Bangladesh, you were beautiful and tragically real. Heartbreaking and healing. In so many ways. There are so many experiences and so many stories that I have yet to put into words, that I have yet to make tangible and release into this world. It is never easy to walk away from a crisis, especially one of this magnitude, and effortlessly return to the ease of the life you temporarily leave behind. There is always an adjustment, sometimes it happens quietly and subtly, and other times it is a full rebellion against anything and everything. There is so much work left to be done and such a significant need for continued support. Shortly after the New Year I will board another plane that will take me back to that corner of the world where I plan to spend more time providing healthcare services and midwifery support to the people and the midwives who need it the most. Until then it is a practice of being present with where I am and who I am with. It is an effort and intent on ‘being’ instead of ‘doing.’
You have no access to labs in the field, no sonogram machine, no blood draws… just your hands and eyes and a basic set of tools/instruments you carry with you, and you’re left to use your best clinical judgment to evaluate, diagnose, and treat patients. It brings you into a space where you begin to question yourself, what you know, what you don’t. The training wheels are off and everything we have grown to rely on to support our clinical judgement is no longer there. It is us and it is the life sitting in front of us that is depending on our accuracy. You have to trust yourself, trust your skill, and trust your judgment. Trust that you know your shit and you’re making the best decision you can with the information you have. Because there will be moments where you find yourself in the middle of the field with one of the worst hemorrhages you’ve seen and you already used your bag of fluids and antihemhorragics on the birth you just left and you were called to this one because you happen to be in the right place at the right time. So you do what you can with what you have to stop the bleeding and stabilize the emergency, because it will take at least 3 hours to get her off the top of this hill and out of the camp to the nearest emergency clinic. …and you don’t always have 3 hours because by then there is a good chance it will be too late. But that’s what you have and you move mountains to get her to the road in 2 1/2 hours instead of 3 and to the clinic and by this time she can barely stay with you and is floating between this world and that one. The image of her surviving four children standing in her blood in the middle of their tent will forever be burned in your mind and you can’t shake the image from your head and you plead with the old gods and the new that she makes it, that she pulls through, because life for these people has been so fucking unfair and they have already had so much taken from them, so please don’t take her too.
**Also, many people have reached out to make donations and I finally created a fundraising page that you can access here:** https://www.youcaring.com/rohingyawomenandchildrenrefugees-1018687?utm_source=mandrill&utm_medium=email&utm_content=Link&utm_campaign=Donor
There is a startling prevalence of gender based violence (GBV) and victims of rape and sexual assault in the camps. The Myanmar military used rape as a weapon of war, a form of coercion and torture, carrying out horrific acts against Rohingya women and young girls. Many governments are side stepping this atrocity, down playing its truth, pretending it is not happening, that it does not exist. But it does, and as midwives we see first hand the silent scars that sexual assault and rape leave behind long after his hands have left her body. The stories are never ending. Every day I sit with women who have been victims of sexual assault and rape. Every day I meet someone who shares her story. Every day I meet someone who has survived the unfathomable. Their stories slip from their lips and fall into our hands. We feel the weight of them, the heaviness, but can never quite wrap our minds around the horror of it. The horror of what has happened to them, the horror of what these women and young girls will carry with them for the rest of their lives.
I was sitting in the sweltering heat of a small Reproductive Clinic inside the camp. A young woman quietly stepped inside the clinic, keeping as close to the wall as possible. Hamil? I asked. She nodded, her hands crossed protectively across her core, her eyes cast downward. I motioned for her to come with me into an exam room. She followed me inside and asked her to take a seat. She pulled back her veil and her eyes were heavy with tears waiting to fall and I knew. It was an intuitive knowing, a recognition, a look that says more than words ever will. I asked careful questions and she revealed her story. One evening the Myanmar military swept through her village. They broke into her home where they tied up her parents and forced them to watch as she was raped and beaten. She says she lost count after four, but the men kept coming. They left her naked, bloody, and bruised until the following morning when they returned. They slaughtered her mother in front of her and her father, telling her that her mother’s death was because of her acts with the men. She and her father fled their village and somewhere between here and there he was murdered, too. She continued the journey alone, eventually being taken in by another fleeing family who continues to care for her. She is 16 years old.
In one way or another, she will forever carry the painful reminder of those men with her. She will nurture it, she will rebirth it, again and again. Their touch has been etched into the depth of her being and she will soon give birth to their ghost, a haunting reminder that has been growing and stirring inside of her for the past several months. …and how do you ever recover from that? When everything was taken from you without ever having a say in it. Your dignity, your innocence, your body, your future, your family. How do you live in a reality where every single thing that shaped you and who you were and who you were becoming has been stripped from you?
She will birth a part of him, a part of them, into her own hands. A beautifully cruel reminder of a darkness that will forever be a part of who she is, for every time she looks into her baby’s eyes, she will see him staring back at her.
The following is a link to a Human Rights Watch Report on Sexual Violence against Rohingya Women and Girls in Burma, published November 2017, I strongly encourage you read this document: https://www.hrw.org/…/…/files/report_pdf/burma1117_web_1.pdf
*This story was shared and posted with consent from the girl and the family caring for her. Her details are protected and there is no identifying information. She was referred to the appropriate NGOs for full assessment, treatment, report, and access to additional healthcare and psychosocial resources.*
Birthing at home is the norm here. It is beautiful to have the opportunity to witness such a primal, natural way of living and being. A far cry from the cold, dry hospitals and pretty birth centers that have shaped a significant portion of my birthing experiences, both personally and professionally. Yesterday afternoon, as the heavy heat of the afternoon sun bore down on the camp, a man came into the clinic and told us his wife was having a baby and he wanted us to check on her. A local midwife and I picked up our birth box and began an almost 2 km hike into the camp. We wound our way up carved out steps in hillsides and balanced across narrow hand crafted bamboo bridges, winding through a never ending maze of tents and homes and people. Eventually we made our way down a steep hillside to a set of tents that lined a latrine filled with dirty sewage water and into a tent on the edge of it all. The inside of the tent was hotter than it was outside. Black tarps lined the roof and the still air inside was sweltering. The mother was just birthing her baby as we walked in and it was a moment where I never felt the need to intervene. She didn’t need us to. She was in her space and there was no fear. She was listening to her body and following its lead and she birthed a 4kg baby into her own hands. There was no screaming, no fear, no desperation. This was normal to her, to her family, to her culture. It was beautiful to sit back and observe such an incredibly intimate and powerful moment. The strength and resilience of these women astound me. Less than an hour later she was walking around her tent, tending to her other 4 children, squatting in front of the fire, and moving about as if she did not just push a baby out of her body. Her baby boy was perfect, healthy, and he came into this world ready to conquer it. The true culture of birth has all but been lost in the western world. I feel like this is stepping back in time and really seeing and understanding what birth is and what it isn’t. What it means and what it stands for. What it could truly be, and return to, if only we could reclaim it from the cold objective hands of medicine and men.
*Trigger Warning* Balukali, a Hope Foundation field clinic in the middle of a massive refugee camp home of the Rohingya. An expansive living, breathing camp that embodies the reality of what it means to flee from mass genocide and ethnic cleansing. It embodies grief and trauma, survival and adaptation, life and death. Yesterday I was in the middle of a flood of prenatal appointments when a woman walks into the tent and hands me a bundle of cloth. I open the cloth and see this tiny baby wrapped inside. The woman was worried about the baby’s feet, which were clubbed. I was worried about the size of this baby and the fact that it looked preterm, an estimated 32-34 weeks. I learn that she is a twin and her brother is in a tent somewhere in the middle of the camp with the mother. I request that the mother and second baby be brought in for evaluation. I examine the baby and begin the process of referral as this baby needs care that exceeds the capacity of the camp. Almost an hour later the woman returns with the second baby. She hands the baby to the Bengali midwives, who are cooing over how tiny he is and they nonchalantly hand me the second baby who is white-gray and cool to the touch. His heart was beating, but just barely. I hand the baby girl to a field worker, and the two of us take off running through the camp, while doing a full code/resuscitation including chest compressions and mouth-to-mouth as we ran almost a mile to the entrance where a small Tuk-Tuk ambulance is waiting for us. We were taken to a field hospital down the road where a team of doctors and I continued the resuscitation effort for another 15 minutes. His heart rate rose to the 140s, his color returned, and his oxygen sats were up to 70% at one point. But he was making no respiratory effort. Just a gasp here and there. And then you find yourself in that heavy space of knowing that even if this kid was to survive he would have no quality of life. You sit with the heaviness of it and the responsibility of what it means to make the call. The call to discontinue the resuscitation. I wrapped the baby boy in his linens and a clean hospital cloth. We reunited the baby with the woman who brought him to us, his aunt, while we tried to get the mom to the hospital as soon as possible so she could be with him. We sat quietly in a tent and we waited. The baby died before the mother arrived. The aunt knew the moment he passed. It was an intuitive moment. Sitting quietly in the tent, listening to his gasps, and then startled she reached out to me and pointed down to him. I looked down and could see the rest of the color leaving his lips, and I listened to a heart that was no longer beating. She knew. Without the need for confirmation, she knew. Hours later, after finding the mother in the camp and admitting her to the field hospital, I returned to the camp with the aunt and the baby. They were bringing the baby home to honor him and his short life according to their customs. It was an intensely humbling reminder that life and death are one in the same. In the world of birth, we dance with life and death on a daily basis, and we accept and honor both. *Photo taken and posted with permission of the family.*