Sunday, October 14, 2012

Going home and reflections

My journey home was long but good. Saying good-bye to the people at Ot Nwal Me Kuc was difficult and sad.  After a long and tiring day we made it to Entebbe and I had dinner with Charity, the woman I met within an hour of arriving – sick and pregnant.  This time she was healthy and full of life and it was a joy to see her and get to know her. She came with me to the airport and it felt I had come full circle.
Charity and me on the shores of Lake Victoria
The next day after an eternity of flying I was going through a long line in security at customs.   One more stop and I would be home.  I made a comment out loud about the number of security stations I had been through and the man in front of me agreed.  Come to find out he too had flown in from Entebbe the night before and after briefly saying where we were staying in Uganda we began to share what we were doing.  He is in the military part of the Special Forces that are there to train the police and government soldiers in Sudan, Congo and CAR – he spent most of his time in the CAR.  I looked him in the eye and asked when they were going to stop Kony and he replied “That’s what my job is and we are trying.”  I had discussions in Atiak with people about Kony and wanted their opinions and it is clear that stopping him, even though he is no longer in Uganda, would make people feel safe and offer some justice.  We spent the next 20 minutes discussing the limitations, the corruption, the stories I heard and the women I met and the scars I saw. The situation became more personal for both of us.  We left each other in gratitude for the work we are both doing and once again, I felt this was not an accidental meeting but one that was important, not only for myself but for he as well.

I've been home one full day now and tired as I am it feels good.  As I reflect on the last few weeks of my life I realize there are no words to adequately describe my experience.  Only those who have been there can relate and yet I need everyone to understand to validate what I have been through. It will take a long time to process it all and try to connect these two very different parts of my life.

It is easy to assume that the people in Northern Uganda are oppressed: limited healthcare and education opportunities, poor infrastructure to support modern technologies, limited food supply and income, high rates of maternal and infant mortality, lower life expectancy... And by our western standards the poverty seems overwhelming to a population as a whole.  Years of war and corruption within their government has left the people with only their own limited resources and those of the NGOs that come to help and offer some ease to the difficulties of their life.

Yet, the simplicity of this life, with all the joys and sorrows, far surpasses much of the quality of life we have here.  I do not pity the people I met and saw, I envy them in many ways. Yes, there were things that were difficult to see and I wish I could alter, but there were also lessons to me in resiliency and what defines a people and a culture and a good life.  My job was to serve the women and families the best I could and not change them.  In many ways I feel I have succeeded.  I tried not to judge but to observe, and give my compassion and my skills to aid these women and children when it was needed.  I feel good about my experience as a whole and as good as it is to be home with my family, it was hard to leave this beautiful and wondrous place.

Two moms and their sons with their attendants

Tuesday, October 9, 2012

Anyadwe - Daughter of the Moon

Lots of deliveries yesterday and today we drove women home.  I went to one village just a short distance from here almost on the South Sudan border.  One little girl, maybe 9 or 10, looked at me and could not keep staring.  She didn't smile or react or anything, just a look of shock on her face.  She warmed to me after a few minutes (she took my hand with caution as I said “Afoyo”) but was very hesitant.  I was told she had never seen a white person before and was a bit frightened and curious.  The children began to call me Anyadwe or Nyadwe (ah nya dway). It means “Daughter of the Moon”.  I am sure it what they call most white women but I am claiming it as my own.

Today is Uganda's Independence Day - but given their history even recently it seems a strange title.  Last night there was music ringing through the air and the children all running around yelling "Hoot! Hoot!"  They finally went to bed but then very late (or very early) a man started in which woke all the roosters and then that encouraged him more and then...uggh.  It was not a good night for sleep.  I am prepared for even more tonight.

October 8, 2012
As I write this there is a huge thunderstorm.  The air is finally fresh and the rain a blessing. I wish it would last all night. Sadly, it will probably only last a few minutes.  

Today we were very busy in the clinic – 2 births, 2 transports to Gulu, and a woman who is in labor still.  After a few days of quiet it feels good to have the activity and chatter here again.  I love how all the children who arrive with the attendants are cared for by everyone.  I love how when someone is in labor the other women peak in and offer their encouragement.  Alone as these women seem while laboring, they are still in a community.  Tonight the clinic is also full of dads who came to admire their new babies and have time with their families.  While encouraged it is not an everyday occurrence.  And, to top things off the mama who birthed this morning brought a sheet!  It was a relief to me to see her more comfortable and clean up was so easy.  She had the most beautiful baby boy. 

Last night we had a labor very late and all three of us midwives came over.  As she labored we all rested in the hammocks, the bats flying above in the room.  It felt good.  And today Corrina arrived, another of the traditional midwives who works here.  She, Carmella, Florence and I hung out in the dark of my hut snacking and chatting and having a wonderful time just being women together, even without the language.  Florence does speak English and could translate but mostly we just sat and laughed. 

Carmella, Corina, me,  Florence and Stewart (everyone's baby)

I heard some very disturbing news today and almost cried when I was told.  The woman who we brought home yesterday, the same woman who I mentioned 2 days ago as looking so worn down, the woman who walked 4 miles home 24 hours after given birth…This woman was not served breakfast yesterday.  There is no excuse and it was deliberate on the part of the server.  Had I known I could have easily brought her food and tea.  Instead, she went home hungry and expected to start on her daily chores and care for her other 4 children.  How can she even begin to believe in compassion if this is how she is treated here?  Yet she never spoke up – that is how beaten down she already is. I am so saddened and feel that as a midwife I have failed to honor and protect the women I am here to serve.  I heard this happened once before last week and I do not understand.  

Sunday, October 7, 2012

Road Trip

Today all the midwives and I went to Adjumani, a town in the neighboring district.  We dropped off the woman who gave birth yesterday and continued the journey there. It was amazing how different it was once your crossed the border – the Arua River.  The landscape was different, beautiful, maybe even more so than Atiak.  There were more hills and rocks – giant boulders.  The villages were right on the road and even the huts were different- many were square.  Pakelle a town on the way even had a mosque.  It was clear that this district had more wealth and support.  Adjumani itself was like a big town/city wannabe.  Only a few main roads with lots of shops and even a bank, a hotel, and 2 petrol stations; but the roads were still dirt and it only took a few minutes to get the full tour.

The woman we dropped off had given birth 24 hours before.  Her baby wrapped in a blanket and wearing one of the two outfits given (no diaper), her basin of supplies on her head – she left the truck and began her 4 mile hike on the paths to her home. 

Earlier in the day a woman arrived fully dilated.  We thought it would be a quick birth as this was her third baby but she seemed afraid to push.  She held back every step of the way until finally hours after she arrived her baby was born. Her second child died at birth two years ago – a breech at home who got stuck and no one was there to attend her.  We all felt maybe she was too overwhelmed with the memory of her last baby.  This woman, Irene, was a second wife.  Men here often take more than one wife, sometimes as many as four.  In general the first wife has all the power and each subsequent wife has less and less control over her situation and is often treated even badly.  The first wife attended to Irene with her own baby on her back and was very loving and helpful.  It was obvious she cared for Irene and after the birth lovingly took this child into her arms as we cleaned Irene.
This afternoon this mama and attendant were cooking dinner over the fire.  Irene approached me and asked for something – I thought a spoon by the signs she was making and pointing.  After I got her a spoon she laughed at me and had to walk to the kitchen hut herself.  She wanted salt.  I felt badly and a little embarrassed. .

Saturday, October 6, 2012

Return to Atiak

October 4, 2012
What a journey back from Nairobi.  After a long tiring morning, but with delightful company at the airport and on the plane I arrived in Entebbe. My driver Ali was there to pick me up and we began the long journey to Atiak.  We made a few stops along the way which put us smack in the middle of a riot in Kampala.  The president of Uganda who is not popular and considered corrupt by most of the people had arrested the main speaker for a strike/ rally that was to occur.  The strike continued and the people spoke out.  The police however, were there to stop it.

There we were, in the middle of the city center, in stop dead traffic with shouts and people in the streets, police were everywhere.  All of a sudden not too far in front of us we could hear tear gas canisters being thrown then screaming and crying and within seconds countless people running through the street crying and gasping and fleeing.  It was obviously very close to us and I was so worried that if it got closer to us I wouldn’t be able to breathe.  Ali, my driver, tried to turn around and was making headway going over the curb but everyone else was doing the same thing.  We were stuck.  Then, very very close – gunshots.  They kept going off and more screaming.  Somehow while we were all ducking Ali got us onto another street but it seemed the gunshots kept following us.  He called a friend and got us good directions out of there but it was 10-15 minutes of terror. I called John a couple times during the event, and while I didn’t want to worry him I didn’t want to be alone. I was actually more afraid of the tear gas than the bullets – whether that was reasonable or not. I do not know, but it was how it was.

On the way to Atiak we saw truckload after truckload full of police being sent down to Kampala. It was very sad.  So marks another eventful arrival to Uganda.

I met Paul in Gulu for the rest of the ride home. It was so good to get back and see everyone who I connected with in such a short time. There is a family from Kenya here having their baby here who are delightful.  After meeting them I walked into the clinic to see how everything was going and literally within 3 minutes caught a lovely baby girl.  Then off to bed for much needed sleep.

October 5, 2012
It was a very hot day. So hot I was dizzy every time I had to go into the sun, and the birthing center was stifling with lack of air movement.  We had a lovely baby boy this afternoon to a mother who didn't even speak Acholi which made it more complicated for everyone, not just myself.

I was speaking to Katherine, one of the TBAs and she was telling me of her children – 2 boys and 1 girl.  Then she mentioned she had 2 other sons, one who died very young and one who was taken from their village nearby by the LRA and killed in that terrible massacre.  I cried when she told me.  The history of this place is so easy to forget and yet it is so close it is palpable…

October 6, 2012
I rode out to the village today to pick up a woman in labor.  She met us on the side of the road with her family. I so wanted a photo but did not want to insult anyone – here I am the white girl gawking.  They probably would have been fine with it.  This family was literally in rags.  Herself, her 3 other children, her husband – and covered in dirt.  They seemed concerned and quiet and a bit taken aback by seeing me in the ambulance.  She also did not speak Acholi and there was no communication.  She gave birth within an hour of arriving - a beautiful little girl.  

I used to think women had a way of speaking to each other that transcends language, and that birth especially is universal. Not here.  At least not the way I am used to.   The women don’t make eye contact and seem so beaten down that they would never consider a bit of comfort. You have to be tough to survive here and maybe any comfort is a luxury that would cost more than it is worth. Yet I can still empathize and understand and try to send them my encouragement and reassurance even without language.  Sometimes I feel there is a connection and understanding, mostly I don’t.  At least not until the birth is over.

Let me share a bit about how birth is done here.  Women are often left alone.  I do not know if that is what they want or not, but their lack of eye contact makes me uncomfortable in stepping in and supporting.  Only once has a woman leaned on me and held me and had me rub her back, and I was told that was very unusual.  Not only am I not with them, but no one else either – not their attendant, not the TBAs. They are brought tea and food, but that is all.  They sometimes go and hang out with the other women in the center.  They are encouraged to move around and be in different positions which I suspect is quite unique to this center and is not done in the villages or anywhere else.  For the birth, however, they are expected to lie down.

In many ways it is disheartening to see these women give birth flat on their backs, naked, on a plastic sheet.  Just seeing them so hot and sweaty and lying on that plastic is difficult for me.  No cotton or polyester sheets as the birth center does not have enough and apparently cannot afford to dirty them.  They used to, but not any more. It would be so much more comfortable for them and make clean up that much easier.  Yet that is the culture here and I have decided that my role is to support these women as much as I can and offer the respect they deserve, regardless of how this seems to me. And really, this isn't about the women or culture but about the center itself and how it is run and what the needs are. I do believe that women are treated better here than in the villages and certainly in the hospitals. And they are treated well.   I actually love how the women are birthing and the attendants and midwives are chatting (not me, I just listen and feel very out of place).  It is clear birth is important, but just another part of daily life.  It is not sacred in the way I am used to, but it is not bad either. I often reflect on how we treat birth back in the states and am even more disheartened. At least here, plastic and all, women are endowed with a strength of knowledge that is not education but at the core of their being that is so lacking with the birthing culture in the US today.

After the birth we clean the woman up with whatever material is handy, usually a piece of cloth or clothing.  We wipe her and the plastic down as well as we can but birth is messy and it is not ever enough. Women are not cleaned with water.  Then she lies back on the plastic that is usually still damp and a piece of some sort of material is put next to her to lay the baby on. Sometimes it is large enough to put her body on as well; sometimes not.   The attendant washes all the laundry and makes her food.  She is left alone again for most of her stay, unless her attendant keeps her company.  Most women are staying overnight and leave as soon as they can in the morning after breakfast.  Their attendants sleep on a straw mat in the middle of the big room.  I was told that one night they had so many babies they had the women move to the mats and then had to have women and babies share mats.  Later the women washes from a basin and will bathe their babies as well.  When they leave they are given 2 outfits and a blanket and we ask them to come back for postpartum care.  Most women do not return - the journey is often too long and difficult.

Wednesday, October 3, 2012


Today will probably be my last post for a while.  Internet in Atiak is too slow and to be honest, I actually never figured out how to get it when I was there anyway.  I will keep writing and saving my thoughts so when I do have access I can keep everyone up to date.

I went to Kilimanjaro today - a dream of mine since I was a little girl.  I saw her through the haze and clouds and admit I was disappointed I could not see her in her full glory.  I actually had the audacity to think I deserved to after these last 2 weeks.  But the truth is, I saw the snow caps before they are gone forever, ; I saw elephants and a lion and a hyena and a warthog and all the other animals I saw on my ride through Nairobi National Park.  I am ashamed I let such spectacular beauty be dimmed by petty disappointment. The truth is, I was truly blessed to be there and experience all I did and I am grateful now.  It was a dream come true. And only later, now, do I want to cry with joy at being able to behold her at all.

Ambesoli National Park is stunning.  It is 151 sq. miles of beauty and wonder on the Tanzania border.  Very dusty, in fact there were small funnels of dirt rising in the air everywhere.  It was also very hot and I was grateful I had my safari hat with me.  And did you know it is not Mount Kilimanjaro, but just plain Kilimanjaro (according to my trusty guide Peter who said the English mess everything up)?

I leave for Entebbe, Uganda very early in the morning and will have a long day of riding ahead of me. I hope to get to Atiak by late afternoon/early evening.  I am looking forward to being back there: working, learning, sharing, wondering, taking it all in...I wonder what adventures await, but to be honest, I will be happy with calm and peaceful and even a little boring would be good.

On another note and probably what everyone is following more closely than my silly adventures:  Rachael made it home safe and sound.  What a relief to all of us who love her. 

Tuesday, October 2, 2012

Rachael is going home and a bit of Nairobi

What an ordeal getting Rachael out of here and on her way safely home.  The insurance company insisted on more paperwork that the physician insisted he had filled out.  No one was communicating and I spent last evening trying to get it all together. Finally, paperwork is in and we have a plan, but no itinerary.  I waited and waited for the email with the information and had to get some sleep. I would rest in 20 minute increments then check the email.  Finally, after midnight we received word she is booked on the 3:40am flight.  Not going to happen!  Then they wanted her on the same flight tonight.  I called first thing in the morning and said "No way."  After strongly suggesting to them that making an ill person stay up all night to catch a flight would set her back and possibly lead to more complications, maybe on the flight,  they decided to look for more options.  It ended up that we found a flight on Kayak that was perfect and called them and got them to buy that one.  I wondered if they just didn't want to deal or had absolutely no clue.  Other than that experience however, I was very impressed with FrontierMedex and how quickly they responded to Rachael's needs.  I will definitely recommend them to everyone.

As soon as we knew Rachael's itinerary I was able to plan mine. Many of you know my emotional struggle with returning immediately to Atiak where there is a need, and taking one day to recoup. As it was, my travel agent could not get me on a morning flight tomorrow, just an evening one, which would be too late to drive north. The decision was made for me taking all the angst out of it.  It feels like it is a sign from God and a release.  So...tomorrow Mt. Kilimanjaro - a dream I've had since being a little girl. Thursday early morning flight to Entebbe, Uganda, then a ride to Gulu, then Paul our driver from the birth center will pick me up there. I should be in Atiak by late afternoon. It will feel good to get back. 

At the same time, I do not for one moment feel my time here was not as important and necessary. I was blessed to be in the right place at the right time, and I was blessed to be able to be of service, but mostly, I was blessed to be given such joy in having this woman brought into my life. This whole experience has taught me much about inner strength and resiliency, about protection, about patience, about trust, about empathy, and things I am not even aware of yet. Plus I got to catch a baby in Kenya - how cool is that? :)

In the meantime, I want to describe the bits of Nairobi I've experienced.  The immense beauty mixed with such intense poverty is overwhelming at times.  I had hoped to visit Moffat again today but it is getting too late and I have to get up early.  The people are the nicest people I have ever met, the driving is one of the worst driving I have ever experienced (India may tie).  At night in the hotel when I would return from Rachael I would watch TV.  The television shows are hysterical - they have Spanish and Swahili shows dubbed in English.  But what makes it even more absurd is the voices do not go with the characters at all and there is no tonal differences except when someone is hysterical.  I wish I could post a video here.  Top three commercials:  a cooking oil commercial that I swear borders on porn.  It is shocking!  A commercial in Swahili I think is about finding the right phone plan for your needs - it is a morbidly obese woman (the largest woman I ever saw) on a couch frantically pulling cell phones out from every fold in her body clearly looking for one she cannot find.  The last - a toothpaste commercial that ends "For those who spit blood while brushing their teeth."  I have gotten to know some of the men selling things on the street and have enjoyed my conversations with them.  It has become my little neighborhood here and I will miss it when I leave Thursday.   Actually, I will be gone all day tomorrow so this is really the end of my time wandering.  I will not miss the hospital however!

Today, while driving Rachael to the airport (I do not drive we take a cab) there was a funeral service van that had "Dolphin Friendly" on its door.  I am posting a photo below because I myself couldn't believe it when I saw it.  What is a dolphin friendly funeral?

Monday, October 1, 2012

Free at last!

Rachael was discharged today!  Now she begins the task of resting up and getting better for her long flight home.  She was able to walk more than I thought she should and her appetite was great (the food here is delicious which helps I am sure).  She had some nice outdoors which healed her body and her spirits.  As for me, it was a day of waiting and phone calls and trying to get all the pieces together from two different continents and no one communicating with each other.  We were hoping she would fly home tomorrow and really, there is no reason why she shouldn't. But the insurance company is insisting on even more paperwork and the docs are balking.  I find it much easier to be patient in Atiak where there is quiet and life just is.  In the city here I expect everything to function efficiently.  This is my lesson of the day, patience.  In the meantime I am enjoying this day with Rachael and soaking up every moment I can with her.

Rachael in her happy to be discharged face and drummer pants.  And her new Kenyan shirt that says "Everything is Alright" in Swahili.

Getting some fresh air and sunshine - healing on all levels

And surprise of all surprises, I don't think I did anything today that would embarrass my family.  Maybe a first for me.