Tears to ecstasy

This program is like falling in love and then out of love everyday. It seems like each time a woman arrives in labor and it is my turn to be her Midwife I open my arms wide, my heart jumping and I fall in love in moments wanting to share every little thing about her with the people around me, wanting them to see how amazing she is feeling blessed that I got one of the “special” ones. I marvel at how she walks, breaths and moves. And then I watch as she gives birth, as life emerges from her body, as she pours her physical strength into the task at hand. Seeing her face as she holds her baby for the first time, a look of dazed shock and then an over joy as she knowingly takes this small being into her arms and begins the processes of nurturing her child for life.

Other times the world seems to be crashing down on my head and I doubt myself and wonder if I can actually do this program, actually complete it. I feel as though I am drowning in it all, my essence slowly seeping from my body, my creativity dead and sleep becoming a fantasy. Some days my actions are robotic, the same questions asked over and over again. Get file, run through questions and vitals, put file away and move onto the next and then the next and then next.

Some days I step outside and look up and around me. Hear church bells in the background, laugh at the kittens outside or breath in the air and marvel how the sunlight reflects on objects around me and I remember.

Tears to ecstasy, tears to ecstasy.

My first catch

September, 23, 2008. 7:21am

Evolution

Change has occurred in the air. Tonight is cold and blustery, I am wrapped in scarves and sweaters against the cold and they feel oh so good. Today is a big day for my class as we begin catching. We have been shadowing the primary care giver the last few weeks learning the ropes of the clinic and getting comfortable with the flow of birth at MLL. Now we are the ones that will be shadowed by our interns and they will be assisting US. In another three weeks we will be flying solo. Many of my class mates are nervous but I’m mostly just excited. So far almost everything has come to me really naturally and feels really right on many different levels. Thats not to say this program stretches and test each and everyone of us to our own limits...

I now actually enjoy drawing blood and am comfortable giving breast exams. We are also able to do pap smears and physical exams. It seems that whenever I begin to find my footing in the clinic another skill is added on. It certainly keeps me on my toes and straining my eyes forward to whatever comes next.

This afternoon Juana , a woman who’s birth I was in the other day came in for her postpartum appointment. She was a walk in client so we had to do her initial which usually takes a few hours while she was in labor. At one point her and her husband asked what kind of pain medication we had. I will never forget the look of shock on her face when I told her we had none. She was 35 but it had been sometime since she had her two others kids who she had birthed in the hospital. I told her that it was very possible and that many women give birth here without pain medication but with lots of assistance and support. When she asked me if I myself had ever given birth I had to say no and felt rather silly about it. Seeing her positively glowing face of joy today was an amazing feeling and her reaction when she saw me was even more heart touching.....

Fall birth

I was in my second birth this morning. It was beautiful and surreal, dappled fall light coming in through the open door and church bells chiming in the background. My body helped support the mama's and when the baby came out I was christened with vernix. She scooped him up into her arms and studied him with wonderment and astonishment covering her face in vernix and laughing as she met her little boy.

Nacimiento

I drifted off to sleep after writing that last post, joking with the other girls that a woman would come in complete and pushing. As I am still in orientation in the clinic we are "shadowing" the interns and watching the roles that each of them play in the birth. I had shadowed Olympia as primary a few nights before and we spent the whole night with a young girl having her first baby. At around five in the morning she and her mom decided to go to the hospital, I suspect there was some strong persuasion going on from grandma as she had difficult obstetrical history. It had been a long night with a bit of a sad ending so I was hoping that perhaps on this shift Olympia and I could complete the circle in a sense.

We both thought it was a joke when we got woken up an hour or so later being told we had a complete and pushing mama! I took the role on as documenter recording each new progression of the labor. For example: head born @ 11:57 am. Baby born at 11:59am, September 25th and so on. In retrospect I was a little shaken by the power I had simply as a documenter, especially in this birth. I made the call that it was 11:59pm when I could have seen the clock as 12:00am which would have made her birthday September 26, a date that she will be used to identify for the rest of her life. Part of being a student at MLL requires that we write a birth report after each birth with our reflections on that birth. Here is mine.


First and thousandth birth....
Allisson’s birth was the first and the thousandth for me. It simply was, as I am, and seemed less of a mystery then I had anticipated. Birth. Beautiful and complete, yes I know this, yes this is familiar. More familiar then anything has ever has been. I am struggling to find the words to describe it. My emotions and thought process seem slow and glitchy. Attempting to find the end of my thoughts to be picked up and examined seems fruitless. It is complete, a full circle with no ending and no beginning to it. I don’t think anything else in life has ever felt so whole and so completely satisfying.

After Allisson was born I lay on the on the bed beside her while her mama was taken care of.
As I listened to to her breath, the thump of her heart and the gurgles of her tummy I was struck with how defined and perfect she was, this creation of woman’s womb. Her skin was so soft, vernix tucked into the roles of her neck, her eyes closed tight against the bright light and her tongue and mouth rooting. She represented to me the beginning and as I looked at her I also saw the end and I found bliss in both.

clinic

Another day almost done at the clinic....its 10pm and my second full shift here. Its been another crazy/wonderful/mad/super tiring day. I did my first breast exam, another initial (which takes a few hours of interviewing in Spanish) watched a pap, attempted to draw blood, and another gazillion things I can think of right now. My last shift here I was up all night following another student in a labor sit. They ended up going to the hospital so I still haven’t seen a birth but am getting the hand of listening to fetal heart tones and feelings bellies. Its so amazing how much can be learned in 24 hours....Off to try and get some sleep in case a laboring mama comes in, I’m up for the birth again...

some more pictures....

Juarez at night

The food bridge bride into Juarez

The view from my bedroom
window in the morning

Shocked at deaths, Guatemala trains midwives

The Associated Press Published: September 19, 2008

Guatemala is trying to reduce the number of women who die during childbirth by providing basic medical training to some 15,000 lay midwives in villages around the country.

More than 600 women die from complications of child birth each year in Guatemala, where midwives deliver six out of every 10 babies. These lay midwives are often the only help available to rural women, and most have no formal medical background.

President Alvaro Colom has announced a five-month program to provide them with training in the basics of gynecology and obstetrics, including how to identify complicated pregnancies and avoid preventable deaths.

"One of our biggest challenges is solving the problem of limited access to health services, and the shortage of qualified midwives in rural areas," Colom said.

For each high-risk pregnancy the midwives refer to a doctor, the government will pay them US$20.

"If we're able to get these women to see a doctor, high-risk cases could be identified and we could take steps to prevent them," said Jackeline Lavidali, who directs Guatemala's reproductive health program.

Guatemala plans to enlist non-governmental organizations already in the field to do the training, using financial support from the United Nations and the U.S. Agency for International Development.

But many obstacles remain — including roads and transportation that are so poor, it is nearly impossible for women to quickly reach a doctor even if their midwives have identified problems. That's why the government is trying to create maternity houses near bigger hospitals where rural women with high-risk pregnancies can arrive days before giving birth.

Francisca Raqueq, a 65-year-old midwife, has helped deliver babies for 50 families in the last 25 years in the village of El Llano, 40 miles (65 kilometers) northwest of Guatemala City.

She said the nearest clinic is 15 miles (25 kilometers) away and it would cost US$70 to rent a pickup truck to get there in an emergency during labor. That's a small fortune for farmers who make US$4 a day.

Sited from:
www.iht.com

Mole

We are now done orientation and will begin integrating into the clinic and working 24 hour shifts. Its been an intense three weeks and more information was crammed into my brain then I thought possible. We all went out for mole (a mexican sauce made out of chocolate and 17 different spices apparently). The restaurant we went to was supposed to be the best on this side of the border. I was certainly not disappointed with my first experience....

Becoming

I have come to accept the fact that the only way to make it through this program is to surrender. It is all consuming. At times it feels as though some great external gravitational force is pulling at every cell in my body. It takes a sense of organization, not just for the stacks of papers and hand outs but organization of the mind. This program is seasoning us as Midwives, we are Midwives. We are gaining our experience and our knowledge through assignments, creating folders, information and protocols that we will use in our own practice. We are defining ourselves and what mid [with] + wife (in the archaic sense [woman] ) means to each of us.

Transition

This morning we went to the hospital to familiarize ourselves with the facility so when a woman transports due to complications of labor we know where to go. After we went to the best place in town to get tamales and ate them from a view point above El Paso. On friday orientation ends and we begin working 24 hour shifts in the clinic. I am starting to see a weariness in the group and in myself. The learning has been intense and I’m starting to wonder just how much more information I can absorb. Each class is so important and even missing five minutes can set you back as the information is so vital. Things are going to be more emotionally intense when we start working in the clinic. I have been speaking little to no Spanish and feeling a need to start exercising that muscle in my brain so that I am able to work with the clients in appointments and help them labor. The only way I feel like I can really prep is reminding myself to breath breath breath for the moments that I know are going to come. These past weeks have been all consuming with my time off usually spent trying to make the apartment more homey or studying. I’ve gotten a lot of homework done which feels great. The information that I learn from doing it feels so important to know and I am so interested in it it rarely feelings a chore. All of it is to help me become a better Midwife and to expand my knowledge which I am hungry for. Right now the 18th months ahead of me seem like forever. I’m looking forward to settling into my life here a bit more. I love it here and want to feel like my life is balanced and complete which it doesn’t feel like right now but its getting there. Its a real blessing to have a home that feels as good as it does and to have such a great roommate.

An El Paso evening

Driving along the highway in the evenings is really amazing. The desert sunsets mixed with the city scape make a strange but beautiful site.....

Venipuncture class

Taking blood is something that I have always been a bit scared of. Something about pushing that needle into the skin has always made me a bit panicky. Whenever I've had blood taken for testing I've never been able to watch it happen and still wasn't able to in class. Pushing the needle in wasn't as bad as I was expecting. The tricky part was stabilizing the barrel and inserting the tube into the barrel to collect blood without letting the needle go in deeper and through the vein or accidentally pulling it out. By the end of class I successfully filled four containers in a series of two punctures. We also tested blood sugar levels and hemoglobin by quickly pricking each others fingers will small sterile dart like tools. It was an emotional day for all of us though some of us held it together better then others.

Labor support and postpartum fetal assessment classes at MLL

A lesson in Spanish....

A SPANISH Teacher was explaining to her class that, in Spanish, unlike English, nouns are designated as either masculine or feminine.

'House' for instance, is feminine: 'la casa.'
'Pencil,' however, is masculine: 'el lapiz.'
So, a student asked, 'What gender is 'computer'?'
Instead of giving the answer, the teacher split the class into two groups, male and female, and asked them to decide for themselves whether 'computer' should be a masculine or a feminine noun. Each group was asked to give four reasons for its recommendation.

The men's group decided that 'computer' should definitely be of the feminine gender ('la Computadora'), because:

1. No one but their creator understands their internal logic;
2. The native language they use to communicate with other computers is incomprehensible to everyone else;
3. Even the smallest mistakes are stored in long term memory for possible later retrieval; and
4. As soon as you make a commitment to one, you find yourself spending half your paycheck on accessories for it.

The women's group, however, concluded that computers should be Masculine ('el computador'), because:

1. In order to do anything with them, you have to turn them on.
2. They have a lot of data but still can't think for themselves.
3. They are supposed to help you solve problems, but half the time they ARE the problem; and
4. As soon as you commit to one, you realize that if you had waited a little longer, you could have gotten a better model.
The women won.

Placenta

Last night I had my first clinical shift (just 3 hours) and was able to examine a placenta. Holding something that I have been reading about and studying for such a long time not to mention something that creates life felt pretty emotional. My moment was interrupted by another student jumping in and I felt a bit shaken. Later at home when I told Jessica I started to cry over my "interrupted" moment and then started to laugh realizing I really must be an MLL Midwife if I get so excited over a placenta and tired and emotional enough that it evokes tears!

Settling in

Writing this from the glow of my computer and candles. Jessica and I are about to spend our second night in the apartment, my first night alone in my own bed and room! We had it set up that our beds would be delivered last night but only one came. This afternoon after school we cleaned the apartment like mad women and started to make the place feel like home. We still don’t have electricity so when it gets dark we spend our evenings strolling the isles of K-Mart eating Taco Time or devouring cereal and warm milk in bed.

Tomorrow is our fourth day of our three week orientation. So much has happened in the past three days I don’t even know where to begin or end. By 9pm my eyes are watering and I am so ready for bed. Tomorrow after a full day of classes I have my first clinical shifts. Its just three hours of following an “intern” (a student that has completed 6 months) and getting a feel of the clinic. I’m looking forward to it.

Classes have been amazing and beyond what I expected. Everybody is so kind and supportive and always checking in and assuring that they will be there every step of the way holding our hands until we are confidant. As the program is excellerated things move fast, really fast. In five and half weeks we will be catching babies. In two and a half we have a long list of things that we must be proficient at and be signed off by the licensed Midwife on duty who overseas the whole clinic.

I know in retrospect I will realize just how much I am absorbing and learning. Right now its all about getting up in the morning, spending all day in class and then rushing around trying to get all the little nitty gritty things taken care of. I’m so thankful that I have Jessica, my partner in crime to make jokes about the “El Pasonian” driving (ITS HORRIBLE) and talk through the moments of panic when we realize how many assignments we have. Were both so happy to be here but also hanging on by our finger nails, trying to stay on top of everything.

El Pasonians

The dust of our arrival has begun to settle and things are working out for Jessica and I. A few days ago I put money down for an apartment of my own, ignoring my instinct. The next day Jessica and I visited the apartment that she had arranged before she came and we decided that it would work for both of us. I lost a little bit of money but in the long run I will save a bunch as we won’t have to buy double of everything! The apartment is currently being fixed up and should be ready for us on Tuesday.









We’ve been stalking craigslist for decent cheap furniture which is not as easy to come by as other cities. We did find a couch we both fell in love with (hide a bed included so if anybody wants to visit we have a place for you now). The only problem was that we couldn’t move it across town. After a bit of brainstorming I suggested we call the manager of our building, Angel, and see if he knew of anybody with a truck and we were in luck!

Yesterday we went to our apartment and met up with Don, the owner of the building and his massive truck. He drove us out to the west side of El Paso where we got our couch. He then took us on a bit of a tour crossing the state line into New Mexico and then drove us along the border where Texas meets Mexico. It was really interesting to hear from him what life on the border is like. Right across the slow muddy river lay another world; shanty towns and poverty. El Paso is certainly not the most pretty place to look at but homes on this side are not made out of scrap metal. Our tour guide explained to us why there was plexiglass set up at intervals. He told us the sometimes the Mexicans would shoot at the American border patrol to just be assholes. Funny, I didn’t see any Mexican border patrols on the other side.....

After dropping off the couch Jessica and I spent some time walking around down town El Paso. It was incredible, shop after shop after shop stacked to the ceilings with cheap discount clothes and shoes, plastic Jesuses, plastic guns, cowboy boots and every other possible cheap discount wallet or pair of knockoff Gucci sunglasses you would ever want.

El Paso is a strange place, straddling two different worlds. Its rough and reminds me of the gathering of debris when several streams or bodies of water meet. Things become caught, colors meld, creating something new and possibly stranger then before.....

Visiting the clinic for the first time

This morning we headed to the school. When we turned onto Magoffin street my heart jumped into my throat and I became so nervous hardly believing that I was here, in El Paso at the school that I have been working so hard to get to for so long. I had to take a second in the car before we walked through the front gate and up the creaky steps. Several men sat on the porch waiting. “Buenos dias” felt good and strange on my lips. Walking through the slamming screen door is a moment I will never forget. A hallway stretched in front of us, the walls covered in posters. To my left was a waiting room filled with about ten or so mammas and babies. To our right one of our soon to be colleagues was doing an initial appointment with a woman. We didn’t get to chat with Kaley, the director of the school, but we did get to walk around, check out the kitchen and upstairs. Its hard to believe that I am going to be living and breathing that place for at least a year and how familiar it is going to be....

Jessica and I are now back at our little home lounging around after a fantastic lunch of fresh tortilla’s, cheap and amazing avocados and really really hot salsa which we ate over frying pans playing the role of plates and using disposable plastic spoons collected throughout our trip....

Arrival in El Paso

So. El Paso, Texas. First impressions? Big, crazy drivers and hot and humid. The rest of our road trip was a stretch for both of us, our zest for the road fading. We found a cheap youth hostel in Denver and crashed out in the heat of the afternoon. I woke up feeling woozy and ending up worshipping the toilet bowl on the old tile floor and later at a gas station. At around 8pm we were fed up and decided to hit the road. Jessica managed to drive for a few hours while I squeezed my eyes shut ignoring the road and praying to keep what water I had in my stomach down. At around 2am we pulled into a truck stop and took a glorious nap on the grass for a few hours. We eventually made it Albuquerque and stopped at a big health food store and stocked up on cheap goods like crazy amounts of apple sauce on sale (the jars will be great for storage later) and mac&cheese for a $1 each. When we pulled up to our car in the parking lot with the shopping cart the guy in the car next to us started laughing asking how the heck we were going to fit it all in my little car. We just laughed and went to work with our magic fingers cramming apple sauce into every possible corner, praying we wouldn’t be hit in the head by it for the last four hours of our drive. When we finally made it to El Paso we checked into a week by week hotel place that ends up being really cheap....

From the road....Downtown Denver

6:53am
I’m writing this from the road. We just crossed the state line in Colorado and are on our way to Denver. We are now in our fifth state and rocking our way to El Paso. We’ve had occasional stops but have pretty much run right through, many bugs have met their demise on our windshield and we have passed every-type of road kill there is (none that we are responsible for). Right now time seems to be standing still. We have been eating pavement for breakfast lunch and dinner since noon yesterday but feel triumphant to have made it this far in such a stint! Our cruise into El Paso should be dreamy and quick.....

Later....
Jessica and I are sitting like crazy ragamuffins in bakery in downtown Denver. Crossing our fingers for a hot shower and somewhere flat to rest our aching backs and heads through the heat of the day...

Visiting Kate in the Kootneys

Tomorrow I head to the boarder and onwards to my new home. Its strange thought, leaving B.C, especially having spent a few days with Kate here in the Kootneys. The wilderness, the green, the tree’s and picking carrots from the garden all feel so right, I feel so at home. I know now for sure that I don’t belong in the city, that I conform to it too much and feel so much better when I’m rolling in the mud. The transformation that I have seen in Kate after her spending these past weeks living on Hollow Frog Farm is truly amazing. She has taken on a such a lightness of spirits, of freedom
and breaking away from the structure that has been ruling her life these last years. I am so thankful that we’ve had this time together. As she put it so eloquently this afternoon while we were lounging on the river bed in the wetlands “we are just being” and what a fantastic thing that is....

Before I left the city Emma and I went swimming down at Wreck beach. I swam way out and was struck with what surrounded me. I began crying feeling as though I had forgotten how to appreciate the beauty around me. I also recognized the strain that working in the DTES has done to me. When I realized that I would be able to come back to B.C and appreciate it in a whole new capacity which will be facilitated as a midwife my spirits soared. A seal appeared shortly after watching me with its big, oily eyes breathing heavily as the rain fell down around us. Its been good to reconnect with the spirit behind what I have been working so hard for.

Kate is making salad dressing as a write. The sky is blue marked by the towering dark tree’s surrounding this cozy home in the forest. Tomorrow I hit the road and just keep going. I’m attempting to capture this moment, this feeling of serene grounded freedom before I begin speeding transcontinental.....

SusanSavageRumbaKukaluLucka

I’m writing this from a little cabin on Hollow Frog Farm near Nelson, B.C with Kate by my side. My trip to El Paso (the long way around) has begun. Mom and I drove up to Vernon on Monday which made leaving Vancouver easier and gave us a chance to hang out and name my GPS with the fantastic name of Susan Savage Rumba KukaluLucka.....

Attempting to fit my life into a car....


Saying goodbye to Greg and Tikka...




Susan on the road....