What would you say is the most important thing in life?
Health and knowing how to live in this world; knowing how to enter a place and how to leave.
There are many ways to leave a footprint and many types of footprints to leave. There are the ones in a dust pile that scatter with the next step; the ones in sand that wash away when the tide comes in; and those accidental ones in freshly poured concrete that continue to harden over time.
About five weeks ago, I landed in Fortaleza. It is a large city on Brazil’s Northeast coast that has sat a the center of the recent Zika epidemic. I came down to study the relationship between Brazil’s restrictive abortion laws and the response to this public health crisis. Specifically, I wanted to identify the challenges healthcare providers face when caring for women with Zika-affected pregnancies, given the high correlation with fetal microcephaly. Questions such as how providers advocate for patients, decide on appropriate follow-up procedures, discuss pregnancy options, and respond to patient concerns within a rigid policial and legal framework.
As luck wouldn’t have it, a few days before my flight I got a rejection letter from a grant for research funding. But my ticket and visa were already purchased. So with that I made my entrance with a little notebook covered in seahorses, some rusty Portuguese, and hope that I hadn’t just made a huge mistake.
Within days after arriving, the heavy disappointment of rejection turned into a relief. I soon realized that had the project been approved, it would have been a tremendous failure. There simply weren’t any new Zika cases to look at. So instead I roamed around the maternity hospital I had been connected to, getting passed among doctors and residents who didn’t mind an eager tag-along. The first couple weeks I spent helping women with large bellies rolled on and off exam tables. During prenatal checkups I took blood pressures, ran measuring tapes from pelvic bones and uterine ceilings, and listened to fetal heartbeats; during ultrasounds I stood in the dark cold room staring at a screen that measured gestational age and health but looked more to me like Escher drawings than any identifiable body parts.
Although Zika-associated microcephaly was no longer on the table, I began paying attention to issues of other maternal-fetal complications. Perhaps these cases would open up similar discussions. At first, I did not hear the conversations I was looking for. The fact of the matter is that in a country where abortion is illegal, these conversations are not obvious. If they happen at all they seem hinted at, touched upon, broken into bite-sized chunks for you to piece together on your own. They require other senses.
But as the days passed, they slowly began to appear. I found them in the absence of patient questions, in the muffled “thank you”s, and silent head shaking. They were in the tears of women who received devastating diagnoses in the ultrasound room. They were in the rejection of a patient’s request to have her tubes tied with her C-section. They were in the swift change of conversation when I began to ask questions.
By slowly connecting the dots, I eventually found who I was looking for. My third week I arrived at Dra. D’s office door. She was the one who facilitated the few legal abortions allowed by the hospital. She met with patients who came looking to terminate pregnancies resulting from sexual assault. It was incredible to watch her work with patients. Her words soothed their wounds and calmed their cries, yet she was firm in her counsel. She promised they would be cared for without sugarcoating the truth of the challenges that still lay ahead. When they collapsed into their chair she did not take them into her arms; instead she helped them stand stronger, walking with them as they navigated the hospital side by side.
This was actually a small part of the work she did as an Ob/Gyn and sexologist. Each day with her was a whirlwind of patients, cases, conversations I could have never planned for:
- a walk through one of the few psych hospitals where heavily sedated men with glazed eyes sat scattered through hallways and open courtyards
- a training on transexual health for hospital staff, many of whom had never heard the word before
- a support group for patients with multiple sclerosis
- couple’s therapy where they shared the intimate details of their sex life and relationship woes
- trans patients looking to begin their transition process
- Play-Doh therapy with a 3 year-old with a suspected case of sexual abuse
- life lessons taught to residents about feminism and empathy for their patients
- physical therapy for a patient with vaginismus
- identifying a learning disability in a 14 yr old patient who couldn’t find her country on a world map
One of the best days was when I joined the last day of a 5 class course. It was a support group for women with sexual dysfunctions of various types. They had already covered questions of physiology, biology, social constructs of sexuality, religious influences, relationships, etc. The day I arrived was about pleasure and eroticism. Dra. D split us into pairs and distributed an assortment of items, which we had to incorporate into a story. I got a massage wax candle, a small vibrator, and a dice with different sexual positions on each of the six sides. At first most women were quiet, shy or giggling with embarrassment. But not my 60 something yr old partner who order me as the scribe to the heated saga she began to tell. When it came time to share, the room erupted in applause and laughter as women surprised even themselves with the erotic stories they created.
So while my proposed study failed died before it began, the experiences I had were ones which seemed to answer the questions I had better than anything I could have planned for or imagined. As my five weeks in Brazil come to an end I’m curious to see what comes of these footprints. Both those I have made and those which I have stepped into. Only time will tell.
For now there seems to be only one way to leave: humbled by the generosity that greeted me, inspired by the stories I bore witness to, and motivated to take on the hard work that lies ahead.