Who needs a Scale Anyway?

Interesting discovery this week on a newborn exam … the local way of measuring growth…strings around each of the extremities and waist to gauge weight gain. I was impressed. This information is passed down from woman to woman, from grannies to new moms, as all great things seem to be.

Meet Martin

Martin on the left. Stewart on the right, whom you will meet later. Always, always fascinated with my camera.

Meet Martin. He is our grounds man who comes on the weekend to tend to the yard, clean the paths from weeds, cut the grass – *totally with a machete*, gardens and helps me build flower beds :). He is there as the sun rises on both Saturday and Sunday, already working when by the time I wake up at 8 a.m. He works his whole holiday break. All of this and he is only 17 years old. He is working to pay for his school fees because he has 3 other brothers and sisters who also are in school. School fees cost about $75a year which is prohibitive for many students to attend. His parents are farmers and work hard just to make ends meet.

He decided as a young boy that he wanted to become a doctor. He isn't sure where his dream came from as all of his family lives in a small village and no one has directly influenced him with medicine. "I just always knew," he tells me. This will require him to have 3 more years of school in the village, pass his exams and then move to a bigger city to attend a boarding medical school attached to the hospital. When talking to him about his future and dreams it was evident to me the depth of this boy's soul, or as I aptly call it: he is an old soul. Much wiser than his years and primed to make a true impact for his family and community.

He is soft-spoken, quite and shy to use his English, although it is much better than he lets on. English is taught in school here, but only as "that" subject. This means that the other subjects are taught in the local language, of which there are many in Uganda. Without someone to practice English with, it is the same as any foreign language (despite it being the official language of Uganda) and harder to learn well. I, therefore, notice right off when someone has very good English and lives out here in the village. It is different than city life where more English is spoken. To me, it shows they have worked hard and studied for many years. Martin is one of them. 

Meet Martin. He is a pretty cool kid, or rather adult -- as most 17 year olds here are married with kids. He is an exception. 

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In Honor of Logan: TREES

I write this post while chomping on a fresh guava. I don’t even know if I’ve ever had a guava before now…

 
 I am sitting here thinking that the innocence of childhood always makes me smile ...

Logan, my 6 year old, cousin is following my Ugandan adventure

along with his mother.

always a fan of children being exposed to the other cultures, languages and beliefs 

this does nothing short of *thrill* me to death --

that a 6 year old mind might be molded through my experiences. 

His question to me was "Are there any pine trees in Africa?"

Seeing that he lives in Mississippi where pine trees are plentiful 

it seemed a well thought out question and assessment. 

I was impressed he even thought to ask!

But the answer is No. I have seen none here in Uganda.

Instead, there are plenty of these ...

banana, guava, lemon, passionfruit, papaya, mango

all of which grow right outside my hut. 

It is beyond wonderful to say the least. 

*Parents: It might be a good idea to discuss these exotic fruits with your child and then go shopping for them to introduce new flavors to their diet, as well as begin age appropriate discussions about how food travels around the world to get to your plate and what this means for the planet, food quality and price. 

Passionfruit flower. No wonder they are so divine; they come from this!!

Passionfruit flower just opening.

Passionfruit is left on the tree until they turn slightly yellow. They shrivel and brown on the shelf.

Guava tree that is harvesting right now!

Guava if you've never seen one.

Beautiful banana tree. Check out the huge beautiful flower at the bottom.

Fields of banana trees surrounding our birth center.

Brenda

Pretty grainy because of the light filtering in. This was our crew, including the child that started wailing when she was watching the shoulder dystocia...kids are so perceptive. Oddly enough, the one holding the baby is not the mother. She is the one in the white dress. Her name is Susan.

It was a 5 day labor for a woman who didn't speak the local dialect. Madi >>  Acholi >> English >> Acholi >> Madi in everything that was said. Initially I thought it might be twins (Which are often surprise twins in the end) because I found two heartbeats. There are no such thing as Ultrasounds here to let me know before. Plus, it is a local belief that the mother should not know if she is having twins before the labor because it means that her delivery will go smoothly. Her big belly was just so big!

She was exhausted by the end and could barely move to the floor where she wanted to deliver on all fours. Her water ruptured all over the floor and it was an enormous amount. The baby was very big and had a shoulder dystocia, meaning the shoulder get stuck after the head delivers. This is an emergency and requires the mother to listen and follow direct instructions to get the baby out. This was not happening. She went into "Labor Land", or so it has been called, and was not fully with us. I believe that rationale thinking sometimes is lost during active stages and pushing for the mother. This is how it was...things got hectic, the cord then snapped off the placenta, kids were screaming ...... it was a good birth.

Traditional Birth Attendant, Catherine, with baby Brenda

The next morning she smiled up at me her beautiful white smile and said she wanted to name the baby after me to remember how much I helped her. Steph-a-nie, I spoke out slowly a few times. With difficulty in the pronunciation for the mother-in-law, it was decided to forgo my name and name the baby the name of my mother. Brenda. This was much easier and they all smiled and clapped with delight.

So, Mom...this one is for you. Lots of Love from Uganda.

Breast is Best.

TIME magazine cover?

Breast is Best.

This has been told to us by both nature and plenty of research and is pretty much irrefutable. Yes, irrefutable! Plenty of mothers have their spin on why this isn’t the case, but it is - hands down.

Being a Midwife, breasts and breast milk is part of my domain now. As weird as it might sound to some, I think about it and pay attention to it way more than any single girl should. I talk a lot about it to mothers and spend a lot of time making sure babies are latching, sucking and feeding often. It seems that a lot of what I do has a lot to do with someone else’s breasts. It is an interesting reality. :)

Breastfeeding just makes me smile. This is for lots of reasons … the numerous health benefits for both the mother and baby – lowered breast cancer rates, decreased ear infections, increased lifetime immunity, weight loss for the mother, convenience, oxytocin which increases bonding, decrease in bleeding, appropriate weight gain for the baby, less allergies, less GERD, increased gut health, birth control!, increased IQ…..and the list goes on …. Plus, it comes in pretty attractive dispensers, it never spoils, and is always at the right temperature!

 

I’m a fan.

In the US, I often run into mothers who believe that 6 months is the magic number. It is a hard line to tow. One the one hand, 6 months is better than no months and I am fully supportive. On the other hand, 6 months is way lower than any international recommendation I’ve ever known and is pitiful when compared to what could/should happen. What is the best response?

If I had better internet here to look up concrete stats and facts, I would. The numbers never lie and it is widely known that the US falls far behind in not only the rates of breastfeeders, but also how long babies are breastfed for. It has always been my understanding that the WHO recommends 1 year of breastfeeding (adding in solid food as appropriate simultaneously); however, because the US had such poor rates to begin with, bringing mothers who breastfed for 2-3 months up to 1 year was a big stretch. This caused the American Academy of Pediatrics to lower the recommendation to 6 months to accommodate the effort it would take to reach the goal. This is where the false security of 6 months initiated.

This blog is not the space to go into all the ways that our government (with maternity leave policies), our country, our culture and our mothers could all affect better breastfeeding and WHY in the US it is how it is. Not to mention the trickle on affects from a public health stance of more breastfed babies. I am only throwing it out there to inform and offer new seeds of thoughts to those that might consider the American way as the best – or only – way. 

I understand all over the reasons why breastfeeding for mothers that work is an effort, sometimes ALOT of effort; really, I do understand. However, there is only one chance at this opportunity to affect the rest of your child's life and this seems to need priority over any inconvenience or effort it might mean. Is this a tough approach? I don't think so. It seems Good Parenting 101 to me.

Hung in the maternity ward at the hospital. Can you imagine the same in our hospitals?

Here in Uganda breasts and breastfeeding is everywhere. Kids are breastfed for 2-3 years, eating too, of course, but always having access to their Mom. Tandem feeding (a 3 year old and a newborn) is common and no shame in exposing breasts out in public is the result. Moms breastfeed in church, on buses, when walking, during eating … there is no such thing as covering up with the special blanket mothers tend to use at home. It is as normal as the pregnancy itself. I must admit, it is a nice change that no one bats an eye. Plus, hardly any women here wear bras so the whole process is very simple.  

I have yet to encounter anyone with latch problems or sore nipples. NO ONE uses a bottle or pacifier or nipple shields or Lanolin crème. Why, then, I wonder are all of these non-issues here issues at home? I could go into all of the reasons I believe this to be true, but suffice it to say ……I believe when there is a will there is a way. Breast is always the best and I will always encourage Mom’s to feed for as long as possible, even when if it means a lot of effort. The results *far* outweigh the costs.

naptime.

Guest Post: Acholi Women by Sarah Harper

Acholi women 

strong, shy, timid with men but fierce with one another

An unspoken rule that they are beneath men

Their place is in the kitchen 

by the fire

Their role is to bear children 

to carry on their family legacy through their little ones

Their survival to work the fields

Do they have rights? Could they refuse?

Must they always acquiesce to the man?

Like stacking firewood...one child after another

They are the pillars of this culture

the foundation of the community

They endure what they must because it is their life

It has been taught to them from a young age

Woven into the fabric of their thinking

Without them the crops are not harvested

the coals not stirred 

the posha not made

Babies to be nursed

tied to their backs 

while beans boil

and rice simmers...

*Sarah is one of the students here with us. Baby catcher + Talented Writer. Budding Poet discovered in Africa?

 

Flower Children

Gladys, Rose and I ... postpartum.

  ...and so it goes. I have inadvertently become the Bestower-of-Names around here.

I spent yesterday digging a flower garden and seeding it with some seeds I found in the storage room. Under the African sun (not Tuscan!), with kids pointing and laughing at the white woman with the hoe, I turned over the earth, fenced it with some old bamboo and planted what – I hope to be - a beautiful mixed flower garden in a few months. It is the rainy season so maybe sooner? Martin, the 17 yo grounds man, was such a big help. Together we created a masterpiece! Him, with his panga (machete) cutting twine, showing me how to chop bamboo and till the earth (no tillers here!) with the hoe, I could feel my green thumbs were growing greener by the second. Loved it!

Martin & I so proud of our work!

In honor of my connection that day with birthing and flower gardening, I decided to ride the flower theme and name "my" second child “Rose”. Poppy then Rose … and I’m already thinking of naming the next Daisy…if I am asked again.

Earlier that morning, about 7 am, Gladys arrived on the back of a boda boda (motorcycle) along with 2 others sandwiching her, the driver and her attendant. Every mom brings with her a family member, usually the mother-in-law, to be with her during and after labor to cook and clean and simply be available so that the mom can rest. They bring with them clothes, buckets, blankets, food, firewood, soap, clothes …. All stuffed into a round pan tied with a blanket by the four corners. It is pretty impressive.

Gladys was clearly in active labor and was a complete champ to have ridden on the back of a motorcycle with strong contractions. Can you imagine?? It is just the way of life here and no one complains. We are so coddled at home!

I had just woken up and was coming out of the (composting!) latrine when she wheeled up to the birth center. Grabbing my sarong to throw on as a skirt over my T-shirt  that I had slept in, I rushed over in time to help her off the back of the bike and get her inside. She had that *look* that I’ve come to be familiar with … the look of a completely dilated cervix and low head. The baby was coming.

Within 20 minutes the baby was skin to skin on her chest and she was laid back breathing heavy with eyes closed. She had escaped to “Labor Land”, as one of my professors called it. For those of you who have never witnessed or experienced childbirth, there is this special moment between baby being born and mother closing her eyes and coming back to the present moment. It is a helluva lot of hard work and the mom’s body and mind just need a quick rest before engaging with the infant. I imagine what it must feel like to summit a mountain and require a few moments of leaning over resting hands on knees taking several deep breaths before savoring the bliss and achievement. Having never birthed a baby myself, I can only assume…but after witnessing the process over and over, most woman drift off before coming back. I have learned to give them their space.

Little Rose was born and she and her Mom slept the rest of the day … while simultaneously having her postpartum hemorrhage managed!…Did you know that postpartum hemorrhage is what kills most woman around the world? This is the heart of the need for more skilled birth attendants around the world. Midwives answer this call. Not that I want to become preachy, but it is important to know that most births and labor are normal; the body knows what it is doing and women’s bodies are born to birth (another blog post maybe on how fascinating this process is and how proud I am to be a woman with this capability!). Midwives are trained to manage normal births as well as normal complications; yes some complications can easily be handled by a skilled attendant. It does not require a hospital, nor a doctor. Obstetricians are trained in surgery and abnormals and, in my opinion, that is what they are good at. The two offer a stark contrast of trainings and mindset surrounding birth. I encourage all of you to read up and research more on your options for your next pregnancy ……. And, of course, I will always be in support of every woman deserving Midwifery care.   

The Circle of Life

It has been a week full of death, funeral rights, burials and sadness. There have been 2 fetal deaths at the birth center plus our kitten – which I simply adored. *sadness* I sometimes can’t believe I am privy to being so intimately involved in these moments in people’s lives - the moments that they remember forever. Births are one; deaths are another. After much experience with death, dying, grief and loss as an ICU Nurse, in so many words, this isn’t my first rodeo … but somehow babies are different. Or are they?

I ask myself this question often as I try not to impose my Western values onto a culture that has experienced so much loss already. Bad news, pain, grief and hard-living seems to be the way of life here. Bracing myself for the tears, wailing, sadness and depression after these fetal losses (like I would expect at home) …… it simply never came. I learn daily with most women in their prenatal history of the multiple children they have lost. Childhood illnesses and miscarriages being the top two; no one is exempt and everyone has lost not one, but two or three children. It is part of life for these people. They pick up. They move on. And they simply put their head down – no tears – and start over again. It is truly a sight to see. This coupled with the war crimes, families torn apart and massive amount of death the Acholi people have experienced, it is as if the sad gene has not been passed down … or maybe the extra coping gene has.

The family whom I transported into town for the ultrasound to the hospital to confirm their intrauterine fetal demise invited me to their funeral on Wednesday, which was not only an honor but a true gift. Myself, Kate, the other midwife, plus the student involved went along and were treated like special guests. I was stunned by the –literally – royal treatment we were given as guests of honor at the event.

We arrived and the service was held underneath a massive tree near their hut. The entire village showed up in their best dress for those who had it. The wind was steadily from the West and we were covered by the shade of the tree. It started on African time … ie, about 2 hours after we were told … and in that time, people simply relaxed, chatted and offered condolences to the family. I brought along a bouquet of flowers from our garden for the mother tied with a strip of fabric in our stash which I gave to the mother and she held it the whole time. (they looked terrible by the time the African heat took hold x 2-3 hours!)

The mother was from Sudan, so many of her family members traveled across the border and were there (remember, we are only 20 miles away), plus most of the members of this particular village. In total, about 100 people were there. There were 3 preachers who pulled out their robes from their bags once it was time to start and dressed in front of us all. They gave a full church service (I think?) and graveside memorial service under the next big tree over. It was of Catholic faith, so it was a lot of standing and sitting…you know the drill…and just ironically the lead preacher was the husband of my adoptive mother, Rose, whom I wrote about last week. This was quite special and he made sure I realized the connection!

Once we arrived, we were immediately escorted to the chairs lining front and center. In this culture, women sit on mats and men in chairs, so this was a high honor. Shortly after, they deemed it necessary to upgrade us by bringing the *only* couch available out of the nearby hut to under the tree so that we could now sit front and center - more comfortably. Mind you, a few men were sitting in wooden straight-back chairs and everyone else on the ground. We all sat in a semi circle facing the preachers, men on one side and women on the other, joined by the couch of foreign white guests in the center. One of the villagers spoke decent English, so he was asked to stand up and translate for us – the only 3 English speaking guests. Notably, all of the Arabic speakers from Sudan were not granted a translator and faced as much of a foreign language divide as we did. It was beyond kind.

It was a long service. The chickens and roosters meandered in and out of the area, pecking at the ground and occasionally letting out a loud crow, while the dogs lazily rolled around in the dirt amongst the circle. The sun started high in the sky and by the end was at my favorite 5 o’clock slant. The wind blew rustling the leaves in the tree above us. It felt exactly as a funeral should feel ….. minus all the Catholic standing and sitting! Once the service was over, led by the preachers in their white robes, we walked along the dirt paths as a large group singing an Acholi hymn. I joined in with the flow, humming along to the tune. It felt really nice to be included in such a way.

 

We gathered around the burial site, in a field of tall grasses – the burial site and a large circle around it flash burned the day before. Both families were brought to the front PLUS US and each given a wreath made of reed grass to lie on the grave and offer a prayer. When it was our turn, the three of us moved forward lifted our small wreath up to the heavens with a spoken prayer that only we could understand. As another hymn was sung, a small stool at the head of the grave was uncovered as a semi-offering plate and all of the villagers, even the ones in rags and tattered clothing, willingly left money for the family as cultural funeral tradition. Funerals, I learned, are quite an expensive affair because we then returned to our seats under the tree and were fed a full meal. During the service, off to the side, women were cooking in large pots – goat meat, posha (a ground corn gooey mixture that you pinch off a bit to pick up beans and meat), another similar to posha, but made of sorghum and millet flours, beans and …. Very fancy….everyone was offered a bottled soda. Warm. It was very kind. We sat at the front with the other important guests – the preachers and high men of the community.

 

It was special not only from a cultural perspective – observing the funeral and burial rights of the local Acholi culture - but also because they included us as significant members of the service. We were asked to make a speech, introducing our connection to the family and how we felt about what had happened. Through a triple translation, the crowd loved it! Lots of laughs at misunderstood words, accents and our message of thankfulness at being included. It was a divine afternoon.

****

I send all these details to you from a place of humbleness. It struck me so many times on this day...how I would or *we* would treat guests at the funeral service of your first and only child’s death? Think about it…Would I/we go over and beyond to honor and include them, much less treat them as royal guests. It is a convicting thought. Yes, we were the medical providers which somehow unduly seems to take precedent in situations like this, but still, it was an exaggerated effort to thank and honor us. I just hope that I would be so kind in the same situation, although I fear I would not.

This whole story brings me to my final thought: Translation is a funny thing … language is a funny thing … but so fundamental to communication and belonging. Over the years of traveling and with many, many moments of English being spoken when I was in the majority, I feel strongly about the extreme kindness this signifies. So for you, the majority of my readers, the closest example I can gleam from home would be Spanish speakers in the US. I have often heard Americans take the stance that “if they are going to be in the US, they should speak English” and defiantly refusing to speak Spanish, almost indignant (not motivated?) to learn any Spanish themselves. I am bumfuzzled why the ethnocentricity? Because of the controversial immigration laws that sometimes spawns this approach, I accept that it is not a fully equal comparison …….. HOWEVER, in my honor and because you now know that these Acholi people and many others around the world have gone out of their way to speak English to me – when they did not have to – please consider the simply kindness it exudes to simply speak their language. So, I ask, in my honor, consider learning basic Spanish just to be kind.

Little Moments Add up to Big Events

Inside the birth center as she was about to go home.

For those of your following on FB, you've already seen this. It didn’t take me to have my own baby to name a child because I named my very first this week for a rape victim who was clueless when I asked her what she was naming her baby. It had been a long labor with this Mom and I particularly liked her because her English was pretty good and I had thus talked with her quite a lot. She told me she wanted a Western name and wanted me to choose. Ummm?? Poppy, Florence, Eliza and Genevieve are the names I gave her and the first to come to mind. Poppy was what she chose……..so Poppy it was, thanks in no small part to my friend Helen in Australia who recently named her little girl Poppy and I had seen her FB pictures that morning. Ha! I guess it was stuck in my subconscious.This is particularly memorable for me because it was my first birth as an official Certified Nurse-Midwife...who knew I would be naming my first!

We are laughing hysterically in this photo because during all the pictures she wanted to take, she was constantly stroking my breast. Here, breasts are definitely not covered or considered anything sexual like in the West, so it was completely culturally appropriate ... but hilarious nonetheless for Sarah and I. Maybe I should blog about sexuality differences here vs. home....And as an aside, Look at her Bicep!! These women are workhorses!

Also, I was also officially adopted into a village this week by a very wonderful TBA who thought it was horrible that I didn’t have a home here. Rose, my “adoptive mother”, told me I should always have an answer for when people asked me where I was from. It was a very flattering gesture and I was honored. We shared a meal in her house together that she was so very proud to extend to me. It’s the little things, you know … when people have so little but so easily give….I have no excuses in my own life.

Ot Nywal Me Kuc, House of Birth and Peace

 

Birth Center Photo from my front door.

Ot Nywal Me Kuc (House of Birth and Peace, pronounced oat new-wal mee kooch) is a sustainable, solar-powered birth house located in Atiak, Uganda, 20 miles south of the border to south Sudan. The closest hospital is 50 miles away—more than two hours by truck on unpaved roads with plenty of pot-holes in them and a tendency to flood when it rains, turning the road into a river in some places and into mud in others. The clinic has the only ambulance in the region, and it is essential to getting laboring mothers from their homes to the birth center or from the birth center to the hospital in emergent cases.

Ot Nywal Me Kuc is a government approved health center served by traditional Ugandan midwives (sometimes called “traditional birth attendants” or TBAs) and an international team of certified professional midwives, certified nurse midwives, and student midwives. Our staff translators are an essential part of our team, making it possible for international midwives to communicate across the language barrier as we are still in the process of learning Acholi. Most of the mothers who come here are internally displaced, refugee and recently resettled women and families. (see my last blog post)

Three to five women give birth daily at the center, and close to 50 come weekly for antenatal care. Outcomes here are significantly better than the national average. The clinic’s goals to reduce maternal and infant mortality are met through comprehensive, individualized care that is run by the people, for the people.

The birth clinic in Atiak is truly the first of its kind. Holistic and restorative reproductive care is essential to a future of peace in Uganda. The very heart and soul of this project is to teach the local woman to safely serve other woman during birth. This is the sustainability piece and is greatly needed in a place with maternity services that are brutal, inconsistent, far away and understaffed.  We believe in the intent of the project and, most importantly, that by furthering the skills of the local midwives, this project has the heart of sustainable development at its core.

~ adapted from the Site Orientation Handbook, Uganda, Mother Health International

Me washing clothes in my front yard.

Life Here

This birth center is part of a small compound which is comprised of 6 personal thatched roof houses  made in the local style, kitchen area, bio-composting latrines, gardens (both medicinal and food), chicken coop and of course the birth clinic center. Sometimes I forget there is anyone around us since the grass is so tall and the land around us so flat. Right next door to us is a large sewing school run by a few nuns that offers a year long course for women. Attached is a school for the children who come with their moms to study sewing for the year.

Village Outreach.

It’s hot, but this is the rainy season so it usually cools off everyday with a nice breeze and low temps after the rain. Surrounding us are banana trees, gardens with cassava, sweet potato, and local greens. All of the TBA’s (Traditional Birth Attendants) are responsible for the upkeep of the gardens, which then in turn are used to feed all of us and the patients + families. We otherwise make a run into Gulu every 2 weeks for food. There is no refrigeration here, so the food options are pretty basic and usually the same every shopping trip. The ‘refrigeration’ here consists of a large clay vessel that sits on the floor that actually works quite well. One of the students bought parmesan cheese and butter on the last trip and it has kept beautifully. I equate this to what the ancient Egyptians must have also used. Water is kept in these too, although I tend to just keep refilling my large plastic liter bottle from the hose off the solar tap (before sunset, of course).  

Our meals are based on beans and rice with every meal, sometimes chapattis, sometimes local greens and a paste called sim-sim, which is a mixture of tahini and peanut butter – all it grown right around here. Today was a bit luxurious to have cassava, a potato like root vegetable, boiled for lunch. Tea is pretty much made with every meal with tea leaves that eventually just sink to the bottom. These options leave a lot of room for creativity, which fortunately several of us like the kitchen. With the bare minimum we have exceeded what I ever thought possible. We’ve made bread, cakes, and curries from literally what seems like nothing. It is pure alchemy!

Part of the team.

I am working within a team of 5. Myself + Kate, an American Homebirth midwife from NY, who has worked for the last 9 months in India, are the two midwives here & there is another Israeli Midwife coming in 2 weeks. There are also 3 students here who are studying now for their CPM (Certified Professional Midwife) licensure. In this process I have actually discovered that I enjoy teaching … who knew??... and amaze myself at what I’ve learned the past 2 years that I now have the ability to now pass on to another. Thank you, Vanderbilt, for preparing me so well!

We live in a bit of a Ugandan bubble with a cook, driver and laundress. She washes everything except our underwear, which we are responsible for, which is only fair, right? We also have a 17 yo boy who works on the weekends to keep the grounds. He ‘mowed’ all of the grass with a machete last weekend and then cleaned all of the paths turning over fresh dirt, which the chickens loved. His name is Martin and his dream is to become a doctor. He is one of my favorite people here, not only because of his quiet, unassuming way, but also because he wears big cowboy belt buckles and had never heard of a cowboy before. ha

Village Outreach

10-2 everyday are open hours for Prenatal appointments which women walk >5 miles for. They also come for Postpartum appointments a few weeks after the birth to get the birth certificate and walk the journey in the sun with the baby so that it can also be checked out at the same time. So far, I’ve found the women to be excellent mothers … all of the infants are always clean and no major illnesses in them so far.

We do village outreach twice a week which are mainly for prenatal check. These usually take me all day to do and are very busy. I take one of the students with on these days.

Ok, enough for this post … much more still to tell!

Ot Nywal Me Kuc in Attiak, Uganda

Composting latrines to the left, Outdoor Shower in Center and my Home!

My house is made of dung, I urinate and defecate in two different areas – both heat composting toilets of sorts, banana and papaya trees are growing outside my window, it rains everyday now so the gardens are ripe for planting and my shower is outside with a sheet as the door. I am in Attiak, Uganda. I have been here for 1 week today and already have loads of stories to tell…

Inside my Hut.

I am here to work as a Midwife in a birth center called, Ot Nywal Me Kuc, meaning “House of Birth and Peace” in local Acholi language. This place is in far Northern Uganda, about 20 miles from the Sudanese border. It took me 8 hours on a local bus from the capital, Kampala, to reach Gulu and then another 2 hours drive to reach the compound.

The land never ends here. There are tall grasses and banana trees that line the entire road with small communities dotted here and there. There are lush green mountains in the distance and red dirt everywhere.

Looking out my door at the flower garden to the Solar powered Birth Center... scattered with infamous jerry cans

 for water.

 There is one main road the stretches from Kampala (where I flew in) all the way through Sudan, which runs directly outside our compound. Here, large cargo trucks travel day and night, mostly loaded with hitchhikers and freight that is coming and going. I’ve seen huge trucks with 50+ people on top, jerry cans for water tied on the back and a load of cattle underneath. Very impressive; more so because none of it is paved, very washed out and is under road construction – which could take years to complete. There are people, bikes, boda bodas (motorcycles used for taxis) and goats tied along the way. It is like the main interstate of Uganda.  

This area is incredibly rich in history, which is part of my attraction, but before I go into the important history of this place, you should at least know what in the world I am doing in Uganda... ??

In essence, I came here for more experience .. a residency of sorts .. with a focus on out-of-hospital Midwifery care since I had none of it in my training. I also came here to breathe and recalibrate and do work that I deeply believe in with local women in a place that truly needs safe care. The maternity care here is inconsistent, brutal and understaffed. In all honesty, this is the type of work that drove me back to school in the first place, so it is rewarding and exciting to now have tangible skills that I dreamed of for so long. However, it is a big learning curve to switch from Vanderbilt University L&D to a remote birth center in Africa with very limited supplies. Births are done by candlelight with Traditional Birth Attendants from surrounding communities at my side. I will stop here because this will be an entirely separate blog post to come.

Mother Health International

I want to give you all a brief history of this area, as well as the back-story to Mother Health International and how they began their work in this area. It is really compassionate story of two American midwives, Rachel and Olivia, who invested in this area and built – with the community’s help – a safe place for women to birth.

 Northern Uganda is infamously known for it’s 23 year long war, which began in the 1980s and ended only 5 years ago. With several coups and attempts of overthrowing the ruling government, several resistance movements, including the Lord’s Resistance Army (LRA) was formed. Joseph Kony, which is a name you might have heard of, headed the LRA.  For years the LRA and other rebel groups raped and pillaged villages, specifically in the Northern part of the country. Atiak, in particular, took a brunt of the abusive.

In the 1990s Atiak was also home to a horrific massacre, which has really distinguished the area. After arriving to the village, soldiers divided the community – women with children here, boys under 14 here, boys over 14 there. They took who they wanted – child soldiers and child bride wives, lined the rest up and shot them all in a row.  This tragedy is still recent and most definitely lives on in the area. Most everyone still living here was affected somehow by the war – loosing family, raped themselves, etc … you can imagine how horrible … this includes the women we are caring for.

Aid organizations were slow to respond and towards the end of the war an IDP (internally displaced people) camp was established in the center of Atiak. Medicines San Frontieres was here and built the health center and the church still has bullet holes in it from the massacre.

The IDP camp was officially closed only last year. Upon closing all aid, assistance to this area was cut off. Today around 30-40% of the original IDP population remain, creating what is now a small center called Atiak. Many people have rebuilt and others are resettling farther around the county. A lack of old large trees is also a recent sign of war – soldiers used these trees to hide out in at night, so many people cut them down off their property.

One year after the war, the founders of Mother Health International (MHI), Rachel and Olivia, were based in Gulu (largest hub, 2hrs South, where most rebuilding efforts were based) working as midwives at the local district hospital. Realizing the true need for appropriate (or rather any) women’s health care, they assessed the need in the area and found that Atiak was most in need and received the least assistance. With much time and consideration they built the Ot Nywal Me Kuc birth center, creating a safe and reliable place for women to get care and give birth. Today, the birth center is run by Rachel and Olivia - from the USA, along with traditional Ugandan midwives from the surrounding communities (they work in week long shifts) and volunteer International midwives.

With only a week under my belt, I am still wide-eyed and excited about each opportunity here. I wake up excited about the adventure the day will bring -- birth, war, resettling efforts, birth customs and traditions... all full topics in their own right. Right now I am watching the sun rise, enjoying fairly decent internet speed and listening to the roosters crow. I'm about to go make some tea.

history adapted from http://kelsihines.wordpress.com/2013/02/08/atiak-uganda/