day 1

Since we started working at temeke hospital, I have been writing down my thoughts and feelings each day in an attempt to process everything that I see, feel and experience. So. Here it is... (Be warned that it can be a bit graphic at times). 

The labor ward was remarkably peaceful when we entered. You walk in the main entrance and to your left is a room that had women with complications or who were recovering from births. They kept most of their sterile equipment like clamps, resuscitation equipment and other things over there. They also had a scale for baby weighing and a couple of tables to put the babies on. There were about 5 beds there and all of them were filled with one or two women. The beds are very high and incredibly challenging for a woman in labor to hoist herself up onto –never mind getting down once she’s had the baby. They are long and flat with a rubber mat covering them. The room to the right was filled with women in active labor. Some of them were recovering from having just given birth and some of them were in tremendous pain and on the verge of delivering.

We met the staff upon our arrival and then quickly changed into our uniforms. The smell all around the labor ward is distinct and disgusting. It smelled like bodily fluids, mainly blood, mixed with different antiseptics. The conditions were shocking. Even just on the way to the toilet there were old dirty, wet khangas strewn around along with other personal belongings like shoes and underwear and garbage. There was also a green bin that had just been returned after its contents of placenta and other bodily fluids were disposed of and it was just sitting outside there.

Before going inside, we met to talk, ask questions and pray together. We were given a brief overview/orientation to our surroundings and told that we are only supposed to be observing for this week at least. But what do you do when there are three women giving birth all at the same time and the nurse refuses to come when she is called for or is unable to attend to all three of the women? I had no idea what to do with myself. The room was filled with women in tremendous pain. Most of them fully naked, laying out on their colorful African fabrics. There were probably just over 10 women in the room at the time. A few women shared beds and had their newly born babies with them. I went over to them first and tried to have a basic conversation with them. Admired their newborns and congratulated them. “Hongera sana mama.” I spent time with a couple of women in labor. One of them was having her eighth child and was incredibly resilient and strong throughout her labor. Some of them were wailing and screaming, calling out for the nurse over and over again. All I could do was stand beside them, mumbling a few things in Swahili, praying, holding their bellies as another contraction would come and go, and gently rubbing their arms and legs. I wanted to be able to do more to help them, or even to have a few comforting words to say but there was little I could do to make the situation better. Over and over again with each woman I would say, “pole” or “pole sana” (sympathetic apologies). Other words/phrases that I picked up and tried to use were bado- not yet, hema- breathe, sukuma – push and nzuri mama- good/well done mama. I adjusted to the smell quickly and didn’t even notice it after a few minutes. I was in a totally different zone, a different universe. Adrenaline rushing through my veins at every moment. Rushing back and forth between rooms. Grabbing equipment or gloves. Taking newborn babies in to be weighed and labeled. I think I witnessed 7 or 8 births that day. Between 11am to 2pm. I didn’t find the birth process shocking or overwhelming necessarily. I felt confident that the mothers and babies would be alright and I managed to stay quite calm as I observed and tried to coach them through it. I prayed silently as much as I could. I was unable to formulate my thoughts properly and all I could muster were quick, short, to the point prayers. “God bring life, help him to breathe, be with this mother, help her not to tear, protect her.” And once the babies came I would welcome them—“karibu sana”—and pray affirmation, acceptance and love over them –dedicating each one to the Lord.

Out of everything that I experienced today, I think the thing that was the most difficult to deal with—the most shocking and disturbing evidence of the massive need for better health care in the developing world—were the conditions. I could handle the blood, the gushing waters, the tearing of genital flesh. But I was so overwhelmed by how poor the level of care was at this place. The women bring most of their needed supplies for the birth with them. A razor blade and clamp for the cord, a large roll of cotton wool, the rubber mat to lay on their bed with, and of course plenty of khangas to clean everything up with and also to wrap the baby in. The hospital staff is clearly overworked and has become hardened towards the women. 

It was such an insane environment. There were some women that ran into the labor room from the antenatal word and had hardly lain down before the baby came. I was racing back and forth between rooms grabbing equipment, taking newborns to clean and weigh them and attempting to clean up the floor when I could. Some of the babies didn’t have a clamp for their cord after the birth and so they would leave them with the forceps still attached or use the end of a sterile glove to tie it off. The hospital is running out of gloves so they were careful to use them sparingly. We brought all of our own equipment because we were aware of this fact ahead of time. Gloves, bulb suction, bag and mask, suture kits and other things. They don’t even have soap to wash your hands with! I’m not sure what the correct way is of doing many things in a hospital setting, but there were so many things that seemed shocking and unsafe to me. Some things were outside of their control because they simply didn’t have adequate supplies, while other things were done because they had either been poorly trained or they weren’t concerned with the potential danger that it could cause the patient.

It was such a shocking environment to be in, yet I was amazed by my capacity to handle it all. It’s extraordinary how your mind finds ways to deal with things that are unfathomably disturbing and shocking.

The women here are incredibly strong. There was a young woman who had been in labor since Friday (four days earlier) and while she was being prepped for a c-section she dilated and the baby’s head started to crown. She was rushed into the labor room and the second she laid down the baby came almost all at once. She was right next to a woman with her newborn and directly across from two or three other women who were sharing a bed. Once they give birth, the placenta has been delivered and any necessary suturing is done, they quickly gather their belongings and try to find a spot on another bed. There were also women on the floor at different times. Two, three, or more, all laying beside one other—packed into a small space and all in a great deal of agony.

At one point there was a woman who had either just given birth or was about to give birth and a flood of brown/green waters came gushing out of her, pouring all over the young girl on the floor beside her bed in active labor. All I could do was look at her with compassion and apologize. I was able to get a bed cleaned and ready for her and helped her over to it. She was a bit traumatized. As was I… I mopped it up as best I could with the dirty mop water.

Near the end of the day around 2 when we were getting ready to leave, there was a very small woman laboring on a bed across the room from where I was standing. All of a sudden I felt a splash of warm water all over my feet and legs. Her membranes ruptured and sprayed all over the place around her. I rushed over and tried to clean her up with the extra khanga she had. When the nurse came over to check her, I saw what looked like a prolapsed cord coming out of the woman’s vagina. Seconds later, we both realized that it was actually a foot. The baby was coming breech and there was nothing we could do about it. She called over the male intern doctor and he did quite well delivering the baby. The baby was blue and limp. He got both legs and the body to come out as the woman pushed, but the shoulders and head were especially challenging. There was blood, fluid and feces everywhere. He pulled with all of his strength on the baby’s body. The woman was calm and gave incredibly strong pushes. I stood beside her holding her head in my right hand and supporting her leg in the other. “Hema, hema mama,” I would remind her to keep breathing as she pushed. At one point the supporting nurse got up on the bed with the woman in order to put all of her strength into pushing down on the woman’s fundus which of course only caused her more pain. Eventually the baby came and they did resuscitation. I hardly had time to check on him before moving on to the next birth.

This one day at temeke alone has been enough to give me a deep passion for healthcare in developing nations. I want to get more training. Probably as a nurse. I’ve never witnessed or faced that much injustice firsthand in my life.

It was mass chaos. In some ways, everything you learned in class goes out the window. You forget about plotting things on a partograph and you hardly have time to even think about the woman or baby’s vitals. All you are really able to do is run back and forth between women and babies. It was difficult not knowing where anything was or even how to handle sterilized equipment. I was not as careful as I should have been about wearing gloves. It was just so chaotic. And dirty. I don’t exactly know how things are supposed to be since I’ve never worked in a hospital before but… I knew that the conditions were extremely unsanitary. Whenever there were fluids on the floor they would be left because no one had time to clean it up. I did my best to clean up messes but it was difficult because I didn’t know where to find any of the supplies. The mop bucket was filled with disgusting brown water and I hated having to use that to spread the mess around even more.

The whole process seemed totally backwards. At different times I remember thinking that they would have been better off delivering at home! They bring all of their own supplies anyways. And they hardly receive any assistance from the nurses or doctor. The conditions in their home may even be more sanitary! They have to fend for themselves and rely on the assistance of their families waiting outside for them. There were crowds of people, mainly women (mothers, sisters, cousins), outside of the labor room waiting to hear news of their loved one’s birth. If the woman needed anything –food, water, or an extra khanga –she had only her family to rely on. Occasionally the nurse would go out and collect items from the family members and bring them in yelling the name of the woman who it was for. In her distress, the woman would respond and she would be brought a plastic bag with some food items and maybe water.

It was literally like being in a war zone. At every moment there was a woman giving birth, about to give birth, or needing to have her placenta delivered. The conditions were awful.