“What exactly are you doing there?”

I’ve been talking about Earth Birth for months in anticipation of my trip here, but hardly knew what I was getting myself into. At the most basic level, Earth Birth is a maternity center that provides services to women in a community deeply traumatized by war. The organization seeks to foster a safe and culturally appropriate environment for women and their babies throughout pregnancy childbirth, and the postpartum period. Earth Birth also functions as a school, pairing senior midwives with student TBAs from the local villages. Classes take place weekly here to go over skills necessary for ensuring safe delivery.

A lot of people have asked me why women don’t prefer to give birth with professionals who have been formally, medically educated and in a hospital. That isn’t a safe or realistic option in Uganda, to say the very least. The nearest hospital is over two hours away via car and if a woman were to make it there she would be faced with a severe shortage of staff, beds, and equipment. Rachel, one of the midwives and co-founder of Earth Birth used to work at the hospital in Gulu and it was the circumstances there that inspired her to create this maternity center. She has told me stories of women laboring in the hallways, getting a bed only when it is time to push, and being discharged just 10 minutes after delivery. In spite of these truths, the Ugandan Ministry of Health has issued a ban against training TBAs and traditional midwives, labeling them as incapable of learning and responsible for Uganda’s high maternal mortality ratio. TBAs, however, remain an essential resource in community health. They have continued to practice as long as there is a demand for them and at over two hours from the nearest hospital where the risk of death is even greater, you can be damn sure the demand is still high in Atiak, Uganda. TBAs and traditional midwives offer essential healthcare where there would otherwise be none and through Earth Birth they are able to do so safely.

My role at Earth Birth will turn out to be quite fluid, from what I can tell after just five days here. In exchange for food, housing, and the experience I will gain here, I’ve committed to three months of working here in what Olivia has called a “managerial position.” I’ve been assigned three main projects that I am trying to get off the ground and running before heading back to the States by Thanksgiving!

1. Olivia and Rachel want as many of the supplies as possible to be sustained by the local economy or through local craft. I am hoping to get sewing, beading, and gardening projects started amongst the women who use Earth Birth services. Vegetables from the garden can be sold in the local market while sewn and beaded projects will be sold in the US through partnerships with fair trade stores – at least that’s the plan I envision for now!

2. Right now, all of the protocols for pregnancy, childbirth, and the postpartum period are written in English, which is useless in a community where most women do not speak English, let alone read it. I am establishing a team of TBAs who do speak English and together we are going to create a protocol manual that uses Luo (the local language) and images for the women who are fully illiterate, but still a crucial resource to their communities.

3. The last major project  is the one I am most excited about. As I mentioned above, the Ugandan Ministry of Health has banned TBAs and their practice, but based on evidence I referenced and further evidence in my dissertation (you can ask, if you really want to read it) this is a less than ideal policy decision. It is impractical to expect TBAs not to practice when the need for them is still so great. I’ll be using my research and Earth Birth statistics to create a report indicating the success of this program and that these women have had on the community in hopes of encouraging the Ministry of Health to consider a more incorporated role for TBAs in the health system.

That’s all for now, but feedback and comments are always appreciated!


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