*Disclaimer: There are medical terms related to birth and breastfeeding
here so read at your own risk
Have you ever seen the show “Call the Midwife”? It is a fun show set in England with a group
of interesting, quirky midwives who serve the under-served in their area. Well, in the village here, we also have a
group of interesting, quirky midwives, of which I am a member. Actually, traditional birth attendants is probably
a better term, but midwife rolls off the tongue more easily!
Two of the three that I work with are mostly kind, helpful women. But the head “midwife” is just one of those
people who can get under your skin. On a
regular basis, she can make me laugh, want to cry, or on occasion, want to strangle her. (pictured from left to right - Rougie (head
midwife), Aissata and Matron Boye (assistant midwives) and Aly (community
health agent and village chief).
I have know Rougie for about 5 years - and we have settled into a
mostly amicable relationship. There are,
of course, the normal culture clashes that occur in the field of women’s
health.
For instance, when I first started attending deliveries with her
- she was well known for something that made me nearly insane. In an effort to stretch those newborns - who
had be scrunched up inside mom for ALL those long months - she, after bathing
them, would suspend them by each appendage - one at a time - and gently shake
them - first one arm, then the next, then flip them upside down - and suspend
them by one leg - and then the next - in an apparent attempt to loosen those
little limbs. Then she would take each
arm and pin it wayyyyyyy behind baby’s back and then repeat that on the other
side.
I can only imagine the look on my
face when I first saw her do this! This
was then followed by gently pushing in on any hematoma that may be on baby’s
head - and then, after checking to make sure that baby was not tongue-tied, she
would give the baby some of the bath water to drink - to show the family that
it could swallow. The whole thing was
capped off by blowing out any water that may have gotten into baby’s ears.
The whole thing nearly gave me hives - made
worse when they did it all in cold water.
I would stand there with a blanket - arms raised - waiting to take the
baby and dry and warm it. Sometimes,
with the smaller babies, who are chilled, I will tuck them under my shirt - up
against my skin - to try to warm them back up.
This - along with my reaction to the shaking - always amuses the other
midwives. “Oh, Gulun-nga, you are SO
funny.” I think - yep - hand me that
baby!
Most days, she is great with the laboring moms. Often, there are 5 - 6 of us women in the
little room. Almost ALWAYS, the laboring
mom saying - it hurts, it hurts - and we all echo back: yes, having babies hurt. They tease me because I only had 3 - seems
wimpy to them! I say - yep, only three.
Then they beg me to have just one more.
And I say - nope, I am satisfied - waiting for grand babies now! And we all laugh.
Now mind you - laboring moms are not really allowed to cry out or
be to loud - or they will be hit. (Not
by me mind you - though I did ONE time tap the mouth of a young, angry laboring
mom who kept trying to bite me - and anyone else within the range of her
teeth).
It is not unusual, in the late night/early morning hours, if labor is progressing slowly, to find the midwives sleeping on straw mattresses - waiting. On occasion, I can be found curled up on a twin sized straw mattress on the floor beside one of the midwives (SUPER COZY) - trying to get a nap and working hard to forget the mosquitos and bats flying around in the darkness.
Rougie has been a midwife for a long time. I can only imagine what she has seen in the
delivery room. That, coupled with the
different way of looking at death, causes some issues when we face death
together. The most stark example of this
was a woman that we delivered about 2 years ago. I was called to the clinic one day and found a
woman from another village in labor. I
started trying to get a brief history on her and assess how far the labor had
progressed. It seemed that she had
delivered 7 children, but only 2 were still living. Most women here have lost at least one baby,
but still, that seemed like a lot.
Labor progressed - and eventually a little girl was born. She seemed to have trouble crying and was
very sleepy - so I asked the midwives to bring me some sugar. I mixed a bit of sugar with some filtered
water, and gave it to baby - and she perked right up. I turned my attention to mom, who had still
not delivered the placenta. Working with
mom and Rougie, we tried and tried but to no avail. I tried to reach in with my hand and manually
extract the placenta - nothing. I gave
her injections of oxytocin - trying to restart contractions. Nothing.
She was losing blood - and I was starting to get concerned. Mom was starting to get agitated. I tried to hang an IV - but she ripped it
out.
We tried manually extracting the
placenta again, but she kicked us away.
Finally, we called the family in and instructed them that they were to
take her to the hospital - 2 hours away.
They refused. Apparently she had
had the same problem before - often retaining the placenta for 4 - 5 days after
birth. I begged - PLEASE. This woman will die if you take her
home. I started to cry. That freaked everyone one. Rougie kept saying - STOP crying. But I couldn’t. I continued to beg - but they continued to
refuse.
So they loaded her up on a
motorcycle and took her home. Several
days later, they were back - with the woman unconscious in the bed of a truck -
wanting us to help. Dr. Sana was there -
and having heard the story from me earlier - told them to go straight to the
hospital. She died on the way. It was the first (and only) mother I have
lost in delivery in my 11 years in Africa as a nurse. For weeks, I was so upset. I was able to
Skype then with an OB-GYN who works in Mali and talk through what
happened.
A few weeks later, Rougie and
I were sitting in the clinic with some other people, and she began to talk
about what happened that day. She was
laughing - not about the woman dying - but about me crying. I think it freaked
her out - and she wasn’t sure how to deal with it. Every so often, it will come up again and she
just laughs and laughs. Just about 2
weeks ago, I was seeing a patient and she said - do you see this woman’s
husband? Do you recognizing him? I didn’t.
Well, she said, it is the husband of the woman who died that day. I said - oh, you mean the day I cried? And she started laughing again - recounting
the story. :^(
Her other favorite delivery story with me was when we delivered a
breech baby - who was positioned cross-legged with its arms folded - presenting
butt first. I had to reach in and pull
out each leg, one at a time, then each arm - then the head got caught. As I was working to deliver the baby, they
were trying all kinds of traditional stuff - including burning a chicken
feather. I was only mildly paying
attention to them - focusing instead on trying to get baby out alive. Finally Rougie said - Gulun-nga, we have
tried EVERYTHING. You need to pray to
Jesus, because He is the only one who can help you now. So my prayer went something like this - OK
God, you heard what she just said!
PLEASE help us. That little girl
is now about 4 years old - healthy as can be and terrified of me.
The midwives also help in the clinic. They do the cleaning and washing of the
sheets that we use on the beds - well, the two assistant midwives do - carrying
out the orders of Rougie - head midwife.
They also help translate sometimes when I am seeing patients and assist
us in whatever way we need. It is not
uncommon to find one or two of them curled up on the exam bed, taking a
nap. I have to move them off (or over)
to assess my patients.
Rougie is notorious for taking the time - with each patient - to explain HER OWN
medical problems as well. She suffers
from gastritis, so ANYTIME we see a patient with the same problem, she lifts up
her shirt and shows everyone in the room where her pain is as well. :^P
She usually wants free medicine - sometimes I give her a few TUMS (on
those days she likes me) and other days I make her pay (on those days, she
says, you are NO good.)
HIPPA compliance officers would develop ulcers in our clinic. Dr. Sana and I really try to stress privacy
for our patients, but Rougie has a different sense of what that means.
Two weeks ago, we were seeing a new mom in the clinic - along
with Matron Boye. Baby about about 10
days old - and this was the first for this mom.
Baby was not nursing well. So I
checked baby out first - he was pretty small, and also was a little
tongue-tied. So I clipped the underside
of the tongue to free it - and then told mom that I wanted to see him try to
nurse. She lifted her shirt - and her
breasts were huge - so full of milk - that the nipples were almost flat against
her breasts. Well, SEE, exclaimed one of
the midwives - it isn't her baby or her breasts - it is the breast noses that are
the problem. It took me a minute to
figure out what they meant: breast noses
= nipples. It made me laugh.
We worked with mom and bit and gave her some
encouragement. Then I asked them to wait
in the waiting room for about 30 minutes - as I wanted to make sure that baby
wasn't going to bleed after having his tongue clipped. It was a SUPER busy day - and I kind of
forgot about them out there. After a
while, the dad stood up and got my attention - asking if they could leave. I called them into the office, and checked
baby - no bleeding. So I sent them on
their way. As they were leaving, Rougie
leaned out of the doorway, and called out to them - in front of the 30 or so people
sitting in the waiting room - “Dad - NO need to worry. It ISN’T her breasts - those are
fine!!!! It is JUST the breast noses
that are an issue!” I just laid my
head down on the desk - so much for privacy.
The next day - a young mom came from another village. She was coming for a quick check-up, and had
left her 2 month old at home. It took a
while for us to finally see her - and then she asked if we could bump her mom
(who was also waiting to be seen) up in line - so that this young woman could
go back and nurse her baby - as they had come together on the same motorcycle. I said - well, we see people by turns here
and if we move her ahead, then other people will get mad. So if you want to go and explain why we are
moving her ahead, and they are ok with it, I am fine with doing it. I did feel
a bit sorry for this young girl - this was her first baby - and she needed to
get home to nurse- as breast milk was leaking down her shirt.
Rougie decided to handle it herself. She went out to the waiting room - called in
the grandma - and turned to the others and made this announcement. “Everyone - please forgive us. This young mother came from another
village. She is not a good mother -
because she left her baby at home and now she has breast milk running down her
front. So we are going to see her mom as
well, so she can go home and nurse her baby.
Sorry.” With that, she marched
back into the office and we continued. I
shook my head!
She tries hard to be a patient advocate - begging me to see
patients after hours - to make an exception for “just one more”. She loves to tell people that we work
together in the clinic. She gets
frustrated with me when I insist on following the rules - especially if it
applies to one of her family members.
Of course, I am sure that I also frustrate her sometimes as
well. If SHE had a blog, and wrote about me, it could probably include
things like - I just don’t understand her.
She is SUCH a rule follower! I
don't know why she cries about things that are Allah’s will. She worries SO much about cleanliness. Some days she makes me want to laugh, some
days cry, and some days I want to strangle her!
:^)
