Bubble in people, bubble in!

Ballots are out in Washington State. These are some very important initiatives, please do your part to make a difference.

______________________________________________

This is our story in Washington too.

That's my hospital and my neighborhood featured in those last two short films.

"Our Culture is Our Resistance"

I LOVE having a bag full of the following items in my living room:

* receiving blankets, onesies, hats, teeny socks, and sleepers (x 40)

* stethoscope, sphygmomanometer, fetoscope, penlight and non-sterile gloves

* bottles and bottles of ibuprofen, prenatal vitamins, ferrous gluconate and syringes

* scrubs, self-filtering water bottles, arnica, expensive camera, sketchbook and journal (the real paper kind, not a computer)

* Call the Midwife, A Midwife's Tale, Where There Are No Doctors, a Spanish dictionary and The Glass Castle

* poncho from a friend who went last year for the afternoons when it drenches and pours

* an expectation that I will somehow get to experience a sweat lodge with one of the traditional Mayan midwives, comadronas, and learn more Spanish.

* passport

Wish me luck on yet another guaranteed-to-change-your-life-once-in-a-lifetime-experience-cultural-immersion-adventure.

PS. if you ever find yourself capable of acquiring any of the following items, I decided that I could probably use a regular income of these for future endeavors: onesies, receiving blankets, non-sterile gloves (smalls), prenatal vitamins, iron, ibuprofen, arnica (homeopathic), amoxicillin, metformin, glucophage, one touch test strips, or urine dip sticks. Save 'em for me, I promise to spread them around the world.

Cheers!

Photographs from the amazing and beautiful book Our Culture is Our Resistance: repression, refuge, and healing in Guatemala by Jonathan Moller.

... because she believes in me.

Today I saw three Seattle Metro buses sporting the above advertisement.

I stopped and stared and began to smile.

For the past three years I have been teaching a course at UW on the culture of birth in this country. The following have been my course titles:

Birth 101: Everything You Ever Wanted To Know About Birth (2009)

Birth; Delivered (2008)

Inquiry Into Childbirth Culture in Contemporary American Society (2007-Inaugural Course)

This was the absolutely brilliant idea of my former doula business partner, Jane Harris. Together we propositioned the CHID department, no not Child, CHID stands for Comparative History of Ideas, in which Jane H. has a degree. This department has a course, CHID 496 that enables students to teach whatever they want, an incredible opportunity that has solidly become one of the highlights on my year.

I am struck today by this in-your-face advert because I have begun my class each year by saying something along these lines:

This class is biased, I will happily be up front about this, you should all know that I support out of hospital birth for healthy term pregnant women, and I support local midwives--providers best suited for the majority of pregnant women out there, healthy, normal and at term (as defined by weeks gestation: 37-42). Ninety-eight percent of babies are born in the hospital in the United States and still you see billboards and sides of buses with advertisements oozing with the cuteness of perfect mini humans all smiles, with phrases like: My Baby Was Born at Ballard, Born at Swedish, and my favorite pretentious claim, Smart Babies Ask to be Born at the UWMC. See, hospitals capitalize on birth, thereby squaring away lifelong loyalty by coaxing patients even before they're born. Question that statement? Who do young women go to for their first exam in the pelvic floor department (I'm talking about "smearing your pap" ladies)? The gynecologist of course, the OBGYN--Obstetrician/Gynecologist in fact. Which means what? Well, that when a lady finds herself preggers, she automatically turns to her Gyno who she's been "seeing" for years. Boom, scheduled sectional surgery later* and there you have another loyal lifelong patient already in place.

*Important note necessary here: This is of course not always the case, depends on a few things, also as much as a I knock surgical birth, please note that what I am actually opposed to is unnecessary medical intervention in an otherwise more-than-perfectly-normal bodily experience, birthing a baby. It is absurd to think that it is normal for our nation to have evolved just so that in that last two and half decades females can no longer accomplish what has been occurring for centuries--thousands of them in fact. What is also worthy of particular mention here is that we have amazing medical interventions today that literally save mother's and baby's lives. The cesarean was born so-to-speak for just that purpose, saving both mother and baby, an option previously unavailable. When cesareans are the only way out for a new member of society, they are one of the most impressive acts of the human hand to witness. It is still very much the birth of a baby.

Anyway, I am very tangential when you get me started talking about birth--did ya ever notice that?

The point is, today there were bus adverts for midwives! My class is based on the underlying philosophy that we live in an economically-based society with the expectation that we have consumer options in life, about everything. And we do, we have the option to birth however we want. Not very many of us even know exactly what midwives do. Incidentally they catch babies, they are trained, experienced, and professional baby catchers who are fully equipped and prepared for any twist and turn in labor. This goes for the scary ones too, at which point midwives make a note of the pink flag, not waiting for it to turn into a red flag and get thee to a medical facility that can implement the tools necessary to keep birth safe. It is extremely rare for an out of hospital birth to transfer in a state of true emergency. So, with consumer options comes public education and commodity marketing. Market away midwives of Seattle! Hurray for choice in this part of the world, exercise your right to education and make the right choice for you. Learn and believe that birth is one of life's most normal events. That, and dying... but I'll save this topic for another moment of sharing down the line. Know that death is also something I am rather passionate about, and like birth it is often medicalized, painful, scary, and in the hospital, alone with providers who don't trust it and therefore tend to contribute to the emotional instability of it, when it could otherwise be supported and protected, peaceful and beautiful.

Speaking of matters of life and death (because this is what keeps you ticking), even though I'm pretty bad at this, I've decided to do the crossword everyday this week... any suggestions?

Shoe part that touches the floor [7 letters] / Wedding rental [4 letters]

Climax

Waring: This post is pretty self-congratulatory.

Graduation was far more climactic than I had anticipated. Especially since I merely walked, I won't technically receive my degrees until August. A minor detail the director of the nursing program assured me, since there aren't any nursing positions right now anyway, and more time to study (read: more time to procrastinate studying?) for the NCLEX board exam for licensure. As close as I am to achieving my second degree, I would be academically bummed if I didn't go for the BA in Women Studies.

It's true, I miss the Women Studies atmosphere. Good old fashioned liberal academia, full of freedoms, individualism, empowerment, anger, human rights, attitude and political activism. I remember when I used to think that this was what nursing school would be about. Well now I know a bit more about that. I do feel that while nursing school has been a proverbial hoop, discipline, struggle, frustration, blood and sweat certainly do have their place in this world. I also realize that while a BA in Women Studies gives me an invaluable grounded position in this society, it doesn't--as readily--give me a job.

Enough negativity. Here is some positivity. 

I graduated! Did I mention that? My first bachelor's degree(s). I started down this road 8 years ago. First I dabbled in mathematics, primarily because I had a crush on my high school calculus teacher. Turns out I'm not great at math. So I switched to nursing, practical reasons; I could do well to take better care of myself, what classes would encourage that? Wait, do those classes offer a degree? A job!? Wooooow, I love nursing. Too bad nursing is really hard to get into these days. So I dinked around a bit, studied in the UK, became a doula, volunteered internationally etc. etc. Started a new degree in the meantime, and finally I was in [passed the perseverance test I'm thinking.] Two more-or-less amnesiac years later, poof! I can put some letters behind my name, never thought I'd see the day, nor did my folks.

There was even a grand culminating moment to all of this, my four and half minutes of small-scale fame. I was nominated by my peers and a faculty committee to give the student's commencement remarks. The only free-style speech at the ceremony. A responsibility traditionally offered to a graduate student in fact. So on behalf of 245 graduating BSNers, Masters, DNPers and PhDers I spoke the following words at my graduation last Friday:

_________________

What a privilege it is to speak on behalf of the various degrees of nurses having accomplished a major feat of academic pursuit and who are ready to re-join our greater community as a new and improved member of society. This is a ceremony of transition. Many of us are transitioning for the first time into the field of nursing; many others are transitioning from long standing nursing careers and are now here reborn as a nurse of a different color.

We are all functioning, contributing members of our healthcare system—no matter the political or financial condition. We are now officially a community of nurses who sometimes shared pain and suffering but who today share a sense of empowerment and great accomplishment. We transition through this stage in our lives together and with each other’s support so that we will be more capable of empowering others, namely, the patient populations we will soon disperse widely amongst us all, and contribute to a healthier society as a whole.

After all, nurses are patient-people.

It is also a great privilege to share this moment with an audience like you. Full of unconditional supporters: faculty, family, and friends. It is likely that without your encouragement, motivational, perhaps financial and certainly emotional support, that a few of us might not have made it. Nurses are strong, but we often require stronger support from those we love. Thank you all, for this.

I want to cheers to Nurse Flo, our founding foremother, in all her revolutionary glory, may we follow in her path and think of the little things that ease the discomfort of our patients as well think of the bigger things, and make room for more revolutions in healthcare. Say for example, advocating for a single payer healthcare system. And we again honor Miss Nightingale, and always wash our hands.

Today’s nursing graduations no longer involve the starched white cap ceremonies, but we know that we are part of an important tradition of care and expertise in our field. We do not need to denote our status in the field with this symbol of otherness; we are a community of healthcare professionals who meet our patients where they are in their process of health and healing.

Reflecting on what it means to be a part of this tradition of nursing, I often come back to 3  questions that frequently lurk when I am in a stressful nursing situation:

When is the best time?

Who is most important? and

What is the right thing to do?

Today I have the answers, they are universal, timeless, relevant to everyone and to me they represent what it means to be a nurse. They are from a children’s story adapted from a piece by Leo Tolstoy called The Three Questions:

“Remember that there is only one important time, 

and that time is now. 

The most important one 

is always the one you are with. 

And the most important thing 

is to do good for the one who is by your side. 

For these are the answers to what is most important in this world. 

This is why we are here.”

Undercover Doula

Disclaimer: I am a HIPAA-Happy provider, don't fret, details have been changed to protect privacy, or permission has been granted.

I am totally freaked out by L&D [labor and delivery] nursing.

I just finished my last clinical during this quarters' OB rotation. When the quarter started, the first thing I did was make an announcement on the doula community boards to warn them that there would be purple scrubbed nursing students roaming the halls of three major obstetrical units in the Seattle area, and to tell their clients to request that there be no students present for their births. To our credit, the nursing students were told it was an observational clinical only, and the most we could do was offer support, like be a doula!!

So the weeks ensued, and I attended a few births at the baby factory that is Swedish First Hill Hospital, where upwards of 800 births occur each month--holy crap--you know that means they put mama's on a ticking clock to make room for the next labor, at absolutely all costs. But I made the most of it, and resorted to my tried-and-true doula alter ego. I successfully avoided doing the charting and administration of procedures and injections and ordering of interventions. Phew. Ethically, I cannot phathom the role of the labor and delivery nurse [incidentally, pizzas are delivered and babies are born]. You leave a labor when your shift is up, not when the baby is born, and you meet the family in the throws of labor, not prentally where you have time to develop a trusting relationship and bond. So I'm just not on board with the whole concept.

A recent repeat doula client's newest babe--also photographed above holding dad's finger.

So on my last clinical day I attended a high risk birth, and morphed again into their doula and not the nursing student. I, alone, coached her through three hours of second stage pushing, with an epidrual, which requires a little coaching as you can't freakin' tell when you're contracting! And the nurse preceptor later tells me, "thanks for doing the pushing--I hate that part" Yikes. And ahem, I did no such thing, that mama pushed her baby out! The baby was called Joseph Michael, tribute is due here to a certain unaware namesake :)

I was later taken into a small hallway room where they keep "memory box" supplies and there was a nurse carrying what looked like just a baby blanket as if she were carrying a baby; nestled into the crux of her arm. She placed the blanket down and unwrapped it on the counter. A teeny less than 1 pound, 21 weeker baby girl was unveiled. She had just been born, after inducing her death because of spina bifida, a spinal cord deformity that is sometimes incapatible with life, as they say. Her tiny finger pads and toes looked like little tadpole digits. Her skin was sticky and transparent so that you could see the intense red of her vascular system barely beneath it. She had perfect ears and nose and eyebrows and even fingernails. She looked like a little tiny alien creature, and she was beautiful in her miniscule human way. The two nurses in the room with me were chatting amongst themselves about their various judgements they had toward the family. I listened, perturbed to the core at their very nerve, and softly touched this little being and sent her soul some reiki. I couldn't help it. Back out on the unit, I thanked my nurse for showing me the "fetal demise" and she said, "oh no problem, we get a lot of those here"...

I was then reading up on incoming patient's charts in the nurses' station, when I saw out of the corner of my eye a familiar face. A doula! I went out into the patient waiting room and chatted with long time doula, Jennifer Mendleson, we attended a birth together, ages ago now, my first home birth actually, the sixth time mom who labored for an hour and with a single push caught her own son and brought him straight out of her home jacuzzi onto her breast. It was so fun to see Jennifer there. She was waiting for her client to come out of surgery for an abdominal birth (sectioned as the L&D nurses affectionately call the cesarean). She asked me if I felt like I was undercover. I laughed. I absolutely do. I love it.

I love birth, and was happy to be a part of the one's I was assigned to, during this rotation, but now I know with conviction that I could never be a labor and delivery nurse, and that I will be a midwife. I think I could make a good birth nurse if I had to, a doula-esque nurse, but it would be ethically challenging for me to do so.

This is one of my doula babies, an awesome birth from 2007. I nanny for her twice a week now. We play, and she teaches me Mandarin. The other day she was playing on the fake phone and apparently having a conference call between my mom, President Obama, and her baby girlfiend. "Hi C. Lee, hi c lee hi clee Obama, Zoe, Obama, Maumi, (Mandarin for Kitty), Zoe, hi c lee, Obama" I love her to pieces!

Next quarter is my last in the nursing program, and my senior practicum placement is the Harborview Psych Emergency Department. Get ready to be spit on, pinned and swung at... says a few knowing colleagues. I'm totally stoked.

Heaviness

Dear all,

The above photo gallery goes like this: Village Spirit Man and grandson, Dorothy's ruby slippers in the hills of Northern Thailand, 85 year old traditional Lahu midwife, Three photographs of watercolor paintings from a book I bought depicting the illegal refuge seeking journey of the Karen people escaping Burma, A small girl crossing the road in a "floating village" in Cambodia, Myself with some new friends (one 5 months pregnant with the first of probably 7 children she said), and a somber face of Angkor Wot.

Since last posting I have been in a bit of a whirlwind of tragedy.

It all began very sweetly with a farewell to Forest, and then the entire group ventured off on our "educational trek." To the surrounding hills of Chiang Mai to spend some time with the hill tribe communities in northern Thailand. We were received with incredible hospitality in the home of the spirit man from the Lahu tribe. You can see him photographed wearing his toddler grandson on his back. We had a beautiful time even though I couldn't stop thinking about the difference between Thailand's Native communitites and North America's as far as brutality, oppression, and genocide. This kind of cultural observation tourism rightfully would never happen in the States--leaving me rather uncomfortable in this setting. Then, I returned Chiang Mai to devastating news from home.

With so little time to comprehend it all, I had to leave almost immediately for our site visit to the border town of Mae Sot. Kimberlee and I were conducting our research into the healthcare system disparities facing displaced persons escaping political turmoil and persecution in Burma. The currupt military Junta has been striving for massive ethnic cleansing and genocide since the 60s.

We visited a grass roots healthcare clinic that was started by a physician from Burma who escaped in order to help others in their plight for refuge. We also were invited to visit the medical director of the nearby refugee camp. Although we had previously attempted to gain official government documentation in order to enter the camp and were in constant contact with the Ministry of Interior, time was not on our side. We thought it was a lost cause. When we met with a French NGO working with the camp (AMI) we were told that it would be possible--if we were willing to follow specific instructions. Up for the challenge we were told to hop on a pick up truck heading to the next town (7 hours from Mae Sot), and to tell anyone who asks, that's where we were heading. We were to pass a police check point, followed by an army check point (if we passed another army check point we missed it). We would start to see a fence, sometimes bamboo, sometimes barbed wire. Wait to get off the truck until you see the end of the 4 km fenced off camp. Walk around until you see a hole or bent part of the fence and just walk through. Yikes!

Well we did so, but not before witnessing two women and their small toddlers get plucked off the truck at the army point because they didn't have identification. We were told that sometimes these patrollings result in imprisonment, and sometimes people are made to clean the army barracks and then are allowed to continue on. This was difficult for us to observe, women attempting to bring bags of rice and fresh vegetables to the camp for their families and roughly ordered off the vehicle by the same officers who smiled at the two of us, like this was a perfectly normal thing a tourist like us would see.

Inside the camp we wandered through slippery muddy narrow walk ways on precarious hills in the two feet alotted between some homes. Homes were bamboo thatch, but poorly-made, cramped and populated. We started asking for "hospital?" and a Karen woman called Rebecca left her cooking to walk us there. We met the medical director of the camp's main hospital and interviewed him for our project and received a tour of the stark concrete and tent structure, housing patients with Tb, cholera, psychosis, and run-of-the-mill myriad other illnesses including an entire unit dedicated to diarrhea. Apparently there was also an avian influenzae outbreak at the next camp north. We were incredibly moved by the dedication, determination and optimism of this man and the plight of his community; displaced, illegal, without access to sustainable resources and living in despair, many for nearly 20 years now. When we asked him what were his un-met needs, he told us they could really use stretchers to collect the patients.

I could go on forever about this single experience; one of the most profound moments of my life.

Back in Chiang Mai I presented another project on schizophrenia and then turned right around again to head to Cambodia for the extended Thanksgiving holiday. It wasn't until we'd arrived by train to Bangkok that we learned there had been a bomb at the airport. The anti-government protestors, who have been working hard at gaining some justice in their corrupt society for over 6 months, staged what was to be a very difficult and terrifying finale to the politic unrest here in Thailand. [I could go on and on, but let me get back to Cambodia.]

We travelled by land across the border into the far more corrupt, Communist government of Cambodia. We made it to Siem Reap, home of the ancient Buddhist ruins of Angkor Wat. We spent our few days surrounded by the beauty of the temples and the incredible humor and laughter of the Cambodians (all of whom are our dear friends now) while at the same time we took in all we could about the horrifying recent history of Pol Pot and the tortuous, insane massacres of nearly a 1/3 of the population by the Khmer Rouge.

Somehow we made it back to Chiang Mai (actually via a 15-hour freezing open air train, I'm just trying to block that out of my memory) in time to give our final culminating project on the story of the Burmese Refugees. Other group projects included child sex traffiking, methamphetamine abuse, and HIV/AIDS. Happy World AIDS day December 1st.

Now it is all over, even annoyed travellers can get to their beach getaway again. These are my final hours in my sweet Chiang Mai, tomorrow I make my way to find Dad. He has somehow also made it to Thailand afterall and together we take off to greater Southeast Asia until sometime around the holidays.

I'm sure I will let you know all about it.

Ps: At least I've plowed through some "uplifting" reading material lately: A Thousand Splendid Suns (rape, war and oppression in Afghanistan), A Child Called It (one of the worst ever recorded cases of child abuse), First, They Killed My Father (Genocide in the Khmer Rouge) and next up: A Long Way Gone (Child soldiers in war-stricken Africa), oh and Sophie's Choice.

***

My heart goes out to Nick Belles and his family & friends

To the people of Thailand right now as they hope/fight for justice, unity and peace

To the situation in Burma, and may refugees rights be formally recognized in Thailand

To the survivors of the Cambodian Khmer Rouge, may you continue smiling and living fully

***

In memory of Leslie Green

Yes We Can

For the first time in my small life, I am proud to be an American.

I am patriotic. I do love my country. I love my President elect. 

I will never forget where I was when my country made history... in a tiny computer study room full of fellow American students, at the moment displaced, but bonding like we never knew we could. Tears, and sweat in the heat of the day in Northern Thailand, as the American people and our Obama, made me proud.

Ohmysoul! VOTE!

There is such a thing as nursing student syndrome, a form of hypochondria.

Today in class we studied anxiety disorders and panic attacks.

So now I believe I am currently having a panic attack....

VOTE for you country! VOTE for your future! VOTE for your rights! VOTE for Obama!

Otherwise I may experience quite a serious nervous breakdown here in Thailand. This PTSD stems from the 2004 elections where I vehemently threatened to disown my American citizenship if Bush were re-elected, and then shamefully went back on my word when I researched and discovered that Canadian nurses didn't enjoy as many of the great privileges American nursing education offered. So here I am having flashbacks, please help me out and VOTE!

Poppies & Globalization

I like my cuppa tea now and then, but whoa...

So when the Dutch Empire began exporting goods from Asia, namely "exotic" teas from Darjeeling, India (where it had been used therapeutically for while already) back to Queen Victoria of England, there began an amazing story of poppies and globalization. Vicky's desires for tea quickly became trend and soon all of England was tea crazed. Tea was determined to be best consumed in porcelain, so thus began the rise in porcelain production--a minor note, but interesting. Of course, tea was significantly improved with a bit of sugar to enhance it's bitter flavor. Thus began the need to also create and export sugar. Thus began the slave trade to sugar plantations in the Americas (here's one more reason for me to boycott sugar... as if being diabetic wasn't enough) Tea was also implicated in the American Revolution, due to it's culpricity in the Boston Tea Party.

Ok, so fascinating chain of events, but stay with me here...

Meanwhile in, for the most part, unexploited lands of native communities in Asia, such as the Golden Triangle (where Burma, Lao and Thailand meet in the north), Turkey and Afghanistan, poppy fields were being harvested as usual for therapeutic and medicinal purposes (easing pain mostly.)

The East Indian Trading Company began to sell opium in order to pay it's tea expenses. Conflict quickly arose between commercially powerful Britain and opium controlling China. Thus began the opium wars. These wars ended when Britain forced unequal treaties upon China which left China with incredibly restricted export regulations and they had to fork over Hong Kong with a cherry on top for the subsequent 155 years to British occupation. China, depleted not only by Britain, but also by opium--economically and physically as so many of the population were addicted and severely ill (1 in 30.) China had a revolution, which lead to the modern Chinese power. China desperately wanted to stop opium traffiking because of the extensive damage.

The opium trading restrictions simply lead to a rise in sales and use/abuse in Siam (now Thailand) and its imports to the west. Thais were imposed by an unlimiting importation of opium. Later the American CIA covertly endorsed opium production in Thailand (specifically the area of the "Golden Triangle") the intention was to compete with and defeat opium efforts in Communist China, the American enemy. CIA endorsement of opium production was underway in Afghanistan as well, to fund and supply weapons to the Afghan people as allies to the American enemy, Communist Russia. In Afghanistan these efforts lead to its neighboring consumers, Pakistan, currently becoming one of the highest density populations of Heroin addiction in the world. 

Incidentally, opium is made for consumption by boiling the raw material from poppies to eliminate impurities, it is then reduced to a thick and beautiful molasses-esque batter. So intense in fact that critter-passers-by keel over dead simply due to the toxic fumes. Not just weak tiny bug respiratory systems, but big critters.. die. Anyway, the development of the more common powdered heroin substance came to be because of the ease of transport, particularly to America, where it was purchased from various mafia cohorts and sold with additives for bulking (powdered sugar or various other, often rather dangerous, substances.) This powder is typically snorted, boiled with water and injected, or boiled all the way to its original form and smoked.

Now, back to the impacts of mass, unregulated production of opium; in Thailand opium was so widely available that the degrees of addiction warranted grand intervention by the present royal family. The beloved King of Thailand made great strides in the illegalization and banishment of recreational opium, but because addiction is, well, addictive, a new drug simply took the lead. Methamphetamine, in Thai: Ya Ba (meaning insane medicine) became the drug of choice, particularly for Thai youth. Now public health measures are making a big difference in its rates of abuse and rehabilitation... and now alcoholism is on the rise.

Unfortunately, I'm sure, this will not be The End of the amazing story of poppies and globalization.

This has been a public service announcement from your friendly global nursing student. Thank you for listening!

Vast flood of information credited to the Hall of Opium in the "Golden Triangle" Chiang Rai province of Northern Thailand. Photo courtesy of google images.

Obama and Palin and Penis Envy

I can now count to 999,999 in Thai*. I should ask someone how to say a million, then get someone to challenge me, like kindergarteners... but alas, I am doing more important things with my time, such as discovering the best way to simultaneously spend one hour of my life plus six dollars. My body type was made for Thai massage; fairly bendable, happy to be popped and cracked and layered just enough so the pain is good pain, for example, when your masseuse curls into a ball and rolls onto her back while holding your arms over her head and walking her knees into your back as your bum lifts off the ground. Très acrobatic.

This weekend I jaunted off to see mom and grammy in Krabi, on the southern peninsula of Thailand, west coast, Andaman Sea. It was über fun. Mom and I even took Gram out for a 3 person kayak trip (she was our queen in the middle, sans oars.) Turns out my camera isn't of the underwater variety--thankfully my pictures were salvaged and people seem to be hopeful that it can be nursed back to life; "it happens everyday" the locals kindly reassure.

For clinical this past week we visited the local Planned Parenthood for our community health course. Again massage and acupuncture are widely used modalities, just like at prison, the drug addiction treatment center and the child development hospital too. We were at one point shared the information that STI prevention and education is being done in outreach settings in rural Thailand. Apparently it's tricky because the condoms don't fit. We were told they are too small for Thai people and too big for the Hill Tribe communities. To which I promptly asked if that was an actual valid statement based on a documented report of clinical testing, or if it was a massive general assumption possibly based on institutionalized racism? This was very much lost in translation. I reserve my suspicions. Later we were shown the condoms, as our curiosity was not lost on our presenter. What was most unique about these was the expiration date, 2555! Wow, that's some serious preservative (melamine?) This is when we learned a great new fact about Thai culture; the calendar is, of course, based on Buddhism. Buddha was born 543 years before J.C., so there you go: normal preservative (I suppose it could still be melamine), presently it is the year 2551 in all Buddhist countries and the size-discrepancy is still to be investigated.... but I probably just won't have the time. However, my offense at the likely affront on the phallusism of it all shall remain.

Unrelated, though it makes for a good title, I now segue into politics--a previously indirectly mentioned topic in this space. Namely, I am having a heck of a time being so removed from much of the goings on, but I am equally relishing in the stark absence of those awful televised party bashings that many of you back home are no doubt inescapably being inundated. I am by no means out of touch completely. The class has convened at one of the professor's apartments for every debate thus far, even if it meant shifting her own theory class for it. I also have the internet. So I have replayed many times the glorious Palin interviews. And just a word here, if I may, "because she's so pretty." is not an answer to: "Why do you support Sarah Palin as a VP hopeful?" Source: BBC.

A lot of things are pretty; Miss America is probably really pretty, I think male peacocks are pretty, and stained glass windows. But I don't think these would make very good options for president (McCain is a septegenerarian, and probably a really stressed out one too.) Now, I'm not saying pretty equates with stupid or inept, not at all. Case in point: my model friend Kaiulani, if you're lucky enough to know her. I'm only saying that Americans (you know the "hockey moms" and I believe Palin also used the phrase "Joe Beer Belly,") cannot use "pretty" or even drop-dead gorgeous for that matter, as a criterion for choosing to sway McPalin. Or maybe I should just say what I really feel here... I heart Barack! He would beat Palin in a poltical beauty contest any day of the week, Obama, you're beautiful.

*Incidentally 999,999 goes like this: Gǎao s33n gǎao muun gǎao pan gǎao rćcy gǎao sìb gǎao!

Politicized Birth... and yes, the Ocean.

So I've traded the lulling sounds of the ocean waves, breezes and the chiming of wooden carvings for the barking dogs of "home" at the birth center again. I spent some time in Lovina and swam in the hot spings, then to Amed where I went a smidge crispy on the beach and finally to Tirta Gangga a hillside village on Mount Agung with misty rice paddies out my front door and nighttime fireflies! I had a gorgeous time, but was looking forward to coming back.

***

Birthing in Bali is just as political as anywhere else in the world I suppose.

Medical care is not available or subsidized by the government, it's all out of pocket. To the point where cars speed up and pass someone on the street who has just been hit and is now in a bad motorbike accident. People won't stop and help, no one comes to take the injured to the hospital because then they would be expected to pay for the hospital bill! 

For births, there are many small clinics around the island that offer "low-cost" maternity care, which is an option for those who cannot afford the hospital. In hospital, a cesarean birth may cost 5 million rupiah, or roughly $500. This is a ridiculously high price for the majority of the Balinese. Here's the catch: If you cannot pay your medical bill after birthing in hospital, you do not get to bring your baby home until you do settle that debt. 

The birth center here is free, and safe and good. But you know, after a few days away, I've been really thinking about the births here. And they are not so gentle sometimes. Maybe they are still better than a hospital where they can keep your baby for ransom, but there are so many things that could be made gentler here. There are a lot of postpartum bleeds--near hemorrhage--and part of it may be the aggressiveness in which the bidans anticipate and worry about the potential for a bleed and therefore are overzealous with the oxytocin injections, cord tugging, and manual extractions. I've seen things here that I have never seen at home. My first bleeds, my first atonic babies, my first fainting in labor, my first neonatal resuscitation. I don't see this in the hospital, at homebirths or at birth centers back home. It makes it really hard and scary to think about families telling the midwives to do anything they can to keep them here at the clinic when things are going badly, because they would rather bring a baby kept alive only by epinephrine to the hospital where it will be allowed to die rather than cope with the debt that befalls the whole village if they transferred for a cesar. This of course is not the case for everyone, not even close, but apparently it does happen. The family who had the one cesarean we've had here in the past 5 weeks told me that their neighbor, an ex-pat from New Zealand, paid their hospital charges. 

Maybe this post should be titled: How being a doula in Bali cannot change the political atmosphere of birthing and health care administration, or even ease the fear-based practices of the midwives who work under pressure of policy and protocol.