Pyrrhic Victory

Last night I attended my last birth for a long time, unless one of my special people asks me over to attend her birth - and you know who you are my loves!

I was working in my capacity as a doula - to my utmost capacity - I calmly stood by while the staff dickered around about whether the meconium was thick or light. I kept a grin off my face when the young medical student estimated that the birthing woman, who was clearly very close to pushing, was "progressing nicely" at six centimeters, and I kept calm when five minutes later she started pushing in earnest. I kept the worried look off my face when it appeared that there might be an abruption, and I supported the nurse while she tried to do her job.

I supported the woman, I supported her husband and her mother. I kept my face devoid of grumpy callouts when staff acted unprofessionally. I pandered to the two young doctors, and praised the Big Doctor Man when my client asked me, in front of him, if he was "good". In short, I brown-nosed the way doulas learn to do in our maternity care system.

The doula's job is to support the birthing family, to bring love into the birthing room, to create a safe space.

So imagine my conundrum when the nurse asked my client if she agreed to erythromycin ointment for the baby's eyes. My client didn't know what to say, so she turned to me for support.
I had to think quickly. I could site the most recent statement by the Canadian Pediatric Society, (http://www.cps.ca/en/documents/position/ophthalmia-neonatorum), which suggests eliminating the practice of universal antibiotic prophylaxis for neonatal eye infections (most dangerously caused by gonorrhea or chlamydia), or I could avoid looking like a know-it-all and making the doctor feel like a fool, and simply use a tactic that I had seen him use a few years ago (something about his wife, can't remember the details).

What to do? Think fast! It's three am and your client wants an answer. She then asked me "Did you give it to your kids?".  An honest answer - yes, I did.

Pipes up the honourable physician, to the effect that my client shouldn't be so stupid as to agree to an intervention just because "someone" had it done to her kids, but rather should have it done because "doctors advise it". Um. We were all rendered rather voiceless. Then, again, Dr. A. pipes up: "Will you vaccinate your child?" My client answers that, yes, of course she will.

Intimation being that I wouldn't vaccinate my kids, and would advise my clients not to. So rude! So judgemental! So many unfounded assumptions! So disrespectful of the birth room!

It makes me sad that people that are supposed to be practicing good medicine, and good science, are practicing mediocre medicine, not reading the literature, and showing off their skills at making an older woman feel like shit at three in the morning. Bravo! Physician, heal thyself!

 

Brutal Births for Asylum Seekers

Yes, as if it wasn't bad enough leaving Mosul, Aleppo, Damascus or any other not so well-known  place where war killed thousands and maimed more (have a peek here to get a sense of the immensity of the crisis), yes if that wasn't bad enough, if it wasn't bad enough to flee - to have to flee, leaving a normal life - the kind of life you and I lead - with phones and laptops and going out to eat and new clothes and a job and a house and cool stuff and a country you love or you love to complain about -if it wasn't bad enough to run through a country you didn't recognize, and maybe get caught by the police, or maybe your brother gets caught and he throws you his child - and you keep running - and then if it wasn't bad enough to have to live in a tent, when you're pregnant and having to pee all the time, and your sister is in Turkey and you are worried about her, and its your first baby and you don't know anything about having a baby because you were studying finance in University before all this shit started - and if it wasn't bad enough to get a call at midnight from the UNHCR telling you to pack your stuff because you're being relocated tomorrow, so any friends you had you can only communicate by Whats App because no one can get around much - and if it wasn't bad enough that you packed all your stuff in one nylon bag, and your belly is hurting and you don't know why, and you are moved to a hotel past the airport, and there is an abusive helper man there but you can't tell anyone, and if it wasn't bad enough to be living in a hotel, with no chance to cook so you want to be back living in a tent in a warehouse ....

Then you may be in labor but you don't really know - and who has ever been pregnant for the first time knows how this feels - and of course we get calls all the time when people think they're in labor and they just need some love and reassurance and they usually go back to sleep, unless they really are in labor in which case we go to be with them.

But in any case, there's no one to call, and you're frightened for the baby, so you call an ambulance. And indeed you're not in labor, but its kind of around your due date, and your baby's big according to the ultrasound, so you have a c-section. Alone, because husbands aren't allowed in, and because you don't have a doula, and because just because. Your life just gets more and more painful, and the blood is awful, and the people speaking Greek to you, loudly so you understand, but you don’t understand anything – not why you had to leave, why you are running, why you can’t just go to Switzerland where your brother is, why you are having your baby cut out of you instead of how normal people have their babies … it is awful, and you think about your friend a few years ago, she had a baby. She had it in the hospital, back home in Syria, she said it was painful but nothing you couldn’t do with just a little encouragement. Her older sister went with her, and she had a nice doctor.

Cesarean section rates are ridiculously high in Greece, much higher than the recommended 15% that the WHO suggests is a rate that both protects mothers and babies, and higher than the rate was in Syria before the war (see Syrian c-section rates here). Our average in Canada is around 25%. That’s one in four babies born – but those figures vary widely across the country and across socio-economic lines. More wealthy and educated people in Canada are now working hard to have a vaginal birth, and of course the possibility of midwifery care greatly increases your chance of having your baby vaginally. My private doula clients have generally had rates of c-section varying from 6 to 15 %. The volunteer doula program I led for many years served marginalized families in Montreal, and our c-section rates were high – up to 35%. I am extrapolating from my figures and from what I heard from the mothers I met, and I suggest that from a Greek 60% it may go up to closer to 90% for asylum seekers, in a rural hospital next to a refugee camp.

If you are an asylum seeker in Greece, you are at the mercy of spotty health care, and that care is embedded in a system that doesn’t work! The medical NGOs are doing their best - Medecins du Monde, Medecins Sans Frontiers, SAM, Rowing Together ... but prenatal care is patchy. And there isn't the kind of continuity that always makes a difference. Frequent ultrasounds are the norm, instead of quality week-by-week prenatal care. Logistically, it’s easier to plan an induction or a c-section than to have a laboring woman transferred by … by what? Taxi? Ambulance? Someone’s private car?  … at 3 in the morning if she goes into labor and has been relocated to the back of beyond? So she gets the call from her doctor, or a doctor who comes to the hotel or the camp, and off she goes.

The word is, that doulas aren’t allowed in the hospitals, but I don’t believe it. I believe a friendly, smiling face accompanying a laboring mother will be welcomed by the hospital, especially if that mother starts screaming the doula’s name when she is separated (sorry, yes, I have done this). I want to change things around for these mothers, and provide them with caring companions who will be with them through thick and thin. Even if they don’t get to go into the labor room, even if a mother does end up having a surgical birth, a smiling face at the end of that tunnel is a life-changer.

I’m not big on bureaucracy, protocols, rules. I believe kindness, unconditional love, and a little who-gives-a-shit attitude can go a long way. I am determined to change some peoples’ lives for the better, starting with their birth day.

Who’s with me? Please let me know if you would like to be part of my dream: leave me a comment and I will reply as soon as I can, or join my group on Facebook: Birth Companions International.

Volunteer Conspiracy: making a difference?

I arrived in Thessaloniki to a huge mess. The snow was only about a foot high, but the city was completely paralyzed. And people living in tents or warehouses were suffering, of course, not only from extreme cold but because we couldn't get there to do our work, for about two days. On the third day, the one car we had that was functioning (mine, because I had wisely left it at the bottom of the hill).

We schlepped out to the camp, bearing supplementary food packs (for pregnant, breastfeeding mums or children under two), diapers, and smiles. Our smiles probably looked a bit grim by the time we arrived because on the way, our chains fell off the front tire so we had a little crisis.

The second night I was there, my glasses broke but they were effectively fixed with white electrical tape so I have looked like a bag lady during this whole time, which probably increases my approachability.

We arrived to the news/rumour that the UNCHR was closing the camps, and they started by removing the vulnerable people, including families with pregnant women, babies or children under two. This made the volunteers' jobs much more difficult because we did not know where everyone was, and we did not have "official permission" to visit some of the hotels that people had been relocated to. Apparently. 

More volunteers kept arriving. The apartment became full of wonderful people, all willing and able to lend a hand where it was needed. I lived with thirteen volunteers at different times during my stay in Thessaloniki and worked with six coordinators of various types.

I would like to share with you what I have seen about the people who give up their jobs, family responsibilities, lives and lovers, homes - for even as short a time as two weeks - to live in a crowded, cold, disorganized small apartment with many other people - just so that they can provide support, care and whatever is needed to the people who are stuck here in Greece after fleeing incomprehensible violence and terror.

I met three other women from Canada. Yay Canadians! I love us for our toughness, kindness, "can do!" attitude, knowledge of chains and snow, sense of humour, sense of responsibility ... political savvy.... 

I met two women from America. One from Portugal, two from Spain, one from Wales, seven from England, and more from Italy, France, and Bahrain...

They brought skills! Knowledge of breastfeeding, midwifery, the art of being a doula (the most valuable skill!), women's health, massage, yoga, Arabic, ... they were dedicated. They were authentic. They were sensitive. 

One was a young soul who loved everyone and everything. She brought joy to everyone she met. One was a wise woman who brought peace. One was a chemist who never complained. One Canadian got grease up to her elbows trying to fix the chains in freezing winds on a Greek highway. One was a firefighter, her friend was a midwife - their friendship made us all feel hope in the world. One was 17 days older than me. Two are from another world, a world full of love, kindness, and amazing food. One is an unbelievable organizer, and makes everything better.... one does African dancing on the balcony... 

We got along! We didn't fight! We cooked together, and cleaned sometimes (sorry Molly) ... I think I was probably the biggest bitch there because I can be an awful bitch. But generally, we laughed, we knit, we took care of each other, we listened.

In the end, it wasn't enough. I have a dream. My dream is just starting to become a reality, and I am gestating it. Many of you know me as a person who gets things done. I am going to get this done. 

Volunteer Reality Check.

Today was my last day visiting the camps. One of them is officially closing next week. There are around fifty people left. Most of the residents have been relocated to hotels or rented apartments, where they suffer isolation from the community within the camp but of course appreciate the conveniences of modern life that they were used to before the war.

I am going to Athens tomorrow and while I'm there I'll be visiting someone who was relocated there from the north who has a newborn, and I'll be visiting the Amurtel centre for mothers and babies.

In the meantime, I am left with a feeling of not having done nearly enough - which I know is a normal response to a crisis as big and as ugly as this one. So what did I actually do, people? I gave out a lot of food packs and diapers. I met with women who were breastfeeding, and tried to encourage them. I weighed babies. I listened to fetal heart rates and reassured pregnant women. I sat and conversed with a lot of people, using sign language and Google translate. I made a difference for a few people I met. I provided continuous prenatal care for a couple of women. Oh, and yesterday I met with a woman who really wanted a nightgown to wear after she gave birth, so we went shopping. We bought a couple of pyjama sets and a few other bits and bobs. It was fun, and gave her a lot of pleasure. Instead of being given something that was old and probably the wrong size, she chose what she wanted and although I paid, I could have been her mother, so it didn't seem so bad.

The maternity care system here is brutal and backwards. Arabic or Kurdish speaking women go into the hospital and often are not allowed to bring anyone in with them. Cesarean section rate is ridiculous.

Will talk more about that in a future post, and about what I am going to do about it, with YOUR help.

But for now, I am just devastated by the level of disorganization and egotism that is apparently rampant amongst the organizations that are here to provide care. The disorganization starts at the top, to wit a screaming match between the UNHCR officials and the military about what day the camp would close.

I understand, I do. We are talking about tens of thousands of people, no money, closed borders, an infrastructure that is on its knees, yes I understand.

But I've heard stories, consistent ones, about disorganization and chaos reigning supreme in the smaller organizations as well, and that, to me, is unacceptable. Are you proud that your organization has 50 volunteers? Because it makes you look like a saviour? Even if each volunteer hands one banana to a refugee every day? And the so-called refugees don't want your crummy banana anyway?

I know what the women and families I met wanted from me. They wanted me to provide good, quality midwifery care. They wanted to see me every week. They wanted me to be able to visit them wherever they lived, whether or not my organization had permission. They wanted me to help them have the baby, to be with them in labor and birth. They wanted care that was not judgemental, no rolling of the eyes when they mentioned circumcising their baby boys.

So, people, I'm working on it. I have a plan. Please keep on supporting me, I'm going to tell you about my plan soon soon. Inshallah.

In the meanwhile, here are some images from the past few weeks that will give you a sense of what I've been seeing.

I'm With Syria

Home for many until Jan 2017

No diaper donations needed!

Warehouse of donated stuff

Look Closely

Handprints on the wall

View of the camp

MotherBaby Tent

School and Playing Field at Camp

Elpida - Charter School of Refugee Camps

Fireside seating

Thanks to Zed

My gratitude alphabet is coming to an end. It started last year when I wrenched my back carrying too many packages over the slippery icy sidewalk, and I was angry at the world. A friend suggested I start a gratitude process to help my back. The back was sorted within a week but my alphabet continued.

Today I am grateful for endings. I'm happy that life is full of changes, and that I have had a pretty amazing ride so far. But I know I wouldn't be where I am today if I hadn't given up on some big projects that I've loved in the past.

But, as always, endings are always embedded in beginnings and vice versa. And I am very, very grateful that some things in my life have remained constant and steady.

If I hadn't moved forward and stepped down from leading MBC, I wouldn't have had the time to do some of the interesting projects I've been able to participate in since the summer: being more involved in my cafe, running more (I say this in a guilty voice because I haven't run much here in Greece), coming to Greece to lend a hand with the asylum seekers here, and stuff like that...

So now what?

Just joking with my co-volunteers about the ending of my gratefulness alphabet - now I can be an absolute asshole for the rest of my life! No, endings aren't like that, actually. Stuff just seems to go on forever, really. I mean, there are always ripples from past experiences and actions. And even when the real ending happens, when someone dies, of course we have memories of that person.

So my time in Greece is almost over for now and I am filled with different emotions: sadness, gratefulness, love, disgust, regret, joy, anger... and my alphabet continues.

Day by Day

"So what are you actually DOING over there? It's amazing you're there, but..."

A valid question. Some days I feel I am not doing anything at all. One of the first days I was here, my glasses broke (actually snapped!) and I haven't been able to replace them here, so I am feeling a little self-conscious.

What am I actually doing here in northern Greece, supposedly volunteering with refugees? First of all, most of the people moving through Greece in the hope of finding a country that will accept them are not official "refugees", but rather "asylum seekers".  This term seems even more precarious to me, and pretty much appears to be someone who has very few of the rights we take for granted.

I live in a small apartment with nine other women. Actually, eleven. Or is it ten? The numbers change all the time. Most of us are volunteers, but some of us are coordinating this huge venture we are involved in.

In the evening, we make bags of supplies for the mothers we are seeing the following day. Food, diapers, and newborn packs for the very pregnant mothers.

In the morning, we leave the apartment and go to visit mothers - either pregnant women, breastfeeding, or both, or women with children under two. Our mandate is to be sure that mothers are effectively feeding their babies. That's the simple story.

What's the rest of the story? What am I doing? I am providing prenatal care, sometimes. I'm weighing babies. I'm giving breastfeeding information and support. I'm looking at various people's ailments. I drive a lot.

I drive a lot because the people that were located in the camps have been relocated by the UNHCR to hotels and apartment buildings all over Greece. The motive was great: it has been very cold here and people were freezing.

Lovely olive tress, but if you were a city person, from a beautiful big old city like Damascus or Aleppo, how would you want to be relocated to a hotel here in the middle of nowhere, away from any community that you had formerly created in the camp - even though the camp is horrible - and possibly away from the people in your family? It's such a difficult situation - and every single person involved is doing the very best they can possibly do. I went to a building today where some families had been settled. A few days ago, it was a mud pool. Today, there were walkways set up with scaffolding, and a gravel road was being put down.

I spend some of my time in camps. These are housed in abandoned warehouses, with rows and rows of tents inside them. Heating, electricity and wifi are provided. Many dedicated volunteers help to provide health care, activities for the children, food, clothing and support for the people living there.

There are two interesting housing projects I have visited. One of them has been made real by a group of people from the UK, who have bought an apartment complex and created a space for families to live. They have named their project "Filoxenia", which means "generosity of spirit". This is a new project and is constantly changing and growing, which houses mostly young families and their children.

The least depressing place I have visited is called "Elpida". This is an abandoned factory that was bought by two philanthropists from North America (an American and a Canadian). It has been rebuilt to house families, and many volunteers help to create community by providing health care, education, activities, communal spaces and a place to belong.

http://togetherforbetterdays.org/elpida/
http://radcliffefoundation.org/project/elpida-home/
https://www.facebook.com/elpidafactory/

But let's remember that all of these great initiatives are just band-aid measures, and the real answers lie with the governments that need to decide what to do about this huge crisis. Every single person I have met, from the lovely young woman who bathes babies to the very young mother living in a hotel with her tiny baby, to the important military-looking people at the camps, they are all doing their best. Tomorrow, I'll be going to a camp and then visiting a pregnant mother who has been relocated to a beautiful apartment she shares with ten other people, who told me that she will be moved again within the month.

I hope I can make a little difference to someone.

Imagine

Imagine you're a professional with a pregnant wife, children and your mother, and you find yourself running through a foreign country, getting captured, and being sent back to where you started from,

which is also a foreign country.

Imagine you're a barber and you finally find yourself in a community, even though its made of tents in a factory, so you set up your barbershop, and then you have to close because everyone is being relocated.

Imagine you have five children under six and you are living in a tent and you're the only adult because the other adults fleeing with you ended up in different places, and a volunteer from elsewhere comes and sets up a tent with a heater and warm water and bathtubs.

Imagine you have to leave your home, your country which isn't perfect but at least it's your country, and you don't think you can ever go back because it's been destroyed so completely, and you know a lot of people think you're a terrorist but all you really want to do is have babies, have a big house with a garden, get a job, maybe have a dog, and eat well.

Imagine - yes, you! Imagine you had to move from your nice arm house into a tent in a warehouse. Imagine when you get up to pee in the night you had to go outside, here:

Imagine you love to create good food, and you can do it anywhere, even in a refugee camp.

Imagine your heart got broken every few minutes and then fixed again and then broken again and then fixed again. This is what it's like. I am hearing terrible, awful stories. I attend lovely pregnant mums and see beautiful newborns and young children. I see the look on a teenager's face when she hears her baby's heartbeat for the first time. I see regular people leaving their jobs and families to come and help out for a week or two, or a month or two. I see pictures of untold horror. I see the love in peoples' hearts.