It was the winter of 2011.
I was living and working in the rural village of Sebikotane, Senegal, developing a family planning and reproductive health class curriculum for high schoolers. I sought guidance from my mentor Oumou, who advised me to consider the pitfalls of knowledge transference in cross-cultural contexts. She illustrates her point with the story of an unfortunate Peace Corps volunteer who had been working as a health teacher in a similar Senegalese community. In her presentation about effective methods of contraception, Oumou explains, this volunteer had put a condom onto a cucumber as a means of demonstrating the proper technique. A few weeks later, one of her students approached her after class and excitedly recounted how she and her husband had been doing exactly as they had been taught: placing a condom-wrapped cucumber beside their bed before having intercourse. This student had believed the condom/cucumber combination to be a sort of gris-gris, or amulet, which would prevent against pregnancy, a completely logical assumption given the cultural context in which she had been raised.
It is now the winter of 2016.
I’m twenty-three. Though it has only been five years since I heard that story, it feels like a lifetime ago. I have changed – my values, goals, politics, even the name I go by look radically different than the ones espoused by the bemused, wide-eyed teenager I once was.
I am living and volunteering at a gentle birth clinic in Denpasar, Bali, completing the Birth Institute Experiential Learning Abroad program, simultaneously working towards my Holistic Doula certification and fulfilling the senior project requirement that will allow me to graduate from university in June. The intervening four years of life experience and education have transformed me from a well-intentioned, naïve teenager into a woman who had learned to think critically and for herself.
But I am not the only thing that’s different this time around.
At this clinic, instead of being expected to lead or instruct, I observe. And what I see is a system in which Balinese midwives provide woman-centered, culturally appropriate care to their peers. In contrast to the unfortunate Peace Corps volunteer who cast herself in the role of educator, Birth Institute students are witnesses, students, and holders of space. With the reigns firmly in the hands of indigenous midwives and administrators, patients are able to receive optimal healthcare while facilitating a sustainable transfer of knowledge between the midwives and their Birth Institute students.
The clearly defined roles for students and staff help to destabilize the inherent imbalance of power that exists between Western organizations and their host communities in the Global South. As a result of this collaboration, patients enjoy a high quality of care that combines both traditional and biomedical methods. The intimate nature of birthing demands a close working relationship between midwives, students, and patients, which leads to the formation of friendships and the sharing of knowledge. As we learn to imagine each other more complexly, we are building a global community that will foster a sense of mutual empathy, respect each individual’s unique perspective, and transcend the cliché, destructive images of the “other.”
I believe doulas and midwives are perfectly positioned to become leaders in global healthcare as delivery strategies shift towards a more egalitarian and humanistic style of care. The central tenants of natural birthwork dovetail beautifully with those of advocates for the decolonization and redistribution of healthcare resources. Birthworkers understand the importance of holism in all things.
Our focus is not pathology, but connection.
We trust inner wisdom and respect the bodily autonomy of the individual. We subvert power structures by insisting on the unity of caregiver and client. And we use medical pluralism – the combination of the best biomedical and folk methods – to create and maintain the health and well-being of individuals and communities.
In upholding these values, maternal healthcare practitioners are quietly demonstrating an alternate pathway towards positive health outcomes, a path that is not predicated on colonialism, capitalism, or patriarchy. Each successive birth helps pave the way to a total systemic overhaul.