Wednesday, November 25, 2015

Where is Rose's Grave?

I wake up and offer my morning prayers to the day as it emerges over the Cascade Mountains.
In this quiet, my heart flies over the mountains and the sea to Cabestore and its trails of small hamlets and family farms.

And then, I write.  I am superstitious.  I think that if I tell this one mother's story, she will not have died in vain.  I believe that if I tell her story, her baby boy will miraculously live until the day I return. I believe that maybe the collective knowledge of her life will wrap her tiny house in goodness and light.

A traditional house surrounded by a family garden in which crops are interplanted - corn, millet, beans and squashes as well as fruit and nut trees.  When the lands are stolen for mon agriculture the results are often tragic.  

I close my eyes and pray hard - "Take care of that fragile family."

"For all the fragile families."

When I flew into Haiti, I looked out the plane window and I saw these tiny lights shining like diamonds in all of the mountains.  I looked again. They were everywhere; a land of diamonds just sitting there in the afternoon sun.  

Soon the plane, dipped down and I could see the rusty tin roofs of the many houses and they were no longer diamonds but rusted, leaking tin roofs.   But I knew that we can choose to see them as diamonds or we can choose to see the rust.   The diamonds, sparkling in the sun,stayed with me on my journey.  I began to look for them in everything I did.  I looked for those moments and places of blinding light amidst equally blinding poverty.

Rose, the mother in my sotry, died of poverty.  

She like all of us, comes form a long line of human beings who traveled and lived in small equalitarian bands of friends and family.   They followed the shoreline all over the world, fishing and gathering food amongst the rocks and meadows of the coast.   Archaeologists believe that these early bands of humans were free of class and were largely democratic.  They think this because of the graves.   Later, in the human story, graves would tell a different story but for thousands of years the final resting places of human beings were remarkably equal.   The other thing they noticed, was that there are virtually no skeletons with baby skeletons inside them. This leading them to consider that not many mothers died in childbirth.

Rose was buried in a poorly kept cemetery in Cabestore.  It sits on a bluff on the way to the "poor kids" school; on the way to the market.   Most people are buried in family graves; cement above ground, multi-layered places of rest similar to New Orleans.  They sit right beside them in their front yards.   I read that this was important because during slave times, there were no graves and so people wanted to keep their loved ones close by.  They can lovingly put things on them and walk by them every day.

The land of Rose's Lakou; her family yard, was lost and so she traveled down the trail to the community grave yard.   By the time, we arrived the burying was over and people were gathered, tied from an all too familiar journey.

The grave in the yard, was a sign of independence. self sufficiency and respect.

This was interwoven into a view of self sufficiency in which each family grew their own food and cared for one another on their own land.   The world could do as it would, but they would keep their land and their traditions.   This might have worked for some time, but in time people would come ( my country included ) and the rich and powerful of Haiti and they would want to consolidate the farms and turn to mono crops.  It was the same in the US farms.   'We can do better. Grow more. Make more money." The problem was that the families depended on the food grown on that land to live.    I watched huge trucks drive by piled high with plantains while the children's cooking pot sat empty.  

Despite a well crafted, ancient system of cooperation and taking care of each other; the land of Rose's family was sold or taken or coaxed away from her and she starved.   I believe her family grave is somewhere on the lost land.   Perhaps the men will  be hired to work the lost farm land and take home a few gouds to try to feed and educate their children.   Each day they will make hard decsions about the few resources they have.
The  baby is passed from arm to arm; from lap to lap no knowing where his mother has gone.

Tuesday, November 24, 2015

This Little Light of Mine

The mornings in Cabestore are veiled in mist; a cool mist that clings to the mountains. I sit on the porch of the birth center with my circle of solar lights.   I breathe in the morning and ask that I have the strength to be good and true and stay calm and kind.

I think about the many aspects of my own inner self.   They tumble out of me all day long and stay with me in my dreams.   I consider the power of these aspects and think that all the spirits of the Hatien Saints are all the many parts of us.   They do not have to enter us, as they say in Voodoo.  They are alway there.  The kindness and love and strength as well as the fear and sorrow.  They are all there; always.

I think they believe that these spirits come and go at will.  I think they think someone can enter your body and take over your sweet disposition with a rage that causes death and destruction.   I think it is all in there always.  We can choose what we nurture and what we try to calm.   We can use these many aspects and when we use them to hurt others, it can indeed feel like a bad spirit has attacked us.  

Sunrise in Cabestore 

This is a my Quaker interpretation of "spirits."   We were taught that each person has an inner light or spirit and that our only task in life was to walk cheerfully across the earth, looking for that light in other people.  Recognizing it and helping it to grow.  We sang "This Little Light of Mine" a lot.

"Ain't gonna let them blow it out !"

Can a whole country become convinced that the spirits blowing their light out are metaphysical and the work of friends and neighbors?

I was a religion major.  I consider how religion can be used to comfort and build community or how it can be used to control and grow fear and discrimination.

When Rose lay dying with her baby sucking the last bit of milk from her breasts; she believed that an evil spirit had entered her body.   She believed that this evil spirit was far greater than the good that was also in her and that no western medicine could take it away.

If the Agent Sante from PIH came to see her, he later agreed that it was "bad spirits" and would consider no other possibilities.

The priest did not walk up that muddy trail to see her or offer last rites.  I doubt they would have bothered to send for him.   They did not ask for a ride in his fancy SUV.  They did not have a mass in the church.   These things cost money and after all they did not have the money to go to the hospital or send their children to school.

The mountains are filled with the bones of mothers.

It is easy to doubt the presence of an inner light in all people.   When I emerge from the isolation of Cabestore, Paris has been attacked and hundreds of mothers will die as bombs are dropped and miss their target.   It is a battle, it seems between evil and good; righteous and evil.   People fighting over the right to God's teachings.

A volunteer asks. "What is the difference between Protestants and Catholics?"

I say well it was the Reformation.  The protestants believed that the common person could understand and have a personal relationship with God.  They believed they could read the Bible for themselves.  The Catholic Church at the time, believed kings and rulers were chosen by God and people needed to go through them to get to God.   They died for the right to pray directly to God.  They died for the separation of church and state.

I believe that good mother died of a bacteria or virus or amoebe and not the curse of a single neighbor. But I also believe that she was weakened by the spirit of greed that has infected her country for hundreds of years.

Sunday, November 22, 2015

Diagnosis - Bad Spirits

 I am standing toe to toe with the family and friends of a mother who had just died as the rain beats down on the tin roof and the yard begins to flood  There are two rooms in the house with only one window in each room.  One room contains the male domino players while most of the women and children and older men are squeezed together in the other empty room.   Small children peer down from an upstairs loft.

Children of the Lakou- always ready to greet us and offer a chair after a walk up the trail to do home visits Their mother is expecting a baby in January a the new birth center

The translator is busy negotiating the adoption of the baby.

I am wondering what type of diarrhea  she had and if it could spread to all these people living so closely together.  I try to remember what her husband had said.

No fever.
No blood.
Her mother had the same thing and died too
She had it for one week

"Does anyone think it might be cholera?" I try to say.

"Bad spirits.  She had bad spirits and they could not get rid of them."

Cholera or dysentary or something else?   They are both caused by crowded conditions and poor sanitation.   Our own country had many serious outbreaks with both diseases.  Cholera was the main cause of death on the Oregon Trail and dystentary killed more soldiers in the US Civil War, than battle.  It killed thousands of babies who were given cow's milk so their mothers could work in the sweat shops of New York City.

We all  remembered the cholera outbreak in Haiti; the one that was traced back to the United Nations Security Forces.  For many years, there were piles of rehydration salts with directions on how to mix it everywhere.   Soap and rehydration salts.

I gave her soap and rehydration fluids.  If we had beds that morning perhaps I might have let her lie down and given her an IV.  But we had just opened and we had no beds.  Later we would blow up an air mattress but that morning we had not yet gotten that far.   We did not yet have IV fluids.  
These things would come but not that day.

I ask the translator to take me to the supervisor for PIH's agent sane program and say again, Maybe cholera?" and he says no, "She had bad spirits."   I figure they should know what cholera looks like as so many people died from it but I am still unsettled and there is the issue of the baby and what he will eat.  I am also there to set up a new birth center.

But I worry that the "spirits" that killed this Mom would impact maternal and infant health.  I began to see those "spirits " as all those things that lead to death and disability hat are not necessarily see under a microscope or can be tested for.   I began to see the "spirits" that killed her while keeping my eyes open for outbreaks or other people with similar symptoms.

As I walked back to the birth center, after my visit, with the agent sante, I began to notice the large number of children not in school.  I  began to see the "spirits" as those things in any society that
any society that deny a mother the ability to feed or educate or get health care for her children.

They had called the "Leaf Doctor" after the woman had come to see me.  He could not save her either.  Dis he turn to him because she could not afford the moto ride to the hospital or because she believed it was spirits he could cast out.

I could have kept her lying in the grass and watched her ads I unpacked.  I could have given her an antibiotic or gently held her head and gave her fluids.  I tell myself I did not know then she would not go to the hospital and that she was going home to die.

The baby is given a container of formula and it is agreed that the baby will go which translator on the week-end.  There are conversations about potential visits and the birth certificate.   Its pins around me and I beignet think that at least the baby will be cared for and live but the spirits were at wow

Saturday, November 21, 2015

The road back home - Rose's Journey Into Death

I am not in Cabestore writing this.    I barely had any electricity in Cabestore and no internet.   I kept a journal and made cartoon sketches of the things going around me at four or five in the morning.   I would turn on solar lights and drink luke warm tea from a thermos.    The dogs often woke me up; the dogs and the roosters.

The place where I stayed was guarded by the priest's guard dogs.  The dogs were kept in crates all day.  People would poke them with sticks to make sure they stayed good and mean. The dogs  got in fights all  night long with the local dogs who were always having babies and in  a state of extreme starvation.  

When I first arrived, Frankie warned me that if I went downstairs to the birth rooms at night, the dogs would attack me and eat me.  

"What about the mothers in labor?  Will they eat the mother's in labor?"

I thought I would simply say we cannot have mother eating dogs at a birth center and they would be moved but they were not.   The priest said if I just used the secret code word, they would not eat me.   It was hard to remember and besides he said,  "Do not let any mothers know the secret dog code."

"How will they keep the dogs from eating them if they don't know the code?"   I am persistent.

Fortunately the mother eating dogs only tried to eat one volunteer whose aunt had died and had tried to go down the stairs before they were put in crates for the day.  I yelled the code world as loud as I could and the cooks called them in.   I considered that my accent was spoiling the use of the code word.   It is actually a sound.  Something like "Ta-tee-ta" but I never got it right.

Most nights, the dogs would start ripping a smaller dog apart and a great deal of crying and screaming of dogs would ensue and then the roosters got up and I could no longer sleep and got up too.

It was cold and damp.   The mist hung all around the mountains and  our clothes were wet.  I thought about the babies; the ones who would show up at the clinic with "Night fevers and grip."  

Was it malaria or simply the effects of sleeping on dirt floors on banana leaf mats.  It was so hot during the day but there by my little solar campfire on the upper porch, it was cold and my cartoons were drawn in the half dark.  

The four hour walk to healthcare 
After the roosters came the first people on the road.   The road was once a trail, like the one we take to Oliver's hamlet but now it was the market road and goes to LasCahobas and on to Merbela and Port-Au-Prince.  

The moto could take you out to the world beyond those small hamlets nestled in the side of mountains.  It could take you to healthcare beyond our capabilities.   It was possible.

 I had told Oliver's mother to go to the hospital; to follow that road but we all have been so sick we could barely manage to get to the bathroom and I was asking her to go all the way, on a moto, to town.   It was a forty-five minute ride to the closest small hospital and another hour to the larger one.  She would cross many streams and it was rocky and she had bad diarrhea and was throwing up.  Someone would have to go with her and who would watch all those kids.  

She nodded at me.  She was bent in half and throwing up the rehydration salts.  

Instead she made her way across the field and up the trail that turned into a creek when it rained and laid down in her small, dirt floor house, with all the children, and died.   I remember that her name was a form of Rose.  It was not exactly Rose but the word Rose was in it.  

Rose would have walked that trail.  Neighbors would have come out to say hello and a leaf doctor would be called.

There is a slight incline to get into her yard.  It is not so steep but if you were sick and walked all the way to the birth center and back sick, it would be one more hard hill to cross.  Her house was in a cleared yard.  There was a porch and all around fields of corn and millet with squash and beans tangled in between.   Her children would be naked, as they always were.   What did she see as she forced herself to climb the incline to her house and find a place to die.  

She would not make her way through the yard and down the incline or down the path that turned into a creek with rain or onto the moto or even back to us.  She could not nurse he baby or even hold him. She did not leave that yard on her own two feet again.  Back then I did not know the way to this hamlet or that she was laying there dying.  

I sat by my solar campfire and worried about the dogs attacking mothers and volunteers and how we would manage until the supplies came.  I made lists of things to do to get a birth center up and going. I made signs in Creole, looking up each word and making drawings to illustrate the danger signs of pregnancy.   I know these signs well, by now.

But I know I am also a placed- based midwife; a midwife who considers the geography of the roads, the condition of the soil, schools and the amount land one has to farm.  While I worried about the dogs and the lack of a bed to give birth on, Rose was dying.

Next - What did you say her diahreaa looked like?   Conversations at a funeral.

Thursday, November 19, 2015

The first time I met Mrs X - Oliver's mother

We had barely gotten the few things we brought to open the new birth center unpacked.    We arranged the birth room and prenatal room.   We knew where emergency kits were and had set up a birth bed and table but we were not yet officially opened.

We arrived Sunday afternoon and by Monday had a full day of prenatal care and machete wounds.   Machete wounds are neat and straight, if you get to them right away.  If you allow them to sit untreated they become an infected mass of puss and scaring.   I had not known this but came to see this but I was new there and this was the day of my first machete wound.  I poured betadine over the wound again and again and put triple antibiotic cream on it. It was too late for stitches and besides I was use to stitching vaginas; not machete wounds.  Later I would put in a few stitches.   Later when I saw how infected they could get and how the children starved if no one went to the farm.   Later when I could no longer see the lines between a birth outcome and the man's ability to farm.

But on that day, looking up from the machete wound, I saw a woman with her husband making her way towards us.  She could barely walk.

The new birth center in Cabestore at dawn with mist still clinging to the mountains

I finished the pouring of the water and tried to get the translator ( a different translator) to help me.   He was restless and did not hold still.  He was from the city and it soon became clear he did not have such a favorable opinion of the  "peasant" community.   It was not what a young, urban, English speaker aspired to.   But he knew the line was not so clearly drawn and the fear of dropping over the edge into such poverty was a day to day struggle of wit and will.

I got that she had diarrhea and it was bad. I rooted through a blue bag where I knew I had packed re-hydration salts.   We used them all the time but this was the first.  I found a bottle and clean water and had her drink some.  She threw up over and over again.  She was lying on the ground in front of the new pink birth center and was having fluids pour out of her.   I gave her anxious husband more packs of de-hydration fluids and told them to go to the hospital.  I said this through a translator who was not paying attention.   Later I would remember this.  Me trying to make sure they knew to go the the hospital, showing them the re-hydration mix and bottle.   The translator walking away and me hauling him back again.

"Are you sure she is going to the hospital? "

"Yes, yes."

But I am never sure.  In the weeks that follow he translates so many things without paying attention and so I am never sure.   It feels too cruel to ask, "Are you sure you told her to go the hospital?"  I ran upstairs and got her a diarrhea pill just to hold her till she got to LasCahabas.

We arrived Sunday and it was only Monday.

Later I would learn to walk upstairs and get 100 gouds and put the sick person on the moto - no going home- no nothing - just go now!

I never saw her again.   The next thing I knew we were walking up the path to her funeral and wondering what to do with the baby.

I had put together some emergency kits to prevent maternal and newborn deaths but there I was with a mother newly dead and a baby with slim chances of survival.

I walked that path many times and as I walked I asked, "Why did she die?"   She had gotten prenatal care at the mobile clinic.  She had not died in childbirth but she had died of an undiagnosed cause and the baby might die too.   In this way, I began to collect clues and conduct an investigation.

In the belief system of many people, a person can put a curse on you.  The translator says the person can send an actual virus or bacteria so it looks like an illness but it was sent by someone.   "Buy who? I ask.

"Sometimes you never know."   He does not have much patience for my questions.   It is just how it is.  He plays music all night long. Between his music and the dogs, it is hard to sleep.   The music keeps the bad spirits away.   I wonder out loud.  Maybe the bad spirit is things people worry about or a past argument or a loss of a good friend or fear.

"More than just that."    he does army calisthenics each morning with the midwives.   The young women at the water pump laugh so hard they can barely stand.  I take it all in - the baby without a mother, the calisthenics and the water pump.

Why did Mrs X Die? A medical mystery of Cabestore, Haiti

This is the story of Oliver; a baby living in Cabestore, Haiti.

His name is not actually Oliver but it is the name the translator gave him, when she wanted to adopt him and now it is the only name I can recall.

Why did your mama die little baby?   

It is the name he was given when his father, still in the deepest stages of grief, brought him to the newly opened birth center for us to care for him.   The translator, had offered to take him home and with the help of other volunteers, feed and love him and make sure he had an education.   When he handed him to her, she found soap and new clothes and washed his hair and put coconut oil over his soft, brown skin.

She took a moto to town, over many streams and rivers to buy formula and bottles.  It seemed a race against time for a baby, in Cabestore, who no longer had his mother's milk.   I have developed a way of looking at baby's skin and hair and development to assess if a baby is exclusively breastfed.  Exclusively breastfed babies in Haiti, are dark skinned with shiny black, soft curls. Despite all our teachings, an exclusively breast fed baby till six months is rare.  It takes constant encouragement.  I doubt Oliver had been given much breast milk during his mother's illness, on top of the cultural norm of broth and food at an early age.  He was already malnourished. He was chubby enough but the chubby of white rice, smashed with a few beans and coaxed into his small mouth.  His skin was too pale and  his hair stiff and dry. He already had signs of skin infections, coughs and wheezing lungs.

He melted into any set of arms that held him.

I first met Oliver at his mother's funeral.   The community health agent invited us and in this way I took my first walk up the trail to his house.    It was hot and sunny when we started out but soon we were standing in a crowded yard amidst a later afternoon downpour  We were invited into the house which was overflowing with children and young men playing dominoes.   It took many funerals for me to understand that young men are suppose to play dominoes at funerals.  How this tradition took root, I do not know but I do know that despite the pouring rain and numerous children, the domino players did not budge.

It grew darker but I could still see the mother's older children, staring at me.    Their mother was gone; buried in the family grave just an hour ago.   I watch the oldest girl, about ten, take her father's hand as the translator is busy offering to adopt the baby.   It does not seem the time to discuss the baby's possible adoption but then again, the baby would need care and food immediately.   There was no sign of food for any one of the many children.

The translator had adopted other children who all lived with her mother in a house in Port-Au-Prince.   It is near to impossible for a white or foreign person to adopt but a Hatien can simply say they are the mother and no one is the wiser.  She had two other children whose mother's had died in childbirth.

I ask the health agent, why the mother died.    He shrugs.  "It was bad spirits."   Later they say, "the grandmother died of bad spirits too."

One daughter and four little boys and a now a baby boy who is just four months old.

I am in Cabestore to help Midwives for Haiti, set up a new birth center.   We are here to help prevent mother's from dying but here she is newly dead and there is nothing anyone thinks could have been done to prevent it.

In the weeks, that lay ahead, I would walk that path many times.    I would ask myself over and over why Oliver had no mother. I mean really, I want to say.  Why did she die and how could it  have been prevented or treated?

I am haunted/inspired by two things.   The television show "House" and the film by the World Health Organization called,  "Why Did Mrs X Die?"

This is the story of Oliver and his young mother but it is also the story of Cabestore and of Haiti; a story of life and death  A slow story;  not a fast paced action story but a slow one in a hot climate with thunderstorms at dusk and market day every Wednesday and Saturday, despite the dyings and birthings that are sung and captured in the mountains.

I write because I too believe in magic.  I hope that if I write this down and send it out into the universe, I will be able to sleep at night.