To make typing easier, I'll just call the place where I went B-Land.
Have you ever seen any TV shows about the world's most dangerous roads? Well, I'm pretty sure I was on some of them! 4-wheel drive straight up and over mountain ridges with a sheer drop off on each side. But the views were heavenly! After flying into ChiangMai (northern Thailand), it was a 4 hour van/bus ride to a town near the border, then a truck came and picked me up for the scary 3 hour ride into the training site.
The training site was on a military base for the "other side", not the B-Land regime. I saw lots of cammo and soldier boys in underwear! The people were lovely and gracious and of course had a great sense of humor. I lived in the building where the trainings took place. Most nights my bed was a hospital bed with a mosquito net. And it was very cold up high in the mountains, on the ridge, and nothing to break the wind, so we were bundled up when we weren't taking cover from pouring rain.
The only electricity was for 2-3 hours in the evenings when the generator was on, and this was the one chance to plug in everything for recharging and getting 10 minutes of internet. The toilets were in an outhouse, with squat toilets, and cold bucket showers. The only water source was rainwater, so that was boiled for drinking. The food was yummy, especially the cabbage salad I think I can replicate. Most meals were rice with one of the following: cabbage, eggplant, pumpkin, cabbage, yellowbean, eggplant, no meat, more cabbage, and a lovely vegetable called : "Fuck me low" Not kidding! The nurse I was working with and I had to ask them to repeat it a few times because we couldn't believe what we were hearing!
I am so thankful that my Thai language is pretty good. The Sh@n language is considered big brother and the Thai language is considered little brother, evolving from Sh@n. I understood a lot of it, especially once I figured out that P's and F's were switched. For example, "twins" in Thai is "FaaFed" and in the other language is "PaaPed." Or the words were slightly different, so "girl and boy" in Thai is "puu ying puu chai"; in the other language it was "fuu ying fuu sai." The medics in the training were thrilled that I could communicate basically, and it was a huge help when I would listen to the translator and know that she wasn't understanding and therefore translating the wrong information!
I was able to teach for about 4 days. We started out by taking a survey of all the local birth practices and labeled them as "helpful" "harmless" or "harmful". I learned so much about this that I am considering writing an article about it for Midwifery Today. The next classes were about taking a prenatal history, doing a basic prenatal exam, the stages of labor, hemorrhage, breast exam, breastfeeding (importance of colostrum; not how, but dealing with mastitis, etc.), fertility awareness method (some access to condoms but not much else), and cord burning.
There were 2 main things that I emphasized through out. First, that what I was teaching was practical for attending births in the jungle. They had been taught some about birth already but so much of it was over-medicalized and appropriate only for hospital. For example, how can someone go in and teach about a "managed 3rd stage" when there is NO PITOCIN AVAILABLE. Or how can someone teach about cutting a cord when there is NOTHING CLEAN to cut it with?? I know these medics will be getting all kinds of information, a lot not evidence-based, and not practical for birthing. Hopefully what I taught will make them think and know that they have other options. Dealing with hemorrhage with only having been taught what to do using pharmaceuticals is dangerous... they needed other options, which I gave.
The second thing I emphasized was working with TBAs (Traditional Birth Attendants). I started by asking a question: "who knows more about birth? TBAs or medics?" They all answered: MEDICS. And so I said, "Oh really? If you have seen 5 births, and a TBA has seen 200 births, who knows more about birth?" Lightbulb moments for all of them, and this opened up a discussion. The medics cannot be at every birth all over their area of northern B-Land. TBAs will continue to be the main source of birth attendants. By working together, they can teach each other. The medics can learn more about normal birth and complications from TBAs while the TBAs can learn about some complications and sanitary birth from the medics.
So my week in B-Land was challenging and fun. I got to hike around a little bit and learned that I'm not as fit as I thought I was. Got to see a Buddhist funeral in the jungle. Learned some things while observing their clinics. Yes I can now differentiate between kidney stones and appendicitis. Enjoyed some "me time" in the evenings just reading or watching DVDs with the other volunteers. And I was very very happy to get out of the country. They closed their borders due to upcoming elections about 3 days before I was supposed to leave. I was in the only truck allowed out!
I took a lot of pictures, but most I cannot put online. Mountains are a no-no because they are identifying landmarks. Faces are a no-no because the medics are at risk. Here are a few that made the cut:
The building where I lived and taught.
Our handwashed clothes hanging up to dry. No clothespins so we used medical forceps and hemostats.
Some of the guys playing Takraw (foot volleyball with wicker ball).
The ... birth... bed.... (we had long discussions about this one and we all agreed the floor with a clean mat was a way better option!)
So many butterflies.
Teaching breast exam. On the table, you can see my doll, pelvis, and placenta - all were a last minute decision to pack, and I used them so much!
I'm really hoping that I can do a repeat trip next year. I am so thankful for the opportunity to go serve and teach in a place where so few foreigners can go.