It's hard to believe it was just a few weeks ago that I spent Rosh Hashanah with the Jewish community near Mbale. It is not only that they took care of me seven years ago when I had malaria. In many ways an egalitarian synagogue where Hebrew is sung with an African beat feels like home. There has been a request made by the community for a birth center, so after services the rabbi’s wife gathers some of the women for me to hear directly from them about their healthcare needs. We sit in a circle on the freshly cut grass under a generous mango tree. The women are wearing their most colorful dresses. After short introductions we go around and each woman shares the need and recounts the price she has already paid for lack of access to safe and gentle maternity care.
“In our new birth center we want to have midwives who will be nice to us, they should not beat us and should not abuse us”; the women all nod in agreement. “We want the place to be clean! See, when you go to the government hospital the midwives will not allow you to use the latrine, in case your baby falls out there. So if you are not yet pushing they ignore you. And by the time you want to push four or five woman have pooped and bled and delivered on your same bed where you are now pushing.”
"There is this injection they can give and it stops your bleeding, it's supposed to be free but if you cannot pay for it they leave you to bleed to death". – "They send you home right away and tell you to come back if you have a complication, but our women don't have money for transport and many of them just die at home, or the baby does”. – "and if you happen to deliver at home because you didn't have time to get there from far away, they look at you very badly". – "There should be warm tea” says the rabbi's wife, “women after birth need warmth, that even helps with those after-pains, and there has to be a doctor and theater available in case something goes wrong. You know my daughter? She was supposed to have a twin brother. She was born at home but he was stuck. We went to the hospital at night but the doctor was not around, I don't know whether he was drunk. By the time they found him in the morning, that baby boy was already dead".
"If you can't afford the plastic bedsheet and cotton and pads and all those supplies, you shouldn't be turned away!" – "and our girls need pads too, because when they don't have they miss school". "And what about birth control?" says a woman who has not yet shared. – "You go for it and they don't have any or they give you some that expired and doesn't work and you end up pregnant again”. The conversation steers away for a while to the topic of birth control side effects. “Is it true that it makes your womb weak?" – "Does it take away your sex drive?" After some excited discussions they get back to the birth center. "We don't need a fancy building, if the place can be clean and the midwives do not beat us, and are nice to us, and let us birth the way we want” one says, demonstrating a squat, "then that place will be very busy quite fast and will save so many lives".
With October being so intense at the birth center that is already saving so many lives I am thankful that I decided to take a few extra days after the holiday to spend time and see some of the beauty that exists alongside so much violence. The healing capacity of nature is an important part of the vision we hold for the land where women heal that we are working to create. It now feels clearer than ever that our current project in Israel is only the first of many sanctuaries of women's healing and wisdom, so urgently needed in Uganda and around the world. I let my heart fill with images of giraffes in the wild, the presence of a mother and baby elephant, a lioness, the strength of the river Nile and the playfulness of chimpanzees.
As I approach Kampala I get a message from my friend Laura. We met seven years ago in Luwero when she was a young medical student who came to spend her term break at the maternity ward where her brother was the doctor and I was a volunteer midwife. Her first shift in the labor ward there were two mamas pushing side by side. Both babies ended up as still births. I remember looking at Laura and not knowing how she would ever not fear birth.
Now, as she is texting me she is in labor! Where are you? I ask, knowing she lives very far away now, all the way by the border with Kenya. "I'm in Kampala" her text announces, after a few minutes when the network was down. I reach her when she is at seven centimeters, she is in the middle of a contraction when I walk in to her birth room, she grabs my hand and squeezes through the pain. We haven't seen each other in seven years. Even though she can afford a private birth room in a private hospital; even though she is a doctor now - little tenderness is available on the metal bed with her legs tied up in stirrups.
While I'm in Kampala I teach a class for the very inspiring GirlUp team. This NGO was started by another one of my friends from seven years ago, Monique. This incredible woman has since completed a masters degree in gender studies. We became friends after I heard her tell the story of her friend almost losing her life after an illegal abortion. The team consists of men and women social workers who are promoting girls' health and adolescence sex education. With a team so passionate about their work and with juicy topics like consent, cross-cultural sex practices, tips for menstrual cramps, natural versus medicalized birth… We talk about the myth that sex should hurt especially the first time, and why it shouldn't, above all if the heart and the womb and the head and the vagina all say yes, and there is proper stimulation at which point I give a little anatomy lesson introducing the clitoris, and there's proper lubrication and no infection…the workshop doesn't want to end. They keep coming up with more and more wonderful questions, and I am reminded of how much I love teaching. To conclude the workshop I ask if they would each share one thing they have learned. Two comments in particular bring tears to my eyes.
One young woman who asked me if it was normal to bleed twice a month was so relieved to hear my explanation, it was clear she was asking about herself. A colander month can be 30 or 31 days, so if your cycle is 28 days long it can be very normal to bleed "twice a month"… If a social worker involved in health promotion for adolescent girls is walking around with the fear that her cycle is abnormal, just imagine how important it is to create safe spaces where questions can be asked. That's why I always take time in the beginning of a class or workshop to establish safe space. The second comment comes from a young man who says he wants to adopt my suggestion that when a girl gets her first period she should receive a gift, maybe flowers. "From now on I want to do that for our girls, and one day that's what I'm going to do for my daughter."
After so many emergencies, it was good to be called to a home birth. I had met the mother the day I landed in Uganda, as I stopped to buy a local SIM card on my way from the airport to the remote location of the birth center. It was supposed to ensure I would be able to communicate and manage my NGO project from afar. In practice, like most things in Africa, communication turned out to be far more complicated. In line in front of me was a very pregnant American woman and her toddler who was running around her in circles. Considering that she looked like she might need a midwife soon enough, I introduced myself. "Oh", she said, "You are the one from Israel, I heard you were coming, I think you are my midwife". And that's how I found myself called to attend a home water birth in Gulu. For a moment after the baby came out into his mother's own hands I was worried why he looked so pale. Then I had to laugh as I reminded myself he was perfectly pink and healthy tor a muzungo baby.