hannatruscott

Post Script: About My Ayiti Blog

2012-01-07T12:42:00.000-08:00

On the wall of Midwives for Haiti House

I went to Haiti from October 26 through November 16, 2011. My interest in going was piqued by meeting Nadene Brunk, CNM (Certified Nurse Midwife), when I heard her speak at the annual ACNM Convention held in Seattle, 2009. With help, Nadene founded Midwives for Haiti, a 10-month educational program which meets standards set by the World Health Organization for providing essential midwifery care. I am a former nurse-midwife myself and have a passion for doing photography projects centered on maternal-infant health issues. Interestingly, media attention to the needless and devastating deaths of women (and infants), particularly those in developing countries, has recently increased largely driven by the United Nation's Millennium Developmental Goals #4 and #5. For years, I have also wanted to do my part using my camera as my tool to focus attention on maternity-centered issues. So, I volunteered for Midwives for Haiti, recording what I've learned through my lens and writing.

I wrote my blog when I returned to the States, designing the subject matter around themes that moved me when I was there. I cobbled together these vignettes from emails, notes, musings, and memories. As a result, my Ayiti blog is not strictly structured in chronological sequencing typical of most travel blogs.

My Suggestions: logically, start with the first entry 24 posts down (!) which was uploaded optimistically in October with expectations of making new entries as I went along. Or, skip around, looking at the images and picking out topics of special interest to read.

I'm relieved, finally, to be able to post my thoughts and photographs. Doing this has been essential to processing my experience and lessons learned. I'm finally able to share.

In any case, thank you for your interest. Comments are welcome if you can figure out how to post them. Mentioning my blog to other people interested in issues addressed here would be flattering.

Welcome to my Ayiti blog!

Au Revoir et Bon Voyage

2012-01-06T16:48:00.002-08:00

It is time to leave Hinche. Moliere returns to take me back to Port-au-Prince where I will board my plane.

I keep thinking about Haiti, a beautiful Caribbean Island, a mere two hour flight from Miami, where people speak a language influenced by French, African, and Spanish. I'm delighted that Creole (kreyol) has several words I can understand. With Haitian's history of struggle against oppression and political corruption, a recent and devastating tremblement-de-terre (earthquake) that added acute injury to chronic problems, there is a strong current, a rising and palpable passion amongst the people for rebuilding. Rebuild Better.

The maternal and infant mortality rate in Haiti is one of the highest in the world, not surprising considering that Haiti is also the most impoverished country in the Western Hemisphere. But, poverty in the physical realm does not obscure wealth of spirit. I leave Haiti with an unforgettable experience impressed on me through the warmth and generosity of the people I encountered. I feel compelled to return.

The Bottom Line

2012-01-06T16:48:00.000-08:00

It takes money to create a sustainable program of midwifery. Midwives for Haiti has a fundraising letter to help volunteer midwives from developed countries garner support for their work. Rather than write my own plea for funds, I will post this letter from Midwives for Haiti. Another way to offer support is to go to the Midwives for Haiti website: http://www.midwivesforhaiti.org/

Even if you don't feel moved to donate, your interest in reading my blog is completely appreciated! And reading the content of this letter will help your understanding of maternal-infant health needs in Haiti.

I stand by this organization. I've seen what they have accomplished in such a small time. I have great hopes for their future endeavors.

THANK YOU!

Cheryl Hanna-Truscott

Dear Friends & Family,

I will be going to Haiti ____________________ to volunteer in a midwifery training project, Midwives for Haiti.

The lack of skilled obstetrical workers makes Haiti the most dangerous place in the western hemisphere to have a baby. According to World Health Organization statistics 670 women die for every 100,000 births. That rate is 60 times higher than in the US.

In the rural areas of Haiti only 15% of births are attended by someone with the training and supplies needed to make birthing safe.

Midwives for Haiti has been working since 2004 to train community midwives. The organization has received the support of the local population and the Ministry of Health.

I have attached the link to the organization’s website which provides a wealth of information about this inspiring and ambitious project. http://www.midwivesforhaiti.org

I am writing to ask you to become a part of the Midwives for Haiti team by providing a donation to help support this life-saving work. Haitian midwives need medical equipment and medications to provide life-saving health care in rural areas. For example, each midwife needs tools that can be sterilized, a steady supply of sterile gloves, basic obstetrical medications, and textbooks that have been translated into Creole. Donations may also be used to assist volunteers cover the costs of translators and travel.

Any donation you make will be greatly appreciated and judiciously used. There are two ways you can make a difference.

A check made out to me will allow me to purchase desperately needed supplies and non-prescription medicines to carry into Haiti this month. This will immediately impact the lives of the poorest mothers and mothers-to-be in our hemisphere.

A check made out to Midwives for Haiti will be used for the longer term needs of the project. Since Midwives for Haiti is a non-profit organization, this type of donation is tax deductible.

Please send your donations to my home address. I will be leaving _______ on ________, but in order to have time to purchase supplies would need to have your check by __________.

Thanks so much for your support. I will be taking a camera and will post photographs of the trip for all of you to see your donations in action.

In Peace,

__________________, CNM

Midwives for Haiti is also on Facebook: https://www.facebook.com/MidwivesForHaiti

How Can Your Donation Make A Difference?

$50 medicates 10 women to stop postpartum hemorrhage.

$100 prevents hypertension in 15 women during their pregnancy.

$250 supplies a student midwife with medical instruments and scrubs.

$500 provides medications for safe deliveries for 10 women at a village birth center

$1,000 provides medications to keep 80 women and their babies healthy during pregnancy

$1,500 provides emergency transport for 100 women and babies to referral centers.

$2,500 supplies a village midwife with prenatal vitamins and antibiotics for 1 year.

$3,600 educates a skilled midwife to serve rural women.

$5,000 provides 115 women with prenatal care for their pregnancy.

$10,000 pays for the instruction of 15 Haitian midwifery students.

$30,000 buys a vehicle to provide prenatal care and transport to rural women.

Link to fundraising: http://midwivesforhaiti.org/donate.htm

http://www.womendeliver.org/updates/entry/maternal-health-in-haiti-on-pbs/

A New Home for Midwives for Haiti

2012-01-06T16:47:00.001-08:00

A New Home

The Midwives for Haiti outgrew their former rental home and are moving in to this new building in time for the Class of 2012 to begin. Classes will be held in the outdoor area with the added benefit of having indoor sessions in difficult weather. Two floors will allow a measure of privacy for the resident teachers. Volunteers and paying students, helping to subsidize costs, will share bedrooms on the first floor.

Beautiful details:

Restful spaces

Awesome views

The gracious spirit and unrelenting resilience of Haitian people, surrounded by the beauty of their Caribbean island, strengthens hope that Midwives in Haiti teachers, staff, students, and volunteers will continue to address the devastation of maternal and infant death in Haiti. This beautiful home base will contribute to a flow of positive energy.

Midwives for Haiti, Class of 2012

2012-01-06T16:46:00.002-08:00

My last day in Haiti was spent observing the admissions process for the fifth class of students. Two days are devoted to reviewing applications and interviewing candidates. Six students had already been pre-admitted because they came highly recommended from trusted sources and also because they had guaranteed jobs waiting at the end of the program.

Women started arriving at 6:00 am although they knew that interviews did not begin until 9:00 am. Word of mouth passed around quickly that there were only nine spaces left for the class of fifteen. Over the two days, fifty-seven candidates, including one male applicant, had their resumes reviewed by a team of American, Canadian, and Haitian midwives and eventually, eleven future midwifery students were selected from this group stretching the Class of 2012 to seventeen.

The applicant's level of education, work experience, and a willingness to relocate for opportunities outside of Hinche were important considerations. A candidate's energy and "feel" were more subtle and compelling qualities. One important interview question was, "Why do you want to be a midwife?" In America, midwives want to "empower women," "bring low technology care to a normal life event," and "promote healthy maternal-infant attachment." These are all great and noble reasons for being a midwife, in fact, these are the essence of midwifery care. But in Haiti, I heard profoundly different answers to this essential question: "Too many women die in childbirth." "Babies die." "I want to help the suffering." "I want to save lives."

A Plea from Midwives for Haiti:

$3,600 educates a skilled midwife to serve rural women.

$5,000 provides 115 women with prenatal care for their pregnancy.

$10,000 pays for the instruction of 15 Haitian midwifery students.

Hopeful midwifery candidates for the upcoming fifth class at Midwives for Haiti stand
outside the closed door where interviews will be conducted.

Security guards collecting CVs

Midwives Nadene Brunk, Kirsty Bourret, and Genette Thelusmond
Interviewing a prospective student

GRADUATION!!!

2012-01-06T16:46:00.000-08:00

Ceremonial events in Haiti, from my limited experience of the two I attended, are very impressive. The midwifery students practiced for graduation very seriously and the end result was notable.

Graduation day began with a two hour long mass at Marthonie's church. The crowds packing the sanctuary flowed out the back where fold-up seats accommodated later arrivals. At the start, the midwives filed two-by-two towards the front pews, bearing gifts for the church. They looked sharp, dressed in matching ivory suits with brown trim, and wearing demeanors befitting the dignity and strength appropriate for the occasion. Incense filled the church with a sweet pungent smell over the sacraments.

Following this, the graduates and invitees made way to the Zenith Night Club in Hinch where festivities continued: speeches, honors, diplomas, gifts, dancing, an enacted birth drama, food, photographs, and congratulatory wishes sent the Class of 2011 off to save Haiti, One Mother and One Baby at a time.

Fifteen graduates with instructors, hospital administrator, and directors

Midwifery Instruction

2012-01-06T16:45:00.001-08:00

The timing of my trip coincided with the last few days of formal education for the Class of 2011. The anticipation of graduation was palpable and I was there for the last official class gathering which was spent largely processing feelings about becoming a midwife. Emotions were high.

Last Day for Class of 2011

Midwifery instructor, Reina Galjour
holding Jamlex, the class baby

Midwifery instructor, Marthonie Raphael

Monthly Continuing Education

Midwifery graduates from miles around come to a monthly workshop to reconnect, share and learn. This month, the topic is postpartum hemorrhage, a leading cause of maternal death and morbidity in developing countries.

Midwifery instructor, Genette Thelusmond

Along Route #3

2012-01-06T16:44:00.002-08:00

There are three main recently constructed highways in Haiti. Route #3 is the one traveled between Port-au-Prince and Hinche. Trianon and Cange are villages situated on the road.

Trianon

Trianon is the site of a new health center where one of the midwives provides prenatal care. There was much excitement looking forward to the official opening of the clinic. Ceremonial events are taken seriously and with great fanfare. The Bishop of Hinche presided over the three hour christening.

Midwives

On the way back to Hinche from Trianon, I took pictures as we rolled along in the pink Midwives for Haiti jeep.

Cange

In Cange, Zanmi Lasante (the Partners in Health Hospital), started as a community clinic but has now grown into a 104 bed, full-service hospital. Doctor Paul Farmer, a physician-anthropologist, is a well-known, committed and compassionate co-founder of Partners in Health, an international health and social justice organization. His work is the subject of Tracy Kidder's 2003 book Mountains Beyond Mountains.

Jackie Williams

Admittedly, I was very excited to visit Zanmi Lasante. I have much admiration for Dr. Paul Farmer who strikes me as a modern day Albert Schweitzer (one of my childhood heros) without the heavily religious zeal. Gladias and I had the privilege of taking a tour of Zanmi Lasante from Jackie Williams who operates a crafts workshop and gift store at the health complex. Jackie, ex-pat since the 1980s, originally came with her engineer husband who helped design a water system that pumped water up the hill from the river below.

Infant and toddler care unit

Neonatal ICU

Public education poster advising women
to seek care post-sexual assault

OBGyn Physician

"The happiest people are those
who make happiness for others."
(Or something like that!)

Children attending the school on hospital grounds

http://en.wikipedia.org/wiki/Paul_Farmer

Fort Resolu Village: Ewins Joseph, Matwons, and Teachers

2012-01-06T16:44:00.000-08:00

Early in my trip, I went to the Saturday morning English language class given by the Brothers to a large room crowded mostly by men with a few women. I went to offer conversational English practice. Entering, I was introduced as a midwife doing photography, and immediately the questions flew. "Is it good to breastfeed a baby right away or are you supposed to wait a few days?" "Is sugarcane bad for pregnant women?" "What are the worse things you have seen?" "Why did you want to be a midwife?" "What good does a midwife do?" "Are breech babies dangerous?" It was such a surprising thing to talk to all these MEN about childbirth. I mean, they really wanted to know! The women remained quiet, perhaps shy and not as confident with speaking.

Later, it was my turn for questions, asking the more vocal men what they wanted to do for Haiti and for themselves. Each has big, honest, visionary dreams... an architect, several agronomists, lawyers, doctors, a nurse, a policeman, but there is lack of educational opportunity. The intelligence and thoughtfulness of these men was touching. I wonder if any will be able to realize his hopes. One of them ended his statement with "God willing."

The last man to linger after class, speaking in nearly perfect English, introduced himself as Ewins Joseph. He asked if I would come to his village, Fort Resolu, where he is a leader of development there. He spoke to me about the twenty traditional birth attendants (matwons) around his village who need education and encouragement. Since my main focus on this trip was to do photography for Midwives for Haiti and I hadn't worked in midwifery for years, I wasn't really sure what I could contribute. Ewins insisted that the matwons would love to meet me and encouragement would be enough. Ewins, surmising that I needed a character reference before agreeing to taking off on a motorcycle taxi to an outlying village, reassured me that he had been in contact several times with the educators from Midwives for Haiti and that he is known to them. We exchanged cell phone numbers, arranged a tentative date based on when the matwons gather for their regular weekly meetings, and parted ways.

Ewins Joseph, leader in Fort Resolu

Fort Resolu and the Traditional Birth Attendants

Ewins and the village pastor rode up to the midwives' home on motorcycle taxis, ready to take Gladias and I to Fort Resolu. Winding our way through the outskirts of Hinche into an outlying rural area about twenty minutes away, we pulled up to a large concrete building that is the village church. School was several yards away: a strip of open-air structures with dirt floors and tin canopies sheltering rows of wooden benches that faced slightly damaged but useable green boards. School children had a few days off for holidays so the rooms were empty except for one where the matwons had gathered to meet that morning.

Pastor Gesther Escilus (front & left) with Ewins Joseph
and the Matwons of Fort Resolu

Initial conversations were light and anecdotal references to assisting farm animals at birth were spoken jokingly. The matwons had varying degrees of experience and the older ones shared stories about their calling into midwifery. Several followed grandmothers or grandfathers into this work, heeding the need for a village birth attendant to replace the older one at some point. Another cited an underwater dream which called her to midwifery. Eventually, the matwons turned to Juslene Regulus, one of their two de-facto leaders and spokeswoman. Juslene had received nurse auxiliary training at St. Therese Hospital and had worked with the midwives there. She brought out a list of supplies that the matwons wished they had: scrubs, blood pressure cuffs, thermometers, gauze, suture material, cord clamps, a baby scale, sterile gloves, pitocin, scissors. Headlamps were on the list as were eyeglasses. Juslene explained, "Some of the matwons are old and it is getting harder for them to see. We attend births at all hours, leaving in the dark, walking over rutted roads, sometimes tripping and falling to get to the laboring mother."

The conversation wound down and It was time to leave. I still feel a lingering hope of returning.

The Following Week

Matwons

Ewins invited me back the following week. I was happy to oblige. Once again, motorcycle taxis took Gladias and I to the matwons' weekly meeting where we gathered in a circle. During the meeting, two matwons arrived late, "I had to help corral a loose ox in my neighbor's garden." "I just delivered a healthy baby girl." The matwons were discussing immediate postpartum care of the newborn. One suggested holding the baby's feet and spanking the baby's bottom to make the baby cry. Another disagreed, stating that what she did was put the baby on the mother's abdomen and dry the baby off there which would keep the baby warm and stimulate breathing. Gladias translated in whispers as dialogue unfolded and I listened in rapt attention. Then, eyes turned to me, "What do you think?" "Well," I began, somewhat hesitantly, "I haven't practiced midwifery in two decades, but what American midwives like to do with healthy babies is to lay them on the mother's tummy, gently dry them off with a towel, and then cover both the baby and mother to keep them warm together." Being asked to participate this way was unexpected and challenging. Some time in the future, I hope to teach basic life-saving skills to matwons like these, reinforcing the good parts they are already doing and perhaps helping them decide to change practices that might be unsafe. I want to make sure I know what I'm doing. These dedicated matwons deserve the best. And so do the families they care for.

Verose Andre & Aliette Bastia

Ludia Saint-Iler & Chrisiana Casimir

Anelus Faveus, Arilia Bernard, and Mercilia Bernard

Felicia Altemour, Voicy St. Jean, and Lucienne Jean-Baptiste

Odilia Joseph

Jesula Louis and Julene Regulus
Leaders of the Fort Resolu Matwons

Teachers

Ewins was eager to show me the school, especially since students were back in class after last week's holidays. Ages of children went from young preschoolers to middle school years.

School children at Fort Resolu

Teacher Charles Lubenson

Ewins, a religious man, prays for a sponsor who will help improve the school at Fort Resolu. The teachers working there perform their jobs as volunteers since salary money is not available. I spend a half hour speaking with them about their visions for a better future. It just doesn't seem enough to listen to their hopes and take their photographs. Is there anything else I can do?

As I left Ewins and Fort Resolu, I showed Ewins my high school ring. I started wearing it again after three and a half decades of keeping it in my drawer. Wearing my ring empowers me. My ring bears the school emblem which includes a banner where the motto is written, "Possunt quia posse videntur", Latin for "They can because they think they can." I started wearing my ring when I began my prison nursery photography project . Ewins paused and asked me to repeat the motto. "They can because they think they can," I say. Ewins thanked me, "I will use that one."

Is there anyone reading this journal who wants to help these Fort Resolu Haitians move themselves forward to a better, educated future? Contact me! I have connections!

Teachers in Fort Resolu
Michel Baselais, Valcourt Ossamile, Joseph Obenson, Charles Lubenson,
Odanie Etienne with Louis Carlo (one month old) , and Amicy Pierre Louise Jesula

Boys and Young Men at Maison Fortune

2012-01-06T16:43:00.000-08:00

During the second half of my stay in Hinche, I lived and ate at the Maison Fortune guesthouse. Maison Fortune is an orphanage in HInche that was started just over a decade ago by Lefort Jean-Louis, a Haitian man educated at Virginia Tech with help from supporters. Long term volunteers from the Catholic Xaverian Brothers include Brother Mike, Brother Harry, and Brother Bill who graciously welcomed me and other visitors to stay in their guesthouse.

The orphanage includes separate living quarters for boys and girls, school, church, and wide grounds for banana trees, poultry, and play fields. Many of the children have family ties in surrounding villages but widespread poverty makes living at the orphanage a privilege where there is opportunity for physical, spiritual, and educational nourishment. After the January 2010 devastating earthquake in Port Au Prince, the numbers of truly parentless orphans swelled the ranks.

It was an experience to be awakened before dawn to the incessant crowing of roosters followed by the rising voices of children getting ready for the day. Younger boys took open air bucket showers followed by dressing in school uniforms, older boys tying the shoelaces for the younger ones. In the late afternoon, younger boys spend time coloring on a porch gathered around Brother Harry who sits in his chair being a manly, fatherly presence. Pick up soccer is played out in the yard.

Brother Harry surrounded by boys

Any lonely moment I have is immediately banished by going outside the guesthouse where dozens of curious children would swarm around practicing English, "What is your name?", "My name is…", "Hello!", "Where are you from?", "What are you doing?"

It is nearly impossible to single out one child for a photograph. As soon as the camera comes out, the children flock around. "Notice me!" they signal, "I am somebody, too."

Althus and Olishard

For the three trips I make to the SIsters of Charity feeding center, I walk through Hinche accompanied by one of the older boys, Althus or Olishard. Each of these boys speaks passable English that gets better every time they assist one of the midwife volunteers.

Althus is about 16 years old. His younger brother and cousin also live at Maison Fortune. Althus dreams of becoming an electrician. This would be a smart move on his part: the orphanage has hooked up recently to city electricity but the service is capricious and unreliable. Brother Bill tells me that the electrical system in Haiti is downright dangerous. The electrical wires are that do exist are hazardous. Generators are used in the evening hours by the people who can afford propane. Candles are used by others less fortunate. The sky becomes dark around six at night and without the light, blackness surrounds.

For a small price, Althus offered three pictures he and his cousins sketched. Brother Mike later told me that Althus is enterprising. He owns some poultry and is saving up to buy a goat.

Althus

Olishard, about 17 years old, wants to become an English teacher for Haitians. Actually, Olishard wants to learn three languages: English, French, and Spanish in addition to already knowing his native Kreyol.

As the two of us walk to the feeding center, I am noticed. There are very few other white-skinned people in this town and I feel a hundred eyes on me. I wonder what I look like? Once, several little children momentarily stared at me and then ran away in fear. As I pass other children, some call out, "Blan! Blan!" White! White! I don't know if this is an insult or a comment so I ask Olishard. He doesn't give a direct answer but emits a little laugh and says, "Some of the midwives call back, 'Noir! Noir!' or 'Black! Black!' " So, I try this the next time and watch the reaction. The children seem surprised.

Olishard tells me that he is the youngest in his rural family of six other children. His oldest sister died recently at 28 years old of some indeterminate stomach problem. He was able to attend the internment services because it was held nearby, Two brothers live in the Dominican Republic and are working there. The other sister helps his parents. With this opportunity for education at Maison Fortune, Olishard's family has hope for his future.

Olishard with Althus in background

Oday

Oday is a younger boy, likely around six or seven years old. Oday came to the orphanage after the earthquake when none of his family could be found. Oday is a squeaky wheel and will never be overlooked. He insinuates himself close to the Brothers whenever possible to do any small task or errand. He is usually the first to greet me as I leave the guest house, "Hello! How are you?" in bold English. Oday is a survivor in every sense of the word.

Oday (pronounced "O-Die")

Standing in front of the Guest House entry wall where children posted
"Welcome Home Brother Mike" signs.
Brother Mike had just returned from a visit to the States.

Neighboring children attend school at the orphanage
if they are lucky to get in.

Food at the guesthouse is delicious, thanks to Bethany. She goes to market every day and returns with fresh fixings for the day's meals. A hot midday lunch is customary with one added dish to the evening meal of leftovers.

Bethany

They Make it Look So Easy!

2012-01-06T16:41:00.001-08:00

Haitian women carry loads of every kind of thing on their heads.

Here is a list of some things I have seen:

two chairs,

one chair with a basket on top,

a basket filled with coiled ropes,

a large bucket of fruit,

two layers of egg cartons with about 26 eggs on each layer,

large, two foot diameter loaves of cassava bread,

long bundles of sticks,

laundry,

big bags of food,

5-10 gallon buckets filled with water,

8 brooms- 4 brush heads pointing one way and 4 the opposite with the balancing point in between,

and a dozen glass soda pop bottles.

HAPPILY, I was at a rural clinic on a beautiful, beautiful day. Clinic was slowing down so I went outside to take photographs of animals. A few schoolgirls saw me, came over, and posed for photographs. And then a young woman in her twenties named Diolen walked over with a GIGANTIC bucket of CORN COBS that she carried on her head. She wanted me to photograph her! She really enjoyed herself and was even laughing in several shots. And then through a combination of sign language and kreyol, told me she had to go. As she walked away, I kept shooting. She turned around and smiled again.

My encounter with Diolen, the "Corn Maiden", was all so lovely... which I find happens on trips like this. Things just seem to fall into place.

A Few Haitian Animals

2012-01-06T16:40:00.001-08:00

Mobile Clinics

2012-01-06T16:39:00.002-08:00

Magdala Jean Gaston, Philomene Chelemaque, and Marie-Ange Esaie, graduates of Midwives for Haiti, are the three providers of maternity and well-baby care at clinics held Mondays through Fridays, rotating through about 20 clinics per month. The midwives pack their suitcases with equipment, medicines, and other supplies and then all pile in the pink Saj Famns pou Ayiti jeep, where they ride over rutted rural roads, cross rivers, and arrive at clinics scattered throughout the Central Plateau. Ronel Emmanuel, an essential partner in this team, is not only a chauffeur but a first-rate mechanic which is necessary for drivers in Haiti.

Rhode Clinic

The clinic is set up on a regular day each month in Magdala's living room. Women gather on the front entry porch of Magdala's home and wait for their turns. This morning before the clinic examined individual women, Philomene stood at the door and gave a health talk to the women.

HIV testing

Savanne Halaine
It takes about 35 minutes of driving on gutted dirt roads and five river crossings for the jeep to make the trip to Savanne Halaine from Hinche.

Magdala Jean Gaston checks the gestational age wheel at the rural Savanne Halaine mobile clinic

as she initiates a first prenatal exam on a woman.

A mother with her four year old son. Her two
children were born at home with the matwon but she likes
going for prenatal care at the clinic to make sure her baby is healthy.

Driving home from Savanne Halaine, Ronel was absolutely exuberant. I was riding in front with the three midwives in the cab. Gladias and a Haitian doctor were in the very back so I didn't have a translator. Ronel talked and talked and the midwives were laughing and laughing! Ronel would beep and honk at passersby and give a thumbs up or a wave because he has a lot of friends on this route. The midwives' jeep is bright pink... unmistakable…and is well known around the Central Plateau. We crossed five small rivers to get out to the clinic and then again back into town. The road is rocky, rutted, steep in places, and has occasional puddles. It was all very pleasant and downright jolly being part of this crew!

Observations in the Delivery Room Setting

2012-01-06T16:39:00.000-08:00

Entry doors to the delivery and gynecology rooms

Today is another day at St. Therese Hospital. The four small clinic rooms are full. I sit quietly and observe:

** One woman was being monitored for postpartum complications. Her 6 month stillborn fetus lay quiet at the foot of the delivery table.

** An older woman crying in pain is brought in by wheelchair. She has cervical cancer.

** Another pregnant woman receives IV pitocin to augment her stalled labor. Her protective membranes and amniotic waters have ruptured so antibiotics are administered.

** By grace, a young, very pregnant woman in a pink gown moans in hard labor. I am hopeful for a healthy birth.

**A young nurse auxiliaire is sitting on an old metal stool at the desk and writes in a chart. She stands up to stretch and the round seat wobbles then clatters down on the floor. She is unperturbed. She picks up the misbehaving seat, balances it back on the frame, and sits down to continue charting.

A Healthy Baby Girl is Born Today

Midwife Bien Amie smiles as she holds a brand new healthy baby.

While the midwife assists the mother in recovery, the auxiliare tends to the newborn.

Midwife doing necessary paperwork!

Midwife Josette Duvil

Through it all, Excellente St. Rose, a janitor at St Therese Hospital for the past 16 years, drifts amongst the rooms, cleaning as she goes, contributing to the upkeep and conversation within. Before the trained midwives started working at St. Therese, the janitors caught babies. I asked Excellente how many babies she had delivered back in the days and she laughed, "… many, many!" Once, she delivered three around the same time.

My Last Day at Azil

2012-01-06T16:38:00.000-08:00

Saturday was my last afternoon at Azil. With some urgency, I take note of the little girl who had been so edematous the weekend before. Her bloating had receded and she was getting IV fluids with antibiotics. Her forehead is hot and Sister Josef passes a cool washcloth on her head. I learned that her name is Dylene and that she is three years old. She had arrived to Azil recently and her mother lives far away. Sister Josef spoke quietly, "She is on the brink between life and death. Now she has to choose. She either fights or she dies. This is very serious." Dylene was no longer whimpering. She lay very still, her eyes glazed. An occasional fly landed on her face. "Dylene," I whispered only to myself with great sincerity, "it might be a good thing for you to go." I think, "Better she die at home in her mother's arms." And then I change my mind; her mother thought she would have a chance here. Her mother did the best she could.

My little guy, Champson, is crying. He saw me and immediately put his arms up to be held. He looks a little healthier now. Am I imagining this? I reached down, knowing I am committed for at least an hour and a half. But we had figured out a rhythm: I juggled him on my hip and I made my rounds, moving from baby to baby. Several are strong enough to feed themselves with their long skinny baby fingers while sitting up in cribs. Eating is serious business and none of the babies laughs or plays with food. Spooning the last of his mash and hard-boiled egg to his mouth, one boy lifted the red, plastic bowl and completely covered his face. His tiny, little hands continued to hold the bowl over his face for an entire minute before letting it drop back down. Of course, I know that well-nourished babies often do the same thing, but witnessing this in a hungry child took on a new meaning for me. I have rarely seen such a dramatic portrayal of hunger.

Sometime in the middle of my stay, I wandered back to Dylene, the very sick girl. One of the nannies had taken notice of her and motioned to another nanny that her breathing had changed. We three stood at the side of the crib, quietly and expectantly. Dylene heaved a sigh. And after that gasp, she died. Dylene died on November 6th, 2011, at 4:18 pm. I noted the date and time for a mother who could not be there. Prayers were murmured. I said a silent one for her mother.

As Dylene was being prepared for her casket, an older preschool girl about five years old had tiptoed into the baby room, pulling a younger friend alongside. The older girl spoke in a loud whisper to the younger child, pointing and staring, fixing their full attention on the silenced, dead, baby girl. My kreyol isn't very good, but I did make some sense of what the older child was explaining. Death. One of the nannies shushed the girls out of the baby room and confirmed my thoughts. Lessons learned at a very young age.

I have an hour before leaving. I circulate around the room of babies. I watch one thin little arm stretch between the crib bars to touch the hand of a little neighbor. I cuddle another who is crying until she quiets. I pay attention to the babies who are alert. The laughing baby from last week wakes from his nap and I go to his crib. We play peek-a-boo and he laughs out loud. The one next to him starts to giggle at a silly song I sing. Another one across the row starts laughing.The game spreads to another few. I am still cradling Champson and even he finally relinquishes a quiet, somber, half laugh. I find myself goofing off for our mutual amusement and after the afternoon of death, I am enchanted by this chorus of seven cooing and giggling babies. It was a gift to be with hungry babies who could still feel a spark of playfulness.

Post script: A good article on one solution for Haiti's hungry children is here:
'Peanut butter medicine' giving hope to Haiti's hungry http://www.cnn.com/2011/WORLD/americas/10/11/cnnheroes.haiti.children/index.html#

Serendipity: fluke, good fortune, good luck

2012-01-06T16:37:00.000-08:00

Ismerilda was in the throes of hard labor when we met. It isn't easy meeting someone for the first time in this situation, but Ismerilda and Simeus were gracious in allowing me to hang out for awhile. I reluctantly left before she gave birth but was able to return with Gladias the following morning to see what had happened to her. I was greeted warmly, almost like an old friend. It was nice to see her transformation from yesterday: fear, pain and tears replaced by confidence, mild discomfort, and engagement with her new daughter.

Ismerilda and Simeus at the hospital

Gladias and I had planned to spend the afternoon with Manno, one of Midwives for Haiti's first employees and staunch advocates. Manno and partners were constructing a new school in their families' village and I wanted a tour. Through a short conversation, we learned that Ismerilda and Simeus live in a home by a river crossing we would take on our way home. Serendipitously, Ismerilda would be at home around the time we planned to return. Gladias listened to a description of their home and off we went, hoping to meet again later.

Following the tour of the new village school, we found Ismerilda's rural abode. Simeus and Ismerilda with their newborn had just arrived and welcomed us in. Through our conversation, I learned that Simeus's first wife died shortly after childbirth and their nine month old son succumbed several months later. Ismerilda and Simeus, with two older daughters, welcome the new baby to their home.

Love and Loss

2012-01-06T16:34:00.000-08:00

Riding in the back of the bright pink Saj Fanms pou Ayiti (Midwives for Haiti) jeep to the christening of the new health center in Trianon, Josette Val, midwife, eventually bent forward, eyes closed, and rested her head in her lap. We were about halfway there on our hour and a half trip. Through Gladias, I asked if she was ok. Josette said she was just tired because she had worked last night at the hospital.

Pause.

"Any babies?" I asked with a smile in my voice. Josette replied, "Two."

Pause again.

I pressed on asking how the night went. Josette continued matter-of-factly, "…and three fetal deaths and one maternal death." The maternal death was a first-time mother, eclamptic seizures ending her life. Staffing at night is limited to two midwives, so Josette and another midwife handled the traumas.

There was nothing more to say. Josette closed her eyes, catching some rest. The jeep rambled on to the celebration.

THROUGHOUT my three weeks in Hinche, I saw many serious problems in women and babies... love and loss.

Midwife student Yvanese Jean Louise works with
the woman behind her who had a stillborn baby two days ago.

Claudie Exume, student midwife, checks the blood pressure of a woman hospitalized for a serious antenatal complication.

Collateral Damage: This eight year old child stayed overnight with her mother who will remain hospitalized until she has her baby. The mother is painfully underweight but has little money and few supports to bring her food.

This little girl had been born at home but bled from her umbilical cord. The day after I took this photograph, I tried to find out if she had survived but she wasn't in the pediatric ward. I wasn't able to learn what happened to her.

Pediatric nurse caring for a very sick baby girl.

Midwife Carline St. Cilles starts an IV on a woman. The husband looks on as he holds his two day old son. The couple's first baby died at two days old.

The midwives treated this 8 day postpartum mom for second-degree burns from a sitz bath with a gentle disinfectant wash and a topical cream. They kept her in the hospital for observation. In spite of her injuries, the mother remained entranced by her newborn.

Witnessing Starvation

2012-01-06T16:32:00.001-08:00

For three weekend afternoons, I spent time in one tiny room at AZIL, the Sisters of Charity feeding center, with eighteen to twenty starving babies. These babies live there and get fed until they are well enough to leave or they die. Oh, and there are at least FOUR rooms of children, babies through preschoolers, in this one building.

I enter the gated community of Azil. From what I'm able to gather, Azil is a multi-room, multistoried grounds, where sick adults, orphans and and starving children live under the care of nuns. An image of Mother Theresa is hand painted on a facing wall. I am greeted by Sister Josef and invited into the children's area. Sister Josef is from South America, short and plump, and has a basic command of English. We ascend stairs and pass through an open room lined with wooden benches for church services. The walls are interesting: I look up to a poster of a Caucasian Jesus surrounded by Caucasian children and a poster with images of Caucasian angels. The images remind me of ones I knew from my very brief, early Sunday school years. I notice that I am the only Caucasian around.

I walk through several rooms where young children are sleeping. It must be nap time on this warm, tropical afternoon. I pass down a hallway, turning to enter the small, white with blue trim room designated for the babies. Catholic icons are fixed to the walls: statuettes, images of religious saints, and several "blan" ("white") girl dollies, each one wearing a fancy dress. A large armoire holding shelves filled with small clothes, cloth diapers, blankets, and washcloths stands by one wall. Next to this is a table where there are large buckets for baby food (bean and rice mash) and water. The remaining three walls are lined with small, old, metal cribs. Two clusters of six cribs stand in the middle of the room, spaced just wide enough to pass in between. The tropical heat, occasional breeze, and filtered sunlight passes through window slats high above one row of cribs.

Starvation. I did say "starving". STARVING! Earlier before setting out to Azil, I thought I was starving because lunch hadn't been served until 1:45 pm. I admonished myself: I was not starving, I was a little hungry, whiny and inconvenienced. Admittedly, I have seen and been moved by photographs of starving babies but I have not really seen starvation. At Azil, I learned that starvation has two different looks: one is bone thin and the other is very edematous. A seriously malnourished baby was propped up in the low wooden chair and at one point, listed over while a nanny rushed to rescue her from a fall. She had the edematous type of starvation, complete with cellulitis of her legs. Close by, I noticed a second whimpering baby with blistered skin from bloat. She lay listlessly, her weeping and open leg sores partly covered by gauzy dressings. I was afraid to hold her thinking I would cause her more pain. Sister Josef told me that the babies with too much bloating are actually worse off than the terribly emaciated ones.

A pathetically thin little girl, between 1.5 and 2 years old, was alert and crying so I picked her up held her, and offered her a bottle. She calmed down immediately but pushed the bottle away. Sister Josef rustled by, telling me that she may just want to be held. I cradled the child until another working nanny gave me a mushy bowl of rice and bean gruel which the baby finally ate. This child's bone thin wrist could fit in the circle I can make when I put the tip of my index finger in the web between that finger and my thumb. Stop reading for a moment and do this yourself. PUT the tip of YOUR index finger in the web between that finger and your thumb. Bone thin!

An alert and engaging baby in the next crib caught my attention. I played kitchie-koo with him and his crib neighbor who also managed a quiet giggle. This was a welcome respite from the desperation I was feeling. But, in the next row of cribs, another crying baby compelled my attention. I walked a few steps over to him, picked him up and was able to get him to drink water. When he finished his cup, I put him back down but he cried and GRABBED me with determination. He had enormous strength in his tenacious grasp. I picked him up again, thinking we apparently were not done with each other. Finally, when I needed to leave, I managed to disengage his grip and set him back in his crib. His loud wail was accompanied by real, wet tears. I left to the sounds of his deep grief. I can't do anything for him now except tell you how he felt. His name is Champson and he has been at Azil for a month.

Leaving the baby room, I passed through the room of preschoolers getting ready for church. The nuns and nannies were dressing little girls in matching ruffled, pouffy dresses, lacy socks and black Mary-Janes. Dark corn-rowed hair was decorated with ribbons and barrettes. Little boys wore uniform-style, short-sleeved shirts. The Sisters themselves were dressed in traditional habits with head scarves leading to long, billowing white garments with blue trim. The colorful energy in the preschool room was in welcome contrast to the plight of the starving babies.

As I was leaving, the preschoolers clamored around me pulling at my backpack, my watch, my high school ring. It was a swarm of little children and in spite of their small sizes, I could barely get away.

The Next Day at Azil

I spent the morning attending the church service at the orphanage. Time for praying, preaching, genuflecting, laughing, and singing. I was introduced as a guest with the Midwives for Haiti and all eyes turned to the back where I was sitting, trying to remain obscure. When it is time for congregants to greet each other, a few brave young boys slowly approached me to shake my hand in welcome. Then a few more, then a few girls, and more and more until finally greeting time was over. A dog ambled through the church. Crowing roosters nearly drowned out the preaching.

I spent that afternoon at the feeding center. As I passed through the preschool room to get to the baby room, eight little girls dressed in identical fancy turquoise dresses were napping all piled up on a bare mattress on the floor. I was reminded of my childhood cats, Annette and Yvette, whose litters of four each would pile up together in a kitty community.

The nannies greeted me somberly as I walked into the baby room. One of the babies had just died minutes before. With sad eyes, serious faces, one nanny spoke, "Mort. Li te mourir." Dead. She just died; shrouded and still, lying in her crib. She was the baby who just yesterday had been propped up in the little wooden chair. Soon, she was carefully laid out by the nannies in a small, wooden casket painted orange and brown and taken away.

I spent my time going from baby to baby, washing faces and hands, changing soiled clothing, and assisting with feeding. The little baby who had clung desperately to me the day before again needed holding. I picked him up, and cuddled him for an hour and a half as I walked the room talking to the others. The two of us spent time with the whimpering edematous girl that I had been afraid to touch yesterday. I reached out to her and held her hand. Although her grasp of my hand was minimal, she quieted immediately. Shortly, I moved on.

After I fed the baby boy I was holding, I gave him a sippy cup (minus the "sippy" cap), changed his diaper, cleaned him up, and laid him down. This time, he was content and did not cry. The two little boys who had spent time yesterday standing in their cribs with big smiles on their faces were there still smiling and engaging my attention. Personality? Healthier?

It hits me again that the most riveting thing witnessed in this room are babies in various stages of malnutrition. I think it is more explicit to say "in various stages of starvation." Saying "malnutrition" seems to sugar coat the problem. Some babies have large heads on withered bodies. Some are bloated. Some manage to sit or stand for awhile and, happily, those babies can reach out to touch a little baby friend in the crib nearby. But, almost all the rest are listless. I manage to spend a few moments with each one… touching, making eye contact, and with a few, eliciting a little baby smile. Then, it's time for me to leave.

Walking Around Hinche with Gladias

2012-01-06T16:31:00.001-08:00

Hinche Cemetary

Public Announcement banner reminding people to
wash their hands well with soap to prevent cholera

Saint Immaculee

Tailor friend of Gladias

Neighbors

Prison Guards

Leclerc Jean-Louis, Ironel Dervilus, and Gerald Gedeon Fritz

I had told Gladias about my work with incarcerated pregnant women so he took me to the prison in Hinche. The guards were very accommodating and let me look through the gates. They weren't able to let me in, however. I did learn that there were very few incarcerated women.

UN Peacekeepers from India throwing out loaves of bread to the crowd

Translating Words, Translating Culture

2012-01-06T16:24:00.000-08:00

A friend of mine, responding to my email about orphans, asked this, "So, has the thought crossed your mind to adopt? I would go crazy with love over some of the children you have described...Can your friends and family "adopt" or rather help, in a personal way?"

This is how I answer: "The person I would want to adopt is my translator, Gladias Sainvil, but I already have three grown children and he already has a mother!" (Actually, Gladias would fit right in with my own!)

When I first learned I would be working with a young male interpreter, I was a little skeptical, but my hesitation soon dissipated as I watched him work. Gladias quietly enters a room and stays practically unnoticed in the background until he is needed. And Gladias doesn't just translate words, he translates his culture. After spending time with one family at the hospital, the husband shyly approached Gladias and called him aside away from me. Gladias later told me what his need had been. The man had asked Gladias for 50 goudes (~$1.20) to pay for a motorcycle taxi to take his wife and baby home. Gladias discretely gave him the money. Later, he told me, "This man really needed it. And, I trusted him. I saw it in his eyes. And, he asked me, not you, so that is a good sign."

Gladias (25 years old) awakens every weekday at 5:00 am to practice karate for an hour with his tutor. Despite lack of

electricity and running water at home, Gladias arrives on his bicycle to greet me promptly every working morning. He is intelligent, honest, respectful, diligent, fun, adorable, sensitive and willing to work hard. I gave Gladias one of the small cameras that Craig, my brother-in-law, donated. I encouraged Gladias to photograph people and things that matter in his life. Several images show his stack of books including his SAT Prep and TOEFL practice book. He studies English and has done well on the TOEFL (the college entry test of English language fluency). He is preparing on his own to take the SAT "because no one here can really help me'". Gladias relies on cyber cafes, handwriting study notes from the computer. His wages from translating help his mother who scratches out a living selling bananas. His younger 20 year old sister is finishing her last year of high school and wants to become a nurse.

Gladias is frequently introducing me to a friend, acquaintance, pastor,
or teacher when we walk around Hinche.

Neighbors

When we approached a school teacher once, I noticed Gladias making this hand sign to him.

I asked him what it meant and he said, "Is it ok to interrupt?"

Gladias has been translating for several years, kept busy by word-of-mouth referrals. He especially enjoys translating for doctors. He shared his dream: get a student visa to America, study premed and then apply to medical school. "People say if I become a doctor in America, I will never come back here. But, I would want to return to Haiti. I want to help my people, my country." Gladias confides that to get into medical school in Port-au-Prince, a person has to have a lot of money and connections… and he has neither one. Two American midwives, also impressed by this young man, are trying to find a way to assist him into a college near where they live. Tuition money is a serious and possibly insurmountable barrier.

Hope. Dreams. Most of us in middle America can reasonably expect a chance for an education that puts us closer to our goals, a chance to test ourselves against the reality of becoming this thing or that thing, choices we have to become who we need to be. I just don't know if that's the case for Haitians. Human potential... such a wealthy and prevalent resource in Haiti and such a loss to the world if not realized.

"The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were." -

-- John F. Kennedy

"If one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with success unexpected in common hours." -

-- Henry David Thoreau

EMERGENCY!!!

2012-01-06T15:47:00.000-08:00

I am at the hospital for only three hours when a pregnant woman in labor is carried, literally carried, into the room having eclamptic seizures. She is laid on a bare, plastic-covered mattress and the midwives, students, and infirmieres auxiliaires (equivalent to LPNs, or licensed practical nurses, in the US) rush to her side to administer care. An IV is started and magnesium sulfate administered while the woman's mother remains at the bedside fanning her daughter's face in the tropical heat of the afternoon.

The other patients and their visitors respectfully observe the spectacle. I am beginning to understand that Haitian people live in very, very close proximity, and are unafraid to touch, to look, to notice. I am quite sure that American ideas of personal space would be very foreign to most Haitians. My own notion of privacy is continuously challenged here: do I look? do I comment? should I take your hand? is it ok to take this photograph?

Thankfully, this woman continued in active labor and a healthy baby was born several hours later.

In the Hospital Ward

2012-01-06T15:39:00.001-08:00

Student midwives wear pink scrubs to distinguish them from the midwives who have already graduated and are working at St. Therese Hospital in Hinche. Today is the last day these pink scrubs will be worn because today is the last day for the student midwives!

Claudie Exume, checks on a high risk antenatal patient

Wilna Bastia, on postpartum rounds

A mother holds her newborn

Paulene Jean-Jacques

A mother holds her 2 day old son

Yvanese Jean Louise

First Day at St. Therese Hospital, Hinche

2012-01-06T15:28:00.000-08:00

The entrance to St Therese Hospital

St. Therese Hospital in Hinche is where the several graduates from Midwives for Haiti and current students handle complications of pregnancy and attend birth. Mothers and babies get their start together in the single level, concrete wing of a building designed for the tropics. There are three mother-baby wards housing ten beds each to accommodate antepartum complications, postpartum patients, and postoperative patients. The midwives' station, complete with a desk and modest supply cabinet, is parked in the corner of the center ward. The student midwives are identified by their bright pink scrubs to distinguish them from the certified midwives. "French style" doors, the upper half opening to light and a rare breeze, define boundaries from the wards to the outside corridor where ambulatory patients and family members hang out together.

Midwives Philomene Chelemaque and Carline St Cilles start an IV on a patient.
Dr. Celestin, OBGyn physician, strides quickly, working almost 24/7.

Midwife Yolande Clereseause with two student midwives

Each woman and her support team of family and friends is responsible for providing sheets, food, water, baby supplies, and a potty bucket which sits beside her cot. Donated medical supplies are sporadic and more often than not, the midwife writes a prescription for needed items so a family member can run to the nearby pharmacy. If the family has no money, treatment is delayed or may not take place.

Maudeline Jean-Louis St Soeur with two student auxiliaires behind her

When birth is imminent, the laboring woman walks or is carried to the delivery area where there are spartan beds in various states of repair. Along with a random assortment of supplies, a large plastic water container sits on the counter by the sink. The running water taps don't work.

The midwives work very hard. A quiet interlude is a welcome respite from a pending emergency. It is not overdramatic to say that birth and death are constants here.

Student midwives at the end of their clinic

Today is the last official clinical rotation day for Midwives of Haiti's fourth class of midwifery students. The fifteen students in the Class of 2011 have completed their ten month midwifery program and will graduate in two weeks on Sunday, November 13.

Beautiful Nadia, a 12 year old girl, waits to visit her grandmother who is hospitalized

On my first day at St. Therese Hospital, I enter the postpartum room with Gladias, my interpreter. Although I am in a foreign country, I feel completely at home with my subject matter. I pick up my camera and get to work.

The Journey to Hinche

2012-01-06T15:16:00.000-08:00

A red-eye to Miami followed by two hours in a sparsely filled jet flies me over Cuba and in to Haiti. I arrive to tropical heat and musician buskers playing a Caribbean beat. A crowd of Haitian baggage handlers flock around wanting to take my luggage, but I am worried about getting separated from my bags. So, I heft my duffel bag on top of my wheeled luggage, sling my backpack over my shoulders, and haul all my heavy stuff down the exit ramp. I am looking for the "Midwives for Haiti- Cheryl Hanna-Truscott" sign but it and the man bearing the sign are not in sight. Arriving in Haiti without a personal greeting has honestly been my worst fear about traveling here but I make a conscious decision to stay calm. Shortly, I am surrounded by several men wanting to help. In spite of my insistence that "my friend" is coming soon to pick me up, I grudgingly (and for a large tip) allow a man speaking halting English to phone my contact person. Finally, connection is made and my driver appears half-apologetically. He had been there all along, he explained, but he had switched assignments with his friend and he didn't have the sign he was supposed to carry. Never mind, I insist. I'm just glad to get going to Hinche.

Route Number Three is a newly constructed two lane paved highway. The ride to Hinche, now almost three hours long, used to take at least six. In spite of my sleep deprivation, riding along Route Three completely awakens my senses. "Let me show you pictures of my family…How do you like this music? I love this girl's singing! She's only nine. Can you believe that?!…They should have made more than two lanes on this road!" Moliere, behind the wheel, is a pleasant and entertaining companion.

Haiti is similar to how I imagined it to be: vibrant colors, lives lived in full view, and serious poverty. But being here is much more exciting than imagining it: the cacophony of motorcycles hurtling down rocky roads carrying FOUR passengers, men hanging out in groups playing cards or working or laughing together, teams of oxen ambling down the road, little boys peeing in a row off a front porch, large straw baskets carried on the flanks of hard-working donkeys, live chickens dangling from the hands of women wearing colorful head scarves, huge loads defying gravity balanced on women's heads, clusters of school children in brightly checkered uniform shirts, hundreds of small stalls selling any kind of little thing, beautiful deep ebony faces with shining eyes and stunning white smiles.

We drive by the Artibonite River, Haiti’s longest and most important river, now disastrously and needlessly contaminated. The cholera epidemic, which began from careless waste disposal practices by UN Peacekeepers, has killed more than 6,600 Haitians and sickened over 476,000 since October 2010. Next, we pass through Cange, home of the life-saving Zanmi Lasante Hopital (Eng: the Partners in Health Hospital). Under a deep blue sky with great white clouds, we gently roller coaster through palms and banana trees, and arrive in Hinche, the capital of Haiti's Central Plateau, my new home for three weeks.

AYITI!

2011-10-25T20:16:00.000-07:00

Tomorrow, I fly to Haiti, or "Ayiti" as it is known in Creole ("Kreyol"). For the first week and a half, I will be staying at the rented house of the Midwives for Haiti . While I'm there, the organization is moving to a different home so I will spend the second week and a half at the guesthouse of the Maison Fortune Orphanage. My work in Haiti will be learning about and photographing the Haitian midwives who are being educated by Midwives for Haiti. Haiti has the highest maternal and infant mortality rate in the Western Hemisphere largely due to the severe poverty which creates conditions perpetuating the heartbreak of maternal and infant death.
Internet connection may be limited but in any case, I will journal and photograph and share what I can when I'm able.

2010-11-03T21:41:00.000-07:00

Where in the World is Mongolia?

Good question!!! Because much to my embarrassment, I had to look at a world map myself to see where Shaine and I would be traveling. Mongolia is a land-locked country, approximately twice the size of Texas and with a variety of terrain, including mountains, steppes, and the Gobi Desert to the south. The country is surrounded by Russia to the north and China to the west, south, and east. The population is estimated at 2.5 million with ~50% living in the capital city of Ulaanbaatar and the other half living a traditional nomadic or semi-nomadic herding life in the vast countryside. Extremes of climate, ranging from minus 40F to 104F, make for a difficult living situation. Mongolians are known to be tough and resilient.

This blog is about the trip my daughter, Shaine, and I took to Ulaanbaator, Mongolia, between August and September 2010. We had a lot of fun working on our blog and even a greater time having the actual experience together. Our weekdays were spent shadowing doctors and midwives in the capitol’s largest Maternal-Child Research Center, hence much of our writing centers on our maternity care experiences. Shaine did most of the initial writing and I have done most of the photography.

For a short trip through the blog, scroll through and enjoy some of the images. For the dedicated readers, start at the very beginning August entries for a greater sense of continuity.

Bayarlalaa! (Thanks!)

SCRAPBOOK... Some Final Thoughts

2010-11-03T21:23:00.000-07:00

Scrapbooks are filled with remembrances: the ticket stub from the 1965 Beatles concert at the Hollywood Bowl, the withered wrist corsage worn at a high school dance, a lock of hair from a first haircut, the napkin used as canvas by a talented artist friend, the snapshots of the dog, an old friend, a hot car. This entry is my scrapbook collection, vignettes of a trip from which I returned seven weeks ago. My final thoughts seem random: I am unable to offer one big summary of my brief, rich experience in this fascinating country.

Traditional Mongolian Cultural Arts

Horsehead fiddle playing

Folk dancer

Masked performer

Musician

Contortionist

and most exciting of all, Tuvan Throat Singing!!!
http://www.youtube.com/watch?v=0M3YFK3sJ54

Hospitality

A most remarkable aspect of Mongolian life is the hospitality ingrained in almost every person I met. Hearing about Mongolian generosity is one thing but experiencing it first hand is astonishing. It’s all true: with most social interactions, an offering of tea, candy, or other food is made. Nomadic life necessitates interdependence and survival is only ensured by being able to count on the kindness of strangers along the way. Karma, or the Golden Rule, permeates this generous spirit. I need to practice more of this at home.

Older brother offering food to a younger sibling. Notice how the toddler accepts the bowl with both hands.
In Mongolia, the polite way to reach for offered food is either by using both hands or accepting with the right hand.

Reminiscing with Julia Roberts:
Wild Horses of Mongolia

Actress Julia Roberts lived with a Mongolian nomad family for several weeks in 1999, only 9 years after Mongolia separated from Russian rule and became a fledgling democracy. A friend told me about the film after hearing that I was going to Mongolia. I watched it in preparation for my trip and then, one recent night back at home, I watched the film again. The second time around flooded me with good feelings and a sense of shared experience even though my time with the nomads and living in gers was so very brief.

In its rush towards democracy and capitalism, there has been a noticeable divide between the growing richer and the becoming poorer. My hopes for Mongolia lie with their ability to protect their nomadic heritage. Increasingly, as the world seeks to become more homogeneous, there is something incredibly unique about a country without fences and freeways. And, at night in the countryside, the sky's star show radiates a kinetic energy seldom seen in modern light-polluted lands.

If you have an hour to spend learning about Mongolia, I recommend watching this hour-long documentary. On YouTube, it is divided into 10 minute segments.
http://www.youtube.com/watch?v=3RzVQ988LDQ

Talking About Child Abuse

During my first week, I was chatting with several doctors, trying to answer their questions about the professional work I do. I tried to explain our child abuse intervention clinic, specifically that I perform medical evaluations on children with allegations of sexual abuse. This is a difficult conversation to have in English let alone in Mongolish. One physician came up with the idea of phoning her daughter with English fluency. A cell phone call later, I explained my job to her daughter who in turn explained it to her mother who in turn told her colleagues. Talk about the telephone game! Judging by the somber reactions on the doctors’ faces, I surmised that the translation went pretty well.

But, the most interesting part was the young woman’s response, “I have a psychologist friend who tells me terrible stories about kids she works with who live in the mental hospital and are afraid to go home because their father or stepfather is abusing them! I’m sure she would love to talk to you! I can arrange it.” I was surprised by her enthusiasm because although I am aware that child abuse happens everywhere, I was reluctant to talk about it outside my own culture. Social response to child abuse allegations seems culturally driven and I wasn’t sure I could offer any information that would be helpful.

The doctor’s daughter met me later the following week to introduce me to two directors of child abuse shelters. After our conversations, I was asked to return the following week to share information with a larger gathering of professionals grappling with how Mongolia needs to respond to child abuse. Younger workers knew enough English to follow along, but a skilled translator made sure we were all on the same page.

“Where do you get the funding?” “The police here interrogate the children.” “The girls have exams to see if they are telling the truth.” “Some mothers don’t want their children to say anything because then they won’t have a home anymore.” “We wish we had a system like yours.” “Can you come back and help us?” I was reminded of our clinic’s beginnings when we first started out a little over two decades ago.

These dedicated professionals are largely working for NGOs with little clout, money, or expertise to make necessary systems changes to deal with child abuse issues. However, the energy and enthusiasm around the room made me believe that these professionals were not going to be deterred.

We Are A Nation of Germ Worriers

Two days after my return from Mongolia, I received a chilling phone call from a police officer stationed at the Fort Lewis military base where my husband was doing a training ride for the Hawaiian Ironman. “Your husband has been involved in a bicycle accident and he is in the Madigan Hospital Emergency Room.” “No, you can’t talk to him.” “No, I don’t know his condition. Uh, drive here carefully, ok?” I was thrust from my month’s stay exploring maternity care in a large, run-down hospital half-way around the world into two weeks of American emergency/intensive medical care where my physician husband was on the receiving end of one of the best trauma centers in the West coast.

That my husband survived and is healing well is testament not only to his impeccably healthy lifestyle and physical conditioning but also to the wealth of advanced medical practices. By “wealth”, I’m including the years of education and arduous training of health care providers along with the physical resources to practice them.

My mind raced over all the “what if” scenarios of my husband’s situation, and one of those was, “What if this had happened in Mongolia?” I didn’t want to dwell on that. But, what was impossible to avoid thinking about were the overwhelming reminders throughout the hospital about sanitation. Excellent hygiene is a reasonable expectation of our health care system and something I worried about when I was in Mongolia given the water supply being periodically shut down, the complete lack of hot running water, and leaking toilets with broken flushers.

But, sometimes I think about our National Germ Obsession and constant use of Hand Sanitizer. Will this hasten the development of Super Bugs? Just wondering.

One Thing I Know For Sure

It is one thing to think about taking a direction in life and another to take steps. Going to Mongolia was one way I could test myself about working on behalf of maternal-infant health advocacy in the developing world. I imagine a much more difficult situation in other remote and impoverished countries so in most respects, Mongolia was plush and organized. Still, I did experience something different than what I know from the USA.

Traveling allows an abundance of living “mindfully” and in the moment. And, I love the surprise and energy of cross-cultural encounters. Focusing on maternal-infant health advocacy allows me to blend my past fascination of cultural anthropology (my university major) with midwifery and photography. Birth (and death) is fundamentally THE basic human passage but how each group of people constructs the process has fascinating variety.

What I experienced Ulaanbaatar is that women labor very quietly and without the presence of family support. There is no widespread epidural availability and only nominal pain medication. When birth is close, women walk themselves to the birth room and climb a step stool to take their place on the delivery bed. Babies are born, they cry, they are tightly swaddled in layers of blankets. Mothers breastfeed. Families bring mothers food and a thermos of tea and wait eagerly by the small hall window to catch a glimpse of their wives/daughters/sisters and greet the newborn. Preparations for the infant, including name giving, are done after the baby’s birth and assured survival. There is an undercurrent of happiness but from my experience there, birth drama is minimal.

A father visits his wife and newborn through the visiting window in the hospital hall

Being in the presence of new mothers and newborns is visually compelling. The mother-infant dance is endlessly intriguing. My remaining years of productive work will often be pointed towards cheering on the players of most fundamentally important jobs: mothering and the development of healthy infants.

YIN YANG: the Countryside as Antidote to Ulaanbaatar

2010-09-17T16:22:00.000-07:00

Manhole! I nearly stumbled into this one, saved from God-knows-what
by the warning of a gracious passerby.

by Cheryl

Frankly, Ulaanbaatar is a difficult city for me. I walk to the hospital every morning, a 45-minute urban hike. I love the walking part, made even more interesting because I navigate through alternating terrain of pavement, concrete rubble, and sand. Uncovered potholes and manholes, along with occasional stubbles of rebar jutting up from the path, necessitates careful attentiveness to the trail. The real difficulty lies in crossing several major streets requiring calculated risk and good timing: at least twice, I grabbed the available arm of a sensible looking Mongolian person when I just didn’t have the moxie or energy to dart across solo. In each case, both persons gave me a sympathetic nod, “American?” Even the host mother of my family admits anxiety about traffic crossings. The topic comes up now and then with both natives and ex-pats asserting, “Ten years ago, it wasn’t like this at all!”

[My two minute clip of crossing the street, complete with an interesting jam at the end: http://www.youtube.com/watch?v=3U9EtLd49uM]

Another thing I dislike, especially in crowded areas, is a seeming disregard for basic social hygiene consciousness: hocking loogies, blowing snot rockets, exhaling cigarette-smoke, and littering punctuate an otherwise pleasant (except for the traffic) stroll around the city. Once, I was walking directly behind a man who did all the above in rapid succession. It didn’t exactly spoil my morning but I could have happily lived without it.

And have I mentioned the Pickpockets? I managed to twice thwart the thieves two days in a row. Feeling the subtle tug on my backpack, I whirled quickly around and slapped the thug before anything was stolen. I felt more angry than threatened. After that, I reluctantly moved my backpack from the more comfortable position on my back to a sling-like carry at my side.

The antidote? Another weekend trip, this time to the countryside of Bulgan Province!

Following a 4+ hour ride by public bus to Raashant aimag (town), and from there, a half-hour drive by jeep, Crystal, my Aussie traveling companion, and I arrived at the guest ger to stay our first night with a warm and welcoming nomadic family. The following night, we traveled by horseback to our second ger-stay with another family.

I do not want to romanticize traditional nomadic life. The weather in Mongolia has harsh extremes, going from 40 degrees celcius (104 degrees F) in the summer to minus 40 degrees (-40 degrees F) in the winter. Water is hauled and therefore a scarce resource. Inevitably, flies buzz around in uncomfortable numbers around the interior of the ger. All this is tolerable to the weekend, passing-by tourist (ie. me!) because of the amazing gifts I do receive here:

-vast landscapes of wide-open spaces, marked by natural rock formations and only rarely punctuated by the site of a distant ger,

-a remarkable sound of stillness and quiet with the peace of blowing wind, the chirping of crickets, and occasional bleating of goats or snorting of cows and horses,

-sightings of animal herds: grazing quietly or moving together in an organic flow,

-incredible nightly star shows: the constellations in reassuring sameness, the Milky Way spanning in an arc across the sky, one brief shooting star each successive night ("Did that just really happen?!?!"). The night sky is electric with palpable energy. I do not remember seeing nights like this since the mid-1990s when Al and I did a mountain-biking trip at the Maze in southwest Utah Canyonlands.

Come Sunday afternoon, it's time to go. "Fun's over! Back on the bus!"

MILK

2010-09-16T22:29:00.000-07:00

By Cheryl

Herder Grandmother ladles simmering milk

Milk curds drying on ger rooftop under the hot Mongolian sun

Over half of Mongolian people are nomadic herders. Milk is a big deal in the food chain for the nation: it is estimated that there are over 130 varieties of dairy products or dishes in Mongolia. According to an article in the MIAT airlines magazine, “tsagaan idee”, the processing of dairy products, is a vital part of the national tradition and heritage. The writer asserts, “There is no other nation except Mongolia who processes milk in so many varieties and ways.” A few of the dairy staples include: aireg (fermented mare’s milk), shimiin arkhi (intoxicating spirit distilled from milk), tarag (yogurt), hoormog (a mix of tarag or aireg with milk), urum and tsutsgii (clotted cream produced from cow, sheep or goat milk), tsagaan tos (white butter), shar tos (yellow butter), byaslag (fresh cheese), tsagaa (a byproduct of the distillation of aireg or tarag to produce alcoholic spirits), aarts (wet milk curd), aaruul (curdled milk, dehydrated and thoroughly dried in the air and sun), and eezgii (another type of hardened milk curds).

It is women who milk the herds: cows, horses, goats, sheep, camels, and yaks. So, it should come as no surprise that human milk is the food-of-champions for human newborns. To my complete delight, I never saw a baby bottle fed or plugged into a pacifier the entire month I was in Mongolia.

Wall painting in the Maternal Child Research Hospital

I am speculating that the acceptance of breastfeeding human infants must be a natural outflow of Mongolian herding lifestyle and likely, a generally grounded way of living naturally in a harsh country that affords few sanitized and packaged amenities. In any case, Mongolian culture completely accepts the biological functioning of mammary glands. In current Western parlance, the “Sisters” or “Twins” are most noted for their erotic properties. I am not railing against that, but witnessing the balance tip to function-over-form was refreshing.

At the hospital, a healthy baby following a normal birth generally gets started at breastfeeding while mom rests, albeit somewhat uncomfortably, on the delivery table.

Midwife assisting newborn's first latch-on

Postpartum recovery generally takes two hours on the delivery table

As I follow Dr. Khishgee on her daily postpartum rounds, room-after-room of mothers are in various states of uninhibited exposure. There are no attempts to cover up even as Dr. Khishgee strides into the room and asks permission for me to take photographs. I don’t notice any special breastfeeding products: no disposable nursing pads, no particular garments worn intended to protect “modesty” or enhance convenience, not even a shawl or blanket to shelter the suckling newborn. Looking around the ward, I see an engorged mother massaging her swollen mounds, a teenage mother wrestling with her baby latching on, an older, experienced mother putting her baby to breast like she has done hundreds of times before with older offspring.

I asked several doctors at the Maternal Child Research Center how breastfeeding is regarded by Mongolian maternity health care providers. Dr. Lagva pointed to a poster that outlined the “ten rules about breastfeeding.” These included training professionals about the importance of breastfeeding, initiating breastfeeding as soon as possible after delivery, expecting the mothers to either nurse or express milk for ailing infants, and extolling the virtues of human milk to promote infant health.

The "10 Rules" poster on maternity center wall

Dr. Khishgee simply stated that mothers are expected to breastfeed at the hospital and bottle options just aren’t available. She acknowledged that once a mother goes home, it is her choice whether or not to continue nursing. Given the early breastfeeding start and the complications and expense of formula feeding, my guess is that most women continue to nurse at home.

Commonly, in public view while roaming around Ulaanbaator, I would see a mother nonchalantly nursing her baby with little fuss about it: at the department store with shoppers passing by, relaxing at a restaurant, riding on the public bus. Admittedly, I noticed one woman with her breast briefly exposed as she unplugged her infant and stood from her seat on the bus. Catching the eye of a male passenger, she stifled a shy smile and quickly covered up, but it was no big deal.

In contrast, I am reminded of the majority culture in the United States: maternity wards giving lip service to breastfeeding while handing out postpartum “gifts” from formula companies that include…[insert pause and a drum roll]… formula! … working mothers having to fight for the right to a decent room and periodic breaks from work to express milk… women who have been arrested for indecent exposure because of breastfeeding in a public place.

Mongolia may be a developing country, but when it comes to breastfeeding policy and practice, it is way more developed than the United States.

The Risks of Being Born

2010-09-13T03:00:00.000-07:00

By Cheryl

“Munkhnaran?” Dr. Bagi and I entered Room 512 where three new mothers gave us puzzled looks. Bagi turned to me, saying, “She must have moved to another room.” I followed Bagi to the nurses’ station, glad that she had insisted on coming with me to find Munkhnaran afterall. I hadn’t wanted to distract Bagi from her labor and delivery shift upstairs on the 6^th floor, but I was looking forward to seeing Munkhnaran. Last Friday, I had made a promise to Munkhnaran that when I returned on Monday, I would find her before noon so I could follow her to the Neonatal Intensive Care where she brought expressed breast milk to her newborn every three hours. I wanted to keep my promise.

“I was named by my grandmother. Munkhnaran translates as ‘Eternal Sun’ in English, “ Munkhnaran said this with a generous smile. Shaine met her two weeks earlier in the NICU where Munkhnaran frequently visited her ailing six-pound son. Fluent English-speaking Mongolians are quick to find us native English speakers and an easy bond forms. Shaine actually volunteered my help since I used to regularly counsel about breastfeeding… twenty years and more ago. Over the past two weeks, I saw Munkhnaran a few times and although she expressed concern about her son, seemed to be optimistic. She said she didn’t really understand what was going on with him, and that she wasn’t really given much explanation. But, she did her part, walking down the long corridors and taking the three flights of stairs to the second floor NICU, bringing her milk during the every three hours visits she was permitted.

At the nurses’ station, Bagi got a charge nurse’s attention. The nurse repeated Munkhnaran’s name, then looked down a long list. Bagi turned to me and said, “She has moved to the second floor.” I felt good, glad to be visiting Munkhnaran and following through with the photo session we had talked about.

…………….

Many midwives and OB/Gyn doctors say that reasons for entering the maternity field are because most young women are healthy, birth is a natural process, and there is a wide variation of skills to use. Maternity care is a generally happy place to be in the medical field. But, that’s not always the case.

The birthrate in Mongolia is increasing and the crowding in the maternity hospitals is creating a rise in neonatal infections. “The survey showed a constant increase in the mortality of children under 5 in the past two years. Also, maternal mortality was 41 % per 1,000 in 2008 but abruptly increased to 88 in 2009.“ [quoted from an interview with MP S. Byambatsogt in The Mongol Messenger, dated January 27, 2010.]

Earlier in the day, I followed Dr. Lkhagvasuren (“Lagva”) on her daily rounds. She is a 46 year old anesthesiologist who has been on the 6^th floor High Risk Pregnancy unity for the past 25 years. She follows high-risk pregnant and postpartum women in consultation with an OB/Gyn consultant. Together, they discuss patients and make plans.

“Bayantsetseg is a 19 year old girl from the countryside, living several hundred kilometers away. First, she had an emergency appendectomy, followed by a cesarian section. This was followed by dehiscence of the scar. So, the provincial doctors had to do a hysterectomy and now she is septic and on antibiotics.” I looked at the young, sad face of this new mother, holding the only child she will bear. Fortunately, she has a healthy baby, a girl. Damdin, the young maternal grandmother, was at the bedside giving support.

Each new woman became a case: “Last night, this patient had an emergency c/section for placenta previa. Her baby was 32 weeks gestational age and weighed 1.8 kilograms. She lost a lot of blood.”… “This 32 year old woman was admitted from the provinces over 500 kilometers away. She has severe pre-eclampsia and the baby has a life threatening fetal anomaly and the prognosis is not good. We will decide whether or not to induce labor.”… “This woman had a seizure at home last night. This was her first pregnancy and she had an emergency cesarian section. Her baby was 36 weeks gestational age and weighed 2.5 kilograms.”

Dr. Lagva ended rounds and showed me the amenities of her floor, starting with an empty operating room where with possessive pride, she pointed out her second-hand anesthesia machine donated by a developed country.

Next was the operating room where surgeons were practicing their art.

And finally to the newly remodeled training room where an open house celebration had taken place a few days ago. “You must see all our books!” Lagva opened the cabinet doors. Lagva had been on 24 hour call the night before and after showing me around for several hours, I asked her if she were tired. “No, no! It’s just my job!” By the proud way she said it, I took it to mean, “This is what I’m here to do. This is my life.”

……………….

My initial joy in learning that Eternal Sun had moved to the second floor was quickly shattered after Dr. Bagi finished her conversation with the nurse. Bagi turned to me, saying, “Munkhnaran’s baby died last night. Munkhnaran left the hospital this morning.”

Jetlag

2010-09-09T20:13:00.000-07:00

By Shaine

“This wine is no good.”

Blank stare from the girl behind the bar.

“You really shouldn’t be giving it to customers, it’s gone sour or something.”

The girl behind the bar disappears for a moment and then reappears with a co-worker who speaks some English. The phrase “this wine is no good” is, unfortunately, not included in my phrasebook. I repeat myself to the new waitress.

Without missing a beat, “why?”

“Why? Because it tastes bad. It’s not good.” I am now encouraging her to try a taste. The wine is truly terrible, a fact I may have minded less had I been less hungry and irritated that literally 2/3rds of the menu (the 2/3rds that I wanted to eat), was off limits for some inexplicable reason. The same thing had happened to me at lunch earlier that day, and in desperation I finally told the waiter to tell me what I wanted since all the things I actually wanted I apparently wasn’t allowed to have. I am not a pleasant person when I am hungry.

As I wildly pantomime my suggestion that the waitress take a sip and see for herself, the entire restaurant goes black. This part of town had been experiencing rolling blackouts. It had taken me 25 minutes earlier in the day to purchase a souvenir for my brother from a shop that was operating in the dark, warm evening of my last day in Mongolia.

Perfect timing I thought to myself.

We ended up switching venues, to a lovely French place down the street where we were able to enjoy egg souflee, smoked fish, fresh leafy greens, great wine, and dairy-free desert. It turned out to be just the thing I needed to say au revoir to UB, and Mongolia overall. Dining success.

Earlier in the day, I had managed to cram all of my souvenir shopping into a few short hours wedged between taking one final trip to the black market and the restaurant fiasco-turned-fete, and even managed to find a few choice XL items for my 6’3” fiancée who has a body like a football player- a biological oddity in Mongolia. Shopping success.

The next morning was a 4am wake-up call for a 6:30am flight. Of course, I didn’t set my alarm right and ended up waking up closer to 4:30, but impressed myself with my ability to get ready for such a big day of travel in less than 7 minutes. Morning routine success.

Spending 8 hours in the Seoul airport, I managed to find a buffet/internet café that charged me $35 to hang out in their lounge and eat and drink and surf the net as much as I wanted for 6 hours. Layover success.

And then, 13 hours later, I was home.

It’s been 48 hours already and I am running on fumes. I have slept precisely 7.5 hours in the last 48 hours, I’m practically pre-verbal. I took a nap on the couch at work today. I’m amazed with myself that I was even able to type this blog. Three gold stars for me!

Far too difficult to come by at this moment are any final thoughts about the trip. When people ask me what Mongolia was like, I generally say “different” (really Shaine, that’s the best you can do?). If or when they ask how, depending on my mood, I generally elaborate on one of the following topics:

As a new democracy, they have a different set of expectations about what their government’s roles and responsibilities are versus what a citizens roles and responsibilities are
Doctors drink in the morning to celebrate a co-worker coming home from vacation (and frankly, I am a little disappointed with my co-workers’ performance today. Sure, they were happy to see me as I them, but no one remembered to bring the fermented mares milk and vodka! What gives?)
Crossing the street in Ulan Bataar is a lot like playing a real life version of Frogger. And you are the frog.

So that’s where I’m at. For the love of everything that is good in this world, I better get some sleep tonight. And on a sentimental note, I will say that, as happy as I am to be home, I genuinely miss my mother. I have never in my life spent so much time with her, and I sometimes think we were crazy for doing it, but this experience would never have happened if not for her.

So, mom, if you’re reading this, can you please remember to pick up a few extra cashmere sweaters, a giant fur hat, some silver bowls, and throw in a few Mongolian babies while you’re at it. I know it’s an international crime, but those babies are just so darn cute! Thanks!

To validate my claim that Mongolia is "different," please reference the following 3 photos. These are the only photos I took the entire time I was there.

Traditional Building and Modern Building. The Modern Building is a major landmark of the city, but totally unoccupied and rumored to be not up to code.

These bears were just hanging out in a planter with an arctic scene behind them. I imagine it looks cool in the wintertime.

1. Ulan Bataar features a Beatles Memorial near the main shopping district.

2. The Beatles Memorial is just next to the singing billboard.

3. These 7 boys were lipsynching "Hey Jude" on repeat for camera crews for several hours last Saturday AM.

The Quest for the Last Emperor

2010-09-09T05:49:00.000-07:00

I wish I could claim credit for the title but credit is due to Ger to Ger, an eco tourism company dedicated to supporting and preserving Mongolia's traditional nomadic herding lifestyle. Early tomorrow, I board a public bus for a 5 hour ride into Bulgan Province where I will be staying the weekend with two local herder families. The agenda includes riding camels and/or horses, going to a worship site, visiting Swan Lake and sand dunes in addition to staying in the guest gers of the nomad families.
Now that Shaine has returned to Salmon and Salads in Seattle, I thought I would be taking this trip alone. But, happily, I will be joined by Crystal, a 27 yo Australian woman volunteer who has interest in international social work. She is holding sessions in Ulaanbaatar with teenage girls, doing some consciousness-raising on issues such as domestic violence and assault. So in addition to having some professional commonalities, neither of us has ridden a camel before.
No internet access for several days and frankly, though inspired, I haven't had the time or focus to sit down and write anything anyway. Meanwhile, Shaine has promised a final post from Seattle sometime when she can unbury herself from the onslaught of work demands. You know how you need to take a vacation after taking a vacation???
Hope to return with some good snapshots!

Plagiarized Journal Article on Herder Immigration to Ulaanbaator

2010-09-06T00:44:00.000-07:00

Posted by Cheryl with disclaimer:

Sorry that I can't quote the source. This came through email, sent by my friend, Jennifer. This echoes sentiments I've heard multiple times.

In 2009, having sold their last animal, she moved with her husband and three children to the ger district in Ulan Bator to try to find work. It was not until June of this year that her husband found a job, as a security guard at a private bus company where he earns $146 a month. Their 22-year-old daughter works in a bread factory.

"It is still difficult trying to get used to this life, having lived all my life as a herder and now having no animals to watch over," she says as she sits in the family's bare yurt with rubbish piled up outside. They had to pawn most of their possessions to afford to send their eldest son to university and their youngest to high school. "Life is hard in Ulan Bator and city people don't like us people from countryside."

"Unemployment is the main problem for those who switch the countryside for the city," says Bolormaa Gulguu, a program officer for Save the Children in Mongolia. "They cannot get access to jobs. When they lived in the countryside they are herders; they have been herding for generations. But when they come to Ulan Bator they don't have the vocation skills that are needed to get a job. Some get involved in informal work at the black market, but many just rely on government benefits."

According to a World Bank report on the ger districts published earlier this year, government benefits represent 20 percent of the region's total income. Of those who found work, almost a third were employed in low-skilled jobs in the construction and manufacturing industries.

"Those herders who have lost everything have to seriously decide if they want to stay in agriculture or move on to a different business," says the UNDP's Noda. "We would probably encourage them to move on to a different business, but nomadic life is in their hearts, so it isn't easy for them."

For herders like Bayanzul, who did not lose their entire livestock and are thus able to enter the city with some money saved, life may not be so hard, but finding a new profession and getting used to an urban existence will not be easy.

"The first year will be hard, I will miss the animals and countryside," he says mournfully, as he looks out over his herd. "But I can't go through another winter like the last."

A lesson in Mongol

2010-09-05T06:12:00.000-07:00

By Shaine Truscott

When traveling in a foreign country, it’s always useful to pick up a few words to help you get through the journey. While I generally consider myself an effective communicator, here in Mongolia, the challenge of communicating is tenfold given that they operate on a different alphabet than I do (Russian Cyrillic) which means I can’t even read anything, and I’m pretty sure they are born with special tongues. Usually, I just carry around my Mongolian phrasebook and point to the words I am trying to express, but this only gets you so far, and it’s fairly awkward to flip through a phrasebook in most circumstances- especially when you are trying to communicate the basics. In any event, I’m about to head back to Seattle, and I felt that I needed to summarize the progress I have made.

San Bano- I have used this word the most. It was the first word I learned, and probably the only one I will remember. It means “hello.” I say this word as often as possible, to as many Mongolians as I can, just to let them know I’m trying.

Byarthla- I use this word almost as much as I use San Bano. It means “thank you.” I use it all the time, and every time I say it, someone corrects me. The “thla” part of the word is actually a sound that I have decided only Mongolian tongues can make, so I have stopped trying to sound like I know what I’m talking about.

Meenee Ahge- I spent the first two weeks referring to my mother as “bi ahge,” loosely translated “I, mother.” No-the-fuck-wonder everyone looked at me like I was speaking in tongues. I just found out 3 days ago that I have been saying it wrong all along. Unfortunately, in that time I haven’t had the opportunity to properly introduce my mother to any Mongolians. I’ll chalk that up as 1 point for Mongolia, zero for Shaine.

Saichan- This has been my standby “starter” word in the premature NICU. I decided I would start using this word after awkwardly hanging out for a few days in the NICU staring at the babies while the mothers gave me the “who are you?” look. I usually point at their baby and say “saichan,” and invariably, the mother repeats the word back to me with the correct pronouncement, and then smiles. My Mongolian phrasebook says that it means beautiful, but I just found out today that it means nice. Whatever. Everyone likes it when you compliment their baby.

Hou/Ohoun- Second most important words to know in the premature NICU. This is how I determine the gender of the baby. Honestly, premature babies aren’t that interesting, they hardly move, never open their eyes, and mostly just sit there like little warm worms wrapped up in blankets. Furthermore, Mongolians have a tradition of not cutting their children’s’ hair until the ages of 3 or 4 which means there’s a hell of a lot of gender-ambiguous children walking around town, something I am 100% in support of. However, parents tend to take offence when you can’t tell if their little Johnny is actually a Sally, so knowing how to distinguish between the two has proven helpful on more than one occasion.

Teem- This means “yes.” Unfortunately, I never learned how to say “no.”

Tsa- This is the hardest word to remember to say. It means OK. If you say it five times fast, you sound like you really know what you are talking about. This is how Mongolians say it. Instead, I just say “OK.”

Golo Hamgalai- I just learned these words yesterday, and already I have been featured on Mongolian national television saying this word and waving like an idiot. This phrase means “save the river” and contains no less than 3 sounds that only Mongolians can make, but I found out that this phrase preceded by an enthusiastic “san bano!,” great eye contact, and an shit-eating grin stopped most people for just long enough to read the petition I had in hand to save the Tuul River that runs through town. The weekend volunteer activity was to gather surveys from Mongolians to petition the Parliament to actually do something this year to save the one river that runs through the town, the river that everyone gets their drinking water from, and that everyone throws their trash into. Working for an organization that runs on political steam, I am always down for a good hour or two or three of political action, even if it’s in a town hundreds and thousands of miles away from my own. But seriously, I may as well be home right now.

So there you have it. Two and a half weeks in Mongolia and I can almost communicate to any native speaker that “Hello, yes my mother is a girl and would you like to save the nice river? OK, thank you.”

This cow speaks better Mongolian than I do

The Tuul River- I tried to save it before I even saw it!

Leave it to my mom and me to find the one cafe in town that serves diet coke, iced coffee, and beer, all printed on an English-language menu. God Bless you, Cafe Amsterdam.

Twins Baby

2010-09-03T02:42:00.000-07:00

By Shaine Truscott

Racing into the hall on 4-inch platform wedges, Dr. Oyuna proudly lifts one of the barely-three pound baby boy twins up in the air for everyone in the premature NICU to see. “Twins baby discharge!” she hollers down the hall, beaming, her whole face smiling.

Oyuna is the doctor I have been assigned to during my time at the maternity hospital. I definitely lucked out. Not only does Oyuna speak great English, giving me a lifeline to the rest of the NICU, but she is incredibly gracious, and hilarious. Her daughter is an aspiring model, her son an aspiring doctor, and she herself is a brilliant combination of the two, with bright red lipstick, well-coiffed hair, painted eyes and a smile that is at the same time practiced and sincere. Our down-time conversation (and there has been a lot of it) easily flows between Mongolian food, culture and politics, neonatal medical research, the health care system, and the latest shopping excursion she has been on. This is my kind of gal.

For the most part, Oyuna has me hang out in her office, on her futon. She has a private office, a symbol of status at this hospital. I think she might be the department director; it’s hard to tell. Occasionally, I’ve been invited into the main doctor’s office for private parties that always involve food, booze, and what sounds like gossip- a solid feature of the work culture here. Oyuna always seems to be in the middle of everything here, she makes people laugh, and I’ve seen her do quite a bit of (again, what sounds like) counseling to the other nurses and doctors that occupy this unit. Yesterday, she brought me lunch.

Oyuna’s only patients this week have been the twins. They arrived into this world 2 months early and several pounds underweight on the same day I arrived to the maternity hospital here in Ulaan Bataar. Still fresh from their mother’s belly, the nurses worked quickly on them, giving them tubes for breathing, tubes for eating, tubes for injecting daily rounds of medicine to help them get healthy. I watched as they gradually improved, shedding their tubes, moving from their shared incubator to the “healthy” room, and finally to their mother’s room, living together under a heatlamp for the last 3 days of their hospitalization, finally able to breathe, eat and move their bodies independent of machines and tubes.

Oyuna, Twins Baby, and Mom

A few times, I have been allowed to carry them- once to the x-ray machines in another building over. Every step I took I was thankful that I didn’t drop them, travelling over the gravel/cement pathway, avoiding the inevitable potholes and lines of sick children. That the nurses manage to make this journey daily and always in heels is beyond me, but potentially made less scary due to the way they swaddle infants in this country. There are so many blankets involved that I almost think they’d bounce if someone accidentally tripped and fell.

More blanket than baby!

By the time the twins were discharged, Oyuna had given them American nicknames (Tommy’s the big one and Johnny’s the small one!), taken multiple photos with them, and posed them for no apparent reason perfectly in their little bed every time she left the room, faces toward each other, noses touching. Every time she did this, one of them, I’m not sure if it was Tommy or Johnny, would invariably start crying. Only 2 weeks old and already sick of each other!

Tommy and Johnny... or potentially Johnny and Tommy

I decided to make my last day at the hospital line up with the twins baby last day. I’d seen enough gore and heard of enough premature babies dying in the night that I needed to leave the hospital with a good taste in my mouth. The mother had decided that noon was the luckiest time to bring the babies out into the world to meet their father, grandmother, grandfather, aunts and uncles for the very first time. This hospital has a policy of not allowing visitors. If you want to see your wife, daughter, friend, new child or grandchild, you have to poke your head through a 1.5x1.5 foot window in the wall and hope that you can catch someone’s attention- either a nurse who is too busy for you, or me, who doesn’t speak your language and just smiles, waves, and wanders by. It’s a brutal system.

The whole family is waiting for Johnny and Tommy, and I am in tow with a camera and the mom’s shoes- I’ve found that one of the best ways to make myself useful at this hospital is to help carry patients’ belongings. This is something I can do without being afraid of tripping while carrying something that might die if I drop it. As soon as she catches sight of the babies, grandma rushes too them, and as soon as she catches sight of me, she poses, hands the baby to dad, who looks not-quite-ready to be a dad of two babies yet, but poses nonetheless. It’s a happy scene, these babies are lucky to have made it through the first week of their lives, and even luckier to have such a warm and loving family on hand to help them as they grow. I feel like an interloper though, even as the mother hands me a rose and gives me a hug goodbye.

I finally understand why my parents chose the professions they did. I see the appeal, the joy and the drama, but I am ready to go home and back to the path that I have chosen.

Proud Mama and Papa- where are the babies?

Pockets

2010-09-02T01:35:00.000-07:00

by Cheryl

A postpartum mother gazing out her window

I wish I could travel light. I try, but like Pigpen of the Snoopy series, seem to acquire and accumulate layers of stuff. I wonder if this strategy evolved from raising three children requiring me to be well-prepared for any little mishap.

Fortunately, the scrubs I was given have great pockets. So does my lab coat brought from home. Here’s what I carry everyday distributed in my pockets while on the maternity ward:

*A 2 ounce bottle of hand sanitizer and pocket Kleenex,

*Normal saline eye drops,

*Small spiral notebook and pen,

*Pocket Mongolian-English/English-Mongolian dictionary with a small magnifier to make it readable,

*My Canon G-10 camera,

*My iconic inmate mother/baby photo postcared with a translated introduction pasted on the back about myself and a statement that roughly says, “I would like to take your picture, please, but only if that’s ok with you”,

*A sheet of paper translated into Mongolian that asks the mother to write her name, baby’s gender, birthday, birthweight and length, email address (if she has one) and postal address in case she does not have email,

*A disposable surgical cap and mask,

*Dehydrated fruit and nuts.

I use every one of these items every day that I spend on the wards. Each is completely essential.

Doctors at the Maternity Hospital

One of the labor rooms

Playing Hookie

2010-09-01T16:27:00.001-07:00

by Shaine

“It looks like they’re lining up to race each other,” our new friend Sequinda pointed out to me. She was, of course, talking about the orphans who had turned out to an event at a children’s center in town to receive backpacks from Projects Abroad: a nice idea that bordered on absurd in the execution. Please bear in mind, however, that in the past two weeks, absurd has become part of our daily vocabulary.

The root of our problem, I believe, is that we don’t speak the language. Hell, we can’t even read the alphabet. Every time I try to introduce my mother (bi eej), a feat I have accomplished to dismal levels of success over 20 times now, my pronunciation still seems foreign and confusing to whomever I am trying to make nice with. Things would be easier with a full time lingual-cultural interpreter on hand to translate the language and answer our questions (such as why do they prohibit selling alcohol on the first of every month?). Instead, my mom and I have taken to telling each other stories to account for gaps in our cultural understanding. For example: the alcoholics need at least a day a month to sober up, after that, its back to the bottle. In the mean time, the rest of us suffer.

The event with the orphans was organized through Projects Abroad, who typically bring volunteers together once or twice a week. This is a great idea, volunteers should get to know each other and forge unlikely bonds in unlikelier circumstances. It’s a great way to swap notes and a laugh, and at the very least, to practice conversational English with a native speaker on the off-chance that we will need to use the language sometime again in the future.

But back to the orphans. At this point during the event, I had figured out a few things primarily through observation, and only occasionally by understanding what was actually going on:

There were about 25 children there, a white catholic French nun, some potentially random Mongolian people, about 15 volunteers, volunteer organizers, some potentially important Mongolian people, and a man with a video camera who could have potentially been from the news station
. Little kids like bubbles
Some of the children were orphans, others weren’t. It was impossible to tell who was in what camp.
The children were going to perform for the audience who was supposed to judge them by the volume of clapping.
Item number 4 made me feel really uncomfortable, and sad.
It’s generally ill advised to feed children popsicles and sugar-juice as they are preparing to sing and dance for potentially important or non-important Mongolians, volunteers and camera crews.

After the song and dance routine was over, the children lined up to receive their backpacks (school started today!) and most people parted their ways feeling warm and fuzzy. I, somehow, managed to miss the warm and fuzzy boat, and instead fell into the cynical, confused, and somewhat-offended life raft.

Perhaps it was my lunchtime conversation (conducted entirely en Francais, merci beaucoup!) about my perception as a Westerner of Ulaan Bataar being a city that is not particularly child friendly (as if American megalopolies have a lot to offer in that realm either). It starts at the hospital, in the Maternity ward where my mother works, and in the Premature Infant wing where I hang out. In the state hospital, a microcosm for the rest of the majority of the country, resources are scarce. Mongolian babies and children have to be tough, because Mongolians have to be tough. The country is still figuring out how to take care of it’s population as they navigate their newfound democracy and reconcile it with their recent communist history and their strong cultural background. Life offers more challenges for men and women of this beautiful country than life will ever hand to me, I understand this, but I have higher hopes for a country that has proven in it’s ancient and recent history that it knows how to fight back and rebuild. I’ve got buckets of respect for what this country is, but barrels of hope for what they still have yet to build.

Perhaps I was letting this cloud of cynicism settle too well, or perhaps I was tired of feeling like a temporary guest in a beautiful, but messy house, or perhaps it was because it really was true, the children did look like they were lining up to race each other, that I turned to Sequinda and offered the first thing that came to my mind, “first one to the front of the stage gets a new mom and dad!”

We shared a laugh and an unlikely connection in an even unlikelier circumstance.

If You Don't Like Babies, Skip This One!

2010-08-30T17:03:00.000-07:00

Like Learning to Ride a Bike Again

2010-08-30T08:19:00.000-07:00

Gerelbsetseq and Borjee

By Cheryl

“Borjee.” She gestured smiling over to her newborn lying swaddled under the baby warmer. Fifteen minutes earlier, I had pulled out my pocket phrase book and in my best Mongolish, established that my name was Cheryl and hers Gerelbsetseq. When I asked her what her son’s name was, she gestured, “Nothing yet. I don’t know.” I waited in the occasional awkward silence shared between people who don’t speak each other’s language. But shortly after talking on her cell phone for a few minutes, a very important decision had been made. Borjee.

….

Mongolian doctors seem to specialize in one area of the hospital and take regular, five day/week shifts in addition to being on 24 hour call about six times a month. I went on rounds with Dr. Sarantuya, one of the doctors staffing the delivery floor, to meet Gerelbsetseq, 29 yo, laboring with her fourth child. Two other women were in early labor. Sarantuya led Gerel to the delivery room and instructed her to take her pants off, climb up on the stepping stool, and be examined for cervical change. Then Dr. Sarantuya announced that it was my turn to check. “Six to seven centimeters, about plus one,” I stated with surprising confidence. Sarantuya agreed. “You do delivery? We can learn from American midwife.” “Well, sure. But I haven’t delivered a baby for over twenty years. You stay with me.” Gerel was assisted off the delivery table and we three walked back to the labor room. Sarantuya looked at me, stating “I go to lunch now.” And off she went.

More than once in Mongolia I’ve had that peculiar realization so aptly put by musician/artist/writer David Byrne, “You may ask yourself, how did I get here?” It wasn’t too hard to figure out what to do… wait patiently, sit on my hands, keep a sense of Gerel’s labor progress. I’ve noticed that laboring women here keep it pretty quiet. Pain medication is not routinely used, would-be support persons are left out of the wards, and sometimes the labor room is shared with other women. Gerel’s efforts became increasingly intense and as I moved toward her to offer support, she wrapped her arms around me and I could feel the powerful strength of her contractions. When she started pushing, I called out an alert. Soon, the nurse, midwife, and doctor appeared.

Gerel walked to the delivery room and again, stepped up on the stool to reposition herself in the semi-recumbent position, the maternity hospital’s expected delivery position. I donned my gown and gloves as several more staff doctors and nurses gathered around. Gerel’s body did the rest. An experienced mother of three other children, she was a pro.

Welcome to the world, Borjee! All 9 pounds and 14 ounces of you!!

Mongolish

2010-08-30T05:01:00.000-07:00

By Shaine

Photos by Cheryl

My mom and I thought it would be a great idea to head out to the country for a bit, completely unplug, and live in a traditional yurt (ger) with a traditional herder family- complete with the horses, cows, goats, dogs, grass, manure, kids, nature, et al. We were right. It was a good idea. Need proof? Check it out:

Our Ger

For me, my weekend ger experience gave context to many of my experiences from the previous week. You see, my brain is wired to plan, prepare, and obsess over the future. As a project on personal development, I decided that I would find value in this trip through the experience. This is why, before coming to Mongolia, and after convincing my mother to spend her hard-earned money to take us to Mongolia, I diligently avoided any kind of preparation that might make me feel like I was more in control of my situation than I really was. Or at least, that’s one version of the story. The other version is that I simply didn’t have the time.

Rationalization or no, my mentality resulted in two pre-trip realities: 1) my mom did all of the planning, packing, and arrangement-making (for which I am ever-grateful!), and 2) The list of things I knew about Mongolia included 4 items:

Something about Ghengis Khan
The movie Babies has a Mongolian baby in it
Yurts
It looks an awful lot like Montana in photographs

Looking at this list now, I feel really foolish for coming to Mongolia at all. I could easily buy a book and learn about Ghengis Khan, I have seen the movie Babies (it was cute, if you like that sort of thing), my parents had a yurt in my backyard (hippies!) when I was a child, and I WOULD BE IN MONTANA RIGHT NOW IF I WEREN’T IN MONGOLIA!!!

It wouldn’t be fair to ignore the eerie likeness between parts of Montana and parts of Mongolia. They're on the same latitudinal co-ordinates, their geology and weather patterns are parallel, which of course results in similarities of agriculture, livestock, outdoor activities, and conversations between locals about the weather (in Mongolia, they say “the weather makes a liar of you,” in Montana, they say “if you don’t like the weather, wait 15 minutes”). Mongolia is the “land of eternal blue sky” to Montana’s “big sky country”. In fact, it’s almost too easy to draw comparisons.

Montana has fences though; people own the land. In Mongolia, the land is there, and so are the people, and the animals, but there are no fences- at least not the kind that mark property lines.

Big blue Mongolian sky

It’s hard to decide where to go from here. I could romanticize the country’s rich nomadic herding culture, and the traditions it encouraged; I could write an undergrad thesis about the country’s history of oppression from neighboring countries Russia and China, and the subsequent people’s revolutions that resulted; I could rant about the corrupt parliamentarians who take advantage of the country’s newfound post-communist democratic system; or I could tell you about my experience on the back of a horse, fingers frozen beyond utility, overlooking the single most exquisitely presented mountain valley backlit by the setting sun over the forest.

Darkhid Valley- our ger is somewhere down there

What I’d really like to tell you about, however, is the leaps and bounds I have made in communicating with non-English speaking Mongolians. Up until this last weekend, I have been spoiled. My head doctor speaks lots of English. Our host mother speaks enough to make sure we are well fed and showered. My mom and primary travel companion, also speaks English. In the city, my ignorance of Mongolian has been an annoyance at best. In the countryside, it’s a handicap.

This is where my favorite new item, the “Mongolian Phrase Book with Comprehensive Dictionary” comes in handy. I can have an hour-long conversation about my dietary preferences with any Mongolian who has the time, patience, boredom, and curiosity enough to watch me flip through the pages of my small brown book to find the words “I”, “Yesterday”, “Sick”, and “Vomit,” and understand that I am not rejecting his wife’s lovely lamb dumplings because I don’t want to eat them (I really don’t want to), it’s just that they might make me vomit all over the beautifully-kept linoleum and grass floor of his guest ger. It just so happens that the Mongolian who possesses the right combination of these qualities happens to live outside of the city, and in order to find him, you in fact, must spend a weekend living in a yurt with a herder family.

Our herder host,Yadamaa, who bore the brunt of my broken Mongolian

With my phrasebook in hand, I learned many things about this beautiful country. For example, yogurt is made from cow’s milk (that took 3 minutes to figure out). And so is everything else (that’s just obvious). Also, the neighbors got married when they were 17 and 18 respectively (that took about 7 minutes), and to really top things off, the sun rises about 6 am (that one took about 10 minutes) and the sun has already set (it was almost getting dark when I asked that question).

Finding out that she was married at 18

Being schooled by a 3-year-old

For a snapshot of everything else that happened this last weekend, please let my mother’s photography do the talking. I need to go figure out how to ask my host mother whether or not there is a disco nearby, and if so, when does it close?

For simplicity, broken down by category:

People:

That little goat is one day old. His mom is not happy with me or our herder host, Dawasuro

OMG! It's just like that movie Babies!

Taking apart grandma's yurt

Moving grandma's yurt.

Can you imagine moving your entire house and all it's contents in two trips on that truck in the background?

They gave my mom the easy horse. He pretty much ate his way through the ride.

Neighbor family

Kids and baby cows, kill me with cuteness.

Figuring out how to get all that hay into the corral.

Throwin' hay... am I in Montana?

Animals:

This dog spent some time gnawing on a piece of horse leg- complete with hoof, hide, and tendons

Our hosts herd goats, sheep and cows

Seeing a bright future as a goat whisperer.

Cow giving another cow a mouth-bath

Gers:

Herder ger

Grandma's ger- we helped her move it about 200 yards from an exposed to a fenced-in area for winter

Ceiling decorations and supportive poles

Neighbors

Saying goodbye

Off to the Guest Ger

2010-08-27T01:29:00.000-07:00

Hey Folks!

We are packing for a weekend in the "countryside". Taking a Russian jeep driven by a Mongolian driver and going over presumably rough roads for an hour outside of Ulaanbaatar into the hills of Terelj National Park.
Shaine has taken an extra measure of peanut butter and bread, nuts and dehydrated fruit. And, at my insistence, beer and wine. We are getting out into what Mongolia is known for... the beautiful open land frequented by campers, hikers, horse riders, and of course, nomads.

Full report when we return.

So Much for My Stomach

2010-08-27T01:22:00.001-07:00

By Shaine

My stomach just can’t take it anymore. For anyone who has spent any amount of time with me, you know I am a picky eater. It’s not that I don’t like to eat, or that I dislike food. I love most foods and I eat nearly constantly. But most foods that normal people, like my mother, can stomach, send my body into a hateful spiral of pain, gas, cramping and fatigue.

Yesterday was one of those days. My mom thinks I drank some tap (read: dirty) water, Oyuna, my host-doctor, thinks it was the grease in the cafeteria food I had been eating, Tayo thinks it was the fish she served me the other night, my dad thinks it’s the stress of travelling. I think it’s all of the above. Whatever the cause, I was out for the count yesterday. So, not a whole lot to report on there.

Today, however, as an antidote to my churning guts, my mom suggested I observe a cesarean section with her. Brilliant idea mother! Let’s expose the weak-stomached, low-blood pressure novice to exposed subcutaneous fat, muscle, and uterine wall! That’ll make her feel all better!

Steeling my stomach against what I was about to witness, I tightened my facemask securely around my mouth and marched into the operation room, my mom my shield. As a child of an OB-GYN and a Midwife who was often brought to work as a young child, I have seen cesareans before, so I figured, “why not?”

“Let’s stand over there,” my mom points to the far side of the room. “We’ll have a better view.” Currently, all I can see is the mother face, and some sheets and occasional tools swabs of blood coming from the surgeons on the opposite side. I think my view is just fine. But, I tell myself, when will I have a chance like this again? Besides, it’s just a cut in a stomach, right? And, eventually, a baby comes out, and that’s pretty rad, isn’t it?

I can stand the better view for all of 3 minutes. I feel hot, I can’t breathe, my facemask is suffocating me. I loosen it. Nope, still can’t breathe. I look outside. My mom tells me she thinks she sees the baby. Nope, it’s just her uterus. Great… I send a text to Oyuna. My body feels warm.

I’m not an expert on Mongolian culture yet, but I feel fairly certain that vomiting in an OR during a c-section, or during any surgery for that matter, is probably considered impolite. I certainly don’t want to be the culturally insensitive Yankee, so, I politely leave the room.

There you have it folks, I’m not as badass as I’d like to have most people believe.

I returned to my host-doctor, back in the safety of the NICU doctor’s lounge, where about 12 doctors are celebrating the return of their colleague from vacation, complete with Mongolian traditional drink Airig, which is made by fermenting horse milk until it reaches an alcohol volume a little higher than beer.

It’s everything I can muster to refuse the drink, publicly offered to me no less than 4 times. Am I in high school? I think, are they going to think I’m lame if I don’t drink with them? Is this a cultural thing? Why do I make Americans look like such weenies all the time?

Finally accepting my lactose intolerance as a legitimate reason to decline the drink, they promptly replace their offer of Airig with an offer of straight vodka and the assurance, “It’s good for your stomach.”

If only I had known!