Absolutely Unforgettable Day
The last two weeks have been nice and chill, not a lot to write about. Last week, I helped deliver three more babies. And my mama with sepsis was finally released from the hospital. I saw her and her baby on Wednesday and they both looked great. Baby has put on quite a bit of weight since he went home. So, all of that is fantastic. It made me incredibly content to see her happy and healing.
Tomorrow I am leaving Uganda and taking the night bus to Kitale (in Kenya) to spend close to three weeks with Jeff and Carla, the couple that runs the childrens’ home that I worked at in Kenya 2012.
I wanted to spend my last full day here at Kasana Hospital. And what a last day it turned out to be.
This morning I went to Kasana at 9:30 a.m. The only people hanging around outside was a family of sheep. As I was walked up to the maternity ward, everything seemed super quiet. I walked into the ward and every bed was full but the place was really calm. I went back and found the midwife. She told me that two women had just arrived that were in labour and needed to be examined. I went to the delivery room with her and first we examined a 16-year-old girl.
The girl got undressed and I helped her up onto the table. The midwife checked the position of the baby, listened to the fetal heart rate, and went to do the vaginal exam (VE). As soon as the midwife went to insert her fingers into the girl’s vagina, the girl immediately clenched up, slammed her legs closed, and would not let Sister do the vaginal exam. Sister starting lecturing her in Lugandan, and I would love to understand everything she was saying. Sister went to do the VE again, and again the girl tensed up and wouldn’t allow it. This time Sister and the girl’s mother started slapping the girl and forcing her legs apart. I was fucking shocked, to say the least. After two more attempts, the girl would not allow it, so Sister told her to get up and get out of the room.
The other girl waiting to be checked came into the room. She was just starting labour and was only one centimetre dialated. I had time, so I went to find the 16-year-old girl to see if I could talk with her. I found her outside and asked if she spoke any English. She did speak it but very basic. I asked her how many days she had been feeling pain and she told me for two days now. I could tell by her contraction pattern and the look in her eyes that she was still in early labour. I then tried to tell her how the pain she is feeling is necessary to bring the baby. I tried to explain that the midwife is not going to hurt her and that she needs to do the exam to make sure her and baby are doing good. All she said to me was "Okay" and I left it at that. I walked around outside with her and massaged her for about an hour. Since everyone was in such early labour, I decided that I would go home and eat an early lunch.
I got back to Kasana at noon. Things were still quiet so I went and asked Sister if she had done the VE on the 16-year-old girl yet. She said she hadn’t and that the girl was on her own because she refused the first time. Now, it is not my place to tell the midwife what to do but I asked her to give the girl another chance. The midwife and another midwife that showed up talked to the mother and then all three of them lectured the girl. After about 10 minutes of this, the girl went into the delivery room to be examined. I held her hand and again she slammed her legs shut and moved away from the midwife. I couldn't believe it. What had made her so scared of the midwife inserting her fingers into her vagina? It was quite strange because she wanted to be at the hospital and she didn't mind having the fetal heart rate or palpation exam on her stomach.
Well, when she did not cooperate, again, for the vaginal exam, Sister decided to grab the scissors and threatened to give her an episiotomy. The mother was slapping the girl’s chest and pulling her legs apart and Sister was threatening her with scissors. What in the FUCK is going on? This is child abuse! I was blown away—I could not believe what I was seeing. I don’t want people to think the midwives are horrible, heartless women, because they are not all this way. Most are really sweet and caring, but this treatment is such a deep ingrained part of their culture. It is what they know, what they have learned, and how they have been treated. It does not make it right but it is the way it is, and not my battle to fight at the moment. After about 10 minutes of this, the girl absolutely refused the VE, and another woman was coming in and needed the delivery bed.
I helped this other woman on the delivery bed and you could tell from the look in her eyes that it was time. Baby was coming soon. She immediately grabbed onto me and was not letting go. While I was helping the woman, her mother, and the 16-year-old girl’s mother, were all lecturing the 16-year-old girl about refusing the VE. They kept giving her shit for quite some time and I kept supporting this other mama-to-be. The 16-year-old girl eventually came back into the room and got onto the other delivery table. Sister tried to do the VE but the girl would not lie still. All three women were trying to force her to lay there but it didn’t work. It was the saddest, most heart-wrenching thing I have experienced here. I stayed with the young mama the whole time and supported her, she would not let me go and her baby’s head was starting to show. It took everything I had in me to keep my shit together, to not cry, and to be here for this girl.
The 16-year-old girl would still not allow a VE and I needed Sister to come over to my table to catch the baby. The delivery went really well. Mama and grandma were happy and a healthy baby girl was born. I helped mama to her bed in the maternity ward and went back to talk to Sister. I asked her why the 16-year-old girl kept refusing the exam and I asked if she had been raped. Sister said she had not been raped but that she fears the pain from the exam so she won’t help her. It does not make any sense to me but with the language barrier I could only do so much.
The second mama from the morning exams, the one that was only one centimetre dialated, was still in labour. She had been walking around outside and came back to be checked again. She was at eight centimeters so I went with her back outside. We walked between contractions and during contractions I massaged her. After some time outside, we went back in where she laboured in the hallway. I stayed with her the whole time. I saw an older woman walk in and sit down at the midwives’ station. When I first saw her, I thought, "There’s no way in hell this old woman is about to have a baby!" Sure enough, she was. She could barely move. She sat at the midwives’ station for about 10 minutes. Sister told me, and my young mama, to move into the delivery room. She brought the older woman in, too, for her VE. The older mama was at four centimetres, so she got up and left the room.
I stayed in the delivery room with my young mama as she was getting close to being ready to push. Literally, 10 minutes later the older mama was back because she said she wanted to push. I could not believe that either. The older mama got back up on the other delivery bed and was bearing down hard. I had to quickly change over all the baby blankets because her baby was going to be here before my mama's baby, and we only have one baby table and scale in the room. Well this old mama did not bring a single thing with her to the hospital. Like I have mentioned before, the women have to bring everything for the delivery with them to the hospital: gloves, plastic to deliver on, cotton to clean with and make a pad, blankets, baby blankets, sheets, and more. So, this mama did not have a single thing with her. Sister ran to the back of the maternity ward to get a small package of cotton and I turned around from changing over the baby blankets and the baby’s head was out. I tossed on a pair of gloves as quickly as I could (it was a miracle we had extra gloves around today) just as I was about to catch the baby, Sister walked back in the room, handed me the cotton, and she caught the baby. She handed me the baby and I wrapped her in the old mama’s dress that she had been wearing. OMG, she was one of the cutest babies I have helped deliver—so alert! An amazing little baby for sure!
The mother of the 16-year-old girl was still in the hallway so we had her go buy a sarong for the older mama to wrap around herself so she wouldn't be walking around naked. I was holding the baby girl and my other mama was still in labour on the other table. So I had baby girl in one hand and I was helping mama drink tea with the other hand. Then Sister had me fill a syringe with Oxytocin for her to give to the older mama. It was insane—holding the brand new baby girl, supporting my other mama in labour, helping Sister, getting needles ready, etc. Totally crazy! The older mama had to lay on the delivery table for a bit while she waited for the sarong and she was not worried one bit about her baby girl. The 16-year-old girl’s mother showed up with the sarong, so the older mama got dressed and just walked out of the delivery room and went to her bed in the ward. I handed off the brand new baby girl to the 16-year-old's mother and she took baby to the old mama's bed.
I went back to support my other mama. An hour later a BIG baby boy was born. I couldn’t believe such a big baby could come out of such a small woman. It was amazing.
What a way to finish off the month and my trip to Uganda. My mind is totally blown from today and I still need to let everything sink in. One thing I know for sure is that I am incredibly grateful that I was there to help all these women. The midwives at Kasana are so overworked it is insane and it makes me incredibly happy to have been able to help them.