Wednesday, February 14, 2007

An American Midwife in Mexico

I wrote in an earlier post that I hoped to publish in WNC Woman's new series, 1000 words and a picture. Here is what I submitted today:

In 2002 I lived for 6 months in Mexico and worked with Doctors Without Borders on a maternal-child health project in the state of Guerrero. I also had the opportunity to travel through a good bit of Mexico – the capital city, Oaxaca City, San Cristobal in Chiapas, and even Acapulco one week when my husband came to visit. I saw that Mexico is really 2 nations; one is the relatively prosperous, relatively modern country of NAFTA. Another is the humble, forgotten Mexico of small villages and barrios.

I worked with an all Mexican medical team and we set up clinics in remote areas of a region referred to as La Montana, or The Mountain. We ran our clinic from 9 am to 2 pm, taking a break from 2 pm to 4 pm, and continuing the clinic until 6 pm. We always gave preference to women and children, but we saw anyone and were available for emergencies all 24 hours. We saw women in a continuous string; they often brought 5 or 6 of their children at one time. As expected, we saw a lot of respiratory and intestinal infections, but also many skin problems, mostly scabies and infected bug bites.

My most memorable patient was a woman named Celia. Within an hour of arriving in one of the communities I learned that she had given birth 8 days earlier. It was her second pregnancy and her first birth had been unproblematic. She started labor in the evening and the contractions had become stronger all night but with no evident progress in labor. In the morning they realized something was wrong with the labor and decided to seek help in the closest town with a medical clinic - this meant a 7-8 hour walk, and then she probably would have been transported the 4-5 hour drive to the only regional hospital. After almost an hour of walking they realized that the road was in too poor condition to be passable. Discouraged and in great pain, Celia decided to turn back and go home.

Once back in her home the partero (male midwife) again tried to facilitate the birth of the baby with a common practice which involves placing a large sash or blanket behind the woman’s back, grabbing both ends, and then shaking the woman from side to side. When that did not work and the contractions seemed to diminish the partero decided to give two injections. The family didn’t know what he gave, and he was not in the community while we were there to tell us (he was further out in the countryside tending to his animals) but I suspect he gave Pitocin. (Pitocin is a synthetic form of the hormone oxytocin which causes the uterus to contract. Anyone can buy the medicine without prescription in Mexico, even though it can have serious side-effects. ) About 10 minutes later the baby’s head came out but the rest of the body was stuck. The partero said the baby was alive because the baby initially sucked on his fingers. He tried everything he could, getting her to move in many different positions before determining that the baby was dead and finally using great force to pull the baby out.

When I met Celia she was lying in bed. She said that she did not feel well. Signs pointed to a uterine infection and we gave her an antibiotic. I visited her several times a day for the week we were close to her home and every day we talked about her loss and grief. Her 2 year-old daughter was the source of much joy for both of us. By the time we left her vital signs were normal and she said she felt much better. In my time in all the communities, hers was the only birth I heard of that ended in a neonatal death. Conditions were difficult, but most of the people we met were relatively healthy and enjoyed their lives centered around family and work.

One of my favorite parts of every day occurred after clinic when other members of the medical team and I would walk the 20 minutes to the natural spring that fed into a little lagoon before flowing into the river. It was always a treat to walk through the cornfields that were ringed by mountains just as the air cooled from the setting sun. We always arrived hot and dirty and left clean and refreshed. I am still struck by how much time and work it took to keep one’s body and clothing clean in communities where there are no conveniences like electricity, running water and appliances.

Every morning I would wake just before sunrise; it was a wonderful time to be outside because the air was fresh and cool and it was the only time I got to see the stars since it was always cloudy or raining at night. I loved seeing the sky so full of constellations that were completely unlike my own in the skies of North Carolina. I also saw things that I didn’t notice during my busy days: mostly just the ebb and flow of the country life that was so foreign to this city girl. I saw baby pigs the size of kittens and baby goats the size of small terriers with their dried umbilical cords still attached, all tottering after their mothers.

I had an amazing experience those 6 months I lived in Mexico. Most of all I learned a great deal from the cultures that are very different from my own. Especially striking to me is that the people from these cultures are geographically very close to us, yet we often do not notice or choose to learn from them. The US and Mexico are both culturally diverse. But what often transcends all groups and exemplifies the Mexican culture is that they value community, the ritual and mythical world, death and nature. These are all values that could greatly enrich our own culture.

P.S. I submitted 3 pictures for the editors to consider. My favorite is of my friend, Ita, who accompanied the medical team into the field and translated from the indigenous Na'savi language to Spanish. She also introduced me to the pleasures of a temezcal - a sauna dug into the side of a hill.

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