Wednesday, May 3, 2017

Marisa

When Marisa came to the clinic that stifling October afternoon, she didn’t say much.  But then she never did.  If not for the village gossips, I would not have known how she suffered.  
“They live upriver all alone on that island, and her man almost never lets her leave the house,” they told me.  “They say he beats her when he gets drunk and sometimes he hurts the children too.  He refuses to buy her any maternity clothes and always makes her wear jeans just to shame her.  We don’t know if he is a little slow, or just plain mean.”    
                Upon entering the clinic she needed no gown since her eight-month stomach protruded from below her cute blouse and above her fitted jeans.  I gently performed her prenatal exam and ran through my standard questions.  Because so many of my prenatal patients were teenagers, my questions were basic, designed to educate and make sure the mother-to-be was planning and preparing for the birth. 
When I asked how she was planning to travel out to the hospital she hung her head and quietly stated that as much as she would like to obey me, she didn’t think her husband would allow it.  My heart sunk.  Her island was an hour upriver from my clinic which was three to four hours and across a river from the hospital.  The only midwife in the area was eighty-five, illiterate, and blind. 
Thinking over the times she had already refused offers from me and other to help her leave her man, I knew she didn’t believe she had many options.  I wasn’t qualified to deliver her baby, and neither was anyone else on this side of the river.  Even though I was convinced that the natural childbirth most of my patients experienced needed no intervention, we were just too far from the hospital to risk the complications that could appear mid-labor.  I explained that by planning to give birth so far from a hospital, she was risking her life and the life of her baby. 
Unwilling to discuss the subject further, she gathered her things and paid the small consult fee of 5 Quetzales.  The equivalent of 85 cents, the consult fee was designed to avoid charity and did not include any necessary medications.  I filled a small black plastic bag with the standard: prenatal vitamins, iron supplements, and a few sheets of patient information that explained the benefits of colostrum and encouraged mothers to nurse their babies immediately after birth.  As she left, with the bag in her hand and her children by her side, I wondered if I would ever see her again.  Would she end up being just one more statistic of Guatemalan maternal/fetal death? 
I sent a short prayer heaven word on her behalf and then returning my attention to the small stack of charts and group of waiting patients.  I knew that if I allowed my heart to get too wrapped up in one case, I would useless to everyone else.  Still, pushing thoughts of her from my mind wasn’t easy as I focused on the wide eyed eleven-year-old with a tooth infection in front of me. 
Marisa and her husband arrived at our dock in a small boat just a few weeks later, and I confirmed that she was in labor.  
“I’ve come to take you back up river to deliver the baby,” her man strongly asserted to me.  “She’s going to have this baby at home just like the last two.” 
Marisa’s man had never spoken to me before, and I wondered if all the things they said about him were true.  He didn’t raise his eyes to mine, and there was no clue in his quick, loose body movements.  What was his story?  How did he see himself and his beautiful little family?  A new contraction of Marisa’s stomach cut off my ponderings, and I considered her options. 
While Marisa had no signs that suggested complications, the idea of labor and delivery in a dark little home of sticks didn’t appeal to me.  I quickly reassessed my feeble midwifery skills.  No formal training, twenty hours of study on the subject, and participating in less than ten other births; no, it didn’t make sense to travel in the opposite direction of the hospital.   
Her pleading eyes, set in that strong, young face started to sway my decision.  Obviously, the hospital was the best option, but she was headed back up river with or without me.  Should I go with her to support her? Should I make myself responsible for any problems or complications, when I wasn’t even sure if I would recognize them?  Or should I let her on her own with two preschoolers and the man who had a lousy record of taking care of her?
Feeling myself start to lean towards helping her, I called my superiors for advice.   ‘’The ultimate decision is up to you Ashley, but it certainly isn’t the recommended course of action,’’ was the response I got from everyone.
Finally, I decided to put into words the prayer that had been running through my mind.  ‘’Lord, what should I do?  I can’t bear to say no.  If something goes wrong and she or her baby dies, I will always ask if I could have done something to help.  But if I am present, and something does go wrong, am I strong enough to face the guilt and the certain recriminations?’’
In the past, I had an unfailing track record of following my superiors’ recommendations.  I trusted Holly and Norma implicitly, and after all, that was why I had called them.  But the sense of stillness, of peace and the assurance that my hands would know what to do made the decision for me.  The security that God would get me through, not only the birth, but also through whatever followed, overcame my heart.
I ran to the river’s edge to the waiting couple in the boat, and asked them to give me just a few minutes more to collect some supplies, and get Yalonda.  I rushed to the clinic and grabbed the large, almost suitcase-sized, plastic, mickey mouse printed bag I had packed for emergency deliveries.                
Always game, Yalonda hopped into the small wooden boat behind me.  We sat opposite each other balancing our weight on the sides of the boat, and settling in for the sixty-minute ride up river.  I alternated between prayer, and worriedly watching Marisa shift uncomfortably on the bottom of the boat.  “Just not in the boat, Lord, please not in the boat.’’
The boat finally slid through the reeds at the river’s edge, and bumped softly against the mud.  We were here.  Her home was even less than I hoped for.  It was indeed one dark room.  Strips of light shone through the saplings that formed the outer wall.  The alternating shadow and light was disorienting and my eyes struggled to adjust.   
A few minutes into my assessment and preparation of the scene my one consolation was dashed.  I heard the motorboat being started and driving away.  
Apparently, considering this women’s work, her husband decided he would rather be off with friends, abandoning us to the island with no transportation in case of emergency.  My last link to help and civilization gone, I asked Yalonda to search the island for cell phone service.  She was no novice and had become adept at climbing trees and waving the clinic cellphone around.  Then I repeated with wide eyes what would become such a common instruction, “And Yalonda, keep praying.”
It was nearly 1 o’clock, and Marisa seemed more concerned with being hostess than birthing a baby.  She started a fire and began patting out the toasty warm tortillas to go with the boiled potatoes she served us.  Her movements were the fluid almost subconscious movements that come with a task so often performed.  Every few minutes, she would hesitate, almost stopping as she leaned against the elevated platform where her fire was located.  I recognized these hesitations and started timing them.  Every suggestion of mine to lie down, or to head to the bed was countered with a soft, ¨Not yet.¨
I started to wonder if she would insist on finishing the tortillas before giving birth.  Just how strong was this woman?  Continuing to eat my potatoes with salt, and completely enjoying getting acquainted with her two dark eyed beauties; suddenly her eyes locked onto mine.  My heart started to pound as I realized that there was no turning back.                               
Without a word, she moved towards the bed with me close behind, a prayer on my lips and my prayer warrior Yalonda on my heels with the oversized Disney bag.  As I adjusted her on the small string bed, the large square of light provided by the open door went dark.  Unfortunately, we were not the only ones to enter the house.  In behind us walked a six-week old calf who nudged Yalonda’s back, almost knocking her over.  Marisa pointed to the oversized bottle filled with milk, and was pleased that the calf’s feeding time had so coincided.  “That will keep the children busy,” she murmured.  
No more than ten minutes later, I was holding a most precious little black-haired bundle.  Suctioning they baby’s nose and mouth, I wrapped her gently in the flannel Yalonda handed me from the delivery packet.  Passing her to Yalonda, Marisa and I delivered the placenta quickly.  After getting Marisa and the baby comfortable, I went outside to stretch and quiet my mind from the still running danger scenarios.  Allowing mother and baby to rest, Yalonda swept her little yard area and played with the children while we waited for her husband to return.  
A few hours later he appeared, apparently unconcerned and obviously intoxicated.  On the ride back down river, we were surprised to feel how much the satisfaction of the safe delivery and the deflation of our worry had tired us.  It was a thankful prayer and a sigh of relief that filled my heart that night when I crawled under my mosquito netting just before the generator went off at 9.  My worries for the day were over.  My hands had been guided and new life had come to the little island home.  For tonight, at least, I would fall asleep without worrying about tomorrow.  I’ll let it in God’s hands.  I’ll just show up.
In the next few weeks I noticed a growing confidence in my medical practice.  I stopped questioning my own judgement, and I started trusting God’s guidance.  My best was all I could offer these people, and it was enough. 
Hearing nothing from Marisa for several months, I was pleased to see her waiting on the bench outside the clinic one afternoon.  Her husband had come to town to drink, and had brought her along so that she would help navigate the boat through the rapids on the trip home.  Taking advantage of the trip, she came for a well-baby checkup.  To my delight everything was fine, and the baby seemed to be gaining weight.  
I’ll never forget, how just before she left, she looked at me with a little sparkle in her eye (the most emotion I had ever seen from her) and said, ¨You know, the children say that now they know where babies come from.
Soon the news had spread among the children of the village too.  They had figured out what no adult would tell them.  The origin of new babies was no longer a mystery. 
“Keep an eye out for the Mickey Mouse bag.” the children whispered among themselves.  “If the Gringa ever visits your house with that bag, there will be a new baby when she leaves.”  

Elena

Whenever I wasn’t busy with patients, I was entertained by the children of the village.  They spent their afternoons teasing me, hanging from the big squeaky, swinging gate in front of the clinic.  They begged to come inside, and I looked for ways to expand their minds beyond the little village.  I searched eBay, stretching my missionary budget to buy Spanish children’s books by the lot.  We spent hours reading the books, looking at the pictures and making up new stories to go with the pictures.  The fruit trees behind the clinic and the church also were a great attraction, and many a little thief would bring me a ripe grapefruit as a peace offering for the dozens he had stolen.  The adults of the village were busy with daily tasks; besides, they were not nearly as interesting as the Gringa in the clinic.  My impromptu classes of tooth brushing or wound care, which were followed by small gifts of bandages or small tubes of toothpaste were very popular.   
Elena was among the many children who hung around the clinic.  Pixie faced and slight for her four years, she constantly readjusted her little sister on her hip. Talkative and bright, Elena’s comments became more disturbing as our relationship grew.  While watching me count out pills, or prepackaging bandages, she casually explained that she had to bring the baby with her since her mother was sleeping.  Her mother spent her nights fishing or crabbing on the river with different men of the village almost every night. 
I had already noticed that the women of the village barely spoke with Elena’s mother, and I found this information troubling.  I decided to investigate further.  My friend and neighbor girl, Suri was always a trusted source to explain the dynamics of the village.  I spent my lunch break in a hammock on Suri’s porch trying to understand.   Suri carefully explained that Elena lived with her mother, and little sister.  No, there was never a father.  Because of the shameful nature of the situation, I had to be especially direct to get the answers I needed out of Suri.  Sadly, my assumptions were correct; Elena’s mother was the village prostitute. 
The inescapable loneliness, shame, and responsibility that this little girl faced angered me.  At the first opportunity, I spoke with her mother in private.  Breaking all the rules of convention, I verbally acknowledged her business and then tried to convince her of the love of Jesus for her and her girls.  Assuring her of God’s promises to care for the husbandless and orphaned, I pledged to support her on her journey, should she decide to change her life.  She thanked me, but she remained unconvinced that God could forgive someone like her.                          As we talked, I was astounded to learn that Elena’s mother was only twenty-two years old, even though her face showed the worries and cares of someone who had lived much, much longer.   She told me of the many women of the village who berated her angrily.  The women were jealous, not only of their husbands’ attentions, but of the money wasted on this woman when their homes and children were barely scraping by. 
After several attempts to alter Elena’s mother’s thinking, I decided to focus on Elena, while continuing to show love and support for her mother.  One day, Elena confided how scared she was at night alone with her baby sister.  She told me how she didn’t know what to do when the baby cried all night.  Sometimes there was milk, and sometimes there wasn’t.  Angry that anyone would force such responsibility on a four-year old, I determined to improve her life.  I invited her and her little sister to stay with me in the clinic any night that she felt scared.  
Too poor for candles or a flashlight, there was often no warning of Elena’s arrival at my door since the area existed without electricity.  Soon, our impromptu slumber parties of three took on a life of their own.  I dreamed of the day I could keep her with me and save her from her hardships.  I wanted to offer her everything she and her little sister deserved.              
One afternoon after only a few weeks of our new arrangement, she came running to the clinic without the baby in her arms.  Her rapid-fire Spanish explained that she didn’t have permission to come and see me, but she couldn’t leave without saying goodbye.  The pressure from the town women was too much to bear and her mother was moving the family several hours away to La Libertad. Business was poor in the village, and by moving to a larger town, her mother could take advantage of the groups of immigrant travelers on their way to El Rio Grande. 
The tight hug from her strong, skinny little arms was almost more than I could bear, but I held back the tears for her sake.  Hurried by her predicament, I grabbed a bag, and filled it with vitamins and a package of cream of wheat for her to take with her.  Including a clinic business card with our phone number, I implored her to call if she ever needed help. 
Two months went by with no word, but I wasn’t surprised.  However capable she may have seemed, she was only four years old.  It would be impossible for her to dial a phone or even know exactly where she was.  However, one sticky afternoon during rainy season, I received an alarming phone call from her mother explaining that Elena was very sick.  She had a high fever for several days, and now she wasn’t taking any food or liquids.  Hoping for a prescription, my quick response startled Elena’s mother. 
“Give me two hours, and I’ll be on my way,” I said.  “Just tell me where you are.”
  She gave me hesitant directions to a bar/brothel on a back street of La Libertad, instructing me to park at least block away and to call before coming in to make sure that the man in charge was not around.  My housefather, Dave supported my hasty decision, and 90 minutes later, we were parked, hearts pounding, a block from the brothel.  I called the number and heard the fear in her voice as she told me to come quickly. 
Worried that the truck could alert unsavory people of my presence, Dave dropped me off at the front door and pulled away.  I walked through the front doors of a saloon for the first time in my life and looked around.  Inside, nothing was as I expected.  Three women with faces as worn and hard as that of Elena’s mother were cleaning the bar of last night’s partying, hosing down the concrete floor and plastic tables and chairs in the main room.  This was no life of luxury.  Elena’s mother quickly directed me to her “room.”  The main room was lined on three sides by doors every eight feet or so.  Opening her door into what seemed like a closet, I saw her cot sized bed touching three of the four walls.  Between the door and the cot, there were only two feet of space where she had an end table with a small pile of folded clothes.  Elena lay on the bed drenched in sweat.  The apprehension in me grew as I looked down at her listless body.  I was sincerely concerned, but not too concerned to keep myself from wondering, where does she go when her mother is working?
Shoving this thought aside, I checked Elena’s pulse and temperature.  She was alive, but she was burning up. 
Suddenly, I was filled suddenly with a courage and purpose not wholly my own. I turned to Elena’s mother. 
“This is no place for her to get better,” I asserted.  “I’m taking her home with me, and you can come get her when she’s better.”                     
Waiting only an instant for her to nod her assent, I began stuffing my thermometer back into the bag.  I scooped Elena into my arms and walked out, past her mother, past the women cleaning the main area, and through the front door.  I prayed for protection even while wondering what the consequences of my actions would be.  I knew that stealing a working girl from her pimp was a murdering offense in this town, but what about Elena?  Surely, she hadn’t been working.
I loaded Elena into the tuk-tuk, and we drove towards the ferry where Dave was waiting with the truck.  The drive home was tension filled as I tried to explain what I had seen.  I didn’t understand how anyone could live in those conditions.
Once home, I focused on rehydrating Elena and decreasing her fever.  A few days later when her mother showed up, Elena was playing with the other children, good as new.  With her hair neatly combed, and wearing a long dress, an onlooker would have been unable to guess that she hadn’t grown up Mennonite.  Her mother had brought her clothing, and to my surprise, her little sister.  Not yet walking, the baby’s smile and almond eyes were irresistible.  My house mother and I promised to care for the girls while Elena’s mom straightened out her life.  We assured her that while we wanted nothing more than to provide her girls with a stable safe environment, they needed their mother.  She agreed to try to start a new life and promised to be back for them in a few months. 
Over the next two months, the girls fit into our life as if they had always been there.  Their smiling faces welcomed me to the breakfast table, and I cuddled them in their flannel pajamas after bath time for a bedtime story.  It was to my surprise and dismay one afternoon that I received a phone call at the clinic from my housemother Christine. 
“Elena’s mother came and got the girls,” she cried softly.  “She and a man with a gun just showed up and packed them up and they’re gone.  I don’t know where she is taking them, or if she has her life figured out, but she didn’t look good.  She almost seemed a little high.”
We mourned the loss of the girls for several weeks, but comforted ourselves with the knowledge that they were with their mother.  While my fellow missionaries and I thought that adoption was beautiful, we believed that children should be with their parents whenever possible. 
Then the stories started to float back through different sources.  A woman had gotten to Elena’s mother.  This woman offered money for the girls.  She insisted that the gringos were stealing the girls.  She insinuated that Elena’s mother might as well sell them and get something for them if she wasn’t going to be with them.
We barely believed the stories even though everyone in town assured us of their veracity.  It wasn’t until two years later that I saw Elena’s mom at the clinic again.  She was pregnant, and her story confirmed and exceeded my worst fears.
She confessed that the rumors were true.  She had sold the girls.  She had been reassured that they would be adopted out to American families who desperately wanted children.  Badly in need of the money, she caved, telling herself she was giving them a chance at a better life while freeing herself from the clutches of her pimp.
Unable to live with what she had done and having been told by other women that this was an unforgivable sin, she had traveled to the city to try to get the girls back.  The baby was long gone, but the woman in charge assured Elena’s mother that the baby had gone to a nice family in the states.
                  Elena, however, was too big for adoption.  Childless couples in the United States wanted babies.  Elena had been put to work instead, caring for the babies who came through the house on their way to homes in the states.  Elena’s mother was allowed a few moments with her daughter before she was told she could only redeem Elena by providing them with another baby to sell.  Elena’s mother returned to La Libertad, and now, six months pregnant, she knew she was only a few months away from buying Elena’s freedom. 
“This baby,” she said, touching her stomach, “is how I’ll get my Elena back.”  And sure enough, four months later she and Elena returned to our village alone.  Elena looked older than her now six years. She was sadder than I remembered.  She was glad to see me, but there was none of the freedom in her expression and her heart was closed off from me.  Her mother was soon pregnant again and delivered yet another baby girl. 
                Once more, Elena’s face became a regular at my clinic window, as she brought her new baby sister for weekly checkups and for the free weight boosters we provided to underweight infants.  Hesitant to describe her time away, she did tell me that her time as a slave wasn’t so bad.  After they sold her little sister, they brought other babies, and Elena took care of each baby that came through the home as if it were her lost sister. 
                Elena’s mother continued to work at night in our village, but she never had enough money for food.  I soon found out that even the cream of wheat meant to bolster the baby’s weight gain was being exchanged at the local store for cigarettes. 
This information initiated me into one of the saddest practices I was to adopt during my time as a nurse in Guatemala.  Every week when Elena brought her baby sister for a weight check, I opened the bag of cream of wheat with my scissors, nullifying the resale value, and then taped it shut.  I reviewed the instructions for preparation with Elena, now eight years old, and I gave her a week’s worth of vitamins. 

                In the days and months that I worked with Elena and her mother, I constantly assured them of their infinite value in God’s eyes.  But mine was one small dissenting voice in a chorus that chanted their worthlessness and their doom.  Perhaps I’ll never know if my presence as a witness, a bystander in their story ever made a difference.  I tried to show Elena love, but she didn’t believe in love anymore by the time she came back to me.  She must be close to seventeen as I write this, and I am haunted by the fear that she is out there somewhere working, just as her mother taught her to.  And somewhere else in the world, there are two little girls who will never know just how loved they were by me and my fellow missionaries and by Elena who gave everything she knew how to sacrifice for their wellbeing.

Tuesday, May 2, 2017

My Writing Process

           This semester I undertook the task of beginning my memoirs with the help of Mr. Dan Glass.  It became a journey of self-discovery and self-understanding as I set aside time to reflect on my past experiences and what they mean to me.  It feels good to remember and record the many people who have influenced my life.  While the rush of my busy life in the present usually occupies most of my thoughts, it is important to look backwards occasionally to consider where we have come from and to contemplate where we are headed.  Often, I, like others forget that my past is a big part of my present.  This time of focused remembering has healed some pain and helped me polish up some of my treasured memories. 
My writing style is just beginning to evolve.  I tend towards dry recounting of facts and forget all the details that my reader doesn’t know.  Much of my storytelling deviates little from the conversations I have with friends about my past.  While I don’t yet know what my writing style is, I am certain about what I want it to be.  I want my stories to be an honest portrayal of the people I met and of those who gave me access to their lives.  I want to give a voice to those who felt like they had none.  There are so many people who have limited choices for their future.  I want those of us who have many opportunities to recognize them, be grateful for them, and use them to increase the options for those who have none. 
This journey has taught me many things.  I learned that I have something to say, and that there are people interested in my story.  I learned that writing well is possible if I am willing to dedicate the time to learning this art.  Writing for me begins with not only a clarity of mind, but with a clarity of soul.  Sorting out the feelings from an event is crucial before I can write and share it with others. 
I received great encouragement from interviewing two writers and one editor.  They, and the books I read, demystified the writing process and gave me hope that I may someday be happy with the writing that I produce.  Mr. Glass’ gentle guidance has improved the clarity of my writing, as well as expedited my somewhat arduous process. 
I felt an incredible lifting of my soul after putting some of these stories to paper.  I did not realize that I was still carrying some of the sorrows of the beautiful people I met.  There are so many stories still trapped inside that now I know I must write them out, even if they never get published.  This act of writing liberates a part of my spirit and honors the memory of the people that I love. 

The past sixteen weeks has only scratched the surface and I would like to spend quite a bit more time learning what makes writing good, and how to express myself in a way that the general public understands what I am trying to say.  I am grateful, however, for the opportunity to have dedicated time to learning the writing process and to studying my past.