If we grow up in a secure household in
Tuesday, February 26, 2008
Suffering and Joy
Home?
We are now in Kumasi
Monday, February 25, 2008
Arrival in Ghana
Clement and I have arrived in Ghana. Like so much of life, it was an adventure getting here - of course there was the necessary and sad bit of saying goodbye to good friends, moving out, selling our things, and packing. Then there was the unnecessary bit of DHL losing my passport when I shipped it with them to the Ghanaian High Commission in Harare, Zimbabwe to get a visa. They were very apologetic but the extra stress led to a few tears and a delay of a week. Finally we left Lilongwe on the 8th of February and, after a night in Addis Ababa, arrived in Accra in the afternoon of the 9th. During the trip as I considered what I was leaving behind and the unknown towards which I was headed, my excitement and anxiety seemed to counteract each other and left me feeling empty.
As soon as we passed through immigration in Accra we found Clement’s classmate Moses waiting for us at the baggage claim with a warm smile. He brought us home to his wife and two little boys. So here we are in their home with all our earthly possession in four bags. We have no home and little idea of what will come in the next days, weeks, months. I must consciously remind myself that beginnings are always difficult but they always pass. I remember my first days in Malawi at the Kapondas’ home filled with excitement but also loneliness and boredom. Now, here I am again in a similar predicament. This need to start life over again and again, to experience new countries and cultures, is at times a burdensome compulsion. However, I doubt this realization will prevent future reoccurrences. At least this time we are two and at least Clement survived culture shock and successfully made a few friends last semester.
Ghana is lot hotter than Malawi. The heat feels like Texas but Accra lacks the ubiquitous air conditioners present in nearly every home and shop in Austin. I don’t mind the heat. I much prefer this climate to the cold but Clement struggles with it. The streets are busier than Malawi; people move faster, are more assertive, more willing to express their opinions, and more likely to start a conversation. There is a wide variety of street food, of which I can only identify a handful, but I’m eager to taste it. In general the food is delicious and spicy but our encounters with vegetables have been minimal. I have only seen three green vegetables in the market – okra, a local green leafy vegetable, and lettuce and usually when they end up on your plate you must search for tiny flakes of green. Vendors flow up and down every street hurrying to make transactions through car and bus windows during pauses at intersections then swiftly jumping aside when the traffic movement resumes. Unlike Malawi the vendors here on the street and in the shops are mostly women and girls. I wonder about their education and their safety. The predominant local language is Twi (pronounced tree) but many people do speak English. Although there are very few faces which are obviously not African people don’t seem to take much notice of me and Clement. There are definitely fewer beautiful development aid vehicles cruising the streets than in Malawi - perhaps a sign of a more independent economy.
The most difficult part of moving is always the lack of friendship and this of course takes time. Wherever I walk small children shout oblonie (white person) and wave. One day as I was walking home with groceries in my arms I heard a small voice yell, "Can I help you?" followed by the patter of small feet. A group of young students in the school uniforms took my bags and escorted me home. Another day when Clement and I stopped to discuss directions on a street corner and a group of five little girls maybe 7 and 8 years old all came up to me and gave me hugs one by one, the last one planted a kiss on my belly. Not a bad welcome.
As soon as we passed through immigration in Accra we found Clement’s classmate Moses waiting for us at the baggage claim with a warm smile. He brought us home to his wife and two little boys. So here we are in their home with all our earthly possession in four bags. We have no home and little idea of what will come in the next days, weeks, months. I must consciously remind myself that beginnings are always difficult but they always pass. I remember my first days in Malawi at the Kapondas’ home filled with excitement but also loneliness and boredom. Now, here I am again in a similar predicament. This need to start life over again and again, to experience new countries and cultures, is at times a burdensome compulsion. However, I doubt this realization will prevent future reoccurrences. At least this time we are two and at least Clement survived culture shock and successfully made a few friends last semester.
Ghana is lot hotter than Malawi. The heat feels like Texas but Accra lacks the ubiquitous air conditioners present in nearly every home and shop in Austin. I don’t mind the heat. I much prefer this climate to the cold but Clement struggles with it. The streets are busier than Malawi; people move faster, are more assertive, more willing to express their opinions, and more likely to start a conversation. There is a wide variety of street food, of which I can only identify a handful, but I’m eager to taste it. In general the food is delicious and spicy but our encounters with vegetables have been minimal. I have only seen three green vegetables in the market – okra, a local green leafy vegetable, and lettuce and usually when they end up on your plate you must search for tiny flakes of green. Vendors flow up and down every street hurrying to make transactions through car and bus windows during pauses at intersections then swiftly jumping aside when the traffic movement resumes. Unlike Malawi the vendors here on the street and in the shops are mostly women and girls. I wonder about their education and their safety. The predominant local language is Twi (pronounced tree) but many people do speak English. Although there are very few faces which are obviously not African people don’t seem to take much notice of me and Clement. There are definitely fewer beautiful development aid vehicles cruising the streets than in Malawi - perhaps a sign of a more independent economy.
The most difficult part of moving is always the lack of friendship and this of course takes time. Wherever I walk small children shout oblonie (white person) and wave. One day as I was walking home with groceries in my arms I heard a small voice yell, "Can I help you?" followed by the patter of small feet. A group of young students in the school uniforms took my bags and escorted me home. Another day when Clement and I stopped to discuss directions on a street corner and a group of five little girls maybe 7 and 8 years old all came up to me and gave me hugs one by one, the last one planted a kiss on my belly. Not a bad welcome.
Friday, February 01, 2008
Cromwell
Cromwell has been living up north with his parents since shortly after his stroke. Over the past two years he managed to recover some of his strength but he was still walking with a notable limp. He came to our wedding in Mangochi and I saw him a couple weeks afterwards for a goodbye before our departure to Ghana. He was laughing as he recounted his experiences at our wedding, Cromwell does not laugh often and I was glad to leave with happy images of him fresh in my mind. Last night Cromwell's brother Jobson called to tell me Cromwell died on Friday and was buried on Monday. He had been watching football (the African Cup of Nations is going on in Ghana) when his heart started racing. An ambulance was called to transport him to the hospital. He died in route. He was 32.
Friday, January 11, 2008
The Unabridged Wedding Story
Clement’s sister Gladys arrived from Sudan in October she had left three years previously - three months before I arrived in Malawi – and this was her first visit home. I immediately liked her warm and talkative ways. Effie, Aisha, (two of Clement’s sisters) and I stayed up the first night listening to her stories. In 2004 Gladys was sponsored by a Malawian Islamic organization to study business management. Higher education opportunities are limited in Malawi and her sponsors promised her a rare straight path to a degree. They assured her that the school possessed good facilities and they promised that she would be taught in English. Thirty Malawians accepted the scholarship including Gladys and her best friend. Although anxious about taking such a blind step, Gladys and her friend allowed their anxiety to be replaced by excitement once in Khartoum as they drove to campus past modern high rises and wealthy neighborhoods with manicured gardens. Finally they reached campus and were deposited in front of several large plastic shipping containers, which had been converted into dorms but in the heat functioned more like ovens. Tears spilled over and continued flowing for days. They could not return to Malawi; everything had been paid for by the organization and their families would never be able to cover the expense of a return ticket.
The second disappointment came with the discovery that classes would be taught in Arabic. Without an alternative, Gladys and her cohort spent the first year studying Arabic. At the end of that year, still not fluent in Arabic, Gladys managed to negotiate with her sponsors to allow her and her friend to transfer to another school where classes were taught in English. (The remainder of her cohort stayed at the original school.) During her first true academic year Gladys performed well, obtaining A’s in all her courses, but at the end of that year her sponsors transferred her to yet another school which would not accept any credit for the courses she had taken. Gladys arrived in Malawi after three years away with only one year of academic credit. That first night she told me, “Joanne, my dream is to obtain a masters degree.” Gladys is a bright woman, someone who in the States would probably obtain her PhD by her mid to late 20s, but given the tortuous trajectory of her education, a masters will be a significant achievement.
Gladys also told us stories about the treatment of the Southern Sudanese by the government, the little she knew about the war that filtered through to eyes and ears despite censorship, her distressing encounters with members of the poorly trained and poorly educated police force, and the heat. Apparently the heat is so intense in Khartoum that people are warned not to directly enter a cold shower when coming from outside. During each year she spent in Sudan one or two foreigner students died this way from shock.
In celebration of Gladys’ return and in anticipation of Clement’s arrival more and more family and friends poured into the little house. The cooking and cleaning always got done, there were always plenty of stories and laughter, and somehow I still managed to find a quiet corner whenever I needed retreat. My friend Meera, a fellow midwife, arrived on December 17th. We spent long hours trading stories of the past months and then Clement arrived on December 19th. I had been counting down the days to his return for months but when he stepped out from the baggage claim in his tee-shirt and jeans he was so much more handsome and my love for him so much more overwhelming than I had expected.
My parents arrived on the 24th. They are both in their 70s and, though healthy for their age, were visibly exhausted by the two days of travel. My sweet little mother appeared to be on the verge of collapse as she stepped out from the baggage claim wearing a sweater, jacket, hat – in the summer of the southern hemisphere – and carrying two small bags. Clement and I hugged them both and my mother asked him to hold her on our way out to the car. The following days, leading up to the wedding, passed quickly. We celebrated Christmas with wonderful friends and food, wrote and designed the wedding program, arranged transportation to Mangochi for friends, met with the priest, and cherished our ordinary evenings with my parents, Meera, and Clement’s sisters.
Finally, the Thursday before the wedding, we packed my little sedan with five people and their luggage; Clement’s, his best man’s, and my father’s suits; my wedding dress; food; and the flowers. (Amazingly we bought all the flowers for the wedding from at Zikomo flower farm for $20.) Around 7pm, a couple hours after sunset, we arrived at Clement’s father’s house in Mangochi, peeled ourselves out of the overcrowded car and stepped into the overcrowded candle-lit house. Space was made on the couches and we were fed nsima and eggs. Clement’s father wanted to take my car to the village to deliver fuel to a truck which was waiting to drive the recently slaughtered bull to the cottage where my parents would stay, so it could be packed in the refrigerator. I handed over the keys but my car wouldn’t start. My parents and Meera were transported by another vehicle to the cottage. After about a half an hour several boys managed to push-start the car. Clement and friends departed to celebrate his penultimate night as a bachelor. I feel asleep on the couch. When Mr Chiwaula arrived with the cow in pieces in the back of the pickup, I followed them in my car to the cottage 20 kilometers out of town. While on our way Clement called, extremely disappointed, to say that the lodge/bar where the guys had planned to party with him (the only bar in town) had unexpectedly closed early. I headed to bed while five men packed an entire cow into two medium sized refrigerators. Meera laughed and said when she went to get water she tried to ignore the puddles of blood collecting under the fridge.
Friday was a blur, I met Clement, we picked up guests dropped them off, we forgot to eat and drink, everyone told us what was going wrong. The rehearsal, scheduled to begin at three began at five, Father Sax arrived at 6:30. The rehearsal consisted of dancing down the isle again and again. I was told that usually the bridal party rehearses for several days before the wedding, but we were apparently quick learners as we polished it off in just three repetitions. When Father Sax arrived we spent a few minutes discussing some of the components Clement and I had added and then, at last, we left the church to eat. At 4pm I had called the hotel, where we had booked our dinner a month previously, to tell them to expect us around six, the receptionist said they would be ready. Twenty of us arrived at the hotel at seven and the shocked waitress quietly asked, “That was for today?” I tried to be optimistic when she said they only had one cook and nothing was prepared but a friend called at that exact moment to ask how I was and the tears broke free. Thankfully Father Sax produced the desired miracle, he sat us all down, took drink and meal orders and within 30 minutes everyone was eating.
Saturday morning was lovely. The sun shined through a light rain. My dad drank coffee on the table outside facing the lake where Meera and I worked on the flowers. Little girls ran through the grass and then to the water’s edge. Fishermen mended their nets on the sand. The older girls and women sat inside slowly transforming the cow into samosas and snacks. I made the bouquets for me and Effie, as well as the corsages and boutonnières for the men and the parents. My heart calmed. Around 11am we drove to the hotel, which was a block away from the church, to get ready.
Once at the hotel I kept meeting people who needed to eat, others who needed rooms, and I still needed to deliver the flowers to the parents and candles to the church. I lost track of time. The wedding was set for 3pm. At 2pm I had a head of wet hair which I was desperately trying to towel dry. Thankfully four friends miraculously appeared with a hairdryer (I had never previously seen a hairdryer in Malawi) and they set to curling and pinning the masses while I put on my makeup. At 3pm I slipped on my dress and called Beatrice asking about our ride to the church. The car arrived after 30 minutes. I took a few deep breaths and got in next to Effie.
As we pulled up to the church everyone was standing outside, women singing Chewa wedding songs ran to encircle the car. Slowly the crowd filtered into the church and I was given permission to step out. I glimpsed my handsome joyful parents and then took their arms as Effie started dancing down the isle between the overcrowded pews. The choir’s voices flowed over heads filling all remaining space, and my eyes fixed on Clement.
Clement and I are both Catholic but have been raised in environments which made it impossible to believe any single path has a monopoly on truth. We are a Malawian and an American. Half of Clement's family is Muslim, the other half Catholic. Clement’s mom is Chewa, his dad is Yao. My mom's family is black American, my dad's family of German descent. Clement and I are accustomed to sitting in the middle, we respect and honor differences while always finding pathways to unity. We wanted our ceremony to embrace diversity and warmly involve all those in attendance.
The final result was a Catholic ceremony with our additions, our vows, and a lot of spontaneous ululating, harmonic singing, and movement. It was beautiful and basically unscripted. Through it all – sitting, standing, walking next to Clement – I felt incredible joy, deep calm, and complete awe that I could be blessed with such a life partner.
As we faced each other holding hands, Father Sax read “Blessing of the Hands," by Rev. Daniel L. Harris,
We signed our marriage certificate and Father Sax concluded the celebration with the Apache Marriage Blessing,
The second disappointment came with the discovery that classes would be taught in Arabic. Without an alternative, Gladys and her cohort spent the first year studying Arabic. At the end of that year, still not fluent in Arabic, Gladys managed to negotiate with her sponsors to allow her and her friend to transfer to another school where classes were taught in English. (The remainder of her cohort stayed at the original school.) During her first true academic year Gladys performed well, obtaining A’s in all her courses, but at the end of that year her sponsors transferred her to yet another school which would not accept any credit for the courses she had taken. Gladys arrived in Malawi after three years away with only one year of academic credit. That first night she told me, “Joanne, my dream is to obtain a masters degree.” Gladys is a bright woman, someone who in the States would probably obtain her PhD by her mid to late 20s, but given the tortuous trajectory of her education, a masters will be a significant achievement.
Gladys also told us stories about the treatment of the Southern Sudanese by the government, the little she knew about the war that filtered through to eyes and ears despite censorship, her distressing encounters with members of the poorly trained and poorly educated police force, and the heat. Apparently the heat is so intense in Khartoum that people are warned not to directly enter a cold shower when coming from outside. During each year she spent in Sudan one or two foreigner students died this way from shock.
In celebration of Gladys’ return and in anticipation of Clement’s arrival more and more family and friends poured into the little house. The cooking and cleaning always got done, there were always plenty of stories and laughter, and somehow I still managed to find a quiet corner whenever I needed retreat. My friend Meera, a fellow midwife, arrived on December 17th. We spent long hours trading stories of the past months and then Clement arrived on December 19th. I had been counting down the days to his return for months but when he stepped out from the baggage claim in his tee-shirt and jeans he was so much more handsome and my love for him so much more overwhelming than I had expected.
My parents arrived on the 24th. They are both in their 70s and, though healthy for their age, were visibly exhausted by the two days of travel. My sweet little mother appeared to be on the verge of collapse as she stepped out from the baggage claim wearing a sweater, jacket, hat – in the summer of the southern hemisphere – and carrying two small bags. Clement and I hugged them both and my mother asked him to hold her on our way out to the car. The following days, leading up to the wedding, passed quickly. We celebrated Christmas with wonderful friends and food, wrote and designed the wedding program, arranged transportation to Mangochi for friends, met with the priest, and cherished our ordinary evenings with my parents, Meera, and Clement’s sisters.
Finally, the Thursday before the wedding, we packed my little sedan with five people and their luggage; Clement’s, his best man’s, and my father’s suits; my wedding dress; food; and the flowers. (Amazingly we bought all the flowers for the wedding from at Zikomo flower farm for $20.) Around 7pm, a couple hours after sunset, we arrived at Clement’s father’s house in Mangochi, peeled ourselves out of the overcrowded car and stepped into the overcrowded candle-lit house. Space was made on the couches and we were fed nsima and eggs. Clement’s father wanted to take my car to the village to deliver fuel to a truck which was waiting to drive the recently slaughtered bull to the cottage where my parents would stay, so it could be packed in the refrigerator. I handed over the keys but my car wouldn’t start. My parents and Meera were transported by another vehicle to the cottage. After about a half an hour several boys managed to push-start the car. Clement and friends departed to celebrate his penultimate night as a bachelor. I feel asleep on the couch. When Mr Chiwaula arrived with the cow in pieces in the back of the pickup, I followed them in my car to the cottage 20 kilometers out of town. While on our way Clement called, extremely disappointed, to say that the lodge/bar where the guys had planned to party with him (the only bar in town) had unexpectedly closed early. I headed to bed while five men packed an entire cow into two medium sized refrigerators. Meera laughed and said when she went to get water she tried to ignore the puddles of blood collecting under the fridge.
Friday was a blur, I met Clement, we picked up guests dropped them off, we forgot to eat and drink, everyone told us what was going wrong. The rehearsal, scheduled to begin at three began at five, Father Sax arrived at 6:30. The rehearsal consisted of dancing down the isle again and again. I was told that usually the bridal party rehearses for several days before the wedding, but we were apparently quick learners as we polished it off in just three repetitions. When Father Sax arrived we spent a few minutes discussing some of the components Clement and I had added and then, at last, we left the church to eat. At 4pm I had called the hotel, where we had booked our dinner a month previously, to tell them to expect us around six, the receptionist said they would be ready. Twenty of us arrived at the hotel at seven and the shocked waitress quietly asked, “That was for today?” I tried to be optimistic when she said they only had one cook and nothing was prepared but a friend called at that exact moment to ask how I was and the tears broke free. Thankfully Father Sax produced the desired miracle, he sat us all down, took drink and meal orders and within 30 minutes everyone was eating.
Saturday morning was lovely. The sun shined through a light rain. My dad drank coffee on the table outside facing the lake where Meera and I worked on the flowers. Little girls ran through the grass and then to the water’s edge. Fishermen mended their nets on the sand. The older girls and women sat inside slowly transforming the cow into samosas and snacks. I made the bouquets for me and Effie, as well as the corsages and boutonnières for the men and the parents. My heart calmed. Around 11am we drove to the hotel, which was a block away from the church, to get ready.
Once at the hotel I kept meeting people who needed to eat, others who needed rooms, and I still needed to deliver the flowers to the parents and candles to the church. I lost track of time. The wedding was set for 3pm. At 2pm I had a head of wet hair which I was desperately trying to towel dry. Thankfully four friends miraculously appeared with a hairdryer (I had never previously seen a hairdryer in Malawi) and they set to curling and pinning the masses while I put on my makeup. At 3pm I slipped on my dress and called Beatrice asking about our ride to the church. The car arrived after 30 minutes. I took a few deep breaths and got in next to Effie.
As we pulled up to the church everyone was standing outside, women singing Chewa wedding songs ran to encircle the car. Slowly the crowd filtered into the church and I was given permission to step out. I glimpsed my handsome joyful parents and then took their arms as Effie started dancing down the isle between the overcrowded pews. The choir’s voices flowed over heads filling all remaining space, and my eyes fixed on Clement.
Clement and I are both Catholic but have been raised in environments which made it impossible to believe any single path has a monopoly on truth. We are a Malawian and an American. Half of Clement's family is Muslim, the other half Catholic. Clement’s mom is Chewa, his dad is Yao. My mom's family is black American, my dad's family of German descent. Clement and I are accustomed to sitting in the middle, we respect and honor differences while always finding pathways to unity. We wanted our ceremony to embrace diversity and warmly involve all those in attendance.
The final result was a Catholic ceremony with our additions, our vows, and a lot of spontaneous ululating, harmonic singing, and movement. It was beautiful and basically unscripted. Through it all – sitting, standing, walking next to Clement – I felt incredible joy, deep calm, and complete awe that I could be blessed with such a life partner.
As we faced each other holding hands, Father Sax read “Blessing of the Hands," by Rev. Daniel L. Harris,
and then we exchanged vows,These are the hands of your best friend, young and strong and full of love for you, that are holding yours on your wedding day, as you promise to love each other today, tomorrow, and forever. These are the hands that will work alongside yours, as together you build your future. These are the hands that will passionately love you and cherish you through the years, and with the slightest touch, will comfort you like no other. These are the hands that will
hold you when fear or grief fills your mind. These are the hands that will countless times wipe the tears from your eyes; tears of sorrow, and as in today, tears of joy. These are the hands that will tenderly hold your children, the hands that will help you to hold your family as one. These are the hands that will give you strength when you need it. And lastly, these are the hands that
even when wrinkled and aged, will still be reaching for yours, still giving you the same nspoken tenderness with just a touch.
Sometime later Father Sax asked us to move down the isle and offer the sign of peace to people, but before we could take a step the church enveloped us; a tidal wave of arms and bodies pulling us from one embrace to the next. It seemed to be a dramatic finale featuring all the major characters of our story in their best clothes and most joyful expressions Cromwell, Doreen, Memory, Msiska, the Nanthowas, maids from the hospital, Innocent and Ven, Tarek and Lara, Masauko, the Namaleus . . . In-between the moments of activity I sat next to Clement, my hand in his, awash in love.I, Clement, affirm my love to you, Joanne, on this day of our wedding in the presence of our dear friends and families. I promise to embrace, respect, and honor your love. I promise to be a faithful companion on this walk through life. Today I humbly offer you my heart and ask you to take me as your husband.
I, Joanne, affirm my love to you, Clement, on this day of our wedding in the presence of our dear friends and families. I promise to embrace, respect, and honor your love. I promise to be a faithful companion on this walk through life. Today I humbly offer you my heart and ask you to take me as your wife.
We signed our marriage certificate and Father Sax concluded the celebration with the Apache Marriage Blessing,
Now you will feel no rain, for each of you will be the shelter for each other. Now you will feel no cold, for each of you will be the warmth for the other. Now you are two persons, but there is only one life before. Go now to your dwelling place to enter into the days of your life together. And may your days be good and long upon the earth.
From the church Clement and I were escorted to the village in a Mercedes in which we were instructed to standup through the sun roof – a hilarious and slightly embarrassing experience. The village welcomed us with drumming and singing and, though eager to join the scene, we were instructed to remain in the car until my parents arrived. We later learned that Father Sax had given them a ride but before joining the reception made a series of stops. The consequence was that Clement and I were trapped in the Mercedes for about an hour. Waves of faces undulated from the darkness to the car and back into the dark. Every once in a while a friend would approach and we would plead for news about my parents’ whereabouts and beg for snacks. Finally my parents arrived and to the dismay of those trying to choreograph our entrance, we claimed our freedom and leaped from the car.
The reception took place in Chiwaula village in front of the chief’s house, under tents, between enormous mango trees, in candle-light. Traditional dancing and drumming was followed by a couple short inaudible speeches and then a mob scene that masqueraded as the cutting of the cake. The cake was delicious; worthy fuel for a small battle. Clement and I enjoyed a few minutes of dancing and then, when the exhaustion that had been marinating our bodies over the past week reached the saturation point, we decided to return to the hotel for sleep.
A man placed the car keys in Clement’s hand, said, “Sakuyenda [It won’t start],” and disappeared. We gathered a few boys to assist but there was a moment when I was actually pushing the car in my wedding dress before a friend told me to stop. The car started and at last we drove back to the hotel, dropping Effie and a friend home on the way. As we pulled into the hotel parking lot we were greeted by a raging party on the lawn just feet outside our beautiful room. A few more people called asking about transportation and finally Meera kindly took my phone to her room. Clement and I, giddy and exhausted, shared the same sentiment, “thank God we NEVER have to do that again!!” Sometime between 2 and 3am the music stopped and I drifted into a shallow sleep, happy and comforted by the breaths of my beloved at my side.
The reception took place in Chiwaula village in front of the chief’s house, under tents, between enormous mango trees, in candle-light. Traditional dancing and drumming was followed by a couple short inaudible speeches and then a mob scene that masqueraded as the cutting of the cake. The cake was delicious; worthy fuel for a small battle. Clement and I enjoyed a few minutes of dancing and then, when the exhaustion that had been marinating our bodies over the past week reached the saturation point, we decided to return to the hotel for sleep.
A man placed the car keys in Clement’s hand, said, “Sakuyenda [It won’t start],” and disappeared. We gathered a few boys to assist but there was a moment when I was actually pushing the car in my wedding dress before a friend told me to stop. The car started and at last we drove back to the hotel, dropping Effie and a friend home on the way. As we pulled into the hotel parking lot we were greeted by a raging party on the lawn just feet outside our beautiful room. A few more people called asking about transportation and finally Meera kindly took my phone to her room. Clement and I, giddy and exhausted, shared the same sentiment, “thank God we NEVER have to do that again!!” Sometime between 2 and 3am the music stopped and I drifted into a shallow sleep, happy and comforted by the breaths of my beloved at my side.
Oh God
Let all lovers be content
Give them happy endings
Let their lives be celebrations
Let their hearts dance in the fire of your love.
—Rumi
We are grateful to all our beloved friends and family who honored us with their presence and to those who were with us in spirit. Our union has grown on the foundation of love and support you have given us over the years; our wedding day was not ours alone but also yours. May God perpetually bless you all.
With genuine gratitude,
Joanne and Clement
With genuine gratitude,
Joanne and Clement
Tuesday, December 04, 2007
Birth Outside Bottom
Thursday was a rare slow day in the labor ward at Bottom labor. There was time to sit and to chat. I have seen much and learned much at Bottom but from the beginning I have also wanted to see birth outside the hospital in Malawi. (Over 50% of women in Malawi still deliver with traditional birth attendants (TBAs).) Thursday I mentioned this to Msiska and she told me about Mrs Msumba. Mrs. Msumba is a famous midwife working in a village on the periphery of the city. As Msiska described her, I realized that she was the same midwife mentioned by several of the clinical staff over a year ago in a derisive conversation about nurses who preferred to have her attend their births rather than deliver at Bottom (it sounded reasonable to me then and now). Msiska said Mrs Msumba had a lot of patients and always referred in time, and unlike other TBAs always accompanied the transferred women to the hospital. I was eager to meet her and asked Msiska how I could find her, in response she said “ukachula mkango udzikwera mtengo [if you mention a lion you must climb up the tree], she is probably on her way now.” I was skeptical since we had never met during all my time at the hospital but within a couple hours Mrs Msumba appeared with a patient and of course Msiska was not surprised. Msiska explained my interest to Mrs Msumba and I gave her my telephone number. Mrs Msumba said she would call when she had a laboring patient.
Sunday night Beatrice and I compiled a list of things to get done for the week for our little non-profit. Monday morning, thinking of nothing else but the non-profit, I woke up and opened the computer but within minutes woman called speaking in rapid Chichewa. I heard “TBA” quickly tossed in and figured it out. I asked if I should come and she said yes. The plan had been that one of the maids from labor ward would escort me but when I phoned her, her phone was switched off. I called Beatrice. She was at Kamuzu Central Hospital and said she would find someone who knew the way and accompany me. When I arrived at Kamuzu Beatrice was waiting with two women from Mrs Msungu’s village who had been delivered by her a couple months previously. The two women directed us through the village and then instructed us to stop at a hedge (a few green leaves budding on top a mound of dirt). From there they led us down a narrow muddy path at once widening and ending at a pen filled with fat guinea pigs eating palm leaves. Mr Msumba was cleaning the pen and after greeting him, the women who led us there called out to Mrs. Msumba who was next door at the her clinic. Mrs Msumba greeted us warmly and led us inside.
Her small clinic was divided into four rooms, the main room which contained a small cabinet with delivery supplies and gloves as well as two “bush” ambulances (tricycles with extended carts used to transport laboring women); a small empty room for prenatal examinations, a recovery room with a single bed, and a tiny delivery room containing only a basic cot for the baby. The building was made of unbaked brick painted with a cement floor and metal roof, it smelled faintly of floral body soap. Two women, having come for prenatal care, sat on the floor in the main room, the first was pregnant with her second child and had no living child and the second woman was pregnant with her fifth. Mrs Msumba counseled them, she talked to them about danger signs, she told the woman with her fifth pregnancy that she must deliver in the hospital (TBAs in Malawi are only supposed to attend second to fourth pregnancies). Every now and then I could hear the woman in the labor room moan and Mrs Msumba occasionally stood and peered in the delivery room. She examined the bellies of the two prenatal patients and let them leave.
During the month of November Mrs Msumba said she had had 62 deliveries and 19 transfers to Bottom. Only after looking through her record book and counting the names could I completely grasp that she alone had cared for 81 laboring women within a single month. Mrs Msumba began working as a midwife in 1975, apprenticed by her mother and grandmother. She laughed and shook her head when I asked if she knows how many deliveries she has conducted. She strays further than walking distance from her home and clinic only when transferring patients. There is no electricity at her clinic so some nights she conducts as many as three deliveries by candle light. She charges 500MK for her services (about US$3) but still many of the women cannot pay, so she often works for free, pays the transportation costs with her own money when women must be transferred, and sustains her family with small businesses such as raising and selling guinea pigs.
In the hospital the women must bring their own caretaker to cook and wash for them, if they have no one they do not eat, and they wash their own clothes after delivery. If the women come alone to Mrs Msumba she cooks for them, she heats bath water for them, she gives them water while they labor, and leaves a covered bucket by their side in case they need to vomit. The women bring a plastic sheet and a few cloths to place on the bare ground in her small delivery room. They labor there, Mrs Msumba encourages them to lie down. She does not yell. When I asked Mrs Msumba about vaginal exams she says she does not check regularly. She takes her time. She watches the women, their bodies and their body language. She palpates their abdomen to feel whether the baby’s head is descending into its mother’s pelvis. She can tell from a woman’s labia if her birth will be difficult. She says she takes her time. She says this way the woman only pushes once or twice and the baby is born.
Stella was laboring with her third baby. I sat next to her on the cement floor as she moaned and turned from side to side. Mrs Msumba walked between the rooms, attentive to Stella but calm. She listened to the baby. As the birth neared she changed clothes, put on gloves, and prepared her delivery kit – a cord clamp, a razor blade, and a piece of string set in her single kidney dish. Stella’s moaning intensified and Mrs Msumba instructed her to move from her side to her back. After two physiological pushes Mrs Msumba held Stella’s baby boy in her hands. She immediately put him on Stella’s breast and in another five minutes the placenta followed with barely a drop of blood. Mrs Msumba cleaned Stella and the room. It was an amazing birth to witness, we thanked Stella and Mrs Msumba but before we were allowed to leave Mrs Msumba ushered us to the steps outside where a lunch of eggs and nsima was waiting.
I asked a few more questions and then Mrs Msumba gave me her list of requests: electricity, a mattress, more metal kidney dishes, and a few blankets. As we were finishing lunch another laboring woman arrived. Mrs Msumba asked us to wait while she examined her just in case the woman needed to be transferred but within minutes she also delivered. We left feeling joyful. It is no mystery why women choose to deliver with Mrs Msumba rather than at the hospital. The care that women receive with Mrs Msumba is impossible to replicate in a hospital where the ratio of laboring women to nurses can be as high as 10:1.
Sunday night Beatrice and I compiled a list of things to get done for the week for our little non-profit. Monday morning, thinking of nothing else but the non-profit, I woke up and opened the computer but within minutes woman called speaking in rapid Chichewa. I heard “TBA” quickly tossed in and figured it out. I asked if I should come and she said yes. The plan had been that one of the maids from labor ward would escort me but when I phoned her, her phone was switched off. I called Beatrice. She was at Kamuzu Central Hospital and said she would find someone who knew the way and accompany me. When I arrived at Kamuzu Beatrice was waiting with two women from Mrs Msungu’s village who had been delivered by her a couple months previously. The two women directed us through the village and then instructed us to stop at a hedge (a few green leaves budding on top a mound of dirt). From there they led us down a narrow muddy path at once widening and ending at a pen filled with fat guinea pigs eating palm leaves. Mr Msumba was cleaning the pen and after greeting him, the women who led us there called out to Mrs. Msumba who was next door at the her clinic. Mrs Msumba greeted us warmly and led us inside.
Her small clinic was divided into four rooms, the main room which contained a small cabinet with delivery supplies and gloves as well as two “bush” ambulances (tricycles with extended carts used to transport laboring women); a small empty room for prenatal examinations, a recovery room with a single bed, and a tiny delivery room containing only a basic cot for the baby. The building was made of unbaked brick painted with a cement floor and metal roof, it smelled faintly of floral body soap. Two women, having come for prenatal care, sat on the floor in the main room, the first was pregnant with her second child and had no living child and the second woman was pregnant with her fifth. Mrs Msumba counseled them, she talked to them about danger signs, she told the woman with her fifth pregnancy that she must deliver in the hospital (TBAs in Malawi are only supposed to attend second to fourth pregnancies). Every now and then I could hear the woman in the labor room moan and Mrs Msumba occasionally stood and peered in the delivery room. She examined the bellies of the two prenatal patients and let them leave.
During the month of November Mrs Msumba said she had had 62 deliveries and 19 transfers to Bottom. Only after looking through her record book and counting the names could I completely grasp that she alone had cared for 81 laboring women within a single month. Mrs Msumba began working as a midwife in 1975, apprenticed by her mother and grandmother. She laughed and shook her head when I asked if she knows how many deliveries she has conducted. She strays further than walking distance from her home and clinic only when transferring patients. There is no electricity at her clinic so some nights she conducts as many as three deliveries by candle light. She charges 500MK for her services (about US$3) but still many of the women cannot pay, so she often works for free, pays the transportation costs with her own money when women must be transferred, and sustains her family with small businesses such as raising and selling guinea pigs.
In the hospital the women must bring their own caretaker to cook and wash for them, if they have no one they do not eat, and they wash their own clothes after delivery. If the women come alone to Mrs Msumba she cooks for them, she heats bath water for them, she gives them water while they labor, and leaves a covered bucket by their side in case they need to vomit. The women bring a plastic sheet and a few cloths to place on the bare ground in her small delivery room. They labor there, Mrs Msumba encourages them to lie down. She does not yell. When I asked Mrs Msumba about vaginal exams she says she does not check regularly. She takes her time. She watches the women, their bodies and their body language. She palpates their abdomen to feel whether the baby’s head is descending into its mother’s pelvis. She can tell from a woman’s labia if her birth will be difficult. She says she takes her time. She says this way the woman only pushes once or twice and the baby is born.
Stella was laboring with her third baby. I sat next to her on the cement floor as she moaned and turned from side to side. Mrs Msumba walked between the rooms, attentive to Stella but calm. She listened to the baby. As the birth neared she changed clothes, put on gloves, and prepared her delivery kit – a cord clamp, a razor blade, and a piece of string set in her single kidney dish. Stella’s moaning intensified and Mrs Msumba instructed her to move from her side to her back. After two physiological pushes Mrs Msumba held Stella’s baby boy in her hands. She immediately put him on Stella’s breast and in another five minutes the placenta followed with barely a drop of blood. Mrs Msumba cleaned Stella and the room. It was an amazing birth to witness, we thanked Stella and Mrs Msumba but before we were allowed to leave Mrs Msumba ushered us to the steps outside where a lunch of eggs and nsima was waiting.
I asked a few more questions and then Mrs Msumba gave me her list of requests: electricity, a mattress, more metal kidney dishes, and a few blankets. As we were finishing lunch another laboring woman arrived. Mrs Msumba asked us to wait while she examined her just in case the woman needed to be transferred but within minutes she also delivered. We left feeling joyful. It is no mystery why women choose to deliver with Mrs Msumba rather than at the hospital. The care that women receive with Mrs Msumba is impossible to replicate in a hospital where the ratio of laboring women to nurses can be as high as 10:1.
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.
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