Maternal mortality in Sierra Leone

I visited the website of Amnesty International Australia last week, and read a report on maternal deaths in childbirth in Sierra Leone. One in eight women risk dying in pregnancy or childbirth there, a tragedy of huge proportions. From the webpage:

Thousands of women bleed to death after giving birth. Most die in their homes. Some die on the way to hospital; in taxis, on motorbikes or on foot. In Sierra Leone, less than half of deliveries are attended by a skilled birth attendant and less than one in five are carried out in health facilities.

I noted there were two comments at the bottom, but that the opportunity to leave any further notes was closed. The first comment is as follows, with only the name removed:

29 SEPTEMBER 2009, 11:22AM
Thank you for this article about thousands of women who bleed to death after giving birth in Sierra Leone. I fully agree with you that the issue of maternal mortality is not only a health care issue. It’s about human rights of women and families living in poverty in Africa. By the way, I truly believe that this is a matter of a reliable transportation in Africa. The non-profit I am working with as an international business developer (Institute for Affordable Transportation) addresses the cycle of poverty by providing local people with a reliable transportation - Basic Utility Vehicle designed for developing countries. Please visit our web site at www.drivebuv.org to see how we help break the cycle of poverty. Again, thank you for thinking about human rights of those living in poverty. Good luck in everything you do!

Nothing overly objectionable about this, and an indication of support for what organisations are trying to do for mothers and babies and their families. The only thing that vaguely disturbed me was the slight hint of advertising involved in the promotion of the Basic Utility Vehicle. But it would enable health workers to get to patients, to mothers in labour, so would obviously be a useful tool for delivering healthcare to Sierra Leone. And the comment revealed an understanding, or at least an acknowledgement, of the multiple issues involved in maternal deaths: poverty, status of women, human rights generally, health care, transport etc.

However, the second comment (which actually appears above the first) caused some disquiet, and then anger:

29 SEPTEMBER 2009, 01:55PM
Providing transportation for medical needs is a crucial element to preventive health care in developing countries. Healthcare is more of a privilege than a right in my opinion. Yes, the BUV mentioned in the previous comment is a valuable asset much like Riders that provides motorcycles for health workers. The BUV Ministry at www.drivebuv.org does offer a valuable and viable solution for this need. There is a brochure on this site under BUV Solutions - titled BUV and Medical Missions.

'Healthcare is more of a privilege than a right in my opinion'. I am glad the person who wrote this comment at least expressed it as his opinion. I disagree with this opinion, in the strongest possible terms. Health care is not a privilege, but a basic right; a right that millions of people are denied because they're poor. The women in Sierra Leone who die in pregnancy or childbirth have a right to proper health care to save their lives, and the lives of their babies, regardless of whether or not they can pay for it. A mother haemorrhaging or in obstructed labour is not going to wait until she can somehow earn money to pay for obstetric care that will save her life and the life of her child. She needs that care immediately.

And whether you're rich or poor, in whatever country you live, if you are diagnosed with a dangerous infection or a malignancy, or any serious illness, you need treatment and care right away, not in a few months when you've saved up for it. Illness waits for no ideology.

To write of health care being a privilege after reading an article about women dying in childbirth in Sierra Leone is to somehow be divorced utterly from humanity.

When I look up the organisation mentioned that provides the innovative transport, I note that it is faith-based. It provides a valuable means for people to improve their lives, which is wonderful, but do they also evangelise? Do the poor have to pay for their poverty by having someone else's religion thrust upon them? I think it inappropriate in the 21st century that people seeking help from poverty, disease and death be subject to such evangelism. Unless, of course, they choose it freely, and are not denied help if they choose in the negative.

I discover that the two people who left the comments on the Amnesty website are, in fact, both associated with the organisation providing the BUV. Somehow, their words take on the less savoury tone of self-promotion of their own interests, be they religious or other.

Meanwhile, mothers and babies keep dying in Sierra Leone. Good on Amnesty International for bringing these issues to the light, and for striving to do something about them.

Taryn Simon and John Singer Sargent

In August I went to two lectures, one at the Gallery of Modern Art and the other at the Queensland Art Gallery. The first was by Taryn Simon, a photographer of things not usually photographed. Her latest project is called An American Index of the Hidden and Unfamiliar, currently on exhibition at the Institute of Modern Art in Brisbane. Her lecture consisted of a slide show of images from this exhibition, as well as an earlier one called The Innocents, with her brief comments in her crisp, clear manner, followed by a question and answer session with the audience.

From American Index we saw a collection of confiscated goods from airport inspections, the things that people were not allowed to bring into the country. Simon had arranged them to look like a still life classical painting. We saw a photo from the cryogenics laboratory, where people are snap frozen in the hope that at some time in the future we will have developed the technology to bring them back to life. There was a picture of the telecommunications cables that travel from the US to Europe, of birds in quarantine, of live HIV in a bottle. The fragility of the protective devices around these things struck the photographer, as it struck us in the audience.

The braille version of Playboy drew laughter, while the story of the breeding of white tigers drew a different response, one of disbelief. There was Kenny the tiger, severely deformed from inbreeding, posed heroically in his delapidated cage, bones distorted and face abnormal, the result of one of the less-admired qualities of humanity.
[caption id="attachment_264" align="aligncenter" width="300" caption="White Tiger (Kenny) Turpentine Creek Wildlife Refuge Eureka Springs, Ark.: In the United States, all living white tigers are the result of selective inbreeding to artificially create the genetic conditions that lead to white fur, ice-blue eyes and a pink nose. Kenny was born in the care of a breeder in Bentonville, Ark., on Feb. 3, 1999. As a result of inbreeding, Kenny is mentally retarded."][/caption]


The Innocents was Simon's photography project from 2003. She photographed people who had been wrongly convicted and imprisoned, and then released when their innocence was proven, usually after many years of incarceration. These pictures needed text to explain their origin, and Simon is acutely aware of what photos cannot communicate, as well as what they can. She incorporates the text as part of the art of her photographs in American Index. The text is a part of the whole, inseparable from the image.

Later that afternoon I went to a conversation between Mark Pennings and Rex Butler at the Queensland Art Gallery on John Singer Sargent. Rex Butler is an established art historian of some note, and a modest and down-to-earth one, who waved his hand to stop the person introducing him from listing his achievements. He spoke with great passion about the paintings of Sargent, drawing us into the paintings in an easy and skilful way, so we saw what he saw, and were moved by what moved him.

I learnt a lot about how to look at a painting. Too often I find myself paying too little attention to the canvas in front of me, not really knowing what I should be paying attention to, whether there is something I am missing that reveals the key to its meaning, its secrets, if they exist. Butler took us on a journey over the face of the beautiful Lady Agnew, showing us its two moods, and how Sargent had created that effect. He revealed to us the power of technique in El Jaleo, although we all gasped when he first showed us the slide representation. Such drama! Such light and dark! But the figures of the musicians in the background, the way the skirt does not follow the dancer's legs at all, but fold and crease according to some other rules.

Who would think such exhilaration could come from sitting in a lecture?

Frustration of a wistful nature

I like to be busy, but productively busy. I particularly like to be busy writing, whether it's reviews or my own creative work. It's not happening, however, and that familiar feeling of frustration is creeping back.

Maybe I am not meant to be a writer. Maybe I like the idea of being a writer more than the actual writing work. Maybe I do not have the talent, or the motivation. The latter is a problem. I'm not ambitious enough to work steadily everyday and submit pieces on a regular basis. This worries me, because it's not what I want.

I want to write and to have what I write published. But I've had this desire for so long that I wonder if I am happy just to have the desire without the fulfillment. As if life consists of this single desire, without the need to fulfill it completely.

I could simply be lazy.

Of course, I have written vast numbers of reviews, and have a 50k manuscript sitting in my laptop (and on paper somewhere), as well as 30k of memoir fragments, and a 30k (terrible) novella that was written for my MA. So I cannot say that I have nothing to show for all this desire.

I need to turn the wistful desire into words, and send them away. What's stopping this?

The psychologist's room

What stops me from writing?

In the psychologist's room, I learn there is a triangle, with me at one point, my Dad at another, and a male friend at the third. But there is no connecting line between my Dad and the friend, not the first time it comes into my head. Why were we three all there together? More to the point, what was the friend doing there?

Turns out there were similarities between my Dad and this friend, and I have problems (how benign a word!) with my relationship with both of them. But my Dad is dead, and the friend is very much alive. My Dad is a ghost, and present everywhere.

Many things happen in the psychologist's room. The triangle links up. I feel small, like a pinpoint, while the two men are enormous. My Dad controlled more with silence than loudness; my friend is loud and aggressive and opinionated. (Why do I let him intimidate me?) I have a knot of tension in my forehead. My friend punches me in this knot, and I punch him back. We have a fistfight, then I put my hands on his shoulders, and calm both of us down.

At some point, the image of a pair of scissors appears. I snip the string (for that is what it is) that connects the three of us. My Dad tumbles off into the distance. I tie the ends of one piece of string around my friend, and we have a calm conversation. I start talking about my writing, about the memoir, and am not embarrassed.

More people come into the room, and my friend starts to fade.

At some point, my mother appears, and collects my father. They wave at me, and I wave back. It is goodbye.

The string is hard to be rid of, however. I put it in a bowl, and throw it out of the window, set fire to it, douse it with water. Finally, it becomes an infinity symbol, and I accept its presence in that form.

Now, the next day, I feel irritable and out of sorts, out of place. I want to scream and throw things around. It is, I know, an inevitable consequence of all that psychological and emotional work. I must wait for these feelings to work through me. I must write.

If only my parents, particularly my war-ravaged father, had had the opportunity to work through the scars of their sorrow too.

Travelling

She thought how strange it was to be sitting in an office with her eyes closed, thinking about something that happened twenty years ago. And then to not just think about it, but really dive into it, and imagine herself back into that moment, or succession of moments, that have never left her. To watch and listen as the self she was then, and the self her father was then, spoke to each other. They weren’t speaking, they were shouting, their mouths were making ugly shapes, their words hurt, their words flung sharp stones and ragged glass.

I need to leave this poisonous house.

You’ll end up in the gutter.

The psychologist takes her through these moments again, she is there with her, asking her to reimagine them. What would you have liked your father to say to you? What would you have said to him? How would you have liked him to respond? She didn’t think she’d be able to create this dialogue, and was surprised when she stumbled out a few words, then those words became stronger. Then she was there, her present self, with her younger self and her father; she was there, and she was talking to her younger self. What would she say to you now? What would your younger self ask you? What would you say to her?

She marvelled at the incongruous contrast of that inner reimagined dialogue, that time travel, created in that cocoon of healing and restitution, with the bustle of the shopping centre crowds, the random conversations, the smells of anonymous meat and fat, the scratched tiles. Babies in strollers. Pierced eyebrows. People who knew nothing of where she had just been.

Eggs

I hated eggs when I was a child. But my parents thought they would help me grow into a big strong girl, and so they gave me one egg every morning.

They would poach or boil it, and put tomato sauce on the plate. I would take tiny spoonfuls, and try to ignore the taste as I chewed and swallowed. Then I would try big mouthfuls, to get through the meal more quickly, but that gave me an explosion of the foulness, the egginess, the white and yellow repellant smoothness. Sometimes I would be unable to keep it down, and flood the breakfast table with my undigested horror.

My parents would also try egg sandwiches, but the bread was never enough to mask the hateful flavour. It became a battle of sorts, with my parents eyeing me defiantly, daring me to come up with another complaint, another reason to not eat such a healthful foodstuff, or another vomit.

I took to hiding the egg sandwiches behind a large cupboard in the dining room. When my mother was in the kitchen, I would silently rise from the chair, and, keeping my eyes on the door, stuff the vile matter into the narrow gap between wood and wall. Sometimes it wouldn’t all fit, and bits of egg would scatter on the floor, or stick to the painted wall. I would frantically scrape it off and poke it back, pick up the squares of bread and force them behind the cupboard with the dust and cobwebs and dead spiders, as far as I could.

When we were sitting at that dining table one evening, a movement on the wall near the cupboard caught my eye. It was a big, black cockroach, the second most revolting thing in the world after eggs, and it was heading towards the space behind the cupboard. My mother saw it and put down her knife and fork.

“Howard, there’s a huge cockroach on the wall.”

She wrinkled her nose and turned down the corners of her mouth.

“Good Lord, what a beast. I’ll get him.”

And in typical Dad fashion, he got a rolled up newspaper and proceeded to clobber the doomed creature with disproportionate violence.

“Lily, there seems to be something behind this cupboard,” he said.

I sat calmly eating my dinner of boiled vegetables and tinned ham, trying to ignore the inevitable.

Dad heaved the cupboard away from the wall enough to reveal a collection of little squares of sandwiches, the freshest at the top of course, with the layers becoming progressively greener, blacker and less distinguishable as sandwiches the further down the pile. The now thoroughly dead cockroach had obviously grown fat on my generous donations.

I tried, briefly, to lie my way out of the situation by saying I knew nothing about the decaying sandwiches, but my parents ignored me. They didn’t become as angry as I had feared, and in fact, they eased up with the eggs, whether poached, boiled, scrambled, fried or sandwiched, with or without tomato sauce, salt, or anything else.

I can tolerate eating eggs now, but occasionally the smell of hard boiled yolk and egg white takes me back to those breakfasts. My spoon pauses in the air, my stomach lurches, and I quietly put the sulphurous memory back on the plate.

The Orange

I looked down at the vast expanse of water, so deep and limitless it seemed like a gigantic shape-shifting beast, surging, cresting, foaming, throwing out spray and flying fish at whim. It merely tolerated our flimsy boat to glide through its surface layers.

Out of a porthole a pair of hands appeared with an orange. They began to peel it. Curly strips of skin fell away into the water, then, when it was fully naked, the mysterious hands withdrew, taking the tempting bright fruit with them.

My mother managed to get one for me, and I sat on the deck with my parents and peeled away curls of dimpled skin like the anonymous hands from the porthold had done. The juice dribbled down my chin, smeared over my cheeks, down my forearms. My tortured stomach gurgled and protested.

Some time later I was back in our cabin, in my bunk bed, turned to the wall. The orange had stayed down for about half an hour. This was the story with all food since the first three days on the ship after leaving Singapore; we were heading for Melbourne. The orange had been a delicious interlude, a folly, a desperate attempt to be well in a flurry of seasickness.

It was sometime after this, when my parents were in the cabin with me, I heard my father say to my mother that I was ‘putting it on’, that I wasn’t really sick, and could stop it if I wanted to. He must have thought I was asleep. Or maybe he didn’t care. I thought about this, and wondered how I could stop vomiting, and how good it would be to be able to do that. However much I tried, the nausea brought me down, again and again. If only the ship would stop moving, I would be able to stop feeling sick.

I spent most of the two week journey in that cabin. We stopped briefly in Perth, and on the way out, the ship encountered gale force winds.

“A creaking ship is a safe ship,” my father said.

And the Patris creaked and groaned and moaned, a wounded animal battered by an ocean in fury. Water beat against the porthole and leaked into the cabin, bringing strong smells of salt and things unknown.

My parents went to a ball one night, my mother resplendent in a halter-neck dress of black and silver that caught the light in hundreds of reflective threads. My father wore a white dinner jacket which accentuated his smooth olive skin. The photo of them taken as they were greeted at the entrance to the ballroom showed my mother beaming, her lips coloured red, a handkerchief tucked neatly into her watchband, and incongruous navy and white plastic sandals peeping out from under her floor-length glamorous gown. The man with whom she was shaking hands was already focused on the next guest.

Once one of the Greek stewards came into our cabin to say hello, and he pinched my cheek as I lay in bed, trying to smile, the covers pulled up to my chin.

There must have been brief interludes when I was not nauseous, as I remember beginning to write a story about Mickey Mouse in an exercise book. My father thought I was writing about our trip, and his face fell when I showed it to him.

I was afraid of the toilets, because there was a time limit to the door. It allowed you fifteen minutes, then it would open automatically. I was terrified that I would lose track of the time and be revealed, stuck to the seat, unable to move, and unable to close the door again.

When we arrived in Melbourne, we travelled straight up to Sydney, and stayed in a caravan park until my parents decided what to do. I soon adjusted to no longer vomiting at the sight of food, and no longer feeling as if the waves were inside my stomach.

My hair, which was past shoulder length, was a bird’s nest of knots, or rather, one enormous knot, at the back of my head. My mother helped me tease it out, but I don’t remember how long that took.