Fern: The biggest issue of the elections this week was about a woman’s right to her own body. Pro-choice won and won big! This heartening result reminded me of another time and another place where women were able – finally -- to make a choice about whether or not to have a baby.
But oddly enough, this is really Joe’s story to tell. Let me begin with an introduction . . .
When Joe retired from the English department he traveled with a team of doctors and nurses to do volunteer work in the Dominican Republic. He did this – usually in February, a good time to get out of Iowa – for eight years. This was before cell phones and he’d call me when the medical team would leave the hospital and go into the city for supplies.
The work was important, the camaraderie was strong, the beer -- named in honor of then Dominican president Rafael Leonidas Trujillo, known as "El Presidente" -- was plentiful. (One night, when Joe drank too much of it and fell asleep, the nurses painted his toe-nails bright red!)
Joe wrote about this experience many years ago and I’m pleased to share it now in this week’s substack.
Joe: Marie, the patient I’ve been assigned to accompany, seems anxious to get started as soon as I approach with her chart. I shake my head and shrug, trying to indicate that we must wait a bit more before going into the prep room. Marie doesn’t speak English, and I speak neither Spanish nor Creole. Perhaps she thinks I am a doctor in my o.r. scrubs, and so I try a reassuring smile.
Around us in the hall, other women sit the on benches, awaiting their turn. No mas niños, the interpreters say to each woman, No more children. They stress the importance of this phrase, both a warning –– the tubal ligation procedure is irreversible –– and a promise: no more pregnancies. No mas!
The women understand. That is what they came for. I watch one woman sigh with relief as she nods agreement; another evokes laughter by lifting her arms heavenward and crying out in grateful anticipation, “No mas niños!”
The women have come here by bus, by cab, by taxi-scooter, all of them dressed as nicely as they can, their braided hair done up in beads and ribbons. Some carry infants or have children clinging to their skirts. Watching them line up at the intake desk, one after the other, I am reminded of the medical task force’s motto: Changing The World, One Woman At A Time.
The women are Haitians, most of them, and they are the poorest of the Dominican Republic’s poor; many had been sneaked in illegally across the border, lured by buscones or recruiters promising work in the sugar cane fields. What they find is a kind of serfdom: work so backbreaking and monotonous that Dominicans refuse to do it. They live in dirt floor shacks, without running water, electricity, or sanitary facilities; their communities, called bateys, are so remotely located in the midst of the cane fields that minimal, if any, educational or medical services can reach them or their children.
The women of the bateys often become pregnant as teenagers. Many are victims of abuse and rape. By the time our team sees them, most have had multiple pregnancies. Not all the children survive. Nor do all the pregnant women. The chief administrator at the mission hospital, Moises, takes personal interest in our team’s work for a special reason: his mother was one of those batey women who died in childbirth.
After Marie is helped onto a gurney, she watches with stoic patience as a nurse readies an i.v. drip then re-checks Marie’s chart. Of your six pregnancies, she directs her question to the interpreter, how many have survived? Marie has four surviving children. Marie is twenty-five years old.
At what ages did your childen die?
Marie holds up her fingers. Two years. And an infant, three months.
The nurse looks up at the interpreter and says softly, “Tell her I am sorry.”
A knock on the door signals that an operating room is ready. We have two operating rooms, and my station is between them; through open partitions I can look in on them as I clean and cold-sterilize the equipment.
Our team is a dozen or so volunteers from the States –– nurses, obstetrician-gynecologists, pharmacologists, anesthesiologists. And me, a retired English professor.
Back home in Iowa there are several doctors in my poker group, each of whom takes time out every year to donate services –– a pediatrician who cares for sick children in Africa, an internist who started a free clinic right in our home town of Ames. One December night at the poker table I happened to mention that when I retired from Iowa State, I wanted to do some volunteering. “But something different from teaching.”
My friend Tim, the ob-gyn sitting next to me spoke up first: a surgical task force team he volunteers for would be making its annual trip to the Dominican Republic. They really could use an extra hand, he explained, if I was willing to pay my own way.
“Surgery?” I stopped shuffling and put down the deck.
Tim explained that the newly constructed mission hospital down there didn’t have an autoclave, and this meant that all surgical instruments had to be cleaned and sterilized manually. By signing on I would free up a medically trained team member to do more specialized work.
“In other words, I’d be the dishwasher.”
“You said you were looking for something different.” Tim smiled. “So...why not?”
Well, why not indeed. I shrugged and started dealing the cards for poker. Heck, after thirty-five years of reading student papers, the idea of scrubbing bloody tissue off surgical instruments sounded like a welcome change.
*****
Our host hospital, El Buen Samaritano in the city of La Romana, was founded by the Rev. Jean Luc Phenord whose mission was to bring health care to the Dominican poor. His efforts resulted in an executive officer of a local resort donating land upon which the hospital was built, and in creating a network of volunteer medical workers from the United States.
During the first few days, new members of the tubal team were driven out to the urban barrios and the rural bateys, to see for themselves where and how the poorest of the DR live. Back at the hospital, we were also expected to become familiar with the tubal procedure by accompanying one patient from intake to surgery to recovery.
When it came my turn to do this, Tara, our coordinator, known to the interpreters as Jefe (The Boss) handed me a notepad along with Marie’s chart. She knew that I was a writer, and she wanted me to be sure and take notes. In volunteer work, she said, so much depends on getting the word out. “Tell people what we do here,” she said.
*****
The operating room is a blend of state-of-the-art and makeshift: there’s a videoscope and monitor newly donated to the hospital, and the insufflator machine we brought down here with us from Iowa. Above the table is a bank of modern-looking overhead lights. But there are also flashlights for the frequent power outages and brownouts. Beneath the sterile sheeting, the table’s padding is held together by duct tape, and hanging from a string beneath its undercarriage is a crescent wrench for manually raising or lowering the table.
The surgeons like working to music, and all week a boombox, positioned on a shelf, has been blaring out Heart, Sonny Rollins, Hank Williams, Madonna. Right now it’s the sound track to O Brother Where Art Thou “...just lay my bones on the alabaster stones, and be my ever lovin’ bay-beh...”
“You’re going to feel a pinprick,” the anesthesiologist tells Marie. Then waits while the interpreter translates. Marie leans her head against the nurse. Soon she is smiling dreamily –– the Valium drip doing its work.
I remain between the two operating rooms, cleaning the instruments as they come. The process has been explained to me: the surgeon will be snaking a scope down through an incision at the woman’s navel while a nurse assists, both watching a monitor with a scope.
The operation goes smoothly, quickly. Afterward, the patient is transferred to a gurney and moved down the hall to recovery.
When the power goes out, as it occasionally does, everything stops, and the whole hospital seems to hold its breath. We wait in total darkness until the lights flicker back on. Sometimes the women will need to stay in recovery longer than planned, creating a bottleneck that slows the entire process
*****
Marie’s vital signs are taken and she is helped walking to where I am waiting for her in the hall. It’s also my job to walk her up the hall and out the exit door. There is a shortage of wheelchairs. Even if donated, they are far too expensive to ship.
Before her departure Marie is given a gift bag, which she cannot resist opening and looking in. The bag contains donations we brought with us and includes something for her kids: lolly-pops, miniature dolls, matchbox cars.
I help her into a taxi that will take her and two other women to the bus station for their three-hour trip back to their bateys. Marie is one of 97 women who will be operated on this trip, and the tubal team has been doing this every year for almost a decade. Yesterday the nurses were talking about how they tried to do the math once, figuring how many unwanted pregnancies had been prevented, and by extension how many down the line. It was daunting and they soon gave up. Doing such math can baffle you, exhaust and discourage in the face of how much more needs to be done.
Every grownup knows that life isn’t fair, but in some parts of the world it seems to be especially, even aggressively unfair. And yet, as I watch Marie’s cab drive off, I understand that her life has been changed today and the lives of her children, who will now have a better chance for a mother’s attention and care. No mas ninos.Marie herself made the choice.
Iowa Writers’ Collaborative Columnists
Laura Belin: Iowa Politics with Laura Belin, Windsor Heights
Doug Burns: The Iowa Mercury, Carroll
Dave Busiek: Dave Busiek on Media, Des Moines
Art Cullen: Art Cullen’s Notebook, Storm Lake
Suzanna de Baca Dispatches from the Heartland, Huxley
Debra Engle: A Whole New World, Madison County
Julie Gammack: Julie Gammack’s Iowa Potluck, Des Moines and Okoboji
Joe Geha: Fern and Joe, Ames
Jody Gifford: Benign Inspiration, West Des Moines
Nik Heftman, The Seven Times, Iowa and California
Beth Hoffman: In the Dirt, Lovilla
Dana James: New Black Iowa, Des Moines
Pat Kinney: View from Cedar Valley, Waterloo
Fern Kupfer: Fern and Joe, Ames
Robert Leonard: Deep Midwest: Politics and Culture, Bussey
Tar Macias: Hola Iowa, Iowa
Kurt Meyer, Showing Up, St. Ansgar
Kyle Munson, Kyle Munson’s Main Street, Des Moines
Jane Nguyen, The Asian Iowan, West Des Moines
John Naughton: My Life, in Color, Des Moines
Chuck Offenburger: Iowa Boy Chuck Offenburger, Jefferson and Des Moines
Barry Piatt: Piatt on Political Behind the Curtain, Washington, D.C.
Macy Spensley, The Creative Midwesterner, Davenport/Des Moines
Mary Swander: Mary Swander’s Buggy Land, Kalona
Mary Swander: Mary Swander’s Emerging Voices, Kalona
Cheryl Tevis: Unfinished Business, Boone County
Ed Tibbetts: Along the Mississippi, Davenport
Teresa Zilk: Talking Good, Des Moines
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Thank you, Joe, for doing what you did to help this team and these women for 8 years. Thank you for telling us this story.
Thank you!