Dante's Inspiration

Tuesday night I went in for my third night shift. Honestly, I was really dreading those 16 hours and the potential unknown horrors they might contain. My previous night shift was so overwhelming that it took me really at least a week to recover. That night there was a point when I just looked around and thought to myself, this is my personal hell and there is no escape. (Mainly because so many women were crying, really crying, in pain and calling out - looking at me pleadingly - but there was no physical way to attend them because of other events going on.) Anyhow, Tuesday night began gently. As I walked through the gates of Bottom all the guardians sat in clusters on the grounds as usual, despite the quickly descending night and dropping temperatures, but unlike usual, one elderly woman danced among them, leading a call and response song. It was a nice beginning. I walked slowly to the labor ward entrance, soaking in the beauty of their voices and finally, reluctantly, closed the door behind me shutting out the singing and steeling myself for the vision around the corner.

Thankfully the ward was fairly quiet and I was happy to see one of my favorite midwives already at work - she is a hard worker who smiles and jokes as she goes, she has taught me a lot, and most importantly, she doesn't yell at the women in labor. There were only four women in the ward, only one needing emergent attention. This woman, pregnant with twins, arrived seconds before I did with her mother, who said she had seized at home. As we started her IV she seized again but she regained consciousness and the babies' hearts sounded good. It was decided that she would have a c-section once her blood pressure stabilized.

And so the night began, most of the time there were only four to six women in the ward and luckily they each took turns with their needs and the timing of their births. There was time to chat and share nsima, time to sit, and enough of us to comfort those calling "A-NURSE-YYYY." Around 3am I went to a c-section to receive the baby and when I returned to the ward, saw that the women with twins had delivered. The twins needed a little resuscitation and did well, but unfortunately the mother was hemorrhaging. The clinical officers went to assist the midwives attending to her, but within just a few minutes two other women began seizing, each pulling away one midwife, and then another woman began crowning, so I went to attend her delivery.

The baby that I caught was pale and floppy. I dried her, cut her cord, and I took her to the resuscitare and began the resuscitation. After about 10 minutes she was breathing and had a heart rate around 100 beats per minute (the minimum that it should be) but she was still pale and floppy. Just then her mother let out another guttural holler, "BWERANI-I-I-I" (come!) and I turned to see the body of a second baby, still encased in its bag-of-waters, emerging bottom first. I left the first twin and delivered the second twin, who looked to be in even worse shape than her sister. When I ruptured the bag a pool of dark and foul smelling fluid formed on the bed, a bad sign meaning that infection was highly likely. I began resuscitating the second little girl but after 20 minutes without any spontaneous respirations, I wrapped her, showed her to her mother, and returned to the first twin who was still struggling.

While I was doing this, yet another woman delivered and the mother of the first set of twins continued bleeding. Finally the hemorrhaging woman was taken to the theatre for a hysterectomy. After that wave passed, another midwife came and attended to the woman whose babies I was trying to help. She dealt with the placenta and gave her medicine to prevent further bleeding while I carried the baby to the nursery. I stayed with the baby for some time. She never improved but just continued hovering in that place between life and death. After a while I left her in the hands of the nursery nurse and returned to the labor ward to find that her mother had also hemorrhaged without anyone noticing. Actually, when I returned the midwife I like so much saw the edge of an ominous puddle peaking out from under her chitengi and said, "Joanne, let's go see your patient and make a diagnosis." We were able to stop her bleeding and she was alright. At that point it was 8:30am, the end of the shift.

Not every day or every birth is a horror story but there are so many. There are so many women and babies who somehow fall through the cracks. Whether prenatally, in the labor ward, or in the days that follow. The shifts are exhausting but they are only really painful when all your efforts are not enough, not even close.

I guess, looking on the bright side, in this kind of environment there is no where to go but up. The potential for positive transformation is boundless and it will be great to be a part of that change. I'm holding onto that thought.

This morning at Bottom I went to the nursery to check on my little girl and found that she had died sometime yesterday. I was also told that the first woman who hemorrhaged continued bleeding after her hysterectomy and was finally transferred to the Intensive Care Unit at Central Hospital. I just now stopped by to visit. She was conscious and her nurses said she is doing well, and so are her babies.