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.