and finally some pictures

It's been over a month since we came home...

It has been well over a month since I have been home.

So many thoughts about the trip in the intervening time. Here is my download, still mixed up and a bit raw…

I have been sitting with how full and beautiful and hard the experience of working with the women of the clinic was, and how totally blessed we were by the home and nurturing environment our host Asia, and her family made for us, and blessed by the learning that comes from being in another culture, and blessed by the gorgeous warm sands and wide ocean and fruit trees and.... I’m wondering why I felt so unsettled this time when I got home, since I have done so much work overseas in the past. Why was this time so unsettling?

Certainly I am a growing and changing person myself. I am continually more and more aware of the impact of my presence, the assumptions I make about good work, continually learning from the many conversations I have about racism and relationships and the dynamics of unearned privilege and oppression, and thinking about what is authentic connection and what is just my limited insular perspective. I am continually reminded that I am a guest and witness in the lives of others, and that I have to wait to be invited in.

I think I have always had one-on-one translation services whenever I have worked in an environment where I don’t know the language well, and have been able to communicate with the women I touch (literally and figuratively). I have learned through years of training (training myself and training others), that communicating solely through face and touch, good intentions and gestures makes a lot of assumptions about connection that are often false. It silences others. Not to mention feeling completely ineffective myself. I know when I am speaking a language that is not my native language, how often I give up and don’t even try to say a more complex thought…

I also realize, I have never gone overseas with mostly US students, I have always worked exclusively with students and health care providers from the local communities in the countries I visit. It is a completely different experience to bring outside students in. Completely changes the purpose and dynamics of the trip and becomes exceedingly difficult to stay clear about what we bring and how we maintain deep integrity, true respect, etc.

I’ve just been asked, and have been asking myself as well, if I would go again. Perhaps in February. I have been thinking a lot about what that would look like and what I would need (in addition to all of the truly amazing things that our hosts and the community already provided and created for us) to make it sit right with me.

Yes! I would love to go again. I would so like to see everyone again already, and I believe for this program to have lasting meaning, the foundation has to be long term, midwife to midwife relationships. I would love to be a part of creating the space for further collaborating with the local midwives and figuring out what that really means.  I would love to positively impact the infant and maternal mortality rates in Senegal, again only if I am invited to do so, perhaps this time directly by the midwives and the community. And then I wonder, are they in a position to say “no”? No you are in the way, no, it makes more work for us, no, we can’t say no, because we feel indebted and we need the supplies you bring. How would I really know what is welcome or useful?

So this is what I have been thinking, none of which is rocket science, and much of which comes from things I have learned from others (including the students on this trip) as well as my prior experiences in clinical training sites.

For us to have an authentic presence of respect and sustainable contribution, we first of all cannot be competing for clinical experience with the Senegalese students, taking away from their own hands-on experience. That is a careful dance for sure. They are the ones who will stay and are the hope for a changing face of health care in a real and permanent way.

And- we need to have full time on-site translation services in Wolof and French to communicate effectively, not only with the midwives and Senegalese students, but of paramount importance to honestly ask the women giving birth their authentic permission to have students "practice" on their bodies. Is it even possible?

Lastly, bringing in students of color and having a higher level of experience in general in the student body, or else being really clear that green students would not get clinical experience beyond their level of experience. I've seen models where one student charts and assists, one student is the doula if needed by the birthing mom, and one student is more primary and catches the baby if skilled, and permission is given. I know tuition is what funds the program and other programs like it, as well as donations from others back home, and I know tuition is a barrier to anyone with a lower income…. So perhaps fundraising for scholarships as well.

One of our advanced students was doing a study project including interviews with the women involved in our trip. Her project was called something like "midwifery tourism in Senegal" and I asked her about the provocative term, since it implies voyeurism and consumerism of bodies. She talked about the book Obstructed Labor by Sheryl Nestel (a history and analysis of the move toward legalization of midwives in Ontario, Canada, and its intersection with racism and exclusion of women of color both as midwives and as clients by default. In the book there is a chapter on midwifery tourism, that while white women dominated these moves toward legalization and often deliberately, or perhaps sometimes unintentionally, marginalized immigrant midwives or midwives of color in the process, these same white women would go overseas to exotic "back-to-our-midwifery-roots-and-traditions" countries to "get their numbers" using women of color to further their own training and experiences). True, we do not need to look at Canada for more examples of this. 

When I got home, in addition to going into surgery (abdominal hernia), and beginning graduate school (MPH in Maternal Child Health) I ordered and read this book. Thank you Megan for suggesting the book, and for giving my shapeless dis-ease, the words to describe it. When we don't speak the language, and when we expect women to allow largely untrained (mostly white) students to do a vaginal exam on them while in labor, we are participating in racism. I don't think it works to say these women are collectively willing, or that we are "so good" that they of course want us there. Is it a service? Are we doing good work? Sometimes. Maybe. Could we do better? I would hope so. 

So? It never is easy. I am so committed to offering midwifery training and creating models of appropriate and effective education, and have never lost my belief and vision that this very low-tech and hands-on set of skills, coupled with the fundamental belief in the ability and strength of women giving birth, can save lives world wide. I am also committed to learning from my dis-ease, and talking about race, class, privilege and oppression while trying to find my way clumsily through as the white woman I am. I am working hard at staying mindful that I am a guest and witness in the lives of others. Pictures to follow. Love, Marijke

April 20th, Friday

Friday am, April 20th. We come awake to the cacophony of bird calls and interweaving bird songs each morning. Roosters with no real sense of timing, doves cooing, little birds chirping in all pitches, and the trill of another bird whose sound always makes me smile. Today there is also a cell phone alarm nearby to remind its owner that it is time to pray. Such a mix of worlds. Through my hands this week, I briefly held a baby whose life left him in those first long moments, a baby who never breathed for himself though we tried to bring breath in, and tried again.  By my hands this week, another baby lived, that would most likely not have lived had my hands been tending to something else that moment. Perhaps another set of hands would have helped instead. It is humbling work. A baby for a baby, not a fair exchange. Never equal of course, especially for the mothers and families connected to these babes. Another baby born into the dirt on the dark road to the clinic last night,  placenta following easily, both scooped into a big tub and brought into the maternite. The baby's cord is still fat and full, he must have just been born. Healthy, chubby, and except for being a little cold, alive and well, big leaves, sand and twigs stuck in the vernix on his back.  Hazel and I take a nap together this morning. She tells me "lie this way mama", so she can snuggle into my arms. We sleep to the sounds of Kafountine, drumming and singing in the distance, roosters, still with no sense of timing, children playing and mothers calling. Maybe today we will walk to the ocean. I love the sun wind and water together. Hazel loves the white sand. We both love collecting the hard little red palm seeds on the way. "here is a good one, mama..."

April 13, 2012

13 April 2012, Friday, Kafountine Senegal.  This is my first chance to post, have not really figured out how to send pictures, so perhaps this will be a colorless blog until i am home and can share the pictures. I promise to send them out when we get back. Our trip from milwaukee through detriot and new york was straight forward, as was our long flight across the ocean to Dakar. Then a lovely break at the home of friends of the project, and then 12 hours by overnight ferry to a town 3 dusty hours from Kafountine our final destination. Hazel was great, did very well on very little sleep, and as I met up with more and more of our group, people helped us make our travels even easier. Now a week later, i have a little time to write. Today, maybe last night, was that first day of angst, as we used to say in our mediation trainings. Tears, we are missing our families, children back home are sick, missing their mamas, and the mamas here are missing their kids, their families. Hazel, normally delighted to go to her Tanta Nima, was quieter than her usual self, wishing she could come with me to work instead which was not possible. I did get an update that she was fine after I left. We have been here now for a week. Such welcoming people here, warm spirits, generosity, many children, beautiful women, vibrant clothing and textiles, long stretches of white sand and dust, wild rhythmic music, poverty and daily hardship side by side with life. Our first day we met many people, especially Awa, the most senior sage femme (midwife) --we witnessed her attend our first birth here, a very small, late preterm complete breech, slide easily out of her mother, give a lusty cry, beautiful and healthy... Then on our days off we settled into our new home away from home, walked the town and markets and went to the ocean. Wide and vast blue ocean, long wooden fishing boats, sun bathing cattle on the white sand and the sun, hot and glorious!  We sit here now, after loosing another baby, the first one was on our last shift, a double footling breech that probably died soon after the mother ruptured membranes.... We are being taught how to say "I am sorry", so sorry. This is her second baby, the other also died in childbirth.... We cannot really know what this does to a woman's life. We are so sorry. In Wolof, or even in all of west Africa, this sounds like "maasaah", I feel empathy for you, we say it when women have pain in labor, or we are told to say when a baby dies,"God is good"or "Trust in God". It does not seem adequate. There are no tears, adults don't cry in public... I gesture my empathy to the father's family. They understand.  We are seeing. Many things we don't normally see, somethings very hard to witness. Tired now. Debriefing with students. Hoping for a normal birth, maybe this evening. That would be good.  My love to all of you. Thank you for holding us in the light.

Hi all, we have been in Senegal since Saturday I think. Beautiful, dusty, friendly and very difficult to have Internet access. I promise I will write soon when I get my timing down to get to the cafe. Getting dark now, time to go home. Love to all of you. Marijke