Sunday Morning~ Lilongwe

March 26, 2017

Mlendo ndi mame~ Guests are like dew

Malawian Proverb

Hi Everyone,

It’s been a sad week. It started out with a sick boyfriend. That’s never a good Monday morning. It was nothing critical, and a few other people around here had similar symptoms, but it’s just not fun to be sick. Tuesday he was feeling a bit better when I dashed out early for my ride to Liwonde. Once he said he thought the worst was over, I plopped his tea down and ran. The driver came early and I had to scoop my fried egg into a plastic container to eat on the road. I finished dressing in the car, attaching my pins and epaulets as we bumped along.  We’ve had a tremendous amount of rain. We’ve had whole days and nights where the rain didn’t stop. That’s a bit unusual for these parts, but it is welcomed, and the crops are robust. Their thirst is well quenched.  The drive that morning was spectacular. The landscape is so beautiful if you can look past the trash on the side of the road. The mountains were ringed with low lying clouds and their peaks popped out the top. Sunlight shone through an opening here and there and the whole scene looked mystical, like something out of the Hobbit. I poured milky tea from my thermos, sipped, and enjoyed the views. I’ve stopped exclaiming about it since Malawians think it’s absurd to comment on natural beauty. It’s just always there. They giggle a bit if I say something but they don’t even look up. It doesn’t strike them as something remarkable.

Since we’d gotten such an early start we were in Liwonde in time to catch the end of the morning report. There was a lively discussion going on, but since I’d missed the beginning of it, I didn’t know what the trigger was. I heard someone say “We are killing these babies!” I thought, eww, something bad must have happened.

I decided to start the day in the postnatal ward before I was tired. I thought that might help my attitude.  It didn’t really.  The students were ready with patients to present to me. The first was a young woman who’d had a c-section the day before for “prolonged labor”. That term doesn’t really mean anything to me here as I find it to be quite subjective. I got the initial report that the baby was in the nursery because he needed oxygen and the mom was expressing breast milk for him. The mom smiled and made an effort to sit up as we discussed her situation. I asked if she’d held the baby and she said not yet. I told the student once we got her settled for the morning, we should go to the nursery to check on him and if possible bring him to his mother so she could nurse him. Or if he couldn’t be moved, we could bring her to the nursery. The mom told us she had slept well during the night and her mother-in-law was with the baby. This young mother was beautiful with long dreadlocks and no sign that she’d had a long ordeal the day before ending with major surgery. She moved amazingly well for someone twelve hours post op.  By the time we’d gotten through her history and examined her it was about 9:30. I thought we should go see what was happening with the babe. Twelve hours is a long time for a mother to be separated from her newborn and she hadn’t even seen him after the delivery.

The student and I went to the nursery to check. There was no nurse in there but several elderly women, guardians, sitting by the babies they were caring for. We asked where our baby was. One of the guardians told us he had died some hours earlier and was taken to be buried. We were confused. The guardians looked away from us and lowered their heads. We went out to the nurses station to find a nurse. None were there. One of the clinical officers asked us what was wrong and we told him. He tried to help find someone who had some information. We tried to find the patient’s guardian. We went outside where several were sitting waiting for morning rounds to be completed. The student called to the group and asked if one of them was with our patient. One sad older woman raised her hand. She was sitting on the cement walkway staring at a brick wall. She came to us and confirmed that the baby had died and the mother-in-law had taken the baby to be buried that morning. I was aghast. “Without telling his mother?!” I asked. She nodded her head. I looked at the student. She looked at me and said, “That isn’t right. She never saw her baby.” I was horrified. I can’t imagine that. Was this cultural? Why did no one tell her that her baby died before they took him away?  The clinical officer said, let’s check the morgue; he might be there. Being hopeful we’d find this child, I wasn’t prepared for what the morgue in the postnatal department looks like. He opened the door, which is just a room off the nursery, and looked in the wooden cubbies. Lots of wooden cubbies lined up on a table top. Although all these cubbies were empty, I still felt like fainting. How many of these cubbies do they need at any one time? Good lord. No baby there, so the medical officer concluded it must have been taken for burial. He looked around for a chart and found one. He flipped through it and confirmed that the baby died at six that morning. I asked, “Who will tell the mother? Do you know why he died? She shouldn’t be kept without knowing this any longer.”  He folded the chart and said, “I guess I will tell her.” So the student, guardian, clinical officer, and I went and surrounded this young mother. There was no private place to take her. The thirty beds were filled with other mothers in various stages of consciousness. Some were sitting up nursing their babies, some were lying still with eyes closed, some were staring into space. We formed a semicircle around her which gave some semblance of privacy. Everyone in there knew what we were telling her. I wondered if she would start wailing. She didn’t. I watched her face as the words I couldn’t understand started sinking in. It was like watching a house of cards collapsing. I put my hand on her shoulder. I watched her eyes. It was thirty five years ago on that day that Jake was born. I imagined myself sitting on my bed that day hearing this news about my baby.

I asked the student what her plan was for this patient now? She told me she would sit with her this morning for emotional support. Right answer. We’d talk later about the cultural implications of taking the baby away to be buried before his mother could hold him. I moved on to be with the next student.

This student was with a patient who sat upright, legs straight out in front of her, back bone completely erect, on a bed with no mattress. She sat on a web of metal bars. I asked where the mattress was? The student told me they had no more. I looked around and six women were sitting on these beds without mattresses. And this wasn’t a piece of plywood. This was a grid of metal bars. It looked like a torture chamber. The women had laid a chithenje over the bars and were lying on them like it was a posture-pedic. I am not kidding, Nelson Mandela’s cell on Robben Island looked more comfortable than this.

I greeted the woman and said to the student, “Ok, tell me her story.”  The student explained that she had been referred from a health center after a prolonged labor with bleeding. Her uterus had ruptured and the baby was already dead when she arrived. They did a hysterectomy. She’s anemic and receiving blood transfusions. She had a reaction to the first blood they give her, but the second one she had no reaction. It was her fourth baby.

As the story is coming from the student I stared at the bars she was sitting on. This woman is post op with a dead baby and no uterus, nearly bled to death, and is lying on a web of metal bars without complaining? We walked through the plan of care for the day while I held on to the bar at the end of the bed. I felt the fried egg churning in my stomach and moved to the bed where the next student was waiting for me. This bed had a mattress as the woman was only one day post op. They shift them around depending on status. It’s like the ones with the mattresses are the ICU.

During this time, a clinical officer was making rounds on the patients. He was alone, stopping at each bed, looking at the charts (which are just a few note pages tied together with a piece of gauze), examining the women with unnecessary roughness, and moving on without washing his hands. He did use a glove if he touched a wound, though, I’ll give him credit for that. I don’t know if his lack of hand washing was due to neglect or the fact that the hospital has no running water. It’s plumbed and the sinks are all there, but there hasn’t been water for several weeks. This hospital is situated mere meters from the largest river in the country. I have no idea why there is no water. It’s the rainy season for God’s sake. We make hand sanitizer for the students which is just a mix of “spirits” (alcohol) and glycerine, and I’ve got my own stash in my pocket, but it’s not as satisfying as soap and water and the regular staff doesn’t even bother with hand sanitizer.

While the third student was presenting his case to me I heard the clinical officer yelling something in Chichewa. I looked up as he grabbed a woman by the back of the neck and forced her head down between her legs, then brought her head back to the bed, then down to her knees again, over and over. She was naked and her arms and breasts were flying like a rag doll.  I said, “What the hell is he doing?!”  No one in the room said a word. When he finished with that exercise, he grabbed her arm and made her stand up. She wrapped a chithenje around herself, then he took her arm and made her walk fast down the length of the room and back again to her bed, where she climbed on and curled up in the fetal position. Her bed had a mattress. I went over to the clinical officer and asked, “What are you doing?”  He replied, “Physical therapy. I like them to be moving soon after surgery. It’s been two days for her and she hasn’t been moving.” and he moved on to the next woman. I put my hand on the shoulder of the curled up woman and said, “Pepani” (I’m sorry), and went back to my student. Before the student continued with his report I said, “Treating a woman like that is never ok.” He nodded and asked if he could borrow my pen.

Before going over to the antenatal ward, which seems like a picnic compared to postnatal, I stopped in labor and delivery to talk with Elizabeth about what I’d seen. She was busy demonstrating a breech delivery to the students there, so I kept going. When I found her much later I told her how upset I was with all that had happened that morning. She shook her head. I was hoping for some local wisdom or encouragement, but she had none. Just shook her head. While we were sitting and chatting, a woman in late stages of labor was lying on the floor, refusing to get onto a bed, writhing in pain. She was refusing to let anyone examine her, so a different clinical officer said she was going to take her to the operating theater. Elizabeth and I looked at each other. Elizabeth said, “That’s ridiculous! She can’t go to surgery without an exam! I’m going to talk to the patient.” So Elizabeth (not too sweetly) told this woman having her eighth baby, to get on to the bed for an exam. I don’t know what she said as she was speaking Chichewa really fast, but the woman obeyed, and Elizabeth checked her. She was fully dilated and pushing but the baby was not coming. I asked about a vacuum. Elizabeth said, “Let’s try it. We can’t let her go for surgery at this point.” Eighth baby! So a group of students (no nurse to be found) got the vacuum out and while Elizabeth put in an IV, I got the cap on, gently pulled, and easily delivered this baby over an intact perineum. I turned to the students and said, “See? No incision on her abdomen, and no lacerations on her perineum. There is no need to cut these women.” We left there soon after the placenta was delivered to make the trip home. It’s all so disjointed and slapdash. Five hours twice a week in this place is nothing.

So the scenery didn’t lift my spirits on the way home. I thought and thought about our role here, what happens to women all over the world, how tiny the steps to improve things, and then the huge backslide for women’s rights happening at home. The driver had the radio on to an English-speaking station and I heard something about the American ambassador, Peace Corps, and killed. I said, “What” What did they say?” But no one else in the car was listening.

I got home and received several messages from a fellow volunteer in Blantyre asking if I was going to the service in Lilongwe for the volunteer killed on Monday. A Peace Corps volunteer who’d been working here for a year in the northern part of the country was killed Monday in a car accident. She was 25 years old.

The incidence of deaths among Peace Corps volunteers is similar to the population at large. Most of of the fatalities are from car accidents and not snake bites. The logistics are difficult though, when faced with calling her family and arranging for her body to be flown home. It’s a Peace Corps director’s worst nightmare. I came up to Lilongwe on Thursday as the memorial was early Friday morning. Volunteers came from all over the country, even those of us who didn’t know her, to be together as a family and support the staff who were terribly distraught.  Thursday evening the director had a gathering at her house where everyone could visit and grieve and be together. Friday morning a vehicle picked us all up at the hotel and took us to the ambassadors residence where the service was held. They did such a beautiful tribute. The language teachers, the office staff, volunteers from her group who were very close to her, the doctor from the hospital where she worked, her host family, all gathered under a tent and began to sing “Let There Be Peace On Earth.”  I sat with Towela, who works with our group of volunteers and a woman we’ve become close to. She said it’s been a hard week. They have taken shifts to sit with the body, never leaving her alone. It’s a Malawian custom. Several people spoke. There was a letter from her family. Her friends made a video. We sang “Amazing Grace” as we filed out of the tent, each dropping a rose in front of her photograph.  I thought, we are all guests here and we are all like dew. We evaporate very quickly if we are in the sun, and linger a little longer if conditions are right.

There is a car going back to Blantyre this afternoon, so I avoided a bus trip and will catch a ride with them. staying the extra night in the empty house of a volunteer who decided to end her service early. I spent yesterday reading and trying to nurse another head cold. I’ve been sick here more than I have in the past twenty years! Others told me they’ve had the same thing, so I’ll lay low, sip on limey tea, read, and shore up for the week ahead. I took a walk with Amber yesterday afternoon, she’s a nurse with our group and I was lamenting how ineffective I feel most of the time. She said, “Linda, don’t you think it’s incredibly arrogant to think you can change things in one year when so many people have been trying for decades?”  She’s right. We are guests here and we are like dew. We evaporate quickly.

Love to all,

Linda