Sunday Morning ~ Blantyre

Dyera linapititsa nchenche ku manda ~ Gluttony brought the fly to the grave.

~Malawian proverb

December 10, 2017

Hi Everyone,

I can’t believe it’s only been a week since I last wrote. It seems like a month.

The internet has been down or very slow so getting news was spotty this week. When it picked up yesterday, I was almost sorry we could read about current events. Again, it feels our country has gone mad (or madder). I woke this morning thinking “I wonder how I’d be writing this blog if Hillary were in the White House where she should be? What would the world be like?” But she’s not in the White House, and dealing with the reality we’ve got has taken on a hostage-like feel. When my marriage crumbled in a heap. I’d wonder what we’d be doing if we were still together? How would holidays or graduations be? Then would remind myself, “We’re not together, so stop thinking like that.” That’s what I feel like when I consider my country right now. Reality is so unfathomable. The lunatics have taken over. My weekly stories seem trite and banal. Who cares? Rome is burning.Then I think, but I pulled my life up from the shambles it was, so the country will, too. Am I in denial? I wonder if I should just mentally prepare for armageddon or believe that, in the end, good will prevail? This proverb gives me hope. When the fly won’t leave the corpse it gets buried along with it. I think all those heinous, sexist, racists being buried alive is a cheery thought!

When I have bouts of hopelessness I usually just keep my nose clean and plod along and that’s what I did this week, showing up on the postnatal ward where my students are doing their next rotation. We’ve moved from labor and delivery and I thought it would be an emotional relief; it’s so hard to watch what happens to women in labor and delivery. It’s a miracle to me that any of them survive. It’s no wonder postpartum depression is so common; the trauma is hideous. But they have nothing else to compare it to and I’m wondering if that’s a blessing. They don’t realize how abused they are. Is that a good thing? Not knowing? There’s another way to experience this? I don’t even know what to think anymore.

My eager students started Monday, learning to care for women in the 24 hours post delivery, on the postnatal ward. Most women go home within 24 hours, and man, I don’t blame them. In this hospital there are between 650 and 750 births a month, so, you can imagine, the postnatal unit is always full. The 60 beds there have at least one woman in them at all times recovering from their ordeal. At 7:30 a.m. the students arrive and “dump dust”, a term I could not, for the life of me, understand. It’s actually “damp dust” they mean, but “dusting” is a stretch. It’s more like dirt than dust, so this term is not accurate. They basically clean for a half hour. They wipe down spots on counters that have no paper or supplies on it, beds that are temporarily vacant, shelves, and carts within their reach. I guess this is a useful activity; I’m all for cleaning up a bit and I’m happy to see the kids are there on time and finding something productive to do. At 8 a.m. the women are all corralled into one bay with twelve beds and they all find a spot to sit holding their babies and looking as if they can barely stay conscious. They sit on the edges of the beds, six or eight to a bed and listen to a health education lecture. One of the students did it the first day, which, I thought showed incentive. They started with a prayer, led by one of the maids, then sang a song about family planning before beginning the talk on proper hygiene: how to care for the umbilical cord, their wounded perineums, and their breasts. Adding a chapter on caring for their minds would be a good idea, too. No one deals with that at all. Except for the family planning part, the talk is the same one they did when I was here 38 years ago.  Several of the mothers shush their crying babies trying to get their nipple into the tiny mouths while balancing uncomfortably on the side of the bed. It looks like torture to me. When the talk is finished, they are all lined up on hard wooden benches in the dark hallway and one by one go into the exam room to be evaluated by students who have never done this before. Fortunately the midwife who works there full time is a great teacher and guided the students through without having to translate everything the mothers said into English for me. It was a real time saver. As it is, it takes at least five hours to get through all the women and they are just sitting out there, many of them having difficulty staying awake since they delivered during the night, waiting to be evaluated. I do not understand why they can’t let them wait in their beds. Those are uncomfortable enough, why do we make them sit on painful incisions in this hallway for hours holding their new baby? There are so many things I would do differently. I so badly want this model ward to happen.

Friday is the postnatal clinic where mothers come back at one and six weeks after they deliver. Half the students stayed in the ward and half went to the clinic and I went with them. There the mothers sit for hours on cement benches instead of the soft wooden ones they have in the ward. Presumably they’re less sore by then, though, so it didn’t seem as inhumane. They’ve had to walk miles to get there, but are dressed to the nines and look quite smart, actually. These women are well off, city dwellers, with husbands who have good jobs. The villagers who’ve delivered here go to the clinic closer to their home for their follow up. Or they go home and never want to be seen by a health care worker ever again, not that I’d blame them.

I am amazed at what kind of outfits and undergarments the women with means wear. Underwire bras, girdles, layers of slips, skirts, and zithenje are common. Slinky skin-tight dresses with complicated closures are donned for this outing. It takes them forever to get it all off to be examined. The undergarments look like they are from the 50’s and 60’s and tremendously uncomfortable. When I was a week postpartum, I felt like a sweatsuit was dressed up. I found this experience exhausting. It’s not life-threatening as in the labor ward, but the care they get is so substandard, I was completely depressed by the end of the day. As each woman came into the exam room I asked the students how old the baby was, one week or six weeks? They immediately picked up the health passport to look for a birthdate. Each time I’d say, “The mother is right here, you can ask her!” I do not understand why they don’t do that. Half the time it isn’t even written in the health passport, and for a culture that is so focused on polite conversation, you’d think they’d address her directly, but no. Never. They act a little like she’s a mannequin. Many of these women were well educated and could speak English, so I could talk with them directly, trying to model to the students, but it wasn’t sinking in. When I found myself getting angry at them, I decided to give it a rest and plan a skills lab for this week. I’m going to role play with them a visit where the woman is actually treated like a living, breathing, human being and make them practice it until it comes more naturally. I don’t have any other ideas. The midwives who work at that clinic disappeared when they saw students had shown up, so there was no one teaching them anything and it was their first day. It was, like I said, depressing.

I’m frustrated that the hospital director cancelled our meeting this week to discuss the model ward project. His excuse was he needed more time to read our proposal (a two page document given to him months ago). It’s discouraging. I thought of the wise words of Dr. Yun, a Korean man who was the head of WHO in Malawi back in the early 80’s. He said, “Does the mosquito give up when you are under the net? No! The mosquito looks and looks for the one little hole until he gets in.” I’ve thought of that a lot this week. It seems any improvement we want for women is always a fight. I am so bloody sick of this. My colleagues here think we should consider an alternative location in case we can’t get this guy to agree to it, but my feeling is he’s just a hospital employee like everyone else. I’m not sure why we need his permission. I’ll keep looking for the hole in the net, but maybe we should look for someone else to bite in the meantime. I thought maybe sitting in his office until he agrees to at least listen to our idea would work. I need to follow my colleague’s cultural lead on this one though. It feels like the same crap we dealt with trying to get the new Women’s Center built in Bar Harbor. Uphill, all the way.

We’re also going a little crazy with cabin fever. Despite the fact that hardly anyone even remembers the violence related to the bloodsucker frenzy, we are STILL restricted from traveling in the region. It’s getting ridiculous and we’re starting to feel like teenagers whose parents are too strict. A few places have opened up, like Cape Maclear on the lake, and we are going to spend the weekend there next week. We really need to get away. It’s hard not to do work over the weekend when we stay home, though I have an easier time with that than George does. He sees horrific cases all week, emotional trauma, one worse than the next, and I think it’s getting to him. Last week he had to deal with a woman with postpartum psychosis who killed her baby in a most horrifying way. He medicated her with an antipsychotic, but when she recovers she’ll be at high risk for suicide when she realizes what she’s done. You don’t just come home after dealing with stuff like that and forget about it. Last year we would mentally regroup by weekends away at beautiful places, get grounded, and remind ourselves how remarkable this place is. Not being able to do that is getting hard. We are taking advantage of the weekends here as best we can, but it’s not the same as really getting away. Our holiday vacation got approved since we are going north to an unrestricted area, so that’s something to look forward to. We’ll leave here on the 21st and have two weeks to camp and relax in the gorgeous north. Hanging on…

The news from home is also depressing so I’m trying to find a lighter note to end on…let me think…we got some really good ripe pineapples and the mangos are abundant.  A woman’s book group started this week over at the international secondary school, and I went to that. That was fun. They are getting the books on their kindles, which I don’t have, but George said I could borrow his. So that’s nice. My sourdough starter worked like a charm and I made some fabulous bread with that….hmm, what else? We decided to treat ourselves and booked the last remaining available room at a luxury place in Cape Maclear, so will write next week from a tropical paradise where we’ll kayak on the lake and try to think of nothing else but how lucky we are to have found each other and have exotic weekends for R&R.

It’s so hot now I keep forgetting it is advent season except for when we sing Oh Come, Oh Come, Emmanuel in church. The only presents I want this year are more indictments from Mueller and approval to start our model ward. Other than that, our lives are full.

Love to all,

Linda