Childbirth in the mountains
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Twenty-seven percent of the earth' s surface is mountains and these mountains are home to over 720 million people. They are also some of the poorest people on earth and the place where far more women and babies die in childbirth.
In many countries that I have visited, the mountains were the places that people fled to when escaping slavery, state making and colonization. The people down below in the valley land see them as living ancestors; carrying with them the traditions and knowledge of the past. Most people originally lived closer to the coast where trading, better soil and more opportunities for growing and hunting for food existed.
In Haiti and as in the Philippines, when the Spanish came some died of disease and were enslaved and some escaped to the mountains. They were sometimes known as maroons; people who escaped from slavery and went to live in the mountains. Brave and resourceful they came to make the unwanted land of the mountains their home. They learned to farm, hunt and build communities high in the crevices of these places.
There were and are still are few roads. Paths connect communities and are often a long way from the road.
In the Philippines, they ask what is to be done about our poor maternal health rating?
"It is" I say, "A matter of mountains."
"Mountains?"
"Yes, mountains. The women can not get down when they need help and no one wants to bring care to them so far up in the mountains. It is matter of roads and people."
The governments hope that the women will come down. They plan for waiting homes and birth homes but they are far from the mountain communities and difficult to get to. They must leave farm and family.
But it is not just roads, it is that the mountains are fragile ecosystems and things like mining and deforestation destroy their source of food and cause severe starvation and malnutrition. Streams are filled in by landslides destroying a source of water.
There is also war. I think of the sandy roads of Cambodia that offered many,well staffed rural health centers. The roads were flat and easy to use. People road bikes and walked and healthcare was greatly improved in this landscape. But even there, high in the mountains, on the border of Thailand and Cambodia, soldiers camped with their families and in that place- that place of on-going conflict, the women had no access to care and were far from help, should it be needed.
In the Philippines, a people fearful of the army and foreign mining companies, have difficulty worrying about birth. The government says, "Come down out of the mountains and give birth down here."
They threaten them with fines; fines for the mothers and fines for the traditional midwives. A woman at a small store says, "They just more further into the mountains where no on will bother them."
When I teach a workshop, usually for the traditional midwives, all the women, children and some men of the village come. I can see from their stories that there, everyone is the midwife. Anyone could find them self beside a woman giving birth; on the road, in a field or by the water. They tell me that there in the mountain they all need to know.
On my way down the mountain, the motorcycle weaves around many new landslides and through mud from hard rains. It is a long, hard ride and even when we get to the main road, it is a long way still to the nearest birth center and even there the midwife is gone and would not be there, even if the woman had made that long journey or could have afforded the motorcycle ride on a day when the road was not washed out.
I too, live on a mountainside. I am 67 and people sometimes say, "I am afraid to come up there on that road to see you" and sometimes friends say "maybe it is time to move off that mountain."
Other times, I sit on a rooftop in LaGonave or sit by the school in Mindanao or sit on my little mountain and look out. Buried in the mountains, we can see lights in the distance and know there is a life out there.
A doctor says , "And how is America? " I consider and say., "It is big place so its hard to say but I live on a dirt road on a little mountain and look out at the dusk creeping over the valley. I have chickens and sheep and the children run and do not want to stop playing. " She can see it is much the same. But it is not. The army has never once come up my mountain and if they are mining this mountain range it is not on my land and mostly never could be. I can get in my car easily, and drive to town. When my grandchildren are born on the side of this mountain, I can easily get down in an emergency.
I look at the group gathered to ask what I think about maternal health in the Philippines and I consider the question. "Mountains. You have to have a plan that considers the mountains and the people who live there; not one just for getting them down but one that respects their culture and their need to be near family and farm. I think the midwives have to go to the mountains."
