The Rhythm of New Beginnings
We are sharing a series of journal entries that the author, JH, contributed following an invitation from Insight Myanmar for publication on our website. She includes the following message: The following entries from my journal along the Burma-Thai border were first shared more than 18 years ago. On the advice of a respected teacher, they were distributed only on paper, so as to protect involved parties while raising awareness. Later, when the Internet became available, many of us still hoped in our hearts that these descriptions would soon become obsolete. Finally, I offer these words here in realizing that certain details remain far too accurate. May they bring benefit. Please forgive my youthful ignorance and arrogance. Errors are my own.
“Rarely have I felt myself such an intimately integral component of the more-encompassing organism. If you’ve ever rowed a crew boat of eight, it’s like that, only the effort is of pure love.”
Burma Border Journals #8
My first morning in the Delivery Room was a Monday, not an auspicious day to take birth, as understood by some English-speaking visitor translating from the S’gaw Karen explanation via Burmese. At 09:03 the first baby came, crowning efficiently, nuchal cord adeptly clamped, cut, and unwound by astute refugees. Blue all over but vigorously rubbed between the clavicles until announcing her arrival in full voice, she turned pink.
The second baby, occiput posterior, had taken all night for the sweet primigravida whose mother held her from behind. Lucky to have a mother or any family at all. The woman was exhausted but fetal heart sounds by ancient wooden fetoscope were overall reassuring. The main female medic made this incredible humming sound, sort of high-b-flat-ish monotone, as each contraction signaled time to push. The mother found a second wind as I too felt the noise enter my body, turning my every molecule to action. Breathing changed in anticipation. Another attendant rubbed ice along the portion of the perineum most prone to tears. Evidently an Austrian obstetrician taught them to do this in order to reduce cervical swelling, and then later a German doctor endorsed the technique for relaxing the underlying musculature and thereby reducing skin tension. It did seem to offer analgesia and at least in this sample size of one, the theory about deep tissue sequelae was not disproven. We all joked around during the lulls nature provides in such work, yet when the next wave arose we moved in unison. Rarely have I felt myself such an intimately integral component of the more-encompassing organism. If you’ve ever rowed a crew boat of eight, it’s like that, only the effort is of pure love.
There was no cephalohematoma, though considerable head molding, but the pale-faced neonate sort of held his eyes open wide and didn’t quite know why a breast was being shoved in his direction. We gave him a tiny nasal canula and warmed him snuggly. Because he would not latch, we loaded a syringe with milk mom expressed into one of those spoons we Westerners use only for eating Chinese noodle soup. Nothing. I washed my hands and inserted a pinky finger up under his small palate. The whole room full of new mothers and sick expecting moms looked on with tenderness. He gave three half-hearted suckle attempts and gradually practiced the motion while we started to relax. Once again the whole female entity rooted in favor of his little life. Assured of an ultimately happy outcome for that boy, we went to one of two food stands outside the compound for lunch, coming back to find a third delivery had occurred entirely without complication.
As it turns out, children here are not named immediately. Various reasons were given when I asked why. One Christian Pwo Karen medic simply said “must wait seven day.” The educated Burman Buddhist explained that the womb is not pure and its influence continues to cloud the new body for around one week. Thus, the new being only fully occupies his or her new vessel when it has had adequate time to sort of outgas all traces of that which bore it. Then the family intuits a name directly from the child. This process involves ceremony and cleansing with specially prepared water. The story brought to mind a woman I met two weeks back. She was in labor, having already birthed three girls. During her husband’s recent death one of his last requests was that she bear him a boy. It didn’t turn out that way. She got another girl, but what I think of is that one of the daughters accompanying her that day was called “Smells nice, smells nice, bright light.” She really did, and she really was. Another girl I’m working with this week, her name sounds like July, as in the month of. It refers to a beautiful yellow flower that grows in the jungles of Eastern Burma. One doesn’t even have to squint to see the resemblance. How lovely to speak her language and to see each person as appreciated through the eyes of those most beloved within a week of emergence. Yet another tradition offered an explanation that involved waiting for or the availability of some revered elder who then gives the name in blessing. How would it be to grow up knowing this honored person had traveled from some far off village to give you this gift of a name, sanctifying your particular life with every utterance?
It seems the waiting to name is neither ethnicity- nor religion-specific. There is a quiet honoring of life’s tides, as in the tradition of dining in silence. Not only does the measurement of time differ here; so do the meanings with which it is imbued. The eight weekdays make reference to Buddha as well as to a Hindu god. The Buddhist regions of Burma use lunar months instead of the solar-referenced names with which foreigners tend to be more familiar. The span and dates of the two systems do not correspond; so, they add a month every few years for alignment. Holidays are described such as that occurring on the “fifteenth day of the waxing moon in the sixth lunar cycle.” According to my Lonely Planet travel guide, various kings gone by have chosen how to count the accumulation of years. The system in current use requires the addition of 638 years in order to add up to 2006 AD. There also seems to be a different way of attributing age to people, but those I ask either don’t know, don’t tell, or don’t understand the question.
Today, the delivery room proved a bit more exciting, not that smooth deliveries aren’t worthy of full attention, but things got necessarily more serious this afternoon. One multiparous and rather heavy woman, which constitutes a peculiarity for a people whose migrants work hard twelve hours seven days per week just to eat, presented in labor with a smear positive for P. falciparum trophozoites (PFT+). She was febrile, and upon rupture of membranes, thick, brownish-maroon fluid oozed out. This is in contrast to the expected gush of clear liquid. We speculated about endometritis. The labor progressed quickly to a healthy child, but she bled afterward, passing 100 cc of old clots. With firm fundal massage, IV hydration, as well as the administration of Oxytocin, hemodynamic stability was achieved, just in time for us to note arrest of labor in the second stage in the woman to her right.
The medic on shift expertly called the shots up to episiotomy and one attempt at vacuum extraction. The baby was just lodged in there, but finally with the consultation and assistance of a guest physician, she was delivered. The new mother had a small vagina that ruptured almost up to the cervix as the head was pulled through, including a tear in the external anal sphincter. The repair of this third-degree laceration went smoothly; mother and child then rested comfortably without further incident. I have also seen meconium aspiration and shoulder dystocia handled in a manner consistent with my Western training. Remember these are non- nurse, non-physician refugees doing the work. The RH department is lucky to have a donated ultrasound machine; so, those with concerning scans and also all those requiring Caesarian sections, such as patients with prior vertical incisions making Vaginal Birth After C-section (VBAC) more risky, are referred to the Thai hospital. Just about the only thing that differed from my prior childbirth experiences in fancy hospitals was what happened when a woman’s sarong got bloodied and being accustomed to giving birth at home where spare clothes are readily available she hadn’t brought a clean one. Or more likely, she no longer had a home and no clothes but those on her person. The female medic simply went to her old, pedal-powered Singer in the lunchroom and sewed the patient a new skirt.
The clinic offers ante-natal and post-partum care as well as compulsory and confidential HIV testing in pregnancy. Seropositivity has been rumored to be as high as 20%. Vectors include the drug trade that funds the Burmese government, both heroin for its needle use and Ya Ba or amphetamine in that it reduces inhibition, and the sex trade, often manifesting in monogamous women who catch the virus from their husbands. Women seen in the RH Outpatient (OPD) or RH Inpatient (IPD) departments are also offered family planning services. The forty-two-year- old gravida eight not yet perimenopausal illustrates a typical case. She responded to the idea of conception as a choice with curiosity, having had no idea that pregnancy was any more predictable than roulette. Incredulous, she nonetheless expressed interest, and wanted to confer with her husband inviting him into the discussion.
May this writing heighten awareness about the plight and great beauty of the people from all parts once called Burma. May it bring benefit to all who are described herein and to all who read it. May you be truly happy.