A day of learning.

7.14.2010

Today, I was supposed to be with Dr. Vicky, but with Natalie’s okay (she was also with Dr. Vicky) I decided to go to Sekou’Toure, a government hospital in Mwanza. After hearing all the crazy stories about Sekou’Toure, I was ready for the worst. This day was probably the worst day of my whole month in Africa. Let me tell you why.

We arrive at Sekou’Toure with Paula and Denny. We wait an hour before the nurse comes to greet us. TIA: This is Africa. Never have seen a birth before, we both wanted to go to the maternity ward first. She gave us a quick tour as we walked past buildings designated for different wards of the hospital. The grounds were fairly large and I was surprised at how much they had to offer. Of course, like anywhere else, people were staring at us as we walk pass. The nurse gives us a tour of the post-birth rooms. There were four: one for women who had normal births, one for those with hypertension, two for those who had other health complications or women who are HIV positive. They even had a room for educating women about prevention of mother to child HIV transmission. Each room had two rows of beds lined along the walls. With not enough beds, many beds had two or more women on them. After a woman gives birth, she would walk over to one of rooms and would be able to rest for up to 6 hours before going home. During that time, the baby would be with her and given vaccinations.

Next we went to the birthing room. As we walked into the building, there was a line of pregnant women standing along the hallway. Each woman was in pain and probably having contractions. One woman was off to the side and had defecated and vomited on the floor. Standing, she leaned against the wall and cried out in anguish. No one was there to help her. There were perhaps 5 nurses and a doctor in the building. We met the doctor, who was actually the head of the hospital. He was only there for women who needed C-sections. The nurses were the ones who delivered the babies. From the hallway with standing pregnant women, we were led to the birthing room. As you enter, there were partitions on each side and a table for registration and discharge on the left. The rectangular room had a tiled floor, made to be easily cleaned with water and drained by a huge drain below the sink. To the left of the registration desk was a partitioned wall and one table bed (like an examination table). To the right of the entrance there were two more partitions with one area having two table beds and one area having one table bed along the wall. On the other side of the wall were huge metal sinks and countertop, lined with windows bringing in the breeze. Below the sinks were huge buckets of chlorine and antiseptic water filled with surgery trays, tongs, and reusable instruments necessary for the birthing process. The largest bucket, as tall as up to my hip, was for the disinfection of the covering laid on top of each table bed for each new patient. It was 10:30am and the chlorinated solution was already murky with blood and discharge from previous births. I’m not sure how often they change the solution.

As we walked in, two women laid on the tables and two babies wrapped in kitenges (African cloth worn by women) on old-school weighing machines. The women were naked, exhausted, and laying legs apart. Blood was everywhere on the tables and floor. The nurse comes in to help push out the placenta. With over 30 births a day, the nurses do this in a methodical fashion and somewhat removed from the actuality of what they are doing. As for myself, this was my first post-birth. Once this past year, I was somewhat intrigued about OB/Gyn and the many roles one can be in in this profession. But there I was in Africa and experiencing second-hand this so-called birthing process. I couldn’t help but to be traumatized with the sight of the placenta, blood, feces, and discharge. At the same time, I was amazed of the birthing process. Here is this crying baby, placenta, and broken amniotic sac, all of which came out of this woman. I’m also amazed that majority of women actually survive this process and still want more children. Perhaps that’s why children are so darn cute. I will never look at mothers the same way. Newfound respect.

These women are tough. So after birth and delivery of the placenta, she is told to clean up herself. She gets off the table by herself, dresses herself, help the nurse clean up, and picks up her belongings (most women have a small plastic or hardcover bag). Yes, most women help clean up after their birthing. The nurse then carries the baby and walks the woman over to the other building for some rest. There’s another nurse who cleans off the table bed and dumps the covering in the huge bucket. She splashes water on the floor and pushes everything towards the drain under the sink. She takes out a new covering that has been soaked and place it in a huge sink under running water, preparing for the next patient. All trays and instruments are rinsed and placed in buckets for sterilization.

The next woman that came in was my first witness to the birthing process. The lady came in, crouching in pain. The nurses are too busy to help the women at all. The woman climbs on top of the table and is left to do her business. At this point, she is fully dilated and is told to push. Natural births. We see the head of the baby. Within a matter of minutes out plops the baby and a sigh of relief from the mother. Neonates’ heads are more oblong than I thought. I can’t help but to think about how the mother feels after the baby traverses the birthing canal. Perhaps I can only compare it to the feeling after a huge poo after being constipated. I think I will not really know until I have my first child. OMG. Lkjfwlkejg;wgj;wiej;weglkjf.

After the nurse clamps and cuts the cord, she quickly cleans the baby and wraps it in the matching kitenge brought by the mother. Matching kitenge patterns is the only way of identification between mother and child. The baby is weighed and the process is repeated for each patient.

Okay, so although the birthing process was an emotional roller coaster for all who were in the room, the process itself wasn’t why today was the worst day. It was a compilation of things that happened during the births. So I’m not the type of person to be placed in a situation and not help whoever needs help. Or am I a happy camper when I am awkwardly standing in the way of things. So here we were in scrubs in this birthing room. I was prepared to help. I put on gloves. Now I’m a huge advocate of not allowing medical students to do things in developing countries that they would not be allowed to do it in the States. So we are here to observe, but why not help when needed. One of the nurses say, “You learn from doing.” I say, “Ok.” As we stood there and watched the nurse clean the room, I wanted to help at least clean. My classmate did not want to go near the table beds and just wanted to watch. I felt uneasy. I don’t mind getting dirty, and although I’m slightly disgusted, I wanted to help. However, I felt that if I helped she would feel like she was obligated to help clean as well. So I just stood there in the way and watched. The worst was during the birth. I felt so embarrassed and ashamed. I just stood there. I felt so uneasy, that I didn’t even think about helping her onto the table bed or holding her hand during the birth. I just stood there like a mzungu staring at an African woman give birth to her child; a moment in her life when she probably felt the most naked and vulnerable. How would I feel if I was naked, giving birth, and a foreigner was staring at my vagina as my child comes shooting out? At that moment, I couldn’t even imagine what the Irish boys were thinking when they were observing days before. Okay, it was slightly okay because I am a medical student and learning, but still. This was a moment when I should have not thought about what people think and do what I felt was right. I was upset with myself.

Then to make things worse, while we were given a more detailed tour, I encountered racial comments. Okay, so in Africa, there are not many Asian people. African people consider all Asian people to be Chinese. Usually, I just brush it off when people yell, “mchina,” or I would say, “Hapana, corea.” I understand that most people aren’t trying to be racist, but just want to get my attention. Shoot, even my own classmates get all the Asian girls in our class confused (even though we don’t even look alike). But there were two times during my trip when I was upset. Today was one of those days. We were introduced to one of the secretaries at the hospital. She called me Chinese and I said, “Hapana, corea.” She responded by saying that well, all Asian people look alike while she made the slit eyes with her fingers and eyes. I didn’t say anything, but already being upset, I couldn’t help think, “Well, you’re dark skin, but I don’t think you’re Kenyan or Ugandan. You are Tanzanian.” Although this may have seemed harsh, I should have said something, because the answer to ignorance is knowledge or change in perspective. The other time was in the market, when a lady flat right said, “Chingchonglala” as I walked pass her. Inappropriate. As we walked out, my classmate is upset because people come up to her and expects her to speak Swahili. I can see how this can be annoying, but hey, at least they talk to her. They just call me Chinese.

During my senior year of college, I met with a Fulbright Faculty Scholar from South Africa. At the time I was thinking about applying for a Fulbright for Kenya. I will never forget what he asked me, “Do you think you’re strong enough?” I was like, “What do you mean?” He explained that one has to be strong to witness the illnesses in Africa and to cope with the feeling of helplessness with the lack of sufficient care. At that time, I said yes. Now, I say yes. Yes, because I am strong enough to empathize and know that, with initiative, care can be changed. But I realized that I am not strong yet to deal with people and ignorance. I feel like all my life I’ve been an advocate for diversity and awareness only to find to be upset when it is not present. I view people not as different races, but as the individual. I guess I expect people to do the same with me. Sometimes I forget I am different looking. Perhaps that is why I am surprised when people don’t treat me the same. I need strength in dealing with people. This I know can change. I am learning.

It is today that we learn that anyone older than us we should greet with “Shikamoo.” Now at the clinic, we haven’t been greeting the staff with “Shikamoo.” I ask Bibi and she says that one greets with Shikamoo to those who are 5 years older than oneself. I became more cognizant about my greetings. Always greet elders with “Shikamoo, “ and others use discretion. Ah, a day without Bibi isn’t a day at all (another reason why today was bad).

By early afternoon, I was ready to leave. We got back to the Nyakato clinic only to remember that we told the Loreto School nurse that we would go to the school to do a presentation about the female reproductive system, the menstrual cycle, and dysmenorrhea. Today was an OB/GYN day.

The Loreto School is a Catholic secondary school for girls. Only a 5-minute walk, we get there and sign in as visitors. We are greeted by the school nurse and led to a classroom filled with 100 or more girls. We have gotten to know the school nurse fairly well through her daily visits to the clinic with sick students. Amit and Priyanka did a STD presentation a couple of weeks ago, but for Natalie, Courtney, and myself this was the first presentation we would give. After the STD presentation, the nurse asked Amit if we could come and speak about the female reproductive cycle, dysmenorrhea, and UTIs. Without previously looking at the slides, Natalie and I jumped in on presenting. We were presenting to Form 3 and 4 students, who were about 14-16 years old. They were quiet at first and would giggle every so often. Considering being the only male in the room, Amit did a great job presenting ovulation and fertilization. Although we all had a good laugh when he mentioned one risk factor of dysmenorrhea is having a positive family history, “such as siblings, as in sisters or brothers…or…um…obviously not brothers.” Haha, oh Amiti! They asked pretty interesting questions. At the end, we asked them to write down any other questions and we would try to answer them the following day. Overall, I am sure the girls had a better understanding of how their body functions, STDs, and how they can both protect and take care of their bodies.

Afterwards, we decide to walk to the local tailor to pick up my skirt and kilemba (head wrap). Then the usual dinner at Lucy’s. Yum!! Usually after dinner, we head over to Paula’s for either internet or leftover desserts. Paula has been making cookies for the Birthing Center ceremony on Friday. We each tried a cookie, you know to see if they okay, hehe. ;) I tried a Lemon cumin cookie, not bad!

After today, I was ready for rest.