MARY ANNE MERCER
The room was nearly dark, illuminated by the quivering light of two kerosene lanterns and a small cooking fire at one end. That shadowy scene would stay
with me for many years when I reflected on my time in rural Nepal. A young woman moaning in pain, her mother murmuring words of comfort, and off to one
side of the room a row of huddled, chanting figures, eerie shadows flickering on their faces.
It was 1979. I was traveling on foot with a small team of local staff in Nepal’s rural district of Gorkha, conducting an immunization campaign and providing something we called “health teaching” in remote villages. A newly-minted nurse practitioner, I also did my best to help villagers who came to me with their health problems. Several months after signing on, I was still dealing with the challenges of learning a new language, making day-long treks on difficult terrain, and persuading mothers with fears about immunizations to surrender their children to western medicine. Muddled up with all of it was the need to navigate a mystifying new culture, one that seemed to pervade every aspect of the life I saw around me.
Late one afternoon as I returned to camp with my small team after a full day of work, a young man approached us on the trail and asked politely if I could come with him to check on his wife. His eyes had a worried, restless look. When asked about his wife’s problem, he replied that she was in labor with their first child, and it was taking “very long.” “Kahile dekhi?” I asked. How long has it been?
“Hijo baata,” he replied. Since yesterday. “A long time. We live very close, just five minutes away.” With that he pointed, with a jut of his chin, to a small settlement nearby. I agreed to go with him, stopping first at camp to pick up a makeshift delivery kit. We arrived shortly at a simple house in the middle of a small hamlet which, I had heard, was a village of Kamis, one of Nepal’s untouchable castes. The young man I’d seen on the trail ushered me inside, then quickly disappeared.
It was still bright daylight outside, but I stepped into a room that was, at first, dark as a cave. It emanated a pervasive gloom that only such shadowy rust-colored, spongy walls could produce, absorbing most of the light from two flickering lanterns. I could faintly see a young woman crouched in the far corner, moaning in pain, with an older woman by her side. I paused to let my eyes adjust to the dim light, then introduced myself. The older woman indicated that her daughter was Sani, and with a drawn, worried look she said that the contractions were getting closer together. She gazed at me intently, as if deciding whether or not I was a safe confidant.
“Can I examine her?” I asked the mother. She hesitated, then nodded in assent. Sani herself barely registered that I was in the room. I helped her lie back on the straw mat and within a few minutes determined that the baby was in a good position, with a strong heartbeat, and the young mother-to-be was almost fully dilated. But this was her first pregnancy, so the delivery could take a while longer. I reassured them that the baby would come before long and said I’d return soon.
Two hours later, dinner finished, I returned to Sani’s house to check on her progress. I’d expected to see the young woman in the care and comfort of her mother, but what I found instead was an eerie, other-worldly scene that would stay with me long after I left Nepal.
Stepping into the still-dark room, I could see Sani squatting in the middle of the mud-pack floor. She was leaning against her mother, who supported her on one side, with another older woman offering assistance on the other. Behind them in a slightly elevated area was an assembly of six or seven ancient-looking village women, some sitting on the floor and others standing in a kind of crouch. Beside the women flickered a low-burning open fire that occasionally illuminated their faces in ghostly flashes. All were focused on Sani.
In the semidarkness I couldn’t see anyone clearly, but the role of the characters in this drama was obvious very quickly. The women barked out commands at Sani, first one, then a chorus with the same admonitions--like a flock of harpies, I thought, unkindly.
When she saw me approaching, Sani’s mother called out plaintively, “Sakena, sakena.” She can’t. The group of women immediately echoed her words, adding a string of concerns: The head won’t come. She won’t push. She has to … and on and on, in an excited babble. The faces of the women in that faint shadowy light were haunting. I could see that they were engaged in a common ritual that everyone understood, though for me it bordered on surreal and was oddly frightening. I had been transported to a place that seemed more dream than reality.
But I was there for a real-world reason. Putting down my bag, I took out a flashlight and knelt down beside Sani to check on her progress. She was fully dressed, and even in her extreme state so modest she would barely let me lift her plaid lungi for a view of what was happening. When I finally succeeded, I saw at once that the baby’s head was crowning, and the delivery was imminent. “Tik chhaa, tauko niskinchha,” I said to Sani’s mother, It’s fine, the head is coming. I reached for my bag to get the plastic sheet to avoid her having to deliver the baby onto the mud-packed floor. “Tauko niskinchha,” the women chanted in response and began urging Sani in a frenzy to push, push, push. I wanted the women to cease their commands, to let Sani rest before her last major effort, but realized I was powerless to affect the momentum of this ancient rite. As I laid the plastic sheet out onto the floor and began to help Sani move onto it, there was a sudden gush of something bulky from under her skirt. I lifted the edge and, sure enough, there she was, a full-term little girl-baby.
I gently moved the infant onto the plastic, horrified at the sight of her lying on such an unclean spot and at the same time exhilarated at the beauty of this new little life. She opened her eyes and blinked, astounded, I was sure, at the sights around her. Then she began a lusty cry, that riveting moment that lifts the heart of any participant in a birth. I looked around at the room with a jubilant smile, elated--and saw that I was the only person in the room with the slightest interest in the baby. The women were instead intent on accomplishing their next task, getting Sani’s placenta delivered.
The chorus began again. “Push, push, push,” they chanted. Then, from one, “Make yourself vomit, like this,” demonstrating the finger-down-the-throat technique for inducing a gag reflex. Sani was mostly oblivious to their commands, but after a few minutes made a feeble effort at putting her fingers in her mouth. She heaved weakly, looking around in exhaustion.
Before long the placenta slithered out from under her skirt with a rush of blood. I checked to be sure it was intact, since any pieces left behind could lead to bleeding, infection, or both. It was all there.
The next task for the group was supervising the tying and cutting of the umbilical cord. I had a heavy silk string ready for the occasion, but Sani’s mother was concerned that it was too thin and brought me a substitute. I nodded and pulled out my sterile scissors, explaining how important it was to keep the cord area very clean. The women all nodded their heads in agreement, “Very clean, very clean.”
Suddenly, looking with concern at my scissors, one of the woman blurted, “Do you cut it all off? Or let it fall off later?” They, of course, had no way of knowing what strange birth customs this foreign woman might practice. I assured them that it always had to fall off after it dried up. Murmurs of relief.
“Sani has to do it,” her mother said, referring to cutting and tying the cord. Though I wanted to support their traditional practices, poor Sani was so exhausted she could barely keep from toppling over.
“She’s very tired, isn’t she?” I said.
“Yes, but she has to do it. We can help,” Sani’s mother replied.
Compromising, I tied off the cord at the level they indicated, gave Sani the scissors, and helped her cut it. The placenta went into a large leaf-bowl that was placed beside us for that purpose. It would be disposed of according to local traditions.
I wondered if the ritual was over. No, cleansing was the next step. Birth, in the Nepali culture, is considered highly polluting. One woman had added a few sticks of wood to the fire and placed a pan of water over the three large stones that served as a grate. Sani changed her blood-stained lungi for a fresh one, still following step-by-step commands from the gallery. Then she was directed to bathe the newborn by pouring the warm water over her and smoothing the blood off the baby with her hands. The commands continued.
“Use this cloth. No, not that one, that’s to wrap her in. Don’t you know anything? And not too much water the first time,” they went on, unrelenting. Then, “Now, take out a breast and feed her. You have to do it right away or she won’t have a good appetite later.”
“She won’t take the breast? Here, do it like this,” said one ancient woman, who whipped out her own saggy breast and showed Sani how to milk it. “Like this. Hold her closer.”
Finally the baby made a few nuzzling attempts at nursing, and murmurs of approval emanated from the women. Satisfied that their mission had been accomplished, one by one they harrumphed, made a few parting comments and took their leave. Sani’s mother helped her daughter onto a straw mat in a corner where she could, finally, rest with her new baby.
I checked Sani for excessive bleeding and also left, promising I’d return in the morning to visit the new mother.
On my way back to camp, I thought about what the future would hold for that new baby, born into a Kami household. Surely she deserved the best that life could offer, but what was in store for her? Kamis and other untouchables were so far down the status ladder that they weren’t even within the caste system. Though caste discrimination was outlawed in Nepal, the lowly status of “outcastes” like her would be a central element of the social system well into the future. She wouldn’t be allowed to enter temples, eat at common gatherings or with higher-caste people, drink from public water sources, or marry a higher-caste man. Her surname would always identify her as being of lowly status. It was hard to imagine a more complete description of discrimination.
During my first few months in the field, I’d felt overwhelmed trying to grasp the meanings of Nepali ideas and practices. Though initially so mysterious, the confusing array of customs and traditions began to be more comprehensible, and often even had their own strange kind of rationality. But caste was different. Every time I encountered the unmovable reality of how the lowest castes were viewed by otherwise reasonable, kind people—even my friends on the team--I found myself screaming inwardly that this system was disgusting and cruel.
When I returned to the house the next morning to check on Sani, she was sitting outside against the wall of the house with her sleeping newborn, her own mother by her side. They greeted me, and Sani held the baby up to show me her fresh, beautiful little face.
I reached down and touched Sani’s shoulder. “What a perfect little girl you have,” I told her. She smiled and gazed adoringly at her firstborn.
I took out my camera with a questioning look and received a proud smile in response. Snapping a picture of the lovely trio, I wondered what the future would hold for this child. Surely she deserved the best that life could offer, but what was in store for her?
Years later, looking at that photo, I’m reminded of the two powerful lessons I learned from my time in Nepal. I was there when Sani’s baby was
born, but her community and the comfort of ancient customs were the real birth attendants. The birthing rites that struck me then as intrusive
and overbearing gave Sani a sense of safety, of being in the expert care of women she trusted. Eventually I came to realize that for some problems
my skills could help, but other times the Nepali traditions and systems for coping were as satisfactory as anything I had to offer.
The second was a harder lesson. Over many months of immersion in village life, I never found a comfortable solution for my feelings about the caste system. A troubling question plagued me then, and follows me today when I pass a homeless woman on a Seattle street, or read of police shooting an unarmed black man. How do I reconcile the searing injustices I see around me with my feeling of joy at living in this amazing world? How do any of us live with those contradictions?
Mary Anne Mercer writes from her home in Seattle overlooking the Salish Sea. She has published on a wide range of topics related to social
justice, global health, and globalization, as well as academic topics. She spent over 35 years working as university faculty, focusing on
strategies to improve the health and survival of pregnant women and their children in resource-poor areas of the world. She is writing a
memoir of her experiences as a nurse trekking for a year with a health team in rural Nepal.
Her web site is Mary Anne Mercer