Tales from a new Midwife

Wednesday, October 25, 2006

Duluth, Wendesday, Oct. 25

I write this last installment from the cold office of my own home. As I told one friend, I very appropriately reentered the U.S. at Houston, where aircraft from outer space land upon returning to Earth. Reentry is rough. It's cold here, dark, winter looms, and there's this big house and kids to take care of. I need a few days to get back into my former life.

Pete and the boys (and Dasher) met me at the airport very late Monday nite, carrying roses and "Welcome Home, Mom!" signs. It was so wonderful to see them. Lots of tears and hugs. So good to get hugs and kisses from my man.

At home, the house was clean, the fridge full, the boys happy. I told Pete that I'll be leaving more often!

Our last few days in Belize went fast. On Saturday, the nurses called me quite early, and I went in for a delivery. This mom had her last baby 11 years ago, and at home she had three boys. When her baby came out, I held the infant up for her to see the gender--and it was a girl! We both cried and celebrated. During her labor, I shared with her that I, too, had a houseful of boys. We talked about what it was like to be the only female, and to not have that woman to woman connection with one of our children. I, of course, have Cassie to love up and look forward to. And now Filipina had her baby girl. She wanted to name the baby after me (!!), but once they heard the name Jana, they decided it didn't transfer well and went for Josephina instead. Oh, well...

That day, I delivered a few more babies, did a whole bunch of newborn exams, cleaned the place, so on and so forth. By late evening, I was done. I had all the numbers I needed. Shell and I looked at one another, and she said, "I can get us to Caye Caulker by midnight."

We didn't get there by midnight, as we could not find a boat to take us in the dark. But we did pack up all our stuff, called the nurses to come take our unused food and kitchen gear we purchased and used, said our goodbyes and took in a few hours of sleep.

Sunday morning we were in Belize City and on a water taxi by 8AM, in Caye Caulker by 9AM, in swimsuits by 9:15, and snorkeling on the reef by noon. Later in the day, margaritas with nachos, a kayak trip to watch the sun go down, and an evening of fishing Belize-style off one on the docks--a 40-lb test line, a big hook, and a bag of sardines. We caught a few grouper, gave them to the group of young men that came to laugh and watch us attempt to fish without a rod and reel.

Next morning, I would have to be on a boat back to the city no later than noon. Spent the morning snorkeling and swimming. Wandered lazily back to the hotel room hours later, only to find that it was 11:47. I left the island with sand in my underwear, salt in my hair. Ran to the boat, got a ride to the airport from the dock, and off to Houston. I arrived in Duluth in need of a shower, sunburned, exhausted, and happy to see the family waiting with smiles and tears.

Thanks for all the love, support, emails, kindnesses...I had a wonderful trip. Hope to do it again someday. And now I'm home, onto my next adventure--getting ready to take my national exams and beginning a practice as a midwife in Duluth.

xoxo, jana

Friday, October 20, 2006

Friday, Oct 20 evening

Just called home and heard the bad news about ol' Ginger. I *knew* this would happen while I was gone. Pete and I talked about it--preparing for the possibility. It was hard to hear my old girl would be gone when I returned. But harder to talk to Ben and Char, listening to them cry. But I can also hear that Pete and Garry are handling things well, and that everyone is coming together to care for one another.

I'm so tired, I'm weaving in my chair. All day at the Maternity Ward. Two more catches. A few interesting situations with placentas and baby exams. Lots of goodbyes to patients. Also watched a few horrifying procedures.

I was not able to get to the Matron today. A young physician from this area died. He'd been in a car accident a few weeks ago, and he passed the day before yesterday. Funeral proceedings began today, so all administrative people were gone. This man's death is a huge loss to this small country. He was only 40 years old, and the nation's only pediatric nephrologist (kidney diseases). Being that he was a local boy, the loss stings even more. It is very sad.

The girls are rallying. I feel like we're on Survivor: Midwife. There was a close call with a defection last nite, but she's cooled her jets. Our instructor Shell got a good nite's sleep and is better equiped to keep dealing with all the challenges of being down here and dealing with a corrupt adminsitration. It's difficult, living on top of one another, the heat, the nurses... But we all went out to dinner, had a good rant, and I think these last two days will be good.

Our trusty wagon, La Bamba, blew a tire on us yesterday. We accepted the help of two young men in changing the tire (along a mud road in a banana field). To hell with feminism; when it's almost 100 degrees in the shade, I will gladly let a man change my tire. She was returned to us with a new tire, the muffler fixed, all the road dust washed off--it just doesn't feel the same. I liked her roar!

I just finished a big plate of shrimp, two gin & tonics, and I'm off to bed. The rest of the crew is heading in for a nite on floor.

Thursday, October 19, 2006

Thursday, October 19 afterroon

Just returned from a day of clinic in a remote village. Did a bunch of pap smears and blood pressure checks with one of the public health nurses. Another preposterously pot-holded road, over a one-lane bridge and into a concrete bunker that serves as community clinic and hurricane shelter. This village, San Antonio Rio Hondo, is actually an island in a river. Some of the village girls told me there were manatees in the river, but I did not see one.

So, pap smears were interesting. We put a mattress up on a wooden table, pulled two chairs to the edge for stirrups, had one of the village men carry in a couple of concrete blocks to use as stairs to the mattress (little Mayan women!), rolled up a blanket to prop and elevate their hips, and then did the old-fashioned kind of slide preps. Virtually none of the women spoke English, and my Spanish is bumbling (altho I did have a decent conversation with a 74-year-old woman in the village about her garden!), so all my hand gestures about scooting down to the end of the table and relaxing their "boom-boom" must have been amusing to some of them. Or frightening, from the looks on their faces.

Meanwhile, trucks roared thru the village at about 60 miles an hour, exploding dust clouds and sending chickens running. They are contraband runners--bringing goods over the river from Mexico, which is just a mile or two away. A 50-lb bag of rice can be bought for half of what would be paid in Belize. So trucks loaded with goods, and occasionally a border patrol truck of men in paramilitary wear pretending to be interested.

Yesterday I had a 14-hour day. Went into the clinic at 8 am. Spent the morning drawing blood for HIV screening, the did intake physicals with newly pregnant women, taught a birth class for new mothers, then did a 10- hour shift on the birth floor. Got two catches last nite, did some more suturing. Almost passed out from the heat in the delivery room, covered head to foot in a canvas gown on top of my scrubs.

Best part of the nite--I got the grandmothers of each of my catches to come back to the neonate room to bathe and dress their new grandchildren, rather than me doing it and bringing them the babies. They were*so* happy, it made me cry. I have the one nurse who wanted to give me a hard time about it the hairy eyeball, and she kept quiet. That was a win for me. It was so worth is all.

I have the nurses won over (finally, now that it's time to go home...) Two of them were in with me last nite, coaching me as I managed the births. They were so excited for me, teaching me to suture, to remove a trailing membrane. And finally, they want me to show them how to wait for the cord to quit pulsing before clamping, then draining the mama's side so the placenta can easily fall out without traction. We've reach a trust, an exchange. I am now invited to hang out behind the desk and tell jokes and eat food, and now I'm going to miss them when I leave.

The other two students are not faring so well. They're still a bit put off and insulted with the nurses. Thing is, how we were treated is how midwives will always be treated--by doctors, by emergency techs, by politicians, even by skeptical mothers and family members. Learning to deal with hostile people is part of this job.

Made a "fallen" Mennonite man very happy yesterday (he was excommunicated). His wife was in labor for two days. I went outside to find him, on the other side of the hospital grounds, to tell him his baby was born. He was so happy and grateful. He keeps reappearing to take me out to dinner as thanks. Just the slightest kindness means so much. He calls me from across the ward, or the street, or the parking lot, "Nurse Gee-na! I vant to tell you thank you!"

I got a ride home at 1am from the ambulance driver, in the ambulance, which also serves as a taxi/bus for hospital workers. He drove the wrong way on all the one ways, telling me he could because he was an ambulance (without lights nonetheless). I love this country.

What else...? Had a really busy nite the nite before last. Lots of c-section moms to attend to, and then a woman walked in at 5cm with a shoulder presentation and no heart tones. Got her off to surgery and baby came out with a low Apgar, but is now doing fine. Luckily, all the stars were aligned: The surgical theater was open, the doctor answered his page, and the maternity phone worked. Many times, women are not so lucky.

Then an ambulance pulled up at the backdoor with two transfers from the Corozal birth clinic--a prolonged labor than needed a csection and a premature birth. And a woman walked in bleeding with low blood pressure. No catches, but lots of work and new experiences.

We're starting to run into people we know around town, seeing babies we've delivered and moms we've helped. It's very nice.

Time here is running down. Geting ready to start packing my things. Trying not to think too much of home so I don't get homesick a few days early. Trying to decide if I should sacrifice the last few shifts and get a water taxi to one of the islands for a day of R&R before coming home.

Tomorrow I'm going to make some waves. Going to go to the Matron with a copy of the Midwifery Today magazine in which I have that article and show it to her. And tell her that I'm writing another article, about the Mennonite midwives. And that I want to know why the apprentice out there can't get her licensure from the hosptial. She's been waiting two years, and they won't let her get legal. The administration is trying to shut those midwives down. It's very political--too much to get into here. But I thought I would use what clout I can to see if I can get Maria the help she needs.

Tuesday, October 17, 2006

October 16, Tuesday evening

Shell and I drove out to a settlement called Shipyard yesterday. An hour down a horrible mud and dirt road, and the jungle opens onto open land, dotted with tidy Mennonite farms. Flat and wide, it feels like the Great Plains--except for the palm trees! The homes are all lovely, with wide verandas, lines of laundry hanging out to dry, orderly papaya orchards, chickens in the yard, windmills, and children playing in the sand. Buggys share the road, driven by women carrying and nursing babies on their laps, or men pulling a farm wagon. Cows wander the pastures, and sawmills stand with piles of drying slabs of mahogony.

The Mennonites came to belize 55 years ago, by way of Mexico, Canada, and before that Russia. Always, they are looking for autonomy. In Belize, they have negotiated the right to farm without paying certain taxes, and without military conscription. In exchange, the provide Belize with a good deal of it's food. They are amazing farmers.

We found the midwife, Maria Braun, and her apprentice Maria Schmidtt. Maria B. is a 66-year-old widow with 11 children, the last two still at home. She has more than 4o grandchildren. Her apprentice Maria S. lives a few farms over, is 42, and has no children of her own.

Across the barnyard, Maria has a small clinic, about the size of a cabin. It's shaded by a big fica tree. Inside, the central room is a pharmacy and exam room. The Mennonites come to her before seeing a doctor. To one side is her prenatal room--an exam bed, a scale, her table of tools. The adjoining room is the birth room, with a queen-sized bed elevated to the midwife's waist, making it easy for her to catch and repair.

Everything is immaculate. Painted blue and white, with cheerful curtians covering the leuvered windows, bright linens on the tables. A little outhouse connects out the back door. Kerosene lamps wait for evening on the tables.

The two Marias speak high German, but are fairly fluent in English, so we were able to have great conversations. We talked about our practices, and found that for the most part, we are very much alike.

Their remoteness demands that they are able to creatively address emergencies. Law requires that they not deliver and first time moms, or moms delivering baby six or more. Those mothers are supposed to drive into Orange Walk. Also that they not have or use drugs for hemmorage, including IVs. Like so many of the ridiculous laws midwives in the US deal with, they have found ways to get around the rules in order to provide a safe birth for each woman. They are well-stocked with hemmoragic drugs and IV equipment, and are able to recite current protocols with no problem--in fact asking if we had any more updated information to share.

Maria told us that she explains to people that they are to go to Orange Walk, but no one will go. Instead, they wait until it is too late, and drive into her yard. She says this with a sparkle in her eye, and hands me her birth records book. In it she has recorded each birth she's attended since 2001, when she opened her clinic. I see many women delivering baby number 9, or 10, or even 13. Their ages range from 19 (a Mennonite may not marry before the age of 18) to 46. To date, Maria has delivered 573 babies. No maternal deaths. Only four transports to the hospital. Four infant deaths, three of which were stillborns, one a premie. No c-sections.

I would challenge any American doctor or institution to come up with such numbers!!

They were very interested in hearing about our waterbirths, and have asked me to send photos. Maria also showed me her glucometer and hemoglobinometer--both of which she has purchased with her own money.

She makes $175 Bz for each birth--about $87 US--and does about 100 births a year. This is her only source of income. The goverment provides her only with a few hemostat clamps, cord clamps and a box of gloves a month. The rest, including the building and equipment, she has purchased on her own. The public health nurse comes out there once a month, and everybody pretends they're all minding the rules, and then it's back to normal.

We took both Marias another hour down an even worse road to see the midwife in the next community, Sara Schmitt. The Marias were *very* excited to go see Sara--they had never been to her home. By buggy, it would take hours to get there and back.

So we managed somehow to get our old Chevy wagon, La Bamba, down the road, in and out of holes, thru giant puddles, around stuck sugar cane trucks. Sara was *very* suprised to see us all coming up her drive! Shell and I met Sara the other day at the hospital, when she'd come in with a patient of hers. So we had a lovely visit at Sara's, and saw her birth clinic. Sara only does about 25 births a year. Her clinic is a small cabin at the back of a pasture, again immaculate and welcoming. She also has spent much money buying equipment.

Sara is 48, with seven children. She has a midwifery business, a pharmacy, a general store, a enormous chicken operation (around 1000 birds), a rice paddy, a papaya orchard, cattle, and more energy than anyone I've ever known. Amazing.

It was getting dark, so we said our farewells, and drove back down the horrible road, arriving back in Shipyard just as it got dark. The fields filled with lightening bugs, the stars came out. Sara Schmidtt, the apprentice, and I felt very close. We are both 42, both apprentices. She very much wanted me to see her home, meet her husband. So with a kerosene lamp, she have me the tour of her small home. It was very nice. She, like all the women, sew all the clothing on an old fashioned push pedal machine. Her sewing room was filled with fabrics, and a little bed for her small dog to be with her. Her husband Henry was very pleased to meet us, and asked us to stay for dinner. Unfortunately, we had to get back.

At Midwife Maria's, about a dozen grandchildren were waiting for her in the barnyard, all looking wide-eyed at the English (word for anyone not Mennonite). Maria hugged and kissed us, and told me I was welcome to come live and work with her. (she was impressed, too, that I know about horses, and could harness up a buggy--but thought it was hysterical that I've never milked a cow!)

I so wanted to stay. It very much felt like home to me. I can't really describe it. A simple life, hard work, but joyful and focused on serving women, babies, and doing the timeless work of a midwife. I get tears in my eyes thinking of it.

Back at the hospital last nite, I spent all nite labor-sitting a very difficult labor for a gravida six with a severly pendulous uterus. She delivered an hour after I left this morning. I would not be allowed to deliver her during the day--she's out of my scope as a gravida six, and with administration and doctors around in the morning, the nurses would be unable to let me catch. Meanwhile another lady came in, saying she'd had pains for about an hour, laid down and splatted out a baby with no one even in the room--I'd gone to get my blood pressure cuff and by the time I walked back in the room, it was over!! A frustrating evening to say the least.

So a few hours tonite for me, and then I'm going to spend the day tomorrow in the prenatal clinic doing intakes and initial exams with newly pregnant moms.

I'm kinda giving up on the catches--it's just not working out that way for me. So I'm focusing on other things. If I get one or two more, I'll be grateful. If not, so be it. I promised myself I would be open to whatever came my way on this trip, and that's what I'm holding up.

Sunday, October 15, 2006

Sunday, October 15, 2006

I'm keeping such weird hours, I don't even know what day it is. I worked two shifts yesterday, getting home this morning at about 8:30. I drank a rum and something referred to as "squash juice," took a cold shower and fell in bed. Now it's about 5:00 pm, and I'm trying to decide what to do next. I want real food, not rice and beans, but I can't muster the energy to go out and find something.

I had a good shift last nite. Caught two baby boys, both delivered without tears or suturing. I swear I have some joo-joo about boys. I'll bet for every one girl I catch, I catch five boys.

The first was a tiny, tiny woman from a remote village having her second baby. She was very frightened. I had to sit in a chair to be eye-to-eye with her, and I explained that it is against the law for me to cut. That I would be with her all nite, until her baby was born, and that I was here to give her lots and lots of love and kindness. She was so happy, she started crying and said that she'd prayed for love. I brought her mother back with us, who was even tinier. She spoke only Spanish, but we held hands and mamasita said prayers and made crosses on all of us, and we got to work.

Sally got to 10 cm rather quickly, and she had a big bulging bag of waters. I brought her into the delivery room, got her on that ridiculous table, and her water broke--all over me, of course. Unfortunately, her cervix also began to close one the bag of waters was gone. Usually, a bag breaks and the baby is close behind. Shell and I got her into a squat on the delivery table to put some pressure down there, but one of the nurses came in and freaked out. So Sally and I went back to the laboring room and kept working. Her baby's head was very ascyclitic, as if he were trying to come out with his head kinked to the the side. So we labored for another two hours--with no change in cervix or baby head. The nurse called in the doctor, and she ordered a pitocin drip--try to make some very, very strong contractions to turn the babies head and allow the cardinal motions to bring the baby farther down into the birth canal. (I also learned to insert a cathedar as part of that deal.)

After an hour of agonizing contrations, the head shifted, began a descent, and we went back to the table. Soon enough, little boy made his appearance. His head was unbelievably swollen into a caput--the conehead-looking thing. He struggled a bit to get started, but he was fine in just a few minutes of stimulation. He was the furriest baby I have ever, ever seen. He had hair one his back, arms, legs--and not just the fine hair of a premature baby. This was long, black hair. He looked like a little hobbit!

Sally's baby was covered in meconium--just covered. Her placenta just smelled. In the US, the placenta would be sent to pathology, and the baby to intensive care where plenty of antibiotics would be administered. Here, the baby is not even monitored. So I'll go back tonite and do a baby exam and check Sally out real well. Make sure they're both recovering well.

Mamasita was so happy when I brought that baby out to see her! She kissed me and blessed me so many times, I think I'm good for many years.

The next was a gravida six, which officially I am not supposed to catch, but Glory, the nurse, pushed me in there and told me to do it anyway. Meanwhile, morning had arrived and a doctor and pediatrician were at the desk, and I kept waiting for one of them to come in. This woman was on baby number six at only 28 years old. Two babies are dead. She pushed him out, I placed the boy on her belly, and she just laid there exhausted. Not the joyful greeting most babies get. She was there with the Tradional Birth Attendant from her village, who explained to me that the mother was disappointed that she didn't end up in surgery--she wants tubal ligation.

The mom promptly began hemmoraging, which required the administration of medication and for me to get the placenta out quickly. Which luckily for me, came out with very little prodding. By the time I got her to her bed, her blood pressure dropped precipitously, and we started an IV. I brought her food and juice, and soon enough she was good to go.

I guess what I'm really learning here is how resiliant babies and mothers are. I know they can die. But holy cow, it's hard to kill a baby. It's really helping me take the adrenaline out of my practice. The life force is strong.

So the news from the Maternity Ward is that we have no garbage bags. Nothing to put at the foot of the delivery tables to catch fluids and trash. She we're using newspaper. Also no soap or towels for hands washing. We do, however, have a big roll of toilet paper to use for drying hands. I buy soap and paper towels and bring them almost everyday.

The news from our group is that the women are getting pissy. Everyone is tired of being bullied at the hospital. It's exhausting to deal with the heat, the language barriers, the shift work. Becca and I, trying to learn management and delivery, really have to fight for our ground with the nurses. My stategy is to flatter--asking them to show me things. It works mostly, but even then I struggle to understand them. Imagine a heavy Nigerian accent speaking English by way of Creole. Also imagine completely different conversational habits, where people don't speak face to face, but looking away without direct eye contact.

Tomorrow I'm walking up the open-air market to buy food. I found a woman with a cart that sells fresh OJ that makes my eyes roll back in my head. She also sells watermelon juice--lots of people drink it. Also found something called salbutes. It's a fried corn tortilla with shredded chicken, marinated cabbage, a slice of tomato, and some sort of brown hot sauce poured on top. They are SOSOSO good.

Missing you all. Thanks for all the messages. I look forward to reading them everyday. j

Saturday, October 14, 2006

Saturday, October 14 evening

I've just slept a few hours, taken another shower and downed more rice and beans. Off to the Maternity Ward for another long shift. I'm spending as much time as humanly possible there, trying to get the most from my time. And trying to be available for catches.

Our newest restriction is no primips. (Code for first-time mothers.) And no gravida sixes (which is code for a mother delivering her sixth baby). Anything in between is fair game. Problem is, most of these moms, having been thru the brutality of birth in a government facility in Belize, come in only when they are ready to push. So if we're not there, we miss it.

All this arises from the fact that we are not trained nurses, and the regional and district administrators are under the gun for having accepted stipends and gifts without following the law regarding visiting health professional laws.

As such, we are being catagorized as Traditional Birth Attendants (TBAs). TBAs work in the remote villages and the Mennonite communites. They are licensed, trained and have a strict protocol set by the Ministry of Health (which is run by a man who is an accountant by trade). They also have had the word midwife stripped from their title, and are not allowed to call themselves such. We're restricted to their protocols.

It's really cutting into our numbers. It's very frustrating. Especially when these primip moms come in, and we nuture them thru labor, get them to where the head is on the perineum, and then one of the staff midwives comes to deliver. And cut. With dull scissors, they cut each primip. Saw is more like it. Then spend a good hour repairing. It's frigging brutal. I try to watch, try to learn, but I can't stand it.

They also rather violently break membranes. As soon as possible. Usually as soon as the cervix is anterior enough to reach, they'll go in with a tweezers. Or, if we've kept the midwives away long enough to get a woman to near complete with intact waters, they'll take their ungloved hand and plunge their fingers in over and over until the water breaks. Even if it's a birth either Becca or I are managing, they'll reach right over or around us, and do the deed. It's as if they're claiming their ground. I cannot even physically block them!

Even more frustrating is that they are wholly uninterested in learning anything new. We've brought new protocols and documentation, and offered to demonstrate. But they refuse to even discuss it.

We are, however, holding our ground with not cutting the umbilical cord until it stops pulsing, and keeping the baby with the mother. It's something.

In the meantime, I'm getting to see and do many new skills. Last nite we had a baby born with respitory distress, and I cared for him for the two hours it took to resolve. That was very valuable learning for me. I also did the newborn exam for a IUGR baby (intra uterine growth retardation), which allowed me to visualize the characteristics. Another baby with a hematoma on the skull. I am certainly completely able to take vitals of moms and babies quickly and with accuracy. Because I do it over and over and over.

Mostly, however, I am spending my time caring for and loving the mothers, grandmothers and new fathers and siblings. Lots of attention, smiles, reassurances. I footprint the babies onto cards or certificates my mom made for me to take along (and the mom's love it!). I bring them extra food (today for lunch each woman was given a banana). I find fans, bring them cold water from the nurses' stash, read their charts to them. I defy the rules and bring in dads and grandmothers to see their loved ones, and when I can't do that, I bring the baby outside to the waiting area. Most of the time they're discharged without even being told how much their babies weigh. I do a whole baby exam for them, with them, and show them all the amazing things their baby can do. So a little bit of love and attention goes a along way.

Even though I'm not getting the numbers I hoped for, and most of this is really not skilled work, it's important work. This is a country of just 250,000 people. If it were drawn out in statistics, I would be affecting the lives and birth experiences of a significant proportion of families! Getting change and bringing compassion to the birth centers will have to come from the mothers. And finding out that compassion is possible is the only thing that will bring change.

I'm not sure what all of this means in terms of my own path in midwifery. More than skills and catches, I'm learning about the life of a midwife. This work is an absolute spiritual commitment; to be usher to the transformation of woman to mother, fetus to child, at the membrane between this world and the other. To hang onto that, even in the face of an endless supply of bottoms that all look the same, of babies that all look the same.

To be a midwife is to accept a life of rebellion; to hold that space, protect it, for the women, their families, and ourselves. I think of midwives--being stoned to death, burned at the stake, drowned. Outlawed. Jailed. Derided and divided. All through time. Sounds dramatic, but it's true. Even where being a midwife is legal, such as in Minnesota, everyday is a balance of providing love and care and navigating the political and legal reality that the next birth could result in arrest and prosecution. I'm very aware of the gatekeepers. Of the people who try to own the birth process, commodify it, restrict access to it. Not allowing family to attend. Not allowing students to attend. All the ritualistic cutting. Keeping TBAs from calling themselves midwives.

But here's the bright spots: A young mother named Cynthia came in the other nite. Her husband wanted badly to stay with her, but the nurses pushed him out as soon as she walked in the ward. Rather than waiting outside the doors on the hard benches, he went around the Maternity Ward wing, outside the window where Cynthia was laboring, pulled up a cement block and watched it all under the cover of night. He told us the next day, thanking us for taking good care of his love.

A radio station reporter snuck into the hospital and Maternity Ward with her tape recorder to interview nurses and mothers, trying to find out why there has been no ultrasound machine for more than a year, and why the surgical theatre is closed down so often, forcing dangerous births and last-minute transfers. You can imagine how I loved that! Security guards came and took her away. They took her tape recorder, too. But she got a good story!

The TBA from one of the Mennonite communities came in the other day with a gravida six. While she was with us, we were able to sneak to her a good deal of supplies the government has been denying her. We sent her home with gloves, suction, sutures, soap, and our respect.

It's the little wins that feel the most rewarding.

It has finally stopped raining. The sun is out everyday. You simply cannot know how humid the air is. I feel like I am never dry. Ever. Looking forward to going home.

Wednesday, October 11, 2006

Wednesday, Oct 11, 2006

We've got clearance to get back to work. Looks like there will be a few restrictions, such as no episiotomies (what a relief!). But for the most park, we're good to go.

Shell and I went to meet with the OB, Dr. Salinas, the Matron, and the head of Maternity. Dr. Salinas was not happy. Clearly, he knew the administrators had taken money and tried to have us working nights, when he would not see us. Thank goodness, he is a decent man, primarily interested in making sure we're qualified and that his patients are protected.

It took quite a while for him to come to terms with the fact that we are not nurses. Just midwives. But midwives with far more training and education than the traditional birth attendants, who are midwives to the remote villages. Even more than some of his floor midwives.

We were also told that each of will need a temporary practice license to be working in-country. Which is the first Shell has heard of that in her eight trips to Belize, three of which she spent weeks delivering babies in facilities all over the country. For this trip, they are waiving the requirement. Just goes to show you how far a few hundred American dollars can go...

So we're flying under the radar, and hoping to keep it that way. Central America has its own rules and ways of working.

Susannah apparently gave up completely and went home. Which is probably good. The two midwives up in San Ignacio are having a great time, and two more are way down in the southern part of the country in Punta Gorda.

Our group of four is wonderful--I really, really like these women. They travel well, move quickly, don't shy away from language barriers, and we're all doing well living in very cramped quarters with one small bathroom. Raphael, the owner of LaBamba the station wagon, drove up and got us a new C/V joint, which makes driving feel much better. Gas costs about $5.50 US a gallon.

We're hoping to stay here in Orange Walk for a few more days, then head north to Corozal, which is a smaller clinic with no surgical theatre. When we have all the births we need for our paperwork, we hope to catch a boat taxi or airplane out to one of the cayes (islands) and spend our last few days snorkeling.

Today, we hired a boat to take us upriver to a Mayan ruin called Lamanai. It was rather Indiana Jones-ish. Speeding along a tropical river thru a rain forest, swooping into turns, arriving at a partially submerged dock an hour later. Off thru the jungle, with howler monkeys making horrible noises at us, stepping over lines of leaf-eater ants carrying back huge chunks of plants to their holes. When we walk by an allspice tree, the aroma makes me think of Thanksgiving and pumpkin pie.

We toured the ruins for about an hour--it's a huge site, but only three pyramids are excavated--everything else is a huge hump, covered in jungle. Then down to the water, where we ate beans and rice, chicken, slaw and Fanta soda for lunch.

Along the river, we passed a few Mennonite communties. They live back there, running farms and living as if it were the 1800s. They raise rice, beans, livestock. Primarily, they speak German, but I hear them speak English and Spanish, as well. They all dress exactly the same: Men in black trousers or overalls, with a long-sleeved button-up shirt and straw cowboy hat. The women all wear calf-length blue dresses, all the same style, with stockings, sandals and a straw hat with a ribbon. The children wear minature versions of the adult outfits. They are all as white and light-haired as Minnesotans, most of them decendants of Americans who immigrated here in the 1950s. As far as I can tell, they never smile. The women give new meaning to the word "severe."

So that's the news for now. I'm still sweaty and hot. Sure missing you all. And the cold air. Although I understand it's been snowing...gawd.