Friday, November 30, 2007
Last Day
Yesterday was my last day at Bottom. It was as I anticipated - just another day. I conducted one vacuum delivery and two normal deliveries. I sat and talked with and rubbed the back of a frightened 19-year-old as she labored. I helped resuscitate two babies. No one remembered that it was my last day except Msiska. She told me they’ll miss my skills. “Any time there is an asphyxiated baby we always wish you were here,” she said. She said she will miss my presence and my friendship. I bought a cake and it was eaten. After three years at Bottom I know, without self pity or drama that my presence had the minimal impact of a drop of water in a pool. That does not bother me. I know it was different with the women. And, I am ready for a change. I am looking forward to the future. I’m sure someday I will return and work again in the new maternity hospital. I hope to find the conditions better. I hope I will have more to give.
Tuesday, November 20, 2007
Hassan
The quadruplets looked wonderful two weeks ago when Lisa (an Australian Pediatrician and dear friend) and I, along with a community nurse and a nutritionist visited them at home. We turned off the main road at the small green mosque and then stopped to ask directions from a neighbor who pointed toward a small mud brick house with a line of baby clothes flapping out front. We found Patuma and her mother sitting on a mat next to the quads who were all bundled in layers of blankets and covered with a single sheet. Slowly Patuma and her mother lifted each one and unwrapped them for inspection. Everyone laughed when I identified each baby by name. Happily we found that Mohammed, Hassan, Hussein, and Hamida had all gained weight. We took pictures and four of the other children joined us. The three year old twins sat in front of their mother, the little girl considering us seriously and her brother hiding behind his hands. Patuma walked us to the car and as we drove away I watched her sweep the twins into her arms and head towards home.
On November 10th Lisa told me that Hassan had been admitted to Kamuzu Central Hospital with fevers. He was the smallest of the four at birth. She said he was on several antibiotics and that they were feeding him through a nasogastric tube. She visited him daily and monitored his care. On the 12th she told me the fevers persisted. I stopped by the hospital on November 13th. When I saw Hassan in his mothers arms I tried not to appear visibly shocked. He looked like withered leaf; I could see his sutures clearly through the thin skin of his scalp – a clear sign of dehydration – and I sadly remembered Gabriel. Patuma handed him to me and as I cradled him, watching his chest rise and fall quickly, his eyes open and close slowly, she told me that he was improving. She said he was inconsolable at first but now he was quiet and eating well. I wondered if he was quiet only because the exhaustion was becoming more than his little body could bear. He made sucking movements with his mouth and I returned him to Patuma’s arms. Mildly astounded I watched him finish about 100 mililiters of formula from a cup and I felt hope rise again. I told them I would return on the 15th, I said goodbye and left.
Lisa called me on November 14th, my 32nd birthday, and told me Hassan had died at 9am. He was one month and two days old.
On November 10th Lisa told me that Hassan had been admitted to Kamuzu Central Hospital with fevers. He was the smallest of the four at birth. She said he was on several antibiotics and that they were feeding him through a nasogastric tube. She visited him daily and monitored his care. On the 12th she told me the fevers persisted. I stopped by the hospital on November 13th. When I saw Hassan in his mothers arms I tried not to appear visibly shocked. He looked like withered leaf; I could see his sutures clearly through the thin skin of his scalp – a clear sign of dehydration – and I sadly remembered Gabriel. Patuma handed him to me and as I cradled him, watching his chest rise and fall quickly, his eyes open and close slowly, she told me that he was improving. She said he was inconsolable at first but now he was quiet and eating well. I wondered if he was quiet only because the exhaustion was becoming more than his little body could bear. He made sucking movements with his mouth and I returned him to Patuma’s arms. Mildly astounded I watched him finish about 100 mililiters of formula from a cup and I felt hope rise again. I told them I would return on the 15th, I said goodbye and left.
Lisa called me on November 14th, my 32nd birthday, and told me Hassan had died at 9am. He was one month and two days old.
Wednesday, October 24, 2007
Shortage of Hands
Today I walked into the labor ward to find Msiska alone with all 14 beds full and women lined up on the benches. She laughed, twirled her arms over her head and said, "Welcome, my friend." When I asked, "Who is working with you?" She said, "You are. Aren't you here?" Where to start?! Six of the 14 women had not been examined at all, a few others had been transferred from clinics due to prolonged labor but hours later they continued to moan and shift on the beds, their IV lines clogged. After the morning rounds finished the situation improved somewhat, the clinical officer, medical intern, nursing students, a medical student from Holland, and a general physician from Palestine joined the fray. By the time I left at 1:30 I had conducted one vacuum extraction, had assisted with two others, diagnosed an IUD (intrauterine demise), initiated the resuscitation of two babies, and examined a handful of patients. I had passed through the full range of emotions, walked several kilometers, discussed the effect of American/Bush's politics on the world with Ahmed, laughed with Elske about a patient calling her Oscar, and visited the quadruplets. Msiska said, "Some day I will write an article about working at Bottom - sometimes you cry, sometimes you laugh." "Sometimes you laugh so that you don't cry," I added (we all laughed). I told her this is not an article but a book. I had to leave for work at the Embassy in the afternoon but patients and referrals continued to arrive. I told Msiska we'd meet tomorrow, "I will have drowned by then," she laughed.
Monday, October 22, 2007
Angels
Sunday morning I went to Bottom. I don’t usually work on the weekends but Friday my friend Msiska said she would have to work 12 straight days because of the shortage of nurses so I volunteered to come in for her. Saturday she sent me a text at 5:30 saying it was a horrible day, at the end of the day they had a stuck breech and the baby died. The whole of last week was bad, I resuscitated several babies who died, there were several severely asphyxiated babies, and there were several very premature deliveries. A cord prolapse that I assisted with was the one significant happy ending – they were twins and the presenting little girl needed some resuscitation but her condition improved quickly.
Sunday morning I arrived at 7:35, grateful to see that the ward was not full. The clinical officer and nurse were busy doing a vacuum extraction and she quickly told me that there was a delivery in progress on the next bed. I rushed to put on gloves and found Yasintha lying on her back with her knees pulled to her shoulders and a palm-sized portion of her baby’s head crowning. I quickly noted the vacuum sitting on the corner of her bed and took it as a sign that this was either a very prolonged second stage or that there had been fetal distress or both but for some reason – probably the neighbor requiring urgent attention - the intervention was not done. I watched Yasintha struggle through two contractions without moving the head any further then grabbed lignocaine and scissors and cut a small episiotomy. Yasintha pushed her baby out into my hands at 7:42, I clamped and cut the cord and rushed him to the resuscitare.
The boy lies flat at first but then, after several minutes, he blinks and begins moving his arms in wide slow circles. When I tilt him upright his eyes open like a doll’s but he is not breathing. I ask the other nurse to draw up some glucose and I give it to him through his cord. I continue with the bagging. Other staff arrive and greet me warmly, “Mwadzuka bwanji?” “So, we’re together today, great.” No one pays much attention to the baby as I bag it. It is not an unusual scene, me standing at the resuscitare over a limp baby first thing in the morning. I am so tired of this. My heart is tired, and what about the mother? She is now silent behind closed curtains. This is her first baby; does she know what is happening? Is she fearful or exhausted? Does she realize now that her baby may die or that if he survives he may have severe developmental problems? I blink away a few tears and consciously pull my thoughts away. I think of Clement in Ghana, we talked last night, he said he is losing weight, his classes are far apart and they last all day, he is walking constantly and not eating much. His trousers fall from his hips even with the belt cinched to the smallest notch. The baby kicks at my hands. He is still not breathing. I hold him up to the heat, he blinks, I plead with him softly, he still does not breathe. I plead with God. Yesterday Effie and I went shopping for zitengi in the market. For a Malawian wedding the couple is supposed to select an African cloth and then people will buy the fabric and have clothes made from it for the day of the wedding. We chose three different cloths, next weekend when we visit Mangochi we will see which is most readily available there and make the final decision. It feels good to have accomplished something. We only have ten weeks remaining before the wedding.
The woman in the bed closest to the resuscitare calls to me in pain, I look up and she says, “Come here.” She can see me with this baby but her baby is close now, her entire body involuntarily contracting to push her out. She needs hands to catch her daughter. I am the only one she can see. The little boy’s heart beats strongly but he only takes an occasional gasp – nothing very hopeful. I think about when I should stop, it has been 40 minutes, I will continue for an hour. It is a horrible torture to be the one who must decide when to stop. One hour passes. I am not ready to stop, maybe two hours. The woman at the near bed has delivered; a midwife arrived just in time. Her daughter lies wrapped in a cloth in her arms, the mother is quiet. I hold the boy again to the warmer. Watching his abdomen I see shallow breaths, he blinks. I stand over him now, caressing his forehead he breathes like a sleeping baby. After a few minutes I take him to his mother. She is asleep and I wake her to see the baby and tell her I will take him to the nursery. She looks concerned, “He hasn’t cried?” “No, he hasn’t.” According to her chart, Yasintha was tranferred hours ago for prolonged labor. I place the baby in his own cart in the nursery and explain the situation to the nurses.
There are two nurses working in the nursery, they are the same experienced nurses who worked all week. They will retire soon. Tereza walks me around the nursery. She says there are now twelve babies depending on formula. There are the quadruplets, a set of triplets, twins whose mother died, a singleton whose mother is suffering from postpartum psychosis, and two others whose mothers are severely ill. She is changing and weighing the quadruplets as she talks, she says the father and an elder from the mosque came and held a naming ceremony. They are now Mohammed, Hussain, Hassan, and Hamida. Hassan smiles periodically in his sleep, Tereza laughs and asks him, “Are you seeing angels now and then?” She says they are losing weight but their condition is good the only problem is that the mother wants to return home. It is planting season and the garden is waiting. The four will not survive if she takes them now. Tereza tells me that the triplets are in the kangaroo room (where the mothers wrap their babies tightly to their chests) she says they are not gaining weight yet but they are strong and clever, she says they will survive.
At the end of the day I return to see the boy. I find his mother sitting on the floor watching other mothers express their breastmilk by hand into small medicine cups. Her baby is screaming, his hands clasped into tight fists, he kicks and punches with what would be fury if her were older. I pick him up and try to soothe him. I tell his mother he is hungry. I know this cry; it is the cry of a baby who has suffered oxygen deprivation. I hold him while she works at expressing her milk. The milk has not yet come in, she manages to catch only two or three drops. I place him back in the cart he now shares with a premature boy who lies quietly, his thin arm resting over his eyes like an old man. We all need more angels.
Sunday morning I arrived at 7:35, grateful to see that the ward was not full. The clinical officer and nurse were busy doing a vacuum extraction and she quickly told me that there was a delivery in progress on the next bed. I rushed to put on gloves and found Yasintha lying on her back with her knees pulled to her shoulders and a palm-sized portion of her baby’s head crowning. I quickly noted the vacuum sitting on the corner of her bed and took it as a sign that this was either a very prolonged second stage or that there had been fetal distress or both but for some reason – probably the neighbor requiring urgent attention - the intervention was not done. I watched Yasintha struggle through two contractions without moving the head any further then grabbed lignocaine and scissors and cut a small episiotomy. Yasintha pushed her baby out into my hands at 7:42, I clamped and cut the cord and rushed him to the resuscitare.
The boy lies flat at first but then, after several minutes, he blinks and begins moving his arms in wide slow circles. When I tilt him upright his eyes open like a doll’s but he is not breathing. I ask the other nurse to draw up some glucose and I give it to him through his cord. I continue with the bagging. Other staff arrive and greet me warmly, “Mwadzuka bwanji?” “So, we’re together today, great.” No one pays much attention to the baby as I bag it. It is not an unusual scene, me standing at the resuscitare over a limp baby first thing in the morning. I am so tired of this. My heart is tired, and what about the mother? She is now silent behind closed curtains. This is her first baby; does she know what is happening? Is she fearful or exhausted? Does she realize now that her baby may die or that if he survives he may have severe developmental problems? I blink away a few tears and consciously pull my thoughts away. I think of Clement in Ghana, we talked last night, he said he is losing weight, his classes are far apart and they last all day, he is walking constantly and not eating much. His trousers fall from his hips even with the belt cinched to the smallest notch. The baby kicks at my hands. He is still not breathing. I hold him up to the heat, he blinks, I plead with him softly, he still does not breathe. I plead with God. Yesterday Effie and I went shopping for zitengi in the market. For a Malawian wedding the couple is supposed to select an African cloth and then people will buy the fabric and have clothes made from it for the day of the wedding. We chose three different cloths, next weekend when we visit Mangochi we will see which is most readily available there and make the final decision. It feels good to have accomplished something. We only have ten weeks remaining before the wedding.
The woman in the bed closest to the resuscitare calls to me in pain, I look up and she says, “Come here.” She can see me with this baby but her baby is close now, her entire body involuntarily contracting to push her out. She needs hands to catch her daughter. I am the only one she can see. The little boy’s heart beats strongly but he only takes an occasional gasp – nothing very hopeful. I think about when I should stop, it has been 40 minutes, I will continue for an hour. It is a horrible torture to be the one who must decide when to stop. One hour passes. I am not ready to stop, maybe two hours. The woman at the near bed has delivered; a midwife arrived just in time. Her daughter lies wrapped in a cloth in her arms, the mother is quiet. I hold the boy again to the warmer. Watching his abdomen I see shallow breaths, he blinks. I stand over him now, caressing his forehead he breathes like a sleeping baby. After a few minutes I take him to his mother. She is asleep and I wake her to see the baby and tell her I will take him to the nursery. She looks concerned, “He hasn’t cried?” “No, he hasn’t.” According to her chart, Yasintha was tranferred hours ago for prolonged labor. I place the baby in his own cart in the nursery and explain the situation to the nurses.
There are two nurses working in the nursery, they are the same experienced nurses who worked all week. They will retire soon. Tereza walks me around the nursery. She says there are now twelve babies depending on formula. There are the quadruplets, a set of triplets, twins whose mother died, a singleton whose mother is suffering from postpartum psychosis, and two others whose mothers are severely ill. She is changing and weighing the quadruplets as she talks, she says the father and an elder from the mosque came and held a naming ceremony. They are now Mohammed, Hussain, Hassan, and Hamida. Hassan smiles periodically in his sleep, Tereza laughs and asks him, “Are you seeing angels now and then?” She says they are losing weight but their condition is good the only problem is that the mother wants to return home. It is planting season and the garden is waiting. The four will not survive if she takes them now. Tereza tells me that the triplets are in the kangaroo room (where the mothers wrap their babies tightly to their chests) she says they are not gaining weight yet but they are strong and clever, she says they will survive.
At the end of the day I return to see the boy. I find his mother sitting on the floor watching other mothers express their breastmilk by hand into small medicine cups. Her baby is screaming, his hands clasped into tight fists, he kicks and punches with what would be fury if her were older. I pick him up and try to soothe him. I tell his mother he is hungry. I know this cry; it is the cry of a baby who has suffered oxygen deprivation. I hold him while she works at expressing her milk. The milk has not yet come in, she manages to catch only two or three drops. I place him back in the cart he now shares with a premature boy who lies quietly, his thin arm resting over his eyes like an old man. We all need more angels.
Monday, October 15, 2007
Eid Mubarrak
Patuma sat on the bench outside labor ward Thursday afternoon along with other women waiting for ultrasound scans. As I motioned her inside the scanning room I noted that the midwife had written “multiple gestation??” on the line for her most recent prenatal visit. Like most other pregnant Malawian women, Patuma was thin and sinewy but as she lifted her dress the size of her belly was so impressive, and her skin over it so taught, that it seemed almost as though a balloon had appendaged itself to her front. When I asked, Patuma said she was only eight months pregnant and that this was her fifth pregnancy. She had 5 living children, two from the previous pregnancy.
Unable to palpate much, I rolled the transducer over the gel on her belly and peered through the window it provided - definitely multiple gestation. I moved slowly in irregular circles making sure not to count the same head twice. Hesitant to tell the mother until my finding was confirmed – I called in the medical intern. He agreed - triplets. I told Patuma she had three babies; she remained quiet and looked mildly shocked. I measured each head, abdomen, and femur to approximate the estimated gestational age and size. This process took me a while as I tried to sort out the kicking rolling bodies and ensure that this leg belonged to this head. I moved back and forth over her belly and Patuma sighed under its weight. According to my scan the babies seemed to be about 32 weeks and all weighed less than two kilograms. Patuma could not remember the specific date of her last period (which would enable a more accurate calculation of the gestation) but from my experience with the women at Bottom, as they approach term, their babies’ measurements fall away from the standard indices, so it was possible that Patuma was already 35 weeks (37 weeks is considered term).
Friday morning only a few women lay on beds in the labor ward when I arrived. On the high risk side of the ward Patuma sat quietly on one bed and across from her lay another woman crying with pain. Patuma was now draining amniotic fluid and apparently in early labor though no one had thought to give her Dexamethasone (a steroid injection shown to accelerate fetal lung maturity, given when women go into preterm labor). The other woman had arrived ten days previously complaining that her current and fifth pregnancy, was overdue (pregnancies passing 42 weeks gestation carry a much higher risk of stillbirth). Although not noted, the midwife added that she had been draining amniotic fluid since admission. Glancing over her chart I saw that she had had several vaginal exams and that no one had started antibiotics. An induction had been ordered Wednesday and the first dose of medicine had been inserted, however no one had documented hearing the baby’s heart since early Wednesday. I considered these two women and felt a wave of anger and despair wash over me. I placed my fetoscope on her belly. Silence. I moved it. Silence. I brought the ultrasound machine in and found the heart, no movement. I called the medical intern. He watched the still heart. He contemplated the reason the baby died and told the mother. I wanted to walk out, go home, and crawl under the covers. Instead, Lonnie, the nursing student with Patuma asked me to come help her make an assessment.
Patuma, though quiet and not appearing to have strong contractions, complained that she needed to push. I told her to go ahead and as she lifted her chitengi I saw a head with dark wet curls emerging. Lonnie rushed to grab a delivery pack and returned in time to catch the first baby boy at 9:20. I brought the ultrasound machine to her bedside and checked the other babies. I found two heads down and a third head in the fundus! Three little hearts beat reassuringly. Patuma said she felt some relief, although still uncomfortable; she could breathe a bit better and looked forward to eating. I examined her and felt the next head almost out of reach. Her contractions spaced out. I began stimulating her nipples (this releases oxytocin, the hormone that causes uterine contractions) and scanned the three heartbeats every few minutes. She worked and waited and now and then would loose confidence. She said, “I have already gone through so much and after this next one there will still be another, I can’t do this.” I told the student but did not tell her she still had three babies inside.
After about 40 minutes of anxious watching, assessing, encouraging, stimulating nipples, and silent praying, I felt the next head settle into her pelvis and we ruptured the membranes. At 10:30 the second little boy arrived. Again we dried her bed, I scanned and examined her. She laughed lightly and told Lonnie we would each have to take a baby home because she had only wanted one. When we asked about her husband’s reaction she said he hadn’t said much but she was not worried because he is usually able to provide for the children. At 11:25 I caught the third boy. As I gave the little one some oxygen, the student examined Patuma and said she could not feel the next baby. I repeated the exam and felt a hand and a foot floating high inside. I called Chikoti, one of the experienced clinical officers, and asked him to put on gloves. He instructed me to rupture the membranes, reach inside, and grab the feet. After explaining the situation to Patuma, I reached in, broke the bag and found a single foot, which I pulled down to where it was visible. Chikoti then helped bring it the rest of the way and as a small crowd of students encouraged Patuma, I assisted her little girl out. 11:55am. At the resuscitare I gave the girl some oxygen, examined her, weighed her and placed her among her brothers. They weighed 1.8kg, 1.6kg, 1.4kg, and 1.5kgs.
The nursing matron helped make the bed and dress Patuma, and then called the newspaper. Shortly thereafter a female journalist arrived at her bedside. I stood directly across with the other woman who still labored with her dead baby. No curtain hung in-between. Patuma and the journalist chatted and laughed softly. The other woman cried, “I’m sorry. I’m sorry. Please take me for a c-section,” moving from her back to her knees, pushing, straining, crying, pleading. I felt the head low in her vagina; her cervix was completely dilated. Her contractions were weak and infrequent but no one wanted to give her pitocin for fear of rupturing her uterus. I stimulated her nipples. We brought over the vacuum to assist, but the pressure gauge would not work and we could not maintain enough suction. At 4:15pm I called Chikoti he said he would come. A screen was located and placed between Patuma and the other woman. I walked to the nursery to see the quadruplets and to restore some joy, then exhausted I left.
This morning I stopped by Bottom to see the babies; they looked pink and peaceful in their single cart. Patuma was all smiles.
Unable to palpate much, I rolled the transducer over the gel on her belly and peered through the window it provided - definitely multiple gestation. I moved slowly in irregular circles making sure not to count the same head twice. Hesitant to tell the mother until my finding was confirmed – I called in the medical intern. He agreed - triplets. I told Patuma she had three babies; she remained quiet and looked mildly shocked. I measured each head, abdomen, and femur to approximate the estimated gestational age and size. This process took me a while as I tried to sort out the kicking rolling bodies and ensure that this leg belonged to this head. I moved back and forth over her belly and Patuma sighed under its weight. According to my scan the babies seemed to be about 32 weeks and all weighed less than two kilograms. Patuma could not remember the specific date of her last period (which would enable a more accurate calculation of the gestation) but from my experience with the women at Bottom, as they approach term, their babies’ measurements fall away from the standard indices, so it was possible that Patuma was already 35 weeks (37 weeks is considered term).
Friday morning only a few women lay on beds in the labor ward when I arrived. On the high risk side of the ward Patuma sat quietly on one bed and across from her lay another woman crying with pain. Patuma was now draining amniotic fluid and apparently in early labor though no one had thought to give her Dexamethasone (a steroid injection shown to accelerate fetal lung maturity, given when women go into preterm labor). The other woman had arrived ten days previously complaining that her current and fifth pregnancy, was overdue (pregnancies passing 42 weeks gestation carry a much higher risk of stillbirth). Although not noted, the midwife added that she had been draining amniotic fluid since admission. Glancing over her chart I saw that she had had several vaginal exams and that no one had started antibiotics. An induction had been ordered Wednesday and the first dose of medicine had been inserted, however no one had documented hearing the baby’s heart since early Wednesday. I considered these two women and felt a wave of anger and despair wash over me. I placed my fetoscope on her belly. Silence. I moved it. Silence. I brought the ultrasound machine in and found the heart, no movement. I called the medical intern. He watched the still heart. He contemplated the reason the baby died and told the mother. I wanted to walk out, go home, and crawl under the covers. Instead, Lonnie, the nursing student with Patuma asked me to come help her make an assessment.
Patuma, though quiet and not appearing to have strong contractions, complained that she needed to push. I told her to go ahead and as she lifted her chitengi I saw a head with dark wet curls emerging. Lonnie rushed to grab a delivery pack and returned in time to catch the first baby boy at 9:20. I brought the ultrasound machine to her bedside and checked the other babies. I found two heads down and a third head in the fundus! Three little hearts beat reassuringly. Patuma said she felt some relief, although still uncomfortable; she could breathe a bit better and looked forward to eating. I examined her and felt the next head almost out of reach. Her contractions spaced out. I began stimulating her nipples (this releases oxytocin, the hormone that causes uterine contractions) and scanned the three heartbeats every few minutes. She worked and waited and now and then would loose confidence. She said, “I have already gone through so much and after this next one there will still be another, I can’t do this.” I told the student but did not tell her she still had three babies inside.
After about 40 minutes of anxious watching, assessing, encouraging, stimulating nipples, and silent praying, I felt the next head settle into her pelvis and we ruptured the membranes. At 10:30 the second little boy arrived. Again we dried her bed, I scanned and examined her. She laughed lightly and told Lonnie we would each have to take a baby home because she had only wanted one. When we asked about her husband’s reaction she said he hadn’t said much but she was not worried because he is usually able to provide for the children. At 11:25 I caught the third boy. As I gave the little one some oxygen, the student examined Patuma and said she could not feel the next baby. I repeated the exam and felt a hand and a foot floating high inside. I called Chikoti, one of the experienced clinical officers, and asked him to put on gloves. He instructed me to rupture the membranes, reach inside, and grab the feet. After explaining the situation to Patuma, I reached in, broke the bag and found a single foot, which I pulled down to where it was visible. Chikoti then helped bring it the rest of the way and as a small crowd of students encouraged Patuma, I assisted her little girl out. 11:55am. At the resuscitare I gave the girl some oxygen, examined her, weighed her and placed her among her brothers. They weighed 1.8kg, 1.6kg, 1.4kg, and 1.5kgs.
The nursing matron helped make the bed and dress Patuma, and then called the newspaper. Shortly thereafter a female journalist arrived at her bedside. I stood directly across with the other woman who still labored with her dead baby. No curtain hung in-between. Patuma and the journalist chatted and laughed softly. The other woman cried, “I’m sorry. I’m sorry. Please take me for a c-section,” moving from her back to her knees, pushing, straining, crying, pleading. I felt the head low in her vagina; her cervix was completely dilated. Her contractions were weak and infrequent but no one wanted to give her pitocin for fear of rupturing her uterus. I stimulated her nipples. We brought over the vacuum to assist, but the pressure gauge would not work and we could not maintain enough suction. At 4:15pm I called Chikoti he said he would come. A screen was located and placed between Patuma and the other woman. I walked to the nursery to see the quadruplets and to restore some joy, then exhausted I left.
This morning I stopped by Bottom to see the babies; they looked pink and peaceful in their single cart. Patuma was all smiles.
An Encounter
Two weeks ago as I was walking up the street from Bottom I noticed a woman also walking in the same direction struggling with her two year old who fought in her arms kicking and screaming. I gave her a small smile and as we walked side by side for a pace she held him out to me saying, "Mzungo, tengani mwana ali mavuto kwambiri." (Take this child he is such a problem.) She passed him to me and I carried him on my hip a few paces. Startled mute he stared at me in shock, everyone around us broke into laughter, and he remained quiet even after I passed him back.
Tuesday, September 18, 2007
A Joyful Home
I met Martin three weeks ago. He was standing outside Shoprite (the South African grocery store chain) holding a thin stack of papers. As I was pulling out of the parking lot he approached my window and timidly said, “Excuse me I’m looking for a well-wisher.” I eyed him suspiciously and asked what he meant. He explained that he was looking for someone to pay his school fees. He had been accepted into a program at the Natural Resource College but had no one to pay his fees. His father is a farmer in the South, his mother died last year. He is one of 9 and has only one employed brother who is a primary school teacher. I told him to meet me at Bottom later in the week.
I thought about Martin occasionally during following days and decided without much debate that I would find a way to pay his fees. From our three minute conversation I had strong sense that he would excel if offered the opportunity. On Thursday afternoon Martin arrived at Bottom still carrying copies of his final grades, the results of the MSCE (the national test taken after high school), his acceptance letter from NRC, and a form listing the fees. We had planned to meet at 4:30, when the shift at Bottom ends, but on Thursday just after 4pm – as it often does – everything happened at once – hemorrhages, births, resuscitations so I walked out into the dark at 5:30 to find Martin waiting for me on the curb near my car.
We stopped by the bank and then I drove him home to the one bedroom house he shares with his brother, his brother’s wife and their three children. After a few minutes we all began to relax. Laston teased Martin and his wife, everyone laughed easily. Rosemary added to the conversation from the kitchen while cooking fish and nsima. Three year-old Roseby fell asleep on her dad’s lap before dinner. I left two hours later.
Saturday I returned to their house to check in with Martin about his first week and to give him the rest of the money for fees. He said it was a good start, he is getting used to the 7 kilometer bike ride he must make twice a day but it doesn’t leave him much time to visit the library and there are no books to take home. I promised that I would do everything possible to find funds for boarding next term (day classes are US$325/term while boarding is US$740/term).
I happened to have my computer in the car so we looked at pictures of the US and then Malawi, we all agreed that Malawi is a beautiful country. Martin and Laston have never been to the lake so we decided to make a trip in December. I laughed so much that my cheeks hurt (a rare feeling) and I left their house feeling light and happy. The kept telling me how grateful they are for my assistance to Martin but I feel equally blessed to have met them.
I thought about Martin occasionally during following days and decided without much debate that I would find a way to pay his fees. From our three minute conversation I had strong sense that he would excel if offered the opportunity. On Thursday afternoon Martin arrived at Bottom still carrying copies of his final grades, the results of the MSCE (the national test taken after high school), his acceptance letter from NRC, and a form listing the fees. We had planned to meet at 4:30, when the shift at Bottom ends, but on Thursday just after 4pm – as it often does – everything happened at once – hemorrhages, births, resuscitations so I walked out into the dark at 5:30 to find Martin waiting for me on the curb near my car.
We stopped by the bank and then I drove him home to the one bedroom house he shares with his brother, his brother’s wife and their three children. After a few minutes we all began to relax. Laston teased Martin and his wife, everyone laughed easily. Rosemary added to the conversation from the kitchen while cooking fish and nsima. Three year-old Roseby fell asleep on her dad’s lap before dinner. I left two hours later.
Saturday I returned to their house to check in with Martin about his first week and to give him the rest of the money for fees. He said it was a good start, he is getting used to the 7 kilometer bike ride he must make twice a day but it doesn’t leave him much time to visit the library and there are no books to take home. I promised that I would do everything possible to find funds for boarding next term (day classes are US$325/term while boarding is US$740/term).
I happened to have my computer in the car so we looked at pictures of the US and then Malawi, we all agreed that Malawi is a beautiful country. Martin and Laston have never been to the lake so we decided to make a trip in December. I laughed so much that my cheeks hurt (a rare feeling) and I left their house feeling light and happy. The kept telling me how grateful they are for my assistance to Martin but I feel equally blessed to have met them.
Suggestion for the EU
Bottom continues much as it has the whole time I have been here. Two weeks ago I had one day during which I attended 9 deliveries. That day we were particularly short-staffed - just two nurses - and there were a few hours during which I was alone with four students and 14 laboring women. In general, most development organizations are focused on capacity building and training; less on salaries/staffing/recruiting/retention of staff. With money spent in this way the few nurses and clinicians assigned to maternity (of course it is the same in all medical wards) rotate through one training program after another to improve their individual skill sets. There is a great deal of repetition among the topics but each organization teaches a slightly different protocol. As a result, I notice that people often revert to their own “non-standardized” techniques as soon as the trainings are completed. I do not believe training and capacity building are unnecessary, but with this as the primary approach the situation becomes almost comic. We can talk about monitoring labor and managing emergencies but when you walk into a labor ward and see two nurses with 14 patients, there is no feasible way all 14 women will receive good care, even if the nurses run frantically between the beds all day.
Last week while driving I heard a story on BBC Africa about the EU’s creation of Blue Cards. Apparently, with the aging of the European work force and the declining birth rates in many European countries it has been determined that Europe will need to attract skilled workers in order to support and build its economy. The Blue Card scheme (modeled after the US’s Green Card) will facilitate the entrance of skilled workers from Africa and Asia. While listening I was grateful that the interviewer shared my sentiment – WHAT ABOUT AFRICA AND ASIA?!!!!! - but despite his repeated attempts to engage the interviewee, that question passed unanswered.
How can we – the global community, especially the western world – consider ourselves proponents of human rights on one hand while with the other we skillfully divert the few resources (human in this case) away from the poorest of the world? How can we talk about improving access to health care and education via our development institutions and hope to be believed? In truth, what we are saying with these policies is that we will consider caring as long as it is not an inconvenience to us. Lucky for the wealthy, the poor are in general a silent group; unless you stand by their bedside you won’t hear their cries. Right now, in Malawi, we have a physician to population ratio of 1:6,500. Even with rocket boosters on their heels, the impact of training and capacity building will be limited.
I have another thought – perhaps a brilliant solution. I am just remembering another BBC story about training individuals with lower levels of education, skills that are normally provided by highly educated individuals. There are many examples of this in the health care sector in Africa, for example small shop owners in rural areas are taught how to diagnose common illnesses and to prescribe the correct medications. Ok, here’s the idea . . . why don’t we allow the unemployed unskilled people who are literally dying to get into Europe in, with these Blue Cards and train them to do these skilled jobs there. This way we are providing training, capacity building, and employment opportunities for many would remain unemployed in Africa and Asia, we are adding to the European work force, and we are not stealing doctors, nurses, or other “best and brightest” individuals away from their home countries where they are most needed.
Last week while driving I heard a story on BBC Africa about the EU’s creation of Blue Cards. Apparently, with the aging of the European work force and the declining birth rates in many European countries it has been determined that Europe will need to attract skilled workers in order to support and build its economy. The Blue Card scheme (modeled after the US’s Green Card) will facilitate the entrance of skilled workers from Africa and Asia. While listening I was grateful that the interviewer shared my sentiment – WHAT ABOUT AFRICA AND ASIA?!!!!! - but despite his repeated attempts to engage the interviewee, that question passed unanswered.
How can we – the global community, especially the western world – consider ourselves proponents of human rights on one hand while with the other we skillfully divert the few resources (human in this case) away from the poorest of the world? How can we talk about improving access to health care and education via our development institutions and hope to be believed? In truth, what we are saying with these policies is that we will consider caring as long as it is not an inconvenience to us. Lucky for the wealthy, the poor are in general a silent group; unless you stand by their bedside you won’t hear their cries. Right now, in Malawi, we have a physician to population ratio of 1:6,500. Even with rocket boosters on their heels, the impact of training and capacity building will be limited.
I have another thought – perhaps a brilliant solution. I am just remembering another BBC story about training individuals with lower levels of education, skills that are normally provided by highly educated individuals. There are many examples of this in the health care sector in Africa, for example small shop owners in rural areas are taught how to diagnose common illnesses and to prescribe the correct medications. Ok, here’s the idea . . . why don’t we allow the unemployed unskilled people who are literally dying to get into Europe in, with these Blue Cards and train them to do these skilled jobs there. This way we are providing training, capacity building, and employment opportunities for many would remain unemployed in Africa and Asia, we are adding to the European work force, and we are not stealing doctors, nurses, or other “best and brightest” individuals away from their home countries where they are most needed.
Personal Updates
Clement is now gone. He left for Ghana on August 16th and so we are already one month closer to our reunion. As for my prospects there, it seems that midwives are in great demand so I have already been told that it will be very easy for me to get a job in the hospital or even as a lecturer at the University, the only problem is that the salaries hover somewhere around $500/mo. We have received about half of Clement's tuition for this year, for which we are incredibly grateful, and our search for funding continues.
Clement started classes a couple weeks ago and has made a few friends. He says Kumasi is beautiful, green, hot, and busy. He is not such a big fan of the food but personally I’m excited about the spicy stews and fufu. We talk for a few minutes a couple times a week; it’s never enough. I’m eager for December and I am trying to remember that four months is not an eternity.
We have set the wedding date for December 29th, the middle of the rainy season. It will be held in the village where Clement’s paternal grandmother lives. My parents will come. Clement’s dad has promised to buy a cow. I could never visualize myself with the typical wedding but now this picture . . . drums, rain, mud, feasting, dancing, my parents, hundreds of villagers, friends, and my beloved, seems perfect.
After Clement left I got pneumonia. I never had a fever just a persistent worsening cough. I finally realized that I needed treatment when walking ten feet made my heart race and left me short of breath. It took me a couple weeks but I am now finally back to my usual routine with my usual energy/fatigue.
Clement started classes a couple weeks ago and has made a few friends. He says Kumasi is beautiful, green, hot, and busy. He is not such a big fan of the food but personally I’m excited about the spicy stews and fufu. We talk for a few minutes a couple times a week; it’s never enough. I’m eager for December and I am trying to remember that four months is not an eternity.
We have set the wedding date for December 29th, the middle of the rainy season. It will be held in the village where Clement’s paternal grandmother lives. My parents will come. Clement’s dad has promised to buy a cow. I could never visualize myself with the typical wedding but now this picture . . . drums, rain, mud, feasting, dancing, my parents, hundreds of villagers, friends, and my beloved, seems perfect.
After Clement left I got pneumonia. I never had a fever just a persistent worsening cough. I finally realized that I needed treatment when walking ten feet made my heart race and left me short of breath. It took me a couple weeks but I am now finally back to my usual routine with my usual energy/fatigue.
Manliness
Last weekend I visited a friend. When I saw her the previous week, she was recovering from malaria. This week as I got out of the car I noticed that her entire face was swollen. L is an extremely jovial person by nature despite the many tragedies that have scarred her life. Normally her eyes sparkle while she talks and punctuates her stories with laughter. Today when I asked her what happened she looked down and quietly said that her young brother beat her up. Her mother died some years ago and now both she and her brother live with their father. L is near 30 she was married and home raising her two children but after the death of her husband, she moved back with her father, and started school again. She is now one year away from her goal of finishing high school. Her 19-year-old brother dropped out of school after 6th grade, he is unemployed and according to L he passes time drinking and causing disturbances. Apparently their fight began when she put her body between his fists and her children.
While we were talking she pointed him out as one of two boys who stood talking a short distance in front of us. He was standing near my car and I asked her if she’d like me to run him over. She gave a weak smile and shook her head. I could feel my blood pressure rising as I watched him – still a child in appearance – approach a friend with a cocky swagger.
She said this was the second incident. The first time, he threw burning coals at her. I asked her if she wanted to call the police. In halting English she explained that it was very possible that the police would beat him to a state near death; this was a family matter; it was better that she just find another house and move. Of course that requires money which she doesn’t have. Her father won’t intervene because he considers her and her children a burden. Actually what she said with a shake of her head, when I asked if her father would help was, “He’s a man.” She used the same phrase when talking about her brother’s abusive behavior. I understand that L’s family is poor. I understand that her brother even with a high school education, would have minimal employment opportunities, and little hope of rising from the endemic poverty that defines his life. I understand that the system he was born into is structured to guarantee struggle rather than survival. I can understand that whether recognized consciously or experientially this social emasculation breeds anger. But, I cannot accept that this anger effects the concept of manliness such that the defining trait becomes physical strength and ability to force others into submission.
From L’s home I went to visit another girl whose baby I delivered two years ago. She is now 20 and over the past years has lived with three different relatives, all barely older than herself, all orphans with low levels of education, all with their own children to support, all finding her - at times - too much of a burden. That Saturday we met at her cousin E’s house. E is now 24, she has two children, no parents, and no high school diploma (I’m not sure if she has a junior high school certificate). M and I chatted and played with her son while waiting for E who also wanted to see me. Within 30 minutes E arrived wearing a strapless open-back shirt and glittering make-up in the company of three men who all drank beer out of opaque water bottles. E sat in a chair opposite me smiling warmly but looking visibly uncomfortable. The oldest of the three men engaged me in conversation; in a confident tone with polished English he told me about his job, his studies and his travel experiences in Europe. After a few minutes M abruptly stood and led me outside. She said she had not wanted to tell me because she didn’t think I would believe her, but she was glad that I could now see with my own eyes. M said she would not prostitute herself; she said when there is no food she doesn’t eat and her thin body corroborated her statement. E soon joined us outside; rushing to express bubbling emotions with her limited English she tripped over words for a few moments, then shrugged her shoulders sadly and said, “It’s a problem.” I just hugged her. Starvation is not a viable option.
After leaving I drove to Foodsworths to buy some bread and eggs. Foodsworths is a small grocery that carries many items which are otherwise difficult to find in Malawi (e.g.cake mix, oreos, sushi wrap) as well as common items. By western standards the grocery is quite basic, but on that Saturday morning it struck me as flagrantly extravagant. Expatriate families wandered the four aisles casually chatting and filling grocery carts with a sampling from the shelves. I bought a dozen eggs, flowers, and a loaf of bread. For hours afterwards I felt guilty about the dozen roses for which I paid $3. I felt exhausted, struggling in the middle, so aware of my privilege, my inadequacies, my fears, my desires to cling to comfort, my longing for joy not just for myself but also for L and M and E.
A few days later M called to tell me that E wants to start a small business but she has no capital and only an idea of what she might do. Tomorrow I will meet with a Malawian woman who used to run a vocational training center for former prostitutes.
While we were talking she pointed him out as one of two boys who stood talking a short distance in front of us. He was standing near my car and I asked her if she’d like me to run him over. She gave a weak smile and shook her head. I could feel my blood pressure rising as I watched him – still a child in appearance – approach a friend with a cocky swagger.
She said this was the second incident. The first time, he threw burning coals at her. I asked her if she wanted to call the police. In halting English she explained that it was very possible that the police would beat him to a state near death; this was a family matter; it was better that she just find another house and move. Of course that requires money which she doesn’t have. Her father won’t intervene because he considers her and her children a burden. Actually what she said with a shake of her head, when I asked if her father would help was, “He’s a man.” She used the same phrase when talking about her brother’s abusive behavior. I understand that L’s family is poor. I understand that her brother even with a high school education, would have minimal employment opportunities, and little hope of rising from the endemic poverty that defines his life. I understand that the system he was born into is structured to guarantee struggle rather than survival. I can understand that whether recognized consciously or experientially this social emasculation breeds anger. But, I cannot accept that this anger effects the concept of manliness such that the defining trait becomes physical strength and ability to force others into submission.
From L’s home I went to visit another girl whose baby I delivered two years ago. She is now 20 and over the past years has lived with three different relatives, all barely older than herself, all orphans with low levels of education, all with their own children to support, all finding her - at times - too much of a burden. That Saturday we met at her cousin E’s house. E is now 24, she has two children, no parents, and no high school diploma (I’m not sure if she has a junior high school certificate). M and I chatted and played with her son while waiting for E who also wanted to see me. Within 30 minutes E arrived wearing a strapless open-back shirt and glittering make-up in the company of three men who all drank beer out of opaque water bottles. E sat in a chair opposite me smiling warmly but looking visibly uncomfortable. The oldest of the three men engaged me in conversation; in a confident tone with polished English he told me about his job, his studies and his travel experiences in Europe. After a few minutes M abruptly stood and led me outside. She said she had not wanted to tell me because she didn’t think I would believe her, but she was glad that I could now see with my own eyes. M said she would not prostitute herself; she said when there is no food she doesn’t eat and her thin body corroborated her statement. E soon joined us outside; rushing to express bubbling emotions with her limited English she tripped over words for a few moments, then shrugged her shoulders sadly and said, “It’s a problem.” I just hugged her. Starvation is not a viable option.
After leaving I drove to Foodsworths to buy some bread and eggs. Foodsworths is a small grocery that carries many items which are otherwise difficult to find in Malawi (e.g.cake mix, oreos, sushi wrap) as well as common items. By western standards the grocery is quite basic, but on that Saturday morning it struck me as flagrantly extravagant. Expatriate families wandered the four aisles casually chatting and filling grocery carts with a sampling from the shelves. I bought a dozen eggs, flowers, and a loaf of bread. For hours afterwards I felt guilty about the dozen roses for which I paid $3. I felt exhausted, struggling in the middle, so aware of my privilege, my inadequacies, my fears, my desires to cling to comfort, my longing for joy not just for myself but also for L and M and E.
A few days later M called to tell me that E wants to start a small business but she has no capital and only an idea of what she might do. Tomorrow I will meet with a Malawian woman who used to run a vocational training center for former prostitutes.
Tuesday, August 07, 2007
A Weekend Away
Saturday morning we set off early to Clement’s mother’s village north of Salima to attend the initiation ceremony of his stepfather as chief. We arrived in Salima by 10am and while rushing around buying sugar, salt, cooking oil, and changing money to take to the village, someone called asking for a ride to the ceremony on Sunday. In our excitement we had set off a day early. Although a bit annoyed with ourselves we decided to enjoy the extra time. We spent several hours lounging on the beach and then left for the village by mid-afternoon.
Clement’s mom, sister, grandmother welcomed us with hugs and laughter and while they prepared the grilled fish, nsima, and okra leaves for our dinner we sat with Clement’s stepdad James, drank tobwa (a fermented, but in this case non-alcoholic, drink made from sprouted maize or millet and sugar), and discussed the ceremony. Apparently when the population of a village grows past a certain point, it is common that a certain group requests to break away and become their own village. Representatives of the group approach the chief with their request and offer the name of the individual they want as their chief (either a man or a woman). If the chief approves, the request is passed on to the Traditional Authority. Once they have the approval of the TA, preparations are begun, the initiate must pass through a training and counseling process, and must arrange for the food and entertainment during the ceremony. In James’ case the process took more than a year. Every now and then my attention would drift from the conversation to the dogs chasing and wrestling each other, a little girl skipping across to her home, a man arriving with a live goat and chicken tied to his bicycle, a cat hunting flies, a girl in a green dress hopping on one foot shadowed by a little sister trying to do the same. These were sweet scenes.
It is winter now in Malawi and the sun sets early; by 6pm the only visible light came from the flickering cooking fire around which the women chatted and the children coughed. We were served dinner inside by a paraffin lantern and then Clement’s grandmother joined us to talk. The majority of what they said slipped by me but I loved watching her wrinkles gather into a conspiratory grin as she spoke and then watching them both convulse with laughter. When he translated her stories they came across more tragic than funny but I realize that transforming sad stories into entertainment is a common skill among survivors, irrespective of their cultural context. She said her house collapsed on her during the winter and now there is only one corner remaining that shelters her from the weather. She sleeps in that corner but sometimes, during a hard rain, even that corner floods and she wakes up and fetches a bucket to chase out the water. Smiling she said she is ready to die; she is ready to rest.
That night Clement and I slept in his mother’s two room hut on a grass mat on the floor. As I drifted off a group of men and a group of women took turns singing outside and I wished I had brought a tape recorder.
In the morning we took his grandmother to town to buy her shoes, a head scarf, and some other small items, we also gave her the 5,000MK (US$35) she said it would cost to build her a new sturdy house. When we returned I left Clement in the hut and wandered towards the women. I photographed them cooking, chicken, goat, nsmia, and rice in a long row of pots over open fires. They teased me and asked me to cook nsima but Clement’s relatives efficiently and repeatedly guided me away from the work towards a chair or mat.
Clement’s mom, sister, grandmother welcomed us with hugs and laughter and while they prepared the grilled fish, nsima, and okra leaves for our dinner we sat with Clement’s stepdad James, drank tobwa (a fermented, but in this case non-alcoholic, drink made from sprouted maize or millet and sugar), and discussed the ceremony. Apparently when the population of a village grows past a certain point, it is common that a certain group requests to break away and become their own village. Representatives of the group approach the chief with their request and offer the name of the individual they want as their chief (either a man or a woman). If the chief approves, the request is passed on to the Traditional Authority. Once they have the approval of the TA, preparations are begun, the initiate must pass through a training and counseling process, and must arrange for the food and entertainment during the ceremony. In James’ case the process took more than a year. Every now and then my attention would drift from the conversation to the dogs chasing and wrestling each other, a little girl skipping across to her home, a man arriving with a live goat and chicken tied to his bicycle, a cat hunting flies, a girl in a green dress hopping on one foot shadowed by a little sister trying to do the same. These were sweet scenes.
It is winter now in Malawi and the sun sets early; by 6pm the only visible light came from the flickering cooking fire around which the women chatted and the children coughed. We were served dinner inside by a paraffin lantern and then Clement’s grandmother joined us to talk. The majority of what they said slipped by me but I loved watching her wrinkles gather into a conspiratory grin as she spoke and then watching them both convulse with laughter. When he translated her stories they came across more tragic than funny but I realize that transforming sad stories into entertainment is a common skill among survivors, irrespective of their cultural context. She said her house collapsed on her during the winter and now there is only one corner remaining that shelters her from the weather. She sleeps in that corner but sometimes, during a hard rain, even that corner floods and she wakes up and fetches a bucket to chase out the water. Smiling she said she is ready to die; she is ready to rest.
That night Clement and I slept in his mother’s two room hut on a grass mat on the floor. As I drifted off a group of men and a group of women took turns singing outside and I wished I had brought a tape recorder.
In the morning we took his grandmother to town to buy her shoes, a head scarf, and some other small items, we also gave her the 5,000MK (US$35) she said it would cost to build her a new sturdy house. When we returned I left Clement in the hut and wandered towards the women. I photographed them cooking, chicken, goat, nsmia, and rice in a long row of pots over open fires. They teased me and asked me to cook nsima but Clement’s relatives efficiently and repeatedly guided me away from the work towards a chair or mat.
The ceremony itself was not very exciting my standards, mostly because I could not understand what was being said. I enjoyed watching the crowd of a few hundred people and befriended several children seated near me who evidently found my presence more captivating than that of the TA. Clement told me later that the TA spoke about the roles of the chief, the importance of humility, the need to work with the people and to serve the people, the role of the chief’s spouse, and a bit on HIV/AIDS. Money was gathered for the new chief and for the Traditional Authority, Clement’s mom and stepdad were ceremoniously guided back to their hut, and the day concluded.
I know life in the village is difficult; it is also beautiful. I am grateful for the food and love and hospitality I was offered. I appreciate the value of each gift and will continue savoring them for time to come.
Monday, August 06, 2007
Punctuation
Thursday morning as I approached the door of Bottom Chikoti, one of the clinical officers, met me and told me that he had been called to see about a woman with a stuck breech. We walked in to find Msiska working with difficulty to extract the head of a baby whose limp body hung from it mother. The mother pushed, every vein in her face and neck expanding with effort, Msiska twisted and pulled, and a small crowd of students encircled them both. Finally Msiska was able to free the baby, the mother fell back, the crowd dispersed, I placed my stethoscope to the baby girl's cool chest and heard silence. I tried resuscitating her for a few minutes but after hearing about how long she had been stuck, I put down the bag and mask, wrapped her in her mother's cloth, and brought her to the bed for her mother to see.
Somehow as her body was born she rotated belly up; for a breech baby to deliver safely, she must be born so that as she emerges her belly is closest to her mother's spine. I was not in the room so I can't say why this happened, maybe the mother began delivering quickly without assistance, or maybe she was assisted but the midwife could not guide the baby to the proper position, or maybe she was simply left alone and found later with the baby in this position. I don't know how it happened but standing there in front of that pale motionless little girl I felt a wave of anger and hopelessness. This was the third baby who died in my first five days back in the labor ward. (Not counting a couple others who died later after surviving for a while in the nursery.) Each of them were preventable deaths. Each so final, so heavy. Each a permanent scar on the mothers' heart. More sadness, more pain in a world where life is already difficult. It is not my personal pain but the exhaustion and sorrow rested on my shoulders.
A few minutes later I found Rabecca sitting up on the first bed. I glanced over her chart. She was 24 years old, this was her fourth pregnancy but her previous three babies were all born very prematurely and died. The problem seemed to be that for some unknown reason Rabecca's cervix always began dilating early thus ending the pregnancy before the baby was ready to live outside of her. Fortunately this pregnancy, she was seen early on my Dr Meguid who had stitched her cervix closed and then removed the sutures only once the baby reached 37 weeks gestation. Just seeing her on the bed with her big belly was a hopeful sign.
The progress on her labor chart was not as hopeful. It seemed she had been stuck at 5 centimeters for some time and when I examined her - three hours after her last exam - I found her cervix still at five centimeters. I thought about the probable course, pitocin, possible c-section, days in the crowed post-natal ward. I put the thoughts aside and closed the curtains around her bed. I couldn't stand the thought of another sad story, regardless of the degree of sadness. I rubbed her back, watched her, and realized that her contractions were not very strong. I showed her how to stimulate her nipples (this helps release oxytocin, the hormone that causes uterine contractions). I stayed with her, kept the curtains closed, gave her water, and encouraged her. As we continued the nipple stimulation her contracts became stronger, I could tell she was exhausted, but she released herself completely to the waves of her body. Within 40 minutes her daughter was born, beautiful and pink. She let out a small cry and then looked around with calm. Rabecca beamed and snuggled her in close. I cleaned her up, helped her breastfeed then closed the curtains around them. Rabecca's birth carried me through most of the day. Everything I did was seasoned with the sweetness of knowing that woman can receive good care in this environment and they can have not only safe births but joyful and beautiful births.
Towards the end of the day, I noticed Ivy crying loudly on the last bed in the room. She labored with her third baby and a student stood by monitoring the baby's heart rate. At Bottom it is unusual for a woman laboring with her third baby to be so vocal. I placed my fetoscope on her belly and heard nothing but her own pulse. I asked two other midwives to check, they also heard nothing. I brought in the ultrasound machine and saw the baby's heart beating slowly maybe at 40 beats per minute, maybe at 20. I lost hope for the baby but an emergency c-section was ordered.
Thirty minutes later I was handed her baby; a large boy with no pulse. He did not respond to resuscitation. His head was molded in an unusual way and I thought for a minute that he had been positioned incorrectly inside but then the clinical officer conducting the c-section told us that the mother's uterus was ruptured. The uterus even as it was ripping continued contracting, pushing the baby - not out of the cervix - but out of the tear. This mother escaped with her life. I met her sister outside the theatre and asked a nurse to explain the situation. She was grateful. She saw the dead child. I went home ungrateful trying desperately to recapture the joy I felt with Rabecca. Trying desperately to make her the center and not merely punctuation.
At home I found Clement subdued. He said one of the students from his school had been hit by a car and killed the previous evening. He was a year behind Clement and they were not close, but friendly acquaintances. The students had just finished their final exams and this one had gone home to drop his belongings, then as he was returning to school, walking along the road in the dark, was struck by a car and killed. The driver brought him immediately to the emergency room and was met there by three close friends of the young man who happened to be on duty. They were unable to resuscitate their friend. He was one of four children, the only one to go to college, the hope of his parents.
Somehow as her body was born she rotated belly up; for a breech baby to deliver safely, she must be born so that as she emerges her belly is closest to her mother's spine. I was not in the room so I can't say why this happened, maybe the mother began delivering quickly without assistance, or maybe she was assisted but the midwife could not guide the baby to the proper position, or maybe she was simply left alone and found later with the baby in this position. I don't know how it happened but standing there in front of that pale motionless little girl I felt a wave of anger and hopelessness. This was the third baby who died in my first five days back in the labor ward. (Not counting a couple others who died later after surviving for a while in the nursery.) Each of them were preventable deaths. Each so final, so heavy. Each a permanent scar on the mothers' heart. More sadness, more pain in a world where life is already difficult. It is not my personal pain but the exhaustion and sorrow rested on my shoulders.
A few minutes later I found Rabecca sitting up on the first bed. I glanced over her chart. She was 24 years old, this was her fourth pregnancy but her previous three babies were all born very prematurely and died. The problem seemed to be that for some unknown reason Rabecca's cervix always began dilating early thus ending the pregnancy before the baby was ready to live outside of her. Fortunately this pregnancy, she was seen early on my Dr Meguid who had stitched her cervix closed and then removed the sutures only once the baby reached 37 weeks gestation. Just seeing her on the bed with her big belly was a hopeful sign.
The progress on her labor chart was not as hopeful. It seemed she had been stuck at 5 centimeters for some time and when I examined her - three hours after her last exam - I found her cervix still at five centimeters. I thought about the probable course, pitocin, possible c-section, days in the crowed post-natal ward. I put the thoughts aside and closed the curtains around her bed. I couldn't stand the thought of another sad story, regardless of the degree of sadness. I rubbed her back, watched her, and realized that her contractions were not very strong. I showed her how to stimulate her nipples (this helps release oxytocin, the hormone that causes uterine contractions). I stayed with her, kept the curtains closed, gave her water, and encouraged her. As we continued the nipple stimulation her contracts became stronger, I could tell she was exhausted, but she released herself completely to the waves of her body. Within 40 minutes her daughter was born, beautiful and pink. She let out a small cry and then looked around with calm. Rabecca beamed and snuggled her in close. I cleaned her up, helped her breastfeed then closed the curtains around them. Rabecca's birth carried me through most of the day. Everything I did was seasoned with the sweetness of knowing that woman can receive good care in this environment and they can have not only safe births but joyful and beautiful births.
Towards the end of the day, I noticed Ivy crying loudly on the last bed in the room. She labored with her third baby and a student stood by monitoring the baby's heart rate. At Bottom it is unusual for a woman laboring with her third baby to be so vocal. I placed my fetoscope on her belly and heard nothing but her own pulse. I asked two other midwives to check, they also heard nothing. I brought in the ultrasound machine and saw the baby's heart beating slowly maybe at 40 beats per minute, maybe at 20. I lost hope for the baby but an emergency c-section was ordered.
Thirty minutes later I was handed her baby; a large boy with no pulse. He did not respond to resuscitation. His head was molded in an unusual way and I thought for a minute that he had been positioned incorrectly inside but then the clinical officer conducting the c-section told us that the mother's uterus was ruptured. The uterus even as it was ripping continued contracting, pushing the baby - not out of the cervix - but out of the tear. This mother escaped with her life. I met her sister outside the theatre and asked a nurse to explain the situation. She was grateful. She saw the dead child. I went home ungrateful trying desperately to recapture the joy I felt with Rabecca. Trying desperately to make her the center and not merely punctuation.
At home I found Clement subdued. He said one of the students from his school had been hit by a car and killed the previous evening. He was a year behind Clement and they were not close, but friendly acquaintances. The students had just finished their final exams and this one had gone home to drop his belongings, then as he was returning to school, walking along the road in the dark, was struck by a car and killed. The driver brought him immediately to the emergency room and was met there by three close friends of the young man who happened to be on duty. They were unable to resuscitate their friend. He was one of four children, the only one to go to college, the hope of his parents.
Monday, July 30, 2007
Thinking of African Mothers
While I was home in the States, visiting my wonderful friends and family I had several conversations with people about starting a non-profit. I am not an organization person. I am a midwife. I love being a midwife. I feel passionately about caring for women, especially for women who often find care in scarce supply. I am not a manager or an administrator. (I feel that statement can and should be followed by a line of exclamation marks.) Over the past two years I certainly feel I have been a funnel for many people’s goodwill and resources but my efforts have lacked order. I described to one friend all my little projects as a spewing, simmering, cauldron; there is a lot of good stuff happening but it is a bit out of control. Still the thought of starting a non-profit scared and, honestly, scares me.
When I reached Austin, I reviewed my mother’s account of all the unsolicited contributions made by family, friends, and strangers over the past two years. The shocking grand total was US$20,000. My immediate thought was, "there is no way that I can handle that amount amount of money in an informal way." While in DC I talked to my friend Leanne who, I must interject, was the person who told me to be a midwife in the first place, meaning she has great instincts. She responded to my fear with excitement and said, “I am an organization person.” Her enthusiasm gave me a push. I returned to Austin and told my friend Sarah about my thoughts; she mentioned that in the building where she works there is a Non-Profit Center that helps people set up non-profits. She made me an appointment. On Tuesday morning I met Sandy who has been setting up non-profits and assisting them for 25 years, surprisingly he also knew quiet a lot about Malawi and midwives. That night, serendipitously, I opened a donation check from a friend for $2,000 - more than enough to cover Sandy’s fees and the IRS fees. The next requirement was a volunteer board of three. I had myself, Leanne, and I called my friend Heidi who is a social worker and has experience with blossoming non-profits as well as community work with teens and moms. She agreed. The stars aligned and the African Mothers Health Initiative was born.
At the moment we have a bank account with almost $12,000. (Sandy has applied for tax-deductible status which he says may take up to nine months but will be retroactive to the date that we filed.) We are working on a website. I need to set up a sister organization here in Malawi before I leave to carry out the work legally. My friend Mrs. Namaleu – the nurse who works on the malnutrition ward – has agreed to continue the projects I have begun. She is two years past the date when she intended to retire but had no other alternative for employment. For the moment we will continue supplying formula for infant orphans, visit those little ones at home as well as any severely ill women during postpartum period, continue the feeding program, and pay school fees. This is where we will start and depending on how things develop I would like to expand. My vision is broadly and basically to provide women with quality care during pregnancy, delivery, and in the postpartum and to ensure that children also receive such care – with particular attention to the ages 0 to 5. At the center of this work I also want to hold the value of honoring people above numbers, lives above cost-effectiveness, and care for women and children above all else.
If anyone is interested in donating. You can send checks made out to the African Mothers Health Initiative to 6808 Belford Dr. Takoma Park, MD 20912. A couple friends are helping me with a website so hopefully that will be up within the month. There is a lot to be done before December.
When I reached Austin, I reviewed my mother’s account of all the unsolicited contributions made by family, friends, and strangers over the past two years. The shocking grand total was US$20,000. My immediate thought was, "there is no way that I can handle that amount amount of money in an informal way." While in DC I talked to my friend Leanne who, I must interject, was the person who told me to be a midwife in the first place, meaning she has great instincts. She responded to my fear with excitement and said, “I am an organization person.” Her enthusiasm gave me a push. I returned to Austin and told my friend Sarah about my thoughts; she mentioned that in the building where she works there is a Non-Profit Center that helps people set up non-profits. She made me an appointment. On Tuesday morning I met Sandy who has been setting up non-profits and assisting them for 25 years, surprisingly he also knew quiet a lot about Malawi and midwives. That night, serendipitously, I opened a donation check from a friend for $2,000 - more than enough to cover Sandy’s fees and the IRS fees. The next requirement was a volunteer board of three. I had myself, Leanne, and I called my friend Heidi who is a social worker and has experience with blossoming non-profits as well as community work with teens and moms. She agreed. The stars aligned and the African Mothers Health Initiative was born.
At the moment we have a bank account with almost $12,000. (Sandy has applied for tax-deductible status which he says may take up to nine months but will be retroactive to the date that we filed.) We are working on a website. I need to set up a sister organization here in Malawi before I leave to carry out the work legally. My friend Mrs. Namaleu – the nurse who works on the malnutrition ward – has agreed to continue the projects I have begun. She is two years past the date when she intended to retire but had no other alternative for employment. For the moment we will continue supplying formula for infant orphans, visit those little ones at home as well as any severely ill women during postpartum period, continue the feeding program, and pay school fees. This is where we will start and depending on how things develop I would like to expand. My vision is broadly and basically to provide women with quality care during pregnancy, delivery, and in the postpartum and to ensure that children also receive such care – with particular attention to the ages 0 to 5. At the center of this work I also want to hold the value of honoring people above numbers, lives above cost-effectiveness, and care for women and children above all else.
If anyone is interested in donating. You can send checks made out to the African Mothers Health Initiative to 6808 Belford Dr. Takoma Park, MD 20912. A couple friends are helping me with a website so hopefully that will be up within the month. There is a lot to be done before December.
Sunday, July 22, 2007
More Good News
Clement has been talking of becoming a Pediatrician since we met. Earlier this year he applied to several medical schools in various countries in Africa. While we were in the States he received news of his acceptance to Moi University in Kenya and then to Kwame Nkrumah University of Science and Technology in Kumasi, Ghana. After talking to many people and doing some research on our own, Clement decided to accept the offer of admission to KNUST. So . . . we will be moving to Ghana.
Classes start for Clement on August 17th this year. There is so much to do but we are experiencing another bureaucratic and infrastructure nightmare. With three weeks left to go, we have not received any additional information from the University. All our emails bounce back, our faxes won’t go through, and phone calls only make it through on average of 1 out of 30. It seems he will need a student visa but the closest Ghanaian High Commission is in Zimbabwe and no one answers the phone there to tell us what he needs or how to get the visa. The High Commission in South Africa, that we can reach, says that he must go through the one in Zimbabwe. We need the visa before buying the ticket. In short we are freaking out. Thankfully we have a small handful of people in Ghana and in the States who are also trying to help us so we are hopeful. We need a minor miracle.
We are also looking for funding for the six year program. Our plans are to return to Malawi and then for Clement to eventually specialize in Pediatrics. Clement wrote a letter to send to organizations/people who might be willing to help fund his education. On the chance that any of you have an idea I am including it below. I’ll feel some peace once I know he is there beginning classes and then I’ll have time to think about how I’ll manage to find work as a midwife in Ghana and wrap up my life here in Malawi. One of my friends, after hearing of all the recent updates, told me that I’m someone who does better on a rollercoaster than a merry-go-round. When my anxiety sits heavy on my chest I take a breath, think of that line, and smile, either way it’s just a ride.
Clement in his words . . .
Since a young age, I have aspired to become a medical doctor. Such inspirations are a result of my own life experiences. As both an in- and out-patient I learned that Malawi’s health care system though free, lacks many resources and this negatively impacts the overall quality and efficiency of care. Perhaps the most significant shortage is that of human resources. Imagine that you fall sick, but with great determination set out early - so that you may be among the first served - and arrive at the out-patient department by 6am. At 10am the clinician arrives and begins reviewing patients but before he reaches you, he leaves for the day. You have no choice but to return home having spent time and energy and perhaps precious money for transportation, without receiving any assistance. Sometimes luck is on your side and you receive a consultation, but once you leave with your prescription you find the dispensary closed, or the laboratory closed. As an in-patient you may stay in hospital for a week but only see a clinician twice and the nurse who may be caring for a ward full of sick individuals alone may not be able to carry out the clinician’s orders in a timely manner. This has been my experience, the experience of many family and friends, and of innumerable Malawians, simply because there are not enough medical practitioners to meet the even the basic needs of patients. Personally, these agonizing experiences ignited my passion to work with the poor and the sick.
After secondary school the path that opened to me was that of a clinical medicine programme. This three year programme was designed to cope with the extreme shortage of medical doctors. The concept of a fast track programme which trains individuals to examine, treat, prescribe medication, and conduct surgery in half the time it takes to train a physician was readily accepted in several southern Africa countries. During the process of obtaining my diploma as a Clinical Officer I came to better understand the problems faced by our health care system and gained a greater appreciation for the importance of pursuing a medical degree.
Malawi is a country of 13 million people of whom 60% are children under the age of 15. Currently there are less than 200 Malawian physicians. Malawi boasts the third worst maternal mortality rate in the world, high infant and child mortality rates, and a life expectancy that hovers around 40. The HIV/AIDS pandemic, although much milder than some neighboring sub-Saharan countries, still affects every industry including education, health, and agriculture as productive individuals fall ill and die. I recognize that I cannot change the system alone and that even though most needs are modest, they are also endless. But, I will provide one more pair of trained hands, and I know with great certainty that for the thousands of patients I will see and treat during my career as a physician, this is a significant contribution. I also understand that after three years of training my knowledge of disease processes and my clinical skills are limited. I see great need and value in further education. Malawians though poor – perhaps because they are poor and more likely to die young - deserve excellent care; I experience a constant thirst for knowledge in order to serve the population more efficiently.
In the course of my departmental rotations I fell in love with pediatric medicine. I feel this is a particularly vital course of study since the majority of Malawians are children and since they are undeniably the future of our nation. Even before I completed the clinical medicine programme I have been seeking a path to pursue my dream of becoming a pediatrician. I am now happy to report that I was recently accepted by Kwame Nkrumah University of Science and Technology in Ghana. Their medical programme lasts six years and will begin August 17th, 2007. My dreams are within sight but one hurdle remains. I am lacking the funds for tuition, which is about US$8,000 annually. For this reason I am appealing to you; for your support of my education. I will be grateful for any contribution and will be happy to send supporting documents and references upon request.
Classes start for Clement on August 17th this year. There is so much to do but we are experiencing another bureaucratic and infrastructure nightmare. With three weeks left to go, we have not received any additional information from the University. All our emails bounce back, our faxes won’t go through, and phone calls only make it through on average of 1 out of 30. It seems he will need a student visa but the closest Ghanaian High Commission is in Zimbabwe and no one answers the phone there to tell us what he needs or how to get the visa. The High Commission in South Africa, that we can reach, says that he must go through the one in Zimbabwe. We need the visa before buying the ticket. In short we are freaking out. Thankfully we have a small handful of people in Ghana and in the States who are also trying to help us so we are hopeful. We need a minor miracle.
We are also looking for funding for the six year program. Our plans are to return to Malawi and then for Clement to eventually specialize in Pediatrics. Clement wrote a letter to send to organizations/people who might be willing to help fund his education. On the chance that any of you have an idea I am including it below. I’ll feel some peace once I know he is there beginning classes and then I’ll have time to think about how I’ll manage to find work as a midwife in Ghana and wrap up my life here in Malawi. One of my friends, after hearing of all the recent updates, told me that I’m someone who does better on a rollercoaster than a merry-go-round. When my anxiety sits heavy on my chest I take a breath, think of that line, and smile, either way it’s just a ride.
Clement in his words . . .
Since a young age, I have aspired to become a medical doctor. Such inspirations are a result of my own life experiences. As both an in- and out-patient I learned that Malawi’s health care system though free, lacks many resources and this negatively impacts the overall quality and efficiency of care. Perhaps the most significant shortage is that of human resources. Imagine that you fall sick, but with great determination set out early - so that you may be among the first served - and arrive at the out-patient department by 6am. At 10am the clinician arrives and begins reviewing patients but before he reaches you, he leaves for the day. You have no choice but to return home having spent time and energy and perhaps precious money for transportation, without receiving any assistance. Sometimes luck is on your side and you receive a consultation, but once you leave with your prescription you find the dispensary closed, or the laboratory closed. As an in-patient you may stay in hospital for a week but only see a clinician twice and the nurse who may be caring for a ward full of sick individuals alone may not be able to carry out the clinician’s orders in a timely manner. This has been my experience, the experience of many family and friends, and of innumerable Malawians, simply because there are not enough medical practitioners to meet the even the basic needs of patients. Personally, these agonizing experiences ignited my passion to work with the poor and the sick.
After secondary school the path that opened to me was that of a clinical medicine programme. This three year programme was designed to cope with the extreme shortage of medical doctors. The concept of a fast track programme which trains individuals to examine, treat, prescribe medication, and conduct surgery in half the time it takes to train a physician was readily accepted in several southern Africa countries. During the process of obtaining my diploma as a Clinical Officer I came to better understand the problems faced by our health care system and gained a greater appreciation for the importance of pursuing a medical degree.
Malawi is a country of 13 million people of whom 60% are children under the age of 15. Currently there are less than 200 Malawian physicians. Malawi boasts the third worst maternal mortality rate in the world, high infant and child mortality rates, and a life expectancy that hovers around 40. The HIV/AIDS pandemic, although much milder than some neighboring sub-Saharan countries, still affects every industry including education, health, and agriculture as productive individuals fall ill and die. I recognize that I cannot change the system alone and that even though most needs are modest, they are also endless. But, I will provide one more pair of trained hands, and I know with great certainty that for the thousands of patients I will see and treat during my career as a physician, this is a significant contribution. I also understand that after three years of training my knowledge of disease processes and my clinical skills are limited. I see great need and value in further education. Malawians though poor – perhaps because they are poor and more likely to die young - deserve excellent care; I experience a constant thirst for knowledge in order to serve the population more efficiently.
In the course of my departmental rotations I fell in love with pediatric medicine. I feel this is a particularly vital course of study since the majority of Malawians are children and since they are undeniably the future of our nation. Even before I completed the clinical medicine programme I have been seeking a path to pursue my dream of becoming a pediatrician. I am now happy to report that I was recently accepted by Kwame Nkrumah University of Science and Technology in Ghana. Their medical programme lasts six years and will begin August 17th, 2007. My dreams are within sight but one hurdle remains. I am lacking the funds for tuition, which is about US$8,000 annually. For this reason I am appealing to you; for your support of my education. I will be grateful for any contribution and will be happy to send supporting documents and references upon request.
Thanks to the Scotts
This past week included my first days back at Bottom. Two months away from birth is long enough. I was eager to witness the covert strength of women surge forth and push their babies into the world. I was eager to see glimmering soft brown eyes as they opened to light and color for the first time. It was wonderful to be back; greeted warmly by the nurses, clinicians, maids, and security guards. The usual chaos reigned: many women, many students, few nurses precepting and overseeing care. Even so, my first three days back at Bottom passed without catastrophe. Wendesday, at some point I encouraged students to get the women up off their backs. Thursday morning I walked in to find two students with their patients in neighboring beds squatting and pushing - pink wriggling babies emerged almost simultaneously within minutes. Friday I assisted students deliver two sets of twins including one breech. I conducted a vacuum for fetal distress - the mother visibly exhausted and the baby’s heartbeat disturbingly slow - but the little girl, once on her mother’s belly, blinked and greeted her mom with a loud cry. The mother asked me for a name, I suggested Mwaye (fortune).
The good days are both gratifying and exhausting. The constant movement and noise in the labor ward at times reminds me of a force of nature, the environment is neither safe nor malevolent. It is the uncommitted energy and space affecting beginnings and endings; expectant mothers face an unpredictable course upon entering the grounds. A hospital should not mimic a force of nature. A hospital should protect dignity and uphold life. It should contain a safe space for women to give birth. It should facilitate necessary interventions (not obstruct them), and offer consistent care in all senses of the word.
There are many reasons why Bottom lingers in a place far from these simple descriptions but happily there will be major changes soon. Last December, Sir Tom Hunter - of the Clinton and Hunter Development Institute - spearheaded a Christmas fundraising drive in Scotland and raised two million pounds to put towards a new maternity hospital. Clinton and Hunter have on-going projects in Malawi but during one of his earliest visits to Malawi, Hunter was whisked off course and directed towards Bottom by an inspired woman who believed that if someone with the means and a conscious saw the conditions, he would feel compelled to help. She was right.
The first quick tour of Bottom led to meetings with the obstetricians, Dr. Chiudzu and Dr. Tarek Meguid, meetings with the representatives from the Ministry of Health, visits from a Scottish media crew to document the progress, and finally approved plans and a full bank account. Saturday a groundbreaking ceremony for a new maternity hospital was held with short speeches from Sir Tom Hunter, The Minister of Health, and The President. Hunter spoke about the construction as a step towards protecting the human rights of Malawian women and mentioned that the money was given with the fundamental understanding that Malawians know best how to care for Malawi.
I have never been as acutely aware of the impacts of a physical structure on human life as I have at Bottom. In the new plans self contained examination rooms will increase possibility the probability of privacy and support. Self contained labor rooms, with enough space for a mother, sister, husband, or friend mean laboring women will have the option of bringing love into space where they give birth. Multiple operating rooms will mean that one life will never have to be weighed against another; a distressed woman over another woman’s distressed baby. The location of the hospital on the grounds of Kamuzu Central Hospital will mean that women who have hemorrhaged will not need to wait hours to receive blood or to be transported to the ICU. The physical structure will make humane care possible. The new hospital will be named after the President’s late wife Ethel waMutharika, a great advocate for Malawian women and mothers.
The good days are both gratifying and exhausting. The constant movement and noise in the labor ward at times reminds me of a force of nature, the environment is neither safe nor malevolent. It is the uncommitted energy and space affecting beginnings and endings; expectant mothers face an unpredictable course upon entering the grounds. A hospital should not mimic a force of nature. A hospital should protect dignity and uphold life. It should contain a safe space for women to give birth. It should facilitate necessary interventions (not obstruct them), and offer consistent care in all senses of the word.
There are many reasons why Bottom lingers in a place far from these simple descriptions but happily there will be major changes soon. Last December, Sir Tom Hunter - of the Clinton and Hunter Development Institute - spearheaded a Christmas fundraising drive in Scotland and raised two million pounds to put towards a new maternity hospital. Clinton and Hunter have on-going projects in Malawi but during one of his earliest visits to Malawi, Hunter was whisked off course and directed towards Bottom by an inspired woman who believed that if someone with the means and a conscious saw the conditions, he would feel compelled to help. She was right.
The first quick tour of Bottom led to meetings with the obstetricians, Dr. Chiudzu and Dr. Tarek Meguid, meetings with the representatives from the Ministry of Health, visits from a Scottish media crew to document the progress, and finally approved plans and a full bank account. Saturday a groundbreaking ceremony for a new maternity hospital was held with short speeches from Sir Tom Hunter, The Minister of Health, and The President. Hunter spoke about the construction as a step towards protecting the human rights of Malawian women and mentioned that the money was given with the fundamental understanding that Malawians know best how to care for Malawi.
I have never been as acutely aware of the impacts of a physical structure on human life as I have at Bottom. In the new plans self contained examination rooms will increase possibility the probability of privacy and support. Self contained labor rooms, with enough space for a mother, sister, husband, or friend mean laboring women will have the option of bringing love into space where they give birth. Multiple operating rooms will mean that one life will never have to be weighed against another; a distressed woman over another woman’s distressed baby. The location of the hospital on the grounds of Kamuzu Central Hospital will mean that women who have hemorrhaged will not need to wait hours to receive blood or to be transported to the ICU. The physical structure will make humane care possible. The new hospital will be named after the President’s late wife Ethel waMutharika, a great advocate for Malawian women and mothers.
Friday, July 13, 2007
A Little More Patience
I know I've been MIA for months and it's really inexcusable but I beg for just a little more patience. I promise stories are on the way. So much is happening, my head is spinning.
Tuesday, May 29, 2007
A Beginning
Clement and I are engaged. We have been talking about marriage for a while, Clement actually asked me before the trip but I requested a re-do which led to several conversations about expectations surrounding the engagement. In Malawi engagement is a process. After the couple decides that they want to become engaged, they each confide in an uncle, the uncles meet and assess the potential partner, then report to the parents, at that point - if everyone is satisfied - there are larger family discussions followed by a formal engagement ceremony. Clement asked me how people become engaged in the States. I told him about the ring and asking the woman's parents for a blessing, then about how the guy kneels down and asks the question, of course in a beautiful memorable setting. Frankly, it sounds a bit silly and regimented. I told him to forget about the ring. Clearly he has my parents' blessing since they've been telling people for weeks that we are engaged. I felt the kneeling part was unnecessary, but I liked the idea of a nice moment in which I was awake. How it happened. . . I was on the couch typing emails, Clement was sitting across from me in a chair studying his new phone and he asked, "So, can we get engaged?" I know he is the one I want to share my life with and I realized that I don't need Hallmark or Hollywood to direct the beginning, I just want to begin. The phone and computer were put aside and the moments after were wonderful.
Sunday, May 27, 2007
Out of Range
Clement and I are in the States. After 26 months I stepped into JFK and back into the whirlwind of life here in the US. Two years is a significant chunk of time and before the trip I worried a bit about the possibility of reverse culture shock. I anticipated at least one emotional breakdown - perhaps in a grocery store or Times Square or my parents' house. But in reality, the joyful reunions with beloved friends and family eclipsed the mundane obscenities of American consumer culture. The humming cities became mere backdrops; familiar and mostly pleasant dreams.
This is Clement's first trip abroad and so he has a greater right to culture shock but because he is such a calm person I tend to forget that everything is new, especially riding the subway and watching Spiderman 3 in an Imax theatre. In general it has been wonderful to be able to show him my world and introduce him to my friends and family. My favorites of his firsts were: viewing New York from the observation deck of the Empire States building, dipping our fingers into the ocean in San Francisco and tasting the sea, and driving through the quiet city streets in Austin at night.
For me the best part has been time with friends and family. I really missed them. Months ago I emailed my eleven midwifery classmates and told them I would be in the Bay Area. They rented a house in Point Reyes and ten of them drove and flew from all over for a four day weekend. Food, chocolate, wine, stories, laughter, and love were abundant. (Clement was spared and spent the weekend with my dear friend Apur and his partner Sabrina). I spent the following weekend camping in Big Sir with three dear friends. The joy exceeds all my pre-trip fantasies. I have amazing friends.
I also missed places. I missed San Francisco, the smells from coffee shops and bakeries I used to bike by in the mornings, the parks, the hills, the ocean, the bridge, the visual feasts. I missed Austin, the warm nights, the sounds of birds and bugs, the green hills (unfortunately now spotted with many more condos and less green). We are in Austin now with my parents; my personal epicenter of warmth and love. Clement will leave Sunday. I still have another month here. I will travel to North Carolina for a wedding, Washington DC, Detroit to visit my dad's family, Austin again, Boston, then New York and finally back to Malawi. I feel blessed beyond words. I also feel that I still belong in Africa but I hope to visit again next year.
This is Clement's first trip abroad and so he has a greater right to culture shock but because he is such a calm person I tend to forget that everything is new, especially riding the subway and watching Spiderman 3 in an Imax theatre. In general it has been wonderful to be able to show him my world and introduce him to my friends and family. My favorites of his firsts were: viewing New York from the observation deck of the Empire States building, dipping our fingers into the ocean in San Francisco and tasting the sea, and driving through the quiet city streets in Austin at night.
For me the best part has been time with friends and family. I really missed them. Months ago I emailed my eleven midwifery classmates and told them I would be in the Bay Area. They rented a house in Point Reyes and ten of them drove and flew from all over for a four day weekend. Food, chocolate, wine, stories, laughter, and love were abundant. (Clement was spared and spent the weekend with my dear friend Apur and his partner Sabrina). I spent the following weekend camping in Big Sir with three dear friends. The joy exceeds all my pre-trip fantasies. I have amazing friends.
I also missed places. I missed San Francisco, the smells from coffee shops and bakeries I used to bike by in the mornings, the parks, the hills, the ocean, the bridge, the visual feasts. I missed Austin, the warm nights, the sounds of birds and bugs, the green hills (unfortunately now spotted with many more condos and less green). We are in Austin now with my parents; my personal epicenter of warmth and love. Clement will leave Sunday. I still have another month here. I will travel to North Carolina for a wedding, Washington DC, Detroit to visit my dad's family, Austin again, Boston, then New York and finally back to Malawi. I feel blessed beyond words. I also feel that I still belong in Africa but I hope to visit again next year.
Friday, April 20, 2007
Water
This morning over my mug of tea I read this in the BMJ,
The Human Development Report estimates that the additional cost needed to achieve the millennium development goals on water and sanitation [i.e. to halve the number of people without access to safe drinking water and sanitation by 2015] is US$10billion a year - half what the developed world spends annually on mineral water.
Eshelby K. Dying for a Drink. BMJ 24 Mar 2007; 334: 610-612.
It’s a short article worth reading, critiquing the development approach which has prioritized healthcare over clean water and sanitation and continues to fumble these goals despite proclaimed intent. [Just as a point of clarification, healthcare deserves to be priority but is inseparably linked to clean water and sanitation.] The article ultimately begs the question that is ever ready on my lips . . . where is our commitment? . . . can we justify these inequalities? . . . do we really want to try?
The Human Development Report estimates that the additional cost needed to achieve the millennium development goals on water and sanitation [i.e. to halve the number of people without access to safe drinking water and sanitation by 2015] is US$10billion a year - half what the developed world spends annually on mineral water.
Eshelby K. Dying for a Drink. BMJ 24 Mar 2007; 334: 610-612.
It’s a short article worth reading, critiquing the development approach which has prioritized healthcare over clean water and sanitation and continues to fumble these goals despite proclaimed intent. [Just as a point of clarification, healthcare deserves to be priority but is inseparably linked to clean water and sanitation.] The article ultimately begs the question that is ever ready on my lips . . . where is our commitment? . . . can we justify these inequalities? . . . do we really want to try?
Tuesday, March 20, 2007
An Anniversary
I remember the months leading up to my departure by the accompanying whirl of emotions. Coming to Malawi was a compulsion. I am not particularly brave. I only knew somehow that life would never be what it should if I stayed, so I bought my one-way ticket and prepared for a death of sorts - purging my possessions, pruning my life, giving my parents a small file with instructions for what-ifs and signing a power of attorney. I knew exactly what I was losing without any idea of what I would gain.
I cried at the airport. My dear friend Megan laughed at my tears reminding me I was following my heart. I, the small child, wanted to walk with her hand-in-hand all the way to the gate. Instead we parted and I remained with only the echo of her gentle laughter for strength.
I knew once I left the States my life would change forever. I could visualize a line – thin and definite – set in space and time. Some days I saw a thread, other days a finger run through sand but regardless of the image I knew my always comfortable and often happy life would change. Perhaps the woman I would become would not want to return to that life, perhaps she would be unable to return. She – that unknown woman and her life – frightened me.
In some ways I was right, there have been many changes. Two years have passed. I miss my friends and family immensely but I feel no need to leave Malawi. I have found great love. I have cried to exhaustion many times. I am content. At times I am devastated, at times angry and tortured, at times humbled, at times filled with peace and light. The force that brought me here roots me to this spot. As I drove last weekend from Lilongwe to Zomba – the road twisting over rolling green fields towards distant blue mountains, neat village homes clustered along the way – I thought, “This is a beautiful country and I am grateful to be here.”
In other deeper ways I have not changed at all. I am the same person I was at five although my eyes have seen much more. My hands have held much more. My heart holds much more. Still inside, the mix of emotions feels the same. The internal voice remains unchanged. The sequence of thoughts leads me along a well-worn path. I wonder how many lifetimes it takes to progress, to transform experience into wisdom, to love without ego, to perceive the world differently, not simply to act differently but to see differently? To believe differently?
I cried at the airport. My dear friend Megan laughed at my tears reminding me I was following my heart. I, the small child, wanted to walk with her hand-in-hand all the way to the gate. Instead we parted and I remained with only the echo of her gentle laughter for strength.
I knew once I left the States my life would change forever. I could visualize a line – thin and definite – set in space and time. Some days I saw a thread, other days a finger run through sand but regardless of the image I knew my always comfortable and often happy life would change. Perhaps the woman I would become would not want to return to that life, perhaps she would be unable to return. She – that unknown woman and her life – frightened me.
In some ways I was right, there have been many changes. Two years have passed. I miss my friends and family immensely but I feel no need to leave Malawi. I have found great love. I have cried to exhaustion many times. I am content. At times I am devastated, at times angry and tortured, at times humbled, at times filled with peace and light. The force that brought me here roots me to this spot. As I drove last weekend from Lilongwe to Zomba – the road twisting over rolling green fields towards distant blue mountains, neat village homes clustered along the way – I thought, “This is a beautiful country and I am grateful to be here.”
In other deeper ways I have not changed at all. I am the same person I was at five although my eyes have seen much more. My hands have held much more. My heart holds much more. Still inside, the mix of emotions feels the same. The internal voice remains unchanged. The sequence of thoughts leads me along a well-worn path. I wonder how many lifetimes it takes to progress, to transform experience into wisdom, to love without ego, to perceive the world differently, not simply to act differently but to see differently? To believe differently?
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