Wednesday, December 23, 2009

birth




I don't really know what I'm setting out to say here, but I've been thinking about the Christmas story from a different angle recently. But let me backtrack...

I finished working at the hospital last week, spending my last 5 days in the labor ward. This was probably my favorite place because the labor ward is the one place in a hospital people come for a usually happy occasion versus having an unexpected tragedy or sickness. 

In certain situations it's almost comical how not-shy I am, meaning I found myself giving laboring mamas backrubs and advice, directed nursing students with jobs to do, and delivered 3 babies (something that was on my life list of things to do). I've seen and participated in births before but being the one who facilitates the passage from one reality to the next for a new baby's life is breathtaking. 

You've probably heard it said that birth is beautiful. Yes, birth is beautiful....but not particularly pretty. It involves hard work, pain, and oh-so-many different body fluids in plenty. 

 I loved watching the midwives because they have more autonomy than most nurses here and it gives them a confidence in the way they work. When they examine their gravid patient it's as if the big belly becomes their canvas they will work a masterpiece upon... Slowly rubbing their hands together first to banish cold fingers, then methodically and purposefully massaging, pressing, and feeling that belly to divine a baby head, back, rump...  These midwives don't have tocodynamometers or bedside ultrasounds. Their sole tool is a tin cone - one side is put against the pregnant belly while the midwife presses her ear against the other side to hear the "Thump-thump-Thump-thump-Thump-thump" of a yet unborn, quickly beating heart. 

The miracle of life, indeed. Watching babies delivered here in Uganda was both fascinating and scary not necessarily because of what they do, but because I know what they lack, as compared to the American labor and delivery process. These midwives seem to go in almost empty handed when you consider the plethora of complications that "could" happen. I had to remind myself several times that I'm a staunch supporter of "natural" childbirth and that women have been having babies for centuries.....which brings me back to where I started - Christmas, the birth of baby Jesus.

I've heard that Mary was probably only in her teens. I'm just trying to imagine what it must have been like for her - dealing with the severe body-image disturbances of pregnancy when she hadn't even really reached womanhood yet. As if that was not enough, she was away from home in a dirty place meant for animals. Who helped her when the moment to deliver came? As far as I can tell the Bible doesn't mention anyone else besides Mary and Joseph...and most expectant fathers I've come across aren't exactly the picture of composure, let alone ready to take the position of midwife. 

I don't really have new or profound thoughts here, I'm just thinking out loud...It's just that I find it equally breathtaking that God would choose to have his Son BORN - to enter the world in a potentially perilous and undeniably messy process - that to me is a divine miracle and mystery. 


Luke 2: 4So Joseph also went up from the town of Nazareth in Galilee to Judea, to Bethlehem the town of David, because he belonged to the house and line of David. 5He went there to register with Mary, who was pledged to be married to him and was expecting a child. 6While they were there, the time came for the baby to be born, 7and she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger, because there was no room for them in the inn.

Sunday, December 13, 2009

The Acculturation Project

I think it’s a pretty simplistic and innocent idea at the surface, one that is ingrained in us at an early age and maintained throughout our lifetime. You know, conversations like these:

“Well you are such a pretty little girl. What do you want to be when you grow up?"  

                 “A ballerina.”

“Jimmy, what do you want to be when you grow 

up?"                     

                  “A fireman.”

“Wow, look at this report card. You are so smart. I bet you’ll be the president of the United States when you grow up.”

These dialogues don’t end when we stop dreaming of pink tutus and red fire engines either. I mean, isn’t that a main driving force of life, this question, “what will I do?” We teach our children their ABC’s so that they will go to high school, so that they can study hard and get good grades, so that they can get into an Ivy League school, so that they earn a degree that will assure them a fulfilling, successful, and lucrative career… right? Maybe that is a bit extremist, but I know that in my own life I often fall into the pattern of thinking ahead to “the next thing” that I will do, whether it be career, job location, education, etc.

We are a resume society thoroughly invested in impressing others so that we can get to the next step where happiness is sure to be waiting for us. I mean, be honest, would you rather say “I’m the chief cardiothoracic surgeon at John Hopkins Hospital” or “I’m the manager at Burger King down on 1st Street”?

For all the striving we do for it, here’s the funny thing about vocation – it doesn’t cause true and lasting happiness. I think you can enjoy your job. I think you can find a sense worth or fulfillment in what you do. But no matter what you do, no matter how much education you have or how many letters you have after your name, you will always have bad days when you wish you could be someone else doing something else. In college we change majors (multiple times). After college (and loans) we change jobs and whole careers because it’s not what we thought it would be.

I’m not all negativity. I think America is what it is today because people have continued to push themselves mentally and physically. It’s why we have things like the Olympics and the Nobel Peace Prize.

I’d like to tell you a story, one of the reasons I’m writing this in the first place.

The last month or so I’ve been working on getting a permanent Ugandan nursing license so that I can be legal and ethical doing my job here. In order to obtain a license I was told that I had to work in a Ugandan hospital for 8 weeks, 8-5, M – F, so that I could gain understanding of the Ugandan healthcare system and healthcare issues. After some finagling and games of “I know so-in-so,” my “sentence” was reduced to 4 weeks, for the hours of 9-3.

I now call this time “The Acculturation Project.” Here’s the truth though. I have not had a good attitude about this time in general because (1) I don’t like being told what to do, (2) I feel uncomfortable with mandatory volunteer work, and (3) I felt that I would have little to learn from the healthcare system of Uganda.

Last week was sad for me. It was week 3 of 4 and it was spent in the pediatrics ward. I’ve never had a desire to work pediatrics mostly because I love kids so much it’s hard for me to see them sick and hurting. Put in this context where I feel essentially powerless is painful.

The nurses on this ward either didn’t know what to do with me or didn’t care, so my time was largely self-directed. I made daily rounds with the doctors and I don’t think they knew what to think either as I followed them around, looked, listened, asked questions, made comments and oh-so-subtle suggestions.

Since I had so much free time I introduced myself to the patients, I made friends with the mothers (who gave me curious looks of “what is this white girl doing?”), and I invariably ended up having favorites.

The people I met and stories I heard gripped me: HIV-positive mother with HIV-positive and Tuberculosis-positive son; small baby with a likely fatal brain injury; children with burns; small baby girl with a life-threatening heart condition…These would be tragedies enough seen in the US where care and resources are almost limitless, but here, where there are no NICU’s, or ventilators, or anesthesiologists them seem needlessly cruel. I’m used to seeing bad, even horrible things after 3 years of working in a trauma ER; I’m not used to seeing bad things without having the resources needed to fix them. The sad truth is the week before, I spent some time taking pregnancy histories from women in the antenatal clinic and almost all women with previous pregnancies have had babies that died. Death is an accepted part of life.

In the midst of these stories, I met Richard. Richard is a 6-month old boy who was in the hospital for malnutrition that had reached a stage called Marasmus (meaning the child reaches a point of emaciation and wasting from protein-energy malnutrition). The first time I saw him he looked up and gave me the biggest laughing smile, as if he didn’t have a care in the world.  What a personality.

Let me explain how hospitals here work; nurses are responsible for giving out medications and administering treatments, but their responsibility ends there. Families are expected to stay with the patient to attend to any patient care needs – like providing food, helping with toileting, providing and changing sheets and clothing, etc.

Richard’s mother was, essentially, absent. The other mothers told me she was probably “out getting food.” I never saw her the first few days I was there. So, I began changing his diapers, holding him, taking him around to “visit” with other kids. Pretty soon all the mothers in the ward knew Richard by name and that he was my special friend.

The last day in the ward was really difficult. Richard was supposed to be discharged, sent home with his mother who would have education and a referral for a follow-up clinic. I was angry. Richard’s mother, it turns out, is a nicely plump woman. I can only hope Richard’s future will be brighter and more full of love than his past has been.

So, how do you say goodbye? I thought about not; I thought about picking him up and walking out the door.  In the end, I told him I loved him. I prayed over him, "The Lord bless you and keep you--the Lord make His face shine upon you, and be gracious to you…”

Most of my thoughts during the week were consumed with thinking about going to medical school and how much more I could help these kids if I did…When the week was over though, the things of true substance did not involve life-saving medical heroics. The only thing that mattered was that I sat and talked with people, I changed diapers, I learned names and remembered them, I held babies and gave them love, I held a hand.

I’m not telling you this story so that you can think I am some sort of a saint, because I’m not. I’m telling you this because I was wrong and I need to constantly redirect my thinking.

Have I strayed too far from where I began? Here’s my point. I spend far too much time worrying about what I should accomplish and what I want to do, rather than focusing on the type of person I want to be.

 

“[They] don’t accomplish what they wanted to accomplish because they weren’t the people they needed to be…God is more concerned about changing you than your circumstances. It could be God wants to keep you in these difficult circumstances cause He’s changing you." 

                        - Francis Chan

 

I still want to be intelligent, talented, and challenged in my career. I will still dream about things I want to do in the future. But more than that, I want to be a woman of excellence and I want my life to be characterized by love.

 

 

“We can do no great things, only small things with great love.”

                    -  Mother Teresa

 

“For this very reason, make every effort to add to your faith goodness; and to goodness, knowledge; and to knowledge, self-control; and to self-control, perseverance; and to perseverance, godliness; and to godliness, brotherly kindness; and to brotherly kindness, love. For if you possess these qualities in increasing measure, they will keep you from being ineffective and unproductive in your knowledge of our Lord Jesus Christ.”

                            1 Peter 1:5-8

 

Tuesday, December 1, 2009

bus stop


A friend and I took this unconventional vacation to Belize last year. I say it was unconventional because although the original plan was to soak up the sun in Mexico, the wind of adventure took us some 12 hours on public transportation to a small fishing village in Belize. It was unconventional because it involved fleas, Rastafarians, more rain than sun, many unplanned days, lots of walking, and lots of waiting.

I have strangely fond memory. We had gone hiking and were ready to catch our public bus back to town. It turns out bus schedules were really only guidelines for a more "relaxed" rule of operation; in the end we waited for our bus for a good 3-4 hours on a semi-deserted highway road (through a rainstorm I might add). 

I learned that much can be said for waiting, watching, and observing. Small details of everyday lives of everyday people suddenly become intriguing;  you meet people who are unusual and outside of your ordinary; you allow your mind to wander and wonder with questions, realities, and possibilities. 

But WAITING....waiting....waiting, is hard. 

It's been on my mind recently, this waiting, probably because it's something I dislike and something I am not good at doing.

I've smacked into this wall called waiting several times since being in Uganda. The culture here is relationship-driven which is interpersonally rich....and functionally slow. Everything takes longer. 

But WAITING....waiting....waiting, is shockingly common. 

I get this "woe-is-me" tendency when things do not go according to my timeline for me. If I dare to turn my head even slightly to look around though, I see waiting happening to everyone. 

So what's the point? Is the value in the waiting itself, or in what comes when it ends, or in what it takes to get through it? 

But WAITING....waiting....waiting, is necessary.

I wonder what kind of a person I would be if my every whim was instantly gratified? The words that come to mind are less than complimentary - selfish, greedy, proud, isolated...

Do we have a choice when it comes to waiting? I'm most certainly first in line when it comes to being proactive, but what about those things outside our realm of control? I suppose the alternatives would be to Give up Hope, or Go Elsewhere. And isn't that just it, that waiting for the time, or the event, the thing, or the person involves that shiny treasure called HOPE? Waiting requires one to have hope and is rewarded by hope for the next time...

I often feel like I have a scattered soul. Like I need 13 lives to do all the things I dream about doing. Like each dream is so distantly far off or unrelated that there is no way it will ever intersect with reality. 

So now what? Do I embrace the "Just do It" philosophy or do I do as John Mayer sings and just wait for the world to change? I don't want to drown in passivity but I don't want to be made ugly by self-sufficiency either. The balance is tricky.

My need for Hope, whether waiting or doing, however does not change....and my Hope is unchanged and unlimited because it is rooted in God, who remains constant and everlasting throughout. 

Is it just coincidence that a new and dear friend of mine here gave me my own Ugandan name, "Ssubi"...."Hope."

"And hope does not disappoint us, because God has poured out his love into our hearts by the Holy Spirit, whom he has given us." Romans 5:5