Photos From Life

On the left is a group of people who prepare meals at the river where my friend and I spent our day a couple of Sundays ago. We bought fried plantians, fried bread and some fried dough with dried fish and vegetables in it.






To the right, is my "office' in the bateys. I sit on the upsidedown carton, my translator and study participants sit in the chairs. This day, I had my study supplies lined up on the ledge and I keep medications (iron and vitamins) in little bags on the floor. All of my consent forms are in the backpack.


The picture below is the pharmacy in the mobile clinic. This day, it was staffed by nursing students from California.

Photos and excerpt from 7/25/08 - Jessica Pettigrew

Ina Mae in Zambia

A Zambian Midwife and the baby bundle in Chipata >>>

In my last week here I have been reading a copy of Ina Mae Gaskins Spiritual Midwifery from 1977. This book is groovy in the true Simon and Garfunkel late 1960’s sort of way. Besides being an integral component of the midwifery cannon of literature, it is a fierce, if not dated, reminder of the potential pleasures of having a baby – and the essential role that trust, sensuality, and surrender has in birthing.

During a presentation I made, I talked about the ubiquitous ‘baby bundle’ – as I call it. After the baby is born, it is whisked away and wrapped in a cloth diaper, then a towel, then a crocheted blanket, then a huge fuzzy adult size blanket – so it looks like an overstuffed burrito baby – which is so large in diameter that it is tough for two adult arms to completely wrap around it. I talked about how that baby bundle reduces any skin-to-skin contact that the mother-baby pair gets, and I included in my list of recommendations that more emphasis be put on the importance of skin-to-skin contact in the hours following birth.

After the presentation, an American woman expressed her dismay in this reduced skin-to-skin time due to the baby-bundle, to which her Zambian colleague responded "everyone in this room was born into a baby bundle. We all survived." Which is true. It’s a good point. And it calls into question that, which I think, from my midwifery background, is ‘essential.’

So what is the answer? Should each clinic around the world strive to create the groovy experiences as Ina Mae and her team does? Or should it be a strictly safely first approach? Or is it an obvious combination of the two that is important?

It is this question of mother-friendly services that brought me into midwifery in the first place, back in 2002 in Tanzaniza, inspired by Mary Kroeger. I think it is this question that will keep me active and passionate about this profession. I think one thing is clear – there is no harm in providing mother-friendly-fulfilling birth experiences. So why not include it? We could all use a bit more Ina Mae.

Excerpt from blog 8/15/08 - Rosha Forman

Research Continued

This week I have found myself in front of a classroom, full of health professionals, professors, and students, as an english teacher. My colleague and research angel was responsible for planning a training session, and she invited me to be a guest lecturer for medical english classes. My being rather unfamiliar with the art of teaching, i'm not sure what help I can be. But the students are cheerful, respectful, and their english is excellent already, so we can have discussions. Today's topics included everything to do with toileting (I'll be intentionally vague here for those who are not intimately involved in health care and may be wary of all this description entails). much to my surprise, I'm actually enjoying myself. I finally have a skill (though being an American, it's difficult to not speak english) that people are interested in and can use in their professions. I hope I can one day feel the same as a nurse practitioner.

Excerpts from blog 7/16/08 - Erin Luskatoff

Community Health Experience, Esteli, Nicaragua - July 2008

Team Nicaragua 2008

Centro de Salud

Casa Materna

Photos contributed by Janna Ekholm

Let This Love Wash Over Me

There is something about birth, about being privileged, honored to participate in one of the most intense and intimate experiences in life that humbles me like nothing else. Why me? Why am I the chosen one? What have I done to deserve this honor? It brings tears to my eyes…what have I done to deserve the trust that women give me, that allows me to assist in the most transformative of life events? After births, while I’m coming down from the so-called “birth high” (which, to me isn’t a high at all. I associate “high” with being in another world, dissociated with reality. When I participate in birth, I feel as if I am so much in this world that the intensity of life in the moment is almost too much, it crushes me, it washes over me, it consumes me. Afterward, I don’t feel high at all but acutely mindful, so aware of everything in the world.) I crave water. I want it to rain so heavily that I’m soaked to the bone. I want to swim, have my head under water so that I hear nothing at all. I want to shower and feel the cool water wash over me. I put my fingers in my ears and hear the water wash over my head. It is cold, but quiet…all I hear, feel, sense is water. The harshness with which I perceive all other stimuli is silenced by water. The day begins with water splashing on the floor (or today with my fingers scratching away at a bag of waters) and ends with me in water, allowing it to consume me as my body, mind, and hands were consumed by the splash on the floor.

So one day in the public hospital = 4 births, 2 of them which I did. One was a direct OP. 2 repairs. Lots of practices that made me want to jump up and down and scream in horror (slapping of the belly, fundal massage during second stage, literally pushing the baby out by applying pressure on the fundus, delivery on a 12in wide delivery table with feet in stirrups), but there were a lot of things that weren’t done that pleased me equally (no medications on board = nicely reactive babies, no bulb syringe suctioning, no insistence that the baby cry it’s head off, no epidurals, no sections, no inductions, no episiotomies, intermittent/no auscultation). In fact, by the end of the day, women wanted to deliver with us, the three “comadronas americanas”. Tomorrow we’ll go back and I’ll be humbled once again by the honor bestowed upon me for reasons I don’t understand.

Excerpts from 6/25/08 blog - Jessica Pettigrew

A Week Under My Belt

Each day this past week I visited a clinic here in Lusaka and hung out with the midwives in the Labor Wards. It has been the best week so far - and it feels all warm and tingly to be doing that which I set out to do. My initial sense? The midwives here are overworked and under paid. They are passionate like midwives around the world about what they do. They are skillful and are hungry for more techniques to save lives and reduce morbidity. They LOVE oxytocin and active management. The only reason they are not using it is if there is not oxytocin available. In some of my interviews, which I expected to be a careful unpacking of attitudes and barriers, I have been getting answers like "I love it" and "It works." The interviews that I expected to last an hour are barely 15 minutes. One midwife actually said "Why do you keep asking me about the same thing?" Hmmm...

But not all is well in the clinics. Mothers are separated from their babies almost immediately and are asked to get up, clean themselves off, and wash their own linens about 10 minutes after delivery. The babies stay stacked on an empty bed, wrapped in a HUGE bundle of blankets and towels, waiting for their mother to nap and rest before they come together. There is very little attention paid to the post partum period. Women are discharged 6 hours after delivery. When I explained that in the US they stay for 2 days post partum there were gasps. "What do you do with them for two days??" Ah, America.

I will spend a few more days observing in Lusaka this week - and then will take off for a series of trips to observe further out. Thursday I'm leaving for the Eastern Province, bordering Malawi... then will return Tuesday to head South to Choma and Mumbwa... then North to Ndola. I have expanded my sites because a) why not? and b) a few days in one place seems like enough time to become acquainted with the culture and the practices of a place. So, 25 births later, I'm feeling like a researcher in Lusaka at last. Time is moving fast now and I just hope I can finish that which I set out to do.

Excerpts from 6/29/08 blog - Rosha Forman

Emancipation Day

So, yesterday we headed to the National Park, which is really more like a city park as we name things in the States, for the festivities celebrating Emancipation Day. This is the day celebrating the end of African slavery in Guyana. There were many booths with food, and crafts, a main stage with children performing dances, and the most exciting was seeing families dressed in African attire. Many families were all dressed in the same pattern, but with varying styles, so you could easily delineate which people were there together. I was interviewed by a reporter from one of the local television channels. We also saw the manatees in the pond at the park.

Excerpt from 8/2/08 blog - Regina Longinotti

Research

So. My purpose in China all along has been to conduct research with older adults, living in the community.

I am using a survey tool called the Reminiscence Functions Scale, which was developed in the USA and Canada, and tested originally on college students. Recently, though, reminiscence has emerged as a possible modality to improve self-esteem and decrease depression in older adults. So, what is reminiscence? In a simple sense, it is recalling past events from one's own life, re-visiting old memories, pleasant and painful, and processing them emotionally. Why is this important? Because as older adults age, there is sometimes an increase in isolation and depression, and a general decline in quality of life. Reminiscence may be a promising way to alleviate these events, without medication, and with human interaction, and perhaps affection.

This was a banner week for me, for data collection. After more than a month of revising the scale, which had been translated from English to Chinese while I was still at school this spring, we finalized the survey tool a few weeks ago. While the language may be Chinese, the cultural and linguistic appropriateness was not achieved, according to at least 3 focus groups we conducted. So, we made vocabulary changes in an attempt to simplify the scale, we consulted linguistic experts within the university, we consulted psychiatrists at the local hospitals and university departments...all in an effort to make the scale the best possible tool. So, for now, we are using a finalized version of the original scale. My colleagues here have been endlessly supportive and helpful. I think, ultimately, the scale may have to be completely revised to be appropriate for older adults in China, but sadly, this is out of my project's scope, as a master's student and novice researcher here for only a few months.

However, that being said, when things happen, they happen fast. We distributed probably over 200 surveys this week, with the most rewarding (for me) including outings to local parks early in the morning (6:30...this, for me, is early! but it certainly affords the opportunity to avoid the excessive heat in subtropical Changsha, and older adults are out en force doing their morning exercises). It is simply blissful for me to observe the flurry of activity, cheerful smiles and greetings in reply to my shy "ni hao?", bustling around the parks and sidewalks...people simply going about their day, living their lives.

I am content.

Pictures and excerpts from 7/6/08 blog - Erin A. Loskutoff

"My Dear - this is Africa!"

It's amazing how much can happen in a week. I feel like I'm standing in a very different pair of shoes than I was during my last post - although in reality it's the same warn pair of Dansko clogs. I returned from Ndola - on a bus - after waiting 4 hrs for the bus to fill to capacity and FINALLY leave the station. No sooner was I done thanking God for the departure than on came the terrible Nigerian soap operas played at unimaginable decibels. After covering my ears and whimpering for a while - the man behind me laughed. "My dear - this is Africa!"

Ndola was a beautiful little city - with wide tree-lined streets, a 'Shop Right' super market, and a nice woman selling hard-boiled eggs and delicious oranges on the corner between my guest house and the hospital. I spent a full three days there - and in total - only observed 7 births. I decided, as most babies are born in the wee hours of the morning - to switch my day shifts into evening/night shifts. My plan all but failed there - as in 11 hours - I only saw one normal delivery. Although my eyes were tired, my confidential envelope was all but empty. Ndola hospital was very well equipped however, and did not buck the trend that I have been seeing: Active Management is used and loved by the midwives.

The last morning of my trip, acknowledging my bad luck at the hospital, I hopped a cab to see the busiest clinic in one of the surrounding compounds. What luck! I saw two beautiful deliveries in one morning. Both done by students- with the midwife looking over her shoulder. So - my total number of birth observations is at 58 (6 higher than expected). I am now heading into the next phase of my project - the analysis and the closure of sites. I have spent the day coding - and making thank you cards. As a gift I am giving protective eye glasses - as all the midwives wanted mine. In my interviews, when asked about what was needed, many said "protective clothing." While 30 pairs of goggles won't save anyone necessarily, hopefully it can prevent one splash from getting in a midwifes eyes. Wednesday I leave on a canoe trip for a few days. Time to see some hephalumps and woozels.

Excepts from 7/21/08 blog - Rosha Forman

Simple Logistics?

Here I am again. Monday was a national holiday here, so I was excited to start my study today but still needed to print my survey with a few adjustments from a review by the head nurse at one of the clinics. I was finally able to print an original copy yesterday on the nurse's association computer- which was a challenge in itself for some odd reason. The next step was to make MANY copies of the 15 page document which includes, a sociodemographic survey, consent form, microbicide acceptability survey, and my 8 interview questions. I need one copy for each study participant, and I have anticipated a minimum of 100 participants (with many less interviews). So, big issue: how to make all these copies. Oh how I wish I could just run to the copy shop on Whitney. Of course no businesses were open in Georgetown yesterday because of the holiday, so here I am this morning trying to get the copies made so I can get started... I just dropped off the 15 pg document at a copy place and when I requested 50 copies (I really wanted 100) the woman working there looked shocked. Reason being, that amount of copies will be quite expensive (about the same price as it would be in the States) which is a lot of money here. I was too nervous to ask for 100 copies because of the amount of cash I'd have to pull out when paying. So, as it goes I am in limbo as I had to drop off the order & they said to call in 2-3 hours to check on it...

Will I become a researcher really one day, this afternoon maybe? Am I already a researcher? It seems a bit surreal: me being a researcher. I was emailing my friend Eden yesterday who is beginning to conduct her own research in Uganda. She mentioned how she really just wanted to be a clinician, and here she was putting so much thought & work into becoming a researcher (I am paraphrasing of course). I empathized, and her words definitely got me thinking about the many roles of a nurse, and how I see myself. I realize that I spent all year in a dual world. I was preparing myself clinically, to see patients and attend to their healthcare needs, advocate for lifestyle changes that might prevent disease, perform skills and tests that sometimes felt like magic, understand the body and its intimacies, and learn to listen, listen, listen- to determine diagnosis. And at the same time, I was formulating my research proposal and later protocol. Working through many drafts and many, many hours of literature review, preparation, interviews, ethical review. Through my first year working toward becoming an Advanced Practice Nurse, I was simultaneously navigating the language of research protocol, and the language of nursing and medicine: a 'triangulated' study versus 'phenomonology', this as foreign to me as the subtleness of the variation in heart sounds, murmurs, and the words used to describe and define them. How to write a 'protocol' of my proposed, hypothetical, research, as mind boggling as the art of conjuring the correct descriptors, to formulate the verbose, almost poetic, details necessary to 'chart' what I previously might have called a simple, 'pink rash' on an extremity.

The familiarity I am still only grasping, of how to incorporate nursing theory into my research design, and how to assess 'normal' when palpating the ever-challenging, ever-individualized, thyroid. This was all new territory for me, challenging me, on both fronts: clinician & researcher- a novice in both. Dealing with certain logistics, I have decided, might make you question anything.

What is my role as a nurse? Am I forgetting my newly acquired clinical skills while being here in Guyana, considering so many other things, none being the innumerable adaptations that occur in the female body during pregnancy or the countless maneuvers to perform during a musculoskeletal exam. Should I review the cranial nerve exam when in the taxi? I have not felt divided until now. I was caught for a moment with my clinician guard down. Is that OK? I know I am a nurse. Because I routinely remind myself of this relatively, newly acquired role: 'You are a nurse. You are a nurse.' I am also a researcher (note to self) as I sit here in a wireless cafe in a foreign country awaiting some of the logistics of my study.

Excerpt from 7/8/08 blog - Regina Longinotti