Sunday Morning~ Blantyre

Sunday Morning~ Blantyre

March 12, 2017

Liwiro la mumchenga nkuyambira limodzi~ When racing in the sand, we must begin together.

Malawian Proverb

Hi Everyone,

I think I’ve told you this before, but when I was here in 1979 there were five million people in the country. Birth control was illegal; we couldn’t even mention it in public.  Sometimes men would ask me how I could “stay with Robinson every night and yet have no baby?” I didn’t know how to answer. Magic? Barren? One of the many blessings of having gotten pregnant while we lived here then was the speculation about “taking special mankwala (medicine) to prevent a baby” was eradicated. Finally, I was accepted as a real woman.

Back then, the President-For-Life made the rules and we never quite understood the rationale for banning contraception. We wondered if he thought his enemies might invade if they thought the population was limited? Since nearly half the children died before their fifth birthday, people thought they needed to have many children because they could only count on half of them surviving. Women had no say and no choice. The ban on birth control lifted with the AIDS crisis and the novel idea of democracy, but that wasn’t until the country couldn’t produce enough food to feed itself. The population is now nearly 17 million and many are hungry.

The roles here are still very traditional. It’s not as drastic as it was, but at church the men still sit on one side, the women the other. Some men come with their wives for prenatal care but I never see one in the delivery room. Never. They aren’t even in the waiting area. They just don’t come to the hospital at all. It’s always a female relative that accompanies a woman for childbirth. I see an occasional man with a child on his back in a chithenje, that’s new. Some men cook a little. More boys go to school than girls, but about twenty percent of the medical students are now female, so things are slowly changing. Glaciers now move way faster than progress toward gender equality around here.

When I was a young public health nurse up north, the majority of my time was spent working at what we called “under five clinics”. These were weekly clinics where we’d immunize kids, weigh them, and assess them for malnutrition and health problems. Adjacent to this was the antenatal clinic where the pregnant women would get care. It would take a couple of hours for the women and kids to arrive, having walked miles, and once a large crowd had gathered the health talk would begin.  The topics for these ranged from hygiene to nutrition and they always started with a song. The songs seemed to be well known as they all joined in robustly, usually one lead singer in the group chanting out a line and the other hundred women joining in the chorus.  I loved to listen to these songs; everyone sang so passionately. The health workers would be dancing and clapping and the women would be ululating and it all seemed so festive and joyous. It was like they were being reborn or singing for joy and then I’d find out the lyrics were things like, “It’s ok to eat eggs when you are pregnant. Eggs are good for you. There is nothing bad about eggs for the baby.” or “We only feed our child with a cup and spoon.” and it would just crack me up.

The fourth year students have begun their high-risk rotations and the group I am with are at a district hospital in Liwonde, two hours away.  I went out this week and spent a day with the ones in the high-risk antenatal ward. Most of the women who are there waiting for labor have either high blood pressure or a previous c-section scar. Those women are at risk for a uterine rupture if they labor too long so they go to the hospital and sit until labor starts. That eliminates having to either walk or find transport for the long journey. Some women are waiting there for months. The ward is one big room with no beds. The women lie on the floor all day. They have each other to talk to, but many seem bored and depressed. Tuesday I arrived in time to see the health talk and I was happy to see the students do a song with the women as well.  It was like the old days, one woman sang out a line and the others rebounded, though it didn’t seem as joyful as I remember. The students had planned a talk on nutrition, so I assumed the song was about that, too. Kulela ine kulela. Ana onsewa ndi khale  olela ine kulela. I asked what the lyrics meant and the students told me it was a song about contraception. The words were translated as “I’m raising children, I’m raising children. All these children–– should I be the one raising these children?”  This sounded more like a protest song than a health education one to me, but I guess, whatever works.  During the health interviews I was impressed that most women had a few years between their pregnancies, so I guess I’m not going to tell them what to sing about. Many of them had lost a child, either in childbirth or from malaria. Many were young. All of them had left their families to lie around on the cement floor for four or more weeks in order to have some kind of trained care during their labor and deliveries. I wondered how everyone got along without them at home. The maize is way over my head now so most of the hard field work is done, but still, it must be strange to leave home for so long. What choices they have to make. And then I thought, maybe this is a rest and relief for them, who knows? I’d love to be able to really communicate with them and just hang out among them for a few days. My Chichewa is coming along, but it’ll never be to the point where I can really communicate with someone from the village. And even if I could, our worlds are so different I might as well be from outer space. I tried to encourage the students to do that––spend time in there just hanging out and talking with them. Get their stories if even it’s just to have someone listen to her.

I felt like I found my groove again that day. I was able to give some feedback, made suggestions about how to elicit more information during the interview, discussed ways to date the pregnancy without an ultrasound or last menstrual period, and felt a little useful. When the students discussed contraception, many women said they wanted a method they could hide from their husbands. Often it’s the men who don’t want to limit their number of children. I understood the song a little better.

Days like that are good for me. I get along well with the students. Other days I feel like a privileged waste, wondering what good I’m doing. I look at the huge difference between the male and female lives here. They are all hard, but the women just have such a steep climb and most don’t even know there is a summit. It’s just slog uphill everyday of their lives. And the unfairness of our own society’s treatment of women makes me wonder who are we to talk? And this pathetic farce of a government we now have at home has no more integrity than any we feel so free to criticize. At the rate we’re going we could regress to the days when birth control will be illegal at home for God’s sake.  And then I think I am so much more privileged than the men are here. And white men are more privileged than me. It’s all so unfair. Yeah yeah yeah, you work hard and get ahead, but so much is just luck. What color is your skin? Like you’ve got bloody control over that.

I made it back from Liwonde in time to get to my Chichewa lesson. I was pretty tired and my brain was still pondering the unfairness of white privilege and then he gave us the proverb and I thought, damn! Yes! There is such poetic wisdom in this culture! Jameson explained that if anyone gets a head start when you are racing in the sand, the other will never catch up. It’s not a fair race. Everyone must start together if you are running in the sand. And I thought, that’s right. Will women here ever get a head start? Because everyone is running in the sand.

Love to all,