The line between safety and savagery

If my previous blog seemed a tad emotional, apologies but my tears caused an uproar over the past week.

Today Anika and I ventured into town with the intention of “losing ourselves.” Over the next 5 hours of dodging traffic, hi-5ing locals and watching our feet turn black with dirt we

•       Discovered the schedule for the Rwanda Trials we’re keen to observe
•       Shopped in the touristy seen one seen em’ all marketplace
•       Sussed out the cost of flights for Zanzibar
•       Satisfied our cravings for milk products at Africafe where 98% of customers are Caucasian and the menu involves burgers, fries and shakes, however iced mocha on powdered milk isn’t quite as appetizing.

So dear old night shift commenced. The first surprise the doctor failed to mention was that another volunteer from Denmark has been doing nights for the past 2 months... she'd just finished school. As luck would have it, we endured a very slow shift where we learned that midwives sleep in between deliveries, only waking to admit women (from their bed) or to deliver.

Around 7am, the great saga began. A lady was pushing unproductively for over half an hour, and obstructed labour was obvious. A combination of fatigue, psychological distress and overwhelming pain was all contributing to what is considered “poor maternal effort” and despite all her strength she was unable to deliver even the head. I understand that in such a situation, the midwives must do anything possible to safely birth babies, but the violence that ensued absolutely tortured me. When intense fundal pressure (pushing externally on the uterus) was ineffective, the staff began punching the uterus in an attempt to drive the baby out. When the mother cried in pain, she was slapped across the back of the neck, chest and face and punched in the leg whilst retorts of “You’re not trying hard enough!” fell on the mothers tear stained ears. With tears in my own eyes, I held my hands over the mother’s thighs to stop the beating, and could only manage to whisper “stop.”

At last the poor baby was finally delivered to the relief of every person in the room – miraculously she was fine. The mother refused sutures to repair the 2^nd degree tear that had resulted, and at that point I was ready to leave. As soon as I crossed the gates I became inconsolable.

Perhaps the worst part of this entire scenario was that the doctor ran after us to share unrelated news with us when he realised I was sobbing and demanded to know why. I should have lied, but in the moment I explained how overwhelmed I was – bad decision. He insisted on taking action... I really hope this doesn't bring about any trouble. 

Rust in all it's glory.

The following night however, my faith in midwives here was heightened with the discovery of Gasto, the only male midwife I’ve come across here. He was patient and kind to women; when they reached out to him, he’d take their hands warmly. When a lady showed up at 2am with swollen feet and contracting, Gasto connected oedema with possible pre-eclampsia (condition of high blood pressure in pregnancy), monitored her blood pressure closely, dragged out the policy on management of pre-eclampsia and ensured the delivery room was stocked with Mag Sulf, medication used to combat the seizures which can result in serious cases. To our relief, the woman was fine and Anika and I each got a catch; Anika’s catapulting onto the bed in the space of 3 seconds.

Thursday night was a combination of a delivery production line and Swahili lessons. Anna, one of the midwives decided that she would only communicate in Swahili, and devoted the entire night to teaching us lengthy phrases that at 3am flew in one ear and out the other. Keen to learn Swahili medical lingo here, I asked her “What’s amniotic fluid?” Shocked, she responded “see the fluid? How can you have studied 3 years and not know fluid!”

After asking Anna to practice VEs, Anika and I took over the assessments for the night. Excellent practice for determining full dilatation and early stages. Often, we were left unsupervised, and when I declared a woman 1cm, thick and posterior, Anna was satisfied and refused to double check. I spent to rest of the night observing her for signs of second stage paranoid I’d miscalculated her assessment, but on her next review 4 hours later she was a perfect 5cm.

In between the high turn over of deliveries, a woman’s husband after a short visit asked the midwives to assess his wife. As no postnatal checks are performed, it’s up to the women to speak out about any complications. Upon pulling back the blanket, I was shocked to find her lying in a pool of blood. A post-partum haemorrhage is classified as blood loss of 500ml or more, and this woman easily had over a litre (despite her record saying 200ml when I checked the following day). When we massaged her fundus, clots double the size of my fist were evacuated. Moving her to a new bed, she fainted into my arms so I had to lift her, bloodied clothing and all, into bed. The midwives acted quickly and got some fluids running which was great, but I'm not sure what the outcome may have been if her husband had not alerted us all.

As we were leaving after I’d caught an uncomplicated misichana mzuri (beautiful girl), we encountered the clinic’s only female doctor who had been held accountable for the horrible birth we’d witnessed days ago. For 10minutes we endured her wrath – I don’t think she was paid for the shift and for that I felt terrible. Her main gripe was that I cried, with the grilling always circling back to “this is Africa, what do you expect? I don’t understand why you would cry! Would you rather I be nice and let the mother and baby die?”

I regret allowing my emotions to overwhelm me as it was never my intention to point the finger at anyone. The cultural barrier is still tricky, and now my greatest fear is that we will not be welcome at the clinic. The upcoming 3-day weekend is much needed!