The empty place within

The empty place within

A mother died in Cabestore and I felt a deep determination to find out why.  I walked out of the birth center doors and out into the community.  I wandered up small, muddy rained out paths, jumped over small streams and followed behind cows and horses and donkeys.  I greeted small children and sat beneath trees in neatly swept yards and watched.  I wanted a diagnosis.  We are taught to make a diagnosis before we can hope for a cure.

In the process I discovered that a lack of education and basic health services, as well as oppression and poverty, were the most likely causes of her death.  If we could have done stool samples or blood tests on family members, we never did.   If we could have tested the water or asked to do STD testing on her husband, we simply did not.   I asked visiting doctors and the community health workers, but in the end I had to accept the “Bad spirits” theory and set out to discover what the bad spirits were, where they came from and how they caused her death. I looked for a different diagnosis.

I do not know if Oliver lived or died.   In my walks up to visit the baby Oliver and to help his family, I wandered off the beaten path.      

Wen I returned from Haiti, it seemed that one parent, after another, in my community were dying too.   Wonderful people who had children and partners who still needed them.  They died of cancer or heart related incidents.   Circles of grief rose up around us as winter settled in.   They were too young. Their children were too young.   Their partners wanted more time with them. 

I took to wandering the hills and riversides in my community too.   Everywhere people were looking for answers in well-funded laboratories.    There was no lack of electricity or education of food but I was in despair.  I thought of Oliver’s mother and I thought of these parents.  I thought of other young parents who had died in recent years with only a month or few days warning. 

Around me, activists and community leaders fought against oil trains and fracking and other forms of pollution.   I saw how the very wealthiest often used the land and air and water to make fortunes with little regard for the people who depend on that very land and water and air to live.   I knew that this had been going for a long, long time.   My own community, though green and lovely, was sitting on a time of earthquake fault, oil trains and gas farms.  The air was filled with arsenic and the rivers killed the fish that tried to swim upstream. 

In the world, when the wealthiest use up the land closest to home, they head to another place to spray DDT or deforest land.  

I felt that the mothers and fathers were dying from an overwhelming greed that filters down and alters their genetic code, nestles in the site their placenta implants, in cells and blood and in time sweeps them away from us.   Perhaps it is “bad spirits.”  Perhaps it really is those indefinable ways that people put curses on us all by poisoning our air, our earth, and our water.  

I could tell a hundred stories of how our power is taken from us but I want to tell the story of how Haitians have organized themselves against all odds to throw off oppression in the form of colonialism, slavery, imperialism, and dictatorships.  What doe sit have to do with maternal health?   Everything. 

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.

George's mother has died.......

George’s mother has died.

George and Rosette's mother died a few months ago of breast cancer.   She had no access to screenings or treatment, leaving her two young children to be care for by a cousin.

I watch him and his younger sister, set out into the world without her.   A cousin has taken them in and I can see that they go to school and have food. But ever since I came to his village, George has tapped on my window or knocked on my door and called for me.  The other children say, “Mamma dead, papa dead.”   It is how they define him.  George is the boy whose both mother and father have died. The children who say this, do not  live with  both of their parents. Their parents live in different cities or even countries trying to find work, trying to find a better future.  They wander too but with the hope that one-day the unknown parent will return and they will be a family once again.   No one says, “Mamma dead. Papa dead.”   There is an occasional phone call or a gift or even a visit.   Even in this hamlet with many parentless children, George and his sister, Rosette, are unique in their lonliness.

George’s mother died of breast cancer.   By the time she sought medical attention it was swollen and abseced.  It was beyond hope.  In my village, we try to find a cure for breast cancer.  They say cancer is cells gone wild.  I think of a gang of teenagers and someone saying that they have gone wild.   A bunch of adolescent cells dividing and growing and taking over the town with no sense of how to behave; no sense of order.  You want to say, “If you keep this up, something really bad is going to happen.  You are bad cells gone wild.”    They use to say some children were just “bad seed.”  It was just a bad crop and noting much could be done about it.  The next year, the next child will be better.   There was a mold n the seed or not enough rain or to much rain.  It was just bad seed gone wild.  

George’s family had little, if any, knowledge of cells, let alone cells gone wild.  No one explained the disease.  They keep saying it was a breast infection and I think how could George’s mother have died of a breast infection but it was cancer which, at the end, looked like an infection to those who cared for her.  They sent her, on the crowded ferry, to Port-Au-Prince but it was too late.   They are grinding corn in a large wooden pestle and mortar as they try to explain why George has no mother. They keep pointing to their own breasts and showing me how large it grew.  

George’s  sister eats a bowl of rice all alone.  She tries to join a game but she cannot. She is frozen.   I begin to notice that love is defined by how tight your braids are, how many there are and if they are tied off with ribbons or brightly colored barrets.  It is defined by someone sitting  down and taking the time to yank on your head and pull the hair tight and braid a hundred small braids that are shiny and black with red and yellow and white ribbons.     Rosette and the other children, living without mothers do not have braids.  

They say, in Haiti, 1 in 44 mothers have a chance of dying in childbirth.  Most of the babies will not survive if their mother dies.   There will be no milk and no one can afford formula.  But George’s mother survived childbirth and nursed him and his sister.  She got them that far.    In a country where so many children never reach their first birthday, this seems like an accomplishment worth noting.  

It is dusty and they are most often covered, like me, in a fine layer of red dust.    It collects in our hair and on our clothes.   Sometimes I look at George and the other children and we are all bathed in the earth.   We try to wash it off but it is not easy.   The water must be collected and poured over you.   Once I gave George a bar of soap and he took his clothes off in one second  and washed.   I had not meant the soap to be an order to bathe but only a small gift.   I think of his mother handing him soap and telling him to bathe.   Dis he see the soap as an order or was he just so exited to use it.   Did he have, even for a moment, a mother who cared if he was clean?

In my village, in the United States, mothers die too.  I have watched beautiful, young, talented.. loving, funny, smart mothers die.   Mothers who ate well, took good care of themselves and devoted a large part of their lives to being a parent.  I knew women who mothered everything they saw and shared their mothering arms with every child they saw, die too soon.   I am ashamed to find myself thinking their deaths are worst; not just because I knew them but because mothers in my country are not suppose to die and deep inside, death in Haiti is not such a surprise.   I can blame poverty, colonialism and the rich elite for George’s mother’s death but here I am forced to accept a mystery.  I am fighting it.  There is no one to really blame and why do I want to blame anyone at all.   It was so sudden, so unexpected, such a rare disease, an accident.  

Their children have the same look in their eyes as George.  I can see it when I run into them.    I sit in the sun watching the sea.   I watch the waves come and go; the shorelines shift and change.   I want to scream, “ I know, I know” but I do not know.   I only see the faces of the children whose mothers died before they were grown..   George’s mothers death was preventable and with early screening, curable.    Maybe other deaths were preventable and curable but how can we prevent everything.   An inner voice tells me I am not being reasonable.  I argue. I am not trying to defy death or believe everything can be prevented.   I am only asking for a moratorium on mother’s dying; on children growing up without mothers.

 I can tell it is too much to ask.    I am brought to my knees by the latest death of a loving mother.    I feel her warmth and radiance around me.   I watch soap bubbles blown into the air; small rainbows that drift until they land and return to the earth.     I want to see her again.  I want the baby to cling to her legs as she talks to me in the hall of the school.   I want to listen, once again, to her hopes and dreams.  

She climbs up on the cliff where I am sitting and George’s mother finds her way there too.    “You two have met?”  I ask.  This seems impossible.  They did not know each other.  They lived in vastly differently countries.    I think they are trying to explain the work they are doing and how there are many ways to mother.   I can see that there are many things I do not understand. I tell them to go away and just let me put my head in my hands and be sad.    Let me paint my body with clay and mud and make a fire and sing all night until I am worn down by grief.    I am not interested in understanding.

I see George and his sister and all the children who lost their mothers.    I want to shake the world and free them from this loss.  I want them to  wake up and discover it was a dream and not true at all.    Are we united by our losses as much as by what we gain?

By morning, the tides have changed and the seas have covered yesterday’s footprints.   On the mountains above me stand the nations who sing their own death songs; their own songs for mothers, for the first words spoken and lost to children taken away and sent to boarding schools.   I know death takes many forms for mothers.

Sometimes I ask my own  motherless children from Cambodia and Vietnam to try to remember their mothers; to think back on any small memory.    I remember a relative saying, “She didn’t try hard enough to live.  She gave up.  “    Another says, “She gave the food to the children. “      I want to keep their mothers alive, for them, but I cannot.  

I think of the last Star Wars movie with Obie One and Datthe Vder and Yoda altogether in the sky, offering love and encouragement to all the world below.  And then I see the mothers; the ones who passed away before their children were grown.   I know they are counting on us to raise their children.  I can see the world they are hoping for. I feel their prayers drifting over all of us all like the cherry blossoms on a windy day.

Later we walk to see an ancient  tree.  I try to explain how the mother tree fell down and began to die but also to make a bed for new, baby trees.  We call it a nurse log because it gives its last bit of life for the next generation.    Although the tree has fallen, it continues to nurture and inspire its young for many, many more years.    And in time they too will lie down and make a bed for the young to grow in as it has been done for all of time.  

I would like to say that I found peace there by the ancient tree but peace comes and goes.  I dive into acceptance and come back out in depression, despair and denial.    They say that the mother who has died had a rare disease that had no cure.  I can see that I have not accepted that as possible.   I take my sad heart out of my dreams and try to work on a plan for mobile, prenatal clinics in rural Haiti.   I think of  the sunrise in Haiti and Vietnam and rural Cambodia.  I look out on my world. I try to understand how I can live within the mystery of death while working hard to prevent the needless deaths of mothers in Haiti.     In these raw early morning struggles I am left only with a faith in a goodness beyond understanding, beyond borders, beyond history, beyond death.    I close my eyes and feel the loving presence of the mothers who died when their children were young and know that I cannot see the world as they do or fully understand.    I only can go out into the world with love for each child; with a vision of the world that honors their life and their children.