Not Just the Joys...
"You have a heart of gold." She told to me with a huge smile. I knew what she meant by it; it was a complement, a way of saying I was sweet, kind, loving, happy etc... but this was not the first thought to cross my mind, what did enter my mind was an answer. An answer to a question I have long had. Her words held truth, and with them I suddenly understood.
In real life, there is death. I've see a lot of death in my life, I can still remember my Grandpa's funeral from when I was only three, and I have been to countless funerals since then. From my pets drawing their last breath in my arms, to lifeless bodies laying neatly in coffins. Death is a part of life, as much as we all try to avoid it, the fact of the matter is that none of us make it out of this life... well, alive. "Live each day like it's your last!" It has been quoted in a number of ways from hip songs to sweet poems. "As soon as your born, you start to die." That is what I have heard said before, but truly we all know life starts nine months before that... as soon as you're conceived your days are numbered, and they don't always measure up to nine months.
Since being here I have seen so much life, something so beautiful, so precious, and thankfully I can hang on to the memory of each life longer then I get to hold them in my arms. I write about them so that I never forget, I name them and share stories of how their first breaths of air began, I pray for them and share the excitement with their mothers as they set their eye's on their beautiful child they have long waited to see. But what I haven't been writing about, has been just as impossible to forget.
"How are you doing today, Kaitlin?" My leader, Melisa, asked me. "Great, grand and splendid! Excited and ready for another day here in the labor ward!" I said as our group of seven was standing around getting ready and about to pray before the work day began. It wasn't long before we were all out on the work floor checking on all the women, calling for the doctors, searching for the records of the different moms and so on. I had already delivered two beautiful baby's this week and I wasn't sure I was going to have the chance to do another one since we took turns as students, none the less I was enjoying smiling with a mom named Lucy. I was taking her vitals and we were getting close to wrapping up for the day, just then I glanced over to the bad across from Lucy... "Melisa! HEAD!... MELISA!" Melisa came running in through the curtains from the other side of the room where she had just delivered a baby with another student. "Who is going to take this one?" She asked as I was standing with my partner and good friend Tiffany. We had already agreed that I would do the delivery if the chance came up, so by now I already had my gloves on and Tiff was getting the clamps, cotton, and blades all ready to go.
Zainabu was her name. I didn't know much else about her at the time because she had just come in a little bit before and I hadn't reached her yet in the line of women needing to be checked. Now I was standing next to her getting ready to help her little one make it's way out, but with one glance I knew this wasn't good... meconium. The awful color of yellowish brown fluids indicated the baby was in high distress. Tiffany soon had a pinard and was checking for the baby's heart rate, she couldn't find it, but we prayed that it was only because of the baby being so far down.
None the less the baby was nearly out and we were trying to spare the mom any tearing by letting the baby come on it's own, there wasn't anything we could do that would have made it come any faster, well that is, anything that wouldn't cause greater damage. That is when I glanced up to see a nurse I had never met before walking our way, and I didn't like the looks of her. Melisa confirmed my thoughts before the nurse got any closer, "Oh no, not her! What ever you do, do NOT let that nurse touch this mother!" I glanced over at Tiff who was holding the mothers hand and helping her to know when push or rest, and I immediately recognized that look she gets in her eyes, she was in defense mode, her protective instincts were kicked in full gear now, she apparently knew this nurse as well. Anyone trying to harm this mom would have to get past Tiff first... and being a strong, tall, island girl who grew up in Asia knowing how to fight, she is not an easy one to get past.
By the time these thoughts ran through my head the nurse was now right next to me. We just continued our work, but kept a watchful eye on her. Sure enough within thirty seconds of standing there she had decided this mom had been pushing long enough (all few minutes worth) and she was going to help push the baby out for the mom, by ramming her fist over and over onto the mothers uterus she was going to push the baby out by hand, this was like her signature move that she did on all the moms causing them extreme pain and tearing. Thankfully Melisa and Tiffany already knew what was coming, as soon as the nurse raised her hands in a fist to the moms stomach... "HAPANA! HAPANA!" (NO! NO!) all tree of us cried at her, and in one motion Tiffany had already thrown herself over the mom to guard her and the look in her eyes told the nurse everything she needed to know. "No!" we said again to the nurse. (who by the way is quite pregnant herself). "This Mama is okay, we have her taking care of and there is no need to push on her uterus." Melisa explained to the nurse in a claimer but stern tone. The nurse chuckled at us, watched for a little while longer, then walked away.
The baby's head was just coming out now, "Cord around the neck?... Yes, and it's very tight." Melisa immediately grabbed the two clamps Tiffany had already prepared and started clamping the cord, then she cut it as the rest of the little boy made it's way out. He was limp, and covered in meconium. I grabbed a bulb suction and started to clear out his mouth and nose, he grunted a bit. I placed two of my fingers on his chest, a beating heart! "In Jesus name I say you will live!" I cried out. By now I was rubbing his back praying for a cry to come, but he just grunted a little more. I handed his limp body to Tiffany, and Melisa left with her to begin resuscitation.
I cleaned up the mother and checked everything to see that she was okay. No tearing, only 200ml blood loss. Mama was doing fine. I helped her place her fluid covered kongas in a plastic bag and get dressed, then I proceeded to wipe the bed down for the next mother. I checked the moms vitals and made sure her body was in working order. She was okay. She started to talk to me in Swahili, I knew she was asking about her baby, but right now I didn't know what was happening. By now it had been almost ten minuets and I had only been hearing the sound I was dreading... the sound of nothing. I walked through the two sets of curtains to the other side of the ward where the baby beds were held. There he was, little Daniel Obadiah as I had named him, laying lifeless as Tiffany and Melisa were trying to keep him from being lost forever... "one, two, three, one, two, three," Tiffany was pushing her two fingers into his soft chest on every count as Melisa was using a mask and air pump to fill his cheeks and lungs on every third count. I had done infant CPR on so many "dummies" as a lifeguard... but now here Daniel lay, not a dummy this time, but a precious little boy.
His heart never started to beat again. He would never learn to crawl or walk, he would never say his first words or know his family, nor would he ever learn to love, but as least he was loved. Nine months, that is all the time in the world he would receive.
Daniel was only one of many many deaths I have witnessed since being here, and it was by far one of the least gruesome. I have seen vacuum births, breach births, prolapsed cords, placenta previa, and premature births. One mother died of blood loss and another was highly infected after her child was ripped out of her. Mothers are cut open with blades when no pain killer has been given and many mothers have HIV or another sickness. What I didn't add to my last blogs was that across from the first baby I delivered on Thanksgiving, was the mom who was bleeding to death. And across from the mother I delivered on my birthday, was the mother who was having her baby ripped out of her, a large stillborn that the nurse just yanked and pulled in every direction as hard as she could (even if it meant standing over the mother on the bed) until the baby was out, then the mother was not taken care of and she was infected so bad that five days later her uterus was the size of being thirty weeks pregnant, and she still hadn't received any antibiotics.
Still, some how, some way, the only emotion I feel, before going, while there and after leaving, is excitement. What happens, happens. I can only do my part in focusing on one women at a time doing the best I can and I'm excited to be doing that. Yes I would love to change so many things, and as a team we are. We have made sure care has been provided for so many women, we have caught so many sickness the doctors didn't know about, and we protect the ones we are with as in the story above. But so often I wondered... why am I so heartless? So many girls come home and break down from the pain of injustice, they may cry, go off alone, write, watch a movie, listen to music, talk with each other or a number of other things so that they can process the day, but not me. I hate leaving and I just want to go back. I come home with my mind a blank slate wondering what tomorrow will bring. I don't feel pain, I don't get upset, I don't feel hunted by anything I saw. As a matter of fact when students were turning away saying they couldn't stand to watch a difficult birth, I ran and held the mothers hand. I couldn't stop what was happening, but I could make sure the mom wasn't alone, but at the same time I was wondering how on earth? I never could and still can not bring myself to watch not even one scary movie and now I stand here and watch real life horror.... and I don't even flinch. Why can I stand and watch in times when everyone else running away?
I've been wondering about this since I started working, but there was my answer... "You have a heart of gold." She said to me with a huge smile. "I know." I said. "It is impenetrable." I just thought I was heartless all along, but I realized then that God gave me a heart, it was just so strong that I could run in when everyone else is running out.
Twenty Years Later
December 4th 1990 -Kissimmee, Florida
5:16am and all the lights in the house were on, "It's a girl!". The cry of a new baby filled the room as the older kids gathered around the tired mother to see their new sister, "What do we name her?" Said the mom to her husband as her mind was a blank slate after the hard work, but dad didn't have a name either, how about the oldest daughter, Kim, being nearly fifteen she would surly be able to think of something better then dolly as their two year old, Baby Di, might have called her. And the three boy's were more then likely too hyper or grossed out to be thinking about names. "Hmmm... Kaitlin... Kaitlin Elizabeth Shock." It flowed so smoothly off of Kim's tongue no other thoughts needed to be added. Kaitlin Elizabeth Shock it was.
Well I've been known to have good memory, but it doesn't go back that far. So I really don't know if that is exactly how it went, but I like to think it went something like that. I'm not sure if it crossed anyone's mind at the time to think about where that little baby girl would be in twenty years, but if it had crossed their mind I doubt it would have looked anything like it actually did.
December 4th 2010 - Tanzania, Africa
5:16am... Florida time. It was actually 1:16pm in Tanzania. And there Kaitlin stood, exactly twenty years from the minute she came out of her mothers womb, who would have ever guessed out of all the places in the world, she was standing in the small storage room of the Temeke hospital labor ward. She was dressed in a blue nurse uniform along with blue gum drop boots, she had her pockets filled with everything from gloves to ink pens, her stethoscope was around her neck and her name tag was clipped onto her top left pocket. "Kaitlin Shock" the name tag read next to a less flattering picture of her, but often times the doctors just called her "Shock". I guess her big sister Kim wasn't thinking about the fact that Kaitlin would be a hard name for people in Africa to pronounce, so her father's last name would have to do, besides, the doctors rather enjoyed saying it and Kaitlin couldn't help but giggle at their impressions of being electrocuted every time they said it.
By now Kaitlin had decided she had everything she needed and began to exit the storage room. Inside she was filled with excitement and outside she was covered in sweat, none of it came from being nervous, it was simply the heat of Africa rising all around her, it seemed to trap it's self more between the walls of the labor ward then it did anywhere else in the world, but there was no where else in the would Kaitlin would rather be at the time. Today was a very special day for Kaitlin, her twentieth birthday, but since she wasn't very fond of being the center of attention the most pleasing way to celebrate for her was to put all the attention on someone else more deserving of it, and who would deserve all the love and attention more then a brand new little life!
It was a Saturday, our day off from the hospital, so it was the last place anyone planned on going, and we can't ever go without a staff. Everyone had made their own plans for that day and we also had homework due. Long before the day approached I was a bit afraid that my hopes of delivering a baby on my birthday were going to be crushed, but God kept assuring me that he knew the desires of my heart and he wouldn't give them to me to than just take them away. So I was excited to find out one of my staff, Marchien, and another student, Emily, decided to help make my dream of delivering a baby on my birthday come true! Unfortunately, Emily stepped on a sea urchin at the beach just a bit before we left and so she was not able to go, but another student, Amy R, came in her place.
Finally there, I had my hands ready for work and heart ready to love. The two nurses on duty had no idea we were coming, but they were more than happy to have us. With eight women all on the edge of pushing their child out I was faced with a question... who's baby was going to be a special birthday baby? I would have loved for all of them to be my birthday babies, but our time was limited and I knew I only had the time to focus on one. I prayed that God would show me the right women, but I didn't feel like it was any of the women in the ward, so I just started checking how all of them were doing and who looked like they might be the closest to delivering.
Mariam was her name, she was a very small mom with light skin getting ready to have her first child, looking at her records I saw she was a PMTCT 1.... HIV positive. We don't look at the moms any different because of this, but we do have to be extra careful. I was holding her hand and breathing with her, just lingering with her a bit to see if she might be "the one", and that is when everything changed.
I heard the quick patter of flip-flops form heavy footsteps coming fast into the room, I looked up to see a women across from me throwing all of her bags onto the floor against the wall along with the spoon that was in her mouth as she kicked off her flip-flops and unwrapped the kangas from around her chest and waist quickly covering the bed with them, now undressed she stood facing me with her back to the bed, she placed the hands on the high bed behind her and in one motion jumped up and back scooting her way up the bed. As soon as she was on the bed the words were out of my mouth, "HEAD! MARCHIEN THERE IS A HEAD COMING!" -The sight of a women running in and jumping on a bed about to deliver is rather quite common, but as soon as I saw her I knew I was there to be with her.
Rehema was her name, she was 24 and about to have her first child as well. PMTCT 2- Negative, but by this time I already had three pairs of gloves on and Marchien standing across from me giving me ques on what to do next, I mean this was only my second delivery. We used a needle to pop her bulging bag of membranes, it was the first time I saw a clean (not full of meconium) bag of membranes since I've been here, and now the baby's head was coming fast, Amy was busy getting everything from clamps to cotton ready to use and a clean konga to catch the baby in. "Sucuma mama! Sucuma!" I said, meaning that the mom needs to push. Before I could say much more a beautiful little head slipped out, "Cord around the neck? Nope." And so came out the body of the most gorgeous little girl. APGAR score- 10 out of 10! We laid the little girl on mamas tummy and the biggest smile crossed her face as she lit up, "Asanta sana" (Thank you very much) she said. By now the baby was letting out the most wonderful sound of a strong healthy cry and her pink arms and legs were getting a good stretch. I clamped and cut her cord as Amy dried her off and took her away to get a good full check. Mama Rehema was still smiling.
The placenta came soon after, but mom did have a little tear. We cleaned her up, took her vitals and found a doctor who could stitch her up. I held her hand while she was being stitched up and she just smiled at me the whole time and kept saying "Asanta sana". - Once the mothers are done they get up, get dressed and go sit on another bed with other mothers and wait till their baby is done being checked and brought to them, then they wait a little while longer, get checked a few times more along with their baby and then they are taken to another room, where they wait some more, are checked some more and then if all is well they are sent home.- But I guess Mama Rehama never heard about doing this. As soon as she was done she got up and dressed and gathered all of her things as quickly as she could, she walked right up to Amy who was checking her baby, and with full enthusiasm picked up her little girl and marched right out of the labor ward heading for home. I looked at the others a bit clueless for a second before running out of the labor ward after the mother. "Mama, Mama, BAS! NJO!" (stop, come) Mama turned and looked at me with the most innocent face, it made me think of a puppy that thought it was finally free and didn't understand why it was being called back. None the less she came back and we took her to where she needed to be along with other mothers who had just delivered, and one of these mothers was Mariam.
Marchien and I started on the stack of paper work that followed and Amy finished checking the baby and returned her to her mother, that is when Marchien realized something was wrong, next to Rehema, Mariam was laying, unconscious. Her uterus had not clamped down and she was quickly loosing a lot of blood. As we called another nurse over I will never forget what Mama Rehema did, she moved her things to another bed by another mother and laid her band new baby girl down along side the another mothers baby, then she turned and picked up Mama Mariam's baby and held is close, she cradled it and loved it caring for it as if it were her new daughter, and she did so until the Mama Mariam was taken care of and well enough to have her baby back. Mama Rehema may have never been a mother before, but I could tell she long had the heart of one.
Once Mama Rehema had her perfect little girl back in her arms we were sadly getting our things ready to go, but we sat with her for a bit and talked in the little Swahili we knew, I really wanted to tell her that it was my birthday and I had been practicing long and hard to be able to say it... "Mama" I said "Lay-oh meme see-koo-koo koo......-la... no... za-....we... no.. oh... lee-wa!" I couldn't imagine having messed it up anymore then I did, but Mama looked up at me and said "oh, you birthday!" "NDIO! It's meme birthday!" I exclaimed. "Hongara!" Mama said. (congrats) We then asked the Mama if she had a name for her little girl. "Bado" (not yet) she then asked us if we had a name. I personally thought it would be selfish to tell her she should name it after me since it was my birthday, but the little girl looked like a Kaitlin to me. None the less before I could say anything Marchien was already telling the Mama that she thought Kaitlin would be a good name for it, and Amy shared that she had prayed and got the name Caris for her. Mama smiled big and looked down at her little girl as if to think about it those names fit her. She looked back up at us and said thank you with a big smile. We weren't sure if that meant she was going to name her either of those, but it didn't really matter. We then prayed for her and the other mothers there, they were all very thankful. And so we left.
Chances are I will never seen them again, Mama Rehema or baby Kaitlin Caris as we call her, like my friend Lindsay said, "Loving them is the easy part, leaving them is what makes our job hard."
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.