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. 

Transport Plan

Although we like to hope for those transports never to happen, they do.  So our job yesterday was to go downtown, buy a stretcher, and work out how to get a pregnant mama down the stairs to a vehicle and into it.

Along with some hilarious moments, we did get a real eye opener to what it might be like, minus the blood, grave concern, fear and adrenaline that comes with emergencies.

I was the mama, and tried to keep myself as limp and possible to let them see the real deal and some of the issues of working with someone who is not conscience.

It was a relief to find that the stretcher, complete with mama; fit through the doorways and down the stairs, because rearranging the whole birth room to accommodate an emergency is important.

Finding a way to make it all work is part of organizing the whole picture.  The next project will be rearranging the supply closet to get all the right tools, disposables, equipment and linens in their logical places,  There are not Kmarts or a Walmart just round the corner, so finding baskets, boxes or containers to hold all the items is more of a challenge.  Not sure what we are going to do about that yet.

Balancing the need for an authority structure, with education of both the midwives and the birth assistants has been pretty straight forward so far.  Lila is the midwife and I am her support/education source.  She does a wonderful job at maintaining order and keeping the right perspective.  It involves keeping the girls busy, making sure the jobs are all done satisfactorily, making the birth assistants feel like they are doing an important work, procuring a good workable board of directors that both she and the Mexican government will respect.  She also is able to exude a confidence level that even though she doesn't necessarily feel competent in the midwife task yet, she seems so to the Mexican people.  That is so important.

Making it all work

Monday was a day of meeting with the Doctors and finding out what they are comfortable with.  They are both very trusting of our midwife skills and open to having us practice with little supervision.  They are not really concerned about being sued or loosing their license.  It doesn't happen very often here in Oaxaca and a Dr. has to do something very heinous to loose their license.

So, we communicated with halting English and Spanish, a translator and the google translator.  We accomplished what we needed to, made a list of things to do before Wednesday and we will meet again on Wednesday.

Today we are working on our transport options.  As the birth rooms are upstairs, we are going into town to look for a stretcher to use to get a mama down to a waiting vehicle.  The stairs are narrow and long, but the doorway seems to be large enough.  We'll get the stretcher, put me on it, and then have the girls try to navigate it down the stairs.  We may need to move the whole birth center down stairs.  This would be really hard, as they have set it up so beautifully as it is.  Still, the moto I encouraged them to consider is be prepared for the worst, and hope for the best.

We got the protocols for Casa Compasiva printed off finally and they are ready for the Dr.s to go over them.  I copied my Montana protocols and Oaxacaized them as much as I understood. I am sure they will need to be revised further as time goes on.

The sunsets are very beautiful.  Maybe because of all the dust.  It is easy to look at the ruins on the opposite side of the hills and look at the sky and think what it was like a thousand years ago, when the Indians were living here and no one else.  The sunset was the same.  The wind, ever present in some form, the cactus and scrub brush the hills, the dirt. All that was the same.

I walked 2 kilometers in the fast approaching dusk last night, getting to the Quezada's home just as it was dark.  The city comes alive at this time, instead of closing up.  All the shop doors are open and people are walking along the roads.  The road to the Quezada's is dirt, of course, with deep ridges from last years heavy rains.  The rains will start again in another month.  It is pure mud then, I am sure, as the ground is silty.  Actually it is a sandy silt mix with lots of rocks popping up.

The birds are chattering excitedly as the morning sun is just about to peep over the mountain.  They roost in the eves under my window. The males are pretty red birds that if you are quick, you can see them.  I have only successfully captured one on camera from a distance.  If you walk by, they fly out and scatter to the nearby trees. They are about the size of sparrows.   The larger white birds with spindly legs are are cow-poop pickers.  They are actually very pretty and look like something you'd find on the coast.

A hard decision today

I am with an organization called Missionary  Midwives.  Kara Rowley is the person in charge of the page. She contacted me asking if I would be interested in filling in for a women in Oaxaca, who was opening a birth center.  The midwife that was going to be there to start it had to go back to the states quickly.

Their opening day was on January 17th.  I have spent the last week training both the missionary women and Mexican Indian women the basics in vitals, prenatals skills, NNR, and emergency birth stuff.  It is all new to them, although some have already given birth. They have worked very hard and are exreemly appreciative.

The c-section rate is 95% and the Oaxacan women are despairing.  They want so much to have a good normal, vaginal birth and to give birth back to the families.  I have spent a lot of time talking with the Mexican women, via a translator.  My Spanish is O.K., but these women come from various Indian tribes and I am not catching it.  So I have gotten pretty good at working with a translator.  It was tiring at first. 

Today we had to make a hard decision. A 15 yr old girl in labor wanted to birth at the center.  She was raped and kicked out of her home. She was being taken care of by an older 78 midwife who agreed to care for her prenatally, but not the birth.  So, this afternoon, at 8 cm, she was looking for a place to have her baby.  I had to tell them to go to the hospital, because her risk factors were too many.  I know she was disappointed.  They are treated so horribly at the hospital here.

Outside of helping an older woman with blood sugar testing this afternoon, I have not done much medical stuff.  I am happy to just teach the basics to the women coming to train as birth assistants.

Next week we are organizing all the new supplies donated and purchased.  We desperately need shelving, but will need to wait for it to be built. The logistics of getting this birth center up and going rests mostly on Lila Quezada.  She is doing a fabulous job and speaks very, very good native Mexican.

The Native Indian women are very diligent in their learning.

Here is one of my favorite pictures.
Sheraya and I are staying in a house that we share with 2 of the teachers in their twenties.  We just got hot water yesterday, so I was very glad to get a shower. A few days ago I did wash my hair in the little sink they have, but the water comes only a trickle.  It was the best trickle I have felt for a long time, even though it was coolish.

There have been an excellent turnout on all the days I have been teaching.  More and more are coming each day. (15) Today we worked on review of taking vitals, going through a prenatal scenario, NNR and a dramatization of a mom in labor and coaching her.  A doula from the states arrived yesterday.  She and I enacted quite the show, complete with sound effects. I had a pillow under my shirt and came in the room about 8 centimeters, and roaring toward the finish line.  Doing it was almost as fun as watching their faces!

The little town of Mitla that we are staying in is very safe.  They are having their yearly town party, celebration or what ever, sort of like our fair at home. It is starting tomorrow.  Lots of very loud fireworks.  Each neighborhood has an annual celebration.  Some of them are very dramatic or fancy, with the neighbors parading with music, flowers, and loud things going boom.

My favorite part in the evening, is the shepherd bringing home his herd of village goats.  Every night I walk 2 kilometers to eat and that is also the time he is bringing home the flock from the hills.  Mitla is actually a valley, with high hills around 360 degrees. (Well, not as high as our hills).  I took a picture tonight.  Hope he didn't mind.

Yesterday, I went over NNR, shock treatment and worse case senarios.  I was afraid I scared them all away.  It was pretty sobering.  But this morning, there they all were, smiling and giving welcome kisses on the cheeks.  And even more are coming.

Today we did review of prenatal skills, including vitals.  We also did postpartum care of mom and baby.  A Doula from Oregon arrived last night, so she and I did a very dramatic reenactment of a mom in labor.  Complete with sound effects.  I came in the door at about 8 centimeters and roaring toward the finish line.  I make lots of "out-of-control" sort of emotions, with the Doula doing a great job bringing me back to focus.  Another expereinced homeschooling mom that has had 8 is there helping out.  She was the midwife, and did a great job catching the baby... which we could not find at the last minute and ended up using a water bottle instead.  Yeah!  Baby is born! My throat hurts from pushing so hard.  My own fault for being so dramatic.

This evening we had dinner and there was just enough.  We'll there was enough, because those who were full, let others finish what they did not want off their plates.   We had a meat stew, with paan (bread) a flat bread baked by a native woman that was whole wheat and very flavorful.  Very chewy. It was good dipped in the stew.  We also had mashed potatoes (yes they have a lot of potatoes here). cauliflower and a custard make by the hostess.  It was good.

I am getting a snap shot view of the lives of the linguistic missionaries here.  They are a fairly large group here in Mitla, with families scattered into the hills learning and translating the Bible into the many different tribal languages of the natives living in the area.  Some missionary families go into the mountains for weeks at a time and leave their children here in Mitla, as they work at the language translation.  This is so that the children can get schooling.

The Mexican that is spoken here is sort of different than the Texas Spanish.  I think that the twang is the native Indian versions and harder for me to understand.  Some are easier than others.  I think I am getting about 1/3 of what is spoken to me.  Most of the time.

The native Indian midwives-to-be/Doulas work very hard and take their classes very seriously.  They write well and are constantly taking notes.  One of the women is a mom who has had two c-sections.  Her mother is a midwife in Southern Mexico.  The Older OB nurse that comes is just fascinated with our perspective.  The one MD that is coming, her mother was a nurse midwife and lives right next to where I am staying.  Her dad was a surgeon.  Some how we have all found one another, through the grace of God and are here together with a vision of making this birth center a house of compassion.

This is a woman that I really have enjoyed getting to know.  She has a real heart for helping other nationals and is very ready to jump right in.  She is steady and has a good understanding of birth already.

Our busy days

Our busy days have been productive.  We have had a good turn out on all days. There is so much to teach and so small amount of time.  I am comforted to know that there will be lots of days ahead to review and go over and over the material for the ladies.

In all the excitement, there has been an interested undercurrent of despair with several of the ladies regarding the helpless tide of unnecessary c-sections here in Oaxaca and in all of Mexico.

Marked sorrow lines the face of one national women in particular.  She mourns the loss of a chance to birth normally.  The vertical uterine scar is often used here many times, so some women feel that they have been doubly cheated from a second chance at a vaginal birth.

In the states, the new trend is allowing at least a trial of labor and hopefully a VBAC.  The women here in Mexico feel like the doctors are not wanting to do anymore vaginal births.  They are using any excuse, made up or imagined, to coheres a woman in labor to consent to a surgical birth.  They are rough and unkind to the women.

So, the idea of kindness, hospitality at the birth center and gentle birth is very attractive.  They want to tell all their friends.  They all wish they could have their babies this way.  This is the way is used to be.

A woman physician who feels strongly about keeping the traditions of natural birth alive, is supporting Casa Compasiva and is working 2 days a week doing prenatals and then the births.  She is open to the midwife ways and learning the different philosophies behind creating a natural, empowering birth that is safe and positive.

Day 1 – This was into the second week of training that I arrived.  They were working on taking blood pressure skills when I walked into the room.  Within a ½ hour of arriving, I was teaching via an interpreter the different ways of midwives and the medical system.

Day 2 – Luggage arrives! Just in the absolute moment I needed my learning props.  The pelvis and doll helped me explain how a baby is born and the different positioning.  We also go though the different positions for birth, comfort measures and their job as a Doula.  I am getting very good at acting out birth scenes.

Day 3 – Prenatal skills.  We do a lot of role playing.  I am understanding about 1/3 of what is being spoken, so I can usually get the gist of the conversation. The sobering part of the day was teaching emergency skills with NNR and shock treatment.  There is nothing like talking about the scary side to make births sound just a little bit risky. 

Casa Compasiva in action!

Sheraya and I left Mexico City on our last leg of the journey to Oaxaca.  The bumpy ride from San Fransisco to Mexico City was the only rough flight.  I had fallen asleep across 3 seats.  Dead asleep.  The bucking plane jerked me awake and I sat up, not remembering where I was, or what was going on.  After recovering from the shakes and not just a little bit worried that our plane was slowing down way too much to avoid the knocking around, I drowsily waited until we arrived.
We had 3 hours after getting off the plane in Mexico City to find our gate to Oaxaca.  It took almost all of that.  Our luggage had not followed us.  We got a missing luggage request form all filled out and just then Ellie Quazada was there to pick us up.
We arrived at Casa Compasive ready to speak and work at understanding the conversations.
Starting out with taking BP, learning the take pulse and temperature, 3 days ago, the 8 ladies were ready to move on to more indepth prenatal and pregnancy information.

  We talked about finding due dates, taking medical histories, role played a bit and fave a much needed break for Lila, who had been sharing herself for several days.

The girls were all very interested and found that sharing with one another helped them to retain information.

In attendance was Lila and her daughter, several women from the area that were already serving as missionaries.  There was also the MD who is supporting the center, a OB nurse and another nurse in attendance, along with me as a midwife and Sheraya.

I left about 3:00 with Lila to go to her home to use the internet, get subjects to study tomorrow and to talk with Tom.

We are now staying at the home of 2 of the teachers that teach at the Christian school nearby.

The area is Mitla, and is 45 minutes from the center.

We're On Our Way to Oaxaca....!

Our early start got us to the Spokane Airport within 2 minutes of being too late get on the international flight....
First I was stopped in Sandpoint by a policeman for speeding... 46 in a 35.  Then I got a parking ticket at the airport for leaving my car unattended for literally 1 minute as I walked Sheraya into the airport door with the heavy suitcases.  Then when I parked the car in the outside parking lot, the shuttle left without me.  I waited an extra 10 minutes until the shuttle bus arrived. We literally ran to security, got through quickly (they must have gotten a clue as I was hustling Sheraya and I though jamming my coat, computer and things into a box and shoving it toward the x-ray machine.

Anyway, we arrived just as they were starting to load the plane.  It was a good flight. Until we arrived close to San Fransisco.  They were enclosed in fog and would not let us land. We circled for about an hour and then had to re-route to Fresno to get more fuel.  We then boarded the plane again and landed in San Fransisco.. but the plane to Houston had already departed.

Sorry, no flights to Oaxaca from Houston until Thursday or Friday.  So, we opted to fly into Mexico City, 6 hours away from Oaxaca and take a bus or flight.  So, we are now waiting until 11:30PM tonight and flying to Mexico City arriving at 5:00AM and then taking a Viva Aero Bus at 8:00 AM, arriving in Oaxaca at 8:45 AM.