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Maternal Health: Learning from Miracles

I think I've had a model of communication in my head for a long time which I am now beginning to question. For much of my life, I've thought of communication as transactional: a process of broadcasting and receiving, with the goal of persuasion. Discourse was purposeful, a time-bound means of outlining my convictions in order to convince someone else. Thus the message, the content, was what I paid attention to: the process of communication was something I was barely aware of.

Yet: when I attune myself to that process, I notice the other person is always choosing their own way, adding their own colour to my black and white messages. My message passes through all of the filters of their experience, translated into the inner world of their understanding. My meaning changes in the listener's hearing of it, and what they mean changes in my experience too. This is quite liberating a realization! It means I don't need to seek approval or fear scorn (as neither of those responses are within the range of my control). I am free to consider fresh points of view because I am concentrating on what I can change: myself.

I live in Lesotho for part of each year, in a little hut in a typical mountain village. When I question what a cultural outsider like me is doing involving myself in inside-out community development, I think of my neighbor Limakatso and what she taught me about two-way communication.

Last year, Limakatso became pregnant at the age of 16. No father stepped forward to take responsibility. Not only is she a teenaged-mother-to-be, she is the head of a household of 5 children, all orphaned after her parent's death from HIV. She has been trading sex for food and basic necessities so she and her siblings can survive.

Her name means “Miracles”. Limakatso: a beauty, like her mother was. She is a rake, tall and lean, taut with muscle, legs like a sprinter. Her hair is shorn to the scalp, no luxury of braids for her. She dresses in raggedy skirts that she’s long outgrown: though she no longer attends, she still wears her school uniform sometimes. It comes halfway down to her knees and is held closed in the front with twists of string. There she is, carrying laundry down to the river. There she is, six in the morning, a pile of branches on her head, walking uphill. There she is, in her yard next door to our house, stirring porridge over the cookfire on a windy evening. As she hauls buckets up and down the slopes around the house, she bundles the smallest child, Relebohile, on her back in a cloth sling. She keeps the family's clothes clean, she stretches the porridge out with water to fill all five bowls. These are the miracles she performs.

Naturally, she cocks her head and narrows her eyes at the weird occurrence next door, our family of white skinned strangers equipped with cars, piles of wildly novel toys, toothbrushes that whirr at the press of a button—our world of unimaginable wealth has settled in next to her world of unbearable deprivation.

She is a hundred times more canny than me, and while she doesn’t exactly outsmart me she learns quickly how to play my moods to her advantage. Here is a kid whose prime directive is to fill her belly, then to get her siblings fed so they will shut up and let up with their whines and their cries. She cares for them, and protects them fiercely, but she is not a mother, and wants to dispense as quickly as possible from her duties so she can hang out like a teenager. I am an obstacle blocking her path to the full cupboards she susses out behind me. If I’m tired, cranky, she is diminutive and darts away with her packet. She does a little curtsey for the bitch. If I’m cheerful, expansive, she plonks down in the camping chair, eats her stew, and entertains me with her loopy drawings. Once she is fed, she may begin to gaze at me and size me up in more nuanced ways, but there is always that first-things-first bluntness to our every interaction that irons out any questions marks I might have about the dynamics of our ‘relationship’. This is not a pity party we’re having here: we are both being pragmatic about an absurd situation, and setting about our roles as best we can, having had no previous instruction in this brand of friendship.

I adore Limakatso: she's a rebel, and proud, quick to laugh and bold enough to stride into our house without knocking. She makes cool earrings and necklaces out of the beads and scraps of fabric in our sewing kit, and shouts like a mother when her near-feral little brothers give her lip. She also sniffs glue to drive away hunger and is deeply imperilled—and is imperilling another tiny being who is just starting out life in her tummy. She is going to need a miracle, miracles, to survive at all, let alone to realize her brilliant beautiful talents out in the world. I tell myself I didn’t come here to look after all the fallen kids of the village, I have public health surveys to conduct and accountancy training to provide… and programs, projects, packets of assistance to deliver. There is nothing I can think up to fix the hellish mess that confronts me next door.

Or maybe there is.

There are dozens of young women who are in Limakatso's boat. Together with local village health workers (mainly, mothers like me who are trained to deal with front-line emergencies in the absence of health professionals) we organize a workshop for pregnant and new mothers in the district. We invite a midwife, nurse, and the heads of HIV support groups from surrounding villages, who tend to be decently resourced community members who keep their eyes out for vulnerable people in their villages. The workshop is intended to offer pre-and post-natal health basics—immunizations, nutritional supplements, help and advice on breastfeeding, birth control, and so on. I thought a lot about Limakatso as we designed it, hoping that she would find some friends among the other teenaged mothers and some practical help from the sympathetic caregivers. But —in the end she didn't come. Girls from 20 and 30 miles away managed to get there, but my neighbour who lives 500 yards from the workshop site took off and didn't come back until it was over.

Afterwards, I chased Limakatso down: I was properly furious. She's 8 month's pregnant, needs an HIV test, needs to face reality and get organized for the arrival of what (I insist!) must be an HIV negative baby... and she's dodged this opportunity because it hurts her pride? And it does, and shame and rage have overwhelmed her to the point where she thinks it's nonsense to go to some lousy workshop and leave with a pile of shabby old baby clothes. She knows from her experience that all the things she ever needed were never given, only snatched or stolen. She thinks she is going to have this baby in the same way: far away from the authorities who have hurt and neglected her. I take a lungful of air to stop from screaming and look at her, chip on her shoulder the size of a tree. I realize that I cannot influence what she believes about herself, I can only tell her what I see. Miracles. Disaster. Potential. Peril.

Later on we go together to the clinic where she meets privately with a nurse. On the way home, we talked about why she skipped out on the workshop. Limakatso told me she'd like to join a young mothers group, but not in a school where all of her former teachers and classmates can see her, and not in a big group. She'd go if there were, maximum, ten girls in attendance. She'd like to do some more of that necklace making, too, and maybe learn more about sewing.

Because of confusing, crystal clear experiences such as this, I am no longer trying to broadcast my ideas like seeds into people's heads. I have so much to learn, but I'm not going to figure it out. I'll have to figure it in. There's too much to learn by listening, and too much to lose by being attached to whether my good intentions and careful interventions are received, or rejected. Rather, I can create conditions which allow change to occur, knowing that I am not the change agent. The other person—the participant, the beneficiary, the subject, whatever you want— is in control of that change. Her twin sister may come up with totally different conclusions, which proves that learning is not external, it's subjective. What 'development' is capable of doing is making different choices available to people. What it is incapable of doing is to control what choices those people will actually make. Sometimes I will be disappointed, and I willl call that 'failure', and if I am sincere I'll go back and ask people what they might want to see woven into the mix next time. I cannot 'deliver' change, fixes, solutions, in response to those articulated wishes, I can only bring those understandings to the table for the next round of program design.

For our next young mothers workshop, we'll consider hosting smaller groups, in more intimate settings. We'll think about doing something with the young women that would be—fun! One idea would be to invite participants to each make two necklaces: one for themselves, and another one for their baby. The girls could be encouraged to consider these little rosaries as strings of wishes they hold for their own lives, and for the lives of their children, using art to provoke a conversation from which we as public health educators could learn so very much.

We have not done that type of follow up workshop yet: I'll report back when we do. In the meantime, Limakatso gets her tests, she gets her little pile of baby things, she gives birth to a healthy boy. She tells me she's never known love like what she feels when she lays eyes on baby Hlompho (Respect).

by andrea palframan (ampersand)

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