we make hope from every small disaster

How to summarize the week thus far? The labor room is always filled with surprises, new lessons, and traumas. I hate to say it, but…. Birth is an incredibly traumatic process. For both mother and baby. Of course it is wonderfully rewarding to have a new life at the end of the painful ordeal, but my goodness.

As I’ve said before, it is so interesting to be able to compare GMH with Temeke Hospital in Tanzania. There are plenty of differences, but also some similarities. And while GMH does seem to have a better handle on things when it comes to caring for patients, there are still a number of injustices and things that confuse and frustrate me. At Temeke it is more in your face though…

There are a couple of different places that women deliver at GMH depending on their risk factors or complications. This is good news for me in some ways because it means that I get to avoid the more traumatic cases. For example –women who are HIV+ deliver in a separate ward, as well as women with pre-eclampsia.

Women are admitted to the labor room when they are considered to be in the “active phase.” Here that means 4cm dilated or more. There are eight delivery tables/beds and they are bare metal with a couple of buckets underneath to collect blood and fluids. Unfortunately, the daimas and ward boys do basically everything. They transport/transfer patients, prepare and fetch any of the necessary supplies for the delivery and do all of the clean up afterwards. If you ever need anything for a delivery, you literally just yell “DAIMA!” and one of women will come over. I actually find the post-delivery clean up process to be really rewarding and fulfilling because it means that you get to complete the job from start to finish and provide full care for the woman. 

The supply situation here is… interesting. They have an abundance of drugs and don’t hesitate to use them. There are zillions of ampoules of drugs I have never even heard of all lined up together in different compartments on one counter. They tend to intervene a bit too much here –in my opinion. Every woman is put on oxytocin/syntocin intravenously and is given even more after the delivery to help with the delivery of the placenta.  Most women are given episiotomies, and if they aren’t, they almost always will tear. This is partly because Indian women are so tiny, but it also has something to do with their diet and lack of nutrition. No meat and severe dehydration make for a thin, tissue paper like perineums that tears quite easily. Ouch. I’ve only seen one woman so far who didn’t require suturing after she delivered. The great news is that the woman doesn’t have to bring any of her own supplies. The hospital has all of the necessary suturing materials and tools. Thank you Lord for lignocaine!

Sterility is a huge problem at GMH. They reuse gloves. Yes, you heard me… Reuse. When you take off your gloves, you throw them into a bucket which is eventually taken away by the daimas who will clean and re-sterilize them in another room. Gross. I feel so sorry for these women. Every day I want to kiss their feet and sing their praises because they do SO much. Without them, this hospital would hardly be able to function!

Because the glove re-sterilization process is so time consuming, we always run out of them and have to use them sparingly. (We’ve also started bringing our own supply of gloves like we used to at Temeke). There seems to be almost no concept or understanding of sterile technique amongst the hospital staff –including the daimas—so it’s no wonder they put every mother on a round of antibiotics post delivery!  

The tables that the women deliver on are just plain disgusting. I have had to swat away a few cockroaches during deliveries because they seem to live on the underside of the beds.

Speaking of which, I have to mention the general lack of sanitation that I’ve experienced here. OH. MAN. Mice in the change room, massive rats that we have spotted daily in the canteen, finding various foreign objects in our food. Yikes. I think I’ll spare you from further details…

Still though, it hasn’t deterred me from eating the food here.  I constantly beg Rachel to let me have a lassi or some of the delicious treats that the vendors sell on the streets but she continues to remind me of the risk of typhoid or hepatitis. We always joke around with one another and say things like: “Why yes sir, I would like a tall glass of mango typhoid,” or, “ Yes please, I’ll have a drink of hepatitis B.” Mmmmm. Delicious! I think I’ll have to stick to eating at the Softy Den or Habli Babli.

Ahem. Now back to what I was saying about the hospital… Another area that they could use some improvement on is their care of newborns. They deliver the baby onto the cold metal table below the mother and immediately clamp and cut the cord. After the mother verifies the sex, baby is placed in a metal tray/basin and carried to the newborn room and left there for someone else to care for. They are immediately weighed, airways cleared with bulb suction, and cord clamped and cut closer to the abdomen. Then they are cleaned off with water or cotton. All of their precious vernix is scrubbed off, in the meantime they are still naked and bare in the metal tray or on a cold marble surface with nothing but a wet, green cloth covering them. They then place the baby in a little compartment on a marble counter. They insist on keeping them in separate areas, but we often place them all together so they are a bit warmer. We also bring our knitted blankets to cover them with. Eventually, the family members will give us a towel or piece of cloth, but by then their temperature has often dropped below the normal range and it takes some effort to get them warmed up again.  They will stay in that room, separated from their mother, sometimes for many hours, until she is transferred to the postnatal ward. So frustrating!

During a week in the labor ward, we each get to spend a day working in the newborn room. Aside from dealing with the frustration of annoying, giggling students questioning your every move, being with babies for a day provides some much needed therapy and solace from the intensity of the labor room. Nothing soothes my soul and replenishes my spirit quite like a newborn life can. Sweet, innocent, pure… The best!

Because it is a teaching hospital, the rooms are all overcrowded with nervous students all wanting to observe or participate in a delivery. I must admit that while I really enjoy teaching and helping others to learn, this dynamic has daily put my patience to the test. In general, we have more experience than them, but we aren’t taken seriously because we are only in our “first year.” (Years of schooling represent your skill or knowledge level). They all fight to assume ownership of a ‘case’ or a delivery and we often will just support and help to monitor the woman.  

I did quite a bit of that this week. I was reminded of how much you can learn when you are teaching someone else. I really love it, and sometimes, I even prefer being the secondary support person during a delivery. I was partnered with my Zambian friend Jenny for three days this week and helped her with three different deliveries. I feel just as connected to those women and their stories as I do with women who I am the primary support for during labor and delivery. Being the secondary means that I get to provide more emotional support and prayer than I would be able to if I was conducting the delivery. I like that. I’m sort of like the coach on the sidelines cheering her on and giving advice and input to the person primarily responsible for her care. I discovered during my week in antenatal that women here have babies very young –just as they did in Tanzania. And as soon as a woman is married, she is expected to start providing her husband with children… (Preferably male children since females are far less valuable). I remember praising one woman that we came across in ANC for having been married for 3 years before getting pregnant. She told the doctor that she knew about family planning and had been tracking her cycles in order to know when she was fertile! Amazing. It was so encouraging to come across a woman who was empowered through education about her own body and was able to actually plan her conception and pregnancy! Anyways, as I was saying, women give birth at a young age here and the women that I assisted Jenny with this week were all under the age of 22. For most of them, it was their first pregnancy and they were terrified. I really can’t remember many details of the deliveries that she did on Monday and Tuesday because I monitored so many women this week that things become blurred together, but I know that I felt very connected to them and their beautiful babies. Here is the mother from Monday – she had a little boy who we named arise or “leval” which means get up in Hindi. 

Jenny and I

More birth stories in the next post!