No Rain

I'm sitting in an office on the grounds of Kamuzu Central Hospital typing this up. I can hear wailing and singing from the mortuary next door and the sky, which should be dark and heavy with the promise of rain is blue blue blue. The first rains should have come late October. I suppose officially they did come, midway through November. People celebrated and began planting but the rains stopped. Now it's mid-December and Lilongwe is sweltering. I'm sure that whatever bits of green pushed through the earth have now dried and withered back to the red dusty crust. People speak only of the absent rains and the heat. Rain is everything. Rain is hope and life.

Yesterday I was assigned to theatre at Bottom. I went in to receive a baby with cord prolapse and came out with two very small but screaming little boys. I returned to the labor ward for a while and ended up next to a woman whose baby's heart rate kept dropping, but when we called theatre to see if an emergency section for fetal distress would be possible, we found that they were in the process of sectioning another woman. That woman's baby had died in-utero because she entered labor with her baby in an impossible position and didn't get to the hospital in time to have a section while the baby was still alive. I was called back to theatre to receive her dead baby and the dead baby of a 24 year-old woman whose uterus had ruptured after spending three unsuccessful days with a traditional birth attendant. I wish all of you, midwives, physicians, watchers of ER, Americans, could just catch a glimpse of the theatre.

The room itself is small and basic. One wall has windows that open to the outside, though which cracks of daylight and fresh air seep in. A simple bed occupies center stage and a small resuscitare without an overhead heater for the baby stands off to the side. There is a machine for monitoring the patient's vital signs and an electrical suction for the woman. A small foot pump suction sits next to the baby's resuscitare besides two oxygen concentrators . There is a cabinet for various syringes and tubes, a sink, a baby scale, and a couple tables holding gloves sutures, sterile packets, and other assorted items. As for the staff, all of us are gowned in theatre attire made from jean material. Everything is reusable - except for the hats and shoe covers which are always in short supply. Often we use plastic aprons tied around our heads and feet - picture everyone with white garbage bags on their heads and feet. Other times old patient gowns (donated, I imagine, by people who logically envisioned these gowns being used by patients) are used by surgeons when they run out of theatre attire. Sterile draps are also made from the jean fabric and many have quite a few holes. The scene strikes me alternately as commical, a bit depressing, or as a great illustration of people's inventive solution to lack of resources, depending on my frame of mind.

Half-way through the surgery yesterday, the shifts changed so a new anestethist came to replace the one who worked during the day. He received a few laughs as he entered the theatre. His creative solution to the absence of theatre hats was to use a carboard box. (Despite the laughs he didn't change his "hat.")

Lwanja, the senior clinical officer on staff conducted the surgery. After the intial cut through her abdomen the baby's hand emerged, confirming a severe rupture, and a stench filled the room confirming necrosis.

Throughout the surgery the theatre nurse just kept saying, "Poor, Malawians, poor, Malawians."

The room soon filled with flies and I wondered momentarily why there are never flies in the hospitals in the US.

Everything went smoothly and everyone agreed that she was lucky. She is 24 years old, she came close to losing her life but she didn't. She lost her uterus and her unborn child but she has a living child.

(When the surgery was done I returned to labor ward and found that the woman with fetal distress had delivered a healthy girl with the help of a vacuum.)

This morning I went to the hosptial to check on the woman who had the surgery and found her resting in the postnatal ward. The postnatal nurse was passing out medications and told me that the patient was all right but that her vital signs had not yet been taken today. I quickly looked over her chart and noted that Lwanja wrote, "check vital signs regularly" but couldn't find even a single set of vital signs since the time of her surgery yesterday. Considering that there is one postnatal nurse for close to a hundred patients, this comes as no surprise. As I was standing near her bed, the nursing matron (i.e. the charge nurse of the hospital) came and told me that someone tested the autoclave machine (the machine that sterilizes all the instruments used in surgery for both Bottom and Kamuzu Central Hospital) and found that it was actually not successfully sterilizing anything. At this point there is only one autoclave so it cannot be put out of commission until fixed. There once was a functioning autoclave at Bottom Hospital but it has not been working for some time for its intended purpose. However, like so many other things, it has gained another use, while it sits waiting for repairs, staff have been using it as a microwave to warm lunches and fries.

All I can say, with a bit of awe and horror, is that life is certainly tenacious.