...Maybe it's Maybelline

Adapted from a letter to my friend, Laurie, with some revisions and additions:

A few months ago, I witnessed another birth-very different from the last one in that the girl was audibly in pain for five to seven hours of labor, with her eyes rolling back in her head, and this time was actually surrounded by the gaggle of yeays (women of grandmother age/ status) that I had expected in the first birth I witnessed.
So for a while, no other patients are coming in and the mid-wife and I are waiting awkwardly, sitting down on the other examination table. She starts doing paper work and I read my book, then I excuse myself for lunch and she approximates when the baby will actually start coming out. Like clock-work, I arrive back from lunch and the baby’s head is peeking out (tuft of hair). The girl has a yeay at every limb so I position myself next to the mid-wife but out of the “line of fire”, or rather “line of splatter”, and stand in such a way as to take up the smallest room possible: straight back, elbows in, feet together (have I mentioned how awkward I am?) I put my hands together and press my fingertips to my mouth- partly because I don’t know what to do, and partly because I don’t trust my stomach to be strong enough to relive both the beauty and horror of watching another human being so bloodily enter the world. One of the yeays confuses this gesture as one of prayer, and appreciatively joins me to offer her thanks to Buddha. As the midwife makes a jagged cut with the scissors to allow for an easier passage for the baby, and the 23-year-old soon-to-be mother looks more and more like Linda Blair with each increased decibel of her scream, I mutter something not to be mentioned here, clutch a fist to my mouth and avert my eyes upwards as to not upchuck myself. Again, this gesture is mistaken for an action of prayer and the yeay starts praising Buddha again and thanking me for my piety. So there you have it-I’m not weak of stomach, I’m pious!
After much aggrieved pushing, cutting and prodding- the babe emerges, only to defecate in gratitude on its mother. Blue for about half a minute before all the mucus is removed from her mouth and nose, the daughter shrieks and continues to poo- but the tension in the air is broken and we can all breathe again.
Now here’s the scary part- the same pair of gloves is used the entire time.
So the same pair that touches the dusty table, touches the instruments, touches the examination table, wipes the baby’s fecal matter and (gasp!) enters the mother to clean out the after-birth! Besides my initial gasp, I couldn’t really say anything on the matter. The damage was done, and to question her authority, especially in front of a patient, would be a breech in the code of Khmer etiquette- being careful not to “break face” by questioning someone’s expertise, thus embarrassing them in front of others.
It’s such a dilemma! I don’t know how to approach the situation without sounding like I’m accusing her. I could call one of the Khmer medical staff for Peace Corps and ask her opinion on the matter, since she may better know how to deal with the situation and the image has been haunting me for weeks, but now so much time has passed that it would be even more awkward to bring it up out now. I guess the best thing I can do, since learning that this sometimes happens, is to address the problem at the time it is occurring. I might not be there for every birth, but for those I do witness, I can learn to be bolder when a concern such as this arises; and perhaps instead of confronting the midwife with my simple Khmer which may come off as aggressive under such circumstances, I could simply hand the midwife a new pair of gloves every time they should be changed, so as to appear helpful rather than reproving.
Anyway, besides working on gaining a stronger stomach, I mostly talk to pregnant women about eating nutritious foods, taking their pre-natal vitamins, avoiding heavy lifting, alcohol, cigarettes, other medicines, hair dye with ammonia, etc, getting their vaccinations...and to mothers about how to wean their babies and to cook a variety of foods with different vitamins. It took a while to figure out what my role could be in the Health Center, and in some ways I’m still figuring that out.
I remember the first few months were just observing the on-goings at my Health Center because I spoke so little Khmer that I could barely be a help in the Health Education department, besides providing patients with health information in the form of pamphlets; but those who were illiterate were out of luck, and I would just direct them to the other staff members to ask their questions. Those first few months were mostly me sitting around asking questions to my staff and sounding like a caveman. Like, “Why baby have this on head?”- miming to the baby’s scabby dome. And every question would receive different remarks from each of the staff members: “because of poor hygiene”, or “it’s normal”, or “maybe she’s born with it”- to which my response would always be “...maybe it’s Maybelline”, eliciting laughter only from me, and quite possibly making me seem deranged for laughing at people’s ailments. No wonder people call me the girl who “laughs easy”, but living in another country means that sometimes you only have the voices in your head with which you can share pop culture references.
My Khmer has notably improved since the early days, but I feel like lately I’ve plateaued- like I’ve learned survival language and work language and can have surface-level conversations, but have yet to dive deeper. I can have convos, but listening to TV or people talking rapidly to each other is rough. It’s like the show “Psych!” where the clues the guy sees light up. Certain words or phrases click in my head, but sometimes I don’t understand the one word that’s the corner-stone of the whole sentence. Perhaps the year mark will see more improvement?
Just this past week, I had the opportunity to revisit one of the villages that I had gone on outreach in early January. It felt so good to feel more comfortable with the material I was teaching, and to have stronger language skills than before. I had some notes to refer to for the topics I talked about, but I didn’t read the information off like a script; I was able to make eye contact, and observe my audience’s reaction as I was speaking so I could clarify the things that I could tell people thought confusing, or turn to my accompanying Khmer village health volunteer to elaborate with a more precise pronunciation. Last time I had visited this village, I had talked about how to make (and “use”) Oral Rehydration Salts when the mothers listening, or their children, have diarrhea, and reminded the mothers about the 3 food groups (in Cambodia, the Ministry of Health teaches 3 food groups instead of the food pyramid- energy foods, strength- building foods and protective foods). But today I was able to not only present the same information more clearly and field questions afterwards, but also quizzed the mothers and children attending my session about what foods are part of which food groups (something simple, but I’ve learned that many are unsure, even though they may say they already know the 3 groups), did a hand washing demonstration with the children (using glitter to represent germs and how they spread) and explaining when we have to wash our hands and why it is important, as well as a teeth-brushing “demo” (where I had the children stand in the form of a mouth to represent the teeth, one child represented the tongue, and the floor was the gums). I used some string to represent floss, and a laundry brush to represent a toothbrush, explained how often and when they should brush their teeth, and the consequences of not brushing. I then passed out toothbrushes I and other volunteers and Peace Corps staff had collected from hotels to the children and quizzed them on the information they had just learned. If anyone else has other (preferably creative) ideas for how to teach health topics to children and adults, please let me know! I’m still working on expanding the topics I talk about, but have to use methods that keep people’s attentions so they will actually want to listen past my accent to hear what I’m saying.
So in other health-related news, I have recently turned in a grant for renovations at my Health Center, and if I raise just over $1,000 my village will have enough money to purchase the materials to paint the entire exterior and interior of the Health Center, fix some of the ceiling tiles, restore the crumbling corners and start a guppy farm (fish to put in water basins to kill mosquito larvae). The public website on which people can donate to the cause will be up soon and I’ll post it as soon as it is. I also have turned in all the paperwork to work as Health Program mentor for the Phnom Penh-based organization Tiny Toones in August and September, where I will lend my ideas as to how to improve their Health Outreach Program whose message focuses on HIV prevention in the ghettos of Phnom Penh. The link is below if you care to take a gander!

Update: Since writing this letter (turned blog) to my friend, I’ve also had experience helping with a birth. Instead of just observing, I actually got to get my hands dirty...literally....well, not quite literally as I was wearing gloves and that would just be gross. I won’t go in to the gritty details here but I will tell you that this time I was in the “line of splatter” as I so previously called it, with galoshes so I wouldn’t slip in any amniotic fluid and a white coat to protect my clothes, if only it was long enough to cover all of me. The midwife armed me with sanitary napkins and instructed me to push on either side of the baby’s crowing head to help it come out. Luckily, I wasn’t hit by the least bit of fluid, although I was prepared to lean towards either size had I seen it coming.