The Graveyard Is Too Small

I participated in a training last week entitled Saving Newborn Lives (SNL) along with the new midwifery faculty at the College and this was the name of the course organizer. He asked me over lunch if my name had any meaning when I said no, he asked another student to translate his name for me, "Manda Yachepa," she said, "the graveyard is too small." They both laughed and told me that this is a very typical Malawian name. I didn't catch his brother's name but he said it is something like, "All our days are tearful." Of course I have met others named Blessings, Sunshine, Memory (yes in English), Tontoso (consolation), and Yankho (answer) - most Malawian names have meaning - but many of the names are quite tragic. This of course reflects in part the high neonatal mortality rate here. The student correctly guessed, by his name alone, that Manda Yachepa's family had experienced the death of many babies before he survived and so began giving their children these names, expecting that they would also die.

This past week I had my first glimpse of what this high mortality rate looks like. As you walk from outside into the labor ward you first pass through a small room with a big metal sink and mops and a small metal rack with four shelves. On the shelves are small bundles, colorful chitingis (the cloth that women wrap around their skirts) with women's names written on tape and stuck on the outside. The first time I passed by, the thought occurred to me that these small colorful bundles might be babies, but I quickly banished the thought when I read "package of so-and-so" written on the tape. I learned later that they are indeed babies and Friday when I walked into the labor ward, I counted seven. Seven bundles of various sizes, which once held life and expectations - life known to the mother by her growing belly, by the twisting and kicking and sleep disturbing movements she had been feeling for months - and now here they are inert on a shelf.

Friday I also attended my first delivery here, assisted by a wonderful Malawian midwife. I came into the ward when the young (maybe 18) first time mother was pushing and a small patch of hair was already visible. Both she and the baby were doing well. Of course since I just was coming from the SNL class, I asked about a bag and mask. People began to search but none was located. The baby's head crowned and was born easily. (I successfully warded off the threat of an episiotomy from an obstetrician who wandered through and made the suggestion to the midwife, and the mother's perineum had no tear! a small success.) Then we waited for the baby to restitute (the baby's head usually turns to the side after it is born to realign with shoulders - part of what it has to do to negotiate the pelvis) but nothing happened. Finally the midwife used her hands to birth the shoulders, arms, and body (the baby's shoulders had never turned), and she lay a blue flacid baby boy on the mother's abdomen. The search for the bag and mask resumed at a more rushed pace but the seconds passed like hours, I kept pleading to do mouth to mouth and the midwife kept saying no.

Finally a bag was located but it didn't work. I took the mouth piece off, covered the baby's mouth and nose and started to try to resuscitate the little one. (I was so nervous I'm not sure I did anything at all.) In the meantime people began searching for string to tie off the cord, so we could cut it and take the baby to the nursery down the hall (no string in the delivery pack). Finally string was found, the cord was cut, and we rushed down the hall. By the time we got to the nursery the baby was pinking up, the heart rate was good, but there was still no cry. The midwife continued the resuscitation - with a proper bag and mask - until it seemed that the baby was stabilizing in its own rhythm of breaths and heart beats, and that was it. Still no cry and the baby's posture was looking ominous to me. I could feel the tears welling in my eyes and I just wanted to stay there with the baby but the midwives walked me out and told me that there was a good chance that the baby would recover. I came back three hours and brought the mom to see her little one - she still hadn't seen him. When we got to the nursery he was screaming and I helped her try to breastfeed. At this point there is no way to tell if the baby sustained any permanent damage that will result in developmental problems but I certainly pray that he will recover fully. He is a beautiful baby. Monday he was discharged home from the nursery.

The experience really shook me up. Of course these things do happen and they are never pleasant but the lack of resources and time delay just made it so much worse. The midwives in my class were all very reassuring and encouraging, no one saw it to be as traumatic as I did but they understood my reaction, since it was my first time to witness and participate in such an event. That was just one story. There are so many already. All I can say is that it really is a miracle that so many do survive.

The SNL training in and of itself was good, but a lot of it was review since I'm fresh from school. I think the most interesting tidbit I learned is that the janitors who work in labor and delivery are also trained in SNL because they are often the ones who end up delivering the babies. Just think about that. Really?!!

Today all the nurses at the hospital are on strike (a skeleton staff is working to assist with emergencies) so I have the day to sit and email and journal. There are two issues (1) there are no supplies at the hospital, not even gloves to do surgeries (2) DFID - the British governmental agency that does development work - recently approved funds to increase the salaries of nurses and physicians here but the vast majority of those monies has been given to people holding administrative positions (e.g. Ministry of Health). What has been allocated to the nurses and doctors is being taxed so heavily that they really are not seeing much of a raise. Nurses currently earn something like $140/mo. Hopefully there is room to maneuver. At least the President has a reputation of no nonsense and no corruption, we'll see what happens. These issues are so huge and yet so basic, where do you even start?