This Blog entry was written on 12.30.06
“You are welcome!” is how I am greeted on my first day at Gulu Regional Referral Hospital. It took four days before I was given permission to work as a volunteer in the maternity ward. I was interviewed by the head nurse, “Sister Grace”, and then forwarded through to an interview with the superintendent of the hosptial, Dr. Tom Otim. After reviewing my doula and childbirth education certificates, I was given a warm welcome by the “big boss”. Gulu Regional (GRRH) was built in the thirties and has not been renovated since. It is a government owned hospital so the patients do not pay for their care. Many of the women are coming in from surrounding villages or IDP camps. Many are teenagers.
There are people scattered about as you enter the gates. People looking for care, people lying down, people washing their babes, washing their clothes, eating, mothers in labor…there is a lot happening
outside. The fresh air is a relief for the patients.
All the nurses refer to the highest trained midwives as “Sister”; the others go by nurse or just their first name if they are “enrolled midwives” (EM). EM have had at least 3 years of training. They still have another year or two to go before they are also considered a “Sister”. I am delighted to refer to my mentors here as Sisters. It is said with genuine love and respect. Sister Grace took me under her wing immediately. She gave me a tour the day before I was to begin. “You should come tomorrow and be free here. I want you to feel comfortable, so that you can come and go. You are one of us now.” It is hard to describe the generosity of this welcome. It warms my heart to be touched by such truly genuine people. This is Acholi land after all! If that was all I received from my time in Africa, it would be more than enough.
I meet Sister Millie (she is also a head nurse and my boss). At first she is a little more reserved with me. She wants to make sure I’m legit. This lasts only about ten minutes before she laughs, taking my hands in hers and says “You are welcome!”.
I am aware that in America this would all be an impossibility. I am humbled, truly humbled, and also confronted with the reality of being muzungu here in Uganda. I do not want to take this privilege for granted — ever. I barely slept the night before my first day. In the morning, I woke up and put on my uniform. It is formal here. The nurses all wear dresses with little white doily hats. I dress in my scrubs (thank you, Mom Bott, for hooking that up in NJ!), tie my hair back in twists, and put on my white sneakers. I’m excited, nervous, and ready to go. I call my bodha friend to come pick me up and we zip down the red dusty road.
The day that I got permission from Dr. Otim, we also received our bags (after 12 days!!). Finally!! The main thing that I was waiting for was a bag that I packed with medical supplies. I just brought the basics: latex gloves, razor blades, hand sanitizer, hand and baby wipes, Mother’s Milk tea, towels, soap…
This blog entry is now being picked up on January 2, 2007.
Happy New Year to all!I started writing the above blog after my first day at GRRH and realized that I was totally overwhelmed and unable to write. Now, four days later, I feel just as overwhelmed but I will attempt to write.
What I am seeing daily is hard to comprehend. The conditions of GRRH are horrendous. This hospital needs serious help. The women, my Sisters, with whom I am working side by side, are teaching me more each day than years of schooling ever could. This education is invaluable. They are experts. They are strong. They work with barely any supplies, medication, or assistance. There are no antibiotics in our ward, no bandages, very little medicine, no running water, few supplies. Since July they have delivered 3074 babies and counting. Often there is only one midwife per shift. Many days there are 15-20 births during an 8 hour shift. The main ingredient for sanitizing equipment is “jik”, which is bleach. The other is one machine that boils water. They only have three delivery sets. A delivery set is a metal kidney-bean-shaped bowl that holds all of your equipment; two clamps, one scissor, and one metal tool for suturing. There are only two suctioning bulbs. There is no betadine, no alcohol. We have a short supply of latex gloves. I brought masks and protective eyewear. The beds are from the 40s or 50s and are corroded with blood, feces, rust, and dirt. One day I spent an hour down on my knees washing the beds with Sister Christine and my dear friend and mentor, Nurse Jaqueline. This is just what you do. The conditions are horrifying. And yet, I am amazed to see that the majority of these births are SVD (spontaneous vaginal births). They do cesarean births, but very few. Breech births are done vaginally, as are twins. Every once in a while there is a stillbirth. There are many “abortions”. At first I was confused but after some explanation I realized that they refer to miscarriages as abortions. Most of the abortions are brought on by malaria or a fever that has not been treated. Many of the women are also HIV positive. The first baby that I saw today was only 2 pounds born to an HIV positive mother. The mother weighed about 80 pounds. I spoke with her, stroked her hand, and admired her baby. She looked like she was going to die. There was little that I could do in this situation other than love her. I work from 9am to 4pm everyday. Throughout my day my Sisters are apologizing for the conditions of the hospital and the lack of supplies. Throughout my day I am thanking them for their wisdom. They have been so generous with me. I am learning everything first hand.
In Uganda there is no such thing as a doula. The women coming to GRRH are brought by their attendants (their family), usually their elders. Today there were four generations of women supporting one woman. They stay overnight into morning, determined to camp out until they can welcome their new family member. They line the hallway, sitting on the floor with teas prepared, some food, and straw mats (if anything at all). They are almost always barefoot. The mothers come with a kaveera which is a thick black, tarp-like sheet. This will be placed on the bed. They will not be admitted without one. The beds are just bare metal. They come in three pieces that are then pushed together with old stirrups on the side. They’re required to bring the following: a kaveera, two pieces of cloth, and a wash bin. The two pieces of cloth can also be the dress or skirt that they’re already wearing. This will be used to wrap the baby once its born, or to deliver the baby. The midwives often use the cloth as a way to protect the perineum. After they give birth they are required to clean up anything that has spilled over onto the floor. My second day, I was with a mother whose kaveera tipped completely. On the floor was a mess of feces, amniotic fluid, clots, and blood. I gestured to get the mop so that I could begin cleaning, and then was instructed not to. The nurse spilled some jik on the floor and the mother mopped up the spill with her kaveera, and soiled cloths. She then placed it all in her wash bin and left to go downstairs to the postpartum ward. This was literally 10 minutes after she delivered her placenta.
During my lunch break I was invited by the Sisters to join them to go buy some meat. I had no idea what they were talking about but out of respect I followed them. We walked through the hospital grounds to an empty plot of grass by a fence. There was a group of about 40 people in a circle surrounding a man that was hacking, hacking, hacking away at some meat with an axe. The meat was being pounding and cut atop a fallen tree. The sight of the meat actually didn’t come as much of a surprise to me; there is meat hanging from hooks under corrugated metal verandas all over town. But the hacking was new. There was a priest, I believe he was Muslim, supervising the meat distribution. They had come to the hospital to offer this meat for free to all employees. Apparently it was a Muslim holiday and I could tell that everyone at the hospital was very excited. I watched as the butcher cut off chunks of beef, rationed pieces, and weighed them on a scale hanging from a hook. He then handed everyone their rations in a black plastic bag. I was encouraged to step forward. It was only then that I realized that the cow had just been slaughtered. First I saw the remnant flesh and the four amputated hooves. I was then pushed in front, handed my own sack of meat, and then we all walked back to deliver babies. I asked them about refrigeration but they assured me that the meat would not spoil. Cautiously satisfied with their explanation, I stowed my sack on top of the nurses table next to my purse.
Kevin came to pick me up and as we were walking we met up with our friend Tony. Needless to say, Tony left with the meat sack.
In the past four days I have been taught how to check the cervix, catch a baby, support the perineum, how to tie a cord with string, how to palpate the uterus, and extract the placenta. They are no fetal heart monitors here. I have learned how to listen to a babies heart with a metal cone. They only have one and you have to listen VERY carefully. I have been thrown into the most rigorous training of my life. I am always supervised closely and walked through each procedure. I have witnessed the midwives handle emergency situations with such patience and confidence. They give women TIME to labor here. They are never rushed. Never. Sometimes they are in the labor ward for days before being brought up to delivery. They come up to delivery, labor for while, get checked, and then either it is time to have their baby or they are sent back downstairs. There is no “on the doctor’s watch” mentality here. It is surreal to be working in an environment that is so under-supplied and neglected and discover a level of “trusting the birth process” that far surpasses any US hospital experience that I’ve ever had. Again, they give their mothers and babies time.
Childbirth education comes through direct experience. But I find that many of the women don’t know what is happening to them. Today a woman needed to vomit but held it in because she feared vomiting her membranes. Many of them are afraid to open their legs. The midwives can be extremely aggressive. If a woman is not cooperating, hitting and screaming at a woman in labor seems to be normal here. I was shocked the first time I witnessed this behavior. But I am coming into such a new culture… I am perplexed by these cultural differences. I am constantly questioning how my race and class impacts this experience. I think about the ethical issues around my training. I realize this is unconventional, and yet it feels true to the craft of midwifery. These issues cannot be ignored. Very few of the women speak English. Most of my communication is being translated from Luo into English. But the truth is that birth has its own language, and most of the time I can understand without any translation needed.
When I tell my midwifery friends about what I do at home as a doula they have a hard time relating. The doulas here are the attendants, the elders. They are family. But they don’t care for a woman the way I have been trained to in US. There is very little touching. Almost none at all. When touching is involved it is a strong grab not a tender touch. The women writhe in pain, unmedicated, and praying to g-d… women cry out, ”please don’t let me die, mama!”. They get through it and usually are dressed and asking to go home within an hour after delivery. I still find myself in the role of doula. I still believe that a loving and kind touch helps. I practice comfort-measures and have taught the midwives a few things, one being counterpressure. But I also see that being a doula for a woman in the US is a privilege.
Yesterday I got off of work and walked with Jackie (my midwife partner) to the market. We looked at textiles and she showed me where her tailor is. The fabric here is incredible. There is a part of the market that is just devoted to seamstresses. I love walking there, looking at that colorful patterns that splash the market. I bought some fabric, and took a bodha to my friends’, Meg and Jess’ house.
After a few hours of brainstorming about GRRH with them, I walked to meet Kevin down the red dusty road. I relished this walk alone toward him. The sun when it sets here is the most incredible diffused light. It is a glowy orange pink. This is my favorite time of day 6:15-6:45pm. Everything radiates this light. The day was long, my feet were tired…I had witnessed so much in one day. The mother screaming in pain while we drained an infected arm and breast. Desperate for antibiotics. A woman in a coma suffering from meningitis. Giving water and supporting the body of a woman delirious with malaria while she was miscarrying. She has been bleeding for days…Catching my first girl baby (the other two babies I caught were boys). Putting her on her mama’s belly then weighing and wrapping her. In this madness there is tremendous beauty. This is life. Birth does not lie.
A few days ago, I was given the honor of naming a baby boy that I caught or as they say “conducted”. At first I resisted. How could I impose a name on a child and family that I don’t even know?! Sister Jennifer explained to me that this would be a tremendous gift for the family. They would be so grateful. She said, “Choose a good Christian name.” After a few seconds, I said, “How about Victor?”. The Grandmother then repeated the name: “Vick-tore”. They told the mother and then they all formally accepted the name with smiles and gratitude. I explained that Victor was my late Grandpa and a very strong man. I told them that he was one of my favorite people, who was dearly loved by everyone that knew him. Living to be 93 in Africa is an anomaly so they were very impressed. Victor Akoko is a strong and a BIG baby, weighing 3.7 kilograms (8.14 pounds). The average weight here 2.5-3 kg. (see photo).
Some words in Luo, the language of the Acholi people:
Birth- Nywal
Sisters- Lamego
Midwife- Lacholo
Mother-Mego
Latin Kienen- Mother & Newborn
Helping- Kony
Heart- Cwiny
Hands- Cing
Togetherness- Ribbe
Push (something I hear all day long)-Chol
Hard (the other word I hear all day long)-Matek or Chol Matek
Continue-Medii
You’ve done a good job- T’emo ma bei
Beautiful- bei
Baby is beautiful- Latin leng or latin bei
As Kevin mentioned in the last blog, I am thinking constantly about collaboration with midwives here and in the US. I have also decided to apply for midwifery school when I return.
There is a great opportunity for us to learn from the Acholi midwives. Their birth model feeds me and renews my faith in the strength and wisdom of women, everyday.
Today Kevin and I returned to the hospital (I had the day off). I wanted to check up on some of the mothers that were laboring during my day duty yesterday. They were all in tremendous pain when I left. They were happy to see me and I'm happy to announce two new "Christian"-named babies: Philip Arwot Olara and Aimee Layet Adong.
Welcome to the world, little ones!
I look forward to sharing more when I get home with family, friends, and with the doula groups in NY.
sending love to all
Afoyo!
love,
aimee
