From Charity to Solidarity

I think I came out of the womb wanting to change the world, to have impact for the better.  It’s innate to my being, and the circumstances of my childhood only strengthened that part of me that wanted to see things be better for people on Earth.  

I remember seeing a TV ad when I was a kid that showed Goldie Hawn (I think it was her) with some black babies and she was telling people they could donate $2 a month or something to feed one starving child in Africa.  I understood the intention but it never sat right with me.  Even as a kid I was wondering “Why are they starving in the first place?”

I understand a lot more now in terms of systemic global issues but of course the world is still a mystery for the most part.  What I do understand is that while charity has its place, the issues that face humanity are deeply complex and intertwined and require solutions that take everything and everyone into account.  What is required in my view is something much more radical than feeding starving children.  We need to address the roots of the issues. I also understand that while there are immense disparities and suffering in this world, along with immense wonder and beauty, we are not really divided into “haves” and “have-nots.”  In my view, we are all in this mess and in the beauty together.  Some of us have a lot more leverage and more comfort and privilege than others and have more impact (for better or worse) or can pretend to distance ourselves if we choose but no one is immune to the suffering of the planet and of humanity.  And every one of us can tap into the beauty and wonder wherever we are.  And though we might have a comfortable life or we might find ourselves in dire circumstances none of us is really separate from the world at large, though we may be blind to our relationship to it.

With this insight I have wanted to find a path toward making a difference that is not about charity but is based in an acknowledgment of our interdependence with all of life.  As a fellow midwife who has done extensive international work once said to me:  "All positive change happens through relationship."

I am happy to report that I have been finding that path in my experience at ACAM and the relationships and collaborations being cultivated there.

ACAM, CONCEPCION CHIQUIRICHAPA

I came here briefly in 2004, to this hidden mountain town of Concepcion Chiriquirichapa, to meet and interview midwives for a research project I wanted to do about midwifery and herbal medicine in Guatemala.  That project turned into a book called Voices of Maya Midwives (Lulu press, 2005.) In the process I gained a deep awe and respect for the women I interviewed.  I had a dream at that time of coming back here to work side by side with them to learn and share as fellow midwives.  The birth center was under construction at that time.

Fast-forward to 2015 and here I am living that dream.  When I reflect on the meaning of being here, it’s so much deeper than a cool exotic opportunity.  It’s about leadership, empowerment of women, vision for a better world, solidarity and sisterhood--and creating bridges across cultural, linguistic, national, and economic divides.  It’s about honoring the interdependence of all beings and finding my way back to a sense of wholeness.  

L to R: Azucena, Antonina, and Imelda at midwives meeting

Essence and I have spent two months with these women in their environments and have grown a deep love, appreciation, and admiration for all that they manage to do and quite simply for who they are in the face of a serious history of oppression and ongoing assaults to their way of life.  We marvel every day at the ways we see their strength, wisdom, and inner power manifested in the ways they work and live.

Two women, Antonina, and Azucena, have been the driving force behind this impressive  maternal health and cultural renewal project.  A couple of weeks ago I organized a field trip that helped me to see these two women and Antonina’s daughter, Imelda, in a whole new light and only deepened my appreciation of each of them.

BUILDING BRIDGES

The following are excerpts from my “report from the field for my colleagues at the BIrth Institute:

Essence and I went this week with Antonina, Azucena, and Imelda (with Andres, Antonina’s husband, driving) on a two day field trip.  We went first to Huehuetenango to visit Casa Materna, which is a maternity waiting home next to the only hospital in the department.  Wow.  There are people in that area that are up to 13 hours from any hospital.

We saw where they keep the women who have high risk pregnancies or simply live very far from the hospital in the special maternity home for 5 or more days on average.  They do not give birth there but they go to the hospital when they are 4 centimeters.  They have nurses and doctors on staff at the waiting home but no midwives.  We thought we would go to the hospital and see some births since they normally do about 50 deliveries a day there.  But for some reason there were no births that day.  

The midwives were told by the Casa Materna Staff that they should just say they are visitors at the hospital (I did have permission from the higher-ups to enter the hospital before we even traveled there) because if the doctors there knew they are midwives they would not let them in the door.  We as foreigners would not have that issue.  So, they did go in with us and as far I as I understand it was the first time any of them had the opportunity to be inside a hospital. 

The nurse in the delivery room (who didn’t have much to do since there were no patients) kind of gave us a tour and then started asking the midwives questions.  The midwives ignored the warning about concealing their identity since we were already there. 

Antonina explained to the nurse that they have a birth center near Xela.

ACAM Midwifery Center

“And who owns it?”  she asked.

“We do,”  Antonina said with her chin a little higher.

“And what if you need an I.V.?”

“We do it.” (note from me: True.  I've seen it twice.)

“And sutures?”

“We do that too.”  (note from me:  While it's true that they have the capacity to do sutures, they have their own effective way of dealing with tears, which has to do with tightly wrapping the women's hips in a "faja" after birth and doing a special vaginal steam bath in the temascal.  That's a whole other subject.)

And the conversation went on with the nurse about how the place is run and what they do.

I loved watching the midwives talk about themselves and their work.  They sure do hold their heads high.  It is clear from this and the other experiences we had that they are damn proud that the birth center belongs to them and that they are the ones who decide who works here and how decisions are made and what the care protocols are.  

The next day we were taken by the folks from PCI, the organization that runs the waiting home, to visit a group of midwives in Todos Santos, a totally quaint little town way high up in the mountains.  Pretty remote.  We were invited to go and the agenda was pretty loose.  I honestly wasn’t even totally clear what my intentions were except that it seemed like a good idea and the midwives were into it.

Midwives of Todos Santos, Essence and me in the middle.

The town has 150 midwives that receive trainings from PCI—most of them the same old boring trainings most midwives have been getting forever—about danger signs.  No one ever actually teaches them skills or hands out meds.  They just drill into them when to bring a woman to the hospital.  Pretty impractical if you have a massive hemorrhage or a woman in preeclamptic convulsions and the hospital is 4 hours away after you track down a vehicle.  Apparently they have done some trainings with doulas from the U.S. as well that were more engaging.

Antonina speaking to one of the Todos Santos midwives

So when we arrived about 30 midwives showed up.  We did some brief introductions as we sat in a huge circle and as soon as I mentioned plant medicine someone interrupted me and wanted to know what plants I used for labor.  It was a bit awkward as I wasn’t prepared to just start talking about specifics but that was what they all seemed to want.  We ended up going around and each of us sharing some of our favorite plants to use.  I used examples of herbs I have used for my kids.  When Azucena and Antonina started talking the questions started firing and they kind of became the center stage.  Azucena talked about her vision of reclaiming the medicinal knowledge of the ancestors and how it would be good for them all to get together again and to bring live plants so they would know specifically what they are talking about.  At one point I turned my head and saw that half the room was suddenly empty.  Where did everyone go?  I asked Essence.  Then I heard someone say they went to look for plants.  We found them outside gathering plants from the roadside to show the others what they were talking about.  They suddenly became so animated and energized! 

Imelda, Antonina's daughter, speaking to the midwives

They made plans for a group of midwives to travel from Todos Santos to the birth center in April to see with their own eyes what is happening here.  They are especially interested in the plant medicines.  Antonina, Azucena, and Imelda are all deeply interested in empowering midwives from other areas to reclaim their value and their place in the community and to build bridges with each other.  Antonina talked to them about how important it is for them to leave their communities sometimes so they can see what is happening in other places and spend time connecting with other midwives and learn and grow and become stronger this way.

These ladies are so inspirational and command such a presence no matter who they are talking to.  Essence and I have both grown deeply fond of them and are so inspired, impressed and humbled by who they are and how they show up for life.

Azucena speaking passionately about plant medicines

The beautiful thing about all of this is that connections were made during our visit and at the end of our lunch conversation Antonina said, “The time has come for us to have a national meeting of midwives and it needs to be right here at ACAM.”  The woman in charge of the waiting home had said something along the lines of her program being the number one model maternity program in Guatemala.  Over our lunch (not to the woman’s face) Antonina said, “No, it isn’t.  As far as I’m concerned, ACAM is number one.  We are the example.  No one owns us.  No one tells us what to do.  What those midwives need is their own maternity house in their own community like we have here.”

Judy Luce and ACAM midwives at the first meeting in 1999

I tend to agree.  ACAM is a model worth studying and replicating.  It has its roots in the community and will stay in the community.  ACAM was born out of a real need and the birth center was born out of a vision held by Antonina and Azucena.  They gathered the midwives of their community to begin addressing their common issues and through a fortuitous meeting with American midwife Judy Luce they were able to secure financial, technical and moral support for building a birth center.  They are incredible leaders and visionaries and are making a huge difference in their community and in my humble opinion this project deserves a global stage.  A birth center like this in every community in the world would for sure make the world a friendlier and more welcoming place for humans.

Essence, me, and Todos Santos midwives

I am convinced, now more than ever, that building bridges and friendships and creating collaboration between groups is essential for forward movement in social change.  During my short visit I have facilitated connections between ACAM and AMA (another birth center), with PCI and the midwives of Todos Santos, and with the Birth Institute and I see how much it strengthens and inspires the midwives to see this network building.  And they have their own networks as well.   As Antonina said to me today, “This is a collaboration.  We are doing this in solidarity with people from the U.S.  It's through this collaboration that we have learned to value ourselves and who we are and what we do. You have been an immense help to us in the births and in helping us make connections.  Without people like you who come here and others who support us this place would not exist.  And without the us, the midwives this place would not exist.  We are doing this together.” 

If you want to learn more about ACAM and their story, check out the very beautiful and moving video on their website: http://www.mayamidwifery.org/blog/

Cultural Humility at the Nexus Between Life and Death

“GRAB AN ONION!”  This is what the midwife said when baby Jose was born with the cord wrapped 3 times tight around his neck and he came out floppy and not breathing.  By this time Essence and I were familiar with the onion routine.  This was our third experience.  Mom or baby having a breathing issue?  Wave an onion in front of their nose and they perk right up.  Well, theoretically.

The first time we became acquainted with the onion was a few days after we arrived.  

“Sarah!  Come quick!”  Of course I thought it was a birth.  It wasn’t.  It was a woman who had given birth several hours earlier and had been having convulsions at home.  Instead of bringing her to the hospital they brought her to us. (Great.  Thanks.)  She wasn’t speaking, her skin was cold and doughy, and I couldn’t find a pulse or hear a blood pressure but she was breathing.  Barely.  While we were busy taking her vitals and assessing the situation she went into convulsions in front of us.  She seemed to stop breathing for a moment and her eyes rolled further back into her head.  That’s when the onion appeared.  Someone (one of her relatives) waved an onion under her nose and for a moment she opened her eyes and her consciousness came back in the room.  It was enough to get her breathing again.  At that point Essence and I were both impressed with the onion.  But clearly she needed much more.  Somewhere in that scene we called an ambulance and soon the woman was escorted to the hospital.

The next time we saw the onion we had a baby that was born at 4 1/2 pounds, prolapsed cord (cord coming before the baby--life threatening), limp and not breathing at birth.  I went full swing into neonatal resuscitation the way I have been taught, which involves giving the baby breaths.  When I came up for air, there was.... the onion, being held under the baby’s nose.  My instinct was to bat the onion out of my way so I could get back to work saving the baby’s life.  When I tried that, the midwife came right back with the onion.  She wasn’t about to accept my rejection of her favorite revival technique.  We settled into a rhythm (with a fair amount of reluctance on my part) of taking turns with me giving breaths and her waving the onion in between. I didn’t want to incriminate myself as some kind of arrogant midwife that rejects traditional ways and yet of course I wanted to save the baby and was sure that my way was his best chance.  After a good long time of our little routine he finally came around to breathing on his own, though with a fair amount of difficulty.  He continued to be limp, was super tiny and did not at all look like a happy camper.  I really really really wanted him to go to the hospital.  I was pretty sure if he didn’t go soon he could perish.

I talked with the midwife about it and she talked with the family in Mam.  Nothing seemed to be happening.  I said something again and the midwife simply said, “No quieren.”  They don’t want to.  That seemed to be that.  End of discussion. 

“Uhhhh, what?  What do you mean they don’t want to?  The baby is not well.  He’s limp, he’s hardly breathing.  He could die.  He needs to be in the hospital.”  

“No quieren.”  

It was a predicament.  The woman herself was not so good with Spanish.  I talked with her husband.  I talked with the mother-in-law.  They listened and then did nothing.  The husband told me a story about some other baby that was born not breathing and he is fine now.  “No.  You don’t understand.  This baby is limp.  He is struggling.  He could die if you take him home.”  No response.  I tried numerous times, talking with the family, talking with the midwife.  My pleas were clearly going nowhere.

This has never happened to me.  I am not used to people not taking my advice as a midwife.  If I say we need to go to the hospital, they go.  I do not take the decision lightly.  I hate sending people to the hospital but I do it when I have to and have never had someone just ignore me like that.

I talked with the midwife in private about it.  “Why won’t they go?”  I asked.  

“This is just how people are,” she said.  “They don’t want to go.”

“Is it because of money?” I asked.  

“Most likely,” she said.  It costs a lot of money and the government doesn’t pay for it.  People prefer to take the baby home and if it lives, it lives, and if not, then it’s God’s will.”

I cried.  I let go.  

“Don’t be sad,” she said.  “This is just how it is.”

I switched my tactics from trying to get them to the hospital to giving them instructions for caring for the baby at home.  I taught them about dropper feeding (I gave them one of my empty dropper bottles and showed them how to do it) because the baby didn’t even have enough life force to nurse, and I taught them about kangaroo care.  We got mom and baby naked together and I had the midwife explain everything about skin to skin contact.  I have no way of knowing if they followed my advice after they went home.  Before we knew it, they were packing up to go home and I clearly had nothing to say about it that they cared to hear.  I would have preferred they spend the night and said so but that was also falling on deaf ears.

I asked them to come back in two days and explained to them why I wanted to check on both baby on mom.  I asked the midwife to explain in Mam.  I told them there would be a doctor here that day (which was true) and they agreed to come back.  They never came.  We did not hear again from the family though they have the phone number of the birth center and could call if they need us.  I don’t know what happened to the baby.  I wish I did.  I think about the experience a lot.

In my mind, I am present at births for many reasons, one of them being to save lives and to let people know what needs to happen in order for lives to be saved.  This experience poked a huge hole in that assumption.  Who am I to tell a family that my priorities of saving their baby’s life in the ways that I know how are more important than theirs, whatever they are?  I can’t know all the reasons why it was so obvious (there seemed to be no discussion amongst them) that they would not go to the hospital no matter how much I insisted, explained, warned, etc.  Nor can I know why they did not come back.

What I do know is that I learned something about cultural humility.  It’s not ultimately my choice.  I am simply a servant and a witness.  I have expertise but I cannot insist that others receive my offering.  They will do what they want to anyway.  Is it right?  Wrong?  Should I, could I have done something else?  I don’t know.  I don’t want to throw my hands up and say “it’s not my problem” and neither do I want to push my agenda on someone else.  But when someone’s life is on the line...and that little being cannot speak for himself....what to do?  It’s a big question.  And the humility is acknowledging that I don’t have the answer.

As for the baby I mentioned above, with the cord around the neck, it was a breeze in comparison to these other experiences.  With the onion, and some vigorous stimulation, he came around to breathing and was totally fine after that.  These ladies swear by their onion.  I, on the other hand, am simply remaining open to what I don’t know and what I don’t know I don’t know.