Senegal

We have just returned from a week in Senegal. Dave and I came along with me so that I could attend I workshop for capacity building of civil society, parliamentarians and the media in budget analysis and advocacy for the health of mother and child.

I hope I haven’t lost your interest already. 

Budget tracking may seem like a boring topic, but I find it so interesting.  For years now, countries across the globe have been saying that maternal and child health is one of their top priorities. Statements have been made, coalitions built, strategies have been developed. On the surface, it would seem as though a lot is happening. But when you look a little closer you find that despite all the rhetoric, little progress has been made in improving the health of mother and children, especially in the poorest countries in the world.

Ever since I have worked in this field,  every time we question why contraceptives are not available in the villages or why health centers are not staffed with qualified personnel, we almost always get the same answers: there’s no money, we don’t have the funding, and we can’t afford it.

A budget is the single best indicator of a country’s priorities.  It is the best way to tell whether a country is putting its money where its mouth is and whether or not it has taken steps towards fulfill the commitments that it has made to maternal and child health.

The three day workshop was attended by delegations from the Democratic Republic of the Congo, Niger, Mali, Burkina Faso and Senegal.  Each country was represented by members of civil society organizations and the media, along with parliamentarians, and their ministries of finance and of health.

The countries represented in the workshop have budgets that rank among the least transparent in the world. Of the countries represented, Burkina Faso’s had the best transparency score  in the International Budget Partnership’s Open Budget Survey – a measly 23 out of a 100, Niger, with the least transparent budget scored a depressing 4/100, with zero meaningful opportunities for civil society to contribute  to the country’s budgeting process. The survey evaluates the transparency of a budget by looking at what information is made public and when, as well as who gets to contribute to the process and how often.

The aim of the workshop was to have members of these delegations first understand the important role that the budget plays in reproductive, maternal, newborn and child health (RMNCH) and the financial costs of not investing in RMNCH. It also taught how good health policies are developed and costed, and provided options for increasing fiscal space – the money to fund these policies – within the existing budget.  A budget is public property, it represents the money that belongs to each and every citizen of a country and therefor, the public should have a genuine say in how the money is distributed and how is has been spent. This workshop provided participants with an outline of the steps that should take place in the budgeting process, and all of the opportunities in which civil society should be able to contribute. At the end, each of the delegations developed advocacy objectives and strategies to improve civil society’s contribution to the budgeting process in order to prioritize health.

A good friend of mine who works in finance once told me that talking about money scares people, that people often feel as though they don’t have enough knowledge to contribute and are too embarrassed to say so. That definitely explains how I have felt and I know some of the participants agreed. We were afraid that the workshop might be too long, too technical and hard to follow, but we could not have been more wrong. The participants lapped up every word on every slide, and were thrilled to be equipped with the knowledge of the role they can plan in ensuring that their country’s budget prioritizes maternal and child health.

The presentation on increasing fiscal space even got a standing ovation!

Ile de Gorée, Senegal

Ile de Gorée, Senegal

Ile de Gorée, Senegal

On a more personal note, attending a conference with my baby and husband was busy, to say the least, and stirred up a lot of feelings that I hadn't anticipated. When I returned to work at the beginning of April, I felt like I was struggling to be the parent that I wanted to be and struggling to do the job that I wanted to. I could no longer stay with the baby all day and I couldn't stay late at work either.  In many ways, the workshop only made these feelings worse.

Usually, when I attend a conference or workshop, I spend the coffee breaks networking with other agencies and donors, or helping out in some way. On this trip I spent my time running through the halls of the now-faded King Fahd Palace Hotel so that I could get back to the room to breastfeed. At the end of the day, rather than debriefing with other facilitators, I was stressing about getting back to Ben and Dave, who had taken a week off of his own work so that I could travel to Senegal. I felt like I was no just falling short at work and parenting but also at being a wife, and questioning if the trip had truly been worth it.   I worried about the precedent that I had set in my office: would other parents now be expected to travel when their babies are 4 months?  Would they be expected to foot the bill for their families to join, as I did?  Had I just done my colleagues a huge disservice? Then I started to beat myself up for being such an over-thinker: do I have to make all the right decisions all the time?  Does everything I do have to be perfectly feminist all the time? Why do I always second guess myself?

Am I the only one that does this, feeling guilty about feeling guilty?

Luckily, in the last days of the trip reminded me of another reason that I went to Senegal: I really do love traveling. After the conference ended, Dave, Ben and I went to Les Collines de Niassam, a beautiful eco-lodge three hours outside of Dakar, were we relaxed, bird watched, ate delicious food, went for a long walk to the salt wells, and took a boat ride, where we gorged ourselves on freshly picked oysters. It may not have answered any of my questions, but it sure was lovely. For now, it feels like it was the right decision to go.

Dave, relaxing on the balcony of our room at Niassam

Senegalese women harvest salt in Palmarin, Senegal

Salt wells in Palmarin 

 Benny came along for the ride.

A man cleaning his fields in Palmarin

Thomas, our boat guide and oyster-picker.

Freshly picked oysters

I think we had about 40 oysters each.

Camille Lepage

  

Camille Lepage in Central African Republic.  AP Photo/Sylvain Cherkaoui, taken from US News

I am completely obsessed with Camille Lepage, the 26 year old photojournalist who was recently killed in Central African Republic.

Camille wanted to show the world about the most neglected conflicts and spend the last two years living in South Sudan and the Central African Republic.

In an interview last year she said, "I want the viewers to feel what the people are going through. I'd like them to empathize with them as human beings, rather than seeing them as another bunch of Africans suffering from war somewhere in this dark continent. I wish they think: 'Why on Earth are those people in living hell; why don't we know about it and why is no one doing anything?' I would like the viewers to be ashamed of their government for knowing about it without doing anything to make it end."

I am not sure what it is that I am drawn to in her work. Maybe its that she took beautiful, often shocking, photos; or maybe its that she worked in countries and on issues that I care about deeply. Maybe its that somehow, she reminds me of myself at 26. I was 26 when I started working for MSF. At the time, I was willing to go anywhere and to do anything to help people in need, particularly those in conflict settings.  Help is a loaded term and probably not the best description of what I was actually doing, but I can't think of a better way to say it, that is truly what I wanted to do. I have changed a lot as a person since then and in some ways better than others, I may be more effective at my work, even more thoughtful and conscientious, but I can get caught so up in skepticism, pragmatism, and diplomacy that I lose my inspiration along the way. In many ways, I miss my 26 year old self and the confidence that I once had.

Some people might say that Camille took too many risks or that she was too young, or even that she died in vein.  I hope they don't. We need more people like her.

Please please please check out her work and learn about the conflicts that she covered in the the New Yorker, New York Times, The Washington Post (here too), AFP and her website.

Our family photos

There are few things that I was really insistent on after having Benoît, but one thing that I really wanted was a professional photographer to come take pictures of the family together. I knew that if we didn't we would only have pictures with either Dave or I in them, but not with both of us. They would also probably all be taken with our phones, which is less than ideal.  We did some initial looking around and found that baby photographers were either really expensive (!)  or were taking pictures that just weren't our style (picture babies in costumes tucked into baskets).

We reached out to Lev Kuperman, our wedding photographer.  He knew exactly what we wanted and took beautiful photos at a really reasonable price.  I was super excited to see that he posted some of our pictures on his blog.  I can't say enough about Lev. He has now shared two very special moments with us, and it just felt right having him come into our home when Ben was so young.  

Nanny and Ben

Life, by virtue of it's sheer persistence, has not been kind to my grandmother these days. She is 95 years old. For the past 3 years she has been just well enough to survive, but not well enough to enjoy living.

We remember her caring for us when we were little, the aroma of her apple pies, playing dress-up in her jewelry. It's not clear what she remembers. Nanny is just lucid enough to know that she has dementia and that she should recognize us, but doesn't. Her not knowing who we are pains us all. Visits are short: we make small talk, carefully avoid telling stories that might upset her or asking questions that might confuse her.  We were fearful of bringing Benoît to meet her yesterday. We didn't know how he would react - would he cry? Would he be scared? Would that upset Nanny even more?

Things did not look promising when we arrived - she was not feeling well and lying in bed unresponsive, but the most amazing thing happened when we put the baby in her bed - he snuggled up to her and her face lit up. No one spoke. They just grinned and stared into each others eyes. It was the first time I had seen her smile in years. Its unclear if she knew who he was, or why he was there but it was clear that she was happy about it.

Unsolicited advice on giving unsolicited advice

The other day I was sitting at a restaurant bottle feeding Ben, when a woman approached me and asked me why I wasn't breastfeeding him.  Despite my knowing that the question was inappropriate and all the possible reasons why a person would or could not breastfeed, I was in shock, and I stumbled to answer, "Uhhh, this is breastmilk... errr, I do breastfeed, I am trying to breastfeed!" And she proceeded to tell me how good breastfeeding was for her, and how she breastfed all of her own kids.

I don't doubt that the woman had the best intentions. I think most people offering unsolicited advice normally do, but that is besides the point. The point is how its received. It is hard for the person getting the advice not to interpret advice as criticism.  In that moment in the restaurant, I took that woman to be telling me that I should be breastfeeding and was doing something wrong by bottle feeding. As new parents, Dave and I have been given a plethora of conflicting advice: breastfeeding will make your baby smarter and healthier, breastfeeding is overrated, let your kid cry a bit and soothe himself if you don't he will be needy, never let your baby cry it will cause permanent emotional damage, co-sleep, don't co-sleep because it will cause attachment, use a pacifier, don't use a pacifier - it will ruin your baby's teeth, use a swaddle, swaddles will ruin your baby's hips, so on and so forth. You get it. Every decision we have made has been with full knowledge of its supposed risks, and none has been with any level of confidence. I truly believe that our experience is one that is common to almost all new parents, and so giving unsolicited advice is actually providing criticism at a time when what is most needed is encouragement.

While I was pregnant I read blog entries on Cup of Jo and Kveller about how nice it feels to have someone tell you that you are a good mom. At the time I didn't quite get just how true that would be. The truth is, whatever advice you are about to give, rest assured, they have heard it. Trust me. So from now on, whenever I get the inclination to offer up some of my expert advice (we are all guilty), I will hold that thought and instead say, "You are a good mom (or dad)".  I am sure that both of us will be better off for it.

Maternity Leave + Paternity Leave = Gourmet Cooking!

I heart paternity leave. Big time. You heard me. Paternity leave. Having Dave around for the past four weeks has been wonderful. As much as I love him, I can't imagine being at home alone with Ben at this stage when he's so small and we're just trying to figure him out.

Dave is bonding with the baby and me in ways that he wouldn't be able to if he were at the office - he has had the time he needs to get to know Ben, to get comfortable consoling him, figuring out what will put him to sleep, or pique his attention. The benefits of having Dave home are many, not the least of which is the extra set of hands. Hands to bring me water when I am nursing, bottles when I am pumping, to take the baby when he's inconsolable and I have tried everything, to play with him, and watch over him when I am busy. Rather than being exhausted (okay - we are both still a bit tired) and overwhelmed, we are happy and doing well.

Dave and I have always loved food and cooking, but one of the best parts of having family leave together has been that we are able to cook dinner together and we have an excuse to stay in! Since Ben's birth we have made a point of experimenting with new recipes, and made a ritual of setting the table, lighting a candle. Here is what we have experimented with and loved:

Delicious salmon with garlic, lemon and dill.
Fennel, quinoa and pomegranate salad (top image).
The best herb roasted lamb chops I have ever tasted.
Pan roasted chicken with harissa chickpeas (image above).
The Plumpjack Balboa burger with pickled onions.
Sausage and broccoli rabe fritatta.
Baked cod wrapped in bacon.
This pasta sauce that we saw on a chalk board at Brooklyn Larder: 1 tin of Matiz sardines, 2 cans of peeled tomatoes, chili de arbol, and some garlic (this was our own addition) over fresh pasta.

PS: We're making an effort to eat more responsibly these days, so all of the meat we have cooked has been local and free range / organic.
PPS: If you are looking at these recipes and worrying about our arteries, here are our philosophies on food:





PPPS: First two images (and most recipes!) from Bon Appetit. Image above from the Print Shop by Alexandra's Kitchen.

Papa t'aime

Dear Ben,

Over the coming years you might notice your father being treated like a second class parent: men get less parental leave than women, if they get any at all.  Fathers who want to stay with their families when their babies are born have to pay exorbitant fees to do so. Today at the library your dad couldn’t find a place to change you because change tables are only found in women’s bathrooms. Even laws heavily favor mothers over fathers.

I want you to know that your father is anything but a second-rate parent. From the moment you were born he has swaddled, shushed and swayed you to sleep, and stayed up at all hours of the night feeding and changing you. He has rushed out in snowstorms to buy breastfeeding paraphernalia to help you eat and gain weight.  He has spent hours researching the best and safest daycares and strollers. He is a member of just about every parent listserv in the whole city and has read enough about your brain’s development and how to nurture it to make him an expert. He will never tire of holding you, kissing you, and playing with you.

In your first weeks of life, your dad has proven himself to be a wonderful, 100% equal, first-rate parent. Hopefully, by the time you are old enough to want kids, things will have changed, and if you choose to become a father, society will acknowledge the importance of your role in raising your kids and support you in doing so.

Love,

Mom

Benoît!

After a long hiatus from blogging due to unforeseen delays in the renovation of our house (which many of you know about and which I will elaborate on much more later) we had another life changing event that we thought was worth sharing - possibly the biggest accomplishment of our lives: on December 31^st of 2013, I gave birth to a healthy baby boy named Benoît. It was simultaneously the most difficult and amazing day of my life. For those who are interested, I have included a blow-by-blow of the experience. Before I start though, I want to say that I chose to have a natural birth. It was a very personal decision, one that I am happy that I made, but by no means would ever want to push on anyone else. My delivery was not easy. I knew my contractions would be difficult, but assumed that I would have some time between them to recuperate. As you will see, my vision of myself relaxing in my candlelit bathtub listening to Air between contractions did not exactly pan out. I now totally understand and respect the reasons why a woman would chose to or not to have a natural birth.

At 12:30 am on Tuesday the 31^st of December (five days before my due date), Dave and I were watching Riki Lake deliver her second baby in the movie The Business of Being Born  (seriously - this is not a joke). Something about her birth must have triggered some hormones of my own, because as I stood up to go to the bathroom, my water broke. Super excited, we called our doula, Sarah Kaylor, who told me to drink some wine and go to bed and told Dave that because I am strep B positive, Dave should call our OB and ask for his advice on what to do next.

Dr. Mussali, our amazing OB, congratulated Dave and I on the broken bag of waters and suggested that we call him when contractions start (even if it was in the middle of the night), otherwise to come into his office the next morning.

Off to bed I went. 

In the morning, I still had not had any regular contractions, so Dave and I took our time getting ready to go to the clinic: we showered, packed our bags, and ate a nice breakfast.  While not happy about it, we assumed that because of my strep B, we would have to be admitted and induced so that I would deliver in the Mt. Sinai required 24 hours.

My contractions started in earnest when I arrived at the clinic at around 10:30. I lay on my side in the doctor’s office with a super-tight fetal heart rate monitor on, having a contraction as Dr. Mussali told me that I was 2cm dilated, and that I should go for a walk in central park to get my labor moving, and come back to his office to get checked out again later at around 1pm.

I remember distinctly thinking these three things:

1.       2cm?!!! WTF. I am never going to make it.

2.       Walk in Central Park?  Is he crazy? I can barely move right now.

3.       If I have to put this fetal heart rate band on one more time, I am not going to make it.

On the way to the car, Dave and I decided that we would head to his parents place in the Upper West Side. Sometime earlier in my pregnancy, we had agreed with his parents that we would do this and that they would head over to our place in Brooklyn and essentially get the house ready for us. Unfortunately, we made this agreement under the assumption that I was going to deliver on or after my due date and the holidays, and not on his mother’s birthday / New Year’s Eve / while Dave’s brother and his fiancé were visiting from out of town.

So, while my in-laws sat biting their fingernails on the other side of the wall, Dave and I set up shop in is parents’ not-as-big-as-I-remember-it bathroom, and waited for our doula, Sarah, to arrive. Note: I do not recommend this! Knowing that other people are listening to you making animal sounds on their bathroom floor is never fun. Though I do think they may have learned a thing or two about childbirth... 

Very quickly my contractions went from being 10 minutes apart to being 2 minutes apart, and Dave had created a little circuit for me: I would spend the first 20 seconds of each contraction sitting on the toilet, then dive on to all fours with my head resting on the garbage can (in case I barfed, which luckily I did not), and then he placed a pillow on the floor at behind the garbage can where I would lie in the fetal position and wait for my next contraction.

This part was really, really hard. Every contraction I was questioning whether or not I could make it.  Breathing really did get me through it, as did Dave. When Sarah arrived at about 12:45, she listened to exactly one contraction and was like, “Have you been doing that, you know that thing where half way through the contraction you start pushing, for long? If so, it’s not really cool that we stay here.” So Dave called Dr. Mussali and asked him to meet us at the hospital.

At around 1:30pm I arrived at the hospital on all fours. Sarah led me in to the hospital while Dave parked the car.  As we walked through the front door, the security guy at the front rushed over with a wheelchair to help me. Sarah told him that I would not need the chair, I was fine on all fours, but if I could please get the emergency elevator that would be very much appreciated. Clearly, she had done this before. In the labor and delivery ward I was rushed into the closest room available and strapped to the fetal monitor. After a whirlwind of fears that there was meconium in my fluid and some hospital staff being nonplussed that I was strep B positive and arriving so late, the nurse asked me if I wanted an epidural. The room fell silent. I was supposed to answer that question?! For myself?! Clearly every fiber of my being wanted that epidural! Somehow, I managed to squeak out a very doubtful, “No thank you” before my next contraction came on.

Next the nurse measured my cervix, after the 2cm incident, I did not want to know how dilated I actually was, but asked that she tell Dave instead. I lasted about 10 seconds before I begged Dave to tell me how dilated I was. Luckily, I was 8cm and very soon after that I was pushing. Before I started though, Dr. Mussali asked me again if I would like an epidural, as it would be my last opportunity to request one. Perhaps sensing my hesitation, he told me that if I wanted a natural birth, I could have one – I was close and he knew that I could do it. It was just the vote of confidence that I needed to keep going.

I was surprised by just how hard pushing was. I certainly did not feel that “close”.  In my mind pushing was going to be this fast process where someone tells me how close I am to meeting my baby and within three pushes he would be out. In reality I was exhausted and the baby’s head, though visible, was not moving down very quickly. Nevertheless, with a lot of guidance and instruction from Sarah, Dr. Mussali and Dave, I delivered at 4:08 pm in, ironically, a modified happy-baby yoga pose. Sitting on that bed looking down at this tiny, cone-headed, blue, mucus-covered baby that has just come out of me was surreal. He was perfect. 

More on our experience as parents later, but one person who needs to be thanked in this story is Ben's uncle Steve, who actually sat in our car for two whole hours on the Upper West Side while I labored because we couldn't find parking at Dave's parents place... He even ran out to buy me gatorade! Thanks Steve!

The top four photos are by Lev Kuperman Photography.

Rapid Growth

It has started. People have begun offering me their seats on the subway. It usually happens after I have been on the train for a couple of stops. Sometimes I hear whispering, or consulting with a friend, "I think she might be pregnant.  Do you think she's pregnant?" The first time it happened I was totally surprised, a man reached over and touched my arm. I was just about to shoot him the don't-touch-me-you-creep look when I saw him smiling kindly and looking at my midsection.

For those who have seen me recently, this may come as a surprise. I wasn't that big at all. I am still not big, but definitely a little rounder in the belly. I know this sounds crazy, but its really surprising how quickly I am growing. Every night I lie in bed with my hands on my tummy thinking, "holy cow, its getting bigger!"  I know, you are probably thinking, well, duh...  But honestly, I didn't anticipate feeling such rapid changes. I am only 17 weeks and I  can't even do up my pants.

Which brings me to my next point: maternity clothes are awesome. I honestly wonder why women who aren't pregnant don't wear them all them all the time. Granted, I am an elasto-phobe, and hate wearing anything that is tight around the waist.  I also love loose tops and frequently have to undo my pants after a big meal (damn you skinny jeans) so I am all over the idea of a belly band, which basically allows you to pull down your fly and still look presentable in public. I will definitely be wearing these long after the baby is born...

The two dresses at the top are from Asos Maternity. The tops and belly bands are from TopShop Maternity.

Fire Island Will Never Get Old

Blue skies on the ferry ride.

When I tell my kids about Fire Island, NY,  I'll tell them it's a magical place that can only be accessed by boat, where there are no cars, and where dogs, babies, and deer run free. And I will be telling the truth.

There are few places that I can think of that are quite as relaxing as Fire Island. Dave and I have been trying to pin point just why that is - most people have wifi and you can check your cell phone on the beach, so its not like you are completely disconnecting from the world - but there is something about the pace at which one moves while in Fire Island that instantly slows your heart rate. As previously stated, there are no cars on the island, except for maintenance and emergencies, so the main modes of transportation are bikes and two-feet-and-a-heartbeat. The island is about the width of a long New York City block, and after your swim, you can stroll across it barefoot in less then three minutes. The beaches rarely get crowded, so there seems to be little incentive to rush anywhere. Even the (mostly) modest beach houses on the island seem to be telling you to just chill out for a minute.  

Being in good company definitely helps too.  This is the second year that we have had the good fortune of staying with friends in Fire Island. Last year we stayed at Todd and Margaret Muhlfelder's house, this year at Jesse and Pam Ellis's. Like last year, the six of us spent most of our weekend together, playing with kids and dogs on the beach by day and eating good food at night. A routine I am pretty sure I will never get tired of.

From left: Dave, Jesse, Pam.  Dogs: Saydie (ours, black fur), Elvis (Pam and Jesse's dog, white fur)

Saydie. I couldn't help myself.

Olivia Muhlfelder, 1.5 years old tests the waters, with her family's support. Photo by Pamela Ellis.

 How cute is that? Photo by Pamela Ellis.

Dave, Todd and Olivia. Photo by Pamela Ellis.

Elvis Ellis trying to chase Saydie down. Photo by Pamela Ellis.

Saydie hangin with her old pal Milo (Todd and Margaret's dog) after a long day of playing.

An Instagram photo from last year's trip: A deer and I check each other out on my trip to the market.

Fire Island Sunset. Photo by Pamela Ellis.

Also: check out this short BBC clip on architecture in Fire Island that just came out this past week. Thanks for sharing Andrew!