Monday, May 26, 2008

Not So Sure About This: Part One

Our quiet village, Boamadumase, was flooded with Methodists this last weekend. Religious men and women (with children) from many major local cities crowded themselves into tro-tros and ventured to visit us- the bush folk.

I had some idea it was going to be an active weekend, mostly because big groups of sweaty men were assembling over twenty tents at the local park, and I heard mutterings of "a camp meeting." I had heard a great deal about camp meetings; weekend long events held in various places. People pilgrimaging to pour out their hearts and souls 24 hours a day. Now I was noticing faces I had never seen before were meeting inside houses and classrooms to pray and sing with a mighty force.

When Simone and I went to buy our beans one morning, a woman dressed in white from head to toe walked over to us with a glowing smile. "Good Morning ..." she said, tilting her head with a twinkle in her eye. She wasn't a villager, but I recognized her. "Do you remember me?" she asked.

"I do."

"From where?" She pressed her palms together in namaste.

"From the prayer meeting, 2 days ago." I said.

Riding our bikes through town that day, both Simone and I were wooed into following the beautiful singing we heard coming from down the hill. We coasted through a soccer game some small boy's were playing, and parked our bikes at the local school. The voices were passionate and loud. We jumped off and walked the perimeter of the building. "They're worshipping God." I said.

Simone couldn't believe it, and replied "I've never heard anything like this, it's incredible. Their voices are amazing. Do you think we can go in?" One can never be close enough when drawn by a mix of authenticity and beauty, and, in less than 2 minutes a man popped his head out and invited us in. We spent the next hour pacing the dark cool room, clapping and singing and praying and observing.

"Yes, that is correct." The woman said. "And do you know what we are doing now?"

She was with a group of about fifteen others, all dressed in white as well.

"No. I don't."

She shifted her neck in, so that our faces were all uncomfortably close. "We are fisssshhhinnng." And when she said this The Smile returned to her face.

I looked at Simone, but before we had time to process the woman clarified for us. "Human fishing, for Our Lord and Savior Jesus Christ."

I looked up and down the road and saw that the visitors had metastasized, into smaller formations, and they were clinging to all parts of village life. Some were nodding and talking to the lady who sells bread, others were sharing with the taxi drivers, a few were wandering looking for a catch.

"Ahhhhhhhh." We replied.



"Will you be coming to the prayer and worship meeting tonight, at the park? I hope to see you there! There will be plenty people and we will go alllllll night!"

Simone and I shot each other glances, and she said, "Sure, yeah yeah, we probably will go, I think-" and then I took over "Ya, maybe later, we'll see you?"

"Okay wonderful. Then tonight, we shall meet."

On the walk home I had a mental debate in my head and tried to examine closely why this form of evangelism always makes me feel conflicted. I wondered if we'd actually go later that evening.

But when the sun set, and darkness settled in, both Simone and I had grown restless. Half of my best friends in the village are Methodists (already) and I knew they were at the gathering. It was my last night in the village before I would go traveling and head back to the U.S., so I figured it could double as a great venue to say goodbye. We decided to go. "And you should wear your African outfit, they'll all love it." Simone reminded me.

The health volunteers had adorned me with a gift of a blouse, skirt, and shoes. They had picked out the colorful traditional Kente fabric and secretly had it sewn into an outfit which actually fit me perfectly. On the day of the CPR teaching, we all said goodbye and they gave me the present. I particularly liked the top, how the stiff shoulders blossomed up and out, in a design that would only make a lover of 80's fashion jealous.

"Okay, but the skirt is kind of funny here at the ankles, it makes me walk like a duck. So we'll have to go slow."

When I tried it on, it looked nice, it was just hard to walk in. I went back to Ma the Midwife's house to show her. I know how excited she gets when I wear the local garb. "Ei! Kaisy! You are looking beautiful! The African dress, it suits you! Ei Kaisy... you will have to marry a Ghanaian." She couldn't stop smiling or taking her eyes off me.

"Ma really likes you eh?" Simone said on our slow walk to the "camp meeting". We could hear people warming up on the microphones, a loud screeching from the speakers permeated the air every few seconds or so.

"Yeah, makes me laugh considering where we started from." The first time I met Ma she made it clear she wasn't interested in teaching anyone, and she had a general distaste of my even being around. I think she said, "But why did you come here if you are not even a nurse? And you know nothing of birth?"

I couldn't believe tonite was my last night in the village. I said a prayer, perhaps a little greedy but I wanted all the experience I could get.

Please send me three births tonight!

For some reason, Simone and I decided to purposely leave our flashlight at home. I thought it would make us less recognizable, maybe we could even blend in, especially in my skirt and top, but when we walked up to the gathering I think it was our skin that gave us away. Everyone took note that the oburoni's had arrived. Hundreds and hundreds of plastic chairs had been placed in rows underneath a ring of tents. People filled the chairs, old people, young people, people intent on a purposeful time, and all dressed in white. They looked like a blanket of snow covering the park. We found our place next to my friend and roommate from last year, Sakola.

Everybody stood up and began to sing, great loud voices, this time contained by no walls. Sakola told me my dress looked nice, very nice, kama kama. I said thank you. The crowd broke out dancing, frenzied wild dancing, dancing for Jesus.

Somebody poked me on my shoulder and I turned around to see one of my friends, the drummer of a local church. "Kasim" he said. He's been calling me this for a year and I haven't the heart to pronounce my name correctly, because it's gone past that point. (When is that point any way?)

"Hello!" I said, stretching to turn sideways.

"How are you? And your friend? How is she?"

I looked at Simone so she could answer, and stop being referred to in the third person.

He pulled up a chair and sat next to us. "Do you like to sing?"

"Yeah. I do." I like to sing alone, when no one is listening, or really loudly when everyone else is doing the same.

"Great. And your friend, does she like to sing?"

"Simone? Yes, Simone loves to sing. She has a beautiful voice too."

"Then, will you sing?"

"Sure." I thought he meant at that moment, amidst the crowd.

"Oh great. Then, what song will you sing?"

When I realized he wasn't talking about 'singing along' but going up in front of this crowd of over 400 people and singing on the microphone I started laughing. "Oh you mean, go up there and sing?"

He threw his head back and laughed. "Ohhhh Kasim! Oh ha haa ha. Are you feeling shy?"

I looked at Simone. "We should." She said.

"Yes." He agreed.

My stomach sank when I pictured weak little self standing in front of all these people to perform.

"Anyone who wants to worship God can go up."

The fact that he made me realize it wasn't about ME wasn't helping much.

I looked at Sakola, who happens to be the most zealous singer in the village, with one of the most impressive voices. I asked him "Are you going to sing?"

He looked down into his lap, tried to contain a laugh, and didn't say a thing.

"Are you?" I asked again. "Sakola, answer me. Are you?"

He said in Twi that he hadn't written his name on the list so he wouldn't be able to. It was a lie. He didn't want to stand up in front of half a thousand people is what it really was, and frankly neither did I. But for some reason, looking at Simone, I couldn't refuse. Her eyes turned puppy dog and she looked genuinely excited.

"Okay, sure. I"ll sing."

Later that evening, Simone mentioned "I was surprised how quickly they got us up to the mics." We didn't wait more than two minutes before we were ushered, me taking delicate baby steps, across the lawn.

My drummer friend's final parting words as he pushed me out to the stage were "be sure to sing gospel!" The next thing we knew, Simone and I both had microphones pressed up to our chins and an eager band backing us. We chose a song we had only sung together twice, on a long car ride the day before. It is a gospel song I learned in Kenya, simple really, but somehow in a bout of nervousness it suddenly seemed incredibly complex.

"Ready?" She whispered, her chest puffed out like she was holding her breath too.

"Ya."

The speakers projected our voices so loudly that the first word we sang startled us into a fit of laughter. Everyone else laughed too. We pulled our hands down to our sides so our voices wouldn't get picked up. "Simone..." "Yeah?" "Uh..." "Ready? Let's start again?" "Okay. Uh..." "Ready?" "Yeah I guess so."

"One two three"

Once we began for the second time, and as long as I couldn't hear my voice, everything was fine. I had to sing barefoot, going barefoot always makes me feel better. A few times we sang different words, or my voice crackled and fell out of tune, or shook from being nervous, but after a while it wasn't so bad. We repeated our verses, I even threw my arms up in the air a few times for dramatic affect, imaging that with this simple gesture the mass of people would sing along.

They didn't.

I was starting to remotely enjoy myself, so much so, that I might have fallen to one knee and brought a fist to my chest if my skirt would have allowed me the freedom. When we finished, and I glanced over at Simone, she had an air of thrill circling her and I knew she wanted more.

My drummer friend walked up and gently took her mic. "Now" he said "we'll sing in Twi." And he picked a song he was certain I knew, because he watched my lips sing it in church last year.

Here we go. I thought, cringing but accepting my fate. This was my pay back for watching the Ghanaian American Idol with Efreeyeh and laughing at the parts where English lyrics were sang in muddled made up words. I knew that I could sing this song, but the words? I only knew half of them, the rest were just sounds.

But now I was being blasted from a microphone for the entire village and then some to hear. But thankfully, my mind created a quick solution to the problem and every time I was forced to sing a word I didn't know I pulled the microphone away from my face and threw my head back towards the sky like I was Celine Dion. I think I fooled most of them, maybe even my friends, because when we were finished and Simone and I walked back to our seats, people walked by us and said in Twi "you have done well."

"That was really fun." Simone said, cracking up and looking around. I had to relax and breathe for a few minutes, feeling a little out-of-bodyish. But the feeling only increased when my old pastor walked up to me and said "You must go quickly, I have just sent a church member to the clinic to deliver. Go fast."

Saturday, May 24, 2008

Forgot to Mention

We had 20 of the 26 health volunteers gathered together in the early morning. They were semi-punctual, something to appreciate in a culture that doesn't count minutes, let alone hours. The days lesson was the Heimlich maneuver. We explained that when a person is choking there is a very efficient method to dislodge the object in their throat, then, step by step, with pictures, simple sentences, and Simone pumping her fist into my stomach, we taught. After I finished my mock choke, and she saved my life, I was gently guided down to the ground and rolled over into recovery position.

Everyone clapped.

"Now" Simone said to the translator, "it is their turn to try."

A few men stood up and walked into the center of the circle. One very tall lanky man, Moses, a health volunteer who has bought my heart with weekly batches of sweet papaya, paired up with the littlest guy I have seen in Ghana. The little guy went behind Moses and reached his arms up and around his frame. His hands barely met. I tried to be serious but the group wasn't helping, pointing and laughing and slapping their knees.

Three sets of people were standing up, about to bravely attempt the Heimlich for the first time. They were timid to begin so we prompted them a bit. "You can start."

The men standing erupted into a slow motion, melodramatic, reenactment of a picnic time fiasco. Watching Moses I almost felt I was the chicken bone in his throat. The other two were just as good, heaving and flopping themselves forward, making us all uncertain of what would be their fate in the near future. The uncomfortable hacking sounds of choking, the desperate grabbing and clawing at throats, I began to wonder if some of the health volunteers, had been given a different opportunity, could have excelled in theatre, or movies.

I turned to Simone, and immediately we laughed. "Are they going to stop?"

She shrugged.

"Okay," I said to David, the translator, "tell them to practice what they learned now."

The choking scene gave way into the upchuck scene, which progressed into the object flying out the mouth and the each person, relieved, passing out into the supporters arms. Eventually, all of them ended up resting on their sides, with eyes closed peacefully.

When the session was over, and everyone felt they were competent life savers, we had a brief discussion where the curious (and confused) asked more and more questions. Why can't we stick our fingers down the throat and pull the object out? We heard self-induced vomiting is just as good as the Heimlich, is this true? What do you do if you are choking alone?

The questions are only the first course in a feast of spawned conversation and realizations of cultural differences. When Simone and I shared that generally Westerners don't eat fish bones and wouldn't be able to successfully crack a chicken bone, let alone chew and digest it, they laughed.

"As for we Africans" one of the feistier ones began "we like the bones too much! We crrrrrrack them, mmm, mmm mmm, and eat alllllllll. Delicious!"

"Yes, our teeth are strrrronnng!" He smiled and tapped on his side ones to prove. Ironically, this man was missing his front tooth.

The women watched and shook their heads, laughing at the men's enthusiasm over bones.

"Calcium." Someone said, and they all clicked their tongues in agreement. Then he asked, "If you people don't eat the bones, where do you get your calcium?" We made it simple and said "milk".

The very last comment, muttered by one of the shyer volunteers and translated by David, was this. "Usually when we are choking, we just cough for a short time and then we are fine. That is how we do it here. I don't think we people will want to be using this every time we feel to choke."

I could tell it was an honest expression, that he was conflicted in even speaking up, but that he just needed to share Somehow, in the entirety of our teaching, Simone and I had forgotten to mention this was for EMERGENCIES only, in life and death situations. The group was thinking we were advocating jumping up and running over to a person, gripping them from behind, and thrusting your fist into them every time they didn't swallow well.

When it was properly relayed this was a life saving technique a wave of understanding moved through the crowd.

Yesterday's lesson was on CPR, and it began like this.

"In case of an emergency..."

Wednesday, May 21, 2008

Better than beans

I heard a taxi pull up in front of the clinic. It was 5 in the morning and the driver laid on his horn a few times before coming to a complete stop. I jumped up to peer out the shutters, half asleep, but hoping it was a case for maternity. The last few dramatic drop offs were mostly for the health clinic, some boy who had a skirmish with his best friend and got slingshotted in the head with a rock, a sick grandmother who couldn't walk, and a teenage child with cerebral malaria whose neck was convulsing sideways. I wasn't in the mood for any of that, I wanted a birth. No better way to start your day.

I kept my eyes focused in on the back seat, where one woman was scooching across and pulling herself out and the other was gathering together a bag of items.

Simone, somewhere between dream state and semi-consciousness asked "is it one?" and then buried her head in the pillow.

I could confidently answer 'yes' after i saw how the woman's sarong jutted out in front and hung down over her globe-like midsection. i went out to greet and invite them in.

"You can go back there." i said in English, too early to think in Twi. She stared at me, perplexed. I tried again. "Ko, ho."

She walked back to the labor ward just as i heard someone else come in. It was Efreeyeh. "Have you already checked her?" She asked.

"No, she just came."

"Then check her Akua."

"Okay, I'll go then-"

"I will go." She said, finishing my sentence. It was our method of learning. We would check how far a woman has dilated, keep it a secret until we both had our conclusions, then tell each other what we found at the same time. This is a tricky part of midwifery for me, considering how different every woman's interior is and not having a lot of instruction while I'm doing it, I literally have to feel my way through this.

We both had our idea and were looking at one another's eyes. "Go." i said.

"6" she said.
"9" i said.

"EI! Akua! 9! You say 9? It isn't 9. She is only 6. Maybe 6 to 7."

I was the first to admit if there was fault it was probably mine. "Okay, 6, sounds good." I made a mental note that 6 cm should feel similar to that.

"No but you say 9."

"Yeah but I don't really know. You've been doing this full time for 2 years. I trust you."

Ma the midwife came in shortly. I asked her to check and she said "AH! Why? But you and Efreeyeh are perfect!" I told her that I thought there was meconium (a child's first stool, and generally not a great sign) and I needed her opinion. "But can't you tell?" She queried.

"Yes, but I want you to check too."

"Hand me some gloves."

I gave her the only ones available, small tight bright purple gloves. She is a large woman with hands as plump as fresh baked muffins.

"Kaisy! Ah! How am I supposed to see what is going on when you give me the purple color? And what size are these? AH! Can I see meconium if I wear these?! Ah! Where is Efreeyeh? Go find me some white color."

I ran over to the injection room on the other side of the clinic and brought back white gloves. She put them on and confidently thrust her fingers into the mother. "6", she said pulling them out and ridding herself of the gloves. She plopped down in the chair. There was no mention of the meconium, so I asked. She seemed a little annoyed this morning. I tried to tread lightly with my inquisitiveness.

"There is meconium, so we will monitor the baby every 30 minutes with the fetalscope to assure it isn't distressed. If it is distressed I will refer her to the hospital."

A few hours passed and before long it was 10 o'clock. Still not a lot had changed. The mother's contractions weren't strong, not a lot of progression was being made, and I was getting hungry. But I didn't want to miss a thing so I asked Simone if she would sacrifice missing the birth to go and buy us food from town.

Suddenly some heavy groans were heard and both Simone and I decided to abandon the food.

Ma bellowed out at us "Won't you take your breakfast! Go buy food! Don't wait here it will be some time before this woman delivers. Won't you go and buy your food? If not, all the food will finish."

It didn't seem like it was going to be that long, and looking at my friend we both couldn't help but laugh. The food in the village is limited, and the best breakfast they have, beans, sells out by 10:30. If you don't make it in time for that, you are lucky if you get anything. Lunch is not any more exciting, with plain white rice being the only food available.

What to do?

"Beans" Simone said, raising her left hand up like one half of a scale "or birth." She brought her other hand up, and balanced out the two. "Beans or birth, beans or birth?"

"Beans." I said.

"Yes, beans." Ma said. "And buy me coco (sour porridge) while you are out. Tell them no sugar in my coco."

I wrote on a piece of paper how to say "I want coco with no sugar" and drew out a little map of where to find the coco lady. We laughed considering the 'downtown' can be traversed in 15 seconds, yet the lady selling coco had remained a mystery. She was the one dipping a plastic cup into a huge metal bowl, pouring the contents into little plastic bags, and sometimes i mentioned, she sold peanuts.

Simone returned having successfully completed her first solo mission: operation buy us breakfast and get back before baby arrives.

We had time to eat, wash our hands, and get back in the ward only to find the woman had vomited quite a bit and was being set up to receive fluids intravenously. Ma was close to referring her when we heard the magic words escape her panting, dry mouth. Translated into English they are- "I have to go poop." Every time I hear a woman say these words, and 95% of laboring mothers say this, it is a good sign the head at the end of the tunnel is soon to come. Pressure of her child's cranium creates a sensation that is similar to the feeling of having to use the restroom. It is a delightful phrase, as sweet to the ears as honey is to the tongue.

Ma sat down while Efreeyeh and I stood on both sides of the mother's legs. This was her 5th child, but she was pushing as if it was her first. She was extremely skinny, and exhausted. "Continue to move your fingers like this" Ma said, watching me from her chair. Efreeyeh chanted "Chim chim!" and one of the nurse's assistants came in to support the woman from the back, hoisting her up into a semi-reclined position. Simone was standing to the side of Efreeyeh with her neck poking out and her jaw slacked, staring at the head wedged deep in the birth canal. She looked stunned. Later she admitted that she almost passed out and had to bend over and breathe. "I just kept thinking, how is that thing gonna come out of there! How?!" Last month at work she tried to revive a woman who was on the edge of death. But, she is unaccustomed to birth, and it was a lot to process, considering she hadn't only seen one and it was during nursing school years and years ago. "But I don't remember having that feeling, like, how is it going to come out of there? At first the head looked really small, and i thought, oh that's a small head, but when it all came out, i thought, oh my God that is huge. She just pushed that thing out."

I was thinking the same thing at a certain point. Ma let me do this delivery, but all the pushing and all my guiding and pulling and stretching weren't doing much. Or at least that's how it felt at a certain point. "Ma" i said after a lot of hard work "I need your help." She stood up and walked over, she grabbed a hold of the child and pulled really hard, the lady winced and arched up and said something in the ancient language of childbirth, and the child, along with a lot of thick goopy meconium, was out.

I am always fascinated by meconium, it's texture, it's darkness, it's ability to stick together in a shape like a baby slug. "Look" i wanted Simone to see it. She nodded, but I think she was processing what had just happened and could care less about a newborn's feces. She watched Efreeyeh scrub down the child's thick head of hair, I stepped to the side when the mother said she was having sharp pains, and observed the delivery of the placenta. After it came, Ma and the others broke into a sponatneous song of thanksgiving. They sang to God, thanking Him for watching over everything, and then Ma somehow segued it into gratitude for food as well.

Generally after a delivery, when I go to take the bundled baby to it's mother, who is still recuperating on the flat black padded exam table she just pushed it out on, the mother gives a faint smile lays back down. Efreeyeh scurries around her, wiping the blood off her legs and buttocks. I always expected more, like a yelp of jubilation, or her to sit upright and demand the infant. But I soon became used to this, realizing the work of labor has drained them of any outward expression towards the deep love they must feel for this new being. But it was different with this woman, as I should assume, it will be different with every person and their baby. This mother broke into a huge smile, but more, her face changed completely. She went from a fatigued skinny woman in pain, crying out "why? why God why?" to a confidant radiant life giving mother connecting with her daughter. The transformation was palpable. Even though her little girls eyes were closed they were communicating on the deepest level.

Later Simone noted "I almost, well I did, cry a little bit when- did you see that- when the mom looked at her baby? Wasn't that the most beautiful thing you've ever seen?" She sighed and held her hand to her chest.

Friday, May 16, 2008

Going Solo

"I am not feeling good at all. What has happened..." she shook her head and shut her eyes "Nye Koraa."

I was on the other side of the desk, sitting dejectedly, feeling guilty about a situation I didn't have much control over.

Ma, the 75 year old midwife, continued. "It should not have happened like that. You see?! Ah! They should have called me! Ah! Akua, why did they not call me?! Leaving you alone to deliver the baby! If something would have happened, do you see, it would have been no good at all. Hmpf."

The case had come in at 11 p.m., the first night my friend Simone, from the US, was in the village. We were in our room, in the maternity ward, admiring the new short haircut I had given her earlier that day. Our car had broke down on the side of the road on the way home from the airport. We made use of our 3 hour wait and sat in somebody's corn field, chopping off her waist length locks with midget sized scissors. By the time we were finished our sweaty bodies were plastered in flecks of hair. We looked like true mammals.

"I like the way it's layered back here" Simone said, pointing at the digital photo I had taken of the cut. "It feels sooo good! And short! I wish there were mirrors in Boamadumase!" We laughed at how vain we felt, snapping at least 10 pictures from different angles.

A few minutes later Efreeyeh came in with a laboring mother and we abandoned our chitchat to go see what was happening.

"First stage Akua, 1 cm. I'm going home. It will take too much time." She said, snapping off an exam glove and throwing it down into a little plastic bucket. She was in her pajamas.

"Is this her first?" I asked.

"Yes, she's a primip. As for this one, she will deliver in the morning time. I need to get some rest but I will be back in a few hours to check."

"Okay." I said, believing that to be true.

The next day I tried explaining to Ma. "She was a primip at 1. We thought it would take a long time."

"But if you would have called me I would have washed up and come. Kaisy, as for birth, you can never tell! You cannot say 'this woman will deliver then' or 'that woman will deliver at that time'. You see? Ah. It's too bad. You cannot guess these things. Birth is unpredictable! I learned this very early in my training, which is why I never leave the mother's side. Where is Efreeyeh?"

I knew she was going to yell at her, admonish her, make her feel small. The matriarch was going to reign, call upon her servants and bark at them for their foolish ways.

"She's behind the clinic, at her house i think. I'll go get her."

When i found Efreeyeh I told her to watch out. Ma was angry, fuming, like an over boiled kettle. She said not to worry, if we could only work our stories out the heavy burden of blame could lighten, with a white lie here and a white lie there.

"But ah! You should be happy Akua, you are a midwife now, and a roadside barber." She slapped my arm and walked in to face her destiny.

But I'm not a midwife, yet, and, i wasn't happy. It wasn't until 3 days later that I could see the situation as a gift.

The night of the delivery, I woke from my sleep with the same feeling I had experienced with the woman who birthed on the side of the road. Something felt imminent, the air was still but heavy. It had only been two hours since she arrived, and if we were lucky she would be at 3-4 cm, only a third of the way to pushing. I jumped up and sleepy eyed, walked into the labor ward. The mother was panicking, walking in circles with a distraught scared look on her face. I asked her to lie on the exam table and in broken Twi explained I would be checking to see her progress.

My fingers immediately ran up against an object, something fleshy feeling, semi-hard, like a huge overripe grape.

"Its her bag of waters." i thought, confused. i paused, and tried again.

it doesn't feel like a bag of waters.

Simone came in, with inquiries. A flash of feeling, a frantic electrical current, zipped from my head to my toes. "Can you please go and get Efreeyeh. She's going to deliver soon. Go fast!"

First night in the village and just like Radhika, she was already head deep in the maternity life.

"I don't have any shoes! And, where does Efreeyeh live?"

"She's in the back house, all the way behind the clinic. Take these-" i said, slipping out of my flip flops, trying to clear my head. I ran over and started gathering everything i would soon need for the delivery.

Simone was gone when the woman started pushing. Everyone was gone. The woman was scared. I was scared. I tried to pretend that I wasn't and I told the woman to push with all her might, but really, I wasn't ready for the baby to come. The words came out of my mouth, but they were a lie. I wanted some back up, some support, some people to share this huge responsibility with.

What if something happens?

A slick line of black hair began to emerge. I couldn't think like that anymore. I had to work, to stretch, to support her perineum.

Again, i said, again. Push. Chim. Chim. Chim.

The room felt very lonely. Vacant, even.

Her mother arrived, ran in the room and chanted in her ear. "Chim, chim, chim!" But she was the most nervous of us all, and succumbed to her fight or flight instinct. Before we knew it, she was gone.

Somewhere in my consciousness I noticed my legs were shaking, a lot. They were visibly wobbling back and forth like I was a cartoon character, or a circus performer about to fall off the tightrope. But the shaking stopped at my waist, and from there up, my hands worked and my mouth spoke and my brain thought. But I didn't let it think too much. I wanted to let everything be.

She pushed again, with her legs flopping out, her feet slipping off the table. I usually hold their legs, i thought, feeling disconnected from my current position. But i focused back in. The strip of black gave way to a circle, and the circle gave way to something with more dimension. It was the head.

The head was completely out and still no one was around.

I prayed to God, out of instinct. I said please. Please. Please. It is all that would manage to come out, as I swiped my fingers around the baby's neck checking to see if the umbilical cord had wrapped itself.

It hadn't.

Thank you.

I grabbed a hold of both sides of the head, pulled lightly, then with more force. I moved my hands down, then up, then splatter pop squish squirt- the child was out.

As if in response to my need, an enormous scream escaped the child and he wiggled on the table before me. I began to clamp and cut just as Simone and Efreeyeh came skidding in to the room. Their presence gave the shake in my legs permission to travel, to make its way up my torso, into my hands, through my voice, although when I tried to talk nothing came out. I didn't know how to feel, or what I was feeling.

It wasn't relief at having someone there. It wasn't happiness at having just done this. It wasn't gratitude for a normal delivery. It wasn't anything, but weird and mixed up and uncomfortable. There was still work to be done, and I wanted to do none of it. I wanted to run, but I moved, with the baby around the room. Washing, weighing, wrapping. With the umbilical cord as I slowly tried to pull and deliver the placenta. "You do the rest." I said to Efreeyeh.

"Oh my God." Simone kept saying as she peered around at what was going on. "You just delivered that baby."

But i didn't feel confidant, or sure, or good. I had a glimpse into the reality of what a midwife is dealt. A midwife guides, she prays, she connects, she reaffirms, and what I now realize, she doubts. I didn't want to doubt, to think about the whatifs, that potentially life and death could rest upon my knowledge, in my accuracy, on the competency of my mind and my skills. "But remember" the head nurse Vic mentioned to me later in conversation, "a midwife prepares. She prepares to reduce the worrying. And with experience and education Kaisy, you are preparing. Little by little, you are preparing. You have done well."

I couldn't sleep that night.

Why do i want to do this? I tried to chase the thought away. Don't I love this?

3 days later, sitting around, the voice came in to my head.

It was a gift. It said.

I had been given the weight of responsibility that occurs with this vocation.

At once, seeming so light and free and beautiful, the word vocation, the idea of a calling, suddenly took on a different flavor, more weighty and serious. I was changing my engagement ring for a wedding band and I saw the full seriousness of the evolution of the relationship.

No going back now.

Midwife, the word hung bright and heavy in my mind. And it hasn't left.

A little love from the hut

Last week was the anniversary of Bob Marley's death. I was spending a weekend at a beach side cottage with Simone, trying to ease her in slowly to life in Ghana. I thought an ocean breeze might take the edge off the heat, a tease really since she was soon to experience the unforgiving rays of the village.

When I picked her up from the airport I let her know as we were driving through the madness of Accra past sundown- the sea of traffic and pollution and peddling vendors- that we were heading somewhere rather peaceful. "It's very mellow there." I said, thinking of this particular place, where our room was booked, where crimpy haired dreadlocked locals strolled the town, nodding and pounding their fists to their chests- saying "Bless" as you walked by.

"Cool." She said, watching skeptically as two cars almost collided in front of us. "These drivers are crazy, eh?"

In the Greater Accra Region of Ghana, (where we would be visiting) May is reserved as a month of reflection and silence. People take this time to listen and connect to their ancestors, and believe it is essential to ban all noise in order to show respect to the spirits of those who have gone before them. Silence is the best way, they believe, to receive messages and give proper thanks. Locals take this very seriously, it is an ancient custom. The Rasta folk are required to put away all instruments, namely their drums, for the 31 days, and reflect.

It was for this very reason I was surprised to hear, on May 10th, the blasting of a Reggae concert when we pulled up to our cottage. Djembe drums, bass, keyboard, guitars, a few wild men shouting into their mic's "Jah Love! Jah Bless! Hale Selasie! Free your miiiiiiiinnnnnnnd"

I asked the man who gave us our room keys about this.

"They are celebrating Bob Marley. It is the anniversary of his death, did you not know?"

I nodded with my eyebrows, pretended that of course I knew the day Bob died. Common knowledge.

"Will you go?" He asked, motioning down to where all the palm trees were swaying oceanside, in the dark, in the area of the party noises.

Simone gave me a smile so I said yes. We would go.

Before I knew it we were shoeless, sweaty, dancing with a crowd passionate about Regaee music, bouncing and bobbing to a stoned tempo. "Welcome to Ghana!" I yelled to Simone, who had already been swooped up by a dancing partner, so huge he dwarfed her in each movement. I decided to link up with the old toothless crazy man in dirty shorts. He didn't leave my side all night, and slipped me his name and number when I told him at 4 am that it was time for me to go. When I said bye I mentioned to him in Twi that I could be his granddaughter and he laughed so hard spit flew out of his mouth in all directions.

The next day we walked on the beach, met some new friends, asked them about this whole respecting your ancestors thing. How deep did it go if they were now pounding wildly on their drums?

"Oh my Queens" they called us "But you must bow down" they said slowly in their heavy Reagee tones, "it is crrruuuccciiaal. Pay RE-spect!"

We joked how Bob Marley trumped their ancestors, and for a second they could see the humor, but with their deep rooted belief that the singer was close to God status they returned to seriousness. "Oh sistah, for 2 days, we must never forget. Never. For 2 days, we gather, we do some meditation on the greatness of the late Bob Marley, our prophet. Burn da fire Always burn da fire. (Smoke pot) Our ancestors, they understand."

We were speaking to a guy by the name of Jah (God) Bless. When Simone and I got inside later that day she told me it was kind of sad, that his name was "job-less". She noted that he did seem a little aimless. "He said it meant God's blessing so I don't feel too bad." I fell over laughing, and joined me when she realized the miscommunication. It's now our fall back phrase in times of boredom, to instigate some humor.

Later he came to fix the neck of her broken guitar. She asked if this was something he wanted to do for free, or did she need to pay him for his services. "Oh my Queen, you can give a little bit, maybe something from your hut."

She came back to me and relayed the conversation. "From our hut? What hut?" We laughed.

"Did he say 'heart'?" I queried. Simone lipped the words the way Jah Bless would have said them.

"OHHH!!! Heart! Ahhaha! I thought he wanted a little something from our hut, like this.." she said picking up a random knicknack, laughing at the recent misunderstandings.

The weekend was a great one, and Simone being a musician herself, appreciated the lift of the silence ban and the acquisition of all these new "friends".

"Everyone is so outgoing."

"Just wait until we get to Boamadumase" I said, sure that the villagers would love her free spirit.

~~~

On a different note, I just want to mention how blessed I feel to have such wonderful family and friends. When I went to the computer today and read all my emails and saw and felt all the love and support you guys give to me I was extremely touched. Thank you for your kind words, your stories, your one-liner keeping in touch emails, your compliments, your updates, your invitations. You are a beautiful thread in my life and I thank you for that.

Wednesday, May 7, 2008

the journey continues, bike rides, babies and more fresh fruit!

The health outreaches continue to impress me, as we (me and the 26 other local health volunteers) ride our red messenger bikes into the remote villages surrounding the clinic, and give our talks on Family Planning. The journey to get there is always dynamic, across this flooded bridge- wind up the path of the cocoa grove- down a crumbling washed out road- through the head high grasses- jump the fallen tree- zoom through this random person's yard while they stop and stare, hey! a white girl!- watch out for those millions of poisonous ants-...!

When we arrive to our destination, we park our bikes and set up a circle of wooden benches under the shadiest tree around. These trees are usually well known and have folks under them already. If not, somebody will run and beat the gong gong drum to bring attention to our arrival. The communities we visit are minute, and usually only fill up about 3 benches or so. Each volunteer has their spiel, and does it with as much zest in front of 4 people or 40. You'd think they were auditioning for Broadway with how animated and passionately they talk of things like the Depo Provera Injection, Male Sterilization and the advantages of using a condom. (The prop of a freshly picked banana and our flip board of images always help with the lessons)

Question and answer sessions are always lively, except for the Muslim village we visited who when offered condoms kept their fists clenched tightly and shook their heads. I tried to look closely, to see if, although the general consensus was disapproving, I could recognize any of the women who come secretly in the middle of the night to receive their birth control. An interesting discussion followed, and I felt a bit imposing being there, even if I do believe in the power of our message. I sometimes wonder when we gather together and our turnout is less than 5, or in this case the people aren't receptive, what the point is. But i try to remember that we are only educating and offering services, and if one person can benefit then we have done quite a lot for them.

i was nervous to visit our next village, quite well known to be dwelling place of the only fetish priest around. people come from distances for his cures, his potions, and even for his curses (on other unsuspecting folks of course). From experience i remembered at an outreach last year he had a lot of criticisms of Western medicine, and i wanted to be warmly welcomed but prepared otherwise.

The turnout for his community was high and they even prepared beforehand by bringing out the plastic chairs and lace doilies for us! Sophie had remembered the fetish preist enjoys hard liqueur and gifted him a huge bottle of (gin?) from London. She pulled it out of her backpack and everyone began to cheer. In turn, he gave us two bottles of "his stuff" and an open forum to talk. a powerful storm interrupted our meeting and everyone ended up crowded together in a small shed for a little over an hour clapping and singing while i bumped butts dancing with a feisty elderly woman with a hoarse voice.

Most communities agree, that yes, The Pill is a wonderful option to prevent conception AND to get beautiful. "Ladies" they say "if you want to become fat we advise you take The Pill, it will make you feel to eat tooooooo much!" Then they all laugh.

But what seems to be a big hit with the women is the IUD. Trained by Dr. Radhika, Efreeyeh (the midwife's assistant and my best girlfriend in the village) is now competent and waiting at the health center to fit the IUD. I was thrilled to finally get to see my first cervix, and had no idea it would look similar to a strawberry donut! (oh the things which excite us!) and the ladies like this method mostly because it is effective for up to 12 years. A lot of them who have already had 4, 5, + babies are walking out with relief on their faces.

Sophie and Radhika have gone back to the UK, and this Saturday my friend Simone, a nurse, will be arriving to travel around and finish up the last leg of the project with me.

Sophie donated a laptop, and everyone is curious how to use it. I've officially opened up classes for 2 weeks at "Kacie's School of Computer Training". So far, a handful of people know how to turn on the computer, turn off the computer, and move a mouse around. Things are lookin' good! I jumped the gun a bit and secretly brought one of the more educated guys to the Internet lab. He seemed to be taking it all in pretty well, nodding his head a lot and rubbing his eyes, but how do you explain, when somebody is still trying to figure out how to double click, that there is a virtual reality at your fingertips. I tried not to blow his mind too much.

In the ward deliveries have continued to come, and Ma (the 75 yr. old head midwife) feels 100 percent confident in allowing just Efreeyeh and I to be at the births. In fact, she seems to have slipped into the shadows here and on her way into retirement. This has increased my hands on learning and I have been able to deliver a few more children. "Akua, put your hands in the baby's ears here, and pull gently..."
I never cease to be amazed at how quickly the moms here birth their children, and how (what appears to be) effortlessly. I am grateful for my training to be happening in a place where the normalcy of birth is innate, the drama has been reserved for the occasions it actually occurs (which is rare), and the mothers are open to including me in their most intimate moments.

Occasionally I'll walk through the village and see a face that seems to be etched into my soul. Usually the women then reach around and pull their child from off their back and hold them up to me with a smile. I know these are the mothers i spent intense hours with and saw deliver last year. One woman in particular, who was referred last minute due to complications and had her baby in a nearby hospital, seems to be forever grateful for my emotional support at her birth and won't stop insisting that each time i try to buy rice from her (which is daily) i take it for free. "no please" i say, handing her the 20 cents "take it." She turns her head and waves me away.

With the little amount many people here do have, they are generous people.

and the land seems to be generous with them, as well. the baby orange trees i saw being planted last year have grown prolifically.
The tops of the mango trees are rustling, from the little boys who climb up high to retrieve it's gifts by shaking them down. and each day now someone comes to adorn me with more fresh fruit, "take the papaya" or "your sisters have left to the UK, oh! you must be lonely. have this pineapple." i usually end up sitting cross legged somewhere, with a new friend, fruit juice dripping down my chin and elbows, a penknife filled with pulpy remnants, engaged in simple conversation.

Thank you for your emails and updates, they make the journey to the Internet lab worthwhile and moments of missing home bearable. Take care!