ILHA DAS FLORES | Guilherme Coelho
I was thirty when I went to the Amazon. I had finished residency in the Southeast of Brazil the year before and moved to São Gabriel da Cachoeira to work as a physician in the Upper Rio Negro. I still believed, without noticing I believed it, that I was bringing something people there needed. I did not call it that. I called it care. I called it evidence-based medicine. I packed a stethoscope and two textbooks and a folded sterile drape that I kept in my bag for months, in case.
The polo base where I worked sat on Ilha das Flores, an island in the middle of the Rio Negro, surrounded by forest that did not end. On my second morning, the radio called me because a first-time mother, Baniwa, was in labor on a boat coming downriver. I was the closest physician. A voadeira took me to meet her. The boatman paddled the last stretch with the engine off so we would not startle her.
She was sitting on a folded blanket at the bottom of another small boat, her hands on the wooden bench, her breath already organized by something I had not taught her. An older woman, her aunt, was wiping her forehead with a cloth dipped in river water. I knelt. I asked, through the aunt, if I could examine her. She nodded with her eyes. A contraction tightened under my palm like a rope being pulled from both ends. Six centimeters. Membranes intact. The baby's heart beating steady, faster than mine.
I remember what I thought. I thought: I can manage this.
We brought her back to the polo base. Three women were waiting inside the wooden building on stilts: the indigenous community health agent, the midwife and the midwife's assistant. They had laid clean cloth on a platform in the corner. A clay pot was steeping on a small stove. The room smelled of cedar and boiled water and river air.
They looked at me when I stepped through the doorway, and for a moment no one spoke. I understood, without being told, that they did not know what to do with me. A man. White. Young. A doctor. The Brazilian state, in a coat.
I did not know what to do with myself either.
The midwife was perhaps sixty, small, with hands that had done this many more times than I had read about it. She looked at me a long moment. Then she said, in a Portuguese that carried another language underneath it, oi moço, ela pode fizer aqui no canto, já temos tudo que precisamos. Hi mister, she can do it over here in the corner, we already have everything we need.
I smiled. I nodded. I tried to put into my eyes something I could not say out loud. She held the look a moment, received it, and turned back to the woman in labor.
I went to the corner she had not assigned me but had allowed me.
The assistant knelt behind the young mother and supported her lower back with both palms, adjusting the pressure to the shape of each contraction. I had read about counterpressure once. I had never seen it done with that kind of attention. The health agent spoke softly in Baniwa, and the words seemed to open space around the woman instead of filling it. The midwife placed a warm cloth, steeped in leaves I could not name, low on the mother's belly. She did not hurry. She did not measure.
The young mother's uncle sat on the wooden steps outside, facing the forest. He did not come in. He did not knock. He stayed there the whole morning.
I stood in my corner and tried to be useful by not being in the way. This was harder than I expected. I kept wanting to offer something. A word, a gesture, a piece of training. I kept having to swallow it. At one point I noticed I was tapping my fingers on my thigh in the rhythm of a Leopold's maneuver I had been taught to perform for fetal position. I made myself stop.
The baby was born a little after ten thirty on a morning that was hot but not yet cruel, with slats of early sun coming through the wooden wall and laying stripes on the floor. A boy. He cried immediately. The midwife caught him with both hands and placed him, wet and furious, on his mother's chest. The assistant wiped him with a clean cloth. The health agent said something in Baniwa that made the young mother laugh through her exhaustion.
Nobody asked me for the Apgar score. Nobody needed it. I gave it anyway, inside my head, because that was what my training did when it did not know what else to do. Eight and nine.
I wrote nothing down.
When the cord had been cut and the placenta delivered and the mother was resting against a folded blanket with her son at her breast, the midwife turned to me. She did not say thank you for waiting. She did not say see, we had everything. She said, and I am putting this into the English of the sentence I heard, not the Portuguese she spoke, you can come closer now, moço.
I came closer. She showed me the baby. I placed my stethoscope on his small chest and listened to a heart that had not required any of my knowledge to begin beating.
The uncle heard the first cry and stood up. When he turned toward the river the light caught the side of his face, and I could see he was smiling, though he did not come in.
I walked back to the voadeira that afternoon with the folded sterile drape still in my bag. The boatman looked at the bag and did not smile this time. He nodded once.
I think about the midwife sometimes. I think about her when I write prescriptions. I think about her when I read a guideline and feel very sure. I do not know what to do with the thinking. I have worked as a physician for seven more years since that morning, and I can tell you what I saw, but I cannot tell you exactly what I learned, because learning does not always come in a sentence.
A boy was born that morning on Ilha das Flores. I was there.
Guilherme Coelho is a family physician and doctoral candidate at the University of Campinas (UNICAMP), Brazil. His narrative medicine writing has appeared in Family Medicine and Hektoen International. Coelho trained in medicine at the Federal University of Rio de Janeiro and completed his residency in Family and Community Medicine at UNICAMP. From 2020 he worked as a physician in São Gabriel da Cachoeira, in the Upper Rio Negro of the Brazilian Amazon, an experience that continues to shape his clinical and literary work. His current doctoral research examines the effects of climate on maternal and perinatal health in Brazil.