Tuesday, July 29, 2008

Book Review: "Monique and the Mango Rains: Two Years with a Midwife in Mali"

"Monique and the Mango Rains: Two Years with a Midwife in Mali"

Kris Holloway
2007, 208 pages

I loved this book. Despite time constraints, I finished it within 48 hours and was utterly fascinated throughout. Before going any further, I highly recommend this book!

This book was written by a Peace Corps volunteer who travelled to Mali and lived and worked with a young Malian midwife (Monique) for two years, beginning in 1989. She kept in touch with Monique after her trip until Monique's tragic death in childbirth eight years later.

This book is very similar to "Baby Catcher" by Peggy Vincent, except that it is set in the third world rather than in modern-day America. But it is the same mix of laughter and tears, celebration and tragedy - a great read for anyone, whether interested in midwifery or no.

I grew up in a fairly insulated American environment, and the church in which I was raised did not have missionaries to come back and tell tales of the third world, so it has only been in the last few years (having moved to a different and more missions-minded church!) that I have heard about the non-Western world first-hand from people who have been there. This book is another of those experiences.

This book followed some very interesting themes, ones that we don't think about too often in America any more. For example, extremely high infant mortality rates are extremely common in the third world, due to protein deficiency and malnutrition, microbial infections, etc. Whereas in America a woman can almost always expect to raise all of her children to adulthood, in Mali it is a rare woman who has not lost one or more children in infancy.

Also raised was the issue of female circumcision, also known as female genital mutilation (FGM). I had read about this issue in an edition of "Midwifery Today," and so didn't find it as shocking as I might have, but this was a good "up close and personal" view of the practice and its effects. In a word: yeeeooouuch!!!!! And that's putting it mildly. Holloway gives some brief descriptions of the different levels of FGM practiced in Africa (practices vary by region in terms of severity of procedure). The effects of FGM are far-reaching in a woman's life. Effects may include constant infection from blocked menstrual flow, sometimes leading to uterine infection and sterility, painful sexual intercourse (and subsequent infections as well), sexual dysfunction, and massive problems during childbirth including deep, unnatural tearing of the perineum and surrounding tissues (despite vertical birthing positions, which in uncircumcised women are almost guaranteed to reduce or prevent tearing).

It is interesting to compare male vs. female circumcision. Unlike most of my natural-childbirth counterparts, I am not opposed to male circumcision (pause while waiting for stones to fly). This is due to both my religious persuasions (after all, the God of the Bible invented circumcision!) and scientific observation - male circumcision has never been proven to cause any health problems, and it has (in a huge majority of studies) been shown to lessen the chance of STD transmission and penile cancer). On the other hand, I am definitely opposed to female circumcision, which has been undoubtedly proven to cause a myriad of life-long health problems.

One interesting thing about FGM is that it is generally done when a girl is a pre-teen, not in infancy as American boys are generally circumcised.

This book also highlighted the health problems due to poverty in Mali. What might in America be an inconvenience is, in Mali, a death sentence. And things like protein scarcity, unclean water, drug shortages and scarcity of medical facilities contribute to much higher rates of morbidity and mortality.

One very interesting note came when the author recorded her trip to Mali following Monique's death in childbirth. Holloway questioned the birth attendant who had been present, and found that Monique had been given a labor-enhancing drug and had died shortly thereafter. While not being able to make positive conclusions, Holloway noted that the drug might have been implicated in Monique's death. Her observations made me realize the harm that Western medicine can do when it teaches faulty birthing practices to third-world medical practitioners. For example, when Westerners impose bad birthing practices like lithotomy (birthing on one's back) and artificial labor-enhancing drugs, we get skyrocketing levels of fetal distress and subsequent caesareans to "save the baby." In the third world, when they implement such techniques, babies and mothers die. Labor-enhancing drugs are especially dangerous in Africa and other poverty-ridden areas, where a majority of women are anaemic and whose bodies cannot handle the drugs. Interesting thought.

One thing I loved, which Holloway pointed out, was the everyday-attitude toward death. Death took place at home and was celebrated and mourned at home. There wasn't any cloistering of death and the dead in hospitals and mortuaries - it was much more natural and "this-is-part-of-life." I think that we might be a healthier society if we could adapt such an attitude.

I highly recommend this book to anyone and everyone. It was a great glimpse into a different world and a different life, one from which we can learn much - both about things that we Americans could change for the better about our culture, and also about things for which we need to be grateful.

Rating: Excellent, excellent!!

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