Back to Birth

When we returned from the States we found new neighbors living in the room next door, a physician and her two daughters. About a month ago they found a house and moved out but yesterday they came by for a visit. Dr. Annie Opoku is from Madagascar but attended medical school in the Ukraine, there she met and married her Ghanaian husband and she has been living here in Ghana now for more than 20 years. Yesterday I learned that she is the medical superintendent of the Maternal and Child Health public hospital here in Kumasi. When she asked what I am doing and I told her that I am still waiting, she offered that I come and volunteer at the hospital a couple days each week. She said she does not mind if I am not officially registered and I will find plenty to do, though no pay. I am so excited. I thought it would be mid-2009 before I again assisted a mother bring her baby into the world. I will go for the first time tomorrow.

Her description of the hospital began with a litany of problems: the high nurse to patient ratio, the high rate of HIV (6.9%), and general lack of resources, etc. Unsurprisingly, Ghana and Malawi seem to share the same set of problems though health indicators speak to some difference in severity. From the way she was talking it seems this hospital is quite small, they only conduct 100 deliveries per month (as compared with Bottom’s 1,000) and they refer their complicated cases out. It was not clear to me whether they even have the capability of doing c-sections. Dr. Opoku did say they do not have a vacuum extractor. (That will top my mental list of necessary donations.)

This past July the government started offering free prenatal and delivery care in an effort to decrease the maternal mortality rate which is over 800 per 100,000 (astoundingly high compared to the US’s rate of 7 but much better than Malawi’s rate of 1,800). This idea sounds wonderful in theory but Dr. Opoku says that it is devastating the health sector. The system is not set up to cope with the numbers of new patients flooding the hospitals nor has the government established a way to efficiently reimburse the hospitals for the increased operating expenses. Hopefully these problems will be addressed relatively quickly (the policy has only been in effect for two months). However if they are not addressed soon and limited resources are consumed and not replaced, the care women receive at public facilities will be no improvement over no care at all. This seems to be another example of how emphasis on numbers, elevates them to the position of an independent goal and obscures the actual desired outcome. The World Health Organization collects statistics on the percentage of births attended by skilled birth attendants, the percentage of women receiving prenatal care, and the percentage of deliveries conducted in hospitals. The assumption is that the higher these figures, the lower the maternal mortality/morbidity and infant mortality/morbidity rates. (As a midwife I know that in all settings whether here or in the US, hospital births are not inherently safer births.) These numbers also provide a clear marker for comparison between countries. Because of this new policy Ghana will soon be able to boast an increase in all these figures but is this increase significant when women will labor in hospital beds alone because there are too few nurses to adequately monitor the laboring women? Or if laboratory tests or medication are unavailable for those who need them because they cannot be stocked regularly? I will see.

At the moment I am just excited to be around birth again. There is nothing that compares to it. One of my favorite experiences is the moment when a baby quiets after his first few cries to attentively take in his world. We exchange awestruck expressions, me at this new person, so complete unique and beautiful and he, I imagine, at the strange beauty of this place. The expression is always something like a tourist gazing at the ceiling of St. Peter’s Basilica. Wide eyes experience color and light for the first time, the quality of sound, the perception of his body and its movement are all different. But there is no fear. Being held securely, warmly, and then the presence of his mother are enough. She too is now completely transformed in his perception but he recognizes her and trusts her without needing to know what trust entails. I am so privileged to bear witness to these moments again and again, to be reminded that there is great beauty here in what we so quickly come to call mundane, and to learn again that miracles happen every day.