Last week, I ran smack into a very difficult culture clash
that broke my heart. I arrived at the
clinic to start work. We began to see
patients when Dr. Sana got a call to run to the next village to see a
patient. He left me there to continue on
my own. As he was leaving, he said, there is a pregnant girl out here who is
suffering with pain. Her paper was
already in the stack of waiting patients.
I saw another patient, but then decided to move her ahead in line.
I wasn't super worried about her.....We see lots of pregnant
women with low belly pain due to STDs.
She was only 17 years old, 7 months along and this was her first
baby. I called her into the office and
registered her in the book and began asking what the problem was. Her pain seems more intense than an STD and
she said it had started the day before.
As she lay down on the exam table, I asked if she was having any
"white water" - the term we use for discharge. Yes, she replied. A lot? I asked. Yes, like I peed. That had me concerned.
I checked her stomach and she seemed to be having
contractions. Baby's heartbeat was nice
and loud. But mom also had significant
edema/swelling in her legs, she was complaining of a headache, and her blood
pressure was 160/110. I did an exam and
she was dilated 1 cm. Since no one here checks
for that during prenatal visits, I had no way of knowing if that was new. I wasn't sure what to do....I kind of wanted
to send her to the hospital, but that was a 2 hour motorcycle ride away on rough
roads.
I called her husband (about 18 years old) and father in and
told them...I want her to start taking medicine and rest here for the
afternoon. We will see if her stomach
calms down - and then we will have a better idea of what to do. They were good with that and the dad went
back to their village to work on the farm until evening, when he would return
to pick them up.
I started her on antibiotics and gave her a shot for the
pain. We mixed up Gatorade and she
started drinking it. I had her lay down
in a quiet room, and continued to see other patients. I checked on her throughout the morning. The pain wasn't getting better, but it wasn't
getting worse either.
By this time, I was way past my time to go home (most days I
only work in the morning), but Sana wasn't back yet and I felt uncomfortable
leaving her alone. I continued to see
patients until everyone was seen. Still
no Sana. I was getting fussy. I was hungry and had a boatload of stuff that
I had been planning on doing that afternoon.
I thought about leaving her at the clinic and running home to grab a
bite to eat. Sana's wife was there
(their house is right beside the clinic) and she could call me if there was a
problem.
Something told me to stay put. It was 3:30 pm at this point and I knew that
we were going to make a decision about what to do with Dyama (the
patient). Her headache was worse and the
pain shot wasn't working. I finally was
able to call Sana to ask where he was.
He said that he was on his way -which means anything from....be there in
10 min to showing up several hours later.
Thankfully this was a 10 minute delay. He pulled in on his Moto and looked at me
with a question on his face. I pointed
to mom, who was standing in the hall. Is
she in labour, he asked?
I think so, I replied....but she is only 7 months
along. And I think she has
pre-eclampsia.
He headed over to his house and I decided to check and see
if she was dilated more. As I went to
get gloves, I heard a loud scream from the other room. Not good, I thought.
I grabbed gloves and laid down an old plastic tablecloth -
our attempt to reduce tetanus. I told
mom to lay down. As she did, I could see
the umbilical cord sticking out. I ran
out and told Sana that I needed help.
We discovered that baby was breech when the first body part
we could find was a foot. Sana's wife
Dena came in to help when she heard the screaming. What followed was about 20 exhausting minutes
of.....
-Dyama screaming and begging us to stop....having never had
a baby, she had NO idea what was happening....she wouldn't lay still, making
our job SO much harder.
-Dena chastising her...telling her that there were men
outside the clinic who could hear her screaming
-Sana and I taking turns trying to reach in for feet and
arms to try to get baby out - his little arms were stretched high above his
head....and the cord was part way out so his blood supply was cut off. Sana said...no way this baby is going to
survive...but I was hopeful.
Finally we got baby delivered - strangely, the placenta came
out with baby- having already detached.
He was a good sized, beautiful little boy. He was not breathing and had no
heartbeat. I was going to try to revive
him, but my delivery bag was at home with my ambu bag and I felt certain it was
already too late. I reached for him,
deciding to try anyway, but Sana stopped me.
I knew he was right.
So there we stood, looking down at the mom and her baby...I
had no idea what to say or how to handle it.
I was opening my mouth to tell mom how sorry I was when I saw her
looking at the baby. She said something
about whether or not it was breathing yet...and I realized that she didn't know
it was not alive. Ok, I thought...let's
see how Sana breaks the news. But he
just brushed her off and said, we will take care of it. Wow, that was not what I was expecting.
We called in a distant relative - a woman for our town - and
explained what happened. We got mom
cleaned up...baby laying next to her the whole time. Finally we moved mom into the next room and
wrapped baby in plastic and laid it out of sight.
We went to the office and Sana called the husband in. He said, I want you to go to your village and
get your family. The husband said, you
are scaring me.
Sana said, nothing to be worried about. Just go get your family and we will wait for
you here. The husband left.
I was stunned ....nothing to be worried about? Seriously?
Sana said, they are both very young. We cannot tell them about the baby until
their parents are here.
Now, before you wonder about me and why I didn't go with my
instincts to tell mom and comfort her,
you need put yourself in my shoes. We are guests here in this country and there
are a million things about the culture that I don't get. Breaking bad news to someone is one of
them. I have seen people lie to the face
of another (there is nothing to be worried about, for example) until they feel
the time is right to break the news. We
rely HEAVILY on Sana, Dena, and our other friends to help us know the correct
cultural way to approach things like this.
So I shut my mouth and waited.
After about 30 minutes, I decided to go and check on
mom. I wanted to check her BP to see if
it was going down. I went in and laid my
hand on her shoulder and ask how she was feeling.
Better, she said. But
where is my baby? Did that lady relative take him to her house?
I couldn't look her in the face. I mumbled something and left the room,
forgetting about taking her blood pressure.
It was awful.
I wanted SO much to sit with her- but I knew I would not be
able to avoid her questions so I sat outside, tears running down my face.
It is cultural no-no to cry like that.....Sana asked why I
was upset...Since it was God who had decided that the baby would not live.
After about 45 min, the husband returned with his in-laws
and a few other people. I was still
crying but trying to get it under control.
We all went into the office. Sana
explained how she had come because she was sick but that it had turned into a
delivery. But that baby was too small
and didn't survive.
The dad was the spokesman for the group. He said that he had heard, and that they were
grateful for all we did. He knew that we
tried. He then said something that
surprised me....He said, "Gulunga (me) stayed here the whole time. She never left Dyama alone. And we thank her for that."
I was surprised, because the 18 year old husband was the
only one from that group at the clinic that day....He must have been the one
who told them that I had been there the whole time (made me SUPER glad I didn't
run home for a bite to eat). It never
occurred to me that it would make the impression that it did.
Sana took the family to see the baby and then we all went
into the room where the mom was laying .
There the dad officially told the baby's parents that the baby didn't
survive (even though the baby's dad had been in the office with us and already
knew).
The family thanked us again for our kindness and for me
staying with her the whole time. After a
short while, all the men left, except the husband. I went in to be with mom for a bit and to
tell her how sorry I was. A group of
women were sitting there with mom, talking.
One of them said, was this her first baby? When they replied that it was, she said,
first babies are hard. They are often
taken from their mom's hand (meaning that they died). Everyone agreed.
That might be reality but it made me angry. I wanted to shout - but it doesn't have to be
that way!!!!! It is not like that
everywhere. That is not to say that it
doesn't happen.....but it is certainly NOT the norm.
I was able to talk to mom for a few moments...telling her
how very sorry I was and prayed for her....that God would bring comfort to her
heart.
I went home broken hearted that day....feelings like I had
failed my patient and her baby.
I known that in will never understand all that is involved
in breaking bad news in this culture.
My hope and prayer is that the families will see my heart
for them, and through me, Jesus's love and concern as well.....no matter how
the news was delivered.
