Friday, March 26, 2010

ROUS and Birth in Africa

Written one week after returning to the USA from attending births for the first time in Africa

From Princess Bride- Buttercup to Wesley while walking through the Fire Swamp: “But what about the ROUS’s?”

Wesley: “Rodents of Unusual Size? (After seeing one a few minutes before.) I don’t think they exist.” A huge rodent jumps on Wesley and attacks him.

I’m here to tell you, rodents of unusual size do exist in Senegal. I’m not usually one to jump at the sight of a mouse, or scream at the size of a rat. (I even had a rat as a pet once, but that’s another story.) However the first night we spent at the clinic when I heard the volume of sounds just over our heads in the labor room, I got cold chills.

Of course, it’s the idea of their size, and the images that evokes more than the critters themselves. When they are making enough noise to keep you awake over your IPOD music coming through ear phones it does tend to produce some pretty scary thoughts. And then when that big noise moves under your bed…well, you get the idea. I’m sure you won’t blame us when you find out that one of our group quickly moved from one particular bed into another single bed already occupied by one of her companions.

Maybe what Wesley meant was not that he didn’t think the rodents existed, but rather that he could handle their existence when he had to. Or perhaps he was trying not to scare Buttercup before she actually had to face them, to give her a few more seconds of hopeful fantasy. Certainly we wouldn’t want to accuse the swashbuckling hero of lying or denial.

Because the bottom line was, when they had too, Wesley and Buttercup did both face the ROUS and defeated them.

There were huge other things to be faced in Africa too, much more serious than rodents. Dealing with the fact that every single woman we attended in labor had been mutilated by some degree of female circumcision was pretty tough. Seeing the lack of sterile technique bothered some of us more than others. Aggressive fundal pressure and what we perceived as rough treatment of the mothers in labor was difficult for most. The fact that there were HIV positive ladies receiving care at the clinic was extremely sobering.

Sometimes we had a tendency not to want to look at difficult things straight on and deal with them, because they were so awful. Or we would start discussing them with clinical detachment and take notes (one of my personal coping techniques). Or go along with certain practices of the local midwives when we really weren’t too sure about them.

For me personally, I’m still processing all the ROUS’s I encountered. Especially when I consider that this trip was a mere introduction to long term maternity work I plan to do in Africa, I have a lot to think about.

I have seen the enormous size of some of the issues I have to face. None of them has actually jumped on me yet. But I’m still walking pretty cautiously through the Fire Swamp.

‘Cause now I have seen with my own eyes what really does exist.

Tuesday, March 9, 2010

Birth sans bendy straws

Update from Kafountine, Senegal, two weeks into a three week internship at a local birthing clinic

I spell relief B-I-R-T-H-S. Lots! Four last night, not counting the two we missed while we were walking to the clinic. (One of those gave birth in the doorway, and the midwife who lives on the grounds didn't even make it.) I got to handle all kinds of fun things- retained placental membranes necessitating manual removal, severe asyclitic presentations, as well as assist with two uncomplicated births, all with good outcomes.

Okay, okay, I know all this may be kind of far out for my non-midwife friends. Just know that this is what makes me the happiest. Clinical details follow which those of you who don't deliver babies may or may not be interested in.

Yesterday, Monday, we started the day with an easy delivery. Then I sat in on appointments for five hours. What kind of appointments, you may ask? Everything from prenatals to postpartums, to well baby checks to family planning visits, to pregnancy tests. Not much "fluff" in the care here. The main goal is to keep everyone alive. So the tetanus shots and malaria prevention in pregnancy is more important that discussing nutrition, exercise, and how you are doing emotionally. But when you are across the desk from someone in their fifth pregnancy who has lost all four children to malaria in the first years of their lives, or someone who has lost several babies half way through pregnancy, or a young woman who has just been gotten a positive AIDS test, the priorities change.

That matter of fact approach extends to the delivery room. The staff sage fems and matrons (think nurse midwives and lay midwives) don't spend a lot of time giving back pressure or sips of water from bendy straws. Actually there hasn't been any running water at the clinic for days, and I have yet to see a straw of any kind.

Around here, it's all about grabbing your ankles and pushing.

But I've gained new respect for these no-nonsense care givers. They can deliver babies that would be automatic C-sections in the States. With the closest hospital that could give that C-section two hours away, you gotta do what you gotta do. Twins? Breech? Bring 'em on.

Around here, you gotta work hard and do what the midwives tell you and push your baby out, with or without your bendy straw. But when you get your baby alive in your arms and walk to the big postpartum room where your mother and everyone else who gave birth in the past three days is also staying and nurse your baby and go to sleep under your mosquito net, it's worth it.

Running water would be nice, but hey, you can't have everything.

Saturday, March 6, 2010

Different and not so different

What I expected to be blogging by now about is how I barely have time to even duck into the internet shop to dash off a quick update with so many births and exciting things going on.

What I am blogging about today is how much free time I have on my hands waiting for births, and how that is wearing on me. Since the only purpose for being here is to attend births and observe at the clinic, when that is done, I find little to occupy myself. When there is no one in labor, and the prenatal and postpartum visits are done, the clinic compound falls silent. I poke my head in the labor room hopefully, only to find it empty. I visit the postpartum room and coo over the babies and take some pictures, but without a common language my stay only lasts so long. Besides, the moms are tired and want to sleep. It may be the only time in their lives they actually get to rest.

I should be more like them. After the deliveries are done, and the reports written, I should take advantage of my respite and go take a nap or read a book. I may not have many opportunies in my life for such a luxury.

Yes, that is what I should do. Maybe I will. Right after I check in at the clinic one more time.

Monday, March 1, 2010

Today marks my first full week in Kafountine. I am happy to report that after several too quiet days at the clinic, the babies started coming. This weekend we had five, three of which I got to deliver.

New parameters. At the Kafountine clinic, being a good midwife means not getting blood on the floor, a fact we were ignorant of at our first delivery. The mom, freshly delivered, looked down at our feet and asked in a concerned voice in French, "Are these real midwives?" It was just what our American egos needed to bring us down a peg.

I'm getting used to the delivery table, considered superfluous if not down right evil by home birth midwives everywhere. The frogs that occasionally cross the floor don't startle me now. I've gotten my basic Wolof and Jola greetings down, and even throw in a word of two of French now and then.

There is so much that would never happen in America, in either a hospital or a home birth setting. Everything from the minister of health- previously met in a formal setting- coming in and tweaking my nose and cheeks after my first delivery, to the refrigerator repair man coming into the delivery room while we had a woman on the table and calmly helping himself to gloves from the box on our supply table, to the large party of Spanish tourists who paraded through our tiny clinic during another delivery.

Next to that repair man and the tourist, the frogs seem downright friendly.

From Kafountine, this is Roxanne saying, Mag i fee. I am here.