Sweet and Sorrowful

Not many expatriates delivery in Malawi. Endemic horror stories convince most that they must escape the hospitals Malawians cannot choose to escape. Of course I intimately know many problems that plague the health care system here, but somehow I still find the alacrity of flight disturbing. I am not saying I would not leave myself if I felt the care I required was more readily available outside. I am saying it disturbs me. It seems that individual decisions to leave reveal our shallow roots. We say, "I like you but I cannot REALLY trust you." "I will work with you but I will always keep my 'get outta jail, free' card in my back pocket." The subtle message being, "we can work at becoming equals but we are not equal." A constant reminder that we are in this world but not of it. Dominique and Patricio, unlike most, decided they would stay and have their baby at Kamuzu Central Hospital.

Tarek introduced us in January. Dominque's due date was the end of March. I was thrilled with the idea of accompanying a couple through the process of pregnancy to birth and beyond, and I instantly fell in love with Dominque's calm certainty as well as with Patricio's energy and adoration for his growing family.

May 9, I met them at the hospital to give them a tour of the labor ward, several weeks before the expected arrival. But Tarek had scanned her just moments before and said the baby was not growing well, he said there was little amniotic fluid and it needed to come out soon. Tarek decided to recheck in two days.

May 11th, the story was the same. Dominique hoped for a vaginal birth and wanted to try an induction, so we began. Inductions are slow. I gave her the first dose of medication to ripen her cervix and we waited. I listened to the baby's heart. And we waited. Two hours later Tarek agreed that we could continue at my house (which is a 5 minute drive from the hospital) and so we packed up and headed there. I cooked and listened and we waited.

After four hours I gave her the second dose. Dominque said she felt well and I listened, but the baby was changing. As the silence between each beat spread, I could feel my heart filling the time with it's own accelerating rhythm. I called Tarek and we quickly agreed that the induction had failed and it was time to move to a caesarian.

Within 30 minutes Dominique was on the operating table, Mr Banda (the Malawian anesthetist) was placing her spinal, Lisa (the Australian pediatrician) was helping me assemble the resuscitation equipment, and Tarek and the scrub nurses were ready to begin. Poor Patricio was left alone in the empty hall looking incredibly anxious, sitting on the single available chair.

Within two minutes of the first incision, a little girl was wiggling in my hands. It took her a minute to pink up - Lisa and I held our breaths in subconscious solidarity - and then she did, and she was beautiful. Mr Banda was the first to give Patricio the good news. I came out a minute later to get the chitengi from Patricio and was surprised to find him talking with Clement (all the Malawian women bring a new colorful chitengi to wrap their little ones in and Dominique had done the same much to the enjoyment of the Malawian nurses). Apparently Clement called me but when I didn't answer he suspected something was happening and headed to the labor ward where he was told that we were in theatre. Patricio said he appeared like an angel, "just when I was ready to kill myself he walked through the door and took away the knife."

It was the most beautiful caesarian ever; one of the most beautiful births. After Dominique was wheeled out of the theatre, everyone who participated stood around together and took pictures as a group. There was a moment when Patricio held his baby girl looking at her with such amazing love, and Tarek and Clement were also gazing over his shoulders adoringly. That was definitely my favorite part, three men completely awestruck by a tiny little girl (2.5kg).

Dominique and Patricio stayed in the hospital Thursday and Friday and then Saturday Tarek said it would be alright if they continued their convalescence at my home. Every morning felt like Christmas - the feeling that an incredible vision was waiting; every morning waking up to see the beautiful baby. Every evening coming home felt like peace. Tuesday Tarek said they could go home and they did. Before they left, after several nameless days, they gave her a name, Lua Joanne Alvarez.

Saturday night, the night new life entered my home, I got a call, someone speaking Chichewa I could not understand. It was the same number I had seen a few time in the previous nights but I always thought it was a wrong number so I just hung up. This time I asked Clement to talk. He said it was the headman from Mbizi saying the baby died. I didn't sleep well, wondering if it was really true, realizing someone had been calling me for help and I had hung up. In the morning Ireen's father called and said her baby had indeed died, he said she didn't have enough milk to give her baby. I told him I would come. He said they would wait for me to bury the body.

I called Deb and of course she wanted to come so we headed out to the village together. When we arrived, women encircled the house and Ireen's father met our car with red eyes and tear stained cheeks. He led us to the house and the women made way for us. Inside little Alinafe was laid out on a grass mat covered by chitengies, which were pulled down for us to see her face. Ireen sat next to her on the floor ceaselessly rocking back and forth and ceaselessly crying, "Mwana anga Mwana anga" (My baby My baby). The women echoed her with their wails. Deb and I cried.

Ireen's father told us that the baby had been "crying too much in the night" and Ireen felt she didn't have enough milk. She had even told me that when I saw her last, but I saw milk in the baby's mouth as she nursed and so I just encouraged Ireen to eat well, drink much, and breastfeed often. She knew. I didn't. They had taken Alinafe to the clinic on Thursday and she died Friday.

After a short while the women placed the body in a small cloth lined box and carried it away from the circle of homes. The men walked with us until we reached the field at that point Ireen's father said he had to stay because the men couldn't go on but that we should continue with the women. Deb and I followed the procession, the last two in the line.

We followed the barefoot women through the fallow fields. I wished I was also barefoot so that the earth could absorb some of my sorrow; so that I too could feel its firmness under me and feel reassured. We walked through fields towards a conspicuous group of trees and as we walked I gathered a small handle of the purple and orange flowers that sprouted up between the drying stalks of maize.

When we entered the circle of trees, the women stopped around a small freshly dug hole. A couple women took turns digging the earth until the size and shape of the hole met their satisfaction, while others wailed. Then Deb helped them lower the small casket into the ground. Once the casket was positioned, the women climbed out, and three or four at a time, they took turns with the hoes to push the dirt back again. As they dug I tossed the flowers down, but someone recovered them and shook them free of dirt. In the end a little mound stood where the hole had been, the woman handed me the flowers, made a small pit at the head of the mound with her hand, and gestured for me to put them there. I did.

We followed the women back out to the houses again. Ireen and her parents told us we must continue to visit even though we had buried our baby. We exchanged greetings with the village headman. We promised to return and then we left.