Ma Paten: The story of a shasfemme

The late Bertille Ann Alie (Ma Paten) was born in La Plaine in December 1897 and died at the age of 91 years in June 1984. She was a mid-wife with a compassionate personality who practiced from the late1930s to 1972. She learned the noble profession and devotion of midwifery from her mother who served the community before her.

After Ma Paten’s husband died in 1952, she devoted her life to the practice of midwifery in La Plaine and the rural East. Her son, the late Haynes Alie said, ‘Ma always responded to a call to assist a woman in labour regardless of the time of night or day and weather conditions’.

Natalie Charles Andrew characterized Ma Paten as Florence Nightingale in her book entitled ‘Famn Kouway’ (Woman of Courage). Ma Paten could also be described as the Mother Theresa of the East.

In answering her noble calls, Ma Paten would venture on foot  across in  the often raging and angry waters of the Sari-Sari, La Ronde, Taberi and Boetica rivers. At nights she would carry a ‘ boozaye’ (home-made kerosene lighted torch) and during inclement weather, she would either travel on horseback, donkey or carried by men in a hammock as she negotiated the sharp hills, ridges and  river valleys  and ravines of La Plaine, La Ronde, La Frenchette, Case Gowrie and Morne Jaune/ Riveire Cyrique on her way to deliver another precious child.

She performed her duties at a time when there were no motorable roads or formally trained health care providers in the district. She was paid very little and there was any payment they were in the form of bartered goods.

The child’s father would often return the favor by working in her garden or delivering a bag of ground provisions ( dasheen, Tania, yams)  to her home, slaughtering an animal or doing some other odd jobs around her house. Often, she had to provide clothes for the new borns of poor women (‘ma-lay-way’).

In the early1970s, Ma Paten’s eyesight, health and strength began to deteriorate. She was no longer able to perform her midwifery duties. She finally stopped practicing her beloved devotion in 1972. At the same time, the majority of rural women began giving birth at the Princess Margaret Hospital in Roseau.

Also in the 70s, the government enacted new midwifery birthing policies which required formally educated, trained and registered nurses to practice midwifery. These polices resulted in the marginalization of the devotion of the ‘Shasfemme’, the courageous and compassionate country midwife such as Ma Paten.

But the beginning of the demise of the ‘Shasfemme’ in Dominica and the East began around 1965 with easier access to the capital city of Roseau via newly constructed roads linking the country. Now expecting mothers who could afford the trip by truck to Roseau chose to give birth at the Princess Margaret hospital.

Before the roads were opened, the two day journey on foot to Roseau from ‘Au Vent’ (Windward coast) went through ‘tete’ Grand Fond, Morne Macaque, Ravine Dejeuner to the Boeri Lake (‘Chemang Letang’-the lake road) to get to Roseau to sell their produce. There is a popular folk song which goes like this- ‘Anno heylay horray, bravoo, Chemim reevey Laplaine; chemin reeevey Au Vent.’ Let’s shout horray, bravo the roads have reached La Plaine; roads have reached (the windward eastern Atlantic coast)- Au Vent.

In rural communities all over Dominica, midwives ( Shasfemmes) in their own unique styles always empowered women to become confident and in control of their pregnancies and become strong, caring and compassionate parents. They exuded the personality and maturity to appreciate the importance of a special event as childbirth to the woman, family and the entire community.

Today, there is a real concern with the increase in caesarian (C) sections procedures during births. Many governments and concerned citizens would like to reverse that trend. Of course, there are many occasions where C-sections are medically necessary and this writer applauds the gigantic medical breakthrough.

But it can also be said that a large number of C-sections can be avoided if the birthing attendances are done by midwives. Some physicians and activists refer to the C-sections as ‘drive by births in baby factories’ to illustrate this distributing trend. The woman often is left to deal with a very different holistic childbirth experience when it is caesarian.

The last twenty years have witnessed a resurgence of midwifery programs in many nursing schools in the United States and Europe. Midwifery is the approach to childbirth and women’s health care that is used extensively in Australia, New Zealand and Japan.

Many health insurance companies and health plans are beginning to realize the long lasting societal benefits of the midwifery practice. That compelling fact was embraced by my wife and me when we made the decision to have a mid-wife instead of a medical doctor assist in the birth delivery of our children at a hospital in Washington DC. We are still in close contact and consider her a family even though our children are teenagers today. It is said that Medical Doctors deliver babies but midwives empower women by helping them to deliver their babies.

Eight years ago a large hospital in Baltimore, Maryland, granted admitting privileges (to the same degree as Medical Doctors) to Certified Nurse Midwives (CNMs) to admit their patients to the hospital. Recognized as competent care providers, these CNMs offer gynecological services, prenatal, birth and postnatal care with drug prescription privileges.

The CNMs’ mission at St. Joseph’s hospital is empowering women to make informed choices regarding their care. This usual involves a choice of having a baby with an epidural or choosing an unmediated and non-interventionist (surgery) approach to birth.

In March 2003, I traveled to Ethiopia as a member of a delegation of a major U. S. Health Care Foundation observing community health delivery models and outreach in the Horn of Africa. At a small health center about 75 miles from the Sudanese border in the African Rift Valley, there were rural women who were learning the ancient art, science and devotion of midwifery from women elders.

After completing their training, these young birthing assistant trainees would return to their villages and practice as midwives. According to a senior health official for the Sodo health district (health district is called Woreda in Amharic language), this area of Southern Ethiopia is where the midwifery model of care is incorporated into every aspect of the health care system.

Soda ‘Woreda’ has the lowest infant mortality rate in Southern Ethiopia in spite of meager resources and poverty. The sight of the older midwives at this clinic in the Ethiopian low lands brought back nostalgic memories of Ma Paten and her sojourns between the Laronde and Sari- Sari river valleys to care for a new born and mother.

In 1999, the Center for Health Professions at the University of California at San Francisco issued a report on the future of Midwifery in America entitled ‘Charting a course for the 21st Century’. The report recommends that every health care system should integrate midwifery services into the continuum of care for women by contracting or employing midwives and informing women of their options.

The report indicated that fully integrating the midwifery model into every aspect of health care practice will not only reduce escalating costs of health care, but will change how care is delivered and managed. This change will ultimately benefit women, their families and society.

Midwifery’s many strengths and contributions are not only realized and championed by progressive health experts but also in literature and art. The book The Red Tent, by Anita Damant is a modern fiction on new perspectives of female life in biblical society.

The tent was a place where women were sequestered during cycles of birthing, menstruation and even illness. Ms. Diamant writes in the voice of Dinah, Jacobs’s ‘daughter, as she reveals the sensual and emotionally charged stories of birthing miracles and sisterhood secrets.

During her sequestration, Dinah delivers a call to the midwife for help and comfort. The Red tent is based upon a mention in the book of Genesis of Jacobs’s only child Dinah, and demonstrates in a very powerful manner how midwifery becomes a symbol of womanly strength, love, wisdom and empowerment.

The last time I saw Ma Paten was at her home in 1982. As we talked, I looked deeply into her sunken eyes that by then had lost most of its seeing ability. She could not see me but I could ‘see’ her. I preferred to ‘see’ her in the past tense. It was painfully clear that the end for her was imminent.

I asked her simple questions such as what was my birth weight. Of course, she did not know, nor did she keep any health records. Also, there were no weight scales to weigh the new borns in the rural east mountains at the time of my birth in the early 60s and before.

She said she could eyeball the baby for a few seconds after birth and know immediately if it was a healthy or sick baby. If the newborn was sick, she would proceed with visiting the mother and changing to the role of a health care provider- ‘Bush doctor’.

I thanked Ma Paten for the guidance, influence and the sacrifices she made to the entire eastern health district. I assured her that even though I was now a long way from the village she was always on my mind. With a faint but reassuring voice, she wished me well.

After her death in June 1984, I reflected on her life as a true, honest and maybe the most respected and loved leader in our small rural community. This was a time where and when there were no real opportunities for women of her generation Her devotion and work ethic was the gold standard that paved the way for an entire community to model off.

She taught us to believe in ourselves, be proud and never forget where we came from. She had earned the utmost respect and love of her people. It was now time for her to gracefully say good-bye.

One of Ma Paten’s ‘babies’ former Police Commissioner Mathias Lestrade told  me  that the Greater La Plaine  area should be eternally grateful to Ma Paten because she virtually delivered all the babies in east in her time. Chief Lestrade suggests that she be recognized by the government posthumously.

I returned home in September 2001 with a group of American dentists to provide dental treatment to patients at the La Plaine Health Center and the schools in the eastern district. As I entered the center’s reception room, I noticed a portrait of Ma Paten hanging on the wall with the caption ‘Famn Kouway’ (Woman of Courage).

I felt that same powerful emotion as the last time I saw her in 1982. Between patients, I smiled at the portrait of this majestic and noble woman on the wall and the favour was returned. She had approved the short dental mission that another one of her ‘babies’ was conducting in the community which she gave so much to for so long.