Puyo Birth Ponderings

I am currently spending my time in Puyo, a small jungle city that has been the launchpad for entry into Amazonian communities for hundreds of years.  On tuesday, I'm leaving early in the morning with the Jungle Mamas team to go back to Pumpuentsa, where we will be giving a workshop on Safe Birthing and Family Health with the women and men we have been working with over the past two years.  The goal has always been to train people locally in being able to identify birth emergencies, attendance and delivery, and illness prevention in mothers and babies, with the objective of reducing the need to travel outside of the community to seek health attention (traveling outside of the community for medical attention means either an expensive airplane flight or a 3 hour hike through think primary forest to a hospital).

The program has indeed been successful - we have seen that the majority of births have been attended to and assisted by the people we have been working with over the past year. However, I have been thinking deeply about what we are doing in the broader context of cultural change.  Previously, women have always gone deep into the forest to give birth by themselves, without the assistance of a mother or a traditional birth attendant or midwife.  If a baby is born irregular-looking, small, or "anormal", it has been the custom to let it die, or leave it in the jungle.  Of course, according to our western ideas about when personhood begins at birth (or somewhere in utero), this sounds unacceptable.  But imagine what the life of a child would be like in an area where there was no reasonable hope of maintaining a good quality of life, or any type of medical attention (western or 'traditional'). Especially from a culture where people literally explain death as "a cause of nature," (so and so couldn't be saved because nature killed them...essentially a cause of nature).  A life where death, like birth, is viewed as a natural process as something that can't necessarily be prevented or intervened with.

As a westerner, myself, engaging in a project that hopes to eliminate maternal and child mortality, there is a lot I have to learn about life and death. Not only how to engage with it on a personal level, but also in an on-the-ground level.  I'm working with people who "traditionally" gave birth alone and by themselves, because it is so sacred, no one (not even family) should look at it. And as any person working in development, community organizing, activism, social change (whatever you choose to call it), you should always be aware and open to learning about traditions and what people practice locally while thinking about how your actions will contribute to "change." However, I am working in a community that is literally amidst the process of change. We're talking about change in the sense that the very first road EVER to enter the territory is already under construction.  There is enough involvement with community leaders moving in and out of the community that new materials, jobs, ideas, medicines, and illnesses are in constant movement.  I'm not working with a stereotypically "traditional" community, but one that has been in the process of grappling with change for years.

My work was made possible by the fact that men and women in the community wanted change - they wanted to learn more about western ways of intervention in birthing - specifically midwifery and illness prevention.  Yet there are still times where I feel like I know nothing. It pains me to hear about the very small select women who continue to hide when they give birth, or hearing about a baby dying of diarrhea, despite all that we have taught.  Change takes time. Also when we think about how different life conditions are in the jungle from the city, we also need to take into account the different logics behind it, instead of writing these situations of as products of "underdeveloped" or "poverty-stricken" societies.

I am reminded of a chapter I read from an ethnography (perhaps one of the most formative in my early life as a student of anthro) in my Introduction to Anthropology class at Reed College. We read Ana Lowenhaupt Tsing's  _In the Realm of the Diamond Queen: Marginality in an Out-of-the-Way Place_ (you should really read it!) called "Family Planning." As an ethnographer, Tsing encountered a moment where she was forced to recognize her cultural differences and concepts of birth in relation to the Meratus people with whom she was working.  After the premature birth of a child, the mother didn't recognize her child for various reasons, such as not being ready (too young), etc and it eventually died.  As an outsider, this was incredibly difficult for Tsing to deal with - she wanted to (and eventually did) intervene, but was not necessarily conscious of the implications of her actions.  She wanted to save the child, to rescue it, but was not prepared to take responsibility for it's life.  Tsing goes into more depth about the deep cultural differences, but it made me think about my role in intervention.  Yes, culture plays a  huge role in if/how/when/why my intervention is successful.  It is extremely difficult at times for me to understand how death can be seen as so natural, yet I also see that the people I am working with are changing the ways in which they think about life and death. That illness and abrupt death is preventable - it is their right.  So there is some kind of change at work, a change that I am both participating in/facilitating and a change that the people I am working with are participating in/facilitating.  It is change from the outside AND the inside.  And that is simultaneously the most beautiful and most challenging element of my work.