Women Hold Up Half the Sky
...but it's the heavier half
Women Hold Up Half the Sky
The room had flowered wallpaper—tiny pink flowers on a taupe background. On the wall, a mother and child rocked gently, sweetly, under a breeze-blown willow. In the room itself, surrounded by poles, tubes, and silver things, a clean bed quietly waited, a large white pillow poised to cradle a weary head. Over the side rail hung a thick, fluffy tan blanket, needed as much for cushioning as for warmth. Across from the bed, a tall, burnt-honey wooden cupboard stood, doors open, offering hangers and extra blankets. A freckled ivy sprawled over the top. A kind young orderly attended to my safety and comfort as he eased my swollen body from the wheelchair to the bed.
A plump nurse in lavender scrubs ushered in her student and each took a place on either side of me. The veteran, gentle and knowing, asked about my due date and how far apart my pains were while the younger nurse, who might have been more excited at the prospect of a new life that I was, scribbled my answers. Within minutes I had a free-flowing IV of hydrating saline and a pillow under my knees, just as the twinges in my back became stronger. I was dilated to four. The ob-gyn was on his way, and the anesthesiologist had been summoned for the epidural.
* * *
A fistula is a hole in the body that should not exist. There are at least two million in the developing world, particularly sub-Saharan Africa and Asia. Fistulae are unheard of in first-world countries, having been eliminated by late 18th-century medical advances like the C-section.
In poor countries there are two causes of fistulae: childbirth, resulting in an obstetric fistula, and sexual violence, causing a traumatic fistula. The first type occurs because the blood supply between the vagina and either the bladder or rectum or both has been cut off, say, by the pressure of the baby’s head in the birth canal. Because they receive no oxygen or nutrients from blood, the surrounding tissues die, and a hole forms through which urine and feces pass uncontrollably. The second type, traumatic fistula, occurs during rapes. In the Congo gang rapes especially are extremely common. Rival factions violate one anothers’ women, whose vaginas are torn apart not only by the men themselves, but by bayonets, tree branches, rifle barrels, and fired bullets.
Major General Patrick Cammaert, a former United Nations force commander, spoke about the use of rape as a war tactic: “It has probably become more dangerous to be a woman than a soldier in armed conflict.” This is because militias consider it “risky” to fight with other militias, so they implemented the most cost-effective way to terrorize civilians: conduct rapes of “stunning brutality.”
Fully 80% of fistula cases in the Congo result from sexual violence.
* * *
Eighteen-year-old Dina is from the Congolese town of Kindu. She has a round, sweet face and, though shy, a quietly regal bearing. She and her five brothers and sisters work on her parents’ farm growing bananas, cassava, and beans in the relentless heat and humidity. Dina walks daily, sick with fear of the roaming militia, to the fields to farm the crops. If she were to act on her fear and stay home, her family would go hungry.
One day, Dina’s dread got the best of her. She decided to walk home early and be there before sunset. Choosing the well-worn path that would guide her home the fastest, Dina slung the meager bag of vegetables over her shoulder and set off. Within minutes, five Hutu militia members crossed her path and forced her to the ground at gun and knife point, saying, “If you cry out, we will kill you.”
As one by one they violated her and also did so with a stick, Dina bore their hatred and evil in wordless terror.
Hours later, when Dina hadn’t arrived home at the usual hour, her family courageously struck out to search for her, themselves terrified of the militia gangs. Finally they found her lying in tall grasses, bleeding badly and half dead. Her father covered her. The family picked her up and bore her home, where they treated her as best they could. There was a small medical facility in Kindu, but Dina’s family had no money. As her loved ones scrambled to provide what Westerners would call folk remedies, she lay paralyzed, unable to walk, unable to get up. The stick had punctured her bladder and torn through her rectum, causing a fistula that constantly drained urine and feces down her legs. Disgusted by her offensive odor, her family built a tiny hut for her a few yards away from the family home. They brought her food and water once a day. One month later, in an agony so complete she lost consciousness, Dina miscarried, a further insult to her already substantial wounds. She lived in isolation in the straw hut with the dirt floor—suffering and lying in her own wastes, broken and unable to move—for another 23 months.
* * *
“Women hold up half the sky” is an ancient Chinese proverb alluding to the idea that what women give to the world is equal to what men give. This proverb or a part of it, “half the sky,” has been used as at least one book title and many essay titles, the contents of which deal with such topics as gender-based violence, maternal mortality, and economic, political, and educational inequality toward women. These topics allude to the seldom-said second half of the proverb: “Women hold up half the sky, but it’s the heavier half.” And the sky is falling, falling, falling.
* * *
Eventually, a neighbor told Dina’s family he’d heard about a hospital that healed injuries like hers—the HEAL Africa hospital in Goma. Dina’s father was able to contact a representative for the hospital, who arranged for a missionary plane to take Dina there. From the airstrip, she rode to the hospital in an ambulance; it was the first time she’d seen such a vehicle. Nurses welcomed her with a plastic diaper and crutches, the latter useless to her, as her muscles had atrophied so severely from her two years in the fetal position that she could not straighten her legs.
Because of this, doctors could not immediately repair Dina’s fistula. They feared that her legs or pelvic bones would break if they tried to manipulate them in order to reach the fistula, so for several months, Dina endured daily physical therapy and massaging of her emaciated limbs. During this time, the dozens of other fistula patients befriended her and loved her through the pain, creating life-long bonds and healing Dina’s spirit. Finally her surgery day came. In two separate procedures, the doctors successfully repaired Dina’s horrendous wounds and administered antibiotics and other restorative medicines and vitamins. She eventually returned to the maelstrom of Kindu, though in fear of being violated again, because her family was poor and because the militia wars had so deeply infiltrated the land that there was simply no safe place to be.
Softly, shyly, Dina later said of the soldiers, “My people had no tribal conflict with them.”
* * *
Dr. Dougan greeted me warmly. “Today’s the day, eh? Let’s bring her into the world!” He was a jolly, rotund black man with a comforting demeanor. He’d done this a million times, no sweat.
Drowsy and pain free because of the epidural, I laughed. “Hey, now, you know it’s a boy. You’d better beef up your washing and waxing arm.” We had a running bet that if he was right, I’d make him a huge batch of peanut butter cookies, and if I was right, he’d wash my car for a month.
“Yeah, right,” he rolled his eyes. “You’d better stock up on peanut butter. I like Jif. Chunky, if it’s all the same to you.”
I was starting to wince and breathe harder now; the urge to bear down was almost irrepressible.
As he checked me over, Dr. Dougan said, “You’re progressing very well. Baby’s heart rate is perfect. Your labor pains will become a bit sharper now and you will want to push, but I want you to breathe through the urge while we prepare the delivery room.”
The plump nurse in lavender scrubs glided in. She’d done this a million times too. After she checked all the beeping things and papers they spit out, she came and sat next to the bed.
“I’m gonna help you through this, Honey. I want you to follow my breathing and concentrate on my hand.” She placed her soft hand on my forehead and rubbed gently left to right.
* * *
Outside the Congo, the majority of fistulae, no less serious or traumatizing, are caused by obstructed labor. Maha Muhammad was just 13 years old when her family sold her to a thirty-five-year-old man for eighty birr (about ten dollars). He married her, then repeatedly thrashed and raped her. Maha became pregnant. Terrified that another beating would cause her to lose her unborn child, she ran away, but was caught, returned, and soundly beaten once more. Maha managed to escape again and headed toward the river. She planned to drown herself. Fortunately, an uncle found her and let her stay in a little hut by his house.
When the time came, because she could not afford a midwife, Maha endured the labor alone. Seven days later, she labored still. Because her pelvic bones were too small, the baby’s head became stuck in the birth canal, causing terrible pain. Maha fell unconscious. Someone discovered her and ran for a “birth attendant,” a person little qualified for a normal birth, let alone a complex and damaging one.
Maha awoke hours later to find that her baby, long since passed away inside her, had been “removed” from her body and that she could not move and had lost control of her bladder and bowels. The baby’s head had cut off the circulation in her pelvis and the tissues had rotted away, creating a gaping fistula. Due to the nerve damage that often accompanies obstructive fistulae, Maha temporarily lost the use of her legs.
“People said it was a curse,” she later recalled. “They said, ‘If you’re cursed, you cannot stay here. You must leave.’” In the end, the townspeople moved her to a hut just outside town.
“Then they took the door off,” she recalled dispassionately, “so that the hyenas would get me.” At nightfall, the hyenas indeed came, and Maha used the only thing she had to intimidate them: a stick. She brandished it at them all night long through pain and utter exhaustion. The next day, she summoned her strength and left to find a mission she’d heard about. After days of searching and sleeping in the wild, Maha found it and Dr. Catherine Hamlin, who took her in, bathed her, gave her new clothes, and set about examining her. Fistula patients often have burns on their legs from the acid in the leaking urine, but Maha had escaped this particular malady. She was weak and infected and in pain, but she found a new family. Like Dina, Maha found dozens of kindred spirits at the mission. The girls walked around in diapers and flip-flops, having dubbed the place “puddle city.”
Maha was fourteen.
* * *
International resources for fistula patients allow for just 6,500 of the two million to be treated, and the surgeries are not always successful. Of the two million, virtually none can ever bear children again. Such women are then ostracized, as they have lost their usefulness as women if they cannot reproduce. Those whose fistulae cannot be repaired are cast away or even killed—the murder labeled “God’s will” because only an evildoer could be cursed with such a foul odor. They are the lepers of our time.
And I was worried about taking a newborn to the store for peanut butter.
* * *
Who are we? We Americans, we women, we world citizens that hold motherhood sacred? Who are we that fawn over expectant mothers who can talk to doctors through email and and buy booties and blankets at will? Who are we to be soaked in privilege, blessed by circumstance? Take it away, and let us see. We are Dina. We are Maha.
About the Creator
Lisa Smith
Hello! I am a teacher, writer, and grandma (not necessarily in that order!) living in Southeastern Idaho. I love to read and think about literature of all kinds as a way, simply, to connect with other lives and worlds.
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