Ann Davenport

The Love Offer

The Love Offer

I remember the first time I did a vaginal exam on a woman in labor as I was making a house call in her rural western Bolivian village. When my back was turned, she ran out the door and hurried up the hill where she birthed her baby in a cornfield. As a midwife, I thought my responsibility included knowing how many centimeters she was dilated and if I had time to deliver the baby. This was her seventh baby. She didnt need me telling her when it was time to give birth. Her body knew. I was the one who didnt know anything. Rural mountain women are petrified with shyness about their bodies, and I had violated her privacy in a way that shamed her. I was hired to teach, but I had so much to learn. Save The Children had hired me as the Midwife-in-residence for the isolated, rural Bolivian Andes province of Inquisivi, in 1991. I was supposed to work towards influencing the practices of the traditional birth attendants and pregnant women concerning prenatal care, birth and newborn care. The idea was to somehow impact knowledge and attitudes, to lower the high rates of maternal and infant mortality. It was impossible for me to know all the pregnant women in all 57 villages of this province, separated by several mountain ranges, much less attend their births. We did the best we could to influence healthy conduct by giving small workshops every month in the villages for the women and their husbands. It was important to educate the husbands because theyre the ones who would decide to seek care - or not - for their wives in case of an emergency. Most didnt even know what constituted an emergency. How much blood means hemorrhage during childbirth? How do you determine post partum

Ann Davenport

The Love Offer

infection if you dont know the symptoms? And where does one access emergency health care? The nearest hospital is eight hours away in La Paz if landslides dont close the road and the bus happens to be running that day. The ranges of the Yungas Mountains in central Bolivia are spectacular in their isolation and abundance there are hundreds of rivers and canyons, flocks of parrots, bats and butterflies, jaguar and bear, lush greenery and theyre blessed with a spring-time climate all year around. Mountain natives are by nature recalcitrant, clannish people in all countries. These folks are sociable only by necessity, due to their poverty and isolation they have exchange fairs once a week to barter their potatoes, oranges, piglets, sheep wool, and other crops for shoes brought in from the city, bicycle tires, cotton shirts, kerosene or needles and thread. People prefer to high live up in the mountains, which they revere in their cosmology as living gods, and not down near their only source of water in the canyons. If a family has a little adobe home in a village down in the valley, its because they probably have children in the grade school there. But that family always has a little plot of land with a small hut on the side of a mountain nearby. Its very important to connect physically with the earth, up as high as you can go toward the clouds where the condors fly. After living in the village of Licoma for a few months, I was surprised and delighted when 34-year-old Carmen Quispe, pregnant with her tenth baby, walked the two hours downhill from her mountain home to visit me at the health post, accompanied by her husband, Juan. He had attended her previous nine births without a hitch, but wanted to meet the new gringa midwife. He had heard about my healthy mother/healthy baby workshops and

Ann Davenport

The Love Offer

thought maybe I could teach him something new for the birth of this baby. To that end, he brought his wife in for her first prenatal visit - ever. She was eight months pregnant. As far as her general health was concerned, everything seemed fine. She was short and slightly built, but wiry and strong. She was pale, but no paler than most malnourished mountain women. I chatted with them for some time about the risk of hemorrhage, and my concern reflected their own when I suggested that maybe ten children were enough for one uterus to handle. I asked them both to think about a family planning method after this birth. Juan seemed interested enough to ask about vasectomies. He had Brazil nut brown skin with thick, calloused farmers hands, as did his wife. They were poor but proud, and he kept fingering the brim of his hat he held while talking to me in a soft, shy voice. They touched hands quite often, which was an unusual gesture of affection between a rural husband and wife. Despite my urgings, Seora Quispe refused to come down from her mountaintop home and stay with us at the health post in Licoma for a few days prior to her due date, to give birth close by our health team. She preferred her own home, where she'd given birth nine times before. Please send someone for me when she starts labor, I asked Juan. Id be happy to assist you and Carmen - free of charge! He smiled at me, to be polite. Deep lines surrounded his brown eyes and I couldnt help wondering if he was laughing at the very idea of me helping him to help her give birth. I was wondering the same thing. Three weeks later, on a hot summer day, our rural Save The Children staff was meeting with the directors who were visiting us from La Paz for their quarterly statistical reports and

Ann Davenport

The Love Offer

recommendations. We all had a hard time keeping our heads upright from the boring presentations and the heat, although the flies helped us from falling over altogether. Then the door banged open, startling all of us wide awake. Carmen and Juans 12-year-old son ran breathlessly into the room, shouting to me, "Come quick! The baby is not coming out, and pap sent me to fetch you." The directors driver from La Paz jumped up and said he would take the boy and me to the base of the mountain in the four-wheel drive. He knew the villages well and knew where to find the footpath that lead up to the village. I grabbed my birth bag from my room on the way out of town. After 20 minutes of traversing winding, dusty roads along the edge of the canyons, we parked on the side of one curve and saw the steep footpath above us. I wondered how long it would take to climb up to their mountain community. Forty-five minutes later and out-of-breath, we heard the sobbing wails of Juan from inside a house. A few old men and several tired-looking women with small children attached to their hips had gathered around and were sitting on the ground under a shady fig tree. They all glanced up at us, but no one said a word or even pointed out which of the small adobe huts clustered near each other was Juan and Carmens house. I followed the crying. "What happened?" I panted upon entering the dark interior. The smell of blood and

human sweat was overwhelming. Wiping away tears, the husband explained, "My wife was in labor all night and this morning. The baby finally came out. Then she looked at me with terror in her eyes, and then she died! Just like that!" He knelt down beside his wife, who was on a faded

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The Love Offer

wool blanket on the dirt floor, and began crying again. He was holding her hand in one of his and hiding his face with the other. I was breathless all over again. I rumbled through my birth bag to find a stethoscope, and tried to think of what could have caused this death. Her body was still warm, even though heartbeats were non-existent. What happened? This was my first experience with death outside a hospital, my first time with no one around to help me decide what to do. Think, think, I said to myself, figure out what caused the death. There was a small amount of blood between her legs, no twin still inside the womb, no placenta nearby. Suddenly, almost an afterthought, I remembered that Juan had said, The baby finally came out. "Where's the baby? What happened to the baby?" I grabbed his shoulders and said to him. He couldnt even speak, just pointed to the other side of the room. Over there in a dark corner, lying naked on top of some dried sheep skins, with the umbilical cord neatly tied, was a barely breathing, fat baby boy. He was still wet, and cold to the touch. My next actions were a reflex, not thinking, just panic-driven. I grabbed a nearby piece of cloth, raced outside into the heat of that summer day, and roughly rubbed him warm and dry while trying to stimulate his weak little heartbeats. I covered his wet head with a bit of old T- shirt Id found. I crossed the dirt yard over to a silent woman sitting nearby who was breast- feeding a toddler. She had her dust-filled hair in braids and an old, faded, blouse open to her daughter, who was suckling a long wrinkled breast while staring at me. I told this mother what I needed to do, lifted up her blouse, shoved the toddler out of the way, and put this newborn

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The Love Offer

next to her bare breast for skin-to-skin contact. She held the baby with one arm and had her other around her daughter. Both were wide-eyed and speechless at my intervention. I was sweating, shaking, breathing through my mouth and trying to explain, in Spanish, "resuscitation of the newborn to the 20 or so villagers who were sitting in the dirt patio under the fig tree. Within a minute, the baby started crying and later began suckling at the breast. Ah! That miraculous cry! I felt tears in my own eyes and looked over at the driver who was grinning. Satisfied that I had just saved the life of a child who would have died, I sat down in the dirt to catch my breath and collect my thoughts. I was smiling and pleased with my self, even though I still felt shaky inside. The fly-killing heat was relentless as I looked for a spot in the shade to sit with the rest of the neighbors. I wondered why no one had offered a tin cup of water to me or the driver as is the custom when an outsider comes to visit the village. I wondered why nobody had even congratulated us, or said thank you. The women looked down at their bare feet, some men looked me in the eyes and didnt look away, didnt smile, didnt nod or have any other gesture of gratitude or even contentment. Was I the only one who felt a sense of accomplishment? I looked over at the driver, who had returned my inquisitive look eyebrows raised, shoulders up and mouth turned down as if to say I dont know whats going on here, do you? One old man finally voiced what all the others were apparently thinking: "Why did you do that, doctora? Who will feed this baby now? Who will take this baby now that the mother has died? Will you? You should have left alone what nature had intended."

Ann Davenport

The Love Offer

Stunned, I looked around at the frozen faces, everyone with arms folded across their chests. I considered my response, while wondering about the word lynch mob in Spanish. Then I took a deep breath and stood to make myself taller and more formal for the occasion. "Here is a crying, wiggling, fat, full-term baby boy, I finally said, sucking contentedly at the breast of this seora, alive and well." I then retrieved the wrapped baby, much to the relief of the startled and unhappy woman, who pulled her blouse down. He seemed to weigh a good seven pounds as I held him out at arms length for all to see. I continued cautiously, "This is a baby, not a puppy. I'm not going to put a knife in his heart or drown him now. Will you? Or you?" I asked, pushing his wiggly body into the faces of a few men around me. "Oh, no, doctora, we're not talking about killing him! You dont know your Spanish! they argued. In Spanish, as in English, "to kill" and "to allow to die" are different verbs and different concepts. I knew exactly what they were talking about. "Well, I retorted, he's not an animal, he is a human being. He has a father and brothers and sisters and a family and a community, and now you want to kill him, because to let him starve to death is the same as killing. Its slower and more cruel than a knife, too. But how will his father feed him, doctora, another woman said, how will his brothers and sisters take care of him now that they have lost their mother?" They all nodded their heads and grumbled. Sweat trickled down my neck and back. The neighbors defended their timeless ritual of infanticide without naming it - while I argued my own cultural values about human

Ann Davenport

The Love Offer

life. We all disagreed for more than an hour, as more community members gathered for this impromptu meeting. I suggested we at least ask the opinion of the father. He was so grief stricken, he couldn't even speak, just waved his hands at us, as if we were so many flies. We asked the opinion of the two village elders, and we asked the siblings (the older boy offered to keep the baby with him, which brought guffaws and grunts all around). We talked about adoption. Everyone had an opinion and they all wanted to punish me for having brought this dilemma into their lives. They were shaking their fists, raising their voices. It was fly-suffocating heat. "YOU take him! You're the one who saved his life!" someone shouted at me. I said I was very sorry I couldnt, but the Bolivian government prohibited foreigners from adopting Bolivian babies. (I wasnt sure of the validity of my claim, but was proud of myself for thinking up that one so quickly!). Then they insisted the driver, who was Bolivian and was now cooing at the baby in his arms, should adopt him. He deftly handed the newborn off to another person sitting nearby, retorting, Oh, no! Not me! I've already got five kids. I offered to buy baby formula and bottles for anyone who would take the child, and received a chorus of "harrumphs" with heads turned away in response. We talked about other couples in other villages near-by who might be willing to raise him. The father came out of his hut, and began to participate a little. He said he would regalar (literally "to gift") his son to whoever would care for him. There were no takers. At long last, a tiny, wrinkled, ancient grandma hauled herself up from the dirt using her cane. She said nothing at first, until everyone became quiet and looked toward her. She spoke

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The Love Offer

to the crowd in a shaky voice, with her finger impolitely pointing at each of them, "I'll take the boy. You all know me. I have nothing in my home, nothing. But I have love. And that is something I see here that no one has. That is what makes you poor". No one said a word. Many feet were examined at that moment. * * * * * * This is only one tiny village, in one isolated province, in a small corner of the Andes, in the huge continent of South America. There are many more mountain and jungle communities that play out this drama every single day. Economics, education and access all play a role in the deaths of women and in a very common practice that we in the North call infanticide. No one in the village wanted to "kill" the baby; but the challenges of day-to-day survival in their lives were more overwhelming to them than the vision of an alternative - a love offering. Eventually, a young couple from another village was found who would take the boy and raise him as their own. They had been married for over a year and hadnt gotten pregnant yet! So, they were anxious to take this baby and create a family for themselves. I believe the mother may have died of an embolism or perhaps a ruptured uterus. There was no way to do an autopsy (that is prohibited in the Aymara culture) and the custom is to bury the dead right away. While all the "negotiating" was going on about the baby in the yard, two old aunts were inside the house with the husband, washing and preparing his wifes body. They called me in at one point to ask what they should do about the placenta, which was still inside her. In Aymara tradition, it's important to bury the placenta in a secret place near the home where its spirit won't come back to claim the life of the baby.

Ann Davenport

The Love Offer

"Well, since she is now a spirit herself, I said, maybe we should just bury her with the placenta inside - what do you think? Then they will both protect the baby." They agreed, and Carmen Maria Quispe, 34, mother of ten children, farmer, wife to Juan for 14 years, was laid to rest that night under a full moon rising over the steep tropical mountains of central Bolivia. # # #

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