Adventures of a midwife-explorer

About our group

2011-05-08T18:44:00.000+10:00

I get many questions about my practice, especially from prospective students and other CNMs in the area. Here is a little about us:
I've been here about 2 years. I moved out here right out of school, at age 26. I joined the largest practice on island. We have 3 CNMs and 2 female OB/GYNs. We run a 7 bed birth center that does about 40 births a month. We do an additional 10-15 including our repeat c/s and primary c/s at the local hospital.

Our Birth Center is a hybrid model of a BC you may find in the States. Basically, it is a low intervention maternity center. By expanding our risk criteria, we have a low transfer rate (9%) and are able to offer more women a low-intervention birth. We take GBS+ moms, we take pregnancies between 37 and 42 weeks. We have the ability to run pit and continuously monitor those patients. That said, the philosophy of providers is what makes it a great place. Each room has a tub for laboring. We have an entire room of birth balls. Rooms ave a mini fridge for food and drinks. Family members are allowed to stay the night on the futons in each room. We do not continuously monitor our patients routinely. They are allowed to eat and drink. They get an IV only if an indication exists. We also have Stadol for pain relief although less than 1 in 4 of our patients request it.

I also get a fair number of questions about bringing children to Guam...There are both public and private schools here. Private schools are all affiliated with a church and range in price. For a child with medical concerns Guam may or may not be a good place. We have a hospital and several pediatricians. Shriners hospital and other specialists visit regularly. Many of our patients go to the Philippines for expensive and intensive healthcare. Some of our preemies go there to the big medical centers where they have specialists. The cost of care is much less there and for the most part, people receive quality care.
I'll answer more questions as they come!

The Maiden Voyage

2011-04-23T13:53:00.000+10:00

After much thought and debate, this week I purchased a stand up paddle board. The 10 foot 6 inch board is used primarily not for surfing but for cruising calm water while standing atop it and navigating with a carbon paddle. I purchased the board (a significant investment) on Wednesday and the remainder of the week either work or low tides got in the way of taking it out. This morning, with high tide at 10:00, my partner and I loaded the mammoth board atop my sedan and I set sail from a nearby beach. Nervous that I might just fall off, I started on my knees. As I picked up speed I slowly stood and paddled along. The morning sun felt so warm on my skin, the fresh humid breeze was intoxicating. Ahhh.

I continued down the beach in one direction before turning the board (not too difficult to do) and paddled back in the other direction. I returned to the beach to check my phone (on-call this weekend) and then headed back out for a second lap. When I became tired, I sat atop the board, I could see colorful fish feeding on the coral below. I laid atop the board and watched clouds drifting. When my arms were tired and it came time to check my phone again, I placed the board on the beach, laid in the shade of two palm trees, dried off and read. All I need now is a waterproof pouch for that cell phone.

Back from a long break

2011-04-17T20:13:00.000+10:00

I'd like to welcome myself back to my blog. It has been a while since my last post and the reasons are many. The last months have brought a midwife student who came and went after completing her 12 week rotation, a visit from my parents, a kitten, and more adventures on this island. Over the past couple of months, I've received a regular emails (maybe 1-2 a month) from prospective nurse-midwives and student midwives considering a move to Guam. To frame it phenomenologically, the focus of the blog heretofore will be to share with readers the lived experience of working as a nurse-midwife and that of a young woman living far from the mainland US. Let's get started, shall we?

In the practice where I work, two of our providers are off island so that leaves the remaining three of us to see all the patients and do deliveries while they are gone. This means that my schedule goes from a comfortable 15-20 patients a day to 20-26. Friday was tough. Busy busy day in clinic. I found myself rushing through my routine visits, knowing that someone else would need the precious time later in the day. When I finally hugged my teary last patient facing a long road ahead of her, I went straight to the birthing center (conveniently located in the same building as the clinic, just 2 mins from my home). A mother who had been in labor all day was very slowly progressing. We began pushing and we pushed and pushed and pushed. Two hours later, with a dime-sized piece of head visible, I called my back-up physician to evaluate. I'd been staring at that dime for the past 45 minutes. At 1130pm, I left the hospital after assisting in the c-section. Beat, I went home turned on the air conditioner, and sat down to read emails. Then everything went black. Literally, the power went out. Since I was still on call and my third floor apartment hadn't yet cooled I considered going into the birthing center to sleep, at least they had a back up generator and A/C. Groaning and starting to sweat, the lights came back on and with them the A/C. I snuggled with my kitten, Pagu and sank into sleep.

Saturday and Sunday were lovely. I slept in, talked to my mom and sister on the phone, read the paper. Saturday I took my book to a resort hotel, and sat poolside reading all afternoon. As the sun started to turn golden in the late afternoon, I road my scooter to my favorite place for frozen yogurt topped with fruit. I joined two friends and dined al fresco enjoying Mexican food and margaritas.
Sunday I found myself sitting in a teak hut upon a cliff drinking iced coffee and reading. The fresh breeze right off the ocean was rejuvenating. Paddle boarding plans were put off due to a very low tide (full moon) and allowed me time to run errands and grocery shop. Upon coming home, I watched a movie and fried up local sweet cooking bananas for dinner. Not a bad way to prep for another busy week ahead.

The Risotto Experiment

2010-10-13T12:32:00.000+10:00

On this rainy Tuesday I loafed around the house, early-voted for local senators, and had lunch with my boyfriend at the Seventh Day Adventist resto, the only vegetarian/vegan place that I know of on the island. In the afternoon, I bought some new toys for our kitty and snoozed on the couch. Upon waking, I flipped through the TV channels and saw a TV chef making a tasty risotto. I'm not a rice eater but I am a mushroom and gorgonzola cheese eater, and those ingredients just happened to be featured in the risotto. I groaned at the thought of stirring tiny carbohydrates over a burner for 30 minutes. But, assured the TV chef, it is not a difficult dish to make and the results make all the stirring worth it. Thinking of my uncle who suggested I make something creative with my dreary day off, I wrote a short grocery list, grabbed a canvas grocery bag and an umbrella and walked to the store.

Porcini mushrooms: nope. None. Nada. Instead I bought a bag of organic mixed wild mushrooms.
Arborio rice: Apparently there isn't a large Italian community on Guam (despite the 100,000+ refined white rice eaters), none. Hmmm. The closet substitute I found was sweet sticky brown rice. It was that or sushi rice. I figured the sticky brown rice would break down similarly to arborio but again, I'm not a rice eater so what do I know?
White wine: Used dry sherry instead.
Gorgonzola cheese: yes! The local grocery store came through on this one.

While walking home I realize that by using brown rice instead of white, I've bought myself at least another half hour of stirring. As I prepared the ingredients, I pulled a stool over to the stove, I might as well sit during all the stirring. I queued up the latest "This American Life" on my computer and listened and stirred...and stirred...and stirred. I munched on sliced pear with gargonzola during all that stirring. After 57 minutes, I began to wonder if brown rice risotto was possible so I googled it and found several recipes. I'm not the only fool to try it. The house smelled divine by the way: mushrooms, stock, sherry, and onion sauteed in butter. Someone should bottle it and sell it as perfume. Finally, at an hour and 10 minutes the rice began breaking down and the creaminess that risotto is known for developed. But, as the mixture took shape salt from the vegetable stock became too pronounced. (I hadn't even added the gorgonzola or parmesan yet). I deviated from the recipe and added some cooked frozen asparagus to absorb the salt and boost the fiber factor. In the end, I omitted the parmesan because the gorgonzola made the dish sufficiently creamy and the parmesan risked over salting the dish.

The result? A dreamy creamy soft and salty risotto. The asparagus was a great addition and really completed the dish. Leaving out all the cheese would make the dish vegan but the gorgonzola flavor was wonderful and made the risotto very creamy. Next time: I would use watered down vegetable stock to prevent over salting. Recipe (with addaptations) follow.

Gorgonzola and porcini mushroom risotto.
Adapted from Giada de Laurentiis
Ingredients

* 3 cups low-sodium vegetable or chicken stock plus 1 1/2 c. water
* 1 1/2 ounces dried porcini mushrooms or 5oz frozenmixed mushrooms
* 3 tablespoons butter
* 1 medium onion, diced
* 1 1/2 cups Arborio rice or brown sweet sticky rice
* 1/2 cup dry white wine or sherry
* 1/2 cup grated Parmesan (I omitted because of excessive saltiness. The dilution of the stock as listed above may allow for the parmesan.
* 3/4 cup (3 ounces) Gorgonzola, crumbled
* 1/4 cup chopped fresh chives

Directions

In a medium saucepan, bring the stock to a boil over medium-high heat. Add the porcini mushrooms. Using a slotted spoon, remove the mushrooms and set aside.

Reheat the stock to a simmer and keep warm over low heat.

In a large, heavy saucepan, melt 2 tablespoons of the butter over medium-high heat. Add the onion and mushrooms and cook until the onions are tender but not brown, about 3 minutes. Add the rice and stir to coat with the butter. Add the wine or sherry and simmer until the wine has almost evaporated, about 3 minutes. Add 1/2 cup of warm stock and stir until almost completely absorbed, about 5 minutes. Continue with remaining stock, adding 1/2 cup at a time, and allowing each addition to be absorbed, until the rice is tender to the bite and the mixture is creamy, about 20 to 25 minutes. If using brown rice, get a stool and a snack, this takes slightly over an hour. Remove the pan from the heat. Stir in the Parmesan, Gorgonzola, chives, pepper. Transfer the risotto to a serving bowl. Serve immediately.

Chickpea helps

One Full Year

2010-07-11T18:58:00.002+10:00

One Full Year
This week marked one year since my arrival on Guam. One year ago I stared out of the window of a plane as it approached the tiny island in the Pacific. I remember the humidity hitting my face and lungs filling my body with the island. Starting my first job after graduate school was a transition. I searched for who I am as a midwife. What is my style? What are my preferences? How do I make clinical decisions? I had to become familiar with my patients, many of whom do not speak English as a first language. They come from a myriad of cultures, each with their own beliefs, superstitions, and each patient with her own story.
One year later, I feel so full. I have encountered a wonderful community of providers and co-workers, patients who make me laugh, scratch my head, and cry tears of joy with them at their births. My boyfriend, Jacob slowly came into my life and each day I am incredibly happy to share another day with him. This island – the warm rain, the salty seas filled with fish of all shades, the shaking earth – is an incredible place to live and work.
My biggest regret is the distance and expense required to travel to see friends and loved ones in the mainland - that and the absence of tango dancing. Just one year on island and my roots are surprisingly deep. My initial thoughts of a 2-year island sejourn have expanded to four or five, possibly longer. Now, I savor the deep sense of satisfaction at each day.

The (in)SANE chapter

2010-04-28T11:42:00.002+10:00

Earlier this month, I traveled to Madison Wisconsin for Sexual Assault Nurse Examiner (or SANE) training. On of my friends here runs the local sexual assault crisis center and has been urging me to become involved as an examiner. After a week of training, jetlagged, and staring at photos of injured little bottoms, strangulation injuries, talks with lawyers and even a sexual assault survivor, I completed the course and am now taking call as an examiner. I'm completely and absolutely terrified.

I am not one who gets into CSI DNA forensic TV shows. I hate violence. I have to cover up my eyes and ears when I see people fighting in movies. During the SANE training, when speakers were discussing cases I cringed and flinched as they described assault and injury. I imagine that it were happening to me and how awful it would be. So why the heck am I doing this? Hmmm. As my colleague said to me "To be with someone during their darkest hour, to gently examine and meticulously document will help them and help get the perpetrator behind bars." We reviewed a case yesterday, photos and all. I left the center feeling ill. Upon arriving home I asked my boyfriend if he would be down with getting burgers and beer and staging a beach picnic. He had a rosary to attend before our birthday dinner with his mom (that i completely forgot). So we compromised. We walked on the beach and had a beer. At the rosary, we sat in the last pew. While the bereaved changed Hail Mary's, the only thing that came to my mind was "God, help the victim heal, help her to heal." I had a sense of total hopelessness. There is nothing I can do that determines whether a victim is able to collect the pieces of their heart and soul and continue in life. My only hope is that a gentle presence, delicate examination, accurate documentation, and a good ear to listen, may provide victims with confidence and courage to seek help in healing.

Tuesday, my favorite day

2010-03-30T17:05:00.003+10:00

I woke up at 730 today. My boyfriend just came back from the gym and was making coffee in our french press. I stared into the fridge and gathered the ingredients for pancakes. Over breakfast I recounted yet another bizarre dream I'd had, this one involved scuba diving.

When he left for work, I perused the paper and worked on a video I was making on my computer. At eleven, I headed to my office to follow-up with a patient. Although it was my day off, I wanted the patient to follow up with me 24 hours after her last visit. I live close to my office so it was no big deal to go in for one patient. As I finished up with her, Jacob called to see if I wanted to join him and a friend for lunch at a downtown cafe.

After a delightful lunch, I was back home chatting on the phone with my mom and sister. I filled out the 2010 census, I cleaned up the kitchen, I perused the internet for recipes because Tuesday is the night that Jacob and I like to go grocery shopping (produce arrives on Tuesday at our store). I watched some food network, wrote some emails, and planned to go to the gym for a class at 4pm. At 330, I was so lazy and tired I wanted to lay down for just a little bit. I took the cat from the couch and plopped her down on the bed with me. We snoozed until 4pm.

I woke up feeling guilty for missing the class, down on myself for not getting my lazy butt to the gym on time. Then I remembered. I remembered that for the past 7 years I lived each day, each weekend, each holiday, each morning and night, with the guilt of a student. "I should be studying...I have that paper to work on...there is that midterm coming up...my thesis needs work...boards are just around the corner." And now? Now I have one full day and two half days off, I take call a couple of times a week, I see patients in clinic 24 hours a week. When I'm not in clinic or on call, I can do anything I like guilt free! This includes scuba diving, reading a book on the beach, making all the movies I like, renting and WATCHING all the movies I like. I would watch entire seasons of TV shows in a day if I so desired. I could cook and bake the most complicated of dishes if I felt compelled. So am I going to feel guilty for missing a day at the gym (well, that makes every day this week)? Hell no! So today, this entry is for the long-time students enjoying freedom from that Ivy Tower, freedom from the deep guilt of our books, our minds, our time as students. May we continue to love learning, but also love our time off.

Sweet 100

2010-02-16T20:42:00.002+10:00

A couple of weeks ago while filling in the details of a birth in my delivery log I noticed that I was at vaginal birth #99, the next one would be #100. In midwifery school, 100 was held up as a marker. "By your hundredth birth, you'll manage second degree lacerations with ease and experience. By baby 100, you'll have a better sense of estimating blood loss, etc." I hadn't noticed baby 100 sneaking up so quickly, but alas, there I was, 99 wet, slippery babies had passed through my hands on their way to their mother's waiting arms. That weekend, I raided the baby isle at Kmart and purchased a set of 3 newborn-sized onsies, some lotion, breast cream, and baby wash to give to the special baby #100. While my boyfriend watched sports on TV, I sat next to him, cut out felt letters, and hand sewed them onto the back of the gender neutral yellow onsie. "I'm #100" it read. I wrapped the remaining onsies in tissue paper, put them in the winnie the pooh gift bag and put in next to the door so I could take it to my next birth. Then I waited.
And waited.
And waited.
One night I received a call and I was sure the patient would deliver on my shift but alas I awoke the next morning at 7AM (the end of my shift) and she was undelivered. The next one I met in the operating room for a cesarean delivery (I don't count those in my numbers). The next day I had a first time mommy whose labor was being induced because her due date had come and gone, we'd waited 10 days, and her amniotic fluid levels were low and it was time to get baby out. While she sat smiling and eating short ribs, she put one down every now and again to say "I think I might have just felt a contraction". She was going nowhere fast. Meanwhile another family came to the clinic. Mom thought she might be in labor, contracting every 15mins for 20 secs. I almost gave her my bit on labor: come when your contractions are very strong, every five minutes, for one hour or more. When I checked her though, she was a whopping 6cms. It would not be long, this was not her first baby. Lunchtime came and went. After work, I drove home, hoping to have a snack before the birth. As I collapsed on the couch for a moment before making a snack my phone rang. "She is 9cms with a big bulging bag of water." Four minutes later I arrived back at the birthing center. There is a common misconception that the water bag must be broken in order for the baby to be born. I checked her to find her fully dilated with the bag of water intact. She started pushing and withing minutes the bag broke. I rushed to put on a pair of sterile gloves as baby descended quickly. Welcome #100.

After this birth, while I was charting I realized that this birth had several things in common with my first birth during my internship in Boston. Both babies came out very quickly. Both mommies bled more than usual. Both mommies sustained significant lacerations that were challenging to repair. The birth in Boston I walked away from feeling panicked, like a failure. I didn't know what doses of medication to use, I didn't think it would work in time. The doctor on the floor that day did the repair. Baby 100, well, I knew exactly what medication and doses to ask for. While waiting for the medication to work, which I knew it would, I employed additional maneuvers to help stop bleeding. I reassessed the source of bleeding. When it subsided I placed a few stitches. When it was all said and done, I remained in the room to help mommy feed her baby for the first time. I don't think my heart rate raised above 65 the entire time and I don't recall being particularly sweaty when it was all said and done.

Do I still have the occasional "oh shit" moment? Absolutely. But they are less and less frequent and I am able to think, and speak, and move and do all the while. So welcome #100, we've come a long way, baby.

The Collapse of Compassion

2010-01-24T11:04:00.003+10:00

I gulp down a glass of chocolate soy milk to appease my growling tummy and climb back into bed shortly after 2AM. While I'm exhausted, beat to the bone, falling over sleepy, my mind and body still pulse with the energy of two people in their most important moment, mother birthing baby. I lay in bed, limp and exhausted but awake and too alive with their energy to fall into the deep sleep that my body needs. I count backward from ten slowly many times in an effort to quell the pulsating energy and sometime between 2AM and 4 AM I doze off. 4AM I wake up to the phone ringing. Another pair has come in signaling it is their time. I groan and stretch, brush my teeth and pull on a pair of scrubs. Once I'm in the room with them, their energy enraptures me and while my body is sleepy, I feel that I have all the energy in the world as mommy grunts and sweats and pushes her baby out.
530AM I crash back into bed and beg their energy to leave me so I can get a couple of hours of sleep before seeing patients in the office at 9AM.
8AM my alarm goes off. I feel like a completely limp flower, so limp, tired and dry that I cannot even be bothered to blow in the wind. I sleep-walk to the shower and hope that the splashing water will wake me. When that fails to rouse me, I brew a cup of strong coffee and hope for compassion and kindness to crawl out of my aching, sleepy body to grace my patients today.
At the office, the coffee stings my tummy and makes it feel raw and sore. A pregnant patient complains of a headache and back ache. I think to myself "You've got a headache and back ache? I was up all night encouraging, massaging, pushing, pulling, sweating, and I'm here with a headache to rival all others and a backache like you wouldn't believe!" Instead, I say "In pregnancy, headaches are common. Let me review a few things we can do to help." It takes everything I have to greet each patient with a smile and muster enthusiasm that they deserve from me at each visit. I move quickly from room to room, the rapid pace gets me in a rhythm and propels me forward.
Lunch time - I drive home, feeling like I've had too much to drink and probably shouldn't be driving. I forget about lunch, drink down a cup of soy milk once again (it's a few calories, some calcium) and crash into bed, the milk still clinging to my teeth and sitting on my tongue.
Twenty five minutes later, my alarm goes off and I repeat the morning steps: splash water on my face, make some tea, and saunter back to work for round two of clinic. Of course, the last patient of the day takes the longest. This is swollen and that aches, and she's so sure she is having a stroke, and while most days I could sit and listen and talk and reassure, today, it is difficult. Nothing I say suits her. "These are all normal parts of the process. If you were sick, we would treat you, but you are not. I feel like we are not meeting your needs. If there is a medicine or test that you want that I am not offering you, please tell me what it is and I am happy to discuss providing it for you. If you want to be admitted to the hospital, we can do that too but I see no reason to admit you. You are healthy, you are well. You may come back next week, or tomorrow again if you like. I am so sorry that you are feeling this way today, I hope that within a day or two with rest and time you will feel better." I am near tears by the end of this encounter. That is how I get when completely exhausted. It is like my body is so tired that it goes on strike and all I can do is sit and cry. I feel defeated. I leave a giant stack of charts on my desk and plan to return to them on Sunday morning, when more rested and when my handwriting will be legible.
On the drive home I give thanks. I give thanks that each of the four births last night, although they didn't go as we had planned, everyone made it. I am thankful there is no snow on the ground. I reflect back to my internship in Boston when I had to rise at 530AM, dig my car out of the snow, put on my boots and wait for a bus to a clinic or hospital where I felt like a stranger, an amateur, a fake. I am thankful I made it through the day without dying because for a while, it really felt like I might. I give thanks for the women who understand, the mothers who confront many sleepless nights and lie awake nursing their fussy babies, begging their baby inside to stop kicking quite so hard. I give thanks that I don't have a little one at home needing me because I need sleep more than anything. I walk in the door, kick off my shoes, step out of my pants. I can't even bother to remove the clothes from my bed, I collapse.

Feliz Navidad

2010-01-04T22:38:00.002+10:00

One evening during the holidays I found myself at the birthing center finishing up yet another beautiful natural birth. While mom, dad, and extended family took in their newest member, I went out to my desk to begin charting and writing my delivery note. From the desk, I heard singing and music. It was 830pm on a Monday so this was unusual for our quiet clinic and birthing center. I took my chart and walked out to the lobby. Alas a group of about 20 Micronesian adults and about 10 children stood caroling in the lobby. Some of our patients who had given birth earlier in the day or the day before came out with their babies and families to listen to the carolers. They had a guitar, a couple of ukeleles, and some tambourines. "Feliz Naividad! We want to wish you a Merry Christmas from the bottom of our hearts!" I took a seat, listened, looked at the adorable children singing. Our cleaning lady and our security guard, joined in the chorus. I sat, looking at the beautiful Christmas tree in our lobby, chart in hand, and sang along. They continued singing and I sat right there and wrote my delivery note surrounded by the families of the patients we serve. So maybe we don't have snow, and it doesn't really feel like "Christmas" in the traditional sense, but I felt it. I felt families coming together, I heard their voices caroling together on a Monday night on a small island in the middle of the Pacific ocean.

Boonie Bites, Episode 3

2010-01-04T22:20:00.000+10:00

Guam Eats Episode 1

2009-12-07T08:13:00.000+10:00

Much to be thankful for

2009-11-26T21:20:00.002+10:00

Thanksgiving is a week-long progressive dinner event on Guam. People bounce from the home of one friend or family member to another. Some families even move the dinner to Friday or Saturday to avoid competing with other dinner obligations. Last year for Thanksgiving, I was in California with my sister and on Thanksgiving morning we went for a long bike ride along Half Moon Bay. It was such a treat to be out exercising and really working up an appetite before the big dinner. I suggested to Jacob that we do something similar. Our plans for hiking or running were jilted when I was called to the birthing center at 4AM for 2 births so I slept in until 1030 and awoke to the smell of ham. Jacob was cooking the Thanksgiving ham at my house because the ovens were full at his family's house. I was happy that I'd prepared the sweet potatoes the day before so my late start meant that we still had time to do something before our first Thanksgiving meal at 2pm.

Jacob suggested we break into the Pacific Islands Club water park. The PIC, as it is called here, is one of the premiere resorts on Guam. It has a huge water park with tons of pools, games, and water slides. Our plan was to ride my scooter over there, walk in though a back entrance, and play in the water until we were kicked out. After being so sneeky and sleuthing our way in, we found that there were no arm bands or tickets or any way to identify guests from non-guests and we were able to play freely without fear of being kicked out. In the hour we were there we played water basketball, went down the slides, played tug of war atop two giant floating lily pads and paddled around several of the pools in the compound. After just an hour it was time for us to go, get our contributions to Thanksgiving dinner, and head to our first Thanksgiving.

The first stop was Jacob's dad's family. Upon our arrival the buffet-style meal was served. I piled my plate with the usual: turkey, sweet potatoes, cranberry, broccoli casserole, and stuffing. After eating, Jacob, Julie, and I (Julie = close friend, engineer for the Air Force who rents a house from Jacob's aunt) took our giant cups of Lychburg lemonade and headed outside for a walk, to stave off the effects of thanksgiving food coma. We walked to a playground near the house and played on the swings, slid down the slide, and took photographs.

Jacob and I then drove 20mins south (very far on this tiny island) to his mother's family's dinner. There, two giant grilled turkeys with bacon placed under the skin graced the buffet. Yes, 20lb turkeys done on a charcoal grill. They are serious about their BBQ here. My belly was still full from our first dinner so I amused myself with a small plate of salmon dip, spinach clam dip, and two servings of Pumpkin Crunch. Pumpkin Crunch is a part of most Thanksgiving dinners on Guam and I can't figure out why it hasn't made it back to the mainland just yet. It is a scrumptious dessert made of a crunchy crumb crust topped with a creamy white mousse like substance and topped with whipped pumpkin. It isn't too sweet, just nice. So tasty. Like many homes on Guam, this one (the home of Jacob's aunt) is equipped with an outdoor kitchen and entertaining area. Several tables were set up under and outdoor tent. The main area, next to the house had the buffet dinner and a table in the center was occupied by the family elders, all women. Jacob's grandmother and her sisters sat there playing bingo and chatting in Chamorro. Jacob and I were called over to play bingo and before long the rowdy table of 20-somethings joined in the game. While Jacob's young cousins played waitress and took our orders for coffee (with or without Kahlua), I covered my bingo cards with pennies and helped the elder to my left search her 12 bingo cards for the numbers as they were called. During our last game, I won an MP3 player and a crossword puzzle book. Bellies full, we drove back to Tamuning. I was thankful for the generosity of families here to set another place at the table, pull up another chair, and welcome another hungry face to their Thanksgiving table.

Family ties

2009-11-12T07:05:00.003+10:00

Family is the central structure of social organization on Guam. This likely explains the difficulty that some outsiders face when coming to Guam. Family trumps all other relationships and without a family here, you're kind of on the outside. Mothers, sisters, and aunts support young women in labor. Pregnant young women are almost always accompanied by either their mother or their boyfriend's mother (or sometimes both) to their OB appointments. On weekends and holidays extended families gather on the beach to barbecue and swim. Yesterday, Jacob and I went swimming in a freshwater swimming hole in a cave. Upon our arrival, two men were their with their sons (or nephews?). Jacob knew one of the guys and they began talking of the party that took place the night before. All while keeping a close eye on the two boys who paddled around with goggles and cannon balled from rocks, he told Jacob that he was out really late and was dead tired today. But guess what? He was up at 7AM, made omlettes for his family and kids and now, here he is with his friend and two little boys swimming around in a cave. The little boys are obviously loving it.

Families are held responsible for social problems. Recently there was a 1 year old baby that was tragically beaten to death by the mother's cousin. His girlfriend was also involved. The mother regularly left the baby with the cousin although the abuse was obvious. This story shook the island. "Where was the family?" "Families know when these things go on, where were they?" Families are held accountable.

Families are open too. They are not governed by strict bloodlines, and distinctions between first cousins and second cousins once removed are unimportant. If your cousin married Maria Christina down the street, she is now your cousin too. When intimate family moments occur, the whole village and their families are invited. Weddings, funerals, and Christenings are the best example of the mega-gatherings on Guam. Last weekend I was invited to the Christening of (get this) the newborn twins of the cousin of a lady I work with. I asked Jacob to come with me since a cultural broker is always helpful in such circumstances. We drove out to the village using a map printed on the back of the invitation. As we turned a corner cars lined both sides of the street people were milling about on the sides of the street, kids played basketball by moonlight, and several wedding tents were set up in the front yard of one of the homes. We parked and walked in. I greeted the nephew of my co-worker. He is a slender clean cut little boy who comes to our office some days after school and his aunt drives him home after work. Hundreds of people sat at outdoor tables, kids were running around in packs, grandpas shushed babies on their shoulders, and adults, young and old sat holding massive plates of food from the buffet. Although the purpose of the gathering was to celebrate the Christening of twins, I believe that such functions serve a broader purpose in the community. Families come together, their kids run around and play, they see their neighbors, their cousins, their former classmates. Everyone see's everyone elses kids. If your sister's kid is acting weird and wearing all kinds of crazy makeup, you can talk about it. If your cousin's kid seems unhappy and alone, you can talk about that too. And while it was pointed out to me that I was the only white lady there (I rarely notice these things anymore), I felt right at home with my friend Jacob and family from work whom I sat with, my plate piled with food and watched their kids run around.

Transitions

2009-09-08T16:37:00.006+10:00

With some big changes and adjustments in the last week or so, I was not looking forward to the Labor Day weekend: 4 days without work (Tuesday is my day off), what was I going to do with such free time? I started the weekend off with a bang by catching a couple of babies on Friday and sleeping in late on Saturday. Saturday afternoon I loafed around, bought a futon, shopped at the mall and ended up dozing on the couch at my friend and neighbor Ben's house while he played songs on his acoustic guitar. I roped him into coming with me to get a massage at a massage parlor recommended by a friend. We went there and they prepared rooms for our shiatsu and hot oil massage. "Okay, we ready fo yoo," said a slim, middle-aged Asian woman. She led us down the hall to a room with two massage tables. "Oh, no, not together," Ben said. I rescued him, "You see, we're related, cousins, so we can't be in here together, we need separate rooms please." "Aah," she said, "Yes, you look very much alike, okay, no problem." and Ben was led away to an adjacent room. I settled in for my hour of massage and the little lady jumped right on my back and crawled around. It was awesome, it felt so good, I was especially sore from a weight lifting class I was roped into taking at the gym, ahhhh, so good.

After our massage, Ben and I wandered to the car in a relaxed stupor. Realizing that we both needed to eat dinner but were both too tired to make anything, we drove to Ruby Tuesday's and took a seat at the bar, as there was a wait for tables. The bartender greeted us, "You guys look like you just woke up." "Even better," I said, "we just had massages." I ordered a glass of cabernet and a salad, Ben had a burger the size of my head.

Saturday night, I met Catrina and another Ben (who is an attorney with her firm) for drinks in Tumon. Catrina chose Porky's, a bar that I don't really care for because the last (and only other) time I was there, the place was filled with white rowdy military men, and there were lewd videos on the two giant TV screens of men doing unsafe things on motorcycles and tan women with low self esteem in bikinis. On this particular evening, it was still early and we were among the only customers in the place. Catrina ordered me an Espresso Patron on the rocks (tequila flavored with coffee). We sat at the bar and before long, a young, black man with dredlocks to his waist who worked behind the bar began chatting with me. I noticed him the last time I was there because he was the only person of color on the bar. Like most non-military people living on Guam his story was interesting: he lived in Japan prior to coming to Guam and the winds blew him this way so here is was. Just another friendly, displaced person loving life on this little island. When we finished our drinks, Catrina, Ben, and I continued to a party at the home of some airforce boys who we lovingly call the "Falcon babies".

The only directions we had to their house were "next to the cranes by the hospital". I knew where the cranes were and we drove toward them until we saw a huge house with a bunch of cars in front of it. A bit of preamble is necessary before I go on about the house. Airforce peeps are give a couple of thousand dollars a month for rent. This makes it extremely difficult for civilians like me to find any decent affordable housing on the island but really good for the local economy, or the foreign companies that own real estate. So, if you've ever seen the Real World, the TV show on MTV where a bunch of young people live in a really nice house and their parties, fights, and flings are captured on film, this house is like that. There are three or four huge bedrooms, balconies that look out onto the ocean, a giant kitchen, a living room with a plasma screen TV mounted on one of the walls, a fire place, and in the backyard, a big swimming pool. The party was catered and yummy pasta and chicken were in warming plates on the granite counter. I greeted the people I knew and introduced myself to those I didn't. The guests were mostly guys (the four who lived there and their buddies) but there were a few ladies there too, some with the military, a couple of locals, and then of course Catrina and me. Someone threw me a Bud-light (ew) and I opened it and walked outside where people were in the pool. I had met some of them before at the beach or other places. I didn't know it was a pool party but I love being in water and the floaties looked so inviting. So I borrowed a tshirt to swim in and jumped in. We played pool games, tried to line up all of the floaties and run across them without falling in the water, paddled around, and after 2 hours I was ready to get out. I borrowed a towel, dried off, and changed back into my strapless summer dress. I made myself a plate of pasta with a yummy tomato shrimp sauce and walked back outside to eat it on a lawn chair next to the pool. By this time, Catrina had been thrown into the pool in her clothes. As I finished my pasta, I knew it was only a matter of time before I was thrown in, in my dry clothes. And yes, before i knew it, I was being catapaulted through the air shrieking and splash! Into the water I went. Over the course of the evening I was thrown in another six times. I finally just stayed in, in my dress.

The next day I met up with a friend from the party, Chris. We bought tickets for a reggae concert later that evening. Tumon was covered with a thick, humid smoke from the many families grilling on the beach on Labor Day. After buying the tickets, we headed out in search of lunch. We settled on a dim sum place and shared plates of steamed BBQ pork buns, egg rolls, and giant rice noodles wrapped around seasoned beef. Chris did a semester abroad in China and impressed the owner of the hotel by ordering in Chinese. After lunch we drove to Yigo (pronouned JEE-go) to CJ's house for a Labor Day BBQ. (CJ = friend of Catrina, in the airforce, has a great dog named Turtle and is watching a friend's puppy (Luna) while he is deployed). Finding CJs house took several phone calls but at last we found it down a random road that looked like it led to nowhere. There, down a tiny one lane gravel road was a cluster of houses that looked like the house that Saddam Hussein lived in in the TV show Arrested Development. CJ lives alone in a nice 3 bedroom house with a yard and everything. When we arrived he was grilling succulent meaty nuggets outside. I'm not much of a carnivore but they put something in the meats here that makes it so tender and tasty and salty, mmmmm. Many of the people from the pool party were here so introductions were easier. Bebe (prounouced Beebee, short for Sahiba) is an outgoing, funny, confident woman who is also in the Airforce. She was at the pool party and I was happy to see her at CJs house. We started talking right away. "You know," she said to me, "I didn't know if you was cool or not last night, but now I'm tellin' you, you real cool." We rode in the car together to the reggae concert and upon our arrival, she took off her jacked and revealed a tight tank top underneath. "Now," she stated, "There aren't many people who can pull off a tank top, but I can, and I love me a tanktop." I agreed, Beebee owned that tanktop, she rocked her jeans, and her high-heeled boots loved her.

While the guys hung back, Bebe and I went to the front of the stage and danced as the full moon rose above the park. Eventually the guys joined us but when people started smoking ganja they nervously fanned their faces so as not to possibly inhale any of the smoke. Ah, they are a tightly wound bunch but I can't blame them. Their futures depend upon passing drug tests, having their hair cut to the proper length, the circumference of their waists.

After the concerts, we all hauled it back up to CJs house. I played with his dogs and asked if I could borrow Luna. Since hearing that someone was looking in my neighbor's apartment windows last week, I've been feeling nervous at home. And lonely. A little pooch could be just what I need for a little while. CJ thought it was a great idea so today I picked her up and her overnight bag and she is staying at my house for a little while as I center myself, snuggle with her and continue the search for meaning.

With Luna as co-pilot, we drove back to Tamuning. She seemed happy in the car, except when I took turns too quickly and she flew across her seat. I found a "Humanistic Buddhism Society" online and have been wanting to find it in person. Since there aren't physical addresses in Guam, the website said "Near the Airport". I drove toward the airport down every road possible and I didn't see the temple. There were pictures of the temple posted online and it looked like a big, regal, Chinese Buddhist temple, very hard to miss. I had never seen anything like it around the airport. Just as I was going to give up, I saw a sign that said "Bello Road". The website said something about Bello road. I pulled a u-turn and splinted Luna in her seat. Down Bello road there was a sign pointing to Guam Buddhist Society, it was also written in Chinese. I proceeded up a hill, past a couple of warehouses and sure enough, on the hill was a huge red and gold temple. One of the gates to the parking lot was open and I drove in. There was a sign that indicated the temple was closed Mondays but open every other day from 8AM-5PM. There were two cars in the parking lot. I rolled down the windows for Luna and walked up the marble steps to the huge doors of the complex. Each door was locked but I finally noticed a sign reading "ring bell". I rang the bell and waited until a person with a shaved head in a gray robe came to the door. The person let me in and greeted me warmly, the voice was feminine, so I knew she was a woman. Compassion and love radiated from her little bald head and drab gray robes. She spoke to me in English with a strong Chinese accent. She seemed so pleased that I had come, like she had been waiting all day just for me to wander up and ring the temple bell. She invited me to sit at a table and gave me a piece of paper on which to write my name, phone number, and email address. She wrote her name on a card: The Venerable Miao Guan. In Chinese, her pupils call her sv-fu, or Master. I told her that I was looking for a place to meditate. She called to a woman, "the volunteer", a 50-something Chinese woman in slacks and a colorful button up top, who came out of one of the inner rooms and introduced herself. Sv-fu instructed her, in Chinese, to take me on a tour of the temple. On the main floor there was a large meditation hall with wood floors and a big gold Buddha statue in the front of the room. We peaked in and bowed respectfully. She led me across the marble entry way to a flight of stairs where we removed our shoes and proceeded to the second level. Photographs of various volunteer charity events adorned the walls with the little bald Sv-fu smiling away in all of them. Most of the people in the pictures were Asian but there were a few whiteys too. After looking at the pictures "Volunteer" showed me to another large meditation hall. This room had five giant Buddhas in various states of bliss at the front of the room. The walls all around the room and behind the Buddhas were covered in mini-Buddha tiles. "Woah," I thought, "Buddha is watching you from all angles in here. No nose picking in here, no way. The old Buddha, all thousand of them, would stare at you while you did". (Although the Buddha was vegetarian so I suppose as long as I wasn't sneaking bits of beef jerky I'd probably be okay.) Behind the giant Buddha statues was a smaller room where "people come, to speak...from heart...compassion...open", said Volunteer. I'm guessing it is a room for prayer and meditation away from the group. Incense burned below the Buddha statues in the smaller, calm room. I really wanted to just take a seat, settle in, open up my heart, and wait. Volunteer seemed anxious to show me the rest of the place and get on with her day.

Back on the main level she showed me a shop filled with books, prayer beads, incense, and lectures on CD. I thanked her profusely for the tour and promised to return after the upcoming 2-week closure of the temple for "cleaning and repairs". It was the cleanest and most ornate Buddhist temple I've ever seen.

Alas I find myself in a place of transitions. Moving between the dominant social scene that presents itself for my peer group and the desire to palpate that which lies beneath the surface. I don't feel the need to choose one or the other. I'm hoping to allow myself the opportunity, and the discipline to experience both, and other.

This just in...

2009-08-25T20:30:00.002+10:00

After being on island for a month and a half I'm happy to report that I'm doing well, eating well, working hard, and getting out and about on this incredible island. No snake sightings yet. Lots of lizards, some crabs, fishies, but none of those famous snakes. I'm working hard. Twenty hours a week in the office and 24 to 48 hours each week on-call. Work feels good but I still feel like I'm playing midwife and not really a midwife. I wonder when I'll feel like a proper midwife in my own right and like less of an actress. I'm trying...trying to really listen to patients, trying to find my own voice, my own practice style, but these things take time. Many patient still ask me how old I am or how many babies I've delivered. I sometimes wonder what news I can share with a mother of five that she didn't already know about her pregnancy. So I ask about her other kids, things like that. My practice is really strict with diet and weight gain and no one likes to hear nutrition and exercise advice from a skinny white girl who is training for a half marathon. One of the other midwives on the island called me and we had lunch together. Like so many midwives I know she shared with me her secrets and encouraged me to listen to my inner midwife as much as possible but she also said that Guam is one of the best places to be a midwife. Overall the transition has been really smooth. I've only come home from work near tears, and that was due to exhaustion after a 24 hour call shift followed by a full day in the office on 2 hours of sleep.

I've got a nice little group of friends comprised of a mix of Chamorro and Haoli folk, young and old. With the younger crowd, we go boonie stomping, to the beach to watch sunsets, out for sushi and drinks (although we're all trying to save money so we may be having more drinks at my house since I have lots of beer leftover after the latest gathering). Then there is the older-than-I-am crowd of the other providers in my practice and their families. We went to see a Beegees cover band and two of the doctors I work with are always happy to go for sushi with me. They are constantly scouting to find me a tango partner and word has it that the new anesthesiologist on island knows how to tango. I'm running, taking yoga classes, reading books, and I rent DVDs through netflix. That has turned out to be a bit of a bust as the last two movies I rented I put in to play them only to realize I'd already seen them. The name and description wasn't enough to tip me off.

In other news my tongue has turned yellow, well today it is more of a rust color. I had a bout of strep throat and I'm assuming that the antibiotics left me with a fungal infection in my mouth which i'm now swishing with nystatin four times a day. It doesn't seem to be helping so if anyone knows what would cause a yellow or bright orange tongue, please pass that article my way (I do not smoke, am not strictly vegetarian, and I'm not starving). Any guesses? Anyone?

Boonie Stomp!

2009-08-10T20:35:00.006+10:00

This Saturday I joined a group of outdoor enthusiasts who romp in the jungle on weekends on a "boonie stomp", or hike. We met at a central place in downtown Haganta, the capitol. I paid $2 and an additional $1 for textured gloves that are needed for climbing on coral rock to prevent the sharp rock from cutting my skin. I drove a Navy friend, Jonathan, and when we got there some other friends Catrina, Ben, and Julie were there ready to stomp it up a notch. After getting directions and a description of the day's hike, we piled into Ben's car with our backpacks, water bottles, sunscreen, and bugspray. A group of about 20 of us set off on a poorly marked trail. The jungle was dense and humid. We hiked passed famous Latte Stones (old stone formations that are found around Guam) and old pieces of pottery and hollowed out rocks that were used eons ago to grind grains and fruit. We climbed up and down rocks that were slippery with moss and I was glad to have the gloves to help grip rocks and branches.
After about an hour we were out of the jungle and standing on a big coral cliff on the edge of the ocean. We hiked along the cliff face for thirty minutes or so before coming to a section of cliff with a blue pool 40 feet below. Here we were invited to shed our backpacks but keep on our gloves and shoes and jump in. I jumped from a 12 foot cliff but other people did back flips from the steep 40 foot cliff face. The water below was warm and turbulent. If not careful we'd be swept up and pushed against the coral.
After jumping in a couple of times, I climbed my way back to the top of the cliff and sat looking out at the beautiful blue ocean.
"We live here, how cool is that?" said Julie. "Very cool."

Eventually we packed up and headed back into the jungle to complete the loop. Pagat cave was the next stop. After my last caving experience I knew this one would be easier and less anxiety inducing. We left our packs at the entrance and took out our flashlights. Shortly after skidding down the slick inclined entrance, we were knee deep in icy fresh water. After a tight squeeze between two rocks the water was waist deep (oh! Was it ever chilly!). From this point, I could see light coming from the next room in the cave. The previous group of visitors lit candles and left them so the room was big, full of water, and about 20 candles were placed on rocks and it lit up the whole inside. It reminded me of that scene in Phantom of the Opera where they are on the boat in some underground area. Erie and beautiful. The water was very cold and deep but the eight or so of us who ventured into the cave swam and learned about the cave from the trek guides.

When we became too cold to stay in any longer, we emerged back into the jungle and steam evaporated off or our skin as we made the steep and vigorous hike back to our cars. There, a cooler of icy home made lemonade awaited us. Our shoes were squishy, our clothes sweaty and dirty, and we all looked like we'd just been rescued from a desert island. In various stages of dress (Catrina in her bathing suit, me with a tshirt and shorts but no shoes (my tennis shoes were squishy with water so I left them in the trunk), we decided a drive to Wendy's restaurant was in order for chocolate frosties and french fries. Once there, we all expanded our order to include burgers, fries, ice cream, salads, chili, and baked potatoes. It was the best meal we'd eaten all day. We were so famished from the hike and I'm sure we looked like a bunch of outcasts but boy, did that food taste good. Stinky, sweaty, dirty, but with full bellies we drove back to Tamuning. I showered and promptly fell asleep on my bed dreaming of jumping off of cliffs and floating in the warm micronesian waters.

Rotary Sushi

2009-08-06T22:39:00.002+10:00

Since recovering from the depths of my illness (strep throat) I had not eaten a proper meal or been outside of a 1/2 mile radius of my house (work is close by). My friend Jacob and I made plans to go for sushi in Tumon. Guam seems to have an abundance of fresh tuna sashimi and aside from preparing it in my home I haven't partaken in it since my arrival, and I love tuna, and sushi. We decided to go to Rotary Sushi, a little resto in a strip mall near the resorts. I'd heard a great deal about the place, everyone raves about it. We walk in and there is a main room, not very large, with a counter, kind of like a diner. The sushi chefs are in the middle and there are people seated on little stools around the entire perimeter of the island. A veritable train of plates of sushi rotate past customers on a belt that continually circulates around the counter. You see what you like, you pull it off. The portions are small so you can try all different kinds. People sit close to each other at the counter, chatting and discussing the different kids of sushi as they rotate by. Jacob ordered tea for us and pulled a bowl of salted edamame off of the belt. I grabbed pieces of a shrimp tempura roll. We both took a plate of fresh pink chunks of tuna spilling out of seaweed cups filled with rice and spicy japanese mayo. We watched new things show up on the belt and Jake eventually decided on grilled eel. I had a delicious creamy crabmeat morsel and my final choice was a little cone of seaweed filled with crunchy little tobiko, fresh sliced cucumbers, rice and a spear of tuna sashimi. It was incredible. And such fun to watch the pieces of sushi, soups, chicken wings, and fried octopus tentacles float by. I'll definitely be hanging out at Rotary, especially since the counter makes it a nice place for solo dining and the people are so friendly that I'm sure I'd have good conversation if I went alone.

This morning, I woke in time to make strawberry oat muffins to take into work. When I arrived with warm healthy muffins in hand, the staff had brought a full-on chamorro breakfast: eggs, fried rice, corn soup, fried spam and sausage 3 ways. Even though I ate 2 muffins at home I was happy to fill a plate with rice, eggs, and sausage. I'm not ready for Spam quite yet. We sat around the nurses station eating and chatting before starting our day. It is nice. They love eating here and they love socializing. I saw my morning patients, went to the back to the birthing center at lunch, caught a baby (a beautiful, powerful, strong birth, the kind that reaffirms why I do this), showered amniotic fluid off of my butt and was back at it for the afternoon session. Since I didn't have time for lunch, Anna, one of our clinic nurses made me a plate of rice and sausage for lunch that I scarfed down in between patients. Did I mention that they LOVE meat and rice here?

YummyTummyCurry!

2009-08-04T18:44:00.002+10:00

After 2 more births last night, I slept late and made myself a strawberry papaya smoothie for breakfast. I must say, papaya reveals some of it's best qualities when cut into chunks, frozen, and blended into a smoothie. Kind of like clams, which I like only when pureed into a sauce with garlic, parsley,olive oil and cheese. I put on a pair of running shorts and tshirt and drove to the birthing center to discharge my patients. They go home pretty quick here, next day for normal deliveries, at the hospital they go home 2 days after c-section.

A note on a birth: A beautiful primip labored like a superwoman while her 20 or so family members and friends sat around in the room having a party. They brought buckets of fried chicken and trays of fried rice. A few kids sat in one corner, playing games with each other. Her Grandmother kept saying over and over "push like you're constipated!" Mom and Grandma held up a sheet to allow her some privacy as she pushed and everyone encouraged her. When the baby finally emerged after one hour of really hard pushing the room erupted in cheers and tears. I cried too.

I drove to the gym and had a wonderful run. Since I am still on the mend from strep throat, I thought that maybe I would run a mild or two but was loving it on the treadmill. It felt so good to be running after taking a week off. Ooh, I could have kept going and going if not for pesky knee pain. At home, I sliced half an avocado and seasoned it with salt, pepper, and balsamic vinegar. I ate it quickly and went back out to finish my errands. First on the list: Tokyo Mart. I'd heard of this japanese grocery store from co-workers and wanted to check it out and maybe buy a bag of nice rice. I walked in and it was like a toy store of food! Wrapped food objects of all sorts lined the shelves in beautiful packaging of all colors. They had some very special grapes for $12.99 for a little container, they had pickled goose eggs, pouches and packages of things that looked like noodles, vegetables, or some seafood product. Fresh fillets of tuna were packaged ready to be eaten as sashimi. Some of the products had things written in English like YummyTummyCurry, and SuperFast Liquid Coffee. At the back of the store were neat little boxes of food prepared to go. I picked a small container of fried dumplings and such. I also bought a bag of rice, a very tiny head of fresh lettuce, chopsticks, a cold can of Assan Milk Tea, and some rice wine vinegar. In the car, I opened the milk tea and took my first sip of my certain risk factor for type 2 diabetes. It was cold, sweet, creamy tea that tasted just the way I like it. The box of fried things contained a piece of fried chicken, which I still haven't eaten, a bright orange marshmallow-looking thing that was a crispy fried scallop, 3 fried seafood shumai, a big piece of tempura fried carrot, and a fried vegetable dumpling. Oh, Tokyo Mart, you are my new favorite place on Guam.

I went to pay my rent and noticed, next to the office, an Asian housewares store. I decided to take a peak. As I walked in, a precocious 8 year old girl called for her mother. I slowly walked around the store and she followed me like a shadow. I asked her what her name was, how old she was. She pointed out little packets of slimy vegetable (I presume, it could have been meat, or poop for all I know) that she likes to snack on. Then she started to advise me on rice cookers and cookware. For $18 she sold me a nice rice cooker, something I wasn't really looking for (not a big rice eater) but I did just buy expensive Japanese rice and she was the cutest thing ever so why not? She, the 8-year-old rang up my purchases and wished me well with my new appliance.

Back at home I cleaned the apartment, swept the floors, smashed some ants, cleaned up gecko poop (I mean come on, you guys can live here but don't make me clean up your poop too), and installed my new wireless router. Now the plan is to make a cucumber salad and watch the last of the movies left over from the sick weekend.

Sick Day(s)

2009-08-02T19:53:00.002+10:00

Considering that my immune system, however strong, is naive to the common afflictions on Guam, and considering that some sort of flu has taken the island by storm, I was not surprised when late last week, I began to feel tired, achy, and a terrible sore throat. I continued to go to work, assuming it would pass but by the weekend, patchy exudates clouded up my throat and I felt awful. I used the illness as an excuse to buy a blender (for smoothies, of course), and a DVD player. I rented four movies at Blockbuster, and stocked up on canned soups and popsicles. I spent Friday morning in the office, the afternoon I was at home in bed. Throughout the weekend, I rotated time sleeping in bed with time watching TV or movies, reading, eating whatever soft foods I could (mashed potatoes and carrots proved comfortalbe), and repeating. The rainy, windy weather accompanied me in my haze.

Ellen called to check on my and diagnosed me with strep throat over the phone. She ordered a course of antibiotics, which I picked up and began taking right away. Saturday night, I was called to the birth center for 2 births. I showed up in my pajamas (they are pretty casual here and one patient really liked my Barack Obama tshirt with scrubs. She was hoping her baby would share Mr President's birthday but it came a couple of days early). I sported a surgical mask to keep my germs within my facial-nasal area. The births were great. Annie showed up at the very end and helped me with the repairs. I returned home in the wee morning hours, made pancakes, talked to my mom on the phone and slept from 6AM until 9AM. When I woke, it was clear the antibiotics were working as the excruciating pain that previously accompanied each swallow was lessening. I watched a movie, ate some grapes, and slept. Ellen called in the afternoon to see how I was and asked if I wanted to come over. As my voice is nearly gone, I thought it would be prudent to stay at home and rest my voice, especially since I'm in the office and on call tomorrow.

In the evening, I drew a warm bath, listened to cool jazz, and read a book as I relaxed. Clearly on the mend, I made a dinner of eggplant, grean beans, and red peppers in a sauce of ginger, garlic, basil from my garden and soy sauce. When I went out to get the basil, the tiniest gecko ran from under my door. It was barely an inch long and so cute. I chopped the basil and added it to the pan of sizzling vegetables. After dinner, I did the dishes that had accumulated over the weekend, well, I put them all in the dishwasher. Tomorrow I return to work for a full day and 24 hours of call. My voice is still gone but I feel a bit better. I've survived my first ailment alone on Guam.

I engage with the democratic process on Guam

2009-07-31T18:54:00.003+10:00

Earlier this week, I had my television debut on Guam's local news. The appearance was brief -the camera panned across the room and there I was, next to a guy holding a sign that said "God created Adam and Eve, not Adam and Steve, but the issue important. After work one day, Dr B, her partner Ellen, and Stephanie planned to go to the state legislature to testify in support of Bill 158, a bill that would legalize extend state benefits to those in civil unions. The debate centered around same-sex civil unions. I rode over with Lina, our business manager, her daughter, niece, and mother to show support of the bill. Lina's mother sat on the opposing side of the room with representatives from the church. As a majority Catholic territory, those opposing the bill quoted Bible verses and talked of the dangers of promiscuity. When it was time for Dr B to speak, she took the stand with her partner of 24 years, Ellen. Dr B has been providing OB/GYN services on Guam for 16 years, since she finished her residency and decided to return to the island she was born on. She and Ellen are a family. They are a part of the community; they are well known and respected. Her point was that the laws should reflect community standards and the community clearly accepts and loves her family so why should the law treat them differently? If Ellen gets sick, shouldn't Annie (Dr B) be the next of kin to make decisions? Stephanie, in a teary voice that cracked with each sentence, pleaded for equal rights for her and her partner Dr Kaaren. It took immense courage for these strong women, respected leaders in our field and on the island as a while to come out, sit next to the Bishop of the Catholic church and ask for their rights too. We were there for over 3 hours until each member of our practice who wanted to speak did. So many people from the practice and brothers and sisters of Annie's family came to support her, to support equal rights for all. I was so proud to be a part of such a supportive and strong group.

After the hearing, we all went to Mermaid's, a local brewpub and restaurant for dinner. It was lovely hanging out with the other providers and more and more, I feel like a part of a group. After dinner, I drove to a resort where I learned they had ballroom dancing twice a week. Ryan, one of my dance partners from the states encouraged me to go and check it out. I arrived just as a spicy bachata finished. I sat down in the mezzanine of the resort that had a dance floor surrounded by wicker chairs and couches. A waiter came up and explained to me that the fee for the evening was $15 but that included pupus (appetizers) and 2 drinks. I wanted neither and wasn't sure I was going to dance so I talked him into letting me sit and watch this time for free. The floor was filled with about 10 couples of young Filipino men and their significantly-older partners. After 2 songs, the DJ announced that it was "Chipmunk time". I thought they were to play a song by the Chipmunks (Alvin, Simon, and Theodore). No, I was wrong. Chipmunk time is when all of the men take to the floor and flamboyantly perform a choreographed dance to the song "I'm too sexy". Yes indeed, some of them were too sexy for their own good gyrating their hips and flinging their arms about in a way that would have made Elton John very proud. The women who sat watching seemed very entertained. The expression on my face was one that expressed a mixture of shock and bewilderment. A few songs later, all dances I don't know - the jive, the rumba, etc. I guy came up to me on his way out and said I looked like a dancer. He wondered why I was sitting down. He introduced himself and told me about the dance studio he runs on the island. He didn't know anything about where I could do Argentine tango but invited me to a few lessons he gives. The final song was a ballroom tango. It barely resembled the close, intimate dance that I love. Dancers held their partner in a boxy embrace, turning their heads away from each other, leaving a giant space between them. Their arms were showy, flinging about here and there. The music was different too, like an oom-pa-pa oom-pa-pa kind of thing. I approached the DJ and asked about Argentine Tango. He said that he could play an A-tango or two next time for me, but alas I do not have a partner. In the States people rotate partners every few dances. Here it was like a BYOP thing. Depressed, I turned to leave. As I walked toward the stairs, an older woman came up to me and said "You do Argentine tango? Such a beautiful dance! I only wish I knew how to do it. You come Friday? My partner, he know tango, a little bit." I said I would come back another night but left, almost in tears. I just wanted one nice or even mediocre tango dance and came up dry.

Later in the week, once my midwifery license was official, I started seeing my own patients in the office. It felt great. There was one couple from off island that came in for an urgent visit. Their English wasn't good but they had a dictionary and had written out the patient's complaints. "Brown wizard in the belly" "to the root of the heel". I had no idea what the problem was but listened to the baby, dipped urine, and offered reassurance. Diagnosis: round ligament pain.

I also had my first birth. A beautiful affair that ended with a giant baby, a worn out mother, a tired midwife who had to see patients an hour later in clinical after being up all night. But I made it through the day. I even went out for lunch with nurses from the office and am beginning to feel a part of that group too. It is amazing how energizing birth is. Bearing witness to such an event kept me going through the day. Realizing that my hands, mind, and entire being have been trained for this was a major victory. I was anticipating a shoulder dystocia because I have been trained to anticipate disasters, something that Dr B is trying to work out of me. Dr B stood in the corner, watched, and put her arm around me after. "Okay Jess, now you do the paperwork, I'll see you in the office in an hour, nice job." Signing the birth certificate with CNM after my name felt especially nice.

Liberation Day

2009-07-23T12:16:00.002+10:00

Tuesday morning, at 71oAM my new running buddies Jacob, Katrina, and Ben, picked me up to run the Liberation Mile. Liberation day is the celebration of the "liberation" of Guam from Japanese foces by American troops and native Chamorros. It is celebrated similarly to the 4th of July in the States but bigger. The theme is barbeque. An all day parade takes place through the capitol of Hagatna (pronounced uh-GAHN-yuh). Families line the sides of Marine drive with canopys covering their spot. Under each canopy are numerous chairs, tables, and at least one charcoal barbeque grill. Even as we walked toward the start of the race at 745AM people were lighting up their grills and turning their marinaded meats. These people are major carnivores, like majorly into meat. At 8:00AM the runners took off down Marine Drive. Families set up on the sides of the road cheered us on. It was only a mile, I ran it in 7min 40secs but all of the smoke from the grills made it feel like I was running a marathon while smoking a cigarette. After the race, runners were offered a choice of water, soda, or beer. Ah, these healthy folks here. You can run but you'd better wash it down with a cold beer and some ribs. One of Katrina's friends was marching in the parade (US airforce) and his pitbull puppy, Luna ran with us. After the short run, she was pooped. I decided it was best to hold her like a baby until she fell asleep.

The parade began around 10AM. Since the day commemorates a military victory the parade was heavily militarized. Thousands of army, navy, and airforce came through on tanks, marching, with their giant guns in hand. The troops were a mix of haolies (white people) and Chamorros. As the sun beat down, we took shelter under a canopy with a family selling snow cones. Jacob and Katrina went off to buy some food and came back with a bag of pumpkin empanadas, puto (the sticky rice balls), milk bread (like hawaiian bread), and one of my new favorites chicken kelleguin (kind of like ceviche made with chicken, beef, or shrimp. This one was cooked chicken with hot peppers, lime juice and cilantro) wrapped in a tortilla. They also bought two small bags of pica daigo which is spicy pickled daikon radishes, quite yummy too. We sat on the curb, ate our food and chased candy from the folks in the parade. By 1130, we were feeling hot from the sun and decided a trip to the beach was in order. We met up with Katrina's friends, 3 haoli airforce guys and split up. Jacob, Ben and I went to my house so I could get my bathing suit. Then we got a sandwhich at a place near the beach. We watched the continuing parade on the giant TV screens there. We met Katrina and Co. at the beach outside the Hyatt resort and spend the rest of the afternoon sipping beers in the shallow water.

I planned to go home and sleep before going to a barbeque at Dr Bordallo's house but just as I laid down, Stephanie called from the birthing center, asking if I wanted to come in for a birth. Since I don't have my license yet, I'm still only watching but it is good for me to watch as many births as I can. This was number 3 for the day for Steph, and she had 2 more in the evening. For the midwives out there, these patients stay on the old Freidman's curve like flies to shit. If anything, they are racing Freidman! One minute they are 5-6cms, then 8cms then boom! It's like a 30 minute second stage is prolonged. So out popped another chubby chamorro baby with lots of hair. I went home to change and Jacob picked me up to go to Dr B's.

A spread of various grilled meats, red rice, rolls, and sliced fruit was on 2 picnic tables outside. Annie's family members, many of whom I'd met at the beach this last weekend, were there. Kids played on the beach in front of her house. A couple of guys next to the grill played ukalele and sang softly. Steph and Kaaren were there. We ate and just as the fireworks started, Steph was paged back to the birthing center. I stood up to go with her and she told me to stay and enjoy the fireworks over the bay in front of Annie and Ellen's house. So I did. Happy Liberation Day.

Who could ask for anything more?

2009-07-20T12:48:00.006+10:00

Sunday morning, around 1030AM, Ellen and Annie picked me up to spend the day at a piece of property owned by Annie's family on the north part of the island. The land has been in the family for generations and even when the American air force base was built the family was able to drive out for weekends of camping on the beach on their property. Since 9/11, that has changed and getting to their own private land, through the base, has become increasingly difficult, requiring someone (a friend or family member) with base access to sign us in and out. Annie's brother met us at the gate and we drove in, past the commissary and base housing, past the military beach to a clearing. We left the cars there, grabbed our bags and started off on the jungle path toward the family property. After only a few minutes, a 4-wheel drive truck drove past and they stopped to ask if we wanted a ride. We climbed into the back of the truck bed and bounced over rocks, coconuts, and sand with jungle cliffs on one side, the ocean on the other. We pulled up to a covered area with a few picnic tables underneath, a sink, and a grill was smoking outside. Annie's family members came to greet us and I was introduced to ten or twelve people who bear some relation to Annie. This person went to kindergarten with Annie's mom and then her son married Annie's sister. This person's grandpa is the sister of Annie's great grandmother and their kids married, or something like that. After introductions, I walked down to the beach where more family members and their kids swam in the water or played in the sand. We were the only people on the beach. Huge cliffs covered in green jungle vines overlooked the clear water around the coral reef. I removed my tshirt and shorts and waded out into the warm water in my bathing suit. I was introduced to Arianne, Annie's 22 year old niece visiting from California. We laid on our bellies in the shallow water and chatted with her mom and sister. Just as I began to feel the sun baking my skin, we were called to lunch and walked up off the beach to the grill and picnic tables. There, grilled meats, rice, and cold drinks awaited us. People will eat meat and rice here for every meal if they can. Ellen, the other haoli (white person) brought a cut up vegetable salad, which I was happy for and seemed to eat the most of. My plate was piled with the salad, hamburger meat on top of a thick grilled corn tortilla, and a blob of something (i've forgotten the name) but it is like sweet balls of sticky rice flour that is eaten with the meal. Everyone was really nice to me, asking me why I chose to join Annie's practice in Guam. There were numerous links to the Dakotas. Two of Annie's nephews just picked up and moved to North Dakota, someone actually attended college at the University of South Dakota, and as Guam has the highest per capita rate of military enlistment, many people have passed through the air force base outside of Rapid City.

Shortly after lunch, Annie's sister Trish began assembling a group of us who were interested in touring a cave in the jungle. I'm claustrophobic and wasn't sure I'd be able to go in, depending on the size of things but I was anxious to ride into the jungle, hoping to see one of the famous brown tree snakes. Seven of us piled into the back of a truck and four guys who looked like pirates (tatoos, long curly dark hair, cigarettes, tattered clothes) came as our guides. Mind you, most of us were in bathing suits and tattered clothes of some variety. Picture the tv show Survivor. I was so kind as to put on a pair of shorts so my butt didn't end up in the face of the person behind me, should I decide to go in the cave. Since no one brought tennis shoes, we wore our water shoes on our feet. I later found out that they don't offer much protection out of the water. The "guides" had property next to Annie's family and seemed like nice people, anxious to show us the cave that their uncle discovered in the 1950s. As we drove deeper into the jungle, coconuts smashed under the tires of the truck. We had to duck down in the bed of the truck as palms swept over us and the occasional coconut fell from the tree above. At one point, I felt something on my leg and looked down to see a giant spider jump off of my leg into the truck. I shrieked and the truck stopped. We all clamored around in the truck bed, trying to smash it. It was a wolf spider and apparently it's bite packs a punch. Our guides would call out things like "tree with thorns on left, left side down!" and "Vines up ahead, watch your head for vines." A pack of wild pigs/boars ran across the road squealing after us.

After much bouncing and sweating, one of the guides said we'd reached the point where we had to get out of the truck to hike. I jumped out of the truck and my foot landed atop a jagged piece of coral, right down the middle of my foot. I gasped, realizing that the water shoes are more like socks with a rubber sole than shoes of any sort. I started to get dizzy as the muscles in my foot seized up in a big cramp. Several deep breaths later, we followed our guides deeper into the green rocky jungle. Huge spiderwebs and spiders the size of my hand looked on as we made our way toward the cave. We stumbled along the coral on the ground and my poor foot cried out with each step. After twenty minutes of what seemed like aimless walking, there was no trail in sight, we arrived at a big rock with a bit of a hole at the bottom. "This is it." said the pirates, "line up so that every third person is a guide and they'll have a flash light." "Woah," Trish said, taking in a deep breath, "I think someone should stay outside in case there is an earth quake or something. I volunteer to be that person." "That looks really small, I don't think I can do this, I'll stay out with Trish," I said. Everyone cajoled us into trying to go in. Trish went in as one of the first. After the next guide went in, I thought I would try but as I lowered myself to the ground, laid back, and prepared to wriggle myself in through the tiny hole I was overcome with anxiety. "Nope, this isn't happening for me, sorry. I'll stay out here and keep watch." As a few other people crawled in, one of the guides and Bill, Annie's American brother-in-law, talked me down. Bill was in the military and really into getting me over this fear. "Just keep breathin', that's all you have to do." So, I sat back down on the ground in front of the cave. I could see Bill just ahead of me, flashlight in hand. I had to lay down on my back to squeeze in and he guided me to the spot where he was standing. The cave opened up a little at this point. Josh, pirate-guide #4 and the one right behind me, came in and used his light to illuminate the huge stalactites and stalagmites coming down from the cave. Further in, we had to shimmy between the hanging down minerals. There were times where we waited for several minutes in complete darkness waiting for the people in front of us to make it down a steep descent. I kept breathing and hoping there wouldn't be an earthquake. Water dribbled from the top of the cave, it was cool but humid inside. After 20 minutes of maneuvering I was instructed to grab the muddy rope that was hanging on the wall and slowly lower myself down the wall all the while being very careful not to knock loose rocks down upon the people below. At the bottom of the cave was a pool of clean, cool water. "So this is Guam's limestone water filtration system," one pirate-guide said. We splashed around and took photos of the giant interior of the cave. We were all relieved to have made it and felt bonded as a group. We turned to head back and the return trip from the depths of the earth felt much faster than the descent. Still, I was amazed at the tiny squeezes necessary to maneuver out of the cave. Finally, I saw light up ahead and crawled out on my bare belly back into the woods. I gulped in the fresh air and daylight, so happy to be back above ground and so proud of myself for facing one of my biggest fears. "You know," I said to the group, "We emerge from the earth as we sprung from our mother's wombs years ago. Warm cave, tight squeeze into the light." They looked at each other awkwardly. Too much, I thought.

Our bare skin covered in mud and my dinged foot causing me to limp, we hiked back to the car, drove back through the jungle, arrived at the property and promptly jumped into the ocean. It was near dusk and as I floated on my back, the sun started to duck behind the high cliffs and the clouds glowed a dramatic pink. I could smell meats grilling back up at the shelter. This is it, I thought. This is the best. Who could ask for anything more? Floating in a warm coral reef, no one else on the beach, cliffs and clouds staring down at us. After another meal of grilled meats and rice the sun had set and we assembled on the beach for a bonfire. So many stars in the sky! Each shone more brightly than the next and it seemed I could make out individual stars in the dusty milkyway. The fire was lit and someone brought down a boom box and we listened to island ukulele music and a man singing with a soft voice. Kids piled onto their parents or aunties and snuggled in. The teenager cousins sat together on one towel and told stories to some of the younger ones. The adults talked about past camping trips to the beach or weddings, funerals, christenings. And although I wasn't apart of it, I don't know their stories, their history, I was there watching, listening, feeling the warmth of the fire. As the fire died down we piled back into the trucks and drove out to where our car was parked. My skin was warm from a day in the sun, my foot ached, and my belly was full. Annie and Ellen dropped me at my house and I showered and climbed into bed. Oh, and not a brown tree snake was seen...I was looking for them too,

Saturday in paradise.

2009-07-18T19:18:00.002+10:00

After a productive and encouraging first week at the office and in the birthing center, Ellen and Annie picked me up at 545AM on Saturday to run in a 5km race. I’m supposed to be in training for a half-marathon but the humidity has given me every excuse not to. We pinned our numbers to our shirts and I took off running as Ellen and Annie walked the route down a big hill from the hospital to Marine drive, around the block and back up the hill. It was quick; I ran it in about 35 minutes but boy was I sweaty! We ran past my house on the left and the beach on the right. The sun was just rising and the sky turned from grey to pink and palm trees rustled in a slight wind. Back at the hospital, volunteers greeted us with tshirts, cold water, and fresh fruit packs. I chatted with a couple of fellow runners who were nurses at the naval (ha ha that sounds like the belly button) hospital. One of them took my number, she’s a women’s health nurse practitioner and said she would call me about getting on an outrigger canoe team. I’ve never paddled before but it seems to be a popular sport here and I like being on the water so why not give it a try? Twenty minutes after I finished, Annie and Ellen made their way up the hill. They introduced me to Jacob, Lina’s nephew who also ran the race. He is about my age and everyone talks about him like he’s the sweetest and kindest guy on the island. We chatted a little bit and he invited me to go out with him and his sister that night. If nothing else it is a good opportunity to meet other peeps my age and see what the youngish folk of Guam do on a Saturday night.

Soaking in sweat, Annie, Ellen, and I went for a big breakfast at a diner near the beach. I had a stack of pancakes and a nice, strong cup of coffee. They dropped me at my house after and I promptly grabbed my book and jumped into the pool. I read in the pool for a while but went in before burning my still-pale skin. In the afternoon I ate my leftover soba noodles, watched tv and had a nap. Now, I sit on my new backyard furniture eating a salad of sliced avocado (picked from the garden of a nurse at the birthing center) and cherry tomatoes, I have a piece of multigrain bread that Ellen brought over smeared with goat cheese and a nice cold beer. The sun is setting to my left, down on the water. Geckos are serenading me with their little chirps and squeaks.

Moving day!

2009-07-17T20:20:00.001+10:00

The 15th of the month finally rolled around, the day I was able to move into my apartment. I was up early and giddy with excitement. While waiting for the furniture to be delivered, I bought towels and a bathmat at Ross. I spent $40I bough an iron, a hamper, all of those things at the world's biggest (and soon maybe only) Kmart. While there, one of the delivery trucks called to say they were on their way. I raced home and met them. They unloaded my bed, dresser, desk, bed table, and a chair. As I unpacked and assembled things from Kmart, my cell phone rang (still awaiting home phone and internet service). It was Ellen (Aka Dr. Bez). Ellen is Annie's (aka Dr Bordallo) partner and they live just down the street. "Hey Jess, do you need any help over there?" I told her I was fine, just putting things together and getting things put away. "Well, I think you're like me in that you'll just keep doing and doing until it is all done. How about I bring you some lunch?" I admitted that I'd worked my way through a stack of oreo cookeis but had little else to eat in the house. Fourty-fine minutes later, Ellen showed up with pizza, salad, and bags of groceries. She sat on the floor with me as I scarfed down the pizza and salad. Ellen was trained as an internal medicine physician but has migrated toward women's health and now spends half a day a week with us, Marianas Physician Group (aka MPG) and runs the rape crisis center. She left as the next batch of furniture arrived. Three big island men brought in and assembled my dining table, 6 chairs, my sofa, love seat, book case, coffee table, and end table. I've never owned furniture! It looks great in my place, I love each and every piece. As they assembled things, I washed my new plates, glasses, and tupperware. EVERYTHING must be kept in tupperware here or else it gets soggy or bugs. As they finished and left, I poked around with one of the faceplates on the wall that I hoped housed a cable jack. I took my screwdriver from the dollar store and unscrewed the plate from the wall. It was painted to the wall so I chisseled it off of the wall. Behind it, Voila! A cable hook-up hooked to something else with another wire coming out. At Hope Depot I explained the set-up to the guy and he sold me the requisite parts. When I got home I unscrewed this, unscrewed that, screwed this in and attached it to the second hand TV that Stephanie and Kaaren gave me and BAM! Cable TV! I've never had cable in my life so this is a big deal. I've already found CNN and Foodtv. Kaaren and Stephanie came over to check on me in the evening and I was so proud to show my place off. I am still in need an area rug or two, some baskets for storing things but for the most part, I'm all set.
This morning, Erin called at 530AM. In California it was late afternoon and she didn't calculate the time change. It was nice to talk to her and after our conversation I thought I'd get up. I was on call at 7AM, with Dr Bordallo so I figured I might as well start the day. First, I put in a load of laundry. All of the clothes I shipped have a dank smell so they are all going through the washing machine...and yes, I have a washer/dryer in my house! Even better is that I don't have to pay for water. After starting the wash, I put on my shorts and tennis shoes and ran down to the beach (across the street). Already, at 630AM it was muggy. There were a few other people on the beach, walking and jogging. I was only able to jog 5 minutes down the beach because then a river croses over the beach and although shallow, I didn't want to get my running shoes wet so I jogged back and fourth a couple of times. There were some chickens milling around on the beach too, out for their morning walk. After doing laps on the beach for 20 minutes, I was drenched in sweat. Damn humidity! I jogged home and changed out of my jogging clothes into my bathing suit, walked out the front door, and jumped into the pool. The water was warm but cool enough to be refreshing. I did a few laps, splashed around, cooled off and went back inside to shower and ready for the day. Thanks to Ellen, I had plenty of groceries to get me through the first few days. I listened to NPR as I made coffee in my single-cup French press. All Things Considered was on, live from Washington DC, the previous day. I folded laundry and put a few more things away. Then Ellen picked me up and brought me to work.
At the office, Dr Bordallo and I saw several patients. Some of them I had seen with her earlier in the week so I feel like I'm getting to know them. We admitted two patients to the birthing center in labor. At lunch time, Dr B drove me up the street to a sporting goods store where I bought a mountain bike, a helmet, and a pedometer. I rode my bike back to work and sat down to eat the left over pizza and salad that Ellen brought over the night before. Anna, our clinic manager came in while i ate and chatted with me. Then, she brought me a small plate with noodles, meat, and cabbage. These people eat. A lot. When I mentioned being anxious at the approaching typhoon season she said "We all like it because after the typhoons, when no one has electricity, we get together and barbeque at someone's house. It's like nature madates a cook-out." Indeed.
While sitting and writing this, a nurse from the birthing center came and asked me if I could come look at something with her. Dr B ran to the hospital to do rounds on patients there and I'm the only provider "in house". I evaluated a patient. Checked our other patient and waited for Dr B to come back to the office to see our patients in the afternoon. You know what? It felt right. I was right back in the midwifery groove. It felt so natural to go in, talk with the patient, their family, the nurse. It was great. Both patients gave birth later in the afternoon. Since I am still waiting on my license, Dr B caught the babies and it was so good for me to watch how things work in the birthing center. It isn't much different from anywhere else, really. One thing that is different is the expectation of providers and labor support. I know that most midwives don't do hours of labor support for all of their patients, that was the expectation as a student: we were with her from the time she walked in until the baby was out and everyone was happy. I know that MDs aren't trained that way but building the relationship is nice. Here, that is tough for a couple of reasons. First, we are very busy. Our practice has 60-70 births a month and so full labor support is not physically possible. Second, most patients do most of their laboring at home and come in an hour or so before giving birth. Third, we are in clinic (attached to the birthing center) sometimes the same days we are on call so we can't be back with patients for hours because then our clinic patients back up and wait. In the event of a delivery, our next batch of patients are rescheduled but we can't take the day off of clinic because someone is in labor because someone is ALWAYS in labor. Finally, most women are accompanied in labor by mothers or sisters who are known to them and support them. Epidurals are not offered so it is not like lack of labor support is to be blamed for epidural anesthesia. Patients are supported by family members and our trained birth assistants and nurses. They don't have the choice of an epidural so, in general, their labors go along normally and we are called when the baby is on it's way out. I hope that initially I can do some of my own labor checks and if I'm not in clinic, or if a patient is lacking support, I'll do intensive labor support. Otherwise, they have their family members with them, the birthing assistants get them up and out of bed, on to a birth ball, in the tub, etc.
Later in the day we had two births. We finished seeing patients in the office and I rode my bike home. It is a short bike ride but in the intense heat I managed to work up a sweat. When I arrived home I put on my bathing suit and jumped in the pool for the second time that day. I floated on my back and looked up at the blue sky, dotted with clouds. Ah, life is nice.

Socializing and socialization.

2009-07-11T22:29:00.006+10:00

What a busy few days I've had. Thus far, I've spent my days arising early and having breakfast with Stephanie and Kaaren. One morning, around 830 I decided to go for a run but came back after just 15 minutes, drenched in sweat and dismayed at the lack of sidewalks.

I've been driving around in the little black sports car, going to the police station for court clearance, checking out furniture at this place and that. I checked out the local Home Depot and Kmart but have decided to buy most of my stuff at local shops. I finally found an apartment and it will be ready to move in on Wednesday. It is a two bedroom unit in a building with 8 condos. It is around the corner from work, across the street from the beach, and a stone's throw from a grocery store. There is a swimming pool and my unit has a front balcony and a back patio area where I plan to grow tomatoes and herbs in containers. After signing the lease, I drove past the building around 6pm and decided to park and walk around. There is a big resort right across the street so finding access to the beach was challenging but I learned I could walk right through the lobby of the resort to their pool area and beach. I walked along the sand, looking at the rocky cliffs on one side, a small island out in front and big hotels to the other side. There was an Indian guy running on the hard sand, I guess I'll do the same. Little fish and crabs scurried around in the shallow warm water.

Today, Kaaren and Stephanie took me to many furniture stores and I finally purchased several items at one store and bargained with the sales man to have them assembled and delivered free of charge. I bought a living room set (sofa, love seat, chair, coffee table, end table), a kitchen table and chairs, and a big book case. While we shopped for pieces, rain poured outside like buckets and buckets of water dumped from the sky. As the rain abated, we drove up to the boonies where folks from some of the other nearby islands live (Yap, Chuk, Palau). The local newspaper, The Pacific Daily News, advertised a micronesian cultural fair up there. We drove and drove (here, if you drive for more than 15 mins, you're on a long trip). Because roads know by their names here, you just look for landmarks like schools and stores. Even for businesses advertised in the paper they say things like, "In Tamuning, next to Cost-u-less). The gravel road ended at a covered tent area. We parked the car and walked over in the mud. A group of women made mwanmwar (flower crowns from Yap). Kids had coconut rolling races. Men in the corner pounded steamed breadfruit and made it into little balls of glutenous stuff that was served with coconut milk. The coconut milk was made from shredded coconut wadded up in a ball inside a cloth that was dipped in water and squeezed out. People sold mangoes, starfruit, sweet corn, and beechnuts which they mix with lime juice and chew for a high. As the next low clouds moved in, we decided to leave the valley so as not to risk being trapped in the mud.

Back at the house, we showered and readied for the first birthday celebration of the child of one of the pediatricians. Celebrations in general are a big thing here: weddings, funerals, christenings, and first birthdays. Kaaren and Stephanie were invited to the event, held at the Sheraton hotel and thought to bring me so I could meet other providers, staff, and community members. We arrived at the hotel and were directed toward an 8-foot tall ballon sculpture of dolphins and fish. We signed the guest book and entered the ballroom where hundreds of people sat at large tables, sipping iced tea and chatting. As we entered, the prayer began. Lina, the office manager from the birthing center came up and greeted us and introduced me to several members of her table who also work at the birthing center. Diane, the other midwife came to greet me for the first time. Diane is tall, thin, and blonde. She and her husband, Sam moved her 3 years ago with their four children, who were with them at the party. Back at the table Sam told me what veggies and plants I can grow here and offered to give me clippings and fresh keffir lime leaves from his garden. Sam works as an archeologist although he's not currently working and volunteered to go to local plant stands and pick out native species that are naturally resistant to beasties and mildew here. We walked through the buffet line and piled our plates high with raw tuna and salmon, soy sauce, wasabi, glass noodles, beef ribs, and sesame chicken. Back at the table, Dr Annie Bordallo, the medical director of the practice, and her partner, also a physician, Ellen came to greet me. My first impression of Annie is that she is great. She seems really easy going, friendly, and approachable. She reminded me of some of my friends from midwifery school, not my medical director. When she found out that my condo was ready for move-in on wednesday she not only told me to take the day off but offered up her SUV for me to use to get the basic necessities. When Ellen and I were talking about my move, she said that she and Annie had relatives that worked for the power company so they would call to make sure my power was turned on. Ellen offered up an old cell phone that I could get service on and use. They live across the street, in fact, next to the resort. They've already set a date to have a "Welcome Jessica" party at their house. They've got a list of possible friends for me, Annie's nephew is my age and likes to jog. Her niece likes to go dancing.

I met several pediatricians and their families; they made sure I felt really welcome. I woke up at 430 this morning, still a big jetlagged and while lying there in bed, I had that feeling like you do the day after christmas when you remember all the stuff you got. I remembered that I'm here and what a wonderful community of people I will soon become a part of.

Day one

2009-07-08T17:55:00.000+10:00

I looked out the window as we approached Guam and saw an island full of green, all different shades of green: blue green water, deep green jungle, mossy green cliffs. I collected my bags from baggage claim and met Lina, the business manager from the birth center. She hugged me and we pushed my luggage cart to the car. When we exited the airport the heavy, humid air fogged up my glasses and, although it was raining and relatively cool, the humidity made me sweat. We chatted about my trip and drove to Lone Star Steakhouse where Stephanie and Kaaren, a midwife and physician from the birth center , “Sagua”, (the birth center is called Sagua Managu) met us. I wasn’t very hungry because I was more jetlagged than anything. I felt dizzy as we were seated in a booth. I ordered a salad and we all began chatting away. It was immediately apparent to me that the practice that hired me was organized and beloved in the community. Various waitresses and customers came up to say hello to Stephanie and Kaaren. And they, along with Lina seemed so happy to see me and to have me joining the practice. They told me about our monthly meetings at the Hilton, the upcoming ninth anniversary of the birth center, and various other occasions when the providers get together to socialize. As we finished our meal, loud country music began to play overhead. The servers marched out to various places between the tables and booths and began to line dance to the music. They were dancing in sync, all of these beautiful young Chamorro people. We clapped as the song ended and they returned to work.

I awoke the next morning at 7:00AM. I was staying at Kaaren and Stephanie’s beautiful 3-story townhome in Tamuning. I took benedryl the night before to sleep me through the night in and effort to minimize jetlag. Kaaren and Stephanie both said I would awake at 4:00AM, which I did, but I went to the bathroom and slept until 7:00. Opened the shades to my room to see roofs, palm trees, and off in the distance, the Pacific ocean. Downstairs, Kaaren and Stephanie made coffee and prepared to leave for their 730 OB department meeting at the hospital. Kaaren urged me to come, “The other doctors are excited to meet you,” but Stephanie assured me that I could stay at their home, write emails, and make phone calls, which I did.

I called a real estate agent, Sean, who is also the husband of a nurse at Sagua. He picked me up and we went to his office to look through a database of available apartments. There were several in the $750-$850 price range and I told him I’d like to start there. Well, they were all crappy. One was really quite nice but across the street from the Bates Motel with strange people living in a run down building. The giant gate around the building probably kept tenants safe enough but I wanted to go running, and not just around the parking lot. He told me to sleep on it and to call him in the morning. I called my parents and they told me to up the ante on the price. “Jess, you’re not a student anymore. You’re a professional and you should live like one, not in squalor!” said my mother. “Now, as your parent, I am most concerned about your safety,” said my dad. I agreed to call Sean in the morning and ask to see places in the next price bracket.

Feeling defeated, I decided to go to the police station to get my background check needed for my professional license. One of the physicians from the hospital had offered her car to me until mine arrived. Stephanie and Kaaren told me it was parked in the visitor spot at their complex. I took the keys to the car and house and went to the parking lot. The only car in the visitor spot was a tiny black two-seater convertible. There must be a mistake, I thought. But sure enough the key on the key ring opened the door and I climbed.

Sean drew me a map to the police station and I set off down the street. I particularly confident rooster played chicken with my car (no pun intended) and stared me down in the middle of the road. I steered around him and drove down Marine Shore Drive. A beautiful expanse of blue-green ocean appeared on my right. People were snorkeling and swimming under the cloudy sky. I found my way to the police headquarters and easily obtained the necessary documents. I was the only white person, or howlie as they call us here, at the station but people didn’t seem to make a fuss of it. I mean, obviously they weren’t pointing and staring but generally as I went about my days activities I felt normal. Unlike the reaction from folks in West Africa who acted as if I had an elephant attached to my backside. From the police station, I attempted to go a couple of towns over to the medical licensing office but became lost and decided to go to Sagua Managu instead.

I pulled up to the birth center in my hot little sports car. From the outside it looks like a nice, new-ish building, unlike many others around town. I walked in and introduced myself to the receptionist and asked if Lina was in. We walked past the birth center shop that sells breastfeeding supplies, baby supplies, snacks, and all kinds of cute jewelry, diaper bags and baby paraphernalia. Lina gave me a tour of the center and it was so beautiful I almost started crying, really. The rooms are large to accommodate families. The décor is beautiful and tasteful. It was designed by an architect friend of Dr. Annie Bordallo’s, the medical director of the practice. Lina showed me the provider office and my desk. My very own desk and bulletin board! Stephanie and Kaaren were there seeing patients. The exam rooms are beautiful, the birth rooms are beautiful, the waiting room is beautiful, the whole place is superb. The staff were excited to meet me, as I was to meet them. Lina said that the group has just taken on breastfeeding as their next challenge and offer a breastfeeding support group and now have a full time lactation consultant. There was a picture on the wall of the providers holding a ton of babies. An attached article explains that the group was named the number one OB/GYN practice on the island. “Oh, we’ll have to get a new picture with you in it too. But maybe this time we won’t use the babies, they kept crying. We had to work really hard for that picture,” Lina said.

From Sagua Managu, Lina pointed me in the right direction to the medical licensing office. A map is of little use here as people use landmarks rather than street names. “Behind the KFC, past Chili’s” is where the office was. I found my way there and took care of business with a new energy and enthusiasm, after seeing the birth center. As I drove back toward Kaaren and Stephanie’s I pulled off the road at the bay I passed on my way into town that day. I parked and walked down along the beach. I removed my sandals and put my feet in the warm water. Little fish scurried around, tiny crabs buried themselves under the sand. Kids played in the water. A couple of guys sitting on the wall watched me, trying to figure out this barefoot howlie driving a crazy convertible car. I looked across the blue-green bay and smiled. Here I am. This is home now.

The Eagle Has Landed

2009-07-08T16:00:00.000+10:00

Getting to Guam requires a degree of determination not possessed by most Americans, so very few have visited. Situated just three hours from Japan, Guam is a tiny island in the middle of the Pacific ocean. Thirty-three miles long by eight miles wide, I had no idea what I signed up for as I boarded the plane at 530AM in Washinton DC. The flight from D.C. to Houston was spent sleeping. From Houston to Honolulu I rotated sleeping with eating, watching TV, and reading. Periodically, I peeked out the window and saw the Mexican desert, then lush mountain highlands, beaches, and then nothing but the blue ocean and white clouds for a very long time. Just as I had dosed off the plane seemed to jerk in one direction, then the other. People began to panic, I gripped the leg of the woman next to me as the plane seemed to plunge out of the sky, through the clouds, toward the ocean. I tried to think of something to bring me peace as we fell but all that came to mind were spiritual songs, hymns that I seemed to be making up in my mind. As I considered calling my mom on my cell phone and saying goodbye, I jerked awake, drenched in sweat, teeth clenched while my fellow passengers snored and read.

After seeing nothing but blue and white for hours, the tiny Hawaiian islands were a welcome sight. I deplaned, walked around the airport a little bit, watched the tourists buy leis and Dole pineapples, and finally decided to get something to eat prior to the next seven and a half hour leg of the journey. I settled on a scoop of mashed potatoes with gravy and a scoop of peas from a cafeteria-type place. I sat at the gate, text messaged my friends and family, and took a good look at the one hundred or so passengers who were also going to Guam that afternoon. Who goes to Guam? Obviously not young white ladies traveling alone, I was the only one of them. There were several people of Asian descent, a few military folk, some Hawaiian or Chamorro families (Chamorro referring to the indigenous people of Guam), and then there was a strange preponderance of middle-aged white men in jeans and polo shirts, potbellies showing through like an expectant mother’s belly.

I boarded the large aircraft and took my window seat next to a slim young boy, who promptly took out a book and began reading. His dad and 2-year-old sister were seated across the isle and the boy next to me had the instincts of a mother as he anticipated her every need before she shrieked out. Water, candy, books, etc. When our lunch trays came, I told him that his looked great, he had a children’s tray complete with lots of snacks. “Do you want some? I’ll never eat all these,” he said. I assured him that my tray was enough for me and asked him if he lived in Guam. He did and then we talked all about what I should know. Mosquitoes are bad in the jungle (ie: a lot of them), you never see snakes, but they are there, you might see a cockroach in your back yard but as long as you don’t leave food out for “a year” they won’t be in the house, in addition to the world’s biggest Kmart, Guam now has a Home Depot, the flea market is open on Saturdays, don’t hang out with “gangsters”, and both of his siblings were born at the birth center I was going to work at. “Oh, my family loves it there,” he said, “Everyone is so nice, it is really great.”

“Ladies and gentlemen,” the captain announced mid-flight, “it is now tomorrow. We have crossed the international date line.” The whole concept of the international date line didn’t make much sense to me so I asked Corey. Corey said it was cool because if you traveled really fast around the world and continually crossed the line, then you could travel back in time. Unfortunately, there are no commercial planes that travel fast. We took out the map in the back of the airline magazine and calculated the 16 hour time change between South Dakota and Guam.

Soon, his little sister came wandering over to our row of seats, she sat on my lap and looked out the window at the clouds. It felt so good to have this little person, arm around me, grasping the reality that we are in the sky above the clouds and ocean. At one point, she gave the cracker in her hand to her brother and vigorously wrapped both of her arms around me in a big hug. She climbed over us, pushed buttons on the remote controls for our TV sets, drank water and issues a strong “Ahhhhh” after each sip. While I was up to the bathroom, her dad met me in the isle, led by the little princess. We started chatting and by the end of our conversation he had given me his business card and offered to drive me to see apartments the next week. Based on my sample of three, Guam is going to be great.

The adventure continues

2009-04-17T00:44:00.001+10:00

I've accepted a position at a birth center in Tamuning Guam. I will move there in early July. Stay tuned for details...

Fotos por amigos en La Romana.

2008-08-20T06:24:00.003+10:00

These photos have been added for my friends in the DR.

Predeparture musings

2008-08-11T03:24:00.002+10:00

August 6, 2008
Here I am, wrapping up the Dominican Republic chapter in my life. At this point, after spending great amounts of time and money to get here, to do this project, to discover this place, it would not be unwise to evaluate what I have learned and reflect on my time here.

First, I slightly lament my relationship with the host organization. The distance that I feel is in large part my doing but I can’t help but feel that the people there do not understand me, my mission, and my goals. They are used to tourists that come for a couple of weeks and suck up everything that GS has to offer, without asking questions. I was very different. I don’t think they were able to understand me and put me in a box. Living on my own, getting around on my own, living here, not just visiting. The constant coming and going of volunteers, students, and professionals was also difficult for me. It seems that as soon as I made friends, they packed up and left. Retrospectively, a homestay would have been great for a couple of weeks: Spanish immersion, a family to care for me, etc.

Academically I have realized a dream of mine that I didn’t know would be such a source of pride and accomplishment for me. Learning of this country, the Haitians here, the phenomenon of pica, the hematology, and then coming here and putting it all together has been truly magical. This is something I dreamt up and did. I created this and nurtured it along. This is my baby.

On the topic of personal growth…Ah, this process is never over. Despite massive pressure from the translators, I held my ground and gained self respect in return. Even with friends though, I still palpated that familiar loneliness below the surface. I felt unsettled. I made some big decisions: seduce a rich French businessman, when that fails, move to Portland, OR to be in a new kind of community, closer to family, closer to “settled”. There are a few things that tagged onto my soul here that I’ll carry with me in my soul’s suitcase forever. I’ll forever remember Brian’s grasp of my hand as we’re spinning away from each other, in opposite directions in a fast merenge. After at turn we are moving, with considerable momentum in opposite directions. My hand glides from his back, across his side, across his stomach and as I’m moving further and further away on the verge of being out of reach, he graps my hand and pulls me back into orbit. I’ll forever remember the fast turns, eyes closed, music filling my ears and chest. I’ll also remember feeling the mist of a waterfall in a rocky canyon, breathless.

And then there are the faces, those who adhere to my soul like sticky mango fibers in my teeth. Little Miss of four years in a leopard print skirt and rat bites on your knees and feet. Sad young soul of 16 with your tiny baby of 6 months, not knowing how, or maybe not wanting to feed her. I can feel her floppy head in my lap, her skinny arms flailing about like a bug stuck on its back. You, who carried your grandfather on your back, hoping for medicine, something to make him strong and full again while he slouches in a chair between this world and whatever comes next.

Sweet creamy papaya shakes, the smell of the sugarcane fields, the feeling of a hundred eyes watching me, trying to figure me out. These things are part of me now. I wil carry them, I will share your stories, I will dream about them on hot summer nights. From now until the day I die, at the sound of a fast merenge or a sweet bachata my hips will move to the rhythm that you taught me and those movements will bring me back to you.

Escape to the mountains.

2008-08-05T02:56:00.004+10:00

While in Santo Domingo, I picked up a book at the Peace Corps office called Trail of Crumbs. In it, a young Korean American woman tells of her (real) life as a lover to a rich French businessman. The book recounts romantic evenings from their pied-a-terre in Paris to extravagant meals prepared in their Provence home. I tore through the book, at record speed savoring, salivating, and growing green with envy. I read the entire time on the bus from Santo Domingo to Jarabacoa until Brian and Michael phoned me to tell me that they were very near where my bus had just stopped and that I should get off and wait for them there, rather than continue to our meeting point high in the misty mountain village of Jarabacoa. I grabbed my backpack and Chinese communist messenger bag, a gift from my sister, and stepped off the bus. I didn’t know where I was, I just knew it was a town called Vega and that the boys would be there in 30-45 minutes to pick me up. I sat on a bench outside a dumpy colmado, or beer stand, and was sucked bay into the world of the book: weekends in Venice, pate de foie gras, and lavender. That was supposed to be my life! And here I was, on a bench, outside of some dumpy bar and the side of the road in some dumpy town in the Dominican Republic. Loud bachata music played above, and I would occasionally look up from my book to swat at bugs and scratch the many mosquito bites on my legs with my long Dominican fingernails. During one of these moments a drunk man, sitting outside the colmado on a plastic chair, asked me if I’d like a beer. When I smiled and said, “No, gracias” he persisted, “Una pequena, una pequena”, a little one, a little one. “Por que no,” I said. I didn’t know how long Brian and Michael would be so I acquiesced. As he got me a cold Presidente Light, a couple of other old guys sitting at the colmado started chitchatting with me. Although I wasn’t in the mood to talk, out of politeness, I did. Not knowing why I was just sitting at the colmado reading, one of them offered me a ride. I told them I was waiting for someone and the boys drove up shortly thereafter. I took my beer and bags and piled into Michael’s 4 wheel drive Honda Civic.

As night fell, we drove up windy mountain roads to our backwoods hotel. The next morning, we opened our balcony and the morning light revealed a tropical paradise. A rushing river cut across the property, a high, narrow bridge lead across the river to a gazebo where we enjoyed icy cuba libres at night, a blue swimming pool with a fountain gurgled across the estate. We made or way to the outdoor restaurant for breakfast and seated ourselves at a table overlooking the river. Steaming cups of locally grown coffee, creamy hot chocolate with cinnamon, piles of mashed plantains, creamy eggs, cheese chunks in basil butter, and sausage were placed in front of us. As we ate, we absorbed the clean, cool mountain air, so different from the muggy, bustling, loud streets in La Romana.

Jarabacoa is known for its waterfalls; we set out to see a couple of them our first day. The most impressive is called Salto Jarabacoa Uno. To get there, we followed rough dirt roads through small mountain villages, past shacks, colmados, banana gardens, and families atop horses. As we wound further up the mountain, the misty clouds turned to rain but we decided to persist and hike to the falls anyway. The trailhead is marked by a hut that explains the ecotourism project that resulted in a nice, but steep, trail to the falls. In the misty rain, we began the hike down into the dense forest. The canopy from the trees provided shelter from the rain and eventually the rain let up altogether. There were no other hikers on the trail or at the falls. When we arrived at the falls, we were speechless in wonderment as we admired the 60 meter waterfall, giant boulders, and steep rock cliffs that dwarfed us. After exploring the area individually, (we each took off in a different direction, as if the enormity and the beauty was such that we had to absorb it as individuals) we reconvened at the base of the falls. The air was cool and damp and the water, icy. As if in an effort to fully give ourselves to this beautiful place, we stripped off our hiking clothes and dove into the frigid pool at the base of the falls. The sound of the water falling next to us filled my chest, the spray from the falls obscured my view. The water was cold and dulce (dulce means sweet but it is used to describe freshwater), unlike the warm salty water from the beaches in La Romana. While Brian and Michael continued to absorb the force of the falls, I climbed out of the water and atop a giant black boulder, slightly warmed by the sun. The boys eventually came over and the three of us laid atop the rock panting, cold but not cold, tired but filled with energy, but all very hungry. We changed back into our clothes and made the very steep climb back to the trailhead. My calves and thighs burned the entire time but our hunger propelled us to the top.

Back in Jarabacoa, we stopped at a food stand on the side of the street and ordered cold Presidente beer and patacon. None of us had ever heard of patacon but it was the specialty at this particular food stand so we ordered 3 of them and waited in plastic lawn chairs, in silence, as if we were still absorbing our day. Within minutes, three plates were brought to us with the tastiest creation I’ve ever sampled. What is patacon? Two 7 inch cakes of salty mashed plantains are pounded thin and fried until crispy. Sandwiched between them is stewed chicken, beef, and pork, onions, melted cheese, tomato, lettuce, ketchup and mayonnaise. We ooed and ahhed with each bite, and continued to marvel at the flavor and texture of patacon the throughout the trip, as we ate them every day were there. That evening, the boys went out with a friend of Michael’s but I stayed back at the hotel to read my book on the balcony, listen to the river, and go to bed early for we had big plans in the morning.

We pulled up to Rancho Biguate around 930AM the following day. A big Dominican breakfast was served and we met with our guides who would take us white water rafting. In the changing room, French women, Dominicans, Austrians, and I changed into damp wetsuits, life jackets, and helmets. Everyone piled into the back of a truck, lined with benches. Our guide spread his arms to hang on to the railings above and his shirtless body was chiseled like a sculpture. A defined 8 pack was cut onto his abdomen, his obliques drew a perfect line from the abs to his pelvic bones. His arms were ripped, huge, and with each muscle perfectly defined. Everyone, EVERYONE on our truck looked at him in amazement. I imagined him injecting steroids, he kind of reminded me of a piece of livestock, like a giant cow or something, so big and strong. I feel the same way about the big muscular guys at my gym in the US. They're like big sauntering creatures. After our rafting training, we pulled our raft into the water. Our raftmates were a group of students from Austria and the ripped muscle man, Wilson, who was our guide. He shouted commands in English to see if our training was effective. “Forward! Back! Right! Left! Everybody down!” I was terrified as we approached the first series of rapids. I held on to the rope, my fingernails digging into my palm. Strong waves of cold water rushed into our raft. In summary, I was terrified the entire time. Brian fell off the raft at one point and was pushed against a rock amid some rapids. He was pulled back in immediately. Michael almost fell off as we were stuck on a rock and all moved to one side of the raft and bounced up and down to get unstuck. And Wilson! Oh Wilson! He does not use steroids, in fact, he had to work so hard, steering us, propelling the raft when we failed to do so in unison. Unfortunately, he was in the back of the raft so we were not able to watch his sculpted body in action. At a half way point, all of the boats pulled off to the side of the river, people jumped in to the cold water to swim in their wetsuits. Wilson and a couple other guides scaled the cliffs of the canyon and did back flips into the river. The rafters were given small ham and cheese sandwiches and fresh orange juice to replenish our shaking adrenaline-filled bodies. The second half of the rafting expedition was a little less terrifying than the first but I was relieved when we reached the end. Back at Rancho Biguate we were served a lunch of beans, rice, stewed beef with onions, stewed chicken, and fried cornbread. As we gobbled down the lunch, a video of the rafting trip, filmed by one of the guides, was played on a screen in the outdoor lunch hall. Bellies full, bodies tired, we drove back to the hotel and napped.

Early in the evening, we headed back into town to meet up with two friends I know from the Peace Corps. We shared beers at an outdoor resto and made plans to go to a merenge concert later in the evening. The concert was held at an outdoor venue far up in the mountains. In fact, we parked the car and walked on a thin rope bridge to the other side of the river: Ben and Claudette (PCVs), Michael and his friend Julie, Brian and me. A perfect balance of gender for all of the dancing to come. A well known merenge band played loud peppy music and couples danced on a dance floor in the middle of the club. Watching them, I try to figure out how I can perfectly emulate the Dominican hips when dancing merenge. Granted, most of the women have larger hips than I but there is something else, a certain ambivalence. It is as if while taking the next step, the hips continue to sway in the opposite way, waiting until the last possible moment to reluctantly move the other way. I study this and try in vain to do exactly the same as Brian and I take to the floor, spinning in the cramped space trying not to bump other couples. There is something enchanting in dance that amazes me with each new dance I learn. With merenge, there is a moment where, after the partner turns and lets go of my hand, we are moving, with considerable momentum in opposite directions. My hand glides from his back, across his side, across his stomach and as I’m moving further and further away on the verge of being out of reach, he graps my hand and pulls me back into orbit. As we bop up and down to the loud beats my calves burn from the hikes and rafting. At half time, the band takes a break and I am so happy to dance a slower, comfortable bachata. Although they are brothers and look incredibly alike, Brian and Michael dance completely differently. They are both very good but lead their partners with different strength, in different ways, using different turns. We dance until 3:00AM and fall into our beds around 4AM.

The next morning is Sunday, the day we have to head back to La Romana and resume our regular lives. After packing up we drive 30 minutes down the road and stop for lunch at a roadside resto. The resto is located outside with thatched palm over a tin roof. As we order our food, mangoes come crashing down on the roof from the trees above. It sounds like boulders, not fruit. A sleepy cat wanders around and chooses a sunny spot next to our table for her nap. I am hungry and grumpy but both of those are remedied when a steaming plate of smoked pork ribs is placed in front of me. I also ordered a dish of sweet mashed plantains with ham and cheese in between the layers. Brian got pigeon peas with rice and stewed goat. Michael ate plantains like mine and helped me with the ribs. The skin on the ribs was crispy, the meat was smoky and salty, the sweet mashed plantains were the perfect contrast to the salty meat. We reluctantly paid our bill and left, wanting to reach home before dark. We were quiet as the steep mountain cliffs were left behind and the urban landscape of Santo Domingo greeted us. From there, we turned east back to La Romana. I continued to read my book in the car, sometimes speaking to the boys in French instead of Spanish accidentally, so immersed in the world of Paris and Provence. We pulled up to our apartment, Michael turned off the ignition and we all just sat there. “Maybe if we just stay in the car it won’t be over” he said. Brian pinched me, as if to wake me from a dream. We sauntered into the apartment. Brian started doing laundry, I peered into the empty refrigerator. I wanted to be back there in the mountains. Then I realized that while I was pining after the life of this random mistress to a rich French man in my book, I had a pretty cool life too. I ate interesting delicious food. I saw stunning beauty and sheer force in a waterfall. I danced merengue in a bar over a river in the mountains until the early morning. I shared this with two handsome, nice, and caring boys that look after me like a sister. Unless I write about it, I’ll never know it.

Hiss!

2008-07-30T03:11:00.000+10:00

As I sit on the couch, sweating in my underwear and chacos, absorbing DEET through every pore, it is with some degree of ambivalence that I announce that I somewhat unsconsciously adopted 2 Dominicanisms today: the wrist nod and the hiss. The first of these, the wrist nod is how Dominicans flag a ride (moto or taxi). For whatever reason, it is incredibly uncool to wave your arms in the air, however slightly, to signal to a moto or public car that you too would like to ride. Sometimes, people do little more than raise their eyebrows to signal to a public car that they want a ride. Today, when leaving the hospital, I stood on the roadside, spotted a beat up car with the letter B on it. He flashed his lights to signal that he had room and I ever-so-slightly pointed my index finger and made an almost imperceptible nod of the wrist to signal that I wanted a ride. When he pulled over, I felt cool, much more cool that after waving my arms in the air to flag a ride. The car I got was actually full so I had to share the front seat with an older gentleman and after he descended, I had the seat to myself.

After the car dropped me where I indicated, I went to my favorite fruit guy and bought some tomatoes, bananas, and a papaya (which, he looked at, told me it wasn’t a good one, and instructed one of his workers to get me a good one). On the way home, I was thinking about what to do with the tomatoes and I decided that I’d like an avocado to eat with my juicy ripe tomatoes. There is a guy that sells avocados, mangos, and coconut water a block from my house so I made a point to stop there on my way home. As I approached his little stand, I noticed that he had just crossed to the shady side of the street to sit in his chair and have a popsicle with his friend. That is when it happened, the hiss. Dominicans hiss at each other to signal a variety of things, mostly to get someone’s attention. I get hissed at all the time by people wanting to give me a ride, sell me a popsicle, and just to get my attention. While I was originally repulsed by constant SSSSSSing, I’ve realized that it is a very effective way to get ones attention. So, as avocado man was sitting eating a popsicle across the street, I looked his way and let out a short, sharp, hiss. He came running across the street and selected an avocado that is perfectly ripe to eat today.

I am in love.

2008-07-29T03:18:00.003+10:00

It’s only been a couple of weeks and we’ve only seen each other a couple of times but I am head-over-heels in love…with Jonas’ 3 year old niece, Laura. The last time I saw her, she had little stitches in her forehead from a recent fall. Today, Jonas and I went back to the batey where his family lives and she stole my heart. Laura climbed right into my lap, like she did last time except today, she wouldn’t let Jonas hold her, she cried when we would leave the house and when we took her with us, she insisted I carry her. She dances a sweet bachata, she eats well, she’s quiet and sweet, and I want to take her with me. She laughed hysterically as I petted and talked to their pig. She played “kitchen” with an empty sardine can and an avocado seed.

Her situation is not unlike other kids in the batey. Her mother, Jonas’ sister, is young and lives in Haiti with her other child. Unable to care for both children, Laura was sent to the Dominican Republic where Jonas’ mom and stepdad look after her. Jonas visits on Sundays but the situation is far from ideal. She is loved dearly though. I gave her a pack of chocolate chip cookies and she gobbled down the whole bag, we have a lot in common. It is probably a frequent occurrence that visitors adopt a favorite kid so I’m not claiming to be the first person to fall in love with a child like Laura. Like them, I can’t help but think about the increased possibilities that she could have in the United States: a school, toys, games, play, etc. Kids here don’t imagine in the same way that American kids do. A Peace Corps volunteer is hosting a camp for kids after realizing that if given a crayon and paper and asked to draw their house, or their family, they just sit there, puzzled. If asked to act out a scene from a story or tell a story of their own, they cannot. Since most adults in the bateys are illiterate, reading books and telling stories is not yet a part of their culture. I really hope that this all doesn’t seem incredibly ethnocentric. “Play” and “imagination” are not valued or encouraged here. As a result (this may be a big jump) many people lack critical thinking skills. This is evidenced when working with health promoters in the bateys who, after multiple training sessions of various sorts, still cannot take a blood pressure. Digital BP cuffs were sent and when they batteries ran out, they sat idle. This matters because the health promoters are to do family planning counseling with women in the bateys and that requires basic critical thinking skills like determining if a woman is a candidate for the pill and if not, what other options might work for her.

And little Laura was the first kid I’ve seen actually play “pretend”. She stirred her little sardine can, she walked a leaf on a leash (a piece of string) around the batey. She is absolutely lovely and, as Jonas jammed out (annoyingly so) to Bob Marley on my ipod on the way back La Romana, I just kept thinking about Laura. I tried to imagine her life. Jonas hopes to get her into a school in a nearby town. I don’t know how she would get there. In the end, she will likely follow in the footsteps of her predecessors. 3 hours of grade school for a few years and, as long as infectious disease doesn’t affect her, she’ll likely have children in 12-15 years. If Jonas stays close by, she may have more of a chance to study beyond grade school. It breaks his heart that after his sister became pregnant, she stopped going to school, married, has another child, and now sells trinkets on the streets in Haiti. She would be so happy to know that her beautiful daughter's light shines so brightly in the dim batey.

Photos from life.

2008-07-26T02:21:00.002+10:00

Here are a few pictures from my life here:

Above is a group of people who prepare meals at the river where my friend, Jonas, and I spent our day a couple of Sundays ago. We bought fried plantians, fried bread and some fried dough with dried fish and vegetables in it. To the right, is my "office' in the bateys. I sit on the upsidedown carton, my translator and study participants sit in the chairs. This day, I had my study supplies lined up on the ledge and I keep medications (iron and vitamins) in little bags on the floor. All of my consent forms are in the backpack. The picture below is the pharmacy in the mobile clinic. This day, it was staffed by nursing students from California.

What did you do today? Well…

2008-07-26T01:42:00.002+10:00

First, I took the Ruta B to the hospital. Here in the DR, in lieu of public busses they have a system of old beat up cars that have a letter on them that indicates their route. They’re cheap too, 13 pesos (about 0.30$). I get my route, B, a block over from the apartment. I just look for a beat up car with a B on it and flag it down. They are small cars but there is always room for one more. At the hospital, I met up with Tara, a nurse practitioner from Kansas City. We climbed into the truck and our driver, Orlando, took us out to the batey. The batey we headed to is in rough shape. The sugar cane company Central Romana consolidated 3 bateys into one mega-batey, so they could plant cane on the land that the other bateys previously occupied. The resulting megabatey is a disaster. Now, for example, it is not cane cutting season so people have no work, no money, and no food. The result is a desperate situation. (Just this week a man stabbed his wife to death, leaving their 5 children motherless and the following night a man's throat was slit with a machete, a machete used to cut cane.)We meet up with the family that Tara works with. Today, we are to take two of their children and the mother to Santo Domingo for health visits. The older of the two, Joanna is 6 years old and was born with a myelomeningeocele. In other words, part of her spinal cord was protruding from her back when she was born. Surgery effectively treated her condition. She can run, walk, and is just like a normal kid except that she experiences some neuropathic deficit to her legs, as in she doesn’t feel pain in her feet. Her feet are also slightly malformed which makes it hard to find shoes for her. So Joanna stepped on a nail or something a while back, didn’t feel it and developed a majorly infected ulcer on her foot. As a last resort prior to amputating her foot, Tara was called to intervene. She works with diabetics and neuropathic wounds in the US. 2 weeks ago, Joanna was taken to Santo Domingo to Foundation CARE. Along with this, Tara is trying to make sure Joanna gets good nutrition at home to help her body heal. In order to do this, she was taking food to the whole family. Although this is necessary, it creates a conflict in the batey because one family is getting helped and the rest aren’t and don’t understand why.

While Tara was at their house changing the dressing and tending to Joanna’s wound, she realized that her 4 year old brother, Enurie, had this giant head. Long story short, he has hydrocephaly and we took him for a CTscan last week only to discover that he is actively bleeding in his brain, hence why over the past 2 weeks he’s lost the ability to walk.

Thus, Mama, Tara, and the two kids and I piled into the truck headed for Santo Domingo so that we can (hopefully) keep Joanna’s foot for a few more months and so Enurie can get brain surgery. Enurie is terrified of white people since his only interaction is in the medical realm. He clung tightly to his mother the entire time. Joanna is lively and sweet but quiet too. She doesn’t speak much Spanish, mostly Creole. The ride to SD was quiet, I brought cookies for everyone in the car and they gobbled them down in silence. At the clinic, Joanna was stone faced during her dressing change. She cried only when her cast was cutoff because she thought they were going to cutoff her foot…a real possibility for her. I held her in my arms but again, I am just a stranger with kind eyes, she has no connection with me. Tara was in our faces taking pictures the whole time. She photographed Joanna crying, the stinking foot, the cast coming off. I felt it was totally inappropriate but Tara looked at me and said "The funders want to see pictures, they want to see what they are paying for." This is true. The cast was reapplied, this time with a 90 degree bend in the knee so that she really can’t walk. She hobbled around on the last one and they don't want her up and about. She doesn't have crutches though and I had to carry her everywhere with this clunky full-leg cast on her leg. When I put her down in the bathroom and helped her take off her panties, she nearly fell over, due to the weight of the cast. I know she isn't suppossed to walk but she can't even get to the bathroom. I worked later this week to get a set of crutches to her so that she can at least get up to go to the bathroom. In the US, we have physical therapy for these kids, here, she just sits in a chair all day alone.

Anyhow, after the day at the hospital, Joanna cried as I carried her to the car, leaving her mother and brother behind. Orlando drove us to a Pica Pollo (fried chicken place) and I bought chicken fingers, french fries, and sodas for all of us. I was starving and ate all of mine, as did Orlando. Little Joanna, in silence, ate every last french fry, chicken finger, and even drank the vinegar sauce that comes with the meal. Joanna was silent as we drove out of the bustling capital to her hut in the batey. The only time she said anything was when we stopped for water and she said she had to pee. I carried her to the bathroom, carried her to the truck, and we were back on the road. She is to go back to Santo Domingo in 2 weeks for a reevaluation of the foot. I wonder what we are doing this all for. She clearly doesn't enjoy the trips, the foot will go at some point, we're just keeping her tied to a chair for weeks at a time to possibly get a little more time.

Existential Rain

2008-07-17T07:41:00.001+10:00

I don’t like the world today. I had a ton of emails in my inbox from uncles and aunts and I didn’t understand what they were about because they were all links to websites and news articles. The news: my 22 year old cousin Alice was hit by a truck and killed while riding her bike to work in DC. I know that Alice gave more life, hope, and love in her short life than many people expend in their entire lifetimes. It is such a tragedy that the world will not continue to experience her vision, love, and enthusiasm. I wish I could talk to my parents or Erin or something, but I can’t. I left the internet café because I couldn’t do any other work after learning of this. Now I sit at home, with lights out, listening to music, alone. What happens to the world when someone dies? Do we just pause for a moment and move on? I was in a batey earlier today where a man stabbed his wife to death just last night leaving her 5 children without a mother. From this batey I took a 4 year old boy into the city for a CT scan of his head today only to find out that the shunt placed months ago is positioned incorrectly and as we sit, he bleeds into his brain. And this batey is so poor. Cane cutting season is over and people have no work, no money, no food. And I wish I could pray. I wish I could go to my knees and feel like something somewhere exists for me to believe in. But I can’t. I only believe in people yet here I am, alone. What is this all? These tears? The smiles? The emotions that fill my body with love of life but that can also leave me limp and saddened like a plant without water? It is all just energy in the end, isn’t it? It is all empty. This reminds me of a Buddhist chant: emptiness, emptiness, nothing but emptiness, no eye, no heart, no sound, no feeling, nothing but emptiness… All of this causes me to postulate why people like to get married. Sometimes the shear immensity of life is a bit too much to swallow on ones own. It might seem more reassuring to have someone by your side to debrief with, to fall into someone’s arms when you’re feeling so full, or empty. At least someone to talk it through with! I’d like someone to help me know which way is up and which way is down and to pull me aside when I’m walking in circles. They say misery loves company, is that why people marry? We’re all so bloody miserable on our own that we can’t stand to be there alone? So then people marry, and then they’re miserable married and they think it is because they are married so they divorce and find themselves just as miserable as before. Perhaps this goes back to what I’ve said before, that my experience is my own and mine alone. I am the only person who sees and feels things exactly as I do. In the end then, we are our own happiness or misery? We have to spin our energy in a way that makes us feel as we like it? We definitely cannot choose to let another person spin our energy, they cannot. And I’m just realizing that there is no “ah-ha” moment in life. I’ve naively believed all these years that at some point, death would cease to terrify me, love would make sense to me, and that I would gain a baseline comprehension of the world. But I see now that it is not so. The picture just gets murkier and murkier. I suppose that we can continue to fight it and try in vain to give order to chaos. Or maybe embrace the chaos: the tragedy, the miracle, the mundane. Ah, and those Unitarians have it right once again “Give yourself to the world, it will consume you in the end. Let it have you living, that it may cradle you dead.”

Destination: Hallelujah

2008-07-17T07:40:00.000+10:00

This Sunday, I went with a Haitian friend, Jonas to the batey where he goes on Sundays to visit his mother. I met Jonas at Casa Pastorale (the place where all the volunteers stay, he lives there too) at 7:45AM. From there, we walked to the central park where many guaguas, or old beat-up vans, depart from. On our way, Jonas said, So, you’ve got your swimming suit? What? Swimming suit? Why? No. I had asked him the day before if there was anything I need bring with me and he did not mention a swimming suit. Oh well, I crossed my fingers and hoped that we could find a tshirt and shorts at his mother’s house. But where were we going swimming in the batey?
We got off the first guagua in a batey that looked like many of the others I’ve visited thus far. We ran to Jonas’ mother’s shack/home, greeted her, his step father and his sweet little niece, Laura. Laura looks to be about 3 years old and as she climbed into my lap, she pointed to her head where she had 3 tiny stitches, the result of a fall of sorts a few days back. Soon, outside we heard people yelling, a car horn honking and Jonas and I ran out to the second guagua of the day that would take us to a river where many people from the bateys go to relax and cool of on the weekends. This guagua was more beat up than the first, you could see the blue sky through the rust holes in the roof. Across the windshield, where one would expect to see the destination of a bus the word Hallelujah was written in purple and yellow bubble letters. As Jonas and I squeezed into the overfilled guagua, I noticed that many of the people had orange lips and fingers. There was a woman aboard selling cheetos and they seemed to be quite the hot item today. I crammed myself into a seat and listened as one woman shouted for silence! We must pray. So she rattled off a prayer in Spanish thanking God for the nice day, a safe trip, and maybe she said a few words for the cheetos and little plastic bags of water. I caught little kids staring at me and occasionally the little girl next to me would put her hand on my arm, as if petting a cat. As we arrived at the river, there was much discussion as to whether the guagua should stop at the top of the road or venture down the bank to drop us literally at the river’s edge. Since there appeared to be some sort of moratorium on walking, the driver started the steep descent toward the river bank. Everyone started praying as the guagua lurched down the side of the steep bank. At one point, we started sliding and I was sure that the thing was going to roll on its side. “Here we go,” I thought, “I hope that my chest cavity can bear the weight of this lady and her 5 kids sitting next to me.” But then, the guagua just slowly slid down the side of the hill and everyone took a moment to praise God, “Gracias a Dios! Hallelujah!” Folks, I thought, maybe God wants us to walk the 100 yards to the river…

At the river, as expected, I was the only white person, or “blanquita” as they say here but no one said anything to me about it. There were no questions about why I was there. Jonas and changed into shorts and tshirts and headed toward the freshwater river. After being warned by the travel medicine professionals never to swim in fresh water, especially if it is still, green, and murky, I waded into the shallow warm river. It was so hot outside and the water was barely cooler than the air itself. The bottom was slimy and Jonas and I hiked back to explore the territory beyond the crowd. There was a man sitting in the river washing his clothes for the week; his horse patiently waded in the river. Around lunch time Jonas and I bought some food from some women that were cooking under the shade of a tarp. We bought fried plantains, a piece of “jonikeita” or fry bread, some fried balls of dough that had salted fish and onion in them, and some habichuelas dulces or sweet bean drink. That was the best! The sweet bean stuff was like a bean tea, kind of like chai with cinnamon, banana, and pepperberries in it. The beans made it creamy and delicious, like a custard that we drank out of a cup. Jonas and I hiked back to the parked guagua and sat there to eat our lunch of fried carbs. It was, of course, delicious. In the afternoon, we got ice cream cones from some guy that drives out to the boonies on his moto to sell ice cream cones for 10 pesos, or 25 cents.
As I waded back into the water, a bunch of little kids were staring at me so I greeted them in Spanish and Kreyole and then I was suck with them. The little herd followed me here and there. The little ones clung to me as we waded though water with a strong current. While we splashed about and they rode on my back, a lady approached the water’s edge and waved to me. I got out of the water and walked over to her. She recognized me from the hospital. It took me a minute but I realized that she had been a patient at the public hospital on one of the days that we delivered babies there. As I asked if I delivered her baby, I remembered that she was there for a missed abortion and I was immediately embarrassed at my question. We talked for a little bit, she asked about my professors who have long since returned to the US. (Coincidentally, the following week while working at a clinic in another batey, a little boy approached me and said that he swam with me at the river the day before. I didn’t recognize him, but we did handstands together against the walls of the clinic.) As the afternoon sun burned my skin, I had to explain to Jonas that white people’s skin burns when they are in the sun and that my skin hurt from the sun. We took shelter under someone’s tarp and waited for the guagua to pack up so we could go. Finally, around 5:00pm, we all piled into the guagua, tables, chairs, pots, pans, babies, cheetoes and all. In the batey we said a quick good bye to Jonas’ mother. I took a family picture for them which I will print and send them. I also took one for the neighbors. We ran through little groups of chickens and chicks to the final guagua that took us through fields and fields of cane, all of which is cut by hand, back to La Romana.

Century mark!

2008-07-12T02:10:00.003+10:00

After failing to enter data for a few days, I was pleasantly surprised yesterday when I saw that my sample size has grown to over 100! That means that if I work really hard next week, I could possibly get to my goal of 150 and complete the data collection prortion by the end of the week. Now, in my last post, I noted that the mean hemoglobin was somewhere around 11. I'm speculating that the women are dehydrated, as the heat and humidity are oppressive here. I've been thinking of ways to tease out what is going on so that I can do more than speculate in my final praxis. This is what I came up with and I ran it by 4 physician colleagues over dinner last night and they concurred that i'm on the right track. I will do a subsample exploratory analysis of about 10 women. I will do the fingerstick hemoglobin on them and also a CBC + serum ferritin. There is a local lab here that can run these for me. I'll pay for them through my Down's funding. This will allow me to compare my hemoglobin (fingerstick) with that of a CBC and also if I can get the serum ferritin or a total iron binding capacity I'll see how much Iron they really have floating around. Yes? Then what will I do with the rest of my time here? My roommates Brian and Michael are wizards at Excel and I need to learn how to work with my data and respresent it graphically. Also, I may follow one of the OB/GYNs for a day or two. The boys and I may go camping for a couple of days on a beachy area not far from here. I'm going to a batey with one of my Haitian friends on Sunday to meet his mother. (Why? I'm not sure, but I'm happy to go to the batey because this could potentially be a site to run my heme tests). Knowing how things run here, it may be a while before I can do the blood sampling so I'm sure I'll have plenty to do.

This afternoon, as soon as i'm finished with my cherry juice and emanada, I'm heading to the beach. Brian and I may go out with the students from Columbia Univeristy tonight. I need to get to the hospital tomorrow to get supplies for drawing blood and get in touch with

the lab that will be running the tests for me. I should be happy and grateful. I can't help but continue to lament the internal dynamics of the groups I work with. But again I remind myself that I am doing (at incredible speed and ease) what I came here to do.

Data collection update

2008-07-04T03:15:00.002+10:00

After reviewing my preliminary data, I am able to report the following:
Out of a sample size of N=64, 23 or about 36% have experienced pica in one or more pregnancies. The most frequently ingested substances are (in order of frequency): ice, ashes, dirt, flour, stones, coffee beans, and cinnamon. The mean hemoglobin is 11.3 Mean age of participants is 27 years old. Mean gravidity= 3.65. Thus far I have 64 participants, with my goal sample size of 150. I have completed 9 interviews, out of a goal total of 20. I am working to get a little more information out of interivews, to dig a little deeper. I was working with a female interpreter yesterday and I think I was able to do that. I'll transcribe those interviews this afternoon and hopefully, code a few more. If I continue at this pace, data collection might be finished in a couple of weeks, which would leave me the rest of my time here to transcribe, code, analyze, and work on that Spanish a bit more.

Rambling on and on.

2008-07-02T02:35:00.002+10:00

I´m at an internet cafe taking a break from my off-day. I´ve decided to do a day in the bateys and then a day off to read, study spanish, and type up results of the previous day.
This morning, I went to trigo de oro, the french cafe I´ve adopted for studying and reading. It is expensive, but there is loud music blaring out of every other place here and I feel like I can sit and linger in peace there. I´m getting to the point where I see people I know while I´m out, which is cool. Today I saw an administrator from the hospital there and he came and spoke to me. I studied spanish and read, but since angelina and teri were here, I feel like my Spanish came to a stand still. I´ve also been hanging out with Haitians which means we speak in French. Last night, Ariel, one of the young, immature translators came over but you know what? we spoke in spanish the whole time so I suppose not all is lost. Then, after leaving the cafe, I walked to the market place for some fruit and also hoping to find some sort of birthday present for mom and erin. Well, shopping here is annoying because I attract alot of attention just by being white so people are talking to me, about me, and also there wasn´t alot there to buy as gifts: hair extensions, shoes, deodorant, baskets, and burned DVDs in spanish. So I bought myself a giant Jamacian avocado, a papaya, and these little red things that I thought were either cherry tomatoes or cherries. I bit into one to find that they are a fruit I´ve never encountered. ¿Maybe quince? Anyhow, i´VE got a bag of them so I guess I´ll be eating them for the next little while. I took my fruits and walked across a public park to some clothing stores. I´m in search of a taylor to make some turkish pants for me. I like the ones that mom gave me but I´d also like a pair in a more subtle color.
Yesterday was really difficult for me. After breaking down on the phone with mom the day before , Angelina and teri left, and Zac the other yale student was frustrated and left. So I had to go back to the bateys with a new group of people to collect data. Before leaving I asked Andy, one of the translators if he would work with me (they get paid by me for chrissake). He said he was committed to something else. So I asked the translator manager who would be working with me and he gave me a choice of two, one of whom was Andy. I´m not a fan of Andy personally but he´s a good translator and I trust him to work with the women i´m working with. We get there (to the batey) and I tell Andy that he´s been assigned to me. He looked at me and said ¨no¨. He´s mad at me because he´s put the moves on me and since then I´ve been really cool with him and haven´t hung out with him or anything. So, I´m in the batey with all my shit to do my study and no translator and this evangelical group. Well, I decided that I´d better just do fingersticks and leave the interviews for another day. I need a bigger fingerstick sample anyhow. While the team took their time setting up the clinic and people gathered round to see what these whities were doing I started to talk to women and do fingersticks. People from the group came up to photograph me, sitting on the ground outside the church sticking women´s fingers and I put my hand out and asked them not to photograph please. God, what is it with these people and photos? It is not polite to photograph anyone without first asking for permission! So in the end I got 20 fingersticks, some with pica but I didn´t do any interviews because I didn´t ahve a translator. At the end of the day, while the team was off praying or something, I sat outside with a bunch of kids that had been peeking in the windows of the clinic all day. They were staring at me, I stared back. This whole group just sitting there watching me. I said a few things to them in spanish. Then, a little 5 year old (small for her age) with messy golden hair came up and showed me her knee which was infected with what looked like scabs or bites. she also showed me her arms, legs, and feet that had the same pussy lesions all over them. She sat in my lap as I applied antibiotic ointment. I asked her what happened and she said she fell. Yes, she fell a couple of weeks ago but since then, rats had been nibbling at her cuts in the night. Does the cream I gave her change that? No, absolutely not. Does anything we do (a month of beta blockers, a weeks worth of antibiotics, a month of prenatal vitamins) change anything? No, not at all. Maybe the ¨bug juice¨that we give to kids to deworm them will help for a little while, but they´ll get worms again. So what does this mean to me? I feel like this is nice, this is okay, but real change means holding the sugar cane companies accountable because they get off very easy each time we come to the bateys with food and medicine. It means working to create conditions in Haiti that will promote a retention of the Haitian workforce such that they won´t travel to the bateys in the first place. I´ve been very pleased to spend time with a 4th year medical student from UMass, Olga. She has been here many times and I love to debrief and philosophize with her over a beer, and then dance bachata with some random Dominicans. Unfortunately she´s only here for 2 weeks but I´ll spend as much time with her as I can before then. That´s it for today. I´ll work on my data this afternoon and maybe head to the beach with the group. When I´m on my back floating in the blue sea, group or no group, prayers or no prayers, I am at peace.

Back again

2008-06-26T07:25:00.002+10:00

Back at the public hospital today for 2 more deliveries. Again, it feels like a dance...the physicians are feeling us out, we´re feeling htem out. When I challenged one MD about taking our 8cm primip to the delivery room for her to push (she must dilate to 10cm) we fought it out. Once in the room, he stepped forward, I stepped back. I asked permission to examine here. Then, together, we danced together and birthed the baby. He cut a mediolateral episiotomy, I watched and learned. He cut the tight nuchal cord, I pulled out the tight shoulders with his hands on mine. The repair...which was massive, I would have done differently but I learned a new way to do it (which I may never use). But it is a dance, a quilt, an intense interaction that terminated with a new mother, a slightly floppy and greyish baby )but she´ll be just fine.

Let this love wash over me

2008-06-26T07:18:00.001+10:00

June 24th
There is something about birth, about being privileged, honored to participate in one of the most intense and intimate experiences in life that humbles me like nothing else. Why me? Why am I the chosen one? What have I done to deserve this honor? It brings tears to my eyes…what have I done to deserve the trust that women give me, that allows me to assist in the most transformative of life events? After births, while I’m coming down from the so-called “birth high” (which, to me isn’t a high at all. I associate “high” with being in another world, dissociated with reality. When I participate in birth, I feel as if I am so much in this world that the intensity of life in the moment is almost too much, it crushes me, it washes over me, it consumes me. Afterward, I don’t feel high at all but acutely mindful, so aware of everything in the world.) I crave water. I want it to rain so heavily that I’m soaked to the bone. I want to swim, have my head under water so that I hear nothing at all. I want to shower and feel the cool water wash over me. I put my fingers in my ears and hear the water wash over my head. It is cold, but quiet…all I hear, feel, sense is water. The harshness with which I perceive all other stimuli is silenced by water. The day begins with water splashing on the floor (or today with my fingers scratching away at a bag of waters) and ends with me in water, allowing it to consume me as my body, mind, and hands were consumed by the splash on the floor.

So one day in the public hospital = 4 births, 2 of them which I did. One was a direct OP. 2 repairs. Lots of practices that made me want to jump up and down and scream in horror (slapping of the belly, fundal massage during second stage, literally pushing the baby out by applying pressure on the fundus, delivery on a 12in wide delivery table with feet in stirrups), but there were a lot of things that weren’t done that pleased me equally (no medications on board = nicely reactive babies, no bulb syringe suctioning, no insistence that the baby cry it’s head off, no epidurals, no sections, no inductions, no episiotomies, intermittent/no auscultation). In fact, by the end of the day, women wanted to deliver with us, the three “comadronas americanas”. Tomorrow we’ll go back and I’ll be humbled once again by the honor bestowed upon me for reasons I don’t understand.

Moving (up or down) in the world

2008-06-26T07:16:00.000+10:00

After struggling with my past living situation for 2 weeks, I have finally moved. A summary of my complaints at my previous apartment in their order of importance:
Cost. $30/day = $900/month which is unheard of in this country.
Domestic worker problems: the woman who was to cook/clean for me was at the apartment watching telenovellas all day. I had no quiet, no space to type up my data, no privacy really. Her friends would come over from time to time, unannounced. In brief, the environment was not conducive to working.
Other: no water x 3 days, rats, roaches, translators showing up to drink and dance at my place because they are not free to do so in public due to the fear of being “spotted” by someone in their church.
Where am I now? Well, I’ve moved into a spacious 2 BR 2 Bath apartment with the 2 Dominican/American brothers from Indiana, Brian and Mike. If it is 2 bedrooms, where am I sleeping? Well, in the bathroom, actually. This sounds strange but the second bathroom is very large and not used as a bathroom so we’ve put a mattress on the floor, put a little dresser in there and it is home sweet sleeping room. You see, the plan is that Mike is to move back to the US sometime in July, at which point I’ll be upgraded to a full fledged bedroom. All I do in there (the bathroom) is sleep anyway. I actually use the other bathroom to shower in an attempt to keep the humidity down (this apartment is clean, nice, but very humid). My professors helped me move in (one backpack and one Rubbermaid tub) and then we went to the empanada stand next door for empanadas and papaya smoothies. My Spanish is sure to improve here, as Brian and Mike speak Spanish between the two of them. Plus, I’m saving myself 25000 pesos ($700) a month! Last night we watched the women’s Olympic gymnastics qualifying competition. I was in heaven! During the commercial breaks I entered data into my computer and ate mini snickers bars. I bought fruit and veggies yesterday and was so pleased to have not fried plantains, not potatoes and bacon, not ham and spaghetti, but sliced tomato and cucumber for dinner.
Today, I will go with my professors back to a hospital in the bateys to meet with their medical director to discuss the possibility of us providing clinical care there.

In the heat of the moment, but they're all hot!

2008-06-19T07:54:00.005+10:00

Data collection day one

A yellow school bus transported a load of volunteers, translators, my research assistant and I to Batey #20A. Junior and I reviewed how the interviews and blood sampling would go and off we went! Junior is one of those people with a personality that encourages trust and that people generally just really like. Right away we saw a pretty young woman with a baby and he asked her (in Creole) how old the baby was, said that she was almost as cute as her mom, etc etc. We followed her back to her home, sat under a tree, and within 10 minutes we'd finished with our first participant and had another small group of women waiting to participate too. As I shuffled around my massive binder looking for consent forms, data sheets, interview prompts, etc. I realized that organization is tantamount to this process. I knew the first day would be rocky though. Today, for example, I spent part of the day making double sided copies of consent forms, organizing in easy-to-access folders, and put all of the materials I need for individual blood sampling into snack bags so that I am not digging through my backpack looking for alcohol swabs, bandaids etc. Each participant has a little baggie with their lancet, their alcohol swab, and one bandaid. We used up all of our consent forms the first day so I was very happy with dag 1. 1/3 of the participants experienced pica during at least one pregnancy. During a meeting with the head of the hospital today, I was given permission to take iron, prenatal vitamins, but also other basic medications to give to people in my study if they so need.
Following data collection, Junior and I sat under a tree and I raised the issue of "development tourism". It is good and fine for white AMerican tourists to come to the bateys and hand out harmonicas and balls that have "Jesus Loves You" written on the side. But then at lunch, we eat empanadas and drink cocacola in the field that is literally the fruits of the labors of those whom we claim to help. The children have fun for a day, they get to sing and play and get toys but that does nothing to affect the structural factors that keep families in the bateys. We need activism! We need each volunteer to go home and instead of posting pictures of "me and little Juan-Roberto who has no clothes", to act. To do raise awareness of the brutal conditions that WE as Americans are reponsible for. (The company that owns the bateys and the families in them is owned by an American family.)I could go on about this all day but alas! There are other things to report.

For example, I had a lovely day today.
PS: last night, while walking to Casa Pastorale, I found myself a tiny bit hungry. I purchased, for 15 pesos (50 cents), 2 pieces of fried bread with a smashed boiled egg between it, the whole thing smattered with ketchup. It was DE-LICIOUS!
First, I met up with 2 of my professors who are visiting and we went to the hospital for a visit with the CEO equivalent. We had a mediocre lunch of tuna sandwiches in the hospital cafeteria, washed down with snickers bars and sweet sweet coffee. Next, we hired a driver and made our way to the public hospital where we hope to do deliveries next week. Wherever we go, people stop and look at us and when I walk the streets by myself, I am constantly catcalled, hissed at, and get a random assortment of greetings. I wear sunglasses to obstruct my blue eyes and also to avoid eye contact. It is never scary but I'm acutely aware that I will never blend in. Even though my hair is brown, for example, people always yell "La rubia!", or Hey blondie! You can imagine the attention we attracted then when Julianna and I hitched a ride to our apartment on the back of Ariel's moto(Ariel y yo in the picture to the left) . Ariel is one of our translators and he offered to give us a ride (10 blocks) from casa pastorale to our house. You see, scooters are family sized vehicles here. It is not uncommon to see a baby, mom, dad and groceries on a tiny scooter. They zip around cars, beep their horns, and cause a general sense of mayhem. Juliana and I laughed and screamed as Ariel proudly drove through the busy streets.
This afternoon, after a trip to JUMBO, the Dominican Walmart equivalent, the driver dropped me at my house. I walked down the street to a photocopy shop and in Spanish, had them print some documents from my zipdrive, 25 pages of different documents, double sided. This is quite a feat to do in a language that I've spoken for just a week, I was very proud. While these printed, I stepped outside to buy a jugo de chinas (freshly squeezed orange juice with crushed ice). I've bought jugo from this particular vendor before. He is Haitian and charges me the same price as domincans pay, 20 pesos. It is icy, sweet, and refreshing. I got my juice and went back into the copy shop. I sat there watching him crush the ice, press the juice. He looked terribly melancholy. It almost made me cry. I thought about his life...I wonder if he has a family. Each morning he must get up, get a big block of ice, fill his cart with oranges, then park himself in the hot, humid afternoon making juice for 20 pesos. Sometimes I think I should have been an anthropologist so that I could do ethnography...ethnography of jugo makers in La Romana. When I think of it, I suppose there are lawyers, carpenters, and bureaucrats who are as miserably as the jugo man appears. His misery is on display on my street outside the copy shop though. I wanted to take a picture, but you know how I am about pictures, afraid to appear disrepectful.
Alas, I came home, sorted out all of my consent forms, created a new system which I will trial tomorrow in the Bateys. Our house keeper made us chicken and plantains for dinner. I'm going to fry up some garlic cloves to eat with this with the hopes of making my blood smell like garlic so the bugs will stop biting me. I don't know what bites but I've got massive welts on my arms and legs. They itch like crazy too. I don't think it's bed bugs but they're not mosquito bites either. Tonight, Juliana and I are going dancing with some of our translator friends at a nearby watering hole. I'm looking forward to furthering my salsa, merengue, and bachata skills but I think I'll sit out for the more suggestive reggaeton. I've got to keep it professional, no?
One last thing: It appears as if I'll be finished with my research much earlier than I thought. One of my professors asked me if I'd consider coming home early. Since I'm funded here for 10 weeks I figure I'll hang out, start analyzing data, maybe get a good start on my final thesis, travel around, and for heaven's sake continue with my Spanish! This means that I'm open for visits any time. Hasta luego!

Papaya shakes after a day at work.

2008-06-18T08:18:00.002+10:00

Let's see, today is Tuesday so I'll recount briefly the weekend before delving into my frist day of data collection.
Sunday:
Day at the beach with Brian, 3 other volunteers, Zac, Brian's brother, Mike, and 2 Peace Corps Volunteers. We ate whole fried parrot fish with fried plantains. The clear blue/green water was like cool bath water, not the slighest chill to it. I read some of my book, relaxed, swam a lot, chatted with the Peace Corps Volunteers. I have to run, will finish this later.
j

Bitter, bitter sugar

2008-06-16T01:06:00.001+10:00

A quick recounting of last night will suffice before plunging into the intense day I’ve had. Julianna and I, along with 2 volunteers who are staying with us for the next few days were invited to Brian’s house. He is a young American/Dominican working here for the past few years. The point of this story is, he is very different from our Haitian translators here in that he is pale skinned, but still looks Dominican, he lives in a nice apartment and I guess what I’m trying to say is that he is part of a different social class than our translator buddies are. This is a place where color, class, and accent, determine where you work, what you do, and who you hang out with. While Junior and his brother, Ariel came by our house to eat dinner earlier and were soon joined by two friends, I debated inviting them to Brian’s house to watch the game. I decided not to and was glad I did so because upon arriving, there were no other Haitians, just Brian, his brother, a Dominican friend, and two very pretty, very thin, very made up Dominican women. Long story short, the basketball game was a minor part of the evening. It was on the entire time but muted, and at every commercial break, and during most of the game, we listened to music and worked on our salsa, bachata, and merengue. Music and dance isn’t just part of life here, it is life being enacted, a means of social interaction in itself.
The Bateys…
Juliana, Zac and I piled into a pickup with an American woman who lives here, and her 2 colleagues. They go to the bateys to offer HIV testing and a short class on HIV (in Creole) to those living in the bateys. As we drove out of the city and into the cane fields, the world changed. Oxen pull giant carts of dried sugar cane to a station where a machine pulls the cane out of the cart and puts it onto train cars. You see, the workers cut the cane when it is heavy and wet but are paid for it’s dry weight, which is much less. We see dark, tired men with machetes whacking away at the cane, as one would have done hundreds of years ago. We arrive at the batey where HIV testing will take place and set up shop in the school house. Men, women, and children line up to see what this curious assortment of people are doing. The houses in the bateys are one room homes made of wood. Juliana and I have the job of occupying the children while the adults are in the class and getting their fingersticks. Without launching into a diatribe on human rights and the global system, suffice it to say that conditions in the bateys are shocking. It makes my stomach churn to see how global systems of exploitation and domination are enacted on individual’s lives. I took some photographs at the request of the children themselves but I won’t post them here, or anywhere public. Those are for my personal album only…sorry, no token pictures of me with the little poor children.

Poco a poco

2008-06-12T05:09:00.000+10:00

So much has happened since yesterday when I wrote. A summary follows, and a detailed description of each event is provided too.

Summary in chronological order:

Tuesday night (June 9) Neighbor girls come over to play Uno
I go to a random basket ball game, one of 2 white people there, and the only female.

Wednesday (June 10) I go to the hospital and am put to work right away assisting (or observing) with surgeries, complicated OB cases, writing medication information in Spanish on envalopes and filling them, then when things slowed down I painted some new water filters that will be sent to the bateys.

Wednesday night Sweet party at mi casa to celebrate the departure of 2 of my roommates. (If you ready any parts of this, read the party description, it was wild.)

Today, (June 11)I adventured solo into the city to the market place where I bought some vegetables and a big glass of freshly squeezed orange juice.

After I last wrote, the neighbor girl, Nicole (age 9) came over and just sat down at the table with me. She started asking me questions that, for the most part I couldn’t understand. I asked her to write them down and I took a dictionary and looked up the words I didn’t know. While this was tedious, she didn’t mind and hung out until her 2 friends came over. They entered and sat down in 2 chairs. Communication was tough and frustrating, so we played Uno instead. ( I must pause here for a moment to say that as I sit here on my bed, a cool breeze has begun to fall because an nice afternoon rain has gifted us with it’s presence. Oh, this cool air feel so nice. The humidity is intense but this cool rain breeze is making my day.) Uno was interrupted when Junior (my translator/hostbrother) called saying he was going to pick me up to go to a basketball game.
The basketball game: First, I go outside not knowing what car Junior has and there are several young black men looking my way and waving and I just don’t know which one is Junior. Mind you, I had only arrived earlier that day! So, I stand there, look in a car or two, hoping that if I come upon Junior he’ll make it really obvious that it is indeed him and that I don’t get in a car with some random friendly dude. Then this sweet corolla, decked out with neon lights on the windshield wiper washer things, pulls up and I know this has to be Junior. We drive over to Casa Pastorale, the other volunteer house. I see Zac, a colleague of mine from Yale who is volunteering here this summer. I meet both my and hiw roommates, they are all watching “House” on a giant TV. I am the oldest of the volunteers here (except for Zac) but the other girls are really sweet, nice, funny, all that one could ask for on a trip like this. Zac and Junior are dressed for basket ball and they ask me if I’m ready to go. I am but the other girls look like they’re not quite ready. “They are staying here to watch tv, you can stay with them if you like, or come with us,” Junior said. Desperate to practice my Spanish (correction, learn some Spanish) I decided to go to the basketball game, assuming that there would be other chicas there with whom I could converse. We drive through crowded streets to an old empty stadium. We walk in and I see about 25 Haitian/Dominican men paying basketball. No spectators, no ladies, Zac and I are the only whities. You can probably guess how this awkward encounter went: Zac and I sat and watched them playing basketball, asking each other why the hell we were there. It was random and strange but I pretended to be an anthropologist and watched the dramatic interactions between the men as they shouted back in forth in a mixture of Kreyole and Spanish.

Day One at the hospital: Junior picked up me and my roommates (who teach at a school near the hospital). I didn’t yet have any plans for the day at the hospital. I though I could meet with the administrator, meet with my advisor, Kristy, and see how things work. I brought a book to read just in case. I showed up in a long skirt, tshirt and sandals and was promptly instructed to don scrubs, a surgical mask, a head cover, and surgical booties…yes, surgery in sandals! I was shown where the OR was and off I went. Wait, rewind. The surgical team is from a church in Georgia and right upon my arrival I was introduced to 2 older men whom I assumed were physicians. When I told I was a midwifery student, they said to me in a strong southern accent “Oh yeah, so like is that a rural thing? You go to school for that?” I was so annoyed but then when they started asking me about salvation, I realized that they were the pastors of the visiting surgical team. They weren’t psyched when I told them I was a Unitarian Universalist. Their job is to sit in a room with the recovering surgical patients and then they do this circle of prayer thing…Yeah, I just hold their hands, bow my head, and try not to dwell on how inappropriate it is to have 2 white men (who speak no Spanish) denying patients privacy while they come out of anesthesia. Anyhow, I saw a couple of hernia repairs, a cholecystectomy (sp?), and we pulled this strange lump out of a young girl’s arm pit (surgically). Then, since it seemed like there were lots of people in the OR and that I was just a spectator and I’m a midwife for God’s sake! I hate surgery. I took off my scrubs and joined a pair of American volunteers who were painting water purification things for the bateys. It really seems like a waste of time to paint these 3 foot tall things. First we paint them white, then blue, then we put their sponsor’s logo on them. Is that really necessary? Anyhow, a Dominican woman whose brother was having surgery joined us to paint for a while but when the afternoon rain blessed us with a cool wind we went into the cafeteria. Kristy (my advisor here and Pediatric nurse practitioner student, nurse, missionary, and amazing woman who has been working in Haiti and the DR for 11 years) came and told me that she had a case for me. To summarize, we examined a 34 weeks pregnant woman who was paralyzed on her right side and was diagnosed with low amniotic fluid volume x 2 on ultrasound to assess for rupture of membranes. Without nitrazine paper, a sterile spec, or a light (my keychain flashlight worked just fine), we determined that she had not in fact ruptured, and we sent her home (we took our chances with the spec and did a clean exam, negative ferning on the slide, no pooling and her cervix was very posterior).

Party (see pictures from early on in the soiree): Because 2 of my roommates who are volunteers for the same organization were leaving, we heard that there was to be a “fiesta” at our house. Junior and I went down the street to buy a few bottles of beers and some ice cream and when we came back the tiny apartment was filled with other volunteers (all women, I think the men, well, man (Zac) was watching the big basketball game) and our translators from Good Samaritan. Someone hooked their ipod up to some speakers and merengue, salsa, and bachata music blared throughout our apartment and our entire compound. Let me remind you that there is no glass on the windows so when one person has a party, everyone knows. In the DR, dancing is not a milieu for individual expression through movement, it is a pair endeavour. And when I broke away from my dance partner to rock it American style to the Black Eyed Peas, everyone stopped, stared, thought it was funny and then coerced me back into the pair dancing situation. Word got out that I spoke French and since many of the translators are Haitian, I ended up speaking more French than Spanish…something I’m not happy about and must continue to insist that we work and converse in Spanish. So here is this tiny apartment filled with Haitians, Dominicans, and Americans, blaring random music, everyone dancing away. The guys were funny, I would catch them saying things to their compadres in Spanish like “No, go dance with that one, I want to dance with this one, okay, one more song only. I get that one for the next song, etc. etc.” It was a blast. No one was drunk. We all had ice cream and a small glass of beer and danced until the walls of the apartment were moist with sweat and humidity. Around 1130 we kicked everyone out, for the sake of our neighbors who could likely hear every beat, every step, every laugh. I took a cool shower and went to bed.

This morning we (my roommate Juliana and I) bid farewell to our 2 other roommates. Even though I only spent 2 days with them, I felt quite close. Travel does that. After they left, I moved my stuff into their old room (see pictures). I feel much better now that I have my own space and have finally unpacked my bags. Around 11AM, I decided to venture into town, to a big marketplace that I’d read about in a book. With a bottle of water I put in the freezer last night and my lonely planet, I set out. I did find the market place. Narrow streets with carts, tables, and trucks make up the market place area. I badly wanted to buy some fruit or empanadas from a vendor but was afraid that my Spanish would make it impossible and that I’d get totally ripped off. I was the only non-Dominican or Haitian I saw. I attracted a fair bit of attention but none of it was sufficient to cause me to turn back and head home. Just a lot of cat calls and “hola, la rubia! Senorita!” I decided to go into a big grocery store to buy a few things I’d forgotten and get some vegetables. This would allow me to assess the price of such things so that when I’m on the street next time and buy a mango, I’ll know that it should cost about 10 cents. I bought some vegetables and on my way home, braved it and stopped at a juice stand to get a fresh squeezed orange juice. “Quiero uno jugo, por favor.” And before I knew it I had paid 25 pesos (like 70 cents, maybe too much?) and had a delicious iced orange juice in my hands. I really wanted to stop for an empanada but thought I’d best leave that for another day…why try my luck at ordering things on my first day out? I came home, took off my sweaty clothes, cut up my tomatoes, cucumber, green pepper, random cheese, and green olives and ate my lunch.

Now, our housekeeper, Dominica, was here for all of this. I’m not sure what is in her job description but she stays here and watches telenovella (soap operas) all day. From the morning until she makes our dinner and leaves in the evening. Now, she is asleep on the tile floor (siesta anyone) with the telenovellas blaring away. While I’d usually be out in the common area, she is there, the TV is on, so I’m in my room on my bed. She doesn’t speak any English, my Spanish is pretty terrible and it is just kind of strange. She brings her laundry here and does it, it just makes it feel like I’m not in my own place. And I’m paying a lot of money to stay here. I think moving out July 1st may be what I decide to do. On that note, I am meeting the prospective roommate tonight. Brian is an American living and working here in the tourism industry since graduating from college. If I end up staying with him, I’ll save loads of money, have a nicer place, and a bit more privacy. The downside: I’ll have to make my own meals which now, Dominica makes them and although heavy, greasy, and fiberless, taste so good when I come home at night.
That is the last 24 hours in a long-winded nutshell. Tomorrow, I have no plans so I’ll go to the hospital in the morning and plan to put in a full day there. I’m so busy, so hot, but so loving it.

Besos!

Helping people help themselves

2008-06-11T08:14:00.000+10:00

As I boarded the airplane in Atlanta bound for Santo Domingo, I noticed that the passengers fell into 3 groups, none of which I was a part: first there were a couple of youth groups from American churches. The largest group adorned with yellow tshirts and their chaperones in matching green ones. The motto “helping people help themselves” was across their back. They were giddy teenagers, annoying, insecure and excited to go help people…help themselves. The philosophy obviously bothered me. Was the latter part a precondition for the former? It seemed so republican. I help people who need help, why should they have to help themselves if I’m helping? I rolled this around in my head for much of the flight. I was just waiting for one of them to ask me what I do so that I could respond “I help people unconditionally”.

Another component of the plane was made of young, newly married, or engaged couples – the Honeymooners. This group booked their stays through websites like Cheapcarribbean.com and was ready to be waited on hand and foot in all inclusives, much like their colonial predecessors. They were going to drink imported cocktails, look at their impeccably manicured toenail polish and pay their way to newlywed bliss.

There was a handful of random spring break-type vacationers on the plane too. All of them had variations on (blood) diamonds gracing their perfectly manicured ring fingers. So I was the odd one out.

Fast forward a few hours…

I arrive at the Santo Domingo Airport. I sail through customs, get my crate and backpack, and push my cart through a massive throng of people, looking at all the signs people are holding up, hoping one of them says: La Senorita Pettigrew. The heat and humidity hit me as soon as I step out of the airport. Random men approach me saying “taxi! Taxi aqui!” I pull out my cell phone (which works) and dial the number of Orlando, the man who was sent by Good Samaritan Hospital to pick me up. Orlando answers and hands the phone to Junior, his compadre and coworker. They tell me they are 20 mins away and that I should hold tight and they’ll be there to pick me up in a truck. I loved watching the happenings at the airport in the meantime. Who takes what taxi, how the taxi guys recruit their customers, where the tourists go (never in local taxis but in large, foreign owned, air conditioned busses).

They arrive, Junior speaks English really well. He’s a youngish Haitian/Dominican who made me feel comfortable the minute I saw him. We loaded my stuff in to the truck and took off. I tried to speak as much Spanish as possible (Orlando, an older version of Junior, speaks no English). I listened to their conversation, listened to the meringue music on the radio, and watched as we raced along the blue/green coastline at rocket speed. I saw a sugar refinery, people selling tropical fruit, guys speeding around on motos (which are actually family vehicles here, carrying 2, 3, even 4 people), donkeys, horses, skinny cows, pretty much everything I expected I would. They are both impressed that I express a desire to eat “el bandera dominicana” or the Dominican flag, which is a national dish of rice, beans, meat and plantains arranged in rows and it looks like a Dominican flag. An hour later, we pull up to a building on a narrow downtown street, el apartemento. (That may well not be the word for apartment.) Junior helps me haul my stuff up to a third floor apartment on a bustling street. When we get there, a young woman is in the hot HOT HOT apartment preparing the evening meal. Junior explains that there are 3 women staying here now (2 bedrooms with bunkbeds) and that 2 of them leave Wednesday. I put down my bag. Junior shows me how to get to the roof, should I want to sit up there because it is so hot in the apartment. The windows don’t even have glass, just bars. We have a glass sliding door but it seems to always be open with a locked bar door open that lets warm but moving air in and keeps intruders out. I introduce myself to the young woman cooking. She tells me to make a plate for myself. I’m starving and exhausted so I make a plate of some empanada like fried pastry crust with chicken inside, a big plop of watery but delicious mashed potatoes, and then there was a plate of cooked onions and chicken. I took a piece of meat out that was actually a piece of cured ham. I assume she added it for flavor and I ate the thing and it was delicious. I took my plate arriba, (above, on the roof) and took in the city while I enjoyed my first meal in my new summer home. There is a sushi restaurant across the street (I know mom!! Can you believe it!?), students coming home from school in their uniforms, people buying fruit, etc. I will take a picture tomorrow when the clouds have passed. It looks exactly as I imagined! I came back downstairs and my roommates had yet to materialize. Although I would love to unpack, I am waiting until the roommates come home because there is no room for my stuff and I don’t want to move their stuff without asking. So I took a nice cold shower, slathered on the bug spray, then my face started burning from it so I washed it off my face, I put on a dress and climbed into the top bunk, turned on the fan, and slept for an hour.

I woke up, our house keeper is gone and the roommates have not yet returned. I just ate a few chilled pieces of melon and pineapple out of the refrigerator. It is still very hot but a nice breeze keeps the air moving. One of our neighbors is playing some peppy music and because no one has glass windows I can hear them preparing their meals, conversing, and going about their evening. A young girl and her sister came to the door and said: “blaksfdl sdfhsoidhfkwe lksfjdlskfjdaijd?” I looked at them. I didn’t know what to do, so I introduced myself and asked her to repeat herself more slowly. She wanted to use our telephone. So I let her. Then her mother came over, introduced herself, said “lkashdf laskjaslkfoihgdfgi?” I asked her to clarify and then just made up the question myself and answered it. “I’m here for 10 weeks. I’m a midwife, I have one sister. I arrived today,’ that should cover most of the bases. As I sit here writing, Junior just came back. He told me he would come back to play a game of Uno. By the way, he will be my translator while I’m here, he’s informed me. He’s worked for Good Samaritan for several years and is excited about my project. We already have a meeting tomorrow to talk about my project and how we’re going to carry things out. He ate some of the cooling fried plantains on the counter and told me he’ll come back shortly to pick me up, he’s going to play basketball with his friends, my friends apparently. So he’s coming back at some point. It’s like a host brother, how great! I know it will be awkward to be the grina girl with all of these Dominicans. I know they will laugh at my Spanish. But I need that, I need to be pushed. I need to hear it, to see it, to try to speak it. I’m sure I’m a bit of a burden but Junior seems really committed to helping me…help myself.

Seriously? A blog?!

2008-05-22T03:44:00.000+10:00

The next narcissistic act in my life has commenced...that of the blog. Why a blog? Well, many folks go the way of the mass email, which I have done in the past but I think that rather than assume that folks want to read a really long email about my experiences when I send it to them, I'll have a blog that folks can peruse (or not) at their leisure. One requirement for my thesis is that I keep a "reflective journal", ahhh. This is the kind of thing that my parents enjoy reading and therefore, in the event that my computer is stolen or carried away by a hurricane (June-September = hurricane season in the Dominican Republic), at least my musings will have been kept safely on line in a place called blogspot.What is this all about? Over the past several months, I've dreamed, developed and sweat over a research project at the Yale School of Nursing. I applied for and received a research grant and a generous fellowship from the Yale School of Medicine that will fund this endeavour. Now, well, about a week from now, I'll be on my way to the Dominican Republic to carry out this study, deliver some babies, learn some Spanish, and try my hand at research. For details of the project, please see the next post, it's what I call my one-pager. A one-page description of my study that takes me to the island of Hispaniola. I welcome questions, comments, and well wishes. Off I go!

Study description

2008-05-22T03:39:00.000+10:00

Yale University School of Nursing
Pica Practices Among Parous Haitian Women
Principle investigator: Jessica - Masters of Science in Nursing (Midwifery) candidate '09

In its 2006 report outlining Millennium Development Goals, the United Nations calls for a 75% reduction in maternal mortality by 2015. The leading cause of maternal mortality worldwide is maternal hemorrhage and one of the highest maternal mortality rates in the western hemisphere befalls Haitian women. One study reports that obstetrical causes of death are second only to death caused by HIV/AIDS among Haitian women between the ages of 15-49. Efforts to reduce maternal mortality have focused on intrapartum factors but 75% of risk factors for adverse delivery outcome can be identified in the antepartum period. This study examines one behavior that is linked to adverse birth outcomes: pica.
Pica is the practice of eating non-nutritive substances like clay, starch, ice, or freezer frost. This phenomenon sometimes occurs during pregnancy and usually spontaneously resolves in the early postpartum period. Since few clinicians routinely screen for it the practice of pica is underreported and underdiagnosed but it is estimated that between 14-73% of pregnant women experience pica at some time during pregnancy. Screening for pica should be considered essential because this practice is associated with trace element deficiency, iron deficiency anemia, lead poisoning, and parasitic infections. Although pica is not bound by culture, race, or socioeconomic status, it is often seen at the intersection of poverty, malnutrition, and culture and is widely observed in women of African descent and in other cultural clusters such as Native Americans.
Research shows an increased prevalence of pica among women with low hemoglobin levels. Lower than normal hemoglobin (termed “borderline anemia”) at time of delivery is associated with an increased risk of postpartum hemorrhage. Therefore, it is plausible that recognition and treatment of pica with trace element replacement, supported by patient and provider education about pica and anemia, could reduce the incidence of postpartum hemorrhage due to anemia globally and bring us closer to achieving the Millennium Development Goal target.
This study will establish the prevalence of pica among parous (pregnant and non-pregnant but having carried at least one pregnancy to term) Haitian women living near La Romana, Domincan Republic. Of particular interest are the substances ingested, the quantity and frequency of ingestion, and cultural beliefs/influences surrounding the practice. Other variables to be evaluated include gravidity, parity, pica with previous pregnancies, diet/starvation, and cultural norms relating to pica and pregnancy.
By way of a theoretical underpinning, Icek Azjen’s Theory of Planned Behavior guides this analysis. This theory suggests that intentions to perform a behavior can be predicted by three factors: attitudes toward the behavior, subjective norms, and perceived behavioral control. Deskins et al. utilized this model to describe barriers to participation in cholesterol screening programs in Appalachia. After screening for pica. A questionnaire will be administered illicit information about participants experiences with pica. The researcher will perform a fingerstick hemoglobin on participants to discover if an association between pica and low hemoglobin, as documented in the literature, exists in this population. Qualitative data analysis will be done through constant comparison and coding of themes. Chi square will be used to estimate the prevalence of pica in this population.