Sunday Morning~Blantyre

December 4, 2016

Hi Everyone,

We’re having a little guard problem here. The college of medicine, who provides housing for us, also provides the guard service. It seems a little extreme to those living in a western culture, but it’s common to have a guard here. They are a security service, supposedly equivalent to an alarm system. It’s a little hard to get used to because they are very close to the house most of the time and there isn’t much privacy. If our cluster of houses were together in a fenced area, the guards would sit together in a small shelter near the entrance, but in this neighborhood we all have separate houses so we all have our own guard. The property is surrounded by a chain-link fence with a gate at the entrance to the driveway. Ideally, they should sit at the gate and open it for people and cars, but we don’t have a car, and the gate is in the hot sun with no shelter from rain, so we don’t expect them to sit there. However, we also don’t expect them to peer into the bathroom window while I am in the shower, which is what happened last evening.

Our day guard, Catherine, we are quite fond of, though she does push the limits occasionally. We pay her to clean the house three days a week, even though she is already getting paid by the security service, so it’s double dipping a bit, but we like her and we asked the authorities, and it’s an acceptable practice, as long as she’s still making sure no one is breaking in. We also pay for her son, Joseph, to go to school. She’ll ask for things like a school bag, or new shoes for him, and notebooks and pencils, but that’s not too pushy. I’ve explained that part of her pay should go to helping Joseph with school supplies, but it is customary for people providing school fees to also provide accoutrements necessary, so I get it. One day she picked up a deck of cards we had on a shelf and asked what it was. I opened it and showed her that it was a game. It was one of seven packs of cards George had brought and she pointed to the others (indicating we had more than enough), held up the one she had in her hand and said, “You give me. You share.”  I said, “Sure. Take it.” then thought I really shouldn’t have given away one of George’s things but figured I’d buy him another pack if he really needed it. It did seem excessive to have so many sitting there and she easily could have stolen it, but she didn’t; she asked for it, which I actually admired.

At five p.m. the hand-over occurs and the night guard comes on duty. This part is a little sketchy. The guy who had been here from the beginning, used to show up on time, then go into the quarters in back of our house, take a shower, change his clothes and leave for awhile. We never knew where he was going, we were just happy to have a little privacy while we were sitting on our porch watching the sunset.  He’d come back around seven and ask us to turn on the outside light for security, and then we didn’t know where he went, but assumed he was nearby. If we went out for the evening, we often found him sleeping in a little closet near our kitchen door when we returned. He’d wake up and greet us, so I assumed he’d wake if there was a burglary. It was awkward but we didn’t do anything about it. Then there started being lots of strange guys here in the early morning taking showers out back and carrying away large jugs of water. Then they’d go into our guava tree and pick all the fruit. We never got one single guava. But we thought, they are hungry and we don’t NEED that fruit, and we have this comfortable house and we can share the water, blah blah blah. But it was getting a little obnoxious. None of them spoke English and I didn’t want to go out and tell them to get out of the tree, that the fruit was ours, though wanted to. I wanted to tell them we’d share it, that they shouldn’t just take it, but I didn’t. It felt colonialist to say the tree was ours (though it’s on our property and really is). If my Chichewa was better and I could have done it with an explanation, it would have been easier for me, but I didn’t. Then we started thinking, who are these guys? Are they casing the joint? They were usually all gone by six a.m.and we just got used to it being part of life here. We weren’t the only ones this was happening to, our friends were experiencing the same thing.

At our conference in Lilongwe, during a session on adjustment, we brought this up to the administration staff. They were emphatic that this was not ok, especially the Malawians on the staff. There is a guy at the Peace Corps office specifically in charge of security, and they said it would be reported to him. Well. As soon as we got back here from Lilongwe, things had changed. There were new night guards. The showering had stopped. The fruit picking has stopped and we thought the problem was solved. But we aren’t familiar with this new crowd of night guards and there seems to be a different one each night.  Last evening we were getting ready to go to out for the evening and I jumped in the shower. The bathroom window is on the wall where the tub is, but the windows are frosted and open out from the bottom, creating a little frosted awning. I don’t have a curtain on it as it didn’t seem necessary. Plus it looks out to the back yard which is completely private. No one except Simon, the gardener, is out there during the weekdays. Well, I’m minding my own business, washing my hair, and I heard something on the outside windowsill. It made more noise than a gecko so thought it might be a bird or something and moved toward the end of the tub to take a look and saw it was a hand. Then I saw a face appear under the awning to peer into the tub! It’s easy to hear the shower going out back, so he knew there was someone in the shower. And you have to climb up on the sill and get your head underneath the small window to look in, it’s not like you can just walk by and glance in and see someone in the shower. This takes an effort.

Now, it’s not like I am terribly freaked about someone seeing my saggy breasts, but this was an invasion. As soon as he saw that I saw him he ran away. We got dressed and went out to walk into to town, and found him sitting with the other guards at the neighbor’s house. I said, “You were looking in my window. Don’t you dare, ever do that again. Do not look in our windows when we are home. Do you understand?” He shook his head like he didn’t get me. I asked, “It was you, right? You were at my house, right?” He said, “Yes.” I said, “I saw you and I am not happy.” One of the other guards got up and tried to understand what was going on. I asked him if he spoke English and he said “Yes.” I said, “Ok, please make him understand that I am upset that he was looking in my window when I was showering. He is never to look in the windows when we are home. Understand?” He translated. The culprit said, “Sorry. Sorry.” and we left. This morning there was a different guard here, so he may have already been sacked, I’m not sure. I’m reporting it to his boss and our security officer at Peace Corps. It wasn’t accidental. I hate this crap.

Other than that, it’s been a very busy week. I feel like I’m finding my voice professionally around here and it feels very good. I’m getting more comfortable and creative with the lecturing and the students are starting to respond in a positive way. They are more interactive in class and that is a huge relief. I’ve got a new group of students out at the district hospital for their first labor and delivery rotation and that’s a challenge, but I love it. Especially since I could actually see some progress this week. I’ve decided I am not standing by and watching women undergo procedures they don’t need without saying something. I’m done with that. The more presence I have on that labor ward, the more credibility I have and people are starting to listen to me. My students have always listened, but now others are starting to as well. It’s been interesting.

The clinical experience here is less than ideal since there are so few faculty members for all the students. Therefore, the students are sent out to the sites and are supposed to be supervised and taught by the local staff.  But there are so few staff and they are overwhelmed and burned out and some have less than perfect skills, so the students learn all sorts of bad habits. Like putting a catheter in every single women so they don’t have to get up to pee. It makes me crazy!

When I arrived there on Tuesday, nine women were in various stages of labor occupying the eight labor beds.  In the first bed, was a teenager with severe pre-eclampsia getting an IV inserted. Her arm was hanging over the bed as a student (from a different nursing school) inserted the needle and was immediately successful at finding the vein. Good job! Then as she was trying to attach the IV tubing, the blood from the needle was steadily dripping onto a chair where the blood pressure cuff, stethoscope, measuring tape, and sterile gloves were situated.  This was in my first minute on the floor. I had been so happy initially to see that someone had found a blood pressure cuff! The last time I was there there wasn’t a manual cuff and the power was out so they couldn’t charge the battery on the automatic one. No one got their blood pressure checked that day. And now this one was covered in blood. Great. As one of my students started cleaning that up I went over to another three students who were with a woman about to deliver. It was her first baby and the head was just starting to be visible. As we were assembling what we needed for the delivery, a male student from another school said the head wouldn’t fit and we needed to cut an episiotomy. I asked, “Why? How do you know the head won’t fit?”  A clinical officer was next to him and agreed, it won’t fit. And started getting a razor blade out to cut a medio-lateral episiotomy. (This is the type they always do here because they are afraid of cutting into the rectum. They make a big cut with a razor blade nearly into the women’s thigh. It’s hideous and unnecessary.) My students just stepped out of the way to let the men do it.  I have just had it with watching women be cut when they don’t need to be. HAD IT! I said, “Wait! She does not need an episiotomy! Stop!” And they stopped. I said, “Give us ten more minutes and you will see. This baby will come out without that.” And then I said to the students, “Listen to me. Tell her to push. I want you to act like she is a football player and you want her to score the winning goal. Cheer for her to push this baby out. Tell her they will cut her if she doesn’t do it.” (No one here encourages women to push. If the kid doesn’t fall out on it’s own, they get cut one way or another.)  I said, “One of you, hold her head, one of you get gloves on, she is going to have this baby right now.” So as the two men watched, we got her to push hard, the head crowned, I showed them how to let the perineum stretch, and deliver the head slowly, and we had a nice baby boy in less than ten minutes over an intact perineum. I tried to have it be a teaching moment but it was hard not to gloat. Everyone just looked agape. They had never seen it done like that before. I said, “See? All these episiotomies are not necessary. The baby will fit if you are patient. And now we don’t have to do the repair and she will lose less blood and heal faster. It’s better for everyone!” The clinical officer didn’t get defensive, just turned and walked away. The other nursing student stayed and wanted me to teach him more. When we were delivering the placenta I said, “It’s like trying to pull a plant out of the ground without hurting the roots. You want to pull it all out together, so if you feel the membranes starting to pull off, think of it like a plant. Stop pulling and be more gentle.” They all got that analogy. I keep repeating, “Be gentle! You don’t have to be so rough with them!”  I’m sick of watching them take a gauze and ram it into a woman’s vagina with needless force. I can understand why they do it, though; it’s the way they have been taught. And the women don’t complain. It’s awful, but for the first time I felt like I could make a tiny difference just by showing them another way. And now I pray that this ripples out.

Later that day another of my students was with a woman who was to go for a c-section. I asked why? She told me that the baby wouldn’t fit and there was fetal distress, but there were no more sterile instruments for the operating room so it would be three more hours before she could have surgery. Really? We are going to wait three hours if it’s fetal distress? I asked what the fetal heart rate was? She told me, 126. I asked her if that was normal? She said, “Yes.” Then I asked, “So why are they saying fetal distress?” She didn’t know. Seriously, women go to the operating room for major surgery with rational as murky as this. So I said, “Well, let’s give her some support and answer her questions. She’s probably scared, don’t you think?” I went with her and she started talking to this woman. Again, young woman, first baby. The student translated to English that the woman said she had to move her bowels. It was one p.m. and they were coming to take her for surgery at 1:30. I got a glove and checked her and the head was about to deliver. I said, “Get a delivery pack, she’s going to deliver here.”  The student replied that we were all out of delivery packs. No more available. I said, Fine, we’ll do it without. Just get a some ties and a razor blade and encourage her to push.”  While she went off to get those, the clinical officer came back and told me not to have her push because she is going for a c-section. I said, “No, she’s not. She’s going to deliver here. The head is right here.” We could see the head but he tells me this is not the head it is just caput and she needs surgery. Every cell in my body wanted to yell, “ARE YOU FUCKING KIDDING ME????”  But I said calmly, “Please just give us a half hour and then we’ll see where the head is.” And he turned away to the woman with pre-eclampsia who was about to have a seizure. (And as sick as this sounds, I was happy he had that distraction.)  I looked at my students and did a repeat of the get-her-to-push lecture, but this was their first day in L&D and they had no experience and didn’t know what to do or say, so I was describing it step by step…hold her head, tell her to take a breath, cheer for her, explain that she’s making progress, tell her the head is coming, wipe her face, etc. etc…when another more experienced student from a different school came over and really started yapping at this girl to push. “That’s what I’m talking about! Look at the progress!” About two minutes later the head was out, and the baby was on the mom’s abdomen. A nice crying baby girl with a head a little molded off to one side. So I could tell that was the hold up. The head was in a funny position. A few minutes later the clinical officer came back to take her to the OR, and said, “Oh! The baby is out?” I said, “Yes, and come here please. I want to show you something.”  And I showed him how the baby’s head was molded. I said, “See? The baby would fit! It’s just she needed more time because the head was turned.” I braced myself for him to get defensive, but he didn’t. He just said, “Ok, thank you.” and left.

When I went back there on Friday, the students came to get me at the nursing station to tell me a woman was about to deliver. I went over behind the curtain and almost started crying. The three students were a beautiful team. One was holding the woman’s head, one was fanning her and one was about to do the delivery. They were all encouraging her to push. It was by far the nicest delivery I’ve seen here. One student did the delivery with my guidance over an intact perineum and when the baby went to the mothers abdomen, the mother started singing a soft chant of praise and welcome. I’m proud of these girls. They told me they are learning a lot from me.

THERE IS HOPE!!!

It was a good week.

Yesterday morning George and I ran a 5K virtual race at the track at the medical school. Someone told us about this on-line running club and there was a world-wide 5K and we decided to do it. That started the day out nicely. Then I shopped at the market and cooked for the week while we had power, then last night after the Peeping Tom incident we went to a beautiful Christmas concert at the Anglican Cathedral in Old Town.

We’re not giving up.

Love to all,

Linda