Sunday Morning~ Blantyre
March 19, 2017
It’s a rainy day. The rainy season is winding down so it doesn’t rain every day now, but today is a socked-in, grey, constant-rain, kind of day. I made it to mass and back before it started and now I can just hunker in and enjoy it. I’ve no place to go, got a goat leg simmering on the stove, and bread rising. I’m feeling rather domestic and cozy. This kind of rain doesn’t usually cause a power outage, but I shouldn’t speak too soon.
The first year students have finished their final exams and have the next two weeks off for holiday. I erroneously thought I had two weeks off as well, but that’s not how this nursing school works. None of the classes have vacation at the same time, so my fourth year students still have clinical and I’m still going out to Liwonde for the foreseeable future. The first year students will start their second term when they get back in two weeks. I will supposedly be teaching something, but still don’t know what that will be. I’ve asked around a few times, “Am I supposed to be teaching something second term?” but the response has always been, “We will meet soon to discuss that.” The meeting should be this week (I hope) and then I can start preparing. The midwifery faculty is so overwhelmed with all their responsibilities it seems they are just doing what has to be done on each particular day. Planning ahead isn’t popular. I’m learning to roll with it. I wish I could roll a little better with the clinical rotations, but I still come home from there feeling traumatized. I wish I could run the wards myself and have everyone do it MY WAY. I can see why women are afraid to come to the hospital. We have got to do a better job.
The mornings I go to Liwonde the driver picks me up at my house a little after 6:30. We drive to collect Elizabeth, another faculty member, and then hit the road for the two hour journey. That part of the day is rather nice. The car is comfy and I can gather up my stamina. We have students in labor and delivery, high risk ante-natal, and high risk postpartum. At this site Elizabeth stays with the students in labor and delivery and I go to the other two wards. Antenatal is not traumatic for me. The health education is fun. They sing and dance a little and the students do a good job of it. The women have very low expectations, so any attention they get seems like a perk. The women get seen in a consultation room, which is just a bare room, but there is a window and a exam table, a bench and two chairs. The walls are painted institution green, but they are clean. I share the bench with the patient and the students sit on the chairs. There is no blood pressure cuff, so I bring mine along when I go. It drives me crazy that there is no functioning cuff there since blood pressure is just a little important for the high risk mothers, most of whom are there for high blood pressure. It’s ridiculous. Anyway, the room provides privacy and the students do a fair bit of one-on-one teaching. I like it there. It’s hot (Liwonde is 3,500 feet lower than Blantyre) but not terribly unpleasant. Smell isn’t bad.
After a couple of hours there I brace myself and go to the postnatal ward. I hate going over there. It is so depressing. There are thirty beds all in one room with no privacy curtains. I can never find a staff person; the students are usually there alone except for the clinical officer who has a woman writhing in pain from his repeated vaginal examinations open for everyone to see, blood everywhere, and the patient screaming. It is horrific. Most of these women are post operative, having had c-sections they may or may not have needed. Their babies are lying next to them, an inch from the edge of the bed and there are no safety bars. I must say though, I have never seen, or heard of, a baby falling off the bed. They’re so bundled up in zithenje and blankets it probably wouldn’t hurt them if they did. I have to dig into the bundle to actually find the baby.
There are no IV poles, so the IV bags are lying on the bed and the blood backs up into the bag so it looks like muddy water being infused. It makes me gag. The urinary catheters are revolting as they stay in for days so the woman doesn’t have to get up to go to the toilet. There are no catheter bags so they use the empty IV bags to collect the urine and these hardly ever get emptied so they overflow and smell and I feel like I can almost see the bacteria. How these poor women survive, I do not know. I want to cry the whole time I am in there.
The students try; they really do. But they don’t have the confidence to speak up to the clinical officers. When I walked in there on Monday and saw this horrific exam going on, I asked the students what he was doing? They said they didn’t know. I walked up beside him and asked, “What is the problem here?” He held up his bloody (non-sterile) glove, which I had watch him jam into her vagina three times, and said, “She’s bleeding.” He had his other hand mashing her uterus which was the part of the exam that was making her scream.
“When did she deliver?” I asked.
“Two days ago, by cesarean.” he replied.
I cringed at how rough he was with the hand on her uterus and said, “Oh, well, at two days that bleeding should still be normal then, right?”
He looked at his hand, put it back in her vagina again, took it out and said, “Well, but it smells bad.”
I said, “Well then maybe she needs an antibiotic.” and left off the last part of that sentence “not a rape”. He wasn’t upset with me, he actually looked like he was happy I came to consult with him. The chilling thought went through my head that he actually didn’t know what to do so just stood there putting his hand in and out of her vagina while all the other patients and their guardians looked on. It is so disturbing. I covered her up while he wrote an order for an antibiotic. I told the students to take the catheter out. That was probably infected, too. I covered the woman with her chitheje, patted her shoulder and said, “Pepani” (I’m sorry) and moved on to the next patient with another student.
In the afternoon we had the students present case studies, one from antenatal and one from postnatal. Well, if I wasn’t depressed already, these stories sure finished me off. The first one was a woman at 27 weeks gestation with eclampsia. She reported that she had a seizure at home, got on a minibus and came to the hospital. Her blood pressure was high and she was advised to terminate the pregnancy. At 27 weeks the baby wouldn’t have survived here, there isn’t a high risk nursery at that hospital and even if the baby got shipped to Zomba where there was one, the chances were very low for survival. But if she did not deliver, chances are she would die if she was already seizing at 27 weeks. She refused to deliver this early and tried to go home. She said if she was going to die she’d rather be at home. She was 19 years old.They gave her some antihypertensive medication and she went home. No one knew if she was still alive. We spent some time discussing how that case could have been handled better. I thought of what I was doing when I was 19.
The postnatal case was a woman who had a postpartum hemorrhage and needed a blood transfusion. As the students were giving us her history I couldn’t help from gasping at regular intervals. This woman, 20 years old, lived in a village and went to her local health center with a complaint of back pain in late pregnancy. She was told to go to the district hospital, but it was 6 p.m. and getting dark and she had no transportation. So she went to spend the night in the room allocated for women waiting to deliver and slept on the floor there. At 3 in the morning she delivered her baby on the floor, picked up the baby, still attached to the placenta (which was still inside her) and went over to the delivery room to get help. The midwife there told her she had been instructed to go to the district hospital so this was not their problem. They would not take care of her. So. She waited until daylight and the minibuses were running, got on one, rode to Liwonde (an hour away), with the baby tied to her abdomen and THE PLACENTA STILL INSIDE HER! When she got to the hospital and they delivered the placenta, she had a major hemorrhage and needed a blood transfusion. Somehow she and the baby lived. Fortunately for me, Elizabeth exploded so I didn’t have to. She cried, “We don’t even treat women like human beings! You students have got to be the ones to change this! I want to know the name of that midwife who sent that woman away!” I will say, the list of “what should have been done differently” was pretty easy to make in this case. God help them, please.
It takes me awhile to recover from days like that. I start spiraling into a hopelessness. I don’t know what I should be doing, but keep plodding along. I gave up alcohol for lent so wasn’t sure if the mint tea would calm me down enough. George listens while I recount the stories. He shakes his head. I feel a little better just saying it out loud. He tells me to go lie down and brings me mint tea with lime. It does help.
We went back there on Thursday and while walking to the antenatal ward I fell into step with a woman walking in the same direction. She asked where I was from and when I said “America” I braced myself for a comment about the presidency, which is pretty much standard these days. Instead, she said, “You Americans are always helping people. You are such good people.” And I thought, that was a nice little gift to brighten my morning. Everyone doesn’t hate us yet.
I rode my bike out to Joseph’s school to pay for the second term. I can finally find the place and rather like going there now. When I handed the money to the principal, he thanked me and said, “God will truly bless you for this.” I remind myself to let go of expectations about what Joseph will become in life. It’s good enough now that he’ll finish his form three. I’m trying to stay in the present. The next day I bumped into Catherine on the road to the nursing school. She still guards our old empty house. I told her I went to pay for Joseph’s second term and she hugged me and said, “Thank you God my mummy!” She wasn’t implying that I was God, I think she was trying to convey the same message as the principal. She told me Joseph would come and see me on Friday, which he did. He was much more pleasant than he had been in our prior interactions. He was smiling and gracious and thanked me for paying for school. Then he said he needed more notebooks and pens, and some clothes for church. I told him I would get those things and bring them to his mother. Then he pointed to my bike and said he would like that as well. (His English is way better than his mothers) I told him, sorry. I’m keeping my bike and when I leave it goes back to Peace Corps. It’s not really my bike, I’m just borrowing it from them. He smiled and said, “Ok. Thank you!” No hard feelings. No whining. Just thought he’d ask. At times like that George and I just say to each other, “If you don’t ask for honey, you’ll only eat wax.” That proverb gets used on a daily basis around here.
Love to all,