It was a tragedy. Afghanistan had once been a developed country where women walked the streets without veils, went to college, and worked as professors and doctors and artists. Now, thanks to religious extremism and decades of fruitless war, those days were gone. A generation of women had been deprived of education, forced to stay indoors, isolated from the world, their lives controlled entirely by men.
“Swollen ankles—who has seen a pregnant woman with swollen ankles?” Jenna spoke in Dari, using words that everyone would understand and not clinical terminology.
Faces old and young lit up, and the women spoke all at once.
“My daughter’s ankles were fat with her first child.”
“Swollen ankles are part of being pregnant, aren’t they?”
“I had swollen ankles with all eight of my children, but I am well.”
Jenna waited until the talk died down to go on. “When a pregnant woman has swollen ankles, it is a warning sign. Her relatives should bring her to the hospital so that we can check her and make sure she isn’t getting sick. Swollen ankles can be a sign of a serious problem like high blood pressure, and that can kill both the mother and the baby.”
She wasn’t sure the women understood what blood pressure was, but that didn’t matter. As long as they knew what to watch for, lives could be saved.
Jenna knew what it was to grow up without a mother. Her mother had committed suicide when Jenna had been tiny. She barely remembered her mom—but the hole that her death had left in Jenna’s life was too real. If Jenna could save even one mother, this entire trip would be worth it.
Then a woman named Afarin spoke. “My daughter-in-law’s ankles were swollen for weeks. One day she fell to the ground and started to shake. We asked my husband to take her to the hospital, but he refused. She died that night with the baby still inside her.”
It was one of the harsh realities of life here. Men controlled women’s access to healthcare, and too many of them refused to let their wives, daughters, and daughters-in-law leave home for medical treatment, even when it meant days of needless pain—and preventable deaths.
Delara, one of the Afghan midwives at the hospital, had said it best.
“It is better to be a goat in Afghanistan than a woman.”
Afarin took in the words of comfort offered by the other women. This exchange of sympathy had become a social ritual in the lives of Afghan women—a response to oppression and suffering beyond anything Jenna could comprehend.
It was their suffering that had brought her to Afghanistan. She’d read the statistics about the one-in-eight lifetime risk Afghan women faced of dying from pregnancy-related causes. As a midwife, she’d felt shehadto do something, so she had signed up to teach and work at a hospital that also served as a midwifery school. Training a generation of Afghan women to become skilled birth attendants was the key to improving maternal and infant mortality in the short term—and enabling Afghanistan in the long term to meet its own healthcare needs.
Jenna waited for a lull in the conversation to make her point. “If your husband had brought your daughter-in-law to the hospital, we could have given her medicine and done surgery to take the baby out. We might have been able to save both her and her baby.”
The women fell silent again.
Jenna let that sink in. “Bleeding is another warning sign that you should come to the hospital. Sometimes early in pregnancy, it’s normal to bleed a little, but lots of blood means you should come to the hospital right away.”
“We soak cotton in whiskey to stop bleeding,” said an older woman, her face wrinkled like an old apple. “We put that inside a woman if she bleeds too much after giving birth.”
Heads turned to see what Jenna would say about this.
“Bleeding happens when the womb won’t contract hard enough after a baby is born—or when a piece of the afterbirth is stuck inside. At the clinic, we can give a mother medicine to make her womb contract. We can also put her to sleep so she won’t feel pain and take out the part of the afterbirth that’s stuck. If she has lost a lot of blood, we can give her a blood transfusion. All of this can save her life so that her child will have a mother.”
“Won’t you hurt her liver if you reach inside her?”
Jenna turned and pointed to the side-view cut-away diagram of the pregnant woman behind her. “The womb is closed at the top. See? You can’t reach a woman’s liver through her womb. The liver is here.”
The conversation went on for another two hours over sugared almonds and cups of sweetkahwah, a kind of green tea spiced with cardamom and cinnamon bark, prepared by Sayah, their hostess and the wife of the village headman.
Jenna had just finished telling them that fever was also a warning sign when she heard the rumble of big engines and a shout outside the door.
The room fell silent, and the women donned their burqas. None of them had known an Afghanistan that wasn’t at war.
Jenna drew her gray headscarf over her hair, stood, and closed the anatomy chart just in case. “I’m sure all is well.”
“Inshallah,” Sayah whispered.God willing.
Farzad and two of his men stood guard, together with men loyal to Sayah’s husband, against any incursions by the militias or local Talibs. Farzad had her paperwork—the letter from the region’s governor, Abdul Jawad Kazi, that gave her permission to work in Balkh Province. But written words meant nothing to men who couldn’t read and wouldn’t help her at all in the case of the Taliban.
She heard Farzad telling someone that it was the will of both God and The Lion of the North—the name Kazi had earned during his days fighting Soviets as a Mujahedeen—that the women of this village should meet today.