Searching for quality maternity care

My husband and I had another pre-natal doctor’s appointment today and again, the quality of the visit was disappointing compared to Bolivia. At my last appointment in Bolivia I received quite a bit of information. In addition to 3-D pictures, the doctor spent a good 45 minutes examining the fetus, he provided detailed and helpful responses to my questions and I learned a lot. I was told the fetus was almost one kilo, and was in the top 3% for height-weight at its point in development. He showed me a chart indicated that if that rate of growth continues, I could expect the baby to be between 3.5 and 4 kilos at birth.

The American doctor listened to the heartbeat and measured my abdomen, saying “OK.” That was it. The answers to our questions were extremely terse and I had the feeling we were taking his valuable time. We asked if there were any doulas he’d recommend. He gave us a single first name.

“Any ideas on how we could locate Gloria?” Mark asked.

I asked why he recommended this particular person. “Because she knows my name,” he said. “The other don’t.”

Is that really a reason why we’d hire someone? Because she knows the doctor’s name?

Mark’s impression is that the doctor is flakey and he isn’t impressed with the knowledge levels displayed by the staff we’ve had contact with. Now, when we still don’t have full confidence in our primary doctor, we have to begin to rotate through the other four doctors in the practice, so that we’ll have had at least five minutes of contact with the random person who will deliver our child.

It’s understandable, with such a low level of personalization, with no single individual really paying attention to the needs of the couple throughout the pregnancy process, that demand is growing for non-medical staff like doulas. I almost look back nostalgically to the local country doctor – the person who knew his client well, who was available to come in the middle of the night if necessary. Since doctors have moved so far from this model, people have to look elsewhere to find a person who will listen, provide personalized advice and promise to be available over a period of several months.

Last Arrival in Santa Cruz

After the week-long seminar, I stopped in the U.S. for a few days. There, in another quiet, upper-class area, I saw Mexicans lined up along the street early in the morning, apparently looking for work. By 9:30, most of them were gone. In the time I previously lived in that area, I’d never seen that. It seems to be a sign of how out of control the immigration situation is becoming – that in towns across America, immigrants stand out in the open looking for work. Yet they are relegated to remain separate, apart from the population and the culture as long as they don’t pay taxes and can’t legally integrate. It’s an issue that definitely needs addressing.

It was nice to enjoy a couple days of summertime as well as unpack boxes into what will be our new home. It’s old and uneven and the basement is full of dust, spiderwebs and even live spiders. But I love it. It full of the soft light of wooden floors, I find the small rooms cozy, and I love being within walking distance of cafes, shops and a library.

So when I flew into Santa Cruz last night, into the chilly late evening, I realized it would be the last time I’d be arriving, at least this year. Mark and I are expecting a child. So I’ll be staying here through the end of August, then will work remotely from our home until after the birth. After more than three years of overseas living, I’ll be based in the U.S. for the first time. That in itself will be quite an adjustment.

After years of being an overseas resident, I’m afraid I may be one of the people Samuel Huntington referred to in a 2004 article,

“Coming back to America from a foreign strand, they are not likely to be overwhelmed with deep feelings of commitment to their “native land.” Their attitudes and behavior contrast with the overwhelming patriotism and nationalistic identification of the rest of the American public. A major gap is growing in America between the dead or dying souls among its elites and its “Thank God for America” public.”

I don’t think it’s so much a lack of feeling or commitment for my country. But it’s a deep questioning of the popular mentality that comes from learning to look at the broader picture, to consider other perspectives, to not accept what one is fed by a single nationalist media, and to not believe in my country’s superiority without comparative proof.

While I’m seeing more and more the underside of my nation, the areas in which services are desperately needed – from improving healthcare to addressing immigration, from building workplaces and life structures that support community and balance to providing safety and a quality education to poor youth, these problems can seem vast – difficult for an individual to impact. Whereas it’s easier to find individuals and issues in other areas where smaller efforts can make a meaningful difference.

Upon exiting the airport in Santa Cruz, I hopped into a taxi outside the airport, shivering in my t-shirt. The driver wore a jacket, fingerless black gloves, and pulled his collar up around his neck, covering half his face. Unlike the kind old man I had as a driver last time, this one was young, the vehicle ratty and the streets dark and bare. I felt nervous to be alone and didn’t enjoy the ride to my apartment much. But luckily, all went well.

I’m satisfied with my new home in Santa Cruz. While it’s still cold, the wind is light, just a whistle outside my window. I have my own bedroom, bath, and walk-in closet. So even though I share the apartment with up to four others at a time, and cockroaches crawl through the kitchen, my room feels almost like an apartment of its own. For the times when I do emerge from my room, I enjoy having some company I can speak Spanish with.

I returned to work today, and to the routine I have adjusted to here in Santa Cruz. I work for a few hours in the morning, get a workout and something to eat during the lunch break, return to work refreshed for the afternoon, then have some time alone to myself in the evening. Only the weekends vary much. On short notice, I was able to quickly fill up my Saturday, leaving Sunday for some quiet time.

I always knew I wouldn’t stay very long in Bolivia. In fact, I’ve been here longer than the initial two to three months planned. However, now that I have my departure ticket for late August, I feel myself a temporary inhabitant more than ever. And I look upon my experiences with an air of finality, knowing I have only so much time to see what there is to see of this area.