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.