O Holy Night

Every direction you turn, images of Christmas..You need not look far to find beautiful and thoughtful displays, tastefully decorated homes with glowing trees, and rows and rows of symmetrical twinkling lights. Step into one of these homes and the warm fire will greet you as you breathe in fresh scents of pine and cinnamon. It is beautiful and clean and so.very.pristine. 

Looking upon these exquisite arrangements one senses order and peace.

O Holy Night

I’m reflecting on the untidy disorder and chaos in the lives of so many celebrating Christmas around the world this year. They experience vastly different surroundings and a much more simplified version of the annual celebration of the Christ child. 

It looks nothing like the photos in the magazines and has not even the tiniest hint of Martha Stewart. There are no smells of fresh-baked cookies or hot apple cider to entice them. They don’t string lights around a tree, pile colorfully wrapped gifts high, or build gingerbread houses; yet meek and mild – they celebrate.

Long lay the world in sin and error pining,’Til He appear’d and the soul felt its worth

How did our celebration of this day become so clean and crisp and utterly tidy? Where are the smells and  sweat and tears that were most certainly a part of Mary and Joseph’s journey?

It begs the question:  Do ‘Better Homes and Gardens’ scenes with sparkling lights and gorgeous perfectly placed decorations reflect the Christmas story best? Are the experiences of a frightened and ashamed teenage mother-to-be anything like that?

Do the marginalized and suffering in our world experience Christmas more like Mary and Joseph did – or do we?

A thrill of hope – the weary world rejoices

I’m reflecting on these two extremes.  I LOVE the exquisitely ordered and the beautifully arranged. 

While yonder breaks a new and glorious morn

I long for a day when disparity and injustice ends. I dream of a Christmas were no child is enslaved, abused, and sold. Where no refugee is left to sleep another night without clothing and food or a place to lie down. I pray for the glorious morn, where the oppressed are free. I long to wake up to learn that no child is suffering or slowly starving to death. I dream of a day when people from every continent and every nation can freely celebrate Jesus and His birth surrounded by love, joy, dancing, singing and immeasurable peace and beauty and justice.

Truly He taught us to love one another; His law is love and His gospel is peace

Truthfully I also find great inspiration in the simple, dingy, gritty, humble celebrations of those who struggle and toil without access to our unstained images of Christmas. I long for their stripped down total dependence on God. I pray for spiritual wealth like that of the materially poor. I want their depth. I want their undying hope. I want a Christmas less like Oprah’s or the magazines and more like theirs.

Chains shall He break for the slave is our brother; And in His name all oppression shall cease

Our youngest daughter Lydia has been struggling with choices. When offered a choice of two things she’ll often reply, “I want two ones.”  When she says that, she means I want them both.

As I soak in Christmas this year I find myself wanting two ones.  I want the perfect looking, delicious smelling, pain-free and unpolluted Christmas and I want the dirty, stinky, humble, difficult, but miraculous Christmas that Mary and Joseph and the rich in faith experience.

Sweet hymns of joy in grateful chorus raise we, Let all within us praise His holy name

While I attempt to reconcile two very different Christmases, the celebrations only make sense to me in the context of good overcoming evil. God coming to earth in the form of a baby, to live a sinless life, to clear our debts for us, to teach us how to love one another … In His resurrection the promise that one day there will be beauty and justice for all.

The end of death. 
The end of suffering.

O Holy Night

(originally written December 2010 - republished at A Life Overseas)

Truth Without Consequence

The month of November is going to be over soon, thanks be to God. 

I am not okay with November 2018. 

Narline and Adrian's home 

We went to visit Narline and her husband Adrian today. 

Narline is the (formerly) pregnant woman in the Prenatal program that we transported last week Tuesday night. On that night the roads were blocked in several places.  Each road block we were able to move. Rocks and other debris, trees, and market stands were all used in different places along the 35 mile route. On the way back home we had to negotiate with some men a bit but we were let through again. 

This was Narline's first pregnancy. She came into care in her 8th week of pregnancy. She learned about the Maternity Center from a friend.

On the 20th of this month Narline arrived to the Maternity Center in labor. She started labor at 40weeks and 5days, a very average time to have a baby for a G1. 

She labored for several hours, everything progressed as normal.  At first Narline was dilating at an average G1 pace. Nothing concerned us except that baby's head wasn't coming down into the pelvis as well as we hoped.  We tried a few things to see if we could encourage baby into a better position. Midwives and OBs hope and want babies to be actively descending into the pelvis by the time labor is really cooking. The ichical spines are the marker for a baby that is at "0 Station". Narline's baby's head was -2 station. 

(For birth nerds, here is an explanation.)

At 9pm we decided that Narline's baby wasn't coming down and we made a decision to transport her. The secondary reason we made that decision when we did, is that her baby's fetal heart tones had gone up a bit. We were concerned that he was showing signs of stress. 

We are midwives, not doctors, and we do not play games with lives. If we feel there is a risk, we get in the ambulance and we go. 

The ride to the hospital took longer due to road blocks. We brought her into the labor triage area at 11:25pm. 

The next morning when we woke up we called Narline's sister to ask if baby had safely arrived. Narline's sister informed us she had still not delivered.

Around 1pm the 21st Narline's sister finally called to tell us they had gone to do a C/S and the baby had died.  She said they showed her the baby boy and allowed her to take a photo for Narline. Around 2pm she called again to say that nobody had come to tell Narline. She wondered if she was responsible to tell her own sister what happened by herself. 

On Friday Narline was released from the hospital.  Rather than have her come to the Maternity Center where the two other babies born that same day were still in house, we decided to take Narline home. Narline said we could come do a postpartum visit with her today.

Today Narline** told us the following story:

She got to the hospital and was given a bed after a while. She was put on Pitocin.  She remained 7cm and the baby's head stayed high with each check that was done. Around 7am (after being there with contractions for 8 more hours without progress) she asked, "Why aren't we going for a C-Section?"  

The Doctor she asked that question did not at all appreciate being asked that and responded unkindly. She told me exactly what he said but I won't pass it along here because it is terrible and I hope to get to talk to the hospital administrator about this. 

They kept trying for a vaginal delivery with Pitocin. She said her baby's heart was still beating and she was able to hear it on the monitor.  She said all of a sudden things changed and they said, "We have to go for a C/S".  She said she was put under general anesthesia and that it took a while to get her into the OR.  When she woke up she was not sure where her baby was. After a bit her sister came to see her and she asked her sister where the baby was.

Narline has one photo of her baby, whom she named Evan. Narline never held her son. She was given a photo by her sister. In the photo he is perfectly developed, beautiful, with a gorgeous head of curls, and he is lying in a cardboard box. 

I am not sharing this to blame any one person or even the hospital.  
Evan has died and that cannot be changed.  

Haiti lacks a few major things and until it is addressed, nothing will change. 
More Narlines will lose more Evans.

First, there are not enough doctors, hospitals, clinics, or caregivers to meet the needs of the 10 million person population. 

I'm most familiar with the options for women's health. I don't have vast or specific knowledge of how other sections of health care work. I do know that it is frustrating that it never seems to improve. That is a issue to be addressed at high levels; sadly those at the high levels suffer from the illness of corruption. I would love for there to be zero need for non-profits and humanitarian aid groups. I would love if everyone could deliver safely with a caregiver. This is an actual crisis.

Second, there is classism and racism and education-based inter-group bias - which apparently is actually called educationism.  

It is not uncommon at all for patients to be treated poorly.  The rarest thing to find in Haiti is a person that knows what their medical history is and has been given an explanation for why things are happening.  9 out of 10 women we interview cannot tell us why they needed a C/S in a past pregnancy.  Nobody bothered to tell them if it was due to pre-e or a poorly positioned head, or something else entirely. 

The poor are not allowed to advocate for themselves without making an educated person feel threatened. Medical professionals do not share information with patients. It is wrong. The lack of compassion is so painful to observe.  The power differential is beyond unfair.  

Now, you might say that number one causes number two.  I agree.  

Not enough doctors and medical care providers means the ones working are pissed-off and overworked and therefore they behave in inhumane ways. 

Narline knew what she needed, so she asked. That ticked off an educated person and I have little doubt that it played into the final outcome. (Of course I can never prove that.) 

Narline's husband attempted to get answers from the hospital, but the materially poor don't get to be angry. The poor take what they are offered and are supposed to be grateful for it. 

Adrian was told, "It's not our fault. There are too many people here that need care. If there were hospitals in Port au Prince near you, then you wouldn't have come here." 

Narline wants her baby boy, little perfect Evan, to be remembered.  

She loves him very much. 

She carried him 40 weeks and he is forever a part of her. 

**This story is shared with the permission of Evan's Mother, Narline. 

Grease the Wheels and Keep Hoping

It is said that hopelessness is the enemy of justice. 

Also, it is often said, mainly by women we work with at the Maternity Center, "Haiti has no justice". As you read that you might think, well - that's hyperbole - certainly there is SOME justice.  

There cannot be zero justice, right?!?

We first came to Haiti in early 2002. I came one week per month for seven months while I waited for Isaac and Hope to legally be free to come to the USA. After all of these years of meeting and working with average Haitians and hearing their experiences and stories, I am here to tell you that it is no exaggeration.

Justice is a commodity - as in you can buy it if you have the means to do so. 

Because the average Haitian citizen does not always have the means to eat three square meals a day and purchase a sufficient amount of potable water and keep their kids in school. For them there is definitely no expendable income to grease the seized-up wheels of justice.

Earlier this year we helped a young woman file a police report for sexual assault. She described what had taken place in detail over and over many times to interview rooms full of men. The manager of that department of the police was very enamored with my friend, KJ.  He was less interested in helping the young woman filing the report than he was in finding a way to get KJ to flirt with him.  He claimed we could pick up a copy of the report if we returned a few days later. We returned no less than four times, but were  given another (always new and creative) excuse why we could not have a copy of the report we had filed. 

It is said that hopelessness is the enemy of justice.

Last week in postpartum class we talked about abuse in Haiti, specifically sexual abuse and children. I shared a few personal stories and posed a question to the women seated in the room. "If we never talk about it or acknowledge it is happening at an alarming rate, how will it ever change? Can we change what we don't address?"  The next 45 minutes were spent with different new mothers sharing horrific stories of abuse. It was hard to hear what had happened in their neighborhoods. Not one had ever been able to report it to authorities. Not one had seen the abuser face consequences. 

It is said that hopelessness is the enemy of justice.  

On Monday, November 5th a little girl named Love was born with probable (not yet diagnosed) VACTERL association at the Heartline Maternity Center. Due to a connection with a long-time volunteer at a local hospital we were able to go directly to a hospital that would see the baby. Typically, Haitian mothers will visit several if not dozens of clinics and hospitals before there is one that takes on the responsibility of diagnosis and care. 

Our experience of being seen the day we walked into that hospital is atypical. Justice in that way came due to connections, which we are INCREDIBLY grateful for and also no more deserving of than any other person. The hospital sent baby Love for several tests, most of which took 8 days to complete. On Monday the 19th we hope to return to the hospital with all of the results of the tests and lab work they ordered to learn what happens next. Returning to the hospital will depend upon the ability to arrive there.  There are rumors of blockades and protests in the coming days which can easily lock up the entire city and render us helpless to arrive at the hospital. 

Mercifully, baby Love has been peeing, pooping, and eating without trouble or these 8 days would have been entirely different.  Love's mother keeps long socks on her to keep her neighbors from seeing her malformed legs and feet.

It is said that hopelessness is the enemy of justice.

Last night a baby boy named Wisler was born at 6:01pm. His one minute APGAR was 1 and his 5 minute APGAR was 2 and his 10 minute APGAR was 3.  At minute eleven he and his mom were in an ambulance heading toward the closest hospital.  At the closest hospital two female medical professionals began asking good questions, at that point Wisler was 30 minutes old. A male doctor walked up and barked, "Can't you see how many malformations and abnormalities this baby has? You need to go to _____ right now!" (He named another hospital.)

Wisler born 11/16 at 6:01pm

I assured him I did see but that we had always been told they were an excellent pediatric hospital. He dismissed us with a flippant wave and told us to get going. Trying to lighten the mood I asked, "What if the next hospital doesn't like my face, we won't get this baby accepted."  As we turned to walk out of the triage room he said, "There are foreigners there, they will like your face." 

We arrived at the second hospital before baby Wisler was an hour old.  The first medical employee to greet us was annoyed we did not have a NICU at our Maternity Center or a referral letter and she did not especially enjoy the fact that the first hospital had sent us on to her. I explained that breathing for the baby and driving to the hospital seemed like a better use of time and resources than sitting down to write a referral letter.  

Wisler was admitted, for which we are grateful.  The reason he was admitted was because we assured the hospital staff that we can pay for his care.  The average Haitian could not afford the small amount (only $57 USD) we spent last night to get things started. The average Haitian would not have arrived at the hospital in an hour. Public transport takes about two and a half times as long as private. 

It is said that hopelessness is the enemy of justice.

Last night, we returned to the Maternity Center at 9pm with Wisler's mom. In just three hours her entire world turned upside down - technically, she is one of the "lucky" ones, she had the connections needed to help grease the wheels.

** ** **

It occurs to me regularly that those of you that read these social media updates and pray specifically for situations we share and financially support the work of Heartline Ministries are the reason we keep hoping.  Your sacrificial love and concern is hopeful and it trickles down. 

You might imagine we don't read messages or see your donations in the busyness of day to day work in Haiti.  

I want you to know today that we do see you. 

We feel the power of your prayers. 

We are lifted from discouragement by your generous words of love sent via several social media outlets. 

We know we can support the costs of the rare sick baby that needs hospitalization because of your generous giving.

You are the grease to the wheels, you are stubborn in hopefulness  - and we thank you this Thanksgiving. 

To learn more about the work of Heartline Ministries, please visit:

www.HeartlineMinistries.org 

Lastly, meet two beautiful little ladies born in the last 24 hours ...

Nadia and MarieLiah - born 11/16 at 5:24pm

MarieAnoute and yet to be named baby girl - born 11/17 at 12:05 am

Waiting on Love to Arrive

New life has always been a symbol of hope. Birth is a new start. On the wall of our prenatal consultation room a sign reads, "Where there is life, there is hope."  

Midwives have the high and holy honor of being with women as they usher in new life and new hope. 

Last night at 10pm Lovely arrived in active labor. She seemed shocked by the pain. I lost track of the count, but she said, 'Miss Tara, this hurts' approximately 73 times in the five hours she labored before her little girl arrived.  

The only thing to respond, 70 times over, is, "Yes, it hurts. It really does."

Motherhood hurts. 

Whether you have an easy life and all the material blessings or a very difficult life with a focus of just surviving day-to-day, giving birth is only the first painful thing in a sequence of events that has literally just begun. 

It is often said, watching your child grow-up and struggle and develop and become their own person is a bit like living with a piece of your heart outside of the protective wall of your own chest. 

Lovely talked a lot during second stage. In between pushes she told us she wasn't sure she could do it.  Once after a particularly long contraction with focused pushing she said, "Am I done?"  

We said, "The baby is still not out, you're not done but you are getting so close."  Lovely told us that KJ had said that it was a little girl during the ultrasound and that she chose the name Chrislove for her daughter but that she would simply call her, Love.

Lovely pushed Love out at 3:13 and ten sconds on Monday the fifth of November. 

Her labor had started at home on Saturday night and  included the extra hour of "falling back", which hardly seems fair.  

In total she worked 34 hours straight. Her labor took her from evening Saturday, through Sunday and into the early hours of Monday before it was finished with a screaming baby girl called Love.

Lovely watched her heart leave her chest last night. 

As we dried off little baby Love I noticed her left foot was formed abnormally. I quickly covered her with a warm blanket to wait and get a better look later.  Love was placed on her Mother's chest and began to nurse.

When it came time to take Love for her newborn exam and allow Lovely to take a bath and clean up, I lifted Love off her Mom's warm chest and saw that both of her feet had not developed normally. Upon further examination we realized her rectum is abnormal as well.

In those moments the very first irrational thought is, "How can we keep this from upsetting her Mother."  As if that is a thing. Midwife Guerline and I whispered about how to tell her.  My brain was busy trying to tell me maybe I could wait and tell her until after she had a few hours to sleep. 

Moms examine their children, and we knew Lovely would come out of the bathroom to really see her daughter for the first time.We showed Lovely her daughter's gorgeous face and perfect hands, we ooohed and aaahhhed over her. We opened up the blanket and talked about her feet and legs.  Lovely shut down fairly quickly.  The words of reassurance and hope fell on deaf ears, she needed time to integrate what she had just seen.

After we had Lovely and Love moved out of the birth room and settled in her postpartum bed, Lovely's Mother in Law came to me. She motioned that we go outside. Then she asked me how we could hide the baby's legs from visitors. I didn't understand. I began to tell the Mother in Law that the main focus for now was to encourage Lovely to bond with her baby and to begin breastfeeding, with our without her eager willingness we need Lovely to hope for Love. I said, we don't have to hide her legs, she's beautiful.

Midwife Guerline saw that I was not understanding what was being communicated. Guerline explained that Lovely's Mother in Law was concerned people that came to visit the baby would say inconsiderate things and believe the baby had a demon or a curse upon her, but if we hid her legs, they would not see it and therefore would not hurt Lovely's chance of bonding. 

We asked Lovely to let us hope for her until she can hope again. 

Will you please pray that supernatural connection is formed today and that by some miracle we can head directly to the correct people that can help address Love's medical needs in a timely manner. 

I read this last night while we waited on Love to arrive .... 

The deepest darkness is the place where God comes to us.
In the womb, in the night, in the dreaming; when we are lost, when our world has come undone, when we cannot see the next step on the path; in all the darkness that attends our life, whether hopeful darkness or horrendous, God meets us. God’s first priority is not to do away with the dark but to be present to us in it. -Jan Richardson

I pray God comes to Love and Lovely and is present to them now.

I Find It Hard Enough To Just Be Faithful

Everything in the grey smaller font print below is what I wrote in 2011 about measuring success. I am reposting it for a specific reason.

This year I have begun to struggle more than ever with the stress of this work we do. Instead of easily remaining mainly hopeful and joyful I have had to fight hard to try to be that way.

I just got back from 16 days away from Haiti. It was a perfect trip and Troy and I truly rested and forgot about work. During our time away I never ever felt a physical desire to drink alcohol.  We had an occasional glass of wine and beers many nights but it was not the slightest bit driven by stress or compulsion.

Today around 4pm I started thinking about having a drink. My desire was not simply because I wanted some down time with Troy. 

For the last year due to stress and some specific situations we are facing I have been medicating my pain, anger, and stress with vodka and wine.  I rarely ever drink one drink only and I went from drinking a couple times a week to almost every single day in 2018. 

I decided about a week ago that I have to do better. I decided not to drink anything for at least two months and re-train my habits of using two Vodka sodas or Moscow Mules to make myself feel less angry and anxious.  I decided to begin November 1, 2018.

Tonight I am staying in my bedroom because the temptation to pour my nightly stress-reliever is too great. 

* ** * ** *

In this work we often find ourselves wanting and needing to provide progress reports to the kind and generous souls praying for or financially supporting it.

While we understand and desire that accountability and honesty with anyone investing in us or in Haiti, it can sometimes feel quite discouraging and uncomfortable trying to quantify progress or label success.

We (Troy and I) spend many nights sitting together asking ourselves what is being accomplished. Is it good? Do we believe in it? Do we feel good about it? We never want to get in a rut or get so comfortable with ourselves or our routines that we don't examine both our motivation and our trajectory.  We need to be asking ourselves difficult questions.

We have no desire to take donations from our church, family, and friends to live here if we cannot say at the end of the day that we are walking this path with God, being faithful to Him and doing things we feel honor Him and exhibit His love. Some days are really confusing because the things that happen in the course of a day aren't necessarily quantifiable. Some days we fall into bed asking each other "Is it right? Does this matter? Should we stay? Is God in this?" 

American culture likes numbers, efficiency, and strict time-tables.  You've got to be able to prove yourself with stats and spreadsheets. In the sports world a new coach has just a few years to produce a championship team or he's out of a job. Even the American church wants to count how many butts are in the seats and how many people signed on a dotted line marked "follow Jesus" or how many will commit to come to the quarterly membership class.  In theory those are good things to value. Who doesn't want tangible outcomes? I'm not up for debating the rightness or wrongness of any of that today, I'm only saying that those sorts of western pushes for big numbers drive ministries working in other cultures abroad to produce reports that don't necessarily represent total truth.

Whenever I read reports out of Haiti spewing numbers, I read between the lines and wonder if the numbers are less about actual provable outcomes and more to please a culture that demands numbers. Accountability is good. We want it. More than that, we need it.  The question becomes, how do the expectations of one culture fit into the reality of working in another? 

If we actually believed like Jesus did that touching one hurting person truly matters, that going the extra mile for one lost sheep is worth it, we wouldn't need to spend so much time counting and proving and counting and proving. 

I'm thankful to be able to honestly share the struggles and not fold to that pressure of reporting big fancy numbers. The frustration lies mainly in the self-imposed pressures to chart it and prove it matters. 

Troy can spend entire day(s) with one timid and afraid 20 year old recently diagnosed and already ill with HIV helping to advocate for her medical care.  He can be at ease as one day turns into three while waiting to get her the tests she needs and fighting a broken, inadequate, and unfair medical system - knowing that he is not expected to quantify the outcome of those hours  ....  time with one person isn't usually looked at as success nor is it at all impressive when plotted on a spreadsheet  - but it matters and it's Kingdom work.  

Last night I read this in Gregory Boyle's memoir titled "Tattoos on the Heart" - it jumped off the pages and deeply resonated with me:

  

"People want me to tell them success stories. I understand this. They are the stories you want to tell, after all. So why does my scalp tighten whenever I am asked this?

Twenty years of this work has taught me that God has greater comfort with inverting categories than I do. What is success and what is failure? What is good and what is bad? Setback or progress? Great stock these days, especially in nonprofits (and who can blame them), is placed in evidence-based outcomes. People, funders in particular, want to know if what you do "works".

Are you in the end, successful? Naturally, I find myself heartened by Mother Teresa's take: 'We are not called to be successful, but faithful.' This distinction is helpful for me as I barricade myself against the daily dread of setback. You need protection from the ebb and flow of three steps forward, five steps backward. You trip over disappointment and recalcitrance every day, and it all becomes a muddle. God intends it to be, I think. For once you choose to hang out with folks who carry more burden than they can bear, all bets seem to be off. Salivating for success keeps you from being faithful, keeps you from truly seeing whoever is sitting in front of you. Embracing a strategy and an approach you can believe in is sometimes the best you can do on any given day. If you surrender your need for results and outcomes, success becomes God's business. I find it hard enough to just be faithful."

Success, I find it hard enough to just be faithful.

* ** * ** *

I feel the same way I did when I wrote this in 2011.  Success cannot be easily measured and some setbacks are actually necessary to correct a ship that is heading off course.  

The only thing that is different is that now I feel more afraid of my anger and grief than I did then.  

I also feel pretty afraid of choosing unhealthy things to help me with stress.  

I hope if you are a praying person or someone with similar struggles that you could toss up a prayer for me to be healthy and take care of this concern now, before I have an even bigger problem.

I would like to be faithful, but I know numbing myself is not the answer to the pressure of it all. 

When you find something good -- SHARE IT

This month is very exciting for us.  We are getting closer and closer to having a completed (printed and in our hot little hands) "How To" manual for the Heartline Maternity Center.

Our model is being shared and we are calling it, "The Starting Place".

The manual contains eleven years of learning things the hard way and the details of the current Prenatal Program, Postpartum Program, Birth Control Program. and Youth/Teen Program. It has taken many years to get here. We first talked about sharing the model in 2013.

We are hosting our first  (pilot) class this week with four participants from other organizations also working in Haiti.  The participants are helping us find what we forgot and are giving valuable feedback before we go to print.



**  See this post for more information about The Starting Place.  **




What is it?
It is a technical manual. It describes everything we do, from the beginning to the end. It includes protocols (medical and practice protocols) and tons of administrative details. It includes ways to start small as a prenatal education or birth control program and and grow into a full service holistic birth center offering maternal health care from early pregnancy until months after delivery. It shares a few case studies. It is practical. It is step by step. It includes all aspects: education, relationship, medical, spiritual, physical, cultural, etc., etc. It is a little bit overwhelming.

What is it not?
It is not hundreds of stories or interesting detailed descriptions of the more than 850 women that have delivered at the Heartline Maternity Center. It is not all or only medical and practice protocols. It is not all statistics about maternal health and information you can find by doing a google search.

Each time a new woman starts the Prenatal program, we do a social and obstetric history interview.  

Often women we work with in Haiti have a hard time recalling and easily verbalizing much of their history. It can take a while to gather the information. It is usually important to ask the questions in a unique ways to get the desired (and hopefully accurate) information.

We are realistic enough to guess that at least half the time we still did not get it all completely accurate because it was neither recalled or shared with that sort of precision.

It is best to ask questions in an assumptive tone.  For example, sometimes women assume if we are asking them, "Have you ever had an abortion?" that perhaps we will judge them if they say yes.

Instead we ask, "How many times have you had an abortion?"  We can also follow that up and pose that same question in four or five other ways, changing wording to be assumptive.

If the answer is zero they are fine sharing that but if the answer is 10, it helps that I assumed it was part of her history because it removes their hesitation or concern of being dismissed due to an answer that they fear we won't find pleasing.  

Daily life is so difficult, it makes survival and the immediate present the priority, which in turn means that recalling history is not an easy task. The blanket term "poor historian" fits pretty well. 

Having, knowing, and understanding your own medical history is actually a privilege. Many in the developing world have no idea what happens at medical visits and more often than not nobody takes the time to describe things to them.

* * * 

We interviewed a 37 year old woman. 

We asked, "You've been pregnant many times in your life, yes?"  She said, "No, only seven." 

That's our bad.  That's a cultural difference.  7 is a lot to me.  Not necessarily true here.

We started at the beginning and walked through each pregnancy and delivery.  Her first four children were all born at home in the house she and her husband have always lived. Those four children, two boys and two girls born in 2005, 2007,2009, and 2012 are all alive and well.

In 2010 their home was badly damaged and some injuries happened due to the earthquake but nobody in their home died. In 2013 she had a baby boy born in a hospital that was never well. She described several anomalies and said he died at 21 days of age. She thinks she was under some sort of curse (persecution) during that pregnancy.

In 2017 she described a situation of a breech delivery and her baby's head being entrapped. She said they had to pull and pull to get the baby girl out. The baby was dead upon delivery. She is now in her 11th week of her 7th pregnancy and will be getting prenatal care for the first time ever in her life. 

When I finished the interview I said, "Wow. That is a lot of trauma you have experienced in your life. That is really difficult."  Tears welled up in her eyes. She nodded slowling in agreement.  So often in a culture of non-stop challenge and frequent trauma, there is not time for anyone to fully acknowledge the pain of what has been experienced. 

Part of the model at Heartline that we are hoping to share with others, is the importance of empathy.  

* * *

From the Starting Place Manual - an excerpt from the Philosophy of care section ... 

Empathy

Spend any amount of time at a hospital in the developing world and there is one key component to women’s health consistently missing: empathy.

Being a woman in the developing world requires a tremendous amount of grit, resourcefulness, and resilience. But a woman is almost never as vulnerable as when she is pregnant, giving birth, and post-natal.

Trust matters, relationships matter, and empathy is more valuable than we can express. Empathy is communicating a message of great value, a message that says,  “You are not alone.” It is rare. As Tara says, “Several of the hospitals in the city where I live, as well as the hospitals and clinics where we’ve worked around the world, who serve the materially poor are lacking the most valuable resource: compassion. Nothing sustainable and life-affirming happens without warm, loving relationships and a lot of compassion.”

It might seem odd to start off the technical manual of Heartline’s Model of Care with a seemingly unprofessional words like “kindness,” “empathy,” “compassion,” or “love” but it has been our experience that this is what truly transforms women. It can bring calm to chaos, hope to despair, connection to isolation, faith to fear. And all of those things matter every day in life but particularly so in birth.

Working in the middle of devastating poverty, one quickly learns that not every story has a happy ending. There are areas of frustration, despair, and brokenness all around us. We cannot fix everything. But we have decided to embrace love and compassion as our philosophy, as much for our patients as for our own souls. This is even more important to us in the face of despair, hurt, wounds, and trauma.

As one small outpost of health and wholeness in the worldwide maternal health crisis, we choose empathy and love and we center love and we practice love. We are committed to excellence, to integrity, to thorough training, to steady competence. But even our excellence of care, our integrity, our training, our competence must be grounded in a philosophy of love. Maternal health has for too long been sidelined and de-emphasized in the world: we believe women deserve not only competent and thorough care but they also deserve dignity, respect, and to feel loved in their most vulnerable moments.