Sadness

Yesterday I experienced a sad and frightening evening.  I have a good friend who was 6 – 7 months pregnant.    The beginning of her pregnancy was emotional.  She had gotten pregnant while breastfeeding her 21 month old little boy Mamodi.  Getting pregnant while you are breastfeeding is a HUGE taboo around here.  So, even though her husband was the baby’s father, they wanted to have an abortion so no one would find out that they were sleeping together.  (In this culture, a husband and wife cannot have relations from when she knows that she is pregnant, until the baby is weaned from breastfeeding – at 2 – 3 years of age.)   

They asked me to give them something to help abort the baby.  Obviously, I refused.  We prayed with them and talked with them and showed them a picture of the fetal development at that point, and they decided to keep the baby.  That night, she started weaning Mamodi.  Because they were so ashamed of how she got pregnant, they wanted to keep it a secret, saying that her mom would beat her if she found out.  Since extended family is the one who normally helps the weaning process by taking the child away from mom for a few days, we became the extended family.  Mamodi came and spent time with us – especially when he was crying to nurse.  It was a long few days, but Isatu was strong and everyone survived.

Eventually, the crisis passed and life settled into a routine.  Mamodi was growing stronger and Isatu was slowly beginning to show.  In June, she was at my house one morning and we pulled out the fetal Doppler that I have and listened to the baby’s heartbeat – nice and strong.  Secretly, I was hoping it was a girl, since she only has boys. (She had a little girl a few years back, but it died within a day or two of birth.)  Every mom here wants a little girl to teach how to cook and to help with the work.  In my mind, I was trying to figure out when she was due, and whether or not we would be in town.

A few days ago, she came to me and asked me to check her.  She said that she was having some low belly pain.  No problem, I said.  She came in the afternoon and I pulled out my Doppler.  No heartbeat.  I tried again.  Nothing.  I was beginning to get worried, but didn’t want to her know.  ”Well”, I said, “I can’t hear anything; maybe the baby is in the wrong position.  Come back in a few days and we will try again.”  She agreed and left.  My mind was racing.  If the baby was not alive, and I was sure it wasn’t, what were our options?   Does she have to go to the hospital or do we wait it out?  If she started to miscarry in the village, would she have problems?  Another friend of mine nearly bled to death having a miscarriage.   I got out the sat modem and sent off an email to an OB-GYN friend to ask for advice.

            

    Isatu came back later that evening.  We talked a little.  I promised to try again the next day to find the heartbeat, but told her, “I don’t think your baby is strong and healthy.  I am concerned for you.”  All night, I was overwhelmed with sadness and concern.  Yesterday afternoon, we tried again.  Nothing.  We talked.  I said, “Maybe you need to go to the hospital and have an x-ray (meaning an ultrasound) there.” (I am not actually sure that you can get one done in Faranah.)  I went back to work.  Later in the afternoon, while I was seeing a porch FULL of patients, she called me from the back porch and told me that she was having some pain in her lower belly and had a tiny bit of bleeding. 

 I debated about whether or not to send her to the hospital, but she said she didn’t have a way to get there.  I sent her home with some Gatorade and Tylenol and told her to rest and that I would check on her later.  I pulled out all of my books on women’s health and midwifery.  All seemed to say that most miscarriages pass without incident and gave warning signs of what to watch for.  I was feeling better about her staying in the village.  We ate supper and I was preparing to go and check on her when her husband, Mordeka, showed up, saying that she was having a lot of pain.  I grabbed a back of supplies and headed out. 

               

 When I entered her dark room, I found her lying on a cloth.  The bleeding had increased a lot, as well as the pain.  I check her – sure enough, her cervix was open and I could feel what felt like the baby’s head coming down.  I sat down beside her and waited.  We talked a little, but mostly we were quiet.  Her kids kept popping their heads in, so finally I pushed a chair up against the door.  The pains were getting stronger.  She gave a push out and pooped what I thought was the head still encased in the amniotic sack, but soon discovered was just a sack of fluid.  I was getting nervous.  She was bleeding a lot.  I am still fairly new at all of this midwife stuff, so wasn’t sure if I should break the sack or not, like I do with a normal delivery.  Would it cause her to bleed more?  I called my family on the radio and asked one of the boys to bring down my delivery bag, which they did.  

 We sat and waited.  I was getting scared.  I prayed over her and sang while we waited.  Jim came down then and was sitting outside with Mordeka.  He was praying and the kids were praying.  We were not making progress.  I sent Mordeka to try to find the town midwife, thinking that, if I did break the sack, and she started bleeding, someone would be there to help me.  The midwife was at the mosque praying.   Isatu mentioned her aunt, who helps with deliveries sometimes, so Mordeka went and called for her. She came a short while later.  We began to work together.   

She was helping Isatu push.  The bleeding was increasing, along with my fear.  Were we going to have to take her to the hospital?  How was that even possible in the condition she was in?  Finally, I decided – I broke the sack.  That seemed to help.  Slowly but surely, the pain and contractions increased.  I could now see the baby’s head.  The midwife showed up – she thought that Isatu was in labor because she was at her due date.  We told her that the baby was not living.  Finally the baby was delivered – a good sized little boy - stillborn.  I was filled with sadness.  He couldn’t have died that long ago.  We got Isatu cleaned up and I wasn’t sure what to do next.  I am still learning customs about death.  Amazingly, neither of the ladies seemed to know what to do either.

                 

We cleaned the baby up and wrapped him in a white blanket (bodies always have to be wrapped in white – thankfully I had a white baby blanket with me.)  The midwife told the aunt to go and tell the family.  She said, “What do I tell them?”  In some small way, that was a big encouragement to me.  Many times, in this culture, I feel at a loss for the right thing to say.  Here were 2 women- from the culture – who were trying to figure it out as well.  They thought for a few minutes.  Finally, the midwife said, “Tell them that the baby was born, that it was a little boy, but that he was not saved.”  She left to do that.   

We got Isatu settled in bed, and the 2 women looked like they were ready to leave.  I sat down on the bed beside Isatu, just wanting to be with her for a while.  She looked completely overwhelmed and sad.  I was afraid that she (and others) would believe that she had lost the baby because of how he was conceived.  I shared with them that I had a miscarriage before I got pregnant with the boys.  The midwife said, “This is the third miscarriage in the village in the past few weeks.” 

 That started a long discussion, and it seemed that we were going to be spared the false blame on the conception of this little boy.  I was SO thankful.  Women started to trickle in as the news spread – even at 10 pm.  The room started to fill up with women who came to sit with Isatu.  In the small 4 foot by 6 foot space, I counted 11 people – plus Isatu and Mamodi.  We had some togetherness going on!  Eventually, I walked home to grab some antibiotics that I wanted her to take – just to prevent any infection that could happen.  While at home, I had Ben warm up some rice that was in the fridge and took it back to her to eat.

She is doing okay now.  I went to check on her, but she was sleeping, so I left some food and came home.  Mordeka came and said she was doing better. 

                

 In the sadness of all of it, I found some things to be thankful for.  First, I was in the village when it happened.  Second, she didn’t have to go to the hospital and is doing okay.  Third, there doesn’t seem to be any blame on how the baby was conceived. 

               

 As I sat there that night on the floor with her, the small lamp casting shadows all over, looking at her leg lined up beside mine, the contrast in the color of our skin hit me.  We may be from different cultures, but we are both women and both moms.  At one point, when she was in pain, she laid her head on my shoulder.  I thought, there is no where I would rather be right now.  I am so thankful for the people here who invite us, not only into the celebrations – but also the sadness – of their lives.  We are blessed.

Eskimo Kissing in Africa?

I recently had a rather interesting experience.  I was called out to see a girl in labor.  As I entered the hut, I had some trouble picking out the pregnant girl.  Now, I don’t pretend to be the sharpest tool in the shed, but I can USUALLY tell who the pregnant, laboring girl is – at least as a general rule.  Sadly, this girl was about 15 years old and only about 8 months pregnant with her first baby.  The baby was clearly tiny.  The girl was from another village – but came to our village because I was here and she was sick with a runny belly (code word for diarrhea).  She was quickly becoming dehydrated.  

I started her on some medicine for the diarrhea, and gave her a Gatorade-like solution to drink.  Over the course of the next few hours, the labor slowed down and stopped.  I was relieved, as I was not sure the baby would survive if born.  They approached me and said that they wanted to take her home.  They were very afraid I would be offended.  No problem, I said.  Just please have the other midwife check her one more time before you leave tonight.  They said they would.

The next afternoon, the midwife came to get me, asking me to come because the girl had delivered the baby.  I was surprised, but grabbed a few things, leaving behind my big delivery bag.  I assumed that the baby had been delivered, and cleaned up, and they just wanted me to see.  As I was walking with the midwife, I began to question her. Was the baby breathing okay?  Is it a boy or girl?  She didn’t seem to know very much.  I said, well, did you wash the baby?  She said, No, we are waiting for you.  

WHAT?  I said, did you cut the cord and deliver the placenta?  No was the reply again.  I was starting to get frustrated.  I turned around and went home to get my delivery bag.  The matron said she had been at the farm and when she got back into town, they called her.  She went, saw the baby delivered, and left it there to come and get me.  I was working to control my breathing.

We arrived at the hut to find the mom sitting on the cow dung/mud floor and the baby lying on a filthy rag beside her.  The cord was still attached to the placenta, which had not been delivered yet.  I cut the cord, wrapped up baby, and gave instructions to get mom cleaned up.  The baby was tiny and cold, but breathing on her own.  I debated about whether or not we should wash it – worried that the bath would lower her body temperature even more.  However, she was filthy and I was worried about tetanus.  Also, it was scorching hot outside and they had heated water.  

I told the midwife, let’s just quickly wash it up and get it wrapped up again.  She agreed with me and we took it outside.  Once outside, she took a look at the baby, pronounced it fully ripe (fully developed) and proceeded to wash and wash and wash the baby.  I was getting frustrated, fearing that the stress on the baby was going to be too much. I kept trying to take the baby to bundle it up.  She refused.  Everyone could tell I was getting frustrated.  

I was talking to myself in English, telling myself to calm down.  They said, Gulunga is getting worried about the baby.  The midwife said – Oh, she always worries about the baby.  She finally handed her over to me and I bundled and bundled and took baby into mom, giving instructions for mom to try to nurse it right away.  I told them I would check back in a while – intending to bring some formula if necessary if the baby was getting stressed from being so small and cold-stressed and trying to nurse.

As I got ready to leave, a short old woman came over to me.  She was a relative of some sort and had been with us the previous day while I sat in the hut waiting for the labor to progress.  She grabbed my chest and began to thank me profusely for the help.  Then she stuck her face up to mine.  I thought she was going to do the French air kiss on each cheek – though, frankly, I was a little surprised that an old woman in the bush would even know how to do that (see the footnote).  

With her hands still clutched to my chest, she reached up and started rubbing her nose on mine!  Hello!  I have to say that I was COMPELTEY unprepared for that.  She kept blessing me and thanking me.  Finally she let go and backed away.  I thought – Did I just get an Eskimo kiss in Africa???  Wow- I didn’t see that coming!  I know we have different thoughts on personal space but really!

I went home smiling and laughed when I told the story to Jim.  Just goes to show that in Africa, you need to be prepared for anything.

I am happy to report that when I returned that night, baby was doing okay and had nursed a little.  Praying that little girl continues to grow big and strong, despite the rough start to her little life.

FOOTNOTE

I just have this to say about the European way of greeting.  I find it sophisticated – but very confusing – though don’t mind participating.  It is just hard for me to figure out – which side do you start on?  Once you get it established, all is good.  But you do have the potential to accidently kiss someone (I should know) if you both start on the same side.  

Once, in Quebec, we were leaving a friend’s house and I kissed the wife goodbye and the husband came to kiss me goodbye in the European way and I started on the wrong side and nearly kissed him on the lips.  Sadly there was not a rock big enough for me to crawl under: “Hey, thanks for having me over, sorry I kissed your husband in front of you!”  Thankfully they were good friends and good sports so all was good.  

Man, they should have a seminar about that!  I am just saying….

A Two Way Street

Many times, in conversations with people who have not lived overseas, I hear the same words/ sentiment expressed – Jim and Dawn, it is so great that you are living in Africa. You have so much to teach people about God, about medical stuff, and about community development. It must be a hard job- trying to bring people out of the dark ages in regard to knowledge.

Honestly, it would make me frustrated, except that I have to confess that, at first, I had a bit of the same sentiment. And when I am not careful, it can creep back in. There are nuggets of truth in that idea. Certainly, as Christians, we have walked with Jesus for many years and have learned a lot of lessons (and are STILL learning) on trust and what God is doing in our lives that we are anxious to share with people.

And medically, most of what I find here in the village is about 100 years behind where we are in the US right now. So we ARE thankful that God has allowed us to grow up where we did, and that He brought us here – for such a time as this. We believe that here are things that we can share with people here that will improve their lives- be it mentally, physically, or spiritually. And we are thankful for this opportunity.

On the other hand, the longer we live here with our friends, we realize the vast amount that they have to teach us about living in community and trust in God and sharing, etc. Let me give you some examples.

TIME – People here are MUCH better about taking time for each other than anyone else that we have EVER seen. Going to visit people is huge here and they think nothing of sitting for a LONG time, chatting or just sitting in silence as a way of being with someone else. Frankly, this is something that I am NOT good at. Usually I have a big list of things that I want to accomplish, and while, I am happy to go out and say hi, after about 5 minutes, I want to be done. I am working to take more time with people.

This is something that Jim is MUCH better at than me. Perhaps because of his personality, or perhaps because he is a faster learned than I am, he has realized the value of taking time with people. Every morning, he enjoys sitting on the porch with the 2 believers here, chatting and drinking coffee and visiting with anyone else who wanders up to the porch. He will go and sit for hours at a funeral or meeting – that would drive me insane. But he is great at it! Honestly, (confession time) for me to feel good about spending long amounts of time with people, I have to write it on my list of things to get done. :^(

TOGETHERNESS – In the US, we seem to value time alone. That is not something that is sought after here much. Perhaps that is a village thing – their whole lives are such a constant jumble of people in and out that there is rarely a moment alone. We might go out into the woods to get away. Here, if you see someone sitting on a bench by themselves, you go and sit with them, so that they will not be alone. Rarely do they just sit around by themselves. I saw a great example of this on my porch a few months ago.

On many days, the daily crowd was getting out of control. On days like Thursday, it is not uncommon to have 50 people waiting out there. People were getting loud and arguing over who would be seen first. So we decided to take the benches where people sit, and put them out in the yard, giving me some distance from the crowd. One bench was left on the porch, and the system is that the child that I am seeing and their parent, and the next patient in line, are allowed to sit there. Everyone else is supposed to be on the benches in the yard.

For the most part, this works okay, and they have just accepted it as one of the MANY strange things that I do. But often, when a sick person comes, several people come with them –to walk them to the house and to be with them. When that patient is called, EVERYONE who has a vested interest in the patient wants to come to the bench – which results in a small crowd, defeating the purpose of the benches in the yard. When I explain that only the patient and the parent should come, they give me kind of an odd look, like, Why would you do that? You want them to have to sit there alone?

Recently I saw a little boy who had a cut on his head. I bandaged it and told him to come back the next day. The next day arrived and he showed up with 2 little friends. They dutifully sat on the bench in the yard, and when I called his name, they each grabbed a hand and walked him up to me. They sat there quietly when I looked at him and put medicine on, and then quietly grabbed his hands and walked him home. (I was not really paying attention to the whole thing as I had a porch full of people but Jim watched it transpire and said it was just the sweetest thing to watch. These little guys chose to take the time to sit with their injured friend when they could have been out playing. Jim said it was a good reminder for him to take time for people).

Frankly, the togetherness aspect usually works in my favor with medical issues. Like all of us, when a new idea is introduced, it often takes several times of hearing it for it to take root. So, when I am giving instructions on the porch, I have a captive audience of people hearing what I am saying (since they usually study me intensely, trying to see what I am doing). It hit me several months back that I have a GREAT opportunity to teach many people at one time. Here is an example…..

One thing that usually scares people to death here during an illness is that the sick person won’t eat. And here, by eat, they mean consume mass amounts of rice in a sitting – twice a day. So, when they bring me a sick kid, they will often say, He won’t eat anything. Usually, with questioning, I find out that the child is drinking water and eating bread or maybe crackers or porridge.

So, when I give them the medicine, I add the following teaching – you know, often people get scared when a sick person doesn’t eat a lot. But when you don’t feel well, you don’t usually like to eat a lot. So, even if this child is not willing to eat a lot of rice, if he is drinking well and eating porridge and bread and bananas and crackers, that is SO great. And as they start to feel better, they will want to eat. So I don’t want you to worry. If the medicine is done, and they are still not eating well, you bring them back. (This rarely happens).

Of course, as I am telling the parents this, I usually have 5 – 20 other sets of ears taking in the information as well. Also, when I go to visit new moms, I talk with them about breastfeeding, and since a new mom is never at home by herself, several other women are getting the same teaching!

SHARING/GIFTS – Our friends here seem to be very good at sharing. Even if they are short on food, if someone comes to visit, there is ALWAYS an invitation to come and eat. If you have company, they always get the best choices. If you have something that someone needs more than you do, you share. That is partially why you see half built houses all over the place. When people get enough money to start a house, they try to take it and start building right away because if you have money, and then someone comes along and asks for it, you really should give it to them. But if you quickly buy bricks and put them in the wall of a house, then the money is gone and you are on your way to getting a new place to live. This principle makes getting ahead very difficult in this culture.

We have friends here who want to get ahead, but this principle sometimes makes this hard. For example, we have a friend who borrowed some money to go a buy his wife a present. Later in the day, after the market has gone, I asked him about what he had bought. Well, he said, not as much as I wanted to. You see, my daughter had a fight with her husband and moved back home. They made up, but I had to buy a gift to give to them so that she could go back to her house again. WHAT? REALLY? I was so mad at him, thinking that he had shorted his wife in favor of his daughter, but apparently, culturally, he needed to do that.

Over and over, we see people teaching us the important of putting relationships over other things. The US has a long way to go in this aspect. Usually, we are all so independent that we don’t have a great need for each other. And that is a loss for us. That sometimes translates into our relationship with God. We like to say that we trust Him, but really, I think that sometimes we have more trust in our bank accounts and in the medical system to make things okay. It was a big lesson for me when we moved to Africa.

As a nurse, I had a lot of fears (still do sometimes) that something will happen to my family when we are so far from medical help. But as I thought about it, it made me realize that, in the US, I had a lot more trust in the fact that Lutheran Hospital was sitting 15 minutes away from me with great doctors and a great facility, than I had trust in God to care for us – in whatever way that transpired. Really, every day, no matter where we live, is an exercise in trust for all of us – because God is ultimately in control, not matter what continent we live on.

While I wouldn’t want to be forced to go backwards in time and technology to live like our national friends, there are certain aspects of their lives that they seem more advanced than we are. We have so many lessons to learn from them. What a privileged to have those lessons being lived out in front of us on a daily basis.

It Takes a Village

We have discovered in our time in Africa that family relationships have a whole new meaning here. I suppose it has something to do with the generally close proximity that families live to each other. Most kids grow up with numerous extended family members within a 5 minute walk. The villagers here don’t seem a bit confused by how everyone is connected, but frankly, it confounds me.

One problem is that we rarely see a father, mother, and all of their children together in one place. And who they call their children may not be someone who was born between a husband and wife. Namesakes can be called kids, as well as nieces and nephews. An aunt might be called a small mom and an uncle a small dad.

I can’t tell you how many times this has happened to me – someone will come to my porch asking for help with money. I will say to them, why don’t you go ask your father? He is dead, they will reply. Okay, what about your mother? She is dead too, is the answer. We go through the whole line – this person will appear to be an orphan. But the following week or month, they will come to me and say – did you hear that my dad (or mom) died? What??? I thought you didn’t have any parents left. Oh, they will say, this was my small dad, (or my small mom) that died! Um….okay.

Kids are often left in the care of grandparents. Many times it is grandpa or grandma who brings a sick child to me. Because women give birth in later years, I try to clarify – is this your child or your grandchild? Sometimes they think that is really funny – other times they act offended. Sometimes they seem really irritated that I can’t figure out who goes with whom. This week a woman said – Don’t you know that she is my grandkid? Sorry, not so much. I am trying so hard to figure out how everyone fits together….

Then you add to the mix wives and co-wives and it gets even more confusing. (On a sad note, the word for co-wife is, at least to my toddler ears, suspiciously close to the word for bucket, okra, and broom – so as a general rule I try to avoid saying it – in an effort to not embarrass someone – myself included! When referring to a co-wife, I say, you know, your husband’s other wife….)

Another interesting family dynamic is that children here belong to the husband. As it has been explained to me (here is your birds and bees lesson – Yalunka style), the man simply implants the entire baby into the woman and she is kind of just the incubator. Therefore, if a child is born out of wedlock – or a woman leaves her husband and returns to her family, the kids stay with dad – as long as they are weaned. They are his property.

Another issue we face is that many people have the same names here. So it is confusing to figure out who someone is referring to. They will be talking about someone and say – you know, Fanta. Since I know about 15 Fantas in town I need more to help me clarify it. So they will say something like – you know, Fanta, the one with the yellow husband who fell out of the tree the other week and broke his leg. Oh, that one……. We personally have names for people so we can tell them apart – we have Bread Foday, White Ali, Nice Teeth Kuta, Peanut Sana, etc. It is simply a way for us to clarify who is who. The villagers don’t have the same problem with us – since we are the only white people around.

I do love to see the interaction between people and it is so great for kids to grow up in close relationships with their families. Now if I could just plot everyone on a family tree……

BYOB

Now, before you report me to the powers that be, this does NOT stand for Bring your own Beer…. Lately I have been reflecting on the life we live here in Guinea. It is a crazy place, I have to say. And I am always amazed by the communal aspect of village living. Everything is shared. I guess, then, I should not be surprised when I am called on to give out of my supplies…..

When I go to baby deliveries, I now carry baby blankets (BYOB – Bring your own blanket). After the baby is born and washed, there rarely seems to be a clean cloth to wrap them in. I spent months being frustrated about this fact – it is NOT like a delivery sneaks up on you – typically there are many months to prepare and 8 -12 hours of labor to locate a clean cloth. But alas, it is a battle that I often lose, so instead of being frustrated, I just take my own.

At my own house, things are worse. I had a young boy arrive recently with a smashed foot. Sadly, he got injured out in the bush (a piece of wood fell on his foot, smashing the 2 smallest toes – completely exposing the bones) so he was forced to walk to town and then, because the injury looked so bad, everyone was afraid to wash it.

So they brought him many miles away to me. By the time he arrived, the mud/blood was ground in and caked on and dried. I tried and tried to scrub it clean, but to no avail. Finally I decided that I needed to soak it. I couldn’t find my normal soaking container so I took off my gloves, washed my hands, went inside, and started going through my Tupperware. I finally found one that would work. I was reluctant to sacrifice it, but what could I do. The whole time I was muttering under my breath – you know, doctors in America don’t have to give up their Tupperware (if you read my blog posting about containers, you will know that they are important to me).

That is not the only thing to go out of my house. I use my aluminum foil to wrap medicine and send home ointment for dressings. My vinegar is used to make a medicinal wash for women. My precious Karo syrup is used for cough syrup and constipation for babies. Vegetable oil is used to soften ear wax. When I run out of a particular medicine for the village, I usually dig into our family stash to fill the need. I have ripped up sheets to make splints and sacrificed pillows for transport of an accident victim.

When I have sick people who are not eating, I will give them oatmeal (this is NOT as much a sacrifice as I think that oatmeal as a cereal is disgusting – though it is NOT bad in monster cookies…..) and milk powder and sugar. For people with colds, I give them mint tea. Old socks are used to cover feet dressings and many times I have had to dig through my kid’s closets to get a shirt or pair of underwear or something for a patient. I also pass out Q-tips to apply medicine in the mouth.

Occasionally I feel crabby about this aspect of village life. But usually something happens to change my perspective. Someone will show up with a pan of rice, or peanuts, or a chicken to say thank you for helping them. They will bless me over and over and tell people how much we did for them. They come by to say thank you and somehow that makes it better. I think it really is more blessed to give than to receive.