Thursday, February 16, 2012

Public Hospital in Tanzania (Part 3 of 4)


Ahadi's house.

It was difficult for me (J.) to determine exactly what the furrowed brow might mean. Of course a doctor doesn't immediately verbalize all the potential things that could go wrong, without confirming them. As T. checked her cervix the second time I heard him whisper while looking up and away, the way people do when they are feeling something they can’t see, “Is that placenta?” He looked crestfallen.

My heart sank. And then began pounding. Although homebirths attended by qualified midwives and physicians are extremely safe, there are a few very rare, but very serious true obstetrical emergencies that cannot be handled completely during a home birth. Placental prolapse is one of them. Immediately I thought, we might lose this mama, and this baby. We were an hour away from the nearest hospital—and that is only if the van did not break down (if it even started), we were not stopped by a police check, there wasn’t a truck broken down in the middle of the road blocking our way or the occurrence of a host of other very common scenarios. I thought about the secondary effects of losing these patients. Would the community trust us? Would they still want us to work with the hospital? Would we look like quacks? I silently mouthed the words to T. “I am worried.” He mouthed back “Me too.”

T. decided it was not placenta, but things were still not normal at all. While he waited to observe he sent me to our house to get some things we would need if we were able to deliver the baby. I gathered bath towels, paper towels, embroidery floss (the best thing I could think of to tie off the cord) paper towels, scissors and rubber gloves. We didn’t have any sterile ones left (Ty had 2 pairs and they were reserved for him.) But I had already come into contact with some things that I shouldn’t have, so I grabbed the rubber gloves from the cleaning shelf.

I ran as fast as I could back to the hut. When I arrived things were already in motion to take Ahadi to the hospital. She was halfway to the van, navigating very uneven ground, walking in between two lazy napping cows. Damaria at her side, I grabbed her other arm and supported her as she walked. I was amazed that she could walk this far. She was past transition, fully dilated and pushing. And there she goes, determined and focused, walking to the van. The instinct of this mother to do what is best for her child must have been very strong, because I know from my own experience, that the instinct to stay put and go nowhere when in the last stages of labor is almost irresistible.

I had already been praying for this mama, for this baby, for this birth—but once I realized that even T. was worried and we had to transport to the hospital I began that really desperate kind of praying—the kind that goes like this, “Please God, help. Save this baby. Please please please. Help us get there in time! Help this van to start! Help us to make the right decisions! Help! HELP! HELP!!!” Not eloquent. But in these moments God is not asking for eloquence. He is asking for trust, faith dependence.

The first prayer was answered when the van started right up. We began barreling through the village at speeds I did not know the van could go. If I were not so worried about Ahadi I would have been terrified for my own life! What we did not need was a car accident on top of an obstetrical emergency. I thought, at this speed we are sure to hit something—a small animal, maybe a child. Lord help us! More simple, desperate prayers.

The van was hot. Ahadi sat directly in front of me perched on the edge of the bench seat, leaning back into my chest during contractions and leaning forward hanging onto the front seat in between them. We were sweating against one another. She grabbed my thigh and squeezed it during her contractions. I interpreted this as a request to massage her thighs, so I did what I could while trying to keep both of us from falling off the seat or hitting our heads on the roof of the van.

It was now about 5pm. It would take one hour to get to the hospital if nothing went wrong. I checked my watch and started counting the minutes. After we got off the compound and through the village we turned onto a small lane and parked in front of some “stores” that look like shacks. What on earth are we doing? Does everyone not know this is an emergency?

“What’s happening?” I asked. “We need fuel.” Was T’s answer. For goodness sake, could someone not have filled the tank an hour ago when we were contemplating transport? Good grief. I spied my watch impatiently as the minutes ticked by. I was concerned that this baby would start coming out hands first long before we arrived at the hospital.

Five minutes later we were off and running again. As soon as it was safe to do so (safe being a very relative term) Baba called the hospital and told them we were coming, and that we had a patient in need of an emergency c-section and to please be prepared for her arrival. We made it to the black top road in less than 30 minutes. Baba rolled through the police check shouting “We have a sick person. We have to get to the hospital!” only after offering the traditional requisite Swahili greetings. They waved us through. I could not imagine in the US begin pulled over for speeding to the hospital and greeting the officer with, “What is the news of the day? What is the news of work? How is your family? Good, good, fine, thank you…well, we have a sick person here and we need to get to the hospital…” My patience was really wearing thin.

I had a million questions for T. but I couldn’t ask him anything. I did not want to create fear in Ahadi or the rest of us for that matter. But I really had little idea of what might actually be happening, medically. All I could do was continue to pray, remind the friends to do the same, hold Ahadi, and tell her over and over that she was doing great, she was very brave, and God is with us. She said she knew that, and she was not afraid.

Mercifully, her contractions slowed. They almost stopped completely. I imagine her body was aware that optimal conditions for delivery were not present. Perhaps her body was trying to stop the baby from coming before it was in a good position. Perhaps it was God. Perhaps our bodies' amazing natural abilities come from God! I believe they do.

I scowled at every bicycle, truck and pedestrian that hardly cared that we were honking and flying down the middle of the road. No one seemed concerned at all that we were driving dangerously fast and not necessarily on our side of the road. I was thoroughly impressed with Baba’s driving. Another answered prayer--we didn’t hit anything, or anyone. Praise God.

As we drove a song came to mind, that I have heard the children here in church sing. The melody is beautiful and a little haunting, it sounds a little like a Gregorian chant. I did not know the words by heart, but I knew the meaning. The repeating line is “God answers prayer.” I began to hum in Ahadi’s ear. Damaria knew the words and sang along. We sang the song over and over until we arrived at the hospital.

We turned off the pavement onto a side street and then turned in the “parking lot” which was a mess of deep ruts, dirt potholes and bumps. It was like an off-roading demonstration park. These last huge bumps must have been so uncomfortable for Ahadi but she did not complain. T. and Baba jumped out and hurried into the hospital before the rest of us could get out of the van. Ahadi amazed me by her strength and composure.

Well, despite our phone call ahead, there was no doctor there and obviously they were not prepared to wheel her into the “theatre.” They directed us to the maternity ward for examination. I was really frustrated. I asked T., “What is going on?? Why isn’t she headed into surgery?” He was very calm and explained that they needed to do their own exam and assessment before they could decide what she needed. I granted this was reasonable, but couldn’t they see that T. is a doctor from America and of course he knows what she needs!! I tried hard to not be indignant and to respect the cultural differences, but it got harder and harder as I observed.

The nurse spent about 20 minutes on the phone, calling the doctor. First they couldn’t get her on the phone. Then they said she was at home without a vehicle and didn’t have a way to get to the hospital. Then they said we needed to go pick her up. It was a total runaround. None of it made sense to me. My fear and frustration were rising.

By this time Ahadi was laying on her side on an exam table in the maternity ward. The room was large and separated down the middle by sheets tied together. On the other side of the curtain there were about 12 women in various stages of labor. One had her newborn baby lying at her side. Most of them seemed fairly relaxed (it was hard to tell who the patients were and who the friends or family may have been) but one woman caught my eye right away. She was a young woman wearing only a kanga (wrap) around her waist, she knelt on the floor contracting, one hand supporting herself on the floor, the other hand slapping and rubbing herself on her lower back. She was moaning. I wanted to rush over to her and help her right away-and I would have, if I were not there for Ahadi. I didn’t want to leave Ahadi’s side. I couldn’t believe that in this room full of women this young mama was essentially laboring alone. She was rubbing her own back for crying out loud!

The midwife finally got off the phone and examined Ahadi. With no obvious tenderness or assurance, she performed a pelvic and abdominal exam and concluded “hand presentation. Transverse lie. Hand prolapse. Yes. And the baby is very small. Is she term?” I told her we thought she was 35 or 36 weeks. She commented again that the baby was very small. Now, so far I am not so impressed with the bedside manner of this midwife, but despite that, it is clear that she knows what she is doing. I feel confident that she will agree to proceed to c-section. The midwife worked with assurance and maybe some arrogance. But honestly, in situations like this, that is what I am looking for in a healthcare provider.

As she performed the exam Damaria and Esta were listening in on a conversation across the curtain, between the laboring young woman and her mother. The mama was vocalizing during her contractions and saying “I’m dying, I’m dying” (I know that sounds really dramatic, but it’s a very common thing for a laboring woman to express just before she gets to meet her baby…it can be an indication that the baby is very close to being born!) Her mother answered her “Stop complaining. Stop yelling. Can’t you see you are disturbing this woman who is suffering?” She was talking about Ahadi. Then she said “If you don’t stop disturbing others I will leave.” The mama continued her groaning. The grandmother left.

The midwife left and came back with some supplies. She put in an IV line and a catheter and started a saline drip. While she was preparing Ahadi for surgery, the laboring young woman crawled under the curtain and appeared on our side of the room. I gathered that this was the “delivery” room, and the other side was for laboring. She was working her way towards the table next to us. The midwife told her “Get up off the floor. Get on the table” the mother struggled. She couldn’t do it. This time the midwife raised her voice and spanked the mama on the backside (she was now naked). She insisted the woman get on the table. I wanted desperately to help her but I felt I could not leave Ahadi’s side. The mama slowly climbed up onto the table and stayed in the hands and knees position. She moaned and groaned and rubbed her own back. With one hand on Ahadi’s IV the midwife stretched out her other hand, spanked the mama on the back again and said “Get on your back!” The mother flipped over like a fish, and clutched the sides of the table.

I immediately found myself thankful, that despite the many problems of American hospital birth practices, it is to be deeply appreciated that laboring women in the US are generally treated with respect and dignity. I don’t think this kind of treatment would ever be tolerated in the US. Not for one second. And I don’t think the average person really has an appreciation for this aspect of our society. So next time you hear someone complaining that their hospital doesn’t allow candles or aromatherapy, remember this mama.

The midwife continued her work with Ahadi while keeping one eye on the mama in the next bed. Suddenly, the woman’s water broke and it sprayed across the room, hitting the curtain and running all over the table and floor. The mama was lying very still, just clutching the table. I wasn’t sure what was happening with her because my focus was still on Ahadi. A few minutes later a shiny wet baby literally shot out and landed, just barely, on the table between the mamas legs. The midwife grabbed a clamp, immediately cut the cord and scooped the baby up by its feet. She held the baby above her head, by the feet, for a couple minutes as she searched for some supplies. She then loosely swaddled the baby in the wrap the mother had been wearing and laid it in a rolling bassinet about 10 feet away. The new mother appeared relieved and exhausted. She immediately got up from the table and started shuffling back towards the other side of the room. She didn’t even glance at her baby. As she left our side of the room the midwife scolded, “Next time listen to me and get up on the table right away. This place is dirty. You can get AIDS crawling around on the floor like that.”

Thankful that this new baby arrived safe and sound, despite the odds, I wondered...would we get the same outcome for Ahadi?

3 comments:

  1. What a terrifying continuation of this story! I am so thankful for all the answers to prayers that it took for you all to even get to the hospital. Your description of the treatment of the other mama is heart-wrenching. Yes, what we take for granted indeed.

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  2. I can barely read this story, it is so painful to think of how scared that mama must have been. Thank God her baby was born and both are ok. (I hope)

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  3. I am fairly certain the mama and baby are just fine. It might have been less traumatic for her than for me--patients here do not expect to be treated any differently. I don't think that makes it OK, but I do think their expectations are very different from ours.

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