Last week I began my orientation in the postnatal ward. This ward consists of two large rooms with about 20 patients each, two medium sized rooms of 6 each and two small rooms with 3 patients each. Once again, all cared for by a single nurse and two nurse assistants (a.k.a. auxiliary nurses). The women here are mostly post-cesearian patients but these rooms also house women with preeclampsia and eclampsia, symphasis pubis dyastisis, women with intrauterine fetal demises (IUFD) awaiting delivery (laying on mattresses aside women nursing their healthy newborns).
Today I saw a woman who delivered premature triplets at home. They were all alive when she arrived at the hospital but when I went to see them they were already wrapped and set aside in a corner of the nursery. The nurse said, “They were so cold already and they didn’t stay long.” No one had told the mother yet, the guardians had been told but not the mother (apparently culturally the guardians are supposed to tell the mother).
Then, I saw a 19-year-old who began laboring in Mozambique but who made her way from home to health center, once she or her birth attendant realized the labor was not progressing normally. The health center transferred her to a larger health center, which then transferred her to Bottom. When she arrived at Bottom, three days into her labor, her uterus had ruptured and her baby had died. She survived but her life cost her her uterus and a blood transfusion.
I saw two eclamptic patients. One of whom, when I asked for her clinic booklet, did not have a single blood pressure recorded for any of her prenatal visits. (Preeclampsia is an awful, poorly understood, systemic disease of pregnancy characterized by high blood pressures. A woman with preeclampsia can seize at any time, but women with elevated blood pressures are usually monitored carefully and given medications to prevent seizures, or delivered early. The only cure is delivery. Once a woman seizes it is said that she has eclampsia. Eclampsia is fairly rare in the developed world. One Scottish OBGYN recently told me that in his 9 years of practice he had never seen eclampsia.)
In the last hour of my day I saw a preeclamptic pregnant woman at 30 weeks gestation seize in the hall. Around the same time, the doctor determined that another woman, complaining of abdominal pain, was approaching septic shock and needed to be prepared for a stat uterine evacuation.
This of all really happened, and more. One day. Eight hours. Unbelievable.
There is so much going on, so much to take in, so much to feel. Some of it is only witnessed but some reaches deep inside. At certain moments I can feel a force moving through me, changing the rhythm of my heartbeat, pressing on my chest, electrifying the tips of my fingers, creating a wide empty space in my belly as an experience is permanently and viscerally recorded. Wherever I choose to be in the world, the stories in Malawi will continue unfolding with their drama, passion, and loss. I could be in so many places, but now I want to be here. Even in the most tragic moments there is solace in the experience of sharing the pain and in the hope that just as pain can compress and diminish life, if met with love, it can expand life. That is the hope.
Last week I met a girl 21 years old, who had had three pregnancies, three deliveries, and no surviving children. Her most recent pregnancy ended with a term IUFD and she was delivered via c-section. After waiting a week in the hospital for her incision to heal, she was discharged home but soon returned with a raging infection (peritonitis and a necrotic uterus) and had a hysterectomy. I met her while she was in the ward recovering from her hysterectomy. She is a beautiful girl but her young body takes the form of an old woman when she walks - bending forward, moving slowly, each step cautious and tender. And yet, even though everything about her communicates the depth of her loss, she almost always smiles at me when I enter the ward – warm and genuine. Over the past week, I always looked for her when I came and I watched her wounds, they are healing well. One large untidy line - thick here then thin, puckering at points - stretches down from her navel and a smaller perpendicular scar marks the right side of her abdomen. There is nothing subtle in her story or in its transcription on her small body.
I was with her today when the clinical officer discovered that somehow - in the process of her illness, and healing, and illness and healing - she had developed a fistula between her urethra and her vagina. He found a hole where it shouldn’t be, but there it is, and now urine constantly runs down her legs. They can and will surgically repair the fistula, but she must wait three months before her body will be ready for the operation. Three months after losing her third baby. Three months after losing her uterus. She will wait three months smelling of urine for yet another surgery. As he explained the problem to her, tears began to silently spill from the corner of her eyes. He said she could go back to the room, to her bed, and then she could go home. Just come back in three months.
I followed her back to her bed. In the middle of the noisy room filled with mothers and guardians, visiting husbands, crying babies, nursing babies, she collapsed on her bed in a small heap and began sobbing, “Amayi, amayi, amayi.” I rubbed her back and her head. And, when I realized she was crying “Mother mother mother . . .” the tears I was holding, broke free. We are so much the same in our expressions of pure emotions. We all call for the same person when life ravishes us, the only person whose love can offer comfort in moments of utter devastation - our mothers. I also realized with a bit of tragic irony that here in Malawi where women are raised to be mothers, this small woman had tried so hard to be just that and it broke both her body and her heart. I cried. And, I prayed. I prayed that she did have a loving mother and a loving husband, that she would again find hope and strength. I stayed with her until she fell asleep.
Only once she was still and her breathing deep and regular, did I notice a small wizened woman standing near the bed. She smiled a kind sorrowful smile and said, placing her hands over her heart and nodding at the sleeping girl, “Mwana anga,” my child.
Today I saw a woman who delivered premature triplets at home. They were all alive when she arrived at the hospital but when I went to see them they were already wrapped and set aside in a corner of the nursery. The nurse said, “They were so cold already and they didn’t stay long.” No one had told the mother yet, the guardians had been told but not the mother (apparently culturally the guardians are supposed to tell the mother).
Then, I saw a 19-year-old who began laboring in Mozambique but who made her way from home to health center, once she or her birth attendant realized the labor was not progressing normally. The health center transferred her to a larger health center, which then transferred her to Bottom. When she arrived at Bottom, three days into her labor, her uterus had ruptured and her baby had died. She survived but her life cost her her uterus and a blood transfusion.
I saw two eclamptic patients. One of whom, when I asked for her clinic booklet, did not have a single blood pressure recorded for any of her prenatal visits. (Preeclampsia is an awful, poorly understood, systemic disease of pregnancy characterized by high blood pressures. A woman with preeclampsia can seize at any time, but women with elevated blood pressures are usually monitored carefully and given medications to prevent seizures, or delivered early. The only cure is delivery. Once a woman seizes it is said that she has eclampsia. Eclampsia is fairly rare in the developed world. One Scottish OBGYN recently told me that in his 9 years of practice he had never seen eclampsia.)
In the last hour of my day I saw a preeclamptic pregnant woman at 30 weeks gestation seize in the hall. Around the same time, the doctor determined that another woman, complaining of abdominal pain, was approaching septic shock and needed to be prepared for a stat uterine evacuation.
This of all really happened, and more. One day. Eight hours. Unbelievable.
There is so much going on, so much to take in, so much to feel. Some of it is only witnessed but some reaches deep inside. At certain moments I can feel a force moving through me, changing the rhythm of my heartbeat, pressing on my chest, electrifying the tips of my fingers, creating a wide empty space in my belly as an experience is permanently and viscerally recorded. Wherever I choose to be in the world, the stories in Malawi will continue unfolding with their drama, passion, and loss. I could be in so many places, but now I want to be here. Even in the most tragic moments there is solace in the experience of sharing the pain and in the hope that just as pain can compress and diminish life, if met with love, it can expand life. That is the hope.
Last week I met a girl 21 years old, who had had three pregnancies, three deliveries, and no surviving children. Her most recent pregnancy ended with a term IUFD and she was delivered via c-section. After waiting a week in the hospital for her incision to heal, she was discharged home but soon returned with a raging infection (peritonitis and a necrotic uterus) and had a hysterectomy. I met her while she was in the ward recovering from her hysterectomy. She is a beautiful girl but her young body takes the form of an old woman when she walks - bending forward, moving slowly, each step cautious and tender. And yet, even though everything about her communicates the depth of her loss, she almost always smiles at me when I enter the ward – warm and genuine. Over the past week, I always looked for her when I came and I watched her wounds, they are healing well. One large untidy line - thick here then thin, puckering at points - stretches down from her navel and a smaller perpendicular scar marks the right side of her abdomen. There is nothing subtle in her story or in its transcription on her small body.
I was with her today when the clinical officer discovered that somehow - in the process of her illness, and healing, and illness and healing - she had developed a fistula between her urethra and her vagina. He found a hole where it shouldn’t be, but there it is, and now urine constantly runs down her legs. They can and will surgically repair the fistula, but she must wait three months before her body will be ready for the operation. Three months after losing her third baby. Three months after losing her uterus. She will wait three months smelling of urine for yet another surgery. As he explained the problem to her, tears began to silently spill from the corner of her eyes. He said she could go back to the room, to her bed, and then she could go home. Just come back in three months.
I followed her back to her bed. In the middle of the noisy room filled with mothers and guardians, visiting husbands, crying babies, nursing babies, she collapsed on her bed in a small heap and began sobbing, “Amayi, amayi, amayi.” I rubbed her back and her head. And, when I realized she was crying “Mother mother mother . . .” the tears I was holding, broke free. We are so much the same in our expressions of pure emotions. We all call for the same person when life ravishes us, the only person whose love can offer comfort in moments of utter devastation - our mothers. I also realized with a bit of tragic irony that here in Malawi where women are raised to be mothers, this small woman had tried so hard to be just that and it broke both her body and her heart. I cried. And, I prayed. I prayed that she did have a loving mother and a loving husband, that she would again find hope and strength. I stayed with her until she fell asleep.
Only once she was still and her breathing deep and regular, did I notice a small wizened woman standing near the bed. She smiled a kind sorrowful smile and said, placing her hands over her heart and nodding at the sleeping girl, “Mwana anga,” my child.