Papayas and Plantains

Thursday I headed back to the labor ward at Maternal and Child Health Hospital (MCHH). A week had passed since my return from Accra but I still felt like hiding in our room from the possibility of more disappointments, but after a week I forced myself out. I forced myself to walk to the bus stop, to board, and then to make my way through the noisy crowded market. I reminded myself that the best moments so far in this city have all happened at MCHH. I reminded myself that there I can be useful - which is what I miss most here - and so I kept walking until I made it through the doors of the maternity ward.

Everyone greeted me warmly. I put on my scrubs and found the midwife on duty delivering a woman with twins. Three other women labored in the adjoining room. I started my rounds with Twumwaa, a 22 year old laboring with her first baby. At first Twumwaa’s face tensed with fear and pain during her contractions but with my hand on her back and a few encouraging words she relaxed visibly. From her I moved to Kate. This was also Kate's first baby and every now and then her body shook and she snapped her fingers as a contraction rolled through her. I stayed with her a while, my fingers lightly on her belly. She was still in early labor and her baby was doing well. Finally there was Rita who was not in labor but had come because her water had broken the day before and she needed antibiotics. As I waited for the night midwife to give me her report I stayed with them, chatting with Twumwaa and rubbing backs. Twumwaa showed me a few wedding pictures on her phone. She told me about her husband and her family. Her sister Porsha had delivered a boy two weeks previously at MCHH and was in the next room waiting for a sickling test. Twumwaa’s mother also came in and out, bringing porridge and water, both happy and anxious.

After a while the midwife told me that none of the women had been examined. By that point Kate’s contractions had picked up and I heard the baby’s heart rate slow after each one (either a sign of distress or approaching delivery). Unfortunately when I examined her she was only one centimeter dilated so we transferred her to KATH, the large teaching hospital up the hill. When I returned to MCHH I sat with Twumwaa, chatted, listened to her baby and periodically listened to Rita’s baby. I would have loved to stay and attend Twuwaa’s birth but I did not like the idea of making my way through Kejetia (the sprawling open market) after dark. So around 3:30 I said goodbye.

The next morning I found Twumwaa smiling ear to ear next to a little baby boy. When I asked her what time she delivered she said, “You told me I would deliver at 6 and I delivered at 6.” Her mother had been with her (or rather outside the delivery room when she delivered) and now greeted me warmly with a big smile and a huge bag of papayas and green plantains.

In the labor room I found Rita now visibly uncomfortable with contractions. I examined her. Her baby was breech, she had no fever but the baby’s heart was racing, and her cervix was only dilated five centimeters. This was Rita’s third delivery. I could not fully grasp the details but Rita said her second delivery was difficult and that the baby had died on his first day of life. Having witnessed too many tragic endings to similar stories I prepped Rita, took her phone number and transferred her to KATH. Each time I came in and out of the postpartum room Twumwaa’s family greeted me with warm smiles. I was not even present for the delivery but their joy at having a healthy newborn overflowed on to my shoulders. When they left that morning, Twumwaa’s mother said they wanted me to come to their home soon and she reminded me to put the papayas and plantains where I would not forget them.

A few hours later after transferring a third patient to KATH, I found Kate post c-section lying besides a sweet baby girl but found Rita still lying on the bed where we had left her. When I put the fetoscope to her belly I heard the same racing heart beat but now with the ominous addition of decelerations after each contractions. I found the nurse on duty and asked her what was happening. She said the doctors would be back soon and with smiles I begged her to take special care of Rita. I kept Rita in thoughts and prayers all day then steeling myself for the worst called her that night. Her voice was joyful, she said that she had delivered vaginally, and that the baby was now okay. Filled with gratitude and relief Clement and I sat down to our meal of black-eyed peas and plantains.