The heartbreaking UNHCR video above shows a cesarean section in a Jordan refugee camp for a mother who fled Syria on account of her pregnancy, worrying whether her baby would be safe at home. She is surrounded by male doctors; the narrator describes that the doctors oversee around ten births a day in the camp. In an interview with the mother, she describes how worried she is for her child with the persistent illnesses that children pick up in the camp. There’s so much trauma here; trauma from the war, from fleeing Syria, from the day to day life in the camp, from the lack of safety and certainly around what the future holds. The health care system in the camps is spread thin and the doctors, who must attend to the many, many other needs around the camp, are overworked. Around 20-30% of the births are via c-section, so there are issues of recovery for the mothers. As the Syrian crisis fades from public view in the west, snapshots like these remind us that it’s very real and that there are thousands and thousands of vulnerable families spending the freezing winter in refugee camps in Jordan and Turkey.
I just listened to a public health lecture from the Imperial College of London on the applications of anthropology in public health. An anthropologist presented on her work for Save the Children in Ethiopia, surveying mothers on their use of health clinics for childbirth. Most mothers preferred to stay at home, citing that it was their custom, that at home they were with family and friends, some of whom provided physical support during labor, that they could move around, and that they could deliver on their knees. They believe that labor at home is short and easy. The health clinics, which they used when labor becomes prolonged or when complications arise, is the opposite. Companions are not permitted to accompany the women, so they say they feel lonely. Unfamiliar faces surround them, performing vaginal exams and shining bright lights on parts of their body that they feel uncomfortable showing to strangers. Instead of the customary position, they are forced to deliver in the lithotomy position, on their backs and with feet in stirrups. While the women valued the health clinics in emergency cases, it wasn’t the ideal space for birth. The doctor’s recommendation was to listen to the women valued and needed around birth, and address ways that the clinics didn’t meet these needs.
We must listen to the distance between what is desired and what is realized.
I wish there were an international midwifery and doula volunteer corps that could just land someplace and work, or that midwives were more integrated into public health crisis, emergency response, and refugee support scenarios around delivery of maternal healthcare. Midwives could work with women during normal births, bringing in a surgeon only when medically indicated. The midwives and doulas could also work with women in the camps, offering courses on reproductive health, family planning, and childbirth education, including methods of supporting women during labor. When I worked with Sudanese refugees in Egypt back in 2005-2006 as a volunteer English teacher, I was amazed at the ways that men and women in limbo–in that liminal space of being neither here nor there, neither Darfur nor Canada–used their time constructively to learn. I worked in an initiative set up by a Sudanese English teacher who was also a refugee, who saw their time in Cairo as an opportunity to impart skills that would improve people’s chances of resettlement abroad and to ease the transition to their new countries by developing critical language skills. He also brought in native-English speaking volunteers to present “cultural case studies” from their lives back home, offering students scenarios that they might encounter.
While I want to drop everything and do and organize and fix and support and heal, mostly I just want to hold the women in the video and have the ability, which I don’t, to tell her that everything is going to be ok.