Wednesday at the Clinic

The birth control methods available at the CASA clinic

Wednesdays are for viewing wellness - and illness. I've arranged with Adriana and Lourdes to spend Wednesdays at the CASA clinic, about 10 minutes away from the youth center. The clinic looks like a regular building from out front, but is unlike any other hospital I have ever visited, at least architecturally. There are many arches, and large open garden spaces right outside of the waiting room and in the maternity ward, complete with flowing fountains. The walls are decorated with an eclectic mix of "patient" photographs, Kandinsky posters, original artist work and advocacy / human rights displays. Best of all, it doesn't smell like a hospital.

Adriana introduced me to a young woman studying to be midwife. There were few clients in the morning, so the partera-in-training and I passed the time chatting; the more we talked, the more I came to respects her. She is 18, with a 2 year old son whom she supports by working an additional job at an organic restaurant in the Centro (note: check it out) - all this in addition to her studies. I left my phone number with her, and she promised to call in case of a birth on Thursday night. Nadine later recommended that we actually pass at least one night a week at the clinic, since no one would be concerned with calling the interns if a woman's water suddenly broke.

The morning crawled on without any visits, so I checked with Adriana to see if it would be better to come in on Mondays, which tend to be busier. I should not have been so impatient. As soon as I left her office, the partera on duty invited me in to observe a prenatal exam. A very pregnant young woman of 23 had come in for a check up. Her 5-year-old was with her. I introduced myself and asked if my company was ok. The woman nodded. Another partera-in-training, this one in her late 40s, was also in the room. She took the young woman's blood pressure and body weight.

The partera was very friendly and professional. She recommended rest when the young woman complained of frequent headaches, and then asked her to lie down on the examination table. While her mommy was getting comforable, the adorable little girl gave the partera a lolipop. Then, she smiled at me.

The partera taught her student how to feel for the baby's head, and to listen to the heartbeat. I wanted to listen, also, but did not have enough nerve to ask. After the exam was over, the partera provided her patient with her cellphone number, in case of emergency, and was rewarded with trinkets from the baby shower - from which I got my own souvenier lolipop.

We were alerted of a second clinical exam, and this time I gathered my courage to ask if I really could listen to the fetus' heart. Of course, smiled the partera. But the confident young woman who entered had other plans. The patient explained that she had a 9-month-old baby at home, and had consistently been using birth control after the birth. However, apparently she had been switching between the pill and other methods - and wound up pregnant again. She feared that the baby would be born with birth defects. Moreover, she and her husband could not support another addition to the family - they already had two first-graders at home, in addition to the baby girl. And she really was so afraid of the birth defects. But an abortion in this 90% Catholic country... and it being illegal and all... She finished her story wiping away tears.

The partera listened patiently, then filled out a form. She asked the young woman to remove her bulky coat (it was a freezing day) to take her blood pressure, and I was surprised at how small the woman was without it. I wish I knew what happened next. but the partera needed to have a confidential conversation with her patient, so I exited the room.

My heart heavy with what I had heard, I entered the waiting room - for more difficult news. A group of three women gathered in the waiting room, streams of tears running down their faces. Two of them looked to be my age. Then, I realized that the third - the matriarch - was holding another young woman close to her bosom, her face hidden, her shoulders shaking. I shot a quizzical look at my friend, the partera-in-training. The girl lost her baby, she explained. Then, Dr. Ismael entered. "You speak Spanish?" he inquired. I replied in the affirmative, and he explained that after 19 weeks of pregnancy, the baby was no longer moving or breathing. "Will you induce artifical labor?" I asked. Yes, they were going to start contractions. Then, he flew down the hall, giving hasty instructions to the assistant. I left soon afterwards, telling Adriana of an upcoming meeting with Nadine. I was actually glad to go - I felt I would join the ranks of the water-shedding women at any moment.