Being back is really strange. I can't believe how clean it is! I spent part of a day in Manhattan on my leg home and felt like the streets and sidewalks were clean enough to eat from and the air clear and fresh. And then to arrive in Portland where it is less polluted! It's also strange to see cars parked neatly against sidewalks and I have to remind myself that in America we don't greet every person who glances at us, or walks by. In Senegal there is a long list of greetings that are said to even the random people you pass by and to not answer them is very rude. Its something I wish we did here. It feels good to acknowledge the presence of someone who is just a stranger in the market.
The trip was rewarding in many ways, and it is hard to decide on favorite moments. I caught 19 babies, 7 of which came in the last week on a 48 hour shift and 6 of those came in a space of 16 hours. That was a crazy evening. I never did make it to the twin deliveries (there were two, one of which was on my shift, but I had preceptors reluctant to go to the clinic, so we didn't go in) and I missed the one breech birth. I'm a bit disappointed about that, but the rewards of experiencing 19 other deliveries and one transport are far greater. The transport is probably one of the most rewarding experiences of life to date. I A mom came in with a placental abruption, essentially she was bleeding internally, filling her womb and the amniotic sac around the babe with blood. Its one of the scariest situations in midwifery, and handling it in Africa, with minimal supplies and ambulance rides that are not affordable and take hours is beyond that. t's amazing what 20 American dollars can get you. In this case, a ride to the closest hospital and a life saved. Not to negate the care that Aimee (one of the other students) and I were able to provide, but there is only so much you can do without modern technology and doctors who can perform Cesareans. There really aren't words to describe the experience of sitting next to someone as their spirit decides where to travel next. I have sat with babies as they make the transition from the other world to this, and I have it seems, witnessed them struggle with the choice to stay in this world or return to the spirit realm, and I have been there when the choice was made not to be born into a physical body, but there is something profoundly different in witnessing a mother make those choices as well. There was a moment where I thought she had slipped beyond our medical care, beyond our human understanding, and I thought the mother was going to join her baby and the angels, but she seemed to drift back just as the ambulance was arriving, a couple hours after we knew she would need one. Here, she would have been to the hospital and probably would have been in recovery by then. Time in Africa has its own category--no one is in a hurry, ever, even when its a life and death experience. Once Aimee and I got the mother on the ambulance we had to return to the duties of the clinic. We would have to wait to hear if this woman made it alive to hospital. Hurry up and wait as they say. The mother did indeed make it. And she wouldn't have made it if Aimee and I hadn't had the 10,000 CFA's to pay for the ride. It leaves me with an odd sense of power, disbelief, and gratitude. But the truth is that these choices are not in our hands. We can have the best hospitals and doctors at our fingertips and not make it, and we can be in a tiny African village where time moves at a snails pace; where it takes over two hours for the ambulance that is less than a mile away to get up and running; where ambulances stop to pick up hitchhikers during a transport, and there are no EMT's riding in the back, and we can make it. We truly are led by the divine and in the hands of the divine and we really have not other option than to surrender.
The family was so appreciative---the families in general were very appreciative. I had a baby named after me, and a couple of moms that were happy to give me one of their children. Including the mother of the twins who's birth I missed. She would be happy to share one of her babies with the American. The people were easy to communicate with, despite the language barrier. Hand gestures and humor get you far. Bargaining in the market was lots of fun, as was having clothing made. Aimee and I had quite a time trying to communicate about dress style and size with the dressmaker who spoke only Wolof---we couldn't get by on Aimee's french this time around. Needless to say, we have Senegalese outfits that do actually fit and I received my second marriage proposal (this was early on in the trip, there were more proposals and refusals made). It's an honor to be the second wife, its actually the preferred marital spot, so I guess I should feel blessed that no one wanted me as a first wife (those wives are really only good for cleaning and cooking). Another highlight was having prayer ties made and relay race of communication that happened around that. It was a big deal that I was even asking to have prayer bags made, me being a non-muslim and an American. This man, probably in his 50's sat under a big neem tree just about every day making these medicine bags. The women and the men wear them around their arms or waists--they are considered powerfully protective and can bring many blessing. The women don't remove them during birth and the babies are given theirs in the first hours postpartum. The prayers are written on long strips of brown paper and then tightly folded and wrapped in colorful leather. The leather is sewn around the paper so that each pouch is sealed. A few of the pouches contain a piece of bone, often a horn. Of course I wanted a horn too, but that was lost in the translation. I am not sure if that was asking too much or if the man just didn't get the message. In any case it took a lot of work to have this piece made. It took my dramatic hand gestures and limited Wolof phrases (including one that translates to "slowly slowly the monkey comes out of the jungle" meaning "I'm sorry I am a foreigner who didn't bother to take the time to learn your language, but I am trying") Aimee's french, a man who translated some of english and some of our french into wolof, another man who translated some of Aimee's french into wolof, a handful of observes, a few children, our taxi driver, his friend (who offered me the last marriage proposal of the trip, once again as second wife) and of course the artist making the bag to get the job done. It was a priceless experience. And I am sure the man making bag was happy to get good payment for his efforts, and I am sure he was relieved that I had refused his marriage proposal (given a week earlier) as I think he realized American women are more trouble than they are worth and wouldn't be very useful wives. By the way, there is a group of men wandering the streets of Mboro waiting for some American women to arrive. Aimee and I promised them that we would send our single female friends their way.
Anyway, that's all I can process for now. It's a lot to filter through!