I have been thinking a lot about the baby we lost. I just wanted to let you know that we did talk about taking him to the hospital. The main problem is that the closest hospital is over an hour away, and that is a private hospital and too expensive for the family. The public hospital is another 2 hours beyond that, this all by car on bad roads more likely the family would have to walk or take an okata (motorcycle taxi), and we were pretty sure that the hospital really didn’t have much to offer in this case. Like I said I wasn’t there for the birth but I suspect that heart tones weren’t good and what he really needed was to be born more quickly, by cesarean, vacuum or forceps, none of which are available here in the village. He was a big baby, especially for here, over 8lbs I would say, and he had a very cone shaped head but otherwise looked good. The MCH aid said that second stage was long, but then that it was 45 minutes and for a first time mom really isn’t long at all. I suspect that he was without oxygen for some time while still inside and that not much that we had available would have helped by the time he was born. It was a hard decision to make but ultimately it seemed to make sense to see what he could do on his own. MOMS mission is not to deliver babies, it is to train TBAs, we will only go to births if invited so I really felt like I had to defer to the MCH aid in this case and she felt like there was no reason to transport, if he made it through that first 24hours then he had a shot at making it.
Every class starts with 2 prayers. A Islamic prayer in Arabic and the Lord’s prayer in English, they are just egalitarian when it comes to religion here, there doesn’t seem to be any religious tension at all in fact. Whole villages celebrated the end of Ramdan or “pray day “ as they call it, just as everyone celebrates Christmas. We Americans could learn a thing or two.
Yesterday I taught a class on anatomy and physiology, after discussing the birth and death that had happened the day before and explaining what happened from my perspective. The TBAs were incredibly interested in the cardiovascular system particularly but we also went over the respiratory and digestive systems. It was wonderful to see their faces light up as they learned about blood flow and oxygen delivery. They were especially excited to learn about anemia and to understand why it is such a problem in pregnancy. Again, as was the case the last time I was here, I am blown away by how much we learn about all this stuff through “osmosis” in our culture, off hand from places like Sesame Street and magazine articles.
After class I went for a run to a neighboring village. I have been doing this everyday but yesterday the sun had come out and it was a hot, glittery afternoon, grasshoppers jumping out of my muddy path. The boys were bathing in the river by the rice swamp and I slowed to say hello. I crossed a small log planked foot-bridge that straddled a marshy area 2 villages out from our own. As usual there were lots of greetings and smiles along the way, the villagers calling out “malo sina weigh” (see you tomorrow) as I turned around and ran back through. The day was completed with the most spectacular double rainbow, spanning all of Ngolahun, that I have ever seen. It’s a silly notion but I like to think that little baby boy was sending us his blessing, letting us know that the all is well. I told Jitta my idea and she beamed, “yes, that is it! He is well.” The falling rain highlighting the bittersweet moment.
I was called away from class at 9:45 this morning to head to
the clinic for a birth. This is our last
morning in Ngolahun, we are headed to Jokibu this afternoon and I was wondering
if I was going to see another baby before departing. We had, thankfully, a healthy baby boy born
at 10:27 am! I was able to show the MCH aid that you can deliver a baby through
a tight nuchal cord (cord around the neck) without clamping and cutting the
cord on the perineum, I was also able to show her that babies can almost always
clear all of the mucous out of their mouth and nose on their own without
shoving a bulb syringe in their and potentially hurting them or inhibiting
breastfeeding. I had been led to believe
that the clinic really had nothing in the way of supplies and was delighted to
discover that is not the case. She had
Pitocin laid out and drawn up and every woman receives it immediately after
delivery (which is a great thing here as almost every woman is at high risk for
hemorrhage), she also had another anti-hemmorhagic (methergine) laid out, along
with if not sterile at least clean, instruments soaking in a closed container
of antiseptic solution, she had delee suction, urinary catheters, IV fluids and
suture supplies. As I said I was pleasantly
surprised at how well stocked that little clinic was. It was so nice to leave the village on a high note.
I was back in class at 11 to finish my lesson on lactation. All the TBAs were delighted to hear about the birth and only slightly disappointed that it was a boy and he couldn’t be named after me. We rolled out of Ngolahun at 130 after a visit to the clinic to see the new mom and present her with a hat, hand knit by my mom, for her new son. The mom who lost her son on Sunday stopped by the house to say goodbye to us. It was small thing but it made me feel good to see her and have her say thank you, she smiled shyly and looked remarkably good considering. I wished her the best of luck.
We ended the night in our new home in Pujehun (a small billage next to Jokibu). It was the first clear night we have had since arriving and it was gorgeous. The waxing half moon lit up the star filled night and we sat outside for hours enjoying the cool breeze and the fireflies flitting through the potato fields next to the house.
Our last night in Pujehun and I am sitting in the hammock under the thatch roof bari in front of our house, watching the night fall. The fireflies dart among the tall grasses and palm trees. The dark, unpolluted by artificial light save the occasional cook fire or flashlight, is absolute. The stars and moon peak through the humid, rainy season clouds and crickets sing a wild chorus as a rare cool breeze blows. There are things that may be hard for a westerner here: cold bucket baths, latrines (which here are just too small holes in a concrete floor, aiming becomes a national pastime) 3 people to a bed, but this right here, swinging gently listening to the sing song cadence of Mende around me, sipping beer and eating boiled ground nuts (peanuts) in not one of them.
Jokibu was a quick stop. 2 days of training, 1 day was review and check in with the TBAs and one was the Helping Babies Breathe training with the 3 head TBAs of this catchment area and the MCH aid. I also was able to see my good friend Joseph who has been living in Liberia so I was not sure that I was going to get to see him this trip. He happened to be in country visiting his family and he came over for the afternoon to hang out and catch up, it was great, so nice to see my old friends here doing well.
And now we are in Daru, where I lived and trained TBAs 4 years ago. We arrived yesterday afternoon in a rainstorm that continued heavily all day, a good afternoon to stay in side and read books. It is great to be back. We are staying at the same house as last time and the owner and her kids all remember me, she even remembered which room had been mine. Fode who was 4 when I was last here and my little buddy is still around still and comes to grab my hand whenever I am around. While he is twice as old and twice as tall, he still has that same sweet, shy smile he did back then.
It is sunny today and the splitting headache that I woke up with is gone, it is hot and the blacksmith next door is pounding away. We have gone to the market and the tailor to pick out fabric and get measured for some new clothes and gone to the charging station (a shack in the razor wire enclosed grounds under the towns massive cell tower) to have all of our various and sundry electronic goods charged, 50 cents per item for a full charge. We will be here for 3 days of training and then head back to Bo Thursday morning. We will have 2 days of Helping Babies Breathe training with 2 separate groups and 1 day of review with the TBAs. This is our final stop for teaching on this trip, I am glad it is here in Daru. It is a much bigger town then the villages we have been staying in, about 15,000 people here. Which is nice in that there are creature comforts like a bathroom in side the house (although still no running water or electricity) and comfortable beds and chairs, but the downside is I don’t feel as safe wandering around by myself like I did in the villages. No runs for me here, at least not by myself. I am really looking forward to seeing all of my TBA friends over the next few days and catching up.