Midwives!!

So I finally met midwives in Brazil... and can I just say, what a unique experience it has been! The NGO is conducting research of traditional midwives to document their knowledge and practice of midwifery as a Brazilian cultural heritage. Basically, for decades these women have served their communities by assisting women in birth where medical facilities were largely unavailable. Most of their knowledge and practice was passed down from a mother or an aunt who was a traditional midwife in her community... but now with increasing access to medical facilities, this practice is dissapearing, and most of the midwives are in their 50-60s or older. Although these women have not usually received `academic´ training, their vocation rose from needs in their communities that no one else was serving. I have grown an immense amount of respect for these women and have enjoyed participating in interviews with three women so far... I have to admit that sometimes they say things that are a little quirky that make me laugh (inside), but there are also some traditional midwifery practices that I put in my mental bank to pull from in the future working as a midwife :-)
(Picture of a midwife to the left)
So to do these interviews we usually have to travel to the `interior´ meaning out of Recife and to more rural communities. What an adventure we had finding the first midwife! We had to park the car, walk 10 minutes down a muddy road between bushes, cross a river in a boat (picture above), and walk another 30 minutes in mud that kept swallowing my flip flops (unfortunately, it started to rain)!! We found it amusing though, and the interview with the midwife was really interesting... 66 years old, and quite intertaining as the interview went 3 hours long with her. Since then I have met two other midwives who weren´t as difficult to locate, but were just as interesting. I´m putting up a few pictures of them just for yall to get an idea of who these women are... usually very poor, uncompensated for their work, and often serve as a sort of homeopathic `healer´- I dont think we even have a word for it in English, but basically they have an immense knowledge of herbal remedies for random things, cramps, headaches, stomach aches, etc. Its really interesting to hear them talk about it and show you the plant...

















Also, just a plug on the rest of my life here in Recife... I`ve really grown to love it. With quite a bit of spare time (as things with the NGO are slow, and interviews are mostly conducted on 2-3 day trips we take), I have grown even closer to my host family and their friends. We took a four day trip to Caruaru, a nearby city, to celebrate São Joãn. Basically in Brazil they have two big holidays, Carnival and São Joãn, and lucky me I was here for one of them! I learned how to dance forro (ha sorta), ate tons of new foods, and got to be really good friends with so many people on the trip! I´ll put up a picture of a bunch of my friends here-- they really make it hard for me to leave in two weeks.

As for this week, I´m traveling again for a couple of days to do some more interviews... more to learn!! I´ve decided that two months is too short of a time to travel to a country, I dont think I´ll do it again for this short of a time. Honestly, the first month was really hard here, but now the second month has really been amazing, and now that I am finally adjusted and learning and speaking portuguese, I´m leaving soon. It really has been a important time for me and I´m still working through all the things that have shaped me during my time here... now to soak up the rest!
Much love to everyone...
Leah

Babies are born

So right now I am processing the day I had... wow, how to even resume a day at a small clinic/hospital with laboring women… I will try. I went with an obstetrician to this clinic that he works out in this smaller town (and finally get some hands on experience with labor in Brazil)—and I ended up gaining much more than what I expected.
This afternoon I experienced one of the hardest ethical and professional decisional moments I´ve ever had. We had been at the clinic since 8 am and no pregnant women had come in—but then one came in, who had was about 5 inches dilated—meaning she still had a couple hours of labor left. So, they took her back into the hospital room, where she sat on a bed in a quiet room alone. I was bored so I started walking around the hospital, saw her, and then went back in the hall. This was the moment—I´m standing in the hall, knowing that this young woman is alone in a room down the hall, in labor. The question is, what do I do? Obviously, I am just a visitor in this clinic. Can I go accompany her? Will they be mad at me? Will she even want me there? I´m still standing in the hall, confused. Is this what it feels like to make an ethical decision? To know that she deserves to have someone with her (her mom had not been allowed in, she was in the waiting room), but not knowing if I have the authority to do anything. I´m still standing in the hall… but something is seriously nudging me to go to her. Uh, I think, fine I´ll go—I mean, I want to go, I just don’t know if I can go. Oh well, if the medical personnel get mad at me I´ll never see them again. So I walk into the room, smile, and suddenly she starts to have a contraction—a hard one. So I just grab her hand and start to breathe with her, try to speak to her in Portuguese. We keep going through this routine for at least 20 minutes—broken Portuguese, trying relaxation techniques, breathing together, massaging her back. The nurse comes in, then goes out. Then the doctor (that I came with) comes in… they both look a little amused at what I´m doing. I walked into this room with a random lady in labor, and now we look like best friends holding hands, breathing together. The obstetrician asks me how far apart the contractions are— I have no idea, I haven’t been paying attention, haha! So he asks us to go into the exam room to see how far along she is—Leisa (the woman) grabs my hand and wont go unless I go with her! So we go together, breathing profusely, and she struggles through the exam—8 inches dilated… she´s close. But she is asking for a C-section (she had one previously)… and unfortunately in Brazil, that is one thing that you get what you ask for (ya, 60-90% C-section rate). Let me restate that—women are routinely told that they cant do labor, that they need C-sections, that normal labor is too painful—but the reality is that C-section increase maternal morbidity seven fold, and the recovery (uh from major abdominal surgery) is painful too, with minimal painkillers (ibuprofen)! So this is the debate in my mind—Leisa, you can do this! You are strong! You are so close! A normal delivery is better for you!! But she is saying, doctor please help me, please get the baby out, it wont fit… and he is going back and forth, well the fetal heart tones sound kinda sketchy, but… and then he says it, OK, we´ll do a C-section. AHHHHHHH (I think), she can do this!! Dang it, can you take it back?? But he couldn´t, and he didn’t, and it did make Leisa happier. So despite my deep belief that she could have a normal delivery, that she was strong enough, that her body could do it… she was gonna have a c-section. But she still had a while before getting into the operating room, so the breathing and relaxation techniques continued for another 30 minutes… and I decided to just go get her mom and bring her to the room to help comfort her, haha, which I didn’t get in trouble for either. Then once we got into the operating room she was so nervous that she wouldn´t let me go anywhere, just stay there with her holding her hand, tell her when the baby came out, tell her it’s a boy, tell her its ok. And even though it wasn’t the experience I would have chosen for her, it turned out to be such a beautiful thing to experience with her. To realize that no one could make the pain (or contractions) go away, but what she needed was support, recognition that she is a person- whether that be from a stranger of her mom. That she just needed someone to sympathize with her, to hold her hand in a scary operating room… to bring the baby to her once she got back to her room. To tell the grandma that it was a boy and her daughter was coming out of the c-section right now. To recognize her right (literally, national and international laws) to have a companion while in labor at a hospital. To be compassionate. And to have to opportunity to be that for a woman, to support them and love them when they need it the most… that is why I want to be a midwife, and that is why I am here, to learn what that looks like in a developing country.
Unfortunately, similar experiences to the one described above have been very limited—I mean this was the first time that I´ve seen a birth in Brazil. I think that is what has been hardest for me here, that the NGO that I work with doesn’t have a lot of hands-on work with pregnant women, so I have had to learn patience patience patience… a very hard thing. But in the midst of everything I have learned to appreciate other things, such as evenings with my host family laughing, eating our Brazilian meals together, going to a traditional Brazilian engagement party, learning to dance forro, and an upcoming trip to Caruaru (a nearby city) with 30 people this next weekend to celebrate São Jõan!
All is well in Recife with me… lots of rain, a particularly bad experience with food poisoning, learning more Portuguese, and all the rest of the good stuff that comes along with being in Latin America again. I´m also working on a Fulbright Application to Mozambique, ha, crazy. Miss everyone dearly!
Much love!
Leah

When it rains, it pours

Some days are awe-fully wet here in Recife... I guess we´re in winter here, when it rains everyday. My dilemma—I take the bus (or several) between my home stay (which is wonderful) and the NGO´s office, which are about 7 km apart. I recently moved in to this house, and so far the commute has been pretty easy; after lunch I leave for work and walk about 15 minutes, and then catch one bus to the office. But when I´m coming back in the evenings I can´t walk cause it´s dark out, so I have to take 2 busses. Well, yesterday I left work at about 5pm, and unfortunately it had begun to pour down rain. I was able to borrow an umbrella, and I began my journey. Went to the bus stop but wasn’t sure which bus to take (oops). So I got on one, got off (wrong one). Talked to a girl, and got on another. After about 10 minutes, the bus took a turn that I realized was the wrong direction, so I got off again. This time I got off at a place where there was A FOOT of water, and as I waded through the water to get back to the street to catch another bus, I couldn’t help but laugh at how stupid I looked wading through the water. So I got on another bus, which a lady assured me was the correct one. I got on and it actually went in the right direction!! BUT I got off to early… the bus was so crowded I couldn´t see out the windows… so then I got on another bus, went about 5 more stops to where I wanted to be. But then I had to catch one more bus that actually took me to my house… so I walked two blocks, during which I was splashed multiple times by cars driving by. I couldn´t help but walk down the street laughing—it was just so funny to me that I was getting soaked. Anyway, I finally got on my 5th bus of the evening, and it was my last. I got home, dried off, and sat down for café com pão y quejo (coffee, bread, and cheese) and laughed with my home stay family (they thought it was quite clever that I had gotten a plastic bag to wrap my purse in so my stuff wouldn´t get wet). I guess some days this experience could leave you really frustrated—but I thought it was really funny… and was really thankful that I was wearing capris and sturdy sandals that could get wet and stay on my feet!

I think this story might represent a lot of what Brasil has been for me so far—some rainy days, confusion, adjustment, but there is almost always some redeeming experience that reminds me how much I am enjoying my time here. It might be simple things such as coffee everyday, Brazilian cuisine, succeeding at Portuguese (some days), learning how to dance forro(pronounced foho), or bigger things such as working with pregnant mothers and having the chance to participate in training for traditional midwives. Either way, I´ve had to realize that learning can be a slow experience, its not like my crazy time-crammed, hyper-active nursing student schedule in the US. Life and learning doesn’t work on my time-table here, so I have had to adjust. Here learning is taking lots of forms: learning about the anthropology of birth has been a big thing, through books I´ve had access to here, and conversations with the anthropologists who work with the NGO; learning about Brazilian culture is a full-time endeavor, mixed in with learning Portuguese… but I have been blessed with some amazing people to guide me through both of those processes (mostly through my home stay family); learning from pregnant women who want their wishes in their labor and delivery to be respected and upheld; and next week I will travel west, into the interior of Brazil, to do interviews and research with midwives there!
Pictures are coming soon!! Beijo,
Leah

So what am I doing in Brazil?

So I realize that I have been writing about my time here in Brazil, but I haven’t mentioned more about the organization I’m working with and explained what they actually do here. The name of the NGO is Instituto Nômades, a fairly small Brazilian organization that exists to advocate the ´humanization of birth´ here in Brazil. This consists of raising awareness and helping educate women on their choices in childbirth—largely due to the fact that in Recife (the city I am in, in the Northeast corner of Brazil) there is a 91-96% cesarean section rate in private hospitals, and up to a 60% c-section rate in public ones. The incredible thing about this reality is that women are routinely coerced into having c-sections when they are not necessary and a c-section increases maternal morbidity five-fold! Apart from that, the treatment women receive when they have vaginal births is not impressive—with the overuse of medical procedures including episiotomies, enemas, constant (and uncomfortable) monitoring, and a lack of support in comfort measures. All that said, maybe this gives a clearer picture of why feminist advocacy and education is so important—that even choices in childbirth, such a personal experience for women, are being denied and ignored.

One of the ways the organization educates women is by having a group of pregnant women that meet weekly to share experiences and information. Every Monday night they get together for 2-3 hours and sit and talk mostly about the procedures mentioned above, and alternatives—such as natural birth, assistance by a doula (who offer non-medical support, with comfort measures and emotional support during birth), coping techniques during birth, etc. I’ve been attending this group and truly find it so amazing to share this information with women and allow them to think through and shape what they want their birth experience to be like. I would really love to be able to start and help lead a group like this in the future, whether that be in the US or elsewhere. Also, I can’t tell you how many videos I’ve recently watched of at home births, births in water, births assisted by midwives, etc! Haha, it has been fun to learn so much. The other task that the organization has sought to undertake is research on the knowledge and practice of traditional midwives that practice mostly in poorer communities. This research is deeply based in anthropology as well, as these midwives represent an important Brazilian heritage throughout the past generations. Therefore, the research seeks to document and respect the cultural aspects that these midwives represent, while also investigating their knowledge and practice in the physical act of childbirth. Although most of these women do not have hospital-based (or academic-based) training, they are what I would maybe call ´vocationally´ trained by grandmothers, mothers, and/or other traditional midwifes. Anyway, this is research that I am really excited to take part in because who better understands community needs than women who dedicate their lives (with little monetary reward) to serving their community? I think I have a lot to learn from them! This research starts next week, so I’ll get back to yall on what I learn… besides that, this week I also got to attend a professional conference on pregnancy and birth and really enjoyed the presentations.

On another note, I just found a wonderful Brazilian family I will be living with for the next 6 weeks! I’ve been living with an anthropologist from Instituto Nômades until I found a more permanent homestay, and yesterday I met the family I’ll be living with. Their youngest daughter is my age and we really hit it off— and she speaks English and Spanish so can help me a long with my Portuguese, but everyone else only speaks Portuguese so I must learn more! Plus when I was over there they were all laughing and joking around with each other—big family of 6. Move in tomorrow!

Ok, long-enough update. P.S. One more lesson—I eat WAY to fast. Maybe it is the college student inside of me always on the run, but every time I sit down to eat, I have to remind myself to look up and chew. I sat down with a couple of kids the other day, ate fast, and when I was done the 7 year old looked at me and said, WOW you eat fast—I hadn’t even realized I scarfed the food down. Here they enjoy their meals, and afterwards we all sit and have a cup of coffee, always. I love it. Much love to everyone... and take a slow lunch today! ;-)

Some things to keep in mind

Lessons I am learning here in Brazil...

+ Portuguese is not Spanish. Before I came I constantly reminded myself that the first two weeks would be the hardest adjusting to the language. And that it has been, a hard week—but I am now progressing… and taking Portuguese classes. I like this challenge though- I really can understand a lot now, just need help converting my thoughts into proper Portuguese.
+ Brasilian food feeds the soul. Ok, maybe not feeds it- Jesus does that- but it sure does make the soul happy. Seriously, I have not had one meal that I have not loved- and I´ve had many meals, they keep me well fed.
+ On time is late here. Duh, I grew up in South America—I should know this!! But the constant need to be on time in America made me forget! One day this week I actually showed up on time, at like 6… the person arrived at their house over an hour later. She was on time—I was early, duh.
+ Women in other countries have a lot to teach us… I am learning a lot a lot a lot from women in the organization about birth and many wonderful things-- challenging even what I view my future as. More to come…
+ Just because America is in a recession does not mean that Brazil is. It costs me over $1 to ride the bus each time. Maybe that doesn’t sound like a lot, but considering that in Uganda and Ecuador it was like 25 cents, it does make a difference. The dollar is killing me here… but I really do love bus rides.
+ Mosquitos love me. Yeah, after 10 bites on each foot/calf I pursued finding insect repellent. My legs are still recovering.
+ Flexibility and patience. Especially when figuring out how I can help the organization when my Portuguese is still coming along… so hopefully next week we will start visiting parteiras (traditional midwives)… so excited to start doing that. In the meantime, I am letting Recife grow on me—with its heat, mosquitos, language, and yummy food.

Feeling the warmth of Brazil

I have to say I definitely hit the ground running once I got here. All went smooth with my flights and baggage, apart from the fact that I had a 14 hour layover in sao paolo-- haha, but finally i arrived in Recife (pronounced hecifi) at 1 am on Thursday night. Daniella, one of the founders of Insituto Nomades, the organization I will be working with, picked me up-- she has been incredibly gracious to me, helping me adjust and taking me around the city! Anyway, Friday I went to an all-day training session about the research the organization will be conducting during the next 8 months. It is heavily rooted in cultural anthropology, with two anthropologists advising the project as well as multiple women who have knowledge about childbirth. We will be going into communities interviewing traditional midwives, women who practice as a vocation with little medical training, but practice due to necessity in their communities. It was a long day for me-- all in portuguese, and I felt pretty lost at times. After finishing at 7 pm, everyone decided to go out for drinks to celebrate their long week of training, and I have to say that I really enjoyed spending this time with everyone. A group of 15 people, from the ages of 18-40 all went out for at least 3 hours to relax and just hang out at a restaurant that overlooked the ocean. SO much fun to watch this Brazilian culture unfold, and they were so nice trying to talk to me and teach me more portuguese! I have to say that I have been absolutely impressed at the friendship everyone has extended. Ya know, in the states I hear comments about people who `come to our country without even knowing our language´ as if that is a bad thing, but here many brazilians have affirmed me for coming and living in Brazil to learn portuguese! They say that is the best way to learn... and they engage me in conversation to help me. Really warm people.
Anyway, saturday I was invited to go to the beach with two girls about my age, neither of whom speak spanish or english! It was really fun spending a day on the beach learning to communicate, eating freshly fried fish while sitting in beach chairs with water splashing our feet, and swimming in the shark infested ocean-- not kidding, we couldn´t go far out, haha! But it was muito legal (very cool).
So anyway... right now I am staying with one of the anthropologists working on the project, and this next week will be low key as they finish arranging interviews with midwives. After that we will begin visiting communities. Right now my focus will be on getting some portuguese lessons, as I realize i could really use them! Once I get a better grasp on the langauge I will be able to help with more things with the organization... so that will be good.
I still am basking in the reality of being here... the weather is absolutely wonderful, warm and humid, but not at all uncomfortable. The culture and people match the environment, welcoming and fun.

Much love to everyone, and if you want to write me, email me at leahbbutts (at) gmail (dot) com

Besos!