The Love Offer

Ann Davenport

 

“The Love Offer”

The  Love  Offer  

  I  remember  the  first  time  I  did  a  vaginal  exam  on  a  woman  in  labor  as  I  was  making  a   “house  call”  in  her  rural  western  Bolivian  village.  When  my  back  was  turned,  she  ran  out  the   door  and  hurried  up  the  hill  where  she  birthed  her  baby  in  a  cornfield.  As  a  midwife,  I  thought   my   responsibility   included   knowing   how   many   centimeters   she   was   dilated   and   if   I   had   time   to   “deliver”   the   baby.   This   was   her   seventh   baby.   She   didn’t   need   me   “telling”   her   when   it   was   “time”  to  give  birth.  Her  body  knew.  I  was  the  one  who  didn’t  know  anything.  Rural  mountain   women  are  petrified  with  shyness  about  their  bodies,  and  I  had  violated  her  privacy  in  a  way   that  shamed  her.  I  was  hired  to  “teach”,  but  I  had  so  much  to  learn.   Save   The   Children   had   hired   me   as   the   Midwife-­‐in-­‐residence   for   the   isolated,   rural   Bolivian  Andes  province  of  Inquisivi,  in  1991.  I  was  supposed  to  work  towards  “influencing  the   practices   of   the   traditional   birth   attendants   and   pregnant   women   concerning   prenatal   care,   birth  and  newborn  care”.  The  idea  was  to  somehow  impact  knowledge  and  attitudes,  to  lower   the   high   rates   of   maternal   and   infant   mortality.   It   was   impossible   for   me   to   know   all   the   pregnant  women  in  all  57  villages  of  this  province,  separated  by  several  mountain  ranges,  much   less   attend   their   births.     We   did   the   best   we   could   to   influence   healthy   conduct   by   giving   small   workshops  every  month  in  the  villages  for  the  women  and  their  husbands.  It  was  important  to   educate  the  husbands  because  they’re  the  ones  who  would  decide  to  seek  care  -­‐   or  not  -­‐   for   their  wives  in  case  of  an  emergency.  Most  didn’t  even  know  what  constituted  an  emergency.   How  much  blood  means  “hemorrhage”  during  childbirth?  How  do  you  determine  post  partum  

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Ann Davenport

“The Love Offer”

infection  if  you  don’t  know  the  symptoms?  And  where  does  one  access  emergency  health  care?   The  nearest  hospital  is  eight  hours  away  in  La  Paz  –  if  landslides  don’t  close  the  road  and  the   bus  happens  to  be  running  that  day.     The  ranges  of  the  Yungas  Mountains  in  central  Bolivia  are  spectacular  in  their  isolation   and   abundance   –   there   are   hundreds   of   rivers   and   canyons,   flocks   of   parrots,   bats   and   butterflies,   jaguar   and   bear,   lush   greenery   and   they’re   blessed   with   a   spring-­‐time   climate   all   year   around.     Mountain   natives   are   by   nature   recalcitrant,   clannish   people   in   all   countries.   These   folks   are   sociable   only   by   necessity,   due   to   their   poverty   and   isolation   –   they   have   “exchange  fairs”  once  a  week  to  barter  their  potatoes,  oranges,  piglets,  sheep  wool,  and  other   crops  for  shoes  brought  in  from  the  city,  bicycle  tires,  cotton  shirts,  kerosene  or  needles  and   thread.  People  prefer  to  high  live  up  in  the  mountains,  which  they  revere  in  their  cosmology  as   living   gods,   and   not   down   near   their   only   source   of   water   in   the   canyons.   If   a   family   has   a   little   adobe   home   in   a   village   down   in   the   valley,   it’s   because   they   probably   have   children   in   the   grade  school  there.  But  that  family  always  has  a  little  plot  of  land  with  a  small  hut  on  the  side  of   a  mountain  nearby.  It’s  very  important  to  connect  physically  with  the  earth,  up  as  high  as  you   can  go  toward  the  clouds  where  the  condors  fly.   After   living   in   the   village   of   Licoma   for   a   few   months,   I   was   surprised   and   delighted   when   34-­‐year-­‐old   Carmen   Quispe,   pregnant   with   her   tenth   baby,   walked   the   two   hours   downhill  from  her  mountain  home  to  visit  me  at  the  health  post,  accompanied  by  her  husband,   Juan.  He  had  attended  her  previous  nine  births  without  a  hitch,  but  wanted  to  meet  the  new   gringa   midwife.   He   had   heard   about   my   “healthy   mother/healthy   baby”   workshops   and  

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Ann Davenport

“The Love Offer”

thought  maybe  I  could  teach  him  something  “new”  for  the  birth  of  this  baby.  To  that  end,  he   brought  his  wife  in  for  her  first  prenatal  visit    -­‐  ever.  She  was  eight  months  pregnant.   As   far   as   her   general   health   was   concerned,   everything   seemed   fine.   She   was   short   and   slightly  built,  but  wiry  and  strong.  She  was  pale,  but  no  paler  than  most  malnourished  mountain   women.   I   chatted   with   them   for   some   time   about   the   risk   of   hemorrhage,   and   my   concern   reflected  their  own  when  I  suggested  that  maybe  ten  children  were  enough  for  one  uterus  to   handle.  I  asked  them  both  to  think  about  a  family  planning  method  after  this  birth.     Juan  seemed  interested  enough  to  ask  about  vasectomies.  He  had  Brazil  nut  brown  skin   with   thick,   calloused   farmers   hands,   as   did   his   wife.   They   were   poor   but   proud,   and   he   kept   fingering  the  brim  of  his  hat  he  held  while  talking  to  me  in  a  soft,  shy  voice.  They  touched  hands   quite  often,  which  was  an  unusual  gesture  of  affection  between  a  rural  husband  and  wife.   Despite  my  urgings,  Señora  Quispe  refused  to  come  down  from  her  mountaintop  home   and   stay   with   us   at   the   health   post   in   Licoma   for   a   few   days   prior   to   her   due   date,   to   give   birth   close   by   our   health   team.     She   preferred   her   own   home,   where   she'd   given   birth   nine   times   before.     “Please   send   someone   for   me   when   she   starts   labor,”   I   asked   Juan.   “I’d   be   happy   to   assist  you  and  Carmen  -­‐   free  of  charge!”  He  smiled  at  me,  to  be  polite.  Deep  lines  surrounded   his  brown   eyes   and   I  couldn’t   help   wondering   if   he   was   laughing   at   the   very   idea   of   me   helping   him  to  help  her  give  birth.  I  was  wondering  the  same  thing.     Three   weeks   later,   on   a   hot   summer   day,   our   rural   Save   The   Children   staff   was   meeting   with   the   directors   who   were   visiting   us   from   La   Paz   for   their   quarterly   statistical   reports   and  

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Ann Davenport

“The Love Offer”

recommendations.   We   all   had   a   hard   time   keeping   our   heads   upright   from   the   boring   presentations  and  the  heat,  although  the  flies  helped  us  from  falling  over  altogether.  Then  the   door   banged   open,   startling   all   of   us   wide   awake.   Carmen   and   Juan’s   12-­‐year-­‐old   son   ran   breathlessly  into  the  room,  shouting  to  me,  "Come  quick!  The  baby  is  not  coming  out,  and  papá   sent  me  to  fetch  you."     The   director’s   driver   from   La   Paz   jumped   up   and   said   he   would   take   the   boy   and   me   to   the  base  of  the  mountain  in  the  four-­‐wheel  drive.  He  knew  the  villages  well  and  knew  where  to   find  the  footpath  that  lead  up  to  the  village.  I  grabbed  my  “birth  bag”  from  my  room  on  the  way   out  of  town.    After  20  minutes  of  traversing  winding,  dusty  roads  along  the  edge  of  the  canyons,   we  parked  on  the  side  of  one  curve  and  saw  the  steep  footpath  above  us.  I  wondered  how  long   it  would  take  to  climb  up  to  their  mountain  community.     Forty-­‐five  minutes  later  and  out-­‐of-­‐breath,  we  heard  the  sobbing  wails  of  Juan  from   inside  a  house.  A  few  old  men  and  several  tired-­‐looking  women  with  small  children  attached   to  their  hips  had  gathered  around  and  were  sitting  on  the  ground  under  a  shady  fig  tree.  They   all  glanced  up  at  us,  but  no  one  said  a  word  or  even  pointed  out  which  of  the  small  adobe   huts  clustered  near  each  other  was  Juan  and  Carmen’s  house.  I  followed  the  crying.      

"What  happened?"  I  panted  upon  entering  the  dark  interior.  The  smell  of  blood  and  

human  sweat  was  overwhelming.  Wiping  away  tears,  the  husband  explained,  "My  wife  was  in   labor  all  night  and  this  morning.  The  baby  finally  came  out.  Then  she  looked  at  me  with  terror  in   her  eyes,  and  then  she  died!  Just  like  that!"  He  knelt  down  beside  his  wife,  who  was  on  a  faded  

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Ann Davenport

“The Love Offer”

wool  blanket  on  the  dirt  floor,  and  began  crying  again.  He  was  holding  her  hand  in  one  of  his   and  hiding  his  face  with  the  other.  I  was  breathless  all  over  again.   I  rumbled  through  my  birth  bag  to  find  a  stethoscope,  and  tried  to  think  of  what  could   have  caused  this  death.  Her  body  was  still  warm,  even  though  heartbeats  were  non-­‐existent.   What   happened?   This   was   my   first   experience   with   death   outside   a   hospital,   my   first   time   with   no  one  around  to  help  me  decide  what  to  do.  “Think,  think”,  I  said  to  myself,  “figure  out  what   caused  the  death.”  There  was  a  small  amount  of  blood  between  her  legs,  no  twin  still  inside  the   womb,   no   placenta   nearby.     Suddenly,   almost   an   afterthought,   I   remembered   that   Juan   had   said,  “The  baby  finally  came  out.”   "Where's  the  baby?  What  happened  to  the  baby?"  I  grabbed  his  shoulders  and  said  to   him.  He  couldn’t  even  speak,  just  pointed  to  the  other  side  of  the  room.  Over  there  in  a  dark   corner,  lying  naked  on  top  of  some  dried  sheep  skins,  with  the  umbilical  cord  neatly  tied,  was  a   barely  breathing,  fat  baby  boy.  He  was  still  wet,  and  cold  to  the  touch.   My  next  actions  were  a  reflex,  not  thinking,  just  panic-­‐driven.  I  grabbed  a  nearby  piece   of  cloth,  raced  outside  into  the  heat  of  that  summer  day,  and  roughly  rubbed  him  warm  and  dry   while  trying  to  stimulate  his  weak  little  heartbeats.  I  covered  his  wet  head  with  a  bit  of  old  T-­‐ shirt  I’d  found.  I  crossed  the  dirt  yard  over  to  a  silent  woman  sitting  nearby  who  was  breast-­‐ feeding  a  toddler.  She  had  her  dust-­‐filled  hair  in  braids  and  an  old,  faded,  blouse  open  to  her   daughter,  who  was  suckling  a  long  wrinkled  breast  while  staring  at  me.  I  told  this  mother  what  I   needed  to  do,  lifted  up  her  blouse,  shoved  the  toddler  out  of  the  way,  and  put  this  newborn  

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Ann Davenport

“The Love Offer”

next  to  her  bare  breast  for  skin-­‐to-­‐skin  contact.  She  held  the  baby  with  one  arm  and  had  her   other  around  her  daughter.  Both  were  wide-­‐eyed  and  speechless  at  my  intervention.   I  was  sweating,  shaking,  breathing  through  my  mouth  and  trying  to  explain,  in  Spanish,   "resuscitation  of  the  newborn”  to  the  20  or  so  villagers  who  were  sitting  in  the  dirt  patio  under   the  fig  tree.  Within  a  minute,  the  baby  started  crying  and  later  began  suckling  at  the  breast.  Ah!   That  miraculous  cry!  I  felt  tears  in  my  own  eyes  and  looked  over  at  the  driver  who  was  grinning.   Satisfied   that   I   had   just   saved   the   life   of   a   child   who   would   have   died,   I   sat   down   in   the   dirt  to  catch  my  breath  and  collect  my  thoughts.  I  was  smiling  and  pleased  with  my  self,  even   though   I   still   felt   shaky   inside.   The   fly-­‐killing   heat   was   relentless   as   I   looked   for   a   spot   in   the   shade   to   sit   with   the   rest   of   the   neighbors.   I   wondered   why   no   one   had   offered   a   tin   cup   of   water   to   me   or   the   driver   –   as   is   the   custom   when   an   outsider   comes   to   visit   the   village.   I   wondered  why  nobody  had  even  congratulated  us,  or  said  “thank  you”.     The  women  looked  down  at  their  bare  feet,  some  men  looked  me  in  the  eyes  and  didn’t   look  away,  didn’t  smile,  didn’t  nod  or  have  any  other  gesture  of  gratitude  or  even  contentment.   Was  I  the  only  one  who  felt  a  sense  of  accomplishment?  I  looked  over  at  the  driver,  who  had   returned  my  inquisitive  look  –  eyebrows  raised,  shoulders  up  and  mouth  turned  down  –  as  if  to   say  “I  don’t  know  what’s  going  on  here,  do  you?”   One  old  man  finally  voiced  what  all  the  others  were  apparently  thinking:  "Why  did  you   do  that,  doctora?  Who  will  feed  this  baby  now?  Who  will  take  this  baby  now  that  the  mother   has  died?  Will  you?  You  should  have  left  alone  what  nature  had  intended."  

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Ann Davenport

“The Love Offer”

Stunned,   I   looked   around   at   the   frozen   faces,   everyone   with   arms   folded   across   their   chests.   I   considered   my   response,   while   wondering   about   the   word   “lynch   mob”   in   Spanish.     Then  I  took  a  deep  breath  and  stood  to  make  myself  taller  and  more  formal  for  the  occasion.   "Here  is  a  crying,  wiggling,  fat,  full-­‐term  baby  boy,”  I  finally  said,  “sucking  contentedly  at   the  breast  of  this  señora,  alive  and  well."  I  then  retrieved  the  wrapped  baby,  much  to  the  relief   of  the  startled  and  unhappy  woman,  who  pulled  her  blouse  down.    He  seemed  to  weigh  a  good   seven  pounds  as  I  held  him  out  at  arms  length  for  all  to  see.     I  continued  cautiously,  "This  is  a  baby,  not  a  puppy.  I'm  not  going  to  put  a  knife  in  his   heart  or  drown  him  now.  Will  you?  Or  you?"  I  asked,  pushing  his  wiggly  body  into  the  faces  of  a   few  men  around  me.     "Oh,   no,   doctora,   we're   not   talking   about   killing   him!   You   don’t   know   your   Spanish!”   they   argued.   In   Spanish,   as   in   English,   "to   kill"   and   "to   allow   to   die"   are   different   verbs   and   different  concepts.  I  knew  exactly  what  they  were  talking  about.     "Well,”   I   retorted,   “he's   not   an   animal,   he   is   a   human   being.   He   has   a   father   and   brothers  and  sisters  and  a  family  and  a  community,  and  now  you  want  to  kill  him,  because  to  let   him  starve  to  death  is  the  same  as  killing.  It’s  slower  and  more  cruel  than  a  knife,  too.”     “But  how  will  his  father  feed  him,  doctora,”  another  woman  said,  “how  will  his  brothers   and  sisters  take  care  of  him  now  that  they  have  lost  their  mother?"  They  all  nodded  their  heads   and  grumbled.  Sweat  trickled  down  my  neck  and  back.  The  neighbors  defended  their  timeless   ritual  of  infanticide  –  without  naming  it  -­‐   while  I  argued  my  own  cultural  values  about  human  

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Ann Davenport

“The Love Offer”

life.  We  all  disagreed  for  more  than  an  hour,  as  more  community  members  gathered  for  this   impromptu  meeting.   I   suggested   we   at   least   ask   the   opinion   of   the   father.   He   was   so   grief   stricken,   he   couldn't   even   speak,   just   waved   his   hands   at   us,   as   if   we   were   so   many   flies.   We   asked   the   opinion  of  the  two  village  elders,  and  we  asked  the  siblings  (the  older  boy  offered  to  keep  the   baby   with   him,   which   brought   guffaws   and   grunts   all   around).   We   talked   about   adoption.   Everyone   had   an   opinion   and   they   all   wanted   to   punish   me   for   having   brought   this   dilemma   into  their  lives.  They  were  shaking  their  fists,  raising  their  voices.  It  was  fly-­‐suffocating  heat.   "YOU  take  him!  You're  the  one  who  saved  his  life!"  someone  shouted  at  me.  I  said  I  was   very   sorry   I   couldn’t,   but   the   Bolivian   government   prohibited   foreigners   from   adopting   Bolivian   babies.  (I  wasn’t  sure  of  the  validity  of  my  claim,  but  was  proud  of  myself  for  thinking  up  that   one   so   quickly!).   Then   they   insisted   the   driver,   who   was   Bolivian   and   was   now   cooing   at   the   baby  in  his  arms,  should  adopt  him.  He  deftly  handed  the  newborn  off  to  another  person  sitting   nearby,  retorting,  “Oh,  no!  Not  me!  I've  already  got  five  kids.”   I   offered   to   buy   baby   formula   and   bottles   for   anyone   who   would   take   the   child,   and   received   a   chorus   of   "harrumphs"   with   heads   turned   away   in   response.   We   talked   about   other   couples   in   other   village’s   near-­‐by   who   might   be   willing   to   raise   him.   The   father   came   out   of   his   hut,   and   began   to   participate   a   little.   He   said   he   would   regalar   (literally   "to   gift")   his   son   to   whoever  would  care  for  him.  There  were  no  takers.   At   long   last,   a   tiny,   wrinkled,   ancient   grandma   hauled   herself   up   from   the   dirt   using   her   cane.  She  said  nothing  at  first,  until  everyone  became  quiet  and  looked  toward  her.  She  spoke  

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Ann Davenport

“The Love Offer”

to   the   crowd   in   a   shaky   voice,   with   her   finger   impolitely   pointing   at   each   of   them,   "I'll   take   the   boy.   You   all   know   me.   I   have   nothing   in   my   home,   nothing.   But   I   have   love.   And   that   is   something  I  see  here  that  no  one  has.  That  is  what  makes  you  poor".    No  one  said  a  word.  Many   feet  were  examined  at  that  moment.   *    *    *    *    *    *   This  is  only  one  tiny  village,  in  one  isolated  province,  in  a  small  corner  of  the  Andes,  in   the   huge   continent   of   South   America.   There   are   many   more   mountain   and   jungle   communities   that  play  out  this  drama  every  single  day.  Economics,  education  and  access  all  play  a  role  in  the   deaths  of  women  and  in  a  very  common  practice  that  we  in  the  North  call  infanticide.  No  one  in   the  village  wanted  to  "kill"  the  baby;  but  the  challenges  of  day-­‐to-­‐day  survival  in  their  lives  were   more  overwhelming  to  them  than  the  vision  of  an  alternative  -­‐  a  love  offering.   Eventually,  a  young  couple  from  another  village  was  found  who  would  take  the  boy  and   raise  him  as  their  own.  They  had  been  married  for  over  a  year  and  hadn’t  gotten  pregnant  yet!   So,  they  were  anxious  to  take  this  baby  and  create  a  family  for  themselves.   I  believe  the  mother  may  have  died  of  an  embolism  or  perhaps  a  ruptured  uterus.  There   was  no  way  to  do  an  autopsy  (that  is  prohibited  in  the  Aymara  culture)  and  the  custom  is  to   bury   the   dead   right   away.   While   all   the   "negotiating"   was   going   on   about   the   baby   in   the   yard,   two   old   aunts   were   inside   the   house   with   the   husband,   washing   and   preparing   his   wife’s   body.   They  called  me  in  at  one  point  to  ask  what  they  should  do  about  the  placenta,  which  was  still   inside   her.   In   Aymara   tradition,   it's   important   to   bury   the   placenta   in   a   secret   place   near   the   home  where  it’s  spirit  won't  come  back  to  claim  the  life  of  the  baby.    

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Ann Davenport

“The Love Offer”

"Well,   since   she   is   now   a   spirit   herself,”   I   said,   “maybe   we   should   just   bury   her   with   the   placenta  inside  -­‐   what  do  you  think?  Then  they  will  both  protect  the  baby."  They  agreed,  and   Carmen  Maria  Quispe,  34,  mother  of  ten  children,  farmer,  wife  to  Juan  for  14  years,  was  laid  to   rest  that  night  under  a  full  moon  rising  over  the  steep  tropical  mountains  of  central  Bolivia.     #  #  #

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