Saturday, October 13, 2012

9/29 - Hospital

Shanti's bookshelf. There is another small shelf
with a lending library for the mothers.
Things to remember

Sister Mary's talk
Walked to lunch at the diocese
Shanti - educating clients, politics, power dynamics
Cristina's (chicken and chips)

Yesterday was a busy, intense day. I find they all are. I'm still going deep down the rabbit hole of what and who I am in Africa - is it a good thing for me, is it a good thing for this community that I am here. I suppose without interviewing all of the Ugandans I won't possibly know what they truly feel. We've seen thousands of people and the Ugandans wear a rather closed off look on their faces that seems unapproachable, and then they approach and the widest, most beautiful smile breaks over their faces. And then there are the occasional people who make a good effort to let you know you are unwanted, not liked- whatever it is they're trying to impart, I am picking up the vibe I shouldn't approach you.

It is scary at times, not knowing what people are thinking. The children here are so incredibly excited when they see muzungus drive by, their faces light up like they've just seen a pile of Christmas presents and they yell, 'Hi Muzungu, hi!!!" and they wave, and wave and wave until we're out of sight. Not all of the children, but if you're driving down the road and slow down whatsoever, you'll be met with children very excited to see you, waving their little hearts out.

Yesterday we were given a tour of the local hospital, it is a level four facility which means it has more capability to help the local people than a lower level clinic. Shanti is a level two. The hospital (I'll have to find out the name) was quite the experience. I feel reluctant to write about it- to have the people I saw there reduced to, "Oh, that's too bad." Or worse, "That's just what happens in Africa."  I'll write about it because the story should be told, because I do want to share it, and because I hope I can do it justice.

Dr. Agaba and Henry gave us a tour of the hospital.  I'm not sure I have this correctly and I'll try to fact check this before I leave, but Dr. Agaba is in charge of the hospital, and Henry is sort of his right hand man, I think. Dr. Agaba is not a tall man but his spirit is bright and his strength resolute. He smiles easy and laughs hard, and has deep understanding of the plight of the people in his community, and the context of what that means in the world, what challenges the Ugandans face in health care and what those factors are - and he cares very, very much about what he does and the people he's responsible for.

When we arrived we were told we could not take photos. I'm glad they had this rule in place, some things are not for tourists, and today, we were all midwives. As we were entering the building Henry approached Dr. Agaba and whispered in his ear. Dr. Agaba alerted us that they had a case of tetanus in the hospital, which was very rare. They had limited capacity to help the sick person - they lack the serum here (which isn't terribly uncommon anywhere in the world, I imagine). The hospital is a compound of several buildings in various stages of being built, and disrepair. The first building we went into was the children's ward. One room with several beds, naked of bedding. Most of the beds filled with mothers holding their unconscious or very sick children in their arms, or touching the child laying on the bed. Everywhere we go, the people here stare at us. The hospital was no different. The mothers all watched as a group of muzungus led by Dr. Agaba filed in among the beds.

I didn't want to look at the children because there was no privacy, just beds together in the room. It felt so rude to me to be looking at someone's most terrible situation, to be worrying about the health of your child, but I also know that it is my own cultural bias that tells me this. I actually don't know what is appropriate in this situation so I hope my heart leads the way that I do not want to invade or pry, only to learn, and that I understand that this could feel like an invasion to some, and maybe not others - I try to keep my energy in integrity as I stand among these mothers, fighting for the lives of their children. With no coaching, it's difficult to know how to be in this room.

Dr. Agaba walked us over to a bed with a child whose mother stood next to him with giant eyes. Her little boy, age maybe 5 or 6, lay on the bed under a sheet. He was very still, receiving an IV drip. Dr. Agaba told us that this boy had tetanus, and as we listened to him explaining it to us, the boy's back arched and his head went back. The mother reached down and tried to pull his head back forward and Sister Mary (the head Midwife at Shanti who had accompanied us) told her not to do that, she could hurt his neck muscles, to let him go. The boys arms were pulled up and rigid and his back taut. Dr. Agaba explained that if we were to see the boy's face, it is pulled back into a tight grin because all of those muscles are seizing too. I dared not look. 

I ached to hug this mom, I wondered what she was thinking. My heart hurt in a way I have never experienced, because I have never been in a room without hope before. 

There is no hope for the boy, and within a few days, if that, he will die. I can explain it all to you, but the short version is that this hospital does not have any serum, and the family can have him transported to a higher level hospital but if they do not carry the serum they'll have to buy it themselves- and there is none anywhere nearby, and they couldn't afford it anyway. 

This could be any parent, anywhere, whose kid, playing outside, stepped on a nail and got sick with tetanus - and I don't expect that my local hospital carries the medicine for tetanus but we'd be able to get it and my kid would have a pretty good chance at surviving. It brought home to me the luxury we have in America to 'discuss' vaccination. I did not become a vaccine flag waver in Africa but it definitely exposed me to the fact that we relish in the knowledge that we will have clean water, we will have safe food, we will have access to medical care one way or another (even if it bankrupts us) to care for our illnesses. It's lofty to be able to discuss vaccination as an option, and how fortunate we are to be so very, very blessed with the abundance we have here. Our children die of preventable diseases too, things happen- but I don't think vaccination is even ever considered to be something a parent wouldn't do in Uganda, Africa? If you want your child to have a shot at surviving, you give them the shot.

Standing in the presence of this mother who already knows what is about to happen to her son, and seeing the terrible situation that the hospital is in to provide help and wondering how I will survive it when my heart breaks into a million pieces. I started to cry, I had to walk away because it felt so desperately inappropriate for me to grieve for her and her family, and her child, to see myself in them- I had to collect myself. I walked away and put my head against Jane and allowed myself to sob for a moment, just one moment, because I was helpless and I hated it, and the hospital was helpless, and I hated that, and worst of all, this mother had to stand by her seizing child, helpless, staring at us, and we could do nothing but look at her. (Writing about this, days later, I am still crying.) We walked away.

We went on to see the terrible conditions and amazing work they're doing at the clinic. They're trying to be recognized as a hospital instead of a clinic so that the government will need to give them more money, which would allow them to provide better care. In one of the rooms we went into, the ceiling is falling in and leaks. Hospital beds are bare of linens for infection control and also because to have enough linens to use and keep safely would be a ridiculously inappropriate luxury when there aren't enough drugs, and there aren't enough of a lot of things to make this hospital function- and yet they are making it work.

We went to the maternity ward and there were several beds, many of which had mothers with their babies. He said that sometimes the ward is so full, there are women on the floors. Shanti Uganda has on average, in the last couple of months, about 12 births per month. The hospital has about 180 births a month. We met Sister Margaret (Sister is a designation for the head midwife/head nurse) the midwife for the hospital. She said that they had someone in labor now and we went in to see the room where the women delivered. There was a woman there in labor, undressed to the waist. She was having intense contractions that made her stretch her back and make pained faces, and sat alone, unattended, on the stripped mattress. 

My heart, my heart, it's breaking, I can't take this- I'm a doula, I'm a human being, I am a woman who has given birth, and I'm on a tour of the hospital and this woman is alone, what do I do? What is appropriate? Would she want me near her, or would it be something she'd have to suffer as she tried to get through her labor alone, on that bed? I looked at Jane and she looked at me and she walked over to the woman and started reassuring her. I am glad she did that, later Jane shared with me that she told the woman she was doing such a good job, and the woman said, "I don't feel like I'm doing a good job." Jane reassured her and we looked at each other and I know that she would have stayed by her side if she could have, as would I, as would any of us, and we couldn't. We had to keep moving. We walked away.

I think that we have this 'noble savage' concept of Africa - that women just set down their headbaskets of wood, squat in the bushes and push out a baby, tie it to her back, picks up her wood and keeps walking.  Also, that the women are so stoic that they don't doubt their strength, they don't doubt their ability to give birth, and they don't really need assistance, or reassurance. It's a problem. I hear this concept in childbirth circles all the time, "Your body was made to give birth!" And yes- this is so, so, deeply true. In addition to that, time and evolution has required us to be attended in labor, to be seen through safely. We require that. Yes, babies will come out without it, but for our optimal birthing situation, we are in attendance. 

That noble savage concept - none of that is true. Anything that you felt when giving birth, women all over the world are feeling. While there are many cultural mores around birth,  the transition into parenthood is something universal- to let go of who we are and become who we need to be- and that will be fraught with worries and preparation and all kinds of traditions.

(10/12 inserting my thought here...) I recently saw a picture posted on Facebook of a few African children standing before a panoramic view, and they're discussing how American children have to sit behind desks, inside for schooling, and how terrible that is, and one of the other children says, "We should take up a collection for them!" I'm paraphrasing but I have to react here, rather than Facebook (and with no bad feelings to people who posted/shared it, whatsoever!) - this very idea that being in a tribal setting, in the bush, is some sort of 'authentic' way to live, is damaging and frankly, a brand of racism. Rather than diminishing the way another race lives, exists, we overly celebrate it and put it on a pedestal. Make no mistake- this is still very much racism. 

When I saw this posted all I could think about are the girls all over the world, even in these 'ideal' tribes, who will never be allowed an education, because they are raised to make babies as soon as they are fertile, and be good wives, and therefore have no need of an education. The Ugandan children who are home all day because their parents can't afford to send them to school, and will grow up with very limited options, and are at risk for dying, at risk for harm, risk for disease, and worse, risk of perpetuating the cycle onto the following generation. The girls who will have sex at a young age to a man too old for her and get pregnant, assuring she will not be able to continue her education, if she even gets to start it. My eyes have been opened and I'm sharing this thought with you- now you must decide what to do with it. Let's drop the "noble savage" concept, okay?

When a woman goes to a health clinic to have her baby and needs a cesarean or life saving treatment that the clinic doesn't have, she has to pay the fuel to be taken to another clinic that can help her. She may be forced to pay for medications if the clinic doesn't stock it. If that family is too poor to pay for the gas, she or her baby (or both?) dies.

Very simple. No gas money? You don't get treatment. You die.

I took this in, I cried again, and felt helpless and overwhelmed again. I will write a check right now so that this never happens again!! And yet, that is not enough, nor is it even adequate. It's just what I know how to do.

We were all quite shaken by what we'd seen. The result of being so shaken is not only to just be upset, but to want to do something. But what? What can we do? How can we possibly assist in such a complex and in many ways corrupt system? I'm white, I'm American, and privileged. Do I share what I have? I don't know the answer, I don't know how to make it better. I don't know where to go, and that feels right to me- because it will come. 

Midwives working on the exercise.
For now, I feel that I am doing a small part to heal the situation with this training. We have met the most amazing, funny, creative, visionary midwives at Shanti. Despite the language barrier that exists between us and a couple of the midwives and staff, we are making it happen. Jane, Melinda and I are continually crafting this workshop to be more culturally relevant, to appeal to the knowledge base of our attendees, to give them the basic skills that any doula training would provide alongside the really awesome differences in opinion that the three of us share on many topics, but in a highly constructive way.

What this means is that the midwives here at Shanti who are already very compassionate and quite skilled, are adding tremendously valuable tools to their toolboxes- things like fetal positioning and how to encourage changes, how to recognize in a labor pattern that a baby might be malpositioned rather than asking a mother to have a vaginal exam, different positions for laboring and how they affect a pregnant woman's anatomy - information that they can give the mothers so that the mothers can make choices in their labors on how they want to help their babies be born.

That my friends- that is a direct impact. Maybe there's a step between me and that laboring mother but it's a critical one and not one I'd ever want to skip.

We have a mama laboring the last few days at Shanti, Viola. She looks like she's 16 and we found out today she's actually 25 and laboring heavily with her 6th pregnancy, 3rd baby. A couple of days ago Lisa showed us massage techniques and some acupressure points on Viola but her she is, two days later- still laboring. It was sweet to meet her and I know that Jane, Melinda and I were both envisioning how delicious it would be to be present at her birth.

Viola's Swing!
Finally today she was almost fully dilated and Melinda and Jane were able to do some midwifing/doulaing with Viola while I taught. Unfortunately she hadn't given birth when we left although she doubtlessly has by now, and hopefully tomorrow we can give her some love before she goes back home. As we discussed positions for birthing, knowing that Viola's baby was asynclitic, we discussed different ways of coping with that and as I started talking about how dangling a mother (having her hold on to something with her arms and let her pelvis completely go, Melinda walked in having thought of the same thing. She managed to wrangle a rope from town and it was installed before we left- and promptly turned into a swing. ;) 

After the day was done we met with Sadie and Sarah from Shanti and had dinner outside, below the almost-full moon, and even provided dinner to some mosquitoes. (I haven't been bit yet, yeah!!) We drank beer together and got to know each other a bit- It was a treat to find out that Melinda has been making beer for 20 years and has even won awards for her brew, and did some matchmaking for Sadie. Every day I feel more and more at ease here. It will be so, so hard to leave.
We went back to the guest house and a couple of our troop went out to a local dance club with some of the volunteers and the rest of us stayed here and drank beer and laughed and chatted until 1:30am. It was solidly good fun and I am so glad we had that downtime together.

Ahhh the latrine hole. At least I
didn't pee on my feet... oh wait...

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