Light

Today I delivered my first baby here in Ghana. I began in the prenatal ward in the midst of well oiled prenatal care. The nurses started the day panicked because two colleagues had called in sick so their solution was to pick up the pace. The conveyor belt flew at full speed and a nurse stood in the door like a coach on the side-line, waving the women towards the finish line shouting, “fast, fast, FAST.” Women obliged, handing off charts while setting down purses, and lifting skirts as they climbed onto the exam table. Each woman lay down, belly exposed, arms stiffly at her sides, her mind absent, eyes fixed on the same corner of the ceiling. I enjoyed pulling them back to Earth, by saying “Good morning,” we would both smile as though we were breaking all the rules and I would watch her muscles relax.

After a few hours of that I was called to do the prenatal ultrasounds. Dr. Annie usually does them but it is just one of her many responsibilities and I enjoy doing them so she has passed it on to me. I feel comfortable with my scans but I would love to take an actual class, know I have a lot to learn. I was taught through oral tradition - receiving hands on instructions then refining tips (some tips contradicting others) from various clinicians, most of whom had learned in the same way. Just as I was moving towards the door a midwife from the labor ward entered, said something to Doris in Twi and threw in the word, “breech.” I asked her, “Is there a breech delivery?” She said yes, asked whether I knew how to conduct a breech delivery and then led me hurriedly away towards the labor ward.

Mary was straining when I walked through the door and I could already see a little corner of a tiny pink bottom emerging from between her legs. The midwife who was there stepped aside and set up the resuscitare - which I soon learned consists of one old ambu bag and a non functioning oxygen machine. Mary was amazing, she smiled at me between her contractions and within ten minutes her little girl's head emerged and I lay the baby on her belly. It was so wonderful to be there that I laughed as I dried her baby, congratulated Mary, and thanked the nurses. I rushed back to the scanning room to find 26 women waiting for me but as soon as I finished the scans I returned to Mary and her baby. Mary looked happy and fresh lying beside her little girl nestled in blankets. This is the beautiful lightness of life.

Ennui Again

As our sentence in limbo extends indefinitely out before us I feel frustrated by inactivity; I feel passion and energy and life bubbling inside, I am ready to do something but life is holding me still keeping blinders over my eyes. I suppose the notion that any life could be overflowing, that moment after moment would be charged with emotion, that incredible joy would be waiting to be discovered out there, is childish. We distill out the salient moments and find that each life holds an amazing story, we hear or read the stories of others and become inspired by 100 words or an autobiography but in the living there are so many more moments of waiting, of expectation, of reflection, of questioning . . . Is this the right path? Perhaps these are the moments when we truly become who we are rather than a laundry list of what we have done.

Clinic Days

Today I woke up happy and excited to go to the hospital again. I need a salary but I would happily go every day without one. The thought occurs that at this moment it is a privilege to be there, perhaps when it becomes an obligation the attraction is ever so slightly diminished. I should remember it is always a privilege.

Even though I’m just in the prenatal clinic I love it. The nurses have welcomed me and they make me laugh silently as they vacillate between gushing over patients and admonishing them harshly and loudly. A young girl came over from the labor ward to tell the charge nurse, Doris that she had delivered. Moments before Doris was frowning deeply and whole-heartedly criticizing a woman for something or other but at the sight of the girl she transformed with light. Proudly she announced to me and then to the rest of the clinic that this was our patient, and then with her arm around the girl, she rushed off to see the newborn. The loud harsh tones still make me uncomfortable (it was the same in Malawi) but I recognize that this is part of the concept of parenting here. All older women are called Auntie or Mama, they are supposed to be treated with respect, and in return older women may treat any young person as they would their own child. In the West few would tolerate a stranger’s reproach of their child and we would just as rarely trust a stranger to care for our child even in the performance of a simple mundane task. The other day a familiar scene struck me in a new way, I watched a woman board the minibus and leave her two year old on the ground behind her as she stepped in. Without a glance back or a word she knew the man opening the door would pick up her child and hand him to her once she was seated, which is exactly what he did. Trust preceded the event and its existence was so deeply understood that it was never even acknowledged. It was beautiful to witness an implicit trust in humanity, and I think particularly on such a small scale. If I can’t trust a stranger to hand my child to me, how can I trust a stranger to care for his community? Or to raise his own children to be compassionate global citizens? Or to conserve natural resources? Or to care for the environment? These are our ideals and they require enormous levels of trust and faith but when it comes to a very small test of trust we so often fail. (I still would not want someone to yell at my child and definitely not slap them - even lightly - but it is useful to consider what we gain and what we lose in each perspective.)

As I spend more time at MCHH I am noticing many small positive differences between this hospital and Bottom. First, all women submit urine and stool samples at the initial prenatal visit to test for both bladder infections and parasites. And it seems that many, though asymptomatic have positive results for which they receive treatment. Also, women are indeed asked quite directly on every visit, whether they have any complaints. The nurses who ask the women about their complaints and offer treatment are aware of the need for privacy (as I was told to sit closer to a woman on account of needing to protect her privacy) but even with the attempt to talk in low voices and distance the client from others waiting by two or three feet, it is obvious that others follow the conversations with interest. In general, despite the strains on the system, when a woman needs a second ultrasound or another lab test or treatment for a yeast infection she is able to get it. Hopefully this will not change despite the increasing numbers. Doris told me that before the announcement of free prenatal care they would see 80 to 100 women every day, now the numbers range from 150 to 300. Finally, though the women are poor, there are more well-nourished women here than among those who come to Bottom. Every day I see quite a few American sized bellies and though I do see many Hbs of 9 (12 to 14 is normal), I don’t see many below that. These differences are really quite small but I imagine that they are in part responsible for the lower maternal mortality rates.

Dr. Annie is sweet, she is always grateful for my presence, the nurses greet me warmly and ask after Clement each morning, and the women smile and trust my hands on their bellies. I enjoy being there, listening and observing. Many of the women have come from rural areas to the city to work. Their bodies are decorated with information I do not understand. Many have scars around their belly buttons transforming a growing pregnancy into a starburst, some have a simple tattoo in the center of their forehead something like two “S”s hanging on each other. Others have hands hennaed, and feet decorated with black paint, others use dark thick charcoal under their eyes. Diversity is beautiful and intriguing.