Thursday morning began with a woman named Clara whose distressed baby was emerging feet first; slipping through a partially opened cervix (footling breeches must always be delivered by c-section because, although bodies may slide through before the cervix is completely dilated, the head will most likely become entrapped). I went to theatre to receive the baby. An hour passed between the minute when I heard the alarmingly slow heart rate and the minute when the struggling baby was placed in my hands. I resuscitated her for about 20 minutes before her breathing became regular but even then her lips remained an ominous shade of purple.
I took her to the nursery and returned to the labor ward to find the nurses preparing magnesium sulfate for an eclamptic woman who had just arrived unconscious. Apparently Jessy was on her way to the hospital complaining of a severe headache (a symptom of preeclampsia) accompanied by her mother when she seized. I helped the others prepared and administer the magnesium and then she seized again. We had no medicine to help lower her blood pressure. She seized again. She looked to be less than 30 weeks pregnant (i.e. very premature and barely viable in Malawi) but the only cure for eclampsia is delivery and you must deliver to save the mother's life regardless of the baby's gestational age. The baby’s heart rate sounded strong so I returned to theatre. Lying unconscious, outside the theatre, waiting for a cervical repair to finish, Jessy seized again. Once the section started, I stood to the side with my sterile cloth, expecting to be handed a creature so small and unprepared for extrauterine life. I was please to meet a pink beautiful little girl with a hopeful weight of 1.6kg.
I took her to the nursery and then returned to the labor ward. In a calm voice Msiska called me, “Joanne, can you help?” and I, slowly and calmly walked over to where she stood. My gaze landed on the horrific sight of a baby’s body dangling freely with the head still inside his mother. I ran for gloves and asked Msiska if the baby was still alive, she said that it had been but that it had died. I quickly delivered the head and then felt a slow but strong pulse and ran with the limp baby boy to the resuscitare. While I was resuscitating him another woman began delivering a footling breech on the bed 10 feet behind me. She had come in just moments before; no warning or time to prepare for a section. I handed over the resuscitation and ran to help deliver the head. The little girl needed just a breath or two with the bag and mask to encourage her. Chipeta delivered her twin sister and placed them side by side.
I don’t remember the flow of events for the remainder of the day. I remember eating an apple. I remember assisting a student manage the care of a woman with a moderate hemorrhage. I remember attending a normal birth. I also checked on the babies in nursery periodically throughout the day. Clara’s baby looked distressed and pale despite the oxygen. Jessy’s baby was lovely. The breech boy held steady although his posture suggested damage to the nerves enervating his right arm. Friday was similarly hectic. I assisted with two shoulder distocias, delivered one baby via vacuum and attended a couple normal deliveries as well.
For almost the whole of last week there was no pethadine at Bottom. In other words there was NO pain medicine. Women delivering at Bottom never receive pain medicine during their labors (except in a rare case when it is given to a mom delivering a dead baby). Usually the precious pain medicine is reserved for women who undergo surgeries, but for a week even they received nothing. Women were anesthetized during the surgical procedures but once in the recovery rooms they received nothing, despite the fact that they had been cut through their skin, fat, muscle, and uteruses. Dr. Meguid often talks about these shortages (other common shortages include antibiotics and suture material) in terms of human rights. I think it's appropriate to frame the situation in this way. We have international documents on human rights and women's rights but what does this mean in a practical way? Certainly it is INhumane to use inappropriate suture material on women and increase their risk for abdominal rupture. It is INhumane to withhold antibiotics and risk peritonitis and the not uncommon subsequent hysterectomy. And it is INhumane to withhold pain medication after surgery. Although this is a situation of absent resources and not withheld resources, is it not in actuality withheld when we consider the global picture? We know what is necessary to treat women humanely on a mundane level. We know practically what is involved to provide adequate maternity care. So, where is the commitment?
I went to Bottom on Sunday just to check on all my babies. Clara's baby had died Saturday night. Jessy's baby, the twins and Esmilo's breech boy were doing well. Jessy was also doing great. I recognized her name but looking at her did not recognize her face. I could not remember how I was involved in her birth until I read the baby's file. Just a couple days before she was swollen and unconscious, Sunday she was laughing, walking, and nursing her baby.
Today I spent my usual half day at Bottom (the morning at Bottom, the afternoon at the Embassy). I walked in and did two deliveries within 15 minutes, the first was an undiagnosed stillborn anencephalic baby; the second was a nice normal girl delivered by a 15 year old. Anencephaly is a rare event, according to my perusal of various sources the incidence lies somewhere between 1 in 100,000 to 1 in 70,000. I have seen 5 since coming to Bottom. Considering that Bottom has only 12,000 births a year and I am only present for a fraction of these, this number is incredibly concerning. I am going to start keeping a log. I checked in the nursery again and was devastated to learn that Jessy's baby died unexpectedly last night. The nurse said Jessy breastfed the baby and then the baby had an apneic attack from which she never recovered. I did not see Jessy but I can only imagine her heartbreak. Just before noon I attended 19 year old Elena's delivery, it was a beautiful birth and she had a boy.
Wednesday, December 06, 2006
Monday, November 27, 2006
Streetkids
Ganizani - and another boy who looks nothing like him but whom he calls his brother - beg outside the PTC grocery store almost every day. Ganizani is 13. His brother is 11. They swear they go to school. I doubt it. Usually, when I shop there, I buy them bread. Last month I told him I wanted to see his home. Clement and I met them outside the PTC one Saturday morning and they directed us across town, moving from paved roads to dirt roads, from green to dust, landing at last in an area where rent (I was told by a Malawian friend) ranges from the equivalent of US$1-3/month. On the way we stopped at a market to buy 50kgs of maize and 5 kgs of beans. Then the two skinny boys excitedly and awkwardly carried the bag between them to their small mud brick home.
Ganizani speaks as a child anxious to grow up, deepening his voice as he raises it, so it becomes lower than seems natural for his size and age. He says he is the oldest of five siblings who live there. Before their parents died they rented a larger house, but once their parents died the landlord evicted them and they just wandered and squatted until someone gave them their current house. Ganizani leans on the door just inches higher than his head and as he talks it comes off the frame. He tries repairing it with a piece of string as he continues. He says usually they walk across town to the PTC and return home just a few kwacha, with this little money they buy maize flour and share it between them; if they don’t have any money, they don’t eat. Their clothes are torn and filthy. They sleep on the bare earth floor without blankets.
This is the effect of extreme poverty and HIV (perhaps that is redundant, perhaps I should simply say this is the effect of extreme poverty). And, I am tempted to ask whether this is also the effect of extreme wealth. Today I saw Ganizani again in front of the PTC, he said the maize had finished and I promised to buy more. What do we do? buy food and blankets? have someone repair their door? make sure these five kids can eat and go to school? set up a trust fund? Am I creating dependency, as my very proactive and vocal Malawian friend Lexa says? Am I harming the country more by acquiescing to basic physical needs without a clear vision for the future? Lexa says kids with parents will take their food and when they leave the house everything will be stolen. She says I need to send them home.
Should I find the distant and most likely impoverished relatives who have not claimed this band of orphans and force them together? Should I send them to an overcrowded orphanage? Is it reckless to feed them now knowing I will leave the country before they are adults? Are these actions for my benefit or theirs? I don’t know. I only know I don’t want them going hungry and I don’t want to ignore them, and waiting for social transformation or a vision will not fill their bellies today.
Ganizani speaks as a child anxious to grow up, deepening his voice as he raises it, so it becomes lower than seems natural for his size and age. He says he is the oldest of five siblings who live there. Before their parents died they rented a larger house, but once their parents died the landlord evicted them and they just wandered and squatted until someone gave them their current house. Ganizani leans on the door just inches higher than his head and as he talks it comes off the frame. He tries repairing it with a piece of string as he continues. He says usually they walk across town to the PTC and return home just a few kwacha, with this little money they buy maize flour and share it between them; if they don’t have any money, they don’t eat. Their clothes are torn and filthy. They sleep on the bare earth floor without blankets.
This is the effect of extreme poverty and HIV (perhaps that is redundant, perhaps I should simply say this is the effect of extreme poverty). And, I am tempted to ask whether this is also the effect of extreme wealth. Today I saw Ganizani again in front of the PTC, he said the maize had finished and I promised to buy more. What do we do? buy food and blankets? have someone repair their door? make sure these five kids can eat and go to school? set up a trust fund? Am I creating dependency, as my very proactive and vocal Malawian friend Lexa says? Am I harming the country more by acquiescing to basic physical needs without a clear vision for the future? Lexa says kids with parents will take their food and when they leave the house everything will be stolen. She says I need to send them home.
Should I find the distant and most likely impoverished relatives who have not claimed this band of orphans and force them together? Should I send them to an overcrowded orphanage? Is it reckless to feed them now knowing I will leave the country before they are adults? Are these actions for my benefit or theirs? I don’t know. I only know I don’t want them going hungry and I don’t want to ignore them, and waiting for social transformation or a vision will not fill their bellies today.
31
November 14th 2006, my eyes opened and moments later the sky opened, releasing the no-longer-bearable-weight of the year’s first rain. I thought briefly of all the homes I have visited with flecks of sky shinning through their tin roofs, of all the mud brick village huts with decrepit thatch roofs, and then of all the fields sitting ready, waiting; dry soil tilled in neat expectant rows. Rain would beget work and happiness and hope; it was a good omen for a birthday. In the past people sowed their fields at the same time every year but the increasingly unpredictable timing of the rains has prompted change. People now wait to see that the rains have come to stay before planting, to avoid the withering of tender crops, coaxed from the soil by early rain then betrayed by relentless heat.
Monday, November 20, 2006
The Parents' Visit
My parents arrived October 9th. I hadn’t seen my folks since I left home in March 2005 and I was so excited about their arrival, I worried about passing out at the airport from sheer excitement. I also worried that somehow they might end up in Thailand or Germany instead of Malawi. Although both my parents lived for years in South America this was their first trip outside the US (besides Mexico) since 1972. Luckily, they arrived intact although exhausted with all of their luggage on the expected date. I didn’t pass out but it was wonderful to see them and the visit improved from there. I can say that for the past 14 years I have recognized that my parents are remarkable people but even so they managed to impress me.
For those of you who don’t know my family, here’s the abbreviated history of my parents. Before they were married my mother worked as a nurse in the Altiplano of Bolivia for six years helping to set up and run a clinic. During the same time period my dad lived and worked in the favelas outside Recife, Brazil. When they talk about their time in South America their eyes sparkle and they turn contemplative. In the late 1960s they both believed they would spend their lives there, but circumstances brought them back to the US – to Detroit, even though my mom is from east Texas – and their lives changed completely. My mom became a pediatric nurse practitioner, my dad became a social worker, they found jobs, they met, married, had me, later adopted my brother, moved to Texas, my dad gave up social work for real-estate, my mother worked in the newborn nursery and raised us, then retired about 10 years ago, my dad still works in real-estate.
In many ways moving across the world actually deepened my relationship with my parents. They know my struggles intimately as their own and find more frequent occasions to share bits of wisdom, especially that gained from reflection on their time abroad almost 40 years ago. In my family, I am not an original but I’m okay with that. As we drove the 30 minutes from the airport to my house, past scenes of boys herding cattle, untended roaming goats, and women carrying bundles on their heads, my dad said, “This feels very comfortable.” For him this was a return.
My dad kept his own journal quite religiously throughout their three weeks here and I’ve asked him to post a sampling of his impressions; he has not yet committed to that but says he will post pictures at some point. I think we did as much as physically possible without totally exhausting everyone. We went to Bottom. We went to the lake. We went on safari in Zambia and saw lions with a kill, a leopard, countless elephants, giraffes, zebra, and even a python. We went to Mr Nankuntho’s village, where he did indeed kill the promised goat (and Clement skinned it). We went to Mua Mission, a hundred-year-old Catholic mission; the Canadian priest who has run the mission for the last 40 years was initiated into the Chewa tribe and, with the permission of the chiefs, has created a museum filled with cultural information about three of the largest ethnic groups in Malawi, notably elevating the local culture rather than desecrating it. We went to Zomba Mountain and finished with a visit to Clement’s home village in Mangochi (home village meaning the village of his father’s father not the place he grew up) to meet his extended family. My parents ate nsmia, drank tobwa, drank water from bore holes, used latrines, kissed babies, learned the basic greetings in Chichewa, received gifts of dried fish, mangos, and a live chicken, and ended each day smiling. Not a moment of culture shock and not a moment of illness.
For me, I loved seeing what has become mudane with all the light and color their eyes gave to it, and I realized again - but a bit more profoundly - that I am surrounded by an amazing community of friends. The only downside of the visit came with passing thoughts about how many miles separate me from my family, the rarity of our visits, and the inevitable aging of my parents. (During their visit my dad turned 71 and my mom turned 75; if I could force them to commit to another 30 years on this planet I certainly would.) They left on October 26th with smiles and hundreds of photos and a few carvings and countless memories; they said the visit was transformative. Last week my dad called and asked if they could return on the weekend. I wish they would.
For those of you who don’t know my family, here’s the abbreviated history of my parents. Before they were married my mother worked as a nurse in the Altiplano of Bolivia for six years helping to set up and run a clinic. During the same time period my dad lived and worked in the favelas outside Recife, Brazil. When they talk about their time in South America their eyes sparkle and they turn contemplative. In the late 1960s they both believed they would spend their lives there, but circumstances brought them back to the US – to Detroit, even though my mom is from east Texas – and their lives changed completely. My mom became a pediatric nurse practitioner, my dad became a social worker, they found jobs, they met, married, had me, later adopted my brother, moved to Texas, my dad gave up social work for real-estate, my mother worked in the newborn nursery and raised us, then retired about 10 years ago, my dad still works in real-estate.
In many ways moving across the world actually deepened my relationship with my parents. They know my struggles intimately as their own and find more frequent occasions to share bits of wisdom, especially that gained from reflection on their time abroad almost 40 years ago. In my family, I am not an original but I’m okay with that. As we drove the 30 minutes from the airport to my house, past scenes of boys herding cattle, untended roaming goats, and women carrying bundles on their heads, my dad said, “This feels very comfortable.” For him this was a return.
My dad kept his own journal quite religiously throughout their three weeks here and I’ve asked him to post a sampling of his impressions; he has not yet committed to that but says he will post pictures at some point. I think we did as much as physically possible without totally exhausting everyone. We went to Bottom. We went to the lake. We went on safari in Zambia and saw lions with a kill, a leopard, countless elephants, giraffes, zebra, and even a python. We went to Mr Nankuntho’s village, where he did indeed kill the promised goat (and Clement skinned it). We went to Mua Mission, a hundred-year-old Catholic mission; the Canadian priest who has run the mission for the last 40 years was initiated into the Chewa tribe and, with the permission of the chiefs, has created a museum filled with cultural information about three of the largest ethnic groups in Malawi, notably elevating the local culture rather than desecrating it. We went to Zomba Mountain and finished with a visit to Clement’s home village in Mangochi (home village meaning the village of his father’s father not the place he grew up) to meet his extended family. My parents ate nsmia, drank tobwa, drank water from bore holes, used latrines, kissed babies, learned the basic greetings in Chichewa, received gifts of dried fish, mangos, and a live chicken, and ended each day smiling. Not a moment of culture shock and not a moment of illness.
For me, I loved seeing what has become mudane with all the light and color their eyes gave to it, and I realized again - but a bit more profoundly - that I am surrounded by an amazing community of friends. The only downside of the visit came with passing thoughts about how many miles separate me from my family, the rarity of our visits, and the inevitable aging of my parents. (During their visit my dad turned 71 and my mom turned 75; if I could force them to commit to another 30 years on this planet I certainly would.) They left on October 26th with smiles and hundreds of photos and a few carvings and countless memories; they said the visit was transformative. Last week my dad called and asked if they could return on the weekend. I wish they would.
1 in 100
I am still alive and still in Malawi, despite the silence. I struggle at times over which thoughts to post and which to hold back, this struggle combined with the undulating swells of fatigue and procrastination leads to no blogging for weeks and weeks. Sorry. I’m back now and want to begin with the story of a c-section from early October.
A 24-year-old woman with her first pregnancy was sent to theatre because her baby wanted to emerge bottom first. (All primips with breech babies are sectioned at Bottom; multips with breeches are allowed to deliver vaginally.) After the anesthetist placed the spinal the woman began an involved monologue clearly captivating the scrub nurse, anesthetist and clinical officer. They added laughter and an occasional short question but only that. A smattering of words filtered though the dullness of my Chichewa speaking mind but still hardly enough to compile a satisfactory picture. When I asked what she was saying, the scrub nurse responded that when the anesthetist placed the spinal he told her the medicine would work as they chatted so clearly she interpreted that to mean that chatting was an essential component for pain relief. “She’s just telling stories from her life; she’s a farmer, she’s talking about her farm.” I wanted more substance but clearly no one wanted to waste time translating for me and miss part of her story.
Following another stretch of narrative, the small audience released a trickle of laughter and the clinical officer casually remarked, “She’s one in a hundred.” The scrub nurse then turned to me to translate the amusing comment made by the patient, which was simply that her husband loved her very much. Personally surprised more by their reaction, than by her statement I asked for clarification. The clinical officer said bluntly, “It is very rare that a woman can say outright that her husband loves her.” At once I felt charmed by this sweet beloved woman who chatted her way to a good outcome and deeply sad for the 99 women who live everyday with and for an unloving partner.
A 24-year-old woman with her first pregnancy was sent to theatre because her baby wanted to emerge bottom first. (All primips with breech babies are sectioned at Bottom; multips with breeches are allowed to deliver vaginally.) After the anesthetist placed the spinal the woman began an involved monologue clearly captivating the scrub nurse, anesthetist and clinical officer. They added laughter and an occasional short question but only that. A smattering of words filtered though the dullness of my Chichewa speaking mind but still hardly enough to compile a satisfactory picture. When I asked what she was saying, the scrub nurse responded that when the anesthetist placed the spinal he told her the medicine would work as they chatted so clearly she interpreted that to mean that chatting was an essential component for pain relief. “She’s just telling stories from her life; she’s a farmer, she’s talking about her farm.” I wanted more substance but clearly no one wanted to waste time translating for me and miss part of her story.
Following another stretch of narrative, the small audience released a trickle of laughter and the clinical officer casually remarked, “She’s one in a hundred.” The scrub nurse then turned to me to translate the amusing comment made by the patient, which was simply that her husband loved her very much. Personally surprised more by their reaction, than by her statement I asked for clarification. The clinical officer said bluntly, “It is very rare that a woman can say outright that her husband loves her.” At once I felt charmed by this sweet beloved woman who chatted her way to a good outcome and deeply sad for the 99 women who live everyday with and for an unloving partner.
Tuesday, October 03, 2006
A New Slant on Personal Incompetence
Last week the nurses had difficulty hearing the fetal heart of a particular woman - even when the baby is well, we occasionally struggle to find the heart with our simple fetoscopes. Luckily there is an ultrasound machine just across the hall so we can walk her a few feet to confirm or dispel our fears.
That day the clinical officer who scanned the woman decided he saw a still heart; he told the nurses and he told the woman. It was her first pregnancy and now she believed she was laboring to deliver a dead baby; her anguish resounded clearly in her cries with each contraction. Several hours later, when the woman was well into an abnormally protracted labor, Msiska decided to listen in again and heard a heartbeat. She called me over and I also heard the heartbeat. Together we scanned the woman and clearly saw the heart beating. We told the woman her baby was fine and a section was arranged. In theatre I was handed a baby boy who needed some resuscitation but quickly perked up. He only cried through couple breaths and then calmly and attentively took in his new world. I wrapped the baby and brought him close to his mother for her to see. The new mom looked at her baby gazing back at her with wide eyes and asked confused, "Is my baby dead?"
A couple days later I saw the clinical officer who initially scanned the woman and had told her her baby was dead. I told him the story and said the baby was very much alive. His response, "God is great!"
That day the clinical officer who scanned the woman decided he saw a still heart; he told the nurses and he told the woman. It was her first pregnancy and now she believed she was laboring to deliver a dead baby; her anguish resounded clearly in her cries with each contraction. Several hours later, when the woman was well into an abnormally protracted labor, Msiska decided to listen in again and heard a heartbeat. She called me over and I also heard the heartbeat. Together we scanned the woman and clearly saw the heart beating. We told the woman her baby was fine and a section was arranged. In theatre I was handed a baby boy who needed some resuscitation but quickly perked up. He only cried through couple breaths and then calmly and attentively took in his new world. I wrapped the baby and brought him close to his mother for her to see. The new mom looked at her baby gazing back at her with wide eyes and asked confused, "Is my baby dead?"
A couple days later I saw the clinical officer who initially scanned the woman and had told her her baby was dead. I told him the story and said the baby was very much alive. His response, "God is great!"
Wednesday, September 13, 2006
SuperSTAR
I had a pretty crummy week last week and it was followed by an equally crummy weekend. There were some woe-is-me moments and a few tears and then just when I started getting comfortable with my misery Frank called and said we needed to meet. This afternoon I drove over to his work and we sat outside the gate in my car and talked.
Just as a reminder Frank is the superstar dad whose took a personal tragedy (his wife died the day after giving birth to their first and only child in January) and used it as a reason to transform his community (he started a feeding program for 60 orphans and looks out for severely impoverished families in his area).
Two pieces of background information First, Frank's family is in Blantyre (4 hours South of Lilongwe) he lives near his in-laws and spends most of his free time with their family and his daughter (culturally the daughter must be raised by women until she is at least a few years old). Frank also supports his in-laws financially to a great extent and defers to them frequently when decisions must be made concerning his own life. This has been working moderately well but it means that there is no one on his side. Second, in Malawi property grabbing is a problem. The typical scenario of property grabbing happens this way - the husband dies, his family comes and takes everything and anything (including children) from the wife, leaving her destitute. There are groups trying to fight this practice both culturally and legally but it still happens.
Frank has close to nothing but he told me that he anticipated such a scenario, he had heard people talking about his sister-in-law wanting his sofa set. He even confronted her months ago saying that if she wanted it to let him know and give him time so he could save and buy another set. When he confronted her she said, "I could never do that to you."
Well, apparently she could. Last night a large group of men showed up at Frank's house. Frank's reaction was to kindly offer them all his possessions. He said, "Would you like the sofa? Ok? Let me help you with that. How about the radio? Yes? Here it is." And, he actually helped them carry his things out of his house to his mother-in-law's house. They left him his small bed and his clothes, he said they even took the bags he used to store his clothes in.
On hearing this I felt completely outraged, I wanted to scream and call the police and get his daughter away from them. I wanted to stop working with the feeding program that runs out of his mother-in-laws house but he said those actions would just cause more suffering for other people. He said he didn't sleep for much of the night until he realized three things: (1) the experience would make him work harder to save money; (2) it would make him a stronger person; and (3) at last he was free, there was nothing else for them to take.
Just as a reminder Frank is the superstar dad whose took a personal tragedy (his wife died the day after giving birth to their first and only child in January) and used it as a reason to transform his community (he started a feeding program for 60 orphans and looks out for severely impoverished families in his area).
Two pieces of background information First, Frank's family is in Blantyre (4 hours South of Lilongwe) he lives near his in-laws and spends most of his free time with their family and his daughter (culturally the daughter must be raised by women until she is at least a few years old). Frank also supports his in-laws financially to a great extent and defers to them frequently when decisions must be made concerning his own life. This has been working moderately well but it means that there is no one on his side. Second, in Malawi property grabbing is a problem. The typical scenario of property grabbing happens this way - the husband dies, his family comes and takes everything and anything (including children) from the wife, leaving her destitute. There are groups trying to fight this practice both culturally and legally but it still happens.
Frank has close to nothing but he told me that he anticipated such a scenario, he had heard people talking about his sister-in-law wanting his sofa set. He even confronted her months ago saying that if she wanted it to let him know and give him time so he could save and buy another set. When he confronted her she said, "I could never do that to you."
Well, apparently she could. Last night a large group of men showed up at Frank's house. Frank's reaction was to kindly offer them all his possessions. He said, "Would you like the sofa? Ok? Let me help you with that. How about the radio? Yes? Here it is." And, he actually helped them carry his things out of his house to his mother-in-law's house. They left him his small bed and his clothes, he said they even took the bags he used to store his clothes in.
On hearing this I felt completely outraged, I wanted to scream and call the police and get his daughter away from them. I wanted to stop working with the feeding program that runs out of his mother-in-laws house but he said those actions would just cause more suffering for other people. He said he didn't sleep for much of the night until he realized three things: (1) the experience would make him work harder to save money; (2) it would make him a stronger person; and (3) at last he was free, there was nothing else for them to take.
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.
Sunday, July 02, 2006
Chiko
Thursday I took the day off from Bottom, the morning I enjoyed by myself, mostly reading in bed and then in the afternoon I decided to visit Chiko. Chikumbutso is the motherless baby girl of Nathan who lives in a village 50km outside of Lilongwe. About a month ago Nathan, her father, and his sister-in-law arrived at Bottom with a listless extremely dehydrated little Chiko. They said she had been having diarrhea for the past 24 hours and already her fontanel and eyes were impressively sunken. We took her to Kamuzu Central right away and after a week of IV fluids she returned to her beautiful bright self. I believed that Nathan would call if they needed milk or if anything were wrong with Chiko but Thursday I felt as though a small voice inside was telling me to go see her.
When I arrived at the house the sister-in-law handed me Chiko and weight the little bundle disturbed me a bit. The aunt said she had malaria. I tucked an electric thermometer under her arm and it shut off once it read 103 degrees Fahrenheit. I also noticed that some spots around her mouth were hypo-pigmented and then was stunned to see more spots spreading from her neck down over her chest. (Later, with the translating help of Sister Namaleu, the aunt told us the spots were vesicles and then sores and were now healing.) I told everyone that we should go the hospital immediately. So the aunt packed up and the three of us headed back to Lilongwe.
The clinical officer started treating her for sepsis immediately, ordered a malaria test, and a full blood count (FBC). The following day I returned to visit her with Sister Namaleu. Her temperature still climbed above 101 and none of the lab results were in the chart, even though blood was drawn early the previous afternoon. Sister Namaleu and I went to the lab to chase down the results; we found that Chiko’s blood was negative for malaria parasites but her hemoglobin was 7.6 (anemic) and her platelets 50 (low). On our way back to the ward we cornered the chief pediatrician who told us that he would not yet consider transfusing her but would repeat the FBC Monday.
I just returned from the hospital where I met Chiko with her pink knitted hat strapped to her aunt's back. She was smiling and cooing and looking much better. The aunt says her antibiotic injections will finish tomorrow. I'll make sure that she gets another FBC to see if there is any change and if it's no worse she'll be heading home on Tuesday.
When I arrived at the house the sister-in-law handed me Chiko and weight the little bundle disturbed me a bit. The aunt said she had malaria. I tucked an electric thermometer under her arm and it shut off once it read 103 degrees Fahrenheit. I also noticed that some spots around her mouth were hypo-pigmented and then was stunned to see more spots spreading from her neck down over her chest. (Later, with the translating help of Sister Namaleu, the aunt told us the spots were vesicles and then sores and were now healing.) I told everyone that we should go the hospital immediately. So the aunt packed up and the three of us headed back to Lilongwe.
The clinical officer started treating her for sepsis immediately, ordered a malaria test, and a full blood count (FBC). The following day I returned to visit her with Sister Namaleu. Her temperature still climbed above 101 and none of the lab results were in the chart, even though blood was drawn early the previous afternoon. Sister Namaleu and I went to the lab to chase down the results; we found that Chiko’s blood was negative for malaria parasites but her hemoglobin was 7.6 (anemic) and her platelets 50 (low). On our way back to the ward we cornered the chief pediatrician who told us that he would not yet consider transfusing her but would repeat the FBC Monday.
I just returned from the hospital where I met Chiko with her pink knitted hat strapped to her aunt's back. She was smiling and cooing and looking much better. The aunt says her antibiotic injections will finish tomorrow. I'll make sure that she gets another FBC to see if there is any change and if it's no worse she'll be heading home on Tuesday.
Ripples and Waves
Frank continues to amaze me. Frank is the young father of Grace, widowed the day after Grace’s birth. A few weeks ago Frank took me to his house for the first time, usually we meet at the mother-in-law’s house where Grace lives. Frank lives in a very modest two-room adobe home that could easily fit into my bedroom, without electricity or indoor plumbing, and he shares this space with a young male relative. I sat on one couch chair and Frank sat on another. As I listened to him talk about his good fortune, I took in our surroundings. He said he might have had to sell his bed and the mattress and his little sofa set (which he bought for 2,200MK) just to try to afford the monthly formula bill of 9,000MK to keep Grace alive. A small shelf pushed into a corning, held some bread, eggs, and a couple old newspapers. He said if it weren’t for the help of others he might be completely destitute but because of the help, his life is good. A cluster of unframed pictures of his dead wife hung on the wall across from where he sat. His own hand-written notes surrounded the pictures; notes to her, notes about how he misses her, notes about the existence of God. Whenever he talks about Grace his eyes tear up and he shakes his head, but his smile always quickly returns. He said he has changed, that before he never understood the depth of despair and could not feel compassion for those who were suffering. A thin sheet hung in the doorway between the sitting room and the bedroom; through the sheet I could see a small simple bed. Now, he said, he just wants to help others. He said his ultimate dream is to start an orphanage.
Some small ripple began with that conversation. Together we decided to start by choosing five destitute families in his area who are supporting orphaned infants, or infants of terminally ill mothers. Frank quickly identified the families and made lists of the dependents and the items he thought they needed most.
A week later we had our first meeting with the group. I held chubby gurgling 4-month-old Grace on my lap as I sat among the other women on a mat. All the children were below 2 years and none of them looked healthy. The oldest, a 16-month-old girl was still not walking or talking and weighed the same as 4-month-old Grace, 7kgs. We told the women that we would buy them basic goods once a month, and then they as a group would have to decided what they wanted to do to support each other (e.g. start a garden, raise chickens, etc). Frank and I went to the market and bought each woman a 40kg bag of maize, 12 candles, cooking oil, 2kgs of beans, formula for the two who still needed to nurse but were unable to nurse, a high protein and calorie mixture for the little girl, soap, and a soy and maize based porridge for all the children. I also distributed some donated clothing.
The following week Frank told me I needed to arrive at the house on Saturday at 9am. Frank’s mother-in-law had called a Malawian Parliamentarian (MP) who said he wanted to support our group. The MP sent a donation of many bags of pala (the enriched porridge) and canned beans and said the President’s wife would also be sending donations from time to time. The MP could not come to the group himself, so Frank’s mother-in-law asked me to come to distribute the items to the families instead. I in turn asked Sister Namaleu to come along because I knew she would be a willing and wonderful asset.
When we arrived, women and children covered the small dirt area in front of the house. A song rose spontaneously and joyfully and as they sang, each woman came up one-by-one to shake our hands. After the greetings, the women served pala to the group of 30 or more children present and then we distributed the pala and beans. Frank decided that with the continued support of the MP, the larger group of children could come to the house to eat pala twice and week and the original group of five would come three times. Our ripple fed a small stream of change and hope.
The greatest part of the morning was watching the little girl – who only one week before personified a tiny exhausted old woman – laughing, squealing, and trying to walk.
It’s stunning how so many people really need so little. And, how so little means so much in certain hands and bellies.
Some small ripple began with that conversation. Together we decided to start by choosing five destitute families in his area who are supporting orphaned infants, or infants of terminally ill mothers. Frank quickly identified the families and made lists of the dependents and the items he thought they needed most.
A week later we had our first meeting with the group. I held chubby gurgling 4-month-old Grace on my lap as I sat among the other women on a mat. All the children were below 2 years and none of them looked healthy. The oldest, a 16-month-old girl was still not walking or talking and weighed the same as 4-month-old Grace, 7kgs. We told the women that we would buy them basic goods once a month, and then they as a group would have to decided what they wanted to do to support each other (e.g. start a garden, raise chickens, etc). Frank and I went to the market and bought each woman a 40kg bag of maize, 12 candles, cooking oil, 2kgs of beans, formula for the two who still needed to nurse but were unable to nurse, a high protein and calorie mixture for the little girl, soap, and a soy and maize based porridge for all the children. I also distributed some donated clothing.
The following week Frank told me I needed to arrive at the house on Saturday at 9am. Frank’s mother-in-law had called a Malawian Parliamentarian (MP) who said he wanted to support our group. The MP sent a donation of many bags of pala (the enriched porridge) and canned beans and said the President’s wife would also be sending donations from time to time. The MP could not come to the group himself, so Frank’s mother-in-law asked me to come to distribute the items to the families instead. I in turn asked Sister Namaleu to come along because I knew she would be a willing and wonderful asset.
When we arrived, women and children covered the small dirt area in front of the house. A song rose spontaneously and joyfully and as they sang, each woman came up one-by-one to shake our hands. After the greetings, the women served pala to the group of 30 or more children present and then we distributed the pala and beans. Frank decided that with the continued support of the MP, the larger group of children could come to the house to eat pala twice and week and the original group of five would come three times. Our ripple fed a small stream of change and hope.
The greatest part of the morning was watching the little girl – who only one week before personified a tiny exhausted old woman – laughing, squealing, and trying to walk.
It’s stunning how so many people really need so little. And, how so little means so much in certain hands and bellies.
A Few Quotes on Happiness
Whatever joy there is in this world
All comes from desiring others to be happy,
And whatever suffering there is in this world
All comes from desiring myself to be happy
-- Shantideva, A Guide to the Bodhisattva’s Way of Life
If you try to subdue your selfish motives—anger and so forth—and develop kindness and compassion for others, ultimately you yourself will benefit more than you would otherwise. . . Foolish selfish people are always thinking of themselves, and the result is negative. Wise selfish people think of others, help others as much as they can, and the result is that they too receive the benefit.
-- His Holiness the Dalai Lama, A Policy of Kindness
There is some kind of ultimate justice or goodness in the universe. It is that goodness that we are all trying to uncover and to free. Whenever we act positively, we move toward it; whenever we act negatively, we obscure it and inhibit it. And whenever we cannot express it in our lives and actions, we feel miserable and frustrated.
--Sogyal Rinpoche, The Tibetan Book of Living and Dying
All comes from desiring others to be happy,
And whatever suffering there is in this world
All comes from desiring myself to be happy
-- Shantideva, A Guide to the Bodhisattva’s Way of Life
If you try to subdue your selfish motives—anger and so forth—and develop kindness and compassion for others, ultimately you yourself will benefit more than you would otherwise. . . Foolish selfish people are always thinking of themselves, and the result is negative. Wise selfish people think of others, help others as much as they can, and the result is that they too receive the benefit.
-- His Holiness the Dalai Lama, A Policy of Kindness
There is some kind of ultimate justice or goodness in the universe. It is that goodness that we are all trying to uncover and to free. Whenever we act positively, we move toward it; whenever we act negatively, we obscure it and inhibit it. And whenever we cannot express it in our lives and actions, we feel miserable and frustrated.
--Sogyal Rinpoche, The Tibetan Book of Living and Dying
Innocent
I told the beginning of Innocent’s story a while back during my first months in Malawi. He is one of many dependants of a woman who has lost 6 of her 8 adult children. With their physical departure each child left her with a few more orphans to add to her household. Innocent is 19, he’s a bright sweet kid who did well in secondary school but could not continue his education because no one was able to pay school fees. He wanted to attend a one-year computer-training course and so with some of the money I received, I paid the fees. His final exams were scheduled for May 2006. In January I went with him to the school to give them a check for the exam fees to ensure that they received the payment on time. In April he was told that he would not be able to sit the exams in May because I was supposed to pay with a bank note and since the school had to obtain the bank note themselves, the fees were not processed in time . . . grrrrr. Of course I went to the school, argued with the school administrator and director but they held firm, it wasn’t their fault that someone from the school failed to tell me this the day I handed them the check, it was Innocent’s fault because he was supposed to know and tell me. Right. Poor Innocent cried in the school office. They then told him he was supposed to take the exams in June from the 26th to the 29th.
Sunday morning, June 25th Innocent’s family called me saying that he had been arrested, had been beaten, and was being held in the main police station. Due to other unforeseen events I didn’t arrive at their house until 3:45pm at which time they told me the station would close at 4. I rushed to the station with a relative and luckily found it open. The police led us to Innocent. They were keeping him in an outside partially covered courtyard, along with two other prisoners, a man and a woman. All three of them looked haggard, cold, with bare feet, and they huddled together on a cement step (winter has arrived in Lilongwe bringing cool night temperatures of about 50 degrees F). Innocent told me that he was accused of stealing the laptop of a foreign student. (His guardian is the housemother at the dormitory of the nursing college and so she lives with her family in a small home built into the dorm.) The student reported a missing laptop and the campus security officer said someone told him that they saw Innocent leaving the building with a bag. Innocent said he did have a bag but that it just contained his books and nothing more. He said at the time of the robbery he was playing darts with friends. He told me that the police had been beating him with a gun. The remainder of my evening was spent trying to find a way to get him out.
First, we went to the arresting officer’s home, who I had been told, had the authority to release Innocent. My biased impression of him was that of a crooked little man with a Napoleon complex; he wanted me to pay him personally the price of the laptop 1,200 British pounds to release Innocent (right). I went to talk to the student, who was quite disturbed by the turn of events but when she asked the college dean what would happen if she dropped the charges, the dean replied that the school would no longer help her with the investigation, nor give her any money towards the stolen laptop. (Supposedly the school was at least partially at fault since they knew the locks on the room needed to be replaced but had not replaced them.) In the end, the student, along with the security officer, and Innocent’s guardian went to the dean’s house. They managed to agree to release him for his exams but he was supposed to return for “questioning” on Thursday. Monday morning, a relative called me to let me know they had released Innocent at 6am. He left the police station and went directly to sit for his exams. I talked to him to him Monday night he sounded sad and tired, and said, “I don’t want to go back.”
Thursday night I had dinner with a group of visiting Americans, they had invited me and a Malawian priest to join them. Our hosts introduced the priest to me as THE spokesperson of the Malawian religious community to the government. Over the course of the evening his passion shone through as he told story after story of his years of advocacy work. Just as he was about to bid everyone goodnight, I told him about Innocent and asked if he knew someone who might be able to help. He made a phone call, quickly explained the story to the person on the other end in Chichewa, and then as he handed me the phone said, “This is the former Attorney General of Malawi.” That knocked the breath out of me. The former Attorney General said he would look into it and took Innocent’s contact information. My fingers are crossed.
Sunday morning, June 25th Innocent’s family called me saying that he had been arrested, had been beaten, and was being held in the main police station. Due to other unforeseen events I didn’t arrive at their house until 3:45pm at which time they told me the station would close at 4. I rushed to the station with a relative and luckily found it open. The police led us to Innocent. They were keeping him in an outside partially covered courtyard, along with two other prisoners, a man and a woman. All three of them looked haggard, cold, with bare feet, and they huddled together on a cement step (winter has arrived in Lilongwe bringing cool night temperatures of about 50 degrees F). Innocent told me that he was accused of stealing the laptop of a foreign student. (His guardian is the housemother at the dormitory of the nursing college and so she lives with her family in a small home built into the dorm.) The student reported a missing laptop and the campus security officer said someone told him that they saw Innocent leaving the building with a bag. Innocent said he did have a bag but that it just contained his books and nothing more. He said at the time of the robbery he was playing darts with friends. He told me that the police had been beating him with a gun. The remainder of my evening was spent trying to find a way to get him out.
First, we went to the arresting officer’s home, who I had been told, had the authority to release Innocent. My biased impression of him was that of a crooked little man with a Napoleon complex; he wanted me to pay him personally the price of the laptop 1,200 British pounds to release Innocent (right). I went to talk to the student, who was quite disturbed by the turn of events but when she asked the college dean what would happen if she dropped the charges, the dean replied that the school would no longer help her with the investigation, nor give her any money towards the stolen laptop. (Supposedly the school was at least partially at fault since they knew the locks on the room needed to be replaced but had not replaced them.) In the end, the student, along with the security officer, and Innocent’s guardian went to the dean’s house. They managed to agree to release him for his exams but he was supposed to return for “questioning” on Thursday. Monday morning, a relative called me to let me know they had released Innocent at 6am. He left the police station and went directly to sit for his exams. I talked to him to him Monday night he sounded sad and tired, and said, “I don’t want to go back.”
Thursday night I had dinner with a group of visiting Americans, they had invited me and a Malawian priest to join them. Our hosts introduced the priest to me as THE spokesperson of the Malawian religious community to the government. Over the course of the evening his passion shone through as he told story after story of his years of advocacy work. Just as he was about to bid everyone goodnight, I told him about Innocent and asked if he knew someone who might be able to help. He made a phone call, quickly explained the story to the person on the other end in Chichewa, and then as he handed me the phone said, “This is the former Attorney General of Malawi.” That knocked the breath out of me. The former Attorney General said he would look into it and took Innocent’s contact information. My fingers are crossed.
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