Last day in Oaxaca

Today has been a beautiful day filled with sunshine and rest.  Last night was a long night with loud (and I mean LOUD) bands playing until 1:30am or so.  I fell asleep.  I guess this was the last night of the big celebration, so there was boxing or wrestling and a big party.  The carnival was going full tilt, with rides and the arcade.  Sheraya won a ceramic rooster for me.  I had not see any since I was here.  I was totally thrilled with the new addition to my kitchen collection back home.

Here is the picture of the house that Sheraya and I stayed in.  It is made of brick and was actually the clinic of the retired nurse midwife who lives next door.  Over 2,000 babies were born in this building.  Her husband who was a doctor and herself, served Mitla for many, many years.  Dr. Donjai, our Dr. working with Casa Compasiva was raised here, and worked with her parents.

It has been remodeled to be a home, of course, and is very comfortable housing American missionaries in it's old age.  

This is the kitchen and bathroom.  Our room had 2 single beds and a built in closet storage drawer area.  We lived out of our suitcases though.  Perhaps it would have made more sense to utilize the closet space, but we were not here much, besides sleeping and late evenings.

The ceilings are all brink with metal beams, and ceramic floors, with cement walls.  The walls are warm to the touch from the sunshine.

There are several houses and the Mexican Christian church that are in this brick walled courtyard. I did not attend the church this time, as it was all in Spanish, and there wasn’t anyone going on the days that we were here.  Unfortunately this little church floods really badly in the rains, hence all the fill mounds that line up around it. 

Saturday another Market Day

Being out of fresh fruit and vegetables is a miserable state.  I guess we gobbled it all up too quickly earlier this week.  But then again they don't last too long either around here with the warmth of the house.

The coolish morning called for a hooded sweatshirt, along with my long skirt and shirt, socks and shoes. The birds were pretty noisy this morning, greeting the day with an argument about who gets the front porch and the nicest tree branches.

We left at about 8:15 AM.  The market opens at 8:00.  Already the vendors were selling their wares with enthusiasm.  Well at least some of them were loudly calling.  Then there are the very quiet, sweet, women kneeling at a blanket full of items just hoping you will choose their fruit to purchase.  Mostly there is just a bunch of one kind, and they like to see you buy a whole bag full.  

Tonight I am making stir fry for the Quezada family, so I purchased some onions, green peppers, broccoli, and 2 big chicken breasts.  Here is the stand where I get my chicken.

They are just killed that morning or last evening and not chilled, so there is no smell and the meat looks bright and fresh.  Not a feather in sight. Not sure how they got every little feather off the head, legs feet.  I had some last week and it was very tasty.  They are corn fed, and grown at a farm, hence the bright yellow colored skin. 

There are a lot of flowers in Oaxaca.  The people like color and that is expressed in many ways.  Not just in the flowers, but in the choice of building paint, the clothing and much of the items made by the artisans. The artisan market is much of the same items, stall after stall.  Not sure why all of the basket makers have stalls next to each other, all the weavers and all the jewelry close together.  Wouldn’t it make more sense to spread out? Maybe birds of a feather flock together.

These women were carrying basket loads of gorgeous flowers home.  I wish I could see the bouquet each arranged to make her home look special for tomorrow, being Sunday.  Perhaps she had guests coming, or maybe she was a house worker for someone with more cash to spend on the blooms, and she was making a room look nice for them.

Everyone carries their purchases home in handled bags.  There are no big paper or plastic bags.  Once you are handed a little baggie with your goods, you have to pack it home.  And if you accumulate too much, you will have to hire a 3-wheeled motor cart to get you back to your kitchen!  Mostly women just carry home what they bought, arms laden down, walking slowly.  I chickened out an brought my back pack.

The big shopping is done in Oaxaca. They actually have a Sam’s Club now, and a big grocery store.  Certainly not as big as a Walmart, but seems big and busy for Oaxaca.  The predominant colors are red, pink, shades of blue and white for boxed items on the shelves.  You can get just about anything there, except for Adams peanut butter…. Sigh.

This guy is selling corn tortillas by the kilo.  I just love the scale. He is not nearly as sweet looking as the lady last week selling them, but I am sure they taste the same.   They are machine pressed earlier in the morning.  There is a tortilla press stall just down the road, but he has brought some over to sell and wrapped them in the white cloth, carrying them in the orange plastic box.  They cost about ten cents each.  I am getting choosier about my tortillas now.  The really good ones are made of corn or wheat, by hand, and cooked right on the grill at the stall.  There is a little tortilleria just around the corner from the birth center.  I guess that would be all I needed for lunch. Am I spoiled yet?

The stalls are filled with local fruits and vegetables, along with some local crafts.  No imported stuff here.  There is a lot to see and I am constantly having to check myself to see I am not staring.  I am totally charmed by the Mexican older women.  I just love their clothing, their quiet and thoughtful demeanor and even their bad teeth.  I can tell that they have led a life of serving.  Each is probably a grandma with children and grandchildren.  I hope that that their families loving care for them. 

The pineapples are a favorite this time of year.  They are really tasty and not too acidic.  Perhaps they are picked when ripe.

Casa Compasiva ready for Grand Opening

Casa Compasiva is ready for their grand opening on February 5^th.  The furniture is in place, the birth rooms ready, and the supply closet is now stocked and organized.  Yesterday we went into downtown Oaxaca to find a place to buy something to organize the instruments and supplies.  We found plastic basket heaven.  All manner of plastic articles, from a baby bath, to toilet plungers, to little cups and dishes, flower pots, about anything a house would need.  We found everything we needed for about 2850.00 pesos.

We had taken the time the day before to pull everything out of the little room and sort it into categories and piles of same stuff.  I had a good time bringing it all together.  Must be the mother in me again.  I like organization, but don’t often take the time to be THAT organized.  I guess that is what I am lacking.  Time.

The floors are all tile, and are easily swept and mopped.  The kitchen now has a working gas stove and a fridge with a freezer.  

The prenatal room is just the right size.  The bed is small, but was actually donated for the birth center by a Dr. who used it for just this purpose.

One of the Christian Mexican woman is very gifted with a paint brush.  She has decorated the walls and about the doors in numerous rooms.  Here are just two of her creations.  On the bigger spaces, she painted a string of flowers and leaves with scripture verses across.

Here are two pictures of the birth rooms.  One is the main room, with the single beds. The room with the double bed is the overflow.  The wonderful thing is that each of these rooms has a good sized bathroom. This seems like the ideal birth center set up.

I can see that the birth center it totally workable and I feel good about the knowledge that the Doulas have absorbed.  Yes, they have a lot to learn, but it will come with time.  Consuela, their retired OB nurse is very medical and gets off on automatic pilot with her way of doing things, but she is readily teachable.  For instance, she is struggling a little bit with the idea that we include the family as a unit in all the prenatal.  She did not think that the birth dad should be in the room with us while we were doing the vitals.  She also did not think that we should be telling the patient what her BP was.

Midwifery is different, we explained.  We include the family together and try to educate the mama about her body and how it works. We help her and give her reasons to eat well, to take care of herself. 

Another issue that came up was, at the first prenatal they had, Consuela counseled the mama not to eat salt so her feet would not swell.  Later, the next morning, we shared with her the “new research” that says that mamas need salt in their diet to taste, to avoid swelling and toxemia.  She received it well, and was very interested in knowing the midwife way of doing things.

She was completely happy to show me how to wrap a sterile instrument pack, with the blue cloth.  Somehow in my midwifery training I missed that.  Now I know.  She showed me about 10 times and talked for about 10 minutes and sterility and the proper care of instruments.  I think I could learn a lot from her!

She will be an excellent teacher of the young aspiring midwives that come to Casa Compasive from the pueblos.  I just wish she spoke English.

The country side around me

On the way to Mitla, the rural town where I am staying, from Oaxaca the big city, I snapped a few pictures of the country side.  There is so much to see, that often I forget to take a pictures.  Some of the most fantastic ones I miss, because the car is moving too fast and I am not quick enough.

The main crop here is a Mezcal ingredient. It is planted in big fields, grown to about the size of 6 feet, harvested, the big leaves hacked off, ground up, fermented and turned into Tequila. (or something similar).

The mountains are rolling, but rising sharply from the valley bottom.  Little trails lead from the bottom to the top of the biggest ones.  These are the trails that are used (not so much anymore) for spiritual pilgrimages and to sacrifice animals to different gods.  There is still a real mix of Catholicism and Spiritualism especially surrounding the dead.

I had to laugh at one of the booths at the local Mitla street fair that has been going on for 2 weeks now.  It is a use a machine gun to shoot-the-guy type hut, with a gross looking skeleton, dressed in shaggy army type garb, with a hideous face and disgusting demon like eyes. OR you can shoot at Michael Jackson.  Those are the two choices.  I guess that tells you what they think of him.

Food in Oaxaca

My expectations for good tasting food in Oaxaca has been granted above and beyond.  Their main sources of protein are eggs, chicken and beans, goat is a favorite,with some pork and beef.  Meat is expensive, but eggs are fairly cheap.  Cheaper cuts can be purchased at the open air market.  I know it's fresh, because there is no refrigeration and it had to have been killed that morning to last!
Most of the poorer native women were buying just a pile of chicken feet or innards or a leg.  Chicken feet are very, very flavorful, so I am sure they got their money's worth.

Not quite brave enough to do the chicken feet thing, at the market, I purchased a chicken breast for 70 pesos.  That was expensive and got Gringo price. I pointed to the piece I wanted and she hauled out of a bucket beside her a whole chicken, gutted and de-feathered, with feet and head attached to hack off the middle breast part.  With a big cleaver, she whacked, whacked, whacked it apart, skinned it and then handed it to me in a plastic baggie.  Good enough.

I also purchased from various vendors some fresh tomatoes, an onion, jalapeno peppers, avocados, garlic, tiny bananas, a big ripe papaya, little limes, and some fresh tangerines.  I would walk up to a vendor with her wares laid out on a cloth on the ground or table. Each item in a pile and pick what I wanted, hand it to her and she would bag it.  Or I would point and she would start loading up the bag. Obvious disappointment clouded the eyes of on vendor when I only wanted 2 little jalapenos. They came in a big 3 lb. bag and I was not about to inject that many! 

The homemade tortilla lady was a quiet soul, with a large metal bin of freshly made, medium sized corn  ones, that were all being kept warm with a small fire below creating a steamer of sorts. They were not the typical white ones we see in the packages at home.  They were made from maize flour, ground and made into the dough and put through the tortilla machine that morning.  They were very good.  She grabbed a stack of around 2 kilos, wrapped it twice in rose colored paper, then handed it to me.  They were cheap.  They stayed warm all the way home and I got one out of the wrapper as soon as I could and ate it with nothing on it.  Tortillas come in all sizes here.  They are made from corn or wheat, although the whole wheat ones are not white, but brown. The wheat tortillas are chewier and have fantastic flavor.  An native Mexican women (a mother of one of our new Doulas) made some for us last week. These have been my favorite of all.  They were very large,thin,  and obviously hand patted out, not by machine, then cooked on a large flat grill over a fire.  They had a slightly smoky taste, along with an occasional ash piece.

Obviously very annoying to another vendor was my last purchase of one head of garlic. I chose a larger vendor, because all I had left was a large bill and I did not want to leave without garlic in my back pack. I chose the garlic head, handed the bill and then waited with an apologetic smile on my face.  He said something in Spanish and then shook his head, but went to his mother to get change.  Thankfully she had what I needed and was able to royally take advantage of my obvious state of over abundance by charging an absorbent price for the garlic head. Ah well.  Then I caught my skirt on a nail sticking out of a box of potatoes on the ground, and that seemed just reward for my white foolishness by the look on their faces and giggles.

There is certainly an abundance of pastellerias (bakeries) that sell many kinds of sweetish breads.  Nothing is as sweet as the doughnuts or even cinnamon rolls that we get in the states.  These pastries of various sizes and shapes are all made with white flour and many taste like a combination of a roll and a not-so-sweet cookie, with different toppings and slight flavorings of topping or fillings.  I likes the coconut ones and the ones that were more like a turnover. 

The bollios (rolls) are eaten like our loaves of bread are. They are made fresh in the bakery and do not stay soft for very long.  They are great with different fillings.  The most popular fillings are bean and a white, crumbly mild tasting Mexican cheese.  Another one has tomato, beans, chicken and avocado.

The small markets are more expensive, but sell things like milk, eggs, laundry soap, cereal, and such.  I got by nicely by just going there and not going into town to the large grocery store in Oaxaca.  That in combination with the Saturday market.  The little stores do not sell meat or cheese or any fresh items.  They do sell yogurt, which is a big favorite.  LaLa brand of milk and yogurt is the most popular.  The strawberry yogurt I got (my only choice)actually wasn't too sweet and had real strawberries of good size in it.  It was the typical bright artificial bright pink color, but it was good.  I am sure that it wasn't full of the live yogurt bacteria that I normally look for at home.

I have really enjoyed the lunches that we have been eating at the birth center each day.  They have mostly been tostadas, round crispy discs or boillios that are spread with beans and then different things like tomatoes, cheese, avacado, chicken.  The winner of the bean recipe was yesterday.  The retired OB nurse made the beans and brought them to share for lunch.  They were the usual black beans, cooked and made into a no-lump slurry. They are flavored with a little salt and she cooked the beans with avocado leaves that made a slightly anise flavor.

I also enjoyed a green tomatillo sauce with small patties of cooked, shredded then fried pork.  I can tell it was probably a cheaper cut of pork with what it looked like inside, but the flavor was good.

Lila has also treated us to great meals each night. She bemoans the fact that she doesn't have the ingredients she'd like, but then produces great meals out of the "not much".  They are simple meals, but great tasting.  The other night she made a special meal for one of the teens that was leaving for school in the states.  She made the same sort of meal we would get down in Mitla at Taco Brown's (the name of their favorite taco place).  It was a savory meat, beef, filling, to be tucked into fresh tortillas along with different things like guacamole, fresh salsa, lime.  She cut up a fresh pineapple and had made a chocolate cake.  What a feast!  Unfortunately the guest of honor did not show up until much later.  We enjoyed the meal anyway.

Last night I used the last of my fresh chicken from the market.  I used 1/2 white onion, a couple cloves of garlic and sauteed them along with 1 jalapeno at the end.  I cut the chicken up in small pieces and sprinkled curry powder, the local chili powder with some sea salt.  I put a few tablespoons of corn starch in with the chicken and coated the chicken pieces.  Then I sauteed the chicken in some olive oil until brown and crispy.  I added a cup pf chicken broth and let it cook down until it made a thick sauce like.  I added back the onions and turned off the propane stove.

The rice I had started was just finished perfectly at about the same time as the chicken was done.  So I piled a nice mound of rice in my bowl, then topped the rice with my chicken, peeled a tangerine and called it dinner.  Oh, yes, a perfectly ripe avocado for dessert.  Actually I ate a chocolate covered coffee bean for desert. I had not tried one before and it was pretty good. Sort of crunchy and very coffeey. (obviously).

About the coffee.  They sort and roast their own coffee beans here.  It is sort of a ritual that the kids do outside at the table chatting away.  Then it is roasted in hot spinner that keeps the beans turning so they don't burn.  The fresh coffee is made quite strong and has a slight cinnamon flavor. Very Mexican.  The hot chocolate I liked best was purchased downtown at a Italian Coffee shop.  It is not too sweet and has a good solid chocolate taste that means business, but not overpowering. If you like chocolate and cream, you'd love this version.

Looking at Oaxaca

Oaxaca is very rural Mexican.  I am sure that there are even more rural areas that are fascinating in culture and social life.  But this is the real deal. No Americanized show here.  Even the majority of tourists are Mexican people in buses taking a pilgrimage of some sort.  Those buses have flower wreaths on the front and maybe a characterization or picture of the saint they are honoring.

The air is clean, except for the faint smell of cooking fires.  There is at least always a small breeze.  There is no rain from about October to May. Only weird surprise showers that don't last.  The mountains rise quickly and are rounded, bare and hide thousands of memories, ruins and history.

The rains start in May.  There are flowers if I look closely.  Here are some of my favorites.

Oaxaca is the land of living fences.  This is one that is just outside my front door.  They are sturdy and made of cactus.  The animals leave them alone.  I have decided that the chickenwire fences are all about keeping the stray dogs out.  There a lot of them.  Medium sized, with scruffy hair.  Some are actually cute.  They are not mean, but keep to themselves.  Any mean ones are poisoned.  (Or so they say.)

 

The city is tucked at the base of a mountain and consists small, concrete homes, weathered and painted bright colors.  Some of them are hundreds of years old.  The ancient ruins are still present in Oaxaca.  Hundreds of years ago, the Catholics came and torn down the temple.  They built the Catholic church out of the stones that the temple was made from, so that they Indians would still perceive the Catholic church sacred.

More colaborating with the doctors and working out details

Today found us hashing out the details of necessary labs, transport to hospital and how to locate a birth center friendly doctor, what to order for birth kits and about certain health conditions that make a mom not a good birth center candidate.  Whew!  That is a lot to cover in one morning. Communication was via an interpreter named Google Translator.  Thankfully, one of the doctors speaks a bit of English, with my little bit of Spanish.  She also reads medical English. She cannot converse in conversation, but could read my protocols with some help. They were absolutely thrilled with the Protocols Dr. Camber and I hammered out this last year.  They were like gold to them.

Conversation goes slowly, but that is not necessarily a bad thing for me, as I talk too fast anyway.  I think that they were happy that we were going to be honoring a good set of protocols that were practical (They kept called them that.)

There are actually a lot of differences in the way they practice here in Oaxaca.  It is all about what can be financially afforded.  Social health care provides the bare minimum and that does not include things like glucose screening unless you are spilling sugar in your urine. It also does not include blanket antibody screening, unless you are already proven negative in blood type.  They are not terribly concerned about future pregnancies.  Just keeping you alive for this one.

They also do not test AT ALL for Group B Strep.  Not at the beginning or at the end of the pregnancy.  Not an issue.  They just watch baby in the nursery for a day or two.

The hosptials are very ready to do a c-section and many of the women do not know why they have to get one.  Several of the women I have interviewed or listen to talk, say that the doctor just told them, "Your baby will die if you do not get a c-section."  So they did.  Now they are angry, sad, grieving, remorseful, and adamant that something should be done to warn other women.

There may be legitimate reasons for some women to get c-sections, but honestly, 85% is a huge number of women unable to vaginally give birth.  The women here do not feel that it is because of the inability to give birth, but that doctors are very overworked and it is more expedient to plan the c-section, that to wait for a mom to dilate to 10.  It is not an issue of being sued.  No one sues here. (Or at least very few, and certainly not the medical system.  They are no lawyers angling for damaged parties here.).  It is simply a matter of convenience.


We got our first patient today!  The woman is 24 weeks along.  She came with her husband.  They do not drive, so someone went to pick them up.  They live in a 2 room very small hut/house.  One room, plus a cooking room.  This is their first baby.  They are a Christian family that attend a baptist church  along with our Mexican retired OB nurse who is volunteering her time at Casa Compasiva.

She was totally enamored with the teaching aids.  She had never seen a picture of a baby inside a mom, with the placenta and all.  She was fascinated and you could see the lights of understanding come on.  It was totally sweet.

Lila did a great job with the prenatal and the Mexican Doulas (Birth Assistants) were all fairly confident with all the role playing we have done all week.  Nothing like a real live patient to get all the bugs worked out of the system.  I think everyone felt good about how it went.  The pregnant woman was very impressed with all the personalized attention and teaching.  She happily paid her down payment of 50 pesos and said she'd be back in 2 weeks.

I have been enjoying skyping with my family.  It has made the evenings full of fun here in my room.  This evening I took my computer into the kitchen while I made Curry Chicken and ShaHannah took her computer into the living room on the floor where she was putting together a puzzle.  We watched each other and talked for about a 1/2 hour.  I think it helps both of us.

I leave on Sunday for home.   I will be taking a piece of Oaxaca with me in my heart and know that with satisfaction, I have worked successfully in sharing midwifery (and the love of Christ) with about 15 women.