Ugh... my eyes slowly opened as my body awakened to the sound of the church bells just outside of our third story window. I glanced at my watch, 6:00am. Every morning without fail the loud bells rang in my ears. I rolled over and placed my pillow over my head in attempt to drown them out... 7:30am, I forced my eyes back open only to wish I could close them a little longer. I looked over at my bible that was covered in dust, I laughed to myself thinking about how some might see that and say I was a “bad Christian” not reading my bible, but really all the dust had settled on it overnight as it rolled in our bare windows from the flat roof top. “Not right now” I thought as I drifted back off for just 10 more minutes of sleep.
Once up I gobbled down some breakfast over our team meeting/morning announcements. It was decided that we would all spend some time reading God's word together rather than worship in song this morning we stared reading in Isaiah... “You will run and not grow weary; you will walk and not grow faint...” One girl read. “Oh God...” I thought to myself, “My run has turned into a walk and I feel as if I am growing faint, but I can't stop yet. Please give me strength for today so I may care for your children as you would.”
An hour later I found myself in the familiar feeling of my shapeless light blue uniform, gum drop boots and gold striped pants peeking out between the two articles keeping my knees covered. “Well girls today is only a half day so we will be leaving at 12:30pm.” Rachel, our staff, said after we finished praying over the day amongst other student nurses in the room. We let out an exhausted cheer and filled our pockets will all things needed.
As soon as I stepped into the left side of the labor ward I went straight to sorting out what was going on in the misted of what most would consider utter madness, well pretty much because that is what it often was. I started by stopping by each mothers bed side, stroking their hair and smiling at them. I would encourage them and ask some questions, it didn't matter that I could not speak their language with words, I had learned to let my actions speak for me. “Kaitlin! A mother over here needs her blood drawn, will you come take it?” Hmmm one of my favorite things to do, how could I say no, so I went right away.
We crossed the bustling hall to the right side of the labor ward where it was often far less busy. Many laboring women where in there but only one was near delivering and next to her stood an audience of student nurses, one of whom would be delivering her baby. The student nurse stood by the mother, average height and rather boney she held her sterile gloved hands together tightly in anticipation of the next coming moments. As I walked by she stopped me “Excuse me ma'am, could you please help me help this mom bear down?” This kind of question would have surprised me at the start of the week as the student nurses often were more in the way than of any help, but as students ourselves we had taken them under our wings knowing if there was going to be any change in the healthcare system, it would come through them. I instructed a student standing by on how to help and let them know I would be there to assist once I finished my task at hand. It was amazing to see that now by the end of the week the nursing students ate up every chance to learn from us and often asked us to help conduct them through their deliveries.
As I returned from handing the blood over to the doctors I took my place next to the mother and started to help her, student nurses joined in right next to me by fanning the mother and giving her water between contractions. As I helped the mother I also instructed the student conducting the delivery. “Okay good, now guard her perineum with your other hand, yup just like that...... okay the head is out now, check for the cord around the neck. Cord? Yes, okay now....” Once the baby was out and whisked away to the newborn room I taught the students how to check for tearing, once we confirmed it was a 1st degree tear I had a line of students asking me to teach them how to suture too.
I left the students to make sure the mother was cleaned up and prepared for suturing as I went away and confirmed with my staff that I could teach them. Once I returned I found the mother cleaned up and ready to be sutured, but no students were anywhere to be seen! I let the mother know I would be back and made my way out of the ward to find where the students had disappeared to. On my way out I noticed an older women sitting on the floor with her very pregnant daughter lying next to her. “You okay?” I asked the daughter as I stroked her arm, she bobbled her head and said “Scan.” as she pointed to the ultrasound machine. I noticed there were no doctors around and she was waiting to be checked. Her mother next to her started to ask me something but having no way of being able to understand her I just assured her that a doctor would come soon to take care of them and with that I was out the door.
I found a group of nurses enjoying their lunch in the changing room and wanted to scold them about leaving the mother alone, but then again all the students looked the same to me and I wasn't sure who to scold. So I grabbed my water and left to return to the mother still waiting to be sutured. As I re-entered the right side of the ward I saw the mother still sitting there with her daughter as I had left them and again she started to ask me something bobbling her head speaking almost in a whisper. Her daughter was resting next to her and like a good mother she was calmly sitting with her just waiting until she would be checked. You didn't have to speak the language to be able to tell that much. So again I assured her that the doctor would come soon. But before I could turn and continue my duty the mother took the courtesy of lifting her daughters dress, I guess soon wasn't going to be soon enough for the doctor to come, the baby's head had already crowned, and I was the only one in the room who could do anything about it. So much for stereotyping people, I thought everyone would find a baby's head coming out to be rather urgent, guess not.
I called for my staff but she was unable to hear me from her crowded side of the ward. A student turned the corner and I noticed her jaw drop at the sight of me delivering a baby on the floor in the door way. “Get me a birth kit!” I instructed her... she didn't move.. “A BIRTH KIT!” I shouted. She turned and ran to grab it hoping not to miss any of the action, and she must of spread the word along the way because she returned with the birth kit, and the whole group of students that had previously disappeared. By now everything that needed to be done was well drilled into my head as I didn't even give a second thought before I had my gloves on and the mothers dress all the way up. After some struggle in communicating I managed to get the mother to set behind her daughter and help her.
I was glad to see Beth come in along behind them as she is one of my team mates and she knew our protocol. She helped me with crowd control by giving farther instructions to the students and I was able to fully focus on the coming baby. The mother and her pushing daughter seemed to be more focused on me than the baby as they hung on to my every word trying to understand and obey my every command. Without a single noise from the daughter her son slid out. He was a bit blue and not too keen on crying, but after some back rubbing, feet flicking and nose sucking he let us know that this wasn't his idea of a great birthday party, and we agreed.
As soon as he was taken away I took a chance to stand and relive my back, as I did so I noticed the warmth I felt on my knees was not the floor but rather a large puddle of amniotic fluid, and what parts of my uniform were not soaked in her fluid were soaked in my own sweat that had been pouring out of me since the sun had risen, really I could not make out where my fluids stopped and hers stared. But not to worry now, I knelt back down into her fluids and delivered the placenta.
-Now at this hospital it is protocol that ALL primi's (First time moms) have an episiotomy done when delivering, and not just any episiotomy rather a 4cm (almost 2 inch) episiotomy. But when we are in charge of a delivery we avoid it as best as possible as it is more often than not unnecessary, but getting any of the doctors to understand that was not very easy. - So by now all the action had attracted the attention of one of the doctors who now stood near. “You need too suture for episiotomy?” She asked. “No Ma'am, I did not give her an episiotomy.” “But is she not a primi! What degree is her tear!?” She looked at me almost scared to hear my answer. “Yes she is a primi... but there is no degree of tear. She is perfectly intact.” The doctor stood in wonder for just a second as every student nurse stood by with gaping mouths. “Well I guess you will not suture than.” With that she left to continue her work, but the students still stood with their mouths gaping a little longer. Had they just witnessed a miracle?!
The cleaning ladies would not let me care for P. Rajini any longer there, so we had to move her to a bed next to a still laboring mother. I cleaned her up as best possible and had just started to take a second set of vitals when I heard Beth speaking, and she sounded worried. I looked up at her just pulling her head from her fetal scope pressed against a mothers protruding belly. “The fetal heart rate is very slow, and dropping. This baby needs to be delivered right now!”
Beth began to get everything ready as I ran to get our staff Rachel. We soon returned. “She is fully dilated, but I know her perineum will not stretch enough and certainly not soon enough. We will have to do an episiotomy.” But I had just looked, there no scissors, no cotton, no bulb suctions well not much of anything to work with really. So Rachel left to find some in the sterilization room and returned successful.
With every contraction we encouraged the mother to push, but her tries were not getting the baby's slowing heart beat out any faster. She was very tired and didn't understand how to push. Beth prepped her with lignocaine and on the next contraction picked up the blunt scissors and began the episiotomy. It started small, but the baby's head would still not come, she cut a bit more, but still no head, the mother just could not push the baby out.
I poured water from my bottle into the mother’s mouth between every contraction and pleaded for Jesus to give her the strength enough for just a few strong pushes. Rachel cupped the mothers sweating face in her hands and looked right into her eyes. “Mama your baby could die very soon if it doesn't come, please mama you need to push.” As soon as Rachel let go of her face her head landed with a thump back onto my shoulder as I held my arm behind her. I realized then that God had given her strength, it was us.
Rachel grabbed the Doppler again.... Heart beat slowing and fading. “This baby has to come right now.” We gave each other a quick glance, Beth standing with her hands guarding the mothers perineum, Me standing behind the mother helping her sit up and Rachel standing the in middle at the mothers side, nothing had to be said, we knew what had to be done next. As for the mother we reverted to the one thing that makes us feel more useful when we couldn't communicate and no one is around to translate.... We started to speak to her in Swahili.
I pushed the mother into an almost upright position and held her rag doll body up as I crawled onto the bed and emptied my over filled pockets that hinder my ability to sit. I wrapped my arms under hers holding her as if I was a lifeguard rescuing someone from behind. I pushed against her back with my chest and stood on my knees. I pressed my sweating face against hers I started to pray quietly by her ear as the next contraction rolled in. “Nooko, nooko, nooko, nooko...” we all started telling the mother together. As I held the mom up and Beth waited for the baby's head to come down Rachel got onto the bed as well and pressed her hands to the mother’s fundus with all of her might and body weight.
After three contractions with us pushing for the mother the baby's head appeared. Cord wrapped around his neck was clamped and cut as hospital protocol and with that the rest of his limp body slid out. We prayed as he was rubbed, suctioned and flicked... nothing... “Heartbeat?” I asked. Beth moved her two fingers to his small chest... “Yes!” He was rubbed, suctioned and flick some more, his eyes opened, and his small lips followed as they parted to let his cry past his lips.
We all let out the breath we had been holding. “Mama your baby is going to be ok!” We showed her the sex and after confirming with us that she did indeed have a son I laid her back down on the bed and took the metal pan from Beth that held the small boy's slippery body. I walked quickly down the hall to the newborn room, on my way I told the madams the name of the mother and they turned to jot it down in a book that is the size of the book of life. There was a lineup of babies. “This one needs oxygen!” I stated and so the other metal pans with babies were quickly moved to make room. He was weighted and I shouted the weight to the madams still jotting information down in the book of life.
I removed him from the cold metal pan and wrapped him in a blanket that was soaked from the blood, vernix and meconium of other babies. I grabbed the oxygen tube and turned it on, holding it close to his nose I noticed the student nurses standing with the baby next to me were just playing with the baby and not taking it from the metal pan. I grabbed the baby's pink tag from its wrist and saw that it had been born twenty minutes before. “Why do you still have this baby in this pan!? Go to its mother's family and get it a blanket now! Can you not see its hands and feet are already blue!?” “But it has no family here.” said one nurse said without moving. I Looked back at the baby's tag and pronounced the mothers name and allowed the students to correct me. I handed the oxygen tube to another nurse and left the room.
At the end of the hall I pulled the curtain aside to expose the crowed of women waiting. As soon as I said the mothers name I immediately caught the attention of three women. “I need a blanket!” I told them... they didn't move, but then again I didn't expect them too. I acted out a cold baby and tugged on the fabric of their clothing until they understood. They left quickly to retrieve one for me.
As I waited, a whole crowd of women fought for my attention asking me about their daughters, did they have their baby yet? Was it a boy or a girl? I didn't have to understand the language to know what they were saying... but then again I delivered a baby on the floor last time I thought that. “Only English.” I said and that was enough for many of them to lose hope in asking me more questions. Then I was grabbed and pushed out of the door way by a doctor in a rush. “Don't talk to these women!” She scolded me “You cannot tell them anything so get out of here!” I knew full well that it was illegal to tell the family members anything here and more than anything you NEVER, Never, never speak about the sex of the baby to them. I tried telling the doctor I knew that and I was only waiting for a blanket but she just pushed me back farther and said again “Don't talk to them!” And then she pushed past me and entered the labor ward behind me. Just then the three women returned to me with a towel and I walked away with it ignoring all questions they had.
I arrived back at the newborn room and wrapped the little girl in a blanket before handing her to the student who looked rather ashamed for lying to me about the baby's family not being there, really she just had not asked. The student buried her eyes into the baby's just waiting to be scolded as her instructor would of done, but I was not her instructor really I was only a student myself who was blessed to have grace in my mistakes. “Hold her close and keep her warm.” I said with a smile and turned back to continue giving oxygen to the baby boy.
After taking multiple sets of vitals, expelling clots, assisting with suturing, fanning women with glove packs, answering student’s questions, taking pictures of hand written documents for the paper work that would follow later and doing full baby checks it was then time to go. We changed out of our uniforms, pried students off of us, and went out to the street to argue with each rickshaw driver till we find one would not overcharge us for being white women. Once home I found myself dragging up the stairs just to plop down in a plastic chair and hold tightly to a box of juice. It was just after 3:00pm.
“So much for leaving at 12:30 today huh?” I mumbled to a fellow student plopped in the chair next to me. “Yea so much for that.” feeling every part of my body groan as I stood up, “Well breakfast was eight hours ago, who wants to get some lunch?”
Beth and I soon found ourselves sitting in a restaurant surrounded by only men. We ate the fried yellow rice and orange colored chicken as fast as our right hands could before slumping in the hard bench to let our food digest for just a minute before leaving. Both of us were exhausted. We chatted about the stress of the day, the demand of work and counted down the days till we had real beds and good food again. But then again we walked away from work knowing we made a difference. It was days like this that put us on the edge of our seats and made life an adventure. I smiled, “It's been a wonderful day to whine.”
I initially started this blog while working overseas to keep my supporters updated, then I did it a time as a required assignment during my midwifery school, but now I write but because I want to. So now I share my current journeys, in hopes that others can learn from them, or at the least have a good laugh.