Wednesday, August 30, 2006
Still Dancing
I checked on the little girl today. She's looking well - no fever, no seizures, physically and developmentally normal on day 7 of life.
Monday, August 28, 2006
Miracles
Thursday was a wonderful day. It didn’t start out wonderful but at 5:30 I felt great. I arrived early at Bottom to meet the usual assortment of urgent cases. Almost all 14 beds were occupied but the voice of one woman rose above everyone. Around 9am the midwife monitoring her decided that the baby was distressed. A caesarian was ordered. At 9:40 I was handed a pale listless little girl. I immediately began resuscitation. Usually the nurse who receives the baby in theatre is the one and only person responsible for that baby, luckily this time there were two medical students and a VOS anesthesiologist whose hands were free. The four of us worked on her . . . suction, bag, mask, chest compressions, drugs, oxygen. I looked at her purple lips and thought the worst but kept going. At 10:20 she cried. She cried weakly at first, then coughed, then cried a bit louder and stronger. I was so happy I could have kissed everyone in the room. Honestly, I don’t remember much about the other patients that day. I just moved from birth to nursery and back. I left her pink and squirming under the warmer that afternoon.
Of course I can’t say that everything will turn out well. There is still a chance she may die this week, and if she survives, she might have cerebral palsy, and even if she is intact physically, she might have severe mental disabilities. There are still so many miracles required to carry her through to adulthood whole, but her first miracle happened while I held her in my hands and that’s enough to make me dance and sing today.
Of course I can’t say that everything will turn out well. There is still a chance she may die this week, and if she survives, she might have cerebral palsy, and even if she is intact physically, she might have severe mental disabilities. There are still so many miracles required to carry her through to adulthood whole, but her first miracle happened while I held her in my hands and that’s enough to make me dance and sing today.
Joy
Wednesday Mr Nanthowa (aka Ireen’s dad) showed up at Bottom on a borrowed bicycle with a bag of peas and sweet potatoes from his garden. I realized that seeing him there meant he had rented a bicycle from a neighbor and then cycled 40 kilometers to deliver that bag of home grown goods to me at Bottom and put them in the trunk of my shiny car. Straight away I decided that Friday I would visit and bring a new bike. I thanked him and told him I would visit. Friday morning after a couple baby visits I went to a shop and bought a shiny new black bike for $60 (thanks to Jeff). A worker there helped me fix it with lots of green rope, so that the trunk almost closed and the handle bars just peeked out. I did fine for the first 20km but at the first bump - as I moved from paved to unpaved road - everything came loose. I retied it myself but even with my knotting skills from rock-climbing days, the trunk bounced each time I hit a good bump. Multiple times along the way I considered just leaving the bike somewhere (the clinic, the police station, etc.) and bringing him to collect it, but each time I scolded myself for the thought and continued bumping slowly along.
As I pulled up between the huts, Mrs Nanthowa emerged with a chitinge wrapped around her, fresh from bathing. She said a million things to me in Chichewa, which I didn’t understand, through smiles and laughter and led me to a mat indoors to wait while she dressed. Mr Nanthowa soon appeared, sat on the mat, and shook my hand. He told me I should park my car in the shade. I asked him if he noticed what I brought for him. Instantly his eyes widened, an enormous smile spread across his face, and he took my hand. I was laughing and he was saying, “Congratulations! Congratulations!”
We unloaded the bike and moved it inside where he began the assembly. As family members came by he proudly showed them the bike and in response they clicked their tongues and shook my hand. I told him about my friend giving the money and he gave me his address, enchanted by the thought of sharing his happiness and gratitude with this kind stranger.
Of course before I left, we ate nsima. I told them that my parents would be coming (they’re coming to Malawi in October!) and Mr. Nanthowa said I had to bring them there. He said, “You’re roots are here. Your parents can stay 2 or 3 days. You can come and go but your parents should stay and we’ll kill a goat. And that’s a promise.” I love the idea of my parents in the village sharing nsima with Mr and Mrs Nanthowa, and the entire village present for a goat roast, but I can’t quite imagine them sleeping on the grass mats. Maybe a morning will suffice.
As I pulled up between the huts, Mrs Nanthowa emerged with a chitinge wrapped around her, fresh from bathing. She said a million things to me in Chichewa, which I didn’t understand, through smiles and laughter and led me to a mat indoors to wait while she dressed. Mr Nanthowa soon appeared, sat on the mat, and shook my hand. He told me I should park my car in the shade. I asked him if he noticed what I brought for him. Instantly his eyes widened, an enormous smile spread across his face, and he took my hand. I was laughing and he was saying, “Congratulations! Congratulations!”
We unloaded the bike and moved it inside where he began the assembly. As family members came by he proudly showed them the bike and in response they clicked their tongues and shook my hand. I told him about my friend giving the money and he gave me his address, enchanted by the thought of sharing his happiness and gratitude with this kind stranger.
Of course before I left, we ate nsima. I told them that my parents would be coming (they’re coming to Malawi in October!) and Mr. Nanthowa said I had to bring them there. He said, “You’re roots are here. Your parents can stay 2 or 3 days. You can come and go but your parents should stay and we’ll kill a goat. And that’s a promise.” I love the idea of my parents in the village sharing nsima with Mr and Mrs Nanthowa, and the entire village present for a goat roast, but I can’t quite imagine them sleeping on the grass mats. Maybe a morning will suffice.
Neighbors
Until last month Masauko worked at the US Embassy as a guard. His company paid him 1250MK a week for 72 hours of work. I never met him until the day he approached me and told me he wanted to go back to school. He said he realized that a better future did not exist for him as a guard. He is 25, married, with two children. He is the oldest of 8. Both parents died and left him responsible for the well being of his younger siblings. On 5,000MK a month he was barely surviving and decided that he should get his MSCE (the equivalent of a high school diploma). He told me about his hopes, about his family, about walking to work in the dark to arrive by 6am and walking home in the dark after 6pm. He told me about meeting hyenas on those walks.
He found a school and I agreed to sponsor him. A couple weeks later he invited me to his home. That day we arrived at an adobe structure no bigger than 8 by 10ft, divided into two small rooms that share one broken window. He lives together with his wife, their children, and her brother. I could see spots of sky through the roof. He said he moved into this bigger home from the smaller one that stood beside it. He said the window was broken by a thief in the night. He showed me his notebooks - line after line of notes copied in his neat crisp handwriting. He showed me the cracks in the soles of his shoes. He apologized for not offering me something saying they had nothing to eat themselves all day. I looked from him to his neighbor, an old woman who now occupied the “old” house. I asked him why he approached me. With a laugh he told me that he heard I helped orphans and thought since he was an orphan, I might help him too.
I thought, “What else can I do?” I desperately refuse to accept the status quo of a world that says this is okay and turns away. So I’ll dig in, one little bite at a time. Then someone needs to help his neighbor, and her family, and their neighbors too.
He found a school and I agreed to sponsor him. A couple weeks later he invited me to his home. That day we arrived at an adobe structure no bigger than 8 by 10ft, divided into two small rooms that share one broken window. He lives together with his wife, their children, and her brother. I could see spots of sky through the roof. He said he moved into this bigger home from the smaller one that stood beside it. He said the window was broken by a thief in the night. He showed me his notebooks - line after line of notes copied in his neat crisp handwriting. He showed me the cracks in the soles of his shoes. He apologized for not offering me something saying they had nothing to eat themselves all day. I looked from him to his neighbor, an old woman who now occupied the “old” house. I asked him why he approached me. With a laugh he told me that he heard I helped orphans and thought since he was an orphan, I might help him too.
I thought, “What else can I do?” I desperately refuse to accept the status quo of a world that says this is okay and turns away. So I’ll dig in, one little bite at a time. Then someone needs to help his neighbor, and her family, and their neighbors too.
Monday, August 21, 2006
Biodiversity, then and now
In response to my post about the visit to Stacia and Kristof's farm, I received the question, “What happened in Malawi to get people cut off from their native plants?” Here is Stacia's response:
There have been many events that have eroded indigenous knowledge, and Malawi is not the only culture that has faced this challenge. The world has narrowed its diet considerably in the past 80 or so years since we have been taken over by conventional agriculture, mass-processing, mass-distribution, extensive advertising, increased commercialism, changes in the work force, lifestyles, and other cultural changes.
For Malawi, the main events seems to be colonialism encouraging the growing and use of foods known to the colonialists and the dictator Dr. Banda continuing on the same track. Reports are that more than 'encouragement' took place when it came to maize; people were forced to change to maize and there were dire consequences if they didn't follow orders. The colonial-based schools introduced a curriculum based on western methods of growing food which replaced the traditional education of learning local plants and animals. For more than 100 years, everything "local" was looked down upon as something for "poor" and "backward" people. The mentality was widespread in every sector (such as health, education, agriculture, economics, etc.). Even today, government programmes focus their work on western ideas and methods - although it is now changing as people are realizing the agricultural and nutritional benefits of the local plants. They are easier to grow, they take little input and effort, they withstand local insects and weather patterns, and they generally are more nutrient-dense foods.
There have been many events that have eroded indigenous knowledge, and Malawi is not the only culture that has faced this challenge. The world has narrowed its diet considerably in the past 80 or so years since we have been taken over by conventional agriculture, mass-processing, mass-distribution, extensive advertising, increased commercialism, changes in the work force, lifestyles, and other cultural changes.
For Malawi, the main events seems to be colonialism encouraging the growing and use of foods known to the colonialists and the dictator Dr. Banda continuing on the same track. Reports are that more than 'encouragement' took place when it came to maize; people were forced to change to maize and there were dire consequences if they didn't follow orders. The colonial-based schools introduced a curriculum based on western methods of growing food which replaced the traditional education of learning local plants and animals. For more than 100 years, everything "local" was looked down upon as something for "poor" and "backward" people. The mentality was widespread in every sector (such as health, education, agriculture, economics, etc.). Even today, government programmes focus their work on western ideas and methods - although it is now changing as people are realizing the agricultural and nutritional benefits of the local plants. They are easier to grow, they take little input and effort, they withstand local insects and weather patterns, and they generally are more nutrient-dense foods.
Goodbyes
One week after Deb and Zack left, Clement and I tearfully escorted Dana and MacPharlen to the airport. Dana and Mac have been wonderful friends to the two of us pretty much since I arrived in the country. Dana completed two tours with Peace Corps here and in the meantime met MacPharlen. They married two years ago and as she boarded the plane to return "home" she was weeks away from completing her seventh year in Malawi.
Most recently Dana worked for Jesuit Refugee Services as the education coordinator on the refugee camp in Dowa. There are two small camps in Malawi mostly housing Rwandans, Burundians, and Congolese. Dowa is the larger of the camps, inhabited by close to 4,000 refugees. In addition to overseeing the schools on the camp, Dana and her Malawian counterpart began an anti-human trafficking campaign as well as a campaign to register all unaccompanied minors.
Human trafficking is an enormous global problem and unsurprisingly most of those trafficked are children and uneducated women from low-income countries, who are either sold by their own families or persuaded by lies of a better life. The networks are incredibly, someone can disappear from Malawi today and then arrive in a brothel in Europe months later. Most people in the developing world never receive a birth certificate, or only receive them with an explicit request and a lot of footwork. To be a bit dramatic this means there is essentially no record of the existence millions of people. The lack of a central registry in turn makes it more difficult to advocate for and rescue trafficked people. Although clearly passionate about her students and teachers, Dana found her calling in the anti-trafficking work. Last fall she applied to schools, this month she will begin a social work program at Case Western and hopes to also get her law degree there.
MacPharlen is an electrical engineer; very warm and hardworking. Escom is the only power company in Malawi and for the past seven years Mac has essentially been responsible for the section of the company serving the entire central region of Malawi. Up until last month he had never traveled outside the country and although he was excited by the possibility of continuing his education he always seemed a bit nervous when I asked him how he felt about leaving. In truth he was leaving his life. Dana frequently joked that it was his turn to learn about her culture although I imagined she was almost as nervous to see the evolution of "her culture" since her last trip home.
Over the past year and a half Dana and I spent countless hours talking about home; feeding each other bits of our histories, frantically trying to catch up on everything that transpired in all the years we were strangers. Of course we also spent hours talking about our relationships, the good and the frustrating, and laughing frequently. I know Clement and Mac also appreciated the links between the four of us. Truly over our short time together our relationship became like family.
On August third I felt excited but anxious for the two of them, entering and re-entering an unknown world; leaving all the connections of home. As I watched their tiny figures wave and board the plane through my tears I realized all my sadness came from their departure and concern for them and none from being left. For now, Malawi is home.
Most recently Dana worked for Jesuit Refugee Services as the education coordinator on the refugee camp in Dowa. There are two small camps in Malawi mostly housing Rwandans, Burundians, and Congolese. Dowa is the larger of the camps, inhabited by close to 4,000 refugees. In addition to overseeing the schools on the camp, Dana and her Malawian counterpart began an anti-human trafficking campaign as well as a campaign to register all unaccompanied minors.
Human trafficking is an enormous global problem and unsurprisingly most of those trafficked are children and uneducated women from low-income countries, who are either sold by their own families or persuaded by lies of a better life. The networks are incredibly, someone can disappear from Malawi today and then arrive in a brothel in Europe months later. Most people in the developing world never receive a birth certificate, or only receive them with an explicit request and a lot of footwork. To be a bit dramatic this means there is essentially no record of the existence millions of people. The lack of a central registry in turn makes it more difficult to advocate for and rescue trafficked people. Although clearly passionate about her students and teachers, Dana found her calling in the anti-trafficking work. Last fall she applied to schools, this month she will begin a social work program at Case Western and hopes to also get her law degree there.
MacPharlen is an electrical engineer; very warm and hardworking. Escom is the only power company in Malawi and for the past seven years Mac has essentially been responsible for the section of the company serving the entire central region of Malawi. Up until last month he had never traveled outside the country and although he was excited by the possibility of continuing his education he always seemed a bit nervous when I asked him how he felt about leaving. In truth he was leaving his life. Dana frequently joked that it was his turn to learn about her culture although I imagined she was almost as nervous to see the evolution of "her culture" since her last trip home.
Over the past year and a half Dana and I spent countless hours talking about home; feeding each other bits of our histories, frantically trying to catch up on everything that transpired in all the years we were strangers. Of course we also spent hours talking about our relationships, the good and the frustrating, and laughing frequently. I know Clement and Mac also appreciated the links between the four of us. Truly over our short time together our relationship became like family.
On August third I felt excited but anxious for the two of them, entering and re-entering an unknown world; leaving all the connections of home. As I watched their tiny figures wave and board the plane through my tears I realized all my sadness came from their departure and concern for them and none from being left. For now, Malawi is home.
Tuesday, August 08, 2006
A Busy Day
My beloved friends Deb and Zack left Malawi for the States on July 27th. Deb is a fourth year medical student at the University of Pittsburgh. She took a year off school to accompany her husband to Malawi. Zack works for Baobab, a small NGO that is setting up computers in the wards at Kamuzu Central Hospital (really incredibly stuff). During her year in Malawi Deb has been my partner in the labor ward and very good friend. She is seven months pregnant and I'm ashamed to say I gave her pretty shoddy prenatal care; I will definitely miss seeing the birth and the introduction of her little one to this world. Before she left, Deb and I has a nice lazy couple of days at Nkwazi lodge - a little place on the lake about 5 hours North of Lilongwe - and we also went to see Ireen again so that they could say goodbye.
I still have not learned my lesson about timing here. Saturday morning we arrived in the village at 11:30 (an hour drive from Lilongwe) and I was supposed to meet Frank and his group at 1pm. Ireen and her parents were at church so we waiting for someone to let them know we were there. Deb had brought photos from a previous visit, including pictures of Alinafe, and those excitedly flowed through fingers as we waited. Finally Ireen and her father appeared; Ireen laughing hysterically at our visit and then crying hysterically at the sight of her lost little girl in the photos. Her father kindly took the pictures from her hands and said, "It happens."
By that time we should have already been making our way back to Lilongwe but Ireen's dad convinced us that we needed to collect her mother from the church and then the mother insisted that we eat nsima. Finally, well after 1pm, we said our goodbyes and let them load the car with pumpkins, popcorn, and two chickens. I promised Ireen's dad that I would bring him a book on HIV (by his request) and a bicycle - since his was beyond repair and had provided the sole means to transport his produce from the garden to the market.
Around 3pm I met Frank and three women from his group who were still waiting for me. I loaded them in the car and we left to see Stacia and Kristof's farm, a short distance outside Lilongwe. Stacia and Kristof came to Malawi as Peace Corps volunteers but have now been here for over a decade. Stacia is a nutritionist and Kristof is an agriculturalist and they both speak fluent Chichewa. On their table Stacia had arranged an elaborate display of dried produce and grains grown in Malawi. She gave a nutrition talk to our small group of five emphasizing dietary diversity and then Kristof led us on a tour of their garden talking to the women about permiculture and crop diversity. The afternoon was rounded off by tea and popcorn made from their produce and a show and tell of a low cost fuel-efficient stove and "charcoal" made from recycled paper. The women accepted a variety of seeds, took notes, and were eager to buy several of the stoves (they are sold in another town outside Lilongwe and we have not yet purchased them). Driving back with their buzz of conversation felt great; although I could not understand much, I certainly sensed the enthusiasm and also felt excited about the possibilities.
I dropped off Frank, the three women, and two chickens just before 6pm; Memory had been waiting for me at the Nature Sanctuary since 5pm. Memory is 16, she is a bright girl with big ambitions. She is an orphan. I am paying her school fees and told her that if she did well on her exams, I would take her to dinner. The Nature Sanctuary is a park that includes a small area of caged animals (hyena, python, baboons, crocs), a large area with the same animals roaming free (you don't often see them but can hear the hyenas at night), and a restaurant with reasonably priced Malawian food that is open in the evenings (a rarity here). It was a sweet evening; I could see that she enjoyed it, even after waiting for me for an hour in the cold. I drove her home, met a few of her cousins, then drove myself home to a hot shower and bed.
I still have not learned my lesson about timing here. Saturday morning we arrived in the village at 11:30 (an hour drive from Lilongwe) and I was supposed to meet Frank and his group at 1pm. Ireen and her parents were at church so we waiting for someone to let them know we were there. Deb had brought photos from a previous visit, including pictures of Alinafe, and those excitedly flowed through fingers as we waited. Finally Ireen and her father appeared; Ireen laughing hysterically at our visit and then crying hysterically at the sight of her lost little girl in the photos. Her father kindly took the pictures from her hands and said, "It happens."
By that time we should have already been making our way back to Lilongwe but Ireen's dad convinced us that we needed to collect her mother from the church and then the mother insisted that we eat nsima. Finally, well after 1pm, we said our goodbyes and let them load the car with pumpkins, popcorn, and two chickens. I promised Ireen's dad that I would bring him a book on HIV (by his request) and a bicycle - since his was beyond repair and had provided the sole means to transport his produce from the garden to the market.
Around 3pm I met Frank and three women from his group who were still waiting for me. I loaded them in the car and we left to see Stacia and Kristof's farm, a short distance outside Lilongwe. Stacia and Kristof came to Malawi as Peace Corps volunteers but have now been here for over a decade. Stacia is a nutritionist and Kristof is an agriculturalist and they both speak fluent Chichewa. On their table Stacia had arranged an elaborate display of dried produce and grains grown in Malawi. She gave a nutrition talk to our small group of five emphasizing dietary diversity and then Kristof led us on a tour of their garden talking to the women about permiculture and crop diversity. The afternoon was rounded off by tea and popcorn made from their produce and a show and tell of a low cost fuel-efficient stove and "charcoal" made from recycled paper. The women accepted a variety of seeds, took notes, and were eager to buy several of the stoves (they are sold in another town outside Lilongwe and we have not yet purchased them). Driving back with their buzz of conversation felt great; although I could not understand much, I certainly sensed the enthusiasm and also felt excited about the possibilities.
I dropped off Frank, the three women, and two chickens just before 6pm; Memory had been waiting for me at the Nature Sanctuary since 5pm. Memory is 16, she is a bright girl with big ambitions. She is an orphan. I am paying her school fees and told her that if she did well on her exams, I would take her to dinner. The Nature Sanctuary is a park that includes a small area of caged animals (hyena, python, baboons, crocs), a large area with the same animals roaming free (you don't often see them but can hear the hyenas at night), and a restaurant with reasonably priced Malawian food that is open in the evenings (a rarity here). It was a sweet evening; I could see that she enjoyed it, even after waiting for me for an hour in the cold. I drove her home, met a few of her cousins, then drove myself home to a hot shower and bed.
Monday, August 07, 2006
Amazing Energy
Sister Namaleu told me months ago about her oldest daughter's pregnancy. Chimwemwe, the first of six girls, was pregnant with the first grandchild who everyone hoped would be a boy. Namaleu asked me to attend Chimwemwe during the birth and I was excited about the prospect.
According to a hazy memory of her last period, her due date was set sometime in June, but June came and went, early July came and went, and still the baby gave no signs that it was ready to see the world. I met Chimwemwe for the first time on July 16 and by a conservative estimate she was well into the 42nd week of the pregnancy (as the pregnancy continues past 42 weeks there is a sharp increase in the risk of stillbirth as the placenta begins to deteriorate). The following day I scanned her at Bottom and could see that the baby was active and had plenty of fluid; her cervix was soft but closed - a sign that labor was still a couple days off. We decided to meet early in the following week for another scan and possibly an induction.
On the 19th I had planned a three day trip to the lake with my friend Deb who would be leaving Malawi permanently on the 27th. I very much wanted to be present for Chimwemwe's birth but both Chim and her mom knew that I would be away for a couple days. Chimwemwe seemed confident that the baby was well and would wait for my return.
Sunday Chimwemwe had mild contractions and neither she nor her mother slept but Monday the contractions stopped. Monday night and Tuesday the pattern repeated. Tuesday night at 1:30am sister Namaleu called and said they were ready to go to the hospital. Pulling myself from my warm cozy sleep, I momentarily doubted my calling as a midwife, and only with great effort escaped the magnetism of my bed. I expected that Chimwemwe was still in early labor and wanted to talk to her or examine her before we left for the hospital, but when I reached their house she and her mother were already standing out in the cold night bundled in chitengies, bags ready at their feet. I realized later that when six girls share a bedroom and when the laboring women shares a twin bed with her younger sister, the hospital is a better option than home, even in early labor. (If I hadn't had a friend sleeping in my guest room I would have brought them to my place.)
When we arrived at the Kamuzu Central Hospital the nurse agreed that Chimwemwe's labor had just begun and sent her to a room to rest if possible and to wait indefinitely. Namaleu and Chimwemwe sent me home to sleep - an invitation I happily accepted. I returned a few hours later with porridge and bread; her cervix was 4cm dilated. Chimwemwe ate a couple cups of porridge, then her mom suggested a "jolly walk." I accompanied her to the end of the outside corridor and then was shocked when she asked me to wait a minute as she ran up and down the flight of stairs three times.
The labor progressed fairly slowly throughout the day. I watched over Chimwemwe and the baby as she visited with sisters and relatives and ate and ate. I had never before seen a woman eat like her during labor. She would only stop chewing during the contractions and then resume - gesturing to hand over her food - as soon as they passed . . . oranges, samosas, bread, rice and beef, nsima and eggs, sausage and greens, juice, water, tea. I told her she would definitely have the strength to push when that moment came.
Finally, around 5pm we moved into the labor ward. Around 7 she seemed to be stuck at 8 centimeters and the baby remained high. Her contractions never came more frequently than once every five minutes. We tried walking, squatting, standing, rocking, but her contractions did not pick up and the baby, although doing well, stopped moving down. I suggested that maybe we give her a little pitocin (a synthetic version of oxytocin - the hormone which drives the pattern and strength of contractions) but she wanted to wait. Seeing the concern on my face she told me in a calm confident tone, "Don't worry, Joanne, I'm still strong." At 8 we started the pitocin, within minutes her cervix was fully dilated, and 20 minutes later I was lifting the baby on to her belly (all that food sure helped). At that exact moment her phone rang and she shouted into it, "IT'S A BOY!!" Chimwemwe was beaming and doing a little dance in the bed; I was laughing and smiled until my cheeks hurt. No more doubts about midwifery. I LOVE this job! I'd do it for bread and water.
A few days later Chimwemwe and her family asked me to give the baby a name. The father had given the first name and I gave the second. He is now forever Precious Yankho. (Yankho means answer, as he was an answer to many prayers.)
According to a hazy memory of her last period, her due date was set sometime in June, but June came and went, early July came and went, and still the baby gave no signs that it was ready to see the world. I met Chimwemwe for the first time on July 16 and by a conservative estimate she was well into the 42nd week of the pregnancy (as the pregnancy continues past 42 weeks there is a sharp increase in the risk of stillbirth as the placenta begins to deteriorate). The following day I scanned her at Bottom and could see that the baby was active and had plenty of fluid; her cervix was soft but closed - a sign that labor was still a couple days off. We decided to meet early in the following week for another scan and possibly an induction.
On the 19th I had planned a three day trip to the lake with my friend Deb who would be leaving Malawi permanently on the 27th. I very much wanted to be present for Chimwemwe's birth but both Chim and her mom knew that I would be away for a couple days. Chimwemwe seemed confident that the baby was well and would wait for my return.
Sunday Chimwemwe had mild contractions and neither she nor her mother slept but Monday the contractions stopped. Monday night and Tuesday the pattern repeated. Tuesday night at 1:30am sister Namaleu called and said they were ready to go to the hospital. Pulling myself from my warm cozy sleep, I momentarily doubted my calling as a midwife, and only with great effort escaped the magnetism of my bed. I expected that Chimwemwe was still in early labor and wanted to talk to her or examine her before we left for the hospital, but when I reached their house she and her mother were already standing out in the cold night bundled in chitengies, bags ready at their feet. I realized later that when six girls share a bedroom and when the laboring women shares a twin bed with her younger sister, the hospital is a better option than home, even in early labor. (If I hadn't had a friend sleeping in my guest room I would have brought them to my place.)
When we arrived at the Kamuzu Central Hospital the nurse agreed that Chimwemwe's labor had just begun and sent her to a room to rest if possible and to wait indefinitely. Namaleu and Chimwemwe sent me home to sleep - an invitation I happily accepted. I returned a few hours later with porridge and bread; her cervix was 4cm dilated. Chimwemwe ate a couple cups of porridge, then her mom suggested a "jolly walk." I accompanied her to the end of the outside corridor and then was shocked when she asked me to wait a minute as she ran up and down the flight of stairs three times.
The labor progressed fairly slowly throughout the day. I watched over Chimwemwe and the baby as she visited with sisters and relatives and ate and ate. I had never before seen a woman eat like her during labor. She would only stop chewing during the contractions and then resume - gesturing to hand over her food - as soon as they passed . . . oranges, samosas, bread, rice and beef, nsima and eggs, sausage and greens, juice, water, tea. I told her she would definitely have the strength to push when that moment came.
Finally, around 5pm we moved into the labor ward. Around 7 she seemed to be stuck at 8 centimeters and the baby remained high. Her contractions never came more frequently than once every five minutes. We tried walking, squatting, standing, rocking, but her contractions did not pick up and the baby, although doing well, stopped moving down. I suggested that maybe we give her a little pitocin (a synthetic version of oxytocin - the hormone which drives the pattern and strength of contractions) but she wanted to wait. Seeing the concern on my face she told me in a calm confident tone, "Don't worry, Joanne, I'm still strong." At 8 we started the pitocin, within minutes her cervix was fully dilated, and 20 minutes later I was lifting the baby on to her belly (all that food sure helped). At that exact moment her phone rang and she shouted into it, "IT'S A BOY!!" Chimwemwe was beaming and doing a little dance in the bed; I was laughing and smiled until my cheeks hurt. No more doubts about midwifery. I LOVE this job! I'd do it for bread and water.
A few days later Chimwemwe and her family asked me to give the baby a name. The father had given the first name and I gave the second. He is now forever Precious Yankho. (Yankho means answer, as he was an answer to many prayers.)
Bursting
I was a bit horrified to see that my last entry was posted over a month ago. I'm sorry to all of you who have been following my entries and waiting for the next batch - I'm overdue. There was no pause in my life here, so I am now bursting with a month of untold stories. Let me just give you the headlines and then I'll come back with details. In the past month, I attended the delivery of a friend's first grandchild, spent three days at the lake, drove four of my closest friends to the airport and watched tearfully as they permanently departed Malawi, had US$3,800 in traveler's checks stolen from my home and cashed, got Bilharzia (a parasite that lives in the lake), visited Frank's group (now called Grace Charity Orphan Foundation) several times - and helped them start a gardening project, and bid a temporary farewell to Clement (my boyfriend) who finished his program of clinical medicine and has moved back to Zomba for the time being. I feel tired. Luckily I'm house-sitting for friends who have a wonderful cat, a comfy couch and plenty of movies - what more do you need for good R&R? hmm . . . maybe chocolate.
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