And So It Goes

He’s waiting for us dressed in a pressed shirt and slacks and the first thing I notice about him is the urgency in his eyes. He blinks rapidly, face turned upward, and my heart is pierced by his expression of extreme yearning.

JT4A5897

He makes nervous gestures to ensure that we feel welcome and comfortable, arranging chairs into a circle under a tree that tempers the blazing Ugandan sun. He brings out a tray of tea and fresh grilled corn cut from the stalks that his wife tended. His wife, she who “flew away” recently despite the many expert hands that tried to save her from the devastating clutches of postpartum hemorrhaging. He watched her fade away, this woman he so loved and with whom he created his family of four precious little girls.

JT4A5907

Postpartum hemorrhaging (PPH) is the leading cause of maternal deaths globally. Each day, approximately 800 women die from PPH, a staggering statistic given the very simple remedy that could save these women. And so it goes that we live in a world that fails the most vulnerable, a woman giving birth to a new life.

There are many reasons why a mother dies from PPH: lack of skilled medical staff, inability of a woman to reach a hospital or for her family to pay for services, expired drugs, lack of syringes, poor education, and timing when she reaches care. Any or a combination of these scenarios can lead to death, swiftly and with little warning. Every day, women perish, avoidably, leaving behind a chaotic set of issues for her children, her family and the community spanning years of affect. And more often than not, she leaves a man in despair, his tears flowing at any mention or reminder of this woman he chose as his life partner.

Her memory lives on in this house of papa and his girls. He has kept her things (shoes, dresses, hair ribbons) in open baskets and keeps referring to “mama’s chickens, mama’s corn”.

JT4A5939

The eldest daughter shows us “mama’s bed”, where she and her younger sister now sleep so they are comforted by the remnants of her spirit by night. The twins she recently bore are in a loving care center until papa can get more organized and find his wise perspective on his newly shattered life. He visits them several times a week, cherishing her last gift to him.

JT4A5927

He is proud of his home, and leads us inside so we can see the rugs she wove and the pink bathroom he made for her out of their old chicken coop to enable her comfort while she nursed twin girls. As he shows us each room, his girls are right by his side, feeling his love as he strokes their hair and wipes their noses and looks at them with assured intention of how he will be there for them the rest of his life.

JT4A5946

Many African men often get mischaracterized by those who commit transgressions against women, marginalizing the men who express devotion to their wives and children. This man epitomizes love in its most tender form: being willing to care for his “band of girls”, ensuring their clothes are clean, playing with them, holding them when they ask for mama.

JT4A5961

There are many organizations that grieve these concerns and are working as fast as they can to eradicate these issues. Working tirelessly, they study challenges, assist with lack of resources, and work with the World Health Organization to build awareness and responses to the far reaching and devastating effects of PPH. And so it goes that we live in a world that is capable of rallying around the most vulnerable.

JT4A5958

No mother should face death from obstetrical concerns. No young girl should fear for her life as she gives life. And no husband deserves this kind of heartbreak.

JT4A5904

At the end of our visit, this profoundly affected man shakes our hand and says goodbye with a strained voice. Emotions run deep within him and frequently surface, and as they do, he reaches down to stroke his daughters’ heads in silence while each little girl raises her tiny hand to find his. Together they stand, facing us with hearts open wide. And a hope for better maternal healthcare for all.

JT4A5977

Ethiopia: Maternal Mortality

I took my first trip to Africa and Madagascar when my three children were in preschool. I set off to bring back images so they could see how children live in developing countries.

Fast forward fifteen years, and this time next week I will be working with the Hamlin Fistula Hospital in Ethiopia to document the work they do to heal and also prevent a devastating maternal condition that occurs due to prolonged labor.

Had I been born an Ethiopian woman living in a rural area, chances are strong that I would have died during the birth of my first child. Ben was too large to fit through my pelvis, and I had an emergency C-section to halt his distress and enable me to give birth to him.

When I look at my three grown children, Ben, Aaron and Brynn, the love I feel overflows into an insatiable desire to help these suffering mothers in Ethiopia.

Ethiopia: Hamlin College of Midwives

Join me as I travel to Addis Ababa, Ethiopia to meet some of the world’s bravest women as they support each other by reducing infant and maternal mortality and the occurrence of the physically and emotionally devastating condition of fistula.

It is a great honor to be asked to visit the Hamlin College of Midwives to capture the essence of their 2011 graduation ceremony. On October 15, 2011, the Hamlin Fistula College of Midwives will graduate a second class of trained midwives. After the ceremony, these newly trained women will return to their rural villages to care for new mothers and assist extremely difficult deliveries.

Every day, 1,000 women and 8,000 babies die due to complications from pregnancy or childbirth. And for each maternal death, at least 20 additional women suffer devastating injuries related to their simple desire to produce a family to help work the fields to sustain their food source.  These World Health Organization statistics are sobering, especially when contrasted with the kind of care that is received elsewhere in the world.

The Hamlin College of Midwives is responding to this crisis by training local rural women much needed midwifery skills and supporting them as they set up services in their rural home villages.

Come along as we celebrate these midwives and the mothers of Ethiopia!  I will be documenting this momentous occasion, as well as other aspects of the beautiful and innovative Ethiopian culture. I will also be writing guest blog entries on Phil Borges’ Stirring the Fire website.

We are hoping that a collective cheer from around the world will be heard as these Ethiopian women extend one of the most loving gestures to one another: helping a mother deliver the life that grew inside of her.

Each midwife has been able to be trained without having to pay fees, which they could never afford. Your help is critical in making this possible. Donations for the midwife college are being accepted now at the Hamlin Fistula USA website.

For Dr. Catherine Hamlin’s story, read about her book here.

Ethiopia: Presentations and Discussions

Here is a list of upcoming lectures/slide show regarding our emergency obstetrics efforts in Ethiopia:

February 17, Portland, OR
Portland State University, 2:00pm classroom discussion. Call for details.

February 17, Lake Oswego, OR
Lake Oswego Reads, 7:00pm, Marylhurst College, 17600 Pacific Highway

April 19, Portland, OR
Medical Society of Metropolitan Portland, 7:30pm, Embassy Suites Hotel, 319 SW Pine St.

May 15, Portland, OR
The Development Salon meets in the Park View Room at the Mirabella in South Waterfront. 4:30pm Wine Reception, 5:30pm Discussion. Mirabella is located one block east of the OHSU aerial tram base at 3550 SW Bond Avenue. Call 503-688-6806 for further directions.

May 16, Bend, OR
Cascade Camera Club: Bend Senior Center, 1600 SE Reed Market Road. Doors open 6:30 pm; meeting begins at 7:00 pm.

Ethiopia: Degie’s Story – Part 3

I enter the room cautiously, not wanting to disturb the family. They motion for me to come all the way in, and when I do, I see beaming faces and hands outreached, scrambling to make contact. I am only the photographer, not a doctor, but their joy and appreciation are boundless: Degie has lived through an obstructed labor and childbirth, and the baby is thriving. I look at Degie, and her smile is wide, tears are in her eyes. I grab her outreached hands and shake them like a mad woman. I too am thrilled to see such a difference in her well-being. I can also detect concern regarding how she will comfortably make the long walk home.

She slowly uncovers the tiny baby boy next to her, her first-born child, and the cool air makes him stir. Lips plump, tiny fists pumping the air, he opens his eyes and makes a sucking sound that makes us all laugh. He is content. I motion outside for someone to come and translate for me, and I tell Degie that I think she will make a wonderful mother. I also tell her that I have never seen such devotion from an extended family, at least three members sitting at her bedside around the clock, waiting to see if she needs anything.

In rural hospitals, the family must provide basic care for the patient. They feed them, bathe them, and sometimes even administer simple nursing tasks. Degie’s sisters, brothers and grandparents have provided exceptional care for her. It is not always like this. At times, there is no family support. These perhaps are the most difficult situations to witness. When a person comes in great crisis, and they have no one to support them, most likely they have no means to pay for services and they reluctantly must turn away. It is heartbreaking to watch a very ill woman, laboring with a child, have to leave the hospital grounds based upon inability to pay the fees. Once again, our souls reach out to her and want to pay the fees, but the hospital administrator strictly advises us that this creates more problems than they can handle once we are gone.

What do they do? Where do they go?

This is simply a way a life here in rural Ethiopia. Our minds turn to how we could possibly make the payment of fees sustainable. An on-going fund for destitute patients? A plea to the government? We don’t know these answers.

But Degie is fortunate in that she has many brothers who sold cows to pay for her surgery, and have taken time from the fields to carry her home. They gently walk her to the makeshift stretcher, and tenderly move her down onto it, covering her with a gabi. A chaotic flurry of hands dip into injera and food is passed around. The men are fed quickly so that they have strength to make the arduous walk over rock strewn terrain back to their village. After a bit more clamoring as they decide who is in front and who is in back, they reach down and pull up on the stretcher, lifting Degie’s body high onto their shoulders. The sisters pack up the food and scurry behind, barefoot with gabbies flowing in the wind.

I watch them turn away from the hospital and walk together down the rocky road toward their village, their feet hitting the ground in rhythmic unison. And as they disappear into the horizon, I see the faint outline of a group of men carrying a woman toward the hospital.

 

Ethiopia: Our Eyes Together

She stands in the doorway, shoulders slumped, hair in tangles from not being washed in a week, shirt stained with blood, tears streaming down her cheeks. One hand is in her lab coat pocket, the other fumbles with the keys that mysteriously no longer work in the door to her sleeping room. Four women walked in with dead babies today alone, with several mothers struggling in other beds; it’s been a difficult day.

She longs to quiet her mind, to place the images of death in perspective with the job at hand. She signed up for this, with full knowledge of the difficulties. A diversion please. Shower? There is no water. Chocolate? Gone. Music? Too much of a reminder of home. A nice note of encouragement via our CDMA internet connection? It’s 3:10am back home, so no news. Like many Ethiopians who are hungry, worn or troubled, she reaches for sleep. But in this place, on this day, it does not come. Tossing and turning, stomach in knots, a fever arises and she whispers: “This is hard.”

Death is a part of the fabric of life here in Ethiopia. The people have come full terms with the likelihood of its occurrence. According to World Health Organization figures, 10,000 babies and 1600 mothers die from childbirth complications every day. Here at Mota Hospital, the director responds to the question regarding what is the most difficult aspect of midwife retention with the words: “We see death of our mothers and sisters every day, on our doorstep, and we have little supplies to help them.”

The problem is quite complex, as many intertwined issues exist in Africa. When a girl or woman labors at home, she may not even be aware that there is a health center nearby. Hospitals have a desperate need for doctors, which are first priority, and they rarely have money for outreach and education. Even if she does know about the hospital, often a woman will suffer in silence and not want to bother her husband, father, brother who toil in the fields all day. By the time she musters the courage to say she thinks she is in trouble, it is often at such a late stage that the baby and mother are well headed toward death.

If she is lucky, the husband, father, brother may then rally several men to carry her over the rock strewn and rugged terrain to get her to the hospital, walking for hours, sometimes days to get her here. And then, once here, they see the costs that are associated with care (most often less than $100) and they quickly realize that they will have to sell all of their cows in order to pay the bill. The pivotal decision must be made: get the care their loved one needs and become destitute, or turn away and go back home. At times, treatment will be started only to have the family run out of money and leave mid-treatment. And perhaps the worse situation is when a woman is carried to the hospital only to find that it is not staffed.

We often long to pay for services when we see that they could save a life. We are told that this is not sustainable for the hospital, as many problems arise when the hospital cannot pay for other villagers after we have gone. Money is best donated toward equipment and occasional free services where they deem it to be appropriate. So, we assimilate to this way of life, and now, here in this tiny village, the problems of Ethiopia become our problems. No longer are we a simple bystander. We feel the loss. We see the complexity. We are saddened by the pain these women and their families suffer.

And, we hold hope, just as the doctors do.

A new road is being built that will connect Addis Ababa to Bahir Dar. Mota will become a stop mid-way, and many believe that this road will create a demand for better services in Mota, such as desperately needed water flow. This will enable the old rusted truck ambulance be to retrieve patients from outposts. It will bring better telecommunications services. The doctors tell us that they have seen immense progress already in the few years that they have been here. I ask them what support they have to mentally keep going when they see so much suffering and death every day. Their answer is said with quiet and passionate devotion: “These are our mothers and our sisters. Of course we will work for them.”

I have often reflected on the eye contact that is present in Ethiopians. I have traveled to many countries, witnessed many rituals and interactions, and never have I seen such an intense and long-holding gaze as here in Ethiopia. A few weeks ago, an Ethiopian man said something to me when I asked about courtship here that plays out in my mind today. His words: “Everything starts and ends with the eyes. It’s all within our eyes. Words are never needed.”

Ethiopians are creative, full of wonder, and tender. They know and experience many things that most of us will never endure, let alone fathom that these situations even exist. When I look into their eyes, I see more than the current situation at hand. I see belief, hope and an almost father-like twinkle that tells me they see me as a child: innocent, comfortable and maybe even if I am lucky, endearing to them. They see through me, because my life, my world, is transparent and thin compared to theirs. Their heart beats hard every day, while mine has long periods of rest, boredom even.

I look at Dr. Philippa as she finally finds sleep, and I admire her dedication to enter this world and exchange information with the midwives, and to also bring us all into the equation of moving toward the goal of creating healing environments for anyone who suffers here.

It is now morning, and Dr. Philippa rises with vigor and purpose. She picks up her stained lab coat, grabs a piece of bread, and pushes the door open to go round on the patients. Before she leaves, she hesitates, looks over at me and starts to say something. She searches my eyes, and then without words, closes the door behind her.

Screening of “A Walk To Beautiful” and Our “Footsteps To Healing” Video

The screening of the movie “A Walk To Beautiful” and our own “Footsteps To Healing” newly released video drew a large crowd at the Hollywood Theater last week.  We are humbled by the response many people have to the maternal conditions that occur in Ethiopia and other parts of the world.

The video I shot for our film was the first time I used the Canon 5DM2’s video capability, and I was amazed at the quality results.

Stirring The Fire: Inclusion of Ethiopia Work

My work surrounding maternal health in Ethiopia has been included on the Stirring The Fire website, and I was invited to chat with Phil Borges about the direction of the project.  I will return to Ethiopia in January 2011 for a month, and perhaps as early as November 2010 to continue documenting the maternal issues which rural Ethiopian women face.

Ethiopia: Jameke & Her Frail Baby

As I pass through the overcrowded aftercare wards, I see a young girl who stands out from the rest of the patients.  She has beautiful deep black skin, and there is an air about her and her family that persuades me go to the nurses’ station to ask about her.  I can’t recall if she is a patient of any of the doctors.  Is everything OK, I ask?  Each nurse just shakes her head and looks away.

I find out that her name is Jemate and she has arrived last night from another hospital.  There, she had tried to give birth to her baby, but the baby could not move through her birth canal.  They tried many things to extract the child, but to no avail.  With her baby wedged in her birth canal, Jemate walked many miles to Gimbie Hospital, and her baby was delivered swiftly by cesarean section.  Her baby, Emanuel, is now holding on, yet fading fast.  Jemate’s family sits in silence.

As we move through our days, I make sure that I check in on Jemate each day to shake hands with each of her family members.  I learn how to say “beautiful” in her language and keep saying it as I peer over Jemate’s father’s shoulders at his grandson, baby Emanuel.

There is stillness between these family members that is difficult to describe.  Coming from a culture where maternal and infant mortality is low, we don’t know the signs of impending death very well.  Everyone here knows that the baby will soon die, and they sit in this accepting silence as other healthy babies cry and are nurtured by other mothers in beds surrounding Jemate.  In addition to baby Emanuel’s fragile condition, Jemate’s body is also recovering from this trauma birth, yet she musters a few smiles through her devastating sadness.

Two days later, we hear that baby Emanuel is still holding on, being fed formula by a syringe.  But, as often happens in Ethiopia, Jemate has slipped into death’s grips while the doctors’ concern was focused toward her child.

Copyright 2018 Joni Kabana. All rights reserved. Site by TD