The Shame Herb: Birth and Debt in Hospital Detention

By Alissa M. Jordan (University of Pennsylvania)

Hospital detention is the institutionalized practice of imprisoning patients within hospitals in order to recover the cost of their care (Yates et al. 2017; Yumba 2016). It is neither unique to Haiti nor confined to clinics in the Global South (Cheng 2018). Rather, it is a widespread practice sutured into neoliberal health care, especially obstetrics, in at least 46 countries around the world (Handayani et al. 2020; Cowgill and Ntambue 2019, 3; Yumba 2016).

The following video, audio, and artwork is the outcome of the “Lopital Pa Prizon” Reproductive-Justice Storytelling Workshop held in Okap, Ayiti, in June 2022. The workshop brought together 11 women survivors of hospital detention (and their family members) with Haitian artist Danipy Georges, anthropologist Alissa Jordan, Haitian midwife “Ani,”[1] Haitian human rights organizer Jean Denis Aureleus, and an experimental Haitian documentary team, including Maredel Pierre-Louis and Robensor Exantus. Following the end of the closed workshop, the film team invited mothers to share their experiences on film before going home. Although it was late, and many were tired, 10 of the 11 women waited for more than two hours for a chance to speak. “Geraldine,” who brought her eight-month-old baby, “Ti Woz,” waited the longest. She was the last to speak. In the video, she responds to the off-camera question: “What is your story? What do you want to share?”

Seven months later, in December 2022, Geraldine succumbed to complications relating to her pregnancy and traumatic birth experience a year prior. The letter following the video is addressed to her daughter (now nearly two years old) and written by the anthropologist. It is an English translation of a longer voice message sent to Ti Woz’s father on the same WhatsApp channel that Geraldine and I used to communicate through exchanges of monologic voice messages that, over time, wove together into an asynchronous and geographically distant dialogue of punctuated self-expression. Though written for Ti Woz, I shared this letter with her father for his ears as well (and he also granted his support for sharing it more broadly). This written message (transmuted from voice) closes the conversation with Geraldine and memorializes the only-ever partial, mediated glimpses (the fitful intimacies...) of the ethnographic encounter. In relation to Geraldine’s appearance and story in the video—her body turned away from the camera, her speech attesting rather than explaining—the letter contrasts the brevity of our encounter and the partial ways in which she allowed herself to be seen with the clarity of her own self-worth.

The Letter

In some places, your mother might have made the news. It’s a silly thought, admittedly. Why would the news matter, with its fickle attentions, its failures, its biases? But that’s what I think when I hear that she died. Do I think first about the news because she said she wanted her story to make it there?

(It was when I asked her about justice, and she responded that justice required shame). Speaking on camera was her way of making all these people, these doctors and administrators and international NGO boards and obstetricians and guards, all feel shame. Not just at that hospital, but across medesin (medicine).

Your mother was 30 years old. You will surely know that by the time you can read this. She turned 30 right before she died. Thirty on the 30th of November. She had a lingering fragrance of soap and baby powder, and beautifully plaited hair; she would add in whatever color was popular at the time.

During the time that I knew her, she repeated often, without pity or angst, the fact that she was alone. (Really, she had cousins in a town over. But that is not what she meant; she meant something about her life and the way she lived it.) Her life was being done alone. “Mwen pa gen moun” (I have no one).

But you. Your mother saw you as her person. Her moun. She would hold you tightly to her chest when she stepped outside with you, as if she was scared you might fall away or slip through her fingers.

What she wanted from me, your mother said, was to “show them the video” (montre videyo pou yo ka wè) so that the people who do these kinds of things would hear. And in hearing, feel shame.

Shame, in this sense, is a much broader task than the end of a single practice. Shame indicts. Shame remembers. Shame makes bodies recoil. She wanted those who hurt her and hurt you to recoil before her voice and her truth.

The ground beneath us is gray and made of concrete and it’s cold in Philadelphia when I find out she died. Of all people, it’s your father that tells me. He is a man I have never met, never even heard of except in passing referentially. He was never so much a character as an afterthought in her mouth, saying, “He left me pregnant,” “He’s never around,” “I am by myself.”

But it’s his voice that gave me the news over a WhatsApp message. “You and I never spoke because Geraldine and I were not together but now she has died. I have her phone. I’m sorry Madame Alissa.”

The pictures he sends show your mother on a hospital bed, hair perfectly done. She looks much younger than 30. Like a young girl stretched out, sleeping. The death certificate is neat and signed and formal, expiating all hope. She didn’t receive the care she needed during your birth, and she died from related complications. Your father and mother were not together, no. Just as he said. But these pictures show they were next to each other at the end. Life is like that sometimes.

“She was always a nice young girl, and you know she cared so much about the child, who is…she is staying with me now…but I’m just, I’m an old man.” The man’s voice cracks and he makes a sob and then pauses and composes himself and continues. “I was old when we got together. Understand? 70 years old. And she got pregnant.”

Shame. There is a plant called shame in the countryside; it grows wild, and when you come near and breathe on its leaves, it shrinks from you, it pulls its leaves in, folding around itself. Mimosa Pudica. It makes itself smaller even if you don’t touch it. Even if you just breathe on it. “Wont” (shame) you say to it. And it gets smaller. And it recoils.

Almost as soon as your mother’s surgery was over, she was ushered to the area of the hospital where mothers are held prisoner for their debts. She was poor, something that is not always a sin, but which is indeed almost always some sort of a crime. According to the hospital, your mother was in default of a loan that secured both your lives. Her body and yours became the corporeal collateral for that loan. The criminal, the debtor, the asset, the mother, the patient, the body, the prisoner, all as one.

She would not fold into herself. She would not shrink, petals pulling tightly, curling, till she was both expendable and valuable, both patient and prisoner, both a body and the thief of her own body.

It is hard to hear. But it mattered to her that the story be heard anyway. Each breath that went into her body and yours had a cost. The oxygen that was supposed to go in, the used air that was supposed to come out, the sound of the hissssss. It only went into your body when the money was handed over.

I was a world away in a Philadelphia neonatal ward two years before when I listened to the hiss of breath and life put into my newborn twins. The cost of the incubators, I knew, was extraordinary. Impossible. A sum that would make no sense to me and that I chose not to think about, had the luxury of not thinking about, until they were safely home. (They were allowed to come home in debt.)

Little by little, she said. She got together the funds little by little. And each time you breathed it filled her with joy. The oxygen that was supposed to go in, the used air coming out, the sound of the hissssss. It only went into your body when the money was handed over, but it went in. It saved you. Your breathing lungs and beating heart filled her with joy.

Your mother, in that imaginary world where her story makes the news before her death, would not have been an ordinary figure. She was the first to show up at the workshop and the last to leave. She allowed herself to feel anger, to express it. She allowed herself to grow. She gave herself permission to be large, to spread out, to open her leaves toward the voices.

Reproductive justice, as envisioned by Loretta J. Ross (2014), involves just as much our right to have as our right to be free from. People have the right to be parents if they choose, to raise those children in peace. They have a right to inclusive reproductive health care, to healthy neighborhoods, to be free from police harassment. They have a right to dream and tell their own stories and cultivate their own version of embodied and soul-nurturing care. It is radical for Geraldine, your mother, to insist she deserves all of that. That she deserves something better. That the system failed to give her something that she was and is still owed.

One guard tasked with keeping mothers and babies behind lock and key after birth doesn’t hide behind niceties. “It’s very bad,” he says. He is defensive in person, more defensive than our conversations. “It’s so hard for Haitians to put up with this system.” And he does, I think, feel shame.

I, too, feel shame. There is shame that I didn’t pick up a call your mother made some days before; it was Christmas and I was traveling and just didn’t feel like it. There was shame I didn’t get her story out in time. Those feelings hold me accountable. Wont.

I never saw her in the countryside. She lived in a corner of an Okap slum that she made into a home when I met her. But I imagine if she did visit the countryside and walk in the warmer Western regions of the country where this herb grows wild and free and there is limestone dust in the air, for better or worse, glittering in the wind, I imagine that she might step by the weeds, the rocks under her feet crunching. She might bring her face near to the shame herb and find that clear voice, that razor-sharp voice that she could muster inside of herself, and using all her breath and words speak her truth…and the plant would shrink away…

Acknowledgments

The work was supported by the Sachs Program for Arts Innovation and the Center for Experimental Ethnography at the University of Pennsylvania.

References Cited

Cheng, Maria. 2018. “Slovak Hospitals Hold New Roma Mothers Against Their Will.” Associated Press, December 10.

Cowgill, Karen D., and Abel Mukengeshayi Ntambue. 2019. “Hospital Detention of Mothers and Their Infants at a Large Provincial Hospital: A Mixed-Methods Descriptive Case Study, Lubumbashi, Democratic Republic of the Congo.” Reproductive Health 16 (1): 1–15.

Handayani, Krisna, Tyas C. Sijbranda, Maurits A. Westenberg, Nuria Rossell, Mei N. Sitaresmi, Gertjan J. L. Kaspers, and Saskia Mostert. 2020. “Global Problem of Hospital Detention Practices.” International Journal of Health Policy and Management 9 (8): 319.

Ross, Loretta J. 2014. “Reproductive Justice as Intersectional Feminist Activism.” Souls 19 (3): 286–314.

Yates, Robert, Tom Brookes, and Eloise Whitaker. 2017. Hospital Detentions for Non-Payment of Fees: A Denial of Rights and Dignity. Chatham: Centre on Global Health Security

Yumba, Pascal Kakudji. 2016. “De la séquestration des mamans insolvables et leurs enfants dans les maternités des établissements de santé de Lubumbashi: Cas de l’hôpital général Jason Sendwe.” RiA Recht in Afrika| Law in Africa| Droit en Afrique 18 (1): 78–96.

Note

[1] The names have been changed.