Translator: Nicoletta Pedrana Reviewer: Michele Gianella
Realizing how lucky I was,
has been a bit like lighting the fuse in my path.
It's 2014 and I'm sent to South Sudan,
the quintessential humanitarian context.
Here, they tell me, "That'll teach you well";
there, they will say:
"Look, they send the first missions here just because they can't say no".
I'm 25 years old,
and so they send me to a hospital
that Doctors Without Borders has been running for more than 20 years,
so that I have time to understand and learn by observing.
But by the moment I understand I might not be up to my task,
I find myself on a boat on the Sobat river,
on my way to Ethiopia with my colleagues,
to save our lives.
But how?
Wasn't supposed to go there and save the others?
It just so happened, the frontline
where the two ethnicities of the civil conflict,
the Dinka and the Nuer, clashed,
had made a sudden leap forward towards the hospital.
And this, for us expats, was a sign
that the evacuation plan had to be implemented
no matter what.
For us expats: the lucky ones, once again.
As we travel I look across the river bank
and in the background I can see the rebel soldiers going to war.
They're racing around in worn out jeeps,
shooting with kalashnikovs into the air to galvanize each other.
Well, I kind of expected that:
I had come to a war-torn country for almost half a century.
But I only understood what war is
when I saw a five-year-old girl in the foreground,
walking in the same direction as us.
She was a little girl dressed in rags
who seemed to be terribly aware of what she had to do.
She was holding a bag and a stick.
An old woman followed, grabbing the other end of the stick,
She was her great-grandmother, perhaps,
and she was blind.
And they walked to save their lives.
The men in the background
were the husbands, brothers and fathers of the two in the foreground.
While I'm thinking, the night falls.
After a few weeks on Ethiopia I find myself back in South Sudan
and they send me to reopen the maternity ward
in a hospital that a few weeks earlier,
during an attack,
had been razed to the ground and set on fire.
I was working there for a few months now,
and as it often happens, the walkie talkie croaks in my hut.
I look out, and it is almost dawn.
This cheers me up
because despite the previous day, I managed to get enough sleep.
The sound is disturbed, so I can't hear well what they say;
but I understand that they need help, so I walk to the hospital.
It's only a three-minute walk at a normal pace,
but when you walk them, you do it so quickly
and your mind is so immersed
on what you will find by opening the maternity tent
that you're there in a moment.
I walk through the hospital's rickety gate
and I see two men coming out of it holding a cot,
a wire mesh of a bed,
and I understand,
the situation I'm going to encounter is a bit borderline, as usual.
In South Sudan, the vast majority of people
dwell in mud and straw huts in the middle of nowhere.
There are no paved roads, there is no electric lighting.
If you are lucky enough to have a working hospital near you,
you know you'll have to walk at least 20 kilometers.
Given that, during the night,
only the Milky Way can light your path,
and in the rainy season
the ground becomes a sea of impractical mud,
if you are a woman, and your labor is going well,
you better deliver in your hut.
If there is a problem, a complication of any kind,
you have to start hoping to be lucky,
you have to be lucky enough
that your loved ones understand the situation,
and to take you to the hospital, instead of the village shaman.
You must be lucky enough that the cot,
which is a luxury good and is shared in the village,
is free and available for you.
But above all, you must be lucky enough that your bodily resistance,
and possibly that of your baby also,
outlast the adversities ahead of you.
In short, I enter a small delivery room,
with two worn-out delivery beds divided by a plastic curtain,
a sink and a shelf with the delivery tools
sterilized in the coal autoclave.
The South Sudanese midwife talks me about the case:
it's a woman in labor of her fourth child.
Contractions are regular, the dilation is full
and pushes are intense.
There is only one, not so trivial detail: the position of the fetus.
this baby does not want to be born with head or podalic, breech;
it wants to be born with the elbow, like this.
My brain opens the handbook of obstetrics
studied in my dear University of Monza,
that in that moment seems light years away from me,
and I only have one certainty:
the birth cannot take place naturally,
it needs an urgent cesarean section, an operating room, special equipment,
and someone who knows how to do the operation.
But remember,
there is no operating room in this hospital,
because it had been burned down a short time before.
I know that if that woman is not operated soon,
her uterus will tear
and bleed
and she will die in a terrible way, more or less quickly.
Just as it had happened to another woman, the day before,
which I had not yet had time to relaborate.
I mean, time is short.
So I call the village chief,
wondering if he can arrange a flight to transfer the patient to the capital.
Too bad it's raining, and in South Sudan you can't get an unscheduled flight,
and there's nothing taking off, nor landing, on that sea of mud.
I give the woman the few available medicines
to try and calm the contractions,
even if I know that a woman's labor can be as powerful as a tornado,
and there is no medicine for that.
The fetal heartbeat is disappeared.
Now we can only help the woman.
Three endless hours pass by
until the power of that woman's body,
in a way that is almost inexplicable to traditional obstetrics,
can shape that lifeless child's body,
push it through the birth canal and then bear it.
The woman is safe, she is alive,
I am exausted, I can't believe my eyes and I'm very relieved.
I walk towards my hut,
I meet Tito - the head of the South Sudanese village,
a tall, thin man without an eye
and with his front teeth well separated, typical of Nuer.
He, as a village chief, already knows what happened in the delivery room
and acknowledges me.
So I try to clarify
and tell him that I didn't do anything:
the woman was just very lucky.
And I tell him: "She was just lucky".
He smiles at me and says:
"Lucky is good, Ileana. Lucky is good".
South Sudan remains in my heart:
in 2016, when they offer me another mission there,
I immediately accept.
They send me to an enormous refugee camp,
130 kilometers north of my first mission.
And I happen to be lucky again.
I meet some South Sudanese colleagues I had worked with last time.
I'm so happy to find them,
still alive.
Between a birth and another they tell me why they had to run away,
and how they did it.
Because conflicts resumed at the sunset,
runaway people had to move during the day and hide in the swamps at night.
They had to spend the night with the children in their arms
because they were covered in mud up to their belly line.
Roda is a midwife of great talent, let alone her unique beauty,
and she tells me about the women who went into labor during those nights,
and the babies assisted with basically nothing:
umbilical cords were cut with scraps of metal plate.
And there's one birth in particular that keeps haunting her.
She keeps repeating to me the maneuvers she did to save the babies -
because it was a twin birth -
like she was asking my approval.
So I tell her that she was great,
that for that mother, and her children, she has been a true gift of life,
and that they were lucky.
And my mind gets back to "Lucky is good".
This and many other stories led me to think
that our local colleagues are the real heroes.
Even though they are the first victims of the war,
they have the strength to come and work with us day and night
to take care of our patients.
Even if they are traumatized, they have the strength to come
and relieve the trauma of their people.
It's as if they know how to pause
the memory of the horrors they go through every day -
from relatives and friends killed to rape, hunger -
to come and take care of our patients,
who are sometimes their enemies.
When in 2017
we opened a maternity hospital in Iraqi Kurdistan
a few kilometers from the battle
for the liberation of Mosul from Isis,
finding midwives willing to work with us near the front
was almost impossible -
rightly so, because they were all afraid.
I finally managed to put together a very heterogeneous team,
a mix of Kurds and Iraqis, Yazidis, Syrians.
And if you consider the history of these people,
it will seem impossible to you.
And yet they worked together in the delivery room, in the front line,
to take care of other women, exhausted by the war.
A year goes by, and as a midwife I am very excited,
because they propose to me to go
to one of the world's largest maternity hospitals
in Khost, Afghanistan.
I am talking about a real children's "factory",
where more than 23,000 children are born every year.
That is about sixty on average per day,
but sometimes even a hundred.
These are mindboggling numbers:
I can't believe them even after I went there.
Here in Italy, if you assist three births per night,
you're allowed to feel tough.
I remember Afghan midwives literally collapsing on the floor,
after a 14 hour nightshift,
in that chaos where two or three women were laboring in the same bed.
A reality at the limits, where life begins and resists.
A bit like Bibi, who gives birth to her fourth daughter in the mountains
and comes to us unconscious, in hemorrhagic shock, almost dead.
In order to try to save her, we can only fly to the operating room
and remove her uterus.
But in order to do so, we need her husband's approval,
which is not always an easy thing to get.
So I run to him together with the interpreter,
and already a little prejudiced,
ready as I am to try and convince him,
spending time we don't actually have.
Instead, I find myself in front of a mountain man,
with a sunburnt skin and a long beard.
He looks to me like a poor among poors, who carefully listens to me,
perhaps he doesn't get everything I say,
but he understands, all he's left with is give us full confidence.
So he pushes his fingerprint on the sheet of informed consent,
because he doesn't know how to sign.
In Afghanistan, I am not even allowed to look a man in the eye.
But I'd give him a hug.
During surgery, Bibi's heart stops twice, not once, and then starts again.
Which is unlikely, with the tools at our disposal.
The situation is extremely critical,
but the surgery ends and Bibi is still alive.
During the night, however, the situation worsens again,
her blood gets crazy, it doesn't clot anymore.
So we just have to go back to the operating room
and fill her belly with gauzes to stop the bleeding,
close her up and watch.
And so we do.
Two days go by, her conditions looks stable,
so we get ready to go back to the O.R.
and take out those gauzes that seemingly did their job.
So we get ready.
We're all very nervous, working quietly and carefully.
Then Bibi herself breaks that silence.
She looks at us, and says in pastun: "Don't worry, I can handle it".
And so it happens:
after three weeks Bibi goes back to her mountains, with her little girl;
and she is full of life.
She was just lucky; lucky is good.
The luck, and the life. Life intertwined with luck.
A luck I also had,
and realizing how lucky I was made me vibrate,
and pushed me far away from home to try and give it back.
A luck that made all the difference
between death and life.
A life to honor and appreciate, looking for what makes us vibrate.
And what about you, now?
What makes you feel alive?
What makes you vibrate?
(Applause)