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Economics of Childbirth

Economics of Childbirth

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Published by Ann Davenport
Economics means the price of a cow or the life of a mother in rural Bolivia.
Economics means the price of a cow or the life of a mother in rural Bolivia.

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Published by: Ann Davenport on Dec 16, 2011
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01/01/2012

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 Ann Davenport “Real Life Drama: The Economics of Birth” 
TheEconomicsofChildbirthinRuralBolivia
Luisa,thenurseauxiliaryatLicoma’shealthpost,andIweretalkingaboutthingslikethepriceofeggs,whilerollingchunksofcoursecottonintolittleballstobesoakedinalcoholforthenextvaccinationcampaign.Itwasawarmsummerdayandthedoorswerewideopen.OurfriendandSaveTheChildrenco-worker,Macario,putteredupthelittlehillonhismotorcycletothehealthpost,dismountedwithoutturningoffthemotor,andcameintoseeus.Macariohassoft,cafélattecoloredskin,withstrongforearmsandbighands.HeisnotonlythebestnurseauxiliaryI’veworkedwith,heisakindmanandagoodfarmer.ThiswasoneofthefewtimesIsawaworriedlookonhisotherwiseplacidIndianface.“WewerevaccinatingoverinHuaycana,andoneofthelittleMamaniboystoldushismotherhadfallendownandwasbleeding”hesaid,“andsheisexpectingababy.Iwentbytoseeher,andsheisbleedingvaginally,butstilltalking.Maybeyoushouldgoseeher.”Asthe“midwife-in-residence”forSavetheChildreninthisruralisolatedprovinceconsistingof57villagesspreadoutover3mountainranges,Ididn’treallyknowallthepregnantwomen.Mosthadtheirbabiesathomebythemselves,ormaybewiththehelpoftheirhusbands.Onrareoccasions,likehavingafootlingbreechoraretainedplacenta,theywouldcallupontheirownvillagemidwife.Andtheywouldneverpurposefullyasktoseeme,the
gringa
foreigner.IrepresentedtheInterventionofLastResort.Itwassignificant,then,thatthiswoman’ssonhadsearchedoutMacariotoaskforhelpforhismother.Mostpeopleintheisolatedmountainvillagesarepainfullyshyandproudabouttheirstonyindependence.
 
 Ann Davenport “Real Life Drama: The Economics of Birth” 
“Doyouwanttogowithme,Luisa?”Iasked,“Itwouldbeagoodlearningexperienceforyou.”ShewasalreadygettingtheIVbagsandtubingandneedlesready,sayingtome,“Doyouhaveyourbloodpressurecuffandstethoscope?Let’sgothen.”Bysomeflukeoffate,thetruckwasinLicomathatdaytheonlytruckSavetheChildrenhadforalltheiragriculturalandhealthprogramsintheentireprovince–anditwasthedriver’sdayoff.Ofcourse,whensomeemergencyhappens,everybodywantstobeinvolvedanddaysoffdisappear.Thedriverwasreadyintenminutes,thetankwasfilledfromoneofthosebigyellow50-gallondrumsinthestoragegaragenexttotheoffice,andwewereoff.Macariostayedatthehealthpostincaseanypatienthappenedtowanderinbymistake.Huaycanawasonly30kilometersfromLicoma,buttheroadsinthesesteeptropicalmountainsarenotonlyhairpin-curved,theyalsotraverserushingriversandtheoccasionalmudslide.So,ittookusalmostanhourtoarrive.Asisthecaseinverysmallvillages,mostpeopleknewwhatwasgoingon,andsomefolksweregatheredalongtheroadtoshowuswhichonewasSeñoraMamani’sadobehut.Itwasdarkandcoolinside,andthesmellofbloodwasasstrongasthesmellofvomit.Averytiny,palewomanwasjustwipinghermouthwiththebackofherapronwhenweduckedunderthedoorframeandcamein.Shereclineduponastrawmattress,whichwascoveredwithafadedwoolblanket.Twosmallchildrenwerealreadyindoors,andthreemorecameinsidewhilewebeganourexamination.LuisaintroducedusinAymara,thenativelanguage,andaskedthewomanifshespokeSpanish.SeñoraMamanilookedupatmeastearsfilledhereyesandnoddedyes.IexplainedtoLuisaandthewomaneverythingIwasdoing,asIfeltherpulse,whichwasveryrapidandthready,andstartedtheIV.Shewascoldtothetouchandshaking,but
 
 Ann Davenport “Real Life Drama: The Economics of Birth” 
abletotellusshewassevenmonthspregnantwithhersixthbaby.WeinfusedtheIVatawide-openrate,putherfeetuponsomeblankets,layherheaddownonthebedandcoveredherwithasoftsheepskin.Iaskedhertotelluswhenthebleedinghadbegun,asIlistenedforthefetalhearttonesanddeterminedthefetalposition.Thebaby’sheartbeatwasalsoveryrapidandthready,butpresent!Thevaginalbleedingwasnotahemorrhage,morelikeatrickle.WegavehersomewaterandsatwithherforafewminuteswhiletheIVwasinfusing,justbeingacalmingpresence.Ilookedaroundtheroom,whichwascombinationlivingroomandbedroom.Kitchensarealwaysinthebackpatio,withanopenpitareaforcooking.Lotsoflittlekid’sclothesweredrapedoverthewoodenrailthatwastheircloset.Thedirtfloorwassweptsmooth,andaluminumdisheswerestackedneatlyontheplainwoodshelves.Fourstraight-backedunpaintedwoodenchairssurroundedasmallwoodentable.Thewomanwaswearingathreadbarecottonskirt,noshoesonhermud-cakedfeet,andawornoutwhiteT-shirtthatsaid“Reebok”inEnglish.“Iwasgatheringwood,andIfelldownthehillinbackofthehouse,”shesaidtousshyly,“Iamalwayssoclumsy,butevenmoresowhenI’mpregnant.I’msorry.”WefussedoverherandbeganthesecondbagofIVfluid.Inordertolistentoherlungs,Iaskedhertositupifshecould.ThenIliftedherT-shirttoexposeherback,andsawtherealreasonforthebleeding:oldandnewwelts,somefreshwithdriedblood.IshowedLuisa.Thewomanhaddifficultybreathing,soIlayherbackdownandasked,“Wasitwoodorleather?”ShelookedatLuisa,andhereyesfilledupagain.“Whatdoesshemean?”sheaskedLuisa,inAymara.

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