessons, which inevitably evolved into splash battles. We had such a good time we decided we want to got to the beach every weekend. Except I think the 'water resistant' label on my sunscreen is a lie, because I reapplied it every two hours and still got so thoroughly cooked I'm probably good to eat.


Posted by Lucille on June 1, 2011 at 9:55 PM Comments comments (0)

I was in that twilight zone last night where you're aware of you're surroundings but too tired to respond to them. My roommate had been up with a cough. I could hear her moving toward the bathroom to get her water bottle. My mosquito net had gotten tangled somewhere behind my head but I was too sleepy to do anything about it. I heard my roommate sit down on her bed, then pause. She got back up again, tiptoed to my bed, and gently tucked the mosquito net back around me. I tried to thank her but the words got lost on the way to my mouth and I fell asleep.


Posted by Lucille on June 1, 2011 at 9:55 PM Comments comments (0)

Two weeks into my stay here, although it will probably be three by the time I post this, I thought it 'd be fun to evaluate my packing skills.

First off, things I should not have brought: my sleeping bag. It's too hot to even consider it.

Things I should have brought:

• More hand sanitizer, more cliff bars, and a deet free insect repellent.

• Aloe vera. It hadn't occurred to me that they wouldn't sell that, but the people here don't burn. I tried to explain to someone what a sunburn was and she thought I was being ridiculous.

• Rain boots.

• A better poncho.

• And a MUCH bigger journal. (Seriously, at least 10x bigger.)

Things that have been saving my life here:

• Sleeping bag liner. It's cool enough to sleep in and treated with insect repellent.

• My clothes and shoes, because they're perfect. Apparently even my scrubs are stylish, as the head of the maternity ward asked me to give them to her when I leave.

• The photo book I made.

• My camera.

• My watch and anti-itch cream.

• My water bottle. I never go anywhere without it.

Nothing Is Safe

Posted by Lucille on June 1, 2011 at 9:50 PM Comments comments (0)

A group member’s passport is molding.


Posted by Lucille on June 1, 2011 at 9:50 PM Comments comments (0)

My legs got eaten.


Posted by Lucille on June 1, 2011 at 9:50 PM Comments comments (0)

That's it. That's all there is to say.

The last couple nights it was too dusty to see well, but tonight it rained just before nightfall. There are more stars than sky. I'm going to have to learn to sleep while I work in the day because it's not worth missing this.

Before I left I talked with a woman who had worked in Africa, and asked her if she could tell me just one thing what she would say. "Africa is intense. On both sides of the spectrum. There's suffering and things so beautiful they'll take your breath away, all mixed up together."

She was right.

Maternity Day 3

Posted by Lucille on June 1, 2011 at 9:40 PM Comments comments (0)

We went to the hospital today (Saturday) to help out with their World Blood Donor Day program, but everything here is on GMT (Gambia Maybe Time), so a couple of people went to maternity. I was busy playing soccer with some kids, but at some point a group member came running out yelling for the head of the hospital. I went in to see what was going on and found a woman who looked nearly delirious lying naked on the ground. Two nurses picked her up by her feet and shoulders, put her back on the table and held her there. Someone told me that she had been pushing for two hours and they had tried the vacuum without success. The group member was stroking her and letting her squeeze her hand, and another group member's face was blank in a way that worried me.

The head of the hospital came in, examined her, and said that she had preeclampsia and the baby's head was too big for her pelvis. He called for an ambulance to transfer her to Banjul for a cesarean. The group member went with her, and the rest of us went to finish with the blood drive.

That night I asked the group member what had happened before we arrived. The rough nurse is apparently not the only person who will pump a woman's uterus and do other forceful procedures that are not allowed in the US. When the woman's labor did not progress, the women in the maternity ward started to do these things, and the patient, after telling them to stop and being ignored, tried to fight them off of her. They actively fought her back.

Although I can clearly see how that would be horrifying, the idea of a patient and nurse in combat does not bother me as much as the women who surrender their bodies or the apathy of the ones who don't want to see their child. I understand that these behaviors are a result of extreme trauma, and I don't fault the women for them at all. And yet, there is a beautiful vitality in fighting for autonomy over your body, however much I wish it wasn't necessary.

According to the group member she made it to Banjul without further trouble and presumably had a successful delivery.



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HIPAA Disclaimer

Sometimes I have the privilege of being a part of intimate, powerful moments in other people’s lives. I cannot and would not share these stories, because they are not mine to tell. However, they touch my life and become part of my own story. When I share these moments here, you can trust that I have not broken anyone’s confidentiality. The characters are invented. They are not real, but could be. I take creative license to communicate the essence of my experience while respecting the privacy of others.