Brave Woman

Adventures of a future nurse-midwife

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And Then There Were Two

Posted by Lucille on June 1, 2011 at 8:55 PM Comments comments (0)

As we were finishing and pushing the last water into the drain, a pregnant woman came in, tore off her clothes, and started climbing onto a table. I started to protest, but one of the nurses said, "No, its ok. We’re done," at which point I realized that they do not have or use disinfectants of any kind. For the once-a-month cleaning, water is the best they have, which made me wonder what they do, if anything, the rest of the time.

We milled around for a while as the other beds filled, waiting for the head of the hospital to arrive or for us to be directed to another station. Then as one of my group members was passing by a bed, the woman grabbed her hand and pulled her to her side, grimacing from a contraction. Our group leader used to be a doula, and we modeled our behavior after hers to support the woman through each wave of intensity.

Thunder clapped outside and a wall of water pelted down. When it rains, it pours. The sound of the rain hitting the sheet metal roofs was deafening. Another woman came in, singing loudly, and I later learned that she had had two previous cesareans and had walked to the hospital in the pouring rain to be transferred to the bigger hospital in Banjul, but the ambulance had also broken down. She was singing to distract herself and try not to push. When a new ambulance arrived, two of our group members were invited to go with her to experience the transport system.

I soon learned that standards of patient care are very different here. In many cultures with high infant mortality rates, the baby is not named until a while after the birth, in this case a week. The birth is considered part of the pregnancy, and therefore not considered an emotional, much less sacred, experience. I knew this, but I was still shocked and horrified by some of the things I witnessed. No attempt was made to ask or even tell the women before anything was done. Vaginal exams were frequent and unnecessarily rough, to the point of being brutal. I started to feel like I was going to be sick or pass out, so I took a walk and thought about turtles for a while, and got back just as the baby was born and placed in a separate bin.

Midwives here seem to have a general idea of sterility. They wear gloves, but attend to multiple patients without changing gloves, and I’m not sure if this is just the way they are trained or if it is because gloves are in short supply. It might be some of both. The midwife who was tending the woman who had just had the baby unwrapped a catheter. Emptying the bladder is sometimes necessary to help with the delivery of the placenta, but I gathered that it is routine here, as the woman was given barely a minute after the birth. The midwife touched the end of the catheter as she unwrapped it and shoved it in, causing a woman who had just delivered a baby in complete silence to scream.

I severed myself mentally from the situation at this point and focused my attention on the baby. She was so incredibly tiny and adorable that I allowed marveling at her to occupy my attention for some time. After a while had passed they took her to breastfeed. I have the mother's expression captured in my mind and will not sully it by trying to describe it, but it was the one thing that made me understand how what she went through could be worth it.

Another woman had come in during this time, who was clearly mad with fear. When I walked by with two other group members, she clutched at us, begging us to help her. I stayed with her for a while, telling her that she was strong and doing a great job, and when I needed to take a break we took shifts so she would not be alone.

Attempts were made to forcefully progress her labor, which included a man kneeling with one foot by her head and one on the windowsill and shoving on her uterus. It occurred to me at this point that most of the more violent procedures were being performed by the same person, a male nurse I’ll refer to as the rough nurse to avoid confusion. The head of the maternity ward and most of the other nurses and midwives were usually more gentle.

When the woman had been in labor for an hour, her labor was determined obstructed (I wondered if her terror alone could cause this) and the midwives decided to send for a vacuum. The rough nurse wanted to use it but the head of the maternity ward told him no and sent for the head of the hospital. As soon as the head of the hospital arrived, everyone relaxed, because he carried an aura of calm with him and very gently began his work. The rough nurse was given the task of controlling the suction on the baby's head. After a few moments, the head of the hospital told him that was enough and started slowly guiding the baby's head out. As soon as he had turned around, the rough nurse started adding more suction, bracing his foot against the wall so he could pull harder. I turned away.

The baby was born, the placenta removed by tugging on the cord, and the head of the hospital left. The rough nurse took a dry cloth (I guess a wet cloth isn’t an option when there is no source of clean water nearby) and began scrubbing the dry blood off the woman's legs. I reminded myself that the skin on your thighs is tough and can probably tolerate that, but he moved down with the same force, scrubbing over extremely sensitive tissues with dry fabric while the woman gripped the table with one hand and bit the other to stifle her cries.

I turned to the baby to keep myself from passing out, and noticed that it wasn't breathing. No one had given the baby a second thought after it was put in the bin. I put my hand on his chest and could feel that he was choking, so I supported his head as well as I could, flipped him over my arm and tapped his back until he spat a good tablespoon of fluid into my gloved hand. I was already holding him by that point, so I decided to keep holding him and walked around for a bit marveling at him. His head had been badly deformed by the force of the suction, but he opened his eyes, smiled, and kicked his legs a bit.

By that point everyone else had left except me and the two group members who had stayed with the woman through the whole thing. She was still holding their hands and looked more relieved and happy than I can possibly describe, blissful. "Thank you, thank you, thank you. You are my friends. Thank you for helping me. Thank you. I will remember you." We told her how amazing she was and I brought over the baby to show her. When he kicked his legs we laughed and said he was strong like his mom. She was exhausted and fell asleep a few minutes later.

I turned to the woman next to her, who was having strong but far apart contractions. I remembered reading about the use of counter pressure to ease contractions for a school project, so using sign language and limited Mandinka, I asked if she would like me to push on her back. She gave an enthusiastic yes and braced herself against the wall so she could push against me. When she rested between contractions, I asked her her name. "Fatou," she said. I learned an African song in dance troupe called Fatou Yo, the rough translation of which is, "My name is Fatou and I live in Africa, where there are giraffes and elephants. I am alive, I dance and sing, my name is Fatou and I am happy." I asked her if she knew it and sang it for her, and she laughed and clapped her hands, and called to the women around her to look, look at the crazy American who knew the song of her name.

By the end of our shift we were so exhausted that we fell asleep on some benches in the courtyard while we waited for our ride.

The ambulance arrived to take us back and we all sat in silence, trying to process the fact that we had just helped deliver two babies and everything we had seen.

"We're all so tired," someone said.

"It was a big day," someone else agreed.

A third person looked up with wild eyes and said, "They said cleaning!"


Cleaning

Posted by Lucille on June 1, 2011 at 8:50 PM Comments comments (0)

The head of the hospital decided that Saturday would be a cleaning day, and although we do not officially start work until Monday we were invited to come help. An ambulance was sent to pick us up. When we arrived we were directed to the head’s office, which is an incredibly hot and stuffy room (though apparently only to us, as the Gambians did not seem bothered). We waited there an hour before news arrived that the car had broken down. The head of the maternity ward, a woman, wanted to get started and invited us to help in her station.

The labor room consisted of six beds, with no screens or curtains or anything. The women labor in front of each other. The "beds" are actually tables with no padding or pillows. In some places there was dried blood a half inch thick along the rim. There were layers of blood spatters on the walls. They brought in a hose and we set about washing the windows (thick with spiders) and scrubbing down the walls. The dirty water, trash, and cobwebs were swept into a drain in the floor.

Despite the conditions, we had a hell of a time. The women danced and sang while they worked with us. We threw sponges to each other over the others’ heads. Water ricocheted off the tables and sprayed everyone, and I remember thinking, "I’m hot, exhausted, and covered from head to toe in other women’s blood...and I’m having the time of my life."


Misunderstanding

Posted by Lucille on June 1, 2011 at 8:50 PM Comments comments (0)

We learned today that the lodge was expecting to be paid at the end of our stay for the food they've been giving us, at a rate that well exceeds our budget. We have enough to spend $5 per person per day, and they were expecting $20. So already the three days of food they've prepared for us has cut way into our money plan. When we expressed that we could not afford it and were happy to make food ourselves, they were taken aback because apparently it would be inappropriate to bring outside food into the 'motel'.

Tensions were raised. We met to discuss what to do, they met to discuss what to do, and finally they offered to accept $15 per person per day, despite that being three times our budget. Our site coordinator told us to pack up and move to his village, which would put us an hour's walk from the hospital. Our group leader requested another day to try to work things out.

The head of the hospital was very upset and came to meet with the people at the lodge to emphasize that having us work at the hospital was very good for the village and that they hoped to have other OCA groups here in future, so it was very important to make us feel welcome. I don't know the specifics of the discussion, but in the end it was decided that we would make breakfast ourselves and pay the mother of someone from the hospital for groceries, $3 per person per day. A shift would be added to the hospital rotations so that one person would cook with her each day. These were the concrete agreements, but the most important change was a shift in mindset. We are no longer seen as tourists, but as a part of the community. It is still a tentative agreement; we have planned a reassessment meeting for Wednesday.

So Much For Roughing It

Posted by Lucille on June 1, 2011 at 8:45 PM Comments comments (0)

When we arrived, the people who live at the lodge told us that they would make us breakfast the next morning to give us time to get settled. At the market when we went to buy dishes, they told us we could use theirs, and when we asked about making lunch they said they had just finished and invited us to share. Together this means that they've made us every meal since we got here. This is definitely more of a hotel situation than the village situation we were expecting. There are aspects of the roughing it experience that I will miss getting to have, but this will probably give us more energy toward other things. We've been socializing with the people who work here so hopefully it will still be the community experience we were looking for.

Close Quarters

Posted by Lucille on June 1, 2011 at 8:45 PM Comments comments (0)

“So I was taking a shower last night, and I hear the door open and my roommate comes in. And you know how our bathrooms don’t have doors, so I said, ‘Hey, just so you know I’m naked back here.’ And she goes, ‘Uh...’ So I say, ‘Did you need something?’ And she says, ‘Yeah, I think I need to throw up.’ So I’m like...I mean what else are you going to say? I’m like, ‘Oh, okay.’ So I’m standing there backed in the corner, butt naked, and all I can think is, ‘Wow...this is only day two!"

This story was shared at breakfast this morning and we all had a good laugh anticipating the dilemmas living in such close quarters will lead to. There are surely many more stories to come.

48 Hour Report

Posted by Lucille on June 1, 2011 at 8:45 PM Comments comments (0)

It has been two days and I have yet to see a drop of rain or a single mosquito.

Children

Posted by Lucille on June 1, 2011 at 8:45 PM Comments comments (0)

The children here are so excited to see visitors, they come running from every direction yelling, "Tubab, tubab!" which means 'white person'. They love looking at our cameras and asking us to take pictures with them. Anywhere I go children come running to hold my hand. I am well cared for here.


Regarding the Opposite Sex

Posted by Lucille on June 1, 2011 at 8:40 PM Comments comments (0)

Before coming here I was concerned that cultural customs regarding interaction with guys might be strict and suppressive. I know there are cultures where smiling at men or shaking their hand is considered inappropriate. It turns out that the customary greeting here is for guys to ask if we're single and can they please have our number. They are SO forward it's ridiculous. Our first day here we collectively received one gift and two love notes. The total as of now includes three marriage proposals, one of which was from a female nurse to a guy in our group, so the forwardness is by no means one sided. It's very flattering and even though we know that's just how they show their affection and how excited they are that we're here we have learned quickly to set clear boundaries.

Food

Posted by Lucille on June 1, 2011 at 8:40 PM Comments comments (0)

For the last two days I have tried everything we've been served, which now includes rice, meat sauce, groundnut, papaya, stew, mango, fried couscous, green tea, and coffee. I honestly don't know what's gotten into me. I know it's not because of any pressure. No one here has pressured me to eat in any way. In fact they've been quite supportive, and curious about how foods they consider commonplace taste to someone who is having them for the first time. I don't know if it's related to travel, if my taste buds have changed, or if I'm just finally ready but I've found myself wanting to find out what the local foods taste like and looking forward to meals to see if there's something new.


Names

Posted by Lucille on June 1, 2011 at 8:40 PM Comments comments (0)

We are sleeping two to a hut. I’m the youngest member of our group and the oldest member invited me to room with her. As one of our hosts was showing us around the lodge, he told us that we will all need Gambian names because our American names are hard to pronounce. He learned that my roommate is the oldest in the group and gave her a traditional name from his tribe, meaning First Daughter or Big Sister. I asked if there was a name for the youngest daughter. “Of course there is,” he said, “But you, you are Jainaba. It means Brave Woman.”

(I learned later that because birth control is a very new part of Gambian culture, if it is known when you are named that you will be the youngest child that means that your mother died in childbirth. These children are sometimes given the name Chad as an insult. I think the fact that it is a unisex name is supposed to make it even worse.)


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