Nada Más Importa

Here in Montevideo, there are still billboards throughout the city saying “Nada más importa”. I’m assured by my friends that the grammar is improper, but the message is clear: Nothing is more important. It is not about reducing deaths or increasing equality, which I hear gynecologists, other doctors, nurses, colleagues, and friends talk about frequently — it’s as if social justice and equality are universally prioritized here. The billboards are also not about eating well and exercising. They’re not about ending the violence I have been reading about in the news constantly. They are about the World Cup.

This frustrates me because, while I enjoyed watching sports in public spaces and in our hostel with passionate fans, I feel sure that futbol/soccer is not the most important thing. I have been thinking pretty constantly about the violence in Israel and Gaza; it has been weighing on my heart, to say the least, and I feel powerless to do anything that will bring an end to the rising death toll (at least 268 Palestinians and 2 Israelis killed in the past ten days). I have frequently thought about working in emergency and disaster settings as a nurse or nurse practitioner, particularly within that conflict, and I think many times a day now about leaving Montevideo to be an extra set of nurse hands in that far-off conflict zone. I don’t go in part because I can’t pay for the trip, but also because I made a commitment to do this research. Some change is fast, as nursing often is: I give a patient a blood transfusion and can see the color return to their face. But some change is very, very slow, like collecting and analyzing data and then hoping to publish and eventually affect policy and practice. In the past ten days I have been doubting if I have the patience to do this type of work. I want to see color return to the cheeks of my patients; I want to see people not die. That includes women choosing to terminate their pregnancies; it includes children playing on beaches; it includes every soldier and every hospital worker in a conflict zone; and it includes everyone whose politics I completely disagree with. I am a nurse and a human: Yes to living with dignity, no to more deaths. Nada más importa.

Thinking this way, it has been difficult for me to want to write publicly about the work that I’m doing here. It has been full of challenges, but none so big as being away from the people I love and feeling powerless in the face of so many deaths. My work seems insignificant, even a little boring. Regardless, we each have our paths, our tasks that will bring us all at least a little closer to a better world. Mine, now, is this investigation.

Methodology

My original thought was to have a list of all of the gynecologists in Montevideo, and attempt to contact each of them. I was not, in the end, able to get a complete list nor contact information for all of them, but one gynecologist kindly sent our email explaining our purpose to her contacts. From that we got about 13 responses from interested gynecologists — or, as one clarified to me, not necessarily interested. “We are not interested. We are helping you.” Gynecologists in Uruguay may obtain a status as a “conscientious objector” to abortion and therefore be exempt from providing abortions. Marking oneself as an objector is taking a fair clear stance on one’s views on abortion, and in the US the topic can be very divisive. Here, regardless of objector status, every gynecologist I have spoken to has been kind, helpful, and curious.

Part of the methodology has been asking each person I speak with whether they know of any other gynecologists who might be interested in completing the survey as well. One day, a doctor in an inpatient hospital setting said that I had interviewed all the gynecologists on the guarda at the moment but that there should be more in emergencia. On this recommendation, I walked into the Emergency Department of the hospital. I gave the speech I have now given countless times: “Hola, soy estudiante de salud pública y enfermería en post-grad. Estoy haciendo un proyecto de investigación con ginecólogos. Puedo hablar con los ginecólogos acá?” It isn’t the best speech I’ve ever written, but considering my rudimentary Spanish skills it works pretty well. The ED intake staff told me which door to walk through. I delivered my speech to the nurses at the nurses’ station, who walked me to the staff break room and asked the gynecologists if they were interested. I was surprised that I was allowed to walk around the hospital without showing any identification, but even more surprised that doctors were giving me moments of their time so generously.

Excited by this idea, I went to another hospital and gave my speech to the person at the information desk, who told me which parts of the hospital had gynecologists on staff: high-risk antepartum, post-partum, gynecologic surgery, outpatient gynecology, emergency. I learned to ask for these specialties specifically when arriving at a hospital. Most of the gynecologists I encountered filled out my survey; a few were too busy, and several asked me to wait “un rato” (a time, usually a short time — I believe). Sometimes this was as much as three hours. A few of the rooms in which I waited had televisions, so I got a taste of telenovelas and wacky morning news programs. I also watched news about Gaza and about local politics, all in Spanish. I took notes on these along with my field notes, and showed them to friends who could help me make sense of them. My Spanish has improved dramatically since I have been here, but the technical language of politics and violence are still foreign to me. (In Hebrew, some of the first words I learned as a teenager at the turn of the millenium were words for soldier, occupation, and bombing. In French and Italian I learned words for food — though I remember almost none of them. In Spanish, before this project, I knew how to ask patients if they were allergic to platelets or if they wanted orange juice.)

With a combination of doctors introducing me to more doctors and walking into hospitals and begging an audience with anyone with ginecólogo/a in their job title, I have obtained 36 completed paper surveys. Heidi also helped by passing them out to gynecologists she encountered in her own research. I did see at a certain point that there were gynecologists in other parts of the country that I could reach as well if I had an online version of the survey, so I made one and have been distributing the link carefully to known gynecologists. I want to ensure that I don’t send them to people who are not part of the sampling frame, i.e. midwives or administrators, thus confusing the data set. I have received three completed online surveys so far, for a total of 39 Montevideo surveys. (I still hope for some from the interior of the country.) My original goal was 30. With an estimated 85 gynecologists in Montevideo, I have data from 46% of the gynecologists in this city.

The next step is to analyze the data, which I have been working on, and present it. I have a lot of work to do, and I am trying to keep my focus. I am trying not to think constantly about my family in Israel or the nurses in el-Wafa Hospital in Gaza. I am trying not to agonize over the fact that my tax dollars, as a US citizen, are paying for this violence. Today was Nelson Mandela’s birthday. In his memory, we can continue to struggle for peace, justice, access to healthcare and to dignity. That struggle takes many forms. Increasing access to safe healthcare services is part of that. I remind myself of that, and I remind you: Thank you for whatever it is you are doing to bring this world closer to a better world.

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