Working in the labor ward can be terrifying. There is a vulnerability that women undergo during labor and delivery that is inexplicable –impossible to describe. There is this feeling as soon as you walk in to those rooms of desperation and need. Women are completely exposed and afraid –they have put their life and the life of their unborn child into your hands and you are responsible to care for them.
There are so many things that frustrate me on a daily basis at temeke hospital. I hate not being able to speak the language. There is a huge level of trust that women extend to you with the assumption that you are a skilled health care provider. They really do place their life in your hands. And that can be absolutely terrifying… especially because I am limited by so many things. First of all, there is the language problem. I hate not being able to explain what is happening to the mother. All I can do is give her basic, one-word instructions to help her push the baby out. That’s one of the problems that I’ve noticed working in the hospital though. Women aren’t educated or informed on the changes that their body is going through and why. (We have worked with patients who didn’t know that there would be a placenta to deliver after the birth of the baby!) They aren’t told when a doctor is about to put their entire arm back inside them to manually remove their placenta. Imagine being on a flat table with people hovering around you, speaking a language you don’t understand, poking you with needles, performing an episiotomy by slicing you with a razor blade, pulling things out of you, violently and firmly massaging your uterus to expel clots and all the while you have no idea what is going on or why… I have taught myself to be more intentional about making eye contact with the mother during the delivery. It’s difficult during the actual birth of the baby, but certainly when the placenta is being delivered –I do my best to look at her in the face to try and communicate through my expressions, because often that is all I have… it’s all I can do to try and bring comfort and reassure her. How do you explain to a mother that her baby has died even after you made every possible effort to save his or her life? What do you say to her after she has torn during the delivery and is left to lie there bleeding and uncomfortable for two hours because there is no lignocaine to numb her before suturing? The problem is that not even the hospital staff, who speak Swahili, take the time to explain these things. I don’t like to make generalizations about an entire culture based on my own personal experiences in it, but… I have observed/experienced things that I believe are deeply embedded into the hearts and minds of people within this culture and that aren’t good. I can make mention of the many positive aspects of this culture and its people, but I am also able to recognize the issues that exist. One of the frustrating things about working here is the lack of questioning that goes on. I can’t think of the right word to describe it. The only thing that comes to mind is complacency. There is this pervasive acceptance of your harsh reality without question. Without fighting to pursue something better. I think that his probably has some root within Islam and the concept of mashaallah or inshallah. People don’t fight things because they believe that much of their reality, be it the present or the future, is outside of their control because it is all foreseen and determined by God or Allah and so whatever happens to you must be willed by Him. I get so frustrated when Africans talk about the corruption and problems that exist in Tanzania and how they wish they could live in Canada or the States because life is so much better there. Instead of envisioning how Tanzania could change or be improved, they have just accepted that this is how it will always be. Nothing will change in this nation until people decide to ask questions and actively pursue justice. It is possible for change to take place in Tanzania. It is possible for the people to rise up and create the change that they want to see. But they just aren’t doing it!
Countless women come in and out of Temeke hospital each day – most of them confused, afraid, uncertain, and possibly fearing for their lives. The most painful thing is to watch a woman suffer in silence and hopelessness. I see it every day. They don’t expect to be taken care of or valued, so they just lie there hoping that it will be over soon. I saw it with the mother who had stillborn twins, with mothers who are HIV+ and know that they will be treated differently and probably neglected, with the mother who is brought over from antenatal with heavy bleeding and a baby who died in the moments of being transferred. Yes, I know we must have grace and compassion on the hospital staff because of what they endure and the limitations they have to work within –but I am still outraged and shocked by how poorly women are treated and how many unnecessary deaths take place on a weekly basis. I get angry when I notice that a woman is at high risk based on her obstetrical history or current health problems and yet no one takes the time to try and make sure that she doesn’t lose another one of her unborn babies by taking extra precautions.
People here don’t ask questions enough. Maybe because they are more indirect in their communication –and to ask too directly you run the risk of being too forward, or harsh, or rude.
I want so desperately to see the nation of Tanzania transformed… and other African nations alike. I constantly wonder what it will take for this to happen. Not because it think that Africa needs to ‘catch up’ with us and start to look and sound like a western society. But because the standard of living has to improve for these people. Because Tanzanians don’t deserve to suffer under the restrictions of poverty and corruption. Because I believe that Christ offers life to the full, and that He deeply desires to meet our deepest needs. Things have to improve in Tanzania. But as with any nation and foreign intervention, no lasting change will take place until the hearts and minds of the people change. A change that takes place through coming to the knowledge of Jesus Christ.
I believe that is one of the biggest challenges of this continent. Billions of dollars worth of foreign aid pour into these nations year after year and with little visible evidence to show for it. And it’s because Africans need to start envisioning a better future. Africa needs more pioneers, more visionaries, more passionate, driven individuals who will stay in their country of origin to pursue and fight for change. Enough with foreigners coming in and trying to fix external problems that are only the outworking of more deeply embedded issues that exist in cultures and hearts and minds. You can install hundreds of wells, build countless schools, clinics and orphanages but how do you change hearts and mindsets? How do you encourage people to see their own value and worth? How do you assure someone that they have what it takes to make a difference?
Too many Africans have accepted their suffering and resolved that their life and their nation will continue to be filled with problems.
I want hope for Africa. I want African people to expect more of themselves and of their governments. I want African men and women receive the most excellent levels of training and education and to remain dedicated to their nations as opposed to leaving to find better opportunities in the west where they can make more money but their services are less needed. I want life to be valued and guarded as a sacred gift from the creator of the universe. For people to value one another as image-bearers of an almighty, all-powerful God. I long to see African nations be independent, autonomous, free from corruption, dictatorships, violent regimes, and foreign intervention.
I don’t know how to live with the things I’ve seen and experienced here. I feel like the more that I witness, the more debilitated and damaged I become. Sometimes I feel like I am too deeply affected by things and other times I wonder how I am able to push through and get things done without getting emotional or upset. I don’t feel much when I’m in the hospital because I’m more concerned about giving good care to women and being in top shape emotionally. But when I get home I still don’t process things very well. I still keep it held together. And now I feel like it’s all starting to slowly catch up to me. I fear going to the hospital. I feel like I’m not able to take on many more traumatic situations because I have already seen enough. Every single day comes with its own set of unknowns that shock and terrify me. Every day I experience something new or different that I’ve never seen before. In postnatal I come across one too many fevers, infections, and secondary post partum haemorrhage. In antenatal there is often a surprise birth, a breech delivery, a 15 year old first time mother who is scared to death, a couple of women being prepped for c/s at the same time, a woman rushed in with all the signs of severe pre-eclampsia, impending convulsions about to take over her body and the high possibility of maternal and/or fetal death. The labor ward is comparable to being in a war zone most of the time with all kinds of chaos and insanity taking place. Heads popping out all over the place… Retained placenta here, eclamptic fitting there, PPH, suturing of a third degree tear, macerated stillbirth being born at the same time as a perfectly healthy delivery of a baby with an APGAR score of 10/10. How do you define or understand your God in the midst of those experiences? How do you hold on to the truths of His character—the wonderful qualities that you want to believe to be true—when you watch countless things go wrong and lives be lost even after you fervently prayed for life and protection?
What do you feel first after a day in the labor ward when there are 6 fetal deaths but 8 mostly healthy deliveries of living babies? How do you explain or see God in that? The confusing mess of emotions that I rush through over the course of a four-hour morning is almost too much to keep up with. At one moment I’m overwhelmed by the joy and excitement of welcoming new life into the world, and the next I’m dealing with the grief and disappointment of losing one. I am confused, and slightly disappointed by God. I have already been through many many years of questioning and anger toward Him because of my own suffering so this is not a new journey or process for me… these aren’t new questions or debates taking place in my mind. No. These are questions and frustrations that have stirred in my spirit for the last eleven years. The problem is that I have yet to find satisfactory answers. Or at least enough understanding to bring some peace in my heart. I want to continue serving this God because of who he says he is and because I do deeply believe that he is true to his word and that his way is the most ideal and that following him is the most rewarding life I could possibly lead… But still. I am disappointed. Confused. I am baffled and uncertain of how to reconcile the existence of such extreme and fierce injustice and suffering with his character and his goodness. I am not childish or immature. I don’t expect there to be no suffering or hardship in the world. I am just not sure how to deal with its existence when Christ’s message is one of salvation, renewal, hope, mercy, love, life, truth, JUSTICE. How do they go together? How am I to pray to this God when prayer seems more like a game of chance than anything else? Prayer seems like a cruel stirring up of faith and hope that often goes unfulfilled. I think I have learned how to pray without getting my hopes up. Because I have experienced such deep and painful disappointment in my relationship with God, I have resolved to expect little so as to guard myself from experiencing that same kind of hurt on a continual basis. If I was to pray with full passion, belief, and hope, I don’t know that I would be able to survive the disappointment and pain that it would involve if/when those prayers went unanswered. I am a Christian, but I struggle with my faith. I wrestle constantly over what I believe and why. I am confused. I lack understanding and confidence, but I am filled with passion. And hope.
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