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The first week of November [1994] I was working in the clinic in El Tablón with Irma and the Health Promoters in the mornings–seeing patients, precepting for Promoters and consulting with Irma. In the afternoons we worked together, quickly trying to analyze the data from the projects and preparing for the upcoming community presentations. One evening, after a long day of work, a boy came running up to our house and told us there were problems with a childbirth. We grabbed a pack of equipment, and Irma, Lissi and I headed through the woods to a small, one-room house.
| Economic opportunities in this area are scarce. Many are left with only one alternative: Making hammocks and other typical weave-work in their homes and selling them in a very informal and exploitative market. The average salary one person can receive in this type of work is less than one dollar a day. |
The expectant mother was in the squatting position and looked completely exhausted. They told us she had been in labor for 16 hours. The local midwife looked tired as well, and she thanked us and left. While Irma prepared our equipment, I asked our patient to sit on the bed and rest, listened to the baby's heart and then performed a vaginal exam. The heart beat sounded good, she was fully dilated, the head was in the cervix and her water had not yet broken. Her problem was that after so many hours of pushing she was incredibly swollen, both inside and out. Irma agreed we should break the water. I did so and while Irma went to get the water we were boiling, I pushed all the swollen tissue out of the way and asked the patient to push so I could see how well she was moving the baby. Much to my surprise, on that, her first push for us, the baby came out full speed, a beautiful and healthy-looking baby boy. This was incredibly exciting for me and I was all smiles as we cleaned the baby, cut and cleaned the cord, gave eye-drops, and delivered the afterbirth.
But not all was as perfect as one would hope. For some reason, the mother didn't seem so happy. She smiled at times, but just as often looked sad. I thought maybe she was just tired, but while we walked home I asked Irma and Lissi if they had noticed the same. Then Lissi, who had been talking with another woman in the house, told us what she had learned. This woman was too poor to support this child, so she had received food throughout the pregnancy from another woman in exchange for the unborn baby. The following day, her newborn son was taken away from her. I was shocked, sad and disturbed by this. It didn't comfort me much when Lissi added that this was not so unusual. In fact, this child was the seventh for this woman and she has only kept two.
– Stephen Miller, MD, January 1995
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