Thursday, April 17, 2014

In my village

I have come home to Portland. 

 I could see that I was pushing against the current and needed to re-think what was happening with maternal health and what useful role if any I could play.   Although 99.9% of all childbirths are attended by matrones, who are largely women, the health care system is paternalistic.  

The skilled midwives, trained at Midwives For Haiti, were suppose to work under doctors who had less training than themselves and their role was constantly undermined.   Nothing was based on what women wanted, World Health Organization standards or research.   It seemed to be based on a system of power stemming from Europe in the middle ages.  There were two worlds.  There was the village or hamlet life with well defined systems of agriculture, market and yard in which women garnished respect and order.  There was then a system of governance, churches, schools and clinics that had rules, regulations and a way of doing things I failed to understand.  The power seemed to come from the town where the boats connected it to Port-Au- Prince and the greater world.  I was told there was a system of status assigned to certain people; there were people who mattered and people who did not. 

Most people, I knew did not venture down the mountain to the town, let alone take the ferry to Port-Au-Prince or leave Haiti.  Migration to earn a wage, was most often the task of young men.  Some teenagers had the opportunity to go to high school in town.  If you were about to die, they might try taking you down the mountain side, across the bay and to a hospital in Port-Au-Prince. Things to sell in the market were brought over on the ferry, but by in large, the families lived in cycles connected to their daily needs, the elements and the comings and goings of birth and death and foods coming in and out of season.

There was not a clear recognition of the importance of prenatal care let alone a birth with a skilled birth attendant.  Women who did come for prenatal care were not routinely tested for STD’s and care was sporadic at best.  I wrestled with what mattered most and what I , an aging, white midwife might offer to people I cared about.   I struggled with the idea that we leave our responsibility for others at borders as well as the many problems with NGO backed health care in Haiti.

I loved my day to day life in the small village.   There were small tasks that took forever to accomplish, a lack of supplies, almost non- existant communication and a chain of consent that was hard to master.  Still I wondered about doing what good I could and settling down into a routine of children, midwives and mothers.   I had to remind myself that I was there to help establish a maternal/ child health system using the skills of these newly trained midwives.   

I decided that mobile prenatal clinics would make the greatest impact on women, children and their communities and to do this well I had to take a step back and try to figure out what it meant to do this well.   The cluster of villages needing mobile clinics had long term relationships with churches in the United States.  They worked in partnership with a large church system that branched off into smaller and smaller streams and ended up in small, rural churches with lay leaders in Haiti.   Somehow I had to swim back up those small streams to the source and gain consensus regarding the importance of this work.    We had to, I felt, start at the beginning and rethink what care is most critical.  Later I would talk with midwives and we would ask ourselves what we would choose, if we had to choose.   Often NGO’s dedicated the most money to hospitals and hospital systems for emergency care or in the hope that women would one day choose to give birth there.  This is where the money most often flowed but it was like putting a band aide on a wound that could have been prevented. Of course the whole maternal health package includes prenatal care, skilled birth attendants, emergency transport,  emergency ready hospitals and  post partum care.

High on the mountains of LaGonave it seemed that care had to begin in the villages, close to home and garden and yard in partnership with the matrones, agent santes and village leaders.   But the question was not just to do it but to do it really, really well.   So I went and visited other mobile clinics and tried to sort out what works and what does not.   I sit and sort this out everyday while living and working in my own village.  

Haiti is always in my heart. I see what is before me and yet there is another lens through which I see things and that lens is Haiti.   In the coming weeks, as I prepare to return and help launch the mobile clinics, I am want to write about maternal health care in my own village.   I can see that I have set a standard for Haiti but what about my own village and what is happening there.  

I can see that heartbreak is central to the human condition and that some of it is preventable and some is not.  I wonder a lot about democracy and all the work it takes to really trust in the process of equity and the courage it takes to enter the conversation.   If I have a fear it is the fear that the worlds I have chosen are not adequate for the task before me.   I am surrounded by power systems, inequities and the long term results of colonialism in my own village.  As I pack and prepare to return, I promised I would take a reflective look at my own village and ask myself if the same obstacles that existed in Haiti, indeed exist here.

Within days of returning several things happened in my village; a wonderful woman and mother had died too young.  Another very young mother with two children faced the dilemmas of housing insecurity or being homeless.   I sunk into despair.  George’s mother died of breast cancer and left him an orphan.  Three girls I loved lost their mother. One of my favorite students ever was facing many obstacles finding a school and home for her children.  I became hesitant to go out in the world.  I could not bare the unfairness of the world but slowly, slowly the garden called to me and I returned to the world; not the same ever but returned none the less to try again, to allow my hear to break, to make mistakes and to try again and again.

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