I admittedly have been slacking on keeping a written account of my travels. My last week in Africa was the most inspiring and intriguing in the hospital... and the most memorable. Every day something exciting or tragic happened. Everyday I learned something miraculous about humankind or perseverance. And so, there was little time to sit and write. But I will try to catch up.
Day 15- playing tourist
Today I had a rough day in the clinic and in the labor ward. There was little to do and I suspected because of the rain very few patients came in. So I left early so that I could play tourist with a couple of Swedes. We took a dala dala into Marangu, a village somewhere on "the mountain," and explored the Chagga caves. These caves were home to the Chagga people years ago and provided an interesting insight to how they lived. There are 2 main tribes in the Kilimanjaro area- the Maasai and Chagga. The Maasai are your quintessential Africans draped in red robes carrying a herding staff, known for being fierce lion killers and cattle herders. The Chagga are the peaceful counterpart living in harmony with "the mountain." The two tribes were rivals to say the least. And that folks is your superficial and brief history lesson, less detailed than a quick google search and probably with false information. So after the caves we explored a waterfall and drove to the gates of the Mt. Kilimanjaro National Park. We ended our tourist day sharing a huge jug of banana beer on the side of the road, our taxi driver in his pink disneyland sweater joined us, and eating a delicious meal of bbq meats. Goat included of course.
Day 16- a day in the OR
Before coming to Africa I had this romantic vision of what being a nurse in a maternity ward meant. I imagined groups of women supporting the laboring mom, a natural progression of labor and delivery, and most importantly an environment that embraced natural childbirth. Well, I was wrong. I saw more cesareans than vaginal births. And I saw a cultural disconnect between patient and caregiver.
I watched a tubal ligation during one of the c-sections today... that means she got her tubes tied. This woman was on her 4th c-section and wanted to call it quits. Understandably so. Ironically, this extremely fertile woman had only one obvious ovary and one obvious uterine tube. Dr. Awesome searched and searched and just couldn't find the second set of sex organs. So, he tied up something that may have looked like a uterine tube and called it a day.
I learned a very important thing that day, a physician- at their own discretion- can opt to perform a tubal ligation on his or her patient if they have had more than 3 c-sections. Controversial? Oh, yes. Discuss. This practice is very telling of many things. Ethics, or lack there of. Hierarchy and position of health care providers. Population management. The struggle of... fill in the blank.
Day 17-
During report the nurses and physicians had a lengthy discussion regarding a patient who had decided to leave the hospital against medical advisement (AMA). Something that one of the head nun said struck me- he, the patient, has to truly love himself before we, the healthcare team, can do anything for him. I can't remember the last time I heard a nurse or a health care provider express concern about a patient loving oneself.
Today was a whirlwind of emotions. I was joined by another volunteer, a pre-med student fresh out of high school from Denmark. We walked into a very busy maternity ward and I was immediately drawn to a little bundle wrapped tightly in a kanga laying on one of the newborn warmers. I poked my finger to touch his precious little cheek and my heart dropped. No, it sank. This baby was dead. My first reaction was not something I am particularly proud of but I recoiled. I snapped my finger back feeling like I had just intruded on a secret. I turned to the Danish girl and whispered "that baby is not alive." I didn't know what to do. I wanted to hold it but at this point no one was giving any attention to this bundle. All hands were on deck for two other laboring mothers. We had mom #1 on the left writhing on the delivery table buck naked quietly begging for someone to help her. I, still being in shock about the baby, went to her side and just said the only thing I knew how to say "pole sana," which roughly translated means "I am sorry you're going through this." It is the thing I hear the midwives say the most. And on the right we had mom #2, screaming and refusing to push. It was a scene I had seen before. Midwife, nurse, doctor all at her side yelling at her to push. There was no monitor but it was obvious that with everything happening the baby was probably not faring well. Mom #1 makes some more noise and the doctor decides to check her. Three minutes later baby is crowning and is delivered. Mom #2 continues to refuse to push, yells that she doesn't care about the baby... wishes it were dead. (All of this obviously translated to me after the fact.) Nurse hops up onto the delivery table and straddles mom... pushes with all her might on the fundus. She is pushing with so much force the delivery table is shaking. Midwife is giving an episiotomy. Meanwhile out of the corner of my eye I see someone take the dead baby to the room where they... take out the laundry. And doctor, after having just delivered a baby scooted on over to stand at the end of the delivery table and barked orders. Finally... Finally, the baby is born. He is pale and still. Dr and nurse rush over to the warmer that 5 minutes ago had a lifeless baby on it and commence CPR. "Oxygen!! Oxygen" the doctor yells, it takes two people and about 10 minutes before they get a cannula and tubing that was patent. And what struck me the most was the excruciating lack of urgency. The staff, nurses and doctors, could not find tubing that would work with the oxygen concentrator. It it seemed like no big deal. I stood mortified and terrified for this baby's life. He was so limp. They suctioned, performed chest compressions, and artificially breathed for him for what felt like 45 minutes but was probably only 15. Still, 15 minutes of continuous CPR and I really thought this baby was gone. When he finally cried I was in awe. Did this really just happen? Holy crap. I helped to warm the baby and wrapped him up in a dry kanga... he was so flaccid. He had no tone. But, he was alive. A half hour of some supplemental oxygen later he was slapped on the butt before being delivered to his mother in the recovery room.
The day ended with a c-section. Aside from the poor mother laying naked on the delivery table waiting for the doctor and the OR team for an hour, it was a routine surgery.
Day 18- last day, mostly sad goodbyes.
I did very little today except for say goodbye to everyone and take some pictures.
Day 19-21: travel. travel. travel. home.
An exhausting 45 hour journey home with a 13 hour layover in NYC where I experienced the antithesis of African life.
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