How to share what is joy for many mothers, but an incredible loss for a few.
Why is it that the pain can feel so much heavier than the joy? Even when joy is all around you?
I hope I can describe the joy but acknowledge the pain.
There are 6 beds in the labour and delivery ward. They are not the fancy beds you might picture when thinking about your own birth experience. They are very simple, very well used metal beds with a thin, vinyl covered mattresses. They are always full. The rotation of women giving birth does not stop. It may give a reprieve for 20 or so odd minutes, but babies do not yet tell time or know the importance of a tea break, and so the bed is soon occupied. At times, even a mattress has to be pulled from the antenatal section and placed somewhere in the middle of the room for a 7th mother to be monitored. Or for a woman in severe eclampsia to be under the watchful eye of the nurses.
One young mother did not even make it to the bench. After taking herbal medicines in the village that induce labour, she gave birth on the floor under the sink before a nurse could even usher her further into the room.
I am often overwhelmed by the number of urgent situations that never cease. I told the nurses that in Canada, each one of these situations would require what is called a "Code team" and there would be masses of people surrounding each "emergency". But the nurses are so calm and cool and take it all in stride. This is what they do. Every day. All day.
Once the baby is wrapped and the mother is stable, she quickly moves to the post-natal ward. Along with the antenatal (before giving birth), it is the most congested part of the hospital. Two women share a bed, along with their babies, carefully curled like 2 question marks at each end of the bed. They take a bit of time to recover but as soon as it is evident that the baby is breastfeeding and the mother has no complications, she is discharged home after about 6 hours.
The women who have undergone C-sections after prolonged or obstructed labour are in a separate section and the positive unintended consequence of having major surgery is that they get their own bed! They stay for 3 days, barring no infections or further complications with instructions to return in a week to have their sutures removed.
And then the "Kangaroo room". Aside from 2 incubators that are never turned on (I'm not sure they even work), premature babies are cared for in this heated room, utilizing the best "technology" out there - skin-to-skin contact with their mothers. They receive extra education about nutrition and caring for their tiny infant. Some of the babies are born weighing less than 1kg. I weighed all the preemies one day. The mothers eagerly anticipating some weight gain, eyeing the mechanical scale carefully, and squealing for joy when the scale was tipped higher than last week.
Each day brings so much joy to so many families. The healthy triplets born to a mother of 9 children. The baby that cried heartily after a painful birth. The mother that makes it to the operating room to stop the excessive bleeding to save her life. I should be walking on a cloud with all the new life around me!
But there, too, is pain. On a particularly difficult day, I walked into the labour and delivery ward to see a full-term infant lying lifeless at the end of the delivery table. Suffocated by the cord that had given him life for 9 months. Then the surgical delivery of a 7 month old lifeless fetus that had suffered placenta previa. The placenta had become detached from the mothers uterus, and the flow of blood to nourish the baby had stopped. And another baby born stillborn. And yet another mother referred in from another health centre with no fetal activity. Everyone around me looking so stoic and continuing on with the day. I wanted to stop the world from revolving and shout "this isn't supposed to happen!! Why aren't people crying?" I wanted to shout against the injustice of this! But I too, had to continue on with my day. My whispered "pole sana Mama" (I'm very sorry Mama) quietly acknowledged by the mother who likely knows this grief all too well.
It is a fine balance to give time and voice to the pain and loss but not to detract from the joy of new life that otherwise surrounds me.
It would be very easy to allow anger at the injustice and inequities of maternal health in Tanzania take over and outweigh the joy. In fact, that would be the easy way out. But I don't like taking the easy way out. I try to tip the balance towards joy, towards strength, towards resilience, towards progress.
And so my approach, against all the odds, is one of a strengths-based perspective.
When I asked "What are your strengths here in the maternity ward?" the answer was,
"We come to work every day because of what we call "huduma ya moyo" or "caring from the heart".
The scale is tipping already.
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