Gentle Creatures

July, 6th 2007

I had to unplug from blogging and writing this week. I had no energy for it. To recall all the events of the week feels like too much, but I feel compelled to at least follow up from my last blog. My last entry was mostly about Harriet. After her cesarean and the death of her son, her body became extremely infected. She was not monitored closely enough by the doctors and ended up with an advanced case of sepsis. When we arrived last Friday morning, her mother, Catherine, was crying and was worried that her daughter was going to die. She told us that during the night Harriet’s breathing was very labored and she was completely unresponsive. It was clear to me that she needed to be transferred to Lacor hospital immediately. We had to wait around for her transfer to be signed off on by the head doctor and then we had to arrange for a car. They don’t just have an ambulance on call ready to go. Once the ambulance is arranged, you personally have to pay for petrol. We helped the family with this cost. What about the families that can’t afford the petrol to Lacor? Harriet was in really bad shape when we transferred her. She was making these deep moans but her eyes were fixed and her breathing was very shallow. Her body was in septic shock. Harriet was taken off the gurney at GRRH and placed on a straw mat in the ambulance with eight relatives crammed around her, including Rachel, who rode with her in the back. We traveled the bumpy dirt road to Lacor and were greeted with frustration by the head maternity nurse. She gave me a long lecture about how GRRH always waits until the last minute to transfer patients to them. She was angry about how this affects the records and statistics at Lacor because, unfortunately, many of the transfer patients die. After all, Gulu hospital is the “referral” hospital. It was a shock to witness the Lacor doctors at work. They moved fast and treated Harriet immediately. We talked to them about the issue of negligence in Harriet’s case. They had a lot to say on this matter and confirmed what we’ve been witnessing at GRRH. Once Harriet was stabilized the doctor told us that he felt very optimistic about her chances for recovery. I felt so relieved. We told her family the good news and left thinking that she would regain consciousness within two days. We told them that we’d come to check her the following day. Her brother, James, spoke English well and was our main way of communicating with her family. He was also a dedicated brother and had been at Harriet’s side everyday. Around 4 pm the next day Rachel and I were getting ready to go to the hospital. I decided to call James just to check in with him. To my shock he told me that Harriet died at 1 pm. I couldn’t believe it. I still can’t believe it. It was just three days before her death that we were singing and dancing together. She was a strong, funny, lively, beautiful girl. How could this have happened? Our conversation was short. I asked him to call back with details about her burial. We hung up and Rachel, Kevin, and I were dumbfounded. I was furious. It wasn’t until later on when I was alone with Kevin that I broke down. It was just too much. Rachel and I attended her burial. She was buried on a plot of land that her young husband’s family owned. The land was deep in the bush… and I mean deep. We drove to a small town and then hiked about 2 kilometers into the bush. James escorted us along with Kenny (our driver and friend from St. Monica’s). I was glad to have him with us. Her family had been waiting for us. They were about 75 people gathered in a clearing in the middle of the bush. Harriet was wrapped in blankets. One was a the katange (cloth) that she labored in at the hospital. Her mother also tore a piece of that material and was wearing it around her waist. They unwrapped her face so that we could see her. Again, I couldn’t believe she was dead. It was heartbreaking to see her mother. We had spent so much time with her mother from the time Harriet arrive in early labor, through active labor, and then post cesarean and the death of her baby. I felt very connected to her and at a loss…The burial was very simple. She was put into the ground and her cousins poured dirt over her. Then they got inside the hole and pounded the dirt on top of her with their feet. This was followed by pounding the dirt with large wooden poles. The women and men sat separately. They watched silently. Harriet’s mother cried a little, but quietly. Rachel and I sat on the straw mat with Catherine and the other mothers of Harriet and we all held hands. She had many mothers, at least four. I think her father had five wives. After the last bit of dirt was pounded down the women erupted in wailing. They began weeping, screaming, and pounding their chests. I was totally taken off guard. The women then got up and began the procession back to the village. The crying and grieving continued all the way down the path. As Catherine passed the grave she threw her flip flops on top. We took the long and sad walk back to our car. Catherine and her sister got in and we drove them back to the IDP camp. She wanted to show us where the baby was buried. We walked through the camp until we got to a hut. There, inside the outer wall of the hut, was a small mound of mud. The baby was inside the wall of the hut. It was so sad to see that little mound of mud, and hard to believe that their baby was buried inside. They took us to where Harriet lived and then we said our goodbyes. There was closure for me in attending her burial. It helped to mourn with her mothers and family. It helped to see her face.

During the week of Harriet’s and her baby’s death there were two other babies and two other mothers who died. The two babies were both women that we had been working with. Their story is equally as important and painful as Harriet’s but I don’t have the energy to retell it during this entry. Even now as I write, Kevin and I are on a bus to Kigali, Rwanda, and nine days have passed since Harriet’s burial. It feels like a long time ago.

My last week in Gulu was filled with a lot of grief and joy. I was fighting a bacterial infection and had the worse case of tonsillitis ever. My body just broke down from the stress and emotional weight of the last month. In that time Jess and Ellen arrived to Gulu. They were here for just a short time but their presence was lovely. The women and staff at the hospital appreciated them so much. They “doula-ed” each woman with great tenderness. I took them to meet the TBAs at Kongya Goka IDP camp. Again, we were greeted with song and dance. In return, Ellen belly danced and was a huge hit! They talked to them about the role of a doula and showed them some positions and pressure points that are helpful for women during labor. They appreciated our short childbirth education class and we were so grateful in return for the wisdom that they shared with us.

I learned a lot from this pilot program about what works and what doesn’t work. In our time at the hospital we witnessed what to us looked like negligence… I wrote about the lack of critical thinking in my last blog. Looking back on that blog I have to apologize to my Acholi friends. I could go back to my blog site and edit it out but I feel it’s important for it to remain. There is critical thinking here. There is self-reflection. It was arrogant of me to write otherwise. It’s hard to process and live in it at the same time. There are days of utter rage, it’s true. But that rage is mixed with the most heartbreaking compassion. The rage is not directed at anyone in particular. I think that once we start indicting the victims, we as westerners lose the wider context of the suffering of the culture. That line is a constant test. My last day at the hospital was a sobering one. I learned a lot from my midwife sisters about what is needed in order to work as a team even in the midst of negligence and death. It is easy to focus on the mistakes at the hospital. It is easy to point a finger at someone and call them incompetent. But the doctors and midwives are not to blame. The hospital is not to blame. The people of Northern Uganda have been so deeply traumatized by war and poverty. We can come in and jump into problem solving and criticizing—all in the name of “research”. But at what cost? We will never know what their reality is. I came to GRRH because the conditions are so atrocious. I came because this hospital is severely lacking in supplies, training, and staff. I came because they are my friends. The women that work in this ward everyday are completely overworked. Often they are not paid for six months. They carry heavy loads at home with orphaned children that need food on the table and school fees that need to be paid. Even the head nursing officers can barely survive. So I apologize if I simplified my own analysis of the situation. I was angry the day that I wrote that blog. I still don’t have answers. Do I need to? For me that’s not the point. I have love for my friends, even the ones that participated in Harriet’s and her baby’s deaths. I am humbled here everyday.

I learned that there is no greater human power than kindness and love. I love this place and the Acholi people so much. My own personal commitment is galvanized with each visit. I had many heartfelt and tearful goodbyes, always to the shock of my Acholi friends. Crying when saying goodbye isn’t part of the culture- as far as I can tell…The nuns at St. Monica’s threw me, Rachel, and Kevin a goodbye party. As usual, our dinner turned into a dance party and was the perfect way to celebrate our goodbye with friends that had been so loving and hospitable to us. They even baked us a beautiful Sacred Heart cake! The next day (Friday morning) we drove Rachel to the bus park to see her off. It had been a month of intense and powerful work together. This was a unique situation and one that I will never forget. I’m grateful for all that I learned from my midwife sister.

July 9th, 2007
We feel good. We’ve just returned from a day-long safari at Murchison Falls with the NYU students and Teachers for Teachers exchange program. There is nothing better than being on safari with the hot sun pouring over you riding on top of a matatu and gazing over the landscape scattered with animals---especially giraffes! I felt in love with these magnificent gentle giants. [editors note: Mrs. Brill has a documented history of falling in love with long-necked, gangly creatures with knobby knees and brown spots all over their skin.] We got to Backpackers hostel at 11:30pm and found out that there were six beds for eleven people in a shared room with ten other travelers that we didn’t know and who already were asleep. Not to mention that there were no pillows or mosquito nets on the beds. It was at this point that we had a simple choice: laugh or leave. As it was midnight already, we were over roughing it and decided to book ourselves into a decent hotel in Kampala. I took about five hot showers in two days.

…So now we’re on the long road to Kigali. It’s a nine hour bus ride and luckily we’ve got great seats up front.

We’re happy to have this time together. The jungle and gorillas are calling.

Love to everyone back home,
Aimee

photo 1 Midwives at GRRH (Sister Millie, Sister Anna, and Sister Irene)
photo 2 Jess and Ellen giving a demonstration on positions during labor
photo 3 Kevin and Sister Rosemary at our last dinner dancing calypso
photo 4 Beautiful giraffes!