This week I was assigned to work in the ANC ward (antenatal care ward) where women labor until they are far enough along to go next door at the labor ward. Yes ANC is where they labor and the labor ward is where they deliver. Today I worked along side the doctors examining each women to see if she was far enough along to move to the labor ward.
"Wewe nurzi dada." I said to Vaileti as I finished examining her. She sat up looking a bit sad. "Bado?" She asked. "Bado." I said "Kesho" she asked. "Hmmmm hapana....... maybe tonight." I answered as she gathered her things to go back to her spot waiting on the floor. As soon as she was gone another women was waiting in pain to take her spot on the examination table. But before she could get onto the table she stopped and bent over to vomit into a kanga she held in her hands. I put my pin down and went over to her, I stared rubbing her back and waited for her to finish. "Jina lako nani?" I asked when she was done. "Hydijah Mgumia" she said so soft it was almost a whisper. I turned back to the desk looking at the group of open boxes labeled "sterile gloves" but that is not what they held. I looked for the box pin marked "NOT SEEN" and began looking for her card. Soon after finding it I set it down and turned back to help Hydijah onto the table. She wasn't afraid to put her full weight on me while making her way up, and once up she laid on the table with a tired thud. I started to take her blood pressure but it took three tries as she was moving a lot and was hanging onto me trying to find a way to cope with the pain. I couldn't do anything but breath with her until I finally asked my staff Bek to take her BP for me. Bek took it as I continued to breath with the mother and confirmed my findings were right, her BP was 140/100... far to high. I marked it down and continued to exam to see if we could find out why it was so high. We turned her from her side to her back and then my mind made notice of why I thought something was different about her, her belly was much to small for her to be in labor yet.
After palpating, measuring and looking at her records we found out that she was only 28 weeks along. If well taken care of the baby might be able to make it. I reached for my pinard and started to look for the baby's heart beat... nothing. We grabbed a Doppler.... nothing. Bek continued praying over the mother and I prepared to do an internal exam. A doctor checked her first and said he only felt membranes and that if he pushed his fingers in any father he would end up popping them. So I want next with my smaller fingers. As I pressed my fingers in the membranes were so close that I also had a fear of bursting them, but I was able to reach over them and felt that the cervix was fully dilated. "She needs to go to labor ward right now!" I said.
I helped Hydijah up and another student gathered her belongings for me to take. I started walking while holding Hydijah up, she was hardly able to push one foot in front of the other so as soon as I spotted a wheelchair in the hallway I was quick to set her in it. The wheels of the wheelchair were just bare, bent, rusted rims and Hydijah had only a string tied between the front chair lags to rest her feet upon, but it was much better than nothing and often times that is all we have to grab form here, anything is better then nothing.
I got her safely to the labor ward and found an empty bed in one of the back corners. As I was setting her things down she stood up and lunged for the bed so fast that the wheelchair went flying back, but thankfully it didn't hit anything. Hydijah was only halfway laying on the bed when she opened her kanga... "Wait... how is this possible?" I thought. "I know I felt soft membranes not a.....HEAD! WE HAVE A HEAD HERE! QUICK PLEASE!" I looked around seeing that people were wondering why I wasn't delivering it. "I HAVE NO GLOVES!" I stated. I realized I used my last pair doing her exam. Celia, another student, was checking on another mother nearby and so quickly dropped her things and ran over. I was calling out for someone to grab the needed items but I realized no one there could, so I left the mother with Celia and ran to the other side of the ward to collect the needed things. Upon returning the rest of the small child was just coming out. Celia and I stared for just a second at the baby now laying on the table between the mothers legs as she too saw her first child for the first time. But this baby was not beautiful. His life had ended a long while back and his body showed it all over. We quickly grabbed a kanga and covered his face. We asked Hydijah what we ask all the mothers once the baby in born, "Is it a boy or a girl?" Celia asked with tears now welling up in her eyes. The baby was so deformed we had to show the Mama more closely. "A boy." She said it showing no emotion. Then he was wrapped up and taken away. I realized after seeing him that it wasn't membranes that I felt, it was the baby's head. But the skull had decade away leaving it's head to be as a bag of fluids.
Celia walked away and asked the staff to take over while trying to hold the flood gate of tears behind her eyes until she could step out. I saw her crying and I looked back at Hydijah who sat in her own fluids still showing no emotion. I wanted to cry, I wanted to cry for her. But no tears came. Another student came in and brought with her new gloves. So I slipped on a pair and continued helping Mama. The placenta came within a few minutes, it came just as dark and lifeless as the baby it once held. By now many students had heard what happened and were now coming to assist. And together we surrounded the mother and prayed over her.
Hydijah continued to sit emotionless as I began to clean her up. Nothing was said but I would sympathize with my eyes as I glanced up at her between my duties. Once she was cleaned, dressed and moved to a new bed where she could rest I prayed over her again and let her know I would be back. I went out to the hospital hall where family's sat on the other side of the wall in wait to see the new life brought into their family. "Family of Hydijah Mgumia?" I called out. It took a few attempts to pronounce the last name well enough for the people to understand, but soon a man came quickly with his wife and child to the wall to greet me. They all were smiling their biggest smiles in excitement for good news of a new baby. I learned that the man was Hydijah's brother and he spoke very good English. But it wasn't my place to tell them the baby had passed away, so I said nothing about it. "Can you please bring some water for your sister." I asked him. "Water. YES!" He said as he handed his little girl to his wife and then turned and started running to the nearest market. He soon returned with a bottle. I told him thank you and left them. I took the water to Hydijah and told her she was blessed to have such a beautiful family that was taking such good care of her. "Thank you." she said. I then had to leave her to go back to the ANC ward and finish my work.
I only worked for another half hour but in my heart I was continually praying for her. As soon as it came time to leave I quickly changed and left to go see her one more time. I walked into the labor ward and saw her still laying just were I last left her. and I was glad to see Louise was doing a check up on her. I walked up to her and noticed there was still no emotion in her eyes. I wedged my way between the beds and found myself standing just in front of her. "Hi Hydijah." I whispered as I laid my hand on her head and started stroking her rough dry hair underneath her Muslim head covering. But as soon as the words out of my mouth and my hand laid on her head, emotion filled her eyes. She grabbed my hand from her head and held it tightly in her own as she reached out and took my other hand from me as well. She pulled me close and pressed my hands to her face along with her own and the tears started to flood from her eyes. I squeezed her hands back as she hang on tightly to mine. I wanted to weep with her, but no tears came. So I prayed. I prayed that she would have time to morn, that she would have rest and be restored, that God would grant her and her family strength and peace for this time and that she would be carried in the arms of Jesus. I thanked God for her family and for the chance to be with her. And then I prayed over her son for her, I told her God gave me the name Micheal for him and that it meant angel. "Angel" she whispered it with a look of happiness. I told her Micheal was with Jesus and she nodded her head in agreement. And so I continued to pray that God would bless her womb and that she would be given more children and another son. I than shared with her that Louise who was still doing checkups on her had also lost a son, Hydijah turned and grab one of Louise's hands in a look of surprise and sympathy and tears had now started to fill Louise's eyes as well. Then we shared with her that God continued to bless Louise and that she did have another son. A smile came to Hydijah's lips as she was glad to hear that. And so I finished speaking.
Her grip on my hands had loosened as her eyes were now on Louise. She turned back to look at me and squeezed my hands again. "Thank you, Thank you, God bless you. I could not have done this without you. Thank you for being here with me. You are a true blessing. Thank you." She said while her eyes filled with new tears. A nurse walked up next to me bringing a canteen of porridge for Hydijah sent by her family. The nurse was being rough and went off on Hydjiah in Swahili. She than asked us why this mama was still resting here. So I told her about the stillborn. "Fresh or macerated?" She asked me. "28 weeks macerated." I told her and pointed to the bundled pink kanga laying alone on the baby bed that held the ones that didn't live. The nurse suddenly seemed very sad and began saying sorry to the mother. Her countenance changed and she started to speak more softly to the women. I turned and said good bye to Hydijah as squeezed her hand one last time and then turned and left her.
I saw many beautiful people this week working in ANC and many people taken care of and healed I was blessed in ANC with energy and was able to take care of many things. And more then just doing vitals and VE's I was also able to do some very deep cleaning which I believe is also a part of health care and the hospital staff said to one of my staff "Your student makes this place shiny. We are very blessed!" =)
We also started one of our mornings singing and dancing to a children's worship song. The nurses laughed and laughed at us, but we really surprised them when we burst out into a Swahili song of praise to Jesus. =D
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.