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Out of Africa or I’ve Been Waiting the Whole Blog to Say That–Jane July 25, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 11:08 pm

So here we are, coming to the end of the midwifery portion of our trip.  We do go on and have several other adventures, such as waking up beside the Nile and seeing monkeys eating old room service, or staying in the absolutely creepiest hotel in the world and surviving, but those are stories of life and its times, not specifically midwifery, so they will stay untold here, unless I get thousands of private messages, filled with Really Good Bribes.

Our last day in Kasana was just so typically Kasana-ish, that it fills me with a certain masochistic joy.  Anna and her new friend Rachel the sophomore UNC volunteer, were planning on making friendship bracelets and doing relay races with the Teen Girls group.  As it turned out, Anna and I ended up leaving a little before the group was scheduled to start, so we didn’t wind up actually doing that.  But we didn’t know that then.  We girded up our loins and walked up to the main road where all the shops live, to gather needed supplies.  We knew this was going to be an exercise in frustration, but we were up for the challenge.  Africa was not going to win today, my friends.

First, we needed string.  We went to five different “stores,” which are really little shack type things, sometimes with a living area behind them, but always full of things you absolutely do not need.  Certainly, no string.  In each store, we were told that we would probably have to go to Kampala.  Really?  Nobody has ever bought string here before?  Finally we ended up getting embroidery thread from a tailor, and that was only after Rachel shared her street bought popcorn with the proprietor.  Then, of course, we needed beads.  Luckily, there has been a donation full of them fairly recently, if we could find anyone at the center who knew where they had been stored, so we felt pretty confident about that.  It was on to the relay race supplies.

Rachel wanted to do three legged races, so we needed some rope.  Of course rope, the elder sister of string, was also not available, even at hardware “stores,” so we ended up buying a mop and disassembling it, and then tying the pieces of mop together to make a rope.  It was a riot, and I think McGyver would have been proud.  We also needed some eggs for the egg and spoon race, so we headed to Hespa’s little roadside stall, next to our house.

Now, I know where eggs come from.  And I know that the place they come from is pretty close to a chicken’s butt.  However, even with all that poultry knowledge, I am still surprised whenever I buy an egg here, and it has chicken s#$& all over it.  I guess maybe all eggs do, but that our American ones are washed before they are sold?  Or maybe Ugandan chickens are really messy?  Or that maybe I should move on, and not spend quite so much time thinking about chickens, their eggs, and their butts?  Ok.  Moving on.

We headed down to Shanti with our booty, and I was actually quite sad, thinking this was the last time I was going to travel this road.  I had come to know the people along my route, the old women sweeping, the children screaming “Mzungu!”, and the eternally formal old men, who stopped their hoeing to wave, and ask me how I was.  We laughed, thinking of how out-of-place any or all of those things would be in Seattle, the land of the aggressive passivity.  If someone called a greeting to stranger from their porch in Seattle either their mental health or their safety would quickly be called into question.  It is the exact opposite here.

It was hot that afternoon, and soon into the walk we began to sweat, the ever-present red dust sticking to our legs and feet.  I resolved to sweat more at home, to actually get outside and interact with my environment, and not hide in my office or behind a keyboard.  I felt alive, dare I say, at peace, with myself and my place in the world.  And I realized, that this leaving had come at exactly the right time.  I love Uganda.  I will come back.  But for now, I was ready to go home.

We got to Shanti, dropped the supplies off in the prenatal clinic, and said our goodbyes.  We took tons of photographs of the grounds, and of the staff, which I promise I will get up on facebook soon.  (If you are not my friend, and are interested in seeing them, just drop me a friend request.  My internet privacy polices are so low as to be non-existent.)  We shed a few tears, exchanged a few email addresses, and then our ride was there, and our time at Shanti was over.  All that anticipation, all the build-up, all the angst, and it was over.  I felt like the bride after a wedding, sort of empty and confused.  Now what would I think about?  What would I spend my time doing, if I couldn’t chase after string or solve waterbirth logistics?   I’m sure I will think of something.

So now I am home.  Our book needs writing, my clients need midwifing, and my husband needs loving.  My days are indeed full again.  But I left a little piece of myself in Kasana, somewhere on that red dirt road.  And I can’t wait to go back and see what it will have done in my absence.

 

Where are the birth stories?–Jane July 19, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 10:36 pm
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Ha!  You noticed!  There aren’t any.  Yes, there was not a single baby born during our stay in Uganda.  However, I learned so much anyway.  It really put the focus on prenatal care, and teaching, which is something I really love, so please believe me when I say that the trip was not in any way disappointing.  Good prenatal care is really the foundation of all midwifery work.  It is not only about meeting mothers where they are, but really peeling back the layers of who she is as a person, and showing her how she is absolutely the best mother for her baby.  It is about showing mothers what they already know, and how they are the experts both on their pregnancy and on their particular baby.  And it’s about convincing other people that no matter who this mother is, whether she is a 15 year old singlemama, or a 35 year attorney , they deserve respect and honor.  And in this case, it was doing all of this in a language I do not speak.

Many many women come to these rural centers never intending to deliver there; in many cases they live too far from the center to reliably make it in time.  In others, the pressure to birth in their village is just too strong.  But they come to Shanti anyway, to learn, to share their pregnancy experience, and to be with other women. Remember, these women cannot just look up a symptom on the internet.  They do not have electricity or running water.  And they may not have their mothers or grandmothers around to ask all those questions that a new mother has.  There are 3,000,ooo orphans in Uganda, victims of a brutal civil war in the 80s and 90s, AIDS, or other diseases.  These women are having children now, and are starved for information and love.

Shanti also functions of a de facto medical clinic, dispensing malaria treatments, parasite eradication protocols, and other basic supportive health care needs to pregnant women.  That’s something I would never see in Seattle, and I’m grateful for the chance to deepen my knowledge.  There is also a huge emphasis on post baby family planning.  It is vital that Uganda get its over population problem under control, or the many strides it has made will be for naught.  Safe, reliable birth control has to have a huge place in Uganda’s future, and I was very pleased to see it taken so seriously at Shanti.  The average Ugandan family has 8 children.  The death rate, thank goodness, is dropping, but the birth rate remains the same.  Clearly this is not sustainable, and is a huge obstacle to the empowerment of Ugandan women.  Choosing to have many children, as some of my most delightful clients at home do, is very different from it being forced upon you by circumstance.  Again, choice, choice, choice.

Immersing oneself in another culture is always challenging.  I am asking a lot of the midwives at Shanti, to reevaluate what they have been taught to do, and what they have been doing effectively in their previous jobs. In turn, I am reevaluating my own methods and work, making sure that they still match up with who I am, and what I believe is my purpose in this world.  And really, that is one of the most important things we can do, as midwives, or just as  human beings.  We keep examining, keep searching for clues as to how to find our true place, and if we are really lucky, we meet others who can help us, like I have both here in Uganda and at home.

 

Waterbirth, Waterbirth, Waterbirth–Jane July 19, 2011

Filed under: Uganda — EssentialMidwifery @ 8:21 pm
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At one point, almost 90% of the births I attended took place in the water.  It has dropped off a little, due to some speedy babies that wouldn’t wait for the tub to be filled, but there is just no denying that this is a very popular way to birth.  I was excited to hear Shanti’s take on it, and share what we have learned over the years.

They have a built in tub there, but it is really much too small and much too deep.  Its lovely, of course, as is everything there, but I’m afraid it just wouldn’t really work.  Luckily, Kristin, the coordinator, already knew that, so I wasn’t breaking anybody’s heart with that observation.  They assured me that they could just pull out all the tile and build another one, quite quickly.  (Now, I don’t want to judge, but “quite quickly?”  Well, we will see.)

I was asked to give a workshop on the down and dirty details of waterbirth, and I was delighted to.  It was so off the wall, so unheard of, that I actually think it could work out fine.  See, Shanti is fighting a battle with their midwives.  They have all been trained in the classic 1950′s Western model of birth.  Even getting them to acknowledge that there are better positions than McRoberts has been a bit of a challenge.  They begged me to ask Kristin to get rid of the large queen sized beds with the homemade quilts in the birthing room, and get them some real hospital beds.  They said the beds were too low, and were hurting their back.  (I can completely sympathize with that, of course)  However, when I gently asked if they could just climb up on the beds with their mamas, well, let’s just say my suggestion wasn’t met with overwhelming enthusiasm.  I did, after much roleplaying and coaxing get several of them to promise to at least try it.  So again,we will see.

And don’t even get me started on the episiotomy issue.  I’ve been reading Jodilyn’s struggle with this, and I can only nod vigorously.  They ladies love to cut.  (When they found out I had never ever done one, I think I actually lost some of their respect.  I had to make it up later by bringing chocolate to share.)

I think the main issue here is that out of hospital birth is not seen as a beautiful, candle lit experience, where the mother is surrounded by people of her choosing, and comes gracefully into her power as a woman.  No, here it is a dark and dirty affair, usually with no trained attendant,  the threat of hemorrhage, or other disasters lurking just over there in the corner.  The hospital is a place of (relative) safety, even though that little bit of increased safety comes at a huge moral price.  Shanti is trying to change that.  But its slow going, especially when you have to start with your staff.

But waterbirth?  They had hardly even heard of it, so they had no preconceived ideas.  And that, I have found, is one of the best places to start from a teaching standpoint.  We talked for hours, first dispelling the normal waterbirth questions that everybody from my mother to the guy in the supermarket have asked me.  No, the baby won’t drown.  No, you shouldn’t leave the baby underwater for a long time.  Yes, we tend to see less tears.  Yes, it IS hard to cut an episiotomy in the water.  How great of you to notice!) Etc etc.

Then, one of my favorite midwives asked the question:  “How do you run a resuscitation?”  And just like that, we were off, off in a completely juicy conversation regarding the physiology of delayed cord clamping, the unseen yet oh so powerful bond between a mother and her child, how the midwife’s own attitude and demeanor can influence outcomes, when to actively help and when to encourage from the sidelines…oh, it was wonderful!  We had almost no common ground to start with; they have not been trained in NRP in the same way that I have, so we really had to start from square one, because we really weren’t even talking about the same thing.  But once we defined our terms a bit, we were deeply engaged in one of those meaty philosophical discussions that all midwives love.  (It was a bit more difficult because of the language barrier, but we kept at it.)

By the end, they were excited about waterbirth, and I think, even a little bit eager to try it out.  Annet even wanted to skype me in on their first one, to help guide them.  I wonder how the mother will feel about that!  And I hope its not a long birth, because there is no electricity at the center.  But those are just details.  I’m sure we will work it out.  The point is that we are starting to give these mothers options, options that they have never even heard of before.  And with options comes choice, and with choice comes dignity.  And that is what all mothers deserve.

 

Mean Girl-Jane July 13, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 9:41 pm
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For the first time today, I felt threatened. It was not from the men who regularly ask me if I want an African lover. I mean, they are shouting from trucks, so even if I decided that, yes, I absolutely did want an African lover,right now, they would be long gone. They may need to work on their technique.

And it was not from the slightly sketchy guys at the Indian supermarket, who glare at me whenever I ask for something they do not carry, as if it is my fault. And it’s not even from the market men who happily cheat me, and charge me twice as much as a Ugandan, cause they smile when they do it, and we both sort of consider it a game.

No, my nemesis is a teenage girl. She approached Rachel, Anna, and I last evening, as we were walking back from the market, munching on some roasted corn. She stepped in front of Rachel quite aggressively, throwing her shoulders back and narrowing her eyes. She demanded to know where we were from, and when told spat out, “Give me your corn. I want it.”

Now, there was no way Rachel was going to give her the corn. It was good, and it was Rachel’s. The girl glared, told us she had no money (although she was carrying school papers, thus was getting an education, and was obviously not starving) and got a little up in Rachel’s face. It was classic bullying behavior, and it was not going to work. Eventually she gave up, said what I can only assume to be a few rude words, tossed her fake hair, and flounced off down the road with her friends.

Now, if that were the end of it, I would have forgotten it already. But this morning, she was outside her house, with her friends, on the road to Shanti. As I passed her, she looked me in the eye. I greeted her and kept walking. I heard her say, “That’s my friend,” loudly, in a way that was definitely not friendly. The hairs on the back of my neck did a little dance, and I was acutely aware that I was alone, carrying a bag with comparatively, quite a bit of money in .

Strange that of all the people I have encountered and all the places I have been, that I would feel intimidated by a run of the mill, common Mean Girl. I will watch out for her.

 

War Stories-Jane July 12, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 7:08 pm
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It is just inevitable that when a group of like minded individuals get together, the war stories come out. (I know of what I speak, for I am the former wife of a F-15 pilot, and the now-wife of an SCA fighter.) This is especially true if there is a stoop involved, and some heavy warm air, maybe not quite enough work to fill the time, and some food to be shared. And so it was today at Shanti.

 

Annet began. “Jane, have you ever had the woman with the pre-eclampsia? She who had a fit? It happened to me, when I was alone here with Martha. It was night time, and the woman had not come to the clinic for two months. She only came when it was time for delivery. And she had great big pitting edema, and her blood pressure was so high. And I was so scared, and I told the mother of the mother that this was very dangerous, and that we had to go to hospital right away.”

 

“So I called Ben (the driver) but I could not get him on the phone, and she was starting to get worse. As I was thinking about what to do, her eyes rolled into her head, and she had a fit. She was shaking and not breathing well, and we were all alone at Shanti in the middle of the night. So I ran down the hill to the end of the road where there lives a boda man (Boda-bodas are motorcycle taxis and the drivers are known for insane traffic moves), and I banged on his door over and over again. Finally, he came to the door and I was screaming, ‘ I am a midwife, and this mother is going to die!’

 

So he came to Shanti and Martha and I were trying to balance this woman who was so out of it and without strength on the back of the boda. There is not really room for three people on the back of the boda, so Martha was standing up to make more room, and I was hanging on to the woman, and all I could think of was what if she had another fit on the way to hospital. And then it started to rain.

 

It rained all the way to hospital, when we finally got there. And she was already pushing on the boda, but she was actually only 6cm, so she had to wait. After a time, she did push out her baby, and she was ok. But I was so scared, and I did not know if I wanted to be a midwife anymore. I had to think about it a lot, but I decided that nobody else could have done better than me in that situation, so I might as well stay.”

 

So here’s a secret, and it is what I told Annet: Every midwife in the world has felt that fear. Everyone from the senior-est PhD Certified Nurse Midwife at Yale down to the youngest traditional birth attendant in a mud hut in Sudan. If they haven’t they are either lying, or a bad midwife. The fear is good. It keeps you and your clients grounded in the moment, and its in single moments when lives are lost or saved.

 

Midwifery is a lifestyle full of contradictions. You must do the schooling and learn the facts, but also be open to your intuition. You speak of honoring families, while neglecting your own.

 

But most importantly, like Annete, you have to humble yourself to the mother’s inner knowledge and respect her experience , yet be arrogant enough to act fast and hard when you have to. Its knowing that when a person’s life depends on you, nobody else can do it better. So you might as well stay.

 

Buying Day-Jane July 12, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 4:39 pm

 

Shanti sponsors two microfinance projects for HIV positive women. In the first women make beautiful beads out of recycled paper, and in the second, they make yoga bags, purses and tote bags. These products are then sent back to Canada to be sold at various festivals and private parties. The profit is turned around and put directly back in Shanti, so technically, this is a non-profit, although the rules are a little different in Africa.

 

They are envisioning the Women’s Group lasting three years, and during that time, the women are expected to diversify their profits into individual money making activities. Then another Women’s Group will start. One woman has had just terrible luck. She took her bead money, and bought a pig. But the pig died. So she bought a bicycle. But the bicycle was stolen. So she bought another bicycle, but that one was stolen too. (Goodness, it sounds like that Monty Python bit from “The Search for the Holy Grail!” “And I built another castle! And it sunk into the swamp! So I built another castle! And it sunk into the swamp!”) So now she’s back to square one. Luckily, she makes very pretty beads, so I think she will be back in the black soon. She thinks so too.

 

That is another thing about the Ugandan people, at least the ones I have met. They have such a happy fatalism. They know bad things happen, and its ok. Well, not ok, per se, but inevitable, and not to be avoided, and that eventually life will be right again. And lawsuits? Not here. Nobody even knows a lawyer, let alone knows how to engage one.

 

Buying Day happens twice a month. The Women’s Group brings their wares, and Kristin decides what to purchase to fill the Vancouver orders. We helped out by providing quality inspections, channelling our inner Seattle Crunchy Mama in deciding what would sell and what wouldn’t. Kristin is adamant that there be no “African” AFrican prints. Meaning, in her words, “No #$%^ giraffes!” Luckily there was only one bag with giraffes on it, and Rachel felt sorry for it, so she bought it.

 

 

 

Buying Day is actually very intense. Kristin only buys a fraction of the beads each woman brings, and is very selective. For instance, NO Yellow. Yellow doesn’t sell. And each bag must be perfect and not have tacky buttons on it. After a while, you kind of forget what is cute and what is not, and it all blurs together. And you find yourself going to bat for a ridiculous pink button with silver sparkles. Perhaps I was thinking of Elisabeth’s daughter Louise when I lobbied for that one.

HIV is a way of life here. I guess it makes sense for the place that practically invented it. If could go online I would deluge you with statistics and facts, but as I’m typing by flashlight at 5am from the Volunteer House, because we have no power, I guess you are just stuck with my impressions. Medicine is available here, but it is difficult to take consistently. Heck, its hard for US patients to take all their drugs at the prescribed time, with no problems or interactions. It’s just impossible here. And many people have to make a choice between food for their families and medicines. There are programs, led by US drug companies to distribute medications for free, but I’m sure that doesn’t work very well. Remember that it takes four hours to cook dinner here. Unless someone actually went door to door, and gave them out, with specific instructions and some concrete incentive, well, I’m not even sure that would work.

HIV status is mentioned in personal ads, and is taught about in schools. There are posters about it hanging on the walls in public buildings. There are songs about how it is transmitted and how to prevent it. And I’m sure this is good. But there is still so much misinformation and tragedy. It hurts to look around the sewing pavilion and know that if I come back, there is a good chance some of these people will not be here.

 

Some Words on Prenatals- Jane July 12, 2011

Filed under: Jane,Uganda,Uncategorized — EssentialMidwifery @ 4:16 pm

 

Ah, prenatals. The backbone of midwifery care. Let me tell you, after doing days and days of these, the one thing that sticks out in my mind is that mi amiga Jodilyn would be tearing her hair out. A model of efficiency and order they are not. But, like everything else here in Uganda, if yo u can let go of any expectations, (and I mean ANY) they can be a heck of a lot of fun.

 

They happen every morning. Sometimes. There are two midwives on duty each day at the clinic, and shifts run from 8am to 6pm and 6pm to 8am. Sort of. Staff comes when they come, and nobody is the least bit upset if their relief is an hour late. Or an hour and a half. Or two hours. Can you imagine that happening in the US? Blood would be shed.

 

Now, to their credit, It is very difficult to get here from Kasana Town. It is actually a lovely 30 minute walk, which I enjoy very much, and the red dirt road is not too treacherous. But as it is the custom to greet everyone you meet, and if you know them at all, there are long and involved exchanges, which have to occur or you are considered incredibly rude.

 

-Hello,how are you?

 

–I am fine. And how are you?

 

-I am fine too. How is your wife? How are your children?

 

–They are also fine. They slept well last night.

 

-That is good. That is very good. I, also, slept well last night.

 

-That is very good.

 

Now, imagine that times everyone you meet. If you are very lucky, you can get away with a quick “Olyotya,” (How are you?) and an ever quicker “Jendi,” (I am fine) and keep walking. But not usually. No wonder it takes an hour to walk 30 minutes!

 

Once the staff is assembled, and everyone has been asked after (“Jane, how are you? And how is Anna? And Rachel? Are they feeling well? Will they be coming to Shanti today? We are so glad they are well. We are also well.”) it is time to get the day started. Ha ha! I kid. It’s really time for breakfast. Today Annet, an extremely bright young midwife, has already brought me boiled corn, chipati (sort of like naan bread), and a steaming hot mug of millet porridge, which she prepared on the Bunsen burner. It is so yummy, and I am so spoiled. Yesterday I brought pineapple to share, but that’s really not as impressive.

 

Now its time to get some midwifing done. Well, some cleaning, at least, which, we all know, is an integral part of midwifery the world over. The clinic’s floors are swept and mopped, the linens changed on the prenatal beds, the chairs wiped down, and many other things I’m sure I missed because I was too busy eating delicious porridge to notice.

 

Then we wait for clients. And wait and wait. Sometimes the come, sometimes they do not. Yesterday was a good day. We had five clients, one of whom was new. And each one took an hour. Now, at home our prenatal visits can easily take an hour, but this is because we are doing Important Midwife Work, like reaching into their innermost souls and connecting with the Divine Feminine. Here, it is most likely because the lab tech is late, so we have to run each lab ourself, or because each chart note has to be entered into three different places on ten different forms. But, as always, nobody minds waiting.

 

I can easily see at least ten ways in which this process could be sped up, but I’m not sure that’s the point. As the clients wait, they chat with each other, they compare notes on their pregnancies, the older mothers counsel the younger mothers, and the passing of knowledge from one generation to another continues. I keep using the word community, but I can’t come up with a better one. Its normal, natural. There are no “community building exercises,”" no block parties, no art walks. Not one single thing to make people meet their neighbors and care about them. And yet, it’s here. Maybe all the greeting is worth it.

 

The process itself is familiar, the nutritional counseling, the blood pressures, the palpation. The midwives here are not taught in school how to palpate for position or lie, but they have had some training in it from a Canadian midwife who was here a few months ago. They do have extensive knowledge of birth positions, and so one of my goals here is to help them integrate this knowledge.

 

They have to learn to find the position of the baby in labor, and figure out which position will help the mother birth mostly easily and safely. Now, of course, most of the time, the mother’s body will tell her what position she needs to be in, but, just like at home, sometimes there are malpositions and puzzles which must be solved at the birthing time. Prenatals are a great time to practice palpation, for everyone. And of course, Ugandan mamas love to know what little baby parts they are feeling, just like American mamas. It’s just another fun way for the mother to bond with her baby, and for me to bond with the mamas.

 

Sometimes I think I prefer to do prenatals in a foreign language. It is just a riot and leads to so much laughter. Clearly, I am not from here, and clearly, I am clueless in Lugandan, the local tribal language. And, some of the prenatal protocols are just hilarious. Everything is written out very clearly, every step of every exam. Now, I appreciate thoroughness as much as the next girl, but how can you not love that you have to check a box that says “Limbs. Lower. Both present?”

 

(Now, now, my politically correct friends. I know. Its bad and tragic when mamas have only one leg. But it is about as common here as in Seattle. This is not landmine country. I’m making fun of the form, not the people.)

 

The mothers here are young, of course, but mostly married, which is good for economic stability. They are poor, but everyone is poor here. We do a lot of nutritional work, of course, and the mothers are taught a few birthing positions at each prenatal visit, so when she is in labor, they are familiar. They are also shown stretches and yoga poses. Imagine me, She Who Does No Yoga, on hands and knees demonstrating cat-cow. Down goes my back, and I bellow,”MOOOOO!” Up goes my back and I screech, “ME-OOOWWW!” Its poetry in motion I tell you.

 

All in all, prenatals are a happy time. And who doesn’t need more happy times?

 

 

 

 

 

 

 

Ask the Mzungu 1.1-Jane July 12, 2011

Filed under: Jane,Uganda,Uncategorized — EssentialMidwifery @ 4:05 pm
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Hey Mzungu! What does Mzungu mean, anyway? Is it racist?

There have practically been volumes written on this. Every travel guide seems to have a different answer. Technically, it does mean White Person. And there is no denying that I am, in fact, a very white person. I live in Ballard, for goodness sake. And I like Weird Al Yankovic. So I don’t take it as racist. I tend to think of it more as meaning “Foreigner,” and this is borne out by the fact that apparently African-Americans are also called Mzungu. In some areas, the term has morphed into meaning “wealthy or privileged.” If you stop, and chat with the kids who call to you, and tell them your name, they will use it next time, and you will be Mzungu no more.

Hey Mzungu! What’s the weather like in Kasana Town?

Well, its just about perfect. All my leftover Filipino sweat fears have, if you will pardon the pun, evaporated. Its rains at night, is cloudy and cool in the morning, and heats up to about 80 with sun sun sun during the day. (The cloudy and cool mornings make the cold shower system a bit challenging, but I am tough, and have only screamed three times.) Occasionally it gets bit warmer, but really, its insanely lovely. In fact,on Planet Jane, the weather is just like this, all the time. I can totally see why mankind decided to start our worldly reign from the East African Rift Valley millions of years ago. What I don’t understand is why we left.

Hey Mzungu! What’s that noise?

If its early morning its either the afore mentioned Muslim call to prayer, or Announcement Guy. Actually Announcement Guy blesses us with his words all day and evening at regular intervals. There is no newspaper here, so all news is given over a loudspeaker that you can hear throughout the whole town. The first time Anna heard it, she thought it was somebody saying “Hide your women and children!” He has a very particular inflection, and to those of us who cannot speak Lugandan, he could either be calling a very close horse race, or auctioning off a wife or two. One of the greatest things about Shanti is that its far enough outside of town that you cannot hear Announcement Guy.

Hey Mzungu! What is the educational system like in Uganda?

Pretty crappy actually. It is expensive, about $30 per three month term, so for families with multiple children the expenses can definitely add up. Creativity is definitely NOT encouraged. Everything is done by rote memorization, and you can hear the children reciting their lessons from our house. There seem to be a lot of schools in Kasana, though, so I suppose that is better than there not being a lot of schools. Corporal punishment is normal, and girls often drop out early. The system is modelled on the English system, as this is a former colony, with O levels and A levels, but few children make it that far in their education. A lot of Peace Corps volunteers end up teaching as their placement, so maybe they can turn the tide a little bit. We met one volunteer, from the Japanese equivalent of Peace Corps. She is a special education teacher, and is teaching a class of 60 deaf students. They range in age from 6-16, and they are learning American sign language. She also teaches their parents, but if the children board here, and their parents live in the villages, they still cannot really communicate. Like everything else in Uganda, its complicated.

Hey Mzungu! What’s the music like there?

Oh, the love of Dolly Parton and Celine Dion is strong and mighty. They are played everywhere. Actually, there is quite a happening music scene, only it is not happening in Kasana. Kampala is apparently the clubbing capital of Eastern Africa, and the house music is allegedly very strong. I have this on good authority from Jeff, and he should know because his age starts with a 2.

Hey Mzungu! What’s your favorite Ugandan food?

Rice balls!! Besides doubling as a useful curse, they are also insanely delicious. I asked Hespa’s daughter to make us 100 for the plane ride back to London. I think she thought I was kidding. I assure you, I was not. They are a little spicy, a little chewy, and all kinds of delicious. Ugandan food in general is quite bland. There is a lot of starchy food, potatoes, rice, corn, matoke, which is plantains, mashed up, and yams. There are several kinds of beans, and some lentils. Meat is not eaten often, as it is quite expensive. We went out to eat at a restaurant for lunch the other day, and I was so excited to see some short ribs! I may have eaten a few more than was polite, but it was my first meat in almost two weeks. I also indulged in what I think was goat. I’m really not sure. It was quite flavorful, but extremely tough. Really, it was like rubber, but I persevered. I just wish I knew what I was persevering.

More later, from your Friendly Neighborhood Mzungu!

 

Details–Jane July 1, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 8:07 am
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It is 5:30 am, and I have just been awoken by the Muslim call to prayer. I’ve heard it described as haunting and beautiful, and it is certainly both of those. The Iman’s voice winds its way up and down and around the minor key, and it is easy to close my eyes and time travel back a thousand years. I like it. There is a large Islamic population in Kasana Town, and while there are certainly some religious tensions, on the whole everyone seems to get along.

 

Our next door neighbor, Hespa, keeps us up to date on such matters. She is a Muslim businesswomen, owning a little roadside store right at the foot of her driveway. We go there every day, buying eggs or water, or whatever goodie she has whipped up in her kitchen, and thought sounded good today. Her rice balls are legendary, and the other day we had some sort of doughnut thingy. The cult of fried dough spans all cultures and geographical regions, and I for one, couldn’t be happier.

 

One of Hespa’s daughters cooks dinner for us. Kristin is trying to teach her how to cook western foods, and the results are highly entertaining. We had burritos the other night, but as there are no tortillas, we ended up eating guacamole inside of chiapa, which, while being flat and made from flour, somehow ended up being just exactly unlike a tortilla. It was still good, though. And seeing Jomila’s face when she tasted the guac was priceless. She wanted to be polite, but… We joked that in a hundred years guacamole will be a Ugandan staple, thanks to this night.

 

There is another volunteer here named Rachel. She is 19 and entering her sophomore year at UNC. She is sweet and goofy, and never met a child she didn’t like . On our way to Shanti today, she and Anna had a whole posse of kids dancing down the road, pretending to be a train. Have any of these kids even seen a train? Who knows? And why should lack of familiarity with transportation get in the way of making big WHOO WHOO noises?

 

Rachel is also a newly trained doula, and just saw her second birth ever yesterday at the hospital here. To say she was shaken is like saying my labrador is a little excitable. its so hard to watch someone in pain, as we all know. We had a long talk about how there is honor in this pain, and how its not her job to take the pain away. Her job is to witness and support, and while its not easy to do when there is a language barrier, I’m sure with time she will come to speak Birth just fine.

 

Uganda is fantastic. Uganda is also inconvenient. Everything takes so long to get anything done. Even something like cooking dinner takes hours and hours. First you shop, then you light the fire outside on the patio, then you cook, then, if needed you come in, and light the propane burner to boil drinking water, which takes forever because it is a very small burner, then, as there is no power in the evenings, you light the candles and then you eat. By this time, its 9 pm, and there is nothing to do but go to bed, and read by flashlight. And then, of course, before you know it, its 5:30 AM, and the Iman;s voice reminds us of the holiness of another ordinary day.

 

A Smartly Dressed Man, Walking his Goat–Jane June 30, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 8:05 am

We came upon this gentleman, on our walk to Shanti today. This was after we passed the gigantic cow, three undoubtably killer roosters, and the feast-for-flies snake carcass. The Ugandan people are so tidy. How they manage to walk these red dirt roads day after day and still remain dust free is completely beyond me. Heck, even the goats seem to manage it.

They are also friendly. Very friendly. No carefully cultivated Northwest ennui here. Greetings are ritualistic and can last several minutes. Every single person greets you with a large smile, asks how you are, tells you how they are, asks after your brother’s health, your sister’s husband;s roommate’s dog’s health. It can last minutes. Long, happy, sincere minutes. Its like Disneyland. Everyone is on their best behavior, but at that moment, its all real.

The kids are the best. The chase you down the road, screaming,” Muzungu! Muzungu! ” and won’t stop until you smile, shake their heads, and wish each and every one of them goodbye. I can see why Madonna wanted to take them all home with her. Some of them even kneel. Seriously. Its what I always imagined my life could be. We high five them and say a few jumbled up words in Ugandan, and life goes on.

I will say that I am very very pleased with the lack of intense poverty here. In this area, at least, there are no 80′s Ethiopian kids, with their big bellies and even bigger eyes. Everyone seems reasonably well fed and happy. There are many schools, even if they are not free.

We delivered the donated supplies to the midwives today. They were appreciative, but not overly so. They seemed a bit standoffish, which I guess I would be too if some muzungu walked onto my turf for a short time,and started rewriting our policy, lecturing us on obscure foreign practices, and generally tried to take over. I will have to really be careful and purposeful in my interactions with them.

Ugandans can be polite, but they are also blunt. Today I was asked if I were pregnant, if I was planning more children, if Anna was my only, if my husband still loved me, what his job was, what our religion is, and why it was that American women aged so much faster than Ugandan women. My daughter was also told that while she was beautiful now, it would only be a short time before she was fat like me. Oi. That’s laying it on a bit thick, Ladies.

NEWSFLASH:  I was about to publish this, but I have to share what ishappening to me right at this very minute!  I am sitting in Read Uganda, partaking in their very slow internet, when all of a sudden, I am hearing Dolly Parton’s “Jolene.”  Apparently, in the time I have been sitting here, a tent has been set up, microphones have been plugged in, and there is now an honest to goodness hoedown happening right outside.  People are a hootin’ and a’hollerin’, and it is just fantastic!  But the best part is, they have played “Jolene” three times now.  Oh b

 

 

 
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