Brave Woman

Adventures of a future nurse-midwife


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

One of the great things about living in another culture for an extended period of time is that you get to go beyond the most striking differences and learn the little quirks and traditions that make their culture unique. One of these is ‘atcha’, which has since become one of our favorite words. We learned most of the words we know in Mandinka by seeing how they were used, and as far as I can tell, atcha means ‘go away,’ ‘come here,’ ‘hand me that,’ ‘close the door,’ ‘push the baby out,’ ‘blow up the balloon,’ ‘hurry up,’ and ‘go play with your friends’. Basically, it's, "Pay attention please and do what I want." You would think it would be a harsh command, but it's used so excessively that that possibility is lost. It's not limited to people, either. Say ‘atcha’ anywhere near a herd of goats, and they will scatter. You have to say it with the right inflection, though, which I can't seem to get. One group member in particular does it best. Goats will go bounding away from her like there was some kind of explosion.

A Day in the Life

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

I told you that the stressful and challenging experiences like dodging mad men in the market and adjusting to conditions at the hospital are not an accurate representation of my experience here. They are the parts that I need to process by writing, but they have actually been only a small part of my experience here, which I hope is making you all wonder what on earth I've been doing the rest of the time. Here's a peek.

We spend a large part of every day in the market. Food storage is not really possible here, so people go to the market every day to buy food. In the market, goats run wild, colorful fabrics wave from vendor stands, and seeing women balancing stacks of egg cartons on their heads is common place. Descriptions of the market do not do it justice. I wish I could stop more to take pictures, but I'd probably get run over by a donkey cart.

And just like a portion of each day is spent shopping, a portion is spent cooking, which is done communally in big mortars and bowls in the common space, with people taking turns at each pot and minding the children that are running around giggling and swinging off the clotheslines.

Food is also eaten communally. A bowl the size of an umbrella will be placed on the ground and up to 20 people will gather around it. They normally eat with their hands, but have been nice and provided spoons for us. They don't eat this way because they lack tables or plates. I know they have them because we've been using them, which they think is ridiculous. They choose to eat this way as a symbol of unity. As a man from the lodge said, "Since we were five years old we came in a circle to eat together. These are my brothers now, and twenty years from now we will still rub shoulders to eat together because we are one family."

With the polygamy thing and extramarital partners I have had difficulty figuring out how, or whether, people are related. Sometimes I think even they have stopped keeping track. But regardless of the complicated web of relations, there is a very strong sense of family between them. Everyone here watches out for each other and they seem to spend most of their time relaxing along the road, enjoying each other's company and visiting with neighbors.

It's incredibly peaceful here. They're in the off-season right now so many people don't have work and will spend most of their day talking with each other. We visited our site coordinator's village while we were considering a change in location, and there were just baobabs, cows, termites, and prehistoric plants for miles around. The children running by were like part of the wilderness. There's something about that kind of serenity here that heals the soul. If I ever get really overwhelmed later in life and need a break, I'm coming to a village in Gambia. Everything is so relaxed that years could pass here without you noticing. And all of that sitting and watching the world seems to have put them in tune with nature. They always know when it's going to rain and when the bugs will come out, so the things I was most worried about never catch us by surprise.

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.