Motherhood – Part 2: Needles

ឆ្លងទន្លេ “chlang tonle” literal: to cross a river/colloquial: to give birth

ម្តាយគិតកូនដោយច្រវាច្រដេញ កូនគិតម្តាយវញិដោយព្រះប្រែក្រោយ។  “A mother thinks about her children like the oar to a canoe. Children think about their mother like the Buddha who has turned his back.” – Khmer proverb

Dear Grampa,

If you want to envision a model Khmer mother-to-be, look no further than Rathana.

You may recall her baby-belly and radiant smile from the previous post about motherhood. Rathana has since reconciled financial issues with her husband, eaten more (of my prescribed) eggs and vegetables than she appreciates, and last week strode with bravado into the health center for her final scheduled pre-natal check-up, accompanied by her mother whose face she shares.

There exists in community health work a certain selective-numbness that one learns to induce in times when the tidal misinformation is thickest or in the face of insurmountable resistance on the part of the patient. For Rathana and her pregnancy, though, I will disclose my total bias. Dull panic ensued whenever I witnessed elders and health care providers either misguiding her or simply not acting with her perfect! optimal! pregnancy! in mind. She has been one of my sweetest confidants since Day 0 on Planet Takeo and also my first close friend to make a human with her body – a baby boy who arrived, to everyone’s surprise, at four in the morning last Wednesday. And no sooner had he been born than his grandmother and father were force-feeding him crushed pills with rainwater to go undigested by his tiny, undeveloped intestines while Rathana lay swathed in thick layers to sweat beside him. Panic, unadulterated.

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On a Wednesday morning prior, Pu Vuth and I saunter from his moto to lay out our paraphernalia on the wooden bed in the common space at the forefront of a local village chief’s home. Vuth arranges the allotted quantities of the appropriate immunizations in a chilled cooler, jumbled from the ride, then casts a cord over an exposed beam to string up the scale. He dons his glasses and scrubs shirt and begins to prepare his record books for the expected patients. I fan out a half-dozen books – some of which contain all the technical knowledge I need to do this job, the rest to be filled with scattered approximations of what is to come. It is always when I finally to rise from my seat to search for a fried banana when the first mothers appear.

Ten days out of every month, one day for each of the ten villages in our commune, we hold vaccine outreach. Babies from one and a half to eighteen months arrive at their village chief’s home or the health center to ensure they’ve received the routine smorgasbord of immunizations. Two months out of the year we administer vitamin A capsules and deworming pills to every child under 5. All this without a single sentiment of protest or condemnation on the part of their caretakers. There may exist posh cafes populated by bespectacled, be-flanneled Cambodians denouncing the vaccine enterprise, but not in this commune.

Despite the cacophony of shrieking babies that follows him like a storm cloud, it is both admirable and refreshing to witness the culture Vuth has inspired regarding vaccinations in our community – even if everyone arrives at once, has never stood in a queue for anything in their life, and can’t stop interrogating me long enough to listen to Vuth. Truly, though, through his own tenacity and connections, the vaccine hype is all his doing. He has absolutely created the social norm that showing up for scheduled vaccinations is irrefutable obligation for parents and grandparents who love their children. On his sweatiest days, I wonder how he feels about it.

Oddly, the most challenging step of the whole ordeal is often convincing moms and grannies to wrestle their kids into the hanging scale. It is admittedly awkward and hardly user-friendly, but still I struggled for ages about why everyone piled their babies on top of each other, grappling for the next fresh needle or deworming pill but wouldn’t give me or their child’s growth pattern the time of day. It is no doubt in part because of the Cambodian reverence for visible, preferably foreign, medicine. On the few occasions we’ve had sizable congregations of mothers balking at the hanging scale, we’ve whipped out large meat scales as a compromise.

There is also a looming fear imposed by the child growth chart: that they will be told, in font of other mothers, that their child is underweight. This ties into the cultural norm of “saving face” in a big way, which in turn effects mothers’ receptiveness to the suggestion that their capacities as a caretaker are both the cause of and the solution to their child’s issue. I haven’t met a mother yet who, once told her child was underweight for their age, didn’t have a retort prepared regarding the child’s simple refusal to eat, day and night, no matter what she does. One instance such as this prompted Vuth’s muttering of the Khmer proverb:

ចាងមិនកើតបន្ទោសឯដែក។

“Incapable of becoming a blacksmith, you blame the metal.”

The truth is that while breastfeeding is prevalent in Cambodia, proper complementary feeding and active feeding practices have been slow on the uptake and are the worst in families with multiple children, which is to say, all of them. The most severe cases of malnourishment I’ve encountered while here have had a common theme: grandmothers. Khmer grandmothers. Yaaeys.

Many mothers now work away from home for some or most of the day, thus kids are left with granny. With granny comes her taboos, traditional beliefs, and an immeasurable love. This kind of love so blinding that it occludes both science and modern counsel can build only throughout a life time of hardship. It is a tall order to try and convince someone who survived for years on watery rice porridge – through genocide and civil war – that their grandbaby will not also do just as well on a similar diet in larger proportion. The yaaeys I know operate on a semblance of the traditional counsel long ago etched into their psyche and total reactivity to their grandchild’s temperament within the moment. A baby’s refusal of a new food will be met with concession and presentation of more favorable treats. Select the recommend feeding practices for any crucial stage of childhood and granny will have a contraindication.

Mothers need to be kept very hot, by fire if necessary, immediately after birth to protect from the vulnerable “cold” stage of pregnancy. Working mothers cannot breastfeed, their “sour” milk makes babies sick. Too many fruits and vegetables give small children fevers. Children with diarrhea need natural, clean, pond or rain water.

Nourishment may suffer with yaaey calling the shots, but you can be certain no harmful spirits will infiltrate grandbaby’s head given that yaaey wouldn’t be caught dead toting baby around without a protective, ritualized blade.

For months I attended these madhouse vaccine events, gradually a little more useful each time, but overall disturbed by my own… disturbance – my downright frustration with the mother’s recoiling at the scale and sometimes Vuth’s needles. It would all be over in mere moments and their child’s health would be newly fortified, I privately fumed. It was only when I finally saw Rathana, who I had only ever known as pregnant, beside her son that so many things clicked.

They appeared as one bundle, inextricable as two separate individuals. Any act she made in defense of that baby, no matter how seemingly trivial or trite, was suddenly justifiable as an extended defense of her identity and charge as a mother. I can no longer fault these women for their nearly hysterical attempts to resist the brief and foreseeable “needles” when it is certain their child’s life will be filled with many other needles, these much longer, that mom will have to both witness and even administer with no alternative.

Kid, someday I may have to entrust you grandma’s in her unwashed, love-filled hands and abide by her every superstition. Someday, I may ask you to forego your education to help us in the fields or at home. Someday, I may ask you to marry someone who you do not love for reasons bigger than both of us. Someday, I will demand that you bring me grandchildren who I will require for the purpose of loving, without abandon, after so many years of not being able to give you everything that I wanted to.

When weighing babies with the meat-scale, the most effective method is to have mom hold baby while she steps on, record the weight, hand baby off, then have mom step back on and record the new weight, sans-baby. It is when the mothers step up for that the second time, the baby-less weight, that I ponder what it must feel like – an ambient pressure or ubiquitous tow – to exist with a piece of you missing, walking around, both hopefully and lamentably growing only larger all the time.

ទូកទៅកំពង់នៅឡើយ។  

“The boat sails, the shore remains.” – Khmer proverb

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Grampa, like my former post, I have to disclaim yet again that I know this dynamic from only one angle. I only have a mother, who you may remember as something of a mom-machine. She, too, managed to charge forth on vaccination day with little Grant and I – despite whackjobs on TV filling their guest chairs with children supposedly handicapped by immunizations. I have recognized mom so often in the fervent new mothers by which I am constantly surrounded. Slowly I am accepting that so much alleviation for the psyche of any mother of grown infant(s) can be afforded by offering her the occasional opportunity to rebuff a proverbial scary hanging scale on your behalf.

Love you all the time,

Kelsifer