Each day we walked about 1 1/2 miles to the Kafountine Clinic. We would be greeted by kids, some at first peaking from behind things looking at us, others coming near the road to greet us with “Toubab.”  Later in the day we walk down the dusty main street with a stream of onlookers; by adults we are also considered “Toubab.”  “Toubab,” at its best translates into a “Tourist,” “Stranger,” but also means a person of European ancestry; we are not recognized as the “Returning African Sistas.”  Not what we Sistas Returning Home wanted to be called. But to these kids and others we are not recognized as long gone returning family members.

Makeda with her waist length locks and African centric clothing, Jessica with her light skin, and me with short hair and tattooed ears; we are not recognizable as being one of Africa’s children by our folks Back Home.  A question is soon asked of us—“How did we get such light skin (did we bleach it?)?” and “Are your parents white?”  We have returned Back Home to find bleached skin and hair weaves as a new icon of beauty.

“Toubab!” Nikki would educate them by pointing at her skin and their skin—we are the same as you —not Toubab; and Makeda would holler back “Toubab” and growl.

We have returned Back Home with this need to tell everyone what happened to our ancestors once we were taken by force from here.  We feel the need to explain all of the things that have happened to us since leaving.  Their knowledge of who we are and how we got to be is practically nonexistent, except for those who have seen a part or all of the “Roots” series.  As a whole, our families Back Home don’t have interest in our past. Not much different from our children in the U.S.

We are not recognizable as family members to our returning family—we carry ourselves differently than their women relatives; we dress differently than their women relatives; we are not the same as their women and they know it.

And I am really so naive as to expect some big “Welcome Home” meta-physical banner to appear (too much TV).

So—once again looking with my eyes blinded me when the Recognition of Sisterhood came to me.  When did the laughing of the women in Le Grand Salon turn from light hearted jokes about my clothes and shoes, to the smiles of welcome when I arrived.  When did they start inviting me to sit down and spend some time with them outside as they cooked? When did the request for me to sing my only Senegalese song and do my one dance step become a group activity?

When the sister-in-law of Mrs. S. handed me one of the twins (Awa) and asked me to carry her to the car, it hit me –Welcome Back Home My Sister. Heart to heart; spirit to spirit, the recognition had happened. I have felt like one of a pair of twins, separated at birth, trying to find my sister and hoping in time she will recognize me from my heart if not from my appearance. And it happened

And towards the end of the trip we and the kids just happily greeted each other as “Toubab.”  They were happy to see us and we felt the same way about them.

Because our airplane is scheduled to leave Ziguinchor at 9:00 am and given the pot-holed road with the toll stops and military check points we need at least 2 ½ hours of travel time.

Papalye, our driver, gives us clear instructions to have our bags ready to be tied on top of the car by 5:30 am and to be ready to leave at 6:00.  Makeda is not making this portion of the trip with us. She is leaving for Ziguinchor a few hours after us to attend a wedding there. She will head to The Gambia for a brief vacation—she is returning to visit a series of OB/Gyn clinics there that are focused on well women care, redesigning women’s rites of passage to exclude female circumcision, and re-training traditional midwives to stop performing female circumcisions and teaching them other skills.  Perhaps the perfect clinical site for ICTC. I could see Sister Shafia Monroe there.  Makeda will return to Kafountine for the week-long Carnival that begins 19.

It is still pitch black dark when the five of us squeeze into the car and head down the road.  Just about 8:00 the right rear tire blows.  Hell and not AAA service for mile (LOL)!

Zuzu and Papalye begin to change the flat tire with the spare that does not look much better. Problem # 1—the jack will not raise the car high enough to get the flat tire off.  We stand by the side of the road as the sun starts to touch the tops of the trees.

Papalye is not worried—this road is traveled by a steady stream of public passenger taxis and busses and someone will loan him a jack, he says with complete confidence.  Four minutes later he flags downs the very next passenger bus and explains his problem.  The driver promptly gives him his jack—no big deal. Papalye will return it to the bus driver, whom he does not know well, when they get back to Kafountine. Papalye memorizes his license plate number and takes the jack.

The new jack is applied with the first jack, the flat tire is removed and the spare tire is put on. As soon as the car is lowered the air leaks out of the spare tire too—it has a leak!  Now what do we now?  It is 8:20.

Papayle says not to worry, a Peugeot like his will come along and let him borrow their spare tire. I see the worry and stress in his face but his words of unquestioning faith are strong.  Just to support his conviction we break into a series of songs to Elegba, the orisha who opens the roads.

As we stand on the side of the road the awakening children in the nearby house come out and introduce themselves to us; one of the young men come over to help Zuzu and Papalye.

The very next car to come down the road was a Peugeot (I am not lying)! And the taxi driver is a friend of Papalye’s. He gives us his spare tire and takes one of Papayle’s flats.  Papalye changes the tire and we are back on the road at 8:40. Asia calls Senegal Air to let them know we are on our way, but no one answers.  Papalye says that the plane will be there when we get there, and drives on as fast as he can on these roads.  I can see that he is sweating this conviction. I am sitting in the front seat next to him and I cannot help but ask him how come he knew that folks would arrive and help.  He says in plain common sense and acknowledgement that all of the men who drive these roads can, at any moment, be in the same situation as he was in and would expect others to stop and help.  Uumm—an Expectation of Brotherhood; of Mutual Cooperation.  Not a phrase quoted once a year at Kwanzaa, but lived every day here among these men.

At 9:15 we enter the town of Ziguinchor and Asia reaches the airline—the plane from Dakar that will take us back there is just landing!!!!!

We arrive at the airport at 9:25; they do not charge us for our excess luggage and the plane leaves at 9:40.

Off to Dakar on a little bitty plane again!

On Saturday morning we developed our plan for our last day at the clinic.  We had yet to visit the beach, had fabric and clothes to pick up in town, and then an early dinner (pizza in the new former termite mound oven) in the early evening with Asia and her family.  We wanted to get photos taken with us and the sage femmes and mattrones (did not happen) and photos of the mothers and babies in Le Grand Salon.

We arrived at 10:00 to have a peace few hours. Within five minutes two laboring mothers arrived and we were back in the groove of birth on our last day.  I caught my 12th baby and Jessica caught her 13^th baby.

We did a brief photo opportunity with the staff, mothers and babies and headed to the beach.

THE BEACH!!!!!!!!!! God, what we had missed!!!!!!!

We were invited to meet with a group of five local traditional midwives and a home birth mother (who will soon be having her third home birth) who live in the small but growing community of Kobar.

When we arrived they were awaiting us, seated under a very large mango tree in the yard of the senior midwife, Sonyoung.

Many of these women are Jolla people, but not all; several languages are spoken among these women. So, the conversations, even between the midwives undergo numerous translations so that all can understand.

The goal of our meeting was for us to learn about the various local herbs used by traditional midwives for pregnancy, labor birth and post partum. Their goal was to learn our labor and birth techniques and to discuss their dream of building and operating a birth center in this small community.

There were 6 herbs and plants which we were introduced to; all of them are used in the last two months of pregnancy (and last trimester) and are designed to make labor easier and shorter.

“Ecoling-coling”:

• Use the bud and make a tea
• Use as a bath

“Ku- bom-boe”:

• This is the bark off of a tree
• You peel off the outer bark and soak the inner bark in water.
• It will make a gelatinous substance, like okra
• Drink as a tea
• Once you start to push the baby will come fast

“Ka-ku-wok”:

• Has little red flowers
• Make a tea
• Use as a bath

“Bu-jing-kup” branches:

• Take leaves and make a tea
• During the last month of pregnancy, put the liquid into a bucket and do this ritual before the bath:
• o Take your right hand and take 2 sips
• o Take your left hand and take 2 sips
• o Now take the bath

Dried brown banana leaves:

• Boil the leaves
• Use the water for a bathe
• As a sitz bath before ne after birth
• As a drink
• Also use the liquid as a massage during labor

“Kakonana” or “Kaput-tananay”:

• Womb cleaner!
• Has yellow flowers and pods
• Make a tea to drink throughout pregnancy
• Also used to reduce menstrual cramps – drink 3 times a day

“Bo-baranap” or “Solom”:

• Has velvety black berries
• Use the leaves
• Pound the leaves and put them into a sealed container
• Then soak in water overnight
• Strain
• Cook with sorghum or rice flour to make a porridge
• Eat porridge for the last month of pregnancy
• This is designed to keep everything strong in your belly*****

****It is customary not to discuss the fetus!! The fetus is not a physical being but a spirit space and only God can know what is happening there. Instead you can ask, “How is your belly?”

Questions asked:

How do you treat post partum hemorrhage?

1. Many Jolla women wear bracelets made of iron which is used as a form of protection for them.

In birth there is a lot of water, meconium and blood. If there is too much blood the Jolla woman takes her bracelet and sucks on it.

1. Also – will place a woman in a very high concentrated salt bath.
2. Last resort – the hospital.

What do you do with the placenta?

1. Dig a hole in the ground to bury the placenta. Encircle the placenta with the umbilical cord.  Make sure the end of the umbilical cord extends above the ground, like a baby plant. Failure to do this, especially leaving the end of the cord above ground, may lead top infertility.

What do you do it the baby is not breathing adequately?

1. Hold the baby upside down
2. Stimulate the baby with shaking cloth around it

What positions do women birth in?

1. Lying on their backs.
2. I demonstrate the various positions we use for pushing, including my favorite “The Rotisserie”.

Why do some women not birth at the Kafountine clinic?

1. Not allowed to bring herbs or other non-Western aids there
2. Not like numerous medical interventions and drugs
3. Not like the treatment laboring women receive from the sage femmes and mattrones

Why so do you want your own birth center here?

1. It is difficult for worm to get to Kafountine for prenatal visits and especially in birth. Plus, it is difficult for their family members to visit and take care of them.
2. There are difference between Carolinke people who are numerous in Kafountine and the Jolla people.
3. They could practice their own traditions

While we are meeting the Sonyoung’s husband picks grapefruit and mandarins from the trees in their yard and Sonyoung peels them and serves them to us.

We are invited to share lunch with them before we head back to town. But first we had to sing for them, “I Love Being a Midwife”.

I brought with me 25 “Mommy and Infant” bags, large gallon-size Ziploc bags stuffed full of items for a new mother and her baby; tooth brush and tooth paste, soap, gum,  shampoo, infant hat and blanket, baby booties,  and a onesie, etc.. The items for these bags were compiled in large part by Sylvia Robinson at ECAC and Gouda Carter.

After I passed out the first set at the end of the first week, word spread about the bags. From then on every post partum mother asked me for one.

Next time, we will make 100 bags!!!

In the last week we have assisted 4 women who’d had clitorectomies give birth. These women have were from the Mandinka and Peuhl tribes and in their late teens through early 20s. These things are not commented upon.

Today we have 4 sets of twins in Le Grand Salon (the post partum room):

On our first day at the clinic we were looking through the birth registration book and noticed numerous sets of twin births. I asked Awa, the sage femme, about the occurrence of twins. She stated that here are normally 2 sets born a month*** and that a twin birth was quite normal for her staff to do. She mentioned that there was a woman due to have twins around Feb. 14^th and that she would call us no matter the day or hour.  Yeah!!!!!

Set #1

On Monday night/ Tuesday morning this week a woman arrived in labor, ready to push and  CheCha, one of the two mattrones, caught the babies (by herself). Baby #A was head down; Baby #B was breech. Mom and babies are fine.

Set #2

Later this Tuesday morning the clinic called us early to let us know that the women who was having twins had arrived but was only 3 cm. dilated.  So what —we rushed over as fast as we could walk on the 1 ½ miles of sandy roads (heart attack pace).

Because it was Jessica’s turn to take care of the next laboring woman (there are 2 of us students and we alternate getting the laboring women), Jessica was given this lady as her client. My turn will come.

At 11:15 a.m. a woman arrives in hard labor and her bags of water had broken at home at an unknown time; this will be her 5^th child and she is assigned to me. I do the initial medical assessment; she is 8 cms., her fundal height is 37 cm. and she is moving along fast.  She does not speak French, Wolof or Jolla.

At 11:35 she pushed out a beautiful little girl who weighs 6.6 lbs. I cut the cord once it has stopped pulsating, hand off the baby to Jessica, guard the lower uterine segment and gently see if the placenta is ready to be delivered. No. It is a requirement of the Senegal Dept. of Health and a standard medical protocol of this country and this clinic that all women receive an injection of psilocin immediately after the baby is delivered. I give the injection and again palpate the uterus—it is still large and round at the top.  I ask Makeda, the preceptor, to look at this with me.  We discuss the global release of placentas,   put the mom in a squat position, and apply and little more gentle traction to the cord and out comes another baby fully enclosed in its bag of waters! A surprise twin! Makeda and I are crying for joy—a little boy weighing 5.2 lbs.

The mother had never come for prenatal care and had thought this baby was just bigger than her other 4 babies and did not move as much as the others.  Money and transportation and experience with birth contributed to her decision not to seek prenatal care. Mom and babies are doing fine.

Set #3

Jessica’s mom did not birth her twins that day. She is a first time mom and had prodromal labor (even with a pot of parsley tea) for 2 days before giving birth on late Thursday night.  CheCha, her aunt was present to catch her niece’s babies.  Things work out for the best—what a gift for her niece to have her aunt there for her. Mom and babies are fine.

Set #4

On Thursday afternoon a cab sped into the clinic courtyard and he called for help. There was a woman inside who had given birth to twins at home alone the day before; a neighbor had discovered her with a post partum hemorrhage and semi conscious. She appeared severely dehydrated, pitted edema, significant blood loss; she is standing at Death’s Door.  The twins, both girls had not been nursed; they weighed 4.2 lbs and 5.0 lbs.  This is her 3^rd set of twins. Mom and babies are not doing fine.

**In Western Africa, the incidence of fraternal twins is very high. Over 20% of the births are twins.

At about 2:30 pm, less than 10 minutes after the ambulance has left for Ziguinchor, a taxi speeds to the front steps of the clinic.

The cab driver says, “come quickly” and hands off one baby to Jessica. I open the back door of the cab to have another baby passed off to me and I passed that baby off to Jessica.  There in the back seat stretched out is a woman who appears to be semi-conscious; closer to dead than alive. The two women in the cab help me get her out and Makeda arrives to help this sick woman to stand.  Within seconds she passes out and we holler for help; women who were still gathered around from the recent ambulance departure help us carry this woman, like a huge sack of potatoes, inside the clinic to the delivery room. Makeda uses the spirits of ammonia and this woman revives enough for the four of us to lift her onto the table.

While Jessica examines the twins (both girls), we examine the mother and collect some basic information.  Mrs. S. gave birth to her third set of twins yesterday at home alone. Her neighbor came by today to check on her and found her semi-conscious, in a large pool of blood, placenta delivered, with the twins who had not been fed but their cords cut. She has had no prenatal care with these twins and has not money. Sometimes she has no food for the family. Mrs. S is a recent widow.

Soon her sister- in-law and other friends arrive to stand watch.

Mrs. S. appears to be severely dehydrated, suffering from post partum hemorrhage, with deep pitted edema radiating above her knees and her limbs are grossly swollen, very elevated blood pressure, and to have pre-eclampsia.  The placenta was delivered at her home and there are no remnants of it in her uterus.  She and the babies are filthy.

With regard to the twin girls, one girl weighs about 2300 grams and appears to doing well.  The other little girl is cold, appears to be dehydrated and weighs about 2100 grams. Neither has been fed anything. They are immediately given antibiotics, washed and wrapped securely, and passed to the arms of the waiting women.

Feeding the babies is a crucial issue now.  One of Mrs. S’s best friends, who is currently nursing her 8 month-old son (I nick name him “The Brown Bomber”) agrees to take responsibility for nursing the twins; she also brings one meal a day to feed Mrs. S.  We purchase formula and water from the pharmacy and the sister-in-law learns how to mix it and feed the babies.

With regard to Ms. S, an IV is started; pitocin (the clinic is out of methergine) and antibiotics are given. She is placed in the midwife call room, where her friends join her.

Over the next week these Sista-friends and relatives keep watch over Mrs. S and take care of her and her twins. They wash, help her to use the chamber pot, feed her; they care for and feed the babies in shifts. Her sister-in law stays awake for 2 ½ days, with her eyes and hands constantly on guard.

Mrs. S is in and out of consciousness for about 3 days. She is then moved in The Grand Salon and her friends move to the bed and floor next to her. On Friday I give each of the twins one of the special “Mommy and Infant bags” that contains baby clothes.  Yaccine arrives and takes the lead on dressing the twins in the outfits.  Thanks Sylvia Robinson and Gouda Carter for making these bags!!!!

Her friend arrives daily to visit for hours and nurse the babies.

By Tuesday Mrs. S has some milk and can supplemental nurse, with her friend still providing most of the breast milk.  She can make it to the outhouse by herself.

During the week the smaller baby loses a substantial amount of weight and gets an eye infection—we teach about the use of breast milk for treating an eye infection. The other twin loses a little weight.

Yaccine, who brings our lunch each day to the clinic, has taken the initiative of giving our extra lunch to Mrs. S and her Sista-friends.

On Thursday, Mrs. S and her twins were scheduled to be discharged. The naming ceremony with the accompanying head shaving was held in the Grand Salon.  The babies were given the white infant hats that I brought to wear after the head shaving. Awa, the larger twin now weighs 2500 grams; Amada, the smaller now weighs 2100 grams.

We slip the sister- in-law some money with which to buy some groceries and other staples.

Jessica and I are asked to carry the babies to the car.  These Sista-friends who speak no English and very little French; us who speak no Jolla, Wolof, Mandinka, or Peuhl speak words of thanks from our hearts that need no translation.

They leave and take a part of my constant prayers with them.

In the two weeks I have been here I have learned to say “Hello” in the four primary languages spoken in Kafountine.  Of course, Arabic greetings are known by most, and some French is also spoken by many.

In order of the most spoken languages in Kafountine:

• Carolinke
• Mandika
• Jolla
• Wollof

I am still waiting for my  11 years of French to show up on this trip.

We arrive one morning and Awa is doing an initial exam on a woman who is experiencing uterine bleeding and sporadic uterine contractions; she is about 8 ½ months pregnant.  Please keep in mind women do not keep note their menstrual cycles and, once pregnancy has been confirmed, estimated due dates are given by noting the month of delivery, not a specific date.

She has diagnosed this woman as having a marginal placenta previa and has decided to share with us her strategy for dealing with this.

She begins by administering an IV, with a drip of an anti-spasmodic medication. She then ruptures the bags of water, which she says will reduce pressure on the placenta and stop the bleeding. It does.

Once the contractions and bleeding have stopped, she slowly adds pitocin to the drip to slowly ripen the cervix. Once the cervix has ripened and dilation has begun (without the return bleeding) she discontinues any medication.

Within 4 hours the issue of marginal placenta previa has been resolved.  A normal labor and delivery continues.